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2023, Number 4

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Med Crit 2023; 37 (4)

Alteration of the renal resistive index as a factor associated with acute kidney injury in severe multiple trauma in the Intensive Care Unit of the Hospital General La Villa

Ramos DE, Mendoza RM, Cortés MJA, López GA

Language: Spanish
References: 42
Page: 320-329
PDF size: 266.12 Kb.


ABSTRACT

Introduction: severe multiple trauma is a pathology of epidemiological importance. One of the complications that increases baseline mortality on admission to intensive care units is the appearance of acute kidney injury. However, regarding the first and second level of hospital care, there are limited tools for its early detection, such as serum creatinine and cystatin C, limited to new determinations capable of detecting early glomerular damage. Objective: to know the association that exists between the alteration, characterized by an increase in the renal resistive index, with the diagnosis of acute kidney injury in patients with severe multiple trauma, supporting decision-making in the timely management of said pathology. Material and methods: a clinical, observational, descriptive and prospective study was carried out including patients with severe multiple trauma who were admitted to the ICU at Hospital General La Villa, CDMX, where data is collected through the measurement of the renal resistive index, serum creatinine, cystine C and the rate of uresis kilogram hour, at admission, 24, 48 and 72 hours later, analyzing the data obtained through measures of central tendency, mode, mean, median with association by p Pearson. Results: the association analysis using the Pearson's p test as a test of association between acute kidney injury and alteration of the renal resistive index, showed significant association and sensitivity. Pearson's association between patients with acute kidney injury who had alterations in IRR and Cystatin C was 0.475, showing similar sensitivity between the two clinical evaluation parameters. Conclusions: the quantification of the IRR in those patients with a diagnosis of severe multiple trauma is useful for the early detection of renal hypoperfusion and, secondary to it, the development of acute kidney injury, with the same sensitivity as the reports of markers such as cystatin C, being useful in units with few or no resources more specific and sensitive early acute kidney injury markers.


REFERENCES

  1. Sonneborn R. Sinopsis histórica del trauma. Rev Chilena de Cirugía. 1997;49(5):588-602.

  2. Feliciano D, Mattox K, Moore E. Trauma. 6a ed. New York: McGraw-Hill; 2008. p. 1.

  3. Reyes-Mendoza LM, Deseano-Estudillo JL, Briones-Garduño JC. Síndrome de respuesta inflamatoria sistémica en el paciente agudo. En: Díaz de León-Ponce MA, Briones-Garduño JC, Aristondo-Magaña GA (ed.). Medicina aguda. 2a ed. México: Ed. Prado; 2014. pp. 37-58.

  4. Meneses-Calderón J, Figueroa-Flores MR, Díaz de León-Ponce MA, et al. Estrés oxidativo en el paciente agudo. En: Díaz de León-Ponce MA, Briones-Garduño JC, Aristondo-Magaña GA (ed). Medicina aguda. 2a ed. México: Ed. Prado; 2014.

  5. Piel DA, Guber PJ, Weinheimer CJ, Courtois MR, Robertson CM, Cooper-smith CM, et al. Mitochondrial resuscitation with exogenous cytocrome c in the septic heart. Crit Care Med. 2007;35(9):2120-2127.

  6. Navarrete ML, Cerdeño MC, Serra MC, Conejero R. Síndrome de distrés mitocondrial y de la microcirculación en el paciente crítico. Implicaciones terapéuticas. Med Intensiva. 2013;37(7):476-484.

  7. Andrades ME, Morina A, Spasic S, Spasojevic I. Bench-to-bedside review: sepsis - from the redox point of view. Crit Care. 2011;15(5):230.

  8. Pinet LM. Atención prehospitalaria de urgencias en el Distrito Federal: las oportunidades del sistema de salud. Salud Pública Méx. 2005;47(1):64-71.

  9. Hoste EA, Schurgers M. Epidemiology of acute kidney injury: how big is the problem? Crit Care Med. 2008;36(4 Suppl):S146-S151.

  10. Bellomo R, Kellum JA, Ronco C. Acute kidney injury. Lancet. 2012;380(9843):756-766.

  11. Soni SS, Pophale R, Ronco C. New biomarkers for acute renal injury. Clin Chem Lab Med. 2011;49(8):1257-1263.

  12. Carrillo-Esper R, De la Torre-León T, Rosales-Gutiérrez AO, Carrillo-Córdova LD. Índice resistivo renal. Fundamentos e implementación en el enfermo grave. Med Sur. 2014;21(2):68-72.

  13. Soubrier S, Leroy O, Devos P, Nseir S, Georges H, d'Escrivan T, et al. Epidemiology and prognostic factors of critically ill patients treated with hemodiafiltration. J Crit Care. 2006;21(1):66-72.

  14. Liaño F, Pascual J. Epidemiology of acute renal failure: a prospective, multicenter, community-based study. Madrid Acute Renal Failure Study Group. Kidney Int. 1996;50(3):811-818.

  15. Mehta RL, Pascual MT, Soroko S, Savage BR, Himmelfarb J, Ikizler TA, et al. Spectrum of acute renal failure in the intensive care unit: the PICARD experience. Kidney Int. 2004;66(4):1613-1621.

  16. Druml W. Long term prognosis of patients with acute renal failure: is intensive care worth it? Intensive Care Med. 2005;31(9):1145-1147.

  17. Liaño F, Junco E, Pascual J, Madero R, Verde E. The spectrum of acute renal failure in the intensive care unit compared with that seen in other settings. The Madrid Acute Renal Failure Study Group. Kidney Int Suppl. 1998;66:S16-S24.

  18. Mehta RL, Pascual MT, Soroko S, Chertow GM; PICARD Study Group. Diuretics, mortality, and nonrecovery of renal function in acute renal failure. JAMA. 2002;288(20):2547-2553.

  19. Lameire N, Van Biesen W, Vanholder R. Acute renal failure. Lancet. 2005;365(9457):417-430.

  20. Nash K, Hafeez A, Hou S. Hospital-acquired renal insufficiency. Am J Kidney Dis. 2002;39(5):930-936.

  21. Cogan MG. Angiotensin II: a powerful controller of sodium transport in the early proximal tubule. Hypertension. 1990;15(5):451-458.

  22. Quan A, Baum M. Regulation of proximal tubule transport by endogenously produced angiotensin II. Nephron. 2000;84(2):103-110.

  23. Liu FY, Cogan MG. Angiotensin II stimulation of hydrogen ion secretion in the rat early proximal tubule. Modes of action, mechanism, and kinetics. J Clin Invest. 1988;82(2):601-607.

  24. Schuster VL, Kokko JP, Jacobson HR. Angiotensin II directly stimulates sodium transport in rabbit proximal convoluted tubules. J Clin Invest. 1984;73(2):507-515.

  25. Blantz RC. Pathophysiology of pre-renal azotemia. Kidney Int. 1998;53(2):512-523.

  26. Badr KF, Ichikawa I. Prerenal failure: a deleterious shift from renal compensation to decompensation. N Engl J Med. 1988;319(10):623-629.

  27. Yared A, Kon V, Ichikawa I. Mechanism of preservation of glomerular perfusion and filtration during acute extracellular fluid volume depletion. Importance of intrarenal vasopressin-prostaglandin interaction for protecting kidneys from constrictor action of vasopressin. J Clin Invest. 1985;75(5):1477-1487.

  28. Honda N. Acute renal failure and rhabdomyolysis. Kidney Int. 1983;23(6):888-898.

  29. Lane R, Phillips M. Rhabdomyolysis. BMJ. 2003;327(7407):115-116.

  30. Lindseth RE, Hamburger RJ, Szwed JJ, Kleit SA. Acute renal failure following trauma. J Bone Joint Surg Am. 1975;57(6):830-835.

  31. Thadhani R, Pascual M, Bonventre JV. Acute renal failure. N Engl J Med. 1996;334(22):1448-1460.

  32. Malinoski DJ, Slater MS, Mullins RJ. Crush injury and rhabdomyolysis. Crit Care Clin. 2004;20(1):171-192.

  33. García de Vinuesa S, Ahijado FJ. Rabdomiólisis y fracaso renal agudo. Nefrología. 1992;12(Suppl 4):165-171.

  34. Kellum JA, Lameire N. KDIGO Working Group. KDIGO clinical practice guideline for acute kidney injury. Kidney Int Suppl. 2012;2:8-12.

  35. Ostermann M, Joannidis M. Acute kidney injury 2016: diagnosis and diagnostic workup. Crit Care. 2016;20(1):299.

  36. Pickkers P, Darmon M, Hoste E, Joannidis M, Legrand M, Ostermann M, et al. Acute kidney injury in the critically ill: an updated review on pathophysiology and management. Intensive Care Med. 2021;47(8):835-850.

  37. Nalesso F, Cattarin L, Gobbi L, Fragasso A, Garzotto F, Calo LA. Evaluating Nephrocheck® as a predictive tool for acute kidney injury. Int J Nephrol Renovasc Dis. 2020;13:85-96.

  38. Oliver JA, Sciacca RR, Cannon PJ. Renal vasodilation by converting enzyme inhibition. Role of renal prostaglandins. Hypertension. 1983;5(2):166-171.

  39. Le Dorze M, Bouglé A, Deruddre S, Duranteau J. Renal Doppler ultrasound: a new tool to assess renal perfusion in critical illness. Shock. 2012;37(4):360-365.

  40. Tublin ME, Bude RO, Platt JF. Review. The resistive index in renal Doppler sonography: where do we stand? AJR Am J Roentgenol. 2003;180(4):885-892.

  41. Keogan MT, Kliewer MA, Hertzberg BS, DeLong DM, Tupler RH, Carroll BA. Renal resistive indexes: variability in Doppler US measurement in a healthy population. Radiology. 1996;199(1):165-169.

  42. Kliewer MA, Hertzberg BS, Keogan MT, Paulson EK, Freed KS, DeLong DM, et al. Early systole in the healthy kidney: variability of Doppler US waveform parameters.1997; 205(1):109-113. doi: 10.1148/radiology.205.1.9314971.




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