journal acs with aki

1. Welcome to Journal Presentation
Presented by:
Dr. Md.Sajjad Safi
Phase –B,Resident
Department of Cardiology
BSMMU

2. Acute kidney injury in patients
wth acute coronary syndrome
Giancarlo Marenzi, Nicola Cosentino, Antonio L
Bartorelli
Centro Cardiologico Monzino,
I.R.C.C.S., University of Milan,
Milan, Italy on 04 August 2015
Downloaded from http://heart.bmj.com/

3. TOPICS
• INTRODUCTION
• PATHOPHYSIOLOGY OF AKI
• DEFINITIONS OF AKI
• INCIDENCE OF AKI
• PROGNOSTIC RELEVANCE OF AKI
– Short-term prognosis
– Long-term prognosis
– Transient versus sustained AKI
• RENAL IMPLICATIONS OF AKI
• CONCLUSIONS

4. INTRODUCTION
Acute kidney injury (AKI) : complex disorder
characterised by early (within hours or days) worsening
of renal function, with clinical manifestations ranging
from minimal increase in serum creatinine (sCr) to
anuric renal failure requiring renal replacement
therapy.

5. • Accumulating evidence of the association between
AKI and acute coronary syndrome (ACS)
• Relevance underestimated by cardiologists and
physicians
• sCr increase in ACS is often a reversible phenomenon
with values that may rapidly return to normal, or
may be partially or completely irreversible, leading to
progressive chronic kidney disease (CKD)
• Surprising that most influential cardiology textbooks
and recent guidelines did not draw much attention
• Its incidence may be as high as 30%.

6. • Lack of a common reference point on AKI created
confusion and made comparisons difficult among
studies investigating preventive and therapeutic
approaches
• Framework of knowledge to raise awareness of AKI
in the cardiology community, with the goal to
ultimately improve outcomes of patients with ACS
developing AKI.

7. PATHOPHYSIOLOGY OF AKI
• Multifactorial Phenomenon
• Systemic and renal haemodynamic changes
secondary to impaired cardiac output (‘arterial
underfilling’) and increased venous congestion
(‘venous overfilling’)that lead to (GFR)
• Imbalance of endogenous vasodilating and
vasoconstrictive
• Enhanced inflammatory response, increased
oxidative stress and sympathetic activation

9. DEFINITIONS OF AKI
• Current myocardial revascularisation guidelines -
absolute increase in sCr ≥0.5 mg/dL or a relative
increase in sCr ≥25% above the baseline value within
48–72 h

10. RELATIONSHIP BETWEEN sCr & GFR
Curvilian relationship

11. CRITERIA OF AKI
• RIFLE Criteria
• AKIN Criteria
• KDIGO Criteria

12. RIFLE criteria
RIFLE
An acute ↑ in sCr or ↓ in GFR over 7 days
Risk ↑ in sCr ≥1.5×baseline or ↓ in GFR >25% UO <0.5 mL/kg/h×6 h
Injury ↑ in sCr ≥2.0×baseline or ↓ in GFR >50% UO <0.5 mL/kg/h×12
h
Failure ↑ in sCr ≥3.0×baseline or
↑ in sCr ≥0.5 mg/dL if baseline sCr ≥4.0 mg/dL or
↓ in GFR >75%
UO <0.3 mL/kg/h×24
h or
anuria× 12 h
Loss Complete loss of kidney function >4 weeks
ESRD End-stage renal disease >3 months

13. AKIN criteria
AKIN
An acute ↑ in sCr or ↓ in GFR within 48 h
Stage 1 ↑ in sCr ≥1.5–2.0×baseline or ↑ in sCr ≥0.3 mg/dL UO <0.5
mL/kg/h×6 h
Stage 2 ↑ in sCr >2.0–3.0×baseline or ↓ in GFR ≥50% UO <0.5
mL/kg/h×12 h
Stage 3 ↑ in sCr >3.0×baseline or sCr ≥4.0 mg/dL with an acute
↑ ≥0.5 mg/dL or initiation of RRT
UO <0.3
mL/kg/h×24 h
or anuria×12h

14. KDIGO Criteria
KDIGO
An acute ↑ in sCr within 48 h or ↓ in GFR over 7 days
Stage
1
↑ in sCr ≥1.5–1.9×baseline or ↑ in sCr ≥0.3 mg/dL UO <0.5 mL/kg/h×6 h
Stage
2
↑ in sCr ≥2.0–2.9×baseline UO <0.5 mL/kg/h× 12 h
Stage
3
↑ in sCr ≥3.0×baseline or sCr ≥4.0 mg/dL with an
acute ↑ ≥0.5
mg/dL Or initiation of RRT
UO <0.3 mL/kg/h×24 h or
anuria×12 h

15. INCIDENCE OF AKI
• The reported incidence of ACS-associated AKI
is extremely heterogeneous, ranging from 5%
to 55%, and it varies with the criteria used for
diagnosing AKI, the clinical setting and the
investigated population

17. PROGNOSTIC RELEVANCE OF AKI
• Short-term prognosis:
– Association between AKI and in-hospital outcomes
– In-hospital mortality(1%,9.5% & 43%)
– Fox et al(7%,14% &32)
• Long-term prognosis:
– Hwang et al
– Amin et al
– Narula et al
• Transient versus sustained AKI

19. RENAL IMPLICATIONS OF AKI

20. CONCLUSIONS
• AKI is a complex syndrome that is increasingly
recognised as a frequent and potentially
catastrophic complication of ACS
• Severity is independently associated with
increasing morbidity and mortality, both at short-
term and long-term follow-up
• Single accepted definition is still lacking
• Fully recover AKI may favour CKD and observed
worse outcomes
• Proper follow-up and secondary preventive
measures may be implemented.

21. THANK YOU