Dramatic Increase of Amoxicillin-Induced Crystal Nephropathy Found in a Cohort Study of French Pharmacovigilance Centers

ABSTRACTAn increase in amoxicillin-induced crystal nephropathy (AICN) incidence has been recently suggested. The aims of this study were to investigate the trend of AICN incidence through Paris' regional centers of pharmacovigilance (Paris RCPVs) and better describe this rare adverse drug reaction. Forty-five AICN cases were identified between 1985 and 2016. All cases, except one, were reported since 2010. Amoxicillin (AMX) was administered intravenously (65 [interquartile range {IQR}, 43 to 110] mg/kg of body weight/day) in all patients, either for treating infection (n= 15) or as surgical prophylaxis (n= 30). Delay between AMX administration and AICN onset was 1 (IQR, 1 to 3) day; 30, 4, and 11 patients developed KDIGO stage 1, 2, and 3 acute kidney injury, respectively. Delay between AICN onset and kidney function recovery was 4 (IQR, 2 to 6) days. Precipitating factors were identified in only one-third of cases. Twelve patients required intensive care unit admission, and 8 needed renal replacement therapy. Neither chronic kidney disease nor death was observed. We confirmed the recent and dramatic increase of AICN in the Paris RCPVs since 2010. The absence of precipitating factors in the majority of cases and the onset of AICN in apparent routine indications, such as surgical prophylaxis, are alarming and justify a high vigilance from all AMX prescribers.

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Acute kidney injury and its outcomes in melioidosis

Journal of Nephrology ◽

10.1007/s40620-021-00970-x ◽

2021 ◽

Author(s):

Ravindra Attur Prabhu ◽

Tushar Shaw ◽

Indu Ramachandra Rao ◽

Vandana Kalwaje Eshwara ◽

Shankar Prasad Nagaraju ◽

...

Keyword(s):

Acute Kidney Injury ◽

Kidney Function ◽

Univariate Analysis ◽

Kidney Injury ◽

Function Recovery ◽

Kidney Involvement ◽

Duration Of Hospitalization ◽

Observational Cohort ◽

Stage 1 ◽

Urinary Abnormalities

Abstract Background Melioidosis is a potentially fatal tropical infection caused by Burkholderia pseudomallei. Kidney involvement is possible, but has not been well described. Aim This study aimed to assess the risk of acute kidney injury (AKI) and its outcomes in melioidosis. Methods A retrospective observational cohort study was performed. Case records of consecutive patients with culture-confirmed melioidosis, observed from January 1st, 2012 through December 31st, 2019 were analysed for demographics, presence of comorbidities, including chronic kidney disease (CKD), diabetes mellitus (DM), and presence of bacteraemia, sepsis, shock, AKI, and urinary abnormalities. The outcomes we studied were: mortality, need for hospitalisation in an intensive care unit (ICU), duration of hospitalization. We then compared the outcomes between patients with and without AKI. Results Of 164 patients, AKI was observed in 59 (35.98%), and haemodialysis was required in eight (13.56%). In the univariate analysis, AKI was associated with CKD (OR 5.83; CI 1.140–29.90, P = 0.03), bacteraemia (OR 8.82; CI 3.67–21.22, P < 0.001) and shock (OR 3.75; CI 1.63–8.65, P = 0.04). In the multivariate analysis, CKD (adjusted OR 10.68; 95% CI 1.66–68.77; P = 0.013) and bacteraemia (adjusted OR 8.22; 95% CI 3.15–21.47, P < 0.001) predicted AKI. AKI was associated with a greater need for ICU care (37.3% vs. 13.3%, P = 0.001), and mortality (32.2% vs. 5.7%, P < 0.001). Mortality increased with increasing AKI stage, i.e. stage 1 (OR 3.52, CI 0.9–13.7, P = 0.07), stage 2 (OR 6.79, CI 1.92–24, P = 0.002) and stage 3 (OR 17.8, CI 5.05–62.8, P < 0.001), however kidney function recovered in survivors. Hyponatremia was observed in 138 patients (84.15%) and isolated urinary abnormalities were seen in 31(18.9%). Conclusions AKI is frequent in melioidosis and occurred in 35.9% of our cases. Hyponatremia is likewise common. AKI was predicted by bacteraemia and CKD, and was associated with higher mortality and need for ICU care; however kidney function recovery was observed in survivors. Graphic abstract

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SARS-CoV-2 infection in hospitalized pediatric patients with kidney disease

Residência Pediátrica ◽

10.25060/residpediatr-2020.v10n3-362 ◽

2020 ◽

Vol 10 (3) ◽

Author(s):

Flávia Silveira ◽

Káthia Zuntini ◽

Márcia Silveira ◽

Lohanna Tavares ◽

Juliana Mendes ◽

...

Keyword(s):

Chronic Kidney Disease ◽

Kidney Disease ◽

Pediatric Patients ◽

Kidney Diseases ◽

Pediatric Population ◽

Transplant Rejection ◽

Kidney Injury ◽

Underlying Disease ◽

Great Divergence ◽

Stage 1

OBJECTIVES: This study aims to present the confirmed cases of SARS-CoV-2 infection in pediatric patients with chronic and acute kidney diseases admitted to a tertiary pediatric hospital. METHODS: Descriptive and retrospective observational study with all children hospitalized between March and June 2020 who had, simultaneously, SARS-CoV-2 infection and renal pathologies. Of this total of patients, those who had another underlying disease besides the renal disease were excluded. RESULTS: During the period, nine children with kidney disease were admitted to the hospital and had infection confirmed by the new coronavirus through positive RT-PCR. Regarding the underlying disease, seven had only kidney disease, three of whom had stage 5 chronic kidney disease; one, with stage 1 chronic kidney disease; one, with cortic-sensitive nephrotic syndrome; and two, with acute kidney injury. Two patients in this study had already undergone kidney transplantation, used immunosuppressants and had their doses reduced due to the infectious condition. Only one required oxygen therapy and transfer to the intensive care unit, but was not intubated and returned to the ward within 24 hours. CONCLUSIONS: According to the cases described, the pediatric population with kidney disease, including those using immunosuppressants due to acute transplant rejection, seems to evolve without severe COVID-19, therefore there is no great divergence in relation to the population of the same healthy age group.

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Renal Protection in Critically Ill Patients

Kidney Protection ◽

10.1093/med/9780190611620.003.0016 ◽

2019 ◽

pp. 163-174

Author(s):

Ryan W. Haines ◽

John R. Prowle

Keyword(s):

Chronic Kidney Disease ◽

Intensive Care Unit ◽

Kidney Injury ◽

Adverse Outcomes ◽

Renal Protection ◽

High Quality ◽

Hemodynamic Stability ◽

Secondary Sources ◽

Short And Long Term

Acute kidney injury complicates over 50% of critical care admissions and is associated with both increased short and long-term mortality and the development or acceleration of chronic kidney disease. While in certain settings, such as cardiac surgery, primary prevention of AKI is possible, in most cases AKI is present or evolving at intensive care unit admission and the main clinical focus is secondary prevention of further kidney injury. In the absence of evidence for specific AKI-targeted therapies, high quality supportive care to maximize hemodynamic stability and avoidance of secondary sources of kidney injury are the cornerstones of renal protection. Fluid overload is particularly associated with adverse outcomes in critical illness complicated by AKI. Continuous methods of renal replacement therapy may promote hemodynamic stability and have been associated with better longer term renal outcomes.

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MP234PREDICTIVE VALUE OF CHRONIC KIDNEY DISEASE (CKD) IN ACUTE KIDNEY INJURY (AKI) PRESENTATION IN AN INTENSIVE CARE UNIT (ICU) OF A LOCAL HOSPITAL

Nephrology Dialysis Transplantation ◽

10.1093/ndt/gfw187.40 ◽

2016 ◽

Vol 31 (suppl_1) ◽

pp. i417-i418

Author(s):

José María Peña Porta ◽

María Esther Esteban Ciriano ◽

Carmen Vicente de Vera Floristán ◽

José Manuel Vicente de Vera Floristán ◽

John Ros Añón ◽

...

Keyword(s):

Chronic Kidney Disease ◽

Intensive Care Unit ◽

Acute Kidney Injury ◽

Intensive Care ◽

Kidney Disease ◽

Kidney Injury ◽

Local Hospital

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Nursing Activities Score and Acute Kidney Injury

Revista Brasileira de Enfermagem ◽

10.1590/0034-7167-2016-0266 ◽

2017 ◽

Vol 70 (3) ◽

pp. 475-480 ◽

Cited By ~ 2

Author(s):

Filipe Utuari de Andrade Coelho ◽

Mirian Watanabe ◽

Cassiane Dezoti da Fonseca ◽

Katia Grillo Padilha ◽

Maria de Fátima Fernandes Vattimo

Keyword(s):

Intensive Care Unit ◽

Acute Kidney Injury ◽

Intensive Care ◽

Kidney Disease ◽

Quantitative Study ◽

Kidney Injury ◽

Nursing Workload ◽

Intensive Care Patients ◽

Stage 1

ABSTRACT Objective: to evaluate the nursing workload in intensive care patients with acute kidney injury (AKI). Method: A quantitative study, conducted in an intensive care unit, from April to August of 2015. The Nursing Activities Score (NAS) and Kidney Disease Improving Global Outcomes (KDIGO) were used to measure nursing workload and to classify the stage of AKI, respectively. Results: A total of 190 patients were included. Patients who developed AKI (44.2%) had higher NAS when compared to those without AKI (43.7% vs 40.7%), p <0.001. Patients with stage 1, 2 and 3 AKI showed higher NAS than those without AKI. A relationship was identified between stage 2 and 3 with those without AKI (p = 0.002 and p <0.001). Conclusion: The NAS was associated with the presence of AKI, the score increased with the progression of the stages, and it was associated with AKI, stage 2 and 3.

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Chronic Kidney Disease

Mayo Clinic Internal Medicine Board Review ◽

10.1093/med/9780190464868.003.0050 ◽

2016 ◽

pp. 565-570

Author(s):

Carrie A. Schinstock

Keyword(s):

Chronic Kidney Disease ◽

Acute Kidney Injury ◽

Renal Failure ◽

Acute Renal Failure ◽

Kidney Disease ◽

Kidney Injury ◽

Relative Increase ◽

Absolute Increase ◽

Definition Of ◽

Stage 1

The term acute kidney injury (AKI) has replaced acute renal failure in contemporary medical literature. AKI denotes a rapid deterioration of kidney function within hours to weeks, resulting in the accumulation of nitrogenous metabolites in addition to fluid, electrolyte, and acid-base imbalances. The definition of AKI was refined to a 3-stage definition, with criteria for stage 1 as follows: 1) an absolute increase in serum creatinine (SCr) by at least 0.3 mg/dL from baseline within 48 hours; or 2) a relative increase in SCr to at least 1.5 times baseline within the past 7 days; or 3) urine output decreased to less than 0.5 mL/kg/h for 6 hours.

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One-Year Progression and Risk Factors for the Development of Chronic Kidney Disease in Septic Shock Patients with Acute Kidney Injury: A Single-Centre Retrospective Cohort Study

Journal of Clinical Medicine ◽

10.3390/jcm7120554 ◽

2018 ◽

Vol 7 (12) ◽

pp. 554 ◽

Cited By ~ 9

Author(s):

June-sung Kim ◽

Youn-Jung Kim ◽

Seung Ryoo ◽

Chang Sohn ◽

Dong Seo ◽

...

Keyword(s):

Risk Factors ◽

Chronic Kidney Disease ◽

Septic Shock ◽

Acute Kidney Injury ◽

Cohort Study ◽

Retrospective Cohort ◽

Kidney Injury ◽

One Year ◽

Stage 1

(1) Background: Sepsis-associated acute kidney injury (AKI) can lead to permanent kidney damage, although the long-term prognosis in patients with septic shock remains unclear. This study aimed to identify risk factors for the development of chronic kidney disease (CKD) in septic shock patients with AKI. (2) Methods: A single-site, retrospective cohort study was conducted using a registry of adult septic shock patients. Data from patients who had developed AKI between January 2011 and April 2017 were extracted, and 1-year follow-up data were analysed to identify patients who developed CKD. (3) Results: Among 2208 patients with septic shock, 839 (38%) had AKI on admission (stage 1: 163 (19%), stage 2: 339 (40%), stage 3: 337 (40%)). After one year, kidney function had recovered in 27% of patients, and 6% had progressed to CKD. In patients with stage 1 AKI, 10% developed CKD, and mortality was 13% at one year; in patients with stage 2 and 3 AKI, the CKD rate was 6%, and the mortality rate was 42% and 47%, respectively. Old age, female, diabetes, low haemoglobin levels and a high creatinine level at discharge were seen to be risk factors for the development of CKD. (4) Conclusions: AKI severity correlated with mortality, but it did not correlate with the development of CKD, and patients progressed to CKD, even when initial AKI stage was not severe. Physicians should focus on the recovery of renal function, and ensure the careful follow-up of patients with risk factors for the development of CKD.

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Risk Factors and Outcomes of Acute Kidney Injury in Critically Ill Patients with Coronavirus Disease 2019

Kidney Diseases ◽

10.1159/000512270 ◽

2020 ◽

pp. 1-9

Author(s):

Yichun Cheng ◽

Nanhui Zhang ◽

Ran Luo ◽

Meng Zhang ◽

Zhixiang Wang ◽

...

Keyword(s):

Risk Factors ◽

Intensive Care Unit ◽

Mechanical Ventilation ◽

Acute Kidney Injury ◽

Logistic Regression ◽

Regression Analysis ◽

Intensive Care ◽

Hospital Mortality ◽

Kidney Injury ◽

Stage 1

Background: Coronavirus disease 2019 (COVID-19) has emerged as a major global health threat with a great number of deaths worldwide. Acute kidney injury (AKI) is a common complication in patients admitted to the intensive care unit. We aimed to assess the incidence, risk factors and in-hospital outcomes of AKI in COVID-19 patients admitted to the intensive care unit. Methods: We conducted a retrospective observational study in the intensive care unit of Tongji Hospital, which was assigned responsibility for the treatments of severe COVID-19 patients by the Wuhan government. AKI was defined and staged based on Kidney Disease: Improving Global Outcomes (KDIGO) criteria. Mild AKI was defined as stage 1, and severe AKI was defined as stage 2 or stage 3. Logistic regression analysis was used to evaluate AKI risk factors, and Cox proportional hazards model was used to assess the association between AKI and in-hospital mortality. Results: A total of 119 patients with COVID-19 were included in our study. The median patient age was 70 years (interquartile range, 59–77) and 61.3% were male. Fifty-one (42.8%) patients developed AKI during hospitalization, corresponding to 14.3% in stage 1, 28.6% in stage 2 and 18.5% in stage 3, respectively. Compared to patients without AKI, patients with AKI had a higher proportion of mechanical ventilation mortality and higher in-hospital mortality. A total of 97.1% of patients with severe AKI received mechanical ventilation and in-hospital mortality was up to 79.4%. Severe AKI was independently associated with high in-hospital mortality (OR: 1.82; 95% CI: 1.06–3.13). Logistic regression analysis demonstrated that high serum interleukin-8 (OR: 4.21; 95% CI: 1.23–14.38), interleukin-10 (OR: 3.32; 95% CI: 1.04–10.59) and interleukin-2 receptor (OR: 4.50; 95% CI: 0.73–6.78) were risk factors for severe AKI development. Conclusions: Severe AKI was associated with high in-hospital mortality, and inflammatory response may play a role in AKI development in critically ill patients with COVID-19.

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The Role of Nephrologist in the Intensive Care Unit

Blood Purification ◽

10.1159/000452318 ◽

2016 ◽

Vol 43 (1-3) ◽

pp. 78-81 ◽

Cited By ~ 4

Author(s):

Zoltán H. Endre

Keyword(s):

Chronic Kidney Disease ◽

Intensive Care Unit ◽

Acute Kidney Injury ◽

Intensive Care ◽

Kidney Injury ◽

Renal Diseases ◽

Continuing Care ◽

Electrolyte Disorders

Participation by nephrologists is needed in most intensive care units, even when such units are ‘closed'. This participation should assist with diagnosis and management of intrinsic and complex renal diseases such as vasculitis, complex metabolic and electrolyte disorders including hyponatremia, and acute kidney injury (AKI) with and without underlying chronic kidney disease (CKD). Early nephrologist involvement will also facilitate transition to continuing care and follow-up after an episode of AKI, but may also assist in avoiding dialysis where treatment is futile. Management of AKI by intensivists should be in partnership with nephrologists to oversight and hopefully to minimize progression to CKD.

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