Kidney Volumetry for Predicting Long-Term Outcome in Acute Kidney Injury: A Retrospective Cohort Study.
4 affiliations
- 1Department of Emergency and Critical Care Medicine, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.
- 2Department of Clinical Laboratory Medicine, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.
- 3Department of Real-World Evidence, The University of Tokyo, Tokyo, Japan.
- 4Department of Emergency and Critical Care Medicine, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan, [email protected].
Abstract
Introduction
Continuous renal replacement therapy (CRRT) is effective for severe acute kidney injury (AKI); however, predicting successful CRRT discontinuation and long-term outcomes remains challenging. Although urinary neutrophil gelatinase-associated lipocalin (NGAL) levels and kidney volume measured by computed tomography (CT) have been associated with renal prognosis, it remains unclear whether their combination improves predictive accuracy. This study evaluated whether combining urinary NGAL levels with kidney volume measured by CT improves prediction accuracy.Methods
In this retrospective cohort study, urinary NGAL levels and height-adjusted total kidney volume (HtTKV) were assessed for their ability to predict successful CRRT discontinuation and major adverse kidney events at 90 days (MAKE90).Results
Among the 74 patients included, CRRT discontinuation was successful in 55 (74.3%), and MAKE90 occurred in 31 (41.9%). Urinary NGAL (area under the curve [AUC], 0.86; 95% confidence interval [CI], 0.76-0.95) was a significant predictor of CRRT discontinuation, whereas HtTKV was not. For long-term outcomes, urinary NGAL (AUC, 0.73 [95% CI, 0.61-0.85]) and HtTKV (AUC, 0.67 [95% CI, 0.54-0.80]) were significantly associated with MAKE90. Adding HtTKV to urinary NGAL significantly improved the prediction of MAKE90, as demonstrated by reclassification analyses (net reclassification improvement and integrated discrimination improvement).Conclusions
Adding HtTKV significantly improved the prediction of long-term MAKE90 based on NGAL levels, but not that of short-term CRRT discontinuation. These findings in this proof-of-concept study suggest that structural kidney assessment by CT volumetry may complement urinary NGAL for long-term risk stratification in patients with severe AKI requiring CRRT.
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BibTeX
@article{tagami2026kidney,
title = {{Kidney Volumetry for Predicting Long-Term Outcome in Acute Kidney Injury: A Retrospective Cohort Study.}},
author = {Shunsuke Tagami and Ryota Inokuchi and Akinori Maeda and Yohei Komaru and Tomoki Wada and Teruhiko Yoshida and Yoshihisa Miyamoto and Kent Doi},
journal = {Blood purification},
year = {2026},
month = oct,
doi = {10.1159/bpu/abpag020},
url = {https://europepmc.org/article/MED/42879330},
note = {CC BY-NC},
}
RIS
TY - JOUR
TI - Kidney Volumetry for Predicting Long-Term Outcome in Acute Kidney Injury: A Retrospective Cohort Study.
AU - Shunsuke Tagami
AU - Ryota Inokuchi
AU - Akinori Maeda
AU - Yohei Komaru
AU - Tomoki Wada
AU - Teruhiko Yoshida
AU - Yoshihisa Miyamoto
AU - Kent Doi
PY - 2026
DA - 2026/10/15
JO - Blood purification
DO - 10.1159/bpu/abpag020
UR - https://europepmc.org/article/MED/42879330
AB - Introduction Continuous renal replacement therapy (CRRT) is effective for severe acute kidney injury (AKI); however, predicting successful CRRT discontinuation and long-term outcomes remains challenging. Although urinary neutrophil gelatinase-associated lipocalin (NGAL) levels and kidney volume measured by computed tomography (CT) have been associated with renal prognosis, it remains unclear whether their combination improves predictive accuracy. This study evaluated whether combining urinary NGAL levels with kidney volume measured by CT improves prediction accuracy.Methods In this retrospective cohort study, urinary NGAL levels and height-adjusted total kidney volume (HtTKV) were assessed for their ability to predict successful CRRT discontinuation and major adverse kidney events at 90 days (MAKE90).Results Among the 74 patients included, CRRT discontinuation was successful in 55 (74.3%), and MAKE90 occurred in 31 (41.9%). Urinary NGAL (area under the curve [AUC], 0.86; 95% confidence interval [CI], 0.76-0.95) was a significant predictor of CRRT discontinuation, whereas HtTKV was not. For long-term outcomes, urinary NGAL (AUC, 0.73 [95% CI, 0.61-0.85]) and HtTKV (AUC, 0.67 [95% CI, 0.54-0.80]) were significantly associated with MAKE90. Adding HtTKV to urinary NGAL significantly improved the prediction of MAKE90, as demonstrated by reclassification analyses (net reclassification improvement and integrated discrimination improvement).Conclusions Adding HtTKV significantly improved the prediction of long-term MAKE90 based on NGAL levels, but not that of short-term CRRT discontinuation. These findings in this proof-of-concept study suggest that structural kidney assessment by CT volumetry may complement urinary NGAL for long-term risk stratification in patients with severe AKI requiring CRRT.
SN - 0253-5068
SN - 1421-9735
ER -