Government Stanley Medical College and Hospital, General Medicine, Chennai, Tamilnadu, India.
Government Stanley Medical College and Hospital, Nephrology, Chennai, Tamilnadu, India.
J Bras Nefrol. 2021 Oct-Dec;43(4):470-477. doi: 10.1590/2175-8239-JBN-2021-0003.
The outcomes of Acute Kidney Injury (AKI) remain dismal even today, owing in part due to the lack of an ideal biomarker for detecting renal damage early enough. We conducted this pilot study to determine the clinical significance of Frusemide Stress Test (FST) to predict the severity of AKI.
A total of 80 patients with AKI-KDIGO (Kidney Disease: Improving Global Outcomes) stage 1 or stage 2 underwent FST by administering a bolus dose of frusemide (1mg/kg for frusemide naïve and 1.5mg/kg for prior frusemide exposure in the past week), and urine output was then measured for the next two hours with volume replacement as desirable. The progression to AKI-KDIGO stage 3 within 14 days of FST was studied as the primary outcome. The composite end point of achieving AKI-KDIGO stage 3 or death within 14 days of FST was studied as the secondary outcome.
Out of 80 patients, 28(35%) patients met the primary outcome, and 34(42.5%) patients met the secondary composite outcome. Except for baseline Chronic Kidney Disease (CKD) status (p=0.018), other demographic characteristics were comparable between progressors and non-progressors group. Using receiver operating characteristics (ROC) curve analysis, a cumulative 2-hour post-FST urine output of ≤300 mL predicted progression to stage 3 AKI with 82.14% sensitivity, 82.69% specificity, and AUC of 0.89±0.03 (p<0.0001).
The FST showed promising results as a novel tubular biomarker to identify progression to severe AKI with good predictive ability.
急性肾损伤（AKI）的预后仍然很差，部分原因是缺乏理想的生物标志物来早期检测肾损伤。我们进行了这项初步研究，以确定呋塞米应激试验（FST）预测 AKI 严重程度的临床意义。
共有 80 例 AKI-KDIGO（肾脏疾病：改善全球预后）1 期或 2 期患者接受 FST，给予呋塞米推注剂量（呋塞米初治患者 1mg/kg，过去一周内曾使用呋塞米者 1.5mg/kg），然后在接下来的 2 小时内测量尿量，并根据需要进行容量替代。FST 后 14 天内进展为 AKI-KDIGO 3 期作为主要结局。FST 后 14 天内达到 AKI-KDIGO 3 期或死亡的复合终点作为次要结局。
在 80 例患者中，28 例（35%）患者达到主要结局，34 例（42.5%）患者达到次要复合结局。除基线慢性肾脏病（CKD）状态外（p=0.018），进展组和非进展组的其他人口统计学特征无差异。使用受试者工作特征（ROC）曲线分析，FST 后 2 小时累积尿量≤300ml 预测进展为 3 期 AKI 的敏感性为 82.14%，特异性为 82.69%，AUC 为 0.89±0.03（p<0.0001）。
FST 作为一种新的管状生物标志物，显示出预测严重 AKI 进展的良好预测能力。
