Low blood pressure is associated with acute kidney injury development and mortality in octogenarians admitted to the emergency room

2019 ◽  
Vol 19 (9) ◽  
pp. 874-878
Author(s):  
Mohsen Abu Alfeilat ◽  
Itzchak Slotki ◽  
Linda Shavit
Keyword(s):  
Blood Pressure ◽  
Acute Kidney Injury ◽  
Emergency Room ◽  
Kidney Injury ◽  
Low Blood Pressure ◽  
Acute Kidney Injury Development

scholarly journals Too slow and too high

2020 ◽  
pp. 102490792093172 ◽  
Author(s):  
Jonathan Chun-Hei Cheung ◽  
Kam Leung Law ◽  
Koon Ngai Lam
Keyword(s):  
Blood Pressure ◽  
Emergency Department ◽  
Acute Kidney Injury ◽  
Renal Failure ◽  
Potassium Level ◽  
Kidney Injury ◽  
Vicious Cycle ◽  
Dopamine Infusion ◽  
Low Blood Pressure ◽  
Electrocardiographic Changes

A 77-year-old woman on metoprolol and lisinopril presented to an emergency department with giddiness after vomiting for few hours. She was found to have low blood pressure and bradycardia 38 beats per minute due to atrioventricular nodal blockade. Her bradycardia was refractory to atropine and dopamine infusion; but improved with calcium gluconate. She was found to have acute kidney injury and hyperkalemia at 6.4 mEq/L. This is a case of Bradycardia, Renal Failure, Atrioventricular-Nodal Blockers, Shock, and Hyperkalemia (BRASH) syndrome, precipitated by dehydration and perpetuated by atrioventricular blockade, illustrating the degree of bradycardia and electrocardiographic changes being out of proportion to the potassium level. BRASH syndrome should be recognized and intervened early in the course to avoid the patient entering a vicious cycle that could be rapidly fatal.

THE SYSTEMIC CIRCULATION IN MEN UNDER 60 YEARS OF OLD WITH MYOCARDIAL INFARCTION AND ACUTE KIDNEY INJURY

2021 ◽  
pp. 7-13
Author(s):  
Gordienko A.V. ◽  
Nosovich D.V. ◽  
Tassybayev B.B.
Keyword(s):  
Myocardial Infarction ◽  
Blood Pressure ◽  
Acute Kidney Injury ◽  
Total Peripheral Resistance ◽  
Peripheral Resistance ◽  
Kidney Injury ◽  
Control Group ◽  
Study Group ◽  
Type I ◽  
Acute Kidney Injury Development

Relevance. Hemodynamics changes in myocardial infarction complicated by acute kidney injury are interpreted in different ways. Aim. To evaluate peripheral hemodynamics changes in men under 60 years old with myocardial infarction complicated by acute kidney injury to improve prevention and outcomes. Material and methods. The study included men 19-60 years old with type I myocardial infarction. The patients were divided into two age-comparable groups: I - study group, with acute kidney injury - 25 patients; II - control, without it - 486 patients. A comparative assessment of circulation indices changes in first 48 hours (1) and the end of third week disease (2), their dynamics, also acute kidney injury development risk analysis (ANOVA) were performed. Results. The study group differed from the control group in lower values of heart rate1 (66.3±12.2 and 75.8±18.8 (bpm), respectively; p=0.003) and higher - arterial pressure, systolic1 (155.6±24.0 and 139.5±28.9 (mm Hg); p=0.006), diastolic1 (98.0 ± 16.0 and 86.6 ± 18.9 (mm Hg); p = 0.002), mean1 (117.2±17.6 and 104.3±21.3 (mm Hg); p=0.001). In the study group compared in the control group, there was a greater decrease in blood pressure (mean: -18.3 and -8.3%, respectively) and total peripheral resistance (-33.5 and -26.3%) (p<0.0001). The risk markers of the acute kidney injury development were the mean arterial pressure1≥106.7, systolic1≥140.0, diastolic1≥90.0 (mm Hg) and heart rate1˂66 bpm. Conclusions. Men under 60 years old with acute kidney injury in myocardial infarction are characterized by arterial hypertension and bradycardia in the first hours of the disease, as well as more pronounced decline dynamics of blood pressure and total peripheral resistance at the end of its subacute period. The listed above values of the circulation parameters should be used in the high-risk groups for the acute kidney injury development formation, as well as prognostic modeling.

scholarly journals A rare case of posterior reversible encephalopathy syndrome in a patient with severe leptospirosis complicated with rhabdomyolysis and acute kidney injury; a case report

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Jayawardane Pathiranage Roneesha Lakmali ◽  
Kanapathipillei Thirumavalavan ◽  
Danapala Dissanayake
Keyword(s):  
Blood Pressure ◽  
Acute Kidney Injury ◽  
Blood Pressure Control ◽  
Posterior Reversible Encephalopathy Syndrome ◽  
Vision Loss ◽  
Kidney Injury ◽  
Pressure Control ◽  
Posterior Reversible Encephalopathy ◽  
Peripheral Nerve Involvement ◽  
Reversible Encephalopathy

Abstract Background Leptospirosis is a zoonotic spirochetal disease caused by Leptospira interrogans. The clinical presentation ranges from an asymptomatic state to a fatal multiorgan dysfunction. Neurological manifestations including aseptic meningitis, spinal cord and peripheral nerve involvement, cranial neuropathies and cerebellar syndrome are well recognized with varying frequencies among patients with this disease. Posterior reversible encephalopathy syndrome is a very rare occurrence in leptospirosis and only two cases are reported in the medical literature up to now. We report a case of posterior reversible encephalopathy syndrome in a patient with leptospirosis with rhabdomyolysis and acute kidney injury. Case presentation A 21 year-old male presented with fever and oliguric acute kidney injury with rhabdomyolysis. A diagnosis of leptospirosis was made and he was being managed according to the standard practice together with regular hemodialysis. The clinical condition was improving gradually. On day 8 of the illness, he developed headache and sudden painless complete bilateral vision loss followed by several brief generalized tonic clonic seizure attacks. Examination was significant for a Glasgow Coma Scale of 14/15, blood pressure of 150/90 mmHg and complete bilateral blindness. The findings of magnetic resonance imaging of the brain were compatible with posterior reversible encephalopathy syndrome. He was managed with blood pressure control and antiepileptics with supportive measures and standard treatment for leptospirosis and made a complete recovery. Conclusion Posterior reversible encephalopathy syndrome, though very rare with leptospirosis, should be considered as a differential diagnosis in a patient with new onset visual symptoms and seizures, especially during the immune phase. Optimal supportive care together with careful blood pressure control and seizure management would yield a favourable outcome in this reversible entity.

scholarly journals Pregnancy-related acute kidney injury at high altitude: a retrospective observational study in a single center

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Xin Li ◽  
Xiaojing Wu ◽  
Muyin Zhang ◽  
Lili Xu ◽  
Guohui Li ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Acute Kidney Injury ◽  
High Altitude ◽  
Kidney Injury ◽  
Hypertensive Disorders Of Pregnancy ◽  
Fetal Outcomes ◽  
Uncontrolled Blood Pressure ◽  
Logistic Regression Models ◽  
Hypertensive Disorders ◽  
Term Delivery

Abstract Background Pregnancy-related acute kidney injury (Pr-AKI) is associated with maternal and fetal morbidity and mortality. There are few studies focusing on Pr-AKI at high altitude in the literature. Objectives to investigate the incidence, etiology, clinical features and maternal-fetal outcomes of Pr-AKI in women living at high altitude. Methods 6,512 pregnant women attending the Department of Obstetrics & Gynecology at local hospital from January 2015 to December 2018 were screened for Pr-AKI. Patients with serum creatinine above normal range(> 70umol/L) then underwent assessment to confirm the diagnosis of Pr-AKI. AKI was diagnosed and staged based on Kidney Disease Improving Global Outcomes(KDIGO) guideline. Individuals meeting the Pr-AKI criteria were recruited. Their clinical data were recorded and retrospectively analyzed. Results Pr-AKI was identified in 136/6512(2.09 %) patients. Hypertensive disorders of pregnancy(HDP) was the leading cause of Pr-AKI(35.3 %). 4(2.9 %) women died and the majority(86.1 %) had recovered renal function before discharge. Fetal outcomes were confirmed in 109 deliveries with gestational age ≥ 20 weeks. Pre-term delivery occurred in 30(27.3 %) cases and perinatal deaths in 17(15.5 %). The rate of low birth weight infant(LBWI) and intrauterine growth restriction(IUGR) was 22.0 and 10.9 % respectively. 16(14.5 %) infants were admitted to NICU after birth. Patients with HDP had a higher cesarean rate(56.3 %). More IUGR(25.0 %) and LBWI(37.8 %) were observed in their infants with a higher risk of admission to NICU(22.0 %). High altitude might have an adverse impact on HDP-related Pr-AKI patients with earlier terminated pregnancy and more stillbirth/neonatal death. Logistic regression models indicated that uncontrolled blood pressure, high altitude and advanced AKI were associated with adverse fetal outcomes in HDP-related Pr-AKI patients. Conclusions Pr-AKI was not rare in high-altitude regions and caused severe fetal morbidities and mortalities. Uncontrolled blood pressure, high altitude and advanced AKI were all risk factors for adverse fetal outcomes in Pr-AKI patients, especially for those with hypertensive disorders of pregnancy.

Blood pressure variability during pediatric cardiac surgery is associated with acute kidney injury

2021 ◽  
Author(s):  
Jennifer E. Fishbein ◽  
Matthew Barone ◽  
James B. Schneider ◽  
David B. Meyer ◽  
John Hagen ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Acute Kidney Injury ◽  
Cardiac Surgery ◽  
Blood Pressure Variability ◽  
Kidney Injury ◽  
Pediatric Cardiac Surgery

scholarly journals Preventing contrast-induced acute kidney injury in the emergency room

2015 ◽  
Vol 3 (1) ◽  
pp. 59-60 ◽  
Author(s):  
Koichiro Homma ◽  
Tadashi Yoshida ◽  
Joe Yoshizawa ◽  
Masaru Suzuki ◽  
Junichi Sasaki ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Emergency Room ◽  
Kidney Injury

scholarly journals Preoperative hemoglobin and uric acid levels as risk factors for acute kidney injury in cardiac surgery patients

2020 ◽  
Vol 73 (1-2) ◽  
pp. 5-12
Author(s):  
Miodrag Golubovic ◽  
Andrej Preveden ◽  
Ranko Zdravkovic ◽  
Jelena Vidovic ◽  
Bojan Mihajlovic ◽  
...  
Keyword(s):  
Risk Factors ◽  
Acute Kidney Injury ◽  
Uric Acid ◽  
Cardiac Surgery ◽  
Kidney Injury ◽  
C Reactive Protein ◽  
Reactive Protein ◽  
Preoperative Hemoglobin ◽  
Significant Difference ◽  
Acute Kidney Injury Development

Introduction. Acute kidney injury associated with cardiac surgery is a common and significant postoperative complication. With a frequency of 9 - 39% according to different studies, it is the second most common cause of acute kidney injury in intensive care units, and an independent predictor of mortality. This study aimed to investigate the importance of preoperative hemoglobin and uric acid levels as risk factors for acute kidney injury in the postoperative period in cardiac surgery patients. Material and Methods. The study included a total of 118 patients who were divided into two groups. Each group included 59 patients; the fist group included patients who developed acute kidney injury and required renal replacement therapy, and the second included patients without acute kidney injury. Types of cardiac surgery included coronary, valvular, combined, aortic dissection, and others. All necessary data were collected from patient medical records and the electronic database. Results. A statistically significant difference was found between the groups in preoperative hemoglobin levels (108.0 vs. 143.0 g/l, p = 0.0005); postoperative urea (26.4 vs. 5.8 mmol/l, p = 0.0005) and creatinine (371.0 vs. 95.0 ?mol/l, p = 0.0005), acute phase inflammatory reactants C-reactive protein (119.4 vs. 78.9 mg/l, p = 0.002) and procalcitonin (7.0 vs. 0.2 ng/ml, p = 0.0005), creatine kinase myocardial band isoenzyme (1045.0 vs. 647.0 mg/l, p = 0.014); duration of extracorporeal circulation (103.5 vs. 76.0 min, p = 0.0005) and ascending aortic clamp during cardiac surgery (89.0 vs. 67.0 min, p = 0.0005). The exception was the preoperative uric acid level, where there was no statistically significant difference (382.0 vs. 364.0 ?mol/l, p = 0.068). There was a statistically significant correlation between the use of inotropic agents and acute kidney injury development. Conclusion. There is a correlation between the preoperative low hemoglobin levels and postoperative acute kidney injury. There is no statistically significant correlation between the preoperative levels of uric acid and postoperative acute kidney injury.

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