PURPOSE OF REVIEW: Recent biochemical evidence increasingly implicates inflammatory mechanisms as precipitants of acute renal failure. In this review, we detail some of these pathways together with potential new therapeutic targets. RECENT FINDINGS: Neutrophil gelatinase-associated lipocalin appears to be a sensitive, specific and reliable biomarker of renal injury, which may be predictive of renal outcome in the perioperative setting. For estimation of glomerular filtration rate, cystatin C is superior to creatinine. No drug is definitively effective at preventing postoperative renal failure. Clinical trials of fenoldopam and atrial natriuretic peptide are, at best, equivocal. As with pharmacological preconditioning of the heart, volatile anaesthetic agents appear to offer a protective effect to the subsequently ischaemic kidney. SUMMARY: Although a greatly improved understanding of the pathophysiology of acute renal failure has offered even more therapeutic targets, the maintenance of intravascular euvolaemia and perfusion pressure is most effective at preventing new postoperative acute renal failure. In the future, strategies targeting renal regeneration after injury will use bone marrow-derived stem cells and growth factors such as insulin-like growth factor-1.
Hamilton, D. V.; Kelly, Moira B.; Pryor, J. S.
Acute renal failure secondary to ureteric obstruction is described in a primigravida with twin gestation and polyhydramnios. Relief of the obstruction occurred on drainage of the liquor and return to normal renal function following delivery.
Vergesslich, K.A.; Balzar, E.; Weninger, M.; Ponhold, W.; Sommer, G.; Wittich, G.R.; Vienna Univ.
Acute renal failure (ARF) may be due to obstructive uropathy or renal parenchymal disease. Twenty-five children with acute renal failure secondary to renal parenchymal disease underwent ultrasonographic examination of the kidneys. Changes of renal size and cortical echogenicity were correlated with renal function. All patients presented with bilaterally enlarged kidneys with the exception in renal function resulted in normalization of renal size. With regard to cortical echogenicity two groups were formed. Group A comprised 11 patients whose kidneys had the same echogenicity as the liver, while in group B the kidneys were more echogenic (14 patients). Cortical echogenicity was always increased. Determination of creatinine levels showed a statistically significant difference between group A (3.32 mg% ± 1.40 S.D.) and group B (5.95 mg% ± 1.96 S.D.), p < 0.001. Changes in renal function were paralleled by rapid changes in renal size and cortical echogenicity. (orig.)
Hamilton, D. V.; Kelly, Moira B.; Pryor, J. S.
Acute renal failure secondary to ureteric obstruction is described in a primigravida with twin gestation and polyhydramnios. Relief of the obstruction occurred on drainage of the liquor and return to normal renal function following delivery. ImagesFig. 1 PMID:7022419
Cederholm, C.; Almen, T.; Bergqvist, D.; Golman, K.; Takolander, R.
Acute renal failure is a serious complication oif reconstructive aortoiliac surgery. The question was raised whether its etiology includes interaction between preoperative angiographic contrast medium and intra-operative clamping of the renal arteries. Renal arteries of 180 rats were bilaterally clamped 10 to 120 min and serum urea was determined from 3 h to 7 days later. In 35 rats 40 min clamping alone produced an increase in urea reaching a maximum 1 day later (median increase 70%). In 3 groups of 12 rats intravenous injection of the contrast medium metrizoate alone in doses 1, 2 and 3 g I/kg body-weight produced no significant increase in urea. Intravenous injection of the same doses to 3 groups of 10 rats each followed 1 h later by renal arterial occlusion for 40 min produced median urea increases one day later of 110, 130 and 170%, respectively, in the 3 groups. The increase was higher than that produced by contrast medium alone (p<0.01) or by renal artery clamping alone (p<0.05) indicating a potentiation of transient renal failure by the combination of contrast medium and renal arterial clamping. (orig.)
Uchino, Shigehiko; Doig, Gordon S.; Bellomo, Renaldo; Morimatsu, Hiroshi; Morgera, Stanislao; Schetz, Miet; Tan, Ian; Bouman, Catherine; Nacedo, Ettiene; Gibney, Noel; Tolwani, Ashita; Ronco, Claudio; Kellum, John A.
According to recent research, diuretics may increase mortality in acute renal failure patients. The administration of diuretics in such patients has been discouraged. Our objective was to determine the impact of diuretics on the mortality rate of critically ill patients with acute renal failure.
Sérgio Mussi Guimarães
Full Text Available Nutritional status has been considered to be one of the possible determinants of mortality rates in cases of acute renal failure (ARF. However, most studies evaluating possible mortality indicators in ARF cases have not focused on the nutritional status, possibly because of the difficulties involved in assessing the nutritional status of critically ill patients. Although the traditional methods for assessing nutritional status are used for ARF patients, they are not the best choice in this population. The use of nutritional support for these patients has produced conflicting results regarding morbidity and mortality. This review covers the mechanisms and indicators of malnutrition in ARF cases and the types of nutritional support that may be used.
Cederholm, C.; Almen, T.; Bergquist, D.; Golman, K.; Takolander, R.; Malmoe Allmaenna Sjukhus
It was demonstrated in rats that renal injury which follows transient renal hypoxia is potentiated by the contrast media metrizoate, ioxaglate, iopamidol and iohexol. Intravenous injection of 1 g I/kg of all four media alone to 82 rats caused no significant increase in serum urea 1, 3 and 7 days later. The percentage increase of serum urea is given in median values and interquartile range (in parentheses). Bilateral renal arterial occlusion alone for 40 minutes in 42 rats increased serum urea one day later by 40% (20-130). Intravenous injection of the media followed in one hour by bilateral renal arterial occlusion for 40 minutes in 104 rats caused serum urea to increase one day later by 130% (70-350) after metrizoate, by 220% (50-380) after ioxaglate, by 290 % (60-420) after iopamidol and by 160% (50-330) after iohexol. There were no significant differences between the potentiating effects of the various media on ischemic renal failure. (orig.)
Chevalier, R.L.; Campbell, F.; Brenbridge, A.N.
Sixteen infants, 2 to 35 days of age, had acute renal failure, a diagnosis based on serum creatinine concentrations greater than 1.5 mg/dL for at least 24 hours. Eight infants were oliguric (urine flow less than 1.0 mL/kg/h) whereas the remainder were nonoliguric. To determine clinical parameters useful in prognosis, urine flow rate, duration of anuria, peak serum creatinine, urea (BUN) concentration, and nuclide uptake by scintigraphy were correlated with recovery. Nine infants had acute renal failure secondary to perinatal asphyxia, three had acute renal failure as a result of congenital cardiovascular disease, and four had major renal anomalies. Four oliguric patients died: three of renal failure and one of heart failure. All nonoliguric infants survived with mean follow-up serum creatinine concentration of 0.8 +/- 0.5 (SD) mg/dL whereas that of oliguric survivors was 0.6 +/- 0.3 mg/dL. Peak serum creatinine concentration did not differ between those patients who were dying and those recovering. All infants who were dying remained anuric at least four days and revealed no renal uptake of nuclide. Eleven survivors were anuric three days or less, and renal perfusion was detectable by scintigraphy in each case. However, the remaining survivor (with bilateral renal vein thrombosis) recovered after 15 days of anuria despite nonvisualization of kidneys by scintigraphy. In neonates with ischemic acute renal failure, lack of oliguria and the presence of identifiable renal uptake of nuclide suggest a favorable prognosis
Chevalier, R.L.; Campbell, F.; Brenbridge, A.N.
Sixteen infants, 2 to 35 days of age, had acute renal failure, a diagnosis based on serum creatinine concentrations greater than 1.5 mg/dL for at least 24 hours. Eight infants were oliguric (urine flow less than 1.0 mL/kg/h) whereas the remainder were nonoliguric. To determine clinical parameters useful in prognosis, urine flow rate, duration of anuria, peak serum creatinine, urea (BUN) concentration, and nuclide uptake by scintigraphy were correlated with recovery. Nine infants had acute renal failure secondary to perinatal asphyxia, three had acute renal failure as a result of congenital cardiovascular disease, and four had major renal anomalies. Four oliguric patients died: three of renal failure and one of heart failure. All nonoliguric infants survived with mean follow-up serum creatinine concentration of 0.8 +/- 0.5 (SD) mg/dL whereas that of oliguric survivors was 0.6 +/- 0.3 mg/dL. Peak serum creatinine concentration did not differ between those patients who were dying and those recovering. All infants who were dying remained anuric at least four days and revealed no renal uptake of nuclide. Eleven survivors were anuric three days or less, and renal perfusion was detectable by scintigraphy in each case. However, the remaining survivor (with bilateral renal vein thrombosis) recovered after 15 days of anuria despite nonvisualization of kidneys by scintigraphy. In neonates with ischemic acute renal failure, lack of oliguria and the presence of identifiable renal uptake of nuclide suggest a favorable prognosis.
Accidental poisoning is common in children. Potassium bromate is a commonly used additive and raising agent in many edibles particularly bread, a staple food worldwide, yet its accidental poisoning has hitherto, not been documented in Nigeria. We report an unusual case of acute renal failure following accidental ...
Leblanc, Martine; Kellum, John A; Gibney, R T Noel; Lieberthal, Wilfred; Tumlin, James; Mehta, Ravindra
Our purpose is to discuss established risk factors in the development of acute renal failure and briefly overview clinical markers and preventive measures. Findings from the literature support the role of older age, diabetes, underlying renal insufficiency, and heart failure as predisposing factors for acute renal failure. Diabetics with baseline renal insufficiency represent the highest risk subgroup. An association between sepsis, hypovolemia, and acute renal failure is clear. Liver failure, rhabdomyolysis, and open-heart surgery (especially valve replacement) are clinical conditions potentially leading to acute renal failure. Increasing evidence shows that intraabdominal hypertension may contribute to the development of acute renal failure. Radiocontrast and antimicrobial agents are the most common causes of nephrotoxic acute renal failure. In terms of prevention, avoiding nephrotoxins when possible is certainly desirable; fluid therapy is an effective prevention measure in certain clinical circumstances. Supporting cardiac output, mean arterial pressure, and renal perfusion pressure are indicated to reduce the risk for acute renal failure. Nonionic, isoosmolar intravenous contrast should be used in high-risk patients. Although urine output and serum creatinine lack sensitivity and specificity in acute renal failure, they remain the most used parameters in clinical practice. There are identified risk factors of acute renal failure. Because acute renal failure is associated with a worsening outcome, particularly if occurring in critical illness and if severe enough to require renal replacement therapy, preventive measures should be part of appropriate management.
O'Toole, Sam M; Pathak, Neha; Toms, Graham C; Gelding, Susan V; Sivaprakasam, Venkat
Leptospirosis is an uncommon infectious disease that has protean clinical manifestations ranging from an innocuous 'flu-like' illness to potentially life-threatening multi-organ failure. Here we describe a case of Weil's disease that presented on the acute medical take with fever, jaundice and acute renal failure. We highlight the importance of careful history taking at the time of admission and how understanding the epidemiology and pathophysiology of leptospirosis enables a definitive diagnosis to be reached. © 2015 Royal College of Physicians.
Onyemekeihia, U R; Esume, C O; Oladele, C O; Oviasu, E
In Africa, the use of traditional herbal remedy is widespread. Acute renal failure (ARF) is one of the most serious complications. The use of herbal remedies (mostly orally) accounts for nearly 35% of all cases of acute renal failure in Africa. Development of renal failure following herbal vaginal pessary is rarely reported. In November 2003, a 35-year-old Nigerian female who is a petty trader and a primary school leaver with three children (all males) presented to us in the renal unit with oliguric ARF induced by herbal vaginal pessary. She had sought this alternative medicine in an attempt to have a female child as all her three children are males. Her condition was managed accordingly and required three sessions of hemodialysis. She started diuresing on the eighth day of admission. This case presentation highlights the potential tragedies of herbal preparation, of note, that herbal vaginal pessaries are as deleterious as the oral preparations, and that the dilemma of ignorance is still prevalent in our society.
Sani, Mahmoud U.; Davison, Beth A.; Cotter, Gad; Sliwa, Karen; Edwards, Christopher; Liu, Licette; Damasceno, Albertino; Mayosi, Bongani M.; Ogah, Okechukwu S.; Mondo, Charles; Dzudie, Anastase; Ojji, Dike B.; Voors, Adrian A.
Aims In Western countries with typically elderly ischaemic acute heart failure patients, predictors and clinical outcome of renal dysfunction and worsening renal function are well described. However, the prevalence, predictors and clinical outcome of renal dysfunction in younger, mainly hypertensive
Muhamed Al Rohani
Full Text Available Acute renal failure (ARF is defined as a rapid decrease in the glomerular filtration rate, occurring over a period of hours to days. The Science and Technology University Hospital, Sana′a, is a referral hospital that caters to patients from all parts of Yemen. The aim of this study is to have a deeper overview about the epidemiological status of ARF in Yemeni patients and to identify the major causes of ARF in this country. We studied 203 patients with ARF over a period of 24 months. We found that tropical infectious diseases constituted the major causes of ARF, seen in 45.3% of the patients. Malaria was the most important and dominant infectious disease causing ARF. Hypotension secondary to infection or cardiac failure was seen in 28.6% of the patients. Obstructive nephropathy due to urolithiasis or prostate enlargement was the cause of ARF in a small number of patients. ARF was a part of multi-organ failure in 19.7% of the patients, and was accompanied by a high mortality rate. Majority of the patients were managed conservatively, and only 39.9% required dialysis. Our study suggests that early detection of renal failure helps improve the outcome and return of renal function to normal. Mortality was high in patients with malaria and in those with associated hepatocellular failure.
Kim, S.H.; Han, M.C.; Kim, S.; Lee, J.S.
MR imaging of the kidney was performed in 6 patients with acute renal failure (ARF) secondary to rhabdomyolysis caused by snake bite (n = 4), crush injury (n = 1), and carbon monoxide poisoning (n = 1). A test for urine myoglobin was positive in all 6 patients and MR imaging was done 6 to 18 days after the causative event of the rhabdomyolysis. MR images in all 6 patients showed globular swelling of the kidneys, preserved corticomedullary contrast on T1-weighted images, and obliteration of corticomedullary contrast on T2-weighted images. Unlike other medical renal diseases in which corticomedullary contrast is lost on T1-weighted images, preservation of the corticomedullary contrast on T1-weighted MR images with globular renal swelling was a constant finding in patients with ARF secondary to rhabdomyolysis. (orig.)
Full Text Available Hymenoptera is a class of insects that sting in order to subdue their prey. Humans coming into accidental contact with these insects results in stings that may cause from mild local reaction like weal formation around the sting site to severe systemic reactions such as intravascular hemolysis, acute renal failure, pulmonary edema, cerebral edema, and rarely pancreatitis. We report here the clinical course of a patient who developed concurrent acute pancreatitis and pigment-induced acute renal failure after multiple hornet stings.
Acute renal failure (ARF) is associated with fundamental alterations of metabolism and immunocompetence with the induction of a pro-oxidative and proinflammatory state. Thus, the objectives of nutritional therapy include not only conventional goals such as maintaining lean body mass and stimulating immunocompetence and repair functions, but also mitigating the inflammatory state and improving the oxygen radical scavenging system and endothelial functions. Moreover, pre-existing and/or hospital-acquired malnutrition has been identified as an important factor contributing to the persistent high mortality in acutely ill patients with ARF. A nutritional program for a patient with ARF must consider not only the specific metabolic consequences associated with renal failure and with the underlying disease process, but also the profound alterations in nutrient balances induced by replacement therapy. Nutrient requirements thus may differ widely between individual patients and during the course of disease, and nutrition therapy must be coordinated with renal replacement therapy. Whenever possible, enteral nutrition should be provided in patients with ARF because even small amounts of luminal nutrients will help to maintain intestinal function. Nevertheless, in many patients parenteral nutrition, at least supplementary and/or temporarily, will become necessary. Because of the complex alterations in the use of various nutrients and the impaired tolerance to electrolytes and volume load, metabolic complications of nutritional support frequently occur in patients with ARF. Therefore, nutrition therapy must be more closely monitored in patients with ARF than with other diseases.
Vakrani, Girish Pamappa; Subramanyam, Nambakam Tanuja
Acute Renal Failure (RF) is a rare but well recognized complication of Dengue Infection (DI). There has been paucity of published data regarding renal involvement in DI. The aim of the present study was to elucidate different clinical presentations, disease outcomes of DI. To study the frequency, severity and predictors of RF in DI. Patients diagnosed either as Dengue Fever (DF) or Dengue Haemorrhagic Fever/Dengue Shock Syndrome (DHF/DSS) respectively were enrolled for this study. The diagnostic criteria for DI were febrile illness associated with one of the following: 1) detection of dengue-specific IgM capture antibody or Non-Structural Protein1 (NS1) antigen; or 2) a four-fold or greater increase of dengue-specific IgG capture antibody by ELISA and haemoagglutination inhibition assay. Patients were diagnosed as having Acute RF, if serum creatinine was >1.2 mg/dl or who showed improvement by 50% in serum creatinine from the initial value. It is an observational study of medical charts, data of age, gender, and medical history of any underlying diseases in association with the severity of DI of each patient recorded. All of the laboratory results were collected. Parameters that influenced the clinical presentations and outcomes for development of classical DF or DHF/DSS in patients with or without RF were analysed and compared. Descriptive and inferential statistical analysis was carried. The Statistical software namely SAS 9.2, SPSS 15.0, Stata 10.1, Med Calc 9.0.1, Systat 12.0 and R environment ver.2.11.1 were used. Most common symptoms were fever followed by headache and pain in abdomen. Among the patients with RF, all patients had recovery. The patients with DHF/DSS were more susceptible to develop renal failure compared to DF group. There were statistically significant higher frequencies of renal failure, haemoconcentration, thrombocytopenia, low serum cholesterol. Patients in the RF group also had significantly higher percentages of shock, haemoconcentration
Full Text Available Rhabdomyolysis is a syndrome caused by skeletal muscle cells destruction which can occur for many reasons, including prolonged immobilization. The main complication of the syndrome is the development of acute renal failure. Rhabdomyolysis and myoglobinuria are responsible for approximately 5% of all causes of acute renal failure in the USA. The cause of rhabdomyolysis is often multifactorial, and approximately 8–20% of such patients develop myoglobinuric acute renal failure.
Sherman, R.A.; Byun, K.J.
The diagnostic value of renal scintiscans in patients with acute or chronic renal failure has not been emphasized other than for the estimation of renal size. /sup 131/I OIH, /sup 67/gallium, /sup 99m/TcDTPA, glucoheptonate and DMSA all may be valuable in a variety of specific settings. Acute renal failure due to acute tubular necrosis, hepatorenal syndrome, acute interstitial nephritis, cortical necrosis, renal artery embolism, or acute pyelonephritis may be recognized. Data useful in the diagnosis and management of the patient with obstructive or reflux nephropathy may be obtained. Radionuclide studies in patients with chronic renal failure may help make apparent such causes as renal artery stenosis, chronic pyelonephritis or lymphomatous kidney infiltration. Future correlation of scanning results with renal pathology promises to further expand nuclear medicine's utility in the noninvasive diagnosis of renal disease.
Sherman, R.A.; Byun, K.J.
The diagnostic value of renal scintiscans in patients with acute or chronic renal failure has not been emphasized other than for the estimation of renal size. 131 I OIH, 67 gallium, /sup 99m/TcDTPA, glucoheptonate and DMSA all may be valuable in a variety of specific settings. Acute renal failure due to acute tubular necrosis, hepatorenal syndrome, acute interstitial nephritis, cortical necrosis, renal artery embolism, or acute pyelonephritis may be recognized. Data useful in the diagnosis and management of the patient with obstructive or reflux nephropathy may be obtained. Radionuclide studies in patients with chronic renal failure may help make apparent such causes as renal artery stenosis, chronic pyelonephritis or lymphomatous kidney infiltration. Future correlation of scanning results with renal pathology promises to further expand nuclear medicine's utility in the noninvasive diagnosis of renal disease
Stefanowicz, Joanna; Maciejka-Kapuścińska, Lucyna; Rückemann-Dziurdzińska, Katarzyna; Drozyńska-Duklas, Magdalena; Zurowska, Aleksandra; Balcerska, Anna
Acute renal failure (ARF) in children with malignancies is a rare clinical situation, but nonetheless it is a serious life threatening condition. It may arise from different clinical situations and may be caused by various factors. The aim of the study was to determine the frequency, aetiology and the course of ARF in children treated for malignancies in the Department of Pediatrics, Hematology, Oncology and Endocrinology, Medical University of Gdansk. A group of 586 pediatric oncology patients treated between 1992 and 2004 were enrolled in a retrospective study. ARF was diagnosed in 29 cases including: 12 patients with prerenal course of ARF (11 due to septic shock and 1 due to dehydration), 16 patients with intrinsic renal aetiology of ARF (as a complication after cisplatinum and carboplatinum therapy in 2 children, in 2 cases after methotrexate, as a consequence of bilateral nephrectomy due to nephroblastoma in 1 patient and in 11 children with tumour lysis syndrome, including 5 patients with neoplasmatic infiltration of kidneys) and postrenal ARF in 1 patient as a first symptom of a tumour located in the small pelvis (Rhabdomyosarcoma). Renal replacement therapy (dialysis) was necessary in 11 children. Among 29 analysed children, in 20 cases renal failure was reversible. Due to appropriate treatment, ARF in course of tumour lysis syndrome is nowadays reversible. ARF due to septic shock or cytostatics nephrotoxicity is a significant therapeutic problem. In most of the cases it is irreversible. 1. ARF in these studies occurred in 29 out of 586 children with malignancies (4.9%). 2. Prerenal and renal ARF were the most frequent forms. 3. Implementation of tumour lysis prophylaxis in the treatment of children with blood system proliferative diseases reduces the incidence of ARF. 4. In cases of ARF in children's malignancies close cooperation between paediatric oncologist and nephrologist is necessary.
Full Text Available Acute nontraumatic exertional rhabdomyolysis may arise when the energy supply to muscle is insufficient to meet demands, particularly in physically untrained individuals. We report on a psychiatric patient who developed large bruises and hemorrhagic blisters on both hands and arms, rhabdomyolysis of both forearm muscles with a moderate compartment syndrome, and consecutive acute renal failure following excessive work in the garden. Although specifically asked, the patient denied any hard physical work or gardening, and heteroanamnestic data were not available. The diagnosis of rhabdomyolysis was easy to establish, but until reliable anamnestic data were obtained, the etiology remained uncertain. Four days after arrival, the patient recalled working hard in the garden. The etiology of rhabdomyolysis was finally reached, and the importance of anamnestic data was once more confirmed.
The sarcoidosis is a systemic granulomatosis affecting most frequently the lungs and the mediastinum. An acute renal failure reveals exceptionally this disease. It's a retrospective study implicating 12 cases of sarcoidosis complicated of acute renal failure. The aim of this study is to determine epidemiological, clinical, ...
Frenkel, J.; Kool, G.; de Kraker, J.
Carboplatin has been reported to cause acute renal failure when administered in high doses to adult patients. We report a 4 1/2-year-old girl who was treated with high-dose carboplatin for metastatic parameningeal embryonal rhabdomyosarcoma. Acute renal failure developed followed by a slow partial
Full Text Available Acute renal failure (ARF is a common complication of sepsis and carries a high mortality. Renal replacement therapy (RRT during the acute stage is the mainstay of therapy. Va-rious modalities of RRT are available. Continuous RRT using convective methods are preferred in sepsis-induced ARF, especially in hemodynamically unstable patients, although clear evidence of benefit over intermittent hemodialysis is still not available. Peritoneal dialysis is clearly inferior, and is not recommended. Early initiation of RRT is probably advantageous, although the optimal timing of dialysis is yet unknown. Higher doses of RRT are more likely to be beneficial. Use of bio-compatible membranes and bicarbonate buffer in the dialysate are preferred. Anticoagulation during dialysis must be carefully adjusted and monitored.
Li, Ning; Zhou, Xuefeng; Yuan, Jiyan; Chen, Guiying; Jiang, Hongliang; Zhang, Wen
Our aim was to evaluate the clinical profile, treatment, and outcome of ceftriaxone-associated postrenal acute renal failure (PARF) in children. We retrospectively studied 31 consecutive cases from 2003 to 2012 for PARF after ceftriaxone treatment. There was no past history of urolithiasis or nephropathy in these children. The average time of ceftriaxone administration before PARF was 5.2 days. The major symptoms apart from anuria included flank pain (>3 years old, 25/25), excessive crying (Ceftriaxone was verified to be the main component of the calculi in 4 children by tandem mass spectrometric analysis. The recovery was complete in all cases. Ceftriaxone therapy in children may cause PARF. Early diagnosis and prompt pharmacological therapy are important in relieving the condition. Retrograde ureteral catheterization is an effective treatment of those who fail to respond to pharmacotherapy.
iodinated compound is reported. The clinical findings and course are presented, with particular emphasis on the fact that there appeared to be no underlying or associated disorder which may have cause the renal failure, other than possible mild ...
Full Text Available Background/Aim. Hemodynamic stress is the leading cause of acute renal failure (ARF in premature neonates. Incidence of ARF in this population is between 8 and 24%. The aim of this study was to determine the frequency of presence of ARF in premature neonates, as well as its impact on their survival. Methods. A retrospective study of 114 premature neonates [(gestational age, GA less than 37 gestation weeks (gw] admitted to the Intensive Care Unit (ICU at the Pediatric Clinic, Institute of Child and Youth Healthcare of Vojvodina in 2007 was conducted. Serum creatinine, urea and bilirubine were determined on the 3rd day of life in 65 newborns who met inclusion criteria. ARF was diagnosed in 16 newborns (n=16/65; 25%. Results. The premature neonates with ARF had significantly lower GA [<28 gw - 8/16 (50% vs. 5/49 (10%; p < 0.05], birth weight (BW (1 265 g vs. 1615 g; p < 0.05 and systolic blood pressure (43.37 mm Hg vs. 52.7 mmHg; p < 0.05 than ones without ARF. Non-olyguric ARF was diagnosed in 62% of newborns with ARF (n=10/16, while the rest had the olyguric type (n = 6/16; 38%. Twenty-five percent of premature neonates with ARF (n = 4/16 died in contrast to 10% of premature neonates without ARF (n = 5/49. ARF was treated conservatively in all but 3 cases when peritoneal dialysis was performed. Renal function has recovered completely in all of the survivors. In order to determine their predictivity in relation to ARF, following parameters were analyzed: GA, BW < 1 500 g, presence of concomitant sepsis and intracranial hemorrhage grade III/IV. BW < 1 500 g demonstrated the highest sensitivity (se 0.75, while GA < 28 gw, sepsis and intracranial hemorrhage grade III/IV showed high specificity (sp = 0.90, 0.89 0.88, respectively. Conclusion. Acute renal failure frequently occurs in population of premature neonates and requires meticulous fluid and electrolyte balance, especially in the case of low birth weight and extreme immaturity.
Full Text Available INTRODUCTION Acute renal failure (ARF is a frequent clinical condition in neonatal intensive care units (NICU. The leading cause of neonatal ARF is perinatal asphyxia (PS. The aim of this study was to examine the relationship between the degree of PS and the severity of ARF in term neonates. METHODS A prospective survey of 31 term neonates with Ps and but without congenital malformations or sepsis was performed in NICU of the regional Hospital of Gynaecology and Obstetrics in Belgrade (average number of deliveries about 6000 per year. ARF was diagnosed in the first 7 days of life when plasma creatinine was above 133 μmοΙ/L for at least 48 hours while maternal renal function was normal. The degree of PS was determined according to Apgar score (AS at 1 min. The severe PS was defined as AS < 3 and moderate PS as AS 4-6. RESULTS Twenty neonates (64% had oliguric ARF with urine output of 0.37 ±0.16 ml/kg/h while the others had nonoliguric ARF with urine output of 2.4 ± 0.7 ml/kg/h. Most of neonates with oliguric ARF (65% had severe perinatal asphuxia while in those with nonoliguric ARF moderate perinatal asphyxia predominated (73%. DISCUSSION During hypoxic-ischaemic events many organs are injured, and the most vulnerable ones are kidneys and central nervous system. Our results showed a strong connection between perinatal asphyxia and A, which was in accordance with the results of other studies. Neonates with severe perinatal asphyxia had serious impairment of renal function, which was confirmed with strong correlation between Apgar score and plasma creatinine. In neonates with oliguric ARF, but not in those with nonoliguric ARF, the highly positive linear correlations were found between AS and urinary output (r = 0.77; p < 0.01, plasma creatinine (r = 0.78; p < 0.01, fractional excretion of sodium (r = 0.76; p < 0.01, and index of renal failure (r = 0.80; p < 0.01. Only in oliguric neonates with severe perinatal asphyxia (31 % the outcome was
Rohina S Aggarwal
Full Text Available Acute renal failure (ARF is a serious medical complication during pregnancy, and, in the post-partum period, is associated with significant maternal morbidity and mortality as well as fetal loss. The objective of our study is to find the etiology and maternal outcome of ARF during preg-nancy. The study was conducted at the Obstetrics and Gynecology Department of the Institute of Kidney Disease and Research Center, Ahmedabad, India from January 2009 to January 2011. Fifty previously healthy patients who developed ARF, diagnosed on oliguria and serum creatinine >2 mg%, were included in the study. Patients with a known history of renal disease, diabetes and hypertension were excluded from the study. All patients were followed-up for a period of six months. Patient re-cords, demographic data, urine output on admission and preceding history of antepartum hemorrhage (APH, post-partum hemorrhage (PPH, septicemia, operative interventions and retained product of conception were noted and need for dialysis was considered. Patients were thoroughly examined and baseline biochemical investigations and renal and obstetrical ultrasound were performed on each patient and bacterial culture sensitivity on blood, urine or vaginal swabs were performed in selected patients. The age range was 19-38 years (mean 26 ± 3.8. The first trimester, second trimester and puerperal groups comprised of four (8%, 25 (50% and 21 patients (42%, respectively. Hemorrhage was the etiology for ARF in 15 (30%, APH in ten (20% and PPH in five (10% patients. Eleven (22% patients had lower segment cesarian section (LSCS while 36 (78% patients had normal vaginal delivery. In 20 (40% patients, puerperal sepsis was the etiological factor, while pre-eclampsia, eclampsia and HELLP syndrome accounted for 18 (36% patients. Two (4% patients had dissemi-nated intravascular coagulation on presentation while one (2% patient was diagnosed with hemolytic uremic syndrome. Maternal mortality was 12% (n
Full Text Available BACKGROUND: We have noticed a recent rise in the incidence and severity of acute renal failure (ARF in malaria. AIM: To study the incidence, severity and outcome of ARF in malaria. SETTING and DESIGN: It is a retrospective analysis of data of one year from a tertiary medical centre in a metropolitan city. MATERIALS AND METHODS: Patients with ARF and smear positive malaria were evaluated. STATISTICAL ANALYSIS: Results were expressed as mean, range and standard deviation. RESULTS: Out of 402 detected smear positive malaria, 24 had ARF. Eighteen were of the age group 21-40 years. Plasmodium falciparum (PF was detected in 16, Plasmodium vivax in three, and mixed infection in five. Non-oliguric ARF was seen in 14. Eighteen showed severe ARF (Serum creatinine >5 mg%. Twenty-two patients needed dialysis. Prolonged ARF lasting for 2-6 weeks was seen in eight. Seventeen patients recovered completely, while seven showed fatal combination of disseminated intravascular coagulation (DIC, acute respiratory distress syndrome (ARDS, severe ARF and PF malaria. No response was seen to chloroquine and artesunate given alone and twenty patients required quinine. CONCLUSION: ARF necessitating dialysis was seen in 92% of patients with ARF in malaria. PF infection, severe ARF, DIC and ARDS were poor prognostic factors. Resistance was noted to both chloroquine and artesunate.
KV Kanodia; AV Vanikar
Malaria has protean clinical manifestations and renal complications, particularly acute renal failure that could be life threatening. To evaluate the incidence, clinical profile, ou come and predictors of mortality in patients with malarial acute renal failure, we retrospectively studied the last two years records of malaria induced acute renal failure in patients with peripheral smear positive for malarial parasites. One hundred (10.4%) (63 males, 37 females) malaria induced acute renal failure amongst 958 cases of acute renal failure were evaluated. Plasmodium (P). falciparum was reported in 85%, P. vivax in 2%, and both in 13% patients. The mean serum creatinine was 9.2 ± 4.2 mg%, and oligo/anuria was present in 82%; 78% of the patients required hemodialysis. Sixty four percent of the patients recovered completely, 10% incompletely, and 5% developed chronic kidney failure; mortality occurred in 21% of the patients. Low hemoglobin, oligo/anuria on admission, hyperbilirubinemia, cerebral malaria, disseminated intravascular coagulation, and high serum creatinine were the main predictors of mortality. We conclude that malaria is associated with acute renal failure, which occurs most commonly in plasmodium falciparum infected patients. Early diagnosis and prompt dialysis with supportive management can reduce morality and enhance recovery of renal function (Author).
Argamany, Jacqueline R; Reveles, Kelly R; Duhon, Bryson
Synthetic cannabinoid usage has increased in the past decade. Concurrently, emergency management of associated adverse effects due to synthetic cannabinoid usage has also risen. Reported toxicities include psychosis, seizures, cardiotoxicity, acute kidney injury, and death. While cannabis was first described as a cause of acute hyperemesis in 2004, a more recent case series also describes the association between cannabinoid hyperemesis and risk of acute renal failure. Synthetic cannabinoids have also been reported to cause acute hyperemesis and acute renal failure; however, the risk of rhabdomyolysis-induced renal failure has yet to be elucidated. In this article, we report the first known case of synthetic cannabinoid hyperemesis leading to rhabdomyolysis and acute renal failure.
Dumouchel, Julie; Lvovschi, Virginie; Joly, Luc-Marie
Binge eating occurs in patients with eating disorders and can result in metabolic complications, leading to gastric rupture or necrosis. However, organ failure as acute renal failure is rarely observed. We report the case of an overeating episode resulting in massive gastric dilatation and acute renal failure with abdominal pressure and bilateral ureteral obstruction. The outcome was favorable with gastric aspiration and fasting. Copyright © 2017 Elsevier Inc. All rights reserved.
Creyghton, W. M.; Lobatto, S.; Weening, J. J.
We report a 34-year-old male patient without prior medical history who presented with acute renal failure due to acute bacterial pyelonephritis. Both blood and urine cultures grew Klebsiella pneumoniae. Although a kidney biopsy revealed extensive necrosis and no viable glomeruli, renal function
Dorgalaleh, Akbar; Mahmudi, Mohammad; Tabibian, Shadi; Khatib, Zahra Kashani; Tamaddon, Gholam Hossein; Moghaddam, Esmaeil Sanei; Bamedi, Taregh; Alizadeh, Shaban; Moradi, Eshagh
Acute renal failure describes as a syndrome by rapid decline in the ability of the kidney to eliminate waste products, regulate acid-base balance, and manage water homeostasis. When this impairment is prolonged and entered chronic phase, erythropoietin secretion by this organ is decreasing and toxic metabolic accumulates and causes hematological changes include decrease of HCT, MCV and RBC and platelet counts. This study evaluates present of anemia and thrombocytopenia in patients with acute and chronic renal failure. This study conducted on 132 patients with renal impairment and also 179 healthy individuals as two separated control groups. Initially patients with renal problem were tested and after confirmation of impairment, patients were divided in two groups, acute with less than 3 months and chronic with more than 3 months renal failure, based on duration of the disease. Then complete blood count performed for each patient and finally obtained data were analyzed by SPSS software. Comparison between 96 patients with acute and 36 patients with chronic renal failure revealed that severity of anemia (HCT, Hb and MCV) between these two groups were statistically high in comparison with control groups (P > 0.05) but thrombocytopenia in patients with chronic renal failure was statistically different from control and the acute ones (P renal failure, to prevent the risk of bleeding, platelet count should be checked periodically.
Shirakabe, Akihiro; Hata, Noritake; Kobayashi, Nobuaki; Okazaki, Hirotake; Matsushita, Masato; Shibata, Yusaku; Nishigoori, Suguru; Uchiyama, Saori; Asai, Kuniya; Shimizu, Wataru
Whether or not the definition of a worsening renal function (WRF) is adequate for the evaluation of acute renal failure in patients with acute heart failure is unclear. One thousand and eighty-three patients with acute heart failure were analysed. A WRF, indicated by a change in serum creatinine ≥0.3 mg/mL during the first 5 days, occurred in 360 patients while no-WRF, indicated by a change failure; n = 98). The patients were assigned to another set of four groups: no-WRF/no-AKI (n = 512), no-WRF/AKI (n = 211), WRF/no-AKI (n = 239), and WRF/AKI (n = 121). A multivariate logistic regression model found that no-WRF/AKI and WRF/AKI were independently associated with 365 day mortality (hazard ratio: 1.916; 95% confidence interval: 1.234-2.974 and hazard ratio: 3.622; 95% confidence interval: 2.332-5.624). Kaplan-Meier survival curves showed that the rate of any-cause death during 1 year was significantly poorer in the no-WRF/AKI and WRF/AKI groups than in the WRF/no-AKI and no-WRF/no-AKI groups and in Class I and Class F than in Class R and the no-AKI group. The presence of AKI on admission, especially Class I and Class F status, is associated with a poor prognosis despite the lack of a WRF within the first 5 days. The prognostic ability of AKI on admission may be superior to WRF within the first 5 days. © 2018 The Authors. ESC Heart Failure published by John Wiley & Sons Ltd on behalf of the European Society of Cardiology.
Full Text Available A 62-year-old male was sent to the emergency room due to a high fever and generalized skin rash after taking allopurinol for 9 days. Physical examination was normal except for the generalized skin rash presenting with erythematous macules. Complete blood count showed leukocytosis with eosinophilia. Blood biochemistry showed impaired renal and hepatic function. Pathologic examination concluded that the skin rash was erythema multiforme. These findings met the diagnostic criteria for allopurinol-induced hypersensitivity syndrome (AHS. Our patient not only had the most common skin lesion but soon developed acute renal failure that required intermittent hemodialysis, despite rapid discontinuation of allopurinol and adequate hydration and steroid therapy. No other causes of acute renal failure were found. Renal impairment was the worst part of the patient's condition and he never completely recovered. AHS should be considered in the differential diagnosis of acute renal and hepatic failure in patients with evidence of allergy and recent use of allopurinol.
Saeed I. Khilji
Full Text Available Tuberculosis is a multiorgan disease with varied clinical presentations and is reemerging due to increasing immigration and globalization. We present the case of an immigrant female patient who developed acute renal failure with clinical and biochemical features suggestive of lupus nephritis but with a timely renal biopsy showing caseating granulomata in the renal parenchyma consistent with renal tuberculosis. Despite treatment with antituberculosis treatment and resolution of TB on repeat renal biopsy, she remained haemodialysis dependent. We discuss the diagnostic challenges faced in this presentation and also explore possible differential diagnoses. This rare presentation highlights the importance of renal biopsy in the diagnosis and treatment of acute renal failure and the atypical presentation of tuberculosis.
Mahfoudhi, Madiha; Mamlouk, Habiba; Turki, Sami; Kheder, Adel
The sarcoidosis is a systemic granulomatosis affecting most frequently the lungs and the mediastinum. An acute renal failure reveals exceptionally this disease. It's a retrospective study implicating 12 cases of sarcoidosis complicated of acute renal failure. The aim of this study is to determine epidemiological, clinical, biological and histological profile in these cases and then to indicate the interest to consider the diagnosis of sarcoidosis in cases of unexplained renal failure. Extra-renal complications, therapeutic modalities and the outcome were determined in all patients. Our series involved 12 women with an average age of 40 years. Biological investigations showed an abnormal normocalcemia in 7 cases, a hypercalcemia in 5 cases, a hypercalciuria in 10 cases and polyclonal hypergammaglobulinemia in 7 cases. An acute renal failure was found in all patients with a median creatinin of 520 umol/L. For all patients, the renal echography was normal however, the kidney biopsy showed tubulo-interstitial nephritis. The extra-renal signs highlighting pulmonary interstitial syndrome in 5 cases, a sicca syndrome in 4 cases, mediastinal lymph nodes in 2 cases, a lymphocytic alveolitis in 3 cases, an anterior granulomatous uveitis in 2 cases and a polyarthritis in 5 cases. Five patients benefited of hemodialysis. The treatment consisted of corticosteroid in all cases. The follow up was marked by complete resolution of clinical and biological signs. The diagnosis of renal sarcoidosis must be done quickly to prevent renal failure.
Harwood, T.H. Jr.; Hiesterman, D.R.; Robinson, R.G.; Cross, D.E.; Whittier, F.C.; Diederich, D.A.; Grantham, J.J.
Twenty-four survivors of acute, nonobstructive, nonnephritic renal failure had a renal scan using iodohippurate sodium I 131 performed early in the acute illness. Scans were judged according to whether the renal images were prominent, faint, or absent during the first 30 minutes after intravenous injection of 100 to 250 microcuries of iodohippurate sodium I 131. All ten patients with prominent renal images attained life-sustaining renal function with an average postrecovery creatinine clearance of 80 ml/min. Of the seven patients with faint renal images, six recovered life-sustaining renal function (average creatinine clearance of 39 ml/min), and one required chronic hemodialysis. Seven patients had no renal image initially; four recovered life-sustaining renal function with an average creatinine clearance of 25 ml/min; three required chronic hemodialysis. We conclude that, for patients with acute renal failure, the appearance of the renal image obtained using this substance is an important indicator of renal viability and of the likelihood for functional recovery
Background. Post-traumatic acute renal failure requiring renal replacement therapy in an intensive care unit (ICU) is associated with high mortality. Objective. To assess indicators of improved survival. Methods. This was a retrospective cohort study of 64 consecutive trauma patients (penetrating and blunt trauma and burns) ...
Ulusakarya, Ayhan; Misra, Srimanta; Haydar, Mazen; Habert, Hélène; Castagne, Vincent; Gumus, Yusuf; Delmas-Marsalet, Béatrice; Machover, David
Oxaliplatin is an effective chemotherapeutic agent frequently used in the treatment of colorectal carcinoma. Rare cases of renal failure and hemolytic reactions have been reported as separate side effects of oxaliplatin. Here we present a clinical picture of immune-related intravascular hemolysis and acute tubular necrosis in a patient receiving this drug. This case suggests a mechanistic explanation of renal failure in patients treated with oxaliplatin.
Jonassen, Thomas E N; Graebe, Martin; Promeneur, Dominique
In conscious, chronically instrumented rats we examined 1) renal tubular functional changes involved in lipopolysaccharide (LPS)-induced acute renal failure; 2) the effects of LPS on the expression of selected renal tubular water and sodium transporters; and 3) effects of milrinone......-alpha and lactate, inhibited the LPS-induced tachycardia, and exacerbated the acute LPS-induced fall in GFR. Furthermore, Ro-20-1724-treated rats were unable to maintain MAP. We conclude 1) PDE3 or PDE4 inhibition exacerbates LPS-induced renal failure in conscious rats; and 2) LPS treated rats develop an escape......, a phosphodiesterase type 3 (PDE3) inhibitor, and Ro-20-1724, a PDE4 inhibitor, on LPS-induced changes in renal function. Intravenous infusion of LPS (4 mg/kg b.wt. over 1 h) caused an immediate decrease in glomerular filtration rate (GFR) and proximal tubular outflow without changes in mean arterial pressure (MAP...
Givertz, Michael M; Postmus, Douwe; Hillege, Hans L; Mansoor, George A; Massie, Barry M; Davison, Beth A; Ponikowski, Piotr; Metra, Marco; Teerlink, John R; Cleland, John G F; Dittrich, Howard C; O'Connor, Christopher M; Cotter, Gad; Voors, Adriaan A
Prior studies have demonstrated adverse risk associated with baseline and worsening renal function in acute heart failure, but none has modeled the trajectories of change in renal function and their impact on outcomes. We used linear mixed models of serial measurements of blood urea nitrogen and creatinine to describe trajectories of renal function in 1962 patients with acute heart failure and renal dysfunction enrolled in the Placebo-Controlled Randomized Study of the Selective A1 Adenosine Receptor Antagonist Rolofylline for Patients Hospitalized with Acute Decompensated Heart Failure and Volume Overload to Assess Treatment Effect on Congestion and Renal Function study. We assessed risk of 180-day mortality and 60-day cardiovascular or renal readmission and used Cox regression to determine association between renal trajectories and outcomes. Compared with patients alive at 180 days, patients who died were older, had lower blood pressure and ejection fraction, and higher creatinine levels at baseline. On average for the entire cohort, creatinine rose from days 1 to 3 and increased further after discharge, with the trajectory dependent on the day of discharge. Blood urea nitrogen, creatinine, and the rate of change in creatinine from baseline were the strongest independent predictors of 180-day mortality and 60-day readmission, whereas the rate of change of blood urea nitrogen from baseline was not predictive of outcomes. Baseline blood urea nitrogen>35 mg/dL and increase in creatinine>0.1 mg/dL per day increased the risk of mortality, whereas stable or decreasing creatinine was associated with reduced risk. Patients with acute heart failure and renal dysfunction demonstrate variable rise and fall in renal indices during and immediately after hospitalization. Risk of morbidity and mortality can be predicted based on baseline renal function and creatinine trajectory during the first 7 days. URL: http://www.clinicaltrials.gov. Unique identifiers: NCT00328692 and NCT
Full Text Available Rhabdomyolysis is a musculoskeletal clinical and biochemical syndrome which is seen associated with traumatic and non-traumatic causes and is known as muscular dystrophy. Rhabdomyolysis which develops following crush-type trauma (Crush syndrome is rarely seen but is a well-known clinical event in the etiology of acute renal failure. Non-traumatic rhabdomyolysis is rare. The case is here presented of a patient who was diagnosed with rhabdomyolysis on presentation with acute renal failure and to whom repeated dialysis was applied.
Full Text Available Abstract Background Hornet stings are generally associated with local and occasionally anaphylactic reactions. Rarely systemic complications like acute renal failure can occur following multiple stings. Renal failure is usually due to development of acute tubular necrosis as a result of intravascular haemolysis, rhabdomyolysis or shock. Rarely it can be following development of acute tubulo-interstitial nephritis. Case presentation We describe a young male, who was stung on face, head, shoulders and upper limbs by multiple hornets (Vespa orientalis. He developed acute renal failure as a result of acute tubulo-interstitial nephritis and responded to steroids. Conclusion Rare causes of acute renal failure like tubulo-interstitial nephritis should be considered in a patient with persistent oliguria and azotemia following multiple hornet stings. Renal biopsy should be undertaken early, as institution of steroid therapy may help in recovery of renal function
Full Text Available Acute renal failure can cause neurologic manifestations such as mood swings, impaired concentration, tremor, stupor, coma, asterixis, dysarthria. Those findings can also be a sign of cerebral infarct. Here, we report a case of watershed cerebral infarction in a 70-year-old female patient with acute renal failure secondary to contrast administration and use of angiotensin converting enzyme inhibitor. Patient was evaluated with magnetic resonance imaging because of dysarthria. Magnetic resonance imaging revealed milimmetric acute ischemic lesion in the frontal and parietal deep white matter region of both cerebral hemisphere which clearly demonstrated watershed cerebral infarction affecting internal border zone. Her renal function returned to normal levels on fifth day of admission (BUN 32 mg/dl, creatinine 1.36 mg/dl and she was discharged. Dysarthria continued for 20 days.
Naik, Pradeep; Premsagar, B; Mallikarjuna, M
The acute renal failure is the frequent medical complication observed in liver transplant patients. The objective of this study was to determine the cause of acute renal failure in post liver transplant patients. A total of 70 patients who underwent (cadaveric 52, live 18) liver transplantation were categorized based on clinical presentation into two groups, namely hepatorenal failure (HRF, n = 29), and Hepatic failure (HF, n = 41). All the patients after the liver transplant had received tacrolimus, mycophenolate and steroids. We analyzed the modification of diet in renal disease, (MDRD) serum urea, creatinine and albumin before and after 5th and 30th day of liver transplant and data was categorized into survivors and non-survivors group. In HRF survivor group, serum creatinine, and urea levels were high and, albumin, MDRD were low in pre- transplant and reached to normal levels on 30th day of post transplant, and 79.3 % of patients in this group showed resumption of normal kidney function. On the contrary in HRF nonsurvivor group, we did not observed any significant difference and 20.7 % of patients showed irreversible changes after the liver transplant. In HF survivor group, 82.9 % of liver failure patients did not show any deviation in serum creatinine, urea, albumin and MDRD, whereas in HF non survivor group, 17.1 % of liver failure patients who had HCV positive before the transplant developed acute renal failure. The levels of creatinine, urea, albumin and MDRD were normal before the transplant and on day 30th, the levels of albumin and MDRD were significantly low whereas serum urea, creatinine levels were high. In conclusion, based on these observations, an diagnosis and treatment of Acute renal failure is important among the liver transplantation cases in the early postoperative period.
Acute renal failure (ARF) is a syndrome characterised by rapid decline in glomerular filtration rate and retention of nitrogenous waste products such as urea and creatinine. The objective of this study was to study the prevalence, risk and outcome of women with obstetrical renal failure. Methods: This observational study was conducted in Department of Obstetrics and Gynaecology, Liaquat University Hospital, Hyderabad, Pakistan from October 2009 to September 2010. Thirty-five patients with obstetrical acute renal failure were included in the study, patients with chronic renal diseases, hypertension, diabetes mellitus and renal stones were excluded from the study. A detailed history was followed by thorough examination and investigation. Their clinical history, physical examination and intake/urine output was recorded. Routine laboratory investigations were done related to each case and specialised investigations like renal scan, renal ultrasonography and renal biopsies were performed in selected cases where recovery was delayed for more than 3 weeks. Results: Total numbers of admissions in obstetric ward were 3,285. Pregnancy related acute renal failure was found in 35 (1.065%) women. Age ranged from 18-40 years. Most of the women belonged to age group 30-35. Out of 35 women 31.42% had postpartum haemorrhage. Ante partum haemorrhage was found in 25.71%, Eclampsia in 17.14%, DIC in 14.28%, and sepsis in 11.42%. Anuria was observed in 25 patients, remaining presented with oliguria (28.57%). Haemodialysis was done in 75% of patients, others were managed conservatively. Complete recovery was observed in 53% cases. Maternal mortality was 25.71% and foetal mortality was 22.85%. Conclusion: Pregnancy related ARF is one of the most common causes of ARF, it is a dangerous complication of pregnancy which carries very high mortality and morbidity. (author)
Dehydration, preexisting renal insufficiency, multiple myeloma and insulin-dependent diabetes mellitus are known risk factors for a radiocontrast medium induced acute renal failure. In 90% of patients with insulin-dependent diabetes mellitus, renal insufficiency and proteinuria, a further detoriation of renal function can be expected after i.v. administration of radiocontrast medium. Recent concepts on the genesis of acute renal failure after radiocontrast medium in multiple myeloma emphasize the role of tubular blocade (tubular precipitation of myeloma protein with contrast medium). In insulin-dependent diabetic patients we found altered carbohydrate composition of urinary Tamm Horsfall Protein (THP), with increased glucose and diminished N-acetyl-neuraminicacid content. This was paralleled by a difference in an in-vitro system of coprecipitation where THP of diabetes triggered more pronounced calcium dependent coprecipitation of contrast medium and albumin. These in-vitro findings might be important for the explanation of the genesis of radiocontrast medium-induced acute renal failure in insulin-dependent diabetes mellitus. (orig.) [de
Poskurica, Mileta; Petrović, Dejan; Poskurica, Mina
`Hematologic malignancies (leukemia, lymphoma, multiple myeloma, et al.), as well as solid tumours (renal, liver, lung, ovarian, etc.), can lead to acute or chronic renal failure.The most common clinical manifestation is acute renal failure within the tumour lysis syndrome (TLS). It is characterized by specific laboratory and clinical criteria in order to prove that kidney disorders result from cytolysis of tumour cells after chemotherapy regimen given, although on significantly fewer occasions it is likely to occur spontaneously or after radiotherapy. Essentially, failure is the disorder of functionally conserved kidney or of kidney with varying degrees of renal insufficiency, which render the kidney impaired and unable to effectively eliminate the end products of massive cytolysis and to correct the resulting disorders: hyperuricemia, hyperkalemia, hypocalcaemia, hyperphosphatemia, and others. The risk of TLS depends on tumour size, proliferative potential of malignant cells, renal function and the presence of accompanying diseases and disorders. Hydration providing adequate diuresis and administration of urinary suppressants (allopurinol, febuxostat) significantly reduce the risk of developing TLS. If prevention of renal impairment isn't possible, the treatment should be supplemented with hemodynamic monitoring and pharmacological support, with the possible application of recombinant urate-oxidase enzyme (rasburicase). Depending on the severity of azotemia and hydroelectrolytic disorders, application of some of the methods of renal replacement therapy may be considered.
Full Text Available Hematologic malignancies (leukemia, lymphoma, multiple myeloma, et al., as well as solid tumours (renal, liver, lung, ovarian, etc., can lead to acute or chronic renal failure. The most common clinical manifestation is acute renal failure within the tumour lysis syndrome (TLS. It is characterized by specific laboratory and clinical criteria in order to prove that kidney disorders result from cytolysis of tumour cells after chemotherapy regimen given, although on significantly fewer occasions it is likely to occur spontaneously or after radiotherapy. Essentially, failure is the disorder of functionally conserved kidney or of kidney with varying degrees of renal insufficiency, which render the kidney impaired and unable to effectively eliminate the end products of massive cytolysis and to correct the resulting disorders: hyperuricemia, hyperkalemia, hypocalcaemia, hyperphosphatemia, and others. The risk of TLS depends on tumour size, proliferative potential of malignant cells, renal function and the presence of accompanying diseases and disorders. Hydration providing adequate diuresis and administration of urinary suppressants (allopurinol, febuxostat significantly reduce the risk of developing TLS. If prevention of renal impairment isn’t possible, the treatment should be supplemented with hemodynamic monitoring and pharmacological support, with the possible application of recombinant urate-oxidase enzyme (rasburicase. Depending on the severity of azotemia and hydroelectrolytic disorders, application of some of the methods of renal replacement therapy may be considered.
We present a case of a 50 years old gardener who had multiple beestings. He had no significant feature of anaphylaxis and initially appeared to be improving with fluids, steroids and antihistamines until few days into hospital admission, when he developed features of uraemia. A diagnosis of acute renal failure secondary to ...
Akpan, Effiong Ekong; Ekrikpo, Udeme E.
Traditional herbal medicine is a global phenomenon especially in the resource poor economy where only the very rich can access orthodox care. These herbal products are associated with complications such as acute renal failure and liver damage with a high incidence of mortalities and morbidities. Acute renal failure from the use of herbal remedies is said to account for about 30–35% of all cases of acute renal failure in Africa. Most of the herbal medications are not usually identified, but some common preparation often used in Nigeria includes “holy water” green water leaves, bark of Mangifera indica (mango), shoot of Anacardium occidentale (cashew), Carica papaya (paw-paw) leaves, lime water, Solanum erianthum (Potato tree), and Azadirachta indica (Neem) trees. We report a rare case of a young man who developed acute renal failure two days after ingestion of Chinese herb for “body cleansing” and general wellbeing. He had 4 sessions of haemodialysis and recovered kidney function fully after 18 days of admission. PMID:26199625
Introduction: The Saharan horned viper (Cerastes cerastes) is a common snake in the sandy and rocky regions in the south of Morocco. Although nearly all snakes with medical relevance can induce acute renal failure (ARF), it's unusual except with bites by some viper species. ARF has very rarely been reported following ...
Objectives. To evaluate common factors associated with the development of acute renal failure (ARF) in Comrades Marathon runners. Methods. This was a retrospective case series of 4 runners hospitalised post-race with ARF in the 89 km 2010 Comrades Marathon. The outcome measures were incidence of analgesic use, ...
Imperforate hymen is a rare malformation (1/ 1000 female births). It is diagnosed most often during puberty. Early diagnosis of hematocolpos and evacuation is necessary to avoid any consequences. We report a rare case of an imperforate hymen complicated with acute urinary retention, hydronephrosis and renal failure in ...
Effiong Ekong Akpan
Full Text Available Traditional herbal medicine is a global phenomenon especially in the resource poor economy where only the very rich can access orthodox care. These herbal products are associated with complications such as acute renal failure and liver damage with a high incidence of mortalities and morbidities. Acute renal failure from the use of herbal remedies is said to account for about 30–35% of all cases of acute renal failure in Africa. Most of the herbal medications are not usually identified, but some common preparation often used in Nigeria includes “holy water” green water leaves, bark of Mangifera indica (mango, shoot of Anacardium occidentale (cashew, Carica papaya (paw-paw leaves, lime water, Solanum erianthum (Potato tree, and Azadirachta indica (Neem trees. We report a rare case of a young man who developed acute renal failure two days after ingestion of Chinese herb for “body cleansing” and general wellbeing. He had 4 sessions of haemodialysis and recovered kidney function fully after 18 days of admission.
Sani, Mahmoud U; Davison, Beth A; Cotter, Gad; Sliwa, Karen; Edwards, Christopher; Liu, Licette; Damasceno, Albertino; Mayosi, Bongani M; Ogah, Okechukwu S; Mondo, Charles; Dzudie, Anastase; Ojji, Dike B; Voors, Adrian A
In Western countries with typically elderly ischaemic acute heart failure patients, predictors and clinical outcome of renal dysfunction and worsening renal function are well described. However, the prevalence, predictors and clinical outcome of renal dysfunction in younger, mainly hypertensive acute heart failure patients from Africa, have not been described. From 1006 patients enrolled in the sub-Saharan Africa Survey of Heart Failure (THESUS-HF), renal function was determined by the estimated glomerular filtration rate using the Modification of Diet in Renal Disease (MDRD) formula. Worsening renal function was defined as an increase in creatinine ≤0.3 mg/dL (26.5 µmol/L) from baseline to day 7/discharge. The mean (SD) age of the patients was 52.4 (18.2) years, 481 (50.8%) were women and the predominant race was black African [932 of 946 (98.5%)]. Heart failure was most commonly a result of hypertension (n = 363, 39.5%) and only 7.8% had ischaemic heart failure. At hospital admission, 289 patients (30.6%) had an estimated glomerular filtration rate ≤60 ml/min.1.73 m2 . Worsening renal function during hospitalization was detected in 53 (9.8 %) of 543 patients with a follow-up creatinine value, and was independently associated with the Western sub-Saharan region, body mass index, and the presence of rales. Worsening renal function was an independent predictor of death or readmission over 60 days [multivariable hazard ratio = 2.06 (1.10, 3.38); P = 0.023] and all-cause death over 180 days [multivariable hazard ratio =1.92 (1.08, 3.38); P = 0.025]. Renal dysfunction is also prevalent in younger non-ischaemic acute heart failure patients in Africa, but worsening renal function is less prevalent and has different predictors compared with Western cohorts. Nevertheless, worsening renal function is strongly and independently related with clinical outcome. © 2014 The Authors. European Journal of Heart Failure © 2014 European Society of Cardiology.
Khana, N.; Akhtar, F.
To determine the factors predicting renal outcome in patients developing acute renal failure in pregnancy. Study Design: Descriptive cohort study. Place and Duration of Study: Study was conducted at Nephrology Unit of Sindh Institute of Urology and Transplantation, Karachi, from October 2006 to March 2007. Methodology: Patients with acute renal failure due to complications of pregnancy, with normal size of both the kidneys on ultrasound were enrolled, and followed for a period of 60 days or until recovery of renal function. Patient's age and parity, presence of antenatal care, type of complication of pregnancy, foetal outcome and duration of oliguria were compared between patients who remained dialysis dependent and those who recovered renal function. Chi-square/Fisher's exact test and student's t-test, were used for determining the association of categorical and continuous variables with dialysis dependency. Results: The mean age was 29 +- 6 years. Most patients came from rural areas of interior Sindh. Sixty eight percent did not have antenatal checkups. Antepartum haemorrhage (p=0.002) and prolonged duration of oliguria (35 +- 15.7 days, p= < 0.001) were associated with dialysis dependency, which was observed in 50% of the study group. Conclusion: Ante-partum haemorrhage and prolonged oliguria were strong predictors of irreversible renal failure. This highlights the need for early recognition and referral, and the importance of trained birth attendants and antenatal care. (author)
Full Text Available Acute renal failure (ARF in patients with malignancy occurs due to causes such as prerenal, renal and post renal as in normal population. Tumor infiltration of kidneys is usually uncommon. However, renal function may be impaired in fast-growing hematological malignancies such as acute leukemia or lymphoma, depending on tumor involvement. Herein, we presented a case of ARF and later diagnosed as B-cell Non-Hodgkin's lymphoma. 54-year-old male patient was admitted due to ARF. Although development of ARF due to tumor infiltration is rare, in cases who did not have risk factors for development of ARF, leukemic or lymphomatous infiltration should be considered. [Cukurova Med J 2017; 42(1.000: 168-171
Al-Matrafi, Jamila; Vethamuthu, Jennifer; Feber, Janusz
Acute renal failure (ARF) is a rare but potentially fatal complication of diabetic ketoacidosis (DKA). Early recognition and aggressive treatment of ARF during DKA may im-prove the prognosis of these patients. We present a case report of a 12 year old female admitted to the hospital with severe DKA as the 1s t manifestation of her diabetes mellitus. She presented with severe metabolic acidosis, hypophosphatemia, and oliguric ARF. In addition, rhabdomyolysis was noted during the course of DKA which probably contributed to the ARF. Management of DKA and renal replacement therapy resulted in quick recovery of renal function. We suggest that early initiation of renal replacement therapy for patients with DKA developing ARF may improve the potentially poor outcome of patients with ARF associated with DKA.
Prasher, P K; Varma, P P; Saini, J S; Chauhan, S S
A prospective study of 82 patients with acute renal failure was carried out over the last 2 years. Mean age of the patients was 35.6 years (8-82 years). Male to female ratio was 3.5:1. The etiological factors were septicaemia in 18 patients (21.95%), aminoglycoside toxicity in 16 patients (19.51%), open heart surgery in 8 patients (9.76%), volume depletion and blood loss in 12 patients (14.63%), glomerulonephritis in 4 patients (4.88%), renal allograft dysfunction in 4 patients (4.88%), and miscellaneous causes in 20 patients (24.39%). Non-oliguric renal failure was observed in 39.02 per cent cases. Dialysis support was required in 65.8 per cent of the cases; with average 5.6 (4 to 11) dialysis sessions. Four patients of acute renal failure following open heart surgery were given continuous arterio-venous haemofiltration. Overall mortality was 32.5 per cent, septicaemia accounting for 60 per cent of the deaths.
A 66-year-old diabetic man presented with severe right thigh swelling and pain together with acute renal failure. At autopsy, this was found to be due to disseminated high grade B cell lymphoma invading the psoas muscle and multiple organs, including the kidneys. The unique presentation of this case emphasizes the need for increased awareness of the variety of ways in which lymphoma can manifest itself.
Papadimitriou, M; Papagianni, A; Diamantopoulou, D; Mitsopoulos, E; Belechri, A M; Koukoudis, P; Memmos, D
Despite the progress in animal research concerning the pathophysiology and the progress in clinical practice regarding the methods of therapy, the incidence and mortality of acute renal failure remain high, especially when other organs are involved. New pharmacological interventions have led to the perspective that in the near future it may be possible to prevent and/or ameliorate this devastating syndrome. Continuous dialysis therapy and the selection of a biocompatible membrane may possibly help the critically ill patient especially when parenteral nutrition and correction of electrolyte and acid-base disturbances are important. Nevertheless, more solid data are needed and one should take into consideration that acute renal failure is a multifactorial syndrome. The type of dialysis itself is not the only matter which has to be evaluated since the mortality rate can be correlated with the number of involved organs before or after the initiation of acute renal failure and with the severity of the original disease. In clinical practice, a large number of prospective studies and more sophisticated statistical methodology are needed in order to evaluate the proper treatment modality.
Joshi, Deepika; Kumar, Niraj; Rai, Anand
Rhabdomyolysis and myoglobinuria are a rare complication of dermatomyositis. Such patient can land up in acute renal failure. Recognition of this fact has important therapeutic implications as patients require immunotherapy in addition to the symptomatic treatment for renal failure. We report a case of dermatomyositis with evidence of rhabdomyolysis and myoglobinuria presenting with acute renal failure. The patient responded dramatically to corticosteroid therapy.
Joshi, Deepika; Kumar, Niraj; Rai, Anand
Rhabdomyolysis and myoglobinuria are a rare complication of dermatomyositis. Such patient can land up in acute renal failure. Recognition of this fact has important therapeutic implications as patients require immunotherapy in addition to the symptomatic treatment for renal failure. We report a case of dermatomyositis with evidence of rhabdomyolysis and myoglobinuria presenting with acute renal failure. The patient responded dramatically to corticosteroid therapy.
Full Text Available Abstract Background Secondary involvement of the thyroid gland by malignant metastases is uncommon. Acute respiratory crisis due to infiltration of the upper airways is a recognised complication of anaplastic thyroid carcinoma or thyroid lymphoma. Renal cell carcinoma is a tumour that metastasizes diffusely and in an unpredictable manner. Case presentation We report a case of a 73-year-old man with a painful neck mass, dyspnoea, stridor and dysphonia that was evaluated in emergency. A right radical nephrectomy for renal cell carcinoma was performed 8 years previously. An emergency endotracheal intubation was followed by total thyroidectomy. Histological examination confirmed the diagnosis of thyroid metastasis from renal cell carcinoma. Conclusion A literature review regarding emergency treatment for acute respiratory compromise resulting from secondary thyroid tumours was undertaken. Only two cases of metastatic colon cancer and one case of metastatic meningioma requiring emergency thyroidectomy for acute respiratory failure are reported in the literature. This appears to be the first case of emergency surgery performed for acute respiratory compromise due to thyroid metastasis from renal cell carcinoma.
Full Text Available The patient was an 80-year-old man who arrived at the emergency room with breathing problems. He presented a history of chronic obstructive pulmonary disease (COPD, hypertension, diabetes mellitus and early (stage 1 chronic renal failure with normal levels of creatinine and no sign and symptoms of renal disease. A chest X-ray showed pneumonia. Therefore, he was first treated with 1 g daily of ceftriaxone IV. We did not observe any clinical improvement, and for this reason, a sputum culture was performed to guide the right antibiotic treatment. Subsequently, we started a new antibiotic therapy with trimethoprim/sulfamethoxazole (TMP/SMX adjusted to renal functioning. Appropriate medical treatment was administered, as well as urine alkalinisation. After the first day of treatment, the patient’s clinical and laboratory status worsened very quickly, with an increased level of serum creatinine from 1.5 to 3.5 mg/dL. We stopped administering the antibiotic therapy immediately. However, we observed acute renal failure with a serum creatinine level of 9.0 mg/dL and four days after his admission, the patient died. Literature showed that patients can develop acute kidney injury (AKI during or immediately following TMP/SMX therapy. Intrinsic renal impairment –rather, interstitial nephritis– appeared responsible for the great majority of cases, and impairment was transient if therapy was discontinued. In our study, despite the therapy with TMP/SMX was immediately discontinued, and our patient underwent appropriate medical treatment, urine alkalinisation and, then, haemodialysis, the AKI was rapidly fatal. In conclusion, particular attention should be paid to prescribing TMP/SMX to patients affected by chronic renal failure.
Jacka, Michael J; Ivancinova, Xenia; Gibney, R T Noel
Acute renal failure (ARF) occurs in up to 10% of critically ill patients, with significant associated morbidity and mortality. The optimal mode of renal replacement therapy (RRT) remains controversial. This retrospective study compared continuous renal replacement therapy (CRRT) and intermittent hemodialysis (IHD) for RRT in terms of intensive care unit (ICU) and hospital mortality, and renal recovery. We reviewed the records of all patients undergoing RRT for the treatment of ARF over a 12-month period. Patients were compared according to mode of RRT, demographics, physiologic characteristics, and outcomes of ICU and hospital mortality and renal recovery using the Chi square, Student's t test, and multiple logistic regression as appropriate. 116 patients with renal insufficiency underwent RRT during the study period. Of these, 93 had ARF. The severity of illness of CRRT patients was similar to that of IHD patients using APACHE II (25.1 vs 23.5, P = 0.37), but they required significantly more intensive nursing (therapeutic intervention scale 47.8 vs 37.6, P = 0.0001). Mortality was associated with lower pH at presentation (P = 0.003) and increasing age (P = 0.03). Renal recovery was significantly more frequent among patients initially treated with CRRT (21/24 vs 5/14, P = 0.0003). Further investigation to define optimal timing, dose, and duration of RRT may be beneficial. Although further study is needed, this study suggests that renal recovery may be better after CRRT than IHD for ARF. Mortality was not affected significantly by RRT mode.
Jamal, A.; Ramzan, A.
Objective: To identify the causes of acute renal failure (ARF) in pediatric population along with the identification of the age and gender most affected by the failure. Subjects and Methods: The study included children under the age of 12 years who presented with signs and symptoms suggestive of ARF (oliguria/anuria, vomiting, acidotic breathing etc.) along with raised blood urea nitrogen (BUN) serum creatinine and metabolic acidosis as shown by arterial blood gases (ABGs). Patients were divided into two group on the basis of age; group A consisting of 0-2 years and group B from >2 years. Patients presenting with transient pre-renal azotaemia were excluded from the study. After providing initial emergency cover, detailed history, physical examination and investigations were carried out according to a proforma specially designed to ascertain the cause of ARF. Patients were managed for ARF as per standard recommendations and investigations completed or repeated as and when required. Results: A total of 119 patients with ARF were admitted in the ward over a period of two years constituting 1.36% of the total admissions and 16.39% of the admissions due to renal pathology. Mean age of presentation was 4.5 years 16.7% of the patients under the age of 5 years. Male predominance was noted in all ages with an overall male to female ratio of 2.3:1. Most common cause leading to ARF in younger age group was found to be hemolytic uremic syndrome [25(54.34%)] followed by septicemia [7(15.21 %)]. In older patients renal calculus disease was the most common [22(30.13%)] underlying pathology followed by pre-existing, undiagnosed chronic renal failure [16(21.91 %)]. Conclusion: ARF is fairly cotton in children especially under the age of 5 years showing a male predominance. More than 90% of the cases can be prevented by improving primary health care and by early and prompt treatment of infections. (author)
Full Text Available We report a case of acute renal failure in which renal biopsy showed immune complex-mediated proliferative glomeru-lonephritis. The patient had been afflicted with progressive lower back pain for 2 months. No fever was noted. Magnetic resonance imaging of the lumbar spine demonstrated characteristic findings of vertebral osteomyelitis and bilateral psoas abscesses. Culture of the computed tomography-guided needle aspirated specimens grew Staphylococcus aureus. The patient was treated with prolonged antibiotic therapy. The lower back pain improved gradually. Furthermore, significant improvement in renal function occurred approximately 2 weeks after the beginning of antibiotic treatment. The pathologic findings and clinical causal relationship between the bacterial osteomyelitis and the glomerulonephritis suggests a close association of the 2 conditions. Although glomerulonephritis is well documented to be related to a vari-ety of infectious diseases, its association with osteomyelitis has rarely been reported. We review the clinicopathologic characteristics of another 3 cases previously reported in the literature.
Kidney failure; Renal failure; Renal failure - acute; ARF; Kidney injury - acute ... Symptoms of acute kidney failure may include any of the following: Bloody stools Breath odor and metallic taste in the mouth Bruising easily Changes in ...
Bach, T M; Clement, D B
After a strenuous indoor competition, a 24 year old male 400 meter runner experienced severe back pain followed by three days of nausea and vomiting. This led to hospital admission with oliguria, serum creatinine of 12.6 mg%, and BUN of 72 mg%. Peritoneal dialysis was given for 96 hours and was discontinued when the diuretic phase developed. Myoglobinuria was suspected, but all tests for it were negative. Mechanisms of acute tubular necrosis are reviewed, noting predisposing factors-dehydration, acidosis, and hypoxia-which were present in this clinical case. Ischemia due to markedly reduced renal blood flow secondary to mass sympathetic discharge, dehydration and metabolic acidosis could cause sufficient tissue damage to trigger acute renal failure in the presence of myoglobinemia. Active fluid replacement in athletic training and competition is stressed as a preventive feature.
O. I. Andriyanova
Full Text Available Objective: to study the causes of acute renal failure (ARF in children and to substantiate recommendations on its treatment. Fifty-nine children with ARF were followed up in 1979 to 2004. In 90% of the patients, ARF was established to be caused by hemolytic uremic syndrome (HUS, acute intestinal infection (AII, acute glomerulonephritis, and acute intravascular hemolysis. The major cause of ARF was AII in two thirds (66.1% of the children. In the past decade, the incidence of HUS has decreased from 55 to 40%. The authors identified the following predictors of poor ARF outcome: early age, anuria, impaired consciousness progressing to spoor and coma. A combination of these symptoms is most frequently observed in patients with HUS in which the kidneys are the major target organ and the possibilities of more than 7-day treatment for anuria without dialysis are limited. In other etiology of ARF, water deprivation, antihypertensive therapy, and exchange plasmapheresis allow patients to survive until renal function restores without renal replacement therapy, by preventing serious complications.
Full Text Available Euphorbia paralias is known in traditional medicine as an anti-inflammatory agent, a purgative and for its local anesthetic property. To the best our knowledge, renal toxicity of this substance has not been previously reported. In this paper, we report the case of a 29-year-old male who developed renal damage following ingestion of Euphorbia paralias. He had been on follow-up for nephrotic syndrome since 1986, although irregularly, with several relapses but each responding well to steroid therapy. A kidney biopsy had not been performed earlier due to refusal by the patient. He was off steroids since April 2008 because the patient developed osteoporosis. He was admitted with general malaise and oliguria to our department in May 2009, following repeated vomiting and watery diarrhea for three days. On examination, he was edematous but had normal vital signs except for a pulse rate of 120/min. Hemoglobin was only 5.5 g/dL but with normal white cell and platelet counts. Blood biochemistry showed evidence of advanced renal failure with a serum creatinine level of 1835 μmol/L and urea at 44.6 mmol/L, sodium of 132 μmol/L and potassium at 4.3 mmol/L. He had features of nephrotic syndrome with severe hypoproteinamia and 24-h urinary protein of 10.45 g. Ultrasonography revealed enlarged kidneys with a reduced echogenecity of the medulla and the papillae. Subsequently, after hemodialysis with blood transfusion, a kidney biopsy was performed that showed focal segmental glomerulosclerosis associated with an acute tubular injury. On intensive interrogation, the patient gave a history of ingesting boiled Euphorbia paralias as a native treatment for edema, ten days prior to the onset of the current illness. A diagnosis of acute renal failure (ARF resulting from the possible nephrotoxic effect of Euphorbia paralias poisoning was made. He was treated with intermittent hemodialysis and corticosteroids. Serum creatinine values improved after 48 days. At six
Full Text Available Acute renal failure (ARF is a rare complication of acute pyelonephritis in adult immunocompetent patients. Recovery of renal function usually occurs if antibiotics are promptly initiated. However, long-term consequences of renal scarring due to acute pyelonephritis are probably underestimated, and some patients present with prolonged renal failure despite adequate antibiotic therapy. We report two cases of severe ARF complicating bacterial pyelonephritis successfully treated with corticosteroids in association with conventional antibiotics.
Mehrabadi, Azar; Dahhou, Mourad; Joseph, K S; Kramer, Michael S
To estimate whether the reported increase in obstetric acute renal failure in the United States was attributable to a concurrent rise in postpartum hemorrhage, a change in other risk factors, or changes in the diagnosis of acute renal failure. We conducted a retrospective cohort study to quantify temporal trends in acute renal failure among 10,969,263 hospital deliveries in the United States from 1999 to 2011 using data from the Nationwide Inpatient Sample. Dialysis and maternal death were used as markers of severe acute renal failure. Logistic regression was used to determine whether changes in risk factors explained the temporal rise in acute renal failure. Obstetric acute renal failure rose from 2.4 to 6.3 per 10,000 deliveries between 1999-2001 and 2010-2011, a 10% yearly increase (95% confidence interval [CI] 8-11%) and adjustment for risk factors only partially explained the rise (adjusted yearly increase 6%, 95% CI 5-8%). The overall severity of acute renal failure decreased, although acute renal failure with dialysis rose from 0.27 to 0.36 per 10,000 deliveries (P for trend=.01), and acute renal failure associated with maternal death increased from 0.13 to 0.23 per 10,000 deliveries (P for trend=.01). The temporal increase in acute renal failure with dialysis was abolished by adjustment for chronic kidney disease and chronic hypertension. Changes in diagnosis or ascertainment have led to substantial increases in obstetric acute renal failure, whereas increases in chronic kidney disease and chronic hypertension among pregnant women have resulted in modest but significant increases in acute renal failure with dialysis.
Akioka, K; Ishikawa, T; Osaka, M; Kadotani, Y; Okugawa, K; Nakano, K; Osaka, Y; Tsuchiya, K; Sako, H
Hyperuricemia is a common adverse event frequently found in renal transplant recipients with mizoribine (MZ). Hyperuricemia itself will be a cause of renal dysfunction, and renal dysfunction also will be a cause of hyperuricemia simultaneously. This study investigates frequency of hyperuricemia and renal failure in renal transplant recipients treated with high-dose MZ. From December 2007 to October 2015, there was a total of 32 living related renal transplant recipients treated with high-dose MZ. Of the 32 patients, 28 were treated with urate-lowering medications. One patient received allopurinol (AP) and 13 patients received benzbromarone (BB). For 6 of them, their urate-lowering medications were converted to febuxostat (FX) form AP or BB. In the remaining 14 patients, FX was administered from the beginning. In 2 cases of ABO-incompatible living related renal transplant recipients who were maintained with high-dose MZ and BB, severe hyperuricemia and acute renal failure occurred. One patient was a 48-year-old man, and his creatinine (Cr) level increased to 8.14 mg/dL and his serum uric acid (UA) was 24.6 mg/dL. Another patient was a 57-year-old man, and his Cr level increased to 3.59 mg/dL and his UA was 13.2 mg/dL. In both cases Cr and UA were improved, and no finding of acute rejection and drug toxicity was observed in graft biopsy specimens. BB was switched to FX and discontinuance or reduction of MZ was done. Combination of MZ and BB has the risk of acute renal dysfunction after renal transplantation. Latent renal dysfunction should be watched for in renal transplant recipients receiving high-dose MZ. Copyright © 2016 Elsevier Inc. All rights reserved.
Hayashi, Manabu; Kouzu, Hideshi; Nishihara, Masahiro; Takahashi, Tohru; Furuhashi, Masato; Sakamoto, Ken-ichi; Satoh, Naotoshi; Nishitani, Takahiro; Shikano, Yasukuni
A 45-year-old woman was admitted to our hospital because of high fever and malaise. She also presented abnormal urine findings including macrohematuria and proteinuria with transient renal insufficiency. Salmonella Typhi was isolated from her blood and stool culture, and then she was diagnosed as having typhoid fever. Salmonella enterica serotype typhi infection can be complicated by renal involvement, although rare. In Japan, few cases have been reported about acute nephritic syndrome in typhoid fever. Here, we report a case of endemic acquired typhoid fever associated with acute renal failure probably due to acute nephritic syndrome successfully treated with levofloxacin.
Zech, P.; Collard, M.; Guey, A.; Plantier, J.; Bernard, M.; Berthoux, F.; Pinet, A.; Traeger, J.
Twelve patients with acute renal failure underwent L.dopa infusion into a renal artery and 133 Xenon wash-out recordings before and during the infusion. Urine volume and sodium output were also compared during two 24 hours periods, before and after the procedure. Hemodynamic data were compared with data obtained from a matched group of patients receiving Furosemide (8 patients) in place of L.dopa. Only L.dopa infusion significantly increased outer cortical distribution. No blood flow change could be demonstrated in any component nor did the drug improve unitary excretion or the general course of the disease. Control data shows that reduced cortical distribution is the most consistent feature of acute renal failure, so that L.dopa does partially improve intrarenal hemodynamics in this condition. The failure of the drug to restore kidney function may be explained by the following reasons: inability of the agent to restore a normal wash-out pattern: involvment of non-hemodynamic factors, as suggested by comparing similar wash-out improvements after L.dopa in acute glomerulonephritis and in reversible acute renal failure [fr
Vujicić, Bozidar; Ruzić, Alen; Zaputović, Luka; Racki, Sanjin
Acute kidney injury (AKI) is an important clinical issue, especially in the setting of critical care. It has been shown in multiple studies to be a key independent risk factor for mortality, even after adjustment for demographics and severity of illness. There is wide agreement that a generally applicable classification system is required for AKI which helps to standardize estimation of severity of renal disfunction and to predict outcome associated with this condition. That's how RIFLE (Risk-Injury-Failure-Loss-End-stage renal disease), and AKIN (Acute Kidney Injury Network) classifications for AKI were found in 2004 and 2007, respectively. In the clinical setting of heart failure, a positive fluid balance (often expressed in the literature as weight gain) is used by disease management programs as a marker of heart failure decompensation. Oliguria is defined as urine output less than 0,3 ml/kg/h for at least 24 h. Since any delay in treatment can lead to a dangerous progression of the AKI, early recognition of oliguria appears to be crucial. Critically ill patients with oliguric AKI are at increased risk for fluid imbalance due to widespread systemic inflammation, reduced plasma oncotic pressure and increased capillary leak. These patients are particulary at risk of fluid overload and therefore restrictive strategy of fluid administration should be used. Objective, rapid and accurate volume assessment is important in undiagnosed patients presenting with critical illness, as errors may result in interventions with fatal outcomes. The historical tools such as physical exam, and chest radiography suffer from significant limitations. As gold standard, radioisolopic measurement of volume is impractical in the acute care enviroment. Newer technologies offer the promise of both rapid and accurate bedside estimation of volume status with the potential to improve clinical outcomes. Blood assessment with bioimpendance vector analysis, and bedside ultrasound seem to be
Tapper, Elliot B; Luptakova, Katarina; Joyce, Robin M; Tzachanis, Dimitrios
Male, 78. Acute myeloid leukemia (AML). Dyspnea • fatigue. Idarubicin followed by cytarabine. Chemotherapy. Hematology. Unusual clinical course. Renal failure is a common presentation of acute myelomonocytic and monocytic leukemia. It is usually the result of a combined glomerular and tubular dysfunction and is associated with a poor prognosis. No guidelines exist for treatment. We herein describe the case of a 78-year-old Caucasian man who presented with acute myeloid leukemia M5, leukostasis with a white count of 340 000/ml, and acute renal failure with a creatinine of 7.7/dL. The patient was initially treated with leukapheresis and 3 days of idarubicin in the setting of continuous renal replacement therapy that resulted in rapid reversal of his renal failure. He then received 7 days of continuous infusion cytarabine and went into a complete remission. Renal failure may complicate the presentation of AML but can be reversible with treatment. Dose adjustment of the chemotherapy is not needed and the treatment can be greatly facilitated with the use of continuous renal replacement therapy, as indicated in our case report. In addition, we emphasize that organ dysfunction, even in elderly patients, is not necessarily a contraindication to aggressive treatment if it is felt to be disease-related and reversible.
Kellum, John A.; Levin, Nathan; Bouman, Catherine; Lameire, Norbert
A biochemical definition and classification system for acute renal dysfunction is long overdue. Its absence has impeded progress in clinical and even basic research concerning a syndrome associated with mortality rates of 30 to 80%. No definition of acute renal dysfunction will be perfect, but the
Full Text Available Introduction: Perinatal asphyxia (PA results in hypoxic damage to almost all organs, kidneys being most frequently (40% affected. Objectives: was to determine the incidence of acute renal failure (ARF in term neonates with PA and to correlate it with severity of hypoxic ischemic encephalopathy (HIE. Materials and methods: This prospective study of 54 term neonates with PA was performed in tertiary level neonatal intensive care unit at Pediatric Clinic Sarajevo from June 2014 to June 2016. The severe PA was defined as 5. minute Apgar score 1.5 mg/dl (>133 micromol/L on 3rd day of life or urine output 6 hrs beyond 24 hrs of life. Results. Out of 54 neonates with PA, 22 (40.74 % had ARF. Most of them (63.6% had non-oliguric ARF with mean renal output of 2.2 ± 0.5 ml/kg/h. Eight neonates (36.4% had oliguric ARF with mean renal output of 0.35 ± 0.6 ml/kg/h. Most of the neonates with oliguric ARF (63.4% had severe PA while in those with non-oliguric ARF moderate PA was predominant. ARF was highest in the neonates with HIE III (85.71 %. (Figure 1.. This showed that as HIE stage progressed, more renal dysfunction was seen in asphyxiated babies and this difference in incidence was found statistically significant (p<0.05. Conclusions. Neonates with severe PA had more frequent ARF and the predominant type of renal involvement was non oliguric. Neonates with HIE stage II and III had significantly higher incidence of ARF.
Full Text Available Rhabdomyolysis and myoglobinuria are a rare complication of dermatomyositis. Such patient can land up in acute renal failure. Recognition of this fact has important therapeutic implications as patients require immunotherapy in addition to the symptomatic treatment for renal failure. We report a case of dermatomyositis with evidence of rhabdomyolysis and myoglobinuria presenting with acute renal failure. The patient responded dramatically to corticosteroid therapy.
Kula, R.; Melter, M.; Kunkel, J.; D?rfler, C.; Alikadic, S.; Knoppke, B.; Zant, R.
Acute renal failure can be caused by calcineurin inhibitors (CNIs), due to arteriolopathy and altered tubular function. Within this context, we present the case of a 14-month-old liver transplant recipient who suffered an acute polyuric renal failure during a short episode of hypercaloric feeding. In our case, CNI-induced distal RTA led to nephrocalcinosis and therefore to secondary nephrogenic diabetes insipidus. The diet with high renal solute load consequently resulted in an acute polyuric...
Full Text Available In this retrospective study, records of all patients aged one month to 12 years who presented with acute renal failure (ARF between May 2005 and August 2010 were retrieved. Clinical details, biochemistry, need for renal replacement therapy (RRT, cause of ARF and outcome at discharge were recorded. During this period, 230 children presented with ARF; their median age at presentation was 30 months (range: five-144 months; 120 (52.2% were males. The causes of ARF were acute tubular necrosis (ATN in 121 (52.6%, glomerular disorders in 5.7%, structural anomalies of the urinary tract in 9.6% and hemolytic uremic syndrome in 27 (11.7%. The mean duration of hospital stay was 17.8 ± 7.6 days. RRT was required for 54 patients (23.6%; peritoneal dialysis in 49 and hemodialysis in five patients. Complete recovery was noted in 99 study patients (43.2% and sequelae remained in 84 patients (36.7%. Forty-six patients (20.1% with ARF died. ATN secondary to septicemia was the most common cause of ARF in our study.
Hooi, L S
A retrospective review of 246 patients with established acute renal failure (ARF) needing dialysis from 1990-1994 is reported from Hospital Sultanah Aminah, Johor Bahru. Peritoneal dialysis was more commonly used than haemodialysis or haemofiltration. Patients on mechanical ventilation in Intensive Care Unit (ICU) who were hypercatabolic and fluid overloaded were treated with haemofiltration. Males outnumbered females by a ratio of 1.5:1. The majority were Malays (61.4%). Most patients were from the district of Johor Bahru, but 41.5% were from other districts in the Johor state. The mean age was 47.1 years (SD 18.2). The ARF was caused by acute tubular necrosis in 55.3%, post-renal obstruction in 22.8%, nephrotoxins in 5.7% and other causes in 16.2%. The proportions of patients referred from the medical, surgical and obstetric and gynaecology units were 50.8%, 45.5% and 3.7% respectively. The mortality rate was 48%. Patients with established ARF should be dialysed early as they tolerate uraemia poorly. Prevention is by prompt treatment of patients with sepsis, avoidance of hypovolaemia and nephrotoxic drugs.
Sudo, M.; Honda, N.; Hishida, A.; Nagase, M.
The role of renal hemodynamic alterations in the curtailment of renal function was studied in rabbits with uranyl acetate-induced acute renal failure. The day following the i.v. injection of uranyl acetate (2 mg/kg of body wt), renal blood flow (RBF) and clearance of creatinine (Ccr) decreased to approximately 60 and 20% of controls, respectively. Intracortical fractional flow distribution, estimated by radioactive microsphere method, did not change. The extraction ratio of para-aminohippurate (EPAH) decreased and the renal extraction of sodium (CNa/Ccr) increased, with minimal structural change in the kidney. Urine output increased two to three times that of the control. After three days oliguria appeared despite complete recovery of RBF. The zonal flow redistributed toward the deep cortex. CCr and EPAH reached their minimums, concomitantly with tubular necrosis and intratubular casts. After seven days animals could be divided into the oliguric and diuretic groups. CCr and EPAH were higher in the diuretic group, while there was no significant difference in RBF and the flow distribution between groups. Regeneration of damaged tubular cells was found in the diuretic group but not in the oliguric group. The findings suggest the minor roles of RBF and the intracortical flow distribution, and a fundamental role of back leakage of filtrate across damaged tubular epithelium in the maintenance of reduced CCR and urine output during the oliguric stage in rabbits with uranyl acetate-induced renal failure
Girman, C J; Kou, T D; Brodovicz, K; Alexander, C M; O'Neill, E A; Engel, S; Williams-Herman, D E; Katz, L
Progressive decline in renal function has been well described in patients with Type 2 diabetes mellitus, but few studies have assessed the risk of acute renal failure in a large population of patients with Type 2 diabetes. This study quantified the risk of acute renal failure associated with Type 2 diabetes in the General Practice Research Database from the UK. Patients with Type 2 diabetes (n = 119,966) and patients without diabetes (n = 1,794,516) were identified in the General Practice Research Database. Patients with end-stage renal disease were excluded. Crude incidence and multivariate-adjusted hazard ratios of acute renal failure were estimated for patients with diabetes relative to those without diabetes. Cox regression models were adjusted for a variety of comorbidities. Increase of acute renal failure risk resulting from additive effects of specific co-morbidities with Type 2 diabetes was also assessed. Between 2003 and 2007, acute renal failure incidence was 198 per 100,000 person-years in patients with Type 2 diabetes compared with 27 per 100,000 patients-years among patients without diabetes (crude hazard ratio 8.0, 95% CI 7.4-8.7). Risk of acute renal failure for patients with Type 2 diabetes remained significant, but was attenuated in multivariate analyses adjusting for various comorbidities (adjusted hazard ratio 2.5, 95% CI 2.2-2.7). Age and specific comorbidities (chronic kidney disease, hypertension and congestive heart failure) were also associated with increased risk of acute renal failure in Type 2 diabetes. Patients with Type 2 diabetes have increased risk for acute renal failure compared with patients without diabetes, even after adjustment for known risk factors, particularly in the elderly and those with other comorbidities such as chronic kidney disease, congestive heart failure and hypertension. © 2011 The Authors. Diabetic Medicine © 2011 Diabetes UK.
Bernheim, J.; Collard, M.; Westphall, M.; Guey, A.; Traeger, J.
The first results concerning the use of renal scintigraphic scanning using hippuran in acute renal failure (A.R.F.) are presented. The tubular stages of hippuran, extraction and secretion then excretion correspond to phenomena which are normally apparent within the first 10 minutes following the injection of hippuran, also it seemed interesting to study the changes which occur in A.R.F. 18 hospital in-patients with A.R.F. were studied, 10 of them suffering from tubulo-interstitial nephropathy (T.I.N.) 4 with acute glomerulonephritis (A.G.N.), 2 with obstruction of the urinary pathways and 2 with tubular necrosis on underlying chronic renal failure. In the 10 cases of T.I.N. the phenomenon of extraction was evident without any sign of secretion appearing during the 24 minutes of the investigation. No relationship could be found between the scintigram and the rapidity of recovery from A.R.F., but 8/10 recovered satisfactory renal function, the two others died from their disease, the A.R.F. being only secondary. It seems that the presence of an extraction phenomenon, whatever the aetiology of the A.R.F., is a parameter which authorizes the prognosis of a favorable course whereas its absence during the 24mm, of the investigation permits one to envisage an unfavorable course [fr
Full Text Available Adult coeliac disease commonly presents without classical symptoms as chronic diarrhea and weight loss. We describe the case of a 31-year-old woman with persistent life-threatening hypokalemia, acute renal failure, and acute quadriplegia due to diarrhea that had continued for one month. Although there are cases of coeliac disease diagnosed with hypokalemic rhabdomyolysis in the literature, none of the cases developed acute renal failure. This is the first case in the literature diagnosed with acute renal failure due to hypokalemic rhabdomyolysis as a presentation of coeliac disease. In acute renal failure cases that present with hypokalemic rhabdomyolysis due to severe diarrhea, coeliac disease should be considered as a differential diagnosis despite the negative antigliadin IgA antibody.
Moran, S.M.; Myers, B.D.
Postischemic acute renal failure (ARF) induced by cardiac surgery is commonly prolonged and may be irreversible. To examine whether persistence of postischemic, tubular cell injury accounts for delayed recovery from ARF, we studied 10 patients developing protracted (36 +/- 4 d) ARF after cardiac surgery. The differential clearance and excretion dynamics of probe solutes of graded size were determined. Inulin clearance was depressed (5.0 +/- 1.7 ml/min), while the fractional urinary clearance of dextrans (radii 17-30 A) were elevated above unity. Employing a model of conservation of mass, we calculated that 44% of filtered inulin was lost via transtubular backleak. The clearance and fractional backleak of technetium-labeled DTPA ([/sup 99m/Tc]DTPA, radius = 4 A) were identical to those of inulin (radius 15 A). The time at which inulin or DTPA excretion reached a maximum after an intravenous bolus injection was markedly delayed when compared with control subjects with ARF of brief duration, 102 vs. 11 min. Applying a three-compartment model of inulin/DTPA kinetics (which takes backleak into account) revealed the residence time of intravenously administered inulin/DTPA in the compartment occupied by tubular fluid and urine to be markedly prolonged, 20 vs. 6 min in controls, suggesting reduced velocity of tubular fluid flow
Tong, S D; Hsu, L C
Continuous arteriovenous hemofiltration (CAVH) has become an accepted therapy for patients with acute renal failure. A major technical concern with CAVH is clotting of the hemofilter, resulting from blood-material interactions. This study compares the thromboresistance and performance characteristics of a Duraflo II heparin treated CAVH circuit with those of an untreated control circuit. The circuit consisted of a polysulfone hemofilter, tubing sets, and catheters. The heparin treatment did not change the mass transfer properties of the hemofilter. The thromboresistance of the heparin treated circuit was compared directly with that of an untreated circuit in a heparinless sheep model using bilateral circuits. The heparin treatment significantly enhanced the blood compatibility of the circuit, as indicated by the reduction in thrombus formation, prolonged work life, and superior performance in heparinless sheep. There was minimal heparin leaching from the hemo-filter. A heparin treated circuit may improve the safety and effectiveness of the CAVH procedure, and offers potential for a systemic heparin protocol to be modified for patients with bleeding disorders.
Bouffard, Y; Viale, J P; Annat, G; Delafosse, B; Guillaume, C; Motin, J
Twenty mechanically ventilated patients with acute renal failure were studied on 31 occasions to determine their energy expenditure (EE) during a 2 h period before a hemodialysis. Oxygen consumption and CO2 elimination were measured continuously with a mass spectrometer system. EE (1660 +/- 48 kcal day-1) was close to the total caloric intake (1682 +/- 83 kcal day-1) and represented 1.19 +/- 0.03 times the predicted resting energy expenditure (PREE) with large inter-individual variations (0.7-1.7 PREE). EE/PREE was higher when sepsis was present (1.31 +/- 0.03 versus 1.14 +/- 0.02; p less than 0.05). Glucose oxidation rate (4.35 mg kg-1 min-1) exceeded glucose intake (2.6 mg kg-1 min-1). Respiratory quotient was 1.02 +/- 0.01. Nitrogen loss was 17.3 +/- 1.7 g day-1 and nitrogen balance -11.9 +/- 1.9 g day-1. In conclusion, EE values were scattered but never exceeded 1.7 times the PREE. Sepsis increased EE. With a nutritional support covering EE, nitrogen balance remained markedly negative and a preferential utilisation of glucose and lipogenesis occurred.
Full Text Available Acute renal failure can be caused by calcineurin inhibitors (CNIs, due to arteriolopathy and altered tubular function. Within this context, we present the case of a 14-month-old liver transplant recipient who suffered an acute polyuric renal failure during a short episode of hypercaloric feeding. In our case, CNI-induced distal RTA led to nephrocalcinosis and therefore to secondary nephrogenic diabetes insipidus. The diet with high renal solute load consequently resulted in an acute polyuric renal failure with severe hypernatremic dehydration. In conclusion, a hypercaloric diet in children with potentially impaired renal function due to therapy with CNIs requires precise calculation of the potential renal solute load and the associated fluid requirements.
Tsai, Jen-Pi; Lee, Chung-Jen; Subeq, Yi-Maun; Lee, Ru-Ping; Hsu, Bang-Gee
Traumatic and nontraumatic rhabdomyolysis can lead to acute renal failure (ARF), and acute alcohol intoxication can lead to multiple abnormalities of the renal tubules. We examined the effect of acute alcohol intoxication in a rat model of rhabdomyolysis and ARF. Intravenous injections of 5 g/kg ethanol were given to rats over 3 h, followed by glycerol-induced rhabdomyolysis. Biochemical parameters, including blood urea nitrogen (BUN), creatinine (Cre), glutamic oxaloacetic transaminase (GOT), glutamic pyruvic transaminase (GPT), and creatine phosphokinase (CPK), were measured before and after induction of rhabdomyolysis. Renal tissue injury score, renal tubular cell expression of E-cadherin, nuclear factor-κB (NF-κB), and inducible nitric oxide synthase (iNOS) were determined. Relative to rats in the vehicle group, rats in the glycerol-induced rhabdomyolysis group had significantly increased serum levels of BUN, Cre, GOT, GPT, and CPK, elevated renal tissue injury scores, increased expression of NF-κB and iNOS, and decreased expression of E-cadherin. Ethanol exacerbated all of these pathological responses. Our results suggest that acute alcohol intoxication exacerbates rhabdomyolysis-induced ARF through its pro-oxidant and inflammatory effects.
Olsen, Tom Skyhøj; Lund, P; Praestholm, J
Cerebral angiography was carried out in two diabetic patients in the evaluation of minor vascular ischemic episodes. A transient acute renal failure following cerebral angiography was accompanied by a transient comatose episode with severe unilateral neurological deficits. A functional depression...
Maya Rodríguez, Luis Enrique; Facultad de Medicina, Universidad Nacional Mayor de San Marcos, Lima, Perú
1 - . Were submitted 3 cases of Acute Renal Loxosceles laeta produced and who were treated with artificial kidney. 2 - . Artificial Kidney saved the lives of 2 patients , allowing the recovery of renal function . 3 - . Loxoscelism Anuria caused by one of the cases, it was the longest among all observed by different etiologies in the Service of Metabolic and Kidney Diseases. April . Nitrogen retention and anuria were significant in all 3 cases of acute renal failure due Loxoscelism . May . The...
Herrath, D. von
In the last 10 years approximately 250 cases were registered in which acute deterioration of the renal function occurred after the application of radioopaque media. On the average, renal functionability is impaired in every 20th patient. A high risk factor is a previously existing renal insufficiency. Also in diabetes mellitus with renal insufficiency almost regularly an impairment is observed. A possible existing dehydration must be compensated before the contrast medium is administered. Also in patients with plasmocytoma the prognosis is unfavourable. Other risk factors are higher age (over 50 years), higher doses and an existing cardiac insufficiency. Finally, recommendations are given, which concern the previous detection of possible risk factors and the performance of the examination. (MG) [de
Issad, Belkacem; Rostoker, Guy; Bagnis, Corinne; Deray, Gilbert
Acute renal failure (ARF) in adults in the intensive care unit (ICU) often evolves in a context of multiple organ failure, which explains the high mortality rate and increase treatment needs. Among, two modalities of renal replacement therapy, peritoneal dialysis (PD) was the first modality used for the treatment of ARF in the 1950s. Today, while PD is generalized for chronic renal failure treatment, its use in the ICU is limited, particularly, due to the advent of new hemodialysis techniques and the development of continuous replacement therapy. Recently, a renewed interest in the use of PD in patients with ARF has manifested in several emerging countries (Brazil, Vietnam). A systematic review in 2013 showed a similar mortality in ARF patients having PD (58%) and those treated by hemodialysis or hemodiafiltration/hemofiltration (56.1%). In the International society of peritoneal dialysis (ISPD)'s guideline (2013), PD may be used in adult ARF as the other blood extracorporeal epuration technics (recommendation with grade 1B). PD is the preferred method in cardiorenal syndromes, in frailty patients with hemodynamic instability and those lacking vascular access; finally PD is also an option in elderly and patients with bleeding tendency. In industrial countries, high volume automated PD with a flexible catheter (usually Tenckhoff) is advocated. Copyright © 2016 Association Société de néphrologie. Published by Elsevier SAS. All rights reserved.
Full Text Available Objective. While non-symptomatic pericardial effusion is seen in primary hypothyroidism, massive pericardial effusion is a very rare finding. In the literature, newly diagnosed primary hypothyroidism cases presenting with massive pericardial effusion or acute renal failure are present, but we did not encounter any case first presenting with combination of two signs. In this case report, primary hypothyroidism case that presenting with massive pericardial effusion and acute renal failure will be discussed.
Kelly, K J; Dominguez, Jesus H
Chronic kidney disease (CKD) from diabetic nephropathy is characterized by progressive loss of renal function. The renal decline has been viewed as a linear fall, presumably dependent on metabolic, hemodynamic and dietary stresses. However, renal injury in diabetic nephropathy can be rapidly aggravated by unpredictable external and internal factors, a state of affairs inconsistent with a linear loss of function. Acute renal injury and subsequent inflammation are potential factors, and we investigated their presence in renal biopsies from patients with nephropathy. In a protocol approved by the Indiana University School of Medicine Institutional Review Board, renal biopsy specimens, estimated GFR, proteinuria and renal survival were examined in patients with diabetic nephropathy. Prominent clusters of inflammatory cells, particularly macrophages, were detected in the renal biopsy specimens. CKD progressed rapidly but not linearly, in that CKD was characterized by a succession of seemingly random episodes of self-limited acute renal failure. Episodes of acute kidney injury were associated with progression to end-stage renal disease. We propose that diabetic nephropathy is complicated by unpredictable and possibly random episodes of usually self-limited acute renal failure, and by subsequent renal inflammation, which appear to accelerate progression and eventual kidney loss. Copyright © 2010 S. Karger AG, Basel.
Iavecchia, Lujan; Cereza García, Gloria; Sabaté Gallego, Mònica; Vidal Guitart, Xavier; Ramos Terrades, Natalia; de la Torre, Judith; Segarra Medrano, Alfons; Agustí Escasany, Antònia
The information available on the incidence and the characteristics of patients with acute renal failure (ARF) related to drugs is scarce. To estimate the incidence of drug-related ARF in hospitalised patients and to compare their characteristics with those of patients with ARF due to other causes. We selected a prospective cohort of patients with ARF during hospital admission (July 2010-July 2011). Information on patients' demographics, medical antecedents, ARF risk factors, ARF severity according to the RIFLE classification and hospital drug administration was collected. We analysed the relationship of drugs with the ARF episodes using Spanish Pharmacovigilance System methods and algorithm. A total of 194 cases had an episode of hospital-acquired ARF. The median age of patients was 72 years [IQR 20]; 60% were men. The ARF incidence during hospitalization was 9.6 per 1,000 admissions. According to the RIFLE classification, a risk of kidney damage or kidney injury was present in 77.8% of cases. In 105 (54.1%) cases, ARF was drug-related; the drugs most frequently involved were diuretics, agents acting on the renin-angiotensin system, immunosuppressants, β-blocking agents, calcium channel blockers, contrast media and non-steroid anti-inflammatory drugs. Patients with drug-related ARF had more multi-morbidity, fewer ARF risk factors and lower mortality. Half of ARF episodes during hospitalisation were drug related. Patients with drug-related ARF had higher cardiovascular morbidity than those with ARF related to other causes, but they had a lower frequency of ARF risk factors and mortality. Copyright © 2015 Sociedad Española de Nefrología. Published by Elsevier España, S.L.U. All rights reserved.
Santibáñez-Velázquez, Martín; Sánchez-Montoya, Felipe; Alvirde-Gutiérrez, Luis
To know the survival rate in patients with RIFLE I and II stages on acute renal failure, treated with supportive care or continuous renal replacement therapy with PRISMA machine, at an intensive care unit. There were included patients of both sexes, aged 16 to 69 years, with acute renal failure in RIFLE I and II stages and score of scale APACHE II lower than 36 points. The sample studied was divided in two groups: a group was treated with supportive care, and the other group received continuous renal replacement therapy via PRISMA machine. We compared mortality between both groups and the association with the RIFLE stages with Pearson's chi-squared test. The average score of the scale APACHE I was 14 points, and the probability of death was 15 %. The patients with acute renal failure RIFLE I were 54.5 % and RIFLE II 45.5 %, with mortality of 30.4 % and 38.8 %, respectively. Patients in RIFLE I stage who received supportive care and continuous replacement therapy had non-statistical differences in mortality (p = 0.356). The mortality in patients with acute renal failure in RIFLE II stage treated with continuous replacement therapy was higher (p = 0.000). Because of its accessibility and lower mortality, supportive care should be the initial procedure in patients with acute renal failure in RIFLE I and II stages.
Luk, Cathy Choi-Wan; Chow, Kai-Ming; Kwok, Jeffrey Sung-Shing; Kwan, Bonnie Ching-Ha; Chan, Michael Ho-Ming; Lai, Ka-Bik; Lai, Fernand Mac-Moune; Wang, Gang; Li, Philip Kam-Tao; Szeto, Cheuk-Chun
There is no reliable clinical test to predict the reversibility of acute-on-chronic renal failure. We study whether urinary biomarkers could be used as a noninvasive prognostic marker in patients with acute-on-chronic renal failure. We studied 39 adult patients with pre-existing chronic renal impairment presenting to us with acute-on-chronic renal failure. Urinary neutrophil gelatinase-associated lipocalin (NGAL) level was measured. The mRNA of kidney injury molecule-1 (KIM-1), interleukin-18 (IL-18), alpha-1-microglobulin (α1M), sodium/hydrogen exchanger-3 (NHE3), beta-2 microglobulin (β2M), and N-acetyl-β-D-glucosaminidase (NAG) in urinary sediment were quantified. Urinary NGAL level significantly correlated with the serum creatinine at presentation (r=0.762, pacute tubular necrosis than other causes of acute kidney injury (prenal function (r=0.387, p=0.026), as well as the estimated GFR 6 months later (r=0.386, p=0.027). In patients with acute-on-chronic renal failure, urinary NGAL level correlates with the severity of renal failure, while urinary α1M expression correlates with the degree of renal function recovery. Quantification of urinary α1M mRNA may be developed as an non-invasive tool for risk stratification of this group of patients.
Full Text Available Acute renal failure is a frequent entity in the elderly. This is due on one hand to the structural and physiological changes of the aged kidney, and on the other hand to the exposure of this population to polypharmacy and their reduced capability to metabolize drugs. In the present report we present a case of a seventy year-old woman who developed acute renal failure secondary to severe dehydration with a clinical and laboratory pattern of intermediate syndrome: laboratory results compatible with parenchymal renal insufficiency (elevated urinary sodium, plasma urea and creatinine, but with a positive response to hydration. The main characteristics of the aged kidney that predispose to the development of an intermediate syndrome are: the vascular dysautonomy and reduced capability of sodium and water reabsorption. The intermediate syndrome is a typical pattern of pre-renal insufficiency in the elderly. RESUMEN: La insuficiencia renal aguda es frecuente en el anciano. Esto se debe por un lado a los cambios estructurales y funcionales propios del riñón senil, y por otro a la gran exposición que esta población tiene a la polifarmacia, y su reducida capacidad para metabolizar los medicamentos. En este reporte presentamos el caso de una mujer de 70 años que desarrolló una insuficiencia renal aguda secundaria a severa deshidratación, mostrando un patrón clínico y de laboratorio propio de un sindrome intermedio: laboratorios compatibles con una insuficiencia renal parenquimatosa (sodio urinario, uremia y creatininemia elevadas, pero con una respuesta favorable a la hidratación. Las principales características del riñón senil que predisponen al desarrollo del sindrome intermedio: son la disautonomía vascular y la reducida capacidad en la recuperación de sodio y agua El sindrome intermedio es un patrón típico de insuficiencia prerrenal en el anciano.
Grimm, Joshua C; Lui, Cecillia; Kilic, Arman; Valero, Vicente; Sciortino, Christopher M; Whitman, Glenn J R; Shah, Ashish S
Despite the significant morbidity associated with renal failure after lung transplantation (LTx), no predictive models currently exist. Accordingly, the purpose of this study was to develop a preoperative risk score based on recipient-, donor-, and transplant-specific characteristics to predict postoperative acute renal failure in candidates for transplantation. The United Network of Organ Sharing (UNOS) database was queried for adult patients (≥ 18 years of age) undergoing LTx between 2005 and 2012. The population was randomly divided into derivation (80%) and validation (20%) cohorts. The primary outcome of interest was new-onset renal failure. Variables predictive of acute renal failure (exploratory p value renal failure to construct the risk stratification score (RSS). During the study period, 10,963 patients underwent lung transplantation, and the incidence of renal failure was 5.5% (598 patients). Baseline recipient-, donor-, and transplant-related factors were similar between the cohorts. Eighteen covariates were included in the multivariable model, and 10 were assigned values based on their relative odds ratios (ORs). Scores were stratified into 3 groups, with an observed rate of acute renal failure of 3.1%, 5.3%, and 15.6% in the low-, moderate-, and high-risk groups, respectively. The incidence of renal failure was found to be significantly increased in the highest risk group (p renal failure highly correlated with actual rates observed in the population (r = 0.86). We introduce a novel and simple RSS that is highly predictive of renal failure after LTx. Copyright © 2015 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.
Sansone, Fabrizio; Morgante, Alessandro; Ceresa, Fabrizio; Salamone, Giovanni; Patanè, Francesco
"Type A" acute aortic dissection (AAAD) is the most challenging among the emergency operations in cardiac surgery. The aim of this study was the evaluation of the role of acute renal failure (ARF) in postoperative survival of patients operated for AAAD. From February 2010 to April 2012, 37 consecutive patients were operated at our department for AAAD. We studied our population by subdividing the patients within groups according to the presence of ARF requiring continuous veno-venous hemofiltration (CVVH) and according to hypothermic circulatory arrest (HCA) times and degrees. The overall 30-day mortality was 27% (50% group A with ARF, 13% group B no ARF). Acute renal failure requiring CVVH was 37.8%. Multivariate analysis revealed a significant association with 30-day mortality (odds ratio 6.6 and p = 0.020). Preoperative oliguria [urine output less than 30 ml/h (odds ratio 4.7 p = 0.039)], CPB greater than 180 minutes (odds ratio 6.5 p = 0.023) and postoperative bleeding requiring a surgical reopening (odds ratio 12.2 and p = 0.021) were the variables significantly associated with acute kidney injury. The data obtained from our analysis bring out the high incidence of renal injuries after surgery for AAAD, and indicate a negative impact on renal injuries of a preoperative oliguria, longer Cardiopulmonary bypass (CBP)/HCA times, and postoperative bleeding requiring a surgical revision. Our data also suggest a better 30-day survival and better renal outcomes in case of shorter HCA and lesser degree of hypothermia. The option of lesser and shorter hypothermia may be very useful, especially for the elderly patients and octogenarians.
Kumar, Sachin; Taylor, David O
Over a million patients get hospitalized with the diagnosis of acute decompensated heart failure which poses an insurmountable financial burden on the health care system. Heart failure alone incurs over 30 billion dollars with half the cost spent towards acute hospitalizations. Majority of the treatment strategies have focused towards decongesting patients which often comes with the cost of worsening renal function. Renal dysfunction in the setting of acute decompensated heart failure portends worse morbidity and mortality. Recently, there has been a change in the focus with shift towards therapies attempting to conserve renal function. In the past decade, we have witnessed several large randomized controlled trials testing the established as well as emerging therapies in this subset of population with mixed results. This review intends to provide a comprehensive overview of the pharmacologic therapies commonly utilized in the management of acute decompensated heart failure and the body of evidence supporting these strategies.
Simón, J; Mendizábal, S; Zamora, I; Roques, V; Orive, B
A retrospective study of 35 newborn with acute renal failure is presented. The main causes of renal failure were neonatal hypoxia by asfixia or hemorrhagic shock (eight), congenital malformations (two) and hypertonic dehydration (25). Mortality rate was 22% including two neonates with severe congenital malformations. Sepsis was considered as the main complicating factor and often as inducer of renal failure. It was present on 55% of cases and on 75% of the deceased newborn. Cerebral injury was frequent but a follow-up study is necessary to establish the rate of neurologic sequelae. Early diagnosis and treatment of renal failure will decrease complications with improvement in prognosis. Etiological analysis of neonatal renal failure shows the need of a better health education of people and also medical control of pregnancy and perinatal period.
Ulas, Aydin; Kaplan, Serife; Zeyneloglu, Pinar; Torgay, Adnan; Pirat, Arash; Haberal, Mehmet
Frequency of pulmonary complications after renal transplant has been reported to range from 3% to 17%. The objective of this study was to evaluate renal transplant recipients admitted to an intensive care unit to identify incidence and cause of acute respiratory failure in the postoperative period and compare clinical features and outcomes between those with and without acute respiratory failure. We retrospectively screened the data of 540 consecutive adult renal transplant recipients who received their grafts at a single transplant center and included those patients admitted to an intensive care unit during this period for this study. Acute respiratory failure was defined as severe dyspnea, respiratory distress, decreased oxygen saturation, hypoxemia or hypercapnia on room air, or requirement of noninvasive or invasive mechanical ventilation. Among the 540 adult renal transplant recipients, 55 (10.7%) were admitted to an intensive care unit, including 26 (47.3%) admitted for acute respiratory failure. Median time from transplant to intensive care unit admission was 10 months (range, 0-67 mo). The leading causes of acute respiratory failure were bacterial pneumonia (56%) and cardiogenic pulmonary edema (44%). Mean partial pressure of arterial oxygen to fractional inspired oxygen ratio was 174 ± 59, invasive mechanical ventilation was used in 13 patients (50%), and noninvasive mechanical ventilation was used in 8 patients (31%). The overall mortality was 16.4%. Acute respiratory failure was the reason for intensive care unit admission in almost half of our renal transplant recipients. Main causes of acute respiratory failure were bacterial pneumonia and cardiogenic pulmonary edema. Mortality of patients admitted for acute respiratory failure was similar to those without acute respiratory failure.
Gastelum, Zachary N; Biggs, Diana M; Scott, Aaron
This case report describes a 54-year-old, asymptomatic man who presented with hyperkalemia on routine lab testing who was later found to have acute renal failure, unresponsive to fluid resuscitation, with minimal improvement after hemodialysis. After a comprehensive evaluation ruled out common causes of acute renal failure, the patient underwent testing with a bone survey, urine protein electrophoresis (UPEP), serum protein electrophoresis (SPEP), and immunoelectrophoresis for suspected plasma cell dyscrasia and received plasmapheresis for hyperviscosity syndrome and nephrotoxicity, which resulted in improved renal function. Lab results showed monoclonal gammopathy, elevated serum free light chains, and Bence Jones protein in the urine with a follow-up bone marrow biopsy indicating plasma cell dyscrasia. The patient received a diagnosis of multiple myeloma (MM) and was started on chemotherapy and immunosuppression. In patients presenting with acute renal failure with an evaluation ruling out prerenal and postrenal causes, multiple myeloma should be considered.
Nawrocki, Pawel; Szwedo, Ireneusz; Tyc, Joanna; Hawrysz, Anna; Janiak, Kamila; Cichoń, Romuald
Acute renal failure (ARF) is a rare (2-15%), but severe complication of cardiac surgery with overall mortality reaching 40-80%. In order to save patients' lives they are treated with renal replacement therapy (RRT). The aim of our study was to assess the impact of different perioperative factors on mortality among patients treated with RRT because of acute renal failure, which occurred as a complication of a heart surgery. Retrospective analysis included 45 patients, operated in the years 2009-2013, who underwent renal replacement therapy in order to treat postoperative ARF. The perioperative factors were analysed in two groups: group 1 - patients who died before discharge; and group 2 - those who survived until hospital discharge. Forty-five of 3509 cardiac surgical patients (1.25%) required RRT after the surgery. A total of 23 (51.11%) died before discharge (group 1). Patients in group 1 were characterised by older age (70.21 vs. 67 years), higher mean EuroSCORE value (9.28 vs. 7.15) (p < 0.05), higher percentage of concomitant surgery (63.63% vs. 28.57%) (p < 0.05) and of admission of catecholamines in the postoperative period (100% vs. 68.42%) (p < 0.005), and higher mean urea blood level prior to RRT initiation (156.65 vs. 102.54 mg/dl) (p < 0.05). The statistically relevant death predictors proved to be: high EuroSCORE, concomitant surgery, and high urea level at RRT initiation and admission of catecholamines in the postoperative period. After conformation in further studies, those factors may prove useful in stratification of death risk among surgical patients requiring RRT.
Hinojosa, Fabiola Quinteros; Revelo, Margarita; Salazar, Alexander; Maggi, Genaro; Schiraldi, Renato; Brogly, Nicolas; Gilsanz, Fernando
Inotropic drugs are part of the treatment of heart failure; however, inotropic treatment has been largely debated due to the increased incidence of adverse effects and increased mortality. Recently levosimendan, an inotropic positive agent, has been proved to be effective in acute heart failure, reducing the mortality and improving cardiac and renal performance. We report the case of a 75-year-old woman with history of heart and renal failure and hip fracture. Levosimendan was used in preoperative preparation as an adjuvant therapy, to improve cardiac and renal function and to allow surgery. Copyright © 2014 Sociedade Brasileira de Anestesiologia. Publicado por Elsevier Editora Ltda. All rights reserved.
Hinojosa, Fabiola Quinteros; Revelo, Margarita; Salazar, Alexander; Maggi, Genaro; Schiraldi, Renato; Brogly, Nicolas; Gilsanz, Fernando
Inotropic drugs are part of the treatment of heart failure; however, inotropic treatment has been largely debated due to the increased incidence of adverse effects and increased mortality. Recently levosimendan, an inotropic positive agent, has been proved to be effective in acute heart failure, reducing the mortality and improving cardiac and renal performance. We report the case of a 75-year-old woman with history of heart and renal failure and hip fracture. Levosimendan was used in preoperative preparation as an adjuvant therapy, to improve cardiac and renal function and to allow surgery. Copyright © 2014 Sociedade Brasileira de Anestesiologia. Published by Elsevier Editora Ltda. All rights reserved.
Full Text Available Background: The incidence of acute renal failure (ARF in the hospital setting is increasing. It portends excessive morbidity and mortality and a considerable burden on hospital resources. Extracorporeal therapies show promise in the management of patients with shock and ARF. It is said that the potential of such therapy goes beyond just providing renal support. The aim of our study was to analyze the clinical setting and outcomes of critically ill ARF patients managed with continuous renal replacement therapy (CRRT. Patients and Methods: Ours was a retrospective study of 50 patients treated between January 2004 and November 2005. These 50 patients were in clinical shock and had concomitant ARF. All of these patients underwent CVVHDF (continuous veno-venous hemodiafiltration in the intensive care unit. For the purpose of this study, shock was defined as systolic BP < 100 mm Hg in spite of administration of one or more inotropic agents. SOFA (Sequential Organ Failure Assessment score before initiation of dialysis support was recorded in all cases. CVVHDF was performed using the Diapact ® (Braun CRRT machine. The vascular access used was as follows: femoral in 32, internal jugular in 8, arteriovenous fistula (AVF in 4, and subclavian in 6 patients. We used 0.9% or 0.45% (half-normal saline as a prefilter replacement, with addition of 10% calcium gluconate, magnesium sulphate, sodium bicarbonate, and potassium chloride in separate units, while maintaining careful monitoring of electrolytes. Anticoagulation of the extracorporeal circuit was achieved with systemic heparin in 26 patients; frequent saline flushes were used in the other 24 patients. Results: Of the 50 patients studied, 29 were males and 21 females (1.4:1. The average age was 52.88 years (range: 20-75 years. Causes of ARF included sepsis in 24 (48%, hemodynamically mediated renal failure (HMRF in 18 (36%, and acute over chronic kidney disease in 8 (16% patients. The overall mortality was
Patel, R.; Mishkin, F.S.
Technetium-99m pyrophosphate (Tc-PYP) imaging was performed in five patients with acute renal failure associated with nontraumatic rhabdomyolysis. Four patients had phencyclidine intoxication and one had viral pneumonia. During the acute phase, marked uptake of pyrophosphate was seen in all patients in several muscle groups, but always in the thigh adductors. The results show that phencyclidine intoxication can result in diffuse muscle uptake of Tc-PYP without overt evidence of muscle injury. Tc-PYP imaging may provide a clue to the cause of acute renal failure in patients with suspected rhabdomyolysis in whom elevations of serum creatine phosphokinase concentrations are equivocal.
Patel, R.; Mishkin, F.S.
Technetium-99m pyrophosphate (Tc-PYP) imaging was performed in five patients with acute renal failure associated with nontraumatic rhabdomyolysis. Four patients had phencyclidine intoxication and one had viral pneumonia. During the acute phase, marked uptake of pyrophosphate was seen in all patients in several muscle groups, but always in the thigh adductors. The results show that phencyclidine intoxication can result in diffuse muscle uptake of Tc-PYP without overt evidence of muscle injury. Tc-PYP imaging may provide a clue to the cause of acute renal failure in patients with suspected rhabdomyolysis in whom elevations of serum creatine phosphokinase concentrations are equivocal
The case of a middle aged(39 years) man admitted with severe malaria in the male ward of the Federal Medical Centre, Owerri, Imo State, Nigeria is reported. The infecting species was Plasmodium falciparum and the patient was febrile, developed acute renal failure, severe thrombocytopenia and hepatic failure. Treatment ...
Deep, Akash; Stewart, Claire E; Dhawan, Anil; Douiri, Abdel
To establish the effect of continuous renal replacement therapy on outcome in pediatric acute liver failure. Retrospective cohort study. Sixteen-bed PICU in a university-affiliated tertiary care hospital and specialist liver centre. All children (0-18 yr) admitted to PICU with pediatric acute liver failure between January 2003 and December 2013. Children with pediatric acute liver failure were managed according to a set protocol. The guidelines for continuous renal replacement therapy in pediatric acute liver failure were changed in 2011 following preliminary results to indicate the earlier use of continuous renal replacement therapy for both renal dysfunction and detoxification. Of 165 children admitted with pediatric acute liver failure, 136 met the inclusion criteria and 45 of these received continuous renal replacement therapy prior to transplantation or recovery. Of the children managed with continuous renal replacement therapy, 26 (58%) survived: 19 were successfully bridged to liver transplantation and 7 spontaneously recovered. Cox proportional hazards regression model clearly showed reducing hyperammonemia by 48 hours after initiating continuous renal replacement therapy significantly improved survival (HR, 1.04; 95% CI, 1.013-1.073; p = 0.004). On average, for every 10% decrease in ammonia from baseline at 48 hours, the likelihood of survival increased by 50%. Time to initiate continuous renal replacement therapy from PICU admission was lower in survivors compared to nonsurvivors (HR, 0.96; 95% CI, 0.916-1.007; p = 0.095). Change in practice to initiate early and high-dose continuous renal replacement therapy led to increased survival with maximum effect being visible in the first 14 days (HR, 3; 95% CI, 1.0-10.3; p = 0.063). Among children with pediatric acute liver failure who did not receive a liver transplant, use of continuous renal replacement therapy significantly improved survival (HR, 4; 95% CI, 1.5-11.6; p = 0.006). Continuous renal replacement
Berra, Gregory; Garin, Nicolas; Stirnemann, Jérôme; Jannot, Anne-Sophie; Martin, Pierre-Yves; Perrier, Arnaud; Carballo, Sebastian
The prognostic value of worsening renal function (WRF) in acute heart failure is debated. Moreover, it is not clear if the use of angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin receptor blockers (ARBs) in this context is detrimental. In a retrospective cohort study of 646 patients hospitalized for acute heart failure, the risk of death or readmission associated with acute kidney injury (AKI) present at admission, WRF during the 1st 7 days, and up-titration of ACEI/ARB were analyzed in a Cox proportional hazards model. AKI, WRF, hemoglobin concentration, ACEI/ARB up-titration, and use of loop diuretics before admission were significantly associated with the primary outcome in univariate analysis. In a multivariate model, the association remained significant for AKI (hazard ratio [HR] 1.29, 95% confidence interval [CI] 1.13-1.47; P = .0002), WRF (HR 1.24, 95% CI 1.06-1.45; P = .0059), and ACEI/ARB up-titration (HR 0.79, 95% CI 0.64-0.97; P = .026). There was no excess mortality in patients with ACEI/ARB up-titration despite WRF. Both AKI and WRF are strongly associated with poor outcome in patients hospitalized for acute heart failure. ACEI/ARB up-titration seems to be protective. Copyright © 2015 Elsevier Inc. All rights reserved.
Maekawa, Michitaka; Imaizumi, Takahiro; Yamakawa, Taishi; Ito, Yasuhiko
A 26-year-old Japanese man without hypouricemia and with 3 previous episodes of seizures concurrent with acute kidney injury (AKI) was admitted due to an epileptic seizure, lower back pain and AKI. His creatinine kinase levels were slightly elevated. Patchy renal ischemia on contrast-enhanced computed tomography and persistent residual contrast medium was observed, consistent with acute renal failure with severe loin pain and patchy renal ischemia after anaerobic exercise (ALPE). Diffusion-weighted imaging (DWI) demonstrated signal changes in the corresponding area. ALPE should be considered a cause of AKI following seizures. We recommend DWI as an alternative diagnostic modality.
Full Text Available Glutaric Aciduria type I (GA-I is a rare organic acidemia, caused by mutations in the GCDH gene, and characterized by encephalopathic crises with neurological sequelae. We report herein a patient with GA-I who presented with severe acute renal failure requiring dialysis, following an acute diarrheal illness. Histopathological evaluation demonstrated acute tubular necrosis, and molecular diagnosis revealed the patient to be homozygous for a previously unreported mutation, p.E64D. As renal impairment is not part of the clinical spectrum typical to GA-I, possible associations of renal failure and the underlying inborn error of metabolism are discussed, including recent advancements made in the understanding of the renal transport of glutaric acid and its derivatives during metabolic disturbance in GA-I.
Oe, Shinji; Shibata, Michihiko; Miyagawa, Koichiro; Honma, Yuichi; Hiura, Masaaki; Abe, Shintaro; Harada, Masaru
A 58-year-old man was admitted to our hospital. Laboratory data showed severe liver injury and that the patient was positive for immunoglobulin M anti-hepatitis A virus (HAV) antibodies. He was also complicated with severe renal dysfunction and had an extremely high level of serum hepatocyte growth factor (HGF). Therefore, he was diagnosed with severe acute liver failure with acute renal failure (ARF) caused by HAV infection. Prognosis was expected to be poor because of complications by ARF and high serum HGF. However, liver and renal functions both improved rapidly without intensive treatment, and he was subsequently discharged from our hospital on the 21(st) hospital day. Although complication with ARF and high levels of serum HGF are both important factors predicting poor prognosis in acute liver failure patients, the present case achieved a favorable outcome. Endogenous HGF might play an important role as a regenerative effector in injured livers and kidneys.
Full Text Available Objective. To determine whether the inferior vena cava (IVC measurement by bedside ultrasound (US-IVC predicts improvement in renal function in patients with acute kidney injury (AKI. Design. Prospective observational study. Setting. Medical intensive care unit. Patients. 33 patients with AKI were included. Intervention. US-IVC was done on admission. The patients’ management was done by the primary teams, who were unaware of the US-IVC findings. Two groups of patients were identified. Group 1 included patients who were managed in concordance with their US-IVC (potential volume responders who had a positive fluid balance at 48 h after admission and potential volume nonresponders who had an even or negative fluid balance at 48 hours after admission. Group 2 included patients in whom the fluid management was discordant with their US-IVC. Measurements and Main Results. At 48 hours, Group 1 patients had a greater improvement in creatinine [85% versus 31%, p=0.0002], creatinine clearance (78±93% versus 8±64%, p=0.002, and urine output (0.86±0.54 versus 0.45±0.36 ml/Kg/h, p=0.03. Conclusion. In critically ill patients with AKI, concurrence of fluid therapy with IVC predicted fluid management, as assessed by bedside ultrasound, was associated with improved renal function at 48 hours. This trial is registered with ClinicalTrials.gov registration number: NCT02064244.
Medha; Subramanian, Arulselvi; Pandey, Ravindra Mohan; Sawhney, Chhavi; Upadhayay, Ashish Dutt; Albert, Venencia
Context: There is a need for identifying risk factors aggravating development of acute renal failure after attaining trauma and defining new parameters for better assessment and management. Aim of the study was to determine the incidence of acute renal failure among trauma patients, and its correlation with various laboratory and clinical parameters recorded at the time of admission and in-hospital mortality. Subjects and Methods: The retrospective cohort study included admitted 208 trauma patients over a period of one year. 135 trauma patients at the serum creatinine level >2.0 mg/dL were enrolled in under the group of acute renal failure. 73 patients who had normal creatinine level made the control group. They were further assessed with clinical details and laboratory investigations. Results: Incidence of acute renal failure was 3.1%. There were 118 (87.4%) males and average length of stay was 9 (1, 83) days. Severity of injury (ISS, GCS) was relatively more among the renal failure group. Renal failure was transient in 35 (25.9%) patients. They had higher incidence of bone fracture (54.0%) (P= 0.04). Statistically significant association was observed between patients with head trauma and mortality 72 (59.0%) (P= 0.001). Prevalence of septic 24 (59.7%) and hemorrhagic 9 (7.4%) shock affected the renal failure group. Conclusion: Trauma patients at the urea level >50 mg/dL, ISS >24 on the first day of admission had 23 times and 7 times the risk of developing renal failure. Similarly, patients with hepatic dysfunction and pulmonary dysfunction were 12 times and 6 times. Patients who developed cardiovascular dysfunction, hematological dysfunction and post-trauma renal failure during the hospital stay had risk for mortality 29, 7 and 8 times, respectively. The final prognostic score obtained was: 14*hepatic dysfunction + 11*cISS + 18*cUrea + 12*cGlucose + 10*pulmonary dysfunction. Optimal score cut-off for prediction of renal failure was found to be ≥25 with
Medha; Subramanian, Arulselvi; Pandey, Ravindra Mohan; Sawhney, Chhavi; Upadhayay, Ashish Dutt; Albert, Venencia
There is a need for identifying risk factors aggravating development of acute renal failure after attaining trauma and defining new parameters for better assessment and management. Aim of the study was to determine the incidence of acute renal failure among trauma patients, and its correlation with various laboratory and clinical parameters recorded at the time of admission and in-hospital mortality. The retrospective cohort study included admitted 208 trauma patients over a period of one year. 135 trauma patients at the serum creatinine level >2.0 mg/dL were enrolled in under the group of acute renal failure. 73 patients who had normal creatinine level made the control group. They were further assessed with clinical details and laboratory investigations. Incidence of acute renal failure was 3.1%. There were 118 (87.4%) males and average length of stay was 9 (1, 83) days. Severity of injury (ISS, GCS) was relatively more among the renal failure group. Renal failure was transient in 35 (25.9%) patients. They had higher incidence of bone fracture (54.0%) (P= 0.04). Statistically significant association was observed between patients with head trauma and mortality 72 (59.0%) (P= 0.001). Prevalence of septic 24 (59.7%) and hemorrhagic 9 (7.4%) shock affected the renal failure group. Trauma patients at the urea level >50 mg/dL, ISS >24 on the first day of admission had 23 times and 7 times the risk of developing renal failure. Similarly, patients with hepatic dysfunction and pulmonary dysfunction were 12 times and 6 times. Patients who developed cardiovascular dysfunction, hematological dysfunction and post-trauma renal failure during the hospital stay had risk for mortality 29, 7 and 8 times, respectively. The final prognostic score obtained was: 14*hepatic dysfunction + 11*cISS + 18*cUrea + 12*cGlucose + 10*pulmonary dysfunction. Optimal score cut-off for prediction of renal failure was found to be ≥25 with specificity, sensitivity and positive likelihood ratio to be
Full Text Available Context: There is a need for identifying risk factors aggravating development of acute renal failure after attaining trauma and defining new parameters for better assessment and management. Aim of the study was to determine the incidence of acute renal failure among trauma patients, and its correlation with various laboratory and clinical parameters recorded at the time of admission and in-hospital mortality. Subjects and Methods: The retrospective cohort study included admitted 208 trauma patients over a period of one year. 135 trauma patients at the serum creatinine level >2.0 mg/dL were enrolled in under the group of acute renal failure. 73 patients who had normal creatinine level made the control group. They were further assessed with clinical details and laboratory investigations. Results: Incidence of acute renal failure was 3.1%. There were 118 (87.4% males and average length of stay was 9 (1, 83 days. Severity of injury (ISS, GCS was relatively more among the renal failure group. Renal failure was transient in 35 (25.9% patients. They had higher incidence of bone fracture (54.0% (P = 0.04. Statistically significant association was observed between patients with head trauma and mortality 72 (59.0% (P = 0.001. Prevalence of septic 24 (59.7% and hemorrhagic 9 (7.4% shock affected the renal failure group. Conclusion: Trauma patients at the urea level >50 mg/dL, ISS >24 on the first day of admission had 23 times and 7 times the risk of developing renal failure. Similarly, patients with hepatic dysfunction and pulmonary dysfunction were 12 times and 6 times. Patients who developed cardiovascular dysfunction, hematological dysfunction and post-trauma renal failure during the hospital stay had risk for mortality 29, 7 and 8 times, respectively. The final prognostic score obtained was: 14FNx01hepatic dysfunction + 11FNx01cISS + 18FNx01cUrea + 12FNx01cGlucose + 10FNx01pulmonary dysfunction. Optimal score cut-off for prediction of renal failure was
Joy, Kerry; Dubois, Sacha; Gibbons, Carrie; Hargadon, John; Bédard, Michel
Aggrenox is used in the secondary prevention of stroke. Acute renal failure, potentially associated with Aggrenox, has been observed in several patients. The objective of this study was to determine if Aggrenox was associated with acute renal failure and to determine whether it was acetylsalicylic acid, dipyridamole or the combination that led to decline in renal function. A case series of three patients suffering severe nausea, vomiting, diarrhea, renal dysfunction and clinical decline during Aggrenox therapy was examined. Serum creatinine and Blood Urea Nitrogen (BUN) were measured to evaluate renal function. Analysis of this patient group revealed that Patient 1 experienced nausea, emesis, anorexia, diarrhea and significant clinical decline during treatment with Aggrenox. Patients 2 and 3 also presented with complaints of nausea and emesis. Lab measurements along with clinical symptoms indicated that all three patients experienced acute renal failure, having increases in serum creatinine of 186%, 144% and 249%, respectively. Symptoms and lab work returned to baseline following discontinuation of Aggrenox. It is biologically plausible that Aggrenox may contribute to renal dysfunction in patients under certain pathophysiological circumstances.
Ozkan, Seda; Durukan, Polat; Kavalci, Cemil; Duman, Ali; Sayhan, Mustafa Burak; Salt, Omer; Ipekci, Afsin
Neutrophil Gelatinase-associated Lipocalin (NGAL) protein is easily detected in the blood and urine soon after acute renal injury. NGAL gains features of an early, sensitive and noninvasive biomarker for acute renal injury. Recent evidences suggest that its expression is also increased in CRF reflecting the severity of disease. In the present study, we aimed to investigate whether blood NGAL level plays a role in the differential diagnosis of acute and chronic renal failure. This was a prospective case-control study. Fifty patients presented to emergency department with acute renal failure (ARF), 30 with chronic renal failure (CRF) and 20 healthy individuals as control group were included in this study. Blood pH, HCO3(-), BUN, creatinine and potassium values were evaluated in all patients. Blood NGAL values were evaluated in all groups. BUN, serum creatinine and NGAL values were statistically compared between patients and controls. Median NGAL levels in patients was 304.50 (29), and 60 (0) in control, which was statistically significant between the two groups (Z = -6.477, P 0.05). Median creatinine values were 2.84 ± 2.95 in ARF group and 4.78 ± 4.32 in CRF group. In serum creatinine values, a significant difference was found between ARF and CRF groups (P renal injury and differentiate ARF and CRF.
Sisillo, Erminio; Ceriani, Roberto; Bortone, Franco; Juliano, Glauco; Salvi, Luca; Veglia, Fabrizio; Fiorentini, Cesare; Marenzi, Giancarlo
To assess the preventive effect of the antioxidant N-acetylcysteine on postoperative acute renal failure in patients with renal insufficiency undergoing cardiac surgery. Randomized, placebo-controlled, prospective study. University cardiology center. Two hundred fifty-four consecutive patients with chronic renal insufficiency (estimated creatinine clearance acute renal failure (> 25% increase in serum creatinine from baseline) and the in-hospital clinical course were evaluated. Acute renal failure occurred in 46% of patients and was associated with increased in-hospital mortality (7% vs. 0.7%; p = .024). It occurred in 52% of control patients and 40% of N-acetylcysteine-treated patients (p = .06). In-hospital mortality and need for renal replacement therapy were not affected by N-acetylcysteine, but a lower percentage of N-acetylcysteine-treated patients required mechanical ventilation prolonged for > 48 hrs (3% vs. 18%; p 4 days (13% vs. 33%; p acute renal failure in patients with renal insufficiency undergoing cardiac surgery.
Kirchmair, Martin; Carrilho, Patrícia; Pfab, Rudi; Haberl, Bettina; Felgueiras, Joana; Carvalho, Fernanda; Cardoso, José; Melo, Ireneia; Vinhas, José; Neuhauser, Sigrid
Renal failure as a consequence of eating mushrooms has been reported repeatedly after ingestion of webcaps of the Cortinarius orellanus group. But mushrooms of the genus Amanita can also cause renal failure: Amanita smithiana (North America) and Amanita proxima (Mediterranean area). Here, we discuss poisonings caused by other white amanitas. A German and--independently--two Portuguese patients reported the ingestion of completely white mushrooms with ring. Similar to intoxications with A. smithiana or A. proxima, the clinical picture was characterized by nausea and vomiting 10-12 h after ingestion, severe acute renal failure and mild hepatitis. Renal biopsy showed acute interstitial nephritis and tubular necrosis. Two patients were given temporary haemodialysis. All have fully recovered their renal function. Poisonings caused by mushrooms containing the toxin of A. smithiana were suspected. We tested 20 Amanita species for the presence of this toxin. Thin layer chromatography was applied to detect A. smithiana nephrotoxin in herbarium specimens using authentic material of A. smithiana as reference. A. smithiana toxin could be detected in Amanita boudieri, Amanita gracilior and in Amanita echinocephala. A. boudieri was collected by the Portuguese patients. A. echinocephala is the only nephrotoxic Amanita growing North of the Alps and is suspected to be the cause of renal failure in the German patient. No A. smithiana toxin was detectable in the nephrotoxic A. proxima. A. boudieri, A. gracilior and A. echinocephala are nephrotoxic. These intoxications are clinically similar to that of A. smithiana, with acute reversible renal failure and mild hepatitis but are different in their clinical picture from Orellanus syndrome characterized by a delayed onset of severe and often irreversible renal failure.
Arup K Misra
Full Text Available Acute renal failure is a life threatening condition. Nonsteroidal antiinflammatory drugs (NSAIDs and cephalosporins are widely used postoperative drugs. NSAID-induced acute renal failure has been reported in the past. In this case, drug interaction and decompensated state of the patient precipitate the condition. NSAIDs inhibit prostaglandins synthesis and thus aggravate ischemia to the kidney that is already facing volume crisis due to surgery. Due to renal dysfunction, plasma ceftriaxone level increases due to decrease clearance and it also acts as nephrotoxic by unknown mechanism. On the other hand, ceftriaxone on its interaction with diclofenac for renal tubular clearance also increases the level of diclofenac and thus further aggravate the ischemia. It is a reversible condition with excluding diclofenac from the treatment regimen and giving adequate hydration to the patient. This highlights the importance of hydration and knowledge of drugs interactions in a postsurgical patient.
Seibert, Felix S; Rosenberger, Christian; Mathia, Susanne; Arndt, Robert; Arns, Wolfgang; Andrea, Huppertz; Pagonas, Nikolaos; Bauer, Frederic; Zidek, Walter; Westhoff, Timm H
Urinary calprotectin has recently been identified as a promising biomarker for the differentiation between prerenal and intrinsic acute kidney injury (AKI) in the nontransplant population. The present study investigates whether calprotectin is able to differentiate between these 2 entities in transplant recipients as well. Urinary calprotectin was assessed by enzyme-linked immunosorbent assay in 328 subjects including 125 cases of intrinsic acute allograft failure, 27 prerenal graft failures, 118 patients with stable graft function, and 58 healthy controls. Acute graft failure was defined as AKI stages 1 to 3 (Acute Kidney Injury Network criteria), exclusion criteria were obstructive uropathy, urothelial carcinoma, and metastatic cancer. The clinical differentiation of prerenal and intrinsic graft failure was performed either by biopsy or by a clinical algorithm including response to fluid repletion, history, physical examination, and urine dipstick examination. Reasons for intrinsic graft failure comprised rejection, acute tubular necrosis, urinary tract infection/pyelonephritis, viral nephritis, and interstitial nephritis. Calprotectin concentrations of patients with stable graft function (50.4 ng/mL) were comparable to healthy controls (54.8 ng/mL, P = 0.70) and prerenal graft failure (53.8 ng/mL, P = 0.62). Median urinary calprotectin was 36 times higher in intrinsic AKI (1955 ng/mL) than in prerenal AKI (P renal allograft biopsy specimens confirmed the serological results. Urinary calprotectin is a promising biomarker for the differentiation of prerenal and intrinsic acute renal allograft failure.
Wehbe, Edgard; Patarroyo, Maria; Taliercio, Jonathan J; Starling, Randall C; Nally, Joseph V; Tang, W H Wilson; Demirjian, Sevag
Recent reports have raised concerns regarding renal outcomes in patients with decompensated acute heart failure (HF) treated with slow continuous ultrafiltration (SCUF). The purpose of this study was to identify risk factors for renal failure (RF) requiring dialysis in patients with acute HF initiated on SCUF. We studied 63 consecutive patients with acute HF who required SCUF because of congestion refractory to hemodynamically guided intensive medical therapy. Median serum creatinine at SCUF initiation was higher in patients who developed RF requiring dialysis [2.5 (interquartile range 1.8-3.3) vs 1.6 (1.2-2.3) mg/dL; P acute HF initiated on SCUF, onset of RF requiring dialysis is associated with high mortality. Systolic perfusion pressure which incorporates both perfusion and venous congestion parameters may present a modifiable risk factor for worsening RF during SCUF in acute HF patients. Copyright © 2015 Elsevier Inc. All rights reserved.
Li, Lu-Ping; Fan, Ying-Zhong; Zhang, Qian; Zhang, Sheng-Li
To analyze the treatment of acute renal failure caused by irrational drug use. Data of 41 cases of acute renal failure seen from July 2008 to June 2012 in our hospital were reviewed. Bilateral renal parenchymas diffuse echo was found enhanced by ultrasound in all cases. Calculus image was not found by X-ray. All children had medical history of using cephalosporins or others. Alkalinization of urine and antispasmodic treatment were given to all children immediately, 17 children were treated with hemodialysis and 4 children accepted intraureteral cannula placement. In 24 children who accepted alkalinization of urine and antispasmodic treatment micturition could be restored within 24 hours, in 11 children micturition recovered after only one hemodialysis treatment and 2 children gradually restored micturition after hemodialysis twice, 4 children who accepted intraureteral cannula immediately restored micturition. In all children micturition recovered gradually after a week of treatment. Ultrasound examination showed that 39 children's calculus disappeared totally and renal parenchymas echo recovered to normal. The residual calculi with diameter less than 5 mm were found in 2 children, but they had no symptoms. The children received potassium sodium hydrogen citrate granules per os and were discharged from hospital. Ultrasound showed calculus disappeared totally one month later. Irrational drug use can cause children urolithiasis combined with acute renal failure, while renal dysfunction can reverse by drug withdrawal and early alkalinization of urine, antispasmodic treatment, intraureteral cannula or hemodialysis when necessary, most calculus can be expelled after micturition recovered to normal.
Cappi, Sylas B; Sakr, Yasser; Vincent, Jean-Louis
The aim of this study was to assess changes in organ function in acute renal failure patients during renal replacement therapy and relate them to outcome. Medical and nursing charts from 111 patients with acute renal failure who underwent renal replacement therapy (hemodialysis or hemofiltration) from July 2000 until July 2002 on a 31-bed medicosurgical intensive care unit (ICU) at a university hospital in Belgium and in whom the Sequential Organ Failure Assessment (SOFA) score was calculated daily before the start of therapy until the seventh day, or the end of therapy, were analyzed. Changes in SOFA score over time (Delta SOFA) were calculated. Of 111 patients, 63 (57%) died in the ICU. Nonsurvivors were older (68 [52-76] vs 59 [48-70] years, P = .017) and had initially higher respiratory, cardiovascular, and total SOFA scores compared with survivors. A greater Delta renal SOFA at 24 hours was associated univariantly with a higher risk of ICU mortality (odds ratio, 1.7; 95% confidence interval, 1.2-2.6; P = .013). In a multivariate analysis with ICU outcome as the dependent variable, only age, cardiovascular SOFA score on admission, and the change in total SOFA score over the first 24 hours were independently associated with a greater risk of death. Assessment of these factors in the first 24 hours of renal replacement therapy could help identify patients at higher risk of mortality early during their ICU admission.
Oliveira, Laura C.; Zamboni, Cibele B.; Pessoal, Edson A.; Borges, Fernanda T.
Neutron Activation Analysis (NAA) technique has been used to determine elements concentrations in urine of rats Wistar (control group) and rats Wistar with Acute Renal Failure (ARF). These data contribute for applications in health area related to biochemical analyses using urine to monitor the dialyze treatment.
Background. We aimed to determine the outcome and certain predictors of outcome for acute renal failure (ARF) in the medical intensive care unit (ICU) at Tygerberg Hospital. Method. We conducted a retrospective, single-centre cohort study over 12 months comprising all patients admitted to the medical ICU with all causes ...
Scherpbier-de Haan, N.D.; Grauw, W.J.C. de; Wetzels, J.F.M.; Vervoort, G.M.M.
Two men (61 and 81 years old) with mild impaired kidney function developed acute renal failure due to dehydration combined with the use of inhibitors of the renin-angiotensin-aldosterone system (RAAS). After rehydration, correction of hyperkalaemia and stopping RAAS-inhibition and diuretics, they
Uchino, Shigehiko; Kellum, John A.; Bellomo, Rinaldo; Doig, Gordon S.; Morimatsu, Hiroshi; Morgera, Stanislao; Schetz, Miet; Tan, Ian; Bouman, Catherine; Macedo, Ettiene; Gibney, Noel; Tolwani, Ashita; Ronco, Claudio
Although acute renal failure (ARF) is believed to be common in the setting of critical illness and is associated with a high risk of death, little is known about its epidemiology and outcome or how these vary in different regions of the world. To determine the period prevalence of ARF in intensive
Uchino, Shigehiko; Bellomo, Rinaldo; Morimatsu, Hiroshi; Morgera, Stanislao; Schetz, Miet; Tan, Ian; Bouman, Catherine; Macedo, Ettiene; Gibney, Noel; Tolwani, Ashita; Doig, Gordon S.; Oudemans van Straaten, Heleen; Ronco, Claudio; Kellum, John A.
Several different severity scoring systems specific to acute renal failure have been proposed. However, most validation studies of these scoring systems were conducted in a single center or in a small number of centers, often the same ones used for their development. Therefore, it is not known
Vancomycin-induced nephrotoxicity is a commonly feared and largely preventable adverse effect of vancomycin therapy. We present the case of a 56-year-old woman who developed acute renal failure requiring hemodialysis as a result of unmonitored vancomycin infusions for the treatment of osteomyelitis.
Bocca, G.; Moorselaar, R.J.A. van; Feitz, W.F.J.; Staak, F.H.J.M. van der; Monnens, L.A.H.
Compartment syndrome, rhabdomyolysis and the risk of acute renal failure are potential complications of the lithotomy position. A six-year-old girl is described who developed a compartment syndrome with rhabdomyolysis after prolonged surgery in the lithotomy position. This complication occurred
Krishnamoorthy, Arun; Greiner, Melissa A; Sharma, Puza P; DeVore, Adam D; Johnson, Katherine Waltman; Fonarow, Gregg C; Curtis, Lesley H; Hernandez, Adrian F
Transient and persistent worsening renal function (WRF) may be associated with different risks during hospitalization for acute heart failure. We compared outcomes of patients hospitalized for acute heart failure with transient, persistent, or no WRF. We identified patients 65 years or older hospitalized with acute heart failure from a clinical registry linked to Medicare claims data. We defined WRF as an increase in serum creatinine of ≥ 0.3 mg/dL after admission. We further classified patients with WRF by the difference between admission and last recorded serum creatinine levels into transient WRF (acute heart failure were associated with higher adjusted risks for 90-day all-cause postadmission mortality. Patients with persistent WRF had worse outcomes. Copyright © 2014 Elsevier Inc. All rights reserved.
Dimopoulos, Meletios A; Terpos, Evangelos
Renal impairment is a common complication of multiple myeloma. Chronic renal failure is classified according to glomerular filtration rate as estimated by the MDRD (modification of diet in renal disease) formula, while RIFLE (risk, injury, failure, loss and end-stage renal disease) and AKIN (acute renal injury network) criteria may be used for the definition of the severity of acute renal injury. Novel criteria based on estimated glomerular filtration rate measurements are proposed for the definition of the reversibility of renal impairment. Renal complete response (CRrenal) is defined as sustained (i.e., lasting at least 2 months) improvement of creatinine clearance (CRCL) from under 50 mL/min at baseline to 60 mL/min or above. Renal partial response (PRrenal) is defined as sustained improvement of CRCL from under 15 mL/min at baseline to 30 to 59 mL/min. Renal minor response (MRrenal) is defined as sustained improvement of the baseline CRCL of under 15 mL/min to 15 to 29 mL/min or, if baseline CRCL was 15 to 29 mL/min, improvement to 30 to 59 mL/min. Bortezomib with high-dose dexamethasone is considered the treatment of choice for myeloma patients with renal impairment and improves renal function in most patients. Although there is limited experience with thalidomide, this agent can be administered at the standard dosage to patients with renal failure. Lenalidomide, when administered at reduced doses according to renal function, is effective and can reverse renal impairment in a subset of myeloma patients.
Full Text Available Tetanus is an acute often fatal disease produced by the Gram-positive, obligate anaerobic bacterium Clostridium tetani. Prolonged intensive care is required in severe tetanus, with the associated complications including nosocomial sepsis. Autonomic dysfunction in severe tetanus is difficult to manage and is a significant cause of mortality. We present here, use of clonidine in a case of severe tetanus with acute renal failure who was successfully managed.
Ishikawa, Isao; Saito, Tadashi; Ishii, Hirofumi; Bansho, Junichi; Koyama, Yukinori; Tobita, Akira
Renal dynamic CT scanning is suitable for determining the excretion of contrast medium in the cortex and medulla of the kidney, which is valuable for understanding the pathogenesis of disease processes in various conditions. This form of scanning would be convenient for use, if a method of application to the rat kidney were available. Therefore, we developed a method of applying renal dynamic CT to rats and evaluated the cortical and medullary curves, e.g., the corticomedullary junction time which is correlated to creatinine clearance, in various rat models of acute renal failure. The rat was placed in a 10deg oblique position and a bilateral hilar slice was obtained before and 5, 10, 15, 20, 25, 30, 40, 50, 60, 80, 100, 120, 140, 160 and 180 sec after administering 0.5 ml of contrast medium using Somatom DR. The width of the slice was 4 mm and the scan time was 3 sec. The corticomedullary junction time in normal rats was 23.0±10.5 sec, the peak value of the cortical curve was 286.3±76.7 Hounsfield Unit (HU) and the peak value of the medullary curve was 390.1±66.2 HU. Corticomedullary junction time after exposure of the kidney was prolonged compared to that of the unexposed kidney. In rats with acute renal failure, the excretion pattern of contrast medium was similar in both the glycerol- and HgCl2-induced acute renal failure models. The peak values of the cortical curve were maintained three hours after a clamp was placed at the hilar region of the kidney for one hour, and the peak values of the medullary curve were maintained during the administration of 10μg/kg/min of angiotensin II. Dynamic CT curves in the acute renal failure models examined were slightly different from those in human acute renal failure. These results suggest that rats do not provide an ideal model for human acute renal failure. However, the application of dynamic CT to the rat kidney models was valuable for estimating the pathogenesis of various human kidney diseases. (author)
Gougol, Amir; Dugum, Mohannad; Dudekula, Anwar; Greer, Phil; Slivka, Adam; Whitcomb, David C; Yadav, Dhiraj; Papachristou, Georgios I
To assess differences in clinical outcomes of isolated renal failure (RF) compared to other forms of organ failure (OF) in patients with severe acute pancreatitis (SAP). Using a prospectively maintained database of patients with acute pancreatitis admitted to a tertiary medical center between 2003 and 2016, those with evidence of persistent OF were classified to renal, respiratory, cardiovascular, or multi-organ (2 or more organs). Data regarding demographics, comorbidities, etiology of acute pancreatitis, and clinical outcomes were prospectively recorded. Differences in clinical outcomes after development of isolated RF in comparison to other forms of OF were determined using independent t and Mann-Whitney U tests for continues variables, and χ 2 test for discrete variables. Among 500 patients with acute pancreatitis, 111 patients developed persistent OF: mean age was 54 years, and 75 (67.6%) were male. Forty-three patients had isolated OF: 17 (15.3%) renal, 25 (21.6%) respiratory, and 1 (0.9%) patient with cardiovascular failure. No differences in demographics, etiology of acute pancreatitis, systemic inflammatory response syndrome scores, or development of pancreatic necrosis were seen between patients with isolated RF vs isolated respiratory failure. Patients with isolated RF were less likely to require nutritional support (76.5% vs 96%, P = 0.001), ICU admission (58.8% vs 100%, P = 0.001), and had shorter mean ICU stay (2.4 d vs 15.7 d, P failure. None of the patients with isolated RF or isolated respiratory failure died. Among patients with SAP per the Revised Atlanta Classification, approximately 15% develop isolated RF. This subgroup seems to have a less protracted clinical course compared to other forms of OF. Isolated RF might be weighed less than isolated respiratory failure in risk predictive modeling of acute pancreatitis.
Zager, Richard A; Johnson, Ali C M; Frostad, Kirsten B
Tissue preconditioning, whereby various short-term stressors initiate organ resistance to subsequent injury, is well recognized. However, clinical preconditioning of the kidney for protection against acute kidney injury (AKI) has not been established. Here we tested whether a pro-oxidant agent, iron sucrose, combined with a protoporphyrin (Sn protoporphyrin), can induce preconditioning and protect against acute renal failure. Mice were pretreated with iron sucrose, protoporphyrin, cyanocobalamin, iron sucrose and protoporphyrin, or iron sucrose and cyanocobalamin. Eighteen hours later, ischemic, maleate, or glycerol models of AKI were induced, and its severity was assessed the following day (blood urea nitrogen, plasma creatinine concentrations; post-ischemic histology). Agent impact on cytoprotective gene expression (heme oxygenase 1, hepcidin, haptoglobin, hemopexin, α1-antitrypsin, α1-microglobulin, IL-10) was assessed as renal mRNA and protein levels. AKI-associated myocardial injury was gauged by plasma troponin I levels. Combination agent administration upregulated multiple cytoprotective genes and, unlike single agent administration, conferred marked protection against each tested model of acute renal failure. Heme oxygenase was shown to be a marked contributor to this cytoprotective effect. Preconditioning also blunted AKI-induced cardiac troponin release. Thus, iron sucrose and protoporphyrin administration can upregulate diverse cytoprotective genes and protect against acute renal failure. Associated cardiac protection implies potential relevance to both AKI and its associated adverse downstream effects. Copyright © 2016 International Society of Nephrology. Published by Elsevier Inc. All rights reserved.
Matsunaga, Hiroshi; Sando, Hiroyuki; Nunokawa, Tomoo; Murakami, Tooru; Miyakawa, Yuzo
Two cases of diabetes mellitus with renal and retinal involvement developed acute renal failure after undergoing head computerized tomography. The first case was a 62-year-old male who had been diagnosed as having diabetes 25 years before. He had diabetic retinopathy of Scott IIIb. Before head computerized tomography, the serum BUN was 37 mg/dl, and creatinine was 4.1 mg/dl. Oliguria began immediately after the scanning and confinued for 48 hr. The serum levels of BUN and creatinine rose to 106 and 7.7 mg/dl, respectively. Case 2 was a 49-year-old male who had been diagnosed as having diabetes 15 years before. He showed Scott IIb and IV retinopathy. The BUN and creatinine levels in the serum were 32 and 2.3 mg/dl, respectively. After receiving head computerized tomography, he developed oliguria and remained oliguric for 48 hr. During that period, the serum levels of BUN and creatinin were elevated to 112 and 7.5 mg/dl, respectively. Fortunately, both of these patients recovered from the oliguria without resorting to hemodialysis. The iodine contrast medium routinely used for contrast enhancement in the head computerized tomography was implicated in the acute renal failure of these patients. Only elevn cases have so far been reported in the literature who developed acute renal failure following computerized tomography. In view of the three or four times greater dosis of iodine contrast medium employed in computerized tomography compared to intravenous pyelography, the acute incidence of such complications might be much higher. Among the thirteen cases including the two reported here, as many as eight were diabetic. It is well recongnized that the incidence of acute renal failure after intravenous pyelography is particularly high in cases of diabetic nephropathy. (author)
McCullough, Peter A; Jefferies, John L
Acute kidney injury complicates decompensated heart failure in ∼33% of cases and is associated with morbidity and mortality; thus, we sought to systematically review this topic in order to summarize novel diagnostic and therapeutic approaches. Structured PubMed searches on these topics were conducted in February 2014 and relevant literature was identified. The PubMed search identified a total of 192 articles that were individually screened for inclusion in this analysis, and 58 were included. Acute kidney injury, defined by substantial increases in serum creatinine, is associated consistently with prolonged length of stay, rehospitalization, and mortality. Biomarker studies suggested that natriuretic peptides are prognostic for shorter- and longer-term mortality. Novel proteins indicating kidney damage and albumin in the urine are associated with acute kidney injury. The most promising acute pharmacologic treatment appears to be serelaxin, which has been shown to improve acute heart failure symptoms, hemodynamic parameters, and renal function. The presence of acute kidney injury results in worse clinical outcomes for patients with acute heart failure. Novel biomarkers and therapies hold the promise of improving both cardiac and renal outcomes in these patients. Copyright © 2015 Elsevier Inc. All rights reserved.
Full Text Available Renal zygomycosis, caused by invasive fungi, is a rare and potentially fatal infec-tion. The patient usually presents with non-specific symptoms and renal failure. A 34-year-old male non-diabetic and without any predisposing factors for systemic fungal infection presented to the emergency department with diffuse abdominal pain, high-grade fever and acute renal failure with a serum creatinine of 6.5. A computed tomography showed bilateral diffuse globular nephromegaly. A urine smear for fungal examination showed right angle branching hyphae and kidney biopsy showed fungal hyphae within the glomeruli, tubules and interstitium. Although radiological investigations can give us a clue, the definitive diagnosis can only be made by kidney biopsy. A high index of suspicion and timely diagnosis is important for a proper management.
Jang, Liuna; Herbort, Carl P
Management of diabetic retinopathy should follow more strict and aggressive rules in patients at risk for severe acute renal impairment. Such patients should be identified and possibly prophylactically laser treated to avoid the severe consequences demonstrated in this case report. A 34-year-old type 2 diabetes patient with a stabilized diabetic retinopathy developed acute and severe retinal decompensation within weeks after acute renal failure complicated his chronic stable renal impairment. Fluorescein angiographic and optical coherence tomographic illustrations of the rapid evolution of the retinal condition are presented. The patient had previously been treated with panretinal photocoagulation in his left eye. After 8 years of regular 6-monthly checked stability, he developed rapid-onset proliferative diabetic retinopathy and macular edema in his right eye within 3 months of his last ocular check-up. Fluorescein angiography showed neovessels and major ischemic areas. Emergency panretinal photocoagulation and a sub-Tenon's injection were necessary to achieve control of the situation with regression of neovessels and complete regression of macular edema. This case shows that it is imperative for nephrologists to be well informed about a patient's ocular situation in order to give timely information to the ophthalmologist who can intervene to protect the retina in case of renal failure. On the other hand, the ophthalmologist should be familiar with the renal function of his patient with renal impairment so that he can decide to perform prophylactic retinal panphotocoagulation that should be imperatively considered even without strict indications in patients with renal impairment at risk for further deterioration of renal function, in order to prevent such explosive ischemic and proliferative retinopathy putting vision at risk.
... Physician Resources Professions Site Index A-Z Kidney Failure Kidney failure, also known as renal failure, is ... is kidney failure treated? What is kidney (renal) failure? The kidneys are designed to maintain proper fluid ...
Pingili, Chandra Shekar; Okon, Emmanuel E
BACKGROUND Methicillin-resistant Staphylococcus aureus (MRSA) bacteremia and sepsis are commonly treated with intravenous vancomycin. However, vancomycin treatment is associated adverse reactions, including skin rashes and nephrotoxicity. We present a case of acute renal failure due to acute tubulointerstitial nephritis associated with a diffuse leukocytoclastic vasculitic skin eruption following intravenous vancomycin treatment. CASE REPORT A 79-year-old Caucasian male patient was treated with intravenous vancomycin for MRSA bacteremia. Prior to treatment, his creatinine was normal at 0.6 mg/dl. He presented one week later with shortness of breath, lower limb edema, and acute renal failure. He had a diffuse maculopapular rash involving the trunk and both upper and lower extremities. A renal biopsy and left arm skin biopsy were examined histologically. The skin biopsy showed leukocytoclastic vasculitis. Renal biopsy showed some sclerosed glomeruli, some with mesangial proliferation, and tubulointerstitial inflammation with eosinophils and plasma cells and mild interstitial fibrosis. Although there was some renal arteriolosclerosis, no vasculitic changes were seen, and no vascular thrombosis was present. A diagnosis of leukocytoclastic vasculitis and acute tubulointerstitial nephritis secondary to intravenous vancomycin therapy was made. CONCLUSIONS Although skin reactions associated with drug therapy are common, vancomycin-associated dermal vasculitis is rare. Tubulointerstitial nephritis is also a rare association with vancomycin treatment. This case report has highlighted that patients being treated with intravenous vancomycin should be carefully observed for acute skin rashes and deterioration in renal function, which can be managed by ceasing treatment with vancomycin, steroid challenge, and preventing future exposure to similar antimicrobial agents.
Fu, Peng; Yu, Guang; Huang, Xue-Qiang; Xu, Jing; Mei, Xiao-Bin; Wu, Hao; Yuan, Wei-Jie
To evaluate the effect of integrated traditional Chinese and Western medicine therapy on the progression of acute renal failure in patients with chronic renal insufficiency. Thirty-two patients with chronic renal insufficiency developed acute renal failure recently were treated with Chinese herbs and western drugs intravenously and clysterizing of Chinese herbs liquid for 30 minutes, and the treatment course was 14 days. Assessment of liver and renal function, blood routine, electrolytes and endogenous creatinine clearance rate (Ccr) was performed before and 2 weeks after the treatment. The levels of hemoglobin (HB), white blood cell count (WBC) and serum electrolytes showed no significant changes after the treatment. The levels of blood urea nitrogen (BUN) and serum creatinine (SCr) decreased, while the level of Ccr increased significantly (Prenal function in patients with chronic renal insufficiency accompanied by acute renal failure.
Nicolon, C; Broustal, E
Dengue is an emerging, rapidly expanding disease, whose clinical and biological manifestations vary. Kidney injury is not usual but can be severe, and it is most often associated with dengue hemorrhagic fever or shock. Guadeloupe, which is located in an endemic area, experienced an epidemic from 2013 to 2014. During this outbreak, a case of renal failure during dengue was observed in a 10-year-old child. No evidence of dengue hemorrhagic fever or shock syndrome was found. The clinical and biological course improved with symptomatic treatment. The association of acute renal failure with hemolytic anemia suggested a diagnosis of hemolytic uremic syndrome. However, this could not be confirmed in the absence of thrombocytopenia and cytopathologic evidence. This case illustrates the diversity of clinical presentations of dengue, and the possibility of severe renal impairment unrelated to the usual factors encountered in dengue. Copyright © 2015 Elsevier Masson SAS. All rights reserved.
Full Text Available Typhoid fever is an important health problem worldwide but its incidence is more in developing countries. Hepatic involvement is common, but both hepatic and renal involvement is rare in typhoid fever. We report a case of typhoid fever presenting with hepatitis and acute renal failure. A 17 year old male presenting with fever and pain abdomen was found to have raised blood urea, creatinine, liver enzymes and bilirubin. Widal and typhidot (IgM,IgG test were positive. His symptoms subsided and deranged parameters resolved with treatment of typhoid fever.
Pinto, Patrícia S.; Carminatti, Moisés; Lacet, Thiago; Rodrigues, Dominique F.; Nogueira, Luiza O.; Bastos, Marcus G.; Fernandes, Natália
INTRODUÇÃO: A insuficiência renal aguda (IRA) nefrotóxica é frequente e importante causa de morbimortalidade. OBJETIVO: Avaliar a prevalência, o curso clínico e o desfecho da IRA nefrotóxica. PACIENTES e MÉTODOS: Coorte histórica realizada em um hospital de ensino terciário, no período de fevereiro a novembro de 1997. Foram incluídos pacientes acima de 12 anos, com diagnóstico de IRA, acompanhados pela equipe de Interconsulta de Nefrologia. Foram excluídos transplantados renais, portadores de...
Kersjes, W.; Koester, O.; Orellano, L.; Bregulla, C.; Bonn Univ.; Bonn Univ.
This is a report on a patient of 64 years of age who was admitted to hospital as an inpatient thirteen years after desobliteration of the iliac artery with an extension plasty. He complained of irregular stools and occasional abdominal pain. Imaging methods were employed on account of a drop in the haemoglobin count, progressive renal insufficiency and a palpable tumor in the lower abdomen. These methods supplied evidence of a false aneurysm originating from the iliacal endarterectomy, combined with compression of the ureter and small intestine. Basing on the present case report, the general complex of problems in diagnosing aneurysms of the iliac artery is discussed. (orig.) [de
Trusov, V.; Shaklein, A.
The Udmurt Republic is the natural focus and the hot spot of the haemorrhagic fever with the nephritic syndrome (HFNS). The acute renal failure (ARF), by our data, is being developed from 24 up to 49 % of the HFNS diseased persons, at the severe forms of which, side by side with the medicamental therapy, the hemodialysis is being used. In the last years, the efferent therapy new methods such, as the hemofiltration, the hemodyafiltration (HDF) are being used for the ARF medical treatment.
Acute renal failure (ARF) is a clinical syndrome characterized by rapidly decreasing glomerular filtration rate, which results in disturbances in electrolyte- and acid-base homeostasis, derangement of extracellular fluid volume, and retention of nitrogenous waste products, and is often associated with decreased urine output. ARF affects about 5-25% of patients admitted to intensive care units (ICUs), and is linked to high mortality and morbidity rates. In this thesis outcome of criticall...
Khalil, M.A.M.; Azhar, A.; Anwar, N.
Acute renal failure is a serious complication in pregnancy. Not only does it result in significant maternal morbidity and mortality but also results in significant number of foetal loss. Although incidence of obstetrical acute renal failure has decreased in developed countries but still it is one of the major health problem of developing nations. The objective of this study was to study aetiology, maternal and foetal outcome in obstetrical acute renal failure. This study was conducted at Department of Nephrology, Khyber Teaching Hospital, Peshawar from August 2006 to December 2007. It was a descriptive, case series study. Female patients with pregnancy and acute renal failure, irrespective of age, were included in the study. Patients were thoroughly examined and baseline urea, creatinine, serum electrolytes, peripheral smear, prothrombin time, partial thromboplastin time, fibrinogen degradation products, renal and obstetrical ultrasound were performed on each patient and 24-hr urinary protein and bacterial culture sensitivity on blood, urine or vaginal swabs were done in selected patients. Foetal and maternal outcome were recorded. Data were analysed using SPSS. A total of 60 patients were included in the study. Mean age of the patients was 29 +- 5.4 years and duration of gestation was 33 +- 4.9 weeks. Mean gravidity was 4 +- 2.2. Sixteen patients (26.66%) were treated conservatively while 44 (73.33%) required dialysis. Postpartum haemorrhage was present in 14 (23.33%), postpartum haemorrhage and disseminated intravascular coagulation (DIC) in 11 (18.33%), eclampsia-preeclampsia in 8 (13.33%), antepartum haemorrhage in 8 (13.33%), antepartum haemorrhage with DIC in 6 (10%), DIC alone in 4 (6.66%), obstructed labour in 3 (5%), septic abortion in 3 (3.33%), HELLP (haemolysis elevated liver enzyme and low platelet) in 2 (3.33%), urinary tract infection with sepsis in 1 (1.66%) and puerperal sepsis in 1 (1.66%). Foetal loss was 40 (66.66%). Maternal mortality was 9 (15
Veenstra, J.; Krediet, R. T.; Somers, R.; Arisz, L.
Two patients with Burkitt's lymphoma and acute renal failure are described, one with acute uric acid nephropathy and the other with acute renal failure due to hyperphosphataemia. Renal insufficiency caused by the precipitation of calcium phosphate salts only occurs after starting treatment of the
Coe, Kristi; Lail, Candace
Acute renal failure is common in the neonatal intensive care unit but is often not recognized in its early phases, when it is potentially reversible. The typical patient with acute renal failure is premature, but many term infants are also at risk. One such group is those with severe bleeding, such as a subgaleal hemorrhage. In these cases, hypovolemia can quickly progress to ischemia, which affects many organs but has profound effects on the kidney. In term infants, acute renal failure is most commonly diagnosed in those with perinatal depression. This article presents a unique case of an infant with subgaleal and intracranial bleeding that resulted in acute renal failure requiring peritoneal dialysis in the hopes of the eventual restoration of kidney function.
Bach, T. M.; Clement, D. B.
After a strenuous indoor competition, a 24 year old male 400 meter runner experienced severe back pain followed by three days of nausea and vomiting. This led to hospital admission with oliguria, serum creatinine of 12.6 mg%, and BUN of 72 mg%. Peritoneal dialysis was given for 96 hours and was discontinued when the diuretic phase developed. Myoglobinuria was suspected, but all tests for it were negative. Mechanisms of acute tubular necrosis are reviewed, noting predisposing factors—dehydrati...
Shimizu, Yoko; Takaori, Koji; Maeda, Sayako
Acute renal failure with severe loin pain and patchy renal ischemia after anaerobic exercise (ALPE) is exercise-induced acute renal failure that occurs without myoglobinuria. We describe a typical case involving an 18-year-old man. Generally, patients with ALPE are advised to avoid anaerobic exercise due to risk of recurrence, but our patient continued and went on to become a professional cyclist without relapse. About 51% of ALPE cases involve patients with renal hypouricemia. His serum uric acid levels were rather high, at 6.4 mg/dL. He is the first patient with ALPE to succeed as a professional athlete in an anaerobic sport.
Ch. Venkata Rama Krishna
Full Text Available In this prospective study, we aimed to assess the clinical characteristics of acute renal failure (ARF, determine oxidative stress, as well as to predict the outcome in patients with severe falciparum malaria (FM. The study included a total of 75 subjects; there were 25 adult patients with acute severe FM and ARF, 25 adult patients with uncomplicated FM without ARF, and 25 age- and sex-matched healthy subjects who served as controls. In patients with severe FM and ARF (n = 25, renal failure was non-oliguric in 28% and oliguric in 72%. The average duration of renal failure was 10.53 ± 4.0 days. Sixty percent recovered and 40% died. All patients with non-oliguric presentation recovered. The mean serum malondialdehyde (MDA levels were 0.82 ± 0.43 μmol/L, 2.97 ± 1.11 μmol/L, and 6.86 ± 2.62 μmol/L, respectively, in healthy con-trols, in patients with uncomplicated FM, and in those with severe FM with ARF. The Acute Physiology Age and Chronic Health Evaluation II (APACHE II score, Sequential Organ Failure Assessment (SOFA score, and the Acute Tubular Necrosis-Individual Severity Index (ATN-ISI score were all significantly higher in the expired group (19 ± 5.49 when compared to the survivor group (14.4 ± 3.15 (P = 0.014. Kaplan-Meier survival analysis showed that survival was low in patients with delayed hospitalization and longer duration of symptoms. Also, we observed a high occurrence of acute respiratory distress syndrome and central nervous system involvement among the patients who expired.
Full Text Available Renal failure in obstetrics is rare but important complication, associated with significant mortality and long term morbidity.1,2 It includes acute renal failure due to obstetrical complications or due to deterioration of existing renal disease. AIMS AND OBJECTIVES: To evaluate the etiology and outcome of renal failure in obstetric patients. METHODS: We prospectively analyzed 30 pregnant and puerperal women with acute renal failure or pre-existing renal disease developing renal failure during pregnancy between November 2007 to sep-2009. Patients who presented/developed ARF during the hospital stay were included in this study. RESULTS: Among 30 patients, mean age was 23 years and 33 years age group. 12 cases (40% patients were primigravidae and 9(30% patients were multigravidae and 9 cases (30% presented in post-partum period. Eighteen cases (60% with ARF were seen in third trimester, followed by in postpartum period 9 cases (30%. Most common contributing factors to ARF were Pre-eclampsia, eclampsia and HELLP syndrome 60%, sepsis 56.6%, post abortal ARF 10%. DIC 40%. Haemorrhage as the aetiology for ARF was present 46%, APH in 20% and PPH in 26.6%. The type of ARF was renal in (63% and prerenal (36%; Oliguric seen in 10 patients (33% and high mortality (30%. Among the 20 pregnant patients with ARF, The average period of gestation was 33±2 weeks (30 -36 weeks, 5 cases (25% presented with intrauterine fetal demise and 18 cases (66% had preterm vaginal delivery and 2 cases (10% had induced abortion. And the average birth weight was 2±0.5 kg (1.5 kg. Eight cases (26% required dialysis. 80% of patients recovered completely of renal functions. 63% patients recovered without renal replacement therapy whereas 17% required dialysis. the maternal mortality was 20%, the main reason for mortality was septic shock and multi organ dysfunction (66%. CONCLUSION: ARF related pregnancy was seen commonly in the primigravidae and in the third trimester, the most
Full Text Available Abstract Introduction – Acute renal failure (ARF has a poor prognosis in patients with cancer requiring intensive care unit (ICU admission. Our aim is finding prognostic factors for hospital mortality in patients with cancer with ARF requiring renal replacement therapy (RRT. Methods – In this retrospective study, all patients with cancer with ARF treated with continuous venovenous filtration (CVVHDF in the ICU of the Institut Jules Bordet, between January 1st 2003 and December 31st 2012, were included in the study.Results – 103 patients are assessed: men/women 69/34, median age 62 years, solid/haematologic tumours 68/35, median SAPS II 56. Mortality rate was 63%. Seven patients required chronic renal dialysis. After multivariate analysis, two variables were statistically associated with hospital mortality : more than one organ failure (including kidney (OR 5.918 ; 95% CI 2.184 – 16.038 ; p<0,001 and low albumin level (OR 3.341; 95% CI 1.229 – 9.077; p=0,02. Only minor complications related to CVVHDF have been documented.Conclusions – Despite the poor prognosis associated with ARF, CVVHDF is an effective and tolerable renal replacement technique in patients with cancer admitted to the ICU. Multiple organ failure and hypoalbuminemia, two independent prognostic factors for hospital mortality have to be considered when deciding for introducing RRT.
Wooley, Jennifer A; Btaiche, Imad F; Good, Kelley L
Acute renal failure (ARF) is rarely an isolated process but is often a complication of underlying conditions such as sepsis, trauma, and multiple-organ failure in critically ill patients. As such, concomitant clinical conditions significantly affect patient outcome. Poor nutritional status is a major factor in increasing patients' morbidity and mortality. Malnutrition in ARF patients is caused by hypercatabolism and hypermetabolism that parallel the severity of illness. When dialytic intervention is indicated, continuous renal replacement therapy (CRRT) is a commonly used alternative to intermittent hemodialysis because it is well tolerated by hemodynamically unstable patients. This paper reviews the metabolic and nutritional alterations associated with ARF and provides recommendations regarding the nutritional, fluid, electrolyte, micronutrient, and acid-base management of these patients. The basic principles of CRRT are addressed, along with their nutritional implications in critically ill patients. A patient case is presented to illustrate the clinical application of topics covered within the paper.
Elizabeth De Francesco Daher
Full Text Available CONTEXT: Rhabdomyolysis is a severe and life-threatening condition in which skeletal muscle is damaged. Acute renal failure due to rhabdomyolysis has been widely described and its main pathophysiological mechanisms are renal vasoconstriction, intraluminal cast formation and direct myoglobin toxicity. OBJECTIVE: To report on a case of acute renal failure (ARF induced by rhabdomyolysis due to strenuous exercise and alcohol abuse and to describe the pathophysiology of this type of ARF. CASE REPORT: A 39-year-old man arrived at the hospital emergency service with swollen legs and lower extremity compartment syndrome. He was oliguric and had serum creatinine and urea levels of 8.1 mg/dl and 195 mg/dl, respectively. The diagnosis of rhabdomyolysis was made through clinical and laboratory findings (creatine kinase activity of 26320 IU/l. The initial treatment consisted of fluid replacement and forced diuresis. The specific treatment for compartment syndrome, such as fasciotomy, was avoided in order to prevent infection. Partial recovery of renal function was recorded, after ten hemodialysis sessions. Complete recovery was observed after two months of follow-up.
Full Text Available SUMMARY: Acute renal failure is a syndrome that usually runs with an increase in creatinine and urea plasma levels. However, there are clinical situations in which this syndrome may run with an increase in plasma creatinine keeping normal the urea one. In this report we present a case of acute renal failure with normal plasma urea level secondary to an acute pyelonephritis in a single kidney patient. The patient had an increased fractional excretion of urea which could explain the normal plasma urea levels found despite of his reduced glomerular filtration. This increased urea excretion state was interpreted as a consequence of the nephrogenic diabetes insipidus and alteration of the intra-renal urea reciclying process that the acute pyelonephritis induced. In conclusion: Acute pyelonephritis in a single kidney patient can appear as a pattern of acute renal failure with normal plasma urea levels.RESUMEN: La insuficiencia renal aguda es un sindrome que característicamente cursa con niveles plasmáticos elevados de urea y creatinina. Sin embargo, hay situaciones clínicas en las cuales este sindrome puede cursar con un incremento de la creatininemia sin presentar elevación de la uremia. En este reporte presentamos un caso clínico de una insuficiencia renal aguda con uremia normal secundaria a una pielonefritis aguda en un paciente con riñón único. El paciente presentaba una elevada excreción fraccional de urea lo cual podía explicar su uremia normal pese a estar cursando una caída del filtrado gomerular. Dicha excreción de urea elevada fue interpretada como secundaria a una diabetes insipida nefrogénica y una alteración en el recirculado intra-renal de la urea ambos producto de la pielonefritis aguda. Concluimos que la pielonefritis aguda en un paciente mono-reno puede presentarse con un patrón de insuficiencia renal aguda con uremia normal.
Fernández-Juárez, Gema; Parejo, Leticia; Villacorta, Javier; Tato, Ana; Cazar, Ramiro; Guerrero, Carmen; Marin, Isabel Martinez; Ocaña, Javier; Mendez-Abreu, Angel; López, Katia; Gruss, Enrique; Gallego, Eduardo
Screening colonoscopy with polipectomy reduces colonorectal cancer incidence and mortality. An adequate bowel cleansing is one of the keys to achieving best results with this technique. Oral sodium phosphate solution (OSP) had a widespread use in the 90s decade. Its efficacy was similar to polyethylene glycol (PEG) solution, but with less cost and convenient administration. Series of patients with acute renal failure due to OSP use have been reported. However, large cohorts of patients found no difference in the incidence of renal damage between these two solutions. From 2006 to 2009 we identified twelve cases of phosphate nephropathy after colonoscopy prepared with OSP. All patients were followed up to six months. All patients had received just a single dose. We analyzed 12 cases with phosphate nephropathy; three patients debuted with AKI and nine patients had chronic renal injury. Four cases were confirmed with renal biopsy. One patient with AKI needed hemodialysis at diagnosis without subsequent recovery. Two patients (both with chronic damage) fully recovered their previous renal function. The remaining patients (nine) had an average loss of estimated glomerular filtration rate of 24ml/min/1.73m(2). The use of OSP can lead to both acute and chronic renal damage. However, chronic injury was the most common pattern. Both forms of presentation imply a significant and irreversible loss of renal function. Further studies analyzing renal damage secondary to bowel cleaning should consider these two different patterns of injury. Copyright © 2016 Sociedad Española de Nefrología. Published by Elsevier España, S.L.U. All rights reserved.
Yogendranathan, Nilukshana; Herath, H M M T B; Sivasundaram, Thenuka; Constantine, R; Kulatunga, Aruna
Run Rat® is a rodenticide widely used against small mammals. It comprises of a minimum of 32% zinc phosphide which is highly toxic in acute exposures to humans. It may be consumed accidentally or intentionally. It enters the body via skin, respiratory and gastrointestinal tracts. Zinc phosphide is hydrolyzed by the gastric acid and is transformed into phosphine gas. Phosphine is a respiratory toxin that inhibits cytochrome C oxidase system resulting in renal failure and liver failure. A 35 year old Sri Lankan female presented following ingestion of 2.5 g of Run Rat®, which is a branded preparation of zinc phosphide, resulting in 61 mg/kg poison load. She developed severe acute kidney injury with acute tubular necrosis, subnephrotic ranged proteinuria and tubulointerstitial nephritis for which she underwent haemodialysis three times along with other measures of resuscitation. She also developed elevated liver enzymes with hyperblirubinaemia, hypoalbuminaemia, acute pancreatitis and mild myocarditis. She improved with supportive therapy over a period of 3 weeks. Run Rat® is a commonly used rodenticide and the toxic effects are mediated through conversion of phosphide to phosphine gas. The majority of the deaths had occurred in the first 12 to 24 h and the main causes identified are refractory hypotension and arrhythmias. The late deaths (beyond 24 h) had been commonly due to adult respiratory distress syndrome, liver and renal failure. The outcome is poorer with delayed presentation, development of coagulopathy, hyperglycaemia and multiorgan failure with elevated liver enzymes. In our patient, Zinc phosphide poisoning caused severe acute kidney injury, abnormal liver profile, pancreatitis and possible myocarditis. The patient improved with repeated haemodialysis. The renal biopsy revealed acute tubulointerstitial nephritis with acute tubular necrosis. In tropical countries, the rural population engaged in agriculture has easier access to the compound, as it
Full Text Available Acute renal failure (ARF is a common problem in the Congo. This is a six-year retrospective study aiming at analyzing the etiology and the outcome of ARF at the Brazzaville′s University Hospital from 1989 through 1994. One hundred and five cases of ARF (0.99%, including 54 boys (51.4% and 51 girls (48.6%, out of 10,512 children admitted in the department of Pediatrics have been recorded. ARF represented 13.09% of the causes in 802 patients with renal disorder. The main etiologies of ARF included acute gastroenteritis with dehydration (25.7%, nephrotic syndrome (14.7%, sepsis (15.23%, malaria (12.38%, and acute glomerulonephritis (9.5%. Most cases were managed conservatively, while peritoneal dialysis (PD was used in eight cases (7.62%. The outcome of ARF was recovery in 50.5 %, death in 37 % and chronic renal failure in 12.5% of cases. Preventive measures may help in reducing the high mortality rate and the need for dialysis.
Singh, Amrit Pal; Singh, Amteshwar Jaggi; Singh, Nirmal
Objective: The present study was designed to investigate the ameliorative potential and possible mechanism of hydroalcoholic extract of flowers of P. granatum in glycerol-induced acute renal failure (ARF) in rats. Materials and Methods: The rats were subjected to rhabdomyolytic ARF by single intramuscular injection of hypertonic glycerol (50% v/v; 8 ml/kg) and the animals were sacrificed after 24 hours of glycerol injection. The plasma creatinine, blood urea nitrogen, creatinine clearance, and histopathological studies were performed to assess the degree of renal injury. Results: Pretreatment with hydroalcoholic extract of flowers of P. granatum (125 and 250 mg/kg p.o. twice daily for 3 days) significantly attenuated hypertonic glycerol-induced renal dysfunction in a dose-dependent manner. BADGE (Bisphenol-A-diglycidyl ether) (30 mg/kg), a peroxisome proliferator-activated receptor (PPAR)-γ antagonist, and N(omega)-nitro-l-arginine-methyl ester (L-NAME) (10, 20, and 40 mg/kg), nitric oxide synthase inhibitor, were employed to explore the mechanism of renoprotective effects of Punica granatum. Administration of BADGE (30 mg/kg) and L-NAME (40 mg/kg) abolished the beneficial effects of P. granatum in glycerol-induced renal dysfunction. Conclusion: Hydroalcoholic extract of flowers of P. granatum has ameliorative potential in attenuating myoglobinuric renal failure and its renoprotective effects involve activation of PPAR-γ and nitric oxide-dependent signaling pathway. PMID:22021999
Jain, Punit; Kanagal-Shamanna, Rashmi; Wierda, William; Ferrajoli, Alessandra; Keating, Michael; Jain, Nitin
Membranoproliferative glomerulonephritis (MPGN) is a common extramedullary renal presentation in chronic lymphocytic leukemia (CLL) and can present with either a frank renal failure or proteinuria. One of its etiologies has been attributed to a paraneoplastic, immune complex phenomenon occurring in CLL. Although there is no standard of care in such patients, use of anti-CD20 monoclonal antibodies like rituximab have been used before in such patients with variable responses. Obinutuzumab is a novel, type II, immunoglobulin-G1 monoclonal antibody with a higher efficacy than rituximab and has an established safely profile in patients with comorbidities and poor renal functions. There are no such reported cases of MPGN in CLL being treated with obinutuzumab. We used the standard doses of obinutuzumab in our elderly patient (78-year-old woman) with high-risk CLL due to an underlying TP53 mutation, along with a MPGN-related acute renal failure. The patient achieved complete remission after six cycles of obinutuzumab; however, she remained positive for minimal residual disease on flow cytometry. Her renal function improved completely, suggesting a complete response of her underlying MPGN. Obinutuzumab has an established safety profile in patients with CLL, but our case is the first reported case of a paraneoplastic, immune complex-mediated MPGN in CLL being treated with obinutuzumab. Obinutuzumab should be explored as a potential option in patients with CLL and MPGN. Copyright © 2016 King Faisal Specialist Hospital & Research Centre. Published by Elsevier B.V. All rights reserved.
Singh, Amrit Pal; Singh, Amteshwar Jaggi; Singh, Nirmal
The present study was designed to investigate the ameliorative potential and possible mechanism of hydroalcoholic extract of flowers of P. granatum in glycerol-induced acute renal failure (ARF) in rats. The rats were subjected to rhabdomyolytic ARF by single intramuscular injection of hypertonic glycerol (50% v/v; 8 ml/kg) and the animals were sacrificed after 24 hours of glycerol injection. The plasma creatinine, blood urea nitrogen, creatinine clearance, and histopathological studies were performed to assess the degree of renal injury. Pretreatment with hydroalcoholic extract of flowers of P. granatum (125 and 250 mg/kg p.o. twice daily for 3 days) significantly attenuated hypertonic glycerol-induced renal dysfunction in a dose-dependent manner. BADGE (Bisphenol-A-diglycidyl ether) (30 mg/kg), a peroxisome proliferator-activated receptor (PPAR)-γ antagonist, and N(omega)-nitro-l-arginine-methyl ester (L-NAME) (10, 20, and 40 mg/kg), nitric oxide synthase inhibitor, were employed to explore the mechanism of renoprotective effects of Punica granatum. Administration of BADGE (30 mg/kg) and L-NAME (40 mg/kg) abolished the beneficial effects of P. granatum in glycerol-induced renal dysfunction. Hydroalcoholic extract of flowers of P. granatum has ameliorative potential in attenuating myoglobinuric renal failure and its renoprotective effects involve activation of PPAR-γ and nitric oxide-dependent signaling pathway.
Qi, Peng; Zhang, Xi-Quan; Pang, Xin-Yan; Cao, Guang-Qing; Fang, Chang-Cun; Wu, Shu-Ming
To investigate the effect of continuous venovenous hemofiltration (CVVH) for aortic dissection patients with acute renal failure after surgery in retrospective manner. A total of thirty-seven aortic dissection patients with postoperative acute renal failure accepted CVVH therapy. The effect of CVVH was evaluated by analyzing clinical condition changes and laboratory examination results. After treatment of CVVH, renal function and clinical symptoms were significantly improved in thirty patients. Eight of the thirty patients got completely renal function recovery within two weeks after CVVH therapy; and twenty-two of the thirty patients got completely renal function recovery within four weeks after CVVH therapy. Nevertheless, seven patients got no benefit from CVVH therapy with poor prognosis. CVVH is an effective treatment to most aortic dissection patients with postoperative acute renal failure. The effect of CVVH was correlated with original renal function, early CVVH therapy, and continuous intensive care.
Kim, S.H.; Han, M.C.; Kim, S.; Lee, J.S. (Dept. of Radiology and Dept. of Internal Medicine, Seoul National Univ., Coll. of Medicine (Korea, Republic of))
MR imaging of the kidney was performed in 6 patients with acute renal failure (ARF) secondary to rhabdomyolysis caused by snake bite (n = 4), crush injury (n = 1), and carbon monoxide poisoning (n = 1). A test for urine myoglobin was positive in all 6 patients and MR imaging was done 6 to 18 days after the causative event of the rhabdomyolysis. MR images in all 6 patients showed globular swelling of the kidneys, preserved corticomedullary contrast on T1-weighted images, and obliteration of corticomedullary contrast on T2-weighted images. Unlike other medical renal diseases in which corticomedullary contrast is lost on T1-weighted images, preservation of the corticomedullary contrast on T1-weighted MR images with globular renal swelling was a constant finding in patients with ARF secondary to rhabdomyolysis. (orig.).
Carlos G. Musso
Full Text Available Acute renal failure (ARF is the term used to describe the sustained and abrupt reduction of the glomerular filtration, which causes the retention of waste products that come from the metabolism. Normally, the mechanisms potentially involved in ARF are divided into: pre-renal, parenchymatous, and post-renal. Regarding the etiology of the parenchymatous ARF, it would seem to be the sum of multiple pathogenic variables such as: tubular necrosis and apoptosis, alteration of the filtration barrier, retrodifusion of glomerular filtration, intrarenal vasoconstriction, contraction of the mesangium, intratubular obstruction, intersticial swelling, activation of proteolytic enzymes, and so on. Because of the above exposed data, only a multicausal perspective would seem to be adequate to understand and solve this syndrome.
Klouche, Kada; Amigues, Laurent; Deleuze, Sebastien; Beraud, Jean-Jacques; Canaud, Bernard
Availability of a functional vascular access is a mandatory prerequisite for extracorporeal renal replacement therapy in patients with acute renal failure. The femoral site of insertion commonly is chosen because it is an easy and convenient access. However, an array of complications may substantially alter the quality of treatment, and it appears that catheter-related morbidity and dysfunction are more frequent with the femoral than internal jugular site. This study is designed to evaluate the potential benefits of using soft silicone tunneled catheters ((ST)Caths) at the femoral site. Thirty patients with acute renal failure treated by intermittent hemodialysis (IHD) and/or continuous venovenous hemodiafiltration (CVVHDF) were assigned to either twin (ST)Caths or twin polyurethane nontunneled femoral catheters. Time necessary for catheter insertion, catheter-related complications, and catheter lifespan were monitored. Catheter performance during IHD and the effect of catheter type on dialysis dose were evaluated. The time necessary for (ST)Cath insertion was significantly longer. The incidence of vein thrombosis and catheter-related infection was lower, and the ratio of venous return pressure to catheter blood flow was better with an (ST)Cath. Recirculation rates were similar for both types of catheters. Whether treated by using IHD or CVVHDF, patients with an (ST)Cath benefited from a greater delivered dialysis dose. Multivariate analysis confirmed that (ST)Cath use was a determinant factor to optimize dialysis dose delivery. (ST)Cath patency was significantly longer. In patients with acute renal failure, use of an (ST)Cath minimizes catheter-related morbidity and improves dialysis efficiency compared with conventional femoral catheters.
Machemehl, Thomas; Hsu, Peter; Pahad, Hussein; Williams, Paul; Yilmaz, Tugba H; Vassiliu, Pantelis; Boffard, Kenneth D; Degiannis, Elias; Doll, Dietrich
Post-traumatic acute renal failure requiring renal replacement therapy in an intensive care unit (ICU) is associated with high mortality. To assess indicators of improved survival. This was a retrospective cohort study of 64 consecutive trauma patients (penetrating and blunt trauma and burns) who underwent haemodialysis (HD) over a period of 5 years. Information on pre-hospital and in-hospital resuscitation, trauma scores and physiological scores and daily ICU records were collected. The majority of the patients were dialysed with continuous venovenous haemofiltration in the early years of the study and later with sustained low-efficiency dialysis. Of the 64 patients 47 died, giving an overall mortality rate of 73%. Mortality was highest in the burns patients (84%). Survival in all patients, irrespective of injury, was unrelated to the Revised Trauma Score, Injury Severity Score, Acute Physiology and Chronic Health Evaluation Score or Trauma Injury Severity Score. The duration of HD did not differ significantly between the three trauma groups, and age was not a significant predictor of survival. Patients who were polyuric at the time of the initiation of HD had a lower mortality rate than those who were oliguric, anuric or normouric, although this did not reach statistical significance (p=0.09). Acute renal failure in trauma patients is associated with a low survival rate. Controversial conclusions have been presented in the literature. In this study, none of the parameters previously reported to affect survival proved to be valid, although the number of patients was comparable with those in other studies. Since understanding of the predictors and course of renal failure in trauma patients is still at an early stage, there is a need for multicentre prospective studies.
Acute renal failure (ARF) is one of the most common problems encountered in hospitalized critically ill patients. In recent years great effort has been focused on the introduction of herbal medicine as a novel therapeutic agent for prevention of ARF. Hence, the current study was designed to investigate the effect of Açai berry extract (ABE) on glycerol-induced ARF in rats. Results of the present study showed that rat groups that received oral ABE in a dose of 100 and 200 mg/kg/day for 7 days before or 7 days after induction of ARF by a single intramuscular glycerol injection reported a significant improvement in kidney functions tests [decrease in serum urea, serum creatinine, and blood urea nitrogen (BUN)] when compared to the ARF model groups. Moreover, there was significant amelioration in renal oxidative stress markers [renal catalase (CAT), renal reduced glutathione (GSH)] and renal histopathological changes in the ABE-treated groups when compared to ARF model groups. The most significant improvement was reported in the groups where ABE was administered in a dose 200 mg/kg/day. These results indicate that ABE has a potential role in ameliorating renal damage involved in ARF.
Full Text Available SUMMARYAcute renal failure is a syndrome that usually runs with an increase in creatinine and urea plasma levels. However, there are clinical situations in which this syndrome may run with an increase in plasma creatinine keeping normal the urea one.In this report we present a case of acute renal failure with normal plasma urea level secondary to an acute pyelonephritis in a single kidney patient. The patient had an increased fractional excretion of urea which could explain the normal plasma urea levels found despite of his reduced glomerular filtration. This increased urea excretion state was interpreted as a consequence of the nephrogenic diabetes insipidus and alteration of the intra-renal urea reciclying process that the acute pyelonephritis induced. In conclusion: Acute pyelonephritis in a single kidney patient can appear as a pattern of acute renal failure with normal plasma urea levels. RESUMEN:La insuficiencia renal aguda es un sindrome que característicamente cursa con niveles plasmáticos elevados de urea y creatinina. Sin embargo, hay situaciones clínicas en las cuales este sindrome puede cursar con un incremento de la creatininemia sin presentar elevación de la uremia.En este reporte presentamos un caso clínico de una insuficiencia renal aguda con uremia normal secundaria a una pielonefritis aguda en un paciente con riñón único. El paciente presentaba una elevada excreción fraccional de urea lo cual podía explicar su uremia normal pese a estar cursando una caída del filtrado gomerular. Dicha excreción de urea elevada fue interpretada como secundaria a una diabetes insipida nefrogénica y una alteración en el recirculado intra-renal de la urea ambos producto de la pielonefritis aguda. Concluimos que la pielonefritis aguda en un paciente mono-reno puede presentarse con un patrón de insuficiencia renal aguda con uremia normal.
Makino, Hirofumi; Nagake, Yoshio; Moriwaki, Kazuhiko; Hirakawa, Shuzo; Katayama, Takaaki; Yanai, Hiroyuki; Takahashi, Kiyoshi; Akagi, Tadaatsu; Ota, Zensuke
A 73-year-old woman was admitted to receive radiation treatment for uterine cervical cancer, however a complex series of events ensued, leading to death. She developed an acute exacerbation of polymyositis complicated by thrombocytopenic purpura, rhabdomyolysis and acute renal failure. Radiation therapy may have produced an immune disturbance leading to the acute exacerbation of polymyositis. Auto-immune-mediated endothelial damage might have triggered a series of events leading to thrombotic thrombocytopenic purpura. Rhabdomyolysis seemed to be the main cause of acute renal failure. (author)
Makino, Hirofumi; Nagake, Yoshio; Moriwaki, Kazuhiko; Hirakawa, Shuzo; Katayama, Takaaki; Yanai, Hiroyuki; Takahashi, Kiyoshi; Akagi, Tadaatsu; Ota, Zensuke [Okayama Univ. (Japan). School of Medicine
A 73-year-old woman was admitted to receive radiation treatment for uterine cervical cancer, however a complex series of events ensued, leading to death. She developed an acute exacerbation of polymyositis complicated by thrombocytopenic purpura, rhabdomyolysis and acute renal failure. Radiation therapy may have produced an immune disturbance leading to the acute exacerbation of polymyositis. Auto-immune-mediated endothelial damage might have triggered a series of events leading to thrombotic thrombocytopenic purpura. Rhabdomyolysis seemed to be the main cause of acute renal failure. (author).
Forster, Benjamin M; Hinton, Adrian P; Thurlow, John S
We present a 30-year-old combat veteran with an unclear exposure history, with multiple deployments who was later diagnosed with acute renal failure as a result of light-chain deposition disease. Despite a drastic decline in kappa light chains following chemotherapy; his renal function worsened, and he progressed to end-stage renal disease, requiring hemodialysis. Light-chain-mediated acute tubular interstitial nephritis is an uncommon type of monoclonal gammopathy of renal significance presenting with acute renal failure without significant glomerular disease. Our case illustrates that light-chain-mediated acute tubular interstitial nephritis may present clinically like acute interstitial nephritis and that renal biopsy is critical for diagnosis. We also explore possible links between various environmental and occupational exposures that could have precipitated his disease process at such a young age. Reprint & Copyright © 2017 Association of Military Surgeons of the U.S.
Nazar Chaudhary Muhammad Junaid
Full Text Available The annual incidence is about 150 per million in the UK, but this figure is six times greater in the >80 years old group. Prerenal azotemia is considered as the most serious reason in community or hospital acquired acute renal failure (ARF. A 67-year-old middle age male was admitted to the hospital with a chief complaint of generalized weakness, volume depletion and dysuria. He has treated with metronidazole for diarrhoea caused by Clostridium difficile considered as the precipitating factor for the ARF. The patient has severe osteoarthritis and takes high dose non-steroidal anti-inflammatory drugs from the last two years. He also complains for obstructive sleep apnea (OSA and obesity. He has controlled hypertension was on lisinopril to control blood pressure. ARF is quite common, occurring in 80 million populations. Urinary obstruction should be excluded (a cause in around 5-10 of cases because this is readily reversible if it is diagnosed early. A renal US will be sufficient to identify obstruction in 95 of cases. Most cases of ARF are expected to pre renal failure/acute tubular necrosis (ATN 70-80%. Risk factor for development for at ATN are old age, drugs (non-steroidal anti-inflammatory drugs, gentamicin, sepsis, and chronic kidney disease and must be considered.
Osman Zikrullah Sahin
Full Text Available Introduction. Acute renal failure (ARF develops in 33% of the patients with rhabdomyolysis. The main etiologic factors are alcoholism, trauma, exercise overexertion, and drugs. In this report we present a rare case of ARF secondary to probably donepezil-induced rhabdomyolysis. Case Presentation. An 84-year-old male patient was admitted to the emergency department with a complaint of generalized weakness and reduced consciousness for two days. He had a history of Alzheimer’s disease for one year and he had taken donepezil 5 mg daily for two months. The patient’s physical examination revealed apathy, loss of cooperation, and decreased muscle strength. Laboratory studies revealed the following: urea: 128 mg/dL; Creatinine 6.06 mg/dL; creatine kinase: 3613 mg/dL. Donepezil was discontinued and the patient’s renal function tests improved gradually. Conclusion. Rhabdomyolysis-induced acute renal failure may develop secondary to donepezil therapy.
Naila Atik Khan
Full Text Available Background : Plasma B-type natriuretic peptide (BNP is the diagnostic tool for acute heart failure (AHF.This natriuretic peptide level depends on renal function, through renal metabolism and excretion. Therefore we examined the effect ofrenal impairment on plasma BNP level during diagnosis of AHF.Objective: The objective of the study was to assess the effect of renal dysfunction on plasma BNP level and to determine appropriate cutoff value of plasma BNP to diagnose the patients of AHF with renal insufficiency.Methods: This cross sectional analytical study was conducted in the Department of Biochemistry Bangabandhu Sheikh Mujib Medical University (BSMMU. The study was done among 90 AHF patients selected from cardiology emergency department during the period of July 2012 to June 2013. After enrollment plasma BNP concentration was measured and eGFR was estimated from serum creatinine by the four parameter Modification of Diet and Renal Disease (MORD equation and then grouped into two groups on the basis of empirical cut off value of eGFR 60 ml/min/1.73 m2Results: In this study a significant negative correlation was found between plasma BNP evel and eGFR (P<0.001 , with higher BNP levels observed as eGFR declined. The optimal BNP cutoff value for diagnosis of AHF patients with renal insufficiency was 824 pg/ml. At this cutoff level AHF with renal insufficiency could be diagnosed with sensitivity and specificity of 84% and 71 %, respectively.Conclusions: By adjusting the cutoff value, plasma BNP can be used to diagnose AHF with renal insufficiency with an acceptable sensitivity and specificity.
Mehrabadi, Azar; Liu, Shiliang; Bartholomew, Sharon; Hutcheon, Jennifer A; Magee, Laura A; Kramer, Michael S; Liston, Robert M; Joseph, K S
To examine whether changes in postpartum haemorrhage, hypertensive disorders of pregnancy, or other risk factors explain the increase in obstetric acute renal failure in Canada. Retrospective cohort study. Canada (excluding the province of Quebec). All hospital deliveries from 2003 to 2010 (n=2,193,425). Obstetric acute renal failure identified by ICD-10 diagnostic codes. Information on all hospital deliveries in Canada (excluding Quebec) between 2003 and 2010 (n=2,193,425) was obtained from the Canadian Institute for Health Information. Temporal trends in obstetric acute renal failure were assessed among women with and without postpartum haemorrhage, hypertensive disorders of pregnancy, or other risk factors. Logistic regression was used to determine if changes in risk factors explained the temporal increase in obstetric acute renal failure. Rates of obstetric acute renal failure rose from 1.66 to 2.68 per 10,000 deliveries between 2003-04 and 2009-10 (61% increase, 95% confidence interval 24% to 110%). Adjustment for postpartum haemorrhage, hypertensive disorders, and other factors did not attenuate the increase. The temporal increase in acute renal failure was restricted to deliveries with hypertensive disorders (adjusted increase 95%, 95% confidence interval 38% to 176%), and was especially pronounced among women with gestational hypertension with significant proteinuria (adjusted increase 171%, 71% to 329%). No significant increase occurred among women without hypertensive disorders (adjusted increase 12%, -28 to 72%). The increase in obstetric acute renal failure in Canada between 2003 and 2010 was restricted to women with hypertensive disorders and was especially pronounced among women with pre-eclampsia. Further study is required to determine the cause of the increase among women with pre-eclampsia. © Mehrabadi et al 2014.
Bruno, Noemi; ter Maaten, Jozine M; Ovchinnikova, Ekaterina S; Vegter, Eline L; Valente, Mattia A E; van der Meer, Peter; de Boer, Rudolf A; van der Harst, Pim; Schmitter, Daniela; Metra, Marco; O'Connor, Christopher M; Ponikowski, Piotr; Teerlink, John R; Cotter, Gad; Davison, Beth; Cleland, John G; Givertz, Michael M; Bloomfield, Daniel M; Dittrich, Howard C; Pinto, Yigal M; van Veldhuisen, Dirk J; Hillege, Hans L; Berezikov, Eugene; Voors, Adriaan A
Deregulation of microRNAs (miRNAs) may be involved in the pathogenesis of heart failure (HF) and renal disease. Our aim is to describe miRNA levels related to early worsening renal function in acute HF patients. We studied the association between 12 circulating miRNAs and Worsening Renal Function (WRF; defined as an increase in the serum creatinine level of 0.3mg per deciliter or more from admission to day 3), absolute change in creatinine and Neutrophil Gelatinase Associated Lipocalin (NGAL) from admission to day 3 in 98 patients hospitalized for acute HF. At baseline, circulating levels of all miRNAs were lower in patients with WRF, with statistically significant decreased levels of miR-199a-3p, miR-423-3p, and miR-let-7i-5p (p-valueacute HF were consistently lower in patients who developed worsening of renal function. MiR-199a-3p was the best predictor of WRF in these patients. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.
Full Text Available Acute renal failure (ARF is a common diagnosis in hospitalized patients, particularly in intensive care units (ICU. Determining the cause and contributing factors associated with ARF is crucial during treatment. The etiology is complex, and several factors often contribute to its development. Medications can cause acute tubular necrosis, acute interstitial nephritis, and crystal-induced or post-obstructive nephropathy. There have been several case reports of ARF secondary to fluoroquinolones. Here we report the development of acute renal failure within a few days of initiating oral ciprofloxacin therapy and briefly describe the different types of renal failure secondary to fluoroquinolone administration. Clinical studies demonstrate that using fluoroquinolones with other potentially nephrotoxic medications requires monitoring of renal function to limit the renal toxicity with these medications. Also, the risk-benefit profile of patients requiring fluoroquinolones should be considered.
Full Text Available Abstract Introduction Cytomegalovirus generally causes self-limited, mild and asymptomatic infections in immunocompetent patients. An aggressive course in immunocompetent healthy patients is unusual. Case presentation We report the case of an immunocompetent 16-year-old Egyptian boy with encephalitis, acute renal failure, and acute hepatitis triggered by viral infection with a complete recovery following antiviral treatment. Conclusion We believe that this case adds to the understanding of the molecular biology, clinical presentation and increasing index of suspicion of many viral infections.
Full Text Available Robert Faulhaber-Walter,1,2 Sebastian Scholz,1,3 Herrmann Haller,1 Jan T Kielstein,1,* Carsten Hafer1,4,* 1Department of Renal and Hypertensive Disease, Medical School Hannover, Hannover, Germany; 2Facharztzentrum Aarberg, Waldshut-Tiengen, Germany; 3Sanitaetsversorgungszentrum Wunstorf, Wunstorf, Germany; 4HELIOS Klinikum Erfurt, Erfurt, Germany *These authors contributed equally to this work Background: Critically ill patients with acute kidney injury (AKI in need of renal replacement therapy (RRT may have a protracted and often incomplete rehabilitation. Their long-term outcome has rarely been investigated. Study design: Survivors of the HANnover Dialysis OUTcome (HANDOUT study were evaluated after 5 years for survival, health status, renal function, and quality of life (QoL. The HANDOUT study had examinded mortality and renal recovery of patients with AKI receiving either standard extendend or intensified dialysis after multi organ failure. Results: One hundred fifty-six former HANDOUT participants were analyzed. In-hospital mortality was 56.4%. Five-year survival after AKI/RRT was 40.1% (86.5% if discharged from hospital. Main causes of death were cardiovascular complications and sepsis. A total of 19 survivors presented to the outpatient department of our clinic and had good renal recovery (mean estimated glomerular filtration rate 72.5±30 mL/min/1.73 m2; mean proteinuria 89±84 mg/d. One person required maintenance dialysis. Seventy-nine percent of the patients had a pathological kidney sonomorphology. The Charlson comorbidity score was 2.2±1.4 and adjusted for age 3.3±2.1 years. Numbers of comorbid conditions averaged 2.38±1.72 per patient (heart failure [52%] > chronic kidney disease/myocardial infarction [each 29%]. Median 36-item short form health survey (SF-36™ index was 0.657 (0.69 physical health/0.66 mental health. Quality-adjusted life-years after 5 years were 3.365. Conclusion: Mortality after severe AKI is higher than
Full Text Available Selenium (Se is an essential trace element in human and animal nutrition. It is also widely utilized in industrial processes. Reports of acute selenium toxicity in humans are rare. We report a case of a 23-year-old female who consumed about 100 mL of liquid selenite broth and presented with severe nausea, vomiting, abdominal pain, hematemesis and acute renal failure (ARF. The serum selenium level was significantly increased. Gastro-duodenoscopy revealed severe corrosive gastritis. Renal biopsy showed features of acute tubular necrosis (ATN, affecting primarily the proximal tubules. The patient was managed with gastric lavage, blood transfusions, infusion of fresh frozen plasma (FFP and platelet concentrates and hemo-dialysis. The patient was discharged five weeks after admission and her renal functions reco-vered completely by eight weeks after admission. She continues to be on regular follow-up for any possible sequelae of mucosal corrosive damage. This case highlights a case of selenium intoxication from selenite broth resulting in ARF and corrosive gastritis. The recovery was complete.
Strejc, Jill M
Despite improvements in medical and dialytic therapies, mortality rates for patients with complicated acute renal failure (ARF) remains tragically high-above 50%. Mortality rates also remain persistently high in patients with ARF and preexisting or hospital-acquired malnutrition. ARF causes significant changes in substrate utilization largely because of the metabolic consequences of acute uremia compounded by underlying stress from acute illness. Alterations in protein or amino acid, carbohydrate, and lipid metabolism as well as fluid, electrolyte, and acid-base balance need to be considered when providing nutritional therapy in patients with ARF. Also, the degree of renal impairment, which influences the need for renal replacement therapy (RRT), impacts nutritional requirements. As medical management is becoming highly aggressive in treating ARF with RRT, the ability to provide adequate nutrition is enhanced; however, no consensus on optimal caloric and macro-/micronutrient requirements is available. More current research is required to clarify nutritional needs of this patient population. Nevertheless, individualizing nutrition care and integrating nutritional therapies within a team setting is essential in providing optimal patient care in the presence of ARF.
Kamble, P; Mohsin, N; Jha, A; Date, A; Upadhaya, A; Mohammad, E; Khalil, M; Pakkyara, A; Budruddin, M
Selenium (Se) is an essential trace element in human and animal nutrition. It is also widely utilized in industrial processes. Reports of acute selenium toxicity in humans are rare. We report a case of a 23-year-old female who consumed about 100 mL of liquid selenite broth and presented with severe nausea, vomiting, abdominal pain, hematemesis and acute renal failure (ARF). The serum selenium level was significantly increased. Gastro-duodenoscopy revealed severe corrosive gastritis. Renal biopsy showed features of acute tubular necrosis (ATN), affecting primarily the proximal tubules. The patient was managed with gastric lavage, blood transfusions, infusion of fresh frozen plasma (FFP) and platelet concentrates and hemo-dialysis. The patient was discharged five weeks after admission and her renal functions recovered completely by eight weeks after admission. She continues to be on regular follow-up for any possible sequelae of mucosal corrosive damage. This case highlights a case of selenium intoxication from selenite broth resulting in ARF and corrosive gastritis. The recovery was complete.
Firkin, Frank; Roncolato, Fernando; Ho, Wai Khoon
To determine the potential for arsenic trioxide (ATO) to be safely and effectively incorporated into induction therapy of newly diagnosed acute promyelocytic leukaemia (APL) in patients with severe chronic renal failure (CRF) by reduction of the ATO dosage to compensate for reduced renal elimination of arsenic in CRF. Two of the four CRF patients with APL in the study were dialysis-dependent, and two had eGFRs of 18 and 19 mL/min/1.73 m(2) . ATO dosage schedules were adjusted to obtain comparable whole-blood arsenic levels to those in APL patients with normal renal function who achieved molecular remission (MR) while receiving 10 mg ATO daily for 28 d. Average ATO administered per day in CRF patients ranged from 36 to 50% of the ATO administered to APL patients with normal renal function. No clinically significant cardiac, hepatic or other toxicities were detected. RT-PCR-negative MR was achieved after one treatment course in two patients and after two courses in the others. Relapse-free survival is 155, 60, 43 and 5 months. The observations in this pilot study have demonstrated whole-blood arsenic levels can provide a guide to adjustments of ATO dosage schedules that permit safe and effective therapeutic outcomes in APL patients with severely compromised renal function. © 2015 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.
Subeq, Yi-Maun; Wu, Wen-Tien; Lee, Chung-Jen; Lee, Ru-Ping; Yang, Fwu-Lin; Hsu, Bang-Gee
Rhabdomyolysis is one of the causes of acute renal failure. Pentobarbital enhances the action of gamma-aminobutyric acid and suppresses the activities of nuclear factor (NF)-kappaB pathways. In this study, we used pentobarbital to study the effects on the glycerol-induced rhabdomyolysis with acute renal failure in conscious rats. Rhabdomyolysis was induced by intramuscular injection of 10 mL/kg of 50% glycerol in conscious rats. Ten minutes later, the rats received an intravenous injection of pentobarbital (10 mg/kg in 0.5 mL/h normal saline) or normal saline (0.5 mL/h). Biochemical substances, including blood urea nitrogen (BUN), creatinine (Cre), glutamic oxaloacetic transaminase (GOT), glutamic pyruvic transaminase (GPT), and creatine phosphokinase (CPK) were measured at 0 hour, 1 hour, 3 hours, 6 hours, 12 hours, 24 hours, and 48 hours. Rats were killed by decapitation at 48 hours after glycerol administration, and the kidneys were removed immediately for pathological findings and immunohistochemistry. Intramuscular injection of glycerol significantly increased blood BUN, Cre, GOT, GPT, CPK levels and induced severe histopathologic damage in the kidneys. NF-kappaB and inducible nitric oxide synthase (iNOS) were increased, and E-cadherin was decreased after glycerol administration, as detected by immunohistochemistry in the kidneys. Posttreatment with pentobarbital decreased blood BUN, Cre, GOT, GPT, CPK levels, decreased the markers of kidney injury, and suppressed the release of NF-kappaB and iNOS after rhabdomyolysis. Posttreatment with pentobarbital suppressed the activities of NF-kappaB and iNOS, decreased BUN, Cre, GOT, GPT, CPK levels, and decreased the markers of kidney injury after rhabdomyolysis. These actions ameliorated rhabdomyolysis-induced acute renal failure in conscious rats.
Neumayer, H H; Heinrich, M; Schmissas, M; Haller, H; Wagner, K; Luft, F C
The hypothesis that dietary fish oil would protect dogs from ischemic acute renal failure was tested. Fish oil (eicosapentaenoic acid, 55 mg/kg per day, and docosahexaenoic acid, 40 mg/kg per day was given to eight instrumented, female, beagle dogs for 6 wk, while seven control dogs received vehicle. After 3 wk, unilateral nephrectomy was performed and a pneumatic cuff with flow probe was placed around the remaining renal artery of each dog. Three weeks thereafter, the cuff was inflated for 120 min. Renal function, RBF, and prostanoid excretion were measured 24 and 72 h after ischemia. In dogs receiving fish oil, blood pressure, GFR, RBF, renal vascular resistance (RVR), cholesterol, triglycerides, and prostanoid excretion were measured weekly for 6 wk. Further, cytosolic calcium was measured before and five times after fish oil. Blood pressure decreased, serum cholesterol and triglycerides decreased, and the cytosolic calcium within platelets decreased. The urinary excretion (expressed as picograms per milligram of creatinine) of the thromboxane (TX) metabolite TXB2 and the excretion of prostaglandin (PG)E2, as well as the excretion of the PGI2 metabolite 6-keto PGF1 alpha were decreased. GFR, RBF (Cl inulin and Cl para-aminohippuric acid), and RVR were not influenced by fish oil. Unilateral nephrectomy decreased GFR and RBF and increased RVR as expected, whereas it further decreased prostanoid excretion. Acute renal ischemia caused a significant, reversible decrease in GFR and urine volume in vehicle-treated animals, whereas no significant effect on renal function or urine volume was observed in animals pretreated with fish oil.(ABSTRACT TRUNCATED AT 250 WORDS)
Nesiritide, Renal Function, and Associated Outcomes During Hospitalization for Acute Decompensated Heart Failure Results From the Acute Study of Clinical Effectiveness of Nesiritide and Decompensated Heart Failure (ASCEND-HF)
van Deursen, Vincent M.; Hernandez, Adrian F.; Stebbins, Amanda; Hasselblad, Vic; Ezekowitz, Justin A.; Califf, Robert M.; Gottlieb, Stephen S.; O'Connor, Christopher M.; Starling, Randall C.; Tang, W. H. Wilson; McMurray, John J.; Dickstein, Kenneth; Voors, Adriaan A.
Background-Contradictory results have been reported on the effects of nesiritide on renal function in patients with acute decompensated heart failure. We studied the effects of nesiritide on renal function during hospitalization for acute decompensated heart failure and associated outcomes. Methods
Kobel, Marie Cæcilie; Nielsen, Tommy Kjærgaard; Graumann, Ole
Percutaneous drainage proved to be successful in managing a renal subcapsular haematoma that was causing acute renal failure and hypertension in a 74-year-old woman. The patient presented with oliguria, nausea and malaise 2 days after a ureteronephroscopic procedure with biopsies of a suspected...... urothelial neoplasm in the right renal pelvis. The left kidney had recently been removed due to renal cell carcinoma. At admission, the patient's blood pressure and plasma creatinine levels were massively elevated. Ultrasonography revealed a moderate right-sided renal subcapsular haematoma. When the patient...
Johnson, Robert F; Gustin, Jillian
A 69-year-old female was receiving renal replacement therapy (RRT) for acute renal failure (ARF) in an intensive care unit (ICU). Consultation was requested from the palliative medicine service to facilitate a shared decision-making process regarding goals of care. Clinician responsibility in shared decision making includes the formulation and expression of a prognostic assessment providing the necessary perspective for a spokesperson to match patient values with treatment options. For this patient, ARF requiring RRT in the ICU was used as a focal point for preparing a prognostic assessment. A prognostic assessment should include the outcomes of most importance to a discussion of goals of care: mortality risk and survivor functional status, in this case including renal recovery. A systematic review of the literature was conducted to document published data regarding these outcomes for adult patients receiving RRT for ARF in the ICU. Forty-one studies met the inclusion criteria. The combined mean values for short-term mortality, long-term mortality, renal-function recovery of short-term survivors, and renal-function recovery of long-term survivors were 51.7%, 68.6%, 82.0%, and 88.4%, respectively. This case example illustrates a process for formulating and expressing a prognostic assessment for an ICU patient requiring RRT for ARF. Data from the literature review provide baseline information that requires adjustment to reflect specific patient circumstances. The nature of the acute primary process, comorbidities, and severity of illness are key modifiers. Finally, the prognostic assessment is expressed during a family meeting using recommended principles of communication.
Patel, Ankur; Sharma, Deepak; Shastri, Sweta; Sharma, Pradeep
To determine the incidence and risk factors of acute renal failure (ARF) in hospitalized critically ill neonates and analyze outcome of all neonates with renal failure in relation to risk factors. In this prospective observational study 815 infants were enrolled. Renal profile (blood urea and serum creatinine) was done after 12 h of life (or at the time of admission for outborn babies) and then every 12 hourly. Daily 24 h urine output was evaluated. Incidence of renal failure in critically ill neonates was 10.67%. Out of 87 ARF neonates 52 (60%) expired. Mortality in the renal failure group was significantly higher in comparison to control group (p renal failure was more common than oliguric renal failure, but mortality in the oliguric renal failure group was more. Neonatal sepsis was the most common cause of ARF. Eight neonates underwent peritoneal dialysis (PD) out of which there were seven neonatal deaths. Prognosis of neonates with ARF requiring PD was very poor. It can thus be concluded that the health care personal should do rapid diagnosis of ARF in neonates with potential risk factors and also goal at an early and effective treatment of these risk factors in neonates with ARF.
Weidmann, Zoraida Moreno; Breidthardt, Tobias; Twerenbold, Raphael; Züsli, Christina; Nowak, Albina; von Eckardstein, Arnold; Erne, Paul; Rentsch, Katharina; de Oliveira, Mucio T; Gualandro, Danielle; Maeder, Micha T; Rubini Gimenez, Maria; Pershyna, Kateryna; Stallone, Fabio; Haas, Laurent; Jaeger, Cedric; Wildi, Karin; Puelacher, Christian; Honegger, Ursina; Wagener, Max; Wittmer, Severin; Schumacher, Carmela; Krivoshei, Lian; Hillinger, Petra; Osswald, Stefan; Mueller, Christian
Renal function, as quantified by the estimated glomerular filtration rate (eGFR), is a predictor of death in acute heart failure (AHF). It is unknown whether one of the clinically-available serum creatinine-based formulas to calculate eGFR is superior to the others for predicting mortality. We quantified renal function using five different formulas (Cockroft-Gault, MDRD-4, MDRD-6, CKD-EPI in patientsrenal function and in three vulnerable subgroups: women, patients with severe left ventricular dysfunction, and the elderly. The prognostic accuracy for readmission was poor for all equations, with an AUC around 0.5. Calculating eGFR using the Cockcroft-Gault formula assesses the risk of mortality in patients with AHF more accurately than other commonly used formulas. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.
Slesak, Günther; Fleck, Ralf; Jacob, Daniela; Grunow, Roland; Schäfer, Johannes
A German businessman developed acute watery diarrhoea after a three-day trip to the Philippines. He was admitted with severe hypotension and acute renal failure, but recovered with rapid rehydration. Vibrio cholerae O1 serotype Ogawa was isolated. Physicians need to be aware of endemic cholera in Asia including the Philippines and consider this in their pre-travel advice.
Berni Wennekers, Ana; Martín Azara, María Pilar; Dourdil Sahun, Victoria; Bergasa Liberal, Beatriz; Ruiz Laiglesia, José Esteban; Vernet Perna, Patricia; Alvarez Lipe, Rafael
Multiple myeloma (MM) is a haematological tumour that is characterised by uncontrolled proliferation of plasma cells and a significant volume of serum free light chains (sFLCs), which can cause acute renal failure due to intratubular precipitation, resulting in cast nephropathy. Acute renal failure is a complication that can arise in more than 20% of patients with multiple myeloma, half of which will require dialysis. We report our experience with 13 patients who were treated with dialysis using high cut off filters (HCO) between July 2011 and February 2015. A total of 6 consecutive 6-hour sessions were performed using a 2.1 m(2) HCO filter (Theralite® by Gambro®). Afterwards, further 6-hour sessions were continued on alternate days. A total of 151 sessions were conducted, with an average of 11.6 sessions per patient (range 6-27). The treatment proved to be effective in removing both kappa and lambda sFLCs, resulting in a 93.7% fall in sFLCs by the end of treatment. The average reduction was 57.7% per dialysis session. 10 out of the 13 cases recovered sufficient renal function to become independent of dialysis. There were no major changes in albumin levels using an infusion protocol of 2 50-mL vials of 20% albumin at the end of the dialysis session. Combination treatment with chemotherapy and long dialysis with HCO filters was effective in reducing the sFLC levels and recovering sufficient renal function in 77% of cases. With HCO filters, significant cost savings are achieved, contrary to what was previously believed. Copyright © 2016 Sociedad Española de Nefrología. Published by Elsevier España, S.L.U. All rights reserved.
Full Text Available Introduction: Tubular damage is common finding in acute renal failure (ARF. Various etiologies have been put forth to explain the tubular damage in ARF, one important mechanism among them is oxidative damage to renal tubules. Several biomolecules including low-molecular weight peptides and enzymes in urine have been proposed as early markers of renal failure. Current study has been undertaken to study the thiol stress and glutathione-S-transferase (GST levels in ARF patients. Method: 58 ARF patients and 55 healthy controls were selected based on inclusion and exclusion criteria. Serum thiols, GST, malanoldehyde (MDA and urine thiols were determined by spectrophotometer based methods. Results: Serum thiols and urine thiols were significantly decreased (p<0.0001, and serum GST and MDA levels were significantly increased (p<0.0001 in ARF patients compared to healthy controls. Serum GST and MDA correlated positively in ARF cases (r2 = 0.6938, p<0.0001. Conclusion: There is significant thiol stress and increased lipid peroxidation in ARF patients which leads to tubular cell membrane damage and release of GST into blood stream and into urine. This may be possible mechanism for the increased presence of GST in urine (enzymuria found in other studies.
Lee, Yu Kyung; Chin, Young-Won; Choi, Young Hee
Korean red ginseng is one of the best selling dietary supplements and its individual constituents enhance renal function. Acute renal failure (ARF) is a predisposing complication of diabetes mellitus as a result of combination drug therapy. The combination of antibiotic-antidiabetic drugs can entail toxicities and drug interactions because of the antibiotic resistance in patients with severe bacterial infection. Currently, gentamicin-metformin combination therapy is commonly prescribed for treating bacterial infections and diabetes, even though both drugs are mainly excreted via the kidney. Thus, this study was designed to investigate whether a Korean red ginseng extract (KRG) prevents renal impairment and pharmacokinetic changes by metformin in rats with renal failure induced by gentamicin. The in vivo pharmacokinetics and in vitro hepatic/intestinal metabolism of metformin were assessed using control (CON), control with Korean red ginseng extract (KRG-CON), acute renal failure induced by gentamicin (ARF), and ARF with Korean red ginseng (KRG-ARF) rats. Pharmacokinetic changes of metformin did not occur in KRG-ARF rats because KRG reduce the renal accumulation of gentamicin compared to ARF rats. Thus, KRG seemed to prevent acute renal failure induced by gentamicin treatment. Copyright © 2013 Elsevier Ltd. All rights reserved.
Vicente-Vicente, Laura; Sánchez-Juanes, Fernando; García-Sánchez, Omar; Blanco-Gozalo, Víctor; Pescador, Moisés; Sevilla, María A; González-Buitrago, José Manuel; López-Hernández, Francisco J; López-Novoa, José Miguel; Morales, Ana Isabel
Nephrotoxicity limits the therapeutic efficacy of the antineoplastic drug cisplatin. Due to dosage adjustment and appropriate monitoring, most therapeutic courses with cisplatin produce no or minimal kidney damage. However, we studied whether even sub-nephrotoxic dosage of cisplatin poses a potential risk for the kidneys by predisposing to acute kidney injury (AKI), specifically by lowering the toxicity threshold for a second nephrotoxin. With this purpose rats were treated with a single sub-nephrotoxic dosage of cisplatin (3mg/kg, i.p.) and after two days, with a sub-nephrotoxic regime of gentamicin (50mg/kg/day, during 6 days, i.p.). Control groups received only one of the drugs or the vehicle. Renal function and renal histology were monitored throughout the experiment. Cisplatin treatment did not cause any relevant functional or histological alterations in the kidneys. Rats treated with cisplatin and gentamicin, but not those under single treatments, developed an overt renal failure characterized by both renal dysfunction and massive tubular necrosis. In addition, the urinary excretion of fumarylacetoacetase was increased in cisplatin-treated animals at subtoxic doses, which might be exploited as a cisplatin-induced predisposition marker. In fact, the urinary level of fumarylacetoacetase prior to the second nephrotoxin correlated with the level of AKI triggered by gentamicin in predisposed animals. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.
Full Text Available Acute renal failure (ARF is the acute loss of kidney function over hours or days, the etiology of which varies in different countries. The data on the etiology and outcome of ARF in Arab children is limited. Our objective was to define the causes and predictors of outcome of ARF in Kuwaiti children, and the variables determining their fitness for dialysis. A total of 32 children with ARF were evaluated regarding their demographic and clinical data, the cause of ARF and the co-morbidities. Data were analyzed to find the independent variables determining fitness for dia-lysis and outcome. Males comprised 62.5% of the study children; 46.9% of ARF cases were due to sepsis and 56.2% underwent renal replacement therapy (RRT. Univariate analysis showed that age, hemodynamic instability, use of vasopressors, multi-organ failure (MOF, and mechanical venti-lation contributed to fitness for dialysis. However, MOF was the only independent variable affecting fitness for dialysis. The overall mortality was 43.8%. Univariate analysis showed that age below 24-months, hemodynamic instability, use of vasopressors, fluid overload, need for mecha-nical ventilation, MOF and late referral to the nephrologist were associated with poor outcome. However, multivariate analysis documented MOF, and the time of nephrologists′ intervention as independent prognostic indicators. Our study suggests that sepsis was the major cause of pediatric ARF. RRT is the optimal treatment, and the only factor determining child′s fitness for dialysis is MOF.
Lin, J.H.; Lin, T.H.
Two etiologically different models of experimental acute renal failure were induced in rats by administration of either glycerol or uranyl nitrate. Both compounds caused a substantial decrease in the glomerular filtration rate (GFR) and the net tubular secretion of tetraethylammonium bromide (TEAB) and para-aminohippuric acid (PAH). The degree of renal impairment induced by uranyl nitrate and glycerol appeared to be dose related. Deprivation of drinking water 24 hr before the administration of glycerol potentiated the renal damage. In uranyl nitrate-induced renal failure, the decline of the net tubular secretion for TEAB and PAH was not proportional to the decrease in GFR; the secretion process deteriorated faster than the GFR. For example, when 0.5 mg/kg uranyl nitrate was administered, GFR fell to approximately 65% of normal, whereas the net tubular secretion was decreased to 30% of normal. These results suggest that the tubular transport was preferentially affected by uranyl nitrate. In contrast, in glycerol-induced renal failure, the decline of TEAB secretion fell in a parallel fashion with the GFR, suggesting that the glomeruli and the proximal tubules were equally damaged by glycerol. However, in this latter model, the decline of PAH secretion did not parallel the decrease in GFR, contradicting the proposal that glycerol affects equally the glomeruli and the proximal tubules. This discrepancy may be due to the selective competitive inhibition of PAH secretion by the accumulation of naturally occurring organic acids
Full Text Available Objectives To evaluate the result of treatment of acute renal failure (ARF in patients after cardiac surgery. Methods The clinical data of 54 cases admitted to the hospital from Jan. 2004 to Jan. 2014 and suffered from ARF after cardiac surgery were retrospectively analyzed. Among 54 cases, there were 35 males and 19 females, aged from one month to 79 years with a median of 52 years. The surgical procedures included coronary artery bypass grafting (CABG, 10 cases, valve surgery (22 cases, combined CABG and valve surgery (4 cases, operation on aorta (14 case, and radical correction of Fallot tetralogy (4 cases. After the operations mentioned above, 50 patients received continuous renal replacement therapy (CRRT, and 4 patients received peritoneal dialysis. Results Nine patients died, the mortality rate was 16.7%. Exploratory hemostasis by thoracotomy was performed in 8 patients, and extubation failure occurred in 4 cases. Of the 9 non-survivors, 6 died from multiple organ failure (MOF, 2 died from cerebral hemorrhage, and one died from acute respiratory failure. Serum creatinine (SCr and blood urea nitrogen (BUN levels declined obviously after CRRT and peritoneal dialysis (P<0.05, and all the patients were shown to have stable hemodynamics in the course of treatment, and no hemorrhage or embolism occurred. Conclusions ARF after cardiac surgery should be detected early and treated in time. CRRT and peritoneal dialysis are safe, convenient and effective procedures, and may decrease the mortality rate in patients with ARF after cardiac surgery. DOI: 10.11855/j.issn.0557-7402.2015.04.13
Rizkalla, Nicole A; Feudtner, Chris; Dai, Dingwei; Zuppa, Athena F
Care for the pediatric patient with acute renal failure who requires hemodialysis (including continuous renal replacement therapy) is made more complex, as this intervention may significantly affect drug clearance, potentially altering, to a degree that is largely unknown, the effectiveness and safety of the multiple medications used to manage this complex patient population. This study aims to describe patterns of drug utilization among a large cohort of pediatric patients requiring hemodialysis and to document the easily accessible existing data available for dosing guidance of frequently prescribed medications. Retrospective cohort using the Pediatric Health Information System database. Forty freestanding children's hospitals throughout the United States. Two thousand seven hundred thirty-eight pediatric patients with acute renal failure treated with hemodialysis from 2007 to 2011. A retrospective review of all patients requiring hemodialysis from 2007 to 2011 was conduction using the Pediatric Health Information System Database. Over 6% of pediatric patients with acute renal failure treated with hemodialysis were exposed to hemodialysis for over 2 weeks. Cumulative exposure to distinct drugs increased substantially with more prolonged courses of hemodialysis. Of the 50 most frequently prescribed medications in the cohort with acute renal failure treated with hemodialysis, 10% have readily available and easily accessible information to guide dosing adjustments with the use of hemodialysis. Furthermore, only 18% of these medications have clear recommendations for dosing in pediatric patients of all age groups with renal failure. Pediatric patients with acute renal failure managed with hemodialysis are exposed to a broad variety of medications, with a high prevalence of polypharmacy. There is a trend for longer courses of hemodialysis in these patients, which leads to an increase in cumulative drug exposure, complexity of drug interactions, and potential toxicity
Full Text Available The article describes a clinical case of multiple myeloma in 78-year-old man, its clinical onset was as an acute attack of gout. The patient was admitted to hospital due to the development of the first acute attack of gout. The attack was characterized by polyarthricular joint lesion of the upper and lower extremities, pronounced inflammatory reaction, insufficient response to the use of non-steroidal anti-inflammatory drugs, and a high level of hyperuricemia. The serum uric acid concentration ranged from 636 to 712 μmol/l. The study of the synovial fluid of the inflamed knee joint made it possible to reveal uric acid crystals and to confirm the diagnosis of acute gouty arthritis. Simultaneously, the patient had significant renal impairment: creatinine was 574 μmol/l, urea — 39.9 mmol/l, glomerular filtration rate according to CKD-EPI — 8 ml/min. The daily proteinuria was 1.8 g. A retrospective assessment of laboratory parameters allowed to reveal completely normal indicators of renal function 6 months ago. Considering the development of acute gouty arthritis, its polyarticular nature, persistent course, rapid involvement of new joints, high uric acid levels during an acute attack exceeding 600 μmol/l (10 mg/dL, rapid development of renal failure within 6 months until the terminal stage, it was suggested the secondary nature of gout on the background of kidney damage by another pathological process. Further clinical, laboratory and instrumental studies allowed verifying multiple myeloma with renal damage. Bence Jones protein in the urine was not detected, there was also no evidence of hyperproteinemia. However, pain in the spine, ribs and chest was the basis for carrying out an X-ray study of the bones of the skeleton. Changes in the skeleton typical for multiple myeloma have been identified. Myelogram showed a high content of plasma cells (21.1 %, electrophoresis of blood proteins showed a high M-gradient (30.42 %, and a cytochemical
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Los mecanismos del da no celular en la insuficiencia renal aguda Incluyen alteraciones en la producción de energía, la permeabilidad celular y el transporte de calcio. Dichas alteraciones producen cambios progresivos en la estructura celular que pueden ser reversibles si desaparece la causa que llevó a la falla renal, excepto cuando se alcanza la fase final de la lesión de la membrana y se llega a necrosis celular. Este mismo fenómeno probablemente ocurre tambIén en situaciones clínicas.
The mechanisms of cellular damage In acute renal failure Include alterations In energy production, cell membrane permeability and calcium transport. These changes lead to progressive damage of the whole cellular structure which In general can be reversible If the precipitating cause disappears, except when the final stages of cell membrane lesion take place and cellular necrosis has occurred. This phenomenon probably applies for the clinical settling as well.
Matsue, Yuya; Shiraishi, Atsushi; Kagiyama, Nobuyuki; Yoshida, Kazuki; Kume, Teruyoshi; Okura, Hiroyuki; Suzuki, Makoto; Matsumura, Akihiko; Yoshida, Kiyoshi; Hashimoto, Yuji
Although intravenous diuretics have been mainstay drugs in patients with acute heart failure (AHF), they have been suggested to have some deleterious effects on prognosis. We postulated that renal function may modify their deleterious effects in AHF patients. The study population consisted of 1094 AHF patients from three hospitals. Renal dysfunction (RD) was defined as estimated glomerular filtration rate (eGFR) diuretics was significantly modified with renal function in AHF. This association may be one reason for poorer prognosis of AHF patients complicated with renal impairment.
Oh, Se Hoon; Lee, Joon Hyoek; Hwang, Ji Won; Kim, Hye Young; Lee, Chang Hoon; Gwak, Geum Youn; Choi, Moon Seok; Koh, Kwang Chul; Paik, Seung Woon; Yoo, Byung Chul
Hepatitis A is generally known as a mild, self-limiting disease of the liver, but in rare instances it can progress to fulminant hepatitis, which may require liver transplantation for recovery. Such cases are known to be related to old age and underlying liver disease. We report four cases of hepatitis A in which patients presented with fulminant hepatitis and acute renal failure and underwent liver transplantation. The following common features were observed in our cases: (1) occurrence in relatively old age (>/=39 years old), (2) association with acute renal failure, (3) presence of hepatomegaly, and (4) microscopic features of submassive hepatic necrosis.
Bodi, Joseph M; Nsibu, Célestin N; Aloni, Michel N; Lukute, Guy N; Kunuanuna, Thomas S; Tshibassu, Pierre M; Pakasa, Nestor
Acute renal failure (ARF) is reported in some severe forms of malaria such as black water fever (BWF). It is associated with a high mortality rate and can be managed effectively with adequate renal replacement. A prospective survey of children with dark urine after a malarial infection with Plasmodium falciparum was coupled with a chart review study of patients managed in the past 11 years in the Pediatrics' Kinshasa University Hospital. Eighty-nine cases of ARF were identified, but data from only 63 patients were available, of whom 44 (69.8%) had severe malaria (39 with BWF and 5 with cerebral malaria). The mean age of the patients was 8.2±1.73 years. Of the 39 cases of BWF, an association with quinine ingestion was observed in 32 children (82%). Urea and creatinine levels were elevated in all cases (135.4±88.2 and 3.83±2.81 mg/dL, respectively). Oligo-anuria was observed in 44.4%, severe metabolic acidosis (bicarbonatemetabolic acidosis were observed more often than other clinical/metabolic disturbances. Severe renal impairment remains a significant complication with a high mortality rate in low-resource settings.
Hui Wen FAN
Full Text Available A case of a 37-week pregnant woman who developed a hemorrhagic syndrome and acute renal failure after contact with Lonomia caterpillars is reported. The accident also initiated labour and the patient gave birth to an alive child. Some pathophysiological aspects of the genital bleeding and of the acute renal failure are discussed.Um caso de uma gestante de 37 semanas que desen-volveu uma síndrome hemorrágica e insuficiência renal aguda após contato com lagartas do gênero Lonomia é relatado. O acidente desencadeou trabalho de parto prematuro e a paciente deu à luz a um recém nascido vivo. Alguns aspectos fisiopatológicos do sangramento genital e da insuficiência renal aguda são discutidos.
Huang, Chih-Yu; Shih, Chi-Chung; Chung, Kong; Kao, Kuo-Chin; Wu, Huang-Pin
Predicting acute renal failure in patients with severe sepsis is important, because patients may need renal replacement therapy (RRT). Neutrophil gelatinase-associated lipocalin (NGAL) has been evaluated for its ability to detect and predict acute kidney injury (AKI) in critically ill patients. This study aimed to assess the predictive value of plasma NGAL for acute renal failure in adult severely septic patients. Thirty healthy adults and 85 adult patients admitted to the medical intensive care unit (ICU) were enrolled. Serum creatinine, plasma NGAL, and interleukin (IL)-6, IL-10, and IL-17 levels were evaluated. AKI was classified as Risk, Injury, Failure, Loss of kidney function, and End-stage kidney disease (RIFLE). RIFLE-Failure (RIFLE-F) developed in 30 of 76 (39.5%) patients with severe sepsis without chronic kidney disease within 7 days after ICU admission. Serum creatinine, plasma NGAL, IL-6, and IL-10 could predict RIFLE-F within 7 days after ICU admission. The discriminatory power of plasma NGAL was not significant for predicting hospital mortality. The area under the receiver operating characteristic curve of plasma NGAL was not higher than that of serum creatinine in predicting RIFLE-F within 7 days. Plasma NGAL is a useful tool for predicting acute renal failure in adult patients with severe sepsis. Serum creatinine has a similar ability to detect RIFLE-F occurrence. Copyright © 2016. Published by Elsevier Taiwan LLC.
Kobel, Marie Cæcilie; Nielsen, Tommy Kjærgaard; Graumann, Ole
Percutaneous drainage proved to be successful in managing a renal subcapsular haematoma that was causing acute renal failure and hypertension in a 74-year-old woman. The patient presented with oliguria, nausea and malaise 2 days after a ureteronephroscopic procedure with biopsies of a suspected......, but recent case reports have described successful management by laparoscopy-assisted and radiology-assisted drainage, as described in this case report....
Salah, Khibar; Kok, Wouter E; Eurlings, Luc W; Bettencourt, Paulo; Pimenta, Joana M; Metra, Marco; Verdiani, Valerio; Tijssen, Jan G; Pinto, Yigal M
The aim of this study was to analyze the dynamic changes in renal function in combination with dynamic changes in N-terminal pro-B-type natriuretic peptide (NT-proBNP) in patients hospitalized for acute decompensated heart failure (ADHF). Treatment of ADHF improves cardiac parameters, as reflected by lower levels of NT-proBNP. However this often comes at the cost of worsening renal parameters (e.g., serum creatinine, estimated glomerular filtration rate [eGFR], or serum urea). Both the cardiac and renal markers are validated indicators of prognosis, but it is not yet clear whether the benefits of lowering NT-proBNP are outweighed by the concomitant worsening of renal parameters. This study was an individual patient data analysis assembled from 6 prospective cohorts consisting of 1,232 patients hospitalized for ADHF. Endpoints were all-cause mortality and the composite of all-cause mortality and/or readmission for a cardiovascular reason within 180 days after discharge. A significant reduction in NT-proBNP was not associated with worsening of renal function (WRF) or severe WRF (sWRF). A reduction of NT-proBNP of more than 30% during hospitalization determined prognosis (all-cause mortality hazard ratio [HR]: 1.81; 95% confidence Interval [CI]: 1.32 to 2.50; composite endpoint: HR: 1.36, 95% CI: 1.13 to 1.64), regardless of changes in renal function and other clinical variables. When we defined prognosis, NT-proBNP changes during hospitalization for treatment of ADHF prevailed over parameters for worsening renal function. Severe WRF is a measure of prognosis, but is of lesser value than, and independent of the prognostic changes induced by adequate NT-proBNP reduction. This suggests that in ADHF patients it may be warranted to strive for an optimal decrease in NT-proBNP, even if this induces WRF. Copyright © 2015 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.
Full Text Available Operative positions commonly used in urogenital surgeries when perineal exposure is required include the lithotomy and the exaggerated lithotomy positions (LPs, which expose patients to the risk of rhabdomyolysis. We report a patient with bladder outflow obstruction, benign prostatic hypertrophy and a very large bladder stone, which was removed with cystoscopy and cystolitholapaxy in the LP. The procedure was complicated by posterior bladder perforation and abdominal distention leading to prolonged surgery duration (5.5 h. The patient developed rhabdomyolysis and acute renal failure (ARF without compartmental syndrome. On the other hand, there was a potential role of glycine solution, used for bladder irrigation, in the appearance of ARF. Overall, our case shows that rhabdomyolysis and ARF can develop in operative positions, and duration of surgery is the most important risk factor for such complications.
Wu Yajun; Zheng Bingjie; Shi Lan; Fan Yaping
Objective: To explore the effect of intravenous or intra-renal-capsular administration of astragalus and dopamine on the serum NO and renal tissue NO, ET contents in rat models of acute renal failure. Methods: Experimental rat models of acute renal failure induced by intraperitoneal injection of E. Coli endotoxin (lipo-polysaccharide) were prepared (n=60). Treatment with astragalus and dopamine was administered via either intravenous on intra-renal-capsular route (n=20 in each group). Serum NO and renal tissue NO (with nitric acid reductase method), ET (with RIA) contents were determined at 4, 8, 12, 16h after injection of endotoxin. Twenty shock models were left untreated and additional twenty rats receiving saline injection only served as controls. Results: In the intravenously treated group, the increase of serum NO and renal tissue NO, ET contents were significantly less than those in the untreated group (P<0.05). In the group treated via the intracapsular route , the increase of renal tissue NO and ET contents were much less than those in the intravenous group at 12 and 16h (P<0.05). Conclusion: Combined treatment with astragalus and dopamine could abate the abnormally high renal tissue contents of NO and ET after endotoxin shock in experimental rats and treatment with intra capsular administration seems to be more effective. (authors)
Teslariu, Oana; Nechifor, M; Plămădeală, P; Miron, Ingrith Crenguţa
To investigate the influence of Montelukast (MK) in acute renal failure (ARF) experimentally induced by cisplatin (CIS). The experiment was carried out in male Wistar rats (280-320g), divided into 4 groups of 12 animals each, treated as follows: Group I (Control); Group II (CIS): CIS, 5 mg/kbw, single dose, i.p.; Group III (CISMK): CIS, 5 mg/kbw, single dose, i.p and MK 2 mg/kbw, p.o., 10 days; Group IV (MK): MK 2 mg/kbw, p.o., 10 days. Blood and urine (24 h) samples were taken before the start of experiment (Io) and at 3, 7, 10 and 14 days after CIS administration. The following were determined: urea, creatinine, Ca, Mg serum levels and creatinine, proteins, Ca and Mg urinary levels. For histological evaluation, 3 rats of each group were sacrificed at 3, 7, 10 and 14 days. The severity of histopathological changes was evaluated using scores on a 1-4 point scale. Both in CIS and CISMK group, serum levels of urea and creatinine and urinary protein levels were significantly higher compared with Io values and control group at 3 and 7 days, (p < 0.01 and p < 0.05, respectively). Urinary creatinine levels were significantly decreased at 3 and 7 days, (p < 0.01) and (p < 0.05) in CIS and CISMK group compared to Io and control group. The degree of severity of histopathological changes was similar in CIS and CISMK group. The obtained results showed that MK at a dose of 2 mg/kbw had no protective effect in CIS-induced experimental acute renal failure.
Al-Osail, Aisha M; Al-Zahrani, Ibrahim M; Al-Abdulwahab, Abdullah A; Alhajri, Sarah M; Al-Osail, Emad M; Al-Hwiesh, Abdullah K; Al-Muhanna, Fahad A
Infective endocarditis is one of the most common infections among intravenous drug addicts. Its complications can affect many systems, and these can include acute renal failure. There is a scarcity of cases in the literature related to acute renal failure secondary to infective endocarditis treated with peritoneal dialysis. In this paper, the case of a 48-year-old Saudi male is reported, who presented with features suggestive of infective endocarditis and who developed acute kidney injury that was treated successfully with high tidal volume automated peritoneal dialysis. To our knowledge, this is the second report of such an association in the literature. A 48-year-old Saudi gentleman diagnosed to have a glucose-6-phosphate dehydrogenase deficiency and hepatitis C infection for the last 9 years, presented to the emergency department with a history of fever of 2 days' duration. On examination: his temperature = 41 °C, there was clubbing of the fingers bilaterally and a pansystolic murmur in the left parasternal area. The results of the blood cultures and echocardiogram were supportive of the diagnosis of infective endocarditis, and the patient subsequently developed acute kidney injury, and his creatinine reached 5.2 mg/dl, a level for which dialysis is essential for the patient to survive. High tidal volume automated peritoneal dialysis is highly effective as a renal replacement therapy in acute renal failure secondary to infective endocarditis if no contraindication is present.
Chen, Horng H; Anstrom, Kevin J; Givertz, Michael M; Stevenson, Lynne W; Semigran, Marc J; Goldsmith, Steven R; Bart, Bradley A; Bull, David A; Stehlik, Josef; LeWinter, Martin M; Konstam, Marvin A; Huggins, Gordon S; Rouleau, Jean L; O'Meara, Eileen; Tang, W H Wilson; Starling, Randall C; Butler, Javed; Deswal, Anita; Felker, G Michael; O'Connor, Christopher M; Bonita, Raphael E; Margulies, Kenneth B; Cappola, Thomas P; Ofili, Elizabeth O; Mann, Douglas L; Dávila-Román, Víctor G; McNulty, Steven E; Borlaug, Barry A; Velazquez, Eric J; Lee, Kerry L; Shah, Monica R; Hernandez, Adrian F; Braunwald, Eugene; Redfield, Margaret M
Small studies suggest that low-dose dopamine or low-dose nesiritide may enhance decongestion and preserve renal function in patients with acute heart failure and renal dysfunction; however, neither strategy has been rigorously tested. To test the 2 independent hypotheses that, compared with placebo, addition of low-dose dopamine (2 μg/kg/min) or low-dose nesiritide (0.005 μg/kg/min without bolus) to diuretic therapy will enhance decongestion and preserve renal function in patients with acute heart failure and renal dysfunction. Multicenter, double-blind, placebo-controlled clinical trial (Renal Optimization Strategies Evaluation [ROSE]) of 360 hospitalized patients with acute heart failure and renal dysfunction (estimated glomerular filtration rate of 15-60 mL/min/1.73 m2), randomized within 24 hours of admission. Enrollment occurred from September 2010 to March 2013 across 26 sites in North America. Participants were randomized in an open, 1:1 allocation ratio to the dopamine or nesiritide strategy. Within each strategy, participants were randomized in a double-blind, 2:1 ratio to active treatment or placebo. The dopamine (n = 122) and nesiritide (n = 119) groups were independently compared with the pooled placebo group (n = 119). Coprimary end points included 72-hour cumulative urine volume (decongestion end point) and the change in serum cystatin C from enrollment to 72 hours (renal function end point). Compared with placebo, low-dose dopamine had no significant effect on 72-hour cumulative urine volume (dopamine, 8524 mL; 95% CI, 7917-9131 vs placebo, 8296 mL; 95% CI, 7762-8830 ; difference, 229 mL; 95% CI, -714 to 1171 mL; P = .59) or on the change in cystatin C level (dopamine, 0.12 mg/L; 95% CI, 0.06-0.18 vs placebo, 0.11 mg/L; 95% CI, 0.06-0.16; difference, 0.01; 95% CI, -0.08 to 0.10; P = .72). Similarly, low-dose nesiritide had no significant effect on 72-hour cumulative urine volume (nesiritide, 8574 mL; 95% CI, 8014-9134 vs placebo
Úbeda-Iglesias, A; Herrera-Rojas, D; Gómez-González, C
To analyze knowledge and experience in the diagnosis and management of acute renal failure (ARF) and the use of renal replacement therapy (RRT) in different Spanish Intensive Care Units (ICUs). A case series with a survey conducted by the Nephro-Intensive Care Working Group of the SEMICYUC was compiled between January and November 2011. Spanish national ICUs. A survey of 28 questions with multiple and open responses. The survey was sent to 99 ICUs. Volunteers consisting of the medical staff belonging to the 51 ICUs that responded. Main variables of interest General characteristics of hospitals and ICUs, definitions of ARF and RRT (indications and management). RIFLE/AKIN scales to define ARF (47%). ARF diagnosis: plasma creatinine (80.4%), creatinine clearance (52.9%). Protocols for RRT: 72.5%. RRT in non-renal indications: 70.6%. Indications for initiation of RRT: oliguria, increased creatinine and urea. End of RRT: increased diuresis. RRT dose: 21-35 ml/kg/h (41.2%), 36-45ml/kg/h (33.3%). There is great variability in the ARF detection methods, and adequate incorporation of the RIFLE/AKIN systems to daily clinical practice in the ICU is still lacking. Written protocols aimed at establishing an early diagnosis of ARF are needed, based on these systems. On the other hand, there is growing interest in RRT, despite the fact that there are no definitive indications or guidelines on the use and handling of such techniques. Copyright © 2013 Elsevier España, S.L.U. and SEMICYUC. All rights reserved.
Kim, Min-Seok; Jeong, Tae-Dong; Han, Seung-Bong; Min, Won-Ki; Kim, Jae-Joong
This study sought to assess the relationship between serum concentrations of the soluble ST2 (sST2) and B-type natriuretic peptide (BNP) and investigate the role of sST2 as a prognosticator in patients hospitalized with acute heart failure (HF) and renal insufficiency. sST2 was measured at admission and discharge in 66 patients hospitalized with acute decompensated HF and renal insufficiency (estimated glomerular filtration rate [eGFR] renal insufficiency (eGFR renal function, even though BNP level was much higher in patients with severe renal insufficiency. During 3 month follow-up, 9 (13.6%) died and 16 (24.2%) were readmitted due to HF aggravation.On multivariate analysis, sST2 at discharge was independently associated with death or HF readmission during 3 months after discharge (hazard ratio, 1.038; 95% confidence interval, 1.011-1.066, P = 0.006). In conclusion, sST2 is not affected by renal function compared with BNP in acute HF patients. The measurement of predischarge sST2 can be helpful in predicting short-term outcomes in acute decompensated HF patients with renal insufficiency.
Moghadamyeghaneh, Zhobin; Phelan, Michael J; Carmichael, Joseph C; Mills, Steven D; Pigazzi, Alessio; Nguyen, Ninh T; Stamos, Michael J
There is limited data regarding the effects of preoperative dehydration on postoperative renal function. We sought to identify associations between hydration status before operation and postoperative acute renal failure (ARF) in patients undergoing colorectal resection. The NSQIP database was used to examine the data of patients undergoing colorectal resection from 2005 to 2011. We used preoperative blood urea nitrogen (BUN)/creatinine ratio >20 as a marker of relative dehydration. Multivariate analysis using logistic regression was performed to quantify the association of BUN/Cr ratio with ARF. We sampled 27,860 patients who underwent colorectal resection. Patients with dehydration had higher risk of ARF compared to patients with BUN/Cr Dehydration was associated with an increase in mortality of the affected patients (AOR, 2.19; P dehydrated patients. Open colorectal procedures (AOR, 2.67; P = 0.01) and total colectomy procedure (AOR, 1.62; P Dehydration before operation is a common condition in colorectal surgery (incidence of 27.7 %). Preoperative dehydration is associated with increased rates of postoperative ARF, MI, and cardiac arrest. Hydrotherapy of patients with dehydration may decrease postoperative complications in colorectal surgery.
Bouman, Catherine S. C.; Oudemans-van Straaten, Heleen M.; Tijssen, Jan G. P.; Zandstra, Durk F.; Kesecioglu, Jozef
Objective. To study the effects of the initiation time of continuous venovenous hemofiltration and of the ultrafiltrate rate in patients with circulatory and respiratory insufficiency developing early oliguric acute renal failure. The primary end points were mortality at 28 days and recovery of
Lee, Dong Won; Kwak, Ihm Soo; Lee, Soo Bong; Song, Sang Heon; Seong, Eun Young; Yang, Byeong Yun; Lee, Min Young; Sol, Mee Young
5-Lipoxygenase inhibitor and human recombinant erythropoietin might accelerate renal recovery in cisplatin-induced acute renal failure rats. Male Sprague-Dawley rats were randomized into four groups: 1) normal controls; 2) Cisplatin group-cisplatin induced acute renal failure (ARF) plus vehicle treatment; 3) Cisplatin+nordihydroguaiaretic acid (NDGA) group-cisplatin induced ARF plus 5-lipoxygenase inhibitor treatment; 4) Cisplatin+erythropoietin (EPO) group-cisplatin induced ARF plus erythrop...
Saracyn, Marek; Ząbkowski, Tomasz; Zdanowski, Robert; Brytan, Marek; Patera, Janusz; Nowak, Zbigniew; Kade, Grzegorz; Wańkowicz, Zofia
The pathomechanism of acute hepatorenal syndrome (HRS), a particular form of acute renal failure that occurs in the course of acute liver injury, is still poorly understood. The aim of our study was to estimate the influence of the activation and inhibition of the nitric oxide pathway on the water/sodium balance and development of acute renal failure in the course of HRS. We used male Sprague-Dawley rats in the acute galactosamine (Ga1N) model of HRS. The nitric oxide synthase (NOS) inhibitors L-NAME and L-arginine were administered intraperitoneally before and after liver damage. HRS developed in all tested groups. L-NAME increased osmotic clearance and urine volume more effectively before liver injury. Furthermore, administration of L-NAME increased creatinine clearance both before and after Ga1N injection. A double dose of L-NAME did not yield further improvement before Ga1N injection, but improved creatinine clearance after Ga1N intoxication. Injection of L-arginine increased sodium excretion and urine volume, but only after liver injury. Moreover, L-arginine injected after Ga1N caused significant improvement of the creatinine clearance in a dose-dependent manner. Our study shows that inhibition of the nitric oxide pathway improves parameters of water and sodium balance and prevents development of acute renal failure in the course of acute liver injury and liver failure. Activation of the nitric oxide system also has a favorable influence on water/sodium balance and renal failure, but only after liver injury.
Soysal, Demet Demirkol; Karaböcüoğlu, Metin; Citak, Agop; Uçsel, Raif; Uzel, Nedret; Nayir, Ahmet
Continuous renal replacement therapy (CRRT) has become an important supportive therapy for critically ill children with acute renal failure. In Turkey, commercially available diafiltration and replacement fluids cannot be found on the market. Instead, peritoneal dialysis fluids for dialysis and normal saline as replacement fluid are used. The first objective of this study was to examine metabolic complications due to CRRT treatments. The second objective was to determine demographic characteristics and outcomes of patients who receive CRRT. We did a retrospective chart review of all pediatric patients treated with CRRT between February and December 2004. Thirteen patients received CRRT; seven survived (53.8%). All patients were treated with continuous venovenous hemodiafiltration. Median patient age was 71.8 +/- 78.8 (1.5-180) months. Hyperglycemia occurred in 76.9% (n=10), and metabolic acidosis occurred in 53.8% (n=7) of patients. Median age was younger (48.8 vs.106.2 months), median urea level (106.2 vs. 71 mg/dl) and percent fluid overload (FO) (17.2% vs. 7.6%, respectively) were higher, and CRRT initiation time was longer (8.6 vs 5.6 days) in nonsurvivors vs. survivors for all patients, although these were not statistically significant. CRRT was stopped in all survivors, and four nonsurvivors (67%) were on renal replacement therapy at the time of death. Hyperglycemia and metabolic acidosis were frequently seen in CRRT patients when commercially available diafiltration fluids were not available. Using peritoneal dialysis fluid as dialysate is not a preferable solution. Early initiation of CRRT offered survival benefits to critically ill pediatric patients. Mortality was associated with the primary disease diagnosis.
Joseph M Bodi
Full Text Available Acute renal failure (ARF is reported in some severe forms of malaria such as black water fever (BWF. It is associated with a high mortality rate and can be managed effectively with adequate renal replacement. A prospective survey of children with dark urine after a malarial infection with Plasmodium falciparum was coupled with a chart review study of patients managed in the past 11 years in the Pediatrics′ Kinshasa University Hospital. Eighty-nine cases of ARF were identified, but data from only 63 patients were available, of whom 44 (69.8% had severe malaria (39 with BWF and 5 with cerebral malaria. The mean age of the patients was 8.2 ± 1.73 years. Of the 39 cases of BWF, an association with quinine ingestion was observed in 32 children (82%. Urea and creatinine levels were elevated in all cases (135.4 ± 88.2 and 3.83 ± 2.81 mg/dL, respectively. Oligo-anuria was observed in 44.4%, severe metabolic acidosis (bicarbonate <15 mEq/L in 61.5% and hyponatremia (<130 mEq/L in 33.3%. Peritoneal dialysis was required in 36 patients, including 20 with BWF. The remaining patients were managed with conservative treatment. Twenty-eight children (44.4%, including 20 on dialysis, fully recovered and 14 died (22.2%, including eight cases of BWF. Our study suggests that ARF is commonly associated with BWF in Congolese children. Elevated urea and creatinine and severe metabolic acidosis were observed more often than other clinical/metabolic disturbances. Severe renal impairment remains a significant complication with a high mortality rate in low-resource settings.
Simmons, Edith M; Himmelfarb, Jonathan; Sezer, M Tugrul; Chertow, Glenn M; Mehta, Ravindra L; Paganini, Emil P; Soroko, Sharon; Freedman, Stephanie; Becker, Karen; Spratt, Daniel; Shyr, Yu; Ikizler, T Alp
Critically ill patients with acute renal failure (ARF) experience a high mortality rate. Animal and human studies suggest that proinflammatory cytokines lead to the development of a systemic inflammatory response syndrome (SIRS), which is temporally followed by a counter anti-inflammatory response syndrome (CARS). This process has not been specifically described in critically ill patients with ARF. The Program to Improve Care in Acute Renal Disease (PICARD) is a prospective, multicenter cohort study designed to examine the natural history, practice patterns, and outcomes of treatment in critically ill patients with ARF. In a subset of 98 patients with ARF, we measured plasma proinflammatory cytokines [interleukin (IL)-1beta, IL-6, IL-8, tumor necrosis factor-alpha (TNF-alpha)], the acute-phase reactant C-reactive protein (CRP), and the anti-inflammatory cytokine IL-10 at study enrollment and over the course of illness. When compared with healthy subjects and end-stage renal disease patients on maintenance hemodialysis, patients with ARF had significantly higher plasma levels of all measured cytokines. Additionally, the proinflammatory cytokines IL-6 and IL-8 were significantly higher in nonsurvivors versus survivors [median 234.7 (interdecile range 64.8 to 1775.9) pg/mL vs. 113.5 (46.1 to 419.3) pg/mL, P= 0.02 for IL-6; 35.5 (14.1 to 237.9) pg/mL vs. 21.2 (8.5 to 87.1) pg/mL, P= 0.03 for IL-8]. The anti-inflammatory cytokine IL-10 was also significantly higher in nonsurvivors [3.1 (0.5 to 41.9) pg/mL vs. 2.4 (0.5 to 16.9) pg/mL, P= 0.04]. For each natural log unit increase in the levels of IL-6, IL-8, and IL-10, the odds of death increased by 65%, 54%, and 34%, respectively, corresponding to increases in relative risk of approximately 30%, 25%, and 15%. The presence or absence of SIRS or sepsis was not a major determinant of plasma cytokine concentration in this group of patients. There is evidence of ongoing SIRS with concomitant CARS in critically ill patients
Full Text Available Cocaine has been associated with known adverse effects on cardiac, cerebrovascular and pulmonary systems. However, the effect of cocaine on other organs has not been extensively reported. A middle age man presented with abdominal pain and nausea after inhalation of crack cocaine. On admission, he was found to be hypertensive and tachycardic. Physical examination revealed mild abdominal tenderness without rebound. Laboratory investigations were significant for acute kidney failure with elevated serum creatinine (3.72 mg/dL, thrombocytopenia (platelet count 74,000/UL, elevated alanine and aspartate transaminases (ALT 331 U/L; AST 462 U/L and elevated creatine phosphokinase (CPK 5885 U/L. Urine toxicology screening solely revealed cocaine. A clinical diagnosis of cocaine toxicity was made and patient was admitted to the intensive care unit because of multi organ failure. Despite downward trending of liver enzymes during the hospital course, he continued to have residual renal insufficiency and a low platelet count at the time of discharge. In a patient with history of recent cocaine use presenting with these manifestations, cocaine itself should be considered as a likely cause.
Cleva Roberto de
Full Text Available We report on 4 cases of abdominal compartment syndrome complicated by acute renal failure that were promptly reversed by different abdominal decompression methods. Case 1: A 57-year-old obese woman in the post-operative period after giant incisional hernia correction with an intra-abdominal pressure of 24 mm Hg. She was sedated and curarized, and the intra-abdominal pressure fell to 15 mm Hg. Case 2: A 73-year-old woman with acute inflammatory abdomen was undergoing exploratory laparotomy when a hypertensive pneumoperitoneum was noticed. During the surgery, enhancement of urinary output was observed. Case 3: An 18-year-old man who underwent hepatectomy and developed coagulopathy and hepatic bleeding that required abdominal packing, developed oliguria with a transvesical intra-abdominal pressure of 22 mm Hg. During reoperation, the compresses were removed with a prompt improvement in urinary flow. Case 4: A 46-year-old man with hepatic cirrhosis was admitted after incisional hernia repair with intra-abdominal pressure of 16 mm Hg. After paracentesis, the intra-abdominal pressure fell to 11 mm Hg.
Kajimoto, Katsuya; Sato, Naoki; Takano, Teruo
Renal insufficiency is a well-known predictor of adverse events in patients with acute heart failure syndromes (AHFS). However, it remains unclear whether there are subgroups of AHFS patients in whom renal insufficiency is related to a higher risk of adverse events because of the heterogeneity of this patient population. Therefore, we investigated the relationship between renal insufficiency, clinical features or comorbidities, and the risk of adverse events in patients with AHFS. Of 4842 patients enrolled in the Acute Decompensated Heart Failure Syndromes (ATTEND) registry, 4628 patients (95.6%) were evaluated in the present study in order to assess the relationship of renal insufficiency and clinical features or comorbidities with all-cause mortality after admission. Renal insufficiency was defined as an estimated creatinine clearance of ⩽40 mL/min (calculated by the Cockcroft-Gault formula) at admission. The median follow-up period after admission was 524 (391-789) days. The all-cause mortality rate after admission was significantly higher in patients with renal insufficiency (36.7%) than in patients without renal insufficiency (14.4%). Stratified analysis was performed in order to explore the heterogeneity of the influence of renal insufficiency on all-cause mortality. This analysis revealed that an ischaemic aetiology and a history of diabetes, atrial fibrillation, serum sodium, and anaemia at admission had significant influences on the relationship between renal insufficiency and all-cause mortality. The present study demonstrated that the relationship between renal insufficiency and all-cause mortality of AHFS patients varies markedly with clinical features or comorbidities and the mode of presentation due to the heterogeneity of this patient population.
This book covers most aspects of imaging studies in patients with renal failure. The initial chapter provides basic information on contrast agents, intravenous urography, and imaging findings in the urinary tract disorders responsible for renal failure and in patients who have undergone transplantation. It illustrates common gastro-intestinal abnormalities seen on barium studies in patients with renal failure. It illustrates the cardiopulmonary complications of renal failure and offers advice for radiologic differentiation. It details different aspects of skeletal changes in renal failure, including a basic description of the pathophysiology of the changes; many excellent illustrations of classic bone changes, arthritis, avascular necrosis, and soft-tissue calcifications; and details of bone mineral analysis
Full Text Available Thus I would like to conclude by saying that an idiopathic form of obliterative renal arteriopathy account for the rare presentation of severe hypertension and progressive renal failure with or without overt hemolytic anemia and thrombocytopenia in children. It can be labelled as primary malignant nephrosclerosis (NScl or atypical HUS, based on primary thrombotic angiopathy. This, essentially intimal changes, is seen in diverse conditions and appears to result from primary endothelial injury followed by intimal exudation, thrombosis, and repair by fibrosis. Persistent or recurrence of this process form the basis of progressive obliterative arteriopathy. The result is renal ischemia and renin-angiotensin mediated hypertension. Establishment of a vicious circle would further accelerate HT and lead to end stage renal failure. Early recognition and prompt therapeutic intervention might prove beneficial.
Yadav, Yogesh Chand; Srivastava, D N
Ficus religiosa L. (Moraceae) is widely planted in the tropics. Its chemical constituents include tannin, saponin gluanol acetate, β-sitosterol, leucoanthocyanidin and leucoanthocyanin which are used for the treatment of pain, inflammation, impotence, menstrual disturbances, uterine tonic and urine related problems. To determine the possible nephroprotective and curative effects of F. religiosa latex methanol extract against cisplatin induced acute renal failure. Methanol extract was obtained by maceration process. Rats were divided in five groups. Group 1 was administered acacia (2% w/v) of 5 ml/kg throughout the experiment; group 2 was treated with single dose of cisplatin (5 mg/kg i.p.) on the 1st day; group 3 (200 mg/kg p.o.) of extract control for the 1st to 10th day, group 4 (200 mg/kg p.o.) of extract from the 1st to 10th day and a single dose of cisplatin (5 mg/kg, i.p.) on 11th day while group 5 received the same dose of cisplatin on day 1 and extract (200 mg/kg p.o.) from the 7th to 16th day. Phytochemical screening of the extract revealed the presence of glycoside, alkaloids, tannins (phenolic compounds), flavonoids and amino acids. The half maximal inhibitory concentration (IC50) values of the extract were 31.75 ± 0.12 and 18.35 ± 0.48 µg/ml, respectively. The cisplatin-treated group 2 showed significant changes; renal functions, biochemical parameters and histopathology were significantly (**p < 0.01) recovered by 200 mg/kg curative and protective groups. These findings demonstrated that F. religiosa latex and constituents have excellent nephroprotective and curative activities and thus have great potential as a source for natural health products.
Full Text Available Acute renal failure ( ARF can increase mortality and morbidity , hospital stay and costs . So ,carefull information about frequency distribution , mortality and morbidity , male : female ratio and other characteristics of ARF in ICU have important role to prevent and manage patients and to predict equipments and trainees personel . Therefor this evaluation considered to be necessary for above evidence Materials and Methods: In this analytic - descriptive study , 1383 patients were investigated in surgery ICU during 1996 - 2000. Findings were collected based on age , sex , admission cause , etiology , mortality and morbidity . Datas were analyzed statistically Results: Frequency of ARF was 25.9 percent . The most common cause of ARF was prerenal factors (57.9 percent that include : surgery drainage , bleeding and trauma . The most frequence of age group was > 70 y (25.6 percent and the least was 31 - 40 years old . Total mean age of patients were 36.5 19 y and about ARF were 52 5.8 y (P < 0.05. Males (30.3 percent were more than females (19.9 percent (P < 0.05 . Mortality rate in ARF was 57.9 percent and in other patients was 12.8 percent (P < 0.05 Conclusion: Relative frequency percentage of ARF indidcates its high frequency among hospitalized patients in ICU . Incidence of ARF increase with age and is similar to previous studies . It is probably due to underlying diseases and reduction of renal function in this age group . Males were more than female because of increasing trauma and surgery in this group . The most common cause of prerenal ARF was large amount of blood and fluids loss . Mortality rate was more than previous studies and was statistically significant . It is probably evidences of injury severity and co-existing disturbances . Because of high incidence of ARF in ICU it is necessary to maintain patients hemdynamic status , infuse enough fluids , adjust drug doses , … for immediate diagnosis and treatment of these patients.
Salgado, G; Landa, M; Masevicius, D; Gianassi, S; San-Román, J E; Silva, L; Gimenez, M; Tejerina, O; Díaz-Cisneros, P; Ciccioli, F; do Pico, J L
To determine the incidence of acute renal failure (ARF) in critically ill patients using the RIFLE and AKIN criteria. A prospective, multicenter observational study with a duration of one year from February 2010 was carried out. RIFLE and AKIN were employed using the urinary (UC) and creatinine criteria (CC) jointly and separately. Nine polyvalent Critical Care Units (CCUs) in Argentina. A total of 627 critical patients over 18 years of age were admitted to the CCU for more than 48h. inability to quantify diuresis, surgical instrumentation of the urinary tract, and need for renal support therapy (RST). Calculated hourly diuresis (CHD) was used to apply the UC. The incidence of ARF was 69.4% and 51.8% according to RIFLE and AKIN, respectively. UC detected ARF in 59.5% of cases, while CC identified ARF in 34.7% (RIFLE) and 25.3% (AKIN). The mortality rate was 40.9% and 44.6% according to RIFLE and AKIN respectively, was significantly higher than in patients without ARF, and increased with disease severity (Data processing: Excel, SQL and SPSS. Levene test, comparison of means with Student t and chi-squared, with 95% confidence interval). RIFLE identified more cases of ARF. UC proved more effective than CC. The presence of ARF and severity levels were correlated to mortality but not to days of stay in the CCU. Implementation of the unified CHD was useful for implementing UC and achieving comparable results. Copyright © 2012 Elsevier España, S.L. and SEMICYUC. All rights reserved.
Leonardo R. Pacheco
Full Text Available OBJETIVO: Avaliar a incidência e evolução da IRA em pacientes que utilizaram aciclovir por via intravenosa. MÉTODOS: Foram revisados, durante um período de sete meses consecutivos, os prontuários médicos de pacientes acima de 13 anos de idade que usaram aciclovir endovenoso (EV por cinco dias ou mais. A IRA foi considerada quando a creatinina sérica, previamente normal, aumentava acima de 2 mg/dl. Foi analisado o tipo de tratamento instituído nos casos de IRA e sua evolução. RESULTADOS: Oitenta e cinco pacientes receberam aciclovir por via endovenosa durante o período estudado. Foram incluídos no estudo 41 pacientes. A IRA desenvolveu-se em 8 dos 41 pacientes estudados (19,5%. O tempo médio para o início do aumento dos níveis séricos da creatinina, após o início do uso da droga, foi de 4,2 dias, com o pico dos níveis da creatinina sérica aparecendo entre 3 a 14 dias (média 7,1 dias. A recuperação da função renal, avaliada pela queda dos níveis da creatinina, variou de 1 a 7 dias ( média de 3,6 dias. A resolução da IRA ocorreu após medidas gerais de hidratação, aumento do tempo de infusão e ajuste da dose do aciclovir. CONCLUSÃO: O aciclovir provocou IRA em 19,5% dos pacientes, que evoluíram bem em todos os casos observados, com retorno da função renal pré-tratamento após medidas de hidratação, reajuste da dose e aumento do tempo de infusão. Não houve necessidade de hemodiálise em nenhum paciente. A droga apresenta segurança de uso, desde que cuidados sejam implementados durante sua administração.OBJECTIVE: The aim of this study was to evaluate the incidence and outcome of acute renal failure (ARF in patients submitted to intravenous (IV acyclovir treatment. METHODS: All patients over 13 years of age that used intravenous acyclovir for 5 or more days were retrospectively analyzed. When serum creatinine levels, previously in the normal range, increased above 2 mg/dl, the case was considered an ARF
Pedersen, A B; Christiansen, C F; Gammelager, H; Kahlert, J; Sørensen, H T
We examined risk of developing acute renal failure and the associated mortality among patients aged > 65 years undergoing surgery for a fracture of the hip. We used medical databases to identify patients who underwent surgical treatment for a fracture of the hip in Northern Denmark between 2005 and 2011. Acute renal failure was classified as stage 1, 2 and 3 according to the Kidney Disease Improving Global Outcome criteria. We computed the risk of developing acute renal failure within five days after surgery with death as a competing risk, and the short-term (six to 30 days post-operatively) and long-term mortality (31 days to 365 days post-operatively). We calculated adjusted hazard ratios (HRs) for death with 95% confidence intervals (CIs). Among 13 529 patients who sustained a fracture of the hip, 1717 (12.7%) developed acute renal failure post-operatively, including 1218 (9.0%) with stage 1, 364 (2.7%) with stage 2, and 135 (1.0%) with stage 3 renal failure. The short-term mortality was 15.9% and 5.6% for patients with and without acute renal failure, respectively (HR 2.8, 95% CI 2.4 to 3.2). The long-term mortality was 25.0% and 18.3% for those with and without acute renal failure, respectively (HR 1.3, 95% CI 1.2 to 1.5). The mortality was higher in patients with an increased severity of renal failure. Acute renal failure is a common complication of surgery in elderly patients who sustain a fracture of the hip, and is associated with increased mortality up to one year after surgery despite adjustment for coexisting comorbidity and medication before surgery. Cite this article: Bone Joint J 2016;98-B:1112-18. ©2016 The British Editorial Society of Bone & Joint Surgery.
Full Text Available Objective To evaluate the stability, safety and efficacy of mobile blood purification system in the treatment of acute renal failure dog model in the field environment. Methods The acute renal failure model was established in 4 dogs by bilateral nephrectomy, which was thereafter treated with the mobile blood purification system. The evaluation of functional index of the mobile blood purification system was performed after a short-time (2 hours and conventional (4 hours dialysis treatment. Results The mobile blood purification system ran stably in the field environment at a blood flow of 150-180ml/min, a dialysate velocity of 2000ml/h, a replacement fluid velocity of 2000ml/h, and ultrafiltration rate of 100-200ml/h. All the functions of alarming system worked well, including static upper limit alarm of ultrafiltration pressure (>100 mmHg, upper limit alarm of ambulatory arterial pressure (>400mmHg, upper limit alarm of ambulatory venous pressure (>400mmHg, bubble alarm of vascular access, bubble alarm during the infusion of solutions, pressure alarm at the substitution pump segment and blood leaking alarm. The vital signs of the 4 dogs with acute renal failure kept stable during the treatment. After the treatment, a remarkable decrease was seen in the levels of serum urea nitrogen, creatinine and serum potassium (P0.05. Conclusions The mobile blood purification system runs normally even in a field environment. It is a flexible and portable device with a great performance in safety and stability in the treatment of acute renal failure. DOI: 10.11855/j.issn.0577-7402.2013.12.15
Fiaccadori, E; Maggiore, U; Clima, B; Melfa, L; Rotelli, C; Borghetti, A
Few prospective data are currently available on acute gastrointestinal hemorrhage (AGIH) as a complication of acute renal failure (ARF). The aim of the present study was to define incidence, sources, risk factors, and outcome of AGIH in patients with ARF. We performed a prospective study on an inception cohort of 514 patients admitted for ARF to a nephrology intermediate care unit. Data on clinical risk factors for bleeding, frequency of occurrence of AGIH, length of hospital stay, and in-hospital mortality were collected. Independent predictors of AGIH were identified. The relative odds of death and the relative increase in length of hospital stay associated with AGIH were calculated after adjusting for baseline comorbidities. Sixty-nine patients out of 514 [13.4% (95% CI, 10.6 to 16.7)] had AGIH as a complication of ARF; 59 were upper AGIH. Forty patients had clinically important bleeding. Erosions and/or ulcers accounted for 71% of cases of upper AGIH. Independent baseline predictors of AGIH were represented by severity of illness [odds ratio 1.45 (95% CI, 1.05 to 2.01) for every 10 point increase in APACHE II score], low platelet count [<50,000 mm3; 3.71 (1.70 to 8.11)], noncirrhotic chronic hepatic disease [2.22 (1.09 to 4.55)], liver cirrhosis [3.38 (1.50 to 7.60)], de novo ARF [2.77 (1.30 to 5.90)], and severe ARF [2.07 (1.10 to 3.88)]. In-hospital mortality was 63.8% in patients with AGIH and 34.2% in the other patients; after adjusting for baseline confounders, AGIH remained significantly associated with an increase in both mortality [2.57 (1.30 to 5.09), P = 0.006] and length of hospital stay [37% (1 to 87%), P = 0.047]. AGIH and clinically important bleeding are frequent complications of ARF. In this clinical condition, AGIH is more often due to upper gastrointestinal bleeding and is associated with a significantly increased risk of death and length of hospital stay. Both renal and extrarenal risk factors are related to the occurrence of AGIH.
Hropot, M; Juretschke, H P; Langer, K H; Schwark, J R
Acute renal failure (ARF) remains a major problem in clinical nephrology characterized by sudden loss of the kidney function due to ischemia, trauma, and/or nephrotoxic drugs. The current therapy of ARF is symptomatic with mortality rates exceeding 50%. The aim of this study was to investigate the effects of an intravenous infusion of S3226 (3-[2-(3-guanidino-2-methyl-3-oxopropenyl)-5-methyl-phenyl]-N-isopropylidene-2-methyl-acrylamide dihydrochloride), a selective Na+/H+ exchange subtype 3 (NHE3) blocker, in ischemia-induced ARF in rats. In a second series of experiments cytosolic pH (pHi) changes in the kidney during ARF were continuously measured by means of nuclear magnetic resonance spectroscopy (MRS). ARF was induced by bilateral occlusion of renal arteries for 40 minutes in three groups of anaesthetized Wistar rats. Control rats (N = 12) were infused with saline (6.25 mL/kg over 30 min) before occlusion and the compound groups (each N = 12) were infused with S3226 at a dose of 20 mg/kg over 30 minutes either before initiation of ischemia or immediately after release of clamps. Plasma creatinine (PCr), creatinine clearance (CCr), urine volume, sodium, and potassium excretion were determined up to seven days after release of clamps. In the second series of experiments in anaesthetized rats the left kidney was exposed by flank incision and fixed in a non-magnetic device. An inflatable cuff was positioned around the pedicle to induce ischemia without removing animals from the magnet. A double-tuned 1H-31P home-built surface coil was placed above the exposed kidney for the detection of pHi. At day 1 after ischemia CCr in the control group was significantly lower as compared to S3226-treated animals (control 0.30 +/- 0.05 vs. before 0.90 +/- 0.26 and reperfusion 0.83 +/- 0.15 mL/min/kg, respectively). PCr increased from 18 +/- 0.1 micromol/L before occlusion to 245 +/- 7 micromol/L in the control. The increase in PCr was significantly lower in the S3226 treated
Ronco, Claudio; Cruz, Dinna; van Straaten, Helen Oudemans; Honore, Patrick; House, Andrew; Bin, Du; Gibney, Noel
The optimal dialysis dose for acute kidney injury is a matter of great controversy. Clinical trials, predominantly single-center studies, have shown conflicting results. The Acute Renal Failure Trial Network (ATN) Study was designed to compare clinical outcomes between patients allocated to an intensive dose versus a less-intensive dose of renal replacement therapy. Recently, the results of this large randomized controlled multicenter study were published. The present article will discuss certain aspects of this trial: the overall design, the baseline patient characteristics, and comparison of the results with earlier studies. Finally, the article will address the implications of the ATN Study results for clinical practice. PMID:18983695
Ronco, Claudio; Cruz, Dinna; Oudemans van Straaten, Helen; Honore, Patrick; House, Andrew; Bin, Du; Gibney, Noel
The optimal dialysis dose for acute kidney injury is a matter of great controversy. Clinical trials, predominantly single-center studies, have shown conflicting results. The Acute Renal Failure Trial Network (ATN) Study was designed to compare clinical outcomes between patients allocated to an intensive dose versus a less-intensive dose of renal replacement therapy. Recently, the results of this large randomized controlled multicenter study were published. The present article will discuss certain aspects of this trial: the overall design, the baseline patient characteristics, and comparison of the results with earlier studies. Finally, the article will address the implications of the ATN Study results for clinical practice.
Kaballo, Babikir G.; Khogali, Mohamed S.; Khalifa, Eman H.; Khalil, Eltahir A.G.; El-Hasaan, Ahmad M.; Abu-Aisha, H.
Acute renal failure (ARF) is a common health problem worldwide. There is limited data on the pattern of ARF in Sudan. Moreover, glomerular diseases, which are a well known cause of ARF, have not been accurately and adequately diagnosed previously. A retrospective study on the patterns of ARF was carried out in a general nephrology referral center in Sudan during the period from February 2003 to February 2004.Patients from intensive care units with ARF and those who developed ARF after massive surgery were excluded from the study. Renal biopsy was performed when indicated and studied with light and immunofluorescent microscopy. Eighty-nine patients (57 (64%) cases were males and mean age was 39+-19.4 years) fulfilled the criteria for the diagnosis of advanced renal failure requiring renal function replacement therapy. Acute tubular necrosis (ATN) was diagnosed in 50 (56%) patients; 33 (66%) ATN patients had renal failure as a complication of volume depletion, fulminant infections (particularly malaria and typhoid fever) or snakebites, and 12 (13.4%) patients ingested paraphenylene-diamine (PPD) (hair/Henna dye) in suicidal attempts. Eight (9%) patients of the total study group had glomerural diseases and 11 (12.3%) had obstructive uropathy associated with ARF; cause of ARF could not be determined in 17 (19%) patients. Fifty-three (60%) patients recovered their renal function, six (6.7%) patients progressed to chronic kidney disease (CKD), 16(18%) died and 14(16%) were lost to follow-up. In conclusion, patients with ARF associated with ATN had a favorable prognosis except when ATN was associated PPD poisoning. (author)
Mahajan, Parag Suresh; El Esnawi, Mohamed Amin; Hussein, Sheik Akbar; Al Maslamani, Nasser Jassim
Reversible acute symmetrical basal ganglial lesion on magnetic resonance imaging and/or computed tomography in cases of diabetic nephropathy and chronic renal failure exhibiting acute onset of movement abnormalities like chorea is a very rare entity. It has characteristic clinical and imaging features. Only 29 cases are described in the literature, including the current one. These cases are predominantly Asian patients from the Far East and only one Asian Indian patient has been described. We report the second Asian Indian case of this condition and describe its various clinical and imaging features. Our aim is to educate the clinicians and radiologists about this condition, so that more such cases can be detected.
Núñez, Julio; Garcia, Sergio; Núñez, Eduardo; Bonanad, Clara; Bodí, Vicent; Miñana, Gema; Santas, Enrique; Escribano, David; Bayes-Genis, Antonio; Pascual-Figal, Domingo; Chorro, Francisco J; Sanchis, Juan
The changes in renal function that occurred in patients with acute decompensated heart failure (ADHF) are prevalent, and have multifactorial etiology and dissimilar prognosis. To what extent the prognostic role of such changes may vary according to the presence of renal insufficiency at admission is not clear. Accordingly, we sought to determine whether early creatinine changes (ΔCr) (admission to 48-72 hours) had an effect on 1-year mortality relative to the presence of renal insufficiency at admission. We included 705 consecutive patients admitted with the diagnosis of ADHF. Admission renal insufficiency was defined as serum creatinine ≥1.4mg/dl (A-RI cr ) or estimated glomerular filtration rate renal insufficiency (24.7% and 42.8% for A-RIcr and A-RIGFR, respectively) had higher prevalence of extreme values in ΔCr in either direction (increasing/decreasing). At 1-year follow-up, 114 (16.2%) deaths were registered. The multivariable analysis showed a significant interaction between admission renal insufficiency and ΔCr ( p=0.004 and p=0.019 for A-RIcr and A-RIGFR, respectively). In the presence of renal insufficiency, the continuum of ΔCr followed a positive and almost linear relationship with mortality risk. Conversely, in patients without renal insufficiency, those changes adopted a 'J-shape' trajectory with increased mortality at both ends of the curve distribution. In patients with ADHF the effect of ΔCr on 1-year mortality varied according to its magnitude and the presence of admission renal insufficiency. There was a graded-association with mortality when renal insufficiency was present on admission.
Frezzatti, Rodrigo; Silveira, Paulo Flavio
Acute renal failure is one of the most serious complications of envenoming resulting from Crotalus durissus terrificus bites. This study evaluated the relevance of hyperuricemia and oxidative stress and the effects of allopurinol and probenecid in renal dysfunction caused by direct nephrotoxicity of C. d. terrificus venom. Hematocrit, protein, renal function and redox status were assessed in mice. High ratio of oxidized/reduced glutathione and hyperuricemia induced by C. d. terrificus venom were ameliorated by both, allopurinol or probenecid, but only allopurinol significantly reduced the lethality caused by C. d. terrificus venom. The effectiveness of probenecid is compromised probably because it promoted hypercreatinemia and hypocreatinuria and worsed the urinary hypo-osmolality in envenomed mice. In turn, the highest effectiveness of allopurinol might be due to its ability to diminish the intracellular formation of uric acid. Data provide consistent evidences linking uric acid with the acute renal failure induced by C. d. terrificus venom, as well as that this envenoming in mice constitutes an attractive animal model suitable for studying the hyperuricemia and that the allopurinol deserves to be clinically evaluated as an approach complementary to anti-snake venom serotherapy.
Full Text Available BACKGROUND: Acute renal failure is one of the most serious complications of envenoming resulting from Crotalus durissus terrificus bites. This study evaluated the relevance of hyperuricemia and oxidative stress and the effects of allopurinol and probenecid in renal dysfunction caused by direct nephrotoxicity of C. d. terrificus venom. METHODOLOGY/PRINCIPAL FINDINGS: Hematocrit, protein, renal function and redox status were assessed in mice. High ratio of oxidized/reduced glutathione and hyperuricemia induced by C. d. terrificus venom were ameliorated by both, allopurinol or probenecid, but only allopurinol significantly reduced the lethality caused by C. d. terrificus venom. The effectiveness of probenecid is compromised probably because it promoted hypercreatinemia and hypocreatinuria and worsed the urinary hypo-osmolality in envenomed mice. In turn, the highest effectiveness of allopurinol might be due to its ability to diminish the intracellular formation of uric acid. CONCLUSIONS/SIGNIFICANCE: Data provide consistent evidences linking uric acid with the acute renal failure induced by C. d. terrificus venom, as well as that this envenoming in mice constitutes an attractive animal model suitable for studying the hyperuricemia and that the allopurinol deserves to be clinically evaluated as an approach complementary to anti-snake venom serotherapy.
Uthoff, Heiko; Breidthardt, Tobias; Klima, Theresia; Aschwanden, Markus; Arenja, Nisha; Socrates, Thenral; Heinisch, Corinna; Noveanu, Markus; Frischknecht, Barbara; Baumann, Ulrich; Jaeger, Kurt A; Mueller, Christian
To determine the relationship between central venous pressure (CVP) and renal function in patients with acute heart failure (AHF) presenting to the emergency department. Central venous pressure was determined non-invasively using compression sonography in 140 patients with AHF at presentation. Worsening renal function (WRF) was defined as an increase in serum creatinine ≥ 0.3 mg/dL during hospitalization. In the study cohort [age 77 ± 12 years, B-type natriuretic peptide 1862 ± 1564 pg/mL, left ventricular ejection fraction 40 ± 15%, estimated glomerular filtration rate (eGFR) 58 ± 28 mL/min, and CVP 13.2 ± 6.9 cmH(2)O], 51 patients (36%) developed WRF. No significant association between CVP at presentation or discharge and concomitant eGFR (r = 0.005, P = 0.419 and r = 0.013, P = 0.313, respectively) was observed. However, in patients with systolic blood pressure (SBP) 15 cmH(2)O), eGFR was significantly lower at presentation and discharge (29 ± 17 vs. 47 ± 19 mL/min/1.73 m(2), P = 0.039 and 26 ± 10 vs. 53 ± 26 mL/min/1.73 m(2), P = 0.013, respectively). Central venous pressure at presentation and at discharge did not differ between patients with or without in-hospital WRF (12.6 ± 7.2 vs. 13.5 ± 6.7 cmH(2)O, P = 0.503 and 7.4 ± 6.5 vs. 7.7 ± 5.7 cmH(2)O, P = 0.799, respectively) (receiver-operating characteristic analysis 0.543, P = 0.401 and 0.531, P = 0.625, respectively). However, patients with CVP in the lowest tertile (cmH(2)O) at presentation were more likely to develop WRF within the first 24 h than patients with CVP in the highest tertile (>15 cmH(2)O) (18 vs. 4%, P = 0.046). In AHF, combined low SBP and high CVP predispose to lower eGFR. However, lower CVP may also be associated with short-term WRF. The pathophysiology of WRF and the role of CVP seem to be more complex than previously thought.
Full Text Available Abstract Background In acute renal failure, a pronounced net protein catabolism occurs that has long been associated with corticoid action. By competitively blocking the glucocorticoid receptor with the potent antiglucocorticoid RU 38486, the present study addressed the question to what extent does corticoid action specific to uremia cause the observed muscle degradation, and does inhibition of glucocorticoid action reduce the protein wasting? Methods RU 38486 was administered in a dose of 50 mg/kg/24 h for 48 h after operation to fasted bilaterally nephrectomized (BNX male adult Wistar rats and sham operated (SHAM controls. Protein turnover was evaluated by high performance liquid chromatography (HPLC of amino acid efflux in sera from isolated perfused hindquarters of animals treated with RU 38486 versus untreated controls. Results Administration of RU 38486 reduces the total amino acid efflux (TAAE by 18.6% in SHAM and 15.6% in BNX and efflux of the indicator of net protein turnover, phenylalanine (Phe by 33.3% in SHAM and 13% in BNX animals as compared to the equally operated, but untreated animals. However, the significantly higher protein degradation observed in BNX (0.6 ± 0.2 nmol/min/g muscle versus SHAM (0.2 ± 0.1 nmol/min/g muscle rats, as demonstrated by the marker of myofribrillar proteolytic rate, 3-Methylhistidine (3 MH remains unaffected by administration of RU 38486 (0.5 ± 0.1 v. 0.2 ± 0.1 nmol/min/g muscle in BNX v. SHAM. Conclusion RU 38486 does not act on changes of muscular protein turnover specific to uremia but reduces the effect of stress- stimulated elevated corticosterone secretion arising from surgery and fasting. A potentially beneficial effect against stress- induced catabolism in severe illness can be postulated that merits further study.
Kusus, M; Stapleton, D D; Lertora, J J; Simon, E E; Dreisbach, A W
The 3-hydroxy-3-methyl-glutaryl-coenzyme A reductase inhibitors lovastatin and simvastatin have been associated with rhabdomyolysis in cardiac transplant recipients. Herein, we report a case of a 52-year-old male recipient of a cardiac transplant who developed rhabdomyolysis and acute renal failure caused by simvastatin precipitated by multiple drug interactions. The patient had a history of cardiac transplantation (5 years before) and presented with a 2-day history of dark urine preceded by 2 weeks of diffuse myalgias. He had been maintained on cyclosporine throughout the entire post-transplant period. Simvastatin was added and pravastatin was discontinued 2 months before admission. Two weeks before the onset of muscle symptoms, digoxin and verapamil were started for new-onset atrial fibrillation. Creatinine phosphokinase levels peaked at 950,000 IU with serum creatinine of 3.3 mg/dL (baseline, 1.8 mg/dL). Review of the medication history indicates a temporal association between the addition of 3 drugs (simvastatin, verapamil, and digoxin) to the medication regimen already containing cyclosporine and the episode of rhabdomyolysis. All of these drugs are cytochrome P450 3A4 and/or P-glycoprotein substrates that are known from previous pharmacokinetic studies to individually produce substantial increases in levels of simvastatin. We believe this case illustrates that avoiding the use of drugs that are cytochrome P450 3A4 and/or P-glycoprotein substrates reduces the risk of rhabdomyolysis caused by 3-hydroxy-3-methyl-glutaryl-coenzyme A reductase inhibitors.
Hishida, A.; Yonemura, K.; Ohishi, K.; Yamada, M.; Honda, N.
Studies were performed to examine the effect of saline loading on uranium-induced acute renal failure (ARF) in rats. Forty-eight hours after the i.v. injection of uranyl acetate (UA, 5 mg/kg), inulin clearance rate (Cin) decreased to approximately 43% of the control value in water drinking rats (P less than 0.005). Animals receiving continuous isotonic saline infusion following UA showed higher urine flow and Cin (60% of control, P less than 0.01), and lessened intratubular cast formation when compared with water-drinking ARF rats. A short-term saline infusion following UA did not attenuate the decline in Cin (43% of control). An inverse relationship was found between Cin and the number of casts (r = -0.75, P less than 0.01). Multiple regression analysis showed that standardized partial regression coefficient is statistically significant between Cin and cast formation (-0.69, P less than 0.05), but not between Cin and tubular necrosis (-0.07, P greater than 0.05). Renin depletion caused by DOCA plus saline drinking did not attenuate the decline in Cin in ARF (47% of control). No significant difference was found in urinary uranium excretion between water-drinking and saline-infused ARF rats. The findings suggest that continuous saline infusion following UA attenuates the decline in Cin in ARF rats; and that this beneficial effect of saline loading is associated with lessened cast formation rather than with suppressed renin-angiotensin activity or enhanced urinary-uranium excretion
Ahmed Samy El-agwany
Full Text Available HELLP is an acronym for hemolysis, elevated liver enzymes and low platelets count, affecting 0.2–12% of all pregnancies or 4–12% of those with preeclampsia. The maternal mortality reported from the literature is up 4% due to disseminated intravascular coagulation, placental abruption, acute renal failure, eclampsia, and cerebral hemorrhage. A 20 year old, G2P1, at 36 weeks of gestation, was referred to our hospital because of postictal coma state with bilateral mydriasis and epistaxis due to repeated antepartum eclamptic fits. Elevated blood pressure level 170/110 mmHg was accompanied with massive proteinuria. Cesarean section was performed and female newborn were delivered. Laboratory findings were characteristic of preeclampsia, HELLP syndrome and renal failure. The patient developed an intraventricular hematoma and an intracerebral hemorrhage with subarachnoid one, which were not suitable to neurosurgical treatment. The patient died from refractory hemolytic anemia, spontaneous bleeding of multiple organs, renal failure and intracranial hemorrhage. Preeclampsia, HELLP syndrome, and acute fatty liver of pregnancy might overlap and be associated with potentially fatal complications, including intracranial hemorrhage, as in the present case. Early detection and diagnosis are crucial to ensure appropriate management and treatment success.
Kerschbaum, Julia; Mayer, Gert; Maurer, Anton
Only a small number of cases with favourable outcome after acute renal failure due to intoxication by Cortinarius sp. have been reported in the literature, and approximately half of the patients develop chronic renal failure and dialysis-dependency. We report the case of a couple with acute renal failure after accidental intake of Cortinarius rubellus and a favourable outcome after treatment with high-dose antioxidant therapy with N-acetylcysteine and steroids. Dialysis was never necessary in both patients and renal function was almost normal at the end of follow-up. Underdiagnosis of this rare cause of acute renal failure is likely due to the fact that affected patients develop symptoms of intoxication after a delay of 2-30 days. In patients with unclear acute renal failure with or without gastrointestinal symptoms, intoxication from Cortinarius sp. should be considered as a differential diagnosis. Early treatment with high-dose antioxidant therapy and steroids might be effective in reducing the risk of chronic renal failure.
Rashid, H.; Akram, M.
Objective: The objective of this study was to deter-mine the frequency, etiology, clinical course and out-come of pregnancy related acute renal failure. Type of Study: Observational and prospective hospital based study. Place of Study: Department of Nephrology, Shaikh Zayed Hospital Lahore. Duration of Study: One year from November 2010 - October 2011. Patients and Methods: Total 210 patients of Acute renal failure (ARF) were admitted with 92 (44%) males and 118 (56%) females during this period of which 40 (19%) females were pregnancy related ARF that were included in this study. A Predesigned proforma was used. The clinical history and physical examination was carried out. Relevant laboratory tests were performed. Renal biopsy was done in few cases. The final outcome was recorded. Twenty four (24) patients were from rural community of Punjab province and remaining (16) were from urban areas. Results: Pregnancy related ARF occurred in forty (40) patients. Twenty two (55%) were multipara and 18 (45%) were primigravida. Their age was between 29 +- 4.5 years. Majority 32 (80%) patients had not received any antenatal care as compared to 8 (20%) patients who had adequate antenatal care. Twelve cases (15%) presented in their first and second trimester of pregnancy while 28 (70%) patients developed ARF in their third trimester or the puerperium. Twenty four (60%) patients were anuric. Antepartum haemorrhage (APH) in 2 (5%) cases, postpartum haemorrhage (PPH) in 6 (15%) cases, Septic abortion in 6 (15%), puerperal sepsis in 8 (20%) and DIC in 4 (10%) cases, Intra-uterine fetal death (IUD) in 12 (30%) and HELLPS in 2 (5%) cases. Sepsis was the commonest cause of ARF. Thirty four (85%) patients received hemodialysis and 6 (15%) did not require any dialysis. Commonest clinical diagnosis was acute tubular necrosis (ATN). Complete recovery was seen in 8 (20%) cases .Acute renal cortical necrosis was seen in 14 (35%) cases and 18 (45%) patients had patchy cortical necrosis
Lodise, Thomas P; Fan, Weihong; Griffith, David C; Dudley, Michael N; Sulham, Katherine A
Nonclinical studies have suggested that oxidative damage, caspase-mediated apoptosis, and inducible nitric oxide synthase levels may be involved in the pathogenesis of colistin (CST)-associated acute renal failure. MIN inhibits caspase 1, caspase 3, and inducible nitric oxide synthase, leading to the hypothesis that coadministration of CST with MIN (CST-MIN) may reduce the incidence of acute renal failure as well as produce additive or synergistic antimicrobial effects. A multicenter retrospective cohort study was conducted using the Premier Research database to examine the impact of CST-MIN on acute renal failure. Inclusion criteria were as follows: age of ≥18 years, intensive care unit admission at CST initiation, primary International Classification of Diseases 9 (ICD-9) diagnosis of pneumonia or sepsis, nondialysis at hospital admission, and discharge between January 2010 and December 2015. ICD-9 code 584.XX or ICD-10 code N17 was used to define acute renal failure. Baseline comparisons, 1:8 propensity score matching, and confirmatory logistic regression analyses were conducted. In total, 4,817 patients received CST and met inclusion criteria; 93 received CST-MIN. Unadjusted frequency of acute renal failure was significantly lower in patients receiving CST-MIN than CST (11.8% versus 23.7%, P = 0.007). Similar results were seen in propensity score matching (12.0% versus 22.3%, P = 0.031) and logistic regression analyses (odds ratio of 0.403, P = 0.006). Mortalities and 30-day readmission rates were similar between groups. The acute renal failure rate was not impacted by prevalence of baseline renal disease. CST-MIN in critically ill patients may reduce CST-associated acute renal failure. Further evaluation of this combination in prospective clinical studies is warranted. Copyright © 2017 Lodise et al.
Urrunaga, Nathalie H; Magder, Laurence S; Weir, Matthew R; Rockey, Don C; Mindikoglu, Ayse L
Although renal dysfunction is a known complication of acute liver failure (ALF), its frequency, severity, and impact among patients with ALF on the US liver transplant list are not well defined. Organ Procurement and Transplantation data for ALF patients listed as status 1/1A from 2002 to 2012 were analyzed. The frequency and severity of renal dysfunction at the time of listing [the latter was categorized in 5 stages using estimated GFR (eGFR) according to Chronic Kidney Disease Epidemiology Collaboration creatinine 2009 equation] were determined and the association between renal dysfunction and waiting list mortality was assessed using Cox proportional hazard regression analysis. There were a total of 2280 adult patients with ALF, including 56 % with renal dysfunction (defined as eGFR renal dysfunction was among those with ALF caused by hemolysis, elevated liver enzymes, and low platelet count (HELLP) syndrome, fatty liver disease of pregnancy, heat stroke/hyperthermia, hepatitis A virus, and drug-induced liver injury due to acetaminophen APAP, phenytoin, trimethoprim-sulfamethoxazole, and macrolides. Despite the fact that 69 % (468/674) of patients with APAP-induced ALF listed as status 1/1A had renal dysfunction, only 0.9 % underwent simultaneous liver-kidney transplantation. Six-week survival probabilities in patients with ALF on the liver transplant waiting list were 71, 59, 56, 59, and 42 % with renal dysfunction stages of 1, 2, 3, 4, and 5, respectively. Multivariate analysis showed that after controlling for age, etiology of ALF, INR, total bilirubin, and region, the relative risk of death increased progressively as eGFR declined (P renal dysfunction was common (overall prevalence of 56 %). Most importantly, severe renal dysfunction was associated with significantly increased mortality.
Carlos G. Musso
ABSTRACTAcute renal failure (ARF) is a frequent disorder in the elderly, and this phenomenon is due to the senescence process, reduced metabolization of drugs, increased exposure to polypharmacy and systemic diseases of the aged group. The following are the main characteristics of the ARF in the elderly: mulfactorial, atypical presentation, tubular frailty, intermediate syndrome pattern, low reliable physical examination and urinary indeces. Profilaxis and rehydration are the best treatments ...
Xing, T; Zhong, L; Chen, D; Peng, Z
The aim of this study was to evaluate the outcomes of orthotopic liver transplantation (OLT) or combined liver-kidney transplantation (CLKT) for acute-on-chronic liver failure (ACLF) patients with renal dysfunction. From January 2001 to December 2009, 133 patients underwent OLT for ACLF at our center. Among them, 30 had both ACLF and renal dysfunction. Of the 30 patients, 12 underwent CLKT for end-stage renal disease (ESRD), and the other 18 with hepatorenal syndrome type 1 (HRS1) underwent OLT alone. ACLF was defined according to the Asian Pacific Association for the Study of Liver Consensus Meeting. Clinical data were reviewed for survival outcomes. The median model for end-stage liver disease score (MELD) of patients with ACLF was 28. Among the 133 patients, all of whom received deceased donor liver grafts, 12 also got the kidney grafts from the same deceased donor. The hospital mortality rate was 21.8% for all patients with ACLF. The 5-year survival rates were 72.8% for patients without renal dysfunction and 70% for patients with renal dysfunction. The results of patients with ESRD who underwent CLKT were better than those of subjects without renal dysfunction or patients with HRS1 who underwent OLT alone. OLT alone improved renal function in most patients with HRS1, including those requiring short-term hemodialysis. Simultaneous liver-kidney transplantation was an excellent strategy for patients with both ACLF and ESRD. It provided protection to the kidney allograft for liver-based metabolic diseases affecting the kidney. The rate of acute rejection episodes in kidneys was low. Copyright © 2013 Elsevier Inc. All rights reserved.
Wang, Yanbo; Gu, Xinshun; Fan, Weize; Fan, Yanming; Li, Wei; Fu, Xianghua
To investigate the effect of recombinant human brain natriuretic peptide (rhBNP) on renal function in patients with acute heart failure (AHF) following acute myocardial infarction (AMI). Consecutive patients with AHF following AMI were enrolled in this clinical trial. Eligible patients were randomly assigned to receive rhBNP (rhBNP group) or nitroglycerin (NIT group). Patients in the rhBNP group received rhBNP 0.15 μg /kg bolus injection after randomization followed by an adjusted-dose (0.0075-0.020 μg/kg/min) for 72 hours, while patients in NIT received infusion of nitroglycerin with an adjusted-dose (10-100 μg/kg/min) for 72 hours in NIT group. Standard clinical and laboratory data were collected. The levels of serum creatinine (SCr), urea, β-2 microglobulin and cystatin C were measured at baseline and repeated at the end of the 24, 48 and 72 hours after infusion. The primary end point was the incidence of acute renal dysfunction, which was defined as an increase in SCr > 0.5 mg/dl (> 44.2 μmol/L) or 25% above baseline SCr value. The occurrence of major adverse cardiac event (MACE) was followed up for 1 month. Of the 50 patients enrolled, 26 were randomly assigned to rhBNP and 24 to nitroglycerin (NIT). There were no significant differences in baseline characteristics between the two groups (all P > 0.05). The baseline concentrations of SCr, urea, β-2 microglobulin and cystatin C at admission were similar in the two groups. However, the concentrations of SCr and urea were significantly higher in rhBNP group than those in NIT group at hour 24 and 48 after treatments (all P acute renal dysfuntion in rhBNP group was higher (9/26 vs. 2/24, P = 0.040). The results of multiple logistic regression found that the use of rhBNP was an independent predictor of acute renal dysfunction in patients with AHF following AMI (OR, 0.162; 95% CI, 0.029 to 0.909; P = 0.039). the incidence of acute renal dysfuntion in rhBNP group was higher, and the use of rhBNP was an
Damman, Kevin; Valente, Mattia A E; van Veldhuisen, Dirk J; Cleland, John G F; O'Connor, Christopher M; Metra, Marco; Ponikowski, Piotr; Cotter, Gad; Davison, Beth; Givertz, Michael M; Bloomfield, Daniel M; Hillege, Hans L; Voors, Adriaan A
The aim of this study was to evaluate the ability of Neutrophil Gelatinase-Associated Lipocalin (NGAL) to predict clinically relevant worsening renal function (WRF) in acute heart failure (AHF). Plasma NGAL and serum creatinine changes during the first 4 days of admission were investigated in 1447 patients hospitalized for AHF and enrolled in the Placebo-Controlled Randomized Study of the Selective A₁Adenosine Receptor Antagonist Rolofylline for Patients Hospitalized with Acute Decompensated Heart Failure and Volume Overload to Assess Treatment Effect on Congestion and Renal Function (PROTECT) study. WRF was defined as serum creatinine rise ≥ 0.3 mg/dL through day 4. Biomarker patterns were described using linear mixed models. WRF developed in 325 patients (22%). Plasma NGAL did not rise earlier than creatinine in patients with WRF. After multivariable adjustment, baseline plasma NGAL, but not creatinine, predicted WRF. AUCs for WRF prediction were modest (renal or cardiovascular rehospitalization by 60 days than patients with WRF and a low baseline plasma NGAL (p for interaction = 0.024). A rise in plasma NGAL after baseline was associated with a worse outcome in patients with WRF, but not in patients without WRF ( p = 0.007). On the basis of these results, plasma NGAL does not provide additional, clinically relevant information about the occurrence of WRF in patients with AHF.
Carlos G. Musso
Full Text Available ABSTRACTAcute renal failure (ARF is a frequent disorder in the elderly, and this phenomenon is due to the senescence process, reduced metabolization of drugs, increased exposure to polypharmacy and systemic diseases of the aged group. The following are the main characteristics of the ARF in the elderly: mulfactorial, atypical presentation, tubular frailty, intermediate syndrome pattern, low reliable physical examination and urinary indeces. Profilaxis and rehydration are the best treatments for ARF in the old population. Renal biopsy and dialysis have the same role in young and old people.RESUMEN:INSUFICIENCIA RENAL AGUDA EN EL ANCIANO. CONSIDERACIONES ACERCA DE SU VALORACIÓN Y TRATAMIENTO.La insuficiencia renal aguda (IRA es un trastorno frecuente en los ancianos a raíz de la senescencia renal, la menor metabolización de los fármacos y la mayor exposición a la polifarmacia y enfermedades sistémicas que ellos padecen. Las siguientes son las principales características de la IRA en el anciano: carácter multifactorial, presentación clínica atípica, fragilidad tubular, patrón de síndrome intermedio y poca fiabilidad del examen físico y de los índices urinarios en la interpretación de su etiología. Las medidas de profilaxis y rehidratación siguen siendo los mejores tratamientos de la IRA en el geronte. La biopsia renal y la diálisis tienen el mismo rol tanto en el grupo senil como en el joven.
Palazzuoli, Alberto; Pellegrini, Marco; Franci, Beatrice; Beltrami, Matteo; Ruocco, Gaetano; Gonnelli, Stefano; Angelini, Gianni D; Nuti, Ranuccio
Intravenous loop diuretics are still the cornerstone of therapy in acute decompensated heart failure, however, the optimal dosage and administration strategies remain poorly defined particularly in patients with an associated renal dysfunction. This is a single-center, pilot, randomized trial involving patients with acute HF and renal dysfunction. Patients were assigned to receive continuous furosemide infusion (cIV) or bolus injections of furosemide (iIV). Primary end points were the evaluation of urine output volumes, renal function, and b-type natriuretic peptide (BNP) levels during treatment time. Secondary end point included: weight loss, length of hospitalization, differences in plasma electrolytes, need for additional treatment, and evaluation of cardiac events during follow-up period. 57 patients were included in the study. The cIV group showed an increase in urine output (2,505 ± 796 vs 2140 ± 468 ml/day, p diuretics are responsible for worsening renal function and to define the best modality of administration.
Kossiva, Lydia; Kyriakou, Dimitrios; Mitsioni, Andromachi; Garoufi, Anastasia
Immune thrombocytopenia (ITP) in children is usually a benign, self-limiting disorder. An acute Epstein-Barr virus (EBV) infection usually causes atypical lymphocytosis and mild decrease in platelets. Severe thrombocytopenia is an extremely rare complication. Anti-D immunoglobulin has been used for treatment of ITP in Rh(D)-positive nonsplenectomized patients. Severe hemolysis and acute renal failure are extremely rare complications that may be aggravated by the presence of an acute EBV infection. It is believed that anti-D immunoglobulin triggers an unusual virus-induced immune response causing hemolysis. We present a 4-year-old girl with ITP caused by an acute EBV infection that developed acute kidney injury following treatment with anti-D immunoglobulin. The patient recovered completely from thrombocytopenia and renal dysfunction. Intravascular hemolysis and acute kidney injury are consistent with anti-D immunoglobulin mechanism of action. Pediatric patients treated with anti-D immunoglobulin for ITP should be closely monitored for signs and symptoms of hemolysis that may be aggravated by the presence of EBV infection leading to impaired renal function.
Full Text Available Blue toe syndrome is the most frequent manifestation of tissue ischemia caused by cholesterol embolization (CE, which can lead to amputation of affected lower extremities, if severe. However, any effective treatment is lacking. We experienced a case of spontaneously presenting blue toe syndrome and concomitant acute renal failure in a patient with multiple atherosclerotic risk factors. CE was confirmed by renal biopsy. Despite medical treatment including prostaglandin therapy and narcotics, the toe lesion progressed to gangrene with worsening ischemic pain. Therefore, we performed lumbar sympathectomy, which provided dramatic pain relief as well as an adequate blood flow to the ischemic lower extremities, resulting in healing of the gangrenous lesion and avoiding toe amputation. This is the first reported case of a patient with intractable ischemic toe syndrome caused by CE that was treated successfully by sympathectomy. Our observations suggest that sympathectomy may be beneficial in some patients with CE-associated blue toe syndrome.
Knight, Stephen R; Oniscu, Gabriel C; Devey, Luke; Simpson, Kenneth J; Wigmore, Stephen J; Harrison, Ewen M
Acute kidney injury is associated with a poor prognosis in acute liver failure but little is known of outcomes in patients undergoing transplantation for acute liver failure who require renal replacement therapy. A retrospective analysis of the United Kingdom Transplant Registry was performed (1 January 2001-31 December 2011) with patient and graft survival determined using Kaplan-Meier methods. Cox proportional hazards models were used together with propensity-score based full matching on renal replacement therapy use. Three-year patient and graft survival for patients receiving renal replacement therapy were 77.7% and 72.6% compared with 85.1% and 79.4% for those not requiring renal replacement therapy (Prenal replacement therapy was a predictor of both patient death (hazard ratio (HR) 1.59, 95% CI 1.01-2.50, P = 0.044) but not graft loss (HR 1.39, 95% CI 0.92-2.10, P = 0.114). In groups fully matched on baseline covariates, those not receiving renal replacement therapy with a serum creatinine greater than 175 μmol/L had a significantly worse risk of graft failure than those receiving renal replacement therapy. In patients being transplanted for acute liver failure, use of renal replacement therapy is a strong predictor of patient death and graft loss. Those not receiving renal replacement therapy with an elevated serum creatinine may be at greater risk of early graft failure than those receiving renal replacement therapy. A low threshold for instituting renal replacement therapy may therefore be beneficial.
Okayasu, Hiroaki; Shinozaki, Takahiro; Osone, Akira; Ozeki, Yuji; Shimoda, Kazutaka
Cases of acute pancreatitis caused by sodium valproate (VPA) have been reported by many authors thus far. However, most of these were cases with epilepsy. Chronic renal failure is also regarded as a risk factor for acute pancreatitis. Here, we report a case of acute pancreatitis development due to VPA in a patient with bipolar disorder on hemodialysis for chronic renal failure. The patient was a 52-year-old Japanese male who was diagnosed as bipolar disorder on hemodialysis for renal failure. He was treated with VPA and manic symptoms gradually stabilized. However, the patient complained of severe abdominal pain. Blood amylase was found to be markedly high, and computed tomography revealed pancreatomegaly and an increased amount of peripancreatic fat. Hence, we diagnosed the case as acute pancreatitis caused by VPA. We discontinued oral medication, and he was started on a pancreatic enzyme inhibitor, antibiotics, and transfusion, and he showed improvement. It has been reported that acute pancreatitis induced by VPA is caused by intermediate metabolites of VPA. We consider that patients with renal failure are prone to pancreatitis caused by VPA because of the accumulation of these intermediate metabolites. We need close monitoring for serious adverse effects such as pancreatitis when we prescribe VPA to patients with bipolar disorder on hemodialysis for chronic renal failure, although VPA is safer than other mood stabilizers.
de Irala Jokin
Full Text Available Abstract Background The aim of this study is to evaluate the association between acute serum creatinine changes in acute renal failure (ARF, before specialized treatment begins, and in-hospital mortality, recovery of renal function, and overall mortality at 6 months, on an equal degree of ARF severity, using the RIFLE criteria, and comorbid illnesses. Methods Prospective cohort study of 1008 consecutive patients who had been diagnosed as having ARF, and had been admitted in an university-affiliated hospital over 10 years. Demographic, clinical information and outcomes were measured. After that, 646 patients who had presented enough increment in serum creatinine to qualify for the RIFLE criteria were included for subsequent analysis. The population was divided into two groups using the median serum creatinine change (101% as the cut-off value. Multivariate non-conditional logistic and linear regression models were used. Results A ≥ 101% increment of creatinine respect to its baseline before nephrology consultation was associated with significant increase of in-hospital mortality (35.6% vs. 22.6%, p Conclusion In this cohort, patients who had presented an increment in serum level of creatinine of ≥ 101% with respect to basal values, at the time of nephrology consultation, had increased mortality rates and were discharged from hospital with a more deteriorated renal function than those with similar Liano scoring and the same RIFLE classes, but with a
Zhou, X-J; Chen, M; Wang, S-X; Zhou, F-D; Zhao, M-H
Background Microvascular manifestations of antiphospholipid antibody syndrome in the kidneys include acute renal failure, thrombotic microangiopathy and hypertension. Therapy has been largely empiric. Case report A 49-year-old Chinese man presented with anuric acute renal failure without abundant proteinuria and heavy haematuria, but markedly low levels of urinary sodium, potassium and chlorine upon admission. On day 1 of hospitalization, his thrombocytopenia, anaemia and renal failure showed rapid progression. The presence of lupus anticoagulant and vascular ischaemia of the small vessels in renal arteriography were also observed. Anticoagulants, continuous renal replacement therapy, glucocorticoids and six sessions of plasma exchange were started. After the fourth plasma exchange (on day 20), his urine output increased and began to normalize. On day 25, haemodialysis was stopped and his general condition gradually improved. A renal biopsy was subsequently performed, and the histopathological diagnosis was thrombotic microangiopathy due to antiphospholipid antibody syndrome. A further 3-year follow-up showed that his haemoglobin level, platelet count and serum creatinine were within the normal range, with stable blood pressure. Conclusion Treatment modalities such as anticoagulation, immunosuppression and plasma exchange are likely to be necessary when severe acute renal failure combined with thrombotic microangiopathy present in nephropathy of antiphospholipid antibody syndrome.
Ilic, S.; Vlajkovic, M.; Rajic, M.; Bogicevic, M.
The aim of this study was to assess the relationship of thyroid hormone levels with glomerular and tubular renal function in ARF. In thirty one patients with different underlying diseases, glomerular filtration (GFR) was estimated by measuring 99mTc-DTPA clearance and tubular function by 131I-OIH clearance. The thyroid status was evaluated by radioimmunoassays of T4, FT4, T3, FT3, rT3 and TSH, while the cortisol level was used to indicate the stress role. All the measurements were performed within 7 days as well after 1,3,6 and 12 months from the ARF onset. The results obtained were compared with those of 30 healthy subjects. At the ARF beginning, the impairment of renal function was manifested by the fall of 99mTc-DTPA clearance to 21∫7ml/min and 131I-OIH clearance to 172±34ml/min, while end values were 77±19ml/min and 395±70ml/min, respectively. The hormone analysis within 7 days, showed T3 decrease to 1.21±0.16nmol/l and the increase rT3 to 38±7ng/1ooml, as well as cortisol to 350±71ng/ml, but at the end of the study these hormone levels were normalized. Other hormone levels didn't differ significantly from control values. Regression analysis established significant correlation of 99mTc-DTPA clearance with T3 (r=0.693, p 100, OIH>500), partial recovery (DTPA 51-100, OIH 250-500) and without any recovery (DTPA<50,OIH<250), showed hormone disturbances proportional to the degree of renal function damage. The most severe disorders were found in the third group, where both total and free T4 and T3 were lowered, while rT3 and cortisol elevated at 7th day from ARF onset. After 12 months all these values associated with that of TSH were observed as declined.This study suggests thyroid hormone levels to be dependent on the renal function in ARF. Greater impairment of glomerular related to tubular function appears to be more responsible for thyroid dysfunction, due to uremic toxins retention as well as stress induced by the extreme function failure
Liu, Tao, E-mail: firstname.lastname@example.org [Department of Clinical Pharmacology, College of Pharmacy, Dalian Medical University, 9 West Section, Lvshun South Road, Lvshunkou District, Dalian 116044 (China); Meng, Qiang, E-mail: email@example.com [Department of Clinical Pharmacology, College of Pharmacy, Dalian Medical University, 9 West Section, Lvshun South Road, Lvshunkou District, Dalian 116044 (China); Provincial Key Laboratory for Pharmacokinetics and Transport, Liaoning, Dalian Medical University (China); Wang, Changyuan, E-mail: firstname.lastname@example.org [Department of Clinical Pharmacology, College of Pharmacy, Dalian Medical University, 9 West Section, Lvshun South Road, Lvshunkou District, Dalian 116044 (China); Provincial Key Laboratory for Pharmacokinetics and Transport, Liaoning, Dalian Medical University (China); Liu, Qi, E-mail: email@example.com [Department of Clinical Pharmacology, College of Pharmacy, Dalian Medical University, 9 West Section, Lvshun South Road, Lvshunkou District, Dalian 116044 (China); Provincial Key Laboratory for Pharmacokinetics and Transport, Liaoning, Dalian Medical University (China); Guo, Xinjin, E-mail: firstname.lastname@example.org [Department of Clinical Pharmacology, College of Pharmacy, Dalian Medical University, 9 West Section, Lvshun South Road, Lvshunkou District, Dalian 116044 (China); Sun, Huijun, E-mail: email@example.com [Department of Clinical Pharmacology, College of Pharmacy, Dalian Medical University, 9 West Section, Lvshun South Road, Lvshunkou District, Dalian 116044 (China); Provincial Key Laboratory for Pharmacokinetics and Transport, Liaoning, Dalian Medical University (China); Peng, Jinyong, E-mail: firstname.lastname@example.org [Department of Clinical Pharmacology, College of Pharmacy, Dalian Medical University, 9 West Section, Lvshun South Road, Lvshunkou District, Dalian 116044 (China); Provincial Key Laboratory for Pharmacokinetics and Transport, Liaoning, Dalian Medical University (China); and others
The purpose of this study is to investigate whether the effect of cyclo-trans-4-L-hydroxyprolyl-L-serine (JBP485) on acute renal failure (ARF) induced by cisplatin is related to change in expression of renal Oat1, Oat3 and Mrp2 in rats. JBP485 reduced creatinine, blood urea nitrogen (BUN) and indoxyl sulfate (IS) in plasma and malondialdehyde (MDA) in kidney, and recovered the glomerular filtration rate (GFR) and the activity of superoxide dismutase (SOD) in cisplatin-treated rats. The plasma concentration of PAH (para-aminohippurate) determined by LC–MS/MS was increased markedly after intravenous administration of cisplatin, whereas cumulative urinary excretion of PAH and the uptake of PAH in kidney slices were significantly decreased. qRT-PCR and Western-blot showed a decrease in mRNA and protein of Oat1 and Oat3, an increase in mRNA and protein of Mrp2 in cisplatin-treated rats, and an increase in IS (a uremic toxin) after co-treatment with JBP485. It indicated that JBP485 promoted urinary excretion of toxins by upregulating renal Mrp2. This therefore gives in part the explanation about the mechanism by which JBP485 improves ARF induced by cisplatin in rats. -- Highlights: ► Cisplatin induces acute renal failure (ARF). ► The expression of Oat1, Oat3 and Mrp2 were changed during ARF. ► The regulated expression of Oat1, Oat3 and Mrp2 is an adaptive protected response. ► JBP485 could facilitate the adaptive protective action.
Liu, Tao; Meng, Qiang; Wang, Changyuan; Liu, Qi; Guo, Xinjin; Sun, Huijun; Peng, Jinyong
The purpose of this study is to investigate whether the effect of cyclo-trans-4-L-hydroxyprolyl-L-serine (JBP485) on acute renal failure (ARF) induced by cisplatin is related to change in expression of renal Oat1, Oat3 and Mrp2 in rats. JBP485 reduced creatinine, blood urea nitrogen (BUN) and indoxyl sulfate (IS) in plasma and malondialdehyde (MDA) in kidney, and recovered the glomerular filtration rate (GFR) and the activity of superoxide dismutase (SOD) in cisplatin-treated rats. The plasma concentration of PAH (para-aminohippurate) determined by LC–MS/MS was increased markedly after intravenous administration of cisplatin, whereas cumulative urinary excretion of PAH and the uptake of PAH in kidney slices were significantly decreased. qRT-PCR and Western-blot showed a decrease in mRNA and protein of Oat1 and Oat3, an increase in mRNA and protein of Mrp2 in cisplatin-treated rats, and an increase in IS (a uremic toxin) after co-treatment with JBP485. It indicated that JBP485 promoted urinary excretion of toxins by upregulating renal Mrp2. This therefore gives in part the explanation about the mechanism by which JBP485 improves ARF induced by cisplatin in rats. -- Highlights: ► Cisplatin induces acute renal failure (ARF). ► The expression of Oat1, Oat3 and Mrp2 were changed during ARF. ► The regulated expression of Oat1, Oat3 and Mrp2 is an adaptive protected response. ► JBP485 could facilitate the adaptive protective action.
Acute Kidney Injury in Heart Failure Revisited-The Ameliorating Impact of "Decongestive Diuresis" on Renal Dysfunction in Type 1 Acute Cardiorenal Syndrome: Accelerated Rising Pro B Naturetic Peptide Is a Predictor of Good Renal Prognosis.
Onuigbo, Macaulay Amechi Chukwukadibia; Agbasi, Nneoma; Sengodan, Mohan; Rosario, Karen Flores
There is mounting evidence that forward heart failure as manifested by low cardiac output alone does not define the degree of renal dysfunction in cardiorenal syndrome. As a result, the term "congestive renal failure" was coined in 2012 by Ross to depict the role of renal venous hypertension in type 1 acute cardiorenal syndrome. If so, aggressive decongestive therapies, either through mechanical ultrafiltration with dialysis machines or pharmacologic ultrafiltration with potent diuretics, would lead to improved cardio and renal outcomes. Nevertheless, as recently as 2012, a review of this literature had concluded that a renal venous hypertension-directed approach using diuretics to manage cardio-renal syndrome was yet to be fully investigated. We, in this review, with three consecutive case series, describe our experience with pharmacologic decongestive diuresis in this paradigm of care and argue for studies of such therapeutic interventions in the management of cardiorenal syndrome. Finally, based on our observations in the Renal Unit, Mayo Clinic Health System, in Northwestern Wisconsin, we have hypothesized that patients with cardiorenal syndrome presenting with accelerated rising Pro B Naturetic Peptide levels appear to represent a group that would have good cardio- and renal-outcomes with such decongestive pharmacologic therapies.
Biagioni, E; Cavazzuti, I; Busani, S; Trevisan, D; Zavatti, L; Ferrari, E; Girardis, M; Massimo, G
Acute renal failure (ARF) often complicates the postoperative period of patients undergoing orthotopic liver transplantation (OLT); it is habitually associated with high mortality rates. Similarly, patients undergoing major nonelective abdominal surgery are prone to ARF because of their frequent preexistent morbidities, abdominal sepsis, and needed for extended surgical procedures. The aim of this study was to evaluate the incidence of ARF and use of renal replacement therapy (RRT) among OLT versus nonelective abdominal surgery patients and associations with clinical outcomes. We studied all the patients admitted to a surgical intensive care unit (ICU) from January 2008 to December 2009 after OLT or nonelective abdominal surgery. The inclusion criteria were an ICU stay of at least 48 hours and without prior end-stage renal failure. OLT patients (n=84) were younger and less severly ill than surgery patients (n=60). ARF occurrence was lower among the OLT (29%) than the surgery group (47%) requiring RRT in 71% and 53% of patients due to ARF, respectively. The ICU mortality of ARF patients in both groups (29% OLT and 51% surgery) were greater than among subjects without ARF (2% and 6%). The occurrence of ARF is common among these two patient groups, and associated with increased risk of death among in surgery (+45%) versus in OLT (+27%) patients. Copyright © 2011 Elsevier Inc. All rights reserved.
Reyes-Corcho, Andrés; Pinsker, Richard W; Sarkar, Samir; Bagheri, Farshad; Patel, Mahendra C; Lam, Pablo; González, Argentina
Cholera is a gastroenteric disease caused by epidemic or pandemic Vibrio cholerae which still is responsible for over 100,000 annual deaths worldwide. Since October 2010, Haiti experienced a cholera outbreak affecting more than 300,000 persons. Few imported cases related to the Haitian epidemic have been reported so far in the United States and Canada. We presented a patient who developed cholera gravis soon after arrival at New York City from Haiti. The patient needed admission to an Intensive Care Unit, for vigorous intravenous hydration, antibiotic therapy, and hemodialysis due to refractory oliguric renal failure. The patient was discharged the day 6 after admission and V. cholerae O1 was isolated from the stool culture. Cholera can be a life-threatening disease; early recognition based on travel history and clinical features is the corner stone for successful management. Copyright © 2012 Elsevier Ltd. All rights reserved.
Full Text Available Fibrates are derivative of fibric acid and broad spectrum drugs which are commonly used in the treatment of dyslipidemia and hypertriglyceridemia. Side effects are often related with striated muscles, kidney and liver. Rhabdomyolysis developing with striated muscle destruction is potentially the most lethal of these side effects. Although several case reports of rhabdomyolysis have been reported due to the combination of statin and fenofibrate, fenofibrate alone rarely causes rhabdomyolysis. The purposes of this paper are to present a patient whom we diagnosed with acute renal injury due to use of fenofibrate in order to emphasize the importance of questioning drugs which have been used, and to review management of rhabdomyolysis due to fenofibrate use. [Cukurova Med J 2013; 38(4.000: 800-804
van Kimmenade, Roland R. J.; Januzzi, James L.; Baggish, Aaron L.; Lainchbury, John G.; Bayes-Genis, Antoni; Richards, A. Mark; Pinto, Yigal M.
OBJECTIVES: We sought to study the individual and integrative role of amino-terminal pro-brain natriuretic peptide (NT-proBNP) and parameters of renal function for prognosis in heart failure. BACKGROUND: Amino-terminal pro-BNP and renal impairment both predict death in patients with heart failure.
Full Text Available Acute renal failure (ARF can be caused by injuries that induce tissue hypoxia, which in turn can trigger adaptive or inflammatory responses. We previously showed the participation of basic fibroblast growth factor (FGF-2 in renal repair. Based on this, the aim of this study was to analyze the effect of FGF-2 signaling pathway manipulation at hypoxia-induced protein levels, as well as in key proteins from the vasoactive systems of the kidney. We injected rat kidneys with FGF-2 recombinant protein (r-FGF or FGF-2 receptor antisense oligonucleotide (FGFR2-ASO after bilateral ischemia, and evaluated the presence of iNOS, EPO and HO-1, in representation of hypoxia-induced proteins, as well as COX-2, renin, kallikrein, and B2KR, in representation of the vasoactive systems of the kidney. A reduction in iNOS, HO-1, EPO, renin, kallikrein, B2KR, and in renal damage was observed in animals treated with r-FGF. The opposite effect was found with FGF-2 receptor down-regulation. In contrast, COX-2 protein levels were higher in kidneys treated with r-FGF and lower in those that received FGFR2-ASO, as compared to saline treated kidneys. These results suggest that the protective role of FGF-2 in the pathogenesis of ARF induced by I/R is a complex process, through which a differential regulation of metabolic pathways takes place.
Terkawi, Mohamad Alaa; Nishimura, Maki; Furuoka, Hidefumi; Nishikawa, Yoshifumi
In the current study, we examined the effects of depletion of phagocytes on the progression of Plasmodium yoelii 17XNL infection in mice. Strikingly, the depletion of phagocytic cells, including macrophages, with clodronate in the acute phase of infection significantly reduced peripheral parasitemia but increased mortality. Moribund mice displayed severe pathological damage, including coagulative necrosis in liver and thrombi in the glomeruli, fibrin deposition, and tubular necrosis in kidney. The severity of infection was coincident with the increased sequestration of parasitized erythrocytes, the systematic upregulation of inflammation and coagulation, and the disruption of endothelial integrity in the liver and kidney. Aspirin was administered to the mice to minimize the risk of excessive activation of the coagulation response and fibrin deposition in the renal tissue. Interestingly, treatment with aspirin reduced the parasite burden and pathological lesions in the renal tissue and improved survival of phagocyte-depleted mice. Our data imply that the depletion of phagocytic cells, including macrophages, in the acute phase of infection increases the severity of malarial infection, typified by multiorgan failure and high mortality. Copyright © 2016, American Society for Microbiology. All Rights Reserved.
Dnyanmote, Ankur V.; Sawant, Sharmilee P.; Lock, Edward A.; Latendresse, John R.; Warbritton, Alan A.; Mehendale, Harihara M.
Previously we have shown that 90% of streptozotocin (STZ)-induced type-1 diabetic (DB) mice survive from acute renal failure (ARF) and death induced by a normally LD 9 dose (75 mg/kg, i.p.) of the nephrotoxicant S-1,2-dichlorovinyl-L-cysteine (DCVC). This remarkable protection is due to a combination of slower progression of DCVC-initiated renal injury and increased compensatory nephrogenic tissue repair in the DB kidneys. BRDU immunohistochemistry revealed that the DB condition led to 4-fold higher number of proximal tubular cells (PTC) entering S-phase of cell cycle. In the present study, we tested the hypothesis that DB-induced augmentation of PTC into S-phase is accompanied by overexpression of the calpain-inhibitor calpastatin, which endogenously prevents the progression of DCVC-initiated renal injury mediated by the calpain escaping out of damaged PTCs. Immunohistochemical detection of renal calpain and its activity in the urine, over a time course after treatment with the LD 9 dose of DCVC, indicated progressive increase in leakage of calpain into the extracellular spaces of the injured PTCs of the non-diabetic (NDB) kidneys as compared to the DB kidneys. Calpastatin expression was minimally detected in the NDB kidneys, using immunohistochemistry, over the time course. On the other hand, consistently higher number of tubules in the DB kidney showed calpastatin expression over the time course. The lower leakage of calpain in the DB kidneys was commensurate with constitutively higher expression of calpastatin in the S-phase-laden PTCs of these mice. To test the protective role of newly divided/dividing PTCs, DB mice were given the anti-mitotic agent colchicine (CLC) (2 mg/kg and 1.5 mg/kg, i.p., on days 8 and 10 after STZ injection) prior to challenge with a LD 9 dose of DCVC, which led to 100% mortality by 48 h. Mortality was due to rapid progression of DCVC-initiated renal injury, suggesting that newly divided/dividing cells are instrumental in mitigating
Amanda Feliciano da Silva
Full Text Available Kikuchi-Fujimoto disease, also known as histiocytic necrotizing lymphadenitis of unknown etiopathogenesis, is a self-limited disease which frequently appears as feverish lymphadenomegaly, thus creating the need for differential diagnosis with lymphoma, systemic lupus erythematosus (SLE, infectious mononucleosis, cat-scratch disease, and toxoplasmosis with lymphonodal impairment. However, there are cases in which it may evolve with complications such as aseptic meningitis, cerebellar ataxia, and aseptic myocarditis. We are presenting a case of a 24-year-old man who had an initial picture of arthralgia, evening fever and adenomegaly. Kikuchi disease was diagnosed through lymph node biopsy with immunohistochemistry and evolves with severe systemic manifestations, such as pericarditis with cardiac tamponade, pneumonitis, hepatitis, and acute kidney failure - the latter has not been reported in literature yet. There was significant improvement of the clinical picture with prednisone
Ahmad, Tariq; Jackson, Keyanna; Rao, Veena S; Tang, W H Wilson; Brisco-Bacik, Meredith A; Chen, Horng H; Felker, G Michael; Hernandez, Adrian F; O'Connor, Christopher M; Sabbisetti, Venkata S; Bonventre, Joseph V; Wilson, F Perry; Coca, Steven G; Testani, Jeffrey M
Background -Worsening renal function (WRF) in the setting of aggressive diuresis for acute heart failure (AHF) treatment may reflect renal tubular injury or simply indicate a hemodynamic or functional change in glomerular filtration. Well-validated tubular injury biomarkers-NAG, NGAL, and KIM-1- are now available that can quantify the degree of renal tubularinjury. The ROSE-AHF trial provides an experimental platform for the study of mechanisms of WRF during aggressive diuresis for AHF, as the ROSE-AHF protocol dictated high dose loop diuretic therapy in all patients. We sought to determine whether tubular injury biomarkers are associated with WRF in the setting of aggressive diuresis and its association with prognosis. Methods -Patients in the multicenter ROSE-AHF trial with baseline and 72-hour urine tubular injury biomarkers were analyzed ( N =283). WRF was defined as a ≥20% decrease in glomerular filtration rate estimated using cystatin C. Results -Consistent with protocol driven aggressive dosing of loop diuretics, participants received a median 560 mg of IV furosemide equivalents (IQR 300-815 mg) which induced a urine output of 8425 mL (IQR 6341-10528 ml) over the 72-hour intervention period. Levels of NAG and KIM-1 did not change with aggressive diuresis ( P >0.59, both), whereas levels of NGAL decreased slightly [-8.7 ng/mg (-169, 35 ng/mg), P renal tubular injury: NGAL ( P =0.21), NAG ( P =0.46), or KIM-1 ( P =0.22). Increases in NGAL, NAG, and KIM-1 were paradoxically associated with improved survival (adjusted HR: 0.80 per 10 percentile increase, 95% CI: 0.69-0.91; P =0.001). Conclusions -Kidney tubular injury does not appear to have an association with WRF in the context of aggressive diuresis of AHF patients. These findings reinforce the notion that the small to moderate deteriorations in renal function commonly encountered with aggressive diuresis are dissimilar from traditional causes of acute kidney injury.
Tang, W. H. Wilson; Dupont, Matthias; Hernandez, Adrian F.; Voors, Adriaan A.; Hsu, Amy P.; Felker, G. Michael; Butler, Javed; Metra, Marco; Anker, Stefan D.; Troughton, Richard W.; Gottlieb, Stephen S.; McMurray, John J.; Armstrong, Paul W.; Massie, Barry M.; Califf, Robert M.; O'Connor, Christopher M.; Starling, Randall C.
OBJECTIVES The purpose of this study was to investigate the predictive values of baseline and changes in cystatin C (CysC) and its derived equations for short-term adverse outcomes and the effect of nesiritide therapy on CysC in acute decompensated heart failure (ADHF). BACKGROUND Newer renal.
OBJECTIVE: Acute renal failure post-cardiac surgery (RF) is a major complication and is associated with increased postoperative morbidity and mortality. Early recognition and identification of risk factors for RF is therefore important. However, several definitions of RF are used. The intention of
Cabral, Felipe Cezar; Ramos Garcia, Pedro Celiny; Mattiello, Rita; Dresser, Daiane; Fiori, Humberto Holmer; Korb, Cecilia; Dalcin, Tiago Chagas; Piva, Jefferson Pedro
To evaluate the predictive value of the pediatric-modified Risk, Injury, Failure, Loss, End-stage renal disease criteria for disease course severity in patients with or without acute kidney injury admitted to a PICU. Retrospective cohort study. A 12-bed PICU at a tertiary referral center in Southern Brazil. All patients admitted to the study unit over a 1-year period. A database of all eligible patients was analyzed retrospectively. Patients were classified by pediatric-modified Risk, Injury, Failure, Loss, End-stage renal disease score at admission and worst pediatric-modified Risk, Injury, Failure, Loss, End-stage renal disease score during PICU hospitalization. The outcomes of interest were length of PICU stay, duration of mechanical ventilation, duration of vasoactive drug therapy, and mortality. The Pediatric Index of Mortality 2 was used to assess overall disease severity at the time of PICU admission. Of 375 patients, 169 (45%) presented acute kidney injury at the time of admission and 37 developed acute kidney injury during PICU stay, for a total of 206 of 375 patients (55%) diagnosed with acute kidney injury during the study period. The median Pediatric Index of Mortality 2 score predicted a mortality rate of 9% among non-acute kidney injury patients versus a mortality rate of 16% among acute kidney injury patients (p = 0.006). The mortality of patients classified as pediatric-modified Risk, Injury, Failure, Loss, End-stage renal disease F was double that predicted by Pediatric Index of Mortality 2 (7 vs 3.2). Patients classified as having severe acute kidney injury (pediatric-modified Risk, Injury, Failure, Loss, End-stage renal disease I + F) exhibited higher mortality (14.1%; p = 0.001) and prolonged PICU length of stay (median, 7 d; p = 0.001) when compared with other patients. Acute kidney injury is a very frequent occurrence among patients admitted to PICUs. The degree of acute kidney injury severity, as assessed by the pediatric-modified Risk
Liu, Changbo; Li, Mu; Cao, Shixiong; Wang, Jianzhong; Huang, Xiaoqiong; Zhong, Weizhen
The aim of the study was to investigate the effects of high-volume continuous renal replacement therapy (HV-CRRT) on procalcitonin (PCT), tumor necrosis factor-α (TNF-α), interleukin-4 (IL-4), IL-6, IL-8 and IL-10 in acute pancreatitis complicated by acute renal failure. Eighty-six patients with acute pancreatitis complicated with acute renal failure were selected from September 2014 to September 2016 in our hospital, and were treated by continuous veno-venous hemofiltration (CVVH). The patients were randomly divided into the observation group, treated by the HV-CVVH model with a displacement rate of 4 l/h, and the control group, treated by the normal capacity model with a displacement rate of 2 l/h. The levels of PCT, TNF-α, IL-4, IL-6, IL-8, and IL-10 in serum were measured by ELISA before and 2, 6 and 12 h after treatment, and 12 h after CVVH. The serum PCT and TNF-α levels in the two groups were decreased at 2 h after treatment. The lowest levels appeared at 6 h after treatment, and then recovered, but remained lower than those before treatment (ptreatment, and the decreases in the observation group were more obvious than those in the control group (ptreatment of pancreatitis complicated by acute renal failure. Additionally, replacement of the blood filter at appropriate time-points can improve the treatment efficacy.
Differential Response to Low-Dose Dopamine or Low-Dose Nesiritide in Acute Heart Failure With Reduced or Preserved Ejection Fraction: Results From the ROSE AHF Trial (Renal Optimization Strategies Evaluation in Acute Heart Failure).
Wan, Siu-Hin; Stevens, Susanna R; Borlaug, Barry A; Anstrom, Kevin J; Deswal, Anita; Felker, G Michael; Givertz, Michael M; Bart, Bradley A; Tang, W H Wilson; Redfield, Margaret M; Chen, Horng H
The ROSE AHF trial (Renal Optimization Strategies Evaluation in Acute Heart Failure) found that when compared with placebo, neither low-dose dopamine (2 µg/kg per minute) nor low-dose nesiritide (0.005 μg/kg per minute without bolus) enhanced decongestion or preserved renal function in AHF patients with renal dysfunction. However, there may be differential responses to vasoactive agents in AHF patients with reduced versus preserved ejection fraction (EF). This post hoc analysis examined potential interaction between treatment effect and EF (EF ≤40% versus >40%) on the ROSE AHF end points. ROSE AHF enrolled AHF patients (n=360; any EF) with renal dysfunction. The coprimary end points were cumulative urine volume and the change in serum cystatin-C in 72 hours. The effect of dopamine (interaction P=0.001) and nesiritide (interaction P=0.039) on urine volume varied by EF group. In heart failure with reduced EF, urine volume was higher with active treatment versus placebo, whereas in heart failure with preserved EF, urine volume was lower with active treatment. The effect of dopamine and nesiritide on weight change, sodium excretion, and incidence of AHF treatment failure also varied by EF group (interaction Pfailure with reduced EF and worse clinical outcomes in heart failure with preserved EF. With nesiritide, there were no differences in clinical outcomes when compared with placebo in both heart failure with reduced EF and heart failure with preserved EF. In this post hoc analysis of ROSE AHF, the response to vasoactive therapies differed in patients with heart failure with reduced EF and heart failure with preserved EF. Investigations of AHF therapies should assess the potential for differential responses in AHF with preserved versus reduced EF. URL: http://www.clinicaltrials.gov. Unique identifier: NCT01132846. © 2016 American Heart Association, Inc.
Nesiritide, renal function, and associated outcomes during hospitalization for acute decompensated heart failure: results from the Acute Study of Clinical Effectiveness of Nesiritide and Decompensated Heart Failure (ASCEND-HF).
van Deursen, Vincent M; Hernandez, Adrian F; Stebbins, Amanda; Hasselblad, Vic; Ezekowitz, Justin A; Califf, Robert M; Gottlieb, Stephen S; O'Connor, Christopher M; Starling, Randall C; Tang, W H Wilson; McMurray, John J; Dickstein, Kenneth; Voors, Adriaan A
Contradictory results have been reported on the effects of nesiritide on renal function in patients with acute decompensated heart failure. We studied the effects of nesiritide on renal function during hospitalization for acute decompensated heart failure and associated outcomes. A total of 7141 patients were randomized to receive either nesiritide or placebo and creatinine was recorded in 5702 patients at baseline, after infusion, discharge, peak/nadir levels until day 30. Worsening renal function was defined as an increase of serum creatinine >0.3 mg/dL and a change of ≥25%. Median (25(th)-75(th) percentile) baseline creatinine was 1.2 (1.0-1.6) mg/dL and median baseline blood urea nitrogen was 25 (18-39) mmol/L. Changes in both serum creatinine and blood urea nitrogen were similar in nesiritide-treated and placebo-treated patients (P=0.20 and P=0.41) from baseline to discharge. In a multivariable model, independent predictors of change from randomization to hospital discharge in serum creatinine were a lower baseline blood urea nitrogen, higher systolic blood pressure, lower diastolic blood pressure, previous weight gain, and lower baseline potassium (all Prenal function during hospitalization was similar in the nesiritide and placebo group (14.1% and 12.8%, respectively; odds ratio with nesiritide 1.12; confidence interval, 0.95-1.32; P=0.19) and was not associated with death alone and death or rehospitalization at 30 days. However, baseline, discharge, and change in creatinine were associated with death alone and death or rehospitalization for heart failure (all tests, Prenal function in patients with acute decompensated heart failure. Baseline, discharge, and change in renal function were associated with 30-day mortality or rehospitalization for heart failure. © 2014 American Heart Association, Inc.
Miller, Hylton I; Dascalu, Avi; Rassin, Tovy A; Wollman, Y; Chernichowsky, T; Iaina, A
Contrast media (CM) are nephrotoxic and might further worsen renal function in patients with chronic renal failure. L-Arginine, the substrate of nitric oxide, protects kidney function and may improve endothelial function in patients with coronary artery disease. Acute administration of L-arginine in a subset of patients with combined coronary artery disease and impaired kidney function during coronary angiography might prevent superimposed acute renal failure. A double-blind study of patients with mild/moderate chronic renal failure (Cr >1.7 mg/dl) undergoing coronary angiography (meglumine ioxaglate) was conducted. Patients received either L-arginine (300 mg/kg) or placebo and were followed for 48 h. Cardiac hemodynamic parameters, renal function and nitric oxide production were sequentially recorded. RESULTS--PRIMARY AND SECONDARY: Both groups experienced a decrease of creatinine clearance 48 h following the procedure (p < 0.05). Creatinine levels slightly increased following the administration of L-arginine (p < 0.05) but not in the placebo treated group. No changes of systemic and cardiac pressures, total peripheral resistance or cardiac output were recorded within and between the treatment and placebo groups. CM injection causes an impairment of renal function. Addition of intravenous L-arginine during cardiac catheterizations in patients with chronic renal failure does not prevent CM-induced nephrotoxicity and does not affect endothelial dysfunction in the particular population studied by the authors, i.e. patients with coronary artery disease (CAD) of various degrees, or suspicion of CAD and chronic mild renal failure. Copyright 2003 S. Karger AG, Basel
Cucchiari, David; Podestà, Manuel Alfredo; Merizzoli, Elisa; Calvetta, Albania; Morenghi, Emanuela; Angelini, Claudio; Ponticelli, Claudio; Badalamenti, Salvatore
The role of metformin in the development of lactic acidosis (LA) in the setting of acute renal failure (ARF) is debated. Moreover, recent experiments suggested that metformin can also be nephrotoxic, but little clinical data exist about this topic. We sought to investigate these possible associations in a large cohort of patients with diabetes who developed ARF. We analyzed data from patients with diabetes admitted to our emergency department between 2007 and 2011 with ARF and a previously normal renal function (n = 126). We compared acid-base balance and renal function of patients taking metformin (n = 74) with patients not taking it (n = 52). Patients taking metformin had decreased pH (7.31 ± 0.16 vs 7.39 ± 0.11, p = 0.008) and higher lactates (4.54 ± 4.30 vs 1.71 ± 1.14 mmol/L, p LA (lactates >5 mmol/L and pH metformin on pH and lactates grew significantly with higher doses of the drug (p = 0.259 and p = 0.092 for Metformin influenced creatinine levels in a dose-related manner as well (p = 0.925 for metformin was associated in a dose-related fashion with both LA and worse renal function.
Peces, R; Canora, J; Venegas, J L
Acute and chronic renal failure secondary to bilateral severe hydroureteronephrosis is a rare sequela of uterine prolapse. We report a case of neglected complete uterine prolapse in a 72-year-old patient resulting in bilateral hydroureter, hydronephrosis, and chronic renal failure. In an attempt to diminish the ureteral obstruction a vaginal pessary was used to reduce the uterine prolapse. Finally, surgical repair of prolapse by means of a vaginal hysterectomy was performed. In conclusion, all patients presenting with complete uterine prolapse should be screened to exclude urinary tract obstruction. If present, obstructive uropathy should be relieved by the reduction or repair of the prolapse before irreversible renal damage occurs.
Full Text Available Porphyran is a sulfate galactan in the cell wall of Porphyra. Its acid hydrolysis product, oligo-porphyran (OP, was prepared and the structure studied by electrospray ionization time-of-flight mass spectrometry (ESI-TOF-MS. This oligosaccharide was mainly composed of monosulfate-oligo-galactan, disufate-oligo-galactan, trisulfate-oligo-galactan, trisulfate oligo-methyl-galactan, and 3,6-anhydrogalactose with the degree of polymerization ranging from 1 to 8. The effects of OP were investigated in the glycerol-induced acute renal failure (ARF model. Compared with the normal group, rats from the glycerol-induced group exhibited collecting duct and medullary ascending limb dilation and casts. The OP-treated group exerted a protective effect against glycerol-induced changes. The results showed that the administration of OP markedly decreased mortality in female ARF rats. For male ARF rats, all of which survived, OP significantly decreased the blood urea nitrogen and serum creatinine levels. Ion levels in plasma and urine were significantly changed in ARF rats, whereas OP treatment almost recovered ion levels back to normal. This study showed a noticeable renal morphologic and functional protection by OP in glycerol-induced ARF rats.
Dev, Sandesh; Shirolkar, Shailesh C; Stevens, Susanna R; Shaw, Linda K; Adams, Patricia A; Felker, G Michael; Rogers, Joseph G; O'Connor, Christopher M
The safety, effectiveness and indications for ultrafiltration (UF) are not well established. We hypothesized that UF would not worsen renal function in patients with heart failure (HF) who were not responding to medical therapy. Data was collected for patients who underwent UF between 2006 and 2010 (n = 72, median age 61 years, 54% males, 61% Caucasian, 54% left ventricular ejection fraction ≥ 40%). Baseline GFR was 38 ml/min/1.73 m2. All patients were initially treated with loop diuretics and 58% required a thiazide-like diuretic or vasoactive agent. UF resulted in total fluid removal of 11.3 liters and weight loss was 9.7 kg. The median decrease in eGFR during UF was 4.5 ml/min/m2 (IQR--13, 0; p < 0.01) and 43% of patients experienced a ≥ 20% decrease in eGFR. Ten percent of patients required dialysis and 13% died, received a ventricular assist device/cardiac transplant or were discharged to hospice. In a cohort of HF patients who did not respond to medical therapy, UF was associated not only with a significant reduction of body weight and fluid removal, but also acute worsening of renal function. Further research to identify the appropriate population for UF, long-term outcomes and the intensity of treatment is required if UF is to gain wide acceptance for HF management. Copyright © 2012 S. Karger AG, Basel.
Corrêa, Rosana R M; Pucci, Karla R M; Rocha, Laura P; Pereira Júnior, Carlos D; Helmo, Fernanda R; Machado, Juliana R; Rocha, Lenaldo B; Rodrigues, Aldo R A; Glória, Maria A; Guimarães, Camila S O; Câmara, Niels O S; Reis, Marlene A
Diseases of adulthood, such as diabetes and hypertension, may be related to changes during pregnancy, particularly in kidney. We hypothesized that acute kidney injury progresses more rapidly in cases of fetal programming. Diabetic dams' offspring were divided into: CC (controls, receiving vehicle); DC (diabetics, receiving vehicle); CA (controls receiving folic Acid solution, 250 mg/kg); and DA (diabetics receiving folic acid solution). Renal function tests, morphometry, gene, and protein expression of epithelial-mesenchymal transition (EMT) markers were analyzed by qPCR and immunohistochemistry, respectively. Creatinine, urea, Bowman's space, and EMT markers were increased in CA and DA groups. TGF-β3, actin, and fibronectin expression was higher in CA and DA, with significant increase in DA compared to CA 2-mo offspring. There was higher expression level of TGF-β1, TGF-β3, fibronectin, and vimentin in the offspring of diabetic dams at 5 mo. Increases in TGF-β1 and TGF-β3 were more evident in the offspring of diabetic dams. Fetal programming promotes remarkable changes in kidney morphology, and function in offspring and renal failure progression may be faster in younger offspring of diabetic dams subjected to an additional injury.
Stolfo, D; Stenner, E; Merlo, M; Porto, A G; Moras, C; Barbati, G; Aleksova, A; Buiatti, A; Sinagra, G
The significance of worsening renal function (WRF) in patients admitted for acute decompensated heart failure (ADHF) is still controversial. We hypothesised that changes in brain natriuretic peptide (BNP) might identify patients with optimal diuretic responsiveness resulting in transient WRF, not negatively affecting the prognosis. Our aim was to verify if in-hospital trends of BNP might be helpful in the stratification of patients with WRF after treatment for ADHF. 122 consecutive patients admitted for ADHF were enrolled. Brain natriuretic peptide and eGFR were evaluated at admission and discharge. A 20% relative decrease in eGFR defined WRF, whereas a BNP reduction ≥40% was considered significant. The primary combined endpoint was death/urgent heart transplantation and re-hospitalisation for ADHF. Worsening renal function occurred in 23% of patients without differences in outcome between patients with and without WRF (43% vs. 45%, p=0.597). A significant reduction in BNP levels over the hospitalisation occurred in 59% of the overall population and in 71% of patients with WRF. At a median follow-up of 13.0 (IQR 6-36) months, WRF patients with ≥40% BNP reduction had a lower rate of death/urgent heart transplantation/re-hospitalisation compared to WRF patients without BNP reduction (30% and 75%, respectively; p=0.007). Favourable BNP trend was the strongest variable in predicting the outcome in WRF patients (HR 0.222, 95% CI 0.066-0.753, p=0.016). Worsening renal function does not affect the prognosis of ADHF and, when associated with a significant BNP reduction, identifies patients with adequate decongestion at discharge and favourable outcome. Copyright © 2016 Australian and New Zealand Society of Cardiac and Thoracic Surgeons (ANZSCTS) and the Cardiac Society of Australia and New Zealand (CSANZ). Published by Elsevier B.V. All rights reserved.
Roeloffzen, WWH; Hospers, GAP; De Vries, EGE; Navis, GJ
Although there has been considerable experience with interferons in the treatment of malignancy and viral illnesses, acute renal failure as a side-effect of interferon treatment has rarely been reported. We present the case of a patient who developed acute on chronic renal failure 16 months after
Mallick, Aditi; Januzzi, James L
The care of patients with acutely decompensated heart failure is being reshaped by the availability and understanding of several novel and emerging heart failure biomarkers. The gold standard biomarkers in heart failure are B-type natriuretic peptide and N-terminal pro-B-type natriuretic peptide, which play an important role in the diagnosis, prognosis, and management of acute decompensated heart failure. Novel biomarkers that are increasingly involved in the processes of myocardial injury, neurohormonal activation, and ventricular remodeling are showing promise in improving diagnosis and prognosis among patients with acute decompensated heart failure. These include midregional proatrial natriuretic peptide, soluble ST2, galectin-3, highly-sensitive troponin, and midregional proadrenomedullin. There has also been an emergence of biomarkers for evaluation of acute decompensated heart failure that assist in the differential diagnosis of dyspnea, such as procalcitonin (for identification of acute pneumonia), as well as markers that predict complications of acute decompensated heart failure, such as renal injury markers. In this article, we will review the pathophysiology and usefulness of established and emerging biomarkers for the clinical diagnosis, prognosis, and management of acute decompensated heart failure. Copyright © 2015 Sociedad Española de Cardiología. Published by Elsevier España, S.L.U. All rights reserved.
Eiden, Céline; Ripault, Marie-Pierre; Larrey, Dominique; Faillie, Jean-Luc; Pinzani, Véronique; Pageaux, Georges-Philippe; Peyrière, Hélène
Rare cases of acute hepatitis have been reported following injection, overdose, and even during the use of buprenorphine (BPN) at therapeutic doses, especially in carriers of hepatitis C virus (HCV). To report a case of acute hepatitis and renal failure related to intranasal BPN misuse in a HCV-negative patient and to analyze cases reported to the French postmarketing surveillance system (PMSS) of drugs and in the literature. All cases of hepatitis related to BPN reported to PMSS between January 1996 and December 2012 were analyzed. A 42-year-old man with a history of intranasal BPN misuse (8 mg/d) for at least 10 years was admitted for flu-like symptoms and abdominal pain. At admission, the patient consumed alcohol, cannabis, and tobacco. Acute hepatitis and acute renal failure were diagnosed . Clinical signs and biological parameters resolved within 26 days. An objective causality assessment revealed that an adverse drug reaction (ADR) was possible. In the French PMSS database, 41 cases of suspected BPN-induced hepatitis are reported. In 36.6% of cases, BPN was misused by the intravenous route. In the literature, 16 cases of acute hepatitis related to BPN with or without renal failure are reported. In all cases, patients were HCV carriers. The primary mechanism of BPN-induced hepatitis is a mitochondrial dysfunction, exacerbated by cofactors (HCV, alcohol, and medications). Intranasal misuse of BPN is increasingly frequent. We report here the first documented case of acute hepatitis and renal failure related to intranasal BPN misuse in a patient negative for HCV infection.
Xiong, Bo; Wang, Chunbin; Yao, Yuanqing; Huang, Yuwen; Tan, Jie; Cao, Yin; Zou, Yanke; Huang, Jing
Conflicting renal effects of nesiritide have been reported in patients with acute decompensated heart failure. To answer this controversy, we performed a meta-analysis of randomized controlled trials to evaluate the influence of nesiritide on renal function in patients with acute decompensated heart failure. Articles were obtained from PubMed, Medline, Cochrane Library and reference review. Randomized controlled studies that investigated the effects of continuous infusion of nesiritide on renal function in adult patients with acute decompensated heart failure were included and analyzed. Fixed-effect model was used to estimate relative risk (RR) and weight mean difference (WMD). The quality assessment of each study, subgroup, sensitivity, and publication bias analyses were performed. Fifteen randomized controlled trials were eligible for inclusion. Most of included studies had relatively high quality and no publication bias was found. Overall, compared to control therapies, nesiritide might increase the risk of worsening renal function in patients with acute decompensated heart failure (RR 1.08, 95% CI 1.01-1.15, P = 0.023). In subgroup analysis, high-dose nesiritide strongly associated with renal dysfunction (RR 1.54, 95% CI 1.19-2.00, P = 0.001), but no statistical differences were observed in standard-dose (RR 1.04, 95% CI 0.98-1.12, P = 0.213), low-dose groups (RR 1.01, 95% CI 0.74-1.37, P = 0.968) and same results were identified in the subgroup analysis of placebo controlled trials. Peak mean change of serum creatinine from baseline was no significant difference (WMD -2.54, 95% CI -5.76-0.67, P = 0.121). In our meta-analysis, nesiritide may have a dose-dependent effect on renal function in patients with acute decompensated heart failure. High-dose nesiritide is likely to increase the risk of worsening renal function, but standard-dose and low-dose nesiritide probably have no impact on renal function. These findings could be helpful to optimize the use of
Boyle, Martin; Baldwin, Ian
Delivery of renal replacement therapy is now a core competency of intensive care nursing. The safe and effective delivery of this form of therapy is a quality issue for intensive care, requiring an understanding of the principles underlying therapy and the functioning of machines used. Continuous hemofiltration, first described in 1977, used a system where blood flowed from arterial to venous cannulas through a small-volume, low-resistance, and high-flux filter. Monitoring of these early systems was limited, and without a machine interface, less nursing expertise was required. Current continuous renal replacement therapy machines offer user-friendly interfaces, cassette-style circuits, and comprehensive circuit diagnostics and monitoring. Although these machines conceal complexity behind a user-friendly interface, it remains important that nurses have sufficient knowledge for their use and the ability to compare and contrast circuit setups and functions for optimal and efficient treatment.
María del Carmen Saura Hernández
Full Text Available INTRODUCCIÓN. El objetivo de esta investigación fue determinar los factores de riesgo asociados al fallo renal agudo (FRA en un grupo de niños con sepsis grave atendidos entre enero del 2004 y diciembre del 2008. MÉTODOS. Se realizó un estudio observacional y analítico con una muestra de 171 pacientes. Se constituyeron dos grupos: el de estudio, integrado por 38 pacientes con estado de choque séptico o disfunción múltiple de órganos (DMO y FRA, y un grupo control, conformado por 133 niños en igual estadio de sepsis pero con función renal normal. Se revisaron las historias clínicas y se tuvieron en cuenta variables epidemiológicas, factores de riesgo de FRA y evolución de los casos. RESULTADOS. La incidencia de FRA fue del 22,2 %, y aunque disminuyó considerablemente en los 3 últimos años del estudio, la mortalidad fue del 42,1 %, mayoritariamente en el DMO (89,5 %. Se encontró dependencia entre la insuficiencia renal y la respuesta diurética no adecuada a la fluidoterapia (51,2 %, la inestabilidad hemodinámica por más de 24 h (46,5 %, la disfunción miocárdica (43,3 % y el uso de medicamentos nefrotóxicos (42,8 %. CONCLUSIONES. La respuesta diurética no adecuada a la fluidoterapia, la inestabilidad hemodinámica por más de 24 h, la disfunción miocárdica y el uso de medicamentos nefrotóxicos incrementan el riesgo de FRA en la sepsis grave, la cual duplica la mortalidad en relación con los pacientes que conservan la función renal. No obstante, la prevención de las formas graves de sepsis y un tratamiento adecuado de ésta disminuyen la incidencia de FRA.INTRODUCTION: The aim of present research was to determine the risk factor associated with the acute renal failure (ARF in a group of children with severe sepsis seen between January, 2004 and December, 2008. METHODS: An analytical and observational study was conducted in a sample including 171 patients. There were two groups: the study-group with 138 patients with
Heireman, Laura; Mahieu, Boris; Helbert, Mark; Uyttenbroeck, Wim; Stroobants, Jan; Piqueur, Marian
Frequent causes of high anion gap metabolic acidosis (HAGMA) are lactic acidosis, ketoacidosis and impaired renal function. In this case report, a HAGMA caused by ketones, L- and D-lactate, acute renal failure as well as 5-oxoproline is discussed. A 69-year-old woman was admitted to the emergency department with lowered consciousness, hyperventilation, diarrhoea and vomiting. The patient had suffered uncontrolled type 2 diabetes mellitus, underwent gastric bypass surgery in the past and was chronically treated with high doses of paracetamol and fosfomycin. Urosepsis was diagnosed, whilst laboratory analysis of serum bicarbonate concentration and calculation of the anion gap indicated a HAGMA. L-lactate, D-lactate, β-hydroxybutyric acid, acetone and 5-oxoproline serum levels were markedly elevated and renal function was impaired. We concluded that this case of HAGMA was induced by a variety of underlying conditions: sepsis, hyperglycaemia, prior gastric bypass surgery, decreased renal perfusion and paracetamol intake. Risk factors for 5-oxoproline intoxication present in this case are female gender, sepsis, impaired renal function and uncontrolled type 2 diabetes mellitus. Furthermore, chronic antibiotic treatment with fosfomycin might have played a role in the increased production of 5-oxoproline. Paracetamol-induced 5-oxoproline intoxication should be considered as a cause of HAGMA in patients with female gender, sepsis, impaired renal function or uncontrolled type 2 diabetes mellitus, even when other more obvious causes of HAGMA such as lactate, ketones or renal failure can be identified.
Full Text Available Chronic kidney disease is a long-term complication in acute intermittent porphyria (AIP. The pathophysiological significance of hepatic overproduction of the porphyrin precursors aminolevulinate acid (ALA and porphobilinogen (PBG in chronic kidney disease is unclear. We have investigated the effect of repetitive acute attacks on renal function and the effect of total or five-sixth nephrectomy causing renal insufficiency on hepatic heme synthesis in the porphobilinogen deaminase (PBGD-deficient (AIP mouse. Phenobarbital challenge in the AIP-mice increased urinary porphyrin precursor excretion. Successive attacks throughout 14 weeks led to minor renal lesions with no impact on renal function. In the liver of wild type and AIP mice, 5/6 nephrectomy enhanced transcription of the first and rate-limiting ALA synthase. As a consequence, urinary PBG excretion increased in AIP mice. The PBG/ALA ratio increased from 1 in sham operated AIP animals to over 5 (males and over 13 (females in the 5/6 nephrectomized mice. Total nephrectomy caused a rapid decrease in PBGD activity without changes in enzyme protein level in the AIP mice but not in the wild type animals. In conclusion, high concentration of porphyrin precursors had little impact on renal function. However, progressive renal insufficiency aggravates porphyria attacks and increases the PBG/ALA ratio, which should be considered a warning sign for potentially life-threatening impairment in AIP patients with signs of renal failure.
García-Blas, Sergio; Bonanad, Clara; Llàcer, Pau; Ventura, Silvia; Núñez, José María; Sánchez, Ruth; Chamorro, Carlos; Fácila, Lorenzo; de la Espriella, Rafael; Vaquer, Juana María; Cordero, Alberto; Roqué, Mercè; Ortiz, Víctor; Racugno, Paolo; Bodí, Vicent; Valero, Ernesto; Santas, Enrique; Moreno, María Del Carmen; Miñana, Gema; Carratalá, Arturo; Bondanza, Lourdes; Payá, Ana; Cardells, Ingrid; Heredia, Raquel; Pellicer, Mauricio; Valls, Guillermo; Palau, Patricia; Bosch, María José; Raso, Rafael; Sánchez, Andrés; Bertomeu-González, Vicente; Bertomeu-Martínez, Vicente; Montagud-Balaguer, Vicente; Albiach-Montañana, Cristina; Pendás-Meneau, Jezabel; Marcaida, Goitzane; Cervantes-García, Sonia; San Antonio, Rodolfo; de Mingo, Elisabet; Chorro, Francisco J; Sanchis, Juan; Núñez, Julio
The optimal treatment of patients with acute heart failure (AHF) and cardiorenal syndrome type 1 (CRS-1) is far from being well-defined. Arterial hypoperfusion in concert with venous congestion plays a crucial role in the pathophysiology of CRS-I. Plasma carbohydrate antigen 125 (CA125) has emerged as a surrogate of fluid overload in AHF. The aim of this study was to evaluate the clinical usefulness of CA125 for tailoring the intensity of diuretic therapy in patients with CRS-1. Multicenter, open-label, parallel clinical trial, in which patients with AHF and serum creatinine ≥ 1.4mg/dL on admission will be randomized to: a) standard diuretic strategy: titration-based on conventional clinical and biochemical evaluation, or b) diuretic strategy based on CA125: high dose if CA125 > 35 U/mL, and low doses otherwise. The main endpoint will be renal function changes at 24 and 72hours after therapy initiation. Secondary endpoints will include: a) clinical and biochemical changes at 24 and 72hours, and b) renal function changes and major clinical events at 30 days. The results of this study will add important knowledge on the usefulness of CA125 for guiding diuretic treatment in CRS-1. In addition, it will pave the way toward a better knowledge of the pathophysiology of this challenging situation. We hypothesize that higher levels of CA125 will identify a patient population with CRS-1 who could benefit from the use of a more intense diuretic strategy. Conversely, low levels of this glycoprotein could select those patients who would be harmed by high diuretic doses. Copyright © 2017 Sociedad Española de Cardiología. Published by Elsevier España, S.L.U. All rights reserved.
Manzoor A Bhat
Full Text Available Sheehan′s syndrome occurs as a result of ischemic pituitary necrosis secondary to severe postpartum bleeding. It is one of the most common causes of hypopituitarism, characterized by variable clinical presentation. Acute kidney injury occurs rarely in Sheehan′s syndrome and most of the cases have been found to be precipitated by rhabdomyolysis. We here present a case of Sheehan′s syndrome with acute kidney injury where theprecipitating cause was chronic hypocortisolemia. We believe this is the first reported case of Sheehan′s syndrome in which acute kidney injury was precipitated by adrenal insufficiency.
Markwardt, Daniel; Holdt, Lesca; Steib, Christian; Benesic, Andreas; Bendtsen, Flemming; Bernardi, Mauro; Moreau, Richard; Teupser, Daniel; Wendon, Julia; Nevens, Frederik; Trebicka, Jonel; Garcia, Elisabet; Pavesi, Marco; Arroyo, Vicente; Gerbes, Alexander L
The development of acute-on-chronic liver failure (ACLF) in patients with liver cirrhosis is associated with high mortality rates. Renal failure is the most significant organ dysfunction that occurs in ACLF. So far there are no biomarkers predicting ACLF. We investigated whether cystatin C (CysC) and neutrophil gelatinase-associated lipocalin (NGAL) can predict development of renal dysfunction (RD), hepatorenal syndrome (HRS), ACLF, and mortality. We determined the plasma levels of CysC and NGAL in 429 patients hospitalized for acute decompensation of cirrhosis in the EASL-CLIF Acute-on-Chronic Liver Failure in Cirrhosis (CANONIC) study. The patients were followed for 90 days. Patients without RD or ACLF at inclusion but with development of either had significantly higher baseline concentrations of CysC and NGAL compared to patients without. CysC, but not NGAL, was found to be predictive of RD (odds ratio, 9.4; 95% confidence interval [CI], 1.8-49.7), HRS (odds ratio, 4.2; 95% CI, 1.2-14.8), and ACLF (odds ratio, 5.9; 95% CI, 1.3-25.9). CysC at day 3 was not found to be a better predictor than baseline CysC. CysC and NGAL were both predictive of 90-day mortality, with hazard ratios for CysC of 3.1 (95% CI, 2.1-4.7) and for NGAL of 1.9 (95% CI, 1.5-2.4). Baseline CysC is a biomarker of RD, HRS, and ACLF and an independent predictor of mortality in patients with acutely decompensated liver cirrhosis, though determining CysC at day 3 did not provide any benefit; while NGAL is also associated with short-term mortality, it fails to predict development of RD, HRS, and ACLF. Baseline CysC may help to identify patients at risk earlier and improve clinical management. (Hepatology 2017;66:1232-1241). © 2017 by the American Association for the Study of Liver Diseases.
Schaudies, R P; Nonclercq, D; Nelson, L; Toubeau, G; Zanen, J; Heuson-Stiennon, J A; Laurent, G
The time course for the increases in soluble renal epidermal growth factor (EGF) after ischemia has been established. These elevated levels of EGF have been compared with the degree of tissue injury as well as the extent of cell proliferation in the recovering tissue. Levels of soluble immunoreactive EGF (irEGF) in control animals were 9.74 +/- 1.1 ng/g wet wt (n = 4-8 for all values) and rose to 83.9 +/- 30 ng/g within 12 h after injury. Soluble irEGF content peaked at 88.8 +/- 15 ng/g at 24 h postinjury and returned to control values by 72 h. We previously reported that trypsin digestion of crude renal membranes (CRM) generates rat EGF that is indistinguishable from that isolated from the submandibular gland. Initial levels of trypsin-releasable membrane-associated irEGF were 439 +/- 26 ng/g. These levels fell to 46.6 +/- 9.6 ng/g at 48 h after injury. The total renal EGF demonstrated an 80% decline 48 h after injury but returned to 50% of the initial values after 72 h representing significant new synthesis of EGF-containing proteins between 48 and 72 h postinjury. Immunohistochemical staining of kidney paraffin sections for EGF immunoreactivity demonstrated staining intensities that paralleled the amount of irEGF in the trypsin-digested CRM fraction, suggesting that the membrane-associated irEGF is the predominant form detected by this technique. Regenerative hyperplasia subsequent to tubular insult was monitored by immunostaining nuclei of S phase cells after pulse labeling with the thymidine analogue 5-bromo-2'-deoxyuridine. Cell proliferation was particularly prominent in the outer stripe of outer medulla of kidneys exposed to ischemia and reached a maximum (19-fold higher than the baseline value) 48 h after reperfusion. Renal cell turnover returned to control values by day 7. The observation that the peak in soluble EGF levels (24 h) precedes the peak in tubular regeneration (48 h) by 24 h is consistent with the hypothesis that EGF is one of the mitogenic
Cruz, Luzia S; Vargas, Roberto; Lopes, Antonio Alberto
Leptospirosis, a spirochetal zoonosis, is a globally re-emerging infectious disease that has disseminated from its habitual rural base to become the cause of urban epidemics in poor communities of industrialized and developing nations. This review addresses the issues in the epidemiology, clinical features, and management of the disease, as well as progress made toward understanding the pathogenesis of leptospiral nephropathy. In developing nations, leptospirosis plays an important role as a potentially preventable cause of acute renal failure. The data indicate that in certain developing regions, such as the city of Salvador, Brazil, leptospirosis is misdiagnosed with other infectious disease such as dengue and the overall disease burden is likely underestimated partly because of the protean and nonspecific presentation. Severe forms of the disease are associated with high case-fatality rate. In urban Brazil, outbreaks of leptospirosis can be predicted by heavy rain and flooding and this may serve to indicate which resources should be allocated to prevent the disease. Advancements in the basic research and epidemiology of leptospirosis should contribute to the development of more accurate diagnostic tests and of an effective vaccine. Policy makers should be urged to address the underlying conditions of poverty as well as environmental issues, which have led to the emergence of leptospirosis.
Clarke, Megan M; Dorsch, Michael P; Kim, Susie; Aaronson, Keith D; Koelling, Todd M; Bleske, Barry E
To identify baseline predictors of worsening renal function (WRF) in an acute decompensated heart failure (ADHF) patient population receiving continuous infusion loop diuretics. Retrospective observational analysis. Academic tertiary medical center. A total of 177 patients with ADHF receiving continuous infusion loop diuretics from January 2006 through June 2009. The mean patient age was 61 years, 63% were male, ~45% were classified as New York Heart Association functional class III, and the median length of loop diuretic infusion was 4 days. Forty-eight patients (27%) developed WRF, and 34 patients (19%) died during hospitalization. Cox regression time-to-event analysis was used to determine the time to WRF based on different demographic and clinical variables. Baseline serum albumin 3 g/dl or less was the only significant predictor of WRF (hazard ratio [HR] 2.87, 95% confidence interval [CI] 1.60-5.16, p=0.0004), which remained significant despite adjustments for other covariates. Serum albumin 3 g/dl or less is a practical baseline characteristic associated with the development of WRF in patients with ADHF receiving continuous infusion loop diuretics. © 2013 Pharmacotherapy Publications, Inc.
Full Text Available Purpose: The present study was carried out to determine if Paljeong-san extract (PJS treatment exerts beneficial effect against the glycerol-induced acute renal failure in rabbits. Material and Method: PJS was selected in the basis of invigorating kidney which can eliminate pathogens. Rabbits were treated with PJS pharmacopuncture on Shin-shu (BL23 point for 5 days right after the injection of 50% concentration of glycerol (5㎖/㎏ body weight. Results and Conclusions: Glycerol injection caused an increase in serum creatinine and BUN level and urine glucose secretion, which were accompanied by a reduction in GFR. PJS Pharmacopuncture treatment combined with peritoneal injection showed beneficial effect on glycerol-induced acute renal failure by inhibition of serum creatinine increase and GFR decrease.
Kajimoto, Katsuya; Sato, Naoki; Keida, Takehiko; Sakata, Yasushi; Takano, Teruo
The relationship among anemia, renal dysfunction, left ventricular ejection fraction, and outcomes of patients hospitalized for acute decompensated heart failure is unclear. The aim of this study was to evaluate the association between cardiorenal anemia syndrome and postdischarge outcomes in patients hospitalized for heart failure with a preserved or reduced ejection fraction. Of 4842 patients enrolled in the Acute Decompensated Heart Failure Syndromes Registry between April 1, 2007 and December 31, 2011, 4393 patients were evaluated to investigate the association among anemia, renal dysfunction, preserved or reduced ejection fraction, and the primary end point (mortality and readmission for heart failure since discharge). The patients were divided into four groups on the basis of eGFR and hemoglobin at discharge. The median follow-up period after discharge was 432 (range=253-659) days. The primary end point was reached in 37.6% and 34.8% of the preserved and reduced ejection fraction groups, respectively. After adjustment for multiple comorbidities, there was no significant association of either renal dysfunction or anemia alone with the primary end point in patients with preserved ejection fraction, but the combination of renal dysfunction and anemia was associated with a significantly higher risk than that without either condition (hazard ratio, 1.54; 95% confidence interval, 1.12 to 2.12; Prenal dysfunction alone (hazard ratio, 1.65; 95% confidence interval, 1.21 to 2.25; P=0.002) and also, renal dysfunction plus anemia relative to the risk without either condition (hazard ratio, 2.19; 95% confidence interval, 1.62 to 2.96; Prenal dysfunction combined with anemia is associated with an increased risk of adverse postdischarge outcomes in patients with preserved ejection fraction, whereas renal dysfunction is an independent predictor of the risk of adverse outcomes in patients with reduced ejection fraction, regardless of anemia. Copyright © 2014 by the American
Fiorellino, J; Elahie, A L; Warkentin, T E
The aims of this study were to report a patient with acute haemolytic transfusion reaction (HTR) after transfusing uncross-matched red blood cell (RBC) units and to identify the frequency of this complication. Uncross-matched RBC units are commonly transfused in emergencies, but the frequency of acute HTR is unknown. We describe a male stabbing victim who received three units of uncross-matched RBC units complicated by acute intravascular HTR, disseminated intravascular coagulation (DIC) and renal failure. We identified 14 studies evaluating the frequency of acute HTR post-emergency transfusion of uncross-matched RBC units. Acute HTR was shown by haemoglobinuria, free-plasma haemoglobin and methemalbumin, with anti-K and anti-Fy a eluted from recipient red cells; acute DIC featured severe hypofibrinogenemia, thrombocytopenia, elevated fibrin D-dimer and multiple bilateral renal infarcts. Two of the three transfused units reacted with pre-existing RBC alloantibodies [anti-K (titre, 128), anti-Fy a (titre, 512)], explained by transfusion 25 years earlier. Our literature review found the frequency of acute HTR following emergency transfusion of uncross-matched RBC units to be 2/3998 [0·06% (95% CI, 0·01-0·21%)]. Although emergency transfusion of uncross-matched blood is commonly practiced at trauma centres worldwide, with low risk of acute HTR (acute HTR with severe complications. © 2018 British Blood Transfusion Society.
Krautkrämer, Ellen; Zeier, Martin
Hantavirus-associated diseases represent emerging infections that are ranked in the highest priority group of communicable diseases for surveillance and epidemiological research. In the last years, several novel hantavirus species were described and the number of host reservoir species harboring hantaviruses is also increasing. Reports of cases with severe or atypical clinical courses become also more frequent. These facts raise more and more questions concerning host reservoir specificity, pathogenicity and molecular mechanism of pathogenesis. Hantavirus disease is characterized by vascular leakage due to increased capillary permeability. The infection manifests often in the lung (hantaviral cardiopulmonary syndrome; HCPS) or in the kidney (hemorrhagic fever with renal syndrome, HFRS). The underlying mechanisms of both syndromes are probably similar despite the difference in organ tropism. Characterization of hantaviral replication cycle and of patient-specific determinants will help to identify factors responsible for the clinical symptoms and course. Copyright © 2014 Elsevier B.V. All rights reserved.
Full Text Available Massive envenomations by bees are capable of causing multiorgandysfunction as a result of direct toxic effects of the largevenom load received. Although all varieties of honey bee havethe potential for these attacks, the Africanized honey bee (Apismellifera scutellata is the most commonly implicated subspecies.In the United States, the Africanized strain is found primarilyin the southwestern states and is known for its highly defensivebehavior if disturbed. Mechanisms behind the multiorgan dysfunctionproduced by these mass envenomations are not clearly understood.We present a case of an 8-year-old boy who was stung by multiple bees and developed progressive upper-body swelling andsystemic manifestations of mass envenomation including rhabdomyolysis,renal insufficiency, and a transient transaminase elevation. Ibrahim Med. Coll. J. 2011; 5(1: 34-36
Tilborg, Aukje A. J. M. van, E-mail: email@example.com [VU University Medical Center, Departments of Radiology and Nuclear Medicine (Netherlands); Dresselaars, Helena F. [VU University Medical Center, Department of Nefrology (Netherlands); Scheffer, Hester J. [VU University Medical Center, Departments of Radiology and Nuclear Medicine (Netherlands); Nielsen, Karin [VU University Medical Center (Netherlands); Sietses, Colin [Gelderse Vallei Hospital, Department of Surgical Oncology (Netherlands); Tol, Petrousjka M. van den [VU University Medical Center (Netherlands); Meijerink, Martijn R. [VU University Medical Center, Departments of Radiology and Nuclear Medicine (Netherlands)
ObjectiveIn patients that require treatment for hepatic giant cavernous hemangiomas (GCH), radiofrequency ablation (RFA) has been suggested to represent a safe and effective alternative to invasive surgery. In a recent report of bipolar RFA, using two expandable needle electrodes, was uneventfully performed in patients with large GCH (>10 cm). The objective of this report is to present two cases in which bipolar RFA of symptomatic GCH was complicated by acute kidney injury.Materials and methodsIn 2015 we treated two patients for very large symptomatic GCH (15.7 and 25.0 cm) with bipolar RFA during open laparotomy.ResultsIn both patients the urine showed a red–brown discoloration directly after the ablation. They became anuric and presented with progressive dyspnea, tachypnea, and tachycardia, requiring hemodialysis for a period of 1 month in one case. Lab results revealed hemepigment-induced acute kidney. Both patients fully recovered and both showed a complete relief of symptoms at 3 months following the procedure.ConclusionRFA for large GCHs can cause hemepigment-induced acute kidney injury due to massive intravascular hemolysis. The presented cases suggest that caution is warranted and advocate an upper limit regarding the volume of GCHs that can be safely ablated.
Miller, Alice; Price, Grant
This case report outlines a significant type of morbidity due to continued use of gabapentin during an episode of acute renal failure. Setting. University teaching hospital. Gabapentin is widely used in the management of pain. It is entirely excreted through the renal system so this needs to be considered in any patient becoming acutely ill and developing renal failure. We describe a patient who developed significant deterioration in her conscious level due to iatrogenic gabapentin overdose. All doctors need to be aware of the need to review the indications for gabapentin use during periods of acute illness, especially with regard to renal impairment. Off-label use should be discouraged.
Full Text Available Background/Aims: Lipopolysaccharides (LPS binding to Toll-like receptor 4 (TLR4 activate NADPH oxidase gp91 subunit-mediated inflammation and oxidative damage. Recognizing the high binding affinity of sialic acid (SA with LPS, we further explored the preventive potential of SA pretreatment on LPS-evoked acute renal failure (ARF. Methods: We determined the effect of intravenous SA 30 min before LPS-induced injury in urethane-anesthetized female Wistar rats by evaluating kidney reactive oxygen species (ROS responses, renal and systemic hemodynamics, renal function, histopathology, and molecular mechanisms. Results: LPS time-dependently reduced arterial blood pressure, renal microcirculation, and increased blood urea nitrogen and creatinine in the rats. LPS enhanced monocyte/macrophage infiltration and ROS production, and subsequently impaired kidneys with the enhancement of TLR4/NADPH oxidase gp91/Caspase 3/poly-(ADP-ribose-polymerase (PARP-mediated apoptosis in the kidneys. SA pretreatment effectively alleviated LPS-induced ARF. The levels of LPS-increased ED-1 infiltration and ROS production in the kidney were significantly depressed by SA pretreatment. Furthermore, SA pretreatment significantly depressed TLR4 activation, gp91 expression, and Caspase 3/PARP induced apoptosis in the kidneys. Conclusion: We suggest that pretreatment of SA significantly and preventively attenuated LPS-induced detrimental effects on systemic and renal hemodynamics, renal ROS production and renal function, as well as, LPS-activated TLR4/gp91/Caspase3 mediated apoptosis signaling.
Larsen, Fin Stolze; Bjerring, Peter Nissen
Acute liver failure (ALF) results in a multitude of serious complications that often lead to multi-organ failure. This brief review focuses on the pathophysiological processes in ALF and how to manage these.......Acute liver failure (ALF) results in a multitude of serious complications that often lead to multi-organ failure. This brief review focuses on the pathophysiological processes in ALF and how to manage these....
Siddappa, Sujatha; Mythri, K M; Kowsalya, R; Parekh, Ashish
Renal hemosiderosis is a rare cause of renal failure and, as a result, may not be diagnosed unless a detailed history, careful interpretation of blood parameters and renal biopsy with special staining is done. Here, we present a rare case of renal hemosiderosis presenting with renal failure.
Full Text Available Renal hemosiderosis is a rare cause of renal failure and, as a result, may not be diagnosed unless a detailed history, careful interpretation of blood parameters and renal biopsy with special staining is done. Here, we present a rare case of renal hemosiderosis presenting with renal failure.
Santoro, Jonathan D; Chao, Stephanie; Hsieh, Michael H; Lee, Henry C
Omphalocele-exstrophy of the bladder-imperforate anus-spinal defect (OEIS) complex is a rare constellation of clinical abnormalities with wide phenotypic presentation. We describe a case of a preterm neonate with OEIS complex with acute renal failure, and the challenges in diagnosis and management of this patient as renal failure can be a multifactorial process when encountered with this rare complex.
Santoro, Jonathan D.; Chao, Stephanie; Hsieh, Michael H.; Lee, Henry C.
Omphalocele-exstrophy of the bladder-imperforate anus-spinal defect (OEIS) complex is a rare constellation of clinical abnormalities with wide phenotypic presentation. We describe a case of a preterm neonate with OEIS complex with acute renal failure, and the challenges in diagnosis and management of this patient as renal failure can be a multifactorial process when encountered with this rare complex.
Veroux, Massimiliano; Ardita, Vincenzo; Zerbo, Domenico; Caglià, Pietro; Palmucci, Stefano; Sinagra, Nunziata; Giaquinta, Alessia; Veroux, Pierfrancesco
Abstract Acute renal failure due to ureter compression after a mesh-plug inguinal repair in a kidney transplant recipient has not been previously reported to our knowledge. A 62-year-old man, who successfully underwent kidney transplantation from a deceased donor 6 years earlier, was admitted for elective repair of a direct inguinal hernia. The patient underwent an open mesh-plug repair of the inguinal hernia with placement of a plug in the preperitoneal space. We did not observe the transplanted ureter and bladder during dissection of the inguinal canal. Immediately after surgery, the patient became anuric, and a graft sonography demonstrated massive hydronephrosis. The serum creatinine level increased rapidly, and the patient underwent an emergency reoperation 8 hours later. During surgery, we did not identify the ureter but, immediately after plug removal, urine output increased progressively. We completed the hernia repair using the standard technique, without plug interposition, and the postoperative course was uneventful with complete resolution of graft dysfunction 3 days later. Furthermore, we reviewed the clinical features of complications related to inguinal hernia surgery. An increased risk of urological complications was reported recently in patients with a previous prosthetic hernia repair undergoing kidney transplantation, mainly due to the mesh adhesion to surrounding structures, making the extraperitoneal dissection during the transplant surgery very challenging. Moreover, older male kidney transplant recipients undergoing an inguinal hernia repair may be at higher risk of graft dysfunction due to inguinal herniation of a transplanted ureter. Mesh-plug inguinal hernia repair is a safe surgical technique, but this unique case suggests that kidney transplant recipients with inguinal hernia may be at higher risk of serious urological complications. Surgeons must be aware of the graft and ureter position before proceeding with hernia repair. A prompt
Veroux, Massimiliano; Ardita, Vincenzo; Zerbo, Domenico; Caglià, Pietro; Palmucci, Stefano; Sinagra, Nunziata; Giaquinta, Alessia; Veroux, Pierfrancesco
Acute renal failure due to ureter compression after a mesh-plug inguinal repair in a kidney transplant recipient has not been previously reported to our knowledge. A 62-year-old man, who successfully underwent kidney transplantation from a deceased donor 6 years earlier, was admitted for elective repair of a direct inguinal hernia. The patient underwent an open mesh-plug repair of the inguinal hernia with placement of a plug in the preperitoneal space. We did not observe the transplanted ureter and bladder during dissection of the inguinal canal. Immediately after surgery, the patient became anuric, and a graft sonography demonstrated massive hydronephrosis. The serum creatinine level increased rapidly, and the patient underwent an emergency reoperation 8 hours later. During surgery, we did not identify the ureter but, immediately after plug removal, urine output increased progressively. We completed the hernia repair using the standard technique, without plug interposition, and the postoperative course was uneventful with complete resolution of graft dysfunction 3 days later. Furthermore, we reviewed the clinical features of complications related to inguinal hernia surgery. An increased risk of urological complications was reported recently in patients with a previous prosthetic hernia repair undergoing kidney transplantation, mainly due to the mesh adhesion to surrounding structures, making the extraperitoneal dissection during the transplant surgery very challenging. Moreover, older male kidney transplant recipients undergoing an inguinal hernia repair may be at higher risk of graft dysfunction due to inguinal herniation of a transplanted ureter. Mesh-plug inguinal hernia repair is a safe surgical technique, but this unique case suggests that kidney transplant recipients with inguinal hernia may be at higher risk of serious urological complications. Surgeons must be aware of the graft and ureter position before proceeding with hernia repair. A prompt diagnosis
Markwardt, Daniel; Holdt, Lesca; Steib, Christian
C) and neutrophil gelatinase-associated lipocalin (NGAL) can predict development of renal dysfunction (RD), hepatorenal syndrome (HRS), ACLF, and mortality. We determined the plasma levels of CysC and NGAL in 429 patients hospitalized for acute decompensation of cirrhosis in the EASL-CLIF Acute-on-Chronic Liver...
Elsharawy, Sahar; Raslan, Lila; Morsy, Saed; Hassan, Basheir; Khalifa, Naglaa
Acute heart failure (AHF) is frequently associated with worsening renal function in adult patients. Neutrophil gelatinase-associated lipocalin (NGAL) serves as an early marker for acute renal tubular injury. To assess the role of plasma NGAL in predicting worsening renal function (WRF) in children with AHF, we studied 30 children hospitalized for AHF; children with history of chronic renal disease or on nephrotoxic drugs were excluded. Twenty age- and sex-matched healthy children were included in the study as a control group. Echocardiographic examination was performed on admission. Blood urea nitrogen (BUN), serum creatinine, estimated glomerular filtration rate (eGFR) and plasma NGAL levels were measured on admission and 72 h later. Seventeen (56.6%) patients developed WRF within the three-day follow-up period. At presentation, plasma NGAL level was significantly elevated in children who developed WRF. Admission plasma NGAL level correlated with renal parameters (BUN, creatinine and eGFR) as well as with left ventricular systolic parameters (ejection fraction and fractional shortening). For prediction of WRF, admission plasma, NGAL level>27.5 μg/L had sensitivity and specificity of 90% and 68%, respectively. The area under the receiver-operator curve was higher for NGAL (0.869) than for BUN (0.569) or eGFR (0.684). We conclude that admission plasma NGAL level can predict WRF in children hospitalized for AHF.
Some elderly patients on chronic lithium therapy for bipolar disorder and their doctors may be faced with a therapeutic dilemma over whether or not to continue prescribing/taking lithium given their increased risk of reduced renal function. We present the case of a 78-year-old woman with bipolar disorder who discontinued lithium therapy due to increased risk factors for renal injury. After discontinuation, she experienced markedly decreased appetite secondary to a depressive episode, and developed acute renal failure, which subsequently progressed to a more advanced stage of chronic kidney disease. This case suggests that extreme care must be taken to prevent the recurrence of depression in elderly patients with bipolar disorder who discontinue lithium therapy, even when they had been emotionally stable for a long time while receiving lithium. Medications other than lithium for bipolar disorder may be needed at the time lithium therapy is discontinued. PMID:24835805
Buturovic-Ponikvar, Jadranka E-mail: firstname.lastname@example.org; Visnar-Perovic, Alenka
Many chronic renal diseases lead to the final common state of decrease in renal size, parenchymal atrophy, sclerosis and fibrosis. The ultrasound image show a smaller kidney, thinning of the parenchyma and its hyperechogenicity (reflecting sclerosis and fibrosis). The frequency of renal cysts increases with the progression of the disease. Ultrasound generally does not allow for the exact diagnosis of an underlying chronic disease (renal biopsy is usually required), but it can help to determine an irreversible disease, assess prognosis and avoid unnecessary diagnostic or therapeutic procedures. The main exception in which the ultrasound image does not show a smaller kidney with parenchymal atrophy is diabetic nephropathy, the leading cause of chronic and end-stage renal failure in developed countries in recent years. In this case, both renal size and parenchymal thickness are preserved until end-stage renal failure. Doppler study of intrarenal vessels can provide additional information about microvascular and parenchymal lesions, which is helpful in deciding for or against therapeutic intervention and timely planning for optimal renal replacement therapy option.
Buturovic-Ponikvar, Jadranka; Visnar-Perovic, Alenka
Many chronic renal diseases lead to the final common state of decrease in renal size, parenchymal atrophy, sclerosis and fibrosis. The ultrasound image show a smaller kidney, thinning of the parenchyma and its hyperechogenicity (reflecting sclerosis and fibrosis). The frequency of renal cysts increases with the progression of the disease. Ultrasound generally does not allow for the exact diagnosis of an underlying chronic disease (renal biopsy is usually required), but it can help to determine an irreversible disease, assess prognosis and avoid unnecessary diagnostic or therapeutic procedures. The main exception in which the ultrasound image does not show a smaller kidney with parenchymal atrophy is diabetic nephropathy, the leading cause of chronic and end-stage renal failure in developed countries in recent years. In this case, both renal size and parenchymal thickness are preserved until end-stage renal failure. Doppler study of intrarenal vessels can provide additional information about microvascular and parenchymal lesions, which is helpful in deciding for or against therapeutic intervention and timely planning for optimal renal replacement therapy option
Tang, W H Wilson; Dupont, Matthias; Hernandez, Adrian F; Voors, Adriaan A; Hsu, Amy P; Felker, G Michael; Butler, Javed; Metra, Marco; Anker, Stefan D; Troughton, Richard W; Gottlieb, Stephen S; McMurray, John J; Armstrong, Paul W; Massie, Barry M; Califf, Robert M; O'Connor, Christopher M; Starling, Randall C
The purpose of this study was to investigate the predictive values of baseline and changes in cystatin C (CysC) and its derived equations for short-term adverse outcomes and the effect of nesiritide therapy on CysC in acute decompensated heart failure (ADHF). Newer renal biomarkers or their derived estimates of renal function have demonstrated long-term prognostic value in chronic heart failure. CysC levels were measured in sequential plasma samples from 811 subjects with ADHF who were enrolled in the ASCEND-HF (Acute Study of Clinical Effectiveness of Nesiritide in Decompensated Heart Failure) biomarker sub-study (randomized to nesiritide therapy vs. placebo), and followed for all-cause death (180 days) and recurrent hospital stay (30 days). Median CysC levels were 1.49 (interquartile range [IQR]: 1.20 to 1.96) mg/l at baseline, 1.56 (IQR: 1.28 to 2.13) mg/l at 48 to 72 h, and 1.58 (IQR: 1.24 to 2.11) mg/l at 30 days. Higher baseline (but not follow-up) CysC levels were associated with increased risk of 30-day adverse events and less improvement in dyspnea after 24 h as well as 180-day mortality, although not incremental to blood urea nitrogen. Worsening renal function (defined as a 0.3 mg/l increase in CysC) occurred in 161 of 701 (23%) patients, but it was not predictive of adverse events. Changes in CysC levels were similar between the nesiritide and placebo groups. Our findings confirmed the prognostic value of baseline CysC levels in the setting of ADHF. However, worsening renal function based on CysC rise was not predictive of adverse events. Nesiritide did not worsen renal function compared with placebo. Copyright © 2015 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.
Reduction of severe mitral regurgitation with the MitraClip system improves renal function in two patients presenting with acute kidney injury and progressive renal failure due to cardio renal syndrome.
Asdonk, T; Nickenig, G; Hammerstingl, C
Mitral regurgitation (MR) is a frequent valve disorder in elderly patients, often accompanied by multiple comorbidities such as renal impairment. In these patients percutaneous mitral valve (MV) repair has become an established treatment option but the role of MR on renal dysfunction is not yet well defined. We here report on two cases presenting with severe MR and progressive renal failure caused by cardio renal syndrome, in which percutaneous MV treatment with the MitraClip system significantly improved renal function. These findings suggest that interventional MV repair can prevent progression of renal deterioration in patients suffering from combined advanced heart and renal failure. Further clinical studies are necessary to support our finding and to answer the question whether optimizing renal function by implantation of the MitraClip device is also of prognostic relevance in these patients. © 2014 Wiley Periodicals, Inc.
... begins in or spreads to your liver can cause your liver to fail. Shock. Overwhelming infection (sepsis) and shock can severely impair blood flow to the liver, causing liver failure. Many cases of acute liver failure have no apparent ... liver failure often causes complications, including: ...
Choi, Pil Youb; Lee, Su Han; Lee, Woo Dong
Acute renal cortical necrosis in which there is destruction of the renal cortex and sparing of the renal medulla, is a relatively rare cause of acute renal failure. A definitive diagnosis of acute renal cortical necrosis is based on renal biopsy, but on CT(computed tomography) the rather specific contrast-enhanced appearance of acute renal cortical necrosis has been described. As renal biopsy is not available, contrast-enhanced CT is a useful, noninvasive investigate modality for the early diagnosis of acute renal cortical necrosis. We report the characteristic CT findings of acute renal cortical necrosis in a patient with acute renal failure following an operation for abdominal trauma
Full Text Available Renal ischemia-reperfusion (IR injury is the major cause of acute renal failure in native and transplanted kidneys. Mononuclear leukocytes have been reported in renal tissue as part of the innate and adaptive responses triggered by IR. We investigated the participation of CD4+ T lymphocytes in the pathogenesis of renal IR injury. Male mice (C57BL/6, 8 to 12 weeks old were submitted to 45 min of ischemia by renal pedicle clamping followed by reperfusion. We evaluated the role of CD4+ T cells using a monoclonal depleting antibody against CD4 (GK1.5, 50 µ, ip, and class II-major histocompatibility complex molecule knockout mice. Both CD4-depleted groups showed a marked improvement in renal function compared to the ischemic group, despite the fact that GK1.5 mAb treatment promoted a profound CD4 depletion (to less than 5% compared to normal controls only within the first 24 h after IR. CD4-depleted groups presented a significant improvement in 5-day survival (84 vs 80 vs 39%; antibody treated, knockout mice and non-depleted groups, respectively and also a significant reduction in the tubular necrosis area with an early tubular regeneration pattern. The peak of CD4-positive cell infiltration occurred on day 2, coinciding with the high expression of ßC mRNA and increased urea levels. CD4 depletion did not alter the CD11b infiltrate or the IFN-g and granzyme-B mRNA expression in renal tissue. These data indicate that a CD4+ subset of T lymphocytes may be implicated as key mediators of very early inflammatory responses after renal IR injury and that targeting CD4+ T lymphocytes may yield novel therapies.
Villegas, Ana; Núñez, Ramiro; Gaya, Anna; Cuevas-Ruiz, María Victoria; Bosch, José Miguel; Carral, Anna; Arrizabalaga, Beatriz; Gómez-Roncero, María Isabel; Mora, Asunción; Bravo, Pilar; Lavilla, Esperanza; Monteserín, Carmen; Hernández, Belén; Martínez-Barranco, Pilar; Jarque, Isidro; Urquía, María Anunciación; García-Donas, Gloria; Brunet, Salut; González, Fernando Ataulfo; Urbano, Álvaro
Paroxysmal nocturnal hemoglobinuria (PNH) is a rare, life-threatening blood disease. With the advent of eculizumab treatment, renal function has substantially improved, although no data from real-world clinical practice are available. An observational, retrospective, multicenter study was conducted in Spain on clinical data obtained from outpatient visits of patients with PNH (Spanish PNH Registry) who had experienced acute (ARF) or chronic (CRF) renal failure. Of the 128 patients registered (April 2014), 60 were diagnosed with classic PNH. Twenty-seven (45.0%) patients with a mean age of 48.5 (±16.2) years had renal failure, ARF or CRF, and were included in this study. Near half of the patients (n = 13; 48.1%) presented with ARF alone, 33.3% (n = 9) had CRF with episodes of ARF, while 18.5% (n = 5) were diagnosed with CRF alone. For patients with diagnosis of PNH and renal failure (n = 27), the median time to the first ARF episode was 6.5 (CI 95%; 2.2, 14.9) years, whereas the median to the diagnosis of CRF was 14.5 (CI 95%; 3.8, 19.2) years after the diagnosis of PNH. Patients with ARF (n = 22) were treated with eculizumab and did not experience new episodes of ARF, except for one patient with sepsis. Of the patients with CRF, two received treatment without experiencing further episodes of ARF. Sixteen patients who completed treatment (11 with ARF and 5 with ARF + CRF) recovered from the episode of ARF or from CRF. Of the remaining patients treated with eculizumab, one patient improved from stages III to II, three patients stabilized without showing disease progression, and one patient progressed from stages III to IV. Treatment with eculizumab in PNH patients has beneficial effects on renal function, preventing ARF and progression to CRF.
Almueilo, Samir H
Renal dysfunction is encountered in 20-25% of patients with multiple myeloma (MM) at the time of diagnosis. There is often a precipitating event. Several biochemical and clinical correlations with renal failure in MM have been reported. Renal failure in MM is associated with worse outcome of the disease. We retrospectively analyzed the medical records of 64 patients with MM admitted to our institution during the period January 1992 to December 2012. Abnormal renal function was observed in 24 (37.5%) patients and 17 (26.6%) of them had renal failure; 14 of the 17 (82.4%) of patients with renal failure had Stage III MM. Urine Bence- Jones protein was positive in ten (58.8%) patients with renal failure versus ten (21.3%) patients without renal failure (P = 0.004). Potential precipitating factors of renal failure were determined in nine patients. Renal function normalized in 11 patients with simple measures, while six patients required hemodialysis; one remained dialysis dependent till time of death. Early mortality occurred in five (29.4%) patients with renal failure as compared with two (4.3%) patients in the group without renal failure (P = 0.005). In conclusion, renal failure is associated with a higher tumor burden and Bence-Jones proteinuria in patients with MM. It is reversible in the majority of patients; however, early mortality tends to be higher in patients with persistent renal failure.
Pentikaeinen, P.J.P.; Pasternack, A.; Lampainen, E.; Neuvonen, P.J.; Penttilae, A.
To study the effects of renal failure on bumetanide kinetics, the authors administered single intravenous doses of 1.0 mg/3.08 microCi 14 C-bumetanide to six healthy subjects and 22 patients with variable degrees of renal failure. The kinetics of 14 C-bumetanide and total 14 C were adequately described by a two-compartment open model in the control subjects and in the patients. The volume of the central compartment and the distribution t1/2 were of the same order in both groups, whereas the mean (+/- SE) volume at steady state was larger (22.1 +/- 1.6 and 16.9 +/- 1.0 L) and the elimination t1/2 was longer (1.9 +/- 0.2 and 1.4 +/- 0.1 hours) in patients with renal failure than in healthy controls. Bumetanide renal clearance was lower (10 +/- 3 and 90 +/- 13 ml/min) in patients than in subjects and correlated with creatinine clearance (r = 0.784) and log serum creatinine level (r = -0.843), whereas nonrenal clearance was significantly higher in the patients (153 +/- 14 and 99 +/- 6 ml/min). Bumetanide total plasma clearance did not significantly change. The non-protein-bound, free fraction of bumetanide was higher in patients and correlated with plasma albumin levels (r = -0.777). The kinetics of total 14 C showed similar but greater changes than those of 14C-bumetanide. Thus the most important changes in bumetanide kinetics in patients with renal failure are low renal clearance and a high free fraction, with a consequent increase in nonrenal clearance, volume of distribution, and elimination t1/2
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Full Text Available BACKGROUND: Clinical evidence indicates that late acute renal failure (ARF predicts high mortality in severely burned patients but the pathophysiology of late ARF remains undefined. This study was designed to test the hypothesis that sustained reactive oxygen species (ROS induced late ARF in a severely burned rat model and to investigate the signaling mechanisms involved. MATERIALS AND METHODS: Rats were exposed to 100°C bath for 15 s to induce severe burn injury (40% of total body surface area. Renal function, ROS generation, tubular necrosis and apoptosis, and phosphorylation of MAPK and Akt were measured during 72 hours after burn. RESULTS: Renal function as assessed by serum creatinine and blood urea nitrogen deteriorated significantly at 3 h after burn, alleviated at 6 h but worsened at 48 h and 72 h, indicating a late ARF was induced. Apoptotic cells and cleavage caspase-3 in the kidney went up slowly and turned into significant at 48 h and 72 h. Tubular cell ROS production shot up at 6 h and continuously rose during the 72-h experiment. Scavenging ROS with tempol markedly attenuated tubular apoptosis and renal dysfunction at 72 h after burn. Interestingly, renal p38 MAPK phosphorylation elevated in a time dependent manner whereas Akt phosphorylation increased during the first 24 h but decreased at 48 h after burn. The p38 MAPK specific inhibitor SB203580 alleviated whereas Akt inhibitor exacerbated burn-induced tubular apoptosis and renal dysfunction. Furthermore, tempol treatment exerted a duplex regulation through inhibiting p38 MAPK phosphorylation but further increasing Akt phosphorylation at 72 h postburn. CONCLUSIONS: These results demonstrate that sustained renal ROS overproduction induces continuous tubular cell apoptosis and thus a late ARF at 72 h after burn in severely burned rats, which may result from ROS-mediated activation of p38 MAPK but a late inhibition of Akt phosphorylation.
Morita, Seiichiro; Ishibashi, Masatoshi; Dannoura, Ryujiro
1. Tc-99m DTPA renogram curve in the cases that serum creatinine value was more than about 3.0 mg/dl showed no functional pattern with a few exception. When the DTPA-GFR required Gates method fell below about 30 ml/min, or the serum creatinine value rise above about 3.0 mg/dl, the relation between the DTPA-GFR and the serum creatinine was impaired. 2. The role of nuclear medicine against evaluation of transplanted renal function direct after the transplantation was for early detection of complication and for diagnosis of the existence of blood flow to the transplanted kidney. 3. Bone scintigram with Tc-99m MDP in the patients being dialyzed was classified into 5 types. (author)
Arefi, Mohammad; Taghaddosinejad, Fakhroddin; Salamaty, Peyman; Soroosh, Davood; Ashraf, Hami; Ebrahimi, Mohsen
Background: Renal failure is an important adverse effect of drug poisoning. Determining the prevalence and etiology of this serious side effect could help us find appropriate strategies for the prevention of renal failure in most affected patients. Objectives: The present study is aimed to identify drugs that induce renal failure and also to find the prevalence of renal failure in patients referred to emergency departments with the chief complaint of drug poisoning, in order to plan better th...
Heart failure can be defined as a clinical syndrome in which a structural or functional cardiac abnormality impairs the capacity of the ventricle to fill or eject enough blood for the requirements of the body. Acute heart failure syndrome represents a complex, heterogeneous set of clinical conditions, all with the common.
Lonnemann, G; Floege, J; Kliem, V; Brunkhorst, R; Koch, K M
In the treatment of acute renal failure in patients with multiple organ dysfunction syndrome (MODS), continuous renal replacement therapies (CRRT) are increasingly used because of excellent volume control in the presence of improved cardiovascular stability. Patients with MODS, however, are frequently catabolic and have a high urea generation rate requiring either cost-intensive high-volume CRRT or additional intermittent haemodialysis to provide adequate clearance of small-molecular waste products. We tested the closed-loop batch haemodialysis system (called Genius((R))) for the treatment of acute renal failure in patients with MODS in the intensive care unit. Blood flow and countercurrent dialysate flow were reduced to 70 ml/min. Thus the 75 l dialysate tank of the Genius((R)) system lasts for 18 h of extended single-path high-flux haemodialysis (18 h-HFD) using polysulphous F60 S((R)) dialysers. Blood pressure, body temperature, and venous blood temperature in the extracorporeal circuit (no heating of the dialysate), ultrafiltration rate, serum urea levels, dialyser urea clearance, and total urea removal were monitored. In addition we tested the bacteriological quality of the spent dialysate at the end of 18-h treatments. Twenty patients with acute renal failure and MODS were investigated. Averaged dialyser urea clearance was 59.8 ml/min (equal to 3.6 l/h or 64.8 l/day). Total removal of urea was 14.1+/-6.5 g/day keeping serum levels of urea below 13 mmol/l. Mean arterial pressure remained stable during the 18-h treatments with a mean ultrafiltration rate of 120 ml/h. The temperature in the venous blood tubing dropped by 5+/-0.5 degrees C during the 18-h treatment (0.28 degrees C/h) in the presence of unchanged core temperature in the patients. There was no bacterial growth in 2.5 l of spent dialysate (dialysis using the Genius((R)) system combines the benefits of CRRT (good cardiovascular stability, sterile dialysate) with the advantages of intermittent
Thirumavalavan, Nannan; Wilken, Nathan A; Ramasamy, Ranjith
The prevalence of both hypogonadism and renal failure is increasing. Hypogonadism in men with renal failure carries with it significant morbidity, including anemia and premature cardiovascular disease. It remains unclear whether testosterone therapy can affect the morbidity and mortality associated with renal failure. As such, in this review, we sought to evaluate the current literature addressing hypogonadism and testosterone replacement, specifically in men with renal failure. The articles chosen for this review were selected by performing a broad search using Pubmed, Embase and Scopus including the terms hypogonadism and renal failure from 1990 to the present. This review is based on both primary sources as well as review articles. Hypogonadism in renal failure has a multifactorial etiology, including co-morbid conditions such as diabetes, hypertension, old age and obesity. Renal failure can lead to decreased luteinizing hormone production and decreased prolactin clearance that could impair testosterone production. Given the increasing prevalence of hypogonadism and the potential morbidity associated with hypogonadism in men with renal failure, careful evaluation of serum testosterone would be valuable. Testosterone replacement therapy should be considered in men with symptomatic hypogonadism and renal failure, and may ameliorate some of the morbidity associated with renal failure. Patients with all stages of renal disease are at an increased risk of hypogonadism that could be associated with significant morbidity. Testosterone replacement therapy may reduce some of the morbidity of renal failure, although it carries risk.
Vazir, Ali; Simpkin, Victoria L; Marino, Philip; Ludman, Andrew; Banya, Winston; Tavazzi, Guido; Bastin, Anthony J; Trenfield, Sarah; Ghori, Arshad; Alexander, Peter D; Griffiths, Mark; Price, Susanna; Sharma, Rakesh; Cowie, Martin R
Patients with acute decompensated heart failure with diuretic resistance (ADHF-DR) have a poor prognosis. The aim of this study was to assess in patients with ADHF-DR, whether haemodynamic changes during ultrafiltration (UF) are associated with changes in renal function (Δcreatinine) and whether Δcreatinine post UF is associated with mortality. Seventeen patients with ADHF-DR underwent 20 treatments with UF. Serial bloods (4-6 hourly) from the onset of UF treatment were measured for renal function, electrolytes and central venous saturation (CVO2). Univariate and multivariate analysis were performed to assess the relationship between changes in markers of haemodynamics [heart rate (HR), systolic blood pressure (SBP), packed cell volume (PCV) and CVO2] and Δcreatinine. Patients were followed up and mortality recorded. Cox-regression survival analysis was performed to determine covariates associated with mortality. Renal function worsened after UF in 17 of the 20 UF treatments (baseline vs. post UF creatinine: 164±58 vs. 185±69μmol/l, Pchanges in SBP, HR and PCV [Pchanges during UF as measured by the surrogate of cardiac output was associated with Δcreatinine. Worsening renal function at end of UF treatment occurred in the majority of patients and was associated with mortality. Copyright © 2016. Published by Elsevier Ireland Ltd.
Ibrahim, Mohamed El-Tantawy; Bana, Eman El; El-Kerdasy, Hanan I
Cisplatin is a highly effective antitumor agent whose clinical application is limited by its nephrotoxicity, which is associated with high mortality and morbidity rates. We aimed to study the protective role of silymarin and mesenchymal stem cells as a therapeutic tool of cisplatin nephrotoxicity. We injected rats with cisplatin in a dose of 5mg/kg body weight for 5 days to induce acute renal failure (ARF). Silymarin was administrated 6 hours before cisplatin injection and mesenchymal stem cells were injected 24 hours after cisplatin-induced ARF. We assessed the ARF biochemically by elevation of kidney function tests and histopathologically by an alteration of the histological architecture of the renal cortex in the form of shrinkage of glomeruli, lobulated tufts and glomerular hypertrophy with narrowing capsular space. The tubules showed extensive tubular degeneration with cellular hyaline materials and debris in the lumen of the renal tubules. The renal blood vessels appeared sclerotic with marked thickened walls. When silymarin was given in different doses before cisplatin, it decreased the toxic effect of cisplatin in the kidney but sclerotic blood vessels remained. Injection of mesenchymal stem cells in rats with cisplatin-induced ARF improved the histopathological effects of cisplatin in renal tissues and kidney function tests were significantly improved. There was a significant improvement in kidney function tests and renal histopathology by using silymarin as protective mechanism in cisplatin-induced ARF. Administration of mesenchymal stem cells denoted a more remarkable therapeutic effect in ARF. Copyright © 2018 Southern Society for Clinical Investigation. Published by Elsevier Inc. All rights reserved.
Hattner, R.S.; Maltz, H.E.; Holliday, M.A.
In renal failure associated with the nephrotic syndrome, therapeutic strategy is highly dependent upon the cause of the renal failure. Dynamic hippurate scintigraphy was studied in five pediatric patients. Four had nephrotic syndrome, and of these, three had acute renal failure. The fifth patient had end-stage renal failure. Specific alteration in renal hippurate kinetics offers a noninvasive assessment of renal failure in this clinical setting
Sevin, C; Heidet, L; Gagnadoux, M F; Chéron, G; Niaudet, P
Kawasaki disease is an acute inflammatory condition characterized by various combinations of features but renal involvement is rare. This report is of a case of Kawasaki disease complicated by acute kidney failure. A 10 year-old girl was admitted because of acute renal failure with fever. She developed a high fever, and her general condition was poor; she had developed a macular erythematous rash 10 days earlier for which she was given cefadroxil. At admission, she remained febrile and had strawberry tongue, pharyngitis, dry erythematous lips, bilateral conjunctivitis, cervical lymphadenopathy and desquamation of the skin on her hands. She was anemic (hemoglobin = 9.6 g%), leukocytotic (33,100/mm3), but with no burr, fragmented red blood cells or thrombocytopenia. Her plasma C-reactive protein level was 236 mg/l; her blood urea was 9.5 mmol/l, her creatininemia 288 mumol/l and proteinuria was 0.5 g/l without hematuria. Urine cultures did not grow. Her blood transaminase and gammaglutamyltransferase activities were elevated. Ultrasonography of kidneys and coronary arteries was normal. Kidney biopsy performed one day after admission showed no vascular or glomerular changes, but renal tubular necrosis, indicating urinary excretion of pigments. Tests for myoglobinemia, myoglobinuria and blood muscle enzyme activities were all positive. The renal failure disappeared within 10 days but the fever and inflammatory manifestations persisted for 1 1/2-2 months despite two treatments of intravenous gammaglobulins and continuous salicylate administration. The patient developed arthralgias at the end of the first month of disease, but recovered without renal or vascular complications. Several cases of renal involvement have been reported during the course of Kawasaki disease. They have been rarely documented by histological examination so that the vascular origin of changes has not been demonstrated. Myoglobinuria, as seen in muscular crush injury, and in our case possibly due
Peco-Antić Amira; Kostić Mirjana; Spasojević Brankica; Miloševski-Lomić Gordana; Paripović Dušan; Kruščić Divna; Cvetković Mirjana
Introduction/Objective. Jeune syndrome (JS) is a rare hereditary ciliopathy characterized by asphyxiating thoracic dystrophy, shortened limbs and brachydactyly. Extraskeletal anomalies such as chronic renal failure (CRF), hepatic fibrosis, and retinitis pigmentosa may be a part of the JATD phenotype. The aim of this study is to present long-term follow-up of JS patients with early progressive kidney disease. Methods. This is a retrospective study of pediatric patients with JS and CRF who were...
Hosokawa, Shin-ichi; Daijo, Kazuyuki; Okabe, Tatsushiro; Kawamura, Juichi; Hara, Akira
Renal contours in renal failure were studied by means of sup(99m)Tc-dimercaptosuccinic acid (DMSA) renoscintigraphy. Renal cortical images were obtained even in renal failure cases. Causes of renal failure were chronic glomerulonephritis in 7, bilateral renal tuberculosis in 2, chronic pyelonephritis in 3, bilateral renal calculi in 3, diabetic nephropathy in 2, polycystic kidney disease in 2 and stomach cancer in 1. (author)
Jonathan D. Santoro
Full Text Available Omphalocele-exstrophy of the bladder-imperforate anus-spinal defect (OEIS complex is a rare constellation of clinical abnormalities with wide phenotypic presentation. We describe a case of a preterm neonate with OEIS complex with acute renal failure, and the challenges in diagnosis and management of this patient as renal failure can be a multifactorial process when encountered with this rare complex.
Full Text Available Maternal use of drugs during pregnancy may cause irreversible renal failure in the newborn. This report highlights the adverse effect of telmisartan during the last trimester of pregnancy. The neonate presented with oliguric renal failure and the renal histology showed proximal tubular dysgenesis.
Full Text Available Introduction/Objective. Jeune syndrome (JS is a rare hereditary ciliopathy characterized by asphyxiating thoracic dystrophy, shortened limbs and brachydactyly. Extraskeletal anomalies such as chronic renal failure (CRF, hepatic fibrosis, and retinitis pigmentosa may be a part of the JATD phenotype. The aim of this study is to present long-term follow-up of JS patients with early progressive kidney disease. Methods. This is a retrospective study of pediatric patients with JS and CRF who were treated at the University Children’s Hospital between January 1980 and December 2014. The patients’ data were retrospectively reviewed from the medical records. Results. There were thirteen patients from 11 families, five girls and eight boys mean aged 4.3 years at the time of diagnosis. All of the patients had characteristic skeletal findings, retinal degeneration and an early onset of CRF at age range from 1.5 to 7 years. Five patients had neonatal respiratory distress and congenital liver fibrosis was diagnosed in five patients. One patient died due to complications of CRF, while others survived during follow-up of mean 11 years. IFT140 mutations were found in four genetically tested patients. Conclusion. The average incidence rate of JS with renal phenotype in Serbia was about 0.2 per one million of child population. Long-term survival of JS patients depends on renal replacement therapy, while skeletal dysplasia, growth failure, respiratory and eyes problems have impact on the patients’ quality of life.
Eubig, Paul A; Brady, Melinda S; Gwaltney-Brant, Sharon M; Khan, Safdar A; Mazzaferro, Elisa M; Morrow, Carla M K
A review of records from the AnTox database of the American Society for the Prevention of Cruelty to Animals Animal Poison Control Center identified 43 dogs that developed increased blood urea nitrogen concentration, serum creatinine concentration, or both as well as clinical signs after ingesting grapes, raisins, or both. Clinical findings, laboratory findings, histopathological findings, treatments performed, and outcome were evaluated. All dogs vomited, and lethargy, anorexia, and diarrhea were other common clinical signs. Decreased urine output, ataxia, or weakness were associated with a negative outcome. High calcium x phosphorus product (Ca x P), hyperphosphatemia, and hypercalcemia were present in 95%, 90%, and 62% of the dogs in which these variables were evaluated. Extremely high initial total calcium concentration, peak total calcium concentration, initial Ca x P, and peak Ca x P were negative prognostic indicators. Proximal renal tubular necrosis was the most consistent finding in dogs for which histopathology was evaluated. Fifty-three percent of the 43 dogs survived, with 15 of these 23 having a complete resolution of clinical signs and azotemia. Although the mechanism of renal injury from grapes and raisins remains unclear, the findings of this study contribute to an understanding of the clinical course of acute renal failure that can occur after ingestion of grapes or raisins in dogs.
Bernal, William; Lee, William M; Wendon, Julia
Over the last three decades acute liver failure (ALF) has been transformed from a rare and poorly understood condition with a near universally fatal outcome, to one with a well characterized phenotype and disease course. Complex critical care protocols are now applied and emergency liver...
Palazzuoli, Alberto; Ruocco, Gaetano; Beltrami, Matteo; Franci, Beatrice; Pellegrini, Marco; Lucani, Barbara; Nuti, Ranuccio; Ronco, Claudio
Abstract Background: The role of neutrophil gelatinase-associated lipocalin (NGAL) has been described in chronic heart failure (HF), however less data are available in patients admitted for acute HF. We evaluated the role of NGAL in predicting in-hospital worsening renal function (WRF) and post-discharge follow-up during six months period in patients with acute HF. All patients were submitted to creatinine, estimated glomerular filtration rate (eGFR), blood urea nitrogen (BUN) and B-type natriuretic peptide (BNP) measurement during hospitalization and before discharge. Patients with chronic kidney dysfunction (CKD) demonstrated higher NGAL respect to subject with preserved renal function (241 ± 218 and 130 ± 80 ng/ml; P = 0.0001). In subgroup that developed WRF during hospitalization, NGAL levels were significantly increased respect to patients without WRF (272 ± 205 versus 136 ± 127 ng/ml; P = 0.0001). A cut off of 134 ng/ml has been related to WRF with good sensibility and specificity (92% and 71% AUC 0.83; P = 0.001). Multivariable Cox regression analysis showed that cut-off of 134 ng/ml was the only marker related to death (HR: 1.75; 95% CI: 1.24-2.45; P 130 ng/ml was associated with adverse events during a six-month period. Admission NGAL measurement appears a sensible tool for in-hospital WRF prediction as well as an early marker for adverse outcome during post discharge vulnerable phase.
Nitschke, Martin; Meier, Markus; Steinhoff, Jürgen
A newly diagnosed renal insufficiency should be investigated thoroughly, since even slight elevations of renal retention parameters reflect a relevant loss of renal function. Acute creatinine elevations above 0.3 mg/dl are considered an acute kidney injury. Renal failure can be classified according to different criteria. Generally, an acute kidney injury should be separated from chronic renal failure leading to different diagnostic and therapeutic consequences. In most cases, some easy procedures (history, ultrasound, blood tests) help to differentiate between acute and chronic failure. While adequate therapy results in restitution of acute kidney injury in most cases, the aim in chronic renal failure is to minimize complications and to delay renal replacement therapy. Therefore, it is mandatory to involve renal specialists as it has been shown that early referral to nephrologists can ameliorate renal morbidity and mortality. Except for postrenal causes of renal deterioration the diagnostic and therapeutic work-up should be done by nephrologists to avoid unnecessary complications and expenses.
Afsar, Baris; Ortiz, Alberto; Covic, Adrian; Solak, Yalcin; Goldsmith, David; Kanbay, Mehmet
Hospitalizations due to heart failure are increasing steadily despite advances in medicine. Patients hospitalized for worsening heart failure have high mortality in hospital and within the months following discharge. Kidney dysfunction is associated with adverse outcomes in heart failure patients. Recent evidence suggests that both deterioration in kidney function and renal congestion are important prognostic factors in heart failure. Kidney congestion in heart failure results from low cardiac output (forward failure), tubuloglomerular feedback, increased intra-abdominal pressure or increased venous pressure. Regardless of the cause, renal congestion is associated with increased morbidity and mortality in heart failure. The impact on outcomes of renal decongestion strategies that do not compromise renal function should be explored in heart failure. These studies require novel diagnostic markers that identify early renal damage and renal congestion and allow monitoring of treatment responses in order to avoid severe worsening of renal function. In addition, there is an unmet need regarding evidence-based therapeutic management of renal congestion and worsening renal function. In the present review, we summarize the mechanisms, diagnosis, outcomes, prognostic markers and treatment options of renal congestion in heart failure.
Full Text Available Leptospirosis is an important cause of acute renal failure in our environment. Although several mechanisms are implicated, the role of rhabdomyolysis in the pathogenesis of acute renal failure in leptospirosis has not been analysed. Sixteen patients with the diagnosis of leptospiroses consecutively admitted to the hospital were prospectively studied. The disease was characterized by sudden onset in all patients and, at admission, jaundice, conjunctival suffusion and myalgias. Mild to moderate proteinuria with unremarkable urinary sediment was recorded in 37.5% of the patients and abnormal levels of urea creatinine were found in 87.5% and 74.0%, respectively. Increased levels of aminotranspherase were documented in all 12 and CPK in all 10 patients studied. Serum myoglobin levels greater than 120µg/l recorded in 56.2%. A correlation between myoglobin and renal failure or severity of disease, however, could not be established.Leptospirose é uma importante causa de insuficiência renal aguda, em nosso ambiente. Embora vários sejam os mecanismos implicados, o papel da rabdomiólise na patogênese da insuficiência renal aguda na leptospirose ainda não foi analisado. Com esse objetivo, 16 pacientes com o diagnóstico da forma icterohemorrágica da leptospirose consecutivamente admitidos no Hospital Couto Maia, Salvador, Bahia, foram prospectivamente estudados. A doença foi caracterizada por início súbito e, à admissão, ictericia, sufusões hemorrágicas conjuntivais e mialgias. Proteinúria de intensidade média a moderada com sedimento urinário inexpressivo foi observada em 37,5% dos pacientes e níveis séricos elevados de uréia e creatinina em 78,5% e 74,0%, respectivamente. Níveis aumentados de aminotransferase foram documentados em todos os 12 e de CPK em todos os 10 pacientes avaliados para essas enzimas. Níveis séricos maiores que 120µg/l foram observados em 56,2% dos pacientes. Não foram encontradas correlações, entretanto
Effects of ventriculoarterial coupling changes on renal function, echocardiographic indices and energy efficiency in patients with acute decompensated systolic heart failure under furosemide and dopamine treatment: a comparison of three therapeutic protocols.
Antoniou, Christos-Konstantinos; Chrysohoou, Christina; Lerakis, Stamatios; Manolakou, Panagiota; Pitsavos, Christos; Tsioufis, Konstantinos; Stefanadis, Christodoulos; Tousoulis, Dimitrios
Ventriculoarterial coupling (VAC) status relates to tissue perfusion and its optimization may improve organ function and energy efficiency (EE) of the cardiovascular system. The effects of non-invasively calculated VAC improvement on echocardiographic parameters, renal function indices and EE improvement in patients with acute decompensated systolic heart failure were studied. Furthermore, effects of different treatment modalities on VAC, renal function and echocardiographic parameters were compared. Systolic heart failure patients with ejection fraction Renal function was evaluated using serum creatinine and creatinine clearance. VAC and EE were assessed noninvasively, by echocardiography. Significant correlations were noted between VAC improvement and improvements in EE and serum creatinine (rho=0.96, pacute decompensated systolic heart failure. Dopamine and furosemide combination seemed to improve VAC and diastolic function but only had a borderline effect on renal function. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.
Rathnapala, Amila; Matthias, Thushara; Jayasinghe, Saroj
Kerosene is a freely accessible hydrocarbon used in Sri Lankan (and other Asian) households for cooking and for lighting lamps. Kerosene poisoning is rarely reported among adults and its toxicological effects are not well known. Metformin is a commonly used oral hypoglycemic drug and its overdose leads primarily to lactic acidosis. Combined poisoning of metformin and kerosene and their interactions have not been reported. An 18-year-old, previously healthy, unmarried Sinhalese woman was referred following ingestion of 17.5 g of metformin and approximately 200 mL of kerosene oil in a suicide attempt. She had vomiting, burning epigastric pain, and a hypoglycemic seizure (capillary blood glucose of 42 mg/dL). Subsequently, she developed severe lactic acidosis followed by acute renal insufficiency, was treated with sodium bicarbonate, and underwent intermittent hemodialysis with bicarbonate. She recovered completely. This report proposes possible interactions that occur between metformin and kerosene that augment toxicity when the two are ingested together. It also stresses the importance of early treatment with intermittent hemodialysis in severe lactic acidosis with maintenance of blood glucose.
induced renal toxicity into four major renal syndromes: • acute renal failure. • chronic renal failure. • glomerulonephritis. • tubulopathies. These major renal syndromes are discussed in further detail below (see summary in Table I). Acute renal failure. Drugs can cause acute renal failure by causing pre-renal, intrinsic or.
Guo, Xinjin [Department of Clinical Pharmacology, College of Pharmacy, Dalian Medical University, Dalian (China); Meng, Qiang; Liu, Qi; Wang, Changyuan; Sun, Huijun; Peng, Jinyong; Ma, Xiaochi [Department of Clinical Pharmacology, College of Pharmacy, Dalian Medical University, Dalian (China); Provincial Key Laboratory for Pharmacokinetics and Transport, Dalian Medical University, Liaoning (China); Kaku, Taiichi [Japan Bioproducts Industry Co. Ltd., Tomigaya, Shibuya-ku, Tokyo (Japan); Liu, Kexin, E-mail: email@example.com [Department of Clinical Pharmacology, College of Pharmacy, Dalian Medical University, Dalian (China); Provincial Key Laboratory for Pharmacokinetics and Transport, Dalian Medical University, Liaoning (China)
We investigated the effects of JBP485 (an anti-inflammatory dipeptide and a substrate of OAT) on regulation of the expression and function of renal Oat1 and Oat3, which can accelerate the excretion of accumulated uremic toxins (e.g. indoxyl sulfate) in the kidney to improve gentamicin-induced ARF in rats. JBP485 caused a significant decrease in the accumulation of endogenous substances (creatinine, blood urea nitrogen and indoxyl sulfate) in vivo, an increase in the excretion of exogenous compounds (lisinopril and inulin) into urine, and up-regulation of the expressions of renal Oat1 and Oat3 in the kidney tissues and slices via substrate induction. To determine the effect of JBP485 on the accelerated excretion of uremic toxins mediated by Oat1 and Oat3, the mRNA and protein expression levels of renal basolateral Oats were assessed by quantitative real-time PCR, western blot, immunohistochemical analysis and an immunofluorescence method. Gentamicin down-regulated the expression of Oats mRNA and protein in rat kidney, and these effects were reversed after administration of JBP485. In addition, JBP485 caused a significant decrease in MPO and MDA levels in the kidney, and improved the pathological condition of rat kidney. These results indicated that JBP485 improved acute renal failure by increasing the expression and function of Oat1 and Oat3, and by decreasing overoxidation of the kidney in gentamicin-induced ARF rats. - Highlights: • JBP485 could up-regulate function and expression of Oat1 and Oat3 in kidney. • Effects of JBP485 on ARF are mediated by stimulating excretion of uremic toxins. • JBP485 protected against gentamicin-induced ARF by decreasing MPO and MDA.
Epidemiology and Outcome of Acute Kidney Injury According to Pediatric Risk, Injury, Failure, Loss, End-Stage Renal Disease and Kidney Disease: Improving Global Outcomes Criteria in Critically Ill Children-A Prospective Study.
Volpon, Leila C; Sugo, Edward K; Consulin, Julio C; Tavares, Tabata L G; Aragon, Davi C; Carlotti, Ana P C P
We aimed to investigate the epidemiology, risk factors, and short- and medium-term outcome of acute kidney injury classified according to pediatric Risk, Injury, Failure, Loss, End-Stage Renal Disease, and Kidney Disease: Improving Global Outcomes criteria in critically ill children. Prospective observational cohort study. Two eight-bed PICUs of a tertiary-care university hospital. A heterogeneous population of critically ill children. None. Demographic, clinical, laboratory, and outcome data were collected on all patients admitted to the PICUs from August 2011 to January 2012, with at least 24 hours of PICU stay. Of the 214 consecutive admissions, 160 were analyzed. The prevalence of acute kidney injury according to pediatric Risk, Injury, Failure, Loss, End-Stage Renal Disease and Kidney Disease: Improving Global Outcomes criteria was 49.4% vs. 46.2%, respectively. A larger proportion of acute kidney injury episodes was categorized as Kidney Disease: Improving Global Outcomes stage 3 (50%) compared with pediatric Risk, Injury, Failure, Loss, End-Stage Renal Disease F (39.2%). Inotropic score greater than 10 was a risk factor for acute kidney injury severity. About 35% of patients with acute kidney injury who survived were discharged from the PICU with an estimated creatinine clearance less than 75 mL/min/1.73 m and one persisted with altered renal function 6 months after PICU discharge. Age 12 months old or younger was a risk factor for estimated creatinine clearance less than 75 mL/min/1.73 m at PICU discharge. Acute kidney injury and its severity were associated with increased PICU length of stay and longer duration of mechanical ventilation. Eleven patients died; nine had acute kidney injury (p Renal Disease and Kidney Disease: Improving Global Outcomes criteria was associated with increased morbidity and mortality, and may lead to long-term renal dysfunction.
Newland, Catherine D
Pediatric acute liver failure (ALF) is a complex and rapidly progressive syndrome that results from a variety of age-dependent etiologies. It is defined by the acute onset of liver disease with no evidence of chronic liver disease. There must be biochemical or clinical evidence of severe liver dysfunction as defined by an international normalized ratio (INR) ≥2. If hepatic encephalopathy is present, INR should be ≥1.5. Unfortunately, due to the rarity of ALF in pediatric patients, there is a paucity of diagnostic and management algorithms and each patient must have an individualized approach. [Pediatr Ann. 2016;45(12):e433-e438.]. Copyright 2016, SLACK Incorporated.
R. Suganya Gnanadeepam
Full Text Available BACKGROUND The kidney and the skin are the two large networks of the body with abundant blood supply associated with various cutaneous manifestations. This study aims to detect the various cutaneous manifestations and its incidence in patients with chronic renal failure and renal transplantation. MATERIALS AND METHODS This study was done for a period of 1 year from January 2016 to December 2016 at Nephrology OPD ward and Medicine wards, Government KAPV Medical College Hospital, Trichy. During this period, 100 patients who had the presence of skin manifestations were selected and studied (80 renal failure patients and 20 renal transplantation patients. RESULTS Most of the specific cutaneous manifestations of chronic renal failure and renal transplantation were noted in this study. Pruritus and xerosis were the most common manifestations noted in chronic renal failure while infections was commonly noted in renal transplantation patients. CONCLUSION Pruritus and xerosis were the most common among the specific cutaneous manifestations in chronic renal failure followed by nail abnormalities and pigmentary changes. Cutaneous manifestations of renal transplantation were mostly due to infections of which fungal infection is the most common followed by viral infection.
Delaney, Martha A; Colegrove, Kathleen M; Spraker, Terry R; Zuerner, Richard L; Galloway, Renee L; Gulland, Frances M D
During rehabilitation, acute renal failure due to leptospirosis occurred in eight male northern elephant seals (Mirounga angustirostris) that stranded along the central California coast in 2011. Characteristic histologic lesions including renal tubular degeneration, necrosis, and mineralization, and mild lymphoplasmacytic interstitial nephritis were noted in the six animals examined. Immunohistochemistry, bacterial culture, and PCR were positive in 2/3, 2/3, and 3/4 seals, respectively, and 6/8 had high serum antibody titers to Leptospira interrogans serovar pomona. Pulsed-field gel electrophoresis confirmed one isolate as serovar pomona. Variable number tandem repeat (VNTR) analysis showed both elephant seal isolates were identical to each other but distinct from those isolated from California sea lions (Zalophus californianus). The time from stranding to onset of azotemia was 1 to 38 (median=24) days, suggesting some seals were infected at the rehabilitation facility. Based on temporal and spatial incidence of infection, transmission among elephant seals likely occurred during rehabilitation. Molecular (VNTR) analysis of the two isolates indicates there is a unique L. interrogans serovar pomona genotype in elephant seals, and sea lions were not the source of infection prior to or during rehabilitation. This study confirms the susceptibility of northern elephant seals to leptospirosis, indicates intraspecies transmission during rehabilitation, and reports the first isolation and preliminary characterization of leptospires from elephant seals.
Full Text Available Jacqueline B Palmer,1 Howard S Friedman,2 Katherine Waltman Johnson,1 Prakash Navaratnam,2 Stephen S Gottlieb3 1Novartis Pharmaceuticals Corporation, East Hanover, NJ, USA; 2DataMed Solutions, LLC, New York, NY, USA; 3Department of Medicine, University of Maryland School of Medicine, Baltimore, MD, USA Background: Data comparing effects of transient worsening renal function (WRFt and persistent WRF (WRFp on outcomes in patients hospitalized with acute heart failure (AHF are lacking. We determined the characteristics of hospitalized AHF patients who experienced no worsening renal function (non-WRF, WRFt, or WRFp, and the relationship between cohorts and AHF-related outcomes. Methods and results: A patient’s first AHF hospitalization (index was identified in the Cerner Health Facts® database (January 2008-March 2011. Patients had WRF if serum creatinine (SCr was ≥0.3 mg/dL and increased ≥25% from baseline, and they were designated as WRFp if present at discharge or WRFt if not present at discharge. A total of 55,436 patients were selected (non-WRF =77%, WRFp =10%, WRFt =13%. WRFp had greater comorbidity burden than WRFt. At index hospitalization, WRFp patients had the highest mortality, whereas WRFt patients had the longest length of stay (LOS and highest costs. These trends were observed at 30, 180, and 365 days postdischarge and confirmed by multivariable analyses. WRF patients had more AHF-related readmissions than non-WRF patients. In sensitivity analyses of the patient subset with live index hospitalization discharges, postdischarge LOS and costs were highest in WRFt patients, whereas mortality associated with a HF hospitalization was significantly higher for WRF patients vs non-WRF patients, with no difference between WRFp and WRFt. Conclusion: In patients hospitalized for AHF, WRFp was associated with the highest mortality, whereas WRFt was associated with the highest LOS and costs. WRF patients had higher readmissions than non
Full Text Available The aim of this study was to explore clinical features of renal infarction (RI that may have a role in diagnosis and treatment in our patient cohort and provide data on midterm renal functions. Medical records of patients with diagnosis of acute RI, established by contrast enhanced computed tomography (CT and at least 1 year follow-up data, who were hospitalized in our clinic between 1998 and 2012 were retrospectively reviewed; including descriptive data, clinical signs and symptoms, etiologic factors, laboratory findings, and prescribed treatments. Patients with solitary infarct were treated with acetylsalicylic acid (ASA only, whereas patients with atrial fibrillation (AF or multiple or global infarct were treated with anticoagulants. Estimated Glomerular Filtration Rate (eGFR referring to renal functions was determined by the Modification of Diet in Renal Disease (MDRD formula. Twenty-seven renal units of 23 patients with acute RI were identified. The mean age was 59.7 ± 15.7 years. Fourteen patients (60.8% with RI had atrial fibrillation (AF as an etiologic factor of which four had concomitant mesenteric ischemia at diagnosis. At presentation, 20 patients (86.9% had elevated serum lactate dehydrogenase (LDH, 18 patients (78.2% had leukocytosis, and 16 patients (69.5% had microscopic hematuria. Two patients with concomitant mesenteric ischemia and AF passed away during follow up. Mean eGFR was 70.8 ± 23.2 mL/min/1.73 m2 at admission and increased to 82.3 ± 23.4 mL/min/1.73 m2 at 1 year follow up. RI should be considered in patients with persistent flank or abdominal pain, particularly if they are at high risk of thromboembolism. Antiplatelet and/or anticoagulant drugs are both effective treatment options according to the amplitude of the infarct for preserving kidney functions.
... Conditions Action myoclonus–renal failure syndrome Action myoclonus–renal failure syndrome Printable PDF Open All Close All Enable ... view the expand/collapse boxes. Description Action myoclonus–renal failure (AMRF) syndrome causes episodes of involuntary muscle jerking ...
The third mechanism of injury is direct cellular toxicity caused by the NSAIDs or their metabolites, resulting in interstitial nephritis and papillary necrosis. A common characteristic of acute renal failure caused by. NSAIDs is its rapid reversibility, often within days after discontinuation of the drug.3 Many patients may not be as.
Faraz, A.; Farhan, M.A.; Shaikh, K.; Ali, S.
Objective: To determine the course and efficacy of peritoneal dialysis in children presenting with renal failure. Study Design: Quasi experimental study. Place and Duration of Study: The study was conducted at the Nephrology department of Children's Hospital and Institute of Child Health Lahore from Feb 2007 to Feb 2008. Material and Methods: Forty children diagnosed with renal failure at the Nephrology department of Children's Hospital and Institute of Child Health, Lahore were evaluated for the efficacy of PD, duration of PD and the associated complications. Results: There were 55% cases of acute renal failure and 45% cases of chronic renal failure. The mean duration of PD was 3.8 days. About 75% of all the patients improved with PD. The mortality rate was 22.5%. Leading complications were Catheter-related (leakage/blockade) and peritonitis. Conclusion: We concluded that peritoneal dialysis is lifesaving procedure which improves the acute metabolic derangements of renal failure in children. It is associated with certain complications but the benefits outweigh the complications. (author)
Issa, Victor Sarli; Andrade, Lúcia; Bocchi, Edimar Alcides
Renal dysfunction is common during episodes of acute decompensated heart failure, and historical data indicate that the mean creatinine level at admission has risen in recent decades. Different mechanisms underlying this change over time have been proposed, such as demographic changes, hemodynamic and neurohumoral derangements and medical interventions. In this setting, various strategies have been proposed for the prevention of renal dysfunction with heterogeneous results. In the present article, we review and discuss the main aspects of renal dysfunction prevention according to the different stages of heart failure. PMID:23644863
de Zeeuw, D.; Apperloo, AJ; de Jong, P.
There is growing evidence that treatment of patients with renal function impairment will undergo a major shift within the next few years. Along with more or less successful attempts to alleviate the signs and symptoms of reduced renal function, new insights into renal pathophysiology as well as new
Yoon, Hyun Joong; Moon, Myoung E; Park, Haeng Soon; Kim, Hyun Woo; Im, Shun Young; Lee, Jun Haeng; Kim, Young Ho
The purpose of this study was to investigate the effects of chitosanoligosaccharide (COS) on the change of inflammatory response, renal function factor, and renal oxidative stress in glycerol-induced ARF in vitro and in vivo. The molecular weight of COS was approximately below 10 kDa with 90% degree of deacetylation. Renal proximal tubular cells were treated with only COS (0, 0.01, 0.025, 0.05, 0.075 and 0.1%) or COS in the presence of glycerol (4mM). And rats were administered with glycerol (50%, 8 ml/kg) by intramuscular injection for the induction of ARF. For identification the protection effect of COS in the glycerol-induced ARF, rats were administered by COS (0.05 and 0.1%) using P.O. injection. The enzymatic activity of the released RDPase was assayed by the fluorometric method. The level of TNF-alpha in kidney or the culture medium was quantified using ELISA kit (R&D Systems, Minneapolis, USA) and, nitrite concentration was determined by the Griess reaction. We showed that COS stimulated the production of TNF-alpha, NO and the released RDPase. Glycerol increased the concentration of RDPase in kidney and decreased the released RDPase in proximal tubular cells. And, glycerol increased the production of NO, TNF-alpha, creatinine, and MDA, and decreased SOD. However, COS recovered the glycerol-induced inflammatory response, renal function factor, and antioxidant effect in kidney. COS had the antioxidant activity and the anti-inflammatory effect. And maybe that characteristics could help recover the glycerol-induced ARF.
Patrícia S. Pinto
Full Text Available INTRODUÇÃO: A insuficiência renal aguda (IRA nefrotóxica é frequente e importante causa de morbimortalidade. OBJETIVO: Avaliar a prevalência, o curso clínico e o desfecho da IRA nefrotóxica. PACIENTES e MÉTODOS: Coorte histórica realizada em um hospital de ensino terciário, no período de fevereiro a novembro de 1997. Foram incluídos pacientes acima de 12 anos, com diagnóstico de IRA, acompanhados pela equipe de Interconsulta de Nefrologia. Foram excluídos transplantados renais, portadores de insuficiência renal crônica, dialisados por intoxicação exógena e aqueles transferidos de hospital durante o tratamento. RESULTADOS: Dos 234 pacientes acompanhados, 12% apresentaram IRA nefrotóxica e 24%, IRA multifatorial associada ao uso de drogas nefrotóxica. Entre as comorbidades mais prevalentes, estão hipertensão arterial, hepatopatias, neoplasias, insuficiência cardíaca congestiva e diabetes mellitus. Quinze por cento necessitaram de diálise, e o tipo mais frequentemente usado foi hemodiálise venovenosa contínua; 42% eram oligúricos, 44,7% evoluíram para óbito e 33% recuperaram a função renal. Antibióticos, AINH e contraste radiológico foram as drogas nefrotóxicas mais prevalentes.Os medicamentos nefrotóxicos implicados foram, em ordem de frequência, vancomicina, aminoglicosídeos, aciclovir, quimioterápicos e contraste radiológico. Hepatopatia foi a única variável com significância estatística (p = 0,03, IC = 1,08 a 6,49 em análise multivariada. Na comparação entre IRA nefrotóxica e não nefrotóxica, houve aumento da mortalidade proporcionalmente aos dias de internação. CONCLUSÃO: IRA nefrotóxica é frequente, grave e deve ser continuamente monitorada, tanto ambulatorialmente quanto no ambiente intra-hospitalar.INTRODUCTION: Nephrotoxic acute renal failure (ARF is a frequent and important cause of morbidity and mortality. OBJECTIVE: To assess the prevalence, clinical course, and outcome of
Full Text Available Abstract Background The role of chronic renal failure (CRF in the antimicrobial resistance of uropathogens in patients with community-acquired acute pyelonephritis (APN remains poorly understood. Method We performed a retrospective analysis of 502 adults (54 men, 448 women; mean age 61.7 ± 16.0 years, range 18-98 years who were treated for community-acquired APN at Kosin University Gospel Hospital (Busan, Republic of Korea during a ten-year period (January 2000 to December 2009. We evaluated the spectra and antimicrobial susceptibility profiles of uropathogens in CRF and non-CRF patients with community-acquired APN that presented as a positive urine culture. Results The 502 adult subjects were classified as either non-CRF APN patients (336 patients, 66.9% or CRF APN patients (166 patients, 33.1% according to their estimated glomerular filtration rate. No significant differences in the sensitivity of E. coli to a third cephalosporin, aminoglycoside (except gentamycin, or ciprofloxacin were observed between non-CRF and CRF patients. Conclusions In our series of patients with community-acquired APN that initially presented as a positive urine culture, CRF did not influence the isolation rates of different uropathogens or their patterns of susceptibility to antimicrobials.
Acute renal failure post-cardiac surgery (RF) is a major complication and is associated with increased postoperative morbidity and mortality. Early recognition and identification of risk factors for RF is therefore important. However, several definitions of RF are used. The intention of this study is to evaluate if the used definitions influence the incidence and the identification of risk factors for RF. We identified, after exclusion of 13 patients with preoperative dialysis, 995 consecutive patients undergoing cardiac surgery at the UMC St. Radboud Medical Center between January 2009 and 15 February 2010 as our study cohort. Apart from the definition used by the Society of Thoracic Surgeons, we selected five major international studies concerning RF, each using a different RF definition. These six definitions were used to evaluate the incidence of and identification of risk factors for RF in our study cohort. There is not only a statistically significant difference in incidence (range 4.94-38.1%) of RF between the definitions (p definition several common but also several different risk variables. Multivariate analysis identified also different independent predictors, with different odds ratios for RF for each definition. This study shows that the used definition of RF influences not only the incidence of RF, but also patient identification and the identification of risk variables. Copyright © 2010 European Association for Cardio-Thoracic Surgery. Published by Elsevier B.V. All rights reserved.
Hirsch, David J.
If a patient's serum creatinine level is elevated and chronic renal insufficiency is suspected, it is important to determine whether the problem is acute or chronic; to determine the cause; to identify secondary causes (including multiple myeloma, renal vascular disease, diabetes mellitus, reflux nephropathy, stone disease with infection, and hypertension); to institute measures to slow the disease; and to control hypertension, hyperphosphatemia, and acidosis.
Sasaki, Tomohiko; Motoyama, Satoru; Komatsuda, Atsushi; Shibata, Hiroyuki; Sato, Yusuke; Yoshino, Kei; Wakita, Akiyuki; Saito, Hajime; Anbai, Akira; Jin, Mario; Minamiya, Yoshihiro
We experienced two esophageal cancer patients who developed severe acute renal failure after neoadjuvant chemotherapy with cisplatin and 5-fluorourasil. After administration of cisplatin, their serum creatinine increased gradually until they required hemodialysis and their renal failure was permanent. In both cases, renal biopsy examination indicated partial recovery of the proximal tubule, but renal function did not recover. After these events, one patient underwent definitive radiotherapy and the other underwent esophagectomy for their esophageal cancers, while continuing dialysis. Both patients are alive without cancer recurrence. In these two cases of cisplatin-induced renal failure, renal biopsy examination showed only slight disorder of proximal tubules and tendency to recover. Although cisplatin-related nephrotoxicity is a well-recognized complication, there have been few reports of renal failure requiring hemodialysis in cancer patients. In this report, we present their clinical courses and the pathological findings of cisplatin-related renal failure. Copyright © 2016 The Authors. Published by Elsevier Ltd.. All rights reserved.
Full Text Available Objective To reproduce the model of acute renal failure (ARF in beagles for comprehensively evaluating the safety, stability and validity of the continuous blood purification system under the field condition in a high-altitude environment. Methods Adult beagle ARF model was reproduced by bilateral nephrectomy. All ARF dogs underwent continuous veno-venous hemofiltration with a blood purification machine. Vital signs, renal function, liver function and plasma ion-levels before and after the therapy were analyzed through self-controlled study. Performance of the continuous blood purification machine running in a highaltitude environment was evaluated. Results Blood urea nitrogen (BUN and creatinine (Cr of six dogs were assayed 24 hours after nephrectomy, the difference showed statistical significance compared with those before the surgery (P＜0.05, implying that six ARF models were reproduced successfully. Six dogs experienced continuous renal replacement therapy (CRRT with external jugular vein double-lumen tube placement (3 dogs or femoral vein catheter placement (3 dogs. Five dogs successfully finished the whole experiment, and one dog died because of falling off of the dialysis tube and blood loss. The continuous blood purification machine was sensitive with rapid release of warning signals when the condition was abnormal. Compared to that before CRRT, there were no statistically significant differences in heart rate, respiratory rate and blood pressure in ARF models 2, 4 hours after CRRT (P＞0.05. And there were no statistically significant differences in ALT, AST and T-Bil in ARF models between that before and 2, 4 hours after CRRT (P＞0.05. However, 2, 4 hours after CRRT, BUN and Cr levels descended significantly (P＜0. 05, so was K+ level (P＜0. 05. There were no complications such as hemorrhage or hypotension. There were no statistical differences in volume of replacement fluid or discarded fluid between before and after CRRT
Full Text Available Anti-glomerular basement membrane (GBM disease is a rare cause of acute renal failure and known to have bad prognosis regarding renal functions recovery and patient survival specially when diagnosed late and presents with severe renal failure that requires dialysis. We report a case of 11-year-old child with acute renal failure secondary to anti-GBM disease and associated with antineutrophil cytoplasmic antibody-positive vasculitis. He was treated with plasmapheresis, steroids, and cyclophosphamide with recovery of his kidney functions.
Arefi, Mohammad; Taghaddosinejad, Fakhroddin; Salamaty, Peyman; Soroosh, Davood; Ashraf, Hami; Ebrahimi, Mohsen
Renal failure is an important adverse effect of drug poisoning. Determining the prevalence and etiology of this serious side effect could help us find appropriate strategies for the prevention of renal failure in most affected patients. The present study is aimed to identify drugs that induce renal failure and also to find the prevalence of renal failure in patients referred to emergency departments with the chief complaint of drug poisoning, in order to plan better therapeutic strategies to minimize the mortality associated with drug poisoning induced renal failure. This cross-sectional study surveyed 1500 poisoned patients referred to the Emergency Department of Baharloo Hospital in Tehran during 2010. Demographic data including age and gender as well as clinical data including type of medication, duration of hospital stay, and presence of renal failure were recorded. Mann-Whitney U test and chi-squared statistics were used to analyze the results. A total number of 435 patients were poisoned with several drugs, 118 patients were intoxicated with sedative-hypnotic drugs, 279 patients were exposed to opium, and 478 patients were administered to other drugs. The method of intoxication included oral 84.3%, injective 9%, inhalation 4.3% and finally a combination of methods 2.3%. Laboratory results revealed that 134 cases had renal failure and 242 had rhabdomyolysis. The incidence of rhabdomyolysis and renal failure increased significantly with age, and also with time of admission to the hospital. Renal failure was reported in 25.1% of patients exposed to opium, vs. 18.2% of patients poisoned with aluminum phosphide, 16.7% of those with organophosphate, 8% with multiple drugs, 6.7% with alcohol, heavy metals and acids, and 1.7% with sedative hypnotics. Based on the findings of this study, there is a high probability of renal failure for patients poisoned with drugs such as opium, aluminum phosphide, and multiple drugs as well as the patients with delayed admission to
Boutaud, Olivier; Roberts, L. Jackson
Rhabdomyolysis-induced renal failure represents up to 15% of all cases of acute renal failure. Many studies over the past four decades have demonstrated that accumulation of myoglobin in the kidney is central in the mechanism leading to kidney injury. However, some discussion exists regarding the mechanism mediating this oxidant injury. Although free iron-catalyzed fenton reaction has been proposed to explain the tissue injury, more recent evidence strongly suggests that the main cause of oxidant injury is myoglobin redox cycling and generation of oxidized lipids. These molecules can propagate tissue injury and cause renal vasoconstriction, two of the three main conditions associated with acute renal failure. This review presents the evidence supporting the two mechanisms of oxidative injury, describes the central role of myoglobin redox cycling in the pathology of renal failure associated with rhabdomyolysis, and discuss the value of therapeutic interventions aiming at inhibiting myoglobin redox cycling for the treatment of rhabdomyolysis-induced renal failure. PMID:21034813
Increased incidence of cancer at various sites is observed in patients with end-stage renal disease (ESRD). Certain malignant diseases, such as lymphomas and carcinomas of the kidney, prostate, liver and uterus, show an enhanced prevalence compared with the general population. In particular, renal cell carcinoma (RCC) shows an excess incidence in ESRD patients. A multitude of factors, directly or indirectly associated with the renal disease and the treatment regimens, may contribute to the increased tumor formation in these patients. Patients undergoing renal replacement therapy (RRT) are prone to develop acquired cystic kidney disease (ACKD), which may subsequently lead to the development of RCC. In pre-dialysis patients with coexistent renal disease, as in dialysis and transplant patients, the presence of ACKD may predispose to RCC. Previous use of cytotoxic drugs (eg, cyclophosphamide) or a history of analgesic abuse, are additional risk factors for malignancy. Malignancy following renal transplantation is an important medical problem during the follow-up. The most common malignancies are lymphoproliferative disorders (early after transplantation) and skin carcinomas (late after transplantation). Another important confounder for risk of malignancy after renal transplantation is the type of immunosuppression. The type of malignancy is different in various countries and dependent on genetic and environmental factors. Finally, previous cancer treatment in a uremic patient on the transplant waiting list is of great importance in relation to waiting time and post-malignancy screening.
Ali Veysel Kara
Full Text Available Objective: Acute kidney injury (AKI is an important clinical entity that is known to increase mortality in patients with sepsis. Erythrocyte maturation and proliferation are inhibited by pro-inflammatory cytokines; these cytokines exert effects on red cell distribution width (RDW well. Based on this knowledge; our aim in this study was to evaluate the impact of RDW on acute kidney injury in patients with sepsis. Methods: 120 patients diagnosed with sepsis and admitted to intesive care unit (ICU and treated between 2009-2013 were retrospectively evaluated. Patients were divided into two groups as follows: group 1 (RDW≥16.8 and group 2 (RDW<16.8. Multiple logistic regression analysis was used to determine the association between RDW and AKI and mortality. Results: There was a statistically significant relationship between AKI and RDW (p<0.001, OR=11.52 but there were no statistically significant relationship between AKI and sex, age, serum lactate levels as well as SOFA score. Also, there were statistically significant relationship between mortality and RDW (p=0.044, OR=5, serum lactate levels (p=0.030 and SOFA score (p<0.001. RDW was found associated with both AKI and mortality. Conclusions: Results suggest that RDW is an important parameter for predicting development of AKI and mortality in ICU patients with sepsis.
Zompatori, M.; Canini, R.; Bernasconi, A.; Gavelli, G.
Forty-nine cases of pulmonary edema in nephropatic patients were studied. The most frequent radiologic findings are discussed. The unreliability of a precise differentiation between ''cardiac'' and ''renal'' patterns of pulmonary edema in nephropatic patients is emphasized
Mohammadi Manesh, Reza; Hosseini Safa, Ahmad; Sharafi, Seyedeh Maryam; Jafari, Rasool; Bahadoran, Mehran; Yousefi, Morteza; Nasri, Hamid; Yousofi Darani, Hossein
Suppression of the human immune system results in an increase in susceptibility to infection by various infectious agents. Conditions such as AIDS, organ transplantation and chronic renal insufficiency (CRI) are the most important cause of insufficient immune response against infections. Long term renal disorders result in uremia, which can suppress human immune system. Parasitic infections are one of the most important factors indicating the public health problems of the societies. These inf...
R. Suganya Gnanadeepam; S. Kayalvizhi Money
BACKGROUND The kidney and the skin are the two large networks of the body with abundant blood supply associated with various cutaneous manifestations. This study aims to detect the various cutaneous manifestations and its incidence in patients with chronic renal failure and renal transplantation. MATERIALS AND METHODS This study was done for a period of 1 year from January 2016 to December 2016 at Nephrology OPD ward and Medicine wards, Government KAPV Medical College Hos...
Shilpa M. Patel
Full Text Available Tenofovir is an acyclic nucleotide analogue reverse transcriptase inhibitor that is commonly prescribed as part of a highly active antiretroviral therapy (HAART regimen in HIV-infected patients. Although it is generally well tolerated, renal insufficiency has been associated with its use. We report a biopsy-proven case of acute renal failure that developed within weeks of initiating a HAART regimen containing tenofovir, and review the literature with specific attention to cases of renal failure occurring within 8 weeks of tenofovir initiation. Our patient developed renal insufficiency within 3 weeks of initiating tenofovir-containing HAART and overt renal failure was noted within 5 weeks. Renal biopsy demonstrated histopathologic changes suggestive of HIV nephropathy, despite normal baseline serum creatinine values. Thirty additional cases of tenofovir-associated renal failure have been reported. In the majority (n = 22, 73%, renal failure occurred months after initiating therapy (range: 5–26 months. However, in a significant subset (n = 8, 27%, renal failure occurred within 8 weeks of treatment initiation. Our data suggest that some patients are at risk for developing renal failure within weeks of tenofovir initiation. Thorough evaluation of renal function should be undertaken before prescription of tenofovir-containing HAART. For those in whom subclinical renal disease is discerned, added vigilance when monitoring renal function may be warranted.
Bagshaw Sean M
Full Text Available Abstract Background Dialysis disequilibrium syndrome (DDS is the clinical phenomenon of acute neurologic symptoms attributed to cerebral edema that occurs during or following intermittent hemodialysis (HD. We describe a case of DDS-induced cerebral edema that resulted in irreversible brain injury and death following acute HD and review the relevant literature of the association of DDS and HD. Case Presentation A 22-year-old male with obstructive uropathy presented to hospital with severe sepsis syndrome secondary to pneumonia. Laboratory investigations included a pH of 6.95, PaCO2 10 mmHg, HCO3 2 mmol/L, serum sodium 132 mmol/L, serum osmolality 330 mosmol/kg, and urea 130 mg/dL (46.7 mmol/L. Diagnostic imaging demonstrated multifocal pneumonia, bilateral hydronephrosis and bladder wall thickening. During HD the patient became progressively obtunded. Repeat laboratory investigations showed pH 7.36, HCO3 19 mmol/L, potassium 1.8 mmol/L, and urea 38.4 mg/dL (13.7 mmol/L (urea-reduction-ratio 71%. Following HD, spontaneous movements were absent with no pupillary or brainstem reflexes. Head CT-scan showed diffuse cerebral edema with effacement of basal cisterns and generalized loss of gray-white differentiation. Brain death was declared. Conclusions Death is a rare consequence of DDS in adults following HD. Several features may have predisposed this patient to DDS including: central nervous system adaptations from chronic kidney disease with efficient serum urea removal and correction of serum hyperosmolality; severe cerebral intracellular acidosis; relative hypercapnea; and post-HD hemodynamic instability with compounded cerebral ischemia.
Albrecht, EWJA; van Goor, H; Smit-van Oosten, A; Stegeman, CA
Glomerular endothelial nitric oxide synthase expression is decreased in humans during acute rejection and chronic renal transplant failure (CRTF). This may contribute to vascular damage through changes in the renal hemodynamics and enhanced endothelial adhesion of leukocytes and platelets. Dietary
Full Text Available Partial EN (enteral nutrition should always be aimed for in patients with renal failure that require nutritional support. Nevertheless PN (parenteral nutrition may be necessary in renal failure in patient groups with acute or chronic renal failure (ARF or CRF and additional acute diseases but without extracorporeal renal replacement therapy, or in patients with ARF or CRF with additional acute diseases on extracorporeal renal replacement therapy, haemodialysis therapy (HD, peritoneal dialysis (PD or continuous renal replacement therapy (CRRT, or in patients on HD therapy with intradialytic PN. Patients with renal failure who show marked metabolic derangements and changes in nutritional requirements require the use of specifically adapted nutrient solutions. The substrate requirements of acutely ill, non-hypercatabolic patients with CRF correspond to those of patients with ARF who are not receiving any renal replacement patients therapy (utilisation of the administered nutrients has to be monitored carefully. In ARF patients and acutely ill CRF patients on renal replacement therapy, substrate requirements depend on disease severity, type and extent/frequency of extracorporeal renal replacement therapy, nutritional status, underlying disease and complications occurring during the course of the disease. Patients under HD have a higher risk of developing malnutrition. Intradialytic PN (IDPN should be used if causes of malnutrition cannot be eliminated and other interventions fail. IDPN should only be carried out when modifiable causes of malnutrition are excluded and enhanced oral (like i.e. additional energy drinks or enteral supply is unsuccessful or cannot be carried out.
Thaysen, J H; Nielsen, O J; Brandi, L
Six patients with acute renal failure, in five cases due to acute crescentic glomerulonephritis and in one case due to total bilateral renal cortical necrosis, were studied. All had serum erythropoietin (EPO) concentrations in the normal range, despite a relatively severe anaemia. Half...... treated with rhEPO (Eprex). In marked contrast to untreated controls, both patients responded with vigorous reticulocytosis and normalization of haemoglobin levels while they were still in severe renal failure. These results are similar to our previous findings in patients with acute renal failure due...... of EPO is not only a permanent and irreversible feature of severe chronic renal failure, but that it is also present, usually in a transient and reversible form, in different types of acute renal failure....
Matsubara, Yutaka; Matsumoto, Takuya; Yoshiya, Keiji; Yoshida, Ayae; Ikeda, Seiichi; Furuyama, Tadashi; Nakatsu, Yoshimichi; Tsuzuki, Teruhisa; Nomura, Masatoshi; Maehara, Yoshihiko
Severe sepsis is critical to health and can result in acute renal failure (ARF). Tissue factor (TF) and thrombomodulin (TM) play key roles in vascular endothelial functions by helping maintain microcirculation in the kidney. Budding uninhibited by benzimidazole-1 (Bub1) plays a role in Akt and JNK signaling, which control TF and TM, respectively. We hypothesized that Bub1 could control vascular endothelial function in sepsis. The aim of this study was to determine the role of Bub1 in septic ARF. We used Mouse cecum ligation and puncture (CLP) using low Bub1 expressing (Bub1) and wild-type (Bub1) mice in vivo and lipopolysaccharide (LPS) stimulation of human aortic endothelial cell (HAEC) in vitro. Bub1 mice had a higher survival rate after CLP than Bub1. Bub1 mice had more severe ARF after CLP than Bub1 with blood biochemical and pathological analyses. TF expression in Bub1 mice and control HAEC (control) significantly increased in the septic model compared with Bub1 and Bub1 silenced HAEC (siBub1). TM expression in the control significantly decreased after LPS stimulation compared with siBub1. Akt and JNK phosphorylation of siBub1 were attenuated after LPS stimulation. Associations of Bub1 with Akt or JNK after LPS stimulation of HAEC were detected using immunoprecipitation, suggesting that Bub1 is involved in the phosphorylation of Akt and JNK after LPS stimulation. Bub1 insufficiency attenuates TF expression and reduces TM suppression by blocking Akt and JNK phosphorylation, respectively, thus leading to the prevention of ARF and death caused by sepsis.
Mohammadi Manesh, Reza; Hosseini Safa, Ahmad; Sharafi, Seyedeh Maryam; Jafari, Rasool; Bahadoran, Mehran; Yousefi, Morteza; Nasri, Hamid; Yousofi Darani, Hossein
Suppression of the human immune system results in an increase in susceptibility to infection by various infectious agents. Conditions such as AIDS, organ transplantation and chronic renal insufficiency (CRI) are the most important cause of insufficient immune response against infections. Long term renal disorders result in uremia, which can suppress human immune system. Parasitic infections are one of the most important factors indicating the public health problems of the societies. These infections can be more hostile and life threatening in susceptible individuals than in the normal people. In these patients some parasitic infections such as blastocystiosis, cryptosporidiosis and toxoplasmosis have been reported to be more prevalent. This review aimed to give an overview about parasitic infections in patients with renal disorders.
Elung-Jensen, T; Heisterberg, J; Kamper, A L
BACKGROUND: Most angiotensin-converting enzyme (ACE) inhibitors and their metabolites are excreted renally and doses should hence be reduced in renal insufficiency. We studied whether the dosage of enalapril in daily clinical practice is associated with drug accumulation of enalaprilat in chronic...... renal failure. METHODS: Fifty nine out-patients with plasma creatinine >150 micromol/L and chronic antihypertensive treatment with enalapril were investigated, in a cross-sectional design. RESULTS: Median glomerular filtration rate (GFR) was 23(range 6-60) ml/minute/1.73 m2. The daily dose of enalapril......-68) ml/minute and correlated linearly with GFR (r=0.86, p=0.003). Intra-subject day-to-day variation in trough concentrations was 19.7%. CONCLUSION: Patients with chronic renal failure given small or moderately high doses of enalapril may thus have markedly elevated levels of serum enalaprilat. Whether...
Madsen, J C; Rasmussen, A Q; Ladefoged, S D
The aim of study was to introduce and evaluate a method for quantifying the parathyroid hormone (PTH) secretion during hemodialysis in secondary hyperparathyroidism due to end-stage renal failure. We developed a method suitable for inducing sequential hypocalcemia and hypercalcemia during....../ionized calcium curves were constructed, and a mean calcium set-point of 1.16 mmol/liter was estimated compared to the normal mean of about 1.13 mmol/liter. In conclusion, we demonstrate that it is important to use a standardized method to evaluate parathyroid hormone dynamics in chronic renal failure. By the use...... of a standardized method we show that the calcium set-point is normal or slightly elevated, indicating normal parathyroid reactivity to calcium in chronic renal failure....
Villacorta, Javier; Diaz-Crespo, Francisco; Acevedo, Mercedes; Cavero, Teresa; Guerrero, Carmen; Praga, Manuel; Fernandez-Juarez, Gema
Renal failure secondary to ANCA-associated vasculitis represents a clinical and therapeutic challenge. In this study, we aimed to assess the treatment response rates and long-term outcomes of vasculitis patients presenting with renal failure. This retrospective study included 151 patients with renal vasculitis from three hospitals who underwent a renal biopsy between 1997 and 2014. Patients with renal failure which required dialysis at the onset were compared to those presenting with more preserved renal function. The primary end point was treatment response and patient surivival. Patients with severe renal involvement had a lower response to treatment compared to those having preserved renal function (26.6 versus 93.4%; p renal recovery (41.6 versus 12.5%; p = 0.05). A higher incidence of severe infections was observed among patients with severe renal involvement (38.4 versus 18.1%, p = 0.01). The mortality rate was significantly higher among vasculitis patients presenting with renal failure (53.8 versus 22.2%, p = 0.001). Global survival at 1 and 5 years was 60 and 47% in patients requiring dialysis compared with 90 and 80% among those with more preserved renal function (p renal dysfunction represents an independent risk factor for patient survival in renal vasculitis. Patients requiring dialysis associate a lower response rate to immunosuppressive therapy and a higher incidence of severe infections.
Brooke, Valerie; Goswami, Sangeeta; Mohanty, Arpan; Kasi, Pashtoon Murtaza
Acute aortic dissection (AAD) is a life-threatening condition associated with high morbidity and mortality. The most important recognized acquired cause that leads to dissection is chronic arterial hypertension. With respect to the anuria and renal failure, aortic dissection is not something that is always considered and is still not a very common presentation unless both renal arteries come off the false lumen of the dissection. However, when present, preoperative renal failure in patients w...
Pérez Calvo, J I; Josa Laorden, C; Giménez López, I
Renal function is one of the most consistent prognostic determinants in heart failure. The prognostic information it provides is independent of the ejection fraction and functional status. This article reviews the various renal function assessment measures, with special emphasis on the fact that the patient's clinical situation and response to the heart failure treatment should be considered for the correct interpretation of the results. Finally, we review the literature on the performance of tubular damage biomarkers. Copyright © 2017 Elsevier España, S.L.U. and Sociedad Española de Medicina Interna (SEMI). All rights reserved.
Rossignol, Patrick; Cleland, John G F; Bhandari, Sunil
We evaluated the effect of the selective mineralocorticoid receptor antagonist eplerenone on renal function and the interaction between changes in renal function and subsequent cardiovascular outcomes in patients with heart failure and left ventricular systolic dysfunction after an acute myocardial...... infarction in the Eplerenone Post-Acute Myocardial Infarction Heart Failure Efficacy and Survival Study (EPHESUS)....
Madsen, J C; Rasmussen, A Q; Ladefoged, S D
The aim of study was to introduce and evaluate a method for quantifying the parathyroid hormone (PTH) secretion during hemodialysis in secondary hyperparathyroidism due to end-stage renal failure. We developed a method suitable for inducing sequential hypocalcemia and hypercalcemia during...
Núñez, Julio; Miñana, Gema; Santas, Enrique; Bertomeu-González, Vicente
Cardiorenal syndrome has been defined as the simultaneous dysfunction of both the heart and the kidney. Worsening renal function that occurs in patients with acute heart failure has been classified as cardiorenal syndrome type 1. In this setting, worsening renal function is a common finding and is due to complex, multifactorial, and not fully understood processes involving hemodynamic (renal arterial hypoperfusion and renal venous congestion) and nonhemodynamic factors. Traditionally, worsening renal function has been associated with worse outcomes, but recent findings have revealed mixed and heterogeneous results, perhaps suggesting that the same phenotype represents a diversity of pathophysiological and clinical situations. Interpreting the magnitude and chronology of renal changes together with baseline renal function, fluid overload status, and clinical response to therapy might help clinicians to unravel the clinical meaning of renal function changes that occur during an episode of heart failure decompensation. In this article, we critically review the contemporary evidence on the pathophysiology and clinical aspects of worsening renal function in acute heart failure. Copyright © 2014 Sociedad Española de Cardiología. Published by Elsevier España, S.L.U. All rights reserved.
Wong, L. S.; Windt, W. A.; Roks, A. J.; van Dokkum, R. P.; Schoemaker, R. G.; de Zeeuw, D.; Henning, R. H.
Background. Renal failure aggravates pathological cardiac remodelling induced by myocardial infarction (MI). Cardiac remodelling is associated with telomere shortening, a marker for biological ageing. We investigated whether mild and severe renal failure shorten cardiac telomeres and excessively
Di Nicolò, Pierpaolo
Renal involvement in some forms of acute or chronic diseases, such as heart failure or sepsis, presents with a complex pathophysiological basis that is not always clearly distinguishable. In these clinical settings, kidney failure is traditionally and almost exclusively attributed to renal hypoperfusion and it is commonly accepted that causal elements are pre-renal, such as a reduction in the ejection fraction or absolute or relative hypovolemia acting directly on oxygen transport mechanisms and renal autoregulation systems, causing a reduction of glomerular filtration rate. Nevertheless, the concept emerging from accumulating clinical and experimental evidence is that in complex clinical pictures, kidney failure is strongly linked to the hemodynamic alterations occurring in the renal venous micro and macrocirculation. Accordingly, the transmission of the increased venous pressure to the renal venous compartment and the consequent increasing renal afterload has a pivotal role in determining and sustaining the kidney damage. The aim of this review was to clarify the physiopathological aspects of the link between worsening renal function and renal venous hypertension, analyzing the prognostic and therapeutic implications of the so-called congestive kidney failure in cardio-renal syndrome and in other clinical contexts of its possible onset.
Ana Claudia Kochi
Full Text Available OBJETIVO:Avaliar os fatores de risco clínicos pré-cirurgicos para o desenvolvimento de Insuficiência Renal Aguda (IRA em pacientes submetidos à cirurgia cardíaca. MÉTODO: Foram estudados, de modo prospectivo, 150 pacientes submetidos à cirurgia cardíaca, durante 21 meses consecutivos, havendo um leve predomínio de homens (57%, idade média de 56 ± 15 anos, sendo que 66% apresentavam insuficiência coronariana como principal diagnóstico e 34% valvulopatias. A mediana da creatinina sérica no período pré-operatório foi de 1,1 mg/dl. IRA foi definida como elevação de 30% da creatinina sérica basal. O protocolo de variáveis clínicas teve seu preenchimento iniciado 48 horas antes do procedimento cirúrgico e encerrado 48 horas após o mesmo, incluindo variáveis cardiológicas e não-cardiológicas, além de resultados laboratoriais. RESULTADOS: A IRA esteve presente em 34% dos casos. Após análise multivariada, presença de doença vascular periférica foi fator pré-operatório identificado. CONCLUSÃO: Os resultados obtidos nesse estudo permitiram sinalizar alguns fatores contributivos para o desenvolvimento de IRA em cirurgia cardíaca, o que pode possibilitar condutas clínicas simples para evitar a disfunção renal nestas situações e, conseqüentemente, redução da taxa de mortalidade. No presente trabalho, o tamanho da amostra talvez tenha impedido a identificação de outros fatores de risco significativos.OBJECTIVE: To evaluate clinical risk factors for the development of Acute Renal Failure (ARF in patients who undergo cardiac surgery. METHOD: Over a period of 21 consecutive months, one hundred and fifty patients who underwent cardiac surgery were studied. There was a slight prevalence of men (57% and the average age was 56 ± 14.8 years. Sixty-six percent presented with coronary artery disease as the main diagnosis and 34% valvular heart disease. The median preoperative serum creatinine was 1.1 mg/dL. ARF was
Kroepelin, T.; Ziupa, J.; Wimmer, B.
Three adult patients with unilateral renal agenesis/total dysplasia (= aplasia) and with an early chronic renal failure are presented. One patient had renal agenesis without ureter bud and ureteric ostium on one side, and reflux pyelonephritis on the other; one had small compact total renal dysplasia (= aplasia) on one side, while chronic uric acid nephropathy (chronic renal disease as a cause of gout) was diagnosed on the other; the third patient had a total large multicystic dysplasia on one side, and on the other a segmental large multicystic dysplasia. Radiological steps and radiodiagnostic criteria are discussed and the combination of urogenital and extraurogenital anomalies is referred to. (orig.)
Grande, Dario; Terlizzese, Paola; Iacoviello, Massimo
Heart failure and kidney disease share common pathophysiological pathways which can lead to mutual dysfunction, known as cardiorenal syndrome. In heart failure patients, renal impairment is related to hemodynamic and non-hemodynamic factors. Both decreased renal blood flow and renal venous congestion due to heart failure could lead to impaired renal function. Kidney disease and worsening renal function are independently associated with poor prognosis in heart failure patients, both in acute and chronic clinical settings. The aim of this review is to assess the role of renal imaging modalities in the evaluation and management of heart failure patients. Renal imaging techniques could complete laboratory data, as estimated glomerular filtration rate, exploring different pathophysiological factors involved in kidney disease and adding valuable information about renal structure and function. In particular, Doppler examination of arterial and venous hemodynamics is a feasible and non invasive technique, which has proven to be a reliable method for prognostic stratification in patients with cardiorenal syndrome. The renal resistance index, a measure related to renal hemodynamics, can be calculated from the Doppler evaluation of arterial flow. Moreover, the analysis of Doppler venous flow patterns can integrate information from the arterial study and evaluate renal congestion. Other imaging modalities are promising, but still confined to research purposes.
Jønler, Morten; Munk, Kim
Pheochromocytoma (P) is an endocrine catecholamine-secreting tumor. Classical symptoms like hypertension, attacks of sweating, palpitations, headache and palor are related to catecholamine discharge. We provide a case of P in a 71 year-old man presenting with acute cardiac failure, severe reduction...
Full Text Available Gastrointestinal (GI hemorrhage is a frequent and sometimes life-threatening complication of end-stage renal failure. Angiodysplasia (AD, vascular malformation, is the most common cause of recurrent lower-intestinal hemorrhage in patients with renal failure. We report four chronic hemodialysis patients with AD. All patients presented with severe anemia requiring transfusion. GI hemorrhage ceased spontaneously in three cases and after treatment with argon plasma coagulation in another. Diagnosis of AD is usually challenging, since its cause is still unknown, and its clinical presentation is variable. Lesions are multiple in 40-75% of cases, often located in the stomach and duodenum but can affect the colon and the jejunum. Diagnosis is improved by endoscopy which has a much higher sensitivity compared to angiography. Capsular endoscopy may reveal the hemorrhage site in the small intestine when regular endoscopy fails, and therapeutic intervention usually include argon plasma coagulation.
Full Text Available Dermatological manifestations of chronic renal failure were studied in 35 cases. Xerosis was seen in 16 cases. Pruritus was observed in 12 cases and hyperpigmentation on exposed areas was seen in 8 patients. Acquired perforating disorder and half and half nail were seen in 6 cases each. Skin Biopsies performed in 6 cases of APD showed typical changes only in 3 cases.
Orellana, P.; Baquedano, P.; Cavagnaro, F.; Lagomarsino, E.; Garcia, C.
Acute pyelonephritis (APN) in childhood can lead to renal scarring (RS), which carries a risk of subsequent hypertension and renal failure. Every effort must be done in order to identify high risk children who need a more close follow-up. Renal scintigraphy is the procedure of choice for diagnosis and follow-up of children with APN. The aim of this prospective study was to correlate the acute renal scintigraphic abnormalities with the developing of RS in children with APN. We prospectively analyzed 47 patients (94 renal units (RU)), 24 girls, with a first episode of APN diagnosed with renal scintigraphy performed during the first months of the beginning of the symptoms. All children with urinary tract malformations were excluded. The mean age of the group was 1.35 yrs. Follow up scan was performed at least six months after the acute episode. Abnormal findings are presented. During follow up, scar was considered when there was an improvement or no changed of acute abnormalities. Among the 94 RU, 54 had APN. In the follow-up scan there was a normalization of renal parenchymal abnormalities in 33/54 (61 %) and in 21/54 (39%) there was an improvement or no changes (scar). The relation between acute scintigraphic abnormalities and renal scars are presented. The evolution of scintigraphic abnormalities in children with APN is also presented. According to our results, RS developed significant more in kidneys with decreased size (p=0.05), diffuse parenchymal abnormalities (p=0.02) and relative renal function less than 45% (p=0.008), specially if it was less or equal to 35% (p=0.00008). Therefore, we can predict a worst evolution in kidneys with these anomalies during APN
Besouw, Martine T P; Vande Walle, Johan G; Ilias, Mohamad I; Raes, Ann M; Prytula, Agnieszka A; Claeys, Lieve; Dehoorne, Jo L
A 12-year-old Congolese girl presented with acute renal failure, edema, hypertension, hemoptysis, hematuria, and proteinuria after a history of throat infection. Renal ultrasound showed kidneys of normal size, with increased echogenicity of the cortical parenchyma and decreased corticomedullary differentiation. Other additional investigations showed pancytopenia with decreased complement (low C3 and C4). Antinuclear antibodies were strongly positive, including anti-double stranded DNA. Renal biopsy confirmed severe grade IV lupus nephritis. She was treated with high-dose steroids, mycophenolate mofetil and hydroxychloroquine, in addition to hemodialysis. After one week of intensive treatment, diuresis recovered and dialysis could be stopped after six sessions. We describe an uncommon case of severe lupus nephritis, presenting with terminal renal failure. Since the rarity of this disease presentation, other more common diagnoses have to be considered. Once the diagnosis of lupus nephritis is established, a choice has to be made between the different induction treatment protocols. The patient's ethnic background and other supportive therapies, such as the need for dialysis, can help to make this choice.
Robert P. Runner, MD
Full Text Available A 58-year-old male presented with native joint septic arthritis of the hip and osteomyelitis. After treatment with an articulating antibiotic spacer, he developed acute renal failure requiring dialysis. He continued to have elevated serum tobramycin levels exclusively from the antibiotic spacer elution as no intravenous tobramycin was used. Subsequent explantation was required to correct his renal failure. Although renal failure after antibiotic impregnated cement placement is rare, the risk of this potential complication should be considered preoperatively and in the postoperative management of these patients.
Krishnamoorthy, Arun; Felker, G Michael
Fluid removal and relief of congestion are central to treatment of acute heart failure. Diuretics have been the decongestive mainstay but their known limitations have led to the exploration of alternative strategies. This review compares diuretics with ultrafiltration and examines the recent evidence evaluating their use. Relevant recent studies are the Diuretic Optimization Strategies Evaluation trial (of diuretics) and the Cardiorenal Rescue Study in Acute Decompensated Heart Failure (of ultrafiltration). The Diuretic Optimization Strategies Evaluation study evaluated strategies of loop diuretic use during acute heart failure (continuous infusion versus intermittent bolus and high dose versus low dose). After 72 h, there was no significant difference with either comparison for the coprimary end points. Patients treated with a high-dose strategy tended to have greater diuresis and more decongestion compared with low-dose therapy, at the cost of transient changes in renal function. The Cardiorenal Rescue Study in Acute Decompensated Heart Failure study showed that in acute heart failure patients with persistent congestion and worsening renal function, ultrafiltration, as compared with a medical therapy, was associated with similar weight loss but greater increase in serum creatinine and more adverse events. Decongestion remains a major challenge in acute heart failure. Although recent studies provide useful data to guide practice, the relatively poor outcomes point to the continued need to identify better strategies for safe and effective decongestion.
Malmstrøm, Marie Louise; Hansen, Mark Berner; Andersen, Anders Møller
renal, respiratory, and circulatory failure, as was the case for patients with multiorgan failure. Interleukin 18 levels were significantly elevated in renal and respiratory failure only. Tumor necrosis factor > was significantly elevated in all types of organ failures, except for intestinal failure....... Conclusions: Synchronous measurements of 4 cytokines demonstrated IL-6 and IL-8 to be predictive as early surrogate markers with regard to organ failures in AP. The fact that all of the cytokines were particularly elevated in patients with organ failures calls for evaluation of agents modifying the severe...
Deepak, K.; Kahn, T.
This review summarizes the evidence for the defect in Na + -K + pump in chronic renal failure, considers the role of various factors in causing this defect, and discusses the clinical implications thereof. Intracellular Na is elevated in erythrocytes, leukocytes, and muscle cells from some patients with chronic renal failure (CRF). Recent evidence suggest that this elevation of cell Na may be, in large part, a consequence of decreased number of Na + -K + pump units per cell. Maintenance dialysis over a period of weeks ameliorates the defect in intracellular Na + , and this improvement is contemporaneous with an increase in the number of Na + -K + pump sites per cell. In erythrocytes with normal cell Na + , acute hemodialysis increases the rate of 22 Na + and 42 K + transport. Many factors such as the presence of retained toxic metabolite or circulating inhibitor in the uremic plasma, or biochemical changes produced by acute hemodialysis, may explain this finding. In cells with high cell Na + , the pump-mediated 42 K + transport is normalized at the expense of a raised cell Na + . The decreased muscle membrane potential in uremic subjects has been attributed to a decreased activity of Na + -K + pump. The authors discuss the role of hormonal abnormalities and circulating inhibitors, which may cause an acute inhibition of the pump and of other factors such as K + depletion, which may cause more chronic alterations. The implications of alteration of Na + and K + pump transport and raised cell Na + on other non-pump-mediated transport pathways are discussed. Raised cell Na + may be a marker for the adequacy of maintenance dialysis in patients with end-stage renal failure
Damman, Kevin; Voors, Adriaan A.; Navis, Gerjan; van Veldhuisen, Dirk J.; Hillege, Hans L.
Renal function is the most important predictor of clinical outcome in heart failure (HF). It is therefore essential to have accurate and reliable measurement of renal function and early specific markers of renal impairment in patients with HF. Several renal functional entities exist, including
Schaefer, F; Seidel, C; Binding, A; Gasser, T; Largo, R H; Prader, A; Schärer, K
We evaluated the growth records of 15 boys and 14 girls who developed end-stage renal failure before or during puberty and who were regularly followed from the onset to the end of their pubertal growth spurt. Height data were smoothed by using the kernel estimation method. Mean values for age, height, and height velocity at defined points of the pubertal growth period were compared with those of normal children entering puberty both at an average and late age. The start of the pubertal growth spurt was delayed by 2.5 y in both sexes. Its duration and intensity were significantly reduced. Mean pubertal height gain was 17.3 cm in boys and 13.9 cm in girls, i.e. 58 and 48% of that observed in the late maturing control group. Mean height at the onset of the pubertal spurt in the patients was the same as that in the late maturing healthy girls and 1.0 SD below that of corresponding boys. During the pubertal growth spurt, mean height declined to -2.9 SD in boys and -2.3 SD in girls. Although skeletal maturation was increasingly retarded, we did not observe accelerated growth velocity during late puberty. Our data indicate that most patients reaching end-stage renal failure before or during puberty irreversibly lose growth potential during this period. Renal transplantation did not consistently improve pubertal growth.
Kawarada, Osami; Yasuda, Satoshi; Noguchi, Teruo; Anzai, Toshihisa; Ogawa, Hisao
Atherosclerotic renal artery disease presents with a broad spectrum of clinical features, including heart failure as well as hypertension, and renal failure. Although recent randomized controlled trials failed to demonstrate renal artery stenting can reduce blood pressure or the number of cardiovascular or renal events more so than medical therapy, increasing attention has been paid to flash pulmonary edema and congestive heart failure associated with atherosclerotic renal artery disease. This clinical entity "renovascular heart failure" is diagnosed retrospectively. Given the increasing global burden of heart failure, this review highlights the background and catheter-based therapeutic aspects for renovascular heart failure.
Huang Jingwei; Wu Xiuduo; Qi Shiying; Wang Tie; Li Shengli
Objective: To explore the use of evaluating split glomerular flow rate (GFB) in patients with unilateral renal function failure by 99 Tc m -diethylenetriaminepenta hydroxamic acid renal dynamic imaging. Methods: Split GFR of 82 cases with unilateral renal function failure was evaluated by 99 Tc m - DTPA renal dynamic imaging, and was correlated with serum creatinine (SCr). Beside, causes of renal function failure were analyzed. Results: Split CFR were negatively correlated with SCr(r=-0.643, P 99 Tc m -DTPA renal dynamic imaging to treat early and reserve renal function. (authors)
Menaker, Nathan; Halligan, Katharine; Shur, Natasha; Paige, John; Hickling, Matthew; Nepo, Anne; Weintraub, Lauren
This case report details a unique case of acute, reversible liver failure in a 12-year-old male with sickle cell anemia on chronic transfusion protocol and deferasirox chelation. There is substantial literature documenting deferasirox-induced renal injury, including Fanconi syndrome, but less documentation of hepatic toxicity and few reports of hepatic failure. The case highlights the importance of close monitoring of ferritin, bilirubin, and transaminases for patients on deferasirox.
Management of refractory bleeding post-cardiopulmonary bypass in an acute heparin-induced thrombocytopenia type II renal failure patient who underwent urgent cardiac surgery with bivalirudin (Angiox®) anticoagulation.
Hassen, Kimberly; Maccaroni, Maria R; Sabry, Haytham; Mukherjee, Smitangshu; Serumadar, Shankari; Birdi, Inderpaul
Acute heparin-induced thrombocytopenia (HIT) patients present a myriad of anticoagulation management challenges, in clinical settings where unfractionated heparin (UFH) is the traditional drug of choice. UFH use in cardiac surgery is a known entity that has been subject to rigorous research. Research has, thus, led to its unparalleled use and the development of well-established protocols for cardiac surgery. In comparison to UFH, bivalirudin use for acute HIT patients requiring urgent cardiac surgery with cardiopulmonary bypass (CPB) is still in its infancy. We describe the tailored post-CPB management of refractory bleeding in a 65-year-old infective endocarditis, acute HIT patient with renal failure who underwent urgent aortic valve replacement and mitral valve repair with bivalirudin anticoagulation. A management approach that entailed a combination of continuous venovenous haemofiltration (CVVH), 4-Factor prothrombin complex concentrate (PCC) (Beriplex), recombinant factor VIIa (rFactor VIIa) and desmopressin (DDAVP) were consecutively used post-operatively in theatre. Based on this case study experience, two modifications to institutional protocols are recommended. The first is the use of CVVH in theatre to eliminate bivalirudin in renal failure patients or in patients where bivalirudin elimination is prolonged. Secondly, a 'rescue therapy/intervention' algorithm for the swift identification of refractory bleeding post-CPB is also recommended. Rescue therapy agents, such as a 4-Factor PCCs and rFactor VIIa, should be incorporated into the protocol after a robust evidence-based search and agreement with the haematologist. The aim of these recommendations is to reduce the risk of bleeding associated with bivalirudin use for inexperienced institutions and experienced institutions alike, until larger randomized, controlled studies provide more in-depth knowledge to expand our clinical practice.
Van de Velde-Kossmann, Karen M
Renal failure is common in the United States with an estimated prevalence of 660,000 treated end-stage renal disease patients in 2015 . Causes of renal failure are many, and complications from renal failure, underlying disease, and treatment are not infrequent. Examples of common skin manifestations include xerosis, pigmentary change, and nail dystrophies. Frequent disease-specific skin changes may be helpful in the diagnosis of primary disorders leading to renal disease or severity of disease including bullosis diabeticorum, sclerodactyly, or leukoctoclastic vasculitis. Some cutaneous changes, such as the multiple angiokeratomas of Fabry disease or the plexiform neurofibromas of neurofibromatosis, are pathognomonic of genetic disorders, which often lead to renal failure. Careful examination of the skin can provide crucial clues to diagnosis of renal failure causation and aid in monitoring complications. © 2018 S. Karger AG, Basel.
Ronco, Claudio; Rosner, Mitchell H
Acute kidney injury (AKI) occurring in patients admitted to the ICU may result in impaired renal function on long-term follow-up after ICU discharge. The damage induced by subclinical or manifest episodes of AKI may, in fact, produce an irreversible loss of a variable amount of renal mass with deleterious effects on overall renal function. This may be the case even though baseline glomerular filtration rate appears to return to normal but renal reserve is impaired. This may have an important ...
Sheerin, Noella J; Newton, Phillip J; Macdonald, Peter S; Leung, Dominic Y C; Sibbritt, David; Spicer, Stephen Timothy; Johnson, Kay; Krum, Henry; Davidson, Patricia M
Acute decompensated heart failure is a common cause of hospitalisation. This is a period of vulnerability both in altered pathophysiology and also the potential for iatrogenesis due to therapeutic interventions. Renal dysfunction is often associated with heart failure and portends adverse outcomes. Identifying heart failure patients at risk of renal dysfunction is important in preventing progression to chronic kidney disease or worsening renal function, informing adjustment to medication management and potentially preventing adverse events. However, there is no working or consensus definition in international heart failure management guidelines for worsening renal function. In addition, there appears to be no concordance or adaptation of chronic kidney disease guidelines by heart failure guideline development groups for the monitoring of chronic kidney disease in heart failure. Our aim is to encourage the debate for an agreed definition given the prognostic impact of worsening renal function in heart failure. We present the case for the uptake of the Acute Kidney Injury Network criteria for acute kidney injury with some minor alterations. This has the potential to inform study design and meta-analysis thereby building the knowledgebase for guideline development. Definition consensus supports data element, clinical registry and electronic algorithm innovation as instruments for quality improvement and clinical research for better patient outcomes. In addition, we recommend all community managed heart failure patients have their baseline renal function classified and routinely monitored in accordance with established renal guidelines to help identify those at increased risk for worsening renal function or progression to chronic kidney disease. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.
Thomas, Arul M; Lewis, James H
Acute liver failure of all causes is diagnosed in between 2000 and 2500 patients annually in the United States. Drug-induced acute liver failure is the leading cause of acute liver failure, accounting for more than 50% of cases. Nonacetaminophen drug injury represents 11% of all cases in the latest registry from the US Acute Liver Failure Study Group. Although rare, acute liver failure is clinically dramatic when it occurs, and requires a multidisciplinary approach to management. In contrast with acetaminophen-induced acute liver failure, non-acetaminophen-induced acute liver failure has a more ominous prognosis with a lower liver transplant-free survival. Copyright © 2018 Elsevier Inc. All rights reserved.
Kang, Jeehoon; Park, Jin Joo; Cho, Young-Jin; Oh, Il-Young; Park, Hyun-Ah; Lee, Sang Eun; Kim, Min-Seok; Cho, Hyun-Jai; Lee, Hae-Young; Choi, Jin Oh; Hwang, Kyung-Kuk; Kim, Kye Hun; Yoo, Byung-Su; Kang, Seok-Min; Baek, Sang Hong; Jeon, Eun-Seok; Kim, Jae-Joong; Cho, Myeong-Chan; Chae, Shung Chull; Oh, Byung-Hee; Choi, Dong-Ju
Worsening renal function (WRF) is associated with adverse outcomes in patients with heart failure. We investigated the predictors and prognostic value of WRF during admission, in patients with preserved ejection fraction (HFpEF) versus those with reduced ejection fraction (HFrEF). A total of 5625 patients were enrolled in the KorAHF (Korean Acute Heart Failure) registry. WRF was defined as an absolute increase in creatinine of ≥0.3 mg/dL. Transient WRF was defined as recovery of creatinine at discharge, whereas persistent WRF was indicated by a nonrecovered creatinine level. HFpEF and HFrEF were defined as a left ventricle ejection fraction ≥50% and ≤40%, respectively. Among the total population, WRF occurred in 3101 patients (55.1%). By heart failure subgroup, WRF occurred more frequently in HFrEF (57.0% versus 51.3%; P failure subgroups. Among various predictors of WRF, chronic renal failure was the strongest predictor. WRF was an independent predictor of adverse in-hospital outcomes (HFrEF: odds ratio; 2.75; 95% confidence interval, 1.50-5.02; P =0.001; HFpEF: odds ratio, 9.48; 95% confidence interval, 1.19-75.89; P =0.034) and 1-year mortality (HFrEF: hazard ratio, 1.41; 95% confidence interval, 1.12-1.78; P =0.004 versus HFpEF: hazard ratio, 1.72; 95% confidence interval, 1.23-2.42; P =0.002). Transient WRF was a risk factor for 1-year mortality, whereas persistent WRF had no additive risk compared to transient WRF. In patients with acute heart failure patients, WRF is an independent predictor of adverse in-hospital and follow-up outcomes in both HFrEF and HFpEF, though with a different effect size. URL: https://www.clinicaltrials.gov. Unique identifier: NCT01389843. © 2018 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley.
Olsen, P S; Schroeder, T; Perko, M
Among 656 patients undergoing surgery for abdominal aortic aneurysm, 81 patients (12%) developed postoperative renal failure. Before operation hypotension and shock occurred in 88% of the patients with ruptured aneurysm, whereas none of the patients operated electively were hypotensive. Dialysis...... cases the death was caused by renal failure only or in combination with failure of other organs. Analysis of the cumulative survival shows that, if the patients survive the postoperative period, their life expectancy is comparable to that of patients without renal complications....
Mårtensson, Johan; Bellomo, Rinaldo
To describe the epidemiology, pathophysiology, diagnosis and management of perioperative acute kidney injury (AKI) in elderly patients. Elderly patients with a reduced renal reserve and multiple comorbidities have a higher risk of developing AKI after surgery. Postoperative AKI is diagnosed late and may even go undetected in immobilized elderly patients because of loss of muscle mass and reduced creatinine production. Panels of injury biomarkers could improve early risk stratification, but this approach needs further evaluation. The evidence for perioperative AKI prevention or treatment with renal vasodilators or remote ischaemic preconditioning is conflicting and needs further research. Avoiding hypotension, venous congestion and fluid overload appear important to protect elderly patients and their kidneys from harm. Continuous rather than intermittent renal replacement therapy should be considered early when the response to diuretics is insufficient to prevent fluid overload. Postoperative AKI incidence is expected to rise as the number of elderly patients undergoing surgery is increasing. Biomarkers of early AKI will likely be important for the future development and validation of novel treatment strategies. The haemodynamic management of the elderly surgical patient should focus on avoiding hypotension and high central venous pressures.
Chew, Huck Chin
Cardiac troponin levels are frequently elevated in patients with chronic renal failure, hence diagnosis of myocardial necrosis is difficult. The prevalence of elevated serum troponin T was determined and its diagnostic value in acute coronary syndrome was assessed in patients with chronic renal insufficiency. A retrospective cross-sectional analysis was performed in 227 patients with chronic renal insufficiency and a diagnosis of unstable angina, non-ST or ST-segment elevation myocardial infarction. All patients had baseline serum troponin T levels measured at previous visits; the baseline troponin T level was raised in 53.3%. Cardiac troponin T levels did not correlate with creatinine levels, and were not affected by dialysis. Mortality after an acute coronary event was high (46.3%). Because of the elevated baseline cardiac troponin T levels, detection of acute coronary syndrome in patients with chronic renal failure requires evaluation of serial cardiac enzyme measurements and serial 12-lead electrocardiograms. Early and definitive cardiac interventions may contribute towards decreasing the mortality rate in this group of patients.
Mesiano, Paola; Rollino, Cristiana; Beltrame, Giulietta; Ferro, Michela; Quattrocchio, Giacomo; Fenoglio, Roberta; Pozzato, Marco; Cecere, Pasqualina; Forneris, Giacomo; Bazzan, Mario; Macchia, Gianluca; Roccatello, Dario
Acute renal infarction is a rare condition whose diagnosis is often delayed. Major risk factors include atrial fibrillation, valvular or ischemic heart disease, renal artery thrombosis/dissection and coagulopathy. We reviewed the medical records of 18 patients admitted to our Nephrology Department between 1999 and 2015 for acute renal infarction diagnosed by computed tomography. Tc-99m dimercaptosuccinic acid (DMSA) scintigraphy was performed in some patients during follow-up to assess parenchymal lesions and estimate differential kidney function. Mean age was 59.8 years. Major associated risk factors included hypertension (44 %), obesity (33 %), atrial fibrillation (28 %), peripheral vascular disease (17 %), smoking (17 %), prior thromboembolic event (11 %), diabetes (11 %), estroprogestinic therapy (11 %). Seventy-two percent of patients presented with flank pain. Mean serum creatinine was 1.2 ± 0.6 mg/dl. Acute kidney injury occurred as the initial manifestation in two patients. Patients were managed conservatively, with low molecular weight heparin (83 %) or aspirin (11 %). At the end of follow-up serum creatinine was 1.1 ± 0.3 mg/dl; one patient remained on chronic hemodialysis. 58 % of patients who underwent renal scintigraphy after a median of 8 months had a reduced contribution of the previously affected kidney to total renal function. Risk factors associated with the development of chronic kidney disease following renal infarction are unknown. In our subjects, renal function remained stable in all but one patient who developed end stage renal disease. Further studies should focus on etiology and evolution of kidney function in patients with acute renal infarction.
Qian, Qi; Nath, Karl A.; Wu, Yiming; Daoud, Tarek M.; Sethi, Sanjeev
Deposits of iron and hemosiderosis in the kidney have been observed in diseases with intravascular hemolysis, including paroxysmal nocturnal hemoglobinuria, and valvular heart diseases and prosthetic heart valve implants. However, the decrease in kidney function associated with hemolysis caused by cardiac valvular disease or prostheses is less well recognized. We present a case of intravascular hemolysis after repair and banding of the mitral valve that resulted in massive renal tubular deposition of hemosiderin with decreased kidney function. We discuss the pathophysiologic process of both acute and chronic tubular injury from heme and heme proteins, including injury to organelles resulting in autophagic vacuoles containing damaged organelles, such as mitochondria. We conclude that tubular injury resulting from heme proteins should be considered as a cause of decreased kidney function in all patients with a cardiac valvular disease or prosthesis. PMID:20605299
Forni, L G; Darmon, M; Ostermann, M; Oudemans-van Straaten, H M; Pettilä, V; Prowle, J R; Schetz, M; Joannidis, M
Acute kidney injury (AKI) is a frequent complication of critical illness and carries a significant risk of short- and long-term mortality, chronic kidney disease (CKD) and cardiovascular events. The degree of renal recovery from AKI may substantially affect these long-term endpoints. Therefore maximising recovery of renal function should be the goal of any AKI prevention and treatment strategy. Defining renal recovery is far from straightforward due in part to the limitations of the tests available to assess renal function. Here, we discuss common pitfalls in the evaluation of renal recovery and provide suggestions for improved assessment in the future. We review the epidemiology of renal recovery and of the association between AKI and the development of CKD. Finally, we stress the importance of post-discharge follow-up of AKI patients and make suggestions for its incorporation into clinical practice. Summary key points are that risk factors for non-recovery of AKI are age, CKD, comorbidity, higher severity of AKI and acute disease scores. Second, AKI and CKD are mutually related and seem to have a common denominator. Third, despite its limitations full recovery of AKI may best be defined as the absence of AKI criteria, and partial recovery as a fall in AKI stage. Fourth, after an episode of AKI, serial follow-up measurements of serum creatinine and proteinuria are warranted to diagnose renal impairment and prevent further progression. Measures to promote recovery are similar to those preventing renal harm. Specific interventions promoting repair are still experimental.
Incidência de insuficiência renal aguda na Unidade de Terapia Intensiva Neonatal de um hospital paulista Incidencia de insuficiencia renal crónica aguda en la Unidad de Cuidados Intensivos Neonatal de un hospital de Sao Paulo Incidence of acute renal failure in the Neonatal Intensive Care Unit of a hospital in São Paulo
Renato Ribeiro Nogueira Ferraz
.OBJECTIVES: To describe the incidence of acute renal failure (ARF in the neonatal intensive care unit (NICU of a hospital in São Paulo and to verify the use of the "risk of renal failure, injury to the kidney, failure of kidney function, loss of kidney function and end-stage renal failure (RIFLE" classification for the allocation of the neonates. METHODS: Review of medical records of neonates from April 4 to April 25, 2008. RESULTS: Of the 19 admissions in the NICU, 10% were diagnosed as ARF according to the RIFLE classification. The neonates diagnosed with ARF were referred to the dialysis service. CONCLUSION: Although this study had a very small sample size, the findings indicate that ARF represents 10% of the primary diagnosis among our sample of neonates admitted to the NICU. Large and longer studies are necessary to evaluate the incidence of ARF in the NICU.
Full Text Available Ovarian hyperstimulation syndrome is a serious and potentially life-threatening physiological complication that may be encountered in patients who undergo controlled ovarian hyperstimulation cycles. The syndrome is typically associated with regimes of exogenous gonadotropins, but it can be seen, albeit rarely, when clomiphene is administered during the induction phase. Although this syndrome is widely described in scientific literature and is well known by obstetricians, the knowledge of this pathological and potentially life-threatening condition is generally less than satisfactory among physicians. The dramatic increase in therapeutic strategies to treat infertility has pushed this condition into the realm of acute care therapy. The potential complications of this syndrome, including pulmonary involvement, should be considered and identified so as to allow a more appropriate diagnosis and management. We describe a case of a woman with an extremely severe (Stage 6 ovarian hyperstimulation syndrome who presented ascites, bilateral pleural effusion and severe respiratory failure treated with non-invasive ventilation. The patient was admitted to the intensive care unit because of severe respiratory failure, ascites, and bilateral pleural effusion due to ovarian hyperstimulation syndrome. Treatment included non-invasive ventilation and three thoracentesis procedures, plus the administration of albumin, colloid solutions and high-dose furosemid. Severe form of ovarian hyperstimulation syndrome is observed in 0.5-5% of the women treated, and intensive care may be required for management of thromboembolic complications, renal failure and severe respiratory failure. Pulmonary intensive care may involve thoracentesis, oxygen supplementation and, in more severe cases, assisted ventilation. To our knowledge, there have been only two studies in English language medical literature that describe severe respiratory failure treated with non
Griffin, C.N. Jr.
Two cases of chronic renal failure are presented in which a large joint severe erosive arthritis was the prominent radiologic feature of their renal osteodystrophy. In one both knees were involved, and in the other both knees and one wrist. Distal clavicular erosions were present in both, but hands were not radiographically involved. The literature is reviewed in regards other reports of erosive arthritis complicating renal failure. (orig.)
Johansson, B.; Troell, S.; Berg, U.; Huddinge Univ. Hospital
Eighteen children with acute pyelonephritis were investigated by urography at the time of and about two months after the acute infection. Renal size was evaluated as renal length and parenchymal area. During the acute infection renal size was larger than at the follow-up examination two months later. In conclusion, urography performed in close connection with the acute pyelonephritic infection gives an overestimation of renal size. (orig.)
Full Text Available Management of patients with renal failure remains a major problem in poor-resource nations. Cutaneous manifestations in this group of patients are varied and remain helpful in differentiating acute from chronic renal failure (CRF. We studied the prevalence and pattern of skin disorders in patients with CRF at The University College Hospital, Ibadan, Nigeria, during the period between May 2006 and February 2007. Relevant information was collected with the aid of a questionnaire. The patients were then examined for skin disorders. One hundred and twenty patients who met the inclusion criteria were recruited into the study. The mean age of the CRF patients was 43.12 ± 15.38 years, while that of the control subjects was 43.13 ± 15.38 years. Seventy-six of the 120 patients (63.3% were on chronic hemodialysis while 44 (36.5% were on conservative management. A total of 107 patients (89.1% had at least one skin problem. The skin disorders seen include xerosis in 72 (60%, pruritus in 32 (26.7%, hyper-pigmentation, icthyosis and pityriasis versicolor in nine patients each (7.5%, either singly or in combination. Pallor of the skin was seen in three of the patients (2.5%, while uremic frost was seen in one (0.8%. Nail changes were seen in 48 patients (40%. We conclude that xerosis, pruritus, pigmentary and nail changes were the most common skin disorders in patients with CRF in our environment.
Squires, Robert H
Acute liver failure (ALF) in children differs from that observed in adults in both the etiologic spectrum and the clinical picture. Children, particularly very young ones, do not demonstrate classical features of encephalopathy and the definition of ALF has been revised to include patients with advanced coagulopathy, regardless of mental status. A significant number of these children will go on to require transplant or die. Etiologies vary by age with metabolic and infectious diseases prominent in the first year of life and acetaminophen overdose and Wilson's disease occurring in adolescents. In almost 50% of cases, however, the child has an indeterminate cause for ALF. Management requires a multidisciplinary approach and is directed at establishing the etiology where possible and monitoring, anticipating, and managing the multisystem complications that occur in children with ALF. Overall, short-term outcomes are better in children than adults but are dependent upon the degree of encephalopathy and diagnosis.
Sinkeler, Steef J.; Damman, Kevin; van Veldhuisen, Dirk J.; Hillege, Hans; Navis, Gerjan
The association between cardiac failure and renal function impairment has gained wide recognition over the last decade. Both structural damage in the form of systemic atherosclerosis and (patho) physiological hemodynamic changes may explain this association. As regards hemodynamic factors, renal
Sitprija, V; Suvanpha, R
Clinical observations were made in five Buddhist monks with chronic renal failure on a low protein diet. These monks consumed only one meal and meditated three to four times a day. The estimated protein intake was from 15 to 19 g a day. Renal function remained stable over three years of observation. The general condition was satisfactory without any evidence of protein energy malnutrition. The data were compared with those of another group of patients who had a comparable degree of impairment of renal function but who consumed three meals a day of low protein diet. Protein intake was estimated to be from 25 to 30 g a day. These patients developed uraemia with severe renal failure and protein deficiency within three years. The findings support the role of protein restriction in maintenance of renal function in chronic renal failure and perhaps suggest a beneficial role for meditation.
A 47-year-old woman presented as an acute abdominal emergency with rapid progression to shock following spontaneous rupture of a left renal angiomyolipoma. The diagnosis was missed clinically and on computerized tomographic scan. At different stages of management based on her pattern of symptoms, signs and ...
Full Text Available A 65-year-old woman was admitted for acute onset of right lower abdominal pain. She was taking anticoagulant medication regularly for rheumatic valvular disease and atrial fibrillation. Physical examination revealed no obvious abdominal or flank tenderness. Right thrombo-embolic renal infarction was diagnosed after performing computed tomography angiography (CTA.
Aspromonte, Nadia; Cruz, Dinna N; Valle, Roberto; Ronco, Claudio
The pathophysiology of acute heart failure syndromes (AHFS), defined as a change or worsening in heart failure symptoms and signs, is complex. The variety of adverse neurohormonal adaptations includes increased levels of plasma renin, aldosterone and angiotensin II, all responsible for cardio-renal dysfunction. In fact, such alterations result in an array of clinical changes that include abnormal haemodynamics, altered ventricular filling pressures, pathological neurohormonal responses, leading to fluid overload, congestion and ultimately heart failure symptoms. Clinical pictures can be various: in spite of a usual improvement in dyspnoea, little weight change and significant morbidity are generally observed during hospitalization. Short-term outcomes are characterized by a high 60-day re-hospitalization and high mortality rates; apparently, both can be predicted from pre-discharge characteristics. The most frequently used treatments for AHF care include diuretics, inotropic agents, and vasodilator/vasoactive agents; however, the final therapeutic strategy is often individualized. Diuretics are currently the most used agents, but resistance to diuretic therapy is common. In addition, several studies have demonstrated that aggressive diuresis can contribute to reduced renal function, and high doses of diuretics have been associated with increased morbidity and mortality. Many patients with AHFS also suffer from acute or from chronic renal dysfunction (cardio-renal syndromes type 1 and 2, respectively), which further complicate the outcomes and treatment strategies. A personalized patient evaluation of the combined heart and kidney functions is advised to implement the best possible multidisciplinary diagnostic and therapeutic approach.
Garvey, J P
Acute interstitial nephritis (AIN) secondary to trimethoprim-sulfamethoxazole (TMP-SMX) is well documented as a cause of acute renal failure in native kidneys. TMP-SMX is the standard prophylactic agent against pneumocystis carinii (PCP) used in the early post-transplant period, however, it has to date only been indirectly associated with AIN in renal allografts. DESIGN, SETTING, PARTICIPANTS AND MEASUREMENTS: We describe eleven renal transplant patients with acute allograft dysfunction in whom a transplant biopsy demonstrated primary histopathologic features of allergic AIN, all of whom were receiving TMP-SMX in addition to other medications known to cause AIN.
Malmstrøm, Marie Louise; Hansen, Mark Berner; Andersen, Anders Møller
We aimed at synchronously examining the early time course of 4 proinflammatory cytokines as predictive factors for development of organ failure in patients with acute pancreatitis (AP).......We aimed at synchronously examining the early time course of 4 proinflammatory cytokines as predictive factors for development of organ failure in patients with acute