Metabolic acidosis, hypokalaemia and acute renal failure with a normal urine output

Introduction: Birth asphyxia is an eventuality having far reaching consequences in the neonatal period. Hypoxia and ischemia can cause damage to almost every tissue and organ in the body and various target organs involved. Renal insult is a recognized complication of birth asphyxia and carries a poor prognosis. Timely detection of renal dysfunction and appropriate management may favorably alter the prognosis in many neonates with birth asphyxia. Objective: The present study was done to find out the incidence of acute renal failure in the full term neonates with birth asphyxia. Methodology: A cross sectional study was conducted at Birat Medical College Teaching Hospital, Morang, Nepal from 1st September 2017 to 28th February 2018. Fifty full term neonates born with Apgar score of <6 at 5 minutes and fulfilling inclusion criteria were enrolled in the study. Asphyxiated neonates having Serum creatinine >1.5gm/dl or urine output<1ml/kg/hr were labeled as cases of Acute Renal Failure. Blood sample for serum creatinine was collected at 24hrs, 48 hrs and 72 hrs of life. Results A total of 50 term asphyxiated neonates were enrolled in the present study. Among them 54% and 46% were males and females respectively with male to female ratio of 1.2:1. In the present study 62% of cases developed acute renal failure in either of the first three days of life with mean urine output 1.02±0.27ml/kg/hr and mean serum creatinine of 1.49±0.32 mg/dL. The incidence of oliguric renal failure was 52% and non oliguric renal failure was 48%.The association between serum creatinine and urine output was statistically significant. Conclusion: In the present study birth asphyxia has been an important cause of neonatal acute renal injury, revealing 31 (62%) cases. Monitoring urine output and serum creatinine has helped in detecting the asphyxiated neonates with acute renal injury in the early stage.

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Frequency of acute renal failure in blackstone poisoning

The Professional Medical Journal ◽

10.29309/tpmj/2020.27.05.4392 ◽

2020 ◽

Vol 27 (06) ◽

pp. 1285-1290

Author(s):

Ahmed Ali Kanhar ◽

Waseem Raja Memon ◽

Nasrullah Aamer ◽

Bahkat Ali Sial ◽

Abdul Aziz Sahito ◽

...

Keyword(s):

Renal Failure ◽

Acute Renal Failure ◽

Urine Output ◽

Low Cost ◽

Tertiary Care ◽

Cross Sectional Study ◽

Care Hospital ◽

College Hospital ◽

Cross Sectional ◽

Output Measurement

Objective: To determine the frequency of acute renal failure in patients presented with Blackstone poisoning in a tertiary care Hospital. Study Design: Cross sectional study. Setting: Medical wards and ICU at Peoples Medical College Hospital, Nawabshah. Period: September 2017 to March 2018. Material & Methods: All the patients of age 20 to 50 years having Paraphenylenediamine (PPD) poisoning (kala-patthar) during ≥6 hours after ingestion and either of gender were included. AKI was labelled as positive if either of any stage was present on the basses of urine output measurement for 24 hours through urine beg r urine output (UO) criteria. All the data was documented in self-made proforma. Results: The mean age for patients was 24.9±8.9 years, 46(19.08%) subjects were male and 195(80.91%) were female. 18(7.5%) study subjects had acute renal failure, out of them 6 study subjects had ARF of stage I, 5 patients had stage II and 7 study subjects had acute renal failure stage III. Conclusion: Acute renal injury is a common complication following PPD ingestion 7.5%. Paraphenylenediamine toxicity is a threat to the region of Asia and is evolving as a substitute to the poisoning of organophosphorus due to its easy accessibility and low cost.

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A teenager presenting with anuric acute renal failure and metabolic acidosis with a high anion gap: Questions

Pediatric Nephrology ◽

10.1007/s00467-020-04549-9 ◽

2020 ◽

Vol 35 (12) ◽

pp. 2253-2255

Author(s):

Çağla Serpil Doğan ◽

Gülşah Kaya Aksoy ◽

Kadir Aras Demircan ◽

Şenay Yıldırım

Keyword(s):

Renal Failure ◽

Acute Renal Failure ◽

Metabolic Acidosis ◽

Anion Gap

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Cardiopulmonary bypass management and acute renal failure: risk factors and prognosis

Perfusion ◽

10.1177/0267659109105251 ◽

2008 ◽

Vol 23 (6) ◽

pp. 323-327 ◽

Cited By ~ 43

Author(s):

E Sirvinskas ◽

J Andrejaitiene ◽

L Raliene ◽

L Nasvytis ◽

A Karbonskiene ◽

...

Keyword(s):

Risk Factors ◽

Renal Failure ◽

Acute Renal Failure ◽

Cardiac Surgery ◽

Cardiopulmonary Bypass ◽

Urine Output ◽

Perfusion Pressure ◽

Venous Pressure ◽

Lung Ventilation ◽

Early Postoperative Period

The aim of the study was to investigate if acute renal failure (ARF) following cardiac surgery is influenced by CPB perfusion pressure and to determine risk factors of ARF. Our research consisted of two studies. In the first study, 179 adult patients with normal preoperative renal function who had been subjected to cardiac surgery on CPB were randomized into three groups. The mean perfusion pressure (PP) during CPB in Group 65 (68 patients) was 60–69.9 mmHg, in Group 55 (59 patients) – lower than 60 mmHg and in Group 75 (52 patients) – 70 mmHg and higher. We have analyzed postoperative variables: central venous pressure, the need for diuretics, urine output, fluid balance, acidosis, potassium level in blood serum, the need for hemotransfusions, nephrological, cardiovascular and respiratory complications, duration of artificial lung ventilation, duration of stay in ICU and in hospital, and mortality. In the second study, to identify the risk factors for the development of ARF following CPB, we retrospectively analysed data of all 179 patients, divided into two groups: patients who developed ARF after surgery (group with ARF, n = 19) and patients without ARF (group without ARF, n = 160). We found that urine output during surgery was statistically significantly lower in Group 55 than in Groups 65 and 75. The incidence of ARF in the early postoperative period did not differ among the groups: it developed in 6% of all patients in Group 65, 4% in Group 55 and 6% in Group 75. There were no differences in the rate of other complications (cardiovascular, respiratory, neurological disorders, bleeding, etc) among the groups. There were 19 cases of ARF (10.6%), but none of these patients needed dialysis. We found that age (70.0 ± 7.51 vs. 63.5 ± 10.54 [standard deviation, SD], P = 0.016), valve replacement and/or reconstruction surgery (57.9% vs. 27.2%, P = 0,011), combined valve and CABG surgery (15.8% vs. 1.4%, P = 0.004), duration of CPB (134.74 ± 62.02 vs. 100.59 ± 43.99 min., P = 0.003) and duration of aortic cross-clamp (75.11 ± 35.78 vs. 53.45 ± 24.19 min., P = 0.001) were the most important independent risk factors for ARF. Cardiopulmonary bypass perfusion pressure did not cause postoperative renal failure. The age of patient, valve surgery procedures, duration of cardiopulmonary bypass and duration of aorta cross-clamp are potential causative factors for acute renal failure after cardiac surgery.

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Reduced abundance of aquaporins in rats with bilateral ischemia-induced acute renal failure: prevention by α-MSH

AJP Renal Physiology ◽

10.1152/ajprenal.1999.277.3.f413 ◽

1999 ◽

Vol 277 (3) ◽

pp. F413-F427 ◽

Cited By ~ 18

Author(s):

Tae-Hwan Kwon ◽

Jørgen Frøkiaer ◽

Patricia Fernández-Llama ◽

Mark A. Knepper ◽

Søren Nielsen

Keyword(s):

Renal Failure ◽

Acute Renal Failure ◽

Proximal Tubule ◽

Urine Output ◽

Collecting Duct ◽

Ischemia Reperfusion ◽

Free Water ◽

Ischemic Injury ◽

Urinary Concentration ◽

Similar Reduction

We examined the effect of temporary renal ischemia (30 min or 60 min) and reperfusion (1 day or 5 days) on the expression of renal aquaporins (AQPs) and urinary concentration in rats with bilateral ischemia-induced acute renal failure (ARF). Next, we tested whether reducing ischemia/reperfusion (I/R) injury by treatment with α-melanocyte stimulating hormone (α-MSH) affects the expression of AQPs and urine output. Rats with ARF showed significant renal insufficiency, and urinary concentration was markedly impaired. In rats with mild ischemic injury (30 min), urine output increased significantly to a maximum at 48 h, and then nearly normalized within 5 days. Consistent with this, semiquantitative immunoblotting revealed that kidney AQP1 and AQP2 abundance was significantly decreased after 24 h to 30 ± 5% and 40 ± 11% ( n = 8) of controls ( n = 9), respectively ( P < 0.05). Five days after ischemia, AQP2 abundance was not significantly decreased and urine output was normalized. In contrast, severe ischemic injury (60 min) resulted in a marked reduction in urine output at 24 h, despite a significant decrease in urine osmolality and solute-free water reabsorption, TcH2O. AQP1 and AQP2 abundance was markedly decreased to 51 ± 5% and 31 ± 9% ( n = 10) of controls ( n = 8) at 24 h ( P < 0.05). After 5 days, the rats developed gradually severe polyuria and had very low AQP2 and AQP1 levels [11 ± 4% and 6 ± 2% ( n = 5) of controls ( n = 8), respectively; P < 0.05]. A similar reduction was observed for AQP3. The reduction in AQP expression in the proximal tubule and inner medullary collecting duct was confirmed by immunocytochemistry. Next, we found that intravenous α-MSH treatment of rats with ARF significantly reduced the ischemia-induced downregulation of renal AQPs and reduced the polyuria. In conclusion, the I/R injury is associated with markedly reduced expression of the collecting duct and proximal tubule AQPs, in association with an impairment of urinary concentration. Moreover, α-MSH treatment significantly prevented the reduction in expression of AQPs and renal functional defects. Thus decreased AQP expression is likely to contribute to the impairment in urinary concentration in the postischemic period.

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Acute Renal Failure and Jaundice without Methemoglobinemia in a Patient with Phenazopyridine Overdose: Case Report and Review of the Literature

Case Reports in Nephrology ◽

10.1155/2014/845372 ◽

2014 ◽

Vol 2014 ◽

pp. 1-3

Author(s):

Ian Holmes ◽

Nathaniel Berman ◽

Vinicius Domingues

Keyword(s):

United States ◽

Renal Failure ◽

Renal Function ◽

Acute Renal Failure ◽

Case Report ◽

Hemolytic Anemia ◽

Normal Renal Function ◽

Urine Output ◽

The United States ◽

Review Of The Literature

Phenazopyridine is a commonly used urinary analgesic available throughout the United States. Ingestion of large quantities can lead to methemoglobinemia, hemolytic anemia, jaundice, and acute renal failure. We report a case of a 78-year-old male with previously normal renal function who developed acute renal failure and jaundice without methemoglobinemia or hyperbilirubinemia after taking nearly 8 g of phenazopyridine over the course of 4 days. Initially presenting with oliguria, the urine output began to increase by day 2 of his admission, and the creatinine peaked 11 days after he began taking phenazopyridine, and he was discharged safely soon after. To our knowledge, this is the first such case of renal failure and jaundice without methemoglobinemia or hemolytic anemia in an adult patient with normal renal function.

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Management of cardiac tamponade due to contrast nephropathy: A case report

Ukrainian Journal of Nephrology and Dialysis ◽

10.31450/ukrjnd.4(64).2019.02 ◽

2019 ◽

pp. 11-14

Author(s):

Nihat M Hokenek ◽

Mehmet O Erdogan ◽

Davut Tekyol ◽

Hakan Hançer ◽

Ergul A Kozan ◽

...

Keyword(s):

Renal Failure ◽

Acute Renal Failure ◽

Pericardial Effusion ◽

Cardiac Tamponade ◽

Urine Output ◽

Clinical Symptoms ◽

Vital Signs ◽

Contrast Nephropathy ◽

Volume Load ◽

Load Increase

Pericardial effusion secondary to contrast nephropathy is a very rare clinical condition. Patients have a volume load increase secondary to acute renal failure. In such a case, the progression of pericardial effusion with tamponade may follow a very rapid course contrary to what is believed. In this case, a 78-year-old male patient with diabetes mellitus and hypertension was admitted to the emergency department with complaints of decreased urine output, nausea, and vomiting. The patient was diagnosed with acute renal failure secondary to contrast nephropathy. Pericardial effusion amount was found to be 2 cm by thorax tomography. As the patient who had no urine output when his vital signs were stable became unstable during dialysis preparation and manifested clinical symptoms of cardiac tamponade, immediate pericardiocentesis was performed. Following that, he became stable and was transferred to the intensive care unit. In current guidelines regarding indications for pericardiocentesis, it is stated that drainage should be performed when the amount of effusion is more than 2 cm in the absence of tamponade, suspected bacterial infection or neoplastic etiology. However, in contrast to the standard approach to patients with acute renal failure, our suggestion is that the indications for pericardiocentesis may be broader in the presence of pericardial effusion.

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