Evaluation of prognostic indexes in critical acute renal failure patients

Objective. To study different prognostic indexes in acute renal failure (ARF) patients admitted to an intensive care unit (ICU). Design. Prospective, cohort study. Individual Severity Score-Acute Tubular Necrosis (ISS-ATN) obtained prospectively and retrospectively, Acute Physiologic and Chronic Health Evaluation (APACHE II) Score, APACHE II Risk, Lung Injury Score (LIS), and Number of Organ Failures (NOF) were calculated for each patient. the outcome analyzed was death in the ICU. Discrimination was evaluated by the area under the receiver operator characteristic curve (AUC). for calibration analysis, the chi-square goodness-of-fit test was used to compare predicted mortality, calculated by ISS-ATN (obtained prospectively or retrospectively) and APACHE II risk, with observed mortality. Setting. ICU, Sao Rafael Hospital, Salvador-BA, Brazil. Patients. Seventy-six ARF patients admitted to the ICU within 6 months. Interventions. Surgical and medical procedures. Measurements and Results. the observed AUC was 0.69 for LIS, 0.73 for prospective ISS-ATN, 0.75 for retrospective ISS-ATN, 0.76 for APACHE II Score, 0.78 for APACHE II Risk, and 0.88 for NOF. These areas were significantly different from 0.5 (p <.001). There was no difference between the observed and expected death rate calculated by ISS-ATN. However, APACHE II underestimated the observed mortality (p <.001). Conclusion. the prognostic indexes studied showed good discriminative power. However, APACHE II was not well calibrated in contrast to the good calibration of ISS-ATN.Sao Rafael Hosp, Nephrol & Hemodialysis Serv, BR-40296720 Salvador, BA, BrazilSao Rafael Hosp, Intens Care Unit, BR-40296720 Salvador, BA, BrazilUniversidade Federal de São Paulo, Escola Paulista Med, Dept Med, Div Nephrol, São Paulo, BrazilUniversidade Federal de São Paulo, Escola Paulista Med, Dept Med, Div Nephrol, São Paulo, BrazilWeb of Scienc

Acute renal failure needing dialysis in the intensive care unit and prognostic scores

Background: Generic prognostic scores used in acute renal failure (ARE) give imprecise results; disease-specific indices applied to distinct populations or intensive care practices becomes inaccurate. the current study evaluates the adequacy of prognostic scores, in patients with severe ARE needing dialysis. Methods: Known generic (APACHE 11) and disease-specific (ATN-ISS) indices were applied to a cohort (n=280) with ARE needing dialysis, under intensive care. Possible risk factors as causal factors, organ dysfunctions and clinical variables were examined, and a local index assembled by multivariate logistic regression analysis. Area under the receiver operating characteristics (ROC) curves evaluated the indices discriminating capacity. Goodness-of-fit testing and linear regression analysis appraised calibration. Validation was accomplished by the bootstrapping technique. the end-point was hospital mortality. Results: Overall mortality Was 85%. Female gender <44 years (OR: 0.29; 95% CI: 0.10-0.84), liver/obstructive biliary disease (OR: 6.03; 95%CI: 1.65-22.08), being conscious (OR: 0.49; 95%CI: 0.21 - 1.14), use of vasoactive drug (OR: 3.13 95%CI: 1.25-7.83), respiratory dysfunction (OR: 5.20 95%CI: 1.25-7.83) or sepsis (OR: 2.62; 95%CI: 1.14-6.02) were associated with outcome. Areas under the ROC curve of 0.815, 0.652 and 0.814; Goodness-of-fit test P=0.593, P<0.001 and P=0.002; and linear regression R-2=0.973, R-2=0.526 and R-2=0.919 for the local index, APACHE 11 and ATN-ISS, respectively, indicate better performance by the local index. the local index median area under the ROC curve, by bootstrapping, was 0.820 (95% CI: 0.741-0.907). Conclusions: APACHE 11 score was inaccurate, and ATN-ISS poorly calibrated. When mortality or intensive care practices significantly deviate, local scores may better evaluate prognosis in severe ARF.PUCRS, Fac Med, Program Posgrad Clin Med Nefrol, Porto Alegre, RS, BrazilUniversidade Federal de São Paulo, Escola Paulista Med, Program Posgrad Nefrol, São Paulo, BrazilUniversidade Federal de São Paulo, Escola Paulista Med, Program Posgrad Nefrol, São Paulo, BrazilWeb of Scienc

The role of growth factors on renal tubular cells submitted to hypoxia and deprived of glucose

Background. in acute renal failure (ARF) renal tubular cell death and detachment can be induced by necrotic and apoptotic mechanisms. Several studies have demonstrated some benefits of the use of growth factors in experimental models of ARF. Methods. MDCK cells were cultured in a glucose-free medium for 24 h and were submitted to hypoxia (pO(2) around 35 mmHg) for additional 24 h. To evaluate the possible protective role of growth factors, EGF, IGF-I or HGF were added to the medium (20 ng mL). LDH release, viability (acridine orange and ethidium bromide dyes) and quantification of apoptotic cells (Hoechst 33342 dye fluorescence) were determined. Results. in the injury group, an increase on LDH release (60% vs. 3%) and on number of apoptotic cells (22% vs. 0.2%) which was associated with a reduced cell viability (61% vs. 94%) when compared with controls. Only HGF, not EGF or IGF-I, was able to protect cells from injury. HGF caused a significant reduction on LDH release (30%) and on number of apoptotic cells (5%), with an increase on viability cellular (79%). Conclusions. HGF decreases cell death on MDCK cells after hypoxic-induced injury, probably acting in both necrotic and apoptotic mechanisms.Universidade Federal de São Paulo, Div Nephrol, Escola Paulista Med, São Paulo, BrazilUniversidade Federal de São Paulo, Div Nephrol, Escola Paulista Med, São Paulo, BrazilWeb of Scienc

Mesangial cells are able to produce catecholamines in vitro

Mesangial cells(MC) participate in the control of the glomerular function due to their ability to synthesize hormones and induce cell contraction. Since MC can produce various kinds of hormones, the purpose of the present study was to determine if they are able to synthesize catecholamines. for this evaluation, the levels of norepinephrine, epinephrine, dopamine, and biopterin, the enzymatic cofactor of tyrosine hydroxylase (TH), were analyzed by HPLC in the intracellular compartment and in the medium of primary cultured MC. To identify and locate the enzymes responsible for monoamine synthesis, TH, dopa decarboxylase, and dopamine beta-hydroxylase, Western blotting and immunocytochemistry were employed using monoclonal and polyclonal antibodies. Concentrations of NE = 57 +/- 8, EPI = 82 +/- 10, and DA=52 +/- 9 pg/mg protein (X +/- SEM) were found in the cell homogenate. the culture medium showed concentrations of NE=25 +/- 3, EPI 33 +/- 3, and DA=62 +/- 15 pg/mg protein. Western blotting analysis and immunocytochemistry evidenced the presence of all enzymes. Moreover, biopterin was also detected in the intracellular compartment and in the medium (0.28 +/- 10.03 and 5.70 +/- 2 nmol/mg cell protein, respectively). Overall, the data indicate that MC have the biosynthetic machinery necessary to produce catecholamines, suggesting that they can act as a paracrine/autocrine hormone system, contributing to the regulation of glomerular hemodynamic and renal microcirculation. (C) 2003 Wiley-Liss, Inc.Universidade Federal de São Paulo, Escola Paulista Med, Div Nephrol, Dept Med, BR-04023900 São Paulo, BrazilUniversidade Federal de São Paulo, Escola Paulista Med, Dept Biochem, Neurosci Lab, BR-04023900 São Paulo, BrazilPontificia Univ Catolica Chile, Fac Ciencias Biol, Dept Physiol Sci, Santiago, ChileUniversidade Federal de São Paulo, Escola Paulista Med, Div Nephrol, Dept Med, BR-04023900 São Paulo, BrazilUniversidade Federal de São Paulo, Escola Paulista Med, Dept Biochem, Neurosci Lab, BR-04023900 São Paulo, BrazilWeb of Scienc