RT info:eu-repo/semantics/article
T1 Diagnosis of cardiac surgery-associated acute kidney injury: State of the art and perspectives
A1 Casanova, Alfredo G.
A1 Sancho Martínez, Sandra M.
A1 Vicente Vicente, Laura
A1 Ruiz Bueno, Patricia
A1 Jorge Monjas, Pablo
A1 Tamayo Gómez, Eduardo
A1 Morales Martín, Ana I.
A1 Lopez Hernandez, Francisco J.
K1 Cardiac surgery
K1 Cardiovascular, aparato -  Cirugía
K1 Cardiology
K1 Kidneys - Diseases
K1 Riñones - Enfermedades
K1 Nephrology
K1 Heart - Diseases - Diagnosis
K1 Corazón - Enfermedades - Diagnóstico
K1 Heart - Surgery
K1 Corazón - Cirugía
K1 Biomarkers
K1 3205.01 Cardiología
K1 3205.06 Nefrología
AB Diagnosis of cardiac surgery-associated acute kidney injury (CSA-AKI), a syndrome of sudden renal dysfunction occurring in the immediate post-operative period, is still sub-optimal. Standard CSA-AKI diagnosis is performed according to the international criteria for AKI diagnosis, afflicted with insufficient sensitivity, specificity, and prognostic capacity. In this article, we describe the limitations of current diagnostic procedures and of the so-called injury biomarkers and analyze new strategies under development for a conceptually enhanced diagnosis of CSA-AKI. Specifically, early pathophysiological diagnosis and patient stratification based on the underlying mechanisms of disease are presented as ongoing developments. This new approach should be underpinned by process-specific biomarkers including, but not limited to, glomerular filtration rate (GFR) to other functions of renal excretion causing GFR-independent hydro-electrolytic and acid-based disorders. In addition, biomarker-based strategies for the assessment of AKI evolution and prognosis are also discussed. Finally, special focus is devoted to the novel concept of pre-emptive diagnosis of acquired risk of AKI, a premorbid condition of renal frailty providing interesting prophylactic opportunities to prevent disease through diagnosis-guided personalized patient handling. Indeed, a new strategy of risk assessment complementing the traditional scores based on the computing of risk factors is advanced. The new strategy pinpoints the assessment of the status of the primary mechanisms of renal function regulation on which the impact of risk factors converges, namely renal hemodynamics and tubular competence, to generate a composite and personalized estimation of individual risk.
PB MDPI
SN 2077-0383
YR 2022
FD 2022
LK https://uvadoc.uva.es/handle/10324/60811
UL https://uvadoc.uva.es/handle/10324/60811
LA eng
NO Journal of Clinical Medicine, 2022, Vol. 11, Nº. 15, 4576
NO Producción Científica
DS UVaDOC
RD 28-nov-2024