Preliminary Report on the Association of Apolipoprotein E Polymorphisms, with Postoperative Peak Serum Creatinine Concentrations in Cardiac Surgical Patients

2001 ◽  
Vol 45 (4) ◽  
pp. 197
Keyword(s):  
Serum Creatinine ◽  
Apolipoprotein E ◽  
Preliminary Report ◽  
Peak Serum ◽  
Surgical Patients

Preliminary Report on the Association of Apolipoprotein E Polymorphisms, with Postoperative Peak Serum Creatinine Concentrations in Cardiac Surgical Patients

2000 ◽  
Vol 93 (2) ◽  
pp. 325-331 ◽  
Author(s):  
Sophia T. H. Chew ◽  
Mark F. Newman ◽  
William D. White ◽  
Peter J. Conlon ◽  
Ann M. Saunders ◽  
...  
Keyword(s):  
Cardiac Surgery ◽  
Renal Impairment ◽  
Serum Creatinine ◽  
Apolipoprotein E ◽  
Genetic Basis ◽  
University Hospital ◽  
Surgical Patients ◽  
Postoperative Changes ◽  
Apolipoprotein E Genotypes ◽  
Postoperative Serum

Background Renal dysfunction after cardiac surgery occurs in up to 8% of patients and is associated with major increases in morbidity, mortality, and cost. Genetic polymorphisms have been implicated as a factor in the progression of chronic renal disease, but a genetic basis for the development of acute renal impairment has not been investigated. The authors therefore tested the hypothesis that apolipoprotein E alleles are associated with different postoperative changes in serum creatinine after cardiac surgery. Methods The authors performed a prospective observational study with use of data from 564 coronary bypass surgical patients who were enrolled in an ongoing investigation of apolipoprotein E genotypes and organ dysfunction at a university hospital between 1989-1999. Renal function was assessed among apolipoprotein E genotype groups by comparisons of preoperative (CrPre), peak in-hospital postoperative (CrMax) and perioperative change (DCr) in serum creatinine values. Results The epsilon4 allele grouping (E2 = 2/2,2/3,2/4; E3 = 3/3; E4 = 3/4,4/4) was associated with a smaller increase in postoperative serum creatinine (perioperative change: E4, +0.17; E3, +0.26; E4, +0.27 mg/dl) and a lower peak postoperative creatinine than the epsilon2 and epsilon3 in univariate and multivariate analysis (peak in-hospital postoperative serum creatinine multivariate P = 0.015 vs. epsilon3, P = 0.038 vs. epsilon2). There was no difference in baseline creatinine among allele groups. Conclusions Inheritance of the apolipoprotein epsilon4 allele is associated with reduced postoperative increase in serum creatinine after cardiac surgery, compared with the epsilon3 or epsilon2 allele. This is the first report of a possible genetic basis for acute renal impairment. These data may contribute to renal risk stratification for cardiac surgery and raise questions regarding apolipoprotein E and the pathophysiology of acute renal injury.

Delayed onset of acute renal failure after significant paracetamol overdose: A case series

2009 ◽  
Vol 29 (1) ◽  
pp. 63-68 ◽  
Author(s):  
WS Waring ◽  
H. Jamie ◽  
GE Leggett
Keyword(s):  
Renal Failure ◽  
Acute Renal Failure ◽  
Serum Creatinine ◽  
Alanine Aminotransferase ◽  
Paracetamol Overdose ◽  
Peak Serum ◽  
Wilcoxon Test ◽  
Aminotransferase Activity ◽  
Baseline Serum ◽  
Alanine Aminotransferase Activity

Acute renal failure is a recognized manifestation of paracetamol toxicity, but comparatively little data is available concerning its onset and duration. The present study sought to characterize the time course of rising serum creatinine concentrations in paracetamol nephrotoxicity. Renal failure was defined by serum creatinine concentration ≥150 μmol/L (1.69 mg/dL) or ≥50% increase from baseline. Serum creatinine concentrations and alanine aminotransferase activity were considered with respect to the interval after paracetamol ingestion. There were 2068 patients with paracetamol overdose between March 2005 and October 2007, and paracetamol nephrotoxicity occurred in 8 (0.4%). All had significant hepatotoxicity, and peak serum alanine aminotransferase activity occurred at 2.5 days (2.2 to 2.9 days) after ingestion. Peak serum creatinine concentrations did not occur until 5.5 days (4.4 to 5.9 days) after ingestion (p = .031 by Wilcoxon test). Serum creatinine concentrations slowly restored to normal, and renal replacement was not required. In this patient series, rising serum creatinine concentrations only became detectable after more than 48 hours after paracetamol ingestion. Therefore, renal failure might easily be missed if patients are discharged home before this. Further work is required to establish the prevalence of paracetamol-induced nephrotoxicity, and its clinical significance.

Prognostic Factors in Neonatal Acute Renal Failure

PEDIATRICS ◽  
1984 ◽  
Vol 74 (2) ◽  
pp. 265-272
Author(s):  
Robert L. Chevalier ◽  
Fern Campbell ◽  
A. Norman A. G. Brenbridge
Keyword(s):  
Renal Failure ◽  
Acute Renal Failure ◽  
Serum Creatinine ◽  
Perinatal Asphyxia ◽  
Urine Flow ◽  
Peak Serum ◽  
Serum Creatinine Concentration ◽  
Creatinine Concentration ◽  
Renal Anomalies ◽  
Renal Uptake

Sixteen infants, 2 to 35 days of age, had acute renal failure, a diagnosis based on serum creatinine concentrations > 1.5 mg/dL for at least 24 hours. Eight infants were oliguric (urine flow < 1.0 mL/kg/h) whereas the remainder were nonoliguric. To determine clinical parameters useful in prognosis, urine flow rate, duration of anuria, peak serum creatinine, urea (BUN) concentration, and nuclide uptake by scintigraphy were correlated with recovery. Nine infants had acute renal failure secondary to perinatal asphyxia, three had acute renal failure as a result of congenital cardiovascular disease, and four had major renal anomalies. Four oliguric patients died: three of renal failure and one of heart failure. All nonoliguric infants survived with mean follow-up serum creatinine concentration of 0.8 ± 0.5 (SD) mg/dL whereas that of oliguric survivors was 0.6 ± 0.3 mg/dL. Peak serum creatinine concentration did not differ between those patients who were dying and those recovering. All infants who were dying remained anuric at least four days and revealed no renal uptake of nuclide. Eleven survivors were anuric three days or less, and renal perfusion was detectable by scintigraphy in each case. However, the remaining survivor (with bilateral renal vein thrombosis) recovered after 15 days of anuria despite nonvisualization of kidneys by scintigraphy. In neonates with ischemic acute renal failure, lack of oliguria and the presence of identifiable renal uptake of nuclide suggest a favorable prognosis.

Theophylline-induced protection in myoglobinuric acute renal failure: further characterization

1987 ◽  
Vol 65 (1) ◽  
pp. 42-45 ◽  
Author(s):  
A. K. Bidani ◽  
P. C. Churchill ◽  
W. Packer
Keyword(s):  
Renal Failure ◽  
Acute Renal Failure ◽  
Serum Creatinine ◽  
Biological Fluids ◽  
Peak Serum ◽  
Tubuloglomerular Feedback ◽  
Protective Effects ◽  
Beneficial Effects ◽  
Adenosine Receptor Antagonist ◽  
Myoglobinuric Acute Renal Failure

We have reported previously that aminophylline has an ameliorating effect on the course and severity of glycerol-induced myoglobinuric acute renal failure in rats. Since aminophylline dissociates into theophylline in biological fluids and since theophylline is an adenosine receptor antagonist, we attributed the ameliorating effects to antagonism of the hemodynamic effects of endogenous adenosine. However, theophylline blocks tubuloglomerular feedback and produces natriuresis, and either of these effects might have accounted for the beneficial effects in acute renal failure. Therefore, this study was designed to further characterize the effects of theophylline in glycerol-induced acute renal failure in rats. Aminophylline had dose-dependent beneficial effects, as judged by the peak serum creatinine during the 3 days following induction of acute renal failure, by the number of animals with peak serum creatinine >1 mg/dL, and by the mortality rate. Both furosemide and theophylline block tubuloglomerular feedback and produce natriuresis, but aminophylline had protective effects, whereas furosemide actually increased mortality, compared with aminophylline, following induction of myoglobinuric acute renal failure. Therefore, aminophylline's protective effects are independent of tubuloglomerular feedback and natriuresis. These results offer further support for the hypothesis that adenosine-induced hemodynamic changes play a pathogenic role in glycerol-induced acute renal failure in rats.

PRELIMINARY REPORT ON THE ASSOCIATION OF APOLIPOPROTEIN E GENOTYPE WITH RENAL IMPAIRMENT AFTER CORONARY BYPASS SURGERY

1998 ◽  
Vol 89 (Supplement) ◽  
pp. 301A
Author(s):  
S T H Chew ◽  
P J Conlon ◽  
W D White ◽  
M F Newman ◽  
B E Tardiff ◽  
...  
Keyword(s):  
Renal Impairment ◽  
Apolipoprotein E ◽  
Preliminary Report ◽  
Bypass Surgery ◽  
Coronary Bypass ◽  
Coronary Bypass Surgery ◽  
Apolipoprotein E Genotype

scholarly journals CO-Oximetry interference by perflubron emulsion: comparison of hemolyzing and nonhemolyzing instruments

1998 ◽  
Vol 44 (10) ◽  
pp. 2183-2190 ◽  
Author(s):  
A P Shepherd ◽  
J M Steinke
Keyword(s):  
Preliminary Report ◽  
Effective Means ◽  
Hemoglobin Concentration ◽  
Blood Substitute ◽  
Surgical Patients ◽  
Clinical Use ◽  
Oxyhemoglobin Saturation ◽  
Blood Samples ◽  
Total Hemoglobin ◽  
Total Hemoglobin Concentration

Abstract Perflubron emulsion is expected to be in clinical use soon as a non-hemoglobin blood substitute. A preliminary report indicates that this new oxygen-carrying fluorocarbon interferes with the measurements of CO-oximeters. Therefore, we have quantified the interference that perflubron causes in the measurements of eight widely used oximeters and CO-oximeters. The AVL Omni 6, CC270, IL482, IL682, and OSM3 are conventional CO-oximeters that hemolyze blood samples before analyzing them. In contrast, the AVOXimeters 1000 and 4000 and the IL Synthesis 35 make their measurements without hemolyzing the samples. Because perflubron is expected to be used most frequently on surgical patients in a hemodiluted state, we conducted all tests on human erythrocytes suspended in plasma at a hemoglobin concentration standardized to 70 g/L (7 g/dL) and with oxyhemoglobin saturation set at 97%. When perflubron was added to the blood samples, the nonhemolyzing CO-oximeters were not seriously affected by perflubron concentrations in and above the therapeutic range. In contrast, some of the hemolyzing CO-oximeters experienced concentration-dependent interference in their measurements of all analytes except total hemoglobin concentration. Thus, we conclude that the nonhemolyzing CO-oximeters provide an effective means for determining whether a hemolyzing CO-oximeter is experiencing clinically important interference in blood from patients receiving perflubron.

Reduction of toxicity of interleukin-2 and lymphokine-activated killer cells in humans by the administration of corticosteroids.

1987 ◽  
Vol 5 (3) ◽  
pp. 496-503 ◽  
Author(s):  
J T Vetto ◽  
M Z Papa ◽  
M T Lotze ◽  
A E Chang ◽  
S A Rosenberg
Keyword(s):  
Weight Gain ◽  
Side Effects ◽  
Serum Creatinine ◽  
Therapeutic Effect ◽  
Interleukin 2 ◽  
Peak Serum ◽  
Control Group ◽  
Lymphokine Activated Killer Cells ◽  
Future Studies ◽  
Lak Cell

In order to evaluate the efficacy of dexamethasone (dex) in reducing the toxicity of therapy with lymphokine-activated killer (LAK) cells and interleukin-2 (IL-2), we treated six patients receiving this form of immunotherapy with intravenous (IV) dex, 4 mg every six hours. Compared with a control group of 27 patients not receiving dex with their immunotherapy, these corticosteroid-treated patients were able to tolerate the administration of more IL-2, yet experienced significantly less toxicity. Dyspnea, confusion, fever, mean peak serum creatinine, and bilirubin levels during treatment were significantly reduced in corticosteroid-treated patients, with a corresponding decrease in pruritus in this group as well. Overall weight gain was not different between groups, although a curtailment of weight gain temporally related to dex treatment was seen in some patients. Hematologic side effects, including anemia, eosinophilia, and thrombocytopenia, were not reduced by dex. These results suggest that dex can inhibit at least some of the toxic side effects of LAK cell and IL-2 therapy. Because of the concern that the therapeutic effect may also be abrogated, future studies combining corticosteroids with this form of immunotherapy should be undertaken with caution.

Effect of Waxy Maize-derived Hydroxyethyl Starch 130/0.4 on Renal Function in Surgical Patients

2013 ◽  
Vol 118 (2) ◽  
pp. 387-394 ◽  
Author(s):  
Claude Martin ◽  
Matthias Jacob ◽  
Eric Vicaut ◽  
Bertrand Guidet ◽  
Hugo Van Aken ◽  
...  
Keyword(s):  
Renal Failure ◽  
Acute Renal Failure ◽  
Renal Replacement Therapy ◽  
Serum Creatinine ◽  
Hydroxyethyl Starch ◽  
Risk Difference ◽  
Surgical Patients ◽  
Waxy Maize ◽  
Calculated Creatinine Clearance ◽  
Renal Safety

Abstract Background: The aim of this meta-analysis was to evaluate renal safety with the active substance of the latest generation of waxy maize-derived hydroxyethyl starch in surgical patients. The authors focused on prospective, randomized, controlled studies that documented clinically relevant variables with regard to renal effects of waxy maize-derived hydroxyethyl starch 130/0.40. Materials and methods: The authors carefully searched for all available prospective, randomized studies and evaluated the greatest delta from baseline values in renal safety variables (serum creatinine values, calculated creatinine clearance, incidence of renal replacement therapy, and acute renal failure). The authors included 17 studies that analyzed patients (n = 1,230) undergoing a variety of surgical procedures. Results: For maximum serum creatinine values, the effect size estimate was 0.068 (95% CI = −0.227 to 0.362), P = 0.65. For calculated creatinine clearance values, pooled risk difference was 0.302 (95% CI = −0.098 to 0.703), P = 0.14. For incidence of acute renal failure, pooled risk difference was 0.0003 (95% CI = −0.018 to 0.019), P = 0.98. For incidence of renal replacement therapy, pooled risk difference was −0.003 (95% CI = −0.028 to 0.022), P = 0.85. Conclusions: The authors found no evidence for renal dysfunction caused by modern waxy maize-derived hydroxyethyl starch 130/0.40 in surgical patients.

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