Clinical Practice Guidelines For Acute Kidney Injury In ChinaⅢ

Diagnosis and monitoring of AKI

Clinical question 4: What are the diagnostic criteria for AKI?

【Recommendations】

1. It is recommended to determine whether AKI occurs and its severity according to KDIGO's AKI diagnostic criteria and staging (1B).

2. If the patient does not have a serum creatinine value within 7 days before the onset of the disease, it is recommended to use the average serum creatinine value available from 7 to 365 days before the onset of the disease as the baseline level (2C).

3. It is recommended that all patients diagnosed with AKI undergo ultrasonography to exclude postrenal obstruction (1A).

4. It is recommended that patients with suspected prerenal AKI receive diagnostic volume support therapy (1B).

5. It is recommended that patients who rule out post-renal and pre-renal AKI should consider undergoing renal biopsy (1A).

6. It is recommended that all AKI patients be fully evaluated and complications prevented (1A).

Click to Cistanche for kidney disease

In 2012, KDIGO released the KDIGO staging criteria, which defined AKI as (1) an increase in serum creatinine of ≥26.5 μmol/L within 48 hours; (2) an increase in serum creatinine of more than 1.5 times the baseline value within 7 days. ; (3) Urine output decreases (<0.5 ml·kg-1·h-1) and lasts for more than 6 hours; if any of the above is met, AKI can be diagnosed. The academic community has conducted a series of validation studies on the above-mentioned AKI diagnostic criteria. A retrospective study included 457 patients with sepsis, and the results showed that the KDIGO criterion (87.5%) could identify more AKI patients than the AKIN (72.8%) and RIFLE (84.2%) criteria (P<0.001). 

Another study included 3107 ICU patients, and the results also showed that more AKI patients (51.0%) were diagnosed by KDIGO criteria than RIFLE (46.9%) and AKIN (38.4%). Some scholars are still trying to use the three standards to predict patient prognosis. Studies conducted in different populations have shown that the KDIGO standard is more advantageous than the RIFLE and AKIN standards in predicting patient death. After reviewing the above literature, the expert group of this guideline believes that the KDIGO criteria should be used first to diagnose the occurrence and severity of AKI.

No matter which diagnostic standard is used, it needs to be compared with the baseline renal function (within 7 days) to judge. It is more difficult to diagnose non-oliguric patients who cannot obtain serum creatinine value or GFR. Some scholars conducted research and compared the difference between the average serum creatinine value measured in three time periods: 7 to 365 days, 7 to 730 days, and 1 to 730 days before admission and the reference standard drawn up by the nephrology expert group. The results showed that before admission, The average serum creatinine value measured from 7 to 365 days has the highest consistency rate with the reference standard. Therefore, it is recommended that if the baseline renal function in the short term (within 7 days) before admission cannot be obtained, the average serum creatinine value from 7 to 365 days before admission can be used as the Alternative assessment of baseline renal function.

Ultrasound examination plays a very significant role in the diagnosis of AKI. The expert group for this guideline unanimously believes that ultrasonic diagnosis has significant advantages in judging post-renal obstruction and can be used as a "gold standard" for clinical promotion. It is recommended that all AKI patients need ultrasound. Check to see if there is post-renal obstruction.

Prerenal AKI is very common in clinical practice. When prerenal AKI is suspected, while improving routine examinations, the urine output can be observed after volume expansion treatment. If the urine output increases, it can support the diagnosis of prerenal AKI; conversely, If there is no significant increase in urine output and no significant decrease in serum urea nitrogen and creatinine after rehydration, it should be considered that prerenal AKI has converted to renal AKI, or that there are prerenal aggravating factors on the basis of renal AKI. After excluding prerenal and postrenal AKI, renal AKI can be diagnosed. For renal AKI, renal biopsy may be considered if conditions permit to identify the primary disease and guide treatment.

With the increasing development of renal replacement therapy (RRT) technology, the cause of death of AKI patients is mainly attributed to the occurrence of various complications. During the diagnosis and treatment of AKI, constant observation is required to prevent complications, including (1) infection; (2) volume overload; (3) electrolyte and acid-base balance disorders; (4) arrhythmia; (5) multiple organ failure ; (6) Bleeding diseases (cerebral hemorrhage, gastrointestinal bleeding, etc.).

The expert group believes that the current diagnostic criteria for AKI still mainly rely on easily obtained kidney function indicators, namely serum creatinine value and urine output, but these two indicators have obvious shortcomings. For example, serum creatinine is affected by volume, age, muscle content, and drugs, and it is often impossible to accurately evaluate changes in glomerular filtration function. Moreover, serum creatinine gradually rises 24 to 36 hours after renal injury. The sensitivity of urine output to AKI is low, and non-oliguric AKI may be missed. 

The expert group believes that in view of the limitations of serum creatinine and urine output in the early diagnosis of AKI, the value of new biomarkers in the diagnosis of AKI in the past 10 years should be paid attention to, such as neutrophil gelatinase-associated lipocalin (NGAL). ) and the combination of tissue inhibitors of metalloproteinase 2 (TIMP-2) and insulin-like growth factor binding protein 7 (IGFBP7) have good clinical value in predicting AKI. When conditions permit, clinical use of the above biomarkers can be considered for auxiliary diagnosis to reduce the missed diagnosis rate when AKI is suspected.

How Does Cistanche Treat Kidney Disease?

Cistanche is a traditional Chinese herbal medicine used for centuries to treat various health conditions, including kidney disease. It is derived from the dried stems of Cistanche deserticola, a plant native to the deserts of China and Mongolia. The main active components of cistanche are phenylethanoid glycosides, echinacoside, and acteoside, which have been found to have beneficial effects on kidney health.

Kidney disease, also known as renal disease, refers to a condition in which the kidneys are not functioning properly. This can result in a buildup of waste products and toxins in the body, leading to various symptoms and complications. Cistanche may help treat kidney disease ase through several mechanisms.

Firstly, cistanche has been found to have diuretic properties, meaning it can increase urine production and help eliminate waste products from the body. This can help relieve the burden on the kidneys and prevent the buildup of toxins. By promoting diuresis, cistanche may also help Reduce high blood pressure, a common complication of kidney disease.

Moreover, cistanche has been shown to have antioxidant effects. Oxidative stress, caused by an imbalance between the production of free radicals and the body's antioxidant defenses, plays a key role in the progression of kidney disease. ies help neutralize free radicals and reduce Oxidative stress, thereby protecting the kidneys from damage. The phenylethanoid glycosides found in cistanche have been particularly effective in scavenging free radicals and inhibiting lipid peroxidation.

Additionally, cistanche has been found to have anti-inflammatory effects. Inflammation is another key factor in the development and progression of kidney disease. Cistanche's anti-inflammatory properties help reduce the production of pro-inflammatory cytokines and inhibit the activation of inflammation mandatory pathways, thus alleviating inflammation in the kidneys.

Furthermore, cistanche has been shown to have immunomodulatory effects. In kidney disease, the immune system can be dysregulated, leading to excessive inflammation and tissue damage. Cistanche helps regulate the immune response by modulating the production and activity of immune cells, such as T cells and macrophages. This immune regulation helps reduce inflammation and prevent further damage to the kidneys.

Moreover, cistanche has been found to improve renal function by promoting the regeneration of renal tubes with cells. Renal tubular epithelial cells play a crucial role in the filtration and reabsorption of waste products and electrolytes. In kidney disease, these cells can be damaged, leading to damaged renal function. Cistanche's ability to promote the regeneration of these cells helps restore proper renal function and improve overall kidney health.

In addition to these direct effects on the kidneys, cistanche has been found to have beneficial effects on other organs and systems in the body. This holistic approach to health is particularly important in kidney disease, as the condition often affects multiple organs and systems. che has been shown to have protective effects on the liver, heart, and blood vessels, which are commonly affected by kidney disease. By promoting the health of these organs, cistanche helps improve overall kidney function and prevent further complications.

In conclusion, cistanche is a traditional Chinese herbal medicine used for centuries to treat kidney disease. Its active components have diuretic, antioxidant, anti-inflammatory, immunomodulatory, and regenerative effects, which help improve renal function and protect the kidneys from further damage. , cistanche has beneficial effects on other organs and systems, making it a holistic approach to treating kidney disease.