Background: Acute kidney injury (AKI) occurs frequently in septic patients. Albuminuria may play a role as an early marker of septic AKI. The potential association between de novo dipstick albuminuria (DA) and septic AKI has not been examined. Methods: We conducted a single-center observational cohort study of 423 critically ill septic patients without chronic kidney disease (CKD) or prior positive DA within 3 months before admission. The association between de novo DA within the first 24 h of presentation and AKI at 72 h was examined. Results: AKI was identified in 268/423 (63%) patients and 20/423 (4.7%) required dialysis. De novo DA was associated with AKI (univariate OR 1.91; 95% CI 1.27-2.86, p = 0.002). The association persisted in a multivariate logistic regression model adjusted for demographics, baseline kidney function, comorbidities, critical illness parameters, and exposure to nephrotoxins (adjusted OR 1.87; 95% CI 1.21-2.89, p = 0.005). The association between de novo DA and AKI was stronger for severe AKI, i.e. Acute Kidney Injury Network (AKIN) stage 3 (adjusted OR 2.99; 95% CI 1.52-5.85, p = 0.001) and AKIN stage 2 (adjusted OR 1.79; 95% CI 1.002-3.21, p = 0.049) but not AKIN stage 1 (adjusted OR 1.41; 95% CI 0.87-2.29, p = 0.16). Conclusions: De novo DA within the first 24 h of admission was independently associated with severe AKI in critically ill septic patients. Future studies are required to fully elucidate the utility of DA testing in the early detection and stratification of AKI.

1.
Angus DC, Linde-Zwirble WT, Lidicker J, et al: Epidemiology of severe sepsis in the United States: analysis of incidence, outcome, and associated costs of care. Crit Care Med 2001;29:1303-1310.
2.
Uchino S, Kellum JA, Bellomo R, et al: Acute renal failure in critically ill patients: a multinational, multicenter study. JAMA 2005;294:813-818.
3.
Bagshaw SM, George C, Bellomo R: Early acute kidney injury and sepsis: a multicentre evaluation. Crit Care 2008;12:R47.
4.
Hotchkiss RS, Karl IE: The pathophysiology and treatment of sepsis. N Engl J Med 2003;348:138-150.
5.
Aird WC: The role of the endothelium in severe sepsis and multiple organ dysfunction syndrome. Blood 2003;101:3765-3777.
6.
Gosling P: Microalbuminuria: a marker of systemic disease. Br J Hosp Med 1995;54:285-290.
7.
Xu C, Chang A, Hack BK, et al: TNF-mediated damage to glomerular endothelium is an important determinant of acute kidney injury in sepsis. Kidney Int 2014;85:72-81.
8.
Ware LB, Johnson AC, Zager RA: Renal cortical albumin gene induction and urinary albumin excretion in response to acute kidney injury. Am J Physiol Renal Physiol 2011;300:F628-F638.
9.
Basu S, Bhattacharya M, Chatterjee TK, et al: Microalbuminuria: a novel biomarker of sepsis. Indian J Crit Care Med 2010;14:22-28.
10.
MacKinnon KL, Molnar Z, Lowe D, et al: Use of microalbuminuria as a predictor of outcome in critically ill patients. Br Anaesth 2000;84:239-241.
11.
Abid O, Sun Q, Sugimoto K, et al: Predictive value of microalbuminuria in medical ICU patients: results of a pilot study. Chest 2001;120:1984-1988.
12.
Gosling P, Brudney S, McGrath L, et al: Mortality prediction at admission to intensive care: a comparison of microalbuminuria with acute physiology scores after 24 hours. Crit Care Med 2003;31:98-103.
13.
Waikar SS, Wald R, Chertow GM, et al: Validity of International Classification of Diseases, Ninth Revision, Clinical Modification Codes for Acute Renal Failure. J Am Soc Nephrol 2006;17:1688-1694.
14.
Kellum JA, Lameire N: Diagnosis, evaluation, and management of acute kidney injury: a KDIGO summary. Part 1. Crit Care 2013;17:204.
15.
Waikar SS, Liu KD, Chertow GM: Diagnosis, epidemiology and outcomes of acute kidney injury. Clin J Am Soc Nephrol 2008;3:844-861.
16.
McCullough PA, Shaw AD, Haase M, et al: Diagnosis of acute kidney injury using functional and injury biomarkers: workgroup statements from the tenth Acute Dialysis Quality Initiative Consensus Conference. Contrib Nephrol 2013;182:13-29.
17.
Haase M, Kellum JA, Ronco C: Subclinical AKI - an emerging syndrome with important consequences. Nat Rev Nephrol 2012;8:735-739.
18.
Bonventre JV, Basile D, Liu KD, et al: AKI: a path forward. Clin J Am Soc Nephrol 2013;8:1606-1608.
19.
James MT, Hemmelgarn BR, Wiebe N, et al: Glomerular filtration rate, proteinuria, and the incidence and consequences of acute kidney injury: a cohort study. Lancet 2010;376:2096-2103.
20.
Grams ME, Astor BC, Bash LD, et al: Albuminuria and estimated glomerular filtration rate independently associate with acute kidney injury. J Am Soc Nephrol 2010;21:1757-1764.
21.
Clark JJ, Wong LL, Lurie F, et al: Proteinuria as a predictor of renal dysfunction in trauma patients receiving intravenous contrast. Am Surg 2011;77:1194-1200.
22.
Hu JY, Meng XC, Han J, et al: Relation between proteinuria and acute kidney injury in patients with severe burns. Crit Care 2012;16:R172.
23.
Molnar AO, Parikh CR, Sint K, et al: Association of postoperative proteinuria with AKI after cardiac surgery among patients at high risk. Clin J Am Soc Nephrol 2012;7:1749-1760.
24.
Fleck A, Raines G, Hawker F, et al: Increased vascular permeability: a major cause of hypoalbuminaemia in disease and injury. Lancet 1985;1:781-784.
25.
Jensen JS, Borch-Johnsen K, Jensen G, et al: Microalbuminuria reflects a generalized transvascular albumin leakiness in clinically healthy subjects. Clin Sci (Lond) 1995;88:629-633.
26.
Kato T, Mizuno-Horikawa Y, Mizuno S: Decreases in podocin, CD2-associated protein (CD2AP) and tensin2 may be involved in albuminuria during septic acute renal failure. J Vet Med Sci 2011;73:1579-1584.
27.
Schreiber A, Theilig F, Schweda F, et al: Acute endotoxemia in mice induces downregulation of megalin and cubilin in the kidney. Kidney Int 2012;82:53-59.
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