Thesis Type: Expertise In Medicine
Institution Of The Thesis: Gazi University, Turkey
Approval Date: 2015
Thesis Language: Turkish
Student: Eser Açıkgöz
Supervisor: HÜSEYİN MURAT ÖZDEMİRAbstract:
Acute kidney injury is frequently encountered during the course of heart failure and it is associated with poor prognosis. Novel biomarkers may detect the acute kidney injury in an earlier stage. Previous studies showed that KIM-1 and cystatin C can detect acute kidney injury within first 24 hour. However, it is not known whether these novel biomarkers are useful in predicting the reversibility of kidney injury. The aim of the present study is to evaluate the predictive value of admission serum cystatin C and urine KIM-1 levels in development and reversibility of acute kidney injury, and association of change in serum cystatin C and urine KIM-1 levels in 24 hours with reversibility of acute kidney injury in patients hospitalized for acute decompensated heart failure. Acute kidney injury was developed in 18 of 45 decompanse heart failure patients in 48th hour of the hospital stay. Admission cystatin C levels were higher than normal reference range in both patients with and without acute kidney injury. 24th hour cystatin levels were higher in patients with acute kidney injury. Admission cystatin C level are independently associated with development of acute kidney injury. While an admission cystatin C level of 1.55 predicted acute kidney injury with 77.8% sensitivity and 85.2% specifity, an admission cystatin C level of 1.34 mg/L predicted acute kidney injury with 83.3% sensitivity and 67% specifity. Admission and 24th hour urine KIM-1 levels were not different between patient with and without acute kidney injury. KIM-1 levels were significantly increased in acute kidney injury patients. Admission BUN, creatinine, cystatin C and KIM-1 levels were not different between patients had recovered and had not recovered from acute kidney injury. Twenty fourth hour cystatin C levels were decreased in patients recovered from acute kidney injury. Urine KIM-1 and KIM-1/creatinine levels were not different between groups. In conclusion, higher admission cystatin C levels are associated with development of acute kidney injury in 48th hour of hospital stay. Decrease in cystatin C levels in 24th hour may be associated with reversibility of acute kidney injury.