P318 PEAK SERUM CREATININE LEVEL FOLLOWING ACUTE KIDNEY INJURY PREDICTS MORTALITY IN HOSPITALIZED PATIENTS WITH ALCOHOLIC HEPATITIS

BackgroundCombining non-contrast CT (NCCT), CT angiography (CTA), and CT perfusion (CTP) imaging (referred to as a CT stroke study, CTSS) provides a rapid evaluation of the cerebrovascular axis during acute ischemic stroke. Iodinated contrast-enhanced CT imaging is not without risk, which includes renal injury. If a patient's CTSS identifies vascular pathology, digital subtraction angiography (DSA) is often performed within 24–48 h. Such patients may receive multiple administrations of iodinated contrast material over a short time period.ObjectiveWe aimed to evaluate the incidence of acute kidney injury (AKI) in patients who underwent a CTSS and DSA for evaluation of acute ischemic symptoms or for stroke intervention within a 48 h period between August 2012 and December 2014.MethodsWe identified 84 patients for inclusion in the analysis. Patients fell into one of two cohorts: AKI, defined as a rise in the serum creatinine level of ≥0.5 mg/dL from baseline, or non-AKI. Clinical parameters included pre- and post-imaging serum creatinine level, time between CTSS and DSA, and type of angiographic procedure (diagnostic vs intervention) performed.ResultsFour patients (4.7%) experienced AKI, one of whom had baseline renal dysfunction (defined as baseline serum creatinine level ≥1.5 mg/dL). The mean difference between baseline and peak creatinine values was found to be significantly greater in patients with AKI than in non-AKI patients (1.65 vs −0.09, respectively; p=0.0008).ConclusionsThis study provides preliminary evidence of the safety and feasibility of obtaining CTSS with additional DSA imaging, whether for diagnosis or intervention, to identify possible acute ischemic stroke.

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Valacyclovir Neurotoxicity and Nephrotoxicity in an Elderly Patient Complicated by Hyponatremia

Drug Target Insights ◽

10.33393/dti.2018.1400 ◽

2018 ◽

Vol 12 (1) ◽

Cited By ~ 1

Author(s):

Takuya Murakami ◽

Tetsu Akimoto ◽

Mari Okada ◽

Erika Hishida ◽

Taro Sugase ◽

...

Keyword(s):

Elderly Patient ◽

Acute Kidney Injury ◽

Renal Function ◽

Serum Creatinine ◽

Serum Creatinine Level ◽

Creatinine Level ◽

Kidney Injury ◽

Blood Purification ◽

Standard Dosage ◽

History Of

A 66-year-old women with no history of renal disease was admitted due to a coma and acute kidney injury with a serum creatinine level of 7.44 mg/dL which were ascribed to valacyclovir neurotoxicity and nephrotoxicity, respectively. She had received valacyclovir at a standard dosage for the treatment of herpes zoster and was finally discharged, having fully returned to her normal baseline mental status with a recovered serum creatinine level of 0.68 mg/dL. We feel that awareness of this pathology remains a challenge for physicians and therefore strongly recommend the further accumulation of experiences similar to our own. Our experience underscores the pitfalls of administering valacyclovir to elderly patients who barely appear to have a favorable renal function. Several concerns regarding the therapeutic management, including blood purification strategies, that emerged in this case are also discussed.

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Results of Autologous Stem Cell Transplantation in Multiple Myeloma Patients with Renal Failure

Blood ◽

10.1182/blood-2020-136264 ◽

2020 ◽

Vol 136 (Supplement 1) ◽

pp. 1-1

Author(s):

Maiia Firsova ◽

Larisa Mendeleeva ◽

Maxim Solovev ◽

Daria Mironova ◽

Valery Savchenko

Keyword(s):

Acute Kidney Injury ◽

Renal Failure ◽

Renal Impairment ◽

Serum Creatinine ◽

Serum Creatinine Level ◽

Creatinine Level ◽

Induction Therapy ◽

Kidney Injury ◽

Platelet Recovery ◽

Renal Response

Introduction According to the Russian register renal impairment at the time of diagnosis was noted in every fifth patient with multiple myeloma (MM). Timely induction therapy followed by autologous stem cell transplantation (ASCT) in some cases contributes to the reversibility of renal failure. Although ASCT appears safe in patients with mild and moderate renal impairment, there are limited data in those with severe acute kidney injury. These patients are often considered to be unfit for ASCT. The aim of the study To study the efficacy and safety of high dose therapy followed by ASCT in patients with MM and renal failure and to evaluate the results of the treatment depending on the severity of acute kidney injury. Materials and methods A retrospective single-center study was performed, including 59 (28 males, 31females) MM patients with renal failure at the time of diagnosis aged 19 to 65 years (median 53) underwent ASCT during a period from 2014 to 2019. Hematologic response and renal response was defined according to International Myeloma Working Group criteria. At the time of diagnosis median of serum creatinine level was 450 μmol/L, and median of glomerular filtration rate (GFR) was 10 ml/min/1.73 m2 (CKD-EPI). 18 patients (30,5%) were dialysis-dependent. Induction therapy included bortezomib-containing regimens in all patients, immunomodulatory drugs were used in 9 patients (15%). Before ASCT overall response rate (CR, VGPR, PR) was documented in 55 patients (93%), median of serum creatinine level was 143 μmol/L, median of GFR increased to 40 ml/min/1.73 m2. Renal response was achieved in 48 patients (81%), in 10 cases dialysis was stopped. 8 patients (13,5%) were dialysis-dependent at the time of ASCT. 43 patients (73%) underwent a single and 16 patients (27%) underwent a tandem ASCT (Mel 140-200 mg/m2). The analysis of such parameters as neutrophil and platelet recovery, a requirement for transfusion therapy was carried out in 2 subgroups: subgroup A - patients without dialysis at the time of ASCT (n = 51), subgroup B - dialysis-dependent patients at the time of ASCT (n = 8). Statistical analysis was done using Statistica 10. Survival curves were constructed using the Kaplan-Meier method. Frequency analysis (Fisher's test) was used. Results Median delay for neutrophil recovery was 14 days and 15 days for platelet recovery in subgroups A and B. Platelet concentrate transfusion was required for all patients of both subgroups in a comparable amount. In patients from subgroup B (dialysis-dependent) compared to those from subgroup A (dialysis independent) significant differences was observed in a requirement of red blood cell transfusions (100% vs 37%, p = 0.001). There was no transplant-related mortality. At 100 days after ASCT overall response rate (CR, VGPR, PR) was achieved in 57 patients (96,6%), median of serum creatinine level was 130 μmol/L, and median of GFR was 50 ml/min/1.73 m2. Renal response was achieved in 49 patients (83%); in one case dialysis was stopped after ASCT (Fig. 1). At one year after ASCT median of serum creatinine level was 127 μmol /L, and median of GFR was 46 ml/min/1.73 m2 (Table 1). Seven patients (12%) remained dialysis-dependent. After a median follow-up of 36 months 5-year overall survival was 60%, and 5-year progression-free survival (PFS) was 40%. The analysis of PFS dependent on the severity of acute kidney injury demonstrated that the 5-year PFS of patients who were dialysis-dependent at the time of diagnosis did not differ from that in patients with mild and moderate renal impairment (42% vs 39%, respectively). Conclusion ASCT is feasible and safe method of treatment in MM patients with severe kidney injury. Dialysis-dependent patients during the early post-transplant period significantly more often require red blood cell transfusions (p = 0.001). Induction therapy followed by ASCT allowed reducing a requirement for dialysis from 30.5% at the time of diagnosis to 12% after ASCT (Fig. 2). In our study 11 of 18 MM patients (61%) became dialysis independent. Overall, this work confirmed no difference in PFS dependent on the severity of acute kidney injury; dialysis-dependent myeloma patients should not be excluded from high dose therapy followed by ASCT. Disclosures No relevant conflicts of interest to declare.

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Assessment of the diagnostic ability of RIFLE and SOFA scoring systems in comparison with protein biomarkers in acute kidney injury

Journal of Laboratory Medicine ◽

10.1515/labmed-2018-0099 ◽

2019 ◽

Vol 0 (0) ◽

Author(s):

Siavash Abedi ◽

Atieh Makhlough ◽

Alireza Rafie ◽

Ali Sharifpour ◽

Masoud Aliyali ◽

...

Keyword(s):

Acute Kidney Injury ◽

Serum Creatinine ◽

Serum Creatinine Level ◽

Creatinine Level ◽

Urine Output ◽

Kidney Injury ◽

Scoring Systems ◽

Risk Level ◽

Control Group ◽

Diagnostic Ability

AbstractBackgroundWe aimed to assess the diagnostic sensitivity of Risk, Injury, Failure, Loss, and End-stage (RIFLE) and Sequential Organ Failure Assessment (SOFA) scoring systems regarding the serum creatinine level in acute kidney injury (AKI) patients hospitalized in the intensive care unit (ICU). This study also aims to compare the sensitivity of these scoring systems with that of mitochondrial pyruvate carrier 1 (MPC-1), interleukin-10 (IL-10) and neutrophil gelatinase-associated lipocalin (NGAL) as biomarkers.MethodsThis is a cross-sectional study. Thirty patients with increased creatinine level and decreased urine output were recognized as AKI patients, and 30 patients were selected as the control group. The serum levels of each of the proteins of interest were measured at the initial state (moment of entrance) and final state (14th day in the ICU). Statistical analysis was performed with respect to t-test, and a p-value < 0.05 was considered significant. The diagnostic ability of biomarkers was assessed using receiver operating characteristic (ROC) curve.ResultsThe majority of patients were recognized in the risk level of RIFLE, and level 1 of SOFA scoring system. There was no correlation between RIFLE and SOFA (p = 0.123). The expression of MPC-1, IL-10 and NGAL was more remarkable compared with the serum creatinine level. The ROC area change for MPC-1 and IL-10 was higher compared with that for NGAL. As a result, MPC-1 and IL-10 are more reliable biomarkers than NGAL to predict the incidence of AKI in the earlier stage.ConclusionsThere was no significant correlation between SOFA and RIFLE classification, and also the sensitivity of these scoring systems was identified at the risk level for AKI patients. Instead, the level of biomarkers alters earlier, and in higher concentration, than creatinine and urine output changes; therefore, they are more reliable than RIFLE and SOFA scoring systems for prognosis purposes.

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Hospital-acquired Acute Kidney Injury: An Analysis of Nadir-to-Peak Serum Creatinine Increments Stratified by Baseline Estimated GFR

Clinical Journal of the American Society of Nephrology ◽

10.2215/cjn.08470910 ◽

2011 ◽

Vol 6 (7) ◽

pp. 1556-1565 ◽

Cited By ~ 18

Author(s):

Jose Calvo Broce ◽

Lori Lyn Price ◽

Orfeas Liangos ◽

Katrin Uhlig ◽

Bertrand L. Jaber

Keyword(s):

Acute Kidney Injury ◽

Serum Creatinine ◽

Kidney Injury ◽

Peak Serum ◽

Estimated Gfr ◽

Hospital Acquired

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The Revelations of Acute Kidney Injury in Cases of Acute Febrile Illness – A Hospital Based Observational Study from North Eastern India

Advancements in Journal of Urology and Nephrology ◽

10.33140/ajun.02.01.04 ◽

2020 ◽

Vol 2 (1) ◽

Keyword(s):

Acute Kidney Injury ◽

Serum Creatinine ◽

Urine Volume ◽

Kidney Injury ◽

Febrile Illness ◽

Hospitalized Patients ◽

Acute Febrile Illness ◽

Medical College ◽

Definition Of ◽

Unexpected Outcome

Background: Clinicians across the globe refer to the published KDIGO definition of Acute Kidney Injury (AKI) as one of the following: • An increase in serum creatinine by ≥0.3 mg/dl (≥26.5 µmol/l) within 48 hrs • An increase in serum creatinine to ≥1.5 times baseline within the previous 7 days • Urine volume <0.5 ml/kg/h for 6 hrs Acute febrile illnesses are a common cause of AKI in hospitalized patients. The present study was undertaken to evaluate the incidence of AKI in patients presenting with acute febrile illness and also study the different etiological factors responsible for acute febrile illness. Materials and Methods: The study included 200 patients of acute febrile illness admitted in Silchar Medical College And Hospital in the Department of Medicine over a period of 24 months. The data regarding the various causes such as the etiology of fever, kidney function tests and other parameters of the cases were obtained and analyzed using simple statistical methods. Results and Observations: A total of 52 patients (26%) with acute febrile illness due to etiologies like Leptospirosis, Falciparum Malaria, Enteric fever, Dengue, Scrub Typhus, and mixed Malaria, etc developed AKI out of the 200 admitted cases presenting with acute febrile illness. Conclusion: The incidence of AKI is common in hospitalized patients of acute febrile illness and a thorough evaluation and detailed clinicobiochemical monitoring of the patients are necessary as it has varied etiology and often lead to an unfavorable or even unexpected outcome.

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Drug-Induced Kidney Injury Caused by Osimertinib: Report of a Rare Case

Nephron ◽

10.1159/000518774 ◽

2021 ◽

pp. 1-6

Author(s):

Takayuki Niitsu ◽

Terumasa Hayashi ◽

Junji Uchida ◽

Takafumi Yanase ◽

Satoshi Tanaka ◽

...

Keyword(s):

Adverse Effects ◽

Serum Creatinine ◽

Serum Creatinine Level ◽

Creatinine Level ◽

Lower Lobe ◽

Kidney Injury ◽

Tubular Injury ◽

Male Smoker ◽

Crescent Formation ◽

First Case

Tyrosine kinase inhibitors (TKIs) that target the epidermal growth factor receptor (EGFR) have shown highly favourable outcomes in patients with advanced-stage non-small-cell lung cancer (NSCLC). The adverse effects of EGFR-TKIs are generally less severe than those of conventional cytotoxic therapies. We report a patient with NSCLC who presented with acute kidney injury associated with biopsy-proven acute tubular injury during osimertinib treatment and whose renal function recovered after reducing the osimertinib dose. A 61-year-old male smoker complained of dyspnoea on exertion for 1 month before his visit to the medical centre. He was diagnosed with lung adenocarcinoma of the left lower lobe (cT4N3M1a, stage IVA) and was positive for an <i>EGFR</i> mutation (exon 19 deletion). Osimertinib was initiated at 80 mg/day. At treatment initiation, the patient’s serum creatinine level was 0.64 mg/dL, with microscopic haematuria; by day 83, this level had increased to 1.33 mg/dL, with proteinuria. On day 83, we reduced the osimertinib dose to 40 mg/day and performed a kidney biopsy on day 98. The histological diagnosis was tubular injury with IgA deposition. Based on the clinical course and histological findings, we speculated that the kidney injury was associated with osimertinib. After dose reduction, the patient’s serum creatinine level decreased to 1.07 mg/dL, and proteinuria disappeared. He maintained a partial response for >6 months after osimertinib administration. We report the first case of biopsy-proven mild IgA deposition, crescent formation, and tubular injury probably caused by osimertinib and demonstrate how reducing the osimertinib dose could strike a balance between its anti-cancer efficacy and adverse effects.

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Acute kidney injury in hospitalized patients with COVID-19 (retrospective study)

Egyptian Journal of Bronchology ◽

10.1186/s43168-021-00056-z ◽

2021 ◽

Vol 15 (1) ◽

Author(s):

Haitham A. Azeem ◽

Hytham Abdallah ◽

Mohamad M. Abdelnaser

Keyword(s):

Acute Kidney Injury ◽

Retrospective Study ◽

Serum Creatinine ◽

Kidney Injury ◽

Multiple Organ ◽

Hospitalized Patients ◽

World Health ◽

Incidence And Mortality ◽

Novel Coronavirus ◽

Health Organization

Abstract Background The World Health Organization (WHO) has named the virus as 2019 novel coronavirus on January 12, 2020, and has declared a public health emergency globally on January 30, 2020. The epidemic started in Wuhan, China, in December of 2019 and quickly spread to over 200 countries. COVID-19 can cause multiple organ injuries (e.g., kidney, heart, blood, and nervous system). Among them, acute kidney injury (AKI) is a critical complication due to its high incidence and mortality rate. So, it is essential to evaluate AKI in COVID-19 patients during this pandemic state. The aim of this work is to detect the occurrence of AKI in hospitalized COVID-19 patients. So, a retrospective study was conducted on hospitalized adult patients > 18 years old with confirmed SARS-CoV-2 infection admitted to the Abo Teeg Hospital at Assiut City, Egypt, from May 1, 2020, to July 1, 2020. All data were collected from medical records, patients’ follow-up, and charts. Data were verified, coded by the researcher, and analyzed using IBM-SPSS 21.0. Results Eighty-six COVID-19 patients were admitted to Abo Teeg Hospital in Assiut City, Egypt, between May and July 2020. Thirty-eight patients (33%) were of the male gender. Mean age was 58.07 ± 17.9, and 61 patients developed AKI. 32.8% of the AKI group were a stage I severity (increase in serum creatinine by 0.3 mg/dl within 48 h), 21.3% of them presented by stage II (2–2.9 times increase in serum creatinine), and 45.9% were in stage III (3 times or more increase in serum creatinine). The overall hospital mortality for the patients admitted to ICU with AKI was 6.7% (11/61), compared to 1% (4/25) in those without AKI. Conclusion Hospitalized patients with COVID-19 had a higher risk of AKI, and we recommended that those patients should be evaluated after discharge for the development of CKD.

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MO380INCREASED PREVALENCE OF ACUTE KIDNEY INJURY AND MORTALITY IN COVID-19 HOSPITALIZED PATIENTS

Nephrology Dialysis Transplantation ◽

10.1093/ndt/gfab082.0034 ◽

2021 ◽

Vol 36 (Supplement_1) ◽

Author(s):

Umberto Maria Morosini ◽

Greta Rosso ◽

Guido Merlotti ◽

Andrea Colombatto ◽

Angelo Nappo ◽

...

Keyword(s):

Acute Kidney Injury ◽

Serum Creatinine ◽

Hospital Stay ◽

Kidney Injury ◽

Length Of Hospital Stay ◽

Hospitalized Patients ◽

Strong Impact ◽

Icu Admission ◽

Increased Risk ◽

Stage 1

Abstract Background and Aims In 2020, SARS-CoV-2 pandemic had a devastating impact on individuals and on national health systems worldwide. Although being primarily a lung disease, COVID-19-associated systemic inflammation and activation of coagulation/complement cascades lead to multiple organ dysfunction including Acute Kidney Injury (AKI). Our aim is to evaluate AKI prevalence and mortality in hospitalized patients during COVID-19 pandemic in a 500-bed University Hospital. Method Observational study on 945 COVID-19 patients (March-May 2020). Data collection from Board Hospital Discharge and serum creatinine (Lab database). AKI stratification in accordance to KDIGO criteria and evaluation of outcome in the different subgroups. The same methodology was adopted to assess AKI prevalence and outcome in 2018-2019. Results 351/945 (37.14%) of all hospital admissions for COVID-19 showed AKI further sub-classified as follows: 173 (18.3%) stage 1, 112 (11.9%) stage 2 and 66 (6.9%) stage 3: the control NO AKI group was 594/945 (62.86%). COVID-associated AKI prevalence was higher than that observed in 2018 (total AKI 17.9%, stage 1 10.7%, stage 2 4.5%, stage 3 2.7%) and 2019 (total AKI 17.2%, stage 1 10.1%, stage 2 4.5%, stage 3 2.6%). During COVID-19 pandemic, in-hospital mortality was 27% for NO AKI group, 28% for total AKI group, further subdivided 24% for stage 1, 45% for stage 2 and 42% for stage 3 group, respectively. Mortality was different from that observed during 2018 (NO AKI 3.77%, total AKI 15.2%, stage 1 9.69%, stage 2 17.24%, stage 3 18.9%) and 2019 (NO AKI 3.56%, total AKI 18.35%, stage 1 10.6%, stage 2 20.1%, stage 3 24.3%). In COVID-19 patients, mean age of NO AKI group was 64.6 ys vs. 71.7 ys of total AKI group divided in 71.6 ys for stage 1, 74.3 ys for stage 2 and 67.9 ys for stage 3, respectively. Mean eGFR at admission was 74.2 ml/min for NO AKI group, 61.3 ml/min for total AKI group divided in 64.3 ml/min for stage 1, 57.8 ml/min for stage 2 and 52.5 ml/min for stage 3. Mean serum creatinine at admission was 1.17 mg/dl in NO AKI group, 1.43 mg/dl for total AKI group divided in1.22 mg/dl for stage 1, 1.4 mg/dl for stage 2 and 2.25 mg/dl for stage 3. Among evaluated comorbidities, only diabetes (p=0,048) and cognitive impairment (p=0,001) were associated with a significant increased risk for AKI development. ICU admission rate was 5% for NO AKI group and 18% for total AKI group divided in 14% for stage 1, 22% for stage 2 and 44% for stage 3. Mean length of hospital stay for NO AKI group was 7.22 days vs 15.08 days for total AKI group divided in 13.67 for stage 1, 15.83 for stage 2 and 21.82 for stage 3. Of note, all different therapies administered to COVID-19 patients did not correlate with AKI incidence. Mean eGFR at discharge was 76 ml/min for NO AKI group vs 66 ml/min for total AKI group divided in 68.7 ml/min for stage 1, 59.3 ml/min for stage 2 and 59.3 ml/min for stage 3. Mean serum creatinine at discharge was 1.14 mg/dl for NO AKI group vs 1.45 mg/dl for total AKI group divided in 1.28 mg/dl for stage 1, 1.58 mg/dl for stage 2 and 2.05 mg/dl for stage 3. Conclusion COVID-19 pandemic is associated with an increased AKI prevalence in hospitalized patients (2-fold increase in all KDIGO stages). AKI associated with an increased risk of mortality: of note, AKI stage2-3 had a strong impact on mortality in comparison to NO AKI group (OR 2.59 and 2.11, respectively). The presence of eGFR >60 ml/min and serum creatinine < 1.2 mg/dl at admission were associated with a lower risk of AKI development: reduced eGFR levels were observed at discharge particularly in AKI stage 2-3. The length of hospital stay and risk of ICU admission depended on AKI incidence and severity. COVID-19 lead to an increased burden for Nephrologists due to increased AKI prevalence: a nephrological follow-up is needed to avoid progression from AKI to chronic kidney disease (CKD).

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