Urinary Actin, as a Potential Marker of Sepsis-related Acute Kidney Injury
Condition: Sepsis; Acute Kidney Injury Due to Sepsis
MeSH terms: Sepsis; Toxemia; Acute Kidney Injury; Wounds and Injuries
Study type: Observational

Summary: 
      In our study, 17 septic, 43 sepsis-related acute kidney injury and 24 control patients were
      enrolled. Blood and urine samples were collected at the intensive care unit from acutely
      diagnosed septic and sepsis-related acute kidney injury patients at three time points (T1-3):
      T1: within 24 hours after admission; T2: second day morning; T3: third day morning of
      follow-up. Patients with malignancies needing palliative care, end-stage renal disease or
      kidney transplantation were excluded. Not more than one sample (venous blood, midstream spot
      urine) was collected from control patients. Serum and urinary actin levels were determined by
      quantitative Western blot. Urinary actin concentrations were expressed as µg/L, while serum
      actin levels were expressed as mg/L. Data were compared with laboratory and clinical
      parameters. Patients were categorized by the Sepsis-3 definitions and 30-day mortality data
      were investigated.
    

Detailed description: 
      Actin is a globular protein present in every cell with a 42 kilodalton molecular mass. It
      plays an important role in muscle contraction while being an essential component of the
      cytoskeleton as well. Several proteins (e.g. gelsolin, Gc-globulin) bind actin in the
      circulation during the physiological cell turnover, thus making its urinary appearance
      unlikely. However, recent studies indicate that actin could be detected in the urine of
      kidney-transplant patients with acute kidney injury. Therefore, the main focus of our
      research was the detection and measurement of actin in the blood and urine in patients with
      sepsis or sepsis-related acute kidney injury, as the early recognition of kidney injury -
      especially in sepsis - is essential in the aspect of therapy and survival.
    

Intervention name(s): Sepsis therapy; Sepsis-related acute kidney injury therapy
Intervention type(s): Other; Other
Intervention description(s): Patients receiving sepsis therapy followed the international guidelines of the 2016 Surviving Sepsis Campaign regarding fluid resuscitation, feeding, vasopressor, respiratory, anticoagulation and hydrocortisone therapy, along with ulcer prophylaxis and sedation. Blood and urine samples were collected at the intensive care unit from this patient group at three time points (T1-3): T1: within 24 hours after admission; T2: second day morning; T3: third day morning of follow-up. 24 patients were documented without sepsis and acute kidney injury as a control group.; Patient management of sepsis and sepsis-related acute kidney injury followed the international guidelines of the 2016 Surviving Sepsis Campaign regarding fluid resuscitation, feeding, vasopressor, respiratory, anticoagulation and hydrocortisone therapy, along with ulcer prophylaxis, sedation and renal replacement therapy (if needed). In this patient group, blood and urine sampling was performed at three time points (T1-3): T1: within 24 hours after admission; T2: second day morning; T3: third day morning of follow-up.
Observational model: Cohort
Time perspective: Prospective
Sampling method: Non-Probability Sample
Study population: 
        Diagnosed septic or sepsis-related acute kidney injury patients
      
Biospecimen description: 
      Blood; Urine
    
Keywords: Sepsis-3; Acute Kidney Injury; Urinary actin; Western blot