Acute Kidney Injury

2016 ◽  
pp. 557-564
Author(s):  
Suzanne M. Norby ◽  
Kianoush B. Kashani
Keyword(s):  
Acute Kidney Injury ◽  
Kidney Injury ◽  
Low Ph ◽  
The Other ◽  
Serum Bicarbonate ◽  
Acid Base ◽  
High Ph ◽  
Compensatory Change ◽  
Hasselbalch Equation ◽  
Initial Change

Simple acid-base disorders are defined by changes in pH and the initial change in 1 of the 2 variables, serum bicarbonate (HCO3-) and PCO2. Low pH indicates acidosis, and high pH indicates alkalosis. If 1 of the 2 components (HCO3-or PCO2) decreases, the other component also decreases (a compensatory change that minimizes the change in the ratio and the pH) and vice versa, as shown in the Henderson-Hasselbalch equation. Emphasis has been placed on the Henderson-Hasselbalch equation because the equation describes the 4 acid-base disorders and their compensatory changes.

scholarly journals Acute kidney injury in children hospitalized for acute gastroenteritis: prevalence and risk factors

2021 ◽  
Author(s):  
Pierluigi Marzuillo ◽  
Maria Baldascino ◽  
Stefano Guarino ◽  
Silverio Perrotta ◽  
Emanuele Miraglia del Giudice ◽  
...  
Keyword(s):  
Risk Factors ◽  
Acute Kidney Injury ◽  
Acute Gastroenteritis ◽  
Kidney Injury ◽  
Normative Values ◽  
Serum Bicarbonate ◽  
Duration Of Symptoms ◽  
Logistic Regression Models ◽  
Early Predictors ◽  
Stage 1

Abstract Background We aimed to evaluate prevalence of acute kidney injury (AKI) and its risk factors in children hospitalized for acute gastroenteritis (AGE) to identify early predictors of AKI. Methods We retrospectively collected clinical and biochemical data of 114 children (57.9% male; mean age 2.9 ± 2.8 years) hospitalized for AGE. AKI was defined according to Kidney Disease/Improving Global Outcomes creatinine criteria. We considered basal serum creatinine as value of creatinine estimated with Hoste (age) equation assuming basal eGFRs were median age-based eGFR normative values for children ≤ 2 years of age, and eGFR 120 mL/min/1.73m2 for children > 2 years. Univariate and multivariate logistic regression models were used to explore associations with AKI. We included in multivariate analyses only variables with significant p after Bonferroni correction. Results AKI was found in 28/114 (24.6%) patients. No patients required hemodialysis, 2 (1.8%) reached AKI stage 3, 2 (1.8%) AKI stage 2, and 24 (21.0%) AKI stage 1. Mean length of stay was 3.6 ± 1.2, 5.0 ± 1.8, and 10.5 ± 5.8 days, for patients with no, mild, and severe AKI (p < 0.001), respectively. Duration of symptoms before hospitalization (OR = 2.5; 95% CI = 1.3–5.0; p = 0.006), dehydration > 5% (OR = 43.1; 95% CI = 5.4–344.1; p = < 0.001), and serum bicarbonate levels (OR = 1.6; 95% CI = 1.2–2.1; p = 0.001) were independent predictors of AKI. Conclusions About one quarter of patients hospitalized for AGE may suffer from AKI with a longer stay for patients with more severe AKI. Particular attention, however, should be paid to volemia and kidney health of patients with AGE especially in the presence of increased duration of symptoms before hospitalization, dehydration, and lower serum bicarbonate levels. Graphical abstract

scholarly journals Unusual Case of Localized Upper Limbs and Truncal Edema Associated with Fever, Anemia, and Acute Kidney Injury

2019 ◽  
Vol 2019 ◽  
pp. 1-3
Author(s):  
Mohammad Tinawi
Keyword(s):  
Acute Kidney Injury ◽  
Creatine Kinase ◽  
Muscle Biopsy ◽  
Unusual Case ◽  
Kidney Injury ◽  
The Other ◽  
Upper Limbs ◽  
Inflammatory Myositis ◽  
Arm Pain ◽  
Extensive Evaluation

The patient is a 75-year-old man who presented with right arm pain, edema, and erythema. The same manifestations appeared in the other arm 3 weeks later. He also developed fever, acute kidney injury, anemia, and truncal edema. Initial extensive evaluation was unrevealing. He was noted to have elevated creatine kinase, and a diagnostic muscle biopsy lead to diagnosis of inflammatory myositis. He improved with corticosteroids.

Dyselectrolytemias and acid-base disorder in acute kidney injury

2012 ◽  
Vol 1 (1) ◽  
pp. 70-75
Author(s):  
Ravi Prakash Deshpandey ◽  
H.S. Anoop Kumar ◽  
Subin Mathew
Keyword(s):  
Acute Kidney Injury ◽  
Kidney Injury ◽  
Acid Base ◽  
Base Disorder

scholarly journals P0601SAFETY AND EFFICACY OF INTRAVENOUS ADMINISTRATION OF RINGER'S LACTATE VERSUS NORMAL SALINE 0.9% SOLUTION IN PATIENTS WITH ACUTE KIDNEY INJURY AND ESTABLISHED CHRONIC KIDNEY DISEASE

2020 ◽  
Vol 35 (Supplement_3) ◽  
Author(s):  
Marios Papasotiriou ◽  
Adamantia Mpratsiakou ◽  
Georgia Georgopoulou ◽  
Lamprini Balta ◽  
Paraskevi Pavlakou ◽  
...  
Keyword(s):  
Chronic Kidney Disease ◽  
Acute Kidney Injury ◽  
Renal Function ◽  
Kidney Injury ◽  
Acid Base Balance ◽  
Acid Base ◽  
Safety And Efficacy ◽  
Ringer’S Lactate ◽  
Base Balance ◽  
The Mean

Abstract Background and Aims Crystalline solutions, such as normal saline 0.9% (N/S 0.9%) and Ringer's Lactate (L/R), are readily administered for increasing plasma volume. Despite the utility of administering N/S 0.9% to hypovolemic patients, the dose of 154 mmol of sodium (Na) contained in 1 L exceeds the recommended daily dose increasing the risk of sodium overload and hyperchloremic metabolic acidosis. In contrast, L/R solution has the advantage of lower Na content, significantly less chlorine and contains lactates which may be advantageous in patients with significant acidemia such as patients with acute kidney injury (AKI) and chronic kidney disease (CKD). The aim of the present study is to investigate the safety and efficacy of administration of L/R versus N/S 0.9% in patients with prerenal AKI and established CKD. Method The study included adult patients with known CKD stage II to V without need for dialysis, with prerenal AKI (AKIN Stage I to III Criteria). Patients with other forms of AKI as well as hypervolemia, heart congestion or hyperkalemia (serum K&gt;5.5 meq/l) were excluded from the study. Patients were randomized in 1:1 ratio to receive intravenously either N/S 0.9% or L/R solution at a dose of 20 ml/kg body weight/day. We studied kidney function (eGFR: CKD-EPI) and response to treatment at discharge and at 30 days after discharge, duration of hospitalization, improvement in serum bicarbonate levels (HCO3), acid-base balance, serum potassium levels and the need for dialysis. Results The study included 26 patients (17 males) with a mean age of 59.1 ± 16.1 years. Thirteen patients received treatment with N/S 0.9% and the rest with L/R solution. Baseline demographic and clinical characteristics at hospital admission and historical data did not show any significant differences in both groups of patients. Renal function at the onset of AKI did not show significant differences between the two groups (16.4 ± 5.8 vs 16.9 ± 5.7 ml/min/1.73 m2, p=ns, treatment with N/S and L/R respectively). The mean volume of solutions received by the two groups (N/S 0.9% 1119 ± 374 vs L/R 1338 ± 364 ml/day, p=ns) as well as the mean total volume of liquids received per day, did not differ significantly (2888 ± 821 vs 3069 ± 728 ml/d, p=ns). Patients treated with L/R were discharged 1 day earlier than patients treated with N/S (5.2 ± 3.2 vs 6.2 ± 4.9 days of hospitalization, p=ns). Renal function improvement during hospitalization and 30 days after discharge did not differ significantly between the two groups. Patients that received L/R showed a higher increase in plasma HCO3 (ΔHCO3) concentration at discharge than those that received N/S 0.9% (4.9 ± 4.1 vs 2.46 ± 3.7 meq/l, p=ns) and pH increase (ΔpH) was slightly higher in those that received L/R solution (0.052 ± 0.066 vs 0.023 ± 0.071, p=ns). Patients treated with N/S 0.9% showed a greater decrease in serum potassium (ΔK) at discharge compared to those treated with L/R (-0.39 ± 1.03 vs -0.17 ± 0.43 meq/l, p=ns, respectively). No patient received acute dialysis treatment. Conclusion Administration of L/R solution as a hydration treatment to patients with prerenal AKI and established CKD is not inferior concerning safety and efficacy to N/S 0.9% solution. In addition, L/R administration seems to marginally improve acid-base balance in this specific group of patients.

Continuous Peritoneal Dialysis Compared with Daily Hemodialysis in Patients with Acute Kidney Injury

2009 ◽  
Vol 29 (2_suppl) ◽  
pp. 62-71 ◽  
Author(s):  
Daniela Ponce Gabriel ◽  
Jacqueline Teixeira Caramori ◽  
Luis Cuadrado Martin ◽  
Pasqual Barretti ◽  
Andre Luis Balbi
Keyword(s):  
Acute Kidney Injury ◽  
Renal Function ◽  
Peritoneal Dialysis ◽  
Survival Rate ◽  
Acute Tubular Necrosis ◽  
Kidney Injury ◽  
Acid Base ◽  
Tubular Necrosis ◽  
Daily Hemodialysis ◽  
Continuous Peritoneal Dialysis

Background In some parts of the world, peritoneal dialysis is widely used for renal replacement therapy (RRT) in acute kidney injury (AKI), despite concerns about its inadequacy. It has been replaced in recent years by hemodialysis and, most recently, by continuous venovenous therapies. We performed a prospective study to determine the effect of continuous peritoneal dialysis (CPD), as compared with daily hemodialysis (dHD), on survival among patients with AKI. Methods A total of 120 patients with acute tubular necrosis (ATN) were assigned to receive CPD or dHD in a tertiary-care university hospital. The primary endpoint was hospital survival rate; renal function recovery and metabolic, acid–base, and fluid controls were secondary endpoints. Results Of the 120 patients, 60 were treated with CPD (G1) and 60 with dHD (G2). The two groups were similar at the start of RRT with respect to age (64.2 ± 19.8 years vs 62.5 ± 21.2 years), sex (men: 72% vs 66%), sepsis (42% vs 47%), shock (61% vs 63%), severity of AKI [Acute Tubular Necrosis Individual Severity Score (ATNISS): 0.68 ± 0.2 vs 0.66 ± 0.22; Acute Physiology and Chronic Health Evaluation (APACHE) II: 26.9 ± 8.9 vs 24.1 ± 8.2], pre-dialysis blood urea nitrogen [BUN (116.4 ± 33.6 mg/dL vs 112.6 ± 36.8 mg/dL)], and creatinine (5.85 ± 1.9 mg/dL vs 5.95 ± 1.4 mg/dL). In G1, weekly delivered Kt/V was 3.59 ± 0.61, and in G2, it was 4.76 ± 0.65 ( p < 0.01). The two groups were similar in metabolic and acid–base control (after 4 sessions, BUN < 55 mg/dL: 46 ± 18.7 mg/dL vs 52 ± 18.2 mg/dL; pH: 7.41 vs 7.38; bicarbonate: 22.8 ± 8.9 mEq/L vs 22.2 ± 7.1 mEq/L). Duration of therapy was longer in G2 (5.5 days vs 7.5 days; p = 0.02). Despite the delivery of different dialysis methods and doses, the survival rate did not differ between the groups (58% in G1 vs 52% in G2), and recovery of renal function was similar (28% vs 26%). Conclusion High doses of CPD provided appropriate metabolic and pH control, with a rate of survival and recovery of renal function similar to that seen with dHD. Therefore, CPD can be considered an alternative to other forms of RRT in AKI.

A rare cause of acute kidney injury: hypothyroidism / Akut böbrek hasarının nadir bir nedeni: Hipotiroidizm

2016 ◽  
Vol 41 (4) ◽  
Author(s):  
Şimal Köksal Cevher ◽  
Ezgi Çoşkun Yenigün ◽  
Ramazan Öztürk ◽  
Fatih Dede
Keyword(s):  
Acute Kidney Injury ◽  
Case Reports ◽  
Hormone Replacement ◽  
Kidney Injury ◽  
Complete Response ◽  
Routine Clinical Practice ◽  
The Other ◽  
Response To Treatment ◽  
Electrolyte Disturbances ◽  
Clinical Conditions

AbstractKidneys and thyroid are two basic organs that interact with each other, and when one of them becomes ill, functions of the other are affected. Although electrolyte disturbances are the most common symptoms reported due to hypothyroidism, some are case reports in the literature suggested that acute kidney injury developed due to hypothyroidism. Despite this, we doubt that this information comes into mind in routine clinical practice. To report a case of reversible hypothyroidism-induced acute kidney injury, and review those two clinical conditions, which are often overlooked in the nephrology practice, in the light of the literature. We reported a 75-year-old female patient who admitted for acute kidney injury associated with deep hypothyroidism, required hemodialysis, and underwent a renal biopsy since no etiological factors were detected for acute kidney injury. We emphasized that the patient’s creatinine concentrations gradually returned to normal following hormone replacement therapy. Renal dysfunction in presence of hypothyroidism is a known, but frequently overlooked entity. Hypothyroidism should not be overlooked as the cause of reversible kidney injury since it is easy to treat, and there is almost complete response to treatment in terms of renal failure.

Acid-base variables in patients with acute kidney injury requiring peritoneal dialysis in the pediatric cardiac care unit

2009 ◽  
Vol 23 (3) ◽  
pp. 334-340
Author(s):  
Hiroshi Morimatsu ◽  
Yuichiro Toda ◽  
Moritoki Egi ◽  
Kazuyoshi Shimizu ◽  
Takashi Matsusaki ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Peritoneal Dialysis ◽  
Kidney Injury ◽  
Cardiac Care ◽  
Acid Base ◽  
Cardiac Care Unit

scholarly journals Time and the etiology of Acute Kidney Injury define prognosis in the course of COVID-19

2021 ◽  
Author(s):  
Ahmet Murt ◽  
Mevlut Tamer Dincer ◽  
Cebrail Karaca ◽  
Sinan Trabulus ◽  
Ridvan Karaali ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Inflammatory Markers ◽  
Kidney Injury ◽  
Final Analysis ◽  
Disease Stage ◽  
Inclusion Criteria ◽  
Acid Base ◽  
Acid Base Status ◽  
Worse Prognosis ◽  
D Dimer

Abstract Aim Kidneys are among the affected organs in COVID-19 and there may be different etiologies resulting in acute kidney injury (AKI) in different stages of the disease. This study aimed to analyze AKI among hospitalized COVID-19 patients in relation to the time and etiologies of AKI. Methods 1056 patients who were hospitalized with COVID-19 diagnosis in our institution were retrospectively evaluated and 383 of them met the inclusion criteria. Eighty-nine patients who developed AKI were involved in the final analysis. Patients were classified into three groups, those who had AKI on admission, those who developed AKI in the first week and those who developed AKI starting from 7th day. Initial lymphocyte counts, creatinine levels, electrolytes, acid-base status and changes in the inflammatory markers were compared between the groups. A comparison between patients who survived and who died was also performed.Results AKI had 24% mortality in COVID-19 patients who had eGFRs of over 60 ml/min/1,73 m2. Patients who developed AKI later had higher peak CRP and D-dimer levels with lower nadir lymphocyte counts (p=0,000, 0,004 and 0,003 respectively). Mortality of patients who had AKI on hospital admission (13%) was similar to the overall COVID-19 mortality for inpatients, however it was 44% for those who developed AKI after 7th day. Early AKI was related to pre-renal causes and had a milder course. However, later AKIs were more related to immunologic response and had significantly higher mortality. Conclusions AKI in COVID-19 is not of one kind. When developed, AKI should be evaluated in conjunction with the disease stage and possible etiologies. AKI that develops later has a worse prognosis.

scholarly journals Evaluation of the Effectiveness of Continuous Venovenous Hemodiafiltration Appli̇ed With Oxiris and AN69 Membranes in Patients With Septic Shock-Related Acute Kidney Injury

2020 ◽  
Author(s):  
Cem Kıvılcım Kaçar ◽  
Osman Uzundere ◽  
Enver Yüksel ◽  
Deniz Kandemir ◽  
Esra Akiz Bıçak ◽  
...  
Keyword(s):  
Septic Shock ◽  
Acute Kidney Injury ◽  
Infusion Rate ◽  
Kidney Injury ◽  
The Other ◽  
Noradrenaline Infusion ◽  
Continuous Venovenous Hemodiafiltration ◽  
Significant Difference ◽  
Group 2 ◽  
Group 1

Abstract Background and objectives: AN69 and Oxiris are filters used in continuous renal replacement therapy. In this study, we aimed to research the effects of these filters on blood cell counts, blood biochemistry, inflammation indicators, clinical status and mortality of patients diagnosed with septic shock-related acute kidney injury. Method: Between March 2019 and October 2019, 42 adult patients (Group 1: Oxiris (n = 21) or Group 2: AN69 (n=21)) with septic shock-related acute kidney injury and received continuous venovenous hemodiafiltration (CVVHDF) in the intensive care unit were included in the study and their results were prospectively observed and compared. The data at the begining of CVVHDF (pre-CVVHDF) and 24 hours after the onset of CVVHDF (post-CVVHDF) were recorded.Results: In the comparison of the pre- and post-CVVHDF values in Group 1, there was a statistically significant decrease detected in the procalcitonin (p = 0.04) and noradrenaline infusion rate (p = 0.02) levels. In terms of the other data there was no statistically significant difference between pre- and post-CVVHDF values in Group 1. In the comparison of the pre- and post-CVVHDF values in Group 2, there was a statistically significant decrease detected in the urea (p = 0.04), platelet count (p = 0.02) and procalcitonin (p = 0.002) levels. There was no statistically significant difference between pre- and post-CVVHDF values in terms of the other data in Group 2. There was no statistically significant difference between the groups in terms of mortality. Conclusions: CVVHDF with Oxiris filter causes a statistically significant decrease in noradrenaline infusion rate. Therefore, we think that the use of CVVHDF with Oxiris filter applied for septic shock-related acute kidney injury will save us time and increase the improvement in the treatment.

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