Renal Fitness in Young Adults with Congenital Heart Disease

先天性心脏病年轻人的肾脏健康

• 批准号: 10379296
• 负责人: Dana Young Fuhrman
• 金额: $ 17.73万
• 依托单位: UNIVERSITY OF PITTSBURGH AT PITTSBURGH
• 依托单位国家: 美国
• 财政年份: 2019
• 资助国家: 美国
• 起止时间: 2019-06-01 至 2024-03-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10379296
• 关键词: Acute Renal Failure with Renal Papillary Necrosis; Admission activity; Adult; Age; Age-Years; Angiotensin-Converting Enzyme Inhibitors; Attention; Attenuated; Award; Biological Markers; Biology; Blood Pressure; Cardiopulmonary Bypass; Caring; Cells; Childhood; Chronic Kidney Failure; Clinic Visits; Clinical; Congenital Abnormality; Coronary Artery Bypass; Creatinine; Development; Dose; Exposure to; Fellowship; Filtration; Foundations; Future; Glomerular Filtration Rate; Goals; Grant; Heart; Hospitalization; Hospitals; Injury; Injury to Kidney; Intensive Care; International; K-Series Research Career Programs; Kidney; Kidney Diseases; Knowledge; Liquid substance; Long-Term Care; Long-Term Effects; Measures; Medical center; Medicine; Mentors; Mentorship; Methods; Monitor; Morbidity - disease rate; Nephrology; Operative Surgical Procedures; Outcome; Patient Care; Patients; Pharmaceutical Preparations; Physiology; Population; Postoperative Period; Predisposition; Proteins; Proteinuria; Renal function; Research; Research Personnel; Risk; Risk Estimate; Risk Factors; Serum; Severities; Standardization; Stimulus; Stress; Time; Training; Tubular formation; Universities; Urinalysis; Work; congenital heart disorder; fitness; follow-up; high risk; innovation; mortality; multidisciplinary; nephrotoxicity; patient population; personalized approach; post gamma-globulins; prevent; professor; renal damage; response; skills; stressor; young adult

ABSTRACT Acute kidney injury (AKI) and chronic kidney disease (CKD) are strongly associated with morbidity and mortality across multiple patient populations. Given that there is currently no specific therapy for AKI or CKD once either has occurred, having a means to predict a patient at risk for renal injury in order to prevent or attenuate damage is invaluable. The overarching goal of this proposal is to predict AKI and AKI to CKD transition in high risk patients. As an assistant professor at the University of Pittsburgh in both pediatric nephrology and intensive care medicine, Dr. Fuhrman has a firm commitment to the study of measures to predict and ultimately prevent the AKI to CKD transition. The main goal of this study is to establish an objective method to quantify renal fitness in young adult congenital heart disease (CHD) patients, a growing population that is at risk for numerous kidney insults across a lifetime. A lack of renal fitness, defined by reduced glomerular reserve and increased susceptibility to tubular injury, may indicate a poor ability of the kidney to respond to external stressors. There currently is no readily available means to quantify renal fitness clinically. Dr. Fuhrman plans to quantify glomerular reserve in CHD patients ages 18-28 by measuring estimated glomerular filtrate rate (eGFR) values using cystatin C before and after a protein load, an easily replicated method that she piloted as a T32 Training Grant recipient along with her mentor, Dr. George Schwartz, during her nephrology fellowship years. When these patients are subsequently admitted to the hospital for coronary bypass (CBP) exposure, she plans to determine the association of glomerular reserve and AKI risk. In addition, prior to a CPB exposure, Dr. Fuhrman will assess the expression of tubular biomarkers, which have been previously shown to be early markers of kidney damage. The association of these biomarkers with AKI similarly will be determined at the time of hospital admission for CBP exposure. Patients will be followed for 1 and 2 years in order to determine if preoperative glomerular reserve and tubular biomarkers estimate the risk of eGFR decline and/or the development of proteinuria. No prior studies have examined the long-term effects of glomerular reserve or preoperative tubular biomarker values in any patient group. Dr. Fuhrman has assembled a mentoring team of internationally recognized researchers led by Dr. John Kellum, her current mentor and an internationally renowned researcher who has done extensive work on predicting AKI and the use of biomarkers. The strong institutional support along with the guidance of a multidisciplinary mentorship team that Dr. Fuhrman will receive under this award will provide her with the necessary foundation to become an independent investigator with expertise in methods to predict and prevent adverse kidney outcomes in numerous patient groups. !

抽象的 急性肾脏损伤（AKI）和慢性肾脏疾病（CKD）与发病率和 多个患者人群的死亡率。鉴于目前尚无针对AKI或CKD的特定疗法 一旦发生了任何一种，就有一种方法来预测有肾脏损伤风险的患者，以防止或 衰减伤害是无价的。该提案的总体目标是将AKI和AKI预测到CKD 高风险患者的过渡。作为匹兹堡大学的助理教授 肾脏和重症监护医学，富尔曼博士对研究措施的坚定承诺 预测并最终阻止AKI到CKD过渡。这项研究的主要目标是建立目标 量化年轻成人先天性心脏病（CHD）患者的肾脏适应性的方法，人口增长 一生中，这有许多肾脏侮辱的风险。缺乏肾脏健身，由减少定义 肾小球储备和增加管状损伤的敏感性，可能表明肾脏能力差 响应外部压力源。当前，尚无临床上量化肾脏适应性的容易获得的手段。 Fuhrman博士计划通过测量估计 使用抑制蛋白C前后蛋白质负载之前和之后，肾小球滤液速率（EGFR）值，易于复制 她与导师乔治·施瓦茨（George Schwartz）博士一起驾驶的方法 她的肾脏学奖学金年。当这些患者随后被送往医院冠状动脉时 她计划确定肾小球储备和AKI风险的关联。此外， 在接触CPB之前，Fuhrman博士将评估肾小管生物标志物的表达， 先前证明是肾脏损伤的早期标记。这些生物标志物与AKI的关联 同样，将在入院CBP暴露时确定。患者将被跟踪1 和2年以确定术前肾小球储备和管状生物标志物是否估计风险 EGFR下降和/或蛋白尿的发展。没有先前的研究检查了长期影响 任何患者组中的肾小球储备或术前管状生物标志物值。富尔曼博士有 组建了由她目前的John Kellum博士领导的国际认可的研究人员的指导团队 导师和国际知名的研究人员，在预测AKI和 使用生物标志物。强大的机构支持以及多学科指导的指导 Fuhrman博士将根据该奖项获得的团队将为她提供必要的基础 一个独立研究者，具有预测和防止不良肾脏结局的方法专业知识 许多患者群体。 呢