The following is a summary of “Clinical and histopathological characteristics of acute kidney injury in a cohort of brain death donors with procurement biopsies,” published in the May 2024 issue of Nephrology by Scurt et al.

Kidney biopsies are very common in diagnosing and predicting outcomes. However, their utility in Intensive care unit (ICU) cases could be more specific. 

Researchers conducted a retrospective study determining the clinical and tissue factors related to patients in ICU suffering from acute kidney injury (AKI) (donor with brain death [DBD]) with lower-quality donor kidneys.

They studied 221 brain-dead donors, 239 kidney biopsies, and 197 recipients. Biopsies were reanalyzed using Banff criteria. The clinical and histopathological data were compared between donors with and without AKI, defined by creatinine and urine output. Logistic regression identified independent risk factors for AKI. The impact of AKI on outcomes was analyzed using RIFLE (Risk, Injury, Failure, Loss of function, End-stage kidney disease), AKIN (Acute Kidney Injury Network), or KDIGO (Kidney Disease Improving Global Outcomes) criteria.

The results showed that AKI occurred in 65% of donors, detected by both serum creatinine and urine output. Creatinine was significantly better at identifying AKI. Multiorgan failure and severe AKI correlated with creatinine levels, while hemodynamic instability linked to urine output. Donors with creatinine-AKI had lower chronic macrovascular scores, and urine output-AKI showed higher chronic microvascular and tubulointerstitial scores. Short-term recipient outcomes differed only in delayed graft function and one-year death-censored graft survival.

Investigators concluded that Serum creatinine is a better option for AKI diagnosis in brain-dead donors. Different risk factors exist for each AKI type. However, the donor’s AKI type does not predict the recipient’s outcome. 

Source: link.springer.com/article/10.1007/s40620-024-01940-9