MO408OBSTRUCTIVE NEPHROPATHY - STILL PREVALENT DISEASE

2021 ◽  
Vol 36 (Supplement_1) ◽  
Author(s):  
Ana Bulatovic ◽  
Verica Todorov Sakic ◽  
Petar Djuric ◽  
Jelena Bjedov ◽  
Aleksandar Jankovic ◽  
...  
Keyword(s):  
Chronic Kidney Disease ◽  
Logistic Regression ◽  
Kidney Disease ◽  
Kidney Injury ◽  
Complete Recovery ◽  
Urinary Obstruction ◽  
Hospital Treatment ◽  
Obstructive Nephropathy ◽  
Partial Recovery ◽  
Hemodialysis Treatment

Abstract Background and Aims Acute kidney injury (AKI) secondary to urinary obstruction is a common urological-nephrological problem. In this retrospective study, our goals were to describe the etiology, management and outcomes of patients with obstructive nephropathy who were hospitalized at Nephrology Department during 2019. Method AKI was defined by the RIFLE classification. Diagnosis of obstruction was defined by ultrasound imaging, intravenous pyelography and CT scan. Results During 2019 AKI secondary to urinary obstruction was diagnosed to 64 patients. 73% of them were male, average age 65 ± 16 years. About 60% of the patients had bilateral hydronephrosis, chronic kidney disease and anuria duration longer than 24h. The following desobstructive procedures were applied: urinary catheterization to 33 patients, percutaneous nephrostomy tube to 14 patients, double-J stent to 7 and other procedures to 10 patients. The most common causes of obstruction were malignancy and benign prostatic hyperplasia 60%, calculosis 17%, and other causes 20% such as neurogenic bladder and retroperitoneal fibrosis. As many as 30% of patients required acute hemodialysis treatment, of which 6% remained on a chronic program in period of three months. Out of all, 30% of patients had a partial recovery of kidney function, while 20% had complete recovery. The most common complication was infection and bleeding. The univariate logistic regression, adjusted for age and hemodialysis treatment, has shown that significant independent predictors for chronic kidney disease progression were anuria duration >24h (RR 2.21; 95% CI 0.014-1.03; p=0.05), polyuria duration (RR 2.11; 95% CI 1.112-3.98; p=0.02) and duration of hospital treatment (RR 9.16; 95% CI 2.102-39.94; p=0.03). The most significant predictor of death was duration of hospital treatment (RR 9.16; 95% CI 2.102-3.399; p=0.003). Multivariate logistic regression did not shown significance any of the above risk factors. Conclusion Given that third of patients with obstructive nephropathy require acute HD, 6% remain in chronic HD, and almost one third require rehospitalization, close cooperation between a nephrologist and urologist is required. Rapid desobstructive procedures and careful monitoring after desobstruction is warranted. Requirement of regular screening remains opened for obstruction in vulnerable populations.

MO408OBSTRUCTIVE NEPHROPATHY - STILL PREVALENT DISEASE

2021 ◽  
Vol 36 (Supplement_1) ◽  
Author(s):  
Ana Bulatovic ◽  
Verica Todorov Sakic ◽  
Petar Djuric ◽  
Jelena Bjedov ◽  
Aleksandar Jankovic ◽  
...  
Keyword(s):  
Chronic Kidney Disease ◽  
Logistic Regression ◽  
Kidney Disease ◽  
Kidney Injury ◽  
Complete Recovery ◽  
Urinary Obstruction ◽  
Hospital Treatment ◽  
Obstructive Nephropathy ◽  
Partial Recovery ◽  
Hemodialysis Treatment

Abstract Background and Aims Acute kidney injury (AKI) secondary to urinary obstruction is a common urological-nephrological problem. In this retrospective study, our goals were to describe the etiology, management and outcomes of patients with obstructive nephropathy who were hospitalized at Nephrology Department during 2019. Method AKI was defined by the RIFLE classification. Diagnosis of obstruction was defined by ultrasound imaging, intravenous pyelography and CT scan. Results During 2019 AKI secondary to urinary obstruction was diagnosed to 64 patients. 73% of them were male, average age 65 ± 16 years. About 60% of the patients had bilateral hydronephrosis, chronic kidney disease and anuria duration longer than 24h. The following desobstructive procedures were applied: urinary catheterization to 33 patients, percutaneous nephrostomy tube to 14 patients, double-J stent to 7 and other procedures to 10 patients. The most common causes of obstruction were malignancy and benign prostatic hyperplasia 60%, calculosis 17%, and other causes 20% such as neurogenic bladder and retroperitoneal fibrosis. As many as 30% of patients required acute hemodialysis treatment, of which 6% remained on a chronic program in period of three months. Out of all, 30% of patients had a partial recovery of kidney function, while 20% had complete recovery. The most common complication was infection and bleeding. The univariate logistic regression, adjusted for age and hemodialysis treatment, has shown that significant independent predictors for chronic kidney disease progression were anuria duration >24h (RR 2.21; 95% CI 0.014-1.03; p=0.05), polyuria duration (RR 2.11; 95% CI 1.112-3.98; p=0.02) and duration of hospital treatment (RR 9.16; 95% CI 2.102-39.94; p=0.03). The most significant predictor of death was duration of hospital treatment (RR 9.16; 95% CI 2.102-3.399; p=0.003). Multivariate logistic regression did not shown significance any of the above risk factors. Conclusion Given that third of patients with obstructive nephropathy require acute HD, 6% remain in chronic HD, and almost one third require rehospitalization, close cooperation between a nephrologist and urologist is required. Rapid desobstructive procedures and careful monitoring after desobstruction is warranted. Requirement of regular screening remains opened for obstruction in vulnerable populations.

scholarly journals Nonsteroidal Anti-Inflammatory Drugs (NSAIDS) Induced Acute Kidney Injury (AKI): Patient Profile and Outcome in Bangladesh Armed Forces

2015 ◽  
Vol 10 (2) ◽  
pp. 39-43
Author(s):  
Azizun Nessa ◽  
Md Amzad H Fakir
Keyword(s):  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Kidney Injury ◽  
Physical Exertion ◽  
Armed Forces ◽  
Complete Recovery ◽  
The Body ◽  
Military Hospital ◽  
Fluid Restriction ◽  
Patient Profile

Introduction: In military environment where musculoskeletal injury is more common, NSAIDs abuse and subsequent AKI carries a special risk. This study of NSAIDs induced AKI was carried out to highlight this issue.Objective: To find out the incidence, risk factors, diagnostic approach, clinical course, management and outcome of patients of Bangladesh Armed Forces.Methods: This longitudinal study was carried out in nephrology centre, combined military hospital (CMH) Dhaka from July 2010 to Jun 2013. Total 59 patients of NSAIDs induced AKI were included in this study. Any patient having pre existing renal pathology or chronic kidney disease was excluded from the study.Results: Total 59 patients were included in this study. Mean age of the patient was 36±7.12 yrs. Forty five patients (76.27%) took NSAIDs at their own and 14 patients (23.73%) were prescribed by physician. Fifty one patients (86.44%) took NSAIDs because of musculoskeletal pain. Dehydration due to physical exertion (30.50%), gastroenteritis (15.25%) and nil per os (NPO) (5.08%) were the common predisposing factors. Common symptoms were swelling of the body (40.67%), headache (32.20%), fatigue (27.11%) and vomiting (13.55%). Oedema was the most common sign (40.67%). Blood urea and serum creatinine were raised in all patients. Treatment includes drug withdrawl (100%), fluid resuscitation (86.44%), fluid restriction (61.01%), short course of steroid (13.55%) and haemodialysis (10.16%). Forty seven patients (79.66%) had complete recovery within two weeks of therapy whereas nine patients (15.25%) required more than two weeks to one month for complete recovery. Three patients (5.09%) developed chronic kidney disease (CKD).Conclusion: NSAIDs induced AKI carries a good prognosis with early diagnosis and proper management and it can be prevented by limiting the availability of over the counter drugs and creating awareness both in physicians and patients.Journal of Armed Forces Medical College Bangladesh Vol.10(2) 2014

Impact of Direct Acting Antiviral Agents on kidney function in Hepatitis C Virus infected patients with chronic kidney disease

QJM ◽  
2021 ◽  
Vol 114 (Supplement_1) ◽  
Author(s):  
Iman I Sarhan ◽  
Osama M Mohamed ◽  
Hayam A Hebah ◽  
Ossama A Ahmed ◽  
Lina E Khedr ◽  
...  
Keyword(s):  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Adverse Events ◽  
Kidney Function ◽  
Antiviral Agents ◽  
Kidney Injury ◽  
Complete Recovery ◽  
Study Groups ◽  
Serious Adverse Events ◽  
Direct Acting Antiviral

Abstract Introduction Despite the significant link between HCV and CKD progression, most of the patients with CKD infected with HCV remain untreated, because they have historically been difficult to treat due to common adverse effects associated with interferon (IFN), ribavirin, and first generation protease inhibitors. Recently, there have been major advancements in the treatment of HCV with the development of new directacting antivirals (DAAs). Objectives To evaluate the safety and efficacy of DAAs and their impact on kidney function in CKD patients. Patients and Methods We conducted a prospective observational study on 100 CKD patients stages 3-4, receiving treatment for HCV at MASRI (faculty of Medicine Ain Shams University Research Institute), with two different DAAs regimens, completed over six months follow up. Kidney function was followed during and after treatment. Results Sustained virological response (SVR) was achieved in all patients. AKI (acute kidney injury) was uncommon; it occurred in three (3%) patients, out of them, two patients showed complete recovery. Adverse events were common (43%), but serious adverse events were uncommon (2%).Improvement of eGFR (8-15 ml/min/1.73 m2) and proteinuria was found in both study groups. Conclusion DAAs were effective and welltolerated for HCV infected patients with stage 3-4 chronic kidney disease, where viral clearance caused improvement in eGFR and proteinuria.

scholarly journals Kidney disease and all-cause mortality in patients with COVID-19 hospitalized in Genoa, Northern Italy

2020 ◽  
Author(s):  
Elisa Russo ◽  
◽  
Pasquale Esposito ◽  
Lucia Taramasso ◽  
Laura Magnasco ◽  
...  
Keyword(s):  
Chronic Kidney Disease ◽  
Acute Kidney Injury ◽  
Kidney Disease ◽  
Vital Signs ◽  
Kidney Injury ◽  
Hospital Treatment ◽  
Risk Of Death ◽  
Laboratory Test Results ◽  
Increased Risk ◽  
Kidney Involvement

Abstract Background The prevalence of kidney involvement during SARS-CoV-2 infection has been reported to be high. Nevertheless, data are lacking about the determinants of acute kidney injury (AKI) and the combined effect of chronic kidney disease (CKD) and AKI in COVID-19 patients. Methods We collected data on patient demographics, comorbidities, chronic medications, vital signs, baseline laboratory test results and in-hospital treatment in patients with COVID-19 consecutively admitted to our Institution. Chronic kidney disease was defined as eGFR < 60 mL/min per 1.73 m2 or proteinuria at urinalysis within 180 days prior to hospital admission. AKI was defined according to KDIGO criteria. The primary and secondary outcomes were the development of AKI and death. Results Of 777 patients eligible for the study, acute kidney injury developed in 176 (22.6%). Of these, 79 (45%) showed an acute worsening of a preexisting CKD, and 21 (12%) required kidney replacement therapy. Independent associates of AKI were chronic kidney disease, C-reactive protein (CRP) and ventilation support. Among patients with acute kidney injury, 111 died (63%) and its occurrence increased the risk of death by 60% (HR 1.60 [95% IC 1.21–2.49] p = 0.002) independently of potential confounding factors including hypertension, preexisting kidney damage, and comorbidities. Patients with AKI showed a significantly higher rate of deaths attributed to bleeding compared to CKD and the whole population (7.5 vs 1.5 vs 3.5%, respectively). Conclusion Awareness of kidney function, both preexisting CKD and development of acute kidney injury, may help to identify those patients at increased risk of death.

scholarly journals Non-steroidal anti-inflammatory drugs induced acute kidney injury: incidence, clinical presentation, management and outcomes of patients at Tertiary Hospital based longitudinal study in Mymensingh, Bangladesh

2018 ◽  
Vol 7 (2) ◽  
pp. 9-16
Author(s):  
Shamima Sattar ◽  
Mahmud Javed Hasan ◽  
Nitai Chandra Ray ◽  
ASM Ruhul Quddus
Keyword(s):  
Chronic Kidney Disease ◽  
Acute Kidney Injury ◽  
Longitudinal Study ◽  
Kidney Disease ◽  
Renal Injury ◽  
Kidney Injury ◽  
Complete Recovery ◽  
Injury Incidence ◽  
Inflammatory Drugs ◽  
Anti Inflammatory

Non-steroidal anti-inflammatory drugs (NSAIDs) are commonly prescribed in primary care for their analgesic and anti-inflammatory effects. Twelve percent of individuals currently report taking a NSAID daily. Renal injury caused by these agents can present in various forms, resulting from either acute or chronic use. Historically approximately five percent of patients initiated on NSAIDs experience a kidney-related adverse event. Drug-induced renal injury accounts for twenty percent of episodes of acute kidney injury (AKI). Patients requiring renal replacement therapy (RRT) have experienced an increased length of stay with associated healthcare costs per incident. The adverse effects of NSAIDs contribute to a significant economic burden, both to the patient and to the healthcare system.This study of NSAIDs induced AKI was carried out to highlight this issue. To find out the incidence, risk factors, diagnostic approach, clinical course, management and outcome of patients, this longitudinal study was carried out at Nephrology Department in Community Based Medical College Hospital Bangladesh from July 2015 to June 2016.Total 65 patients of NSAIDs induced AKI were included in this study. Any patient having pre existing renal pathology or chronic kidney disease was excluded from the study. Mean age of the patient was 36±7.12 yrs. Forty nine patients (74.38%) took NSAIDs at their own and 16 patients (24.61%) were prescribed by physician. Fifty six patients (86.15%) took NSAIDs because of musculoskeletal pain. Dehydration due to physical exertion (29.23%) gastroenteritis (16.92%) and nil per os (NPO) (6.15%)were the common predisposing factors. Common symptoms were swelling of the body (36.9%) headache (26.15%) fatigue (21.53%) and vomiting (13.84%) Oedema was the most common sign (36.9%) Blood urea and serum creatinine were raised in all patients. Treatment includes drug withdrawal (100%), fluid resuscitation (83.07%) fluid restriction (13.85%) short course of steroid (15.38%) and haemodialysis (10.76%) . Fifty one patients (78.46%) had complete recovery within two weeks of therapy whereas ten patients (15.38%) required more than two weeks to one month for complete recovery. Three patients (4.61%) developed chronic kidney disease (CKD). NSAIDs induced AKI carries a good prognosis with early diagnosis and proper management and it can be prevented by limiting the availability of over the counter drugs and creating awareness both in physicians and patients. These medications should be prescribed for the shortest duration, the lowest effective dose, and with careful surveillance to monitor nephrotoxicity precisely. NSAIDs should be used with special caution in elderly patients. CBMJ 2018 July: Vol. 07 No. 02 P: 09-16

scholarly journals Postoperative acute kidney injury in adult non-cardiac surgery: joint consensus report of the Acute Disease Quality Initiative and PeriOperative Quality Initiative

2021 ◽  
Author(s):  
John R. Prowle ◽  
Lui G. Forni ◽  
Max Bell ◽  
Michelle S. Chew ◽  
Mark Edwards ◽  
...  
Keyword(s):  
Chronic Kidney Disease ◽  
Acute Kidney Injury ◽  
Cardiac Surgery ◽  
Kidney Disease ◽  
Kidney Injury ◽  
Adverse Outcomes ◽  
Baseline Risk ◽  
Major Surgery ◽  
Increased Risk

AbstractPostoperative acute kidney injury (PO-AKI) is a common complication of major surgery that is strongly associated with short-term surgical complications and long-term adverse outcomes, including increased risk of chronic kidney disease, cardiovascular events and death. Risk factors for PO-AKI include older age and comorbid diseases such as chronic kidney disease and diabetes mellitus. PO-AKI is best defined as AKI occurring within 7 days of an operative intervention using the Kidney Disease Improving Global Outcomes (KDIGO) definition of AKI; however, additional prognostic information may be gained from detailed clinical assessment and other diagnostic investigations in the form of a focused kidney health assessment (KHA). Prevention of PO-AKI is largely based on identification of high baseline risk, monitoring and reduction of nephrotoxic insults, whereas treatment involves the application of a bundle of interventions to avoid secondary kidney injury and mitigate the severity of AKI. As PO-AKI is strongly associated with long-term adverse outcomes, some form of follow-up KHA is essential; however, the form and location of this will be dictated by the nature and severity of the AKI. In this Consensus Statement, we provide graded recommendations for AKI after non-cardiac surgery and highlight priorities for future research.

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