Update on clinical trials for the prevention of acute kidney injury in patients undergoing cardiac surgery.

Background: Effective therapeutic agents for the prevention and treatment of acute kidney injury (AKI) after cardiac surgery remain elusive despite the tremendous advances in surgical techniques, technology, and understanding of disease processes. Recent developments and their effect on the incidence of AKI after cardiac surgery are discussed.

Data Sources: Published clinical trials in PubMed, strength of evidence assessed by the guidelines of the American Family Physicians.

Post-operative serum uric acid and acute kidney injury.

Background: We hypothesized that post-operative serum uric acid (SUA) may be associated with acute kidney injury (AKI).

Methods: In this prospective, observational study, the relationships between SUA, urine neutrophil gelatinase-associated lipocalin (uNGAL) and interleukin-18 (uIL-18), serum monocyte chemoattractant protein-1 (sMCP-1) and tumor necrosis factor-alpha (sTNF-alpha), and incidence of AKI were determined. SUA were divided into tertiles and their association with AKI investigated.

Regional citrate anticoagulation for slow continuous ultrafiltration: risk of severe metabolic alkalosis.

Background: Slow continuous ultrafiltration (SCUF) is a safe and efficient treatment for fluid overload in patients who are hemodynamically unstable, have low urine output, and are not in need of dialysis or hemofiltration for solute clearance. Sustained anticoagulation is required for these long treatments, thus posing clinically challenges for patients having contraindications to systemic anticoagulation with heparin. Regional citrate anticoagulation would be an alternative option; however, we believed that this would be problematic due to citrate kinetics that predicted the development of metabolic alkalosis.

Perioperative fluid balance and acute kidney injury.

Background: Positive fluid balance (FB) has been linked to adverse clinical outcomes. We performed this study to explore the relationship between perioperative fluid balance and acute kidney injury (AKI).

Methods: The relationships between FB and AKI were explored using a prospective, observational design.

Rituximab in immunologic glomerular diseases.

Experimental data suggest that the B-cell antigen CD20 may play a significant role in the pathogenesis of many diseases including glomerular diseases. These and other findings underpin the central concept of B-cell-depleting therapies that target CD20 antigen as treatments for lupus nephritis, idiopathic membranous nephropathy, focal segmental glomerulosclerosis, cryglobulinemic glomerulonephritis, antibody mediated renal allograft rejection and recurrent glomerulonephritis in renal allograft. Use of rituximab as a B-cell depleting therapy has been associated with clinical improvement and has emerged as a possible adjunct or alternative treatment option in this field of nephrology.

Practice implications of recent clinical trials for the prevention of acute kidney injury in cardiovascular surgery.

Acute kidney injury in patients undergoing cardiovascular surgery is a complex problem with associated increased risks for dialysis, short- and long-term mortality, and progression to end-stage renal disease. Interventions to prevent and treat renal complications in this cohort have seldom been uniformly satisfactory due to the differences in strategies for intervention, drug doses and duration of treatment, baseline renal functions, and population studied. Nonetheless, significant advances have been made and include recognition of the effect of preexisting organ dysfunction on renal outcomes, reassessment of existing therapeutic interventions, and exploration of the feasibility of newer agents to prevent and treat acute kidney injury in cardiovascular surgery patients.