Furosemide stress test to predict acute kidney injury progression in critically ill children
Background Furosemide stress test (FST) is a novel functional biomarker for predicting severe acute kidney injury (AKI); however, pediatric studies are limited. Methods Children 3 months to 18 years of age admitted to the intensive care unit (ICU) of a tertiary care hospital from Nov 2019 to July 20...
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| Veröffentlicht in: | Pediatric nephrology (Berlin, West) West), 2025-01, Vol.40 (1), p.243-251 |
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| creator | Krishnasamy, Sudarsan Sinha, Aditi Lodha, Rakesh Sankar, Jhuma Tarik, Mohamad Ramakrishnan, Lakshmy Bagga, Arvind Hari, Pankaj |
| description | Background
Furosemide stress test (FST) is a novel functional biomarker for predicting severe acute kidney injury (AKI); however, pediatric studies are limited.
Methods
Children 3 months to 18 years of age admitted to the intensive care unit (ICU) of a tertiary care hospital from Nov 2019 to July 2021 were screened and those who developed AKI stage 1 or 2 within 7 days of admission underwent FST (intravenous furosemide 1 mg/kg). Urine output was measured hourly for the next 6 h; a value > 2 ml/kg within the first 2 h was deemed furosemide responsive. Other biomarkers like plasma neutrophil gelatinase-associated lipocalin (NGAL) and proenkephalin (PENK) were also evaluated.
Results
Of the 480 admitted patients, 51 developed AKI stage 1 or 2 within 7 days of admission and underwent FST. Nine of these patients were furosemide non-responsive. Thirteen (25.5%) patients (eight of nine from FST non-responsive group) developed stage 3 AKI within 7 days of FST, nine (17.6%) of whom (seven from non-responsive group) required kidney support therapy (KST). FST emerged as a good biomarker for predicting stage 3 AKI and need for KST with area-under-the-curve (AUC) being 0.93 ± 0.05 (95% CI 0.84–1.0) and 0.96 ± 0.03 (95% CI 0.9–1.0), respectively. FST outperformed NGAL and PENK in predicting AKI stage 3 and KST; however, the combination did not improve the diagnostic accuracy.
Conclusions
Furosemide stress test is a simple, inexpensive, and robust biomarker for predicting stage 3 AKI and KST need in critically ill children. Further research is required to identify the best FST cut-off in children.
Graphical abstract
A higher resolution version of the Graphical abstract is available as
Supplementary information |
| doi_str_mv | 10.1007/s00467-024-06387-5 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_3050177094</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>3131987835</sourcerecordid><originalsourceid>FETCH-LOGICAL-c375t-1a806ed9e56e3c8fab3c95900958b29736b269233a65cf3ef3ec99e6d2df7d4c3</originalsourceid><addsrcrecordid>eNp9kM9LHDEUx0NR6lb7D_QgAS9epr7Mm_w6ilQrCL0oeBDCbPLGZjs7Y5OZw_73zXa3FjwIgUDe533z5cPYFwFfBYC-yACN0hXUTQUKja7kB7YQDdaVsObxgC3AoqigEY9H7FPOKwAw0qiP7AiNskLIesGeruc0ZlrHQDxPiXLmE-WJTyN_SRSin3jr54n4rxgG2vA4rOa0KbPxeQvHcShP3Kc4Rd_2fQH6nvufsQ-JhhN22LV9ps_7-5g9XH-7v_pe3f24ub26vKs8ajlVojWgKFiSitCbrl2it9ICWGmWtdWolrWyNWKrpO-QyvHWkgp16HRoPB6z811uqfV7LvXdOmZPfd8ONM7ZIUgQWoNtCnr2Bl2NcxpKO4cCizdtUBaq3lG-yMmJOveS4rpNGyfAbd27nXtX3Lu_7t126XQfPS_XFF5X_skuAO6AXEbDM6X_f78T-wf3MZA1</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>3131987835</pqid></control><display><type>article</type><title>Furosemide stress test to predict acute kidney injury progression in critically ill children</title><source>MEDLINE</source><source>Springer Nature - Complete Springer Journals</source><creator>Krishnasamy, Sudarsan ; Sinha, Aditi ; Lodha, Rakesh ; Sankar, Jhuma ; Tarik, Mohamad ; Ramakrishnan, Lakshmy ; Bagga, Arvind ; Hari, Pankaj</creator><creatorcontrib>Krishnasamy, Sudarsan ; Sinha, Aditi ; Lodha, Rakesh ; Sankar, Jhuma ; Tarik, Mohamad ; Ramakrishnan, Lakshmy ; Bagga, Arvind ; Hari, Pankaj</creatorcontrib><description>Background
Furosemide stress test (FST) is a novel functional biomarker for predicting severe acute kidney injury (AKI); however, pediatric studies are limited.
Methods
Children 3 months to 18 years of age admitted to the intensive care unit (ICU) of a tertiary care hospital from Nov 2019 to July 2021 were screened and those who developed AKI stage 1 or 2 within 7 days of admission underwent FST (intravenous furosemide 1 mg/kg). Urine output was measured hourly for the next 6 h; a value > 2 ml/kg within the first 2 h was deemed furosemide responsive. Other biomarkers like plasma neutrophil gelatinase-associated lipocalin (NGAL) and proenkephalin (PENK) were also evaluated.
Results
Of the 480 admitted patients, 51 developed AKI stage 1 or 2 within 7 days of admission and underwent FST. Nine of these patients were furosemide non-responsive. Thirteen (25.5%) patients (eight of nine from FST non-responsive group) developed stage 3 AKI within 7 days of FST, nine (17.6%) of whom (seven from non-responsive group) required kidney support therapy (KST). FST emerged as a good biomarker for predicting stage 3 AKI and need for KST with area-under-the-curve (AUC) being 0.93 ± 0.05 (95% CI 0.84–1.0) and 0.96 ± 0.03 (95% CI 0.9–1.0), respectively. FST outperformed NGAL and PENK in predicting AKI stage 3 and KST; however, the combination did not improve the diagnostic accuracy.
Conclusions
Furosemide stress test is a simple, inexpensive, and robust biomarker for predicting stage 3 AKI and KST need in critically ill children. Further research is required to identify the best FST cut-off in children.
Graphical abstract
A higher resolution version of the Graphical abstract is available as
Supplementary information</description><identifier>ISSN: 0931-041X</identifier><identifier>ISSN: 1432-198X</identifier><identifier>EISSN: 1432-198X</identifier><identifier>DOI: 10.1007/s00467-024-06387-5</identifier><identifier>PMID: 38691152</identifier><language>eng</language><publisher>Berlin/Heidelberg: Springer Berlin Heidelberg</publisher><subject>Acute Kidney Injury - blood ; Acute Kidney Injury - diagnosis ; Acute Kidney Injury - etiology ; Acute Kidney Injury - urine ; Adolescent ; Biomarkers ; Biomarkers - blood ; Biomarkers - urine ; Child ; Child, Preschool ; Children ; Critical Illness ; Disease Progression ; Diuretics - therapeutic use ; Enkephalins ; Female ; Furosemide ; Furosemide - administration & dosage ; Furosemide - therapeutic use ; Gelatinase ; Humans ; Infant ; Kidneys ; Leukocytes (neutrophilic) ; Lipocalin ; Lipocalin-2 - blood ; Lipocalin-2 - urine ; Male ; Medicine ; Medicine & Public Health ; Nephrology ; Original Article ; Patients ; Pediatrics ; Predictive Value of Tests ; Proenkephalin ; Protein Precursors ; Urology ; What’s new in AKI</subject><ispartof>Pediatric nephrology (Berlin, West), 2025-01, Vol.40 (1), p.243-251</ispartof><rights>The Author(s), under exclusive licence to International Pediatric Nephrology Association 2024. Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.</rights><rights>2024. The Author(s), under exclusive licence to International Pediatric Nephrology Association.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c375t-1a806ed9e56e3c8fab3c95900958b29736b269233a65cf3ef3ec99e6d2df7d4c3</citedby><cites>FETCH-LOGICAL-c375t-1a806ed9e56e3c8fab3c95900958b29736b269233a65cf3ef3ec99e6d2df7d4c3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://link.springer.com/content/pdf/10.1007/s00467-024-06387-5$$EPDF$$P50$$Gspringer$$H</linktopdf><linktohtml>$$Uhttps://link.springer.com/10.1007/s00467-024-06387-5$$EHTML$$P50$$Gspringer$$H</linktohtml><link.rule.ids>314,776,780,27903,27904,41467,42536,51297</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/38691152$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Krishnasamy, Sudarsan</creatorcontrib><creatorcontrib>Sinha, Aditi</creatorcontrib><creatorcontrib>Lodha, Rakesh</creatorcontrib><creatorcontrib>Sankar, Jhuma</creatorcontrib><creatorcontrib>Tarik, Mohamad</creatorcontrib><creatorcontrib>Ramakrishnan, Lakshmy</creatorcontrib><creatorcontrib>Bagga, Arvind</creatorcontrib><creatorcontrib>Hari, Pankaj</creatorcontrib><title>Furosemide stress test to predict acute kidney injury progression in critically ill children</title><title>Pediatric nephrology (Berlin, West)</title><addtitle>Pediatr Nephrol</addtitle><addtitle>Pediatr Nephrol</addtitle><description>Background
Furosemide stress test (FST) is a novel functional biomarker for predicting severe acute kidney injury (AKI); however, pediatric studies are limited.
Methods
Children 3 months to 18 years of age admitted to the intensive care unit (ICU) of a tertiary care hospital from Nov 2019 to July 2021 were screened and those who developed AKI stage 1 or 2 within 7 days of admission underwent FST (intravenous furosemide 1 mg/kg). Urine output was measured hourly for the next 6 h; a value > 2 ml/kg within the first 2 h was deemed furosemide responsive. Other biomarkers like plasma neutrophil gelatinase-associated lipocalin (NGAL) and proenkephalin (PENK) were also evaluated.
Results
Of the 480 admitted patients, 51 developed AKI stage 1 or 2 within 7 days of admission and underwent FST. Nine of these patients were furosemide non-responsive. Thirteen (25.5%) patients (eight of nine from FST non-responsive group) developed stage 3 AKI within 7 days of FST, nine (17.6%) of whom (seven from non-responsive group) required kidney support therapy (KST). FST emerged as a good biomarker for predicting stage 3 AKI and need for KST with area-under-the-curve (AUC) being 0.93 ± 0.05 (95% CI 0.84–1.0) and 0.96 ± 0.03 (95% CI 0.9–1.0), respectively. FST outperformed NGAL and PENK in predicting AKI stage 3 and KST; however, the combination did not improve the diagnostic accuracy.
Conclusions
Furosemide stress test is a simple, inexpensive, and robust biomarker for predicting stage 3 AKI and KST need in critically ill children. Further research is required to identify the best FST cut-off in children.
Graphical abstract
A higher resolution version of the Graphical abstract is available as
Supplementary information</description><subject>Acute Kidney Injury - blood</subject><subject>Acute Kidney Injury - diagnosis</subject><subject>Acute Kidney Injury - etiology</subject><subject>Acute Kidney Injury - urine</subject><subject>Adolescent</subject><subject>Biomarkers</subject><subject>Biomarkers - blood</subject><subject>Biomarkers - urine</subject><subject>Child</subject><subject>Child, Preschool</subject><subject>Children</subject><subject>Critical Illness</subject><subject>Disease Progression</subject><subject>Diuretics - therapeutic use</subject><subject>Enkephalins</subject><subject>Female</subject><subject>Furosemide</subject><subject>Furosemide - administration & dosage</subject><subject>Furosemide - therapeutic use</subject><subject>Gelatinase</subject><subject>Humans</subject><subject>Infant</subject><subject>Kidneys</subject><subject>Leukocytes (neutrophilic)</subject><subject>Lipocalin</subject><subject>Lipocalin-2 - blood</subject><subject>Lipocalin-2 - urine</subject><subject>Male</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>Nephrology</subject><subject>Original Article</subject><subject>Patients</subject><subject>Pediatrics</subject><subject>Predictive Value of Tests</subject><subject>Proenkephalin</subject><subject>Protein Precursors</subject><subject>Urology</subject><subject>What’s new in AKI</subject><issn>0931-041X</issn><issn>1432-198X</issn><issn>1432-198X</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2025</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp9kM9LHDEUx0NR6lb7D_QgAS9epr7Mm_w6ilQrCL0oeBDCbPLGZjs7Y5OZw_73zXa3FjwIgUDe533z5cPYFwFfBYC-yACN0hXUTQUKja7kB7YQDdaVsObxgC3AoqigEY9H7FPOKwAw0qiP7AiNskLIesGeruc0ZlrHQDxPiXLmE-WJTyN_SRSin3jr54n4rxgG2vA4rOa0KbPxeQvHcShP3Kc4Rd_2fQH6nvufsQ-JhhN22LV9ps_7-5g9XH-7v_pe3f24ub26vKs8ajlVojWgKFiSitCbrl2it9ICWGmWtdWolrWyNWKrpO-QyvHWkgp16HRoPB6z811uqfV7LvXdOmZPfd8ONM7ZIUgQWoNtCnr2Bl2NcxpKO4cCizdtUBaq3lG-yMmJOveS4rpNGyfAbd27nXtX3Lu_7t126XQfPS_XFF5X_skuAO6AXEbDM6X_f78T-wf3MZA1</recordid><startdate>20250101</startdate><enddate>20250101</enddate><creator>Krishnasamy, Sudarsan</creator><creator>Sinha, Aditi</creator><creator>Lodha, Rakesh</creator><creator>Sankar, Jhuma</creator><creator>Tarik, Mohamad</creator><creator>Ramakrishnan, Lakshmy</creator><creator>Bagga, Arvind</creator><creator>Hari, Pankaj</creator><general>Springer Berlin Heidelberg</general><general>Springer Nature B.V</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7QP</scope><scope>K9.</scope><scope>NAPCQ</scope><scope>7X8</scope></search><sort><creationdate>20250101</creationdate><title>Furosemide stress test to predict acute kidney injury progression in critically ill children</title><author>Krishnasamy, Sudarsan ; Sinha, Aditi ; Lodha, Rakesh ; Sankar, Jhuma ; Tarik, Mohamad ; Ramakrishnan, Lakshmy ; Bagga, Arvind ; Hari, Pankaj</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c375t-1a806ed9e56e3c8fab3c95900958b29736b269233a65cf3ef3ec99e6d2df7d4c3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2025</creationdate><topic>Acute Kidney Injury - blood</topic><topic>Acute Kidney Injury - diagnosis</topic><topic>Acute Kidney Injury - etiology</topic><topic>Acute Kidney Injury - urine</topic><topic>Adolescent</topic><topic>Biomarkers</topic><topic>Biomarkers - blood</topic><topic>Biomarkers - urine</topic><topic>Child</topic><topic>Child, Preschool</topic><topic>Children</topic><topic>Critical Illness</topic><topic>Disease Progression</topic><topic>Diuretics - therapeutic use</topic><topic>Enkephalins</topic><topic>Female</topic><topic>Furosemide</topic><topic>Furosemide - administration & dosage</topic><topic>Furosemide - therapeutic use</topic><topic>Gelatinase</topic><topic>Humans</topic><topic>Infant</topic><topic>Kidneys</topic><topic>Leukocytes (neutrophilic)</topic><topic>Lipocalin</topic><topic>Lipocalin-2 - blood</topic><topic>Lipocalin-2 - urine</topic><topic>Male</topic><topic>Medicine</topic><topic>Medicine & Public Health</topic><topic>Nephrology</topic><topic>Original Article</topic><topic>Patients</topic><topic>Pediatrics</topic><topic>Predictive Value of Tests</topic><topic>Proenkephalin</topic><topic>Protein Precursors</topic><topic>Urology</topic><topic>What’s new in AKI</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Krishnasamy, Sudarsan</creatorcontrib><creatorcontrib>Sinha, Aditi</creatorcontrib><creatorcontrib>Lodha, Rakesh</creatorcontrib><creatorcontrib>Sankar, Jhuma</creatorcontrib><creatorcontrib>Tarik, Mohamad</creatorcontrib><creatorcontrib>Ramakrishnan, Lakshmy</creatorcontrib><creatorcontrib>Bagga, Arvind</creatorcontrib><creatorcontrib>Hari, Pankaj</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Calcium & Calcified Tissue Abstracts</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Premium</collection><collection>MEDLINE - Academic</collection><jtitle>Pediatric nephrology (Berlin, West)</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Krishnasamy, Sudarsan</au><au>Sinha, Aditi</au><au>Lodha, Rakesh</au><au>Sankar, Jhuma</au><au>Tarik, Mohamad</au><au>Ramakrishnan, Lakshmy</au><au>Bagga, Arvind</au><au>Hari, Pankaj</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Furosemide stress test to predict acute kidney injury progression in critically ill children</atitle><jtitle>Pediatric nephrology (Berlin, West)</jtitle><stitle>Pediatr Nephrol</stitle><addtitle>Pediatr Nephrol</addtitle><date>2025-01-01</date><risdate>2025</risdate><volume>40</volume><issue>1</issue><spage>243</spage><epage>251</epage><pages>243-251</pages><issn>0931-041X</issn><issn>1432-198X</issn><eissn>1432-198X</eissn><abstract>Background
Furosemide stress test (FST) is a novel functional biomarker for predicting severe acute kidney injury (AKI); however, pediatric studies are limited.
Methods
Children 3 months to 18 years of age admitted to the intensive care unit (ICU) of a tertiary care hospital from Nov 2019 to July 2021 were screened and those who developed AKI stage 1 or 2 within 7 days of admission underwent FST (intravenous furosemide 1 mg/kg). Urine output was measured hourly for the next 6 h; a value > 2 ml/kg within the first 2 h was deemed furosemide responsive. Other biomarkers like plasma neutrophil gelatinase-associated lipocalin (NGAL) and proenkephalin (PENK) were also evaluated.
Results
Of the 480 admitted patients, 51 developed AKI stage 1 or 2 within 7 days of admission and underwent FST. Nine of these patients were furosemide non-responsive. Thirteen (25.5%) patients (eight of nine from FST non-responsive group) developed stage 3 AKI within 7 days of FST, nine (17.6%) of whom (seven from non-responsive group) required kidney support therapy (KST). FST emerged as a good biomarker for predicting stage 3 AKI and need for KST with area-under-the-curve (AUC) being 0.93 ± 0.05 (95% CI 0.84–1.0) and 0.96 ± 0.03 (95% CI 0.9–1.0), respectively. FST outperformed NGAL and PENK in predicting AKI stage 3 and KST; however, the combination did not improve the diagnostic accuracy.
Conclusions
Furosemide stress test is a simple, inexpensive, and robust biomarker for predicting stage 3 AKI and KST need in critically ill children. Further research is required to identify the best FST cut-off in children.
Graphical abstract
A higher resolution version of the Graphical abstract is available as
Supplementary information</abstract><cop>Berlin/Heidelberg</cop><pub>Springer Berlin Heidelberg</pub><pmid>38691152</pmid><doi>10.1007/s00467-024-06387-5</doi><tpages>9</tpages></addata></record> |
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| subjects | Acute Kidney Injury - blood Acute Kidney Injury - diagnosis Acute Kidney Injury - etiology Acute Kidney Injury - urine Adolescent Biomarkers Biomarkers - blood Biomarkers - urine Child Child, Preschool Children Critical Illness Disease Progression Diuretics - therapeutic use Enkephalins Female Furosemide Furosemide - administration & dosage Furosemide - therapeutic use Gelatinase Humans Infant Kidneys Leukocytes (neutrophilic) Lipocalin Lipocalin-2 - blood Lipocalin-2 - urine Male Medicine Medicine & Public Health Nephrology Original Article Patients Pediatrics Predictive Value of Tests Proenkephalin Protein Precursors Urology What’s new in AKI |
| title | Furosemide stress test to predict acute kidney injury progression in critically ill children |
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