MP237INCIDENCE AND RISK FACTORS OF ACUTE KIDNEY INJURY ASSOCIATED WITH ACUTE PYELONEPHRITIS ACCORDING TO RIFLE CLASSIFICATION

BACKGROUND Acute pyelonephritis (APN) is one of the most severe forms of urinary tract infections (UTI) with a higher incidence among females compared to males. Escherichia coli is the commonest causative organism isolated in 80 % of the cases in Kerala. Risk factors like structural or functional abnormalities of urogenital system, immunosuppression, comorbidities and virulence & resistance of microorganism play vital roles in predicting the prognosis. Our aim was to study the prevalence of various risk factors of acute pyelonephritis in adult patients, the clinical profile, aetiological agents and their sensitivity to antibiotics, and related complications on their usage. METHODS In a cross-sectional observational study, 100 adult patients with acute pyelonephritis admitted in a tertiary teaching hospital in Kerala were studied between January 2016 and January 2017. Detailed history and clinical examination were carried out. Complete haemogram, random blood sugar, renal function test, urine culture and sensitivity, and ultrasonogram of abdomen and pelvis were done. RESULTS The most common age group was 40 - 49 years with a male to female ratio of 2:3. Dysuria was observed in 82 % of patients followed by increased frequency of micturition in 65 % and vomiting in 42 %. Diabetes mellitus was observed in 55 % of patients and recurrent UTI in 44 %. Escherichia coli was found in 66 % of patients followed by Klebsiella in 23 %. Culture showed that 85 % of the bacteria were sensitive to piperacillin-tazobactam. 44 % of the patients did not respond to the empirical antibiotic, and the failure rate was higher among those empirically treated with ciprofloxacin. 41 % of the patients developed acute kidney injury, which necessitated haemodialysis in 23 %. 14 % of the patients developed septic shock and the mortality was 10 %. CONCLUSIONS Certain risk factors such as diabetes, hypertension, chronic kidney disease and indwelling catheters were associated with increased incidence of complications. Hence, in presence of such risk factors appropriate treatment and preventive measures should be initiated promptly. Among the pathogens, 85 % of the organisms were sensitive to piperacillin–tazobactam. Hence, piperacillintazobactam can be recommended as the first line empirical antibiotic. KEYWORDS Acute Pyelonephritis, Urinary Tract Infection, Acute Kidney Injury (AKI), and E. coli

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Incidence and risk factors for acute kidney injury after spine surgery using the RIFLE classification

Journal of Neurosurgery Spine ◽

10.3171/2014.2.spine13596 ◽

2014 ◽

Vol 20 (5) ◽

pp. 505-511 ◽

Cited By ~ 13

Author(s):

Bhiken I. Naik ◽

Douglas A. Colquhoun ◽

William E. McKinney ◽

Andrew Bryant Smith ◽

Brian Titus ◽

...

Keyword(s):

Risk Factors ◽

Acute Kidney Injury ◽

Renal Failure ◽

Acute Renal Failure ◽

Lumbar Spine ◽

Kidney Function ◽

Spine Surgery ◽

Kidney Injury ◽

Lumbar Spine Surgery ◽

Rifle Classification

Object Earlier definitions of acute renal failure are not sensitive in identifying milder forms of acute kidney injury (AKI). The authors hypothesized that by applying the RIFLE criteria for acute renal failure (Risk of renal dysfunction, Injury to the kidney, Failure of kidney function, Loss of kidney function, and End-stage kidney disease) to thoracic and lumbar spine surgery, there would be a higher incidence of AKI. They also developed a model to predict the postoperative glomerular filtration rate (GFR). Methods A hospital data repository was used to identify patients undergoing thoracic and/or lumbar spine surgery over a 5-year period (2006–2011). The lowest GFR in the first week after surgery was used to identify and categorize kidney injury if present. Risk factors were identified and a model was developed to predict postoperative GFR based on the defined risk factors. Results A total of 726 patients were identified over the study period. The incidence of AKI was 3.9% (n = 28) based on the RIFLE classification with 23 patients in the risk category and 5 in the injury category. No patient was classified into the failure category or required renal replacement therapy. The baseline GFR in the non-AKI and AKI groups was 80 and 79.8 ml/min, respectively. After univariate analysis, only hypertension was associated with postoperative AKI (p = 0.02). A model was developed to predict the postoperative GFR. This model accounted for 64.4% of the variation in the postoperative GFRs (r2 = 0.644). Conclusions The incidence of AKI in spine surgery is higher than previously reported, with all of the patients classified into either the risk or injury RIFLE categories. Because these categories have previously been shown to be associated with poor long-term outcomes, early recognition, management, and follow-up of these patients is important.

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Review for "Risk factors for high‐dose methotrexate associated acute kidney injury in patients with hematological malignancies"

10.1002/hon.2759/v1/review1 ◽

2019 ◽

Keyword(s):

Risk Factors ◽

Acute Kidney Injury ◽

Hematological Malignancies ◽

Kidney Injury ◽

High Dose ◽

High Dose Methotrexate ◽

Dose Methotrexate

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Acute kidney injury in preterm neonates with ≤30 weeks of gestational age and its risk factors

Minerva Pediatrica ◽

10.23736/s0026-4946.18.04964-2 ◽

2019 ◽

Vol 71 (5) ◽

Author(s):

Rita Ladeiras ◽

Filipa Flor-De-Lima ◽

Henrique Soares ◽

Bárbara Oliveira ◽

Hercília Guimarães

Keyword(s):

Risk Factors ◽

Acute Kidney Injury ◽

Gestational Age ◽

Kidney Injury ◽

Preterm Neonates

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KIDNEY INJURY IN CANCER THERAPY

Nephrology (Saint-Petersburg) ◽

10.24884/1561-6274-2018-22-5-17-24 ◽

2018 ◽

Vol 22 (5) ◽

pp. 17-24 ◽

Cited By ~ 1

Author(s):

E. V. Burnasheva ◽

Y. V. Shatokhin ◽

I. V. Snezhko ◽

A. A. Matsuga

Keyword(s):

Risk Factors ◽

Acute Kidney Injury ◽

Cancer Therapy ◽

Cancer Patients ◽

Cytotoxic Effect ◽

Tumor Lysis Syndrome ◽

Kidney Injury ◽

Chemotherapeutic Agents ◽

Oxygen Intermediates ◽

Circulating Blood Volume

Кidney injury is a frequent and significant complication of cancer and cancer therapy. The kidneys are susceptible to injury from malignant infiltration, damage by metabolites of malignant cells, glomerular injury, nephrotoxic drugs including chemotherapeutic agents. Also bone marrow transplantation complications, infections with immune suppression (including septicemia), tumor lysis syndrome should be taken into account. Chemotherapeutic agents are a common cause of acute kidney injury but can potentially lead to chronic kidney disease development in cancer patients. This article summarizes risk factors of acute kidney injury in cancer patients. Risk factors are divided into two groups. The systemic are decrease of total circulating blood volume, infiltration of kidney tissue by tumor cells, dysproteinemia, electrolyte disturbances. The local (renal) risk factors are microcirculation disturbances, drugs biotransformation with formation of reactive oxygen intermediates, high concentration of nephrotoxic agents in proximal tubules and its sensitivity to ischemia. Drug-related risk factors include: drugs combination with cytotoxic effect high doses long term use necessity, direct cytotoxic effect of not only chemotherapeutic agents but also its metabolites, mean solubility forming intratubular precipitates. Early diagnosis, timely prevention and treatment of these complications provide significantly improve nononcologic results of treatment.

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