Mortality after urinary tract infections in patients with advanced cirrhosis - Relevance of acute kidney injury and comorbidities

2013 ◽  
Vol 33 (2) ◽  
pp. 220-230 ◽  
Author(s):  
Philipp A. Reuken ◽  
Andreas Stallmach ◽  
Tony Bruns
Keyword(s):  
Acute Kidney Injury ◽  
Urinary Tract ◽  
Urinary Tract Infections ◽  
Kidney Injury ◽  
Advanced Cirrhosis ◽  
Tract Infections

Renal emergencies

2019 ◽  
pp. 289-326
Author(s):  
Punit S. Ramrakha ◽  
Kevin P. Moore ◽  
Amir H. Sam
Keyword(s):  
Acute Kidney Injury ◽  
Urinary Tract ◽  
Interstitial Nephritis ◽  
Urinary Tract Infections ◽  
Kidney Injury ◽  
Renal Stones ◽  
Upper Urinary Tract ◽  
Contrast Nephropathy ◽  
Cholesterol Embolism ◽  
Tract Infections

This chapter discusses renal emergencies, including acute kidney injury (AKI), anuria, interstitial nephritis, rhabdomyolysis, hepatorenal syndrome, acute upper urinary tract infections, renal colic and renal stones, haematuria, renovascular disease, cholesterol embolism, and contrast nephropathy.

Renal emergencies

2010 ◽  
pp. 281-308
Author(s):  
Punit S. Ramrakha ◽  
Kevin P. Moore ◽  
Amir Sam
Keyword(s):  
Acute Kidney Injury ◽  
Urinary Tract ◽  
Interstitial Nephritis ◽  
Urinary Tract Infections ◽  
Hepatorenal Syndrome ◽  
Renal Colic ◽  
Kidney Injury ◽  
Renal Stones ◽  
Upper Urinary Tract ◽  
Tract Infections

Acute kidney injury (AKI) 1 282 AKI 2 284 AKI: investigations 286 AKI: management 288 AKI: further management 290 Anuria 292 Interstitial nephritis 293 Rhabdomyolysis 294 Hepatorenal syndrome 296 Acute upper urinary tract infections 298 Renal colic and renal stones 300 Haematuria 302 Renovascular disease ...

scholarly journals Reducing urinary tract infections in care homes by improving hydration

2019 ◽  
Vol 8 (3) ◽  
pp. e000563 ◽  
Author(s):  
Katie Lean ◽  
Rasanat Fatima Nawaz ◽  
Sundus Jawad ◽  
Charles Vincent
Keyword(s):  
Urinary Tract ◽  
Urinary Tract Infections ◽  
Hospital Admissions ◽  
Low Cost ◽  
Care Home ◽  
Kidney Injury ◽  
Care Staff ◽  
Care Homes ◽  
Raising Awareness ◽  
Tract Infections

Dehydration may increase the risk of urinary tract infections (UTIs), which can lead to confusion, falls, acute kidney injury and hospital admission. We aimed to reduce the number of UTIs in care home residents which require admission to hospital. The principal intervention was the introduction of seven structured drink rounds every day accompanied by staff training and raising awareness. UTIs requiring antibiotics reduced by 58% and UTIs requiring hospital admissions reduced by 36%, when averaged across the four care homes. Care home residents benefited from greater fluid intake, which in turn may have reduced infection. Structured drink rounds were a low-cost intervention for preventing UTIs and implemented easily by care staff.

scholarly journals Acute Kidney Injury Caused by Obstructive Nephropathy

2020 ◽  
Vol 2020 ◽  
pp. 1-10
Author(s):  
Jonathan S Chávez-Iñiguez ◽  
Goretty J Navarro-Gallardo ◽  
Ramón Medina-González ◽  
Luz Alcantar-Vallin ◽  
Guillermo García-García
Keyword(s):  
Acute Kidney Injury ◽  
Urinary Tract ◽  
Kidney Function ◽  
Kidney Injury ◽  
Inflammatory Factors ◽  
Obstructive Nephropathy ◽  
Urine Retention ◽  
Frequent Event ◽  
History Of ◽  
Tract Infections

Acute kidney injury secondary to obstructive nephropathy is a frequent event that accounts for 5 to 10% of all acute kidney injury cases and has a great impact on the morbidity and mortality in those affected. The obstruction in the urinary tract has a profound impact on kidney function due to damage produced by ischemic and inflammatory factors that have been associated with intense fibrosis. This pathology is characterized by its effects on the management of fluids, electrolytes, and the acid-base mechanisms by the renal tubule; consequently, metabolic acidosis, hyperkalemia, uremia, and anuria are seen during acute kidney injury due to obstructive nephropathy, and after drainage, polyuria may occur. Acute urine retention is the typical presentation. The diagnosis consists of a complete medical history and should include changes in urinary voiding and urgency and enuresis, history of urinary tract infections, hematuria, renal lithiasis, prior urinary interventions, and constipation. Imaging studies included tomography or ultrasound in which hydronephrosis can be seen. Management includes, in addition to drainage of the obstructed urinary tract system, providing supportive treatment, correcting all the metabolic abnormalities, and initiating renal replacement therapy when required. Although its recovery is in most cases favorable, it seems to be an undervalued event in nephrology and urology. This is because it is mistakenly believed that the resolution and recovery of kidney function is complete once the urinary tract is unobstructed. It can have serious kidney sequelae. In this review, we report the epidemiology, incidence, pathophysiological mechanisms, diagnosis, and treatment of acute kidney injury due to obstructive nephropathy.

scholarly journals 2273. Outcomes of Trimethoprim/Sulfamethoxazole as Definitive Therapy for Urinary Tract Infections with Multi-Drug-Resistant Enterobacteriaceae

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S778-S778
Author(s):  
Fatima Adhi ◽  
Yanina Dubrovskaya ◽  
Samuel Cytryn
Keyword(s):  
Urinary Tract ◽  
Urinary Tract Infections ◽  
Care Center ◽  
Tertiary Care ◽  
Kidney Injury ◽  
Resistant Organism ◽  
Drug Resistant ◽  
Duration Of Treatment ◽  
Definitive Therapy ◽  
Tract Infections

Abstract Background Trimethoprim/Sulfamethoxazole (TMP/SMX) is not routinely employed for urinary tract infections (UTI) with multi-drug-resistant organisms (MDRO) due to paucity of effectiveness data, concerns regarding inadequate urinary penetration, and risk of adverse effects. We describe our experience with TMP/SMX as definitive therapy for MDRO Enterobacteriaceae (MDRO-E). Methods We carried out a retrospective review of patients hospitalized at a tertiary care center and treated with TMP/SMX as definitive therapy for UTI with MDRO-E (as defined by resistance to third-generation cephalosporins in culture). We evaluated rates of overall cure rate (CR), adverse events (AE), recurrence (RC) and reinfection (RI). Repeat growth of same or different pathogen in urine culture (UC) within 30 days of completion of treatment was defined as RC or RI, respectively. Results 92 patients had 101 episodes of MDRO-E UTIs treated with TMP/SMX as initial (n = 26, 25.7%) or as step-down therapy (n = 23, 77%) after broad-spectrum empiric antimicrobials (ceftriaxone n = 22, cefepime n = 21, piperacillin/tazobactam n = 12, carbapenems n = 6, ciprofloxacin n = 3). 63 (68.5%) patients were 65 years or older. MDRO-E in 10 (9.9%) episodes were also resistant to carbapenems. Empiric therapy was appropriate in 56 (55.5%) episodes. Median duration of treatment was 8.5 (range 3–24) days for all antimicrobials and 7 (range 2–15) days for TMP-/SMX. Overall CR was 100%. RC/RI was seen in 23/101 (22.8%) episodes (RC n = 9; RI n = 14); UC data were available for 20 of which 8/20 (40%) had a TMP/SMX-resistant organism. 4 (3.9%) patients required readmission for a RC/RI UTI. In terms of AEs: 10 (9.9%) episodes of hyperkalemia (median maximum potassium level 4.5 mmol/L, range 2.7–6.4), 3 (2.9%) episodes of acute kidney injury, 5 episodes of Clostridium difficile infection, and 4 (3.9%) readmissions for a RC/RI UTI within 90 days. Conclusion Our findings suggest that TMP/SMX can be safe and effective as definitive therapy for ESBL-E UTI. The major AE are hyperkalemia and AKI, the incidence of which is high when TMP/SMX is used in combination with ACEI/ARBs. No clinical factors were found to be predictive of recurrence of reinfection. Disclosures All authors: No reported disclosures.

scholarly journals Risk factors for urosepsis in chronic kidney disease patients with urinary tract infections

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Zorica Dimitrijevic ◽  
Goran Paunovic ◽  
Danijela Tasic ◽  
Branka Mitic ◽  
Dragoslav Basic
Keyword(s):  
Risk Factors ◽  
Chronic Kidney Disease ◽  
Urinary Tract ◽  
Kidney Disease ◽  
Urinary Tract Infections ◽  
Urinary Catheter ◽  
Kidney Injury ◽  
Length Of Hospital Stay ◽  
E Coli ◽  
Tract Infections

AbstractOccurrence of urosepsis is not uncommon following urinary tract infections (UTI). However, there is a lack of evidence explaining the risk factors predisposing to urosepsis in patients with chronic kidney disease (CKD). This retrospective study was undertaken to evaluate the incidence and possible risk factors for urosepsis among patients hospitalized with UTI in a cohort of CKD patients. Patients were divided into the urosepsis group and the non-urosepsis group. Of 489 hospitalized patients with UTI, 70 (14.3%) acquired urosepsis. Stepwise multivariate logistic regression demonstrated that diabetes, urinary catheter and length of hospital stay (p < 0.001 for all) were significant independent predictive risk factors for urosepsis in CKD patients with UTI in addition to age, glomerular filtration rate, hydronephrosis, acute kidney injury and E. coli infection (p < 0.05 for all). Finally, Klebsiella spp. cases were associated with significantly higher odds for urosepsis than E. coli cases (OR: 3.5, 95% CI: 2.86–7.23, p < 0.001 vs. OR: 1.38, 95% CI: 1.19–3.69, p = 0.038). Diabetes, presence of an indwelling urinary catheter, length of hospitalization, and infection with Klebsiella spp were independent risk factors for urosepsis in CKD patients with UTI.

scholarly journals Cytokines and SLPI profiles in children and adults with urinary tract infections

2019 ◽  
pp. 13-19
Author(s):  
M. Kolesnуk ◽  
V. Driianska ◽  
N. Stepanova ◽  
O. Lavrenchuk ◽  
I. Bagdasarova ◽  
...  
Keyword(s):  
Urinary Tract ◽  
Inflammatory Cytokines ◽  
Urinary Tract Infections ◽  
Prognostic Markers ◽  
Kidney Injury ◽  
Serum Levels ◽  
Lipocalin 2 ◽  
Tnf Α ◽  
Anti Inflammatory ◽  
Tract Infections

Pro- and anti-inflammatory cytokines, SLPI and NGAL are involved in anti-infectious immunity. Studies of these indicators’ role in patients with urinary tract infections (UTIs) may determine their significance as diagnostic and prognostic markers in the case of pyelonephritis and cystitis. The objective of our study was to investigate plasma and urine cytokines and SLPI levels in patients with UTIs, determine the features in children and adults. Materials and methods. ELISA method and related test systems - «Immunotech», «Diaclon» (France); «DRG» (Germany), «Hycult biotechnology» ((Netherlands)  were used to study blood cytokine levels in 118 adults and 67 children, SLPI levels in the blood and urine in 59 and 58, respectively. NGAL serum levels of 26 adults with acute pyelonephritis (AP) and 30 adults with chronic pyelonephritis (ChP) were studied using «Human lipocalin-2 / NGAL ELIZA» (Biovendor, Czech Republik) for NGAL. Comparison groups included 10 healthy donors and 11 patients with acute kidney injury (AKI).  Results. The study showed an increase in pro- (IL-1, -17, -18, -23, TNF-α, MCP-1) and anti-inflammatory cytokines (IL-17, TGF-β), SLPI, NGAL in patients with UTI, some features in the case of chronic cystitis (ChC), AP and ChP. In adults, TNF-α in the blood and urine, IL-17 in the blood was higher in the case of ChC than ChP. The analysis showed a significant increase in all studied indicators’ levels for AP and ChP in children and adults. The average MCP-1 level in patients with AP was significantly higher than ChP, whereas TNF-α did not differ. In adults, IL-18 and IL-23 were highest in the case of AP, and TGF-β was the highest in the case of ChP. MCP-1, IL-23 levels in the blood of adults were higher than in children in the case of AP, and TNF-α - in the case of ChP. SLPI is involved in the AP pathogenesis and ChP exacerbation. High SLPI levels have been determined in serum and urine (NGAL in the blood) in patients with pyelonephritis (NGAL - AP) who can be used, as well as cytokines, as additional diagnostic and prognostic markers. Conclusions. High levels of TNF-α, MCP-1, and IL-23 in the blood of adults and children confirm their important role in both AP and ChP, but MCP-1 can be considered as an AP predictor/ ChP exacerbation. According to the studied cytokines, adults have a more significant immune response. The SLPI level is an additional feature for diagnosing and monitoring the course of pyelonephritis and cystitis.

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