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Please use this identifier to cite or link to this item: http://hdl.handle.net/123456789/14429

Title: Assessment of acute kidney injury among Hospitalised patients
Authors: Adoba, Prince
Sakyi, Samuel Asamoah
Keywords: Acute Kidney
Injury
Hospitalised Patients
Issue Date: 19-Jul-2021
Abstract: Acute kidney injury (AKI) is a major clinical syndrome associated with high hospital morbidity and mortality. The condition is routinely diagnosed by creatinine-based and urine output guidelines which are sub-optimal markers after injury due to renal and nonrenal factors. Also, AKI is insidious and may progress to chronic kidney disease unnoticed, hence the need for early and specific biomarkers. This prospective crosssectional study used novel cell cycle arrest biomarkers tissue inhibitor metalloproteinase 2 and insulin-like growth factor binding protein 7 (TIMP-2 and IGFBP7), and neutrophil gelatinase associated lipocalin (NGAL) to assess AKI among general hospitalized patients, and compare their diagnostic performance to the kidney disease improving global outcomes (KDIGO) guideline. The study conveniently enrolled 151 hospitalised patients at the Trauma and Specialist Hospital, Winneba in Ghana. Socio-demographic and clinical information were collected using structured questionnaires. Blood samples were collected for the estimation of serum creatinine, and AKI diagnosed and staged using the KDIGO guideline. Fresh urine samples were collected within 24 hours of admission and urinary NGAL, TIMP-2 and IGFBP-7 estimated using ELISA kits. AKI was present in 44 (29.1%) of the participants. Stage 1 AKI was found in 13.2% of the participants, followed by stage 2 (9.3%) and stage 3 (6.6%). The cell cycle arrest biomarkers and NGAL were significantly (P<0.001) higher among participants with AKI than those without AKI. [TIMP-2]*[IGFBP-7] showed the best diagnostic performance (AUC= 0.94, CI= 0.90-0.98) followed by [IGFBP-7]*NGAL] (AUC= 0.93, CI= 0.87- 0.99), with NGAL having the least (AUC=0.62, CI= 0.46-0.78). The best predictive cutoff values of the biomarkers were 15.59 for TIMP-2, 40.68 for IGFBP-7, 39.20 for NGAL, 0.30 for [TIMP-2]*[IGFBP-7], 0.65 for [TIMP-2]*[NGAL] and 0.75 for [IGFBP- 7]*[NGAL]. The cut-off for [TIMP-2]*[IGFBP-7] showed the best predictive ability (95.8% sensitivity, 77.2% specificity, 44.2% positive predictive value and 99% negative predictive value). Patients with pre-hypertension, hypertension, hepatitis B and those who use local herbal preparations were more likely to develop AKI (P<0.05). The cell cycle arrest biomarker [TIMP-2]*[IGFBP-7] best predicts the development of AKI, and can be used in high risk patients for early diagnosis of AKI. Kidney function of persons with hypertension, hepatitis B infection and people using herbal drugs should be assessed periodically for early detection and management of AKI developed. A combination of the biomarkers ([TIMP]*[IGFBP-7]) should be incorporated in the management of hospitalized patients in order to increase the predictive ability in diagnosing AKI.
Description: A thesis submitted to the Department of Molecular Medicine, Kwame Nkrumah University of Science and Technology in partial fulfillment of the requirements for the Award of Degree of Master of Philosophy in Chemical Pathology .June, 2019
URI: http://hdl.handle.net/123456789/14429
Appears in Collections:College of Health Sciences

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