Effects of Hydroxyethyl Starch 130/0.4 on Serum Creatinine Concentration and Development of Acute Kidney Injury in Nonazotemic Cats

Background Differences in the impact of contrast medium on the development of contrast‐induced acute kidney injury (CI‐AKI) in patients undergoing transcatheter aortic valve implantation (TAVI) or a coronary angiography/percutaneous coronary intervention (CA/PCI) have not been previously investigated. Methods and Results Patients treated with TAVI or elective CA/PCI were retrospectively analyzed in terms of baseline and procedural characteristics, including preprocedural and postprocedural kidney function. CI‐AKI was defined as a relative increase in serum creatinine concentration of at least 0.3 mg/dL within 72 hours of contrast‐medium administration compared with baseline. The incidence of CI‐AKI in the TAVI versus CA/PCI group was compared. After the exclusion of patients in dialysis and emergency procedures, 977 patients were analyzed; there were 489 patients who had undergone TAVI (50.1%) and 488 patients who had undergone CA/PCI (49.9%). Patients treated by TAVI were older, presenting a higher rate of anemia and chronic kidney disease ( P <0.001 for all comparisons). Consistently, they also had a significantly lower glomerular filtration rate and higher serum creatinine concentration ( P <0.001 for all). However, the occurrence of CI‐AKI was significantly lower in these patients compared with patients treated by a CA/PCI (6.7% versus 14.5%, P <0.001). At multivariate analysis, the TAVI procedure had an independent protective effect on CI‐AKI incidence among total population (odds ratio, 0.334; 95% CI, 0.193–0.579; P <0.001). This observation was confirmed after propensity score matching among 360 patients (180 by TAVI and 180 by CA/PCI; P =0.002). Conclusions CI‐AKI occurred less frequently in patients undergoing TAVI than in patients undergoing a CA/PCI, despite a worse‐risk profile. The impact of contrast administration on kidney function in patients who had undergone TAVI may be better tolerated because of the hemodynamic changes following aortic valve replacement.

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Acute Kidney Injury - Part II: Special Situations

10.2310/fm.1631 ◽

2019 ◽

Author(s):

Paul W Sanders ◽

Anupam Agarwal

Keyword(s):

Multiple Myeloma ◽

Acute Kidney Injury ◽

Renal Failure ◽

Serum Creatinine ◽

Hepatorenal Syndrome ◽

Kidney Injury ◽

Serum Creatinine Concentration ◽

Creatinine Concentration ◽

Waste Products ◽

Abrupt Decrease

Acute renal failure (ARF) has been defined as a syndrome in which an abrupt decrease in renal function produces retention of nitrogenous waste products. Translating this abstract description into a clinically useful, accurate, and widely accepted definition has been challenging, in large part because of the focus on serum creatinine concentration, which is easily obtained but has the inherent limitation of poor detection of rapid or subtle, but clinically important, changes in the glomerular filtration rate (GFR). In recent years, therefore, the term acute kidney injury (AKI) has replaced ARF because AKI denotes the entire clinical spectrum from mild increases in serum creatinine to overt renal failure. AKI is defined by the Risk-Injury-Failure-Loss-ESRD (RIFLE) criteria, based on serum creatinine concentration and urine flow rate. The Acute Kidney Injury Network (AKIN) subsequently modified the definition further and divided AKI into three stages. This part of the AKI review specifically discusses special situations: rhabdomyolysis, aristolochic acid nephropathy, acute urate nephropathy, acute phosphate nephropathy, AKI in multiple myeloma, ehytlene glycol poisoning, contrast-induced nephropathy, AKI in sepsis, hepatorenal syndrome, and AKI in pregnancy. This review contains 10 tables, and 47 references. Keywords:Acute kidney injury, dialysis, contrast, rhabdomyolysis, nephropathy, urinalysis, multiple myeloma, ethylene glycol, sepsis, hepatorenal syndrome

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Acute Kidney Injury - Part I

10.2310/fm.1164 ◽

2019 ◽

Author(s):

Paul W Sanders ◽

Anupam Agarwal

Keyword(s):

Acute Kidney Injury ◽

Renal Failure ◽

Serum Creatinine ◽

Kidney Injury ◽

Acute Kidney Injury Network ◽

Serum Creatinine Concentration ◽

Cardiac Conduction ◽

Creatinine Concentration ◽

Waste Products ◽

Abrupt Decrease

Acute renal failure (ARF) has been defined as a syndrome in which an abrupt decrease in renal function produces retention of nitrogenous waste products. Translating this abstract description into a clinically useful, accurate, and widely accepted definition has been challenging, in large part because of the focus on serum creatinine concentration, which is easily obtained but has the inherent limitation of poor detection of rapid or subtle, but clinically important, changes in the glomerular filtration rate (GFR). In recent years, therefore, the term acute kidney injury (AKI) has replaced ARF because AKI denotes the entire clinical spectrum from mild increases in serum creatinine to overt renal failure. AKI is defined by the Risk-Injury-Failure-Loss-ESRD (RIFLE) criteria, based on serum creatinine concentration and urine flow rate. The Acute Kidney Injury Network (AKIN) subsequently modified the definition further and divided AKI into three stages. This chapter includes discussions of the etiology and diagnosis of AKI in hospitalized patients and community-acquired AKI. The specific causes, management, and complications of AKI are also discussed. Figures illustrate the pathophysiologic classification of AKI and the effect of hyperkalemia on cardiac conduction—electrocardiogram (ECG) changes. A worksheet for following patients with AKI is provided. This review contains 3 figures, 20 tables, and 46 references. Keywords:Acute kidney injury, dialysis, contrast, rhabdomyolysis, nephropathy, urinalysis, multiple myeloma, ethylene glycol, sepsis, hepatorenal syndrome

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Acute Kidney Injury - Part I

10.2310/im.1164 ◽

2019 ◽

Author(s):

Paul W Sanders ◽

Anupam Agarwal

Keyword(s):

Acute Kidney Injury ◽

Renal Failure ◽

Serum Creatinine ◽

Kidney Injury ◽

Acute Kidney Injury Network ◽

Serum Creatinine Concentration ◽

Cardiac Conduction ◽

Creatinine Concentration ◽

Waste Products ◽

Abrupt Decrease

Acute renal failure (ARF) has been defined as a syndrome in which an abrupt decrease in renal function produces retention of nitrogenous waste products. Translating this abstract description into a clinically useful, accurate, and widely accepted definition has been challenging, in large part because of the focus on serum creatinine concentration, which is easily obtained but has the inherent limitation of poor detection of rapid or subtle, but clinically important, changes in the glomerular filtration rate (GFR). In recent years, therefore, the term acute kidney injury (AKI) has replaced ARF because AKI denotes the entire clinical spectrum from mild increases in serum creatinine to overt renal failure. AKI is defined by the Risk-Injury-Failure-Loss-ESRD (RIFLE) criteria, based on serum creatinine concentration and urine flow rate. The Acute Kidney Injury Network (AKIN) subsequently modified the definition further and divided AKI into three stages. This chapter includes discussions of the etiology and diagnosis of AKI in hospitalized patients and community-acquired AKI. The specific causes, management, and complications of AKI are also discussed. Figures illustrate the pathophysiologic classification of AKI and the effect of hyperkalemia on cardiac conduction—electrocardiogram (ECG) changes. A worksheet for following patients with AKI is provided. This review contains 3 figures, 21 tables, and 46 references. Keywords:Acute kidney injury, dialysis, contrast, rhabdomyolysis, nephropathy, urinalysis, multiple myeloma, ethylene glycol, sepsis, hepatorenal syndrome

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Acute Kidney Injury - Part II: Special Situations

10.2310/tywc.1631 ◽

2019 ◽

Author(s):

Paul W Sanders ◽

Anupam Agarwal

Keyword(s):

Multiple Myeloma ◽

Acute Kidney Injury ◽

Renal Failure ◽

Serum Creatinine ◽

Hepatorenal Syndrome ◽

Kidney Injury ◽

Serum Creatinine Concentration ◽

Creatinine Concentration ◽

Waste Products ◽

Abrupt Decrease

Acute renal failure (ARF) has been defined as a syndrome in which an abrupt decrease in renal function produces retention of nitrogenous waste products. Translating this abstract description into a clinically useful, accurate, and widely accepted definition has been challenging, in large part because of the focus on serum creatinine concentration, which is easily obtained but has the inherent limitation of poor detection of rapid or subtle, but clinically important, changes in the glomerular filtration rate (GFR). In recent years, therefore, the term acute kidney injury (AKI) has replaced ARF because AKI denotes the entire clinical spectrum from mild increases in serum creatinine to overt renal failure. AKI is defined by the Risk-Injury-Failure-Loss-ESRD (RIFLE) criteria, based on serum creatinine concentration and urine flow rate. The Acute Kidney Injury Network (AKIN) subsequently modified the definition further and divided AKI into three stages. This part of the AKI review specifically discusses special situations: rhabdomyolysis, aristolochic acid nephropathy, acute urate nephropathy, acute phosphate nephropathy, AKI in multiple myeloma, ehytlene glycol poisoning, contrast-induced nephropathy, AKI in sepsis, hepatorenal syndrome, and AKI in pregnancy. This review contains 10 tables, and 47 references. Keywords:Acute kidney injury, dialysis, contrast, rhabdomyolysis, nephropathy, urinalysis, multiple myeloma, ethylene glycol, sepsis, hepatorenal syndrome

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Acute Kidney Injury - Part I

10.2310/tywc.1164 ◽

2019 ◽

Author(s):

Paul W Sanders ◽

Anupam Agarwal

Keyword(s):

Acute Kidney Injury ◽

Renal Failure ◽

Serum Creatinine ◽

Kidney Injury ◽

Acute Kidney Injury Network ◽

Serum Creatinine Concentration ◽

Cardiac Conduction ◽

Creatinine Concentration ◽

Waste Products ◽

Abrupt Decrease

Acute renal failure (ARF) has been defined as a syndrome in which an abrupt decrease in renal function produces retention of nitrogenous waste products. Translating this abstract description into a clinically useful, accurate, and widely accepted definition has been challenging, in large part because of the focus on serum creatinine concentration, which is easily obtained but has the inherent limitation of poor detection of rapid or subtle, but clinically important, changes in the glomerular filtration rate (GFR). In recent years, therefore, the term acute kidney injury (AKI) has replaced ARF because AKI denotes the entire clinical spectrum from mild increases in serum creatinine to overt renal failure. AKI is defined by the Risk-Injury-Failure-Loss-ESRD (RIFLE) criteria, based on serum creatinine concentration and urine flow rate. The Acute Kidney Injury Network (AKIN) subsequently modified the definition further and divided AKI into three stages. This chapter includes discussions of the etiology and diagnosis of AKI in hospitalized patients and community-acquired AKI. The specific causes, management, and complications of AKI are also discussed. Figures illustrate the pathophysiologic classification of AKI and the effect of hyperkalemia on cardiac conduction—electrocardiogram (ECG) changes. A worksheet for following patients with AKI is provided. This review contains 3 figures, 20 tables, and 46 references. Keywords:Acute kidney injury, dialysis, contrast, rhabdomyolysis, nephropathy, urinalysis, multiple myeloma, ethylene glycol, sepsis, hepatorenal syndrome

Download Full-text

Acute Kidney Injury - Part II: Special Situations

10.2310/im.1631 ◽

2019 ◽

Author(s):

Paul W Sanders ◽

Anupam Agarwal

Keyword(s):

Multiple Myeloma ◽

Acute Kidney Injury ◽

Renal Failure ◽

Serum Creatinine ◽

Hepatorenal Syndrome ◽

Kidney Injury ◽

Serum Creatinine Concentration ◽

Creatinine Concentration ◽

Waste Products ◽

Abrupt Decrease

Acute renal failure (ARF) has been defined as a syndrome in which an abrupt decrease in renal function produces retention of nitrogenous waste products. Translating this abstract description into a clinically useful, accurate, and widely accepted definition has been challenging, in large part because of the focus on serum creatinine concentration, which is easily obtained but has the inherent limitation of poor detection of rapid or subtle, but clinically important, changes in the glomerular filtration rate (GFR). In recent years, therefore, the term acute kidney injury (AKI) has replaced ARF because AKI denotes the entire clinical spectrum from mild increases in serum creatinine to overt renal failure. AKI is defined by the Risk-Injury-Failure-Loss-ESRD (RIFLE) criteria, based on serum creatinine concentration and urine flow rate. The Acute Kidney Injury Network (AKIN) subsequently modified the definition further and divided AKI into three stages. This part of the AKI review specifically discusses special situations: rhabdomyolysis, aristolochic acid nephropathy, acute urate nephropathy, acute phosphate nephropathy, AKI in multiple myeloma, ehytlene glycol poisoning, contrast-induced nephropathy, AKI in sepsis, hepatorenal syndrome, and AKI in pregnancy. This review contains 10 tables, and 47 references. Keywords:Acute kidney injury, dialysis, contrast, rhabdomyolysis, nephropathy, urinalysis, multiple myeloma, ethylene glycol, sepsis, hepatorenal syndrome

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Effect of concomitant vancomycin and piperacillin–tazobactam on frequency of acute kidney injury in pediatric patients

American Journal of Health-System Pharmacy ◽

10.1093/ajhp/zxz125 ◽

2019 ◽

Vol 76 (16) ◽

pp. 1204-1210 ◽

Cited By ~ 5

Author(s):

Kaitlyn M Buhlinger ◽

Kathryn A Fuller ◽

Cassidy B Faircloth ◽

Jessica R Wallace

Keyword(s):

Acute Kidney Injury ◽

Serum Creatinine ◽

Trough Concentration ◽

Pediatric Patients ◽

Group Versus ◽

Kidney Injury ◽

Secondary Outcome ◽

Study Cohort ◽

Creatinine Concentration ◽

Vancomycin Trough

Abstract Purpose Results of a study of rates of acute kidney injury (AKI) in pediatric patients treated with vancomycin plus piperacillin–tazobactam or vancomycin plus alternative antipseudomonal β-lactams (APBLs) are reported. Methods A retrospective, single-center cohort study was performed. Pediatric patients were included in the study cohort if they received combination therapy for at least 48 hours, had documented baseline and follow-up serum creatinine levels, and had a documented serum vancomycin trough concentration. The primary outcome was the frequency of AKI, defined as a 50% or greater increase in serum creatinine concentration from baseline or an increase of at least 0.5 mg/dL from baseline. The secondary outcome was time to AKI onset. Results A total of 474 patients were included. Among 100 patients who received vancomycin plus piperacillin–tazobactam, the rate of AKI was higher than the rate in the group treated with vancomycin plus alternative APBLs (27% versus 7%, p < 0.0001). The median time to AKI onset was shorter in the piperacillin–tazobactam group versus the alternative APBL group (3.8 versus 7.9 days, p = 0.0065). Patients who were administered piperacillin–tazobactam were almost 6 times as likely to develop AKI (odds ratio [OR], 5.955; 95% confidence interval [CI], 2.774–12.784), and patients who had a maximum vancomycin trough concentration greater than 20 mg/L were 7.5 times as likely to develop AKI (OR, 7.552; 95% CI, 3.625–15.734). Conclusion Pediatric patients treated with concomitant vancomycin and piperacillin–tazobactam had a higher rate of AKI, with faster AKI onset, than those who received vancomycin in combination with other APBLs.

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Acute kidney injury after cardiac surgical operations specially including coronary artery bypass graft operations

Journal of Medical Science ◽

10.20883/medical.e34 ◽

2015 ◽

Vol 84 (1) ◽

pp. 41-45

Author(s):

Adam Lipski ◽

Marta Szymoniak-Lipska ◽

Krzysztof Greberski

Keyword(s):

Risk Factors ◽

Acute Kidney Injury ◽

Renal Replacement Therapy ◽

Serum Creatinine ◽

Replacement Therapy ◽

Early Period ◽

Kidney Injury ◽

Type I ◽

Creatinine Concentration ◽

Surgical Operations

Introduction. Acute kidney injury as abrupt loss of kidney function leads to accumulation nitric and non-nitric metabolites, toxins. It coexists with deep disorder of fluid balance. Most of cardiac surgical operations are performed using extracorporeal circulation (ECC). To the main risk factors of the postoperative dysfunction of kidneys belong: age above 70, congestive heart failure, previous CABG, preoperative creatinine concentration 124–177 µmol/L, diabetes type I, glucose concentration > 16,6 mmol/L, EEC longer than 3 hours and decreased cardiac output (CO).Material and methods. The serum creatinine is not enough sensitive marker to diagnose early period of acute kidney injury because the serum creatinine increase occur later than true GFR changes and it needs time to accumulate. It depends on factors like: age, sex, weight, hydration status and what patient eat. NGAL (neutrophil-gelatinase associated lipocalin), cystatin C, KIM-1, IL-18, L-FABP are new markers of acute kidney injury which better than the serum creatinine concentration correspond with kidney injury. The risk factors of the acute kidney injury (AKI) are kidney hypoperfusion, microembolisation by bubbles or material particles and significant activation of humoral factors.Results. One of the methods reducing mortality CSA-AKI (cardiac surgery associated kidney injury) is renal replacement therapy (RRT), which should be used in early period of acute kidney disease before severe symptoms and complications develop.Conclusions. There is necessity to find early, easy and cheap markers of acute kidney injury which help decide if use renal replacement therapy. It increases the effectiveness of treatment and improves prognosis in this group of patients.

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