ETIENNE MARIA VASCONCELLOS DE MACEDO
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- Phenotype standardization for drug-induced kidney disease(2015) MEHTA, Ravindra L.; AWDISHU, Linda; DAVENPORT, Andrew; MURRAY, Patrick T.; MACEDO, Etienne; CERDA, Jorge; CHAKARAVARTHI, Raj; HOLDEN, Arthur L.; GOLDSTEIN, Stuart L.Drug-induced kidney disease is a frequent cause of renal dysfunction; however, there are no standards to identify and characterize the spectrum of these disorders. We convened a panel of international, adult and pediatric, nephrologists and pharmacists to develop standardized phenotypes for drug-induced kidney disease as part of the phenotype standardization project initiated by the International Serious Adverse Events Consortium. We propose four phenotypes of drug-induced kidney disease based on clinical presentation: acute kidney injury, glomerular, tubular, and nephrolithiasis, along with the primary and secondary clinical criteria to support the phenotype definition, and a time course based on the KDIGO/AKIN definitions of acute kidney injury, acute kidney disease, and chronic kidney disease. Establishing causality in drug-induced kidney disease is challenging and requires knowledge of the biological plausibility for the specific drug, mechanism of injury, time course, and assessment of competing risk factors. These phenotypes provide a consistent framework for clinicians, investigators, industry, and regulatory agencies to evaluate drug nephrotoxicity across various settings. We believe that this is the first step to recognizing drug-induced kidney disease and developing strategies to prevent and manage this condition.
- Urine Output Assessment as a Clinical Quality Measure(2015) MACEDO, EtienneUrine output (UO) is a relevant marker of kidney function and an independent marker of serum creatinine. Although oliguria can be the result of transitory changes in volume status or due to external influences, such as drug administration, UO is currently included as a criterion to diagnose and stage acute kidney injury (AKI). In clinical practice, the potential of earlier alert of kidney injury with frequent assessment of UO can help patient screening and risk assessment. In this review, we will discuss recent studies applying UO for AKI diagnosis and prognostication and propose methods to assess UO and improve quality of care. (C) 2015 S. Karger AG, Basel
- Urinary Biochemistry in the Diagnosis of Acute Kidney Injury(2018) LIMA, Camila; MACEDO, EtienneAcute kidney injury (AKI) is a common complication, impacting short- and long-term patient outcomes. Although the application of the classification systems for AKI has improved diagnosis, early clinical recognition of AKI is still challenging, as increments in serum creatinine may be late and low urine output is not always present. The role of urinary biochemistry has remained unclear, especially in critically ill patients. Differentiating between a transient and persistent acute kidney injury is of great need in clinical practice, and despite studies questioning their application in clinical practice, biochemistry indices continue to be used while we wait for a novel early injury biomarker. An ideal marker would provide more detailed information about the type, intensity, and location of the injury. In this review, we will discuss factors affecting the fractional excretion of sodium (FeNa) and fractional excretion of urea (FeU). We believe that the frequent assessment of urinary biochemistry and microscopy can be useful in evaluating the likelihood of AKI reversibility. The availability of early injury biomarkers could help guide clinical interventions.
- Measuring renal function in critically ill patients: tools and strategies for assessing glomerular filtration rate(2013) MACEDO, Etienne; MEHTA, Ravindra L.Purpose of review Alterations in kidney function are common in critically ill patients and are generally assessed by changes in serum creatinine (sCr) or urine output, which are considered surrogates for glomerular filtration rate (GFR) but do not reflect the overall kidney function. There is a great need for more reliable measurements of glomerular filtration in order to guide diagnosis and therapy for acute kidney injury. In this review, we will focus on recent advances to measure GFR that could help to better evaluate kidney function and improve patient care. Recent findings Standardized assays for sCr measurements, the use of a more precise scale with more frequent measurements, and the interpretation of the results based on patient's characteristics can increase the clinical value of sCr. New endogenous and exogenous markers will provide a more precise estimation. Imaging techniques are being developed and will probably be available in the near future. New gold standards for glomerular filtration will help in the development and improvement in the use of new biomarkers of kidney injury.