Acute Kidney Injury, COVID-19, Sepsis, Severe
Conditions
Keywords
Magnetic Resonance Imaging, Fluid Therapy, Renal Circulation, Renal Oxygenation
Brief summary
A study of renal blood flow and renal oxygenation measured by magnetic resonance after a standardized fluid challenge in critically ill, resuscitated, patients with sepsis due to COVID-19 or other agents.
Detailed description
Critically ill, septic patients with or without acute kidney injury (AKI) above 18 years of age who have been circulatory and respiratory stabilized will be screened for inclusion. After the patients have been adequately treated with antimicrobial agents, source control and circulatory and respiratory stabilized, the patient will be moved to the Magnetic resonance imaging (MRI)-suite and placed in the MRI-camera. We plan to, at the same time, study renal blood flow (RBF) and oxygenation with 4 different MRI techniques; arterial spin labeling (ASL), Blood oxygen level dependent (BOLD)-technique, T(2) -Relaxation-Under-Spin-Tagging (TRUST) and Phase contrast at two conditions; 1. at baseline after stabilization 2. after intravenous infusion of 7,5 ml/kg mL Ringer's acetate The following data will be registered: 1. Age, gender, length and weight, 2. concomitant diseases and treatment, 3. present disease and treatment, 4. source of admission - emergency department or ordinary ward, 5. daily laboratory reports, 6. results from other investigations, e.g. x-rays, cultures etc., 7. recordings from the intensive care unit (ICU) monitors 8. Continuous renal replacement therapy (CRRT) - duration type, flow rate, replacement fluid, etc. 9. dead or alive at discharge and 90 days mortality, 10. renal function at discharge, 11. treatment restrictions, 12. if the patient has died, the results from a possible postmortem examination. As well as all data obtained during the MRI-examination.
Interventions
OTHERPlasma expansion with Ringer's Acetate
7,5 ml/kg mL Ringer's acetate during 5-10 minutes will be administered intravenously
Sponsors
Uppsala University
Study design
Allocation
NA
Intervention model
SINGLE_GROUP
Primary purpose
OTHER
Masking
NONE
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* Patients with clinical diagnosis sepsis (infection and organ dysfuncion) treated in intensive care. * Manifest Acute kidney injury (AKI) or risk of AKI. * 18 years of age or older
Exclusion criteria
* Pregnancy * Chronic kidney failure * Renal Replacement Therapy * Instability in vital parameters to a degree where MRI is not feasible * Contraindications for MRI (implants, coils, pacemakers, etc)
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Change in renal blood flow and renal oxygenation after standardized plasma expansion with fluid bolus | When achieved according to protocol, approximately 3-10 minutes after intervention | Measured with arterial spin labelling (ASL), Phase Contras, Blood oxygenation level dependent (BOLD) and T(2) -Relaxation-Under-Spin-Tagging (TRUST), compared to baseline measurement |
| Descriptive renal oxygenation and blood flow in critical illness due to sepsis | During Critical illness - at one time point | Measured with arterial spin labelling (ASL), Phase Contras, Blood oxygenation level dependent (BOLD) and T(2) -Relaxation-Under-Spin-Tagging (TRUST) during baseline measurement. |
| Descriptive renal oxygenation and blood flow in critical illness in no/low grade AKI or high grade AKI. | During Critical illness - at one time point | Measured with arterial spin labelling (ASL), Phase Contras, Blood oxygenation level dependent (BOLD) and T(2) -Relaxation-Under-Spin-Tagging (TRUST) images stratified in groups in regards to KDIGO grade during exam. |
Countries
Sweden
Outcome results
None listed