Presentation is loading. Please wait.

Presentation is loading. Please wait.

Biomarkers to define AKI Michael Zappitelli, MD, MSc.

Published byOctavia Jackson Modified over 9 years ago

Similar presentations

Presentation on theme: "Biomarkers to define AKI Michael Zappitelli, MD, MSc."— Presentation transcript:

1 Biomarkers to define AKI Michael Zappitelli, MD, MSc

2

3 What are these new biomarkers? KIM-1 NGAL IL-18 TIMP2/IGFBP GST CysC Metabolomics

4 Objectives Focus on utility and not actual biomarkers: e.g. PICU, Cardiac Maximizing biomarkers: Renal angina index Future

5 1 year old for TOF repair Serum creatinine (umol/L) 0-6 hrs 45 2 days 100 before surgery 40 surgery low BP 5 days peritoneal dialysis

6 What happened here … Could this have been prevented? Could novel biomarkers help?

7 Post-operative AKI prediction: early SCr rise IL-18 uNGAL pNGAL

8 Post-operative AKI prediction: NGAL & IL-18: AUC Adults Children 5 th Quintile cutoffs Sensitivity/Specificity: IL-18: 60 pg/ml 54% /82% 364 pg/ml 38% / 84% uNGAL 102 ng/ml 46% /81% 72 ng/ml 42% / 85% pNGAL 293 ng/ml 50% / 82% 261 ng/ml 27% / 81%

9 Biomarker combinations Single: 0.56 – 0.76

10 1 year old for TOF repair Serum creatinine (umol/L) 0-6 hrs 45 2 days 100 before surgery 40 surgery low BP 5 days peritoneal dialysis

11 12 year old girl with sepsis PICU SCr rise ?truly AKI Will she need dialysis? Will she progress? Nephrotoxins Low BP

12 NGAL AUC 0.78

13 Adding biomarker to other data

14 SCr has risen: should I worry? Outcome: AKI>48 hrs AUC=0.80 Replication cohort, unpublished: Day AKI first appears: NGAL: AUC 0.75 IL-18: AUC 0.80 LFABP: AUC 0.80

15 CAN WE DO BETTER? RENAL ANGINA INDEX

16 Focus is on QUICK and SIMPLE assessment Intent is to have an index / threshold risk with HIGH NPV No Renal Angina: HIGHLY likely NOT to develop AKI Do NOT study biomarker performance Do NOT use biomarkers to predict AKI (future)

17 New: Proposed RA index Basu et al, KI 2014

18

19 Take a step back: summarize  Biomarkers: Several candidates – which work best in what patients. Early diagnosis Short term prognosis ?Long-term prognosis Biomarker combinations +/- clinical risk factors likely best Will allow for clinical trials  Taking Focus Study:  Using biomarkers and fluid overload severity to make decisions on fluid management and CRRT start.

20 Suggest to read:

21 THANK YOU pCRRT conference organizers Montreal Children’s Hospital AKI research team Collaborators/mentors: Stuart Goldstein, Prasad Devarajan, Chirag Parikh The Kidney Injury During Membrane Oxygenation group

Download ppt "Biomarkers to define AKI Michael Zappitelli, MD, MSc."

Similar presentations

AKI in Pediatrics Patrick D. Brophy MD Associate Professor

AKI in Pediatrics Patrick D. Brophy MD Associate Professor
Journal Club: AKI and timing of RRT in Post-op ITU Patients

Journal Club: AKI and timing of RRT in Post-op ITU Patients
REMEDIAL II Renal Insufficiency Following Contrast Media Administration Trial II (REMEDIAL II): RenalGuard™ System In High-Risk Patients for Contrast-Induced.

REMEDIAL II Renal Insufficiency Following Contrast Media Administration Trial II (REMEDIAL II): RenalGuard™ System In High-Risk Patients for Contrast-Induced.
Pediatric Bone Marrow Transplant Recipients with Acute Kidney Injury Stuart L. Goldstein, MD Associate Professor of Pediatrics Baylor College of Medicine.

Pediatric Bone Marrow Transplant Recipients with Acute Kidney Injury Stuart L. Goldstein, MD Associate Professor of Pediatrics Baylor College of Medicine.
AKI to CKD: How Should We Look For It Prasad Devarajan, MD Professor of Pediatrics and Developmental Biology University of Cincinnati College of Medicine.

AKI to CKD: How Should We Look For It Prasad Devarajan, MD Professor of Pediatrics and Developmental Biology University of Cincinnati College of Medicine.
AKI Definitions Stuart L. Goldstein, MD Professor of Pediatrics University of Cincinnati College of Medicine Director, Center for Acute Care Nephrology.

AKI Definitions Stuart L. Goldstein, MD Professor of Pediatrics University of Cincinnati College of Medicine Director, Center for Acute Care Nephrology.
The New Paradigm: Biomarkers to Define AKI Prasad Devarajan, MD Professor of Pediatrics and Developmental Biology University of Cincinnati College of Medicine.

The New Paradigm: Biomarkers to Define AKI Prasad Devarajan, MD Professor of Pediatrics and Developmental Biology University of Cincinnati College of Medicine.
IMPROVING OUR UNDERSTANDING OF DRUG ASSOCIATED AKI Sandra Kane-Gill, PharmD, MS, FCCM, FCCP Associate Professor of Pharmacy, Critical Care Medicine, and.

IMPROVING OUR UNDERSTANDING OF DRUG ASSOCIATED AKI Sandra Kane-Gill, PharmD, MS, FCCM, FCCP Associate Professor of Pharmacy, Critical Care Medicine, and.
Biomarkers in the Cardiorenal Syndromes

Biomarkers in the Cardiorenal Syndromes
PREDICTING AKI IS MORE CHALLENGING AS AGE PROGRESSES Sandra Kane-Gill, PharmD, MSc Associate Professor, School of Pharmacy.

PREDICTING AKI IS MORE CHALLENGING AS AGE PROGRESSES Sandra Kane-Gill, PharmD, MSc Associate Professor, School of Pharmacy.
©2013 Astute Medical, Inc. PN 0138 Rev B 2013/03/19

©2013 Astute Medical, Inc. PN 0138 Rev B 2013/03/19
Critical care conference Acute Kidney Injury: A Relevant Complication After Cardiac Surgery 2011 society of thoracic surgeons 主講人 : R2 顏介立.

Critical care conference Acute Kidney Injury: A Relevant Complication After Cardiac Surgery 2011 society of thoracic surgeons 主講人 : R2 顏介立.
AKI ITSELF EPIDEMIOLOGY Michael Zappitelli, MD, MSc Montreal Children's Hospital McGill University Health Centre.

AKI ITSELF EPIDEMIOLOGY Michael Zappitelli, MD, MSc Montreal Children's Hospital McGill University Health Centre.
Stuart L. Goldstein, MD Professor of Pediatrics Baylor College of Medicine Pediatric Acute Kidney Injury and Biomarkers 6th PCRRT Conference, Rome 2010.

Stuart L. Goldstein, MD Professor of Pediatrics Baylor College of Medicine Pediatric Acute Kidney Injury and Biomarkers 6th PCRRT Conference, Rome 2010.
Sean M Bagshaw, MD, MSc Division of Critical Care Medicine Faculty of Medicine and Dentistry, University of Alberta 1 st International Symposium on AKI.

Sean M Bagshaw, MD, MSc Division of Critical Care Medicine Faculty of Medicine and Dentistry, University of Alberta 1 st International Symposium on AKI.
Major Published Clinical Trials in AKI: What do they Really Mean? Michael Zappitelli, MD, MSc Montreal Children's Hospital McGill University Health Centre.

Major Published Clinical Trials in AKI: What do they Really Mean? Michael Zappitelli, MD, MSc Montreal Children's Hospital McGill University Health Centre.
Acute Kidney Injury after Cardiopulmonary Bypass Catherine Krawczeski, MD Associate Professor of Pediatrics University of Cincinnati College of Medicine.

Acute Kidney Injury after Cardiopulmonary Bypass Catherine Krawczeski, MD Associate Professor of Pediatrics University of Cincinnati College of Medicine.
Fluids & AKI Fluids are GOOD Volume overload is BAD UGLY Fluids cause AKI.

Fluids & AKI Fluids are GOOD Volume overload is BAD UGLY Fluids cause AKI.
Renal Services Dr Donal O’Donoghue National Clinical Director for Kidney Care UKRR Annual Audit Meeting QEH Birmingham 30 September 2010 Working for Better.

Renal Services Dr Donal O’Donoghue National Clinical Director for Kidney Care UKRR Annual Audit Meeting QEH Birmingham 30 September 2010 Working for Better.
Acute Kidney Injury & Sepsis Patrick D Brophy, MD, MHCDS Director Pediatric Nephrology Professor The University of Iowa London 2015.

Acute Kidney Injury & Sepsis Patrick D Brophy, MD, MHCDS Director Pediatric Nephrology Professor The University of Iowa London 2015.

Similar presentations

Ads by Google