scholarly journals Preventing contrast-induced acute kidney injury in the emergency room

2015 ◽  
Vol 3 (1) ◽  
pp. 59-60 ◽  
Author(s):  
Koichiro Homma ◽  
Tadashi Yoshida ◽  
Joe Yoshizawa ◽  
Masaru Suzuki ◽  
Junichi Sasaki ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Emergency Room ◽  
Kidney Injury

P0646PREDICTABLE CAPACITY OF ACUTE KIDNEY INJURY OF NEPHROCHECK TEST IN EMERGENCY ROOM PATIENTS

2020 ◽  
Vol 35 (Supplement_3) ◽  
Author(s):  
Elena Gomá ◽  
Guillermo Gonzalez-Martin ◽  
Juan Alfredo López-López ◽  
Maria Vanessa Perez Gomez ◽  
Alberto Ortiz ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
High Risk ◽  
Emergency Room ◽  
Past History ◽  
Kidney Injury ◽  
Urine Osmolality ◽  
Mortality Prediction ◽  
Emergency Room Patients ◽  
History Of ◽  
Heat Failure

Abstract Background and Aims Acute kidney injury (AKI) is increasingly prevalent and it is associated to increased hospital stay and costs, higher risk of developing a chronic kidney disease, and also major morbidity and mortality. Prediction tools may identify patients at high risk of AKI, allowing early intervention. Nephrocheck quantifies biomarkers of AKI (TIMP-2 and IGFBP-7), providing results within 20 minutes. This may allow stratification of the risk of developing an AKI in the next 12 hours in critically cardiovascular or respiratory ill patients and therefore implement preventive measures. We aimed to assess Nephrocheck performance to predict AKI development within 12 hours to 5 days in incident Emergency Room (ER) patients. Method Prospective observational study of 52 incident ER patients. Data were collected from April 2017 to November 2018. Inclusion criteria: sepsis of any origin, or cardiopulmonary insufficiency without AKI at baseline. Nephrochek was performed at baseline, patients were stratified into low (Nephrocheck test < 0.3), moderate (Nephrocheck between 0.3-2) and high risk (Nephrocheck >2) of AKI and occurrence of AKI was assessed (diagnosed as an increase of 0.3 mg/dl of serum creatinine) at 12, 24, 48 h and 5 days. Results Mean age as 70±13 years, 22/52 (43%) were women, risk factors included hypertension (54%), DM (29%), Cirrhosis: 2/52 (4%), heat failure (27%), prior CKD (12%), nephrotoxic use (38%). 18/52 (35%) of patients were Nephrocheck low risk, 21/52 (40%) were intermediate risk and 13/52 (25%) were high risk. AKI developed in 7/18 (39%), 3/21 (14%) and 3/13 (23%) of low, intermediate and high risk, respectively. When comparing patients who developed AKI with those who did not, those who developed AKI had been exposed more frequently to nephrotoxins and had lower urinary osmolarity and higher MAP (Table 1). However, a high risk Nephrocheck score identified patients with significantly higher urine osmolality (672±139 vs 387±172 mOsm/L, P=0.005) and lower MAP (76.7 ± 18.4 vs 101.62±22.7 mmHg; P=0.002). Conclusion LIMITATIONS: knowledge of Nephrocheck results may have changed patient care. CONCLUSIONS: A high risk Nephrocheck score was not associated with a higher risk of AKI in a ER setting. More nephrotoxins were used in the AKI group. Presumabily, these were discontinued in the ER, thus lowering AKI risk. By contrast, a past history of nephrotoxin use and lower urine osmolarity were associated with a higher incidence of AKI.

scholarly journals FP320RENIN ANGIOTENSIN SYSTEM (RAS) BLOCKADE AND THE RISK OF ACUTE KIDNEY INJURY (AKI) IN MEDICAL PATIENTS ADMITTED VIA THE EMERGENCY ROOM (ER)

2019 ◽  
Vol 34 (Supplement_1) ◽  
Author(s):  
Maria Rosa Panagiotou ◽  
Marios Tsoukakis ◽  
Thanos Fidakis ◽  
Ourania Tsotsorou ◽  
Dimitra Bacharaki ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Emergency Room ◽  
Kidney Injury ◽  
Medical Patients ◽  
Angiotensin System

P0598COMPARISION OF OUTCOMES ACCORDING TO URINE CHEMISTRY TESTING TIME FOR THE CAUSES OF ACUTE KIDNEY INJURY PATIENTS ADMITTED TO THE EMERGENCY ROOM

2020 ◽  
Vol 35 (Supplement_3) ◽  
Author(s):  
Won Min Hwang ◽  
Sung Ro Yun ◽  
Se Hei Yoon
Keyword(s):  
Acute Kidney Injury ◽  
Emergency Room ◽  
Kidney Function ◽  
Renal Tubule ◽  
Kidney Injury ◽  
Rapid Identification ◽  
Testing Time ◽  
Early Group ◽  
Hospital Patients ◽  
Late Group

Abstract Background and Aims Rapid identification and treatment of acute kidney injury can help to restore kidney function. In order to differentiate between prerenal AKI and intrinsic AKI, we perform a urine chemistry test to determine the function of the renal tubule. However, there is no report that it is helpful to arrive at the hospital as early as possible and to perform these urine chemistry tests as soon as possible. Method We analyzed the timing of urinary chemistry in AKI patients who were admitted to our hospital through the emergency room for 3 years and divided into two groups. Early group was defined as patients who performed the test within 3 h of arrival in the emergency room. Late group was defined as patients who were late or not. The prognostic factors were change in 30 day eGFR and duration of hospital stay. We also compared the usefulness of urine chemistry test between pre renal AKI and intrinsic AKI in each group. Results The changes of eGFR after 30 days in each group are 41.6 ± 27.6 mL/min/1.73 m2 (Early group, n = 92) vs 30.4 ± 26.8 mL/min/1.73 m2 (Late group, n = 180) (P = 0.0013). Early group patients were discharged more quickly than patients in the late group (Hospital day: 11.5 ± 10.1 vs 13.8 ± 10.5, P = 0.0450). When analyzed according to the causes of AKI, these changes showed differences in prerenal AKI rather than intrinsic AKI(Figure). Conclusion A urine chemistry test is a test to help determine the cause of AKI. Based on the results of urine chemistry performed within 3 h after arrival at the hospital, patients with AKI who visited the emergency room had better improved kidney function and less hospitalization.

scholarly journals Intravenous Contrast Medium Administration for Computed Tomography Scan in Emergency: A Possible Cause of Contrast-Induced Nephropathy

2015 ◽  
Vol 2015 ◽  
pp. 1-4 ◽  
Author(s):  
Lantam Sonhaye ◽  
Bérésa Kolou ◽  
Mazamaesso Tchaou ◽  
Abdoulatif Amadou ◽  
Kouméabalo Assih ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Emergency Room ◽  
Ct Scan ◽  
Odds Ratio ◽  
Kidney Injury ◽  
Intravenous Contrast ◽  
Intravenous Contrast Medium ◽  
Increased Risk ◽  
Possible Cause ◽  
Tomography Scan

The goal of this study was to assess risk for CIN after CT Scan during an emergency and to identify risk factors for the patient. Prospective review of all patients admitted to the emergency room (ER) of the Teaching Hospital of Lomé (Togo) during a 2-year period. CIN was defined as an increase in serum creatinine by 0.5 mg/dL from admission after undergoing CT Scan with intravenous contrast. A total of 620 patients underwent a CT Scan in the emergency room using intravenous contrast and 672 patients took the CT Scan without intravenous contrast. Out of the patients who received intravenous contrast for CT Scan, three percent of them developed CIN during their admission. Moreover, upon discharge no patient had continued renal impairment. No patient required dialysis during their admission. The multivariate analysis of all patients who had serial creatinine levels (including those who did not receive any contrast load) shows no increased risk for acute kidney injury associated intravenous contrast (odds ratio = 0.619,pvalue = 0.886); only diabetes remains independent risk factor of acute kidney injury (odds ratio = 6.26,pvalue = 0.031).

scholarly journals Acute Kidney Injury due to Rhabdomyolysis Followed by Alcohol Intake and Physical Aggression: Case Report and Literature Review

2012 ◽  
Vol 13 (2) ◽  
pp. 212-215
Author(s):  
Elizabeth De Francesco Daher ◽  
Neiberg De Alcantara Lima ◽  
Rafael Siqueira Athayde Lima ◽  
Pedro Henrique de Oliveira Filgueira ◽  
Meissa Kretzman ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Emergency Room ◽  
Case Reports ◽  
Extracellular Fluid ◽  
Supportive Therapy ◽  
Kidney Injury ◽  
Initial Therapy ◽  
Lower Limbs ◽  
Fluid Replacement ◽  
Laboratory Findings

Rhabdomyolysis is defined as a skeletal muscle injury, with subsequent release of cellular constituents into the extracellular fluid and the circulation. Several conditions can lead to rhabdomyolysis, and new causes are constantly expanded with new case reports. The aim of this paper is to report on a case of acute kidney injury (AKI) induced by rhabdomyolysis due to alcohol abuse and physical agression. A 48-year-old man was admitted to the emergency room with dyspnea, lower limbs edema, weakness, oliguria and dark brown urine. Four days before admission he was physically attacked, after drinking almost 2.5 liters of beer. The diagnosis of AKI due to rhabdomyolysis was made through clinical and laboratory findings (creatine kinase 184,376 IU/l, serum urea 275 mg/dL, creatinine 14.6 mg/ dL, potassium 7.9 mEq/L). Urgency hemodyalisis was started due to anuria, refractory hiperkalemia and hypercatabolism. Recovery of renal function was recorded, after fourteen hemodialysis sessions. Patients with rhabdomyolysis are common in the emergency room. Initial therapy of fluid replacement is essential to prevent progression to renal failure. Once established, the dialysis is indicated early. The prognosis is good, when early supportive therapy is adequate. DOI: http://dx.doi.org/10.3329/jom.v13i2.12759 J Medicine 2012; 13 : 212-215

scholarly journals Pneumomediastinum as a Manifestation of Granulomatosis with Polyangiitis

2020 ◽  
Vol 2020 ◽  
pp. 1-4
Author(s):  
Ahmed Alhazmi ◽  
Mohamed Moulaye Cheikh ◽  
Rola Yousef Hassan
Keyword(s):  
Computed Tomography ◽  
Acute Kidney Injury ◽  
Case Report ◽  
Emergency Room ◽  
Plasma Exchange ◽  
Granulomatosis With Polyangiitis ◽  
Kidney Injury ◽  
Smoking History ◽  
Pulse Steroids ◽  
Purpuric Rash

A 38-year-old hypertensive male with a smoking history presented to the emergency room with significant hemoptysis, arthritis, and a purpuric rash. Other findings included a dropping hemoglobin and acute kidney injury with microscopic hematuria. The pulmonary computed tomography was significant for alveolar hemorrhage and a rarely reported pneumomediastinum. Along with this constellation of findings, a positive antiproteinase 3 helped to confirm this patient’s diagnosis of granulomatosis with polyangiitis. Treatment commenced with sessions of plasma exchange and pulse steroids along with cyclophosphamide infusions. The patient had since improved and made a full recovery. This case report highlights the rarely described pneumomediastinum in association with vasculitides.

scholarly journals Acute kidney injury among paediatric emergency room admissions in a tertiary hospital in South West Nigeria: a cohort study

2018 ◽  
Vol 12 (4) ◽  
pp. 521-526 ◽  
Author(s):  
Adebowale D Ademola ◽  
Adanze O Asinobi ◽  
Esther Ekpe-Adewuyi ◽  
Adejumoke I Ayede ◽  
Samuel O Ajayi ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Serum Creatinine ◽  
Emergency Room ◽  
Tertiary Care ◽  
Kidney Injury ◽  
Sub Saharan Africa ◽  
Care Hospital ◽  
College Hospital ◽  
Paediatric Emergency ◽  
Sub Saharan

Abstract Background Epidemiological data on paediatric acute kidney injury (AKI) in sub-Saharan Africa are limited and largely retrospective. We performed a prospective study of AKI among patients admitted through the emergency room. Methods Children admitted to the post-neonatal emergency room of the University College Hospital, Ibadan, Nigeria between February 2016 and January 2017 were studied. AKI was defined by Kidney Disease: Improving Global Outcomes serum creatinine criteria. AKI ascertainment relied on serum creatinine measurements carried out in routine care by post-admission Day 1. We compared in-hospital mortality by post-admission Day 7 for patients with and without AKI (no-AKI). Results Of the 1344 children admitted to the emergency room, 331 were included in the study. AKI occurred in 112 patients (33.8%) with a median age of 3.1 years [interquartile range (IQR) 0.9–9.4] and was Stage 3 in 50.5% of the cases. The no-AKI group had a median age of 1.8 (IQR 0.7–5.8) years. The underlying diagnoses in patients with AKI were sepsis (33.0%), malaria (12.5%) and primary renal disorders (13.4%). Twenty-four of the patients with AKI underwent dialysis: haemodialysis in 20 and peritoneal dialysis in 4. By Day 7 of admission, 7 of 98 (7.1%) patients in the AKI group had died compared with 5 of 175 (2.9%) patients in the no-AKI group [odds ratio 2.6 (95% confidence interval 0.8–8.5)]. Outcome data were not available for 58 (17.5%) patients. Conclusions AKI is common among paediatric emergency room admissions in a tertiary care hospital in sub-Saharan Africa. It is associated with high mortality risk that may be worse in settings without dialysis.

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