MO302ACUTE POST-INFECTIOUS GLOMERULONEPHRITIS IN ADULTS: A TUNISIAN SINGLE CENTER EXPERIENCE

2021 ◽  
Vol 36 (Supplement_1) ◽  
Author(s):  
Imen El Meknassi ◽  
Mrabet Sanda ◽  
Guedri Yosra ◽  
Zellema Dorsaf ◽  
Azzabi Awatef ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Kidney Injury ◽  
Acute Glomerulonephritis ◽  
Industrialized Countries ◽  
Single Center Experience ◽  
Nephritic Syndrome ◽  
Stage Renal Disease ◽  
End Stage ◽  
Post Infectious

Abstract Background and Aims Acute post-infectious glomerulonephritis (APIGN) is a reactive immunological disease. Its prevalence in industrialized countries is declining contrasting with developed ones. It is uncommon in adults but the prognosis may be reserved. The aim of our study was to evaluate the epidemiological, clinical and histological features of APIGN as well as its prognosis. Method A retrospective and descriptive study was conducted in our department. Were included all cases of histologically proven APIGN between December 2006 and December 2017. Results We had collected 38 cases. The mean age was 37.7 ± 17.8 years. The sex ratio was 1.92. Twelve (31.6%) patients were diabetic and four of them had already a chronic kidney disease (CKD). APIGN was preceded by an infection in 27 cases with an average interval of 10 ± 5 days. The most common site of infection was the respiratory tract (15 cases). At presentation, 27 patients had nephritic syndrome and 13 had nephrotic-range proteinuria. Hematuria was observed in 97.4%, peripheral edema in 84.2% and hypertension in 73.7% of cases. Most patients (78.9%) had acute kidney injury and 10 (26.3%) patients required dialysis. Renal biopsy had shown benign acute glomerulonephritis in 31 cases and malignant form in 7 cases. An underlying nephropathy was found in 12 cases with mostly a diabetic nephropathy. Corticosteroids were used in 3 cases of benign APIGN and 5 cases of malignant form. During the follow-up, CKD was noted in 14(36.8%) patients including 7(18.4%) patients who progressed to end-stage renal disease. Poor prognostic factors were diabetes, the presence of an underlying nephropathy in the biopsy, acute kidney injury and the need for dialysis. Conclusion The APIGN is uncommon in adults, yet its prognosis may be reserved with progression to CKD.

scholarly journals Urinary actin, as a potential marker of sepsis-related acute kidney injury: A pilot study

PLoS ONE ◽  
2021 ◽  
Vol 16 (7) ◽  
pp. e0255266
Author(s):  
Dániel Ragán ◽  
Péter Kustán ◽  
Zoltán Horváth-Szalai ◽  
Balázs Szirmay ◽  
Beáta Bugyi ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Kidney Injury ◽  
Major Complication ◽  
Multiple Organ ◽  
Potential Marker ◽  
Blood And Urine Samples ◽  
Stage Renal Disease ◽  
End Stage ◽  
And Control

Introduction A major complication of sepsis is the development of acute kidney injury (AKI). Recently, it was shown that intracellular actin released from damaged tissues appears in the urine of patients with multiple organ dysfunction syndrome. Our aims were to measure urinary actin (u-actin) concentrations of septic and control patients and to test if u-actin levels could predict AKI and mortality. Methods Blood and urine samples were collected from septic and sepsis-related AKI patients at three time points (T1-3): T1: within 24 hours after admission; T2: second day morning; T3: third day morning of follow-up. Patients with malignancies needing palliative care, end-stage renal disease or kidney transplantation were excluded. Serum and u-actin levels were determined by quantitative Western blot. Patients were categorized by the Sepsis-3 and KDIGO AKI classifications. Results In our study, 17 septic, 43 sepsis-induced AKI and 24 control patients were enrolled. U-actin levels were higher in septic patients compared with controls during follow-up (p<0.001). At T1, the septic and sepsis-related AKI groups also showed differences (p<0.001), yet this increase was not statistically significant at T2 and T3. We also detected significantly elevated u-actin concentrations in AKI-2 and AKI-3 septic patients compared with AKI-1 septic patients (p<0.05) at T1 and T3, along with a significant increase in AKI-2 septic patients compared with AKI-1 septic patients at T2 (p<0.01). This tendency remained the same when referring u-actin to urine creatinine. Parameters of first-day septic patient samples could discriminate AKI from non-AKI state (AUC ROC, p<0.001): u-actin: 0.876; se-creatinine: 0.875. Derived cut-off value for u-actin was 2.63 μg/L (sensitivity: 86.0%, specificity: 82.4%). Conclusion U-actin may be a complementary diagnostic biomarker to se-creatinine in sepsis-related AKI while higher u-actin levels also seem to reflect the severity of AKI. Further investigations may elucidate the importance of u-actin release in sepsis-related AKI.

scholarly journals Specific impact of past and new major cardiovascular events on acute kidney injury and end-stage renal disease risks in diabetes: a dynamic view

2019 ◽  
Vol 13 (1) ◽  
pp. 17-23
Author(s):  
Cédric Pinier ◽  
Philippe Gatault ◽  
Laurent Fauchier ◽  
Denis Angoulvant ◽  
Maud François ◽  
...  
Keyword(s):  
Risk Factors ◽  
Acute Kidney Injury ◽  
End Stage Renal Disease ◽  
Cardiovascular Events ◽  
Kidney Injury ◽  
Major Cardiovascular Events ◽  
Stage Renal Disease ◽  
End Stage ◽  
Specific Impact

Abstract Background Interconnections between major cardiovascular events (MCVEs) and renal events are recognized in diabetes, however, the specific impact of atrial fibrillation (AF), heart failure (HF) and acute coronary syndrome (ACS) on the risk of end-stage renal disease (ESRD) on top of established renal risk factors is unclear in type 2 diabetes mellitus. Methods We conducted a retrospective study in 861 consecutive patients followed in a nephrology setting during the 2000–13 period. Results The mean age was 70 ± 10 years, 65.1% were men and the estimated glomerular filtration rate (eGFR) was 42.4 ± 21.0 mL/min/1.73 m2. During follow-up (median 59 months), 194 patients reached ESRD. A history of AF, HF or ACS was associated with an increased risk of reduced baseline eGFR. In turn, reduced baseline eGFR resulted in a greater risk of new MCVE (especially HF) during follow-up. Finally, all new MCVEs were risk factors for subsequent acute kidney injury (AKI) {HF: hazard ratio [HR] 8.99 [95% confidence interval (CI) 7.06–11.4]; AF: HR 5.42 (3.91–7.52); ACS: HR 8.82 (6.24–12.5); all P &lt; 0.0001} and ESRD [HF: HR 5.52 (95% CI 4.01–7.60), P &lt; 0.0001; AF: HR 3.48 (2.30–5.21), P &lt; 0.0001; ACS: HR 2.31 (1.43–3.73), P = 0.0006]. The AF- and HF-associated risks of ESRD were significant after adjustments on all renal risks of ESRD (gender, blood pressure, eGFR, albuminuria, renin–angiotensin blockers, retinopathy and AKI), but the association was less strong for ACS. Importantly, no association was noted between other major events such as stroke or infections and the risk of ESRD. Conclusions Past and new cardiovascular events (more HF and AF than ACS) have a strong, independent impact on the development of ESRD above and beyond established risk factors in diabetes.

scholarly journals Outcomes of acute kidney injury in children at Muhammad Husin Hospital, Palembang

2014 ◽  
Vol 54 (5) ◽  
pp. 266
Author(s):  
Hertanti Lndah Lestari ◽  
Dahler Bahrun ◽  
Eka Lntan Fitriana
Keyword(s):  
Acute Kidney Injury ◽  
Kidney Injury ◽  
Acute Glomerulonephritis ◽  
Chi Square ◽  
Younger Age ◽  
Common Etiology ◽  
The Common ◽  
Stage Renal Disease ◽  
End Stage ◽  
Renal Origin

Background Acute kidney injury (AKI) is a common problemin hospitalized pediatric patients, with effects on morbidity andmortality.Objectives To assess for the incidence and common etiologies ofAKI, as well as to review factors that affect patient outcomes atMuhammad Husin Hospital, Palembang.Methods We reviewed data from our nephrology registry fromJanuary 2010 to June 2013. Independent variables were age, stageand etiology of AKI, requirement of renal replacement therapy(RRT) , and PICU admission. The dependent variable was patientoutcomes, categorized as survived or died. Association betweenclinical data and outcomes were analyzed by Chi-square test.Results The incidence of AKI was 28.3%. Using the pediatric risk,injury, failure, loss, end stage renal disease (pRIFLE) criteria, 65(36.7%) patients were in the risk stage, 56 (31.6%) in the injurystage, and 56 (31.6%) in the failure stage. Twelve (6.8%) patientsrequired RRT and 29 (16.4%) patients were admitted to the PIW.The mortality rate from AKI was 20.9%. The common etiologies ofAKI were acute glomerulonephritis (55 subjects; 31.1 % ), multipleorgan dysfunction (24 subjects; 13.6%), dehydration (23 subjects;13.0%), hypoalbuminemia (20 subjects; 11.3%), heart failure (11subjects; 6.2%) and nephrotoxic agents (12 subjects; 6.8%) . Themortality rate was significantly higher in children of younger age(<5 years) (P=0.0001), in the failure stage of AKI (P=0.014),with non-renal origin of illness (P=0.0001) and those with anindication for PIW admission (P=0.0001).Conclusion AKI is found in one-third of nephrology patients.The most common etiology of AKI is acute glomerulonephritis.One-fifth of patients with AKI do not survive. Recognition ofriskfactors and detection of AKI in early stages might improve patientoutcomes.

scholarly journals A study of factors determining outcome of acute kidney injury patients requiring hemodialysis

2018 ◽  
Vol 6 (9) ◽  
pp. 2974
Author(s):  
Vasanth G. ◽  
Surendrakumar P. ◽  
Catherine P. ◽  
Venu G.
Keyword(s):  
Acute Kidney Injury ◽  
High Mortality ◽  
Hepatorenal Syndrome ◽  
Kidney Injury ◽  
Demographic Variables ◽  
Acute Glomerulonephritis ◽  
Severe Renal Failure ◽  
One Year ◽  
Stage Renal Disease ◽  
End Stage

Background: High mortality rate in acute kidney injury (AKI) has interested many authors to conduct studies about factors predicting its outcome. The need for both dialysis and ICU care defines a group of critically ill patients who may have poor prognosis and consume vast amounts of resources. In this study we determine the variables predicting the outcome of patients with severe acute kidney failure requiring haemodialysis and to ascertain the aetiology of acute kidney injury in this group.Methods: We prospectively analysed 114 patients admitted with severe renal failure requiring renal replacement therapy over a period of one year. The influence of various factors such as demographic variables, pre morbidities, details of admission, clinical presentation and extent of organ dysfunction on the clinical outcome such as mortality and progression to end stage kidney disease were statistically analyzed using SPSS version 12 (SPSS Inc., Chicago, Ill).Results: Univariate and multivariate analysis showed that parameters such as chronic liver disease, preexisting heart disease, mechanical ventilation and vasopressor requirement, oliguria, sepsis, hepatorenal syndrome, cardiogenic shock and admission in ICU were associated with high mortality (p<0.05). Of the 114 patients, 49 died (42.98%), 61 (53.5%) were dialysis independent and 4 patients (3.5%) progressed to end stage renal disease (ESRD).Conclusions: AKI patients requiring hemodialysis were associated with high hospital mortality.  Patients who were diagnosed to have acute glomerulonephritis especially rapidly progressing glomerulonephritis as the cause of AKI were more prone to ESRD. Most survivors were dialysis independent at the time of discharge.

scholarly journals Quantification and Dosing of Renal Replacement Therapy in Acute Kidney Injury: A Reappraisal

2017 ◽  
Vol 44 (2) ◽  
pp. 140-155 ◽  
Author(s):  
William R. Clark ◽  
Martine Leblanc ◽  
Zaccaria Ricci ◽  
Claudio Ronco
Keyword(s):  
Acute Kidney Injury ◽  
Renal Replacement Therapy ◽  
Replacement Therapy ◽  
Journal Club ◽  
Kidney Injury ◽  
Accurate Estimation ◽  
Stage Renal Disease ◽  
End Stage ◽  
Dose Assessments ◽  
Solute Clearance

Background/Aims: Delivered dialysis therapy is routinely measured in the management of patients with end-stage renal disease; yet, the quantification of renal replacement prescription and delivery in acute kidney injury (AKI) is less established. While continuous renal replacement therapy (CRRT) is widely understood to have greater solute clearance capabilities relative to intermittent therapies, neither urea nor any other solute is specifically employed for CRRT dose assessments in clinical practice at present. Instead, the normalized effluent rate is the gold standard for CRRT dosing, although this parameter does not provide an accurate estimation of actual solute clearance for different modalities. Methods: Because this situation has created confusion among clinicians, we reappraise dose prescription and delivery for CRRT. Results: A critical review of RRT quantification in AKI is provided. Conclusion: We propose an adaptation of a maintenance dialysis parameter (standard Kt/V) as a benchmark to supplement effluent-based dosing of CRRT. Video Journal Club “Cappuccino with Claudio Ronco” at http://www.karger.com/?doi=475457

Acute Kidney Injury and Renal Replacement Therapy

2020 ◽  
Author(s):  
Karen L. Krechmery ◽  
Diego Casali
Keyword(s):  
Acute Kidney Injury ◽  
Renal Replacement Therapy ◽  
Replacement Therapy ◽  
End Stage Renal Disease ◽  
Kidney Injury ◽  
Treatment Modalities ◽  
Optimal Timing ◽  
Timing Of Initiation ◽  
Stage Renal Disease ◽  
End Stage

Acute kidney injury (AKI) is a common syndrome encountered in critical illness and is associated with significant morbidity and increased mortality. Despite attempts to prevent the development of AKI, its incidence continues to rise, probably due to increased recognition in the setting of clearer definitions of the stages of AKI. Despite advances in the field of Nephrology, the treatment of AKI and its complications remains difficult in clinical practice. Critical care clinicians must have an understanding of the current definitions, pathophysiology, and treatment modalities. Renal replacement therapy (RRT) is a mainstay of treatment, but a lack of consensus regarding the optimal timing for initiation remains. There is a need for further research regarding both the timing of initiation of RRT and biomarkers that might allow earlier detection, differentiation of etiologies and monitoring of interventions. This review contains 3 figures, 4 tables, and 31 references Key Words: acute kidney injury (AKI), KDIGO, renal replacement therapy (RRT), risk, injury, failure, loss of kidney function, end stage renal disease (RIFLE), nephrology  

Acute Kidney Injury

2020 ◽  
Author(s):  
Aileen Ebadat ◽  
Eric Bui ◽  
Carlos V. R. Brown
Keyword(s):  
Acute Kidney Injury ◽  
Renal Failure ◽  
Kidney Injury ◽  
Acute Kidney Injury Network ◽  
Loss Of Function ◽  
Management Algorithm ◽  
Consensus Statements ◽  
Definition Of ◽  
Stage Renal Disease ◽  
End Stage

Acute renal failure definitions have changed dramatically over the last 5 to 10 years as a result of criteria established through the following consensus statements/organizations: RIFLE (Risk, Injury, Failure, Loss of function, End stage renal disease), AKIN (Acute Kidney Injury Network), and KDIGO (Kidney Disease: Improving Global Outcomes). In 2002, the Acute Dialysis Quality Initiative was tasked with the goal of establishing a consensus statement for acute kidney injury (AKI). The first order of business was to provide a standard definition of AKI. Up to this point, literature comparison was challenging as studies lacked uniformity in renal injury definitions. Implementing results into evidence-based clinical practice was difficult. The panel coined the term “acute kidney injury,” encompassing previous terms, such as renal failure and acute tubular necrosis. This new terminology represented a broad range of renal insults, from dehydration to those requiring renal replacement therapy (RRT). This review provides an algorithmic approach to the epidemiology, pathophysiology, diagnosis, prevention, and management of AKI. Also discussed are special circumstances, including rhabdomyolysis, contrast-induced nephropathy, and hepatorenal syndrome. Tables outline the AKIN criteria, most current KDIGO consensus guidelines for definition of AKI, differential diagnosis of AKI, agents capable of causing AKI, treatment for specific complications associated with AKI, and options for continuous RRT. Figures show the RIFLE classification scheme and KDIGO staging with prevention strategies. This review contains 1 management algorithm, 2 figures, 6 tables, and 85 references. Keywords: Kidney, renal, KDIGO, azotemia, critical, urine, oliguria, creatinine, dialysis

Renal medicine

2021 ◽  
pp. 353-382
Author(s):  
Gopesh K. Modi ◽  
Vivekanand Jha
Keyword(s):  
Kidney Disease ◽  
Renal Disease ◽  
Rapidly Progressive Glomerulonephritis ◽  
Kidney Injury ◽  
Renal Stones ◽  
Renal Diseases ◽  
Acute Glomerulonephritis ◽  
Glomerular Diseases ◽  
Stage Renal Disease ◽  
End Stage

Assessing renal function, Urinalysis, Proteinuria, Hematuria, Chyluria, Imaging in renal disease, Kidney biopsy, Acute Kidney Injury (AKI), Chronic Kidney Disease (CKD), Diabetic Nephropathy, End Stage Renal Disease and Dialysis, Kidney Transplantation, Glomerular diseases, Acute glomerulonephritis, Urinary schistosomiasis (bilharzia), Infections and Kidney Disease, Rapidly Progressive glomerulonephritis, Tubulointerstitial Disease, Urinary Tract Infection, Vesico-ureteric reflux, Renal Stones, Renal Disease in Pregnancy, Renal Artery Stenosis, Renal Mass, Inherited Renal Diseases

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