Om oss

Karolinska Intensive Care Nephrology Group.

Our research focuses on acute kidney injury, which is a major problem in the intensive care unit and incidence is rising. Almost 50 per cent of patients with acute kidney injury die during their hospital stay, and the syndrome causes more than four million deaths per year worldwide.

Survivors of acute kidney injury (AKI) have significant short- and long-term risk of complications, and almost 10 per cent develop end-stage kidney failure with need of lifelong dialysis.

AKI is a disturbing clinical issue in part because it is difficult to identify early. Risk assessment for AKI is recommended by practice guidelines, but risk stratification remains very difficult, mainly due to limited sensitivity and specificity of the available diagnostic tests for AKI. In everyday clinical practice, physicians are forced to use functional markers, like creatinine, urea and urine output. These markers have been used since the Second World War, and are not affected until days after the injury process has started in the kidney parenchyma.

Efforts to treat AKI or at least prevent its deterioration have failed; likely a consequence of the late diagnosis offered by functional markers - identifying the acute kidney injury at a time when it is already established and the organ is beyond recovery.

This group has three areas of interest:

• Biomarker studies, where we investigate novel injury markers of acute kidney injury. We also investigate markers of kidney function and glomerular filtration.
• The epidemiology, risk factors and long term outcome of acute kidney injury.
• Pathophysiology of acute kidney injury.

Group members

Projects

• Plasma HNL/NGAL as a marker of sepsis in critically ill patients.

Collaboration with the Department of Medical Sciences, Clinical Chemistry, Uppsala University.

Aim: To study the ability of plasma HNL/NGAL and its isoforms to (1) predict bacterial sepsis and to (2) guide in antibiotic stewardship.

• Renal outcome after acute kidney injury in the ICU.

Collaboration with the Department of Nephrology, Karolinska University Hospital Solna.

Aim: To describe the incidence of long-term renal recovery, end-stage kidney disease and mortality in ICU survivors with acute kidney injury. Study clinical and biochemical predictors aiming to identify patients at risk for developing chronic kidney disease after ICU discharge.

• Surrogate markers of GFR in critically ill patients.

Collaboration with the Department of Medical Sciences, Clinical Chemistry, Uppsala University.

Aim: To investigate cystatin C and creatinine as surrogate markers of glomerular filtration rate (GFR) in ICU patients.

• Monitoring renal recovery in patients treated with acute renal replacement therapy (RRT)

Collaboration with the Department of Medical Sciences, Clinical Chemistry, Uppsala University.

Aim: To study the kinetics of creatinine, cystatin C and HNL/NGAL in plasma and urine during RRT treatment and to assess their ability to predict successful weaning from the RRT machine.

• Timing of renal replacement therapy in Swedish ICUs, impact on outcome

Collaboration with SIR, the Swedish Intensive Care Registry.

Aim: To determine if early initiation of renal replacement therapy lowers mortality and/or risk for end-stage renal disease.

• Octogenarians with AKI, short- and long-term outcome

Collaboration with SIR, the Swedish Intensive Care Registry.

Aim: To determine the outcome for the old, and very old, patients with acute kidney injury in Swedish ICUs.

Research funding

• Stockholm County Council (ALF)
• Stiftelsen Lars Hiertas minne
• Gambro Lundia AB
• Karolinska Institutet

Publications

Immunoassays distinguishing between HNL/NGAL released in urine from kidney epithelial cells and neutrophils.


Mårtensson J, Xu S, Bell M, Martling C, Venge P
Clin. Chim. Acta 2012 Oct;413(19-20):1661-7

Long-term outcome after acute renal replacement therapy: a narrative review.


Rimes-Stigare C, Awad A, Mårtensson J, Martling C, Bell M
Acta Anaesthesiol Scand 2012 Feb;56(2):138-46

Impact of sepsis on levels of plasma cystatin C in AKI and non-AKI patients.


Mårtensson J, Martling C, Oldner A, Bell M
Nephrol. Dial. Transplant. 2012 Feb;27(2):576-81

Neutrophil gelatinase-associated lipocalin in adult septic patients with and without acute kidney injury.


Mårtensson J, Bell M, Oldner A, Xu S, Venge P, Martling C
Intensive Care Med 2010 Aug;36(8):1333-40

Continuous renal replacement therapy in septic patients: is it really harmful?


Mårtensson J, Bell M, Martling C
Crit. Care Med. 2009 Sep;37(9):2677-8; author reply 2678

Cystatin C is correlated with mortality in patients with and without acute kidney injury.


Bell M, Granath F, Mårtensson J, Löfberg E, Ekbom A, Martling C, et al
Nephrol. Dial. Transplant. 2009 Oct;24(10):3096-102

End-stage renal disease patients on renal replacement therapy in the intensive care unit: short- and long-term outcome.


Bell M, Granath F, Schön S, Löfberg E, , Ekbom A, et al
Crit. Care Med. 2008 Oct;36(10):2773-8

Continuous renal replacement therapy is associated with less chronic renal failure than intermittent haemodialysis after acute renal failure.


Bell M, , Granath F, Schön S, Ekbom A, Martling C
Intensive Care Med 2007 May;33(5):773-80

Long-term outcome after intensive care: can we protect the kidney?


Bell M, Martling C
Crit Care 2007 ;11(4):147

Optimal follow-up time after continuous renal replacement therapy in actual renal failure patients stratified with the RIFLE criteria.


Bell M, Liljestam E, Granath F, Fryckstedt J, Ekbom A, Martling C
Nephrol. Dial. Transplant. 2005 Feb;20(2):354-60