Abstract: FR-PO652
Does a Very High Nephrocheck Level (Above 10) Predict the Need of Early RRT?
Session Information
- Trainee Case Reports - IV
October 26, 2018 | Location: Exhibit Hall, San Diego Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Trainee Case Reports
- 102 AKI: Clinical, Outcomes, and Trials
Authors
- Gupta, Sanjeev, Westchester county medical center, White Plains, New York, United States
- Papanagnou, Anastasios, Westchester Medical Center, Bayside, New York, United States
- Chugh, Savneek S., New York Medical College, Hartsdale, New York, United States
Introduction
Studies have shown that elevated levels of TIMP-2 (tissue inhibitor of metalloproteinase) and IGFBP7 (insulin-like growth factor binding protein) predict AKI early on compared to other biomarkers, and early intervention can prevent AKI or its progression. It is, however, unknown if elevated levels of these biomarkers can predict the need for RRT. We present two cases of high Nephrocheck levels (above 10) who required RRT within 24 hours.
Case Description
(1) 51 y/o woman with a PMH of DVT and DM-2 was transferred to our hospital with complaints of nausea, dizziness, and abdominal pain. She was found to have wide complex tachycardia; she was subsequently cardioverted and started on amiodarone, as well as lidocaine drip. 2D Echo showed an EF of 10% with SBP in the 80s. Emergent cardiac catheterization did not reveal any CAD; an IABP was placed and the patient was transferred to our facility for ECMO placement. Her BUN/Cr initially was 20/0.91 which increased to 33/3.3. Nephrocheck was performed showing a level of more than 10; her Cr worsened the following day and the patient became anuric; CVVHD was started.
(2) 52 y/o woman with a PMH of sickle cell disease and asthma was transferred to our hospital for further management of septic shock. On admission, her Cr was 1.5 which worsened to 2.3. Nephrocheck was done showing a level of more than 10; the patient was placed on HD shortly thereafter.
Discussion
Nephrocheck has a high negative predictive value, ruling out potential AKI if the value is negative; however, it has a low positive predictive value. A high Nephrocheck level is indicative of significant kidney injury; however, no studies have been done, thus far, examining the correlation between a high Nephrocheck level predicting the need for early or late RRT. Both of our patients with Nephrocheck levels above 10 required RRT within 24 hours of admission. Therefore, Nephrocheck can be used an early surrogate marker of kidney injury, seen prior to elevations in serum Cr; this data can be helpful to triage the patients with severe AKI requiring RRT.