京都大学 / 0048 / 新制・課程博士 / 博士(医学) / 甲第21008号 / 医博第4354号 / 新制||医||1028(附属図書館) / 京都大学大学院医学研究科医学専攻 / (主査)教授 長船 健二, 教授 小川 修, 教授 横出 正之 / 学位規則第4条第1項該当 / Doctor of Medical Science / Kyoto University / DFAM

京都大学 / 0048 / 新制・課程博士 / 博士(医学) / 甲第21678号 / 医博第4484号 / 新制||医||1036(附属図書館) / 京都大学大学院医学研究科医学専攻 / (主査)教授 柳田 素子, 教授 福原 俊一, 教授 今中 雄一 / 学位規則第4条第1項該当 / Doctor of Medical Science / Kyoto University / DFAM

京都大学 / 新制・課程博士 / 博士(医学) / 甲第24478号 / 医博第4920号 / 新制||医||1062(附属図書館) / 京都大学大学院医学研究科医学専攻 / (主査)教授 山本 洋介, 教授 近藤 尚己, 教授 柳田 素子 / 学位規則第4条第1項該当 / Doctor of Medical Science / Kyoto University / DFAM

京都大学 / 新制・課程博士 / 博士(医学) / 甲第24518号 / 医博第4960号 / 新制||医||1065(附属図書館) / 京都大学大学院医学研究科医学専攻 / (主査)教授 柳田 素子, 教授 江木 盛時, 教授 長船 健二 / 学位規則第4条第1項該当 / Doctor of Medical Science / Kyoto University / DFAM

Ultrasound measurement of change in kidney volume is a sensitive indicator of severity of renal parenchymal injury. Am J Physiol Renal Physiol 319: F447–F457, 2020. First published July 20, 2020; doi:10.1152/ajprenal.00221.2020.—Noninvasive determination of the severity of parenchymal injury in acute kidney injury remains challenging. Edema is an early pathological process following injury, which may correlate with changes in kidney volume. The goal of the present study was to test the hypothesis that “increases in kidney volume measured in vivo using ultrasound correlate with the degree of renal parenchymal injury.” Ischemia-reperfusion (IR) of varying length was used to produce graded tissue injury. We first determined 1) whether regional kidney volume in rats varied with the severity (0, 15, 30, and 45 min) of warm bilateral IR and 2) whether this correlated with tubular injury score. We then determined whether these changes could be measured in vivo using three-dimensional ultrasound. Finally, we evaluated cumulative changes in kidney volume up to 14 days post-IR in rats to determine whether changes in renal volume were predictive of latent tubular injury following recovery of filtration. Experiments concluded that noninvasive ultrasound measurements of change in kidney volume over 2 wk are predictive of tubular injury following IR even in animals in which plasma creatinine was not elevated. We conclude that ultrasound measurements of volume are a sensitive, noninvasive marker of tissue injury in rats and that the use of three-dimensional ultrasound measurements may provide useful information regarding the timing, severity, and recovery from renal tissue injury in experimental studies.

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<p>Reduced kidney function around the time of surgery is an important risk factor for postoperative mortality. Despite this there is limited information on how reduced kidney function prior to surgery alters prognosis, what causes sudden decrements in kidney function after surgery (known as acute kidney injury), or how they might be avoided. The studies in this thesis inform these knowledge gaps. Chapter 2 describes the results of a post hoc analysis of the interaction between preoperative estimated glomerular filtration rate, a marker of kidney function, and postoperative cardiac troponin T, a marker of heart damage, for predicting 30-day mortality in a prospective cohort study of patients undergoing noncardiac surgery. Chapter 3 uses administrative and clinical data from a single centre to inform the risk of acute kidney injury after noncardiac surgery by concentrations of preoperative hemoglobin and change in postoperative hemoglobin. Chapter 4 uses the same data to determine a definition of intraoperative hypotension that is prognostic of acute kidney injury, myocardial injury and death. Chapter 5 describes a randomized controlled trial that compares a novel therapeutic procedure called remote ischemic preconditioning to a sham procedure in patients undergoing cardiac surgery.</p> / Doctor of Philosophy (PhD)

Yes / Hospital-acquired Acute Kidney Injury (H-AKI) is a common cause of avoidable morbidity and mortality. To determine if the patients’ vital signs data as defined by a National Early Warning Score (NEWS), can predict H-AKI following emergency admission to hospital. Methods: Analyses of emergency admissions to York hospital over 24-months with NEWS data. We report the area under the curve (AUC) for logistic regression models that used the index NEWS (model A0), plus age and sex (A1), plus subcomponents of NEWS (A2) and two-way interactions (A3). Likewise for maximum NEWS (models B0,B1,B2,B3). Results: 4.05% (1361/33608) of emergency admissions had H-AKI. Models using the index NEWS had the lower AUCs (0.59 to 0.68) than models using the maximum NEWS AUCs (0.75 to 0.77). The maximum NEWS model (B3) was more sensitivity than the index NEWS model (A0) (67.60% vs 19.84%) but identified twice as many cases as being at risk of H-AKI (9581 vs 4099) at a NEWS of 5. Conclusions: The index NEWS is a poor predictor of H-AKI. The maximum NEWS is a better predictor but seems unfeasible because it is only knowable in retrospect and is associated with a substantial increase in workload albeit with improved sensitivity. / The Health Foundation

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