SP215SEVERE ACUTE KIDNEY INJURY IN CARDIOVASCULAR SURGERY: THROMBOTIC MICROANGIOPATHY AS A DIFFERENTIAL DIAGNOSIS TO ISCHEMIC RENAL INJURY

Background: Acute kidney injury (AKI) after cardiovascular surgery (CVS) infers high morbidity and mortality and may be caused by thrombotic microangiopathy (TMA). This study aimed to assess incidence, risk factors, kidney function, and mortality of patients with a postoperative TMA as possible cause of severe AKI following cardiovascular surgery. Methods: We analyzed retrospectively all patients admitted to the ICU after a cardiovascular procedure between 01/2018 and 03/2019 with severe AKI and need for renal replacement therapy (RRT). TMA was defined as post-surgery-AKI including need for RRT, hemolytic anemia, and thrombocytopenia. TMA patients were compared to patients with AKI requiring RRT without TMA. Results: Out of 893 patients, 69 (7.7%) needed RRT within one week after surgery due to severe AKI. Among those, 15 (21.7%) fulfilled TMA criteria. Aortic surgery suggested an increased risk for TMA (9/15 (60.0%) vs. 7/54 (31.5%), OR 3.26, CI 1.0013-10.64). Ten TMA patients required plasmapheresis and/or eculizumab, and five recovered spontaneously. Preoperative kidney function was significantly better in TMA patients than in controls (eGFR 92 vs. 60.5 mL/min, p = 0.004). However, postoperative TMA resulted in a more pronounced GFR loss (ΔeGFR −54 vs. −17 mL/min, p = 0.062). There were no deaths in the TMA group. Conclusion: Our findings suggest TMA as an important differential diagnosis of severe AKI following cardiovascular surgery, which may be triggered by aortic surgery. Therefore, early diagnosis and timely treatment of TMA could reduce kidney damage and improve mortality of AKI following cardiovascular surgery, which should be further investigated.

Download Full-text

Assessment of Cardiopulmonary Bypass Duration Improves Novel Biomarker Detection for Predicting Postoperative Acute Kidney Injury after Cardiovascular Surgery

Journal of Clinical Medicine ◽

10.3390/jcm10132741 ◽

2021 ◽

Vol 10 (13) ◽

pp. 2741

Author(s):

Tao Han Lee ◽

Cheng-Chia Lee ◽

Jia-Jin Chen ◽

Pei-Chun Fan ◽

Yi-Ran Tu ◽

...

Keyword(s):

Acute Kidney Injury ◽

Cardiopulmonary Bypass ◽

Fatty Acid Binding Protein ◽

Cardiovascular Surgery ◽

Kidney Injury ◽

Fatty Acid Binding ◽

Discriminatory Ability ◽

Postoperative Risk ◽

Study Population ◽

Postoperative Aki

Urinary liver-type fatty acid binding protein (L-FABP) is a novel biomarker with promising performance in detecting kidney injury. Previous studies reported that L-FABP showed moderate discrimination in patients that underwent cardiac surgery, and other studies revealed that longer duration of cardiopulmonary bypass (CPB) was associated with a higher risk of postoperative acute kidney injury (AKI). This study aims to examine assessing CPB duration first, then examining L-FABP can improve the discriminatory ability of L-FABP in postoperative AKI. A total of 144 patients who received cardiovascular surgery were enrolled. Urinary L-FABP levels were examined at 4 to 6 and 16 to 18 h postoperatively. In the whole study population, the AUROC of urinary L-FABP in predicting postoperative AKI within 7 days was 0.720 at 16 to 18 h postoperatively. By assessing patients according to CPB duration, the urinary L-FABP at 16 to 18 h showed more favorable discriminating ability with AUROC of 0.742. Urinary L-FABP exhibited good performance in discriminating the onset of AKI within 7 days after cardiovascular surgery. Assessing postoperative risk of AKI through CPB duration first and then using urinary L-FABP examination can provide more accurate and satisfactory performance in predicting postoperative AKI.

Download Full-text

Kahweol Ameliorates Cisplatin-Induced Acute Kidney Injury through Pleiotropic Effects in Mice

Biomedicines ◽

10.3390/biomedicines8120572 ◽

2020 ◽

Vol 8 (12) ◽

pp. 572

Author(s):

Jung-Yeon Kim ◽

Jungmin Jo ◽

Jaechan Leem ◽

Kwan-Kyu Park

Keyword(s):

Oxidative Stress ◽

Acute Kidney Injury ◽

Renal Injury ◽

Manganese Superoxide Dismutase ◽

Immune Cell ◽

Nicotinamide Adenine Dinucleotide Phosphate ◽

Kidney Injury ◽

Pleiotropic Effects ◽

Induced Apoptosis ◽

Vascular Adhesion

Cisplatin is an effective chemotherapeutic agent, but its clinical use is frequently limited by its nephrotoxicity. The pathogenesis of cisplatin-induced acute kidney injury (AKI) remains incompletely understood, but oxidative stress, tubular cell death, and inflammation are considered important contributors to cisplatin-induced renal injury. Kahweol is a natural diterpene extracted from coffee beans and has been shown to possess anti-oxidative and anti-inflammatory properties. However, its role in cisplatin-induced nephrotoxicity remains undetermined. Therefore, we investigated whether kahweol exerts a protective effect against cisplatin-induced renal injury. Additionally, its mechanisms were also examined. Administration of kahweol attenuated renal dysfunction and histopathological damage together with inhibition of oxidative stress in cisplatin-injected mice. Increased expression of nicotinamide adenine dinucleotide phosphate oxidase 4 and decreased expression of manganese superoxide dismutase and catalase after cisplatin treatment were significantly reversed by kahweol. Moreover, kahweol inhibited cisplatin-induced apoptosis and necroptosis in the kidneys. Finally, kahweol reduced inflammatory cytokine production and immune cell accumulation together with suppression of nuclear factor kappa-B pathway and downregulation of vascular adhesion molecules. Together, these results suggest that kahweol ameliorates cisplatin-induced renal injury via its pleiotropic effects and might be a potential preventive option against cisplatin-induced nephrotoxicity.

Download Full-text

Dynamics in perioperative neutrophil-to-lymphocyte*platelet ratio as a predictor of early acute kidney injury following cardiovascular surgery

Renal Failure ◽

10.1080/0886022x.2021.1937220 ◽

2021 ◽

Vol 43 (1) ◽

pp. 1012-1019

Author(s):

Yang Li ◽

Zhouping Zou ◽

Yunlu Zhang ◽

Bowen Zhu ◽

Yichun Ning ◽

...

Keyword(s):

Acute Kidney Injury ◽

Cardiovascular Surgery ◽

Kidney Injury

Download Full-text

The Significance of “Fractional Excretion of Urea” in The Differential Diagnosis of Acute Kidney Injury in Cirrhotic Patients

QJM ◽

10.1093/qjmed/hcab100.028 ◽

2021 ◽

Vol 114 (Supplement_1) ◽

Author(s):

Sameh Mohamed Ghaly ◽

Moataz Serry Seyam ◽

Mohamed Osama Aly ◽

Ahmed Mohamed Hesham Abdelfattah ◽

Ahmed R. Mashaal

Keyword(s):

Acute Kidney Injury ◽

Differential Diagnosis ◽

Kidney Injury ◽

Fractional Excretion ◽

Final Diagnosis ◽

Good Alternative ◽

Decompensated Cirrhosis ◽

Eligibility Criteria ◽

Significant Difference ◽

Cirrhotic Patients

Abstract Background Patients with cirrhosis are more susceptible to develop AKI than the non-cirrhotic individuals. AKI has an estimated prevalence of approximately 20% to 50% among hospitalized patients with cirrhosis. Physicians caring for patients with cirrhosis should recognize the acute or chronic character of renal disease, the causes of renal injury, the clinical conditions leading concomitantly to AKI and liver dysfunction, and the prognostic factors associated with the progression of AKI. Hypovolemia (due to diuretics, hemorrhage and diarrhea), acute tubular necrosis (ATN), sepsis, nephrotoxic agents (such as nonsteroidal anti-inflammatory drugs, aminoglycosides and/or radiological contrasts) and hepatorenal syndrome (HRS)-type 1 are the most common causes of AKI in cirrhotic patients. Objective To evaluate the sensitivity of fractional excretion of urea (FEUrea) vas a diagnostic biomarker for different causes of acute kidney injury in liver cirrhosis. Patients and Methods This study was conducted in co-operation between Tropical Medicine Department, Ain-Shams University and the Gastroenterology and Hepatology Department, Theodor Bilharz Research Institute between July 2019 to January 2020. It included 70 adult Egyptian patients admitted for treatment of complications of cirrhosis who fulfilled the eligibility criteria and compared to 10 cirrhotic patients without renal impairment. All patients were subjected to; full history taking, thorough clinical examination, laboratory investigations, Child-Pugh score was calculated for admission and urine samples were collected for urinary urea and creatinine levels to calculate FEUrea. Results Concerning the gender distribution in this study, male to female percent was 40 (57.10%) males and 30 (42.90%) females for gender, respectively. As regards to the causes of AKI, there were 24 (34.30%) PRA, 7 (10.00%) HRS and 39 (55.70%) ATN for final diagnosis. In the current study, there was significant difference (P = 0.0001; P < 0.05) in FE urea % among PRA, HRS and ATN groups (26.28±2.89, 11.76±3.44, and 47.37±10.53, respectively). Findings showed a higher FEUrea cut-off for ATN (>33%) compared to lower cut-off values for PRA (<33% and >21%) and HRS (<21%). Conclusion FEUrea was found to be an excellent simple tool for the differential diagnosis of AKI in patients with decompensated cirrhosis and ascites. FEUrea has also proven to be a useful “tubular injury” marker by differentiating ATN from non-ATN with high diagnostic accuracy (Sensitivity and Specificity exceeding >90%). FEUrea was found to be a good alternative and noninvasive tool for differentiating causes of AKI in cirrhotic patients instead of other non-available or expensive markers.

Download Full-text

Biomarkers of Renal Injury in Cirrhosis: Association with Acute Kidney Injury and Recovery after Liver Transplantation

Nephron ◽

10.1159/000479074 ◽

2017 ◽

Vol 138 (1) ◽

pp. 1-12 ◽

Cited By ~ 6

Author(s):

Ashwani K. Singal ◽

Bradford Jackson ◽

Glauber B. Pereira ◽

Kirk B. Russ ◽

Paul Stephen Fitzmorris ◽

...

Keyword(s):

Liver Transplantation ◽

Acute Kidney Injury ◽

Renal Injury ◽

Kidney Injury

Download Full-text

Acute Kidney Injury Relevant to Tubulointerstitial Nephritis with Late-Onset Uveitis Superimposed by Thrombotic Microangiopathy: A Case Report and Review of the Literature

Kidney Diseases ◽

10.1159/000507668 ◽

2020 ◽

Vol 6 (6) ◽

pp. 414-421

Author(s):

Youlu Zhao ◽

Junwen Huang ◽

Tao Su ◽

Zhikai Yang ◽

Xizi Zheng ◽

...

Keyword(s):

Acute Kidney Injury ◽

Thrombotic Microangiopathy ◽

Tubulointerstitial Nephritis ◽

Late Onset ◽

Drug Hypersensitivity ◽

Oral Prednisone ◽

Kidney Injury ◽

Renin Angiotensin System ◽

Renal Recovery

Background: The syndrome of tubulointerstitial nephritis and uveitis (TINU) is an uncommon and multisystemic autoimmune disorder. This review reports a rare case of TINU being superimposed on thrombotic microangiopathy (TMA) and, by comparing with the available literature, also summarizes the clinical features, associated conditions, treatment, and outcome of patients with TINU. Summary: Herein, we report the case of a 37-year-old male patient with acute kidney injury (AKI) clinicopathologically identified as malignant hypertension-induced TMA superimposed by acute tubulointerstitial nephritis, which was suspected to be related to drug hypersensitivity. After treatment with oral prednisone combined with a renin-angiotensin system inhibitor, the patient achieved partial renal recovery and was withdrawn from hemodialysis. Recurrent AKI concomitant with new-onset asymptomatic uveitis was detected during routine clinical follow-up after cessation of prednisone. TINU was then diagnosed, and prednisone followed by cyclophosphamide was prescribed. The patient achieved better renal recovery than in the first round of treatment and maintained stable renal function afterward. By reviewing the literature, 36 cases were reported as TINU superimposed on other conditions, including thyroiditis, osteoarthropathy, and sarcoid-like noncaseating granulomas. Key messages: TINU could be complicated by many other conditions, among which TMA is very rare. When presented as AKI, kidney biopsy is important for differential diagnosis. The case also shows that recurrent AKI with concomitant uveitis after prednisone withdrawal strongly suggested the need for long-term follow-up and elongated prednisone therapy for TINU syndrome.

Download Full-text

Renalase and Biomarkers of Contrast-Induced Acute Kidney Injury

Cardiorenal Medicine ◽

10.1159/000439117 ◽

2015 ◽

Vol 6 (1) ◽

pp. 25-36 ◽

Cited By ~ 10

Author(s):

Maciej T. Wybraniec ◽

Katarzyna Mizia-Stec

Keyword(s):

Acute Kidney Injury ◽

Renal Injury ◽

Amine Oxidase ◽

Kidney Injury ◽

Cardiorenal Syndrome ◽

Creatinine Concentration ◽

Invasive Cardiology ◽

Proximal Tubular ◽

Novel Biomarkers

Background: Contrast-induced acute kidney injury (CI-AKI) remains one of the crucial issues related to the development of invasive cardiology. The massive use of contrast media exposes patients to a great risk of contrast-induced nephropathy and chronic kidney disease development, and increases morbidity and mortality rates. The serum creatinine concentration does not allow for a timely and accurate CI-AKI diagnosis; hence numerous other biomarkers of renal injury have been proposed. Renalase, a novel catecholamine-metabolizing amine oxidase, is synthesized mainly in proximal tubular cells and secreted into urine and blood. It is primarily engaged in the degradation of circulating catecholamines. Notwithstanding its key role in blood pressure regulation, renalase remains a potential CI-AKI biomarker, which was shown to be markedly downregulated in the aftermath of renal injury. In this sense, renalase appears to be the first CI-AKI marker revealing an actual loss of renal function and indicating disease severity. Summary: The purpose of this review is to summarize the contemporary knowledge about the application of novel biomarkers of CI-AKI and to highlight the potential role of renalase as a functional marker of contrast-induced renal injury. Key Messages: Renalase may constitute a missing biochemical link in the mutual interplay between kidney and cardiac pathology known as the cardiorenal syndrome.

Download Full-text

A case of acute kidney injury associated with anti-glomerular basement membrane antibody disease and thrombotic microangiopathy

Nihon Toseki Igakkai Zasshi ◽

10.4009/jsdt.45.973 ◽

2012 ◽

Vol 45 (10) ◽

pp. 973-978

Author(s):

Aiko Ookubo ◽

Yuka Shimizu ◽

Taisuke Irifuku ◽

Takayuki Naito ◽

Takahiko Ogawa ◽

...

Keyword(s):

Acute Kidney Injury ◽

Basement Membrane ◽

Glomerular Basement Membrane ◽

Thrombotic Microangiopathy ◽

Kidney Injury

Download Full-text

COVID-19- or Tramadol-induced Seizure: A Differential Diagnosis in Young People

International Journal of Medical Toxicology and Forensic Medicine ◽

10.32598/ijmtfm.v10i4.32009 ◽

2020 ◽

Vol 10 (4) ◽

pp. 32009.1-32009.2

Author(s):

Solmaz Nekoueifard ◽

◽

Mohammad Majidi ◽

Keyword(s):

Myocardial Infarction ◽

Acute Kidney Injury ◽

Differential Diagnosis ◽

Acute Respiratory Distress Syndrome ◽

Distress Syndrome ◽

Kidney Injury ◽

World Health ◽

The World ◽

Life Threatening ◽

Health Organization

Coronavirus disease 2019 (COVID-19) was first declared in December 2019 from Wuhan, China [1, 2]. It then has been reported a pandemic in March 2020 by the World Health Organization [3]. Clinical features of COVID-19 are different from asymptomatic to mild to moderate symptoms, such as fever, headache, myalgia, sore throat, anosmia, cough, fatigue headache, hemoptysis, and dyspnea to the life-threatening complications, including shock, pneumonia, acute respiratory distress syndrome, myocarditis, myocardial infarction, acute kidney injury, multi-organ failure, and even death [1, 2].

Download Full-text