SuO035DESCRIPTION OF THE NATURAL HISTORY OF PROTEINURIA FOLLOWING ACUTE KIDNEY INJURY

e18816 Background: Acute Kidney Injury (AKI) in patients with COVID-19 infection is associated with poor clinical outcomes. We examined outcomes (hemodialysis, mechanical ventilation, ICU admission and death) in cancer patients with normal estimated glomerular filtration rate (eGFR) treated in a tertiary referral center with COVID-19 infection, who developed AKI within 30 days of diagnosis. Methods: All patient data — demographics, labs, comorbidities and outcomes — were aggregated and analyzed in the Syntropy platform, Palantir Foundry (“Foundry”), as part of the Data-Driven Determinants of COVID-19 Oncology Discovery Effort (D3CODE) protocol at MD Anderson. The cohort was defined by the following: (1) positive COVID-19 test; (2) baseline eGFR >60 ml/min/1.73m2most temporally proximal lab results within 30 days prior to the patient’s infection. AKI was defined by an absolute change of creatinine ≥0.3 within 30 days after the positive COVID-19 test. Kaplan-Meier analysis was used for survival estimates at specific time periods and multivariate Cox Proportional cause-specific Hazard model regression to determine hazard ratios with 95% confidence intervals for major outcomes. Results: 635 patients with Covid-19 infection had a baseline eGFR >60 ml/min/1.73m2. Of these patients, 124 (19.5%) developed AKI. Patients with AKI were older, mean age of 61+/-13.2 vs 56.9+/- 14.3 years (p=0.002) and more Hypertensive (69.4% vs 56.4%, p=0.011). AKI patients were more likely to have pneumonia (63.7% vs 37%, p<0.001), cardiac arrhythmias (39.5% vs 20.7%, p<0.001) and myocardial infarction (15.3% vs 8.8%, p=0.046). These patients had more hematologic malignancies (35.1% vs 19%, p=0.005), with no difference between non metastatic vs metastatic disease (p=0.284). There was no significant difference in other comorbidities including smoking, diabetes, hypothyroidism and liver disease. AKI patients were more likely to require dialysis (2.4% vs 0.2%, p=0.025), mechanical ventilation (16.1% vs 1.8%, p<0.001), ICU admission (43.5% vs 11.5%, p<0.001) within 30 days, and had a higher mortality at 90 days of admission (20.2% vs 3.7%, p<0.001). Multivariate Cox Proportional cause-specific Hazard model regression analysis identified history of Diabetes Mellitus (HR 10.8, CI 2.42 - 48.4, p=0.001) as an independent risk factor associated with worse outcomes. Mortality was higher in patients with COVID-19 infection that developed AKI compared with those who did not developed AKI (survival estimate 150 days vs 240 days, p=0.0076). Conclusions: In cancer patients treated at a tertiary cancer center with COVID-19 infection and no history of CKD, the presence of AKI is associated with worse outcomes including higher 90 day mortality, ICU stay and mechanical ventilation. Older age and hypertension are major risk factors, where being diabetic was associated with worse clinical outcomes.

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Acute kidney injury as initial presentation of renal lymphoma: Diagnostic and therapeutic challenges in a resource-limited setting

SAGE Open Medical Case Reports ◽

10.1177/2050313x19845251 ◽

2019 ◽

Vol 7 ◽

pp. 2050313X1984525 ◽

Cited By ~ 1

Author(s):

Jeannine Anyingu Aminde ◽

Nkweta Eugene Adze ◽

Guisilla Ankwatia Dedino ◽

Leopold Ndemnge Aminde

Keyword(s):

Acute Kidney Injury ◽

State Of The Art ◽

Renal Involvement ◽

Kidney Injury ◽

Abdominal Distension ◽

Lymphoma Patient ◽

Limited Data ◽

Resource Limited ◽

History Of ◽

Limited Setting

Non-Hodgkin’s lymphoma is reportedly common in Africa; however, there is limited data on renal involvement. Acute kidney injury only at presentation is rare for lymphoproliferative malignancies. A 7-year old presented to our facility with a 2-week history of progressive abdominal distension and pain, examination revealed anasarca and hypertension. On further evaluation, there were bilateral nephromegaly, acute kidney injury (AKI) and cytomorphological findings suggestive of lymphoma. Patient management was mostly supportive, and evolution was unfavourable leading to his demise. We discuss diagnostic and therapeutic challenges due to unavailability of state-of-the-art facilities in resource-constrained settings.

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P0646PREDICTABLE CAPACITY OF ACUTE KIDNEY INJURY OF NEPHROCHECK TEST IN EMERGENCY ROOM PATIENTS

Nephrology Dialysis Transplantation ◽

10.1093/ndt/gfaa142.p0646 ◽

2020 ◽

Vol 35 (Supplement_3) ◽

Author(s):

Elena Gomá ◽

Guillermo Gonzalez-Martin ◽

Juan Alfredo López-López ◽

Maria Vanessa Perez Gomez ◽

Alberto Ortiz ◽

...

Keyword(s):

Acute Kidney Injury ◽

High Risk ◽

Emergency Room ◽

Past History ◽

Kidney Injury ◽

Urine Osmolality ◽

Mortality Prediction ◽

Emergency Room Patients ◽

History Of ◽

Heat Failure

Abstract Background and Aims Acute kidney injury (AKI) is increasingly prevalent and it is associated to increased hospital stay and costs, higher risk of developing a chronic kidney disease, and also major morbidity and mortality. Prediction tools may identify patients at high risk of AKI, allowing early intervention. Nephrocheck quantifies biomarkers of AKI (TIMP-2 and IGFBP-7), providing results within 20 minutes. This may allow stratification of the risk of developing an AKI in the next 12 hours in critically cardiovascular or respiratory ill patients and therefore implement preventive measures. We aimed to assess Nephrocheck performance to predict AKI development within 12 hours to 5 days in incident Emergency Room (ER) patients. Method Prospective observational study of 52 incident ER patients. Data were collected from April 2017 to November 2018. Inclusion criteria: sepsis of any origin, or cardiopulmonary insufficiency without AKI at baseline. Nephrochek was performed at baseline, patients were stratified into low (Nephrocheck test < 0.3), moderate (Nephrocheck between 0.3-2) and high risk (Nephrocheck >2) of AKI and occurrence of AKI was assessed (diagnosed as an increase of 0.3 mg/dl of serum creatinine) at 12, 24, 48 h and 5 days. Results Mean age as 70±13 years, 22/52 (43%) were women, risk factors included hypertension (54%), DM (29%), Cirrhosis: 2/52 (4%), heat failure (27%), prior CKD (12%), nephrotoxic use (38%). 18/52 (35%) of patients were Nephrocheck low risk, 21/52 (40%) were intermediate risk and 13/52 (25%) were high risk. AKI developed in 7/18 (39%), 3/21 (14%) and 3/13 (23%) of low, intermediate and high risk, respectively. When comparing patients who developed AKI with those who did not, those who developed AKI had been exposed more frequently to nephrotoxins and had lower urinary osmolarity and higher MAP (Table 1). However, a high risk Nephrocheck score identified patients with significantly higher urine osmolality (672±139 vs 387±172 mOsm/L, P=0.005) and lower MAP (76.7 ± 18.4 vs 101.62±22.7 mmHg; P=0.002). Conclusion LIMITATIONS: knowledge of Nephrocheck results may have changed patient care. CONCLUSIONS: A high risk Nephrocheck score was not associated with a higher risk of AKI in a ER setting. More nephrotoxins were used in the AKI group. Presumabily, these were discontinued in the ER, thus lowering AKI risk. By contrast, a past history of nephrotoxin use and lower urine osmolarity were associated with a higher incidence of AKI.

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Rifampicin Induced Acute Interstitial Nephritis in a Patient with Tubercular Lymphadenitis: A Case Report

BIRDEM Medical Journal ◽

10.3329/birdem.v8i3.38134 ◽

2018 ◽

Vol 8 (3) ◽

pp. 257-259

Author(s):

Hafsa Hassan Khan ◽

Muhammad Abdur Rahim ◽

Mehruba Alam Ananna ◽

Tufayel Ahmed Chowdhury ◽

Sarwar Iqbal

Keyword(s):

Acute Kidney Injury ◽

Case Report ◽

Adverse Effects ◽

Interstitial Nephritis ◽

Case History ◽

Kidney Injury ◽

Acute Interstitial Nephritis ◽

History Of ◽

Tubercular Lymphadenitis ◽

Prompt Diagnosis

Rifampicin is one of the most effective anti-tubercular agents. Among its rare adverse effects, acute interstitial nephritis (AIN) is noteworthy. Here, we describe the case history of a 55-year-old female with tubercular lymphadenitis who developed rifampicin induced AIN upon re-exposure and recovered satisfactorily without requiring steroids. Rifampicin induced AIN should be kept in mind when patients present with acute kidney injury as prompt diagnosis and discontinuation of the drug has excellent prognosis.Birdem Med J 2018; 8(3): 257-259

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Predictors of Acute Kidney Injury Following Surgical Valve Replacement

The Thoracic and Cardiovascular Surgeon ◽

10.1055/s-0040-1710318 ◽

2020 ◽

Author(s):

Khalid S. Ibrahim ◽

Khalid A. Kheirallah ◽

Fadia A. Mayyas ◽

Nizar A. Alwaqfi

Keyword(s):

Heart Failure ◽

Acute Kidney Injury ◽

Blood Transfusion ◽

Valve Replacement ◽

Artery Bypass ◽

Kidney Injury ◽

Inotropic Support ◽

History Of ◽

Surgical Valve Replacement ◽

Perioperative Blood Transfusion

Abstract Background Acute kidney injury is a serious complication after surgical valve replacement and holds increased mortality rates. Objectives To study predictors of acute kidney injury after surgical valve replacement. Materials and Methods Patients who underwent valve surgery procedures at our center were included. Procedures included aortic valve replacement (AVR), mitral valve replacement (MVR), AVR with coronary artery bypass grafting (CABG), MVR with CABG, or AVR and MVR with/without CABG. Results A total of 346 patients were included. The mean age was 51.56 (16.1). Males (n = 178) comprised 51%.At the univariate level analysis, predictors of acute kidney injury were found including age, ejection fraction, hypertension, history of CAD, emergency surgery, recent myocardial infarction, diabetes, atrial fibrillation, history of heart failure, mitral regurgitation (MR), pump time >120 minutes, aortic cross clamp >90 minutes, perioperative blood transfusion, re-exploration for bleeding, use of mechanical and biologic valve in aortic position, use of biologic valve in mitral position, prolonged inotropic support, postoperative stroke, and use of angiotensin converting enzyme inhibitors (ACEi) < a month, (all p < 0.05).By Logistic regression analysis, Age (p < 0.0001, odds ratio[AOR] = 1.076), hypertension (p = 0.039, AOR = 1.829), heart failure (p = 0.019, AOR = 2.448), MR (p = 0.0001, AOR = 3.110), use of ACEi <month (p = 0.043, AOR= 2.181), pump time >120 minutes (p = 0.022, AOR = 1.797), perioperative blood transfusion (p = 0.008, AOR = 2.532), and prolonged inotropic support (p = 0.012, AOR = 2.591) were significant and independent predictors of AKI. Conclusion Independent predictors of acute kidney injury following valve surgeries include age, hypertension, heart failure, MR, use of ACEi <month, perioperative blood transfusion, and prolonged pump time or inotropic support.

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ICU treatment of acute kidney injury

10.1093/med/9780199568741.003.0151 ◽

2018 ◽

Author(s):

Matt Wise ◽

Paul Frost

Keyword(s):

Risk Factors ◽

Septic Shock ◽

Acute Kidney Injury ◽

Haematological Malignancy ◽

Previous History ◽

Kidney Injury ◽

History Of ◽

Nephrotoxic Drugs ◽

Abdominal Compartment ◽

Icu Treatment

Traditionally, the etiology of acute kidney injury (AKI) is considered in terms of prerenal, renal, and obstructive causes. However, this categorization is less useful in the ICU, where the etiology of AKI is usually multifactorial and often occurs in the context of multi-organ failure. Hypotension, nephrotoxic drugs, and severe sepsis or septic shock are the most important identifiable factors. Less frequently encountered causes include pancreatitis, abdominal compartment syndrome, and rhabdomyolysis. Primary intrinsic renal disease such as glomerulonephritis is extremely uncommon. A previous history of cirrhosis, cardiac failure, or haematological malignancy, and age >65 years, are important risk factors. This chapter covers symptoms, complications, diagnosis, investigations, prognosis, and treatment of renal failure in the ITU.

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Rhabdomyolysis and Hepatotoxicity From Valproic Acid: Case Reports

Journal of Pharmacy Practice ◽

10.1177/0897190019882880 ◽

2019 ◽

pp. 089719001988288 ◽

Cited By ~ 1

Author(s):

Cucnhat P. Walker ◽

Subrata Deb

Keyword(s):

Valproic Acid ◽

Acute Kidney Injury ◽

Case Reports ◽

Alternative Therapy ◽

Kidney Injury ◽

African American Female ◽

Coagulation Disorders ◽

Hyperammonemic Encephalopathy ◽

History Of ◽

Hispanic Male

Valproic acid (VPA) has been widely used more frequently as its approved indications have been expanded. More and more case reports on rare toxicities have been published in the literature (ie, hepatotoxicities, hyperammonemic encephalopathy, coagulation disorders, pancreatitis, thrombocytopenia). In spite of the long history of VPA, there is a lack of awareness of VPA toxicities among clinicians. We present two cases of a 44-year-old African American female and a 60-year-old Hispanic male taking chronic VPA therapy for psychiatric disorders admitted to the hospital with a combination of hepatotoxicities and acute kidney injury–associated rhabdomyolysis. In both cases, home VPA therapy was continued during hospitalization. Consequently, the female patient deceased and the male patient survived and discharged with continuation of his chronic VPA therapy. In cases of surviving patients, resumption of maintenance VPA upon discharge should be held and alternative therapy should be considered.

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