scholarly journals Sequential pathophysiological changes characterizing the progression from renal dysfunction to acute renal failure following cardiac operation

1980 ◽  
Vol 79 (6) ◽  
pp. 838-844 ◽  
Author(s):  
Mark Hilberman ◽  
Geraldine C. Derby ◽  
Robin J. Spencer ◽  
Edward B. Stinson
Keyword(s):  
Renal Failure ◽  
Acute Renal Failure ◽  
Renal Dysfunction ◽  
Cardiac Operation

Oestrogen protects against ischaemic acute renal failure in rats by suppressing renal endothelin-1 overproduction

2002 ◽  
Vol 103 (s2002) ◽  
pp. 434S-437S ◽  
Author(s):  
Masanori TAKAOKA ◽  
Mikihiro YUBA ◽  
Toshihide FUJII ◽  
Mamoru OHKITA ◽  
Yasuo MATSUMURA
Keyword(s):  
Renal Failure ◽  
Renal Function ◽  
Acute Renal Failure ◽  
Renal Dysfunction ◽  
Tissue Injury ◽  
Male Rats ◽  
Left Renal Artery ◽  
Protective Effects ◽  
Endothelin 1 ◽  
Ischaemia Reperfusion

We investigated whether the treatment with 17β-oestradiol has renal protective effects in male rats with ischaemic acute renal failure (ARF). We also examined if the effect of 17β-oestradiol is accompanied by suppression of enhanced endothelin-1 production in postischaemic kidneys. Ischaemic ARF was induced by clamping the left renal artery and vein for 45min followed by reperfusion, 2 weeks after contralateral nephrectomy. Renal function parameters such as blood urea nitrogen, plasma creatinine and creatinine clearance were measured to test the effectiveness of the steroid hormone. Renal function in ARF rats markedly decreased 24h after reperfusion. The ischaemia/reperfusion-induced renal dysfunction was dose-dependently improved by pretreatment with 17β-oestradiol (20 or 100µg/kg, intravenously). Histopathological examination of the kidney of untreated ARF rats revealed severe lesions, such as tubular necrosis, proteinaceous casts in tubuli and medullary congestion, all of which were markedly improved by the higher dose of 17β-oestradiol. In addition, endothelin-1 content in the kidney after the ischaemia/reperfusion increased significantly by approx. 2-fold over sham-operated rats, and this elevation was dose-dependently suppressed by the 17β-oestradiol treatment. These results suggest that oestrogen exhibits protective effects against renal dysfunction and tissue injury induced by ischaemia/reperfusion, possibly through the suppression of endothelin-1 overproduction in postischaemic kidneys.

scholarly journals Expanding the pool of kidney donors: use of kidneys with acute renal dysfunction

2015 ◽  
Vol 13 (2) ◽  
pp. 319-325 ◽  
Author(s):  
Ana Cristina Carvalho de Matos ◽  
Lúcio Roberto Requião-Moura ◽  
Gabriela Clarizia ◽  
Marcelino de Souza Durão Junior ◽  
Eduardo José Tonato ◽  
...  
Keyword(s):  
Renal Failure ◽  
Acute Renal Failure ◽  
Renal Dysfunction ◽  
Patient Survival ◽  
Machine Perfusion ◽  
Acute Renal Dysfunction ◽  
Morphological Findings ◽  
History Of ◽  
Expanded Criteria ◽  
Support Decision Making

ABSTRACT Given the shortage of organs transplantation, some strategies have been adopted by the transplant community to increase the supply of organs. One strategy is the use of expanded criteria for donors, that is, donors aged >60 years or 50 and 59 years, and meeting two or more of the following criteria: history of hypertension, terminal serum creatinine >1.5mg/dL, and stroke as the donor´s cause of death. In this review, emphasis was placed on the use of donors with acute renal failure, a condition considered by many as a contraindication for organ acceptance and therefore one of the main causes for kidney discard. Since these are well-selected donors and with no chronic diseases, such as hypertension, renal disease, or diabetes, many studies showed that the use of donors with acute renal failure should be encouraged, because, in general, acute renal dysfunction is reversible. Although most studies demonstrated these grafts have more delayed function, the results of graft and patient survival after transplant are very similar to those with the use of standard donors. Clinical and morphological findings of donors, the use of machine perfusion, and analysis of its parameters, especially intrarenal resistance, are important tools to support decision-making when considering the supply of organs with renal dysfunction.

scholarly journals P. falciparum Malaria induced Renal impairment

2019 ◽  
Vol 5 (6) ◽  
pp. 220-223
Author(s):  
Tarkeswar Aich ◽  
Keyword(s):  
Renal Failure ◽  
Acute Renal Failure ◽  
Serum Creatinine ◽  
Renal Dysfunction ◽  
Falciparum Malaria ◽  
Acute Tubular Necrosis ◽  
Mean Value ◽  
Intravascular Haemolysis ◽  
Tubular Necrosis ◽  
Oliguric Renal Failure

Introduction: The involvement of the kidney in falciparum malaria has been known for decades. In 1944, Spitz observed acute renal failure due to falciparum infection in soldiers during World War II. This observation was later supported by other workers who detected oliguria developing in patients with black water fever. The initial clinical pattern is that of reversible renal dysfunction or pre-renal azotemia, which rapidly progresses to acute tubular necrosis if treatment is not started early. Patients with malaria induced renal failure are hypercatabolic with blood urea and serum creatinine levels rising rapidly.Oliguric as well non-oliguric renal failure are observed and duration of oliguric renal failure ranges from a few days to several weeks depending on the severity of renal dysfunction. Acute renal failure in falciparum malaria is usually associated either with acute intravascular haemolysis or heavy parasitemia. Acute renal failure in falciparum malaria is also observed in patients with severe intravascular haemolysis resulting in haemoglobinuria. It may be induced by malarial fever or by anti-malarial drugs in a patient with or without G6-PD deficiency. Materials and Methods: This is a hospital based cross sectional study carried out in a total of 50 cases of acute renal failure who were selected from diagnosed patients of P. falciparum malaria. Cases were confirmed either by P. falciparum antigen test and/or peripheral blood smear test(both thick and thin smear).Malarial ARF (MARF) is diagnosed when serum creatinine level > 3 mg/dl, and/or urine output < 400 ml/24hrs despite adequate rehydration. Result: Out of 174 cases of falciparum malaria 50 patients (28.7%) had acute renal failure in falciparum malaria. 36 (72%) cases were males and 14 (28%) were females, indicating a much higher incidence in males. Approximately 78% of the cases in the present study were below the age of 40 years. The youngest was 15 years old and the oldest was 61 years old (Mean age – 32 ± 11.6 years). All were febrile (100%) and a majority had oliguria or anuria (72%); jaundice was detected in 30 (60%) patients on presentation. Hepatomegaly & Splenomegaly were found in 76% & 66% of the cases respectively. Out of the total 50 cases of malaria induced ARF, 14 cases (28%) had pre-renal ARF while in the majority, 72% the clinical course was that of ATN. The pathogenesis of ATN in the 36 cases was found to be heavy parasitaemia in 40% of the cases, IV hemolysis with haemoglobinuria in 3 (6%) of cases; and cholestatic jaundice in 26% of falciparum patients. Examination of the urinary sediments revealed that albumin was present in urine in 40 cases (80%). Majority of the patients had significant rise in blood urea level with a mean value of 177 mg. S. creatinine levels ranged between 3.2 - 13.6 mg with a mean value of 7.83 mg. The mean creatinine clearance rate was 11.71 ml/min. The overall mortality rate was 26%. Conclusion: AKI is common in Falciparum malaria. The pathogenesis of AKI is largely unknown but may be related to the erythrocyte sequestration and agglutination within the renal microcirculation interfering with flow and metabolism. Clinically and pathologically, this syndrome manifests as Pre-renal azotemia and acute tubular necrosis. Acute renal failure may occur simultaneously with other vital-organ dysfunction (in which case the mortality risk is high) or may progress as other disease manifestations resolve. Early dialysis or hemofiltration considerably enhances the likelihood of a patient’s survival, particularly in acute hypercatabolic renal failure. Severity of oliguria and presence of one or more associated complications like pulmonary oedema, acidosis, and altered sensorium have considerable influence on the outcome of the patients.

The Impact of Mild Renal Dysfunction on Postoperative Mortality in the Surgical Intensive Care Unit

2007 ◽  
Vol 73 (8) ◽  
pp. 743-747
Author(s):  
Mary-Margaret Brandt ◽  
Anthony Falvo ◽  
H. Mathilda Horst
Keyword(s):  
Intensive Care Unit ◽  
Renal Failure ◽  
Renal Function ◽  
Acute Renal Failure ◽  
Intensive Care ◽  
Renal Dysfunction ◽  
Postoperative Mortality ◽  
Surgical Intensive Care Unit ◽  
Surgical Intensive Care ◽  
The Impact

The negative impact of mild to moderate renal dysfunction on patient outcome is often underestimated. Any amount of renal dysfunction is deleterious in the surgical intensive care unit (SICU). We evaluated all surgery patients admitted to our SICU. We identified two groups of patients: no renal failure and acute renal failure. A total of 5152 patients were included in this study. There were 1259 patients in the acute renal failure group. The average number of ventilator days increased by 2.2 for every increase of creatinine by 1.0. Patients who required dialysis stayed an average of 11 days longer than patients who did not have any renal failure. For every increase of creatinine by 1.0, average cost increased by $23,048. Only 7 per cent of the patients with acute renal failure required dialysis (n = 85). The odds ratio for mortality compared with those patients without renal failure was 7.06 (confidence interval, 3.91–12.76) regardless of the definition of renal failure. This study demonstrates that even mild to moderate renal failure increases mortality. Moreover, we demonstrated that even a mild decline in renal function increases length of stay, ventilator days, and cost in patients in the SICU. Aggressive vigilance in the prevention of any loss of renal function is warranted in the SICU.

Contrast-induced nephropathy (Pharmacology of X-ray contrast agents)

2016 ◽  
Vol 7 (1) ◽  
pp. 97-105 ◽  
Author(s):  
Vladislava A Raptanova ◽  
Alexandra A Speranskaya ◽  
Sergei N Proshin
Keyword(s):  
Renal Failure ◽  
Acute Renal Failure ◽  
Serum Creatinine ◽  
Renal Dysfunction ◽  
Urine Volume ◽  
Contrast Induced Nephropathy ◽  
Acute Renal Dysfunction ◽  
X Ray ◽  
Sustained Reduction ◽  
Nephrotoxic Drugs

In the last 30 years the use of X-ray contrast media (RCM) has increased significantly during urography, angiography, computed tomography, and operating procedures. Every year the world uses about 60 million doses of PKM, but, despite the use of newer and less nephrotoxic drugs, the risk of contrast-induced nephropathy (CIN) is still significant, especially among patients with prior renal impairment. Contrast induced nephropathy is a major cause of acute renal injury and is a huge problema in clinical practice. So far, con-tradictions remain in the understanding of many aspects of CIN. Contrast-induced nephropathy is acute renal failure (ARF) occurs within 48-72 hours after intravenous administration of contrast sub-stances. Toxicity PKC determined their molecular structure and its ability to dissociate in aqueous solution into ions which consist of salts which dissociate into cations and anions. The contrast-induced nephropathy is manifested in the increase of serum creatinine of 44 mmol/L (0.5 mg / dl) or more and the same rise in serum creatinine of more than 25 % compared to baseline in the absence of other possible causes. ARF is a sudden and sustained reduction in glomerular filtration rate and urine volume, or both together. Thus renal dysfunction existing even more than 1 month can be regarded as acute renal dysfunction. Usually the development of acute renal failure occurs within 1-7 days. The criteria of sustainability is a dysfunction of its registration within 24 hours or more. The aim: to consider different approaches to the pathogenesis, risk factors and achievements in the prevention of contrast-induced nephropathy.

scholarly journals Off-Pump Coronary Revascularization preserves Renal Function in patients with Preoperative Non-Dialysis dependent renal dysfunction - A Prospective, Randomized Study

2016 ◽  
Vol 20 (3) ◽  
Author(s):  
Shahzad Gull Raja ◽  
Zulfiqar Haider ◽  
Haider Zaman
Keyword(s):  
Renal Failure ◽  
Renal Function ◽  
Acute Renal Failure ◽  
Coronary Artery ◽  
Renal Dysfunction ◽  
Coronary Artery Bypass ◽  
Artery Bypass ◽  
Randomized Study ◽  
Off Pump ◽  
Pump Coronary Artery Bypass

The off-pump coronary artery bypass operation (OPCAB) is a relatively new surgical procedure, which avoids the use of cardiopulmonary bypass and is intuitively considered renoprotective in patients with preoperative normal renal function. However, no prospective, randomized study has been done so far to show whether these benefits may also apply to patients with preoperative non-dialysis dependent renal dysfunction. This first ever prospective, randomized, controlled trial was performed in 50 patients (45 men, mean age 51.2±4.8 yrs) with preoperative nondialysis dependent renal insufficiency, undergoing first-time elective coronary artery bypass grafting. Patients were randomly assigned to conventional revascularization with cardiopulmonary bypass (on-pump) or beating heart revascularization (off-pump). Glomerular and tubular functions were assessed upto 48 hrs postoperatively. There were no deaths, strokes or myocardial infarctions in either group. Glomerular function as assessed by creatinine clearance and the urinary microalbumin/creatinine ratio was significantly worse in the on-pump group (p=0.0003 and p=0.008, respectively). Renal tubular function was also significantly impaired in the on-pump group as assessed by the increased N- acetyl glucosaminidase activity (p=0.021). Six patients in the on-pump group developed acute renal failure requiring renal support compared with one in the off-pump group although statistically the comparison was not significant (p=0.098). This study suggests that off-pump coronary artery bypass surgery reduces the likelihood of acute renal failure in patients with preoperative non-dialysis dependent renal dysfunction and thus shortens postoperative intensive care and length of hospital stay.

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