PROGNOSIS SIGNIFICANCE OF CONTRAST-INDUCED ACUTE KIDNEY INJURY IN PATIENTS WITH PREVIOUSLY NORMAL RENAL FUNCTION (UP TO 2 YEARS FOLLOW UP)

Background. Severe acute kidney injury (AKI) among hospitalized patients often necessitates initiation of short-term dialysis. Little is known about the long-term outcome of those who recover to normal renal function. The aim of this study was to determine the long-term renal outcome of patients experiencing AKI requiring dialysis secondary to hypoperfusion injury and/or sepsis who recovered to apparently normal renal function. Methods. All adult patients with AKI requiring dialysis in our centre between 1 January 1980 and 31 December 2010 were identified. We included patients who had estimated glomerular filtration rate (eGFR) >60 mL/min/1.73 m2 12 months or later after the episode of AKI. Patients were followed up until 3 March 2015. The primary outcome was time to chronic kidney disease (CKD) (defined as eGFR persistently <60 mL/min/1.73 m2) from first dialysis for AKI. Results. Among 2922 patients with a single episode of dialysis-requiring AKI, 396 patients met the study inclusion criteria. The mean age was 49.8 (standard deviation 16.5) years and median follow-up was 7.9 [interquartile range (IQR) 4.8–12.7] years. Thirty-five (8.8%) of the patients ultimately developed CKD after a median of 5.3 (IQR 2.8–8.0) years from first dialysis for AKI giving an incidence rate of 1 per 100 person-years. Increasing age, diabetes and vascular disease were associated with higher risk of progression to CKD [adjusted hazard ratios (95% confidence interval): 1.06 (1.03, 1.09), 3.05 (1.41, 6.57) and 3.56 (1.80, 7.03), respectively]. Conclusions. Recovery from AKI necessitating in-hospital dialysis was associated with a very low risk of progression to CKD. Most of the patients who progressed to CKD had concurrent medical conditions meriting monitoring of renal function. Therefore, it seems unlikely that regular follow-up of renal function is beneficial in patients who recover to eGFR >60 mL/min/1.73 m2 by 12 months after an episode of AKI.

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Implications of Antiphospholipid and Antineutrophilic Cytoplasmic Antibodies in the Context of Postinfectious Glomerulonephritis

Case Reports in Medicine ◽

10.1155/2017/9896210 ◽

2017 ◽

Vol 2017 ◽

pp. 1-3

Author(s):

Daniel Leifer ◽

Lavjay Butani

Keyword(s):

Acute Kidney Injury ◽

Renal Function ◽

Normal Renal Function ◽

Antiphospholipid Antibodies ◽

Severe Disease ◽

Kidney Injury ◽

Antineutrophil Cytoplasmic Antibody ◽

Common Occurrence ◽

Postinfectious Glomerulonephritis

While antineutrophil cytoplasmic antibody (ANCA) positivity has been documented in some patients with postinfectious glomerulonephritis (PIGN) and is associated with more severe disease, antiphospholipid antibodies (APA) are not known to be a common occurrence. We describe a child with severe acute kidney injury who was noted to have prolonged positivity of both ANCA and APA; a renal biopsy showed noncrescentic immune complex mediated glomerulonephritis with subepithelial deposits compatible with PIGN. He recovered without maintenance immunosuppressive therapy and at last follow-up had normal renal function. We discuss the cooccurrence and implications of ANCA and APA in children with PIGN.

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Kidney transplantation with donors in severe acute kidney injury. Should we use these organs? Retrospective Case Series

Brazilian Journal of Nephrology ◽

10.1590/2175-8239-jbn-2018-0264 ◽

2019 ◽

Vol 41 (4) ◽

pp. 534-538 ◽

Cited By ~ 2

Author(s):

Guilherme Palhares Aversa Santos ◽

Luis Gustavo Modelli de Andrade ◽

Mariana Farina Valiatti ◽

Mariana Moraes Contti ◽

Hong Si Nga ◽

...

Keyword(s):

Acute Kidney Injury ◽

Renal Function ◽

Renal Transplantation ◽

Case Series ◽

Kidney Injury ◽

Organ Donors ◽

Retrospective Case ◽

Proportional Increase ◽

Deceased Donors

ABSTRACT Introduction: The number of incident and prevalent patients on dialysis has increased, as well as the number of candidates for renal transplantation in Brazil, without a proportional increase in the number of organ donors. The use of expanded kidneys, as to renal function, may be an alternative to increase the supply of organs. Objective: to discuss the feasibility of using expanded kidneys for renal function, which are in severe acute renal injury. Methods: All cases of renal transplantation of deceased donors performed at the Hospital das Clínicas de Botucatu of UNESP, from January 2010 to June 2018, totaling 732 cases were evaluated. Cases with final donor creatinine greater than 6 mg/dL were selected. Results: four patients were selected, of whom all donors were in severe acute kidney injury (AKI). These donors presented rhabdomyolysis as a probable cause of severe AKI, were young, with no comorbidities and had decreased urinary volume in the last 24 hours. The clinical evolution of all the recipients was satisfactory, with a glomerular filtration rate after transplantation ranging from 48 to 98 mL/min/1.73 m2. Conclusion: this series of cases shows the possibility of using renal donors in severe AKI, provided the following are respected: donor age, rhabdomyolysis as the cause of AKI, and implantation-favorable biopsy findings. Additional studies with better designs, larger numbers of patients and longer follow-up times are needed.

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Acute kidney injury and acyclovir-associated encephalopathy after administration of valacyclovir in an elderly person with normal renal function

Medicine ◽

10.1097/md.0000000000026147 ◽

2021 ◽

Vol 100 (21) ◽

pp. e26147

Author(s):

Tsuneaki Kenzaka ◽

Kazuma Sugimoto ◽

Ken Goda ◽

Hozuka Akita

Keyword(s):

Acute Kidney Injury ◽

Renal Function ◽

Normal Renal Function ◽

Elderly Person ◽

Kidney Injury

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P0602CLINICAL PATTERN, RENAL RECOVERY AND PATIENT OUTCOMES AFTER ACUTE KIDNEY INJURY IN ADULTS IN AN EMERGING COUNTRY

Nephrology Dialysis Transplantation ◽

10.1093/ndt/gfaa142.p0602 ◽

2020 ◽

Vol 35 (Supplement_3) ◽

Author(s):

Arunkumar Subbiah ◽

Sanjay Kumar Agarwal

Keyword(s):

Acute Kidney Injury ◽

Renal Function ◽

Hospital Mortality ◽

Kidney Injury ◽

Hospitalized Patients ◽

Renal Recovery ◽

Common Source ◽

Partial Recovery

Abstract Background and Aims Acute Kidney Injury (AKI) is an important determinant of outcome in hospitalized patients. Further, there is a risk for development of Chronic Kidney Disease (CKD) in the future. Though the long-term impact of AKI has been studied in developed countries, there is a paucity of data in this area from the Indian subcontinent. This single-centre study aimed to assess the pattern, clinical spectrum, short-term and long-term outcomes of AKI. Method In this prospective observational cohort study, detailed demographic and clinical data at presentation, during hospital stay and follow-up at 1, 3, 6 and 12 months after discharge were obtained prospectively for a cohort of patients with AKI. Both community (CAAKI) and hospital acquired AKI (HAAKI) were included. Patient with pre-existing CKD were excluded. Outcome variables examined were in-hospital mortality, renal function at discharge and on follow-up after discharge from hospital. Results In our study cohort with 476 patients, majority of the cases were CAAKI (395, 83%). The mean age at presentation was 44.8 ± 18.7 years. Medical causes (84%) contributed to the majority of AKI while the remaining were due to surgical (10%) and obstetrical (6%) causes. Sepsis (176/476; 36.9%) was the most common cause of AKI. The most common source for sepsis was respiratory (41%) followed by urological source (18.7%). The in-hospital mortality rate for patients with AKI was 38%. Age >60 years (HR = 1.51; 95% CI, 1.11 – 2.07), oliguria (HR = 1.48; 95% CI, 1.05 – 2.10), need for ventilator (HR = 2.45; 95% CI, 1.36 – 4.41) and/or inotropes (HR = 14.4; 95% CI, 6.28 – 33.05) were predictors of mortality. At discharge, 146 (30.7%) patients had complete renal recovery, while 149 (31.3%) had partial renal recovery. Oliguria (p < 0.001), hypoalbuminemia (p = 0.001) and need for renal replacement therapy (RRT) (p = 0.01) were significantly associated with partial recovery. Of the 295 patients on follow-up at discharge, 211 (71.5%) patients had normal renal function, 4 (1.4%) died and 33 (11.2%) were lost to follow up; 47(15.9%) patients developed CKD of which 6 (2%) were dialysis dependent. Elderly patients, higher AKIN stage with oliguria and those requiring RRT were more likely to develop CKD. Among these, the need for in-hospital RRT was the single most important factor predicting the risk of CKD (OR 1.77, 95% CI, 1.12-2.78). Conclusion In conclusion, our data shows that AKI in hospitalized patients still has high mortality in emerging countries like India. Though a fairly good percentage of cases recovered, there is a definite risk of CKD development, especially in patients who required RRT during hospitalization.

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Long-Term Preservation of Renal Function in Septic Shock Burn Patients Requiring Renal Replacement Therapy for Acute Kidney Injury

Journal of Clinical Medicine ◽

10.3390/jcm10245760 ◽

2021 ◽

Vol 10 (24) ◽

pp. 5760

Author(s):

Filippo Mariano ◽

Consuelo De Biase ◽

Zsuzsanna Hollo ◽

Ilaria Deambrosis ◽

Annalisa Davit ◽

...

Keyword(s):

Septic Shock ◽

Acute Kidney Injury ◽

Renal Function ◽

Renal Replacement Therapy ◽

Kidney Injury ◽

Burn Patients ◽

Urine Protein ◽

Urine Albumin

Background. The real impact of septic shock-associated acute kidney injury (AKI) on the long-term renal outcome is still debated, and little is known about AKI-burn patients. In a cohort of burn survivors treated by continuous renal replacement therapy (CRRT) and sorbent technology (CPFA-CRRT), we investigated the long-term outcome of glomerular and tubular function. Methods. Out of 211 burn patients undergoing CRRT from 2001 to 2017, 45 survived, 40 completed the clinical follow-up (cumulative observation period 4067 months, median 84 months, IR 44-173), and 30 were alive on 31 December 2020. Besides creatinine and urine albumin, in the 19 patients treated with CPFA-CRRT, we determined the normalized GFR by 99mTc-DTPA (NRI-GFR) and studied glomerular and tubular urine protein markers. Results. At the follow-up endpoint, the median plasma creatinine and urine albumin were 0.99 (0.72–1.19) and 0.0 mg/dL (0.0–0.0), respectively. NRI-GFR was 103.0 mL/min (93.4–115). Four patients were diabetic, and 22/30 presented at least one risk factor for chronic disease (hypertension, dyslipidemia, and overweight). Proteinuria decreased over time, from 0.47 g/day (0.42–0.52) at 6 months to 0.134 g/day (0.09–0.17) at follow-up endpoint. Proteinuria positively correlated with the peak of plasma creatinine (r 0.6953, p 0.006) and the number of CRRT days (r 0.5650, p 0.035) during AKI course, and negatively with NRI–GFR (r −0.5545, p 0.049). In seven patients, urine protein profile showed a significant increase of glomerular marker albumin and glomerular/tubular index. Conclusions. Burn patients who experienced septic shock and AKI treated with CRRT had a long-term expectation of preserved renal function. However, these patients were more predisposed to microalbuminuria, diabetes, and the presence of risk factors for intercurrent comorbidities and chronic renal disease.

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Efficacy of Three Renal Replacement Therapy Modalities for the Treatment of Acute Kidney Injury Caused by Wasp Sting

Blood Purification ◽

10.1159/000514284 ◽

2021 ◽

pp. 1-11

Author(s):

Fugang Li ◽

Li Liu ◽

Dezheng Chen ◽

Yong Zhang ◽

Mingli Wang ◽

...

Keyword(s):

Acute Kidney Injury ◽

Renal Function ◽

Renal Replacement Therapy ◽

Replacement Therapy ◽

Kidney Injury ◽

Therapeutic Effects ◽

Wasp Sting ◽

Laboratory Results ◽

Better Than

Background/Aim: This study mainly aimed to explore the therapeutic effects of 3 renal replacement therapy (RRT) modalities on acute kidney injury (AKI) caused by wasp stings. Methods: A retrospective study from September 2016 to December 2019 was conducted. Thirty-one patients with AKIs caused by wasp sting were selected and divided into 3 groups according to the initial RRT modality received, namely, (1) the intermittent hemodialysis combined with hemoperfusion (IHD + HP) group, (2) the continuous veno-venous hemodiafiltration (CVVHDF) group, and (3) the CVVHDF combined with HP (CVVHDF + HP) group. The laboratory results were measured and analyzed before treatment on the 3rd, 7th, and 14th days of treatment. The renal function outcomes and survival of the patients were investigated at 3 months follow-up. Results: The laboratory results of enzyme measures and inflammatory indicators in wasp sting patients increased significantly in the early stage and 3 RRT modalities were effective in reducing these indicators. In addition, continuous RRT modality (CVVHDF and CVVHDF + HP) showed better clearance of myoglobin than IHD + HP. The serum creatinine levels of patients in the 3 groups did not recover to baseline within 14 days after beginning treatment. Nevertheless, the CVVHDF + HP group was better than the CVVHDF group, and CVVHDF was better than the IHD + HP group on the 3rd day. The interleukin (IL)-6 and IL-10 levels in CVVHDF + HP and IHD + HP groups were obviously lower than those in the CVVHDF group on the 3rd day. In the follow-up study, the recovery rate of renal function in CVVHDF and CVVHDF + HP groups was significantly better than that in the IHD + HP group. Conclusion: Early RRT was effective in the treatment of patients with A KI caused by wasp sting. CVVHDF + HP and CVVHDF modalities were better than the IHD + HP group in venom clearance and renal function recovery.

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Characteristics and Outcomes of Adults Hospitalized with Dengue Viral Infection and Acute Kidney Injury in Southern Thailand

American Journal of Tropical Medicine and Hygiene ◽

10.4269/ajtmh.21-0130 ◽

2021 ◽

Author(s):

Smonrapat Surasombatpattana ◽

Pornpen Sangthawan ◽

Thanaporn Hortiwakul ◽

Boonsri Charoenmak ◽

Sarunyou Chusri

Keyword(s):

Acute Kidney Injury ◽

Renal Function ◽

Mortality Rate ◽

Viral Infection ◽

Kidney Diseases ◽

Kidney Injury ◽

Volume Overload ◽

Adult Patients ◽

Southern Thailand

Dengue viral infection (DVI) among adult patients is increasingly problematic in tropical and subtropical regions. Acute kidney injury (AKI) after DVI poses substantial clinical outcomes and economic impact. This prospective study focused on the characteristics, risk factors, and outcomes of adult patients with AKI due to DVI hospitalized in nine network hospitals within Southern Thailand from January 2017 to December 2019. Among 120 adult patients hospitalized due to DVI without preexisting kidney diseases, 17 patients (14%) presented with AKI. During hospitalization, four patients required acute hemodialysis. The predominant characteristic of urinalysis was proteinuria, followed by pyuria and hematuria with remarkable dysmorphic red blood cells. Complications included acidosis, followed by hyperkalemia and volume overload. Most complications and deterioration of renal function occurred within the first week, but renal function recovered in second week of hospitalization. Stability of renal function was regained within the fourth week to the third month. However, four AKI patients recovered, with estimated glomerular filtration rate >60 mL/min/1.73 m2 within 3 months. Forty-day mortality rate and resource utilization, including hospital cost and length of hospitalization, among those with AKI were significantly higher than those without AKI. Thirty-day and in-hospital mortality rate among those with AKI was also higher than those without AKI. High APACHE II scores due to bleeding disorder and current use of non-steroidal anti-inflammatory agent were significantly associated with the emergence of AKI. Acute kidney injury among adult patients hospitalized due to DVI should be a concern and should be monitored for prompt treatment and follow-up.

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Acute kidney injury associated with ingestion of star fruit: Acute oxalate nephropathy: a report of two cases

Community Based Medical Journal ◽

10.3329/cbmj.v8i2.55773 ◽

2019 ◽

Vol 8 (2) ◽

pp. 47-51

Author(s):

Mahmud Javed Hasan ◽

Nitai Chandra Ray ◽

Shaikh Shariful Islam ◽

Shakil Azam Nahid ◽

Tumpa Shom ◽

...

Keyword(s):

Acute Kidney Injury ◽

Renal Function ◽

Normal Renal Function ◽

Herbal Remedy ◽

Case Reports ◽

Kidney Injury ◽

Young Male ◽

Empty Stomach ◽

Star Fruit ◽

History Of

There are few case reports regarding star fruit's nephrotoxicity and neurotoxicity in chronic kidney disease patients. Star fruit (Averrhoa carambola) is commonly consumed as a herbal remedy for various ailments in tropical countries. However, the dangers associated with consumption of star fruit are not commonly known. Although star fruit induced oxalate nephrotoxicity in those with existing renal impairment is well documented, reports on its effect on those with normal renal function are infrequent. We report two unique clinical presentation patterns of star fruit nephrotoxicity following consumption of the fruit. The first patient is a 52 year-old male diabetic patient who had normal renal function prior to developing acute kidney injury (AKI) after consuming large amount of star fruit juice at once for remedy of diabetes. The second patient, a 27 years old young male who developed acute kidney injury following star fruit ingestion in empty stomach. One case needed 4 sessions of hemodialysis another case recovered over 2 weeks without the need for haemodialysis. Consumption of star fruit, especially on an empty stomach or in a state of dehydration may precipitate acute kidney injury. A history of star fruit ingestion must be actively looked for in patients presenting with unexplained acute kidney injury. The use of star fruit as a therapy for diabetes should be discouraged. CBMJ 2019 July: Vol. 08 No. 02 P: 47-51

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The incidence of treatment related acute kidney injury in cancer patients: A retrospective analysis.

Journal of Clinical Oncology ◽

10.1200/jco.2020.38.15_suppl.e14150 ◽

2020 ◽

Vol 38 (15_suppl) ◽

pp. e14150-e14150

Author(s):

Bohdan Baralo ◽

Samia Hossain ◽

Muhammad Hanif ◽

Suhail Khokhar ◽

Sana Mulla ◽

...

Keyword(s):

Acute Kidney Injury ◽

Renal Function ◽

Kidney Injury ◽

Close Monitoring ◽

Repeat Test ◽

Significant Incidence ◽

Improved Outcomes ◽

Platinum Based Chemotherapy ◽

Before And After

e14150 Background: Development of the Acute kidney injury (AKI) in the patients receiving chemotherapy and immunotherapy is a factor associated with higher admission to the hospital, prolonged hospitalization, increased morbidity and mortality, dose reduction, moving to less effective regimens, inability to enroll in clinical trials. Methods: A retrospective cohort of the 95 patients, who received chemo immunotherapy in the infusion center of Mercy Fitzgerald Hospital in 2018-2020 were analysed. The pool of the patients had multiple oncological pathologies and were on different chemo immunotherapeutic regimens. All creatinine levels before starting chemotherapy, before and after each cycle were assessed. We used a Kidney Disease: Improving Global Outcomes criteria to define AKI (at least 1.5 increase in creatinine within 7 days of cycle or 0.3 creatinine increase in 48 hours) and grades of AKI. We considered AKI related to chemotherapy, if it developed in specified timeframe after chemotherapy defined above. The cases when patient did not meet criteria for AKI, but had a patterns suggestive of it (no repeat test within 7 days, but repeat test within 3 weeks, with increase in creatinine > 37.5%) were defined as potentially missed AKI. Results: 12 patients developed chemoimmunotherapy related AKI (12.63%). 1 patient had 3 episodes of the AKI related to chemotherapy. 4 patients received platinum-based chemotherapy. On average every patient received 12cycles of chemotherapy. After the first two cycles of chemotherapy AKI developed in 7 Patients (58.33%). 10patients had AKI after 7 cycles (83.33%). It worth mentioning that only 42% of the chemotherapeutic cycles had follow-up creatinine within 7 days. 7 patients (7.37%) had fallen under a potentially missed AKI criteria. 2 more patients were diagnosed with AKI that was not related to the chemotherapy. Conclusions: In our study there was a significant incidence of AKI in the patients receiving chemoimmunotherapy. Current guidelines do not advocate close monitoring(weekly) of renal function in patients receiving chemoimmunotherapy unless the patient receives an chemotherapeutic agent known to cause nephrotoxicity. Repeat creatinine within 7 days after chemotherapy may be necessary to allow early detection of AKI, that can potentially to improved outcomes. Large prospective studies may be necessary to confirm our findings that very close monitoring of renal function can improve detection of the AKI and outcomes due to possibility of early intervention.

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