Cited by 297Acute Kidney Injury ResearchChronic Kidney Disease and DiabetesSepsis Diagnosis and Treatment

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Derivation and validation of the renal angina index to improve the prediction of acute kidney injury in critically ill children

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Basu, Rajit K., Zappitelli, Michael, Brunner, Lori, Wang, Yu, Wong, Hector R., Chawla, Lakhmir S., Wheeler, Derek S., Goldstein, Stuart L.·2014·Kidney International

DOI 10.1038/ki.2013.349PMC PMC4659420

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Abstract

Reliable prediction of severe acute kidney injury (AKI) has the potential to optimize treatment. Here we operationalized the empiric concept of renal angina with a renal angina index (RAI) and determined the predictive performance of RAI. This was assessed on admission to the pediatric intensive care unit, for subsequent severe AKI (over 200% rise in serum creatinine) 72 h later (Day-3 AKI). In a multicenter four cohort appraisal (one derivation and three validation), incidence rates for a Day 0 RAI of 8 or more were 15-68% and Day-3 AKI was 13-21%. In all cohorts, Day-3 AKI rates were higher in patients with an RAI of 8 or more with the area under the curve of RAI for predicting Day-3 AKI of 0.74-0.81. An RAI under 8 had high negative predictive values (92-99%) for Day-3 AKI. RAI outperformed traditional markers of pediatric severity of illness (Pediatric Risk of Mortality-II) and AKI risk factors alone for prediction of Day-3 AKI. Additionally, the RAI outperformed all KDIGO stages for prediction of Day-3 AKI. Thus, we operationalized the renal angina concept by deriving and validating the RAI for prediction of subsequent severe AKI. The RAI provides a clinically feasible and applicable methodology to identify critically ill children at risk of severe AKI lasting beyond functional injury. The RAI may potentially reduce capricious AKI biomarker use by identifying patients in whom further testing would be most beneficial.

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Self-citation

Authors: Basu, R. K., Zappitelli, M., Brunner, L., Wang, Y., Wong, H. R., Chawla, L. S., Wheeler, D. S., & Goldstein, S. L.
Affiliations: Cincinnati Children's Hospital Medical Center (US)
Montreal Children's Hospital (CA)
George Washington University (US)
Corresponding author: Basu, Rajit K.
ORCID: Basu, Rajit K.
Zappitelli, Michael
Wang, Yu
Wong, Hector R.
Chawla, Lakhmir S.
Wheeler, Derek S.
Goldstein, Stuart L.
Venue: Kidney International
Publisher: Elsevier BV
Published: 2014-03
Volume: 85
Issue: 3
Pages: 659-667
ISSN: 0085-2538 (ISSN-L)
DOI: 10.1038/ki.2013.349
PMC: PMC4659420
OpenAlex: W2007813089
Cited by: 297
References: 49
Citations by year: 2026: 22 · 2025: 34 · 2024: 21 · 2023: 28 · 2022: 31 · 2021: 27 · 2020: 18 · 2019: 22 · 2018: 28 · 2017: 15 · 2016: 21 · 2015: 16 · 2014: 12
FWCI: 12.63
Type: journal article
Language: en
Open access: bronze
doi.org
Licence: www.elsevier.com/tdm/userlicense/1.0/ (tdm)
www.elsevier.com/open-access/userlicense/1.0/ (vor, 1461 d)
Locations: Kidney International (publishedVersion)
PubMed (publishedVersion)
Europe PMC (PubMed Central) (acceptedVersion)
PubMed Central (acceptedVersion)
Funders: National Institutes of Health (5ul1rr026314-03, 5rc1hl100474-02, UL1TR000077)
National Heart, Lung, and Blood Institute (RC1-HL100474)
National Institute of General Medical Sciences (R01GM064619, R01GM108025, R01GM099773)
National Institute of Diabetes and Digestive and Kidney Diseases (P50DK096418)
National Center for Research Resources (UL1-RR026314, UL1RR02631401)
National Center for Advancing Translational Sciences
Topics: Health Sciences › Medicine › Nephrology › Acute Kidney Injury Research
Health Sciences › Medicine › Nephrology › Chronic Kidney Disease and Diabetes
Health Sciences › Medicine › Critical Care and Intensive Care Medicine › Sepsis Diagnosis and Treatment
Keywords: renal angina index, acute kidney injury, pediatric intensive care, critically ill children, AKI prediction, risk stratification, serum creatinine, KDIGO staging, kidney injury biomarkers, negative predictive value
MeSH terms: Child, Child, Preschool, Creatinine, Female, Humans, Infant, Male, Severity of Illness Index, Biomarkers, Critical Illness, Acute Kidney Injury

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Derivation and validation of the renal angina index to improve the prediction of acute kidney injury in critically ill children

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