Sepsis associated acute kidney injury

ABSTRACT Sepsis is defined as organ dysfunction resulting from the host’s deleterious response to infection. One of the most common organs affected is the kidneys, resulting in sepsis associated acute kidney injury (SA-AKI) that contributes to the morbidity and mortality of sepsis. A growing body of knowledge has illuminated the clinical risk factors, pathobiology, response to treatment, and elements of renal recovery that have advanced our ability to prevent, detect, and treat SA-AKI. Despite these advances, SA-AKI remains an important concern and clinical burden, and further study is needed to reduce the acute and chronic consequences. This review summarizes the relevant evidence, with a focus on the risk factors, early recognition and diagnosis, treatment, and long term consequences of SA-AKI. In addition to literature pertaining to SA-AKI specifically, pertinent sepsis and acute kidney injury literature relevant to SA-AKI was included.

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Risk Factors for Long-Term Mortality and Progressive Chronic Kidney Disease Associated With Acute Kidney Injury After Cardiac Surgery

Medicine ◽

10.1097/md.0000000000002025 ◽

2015 ◽

Vol 94 (45) ◽

pp. e2025 ◽

Cited By ~ 46

Author(s):

Jia-Rui Xu ◽

Jia-Ming Zhu ◽

Jun Jiang ◽

Xiao-Qiang Ding ◽

Yi Fang ◽

...

Keyword(s):

Risk Factors ◽

Chronic Kidney Disease ◽

Acute Kidney Injury ◽

Cardiac Surgery ◽

Kidney Disease ◽

Kidney Injury ◽

Long Term Mortality

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Acute kidney injury

10.1093/med/9780199659579.003.0127 ◽

2017 ◽

Author(s):

Edward Sharples

Keyword(s):

Acute Kidney Injury ◽

Early Recognition ◽

Kidney Injury ◽

Epidemiological Studies ◽

Hospitalized Patients ◽

Early Management ◽

Common Causes ◽

Definition Of ◽

End Stage

Acute kidney injury (AKI) is a common, major cause of morbidity and mortality in hospitalized patients, and contributes significantly to length of stay and hence costs. Large epidemiological studies consistently demonstrate an incidence of AKI of 5–18% depending on the definition of AKI utilized. Even relatively small changes in renal function are associated with increased mortality, and this has led to strict definition and staging of AKI. Early recognition with good clinical assessment, diagnosis, and management are critical to prevent progression of AKI and reduce the potential complications, including long-term risk of end-stage renal failure. In this chapter, the pathophysiology, causes, and early management of AKI are discussed. Hypovolaemia and sepsis are the most common causes in hospitalized patients, across medical and surgical specialities. Other common causes are discussed, as well as diagnostic criteria.

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1481. A Study for Risk Factors of Acute Kidney Injury in Leptospirosis in a Tertiary Health Center in South India

Open Forum Infectious Diseases ◽

10.1093/ofid/ofz360.1345 ◽

2019 ◽

Vol 6 (Supplement_2) ◽

pp. S540-S540

Author(s):

Bhavana Surapareddy ◽

Muralidhar Varma ◽

Shashidhar V

Keyword(s):

Risk Factors ◽

Acute Kidney Injury ◽

Early Recognition ◽

Care Center ◽

Tertiary Care ◽

Laboratory Data ◽

Kidney Injury ◽

Serum Lactate ◽

Significant Difference ◽

Serum Bicarbonate Level

Abstract Background Leptospirosis is the most widespread zoonotic disease in the world. In India, it is endemic in coast lined states. Renal failure is a severe complication with mortality approaching 22%, early recognition of which helps clinicians in acting fast. This study aimed to investigate the predictors of Acute Kidney Injury (AKI) in Leptospirosis Methods This is a prospective, case–control study done in a tertiary care center in Southern India carried out between October 2017 and December 2018. Patients with confirmed Leptospirosis as per CDC 2013 and Faine’s criteria (2012) having AKI as per KDIGO criteria were defined as cases. Subjects without AKI were controls. Demographic, clinical and laboratory data were compared between the groups and analyzed. Logistic regression was performed to analyze the possible risk factors associated with AKI in Leptospirosis. Results A total of 329 subjects met the inclusion criteria of the study. 187 patients with AKI (CASES) and 142 patients without AKI (CONTROLS) were studied. Patients with AKI were older, (mean age- 46.99 ± 13.21 vs. 42.99 ± 15.15 years) had longer hospital stay (9.04 ± 5.62 vs. 6.27 ± 3.27 days) had higher SOFA (7.97 ±2.9 vs. 3.37 ± 2.6) and APACHE 2 scores (14.37±5.93 vs. 4.66 ± 4.4), lower mean arterial pressure (84.01 ± 14.45 vs. 89.01 ± 10.63 mmHg; P = 0.001) lower serum bicarbonate level (21.70 ± 2.35 vs. 18.73 ± 3.78 mEq/dL; P < 0.001). Factors like serum lactate, AST, ALT had no significant difference between the groups. Serovar identification was done in 88 patients, of which 57 had AKI. Australis (16.7%), Pyrogenes (16.7%) and Grippotyphosa (11.1%) were the commonest serovars isolated. Serovar most commonly associated with AKI was Pyrogenes (17.5%) Predictors for AKI were jaundice (P = 0.01, OR 2.25; CI 1.21 –3.26), vomiting (P = 0.017, OR 1.9, CI 1.12- 3.26) Hypotension (P = 0.02, OR = 12.3, CI 1.85 – 107.2), tachypnea (P = 0.006, OR = 2.55, CI 1.11- 3.24), leukocytosis (P < 0.001, OR 5.45, CI 1.86- 4.89), thrombocytopenia (P < 0.001, OR 6.49, CI 2.33 – 6.75) Conclusion Identification of features like hypotension, tachypnea, acidosis, leukocytosis, thrombocytopenia, the occurrence of serovar Pyrogenes should alert the clinician on risk of developing AKI Disclosures All authors: No reported disclosures.

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Acute kidney injury following coronary angiography: a nationwide study of incidence, risk factors and long-term outcomes

Journal of Nephrology ◽

10.1007/s40620-018-0534-y ◽

2018 ◽

Vol 31 (5) ◽

pp. 721-730 ◽

Cited By ~ 5

Author(s):

Dadi Helgason ◽

Thorir E. Long ◽

Solveig Helgadottir ◽

Runolfur Palsson ◽

Gisli H. Sigurdsson ◽

...

Keyword(s):

Risk Factors ◽

Acute Kidney Injury ◽

Coronary Angiography ◽

Kidney Injury ◽

Long Term Outcomes ◽

Nationwide Study ◽

Incidence Risk

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The Incidence of Acute Kidney Injury Following Lung Transplantation Performed on Cardiopulmonary Bypass; Risk Factors, Effect on Short and Long-Term Mortality

The Journal of Heart and Lung Transplantation ◽

10.1016/j.healun.2019.01.1068 ◽

2019 ◽

Vol 38 (4) ◽

pp. S419 ◽

Cited By ~ 1

Author(s):

C. Carlheim ◽

A.M. Holm ◽

J.F. Bugge

Keyword(s):

Risk Factors ◽

Acute Kidney Injury ◽

Cardiopulmonary Bypass ◽

Lung Transplantation ◽

Kidney Injury ◽

Short And Long Term ◽

Long Term Mortality

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Long-Term Outcomes and Risk Factors of Renal Failure Requiring Dialysis after Heart Transplantation: A Nationwide Cohort Study

Journal of Clinical Medicine ◽

10.3390/jcm9082455 ◽

2020 ◽

Vol 9 (8) ◽

pp. 2455 ◽

Cited By ~ 1

Author(s):

Tsai-Jung Wang ◽

Ching-Heng Lin ◽

Hao-Ji Wei ◽

Ming-Ju Wu

Keyword(s):

Risk Factors ◽

Acute Kidney Injury ◽

Renal Failure ◽

Heart Transplantation ◽

Renal Dysfunction ◽

Heart Transplant ◽

Kidney Injury ◽

Dialysis Patients ◽

Term Survival

Acute kidney injury and renal failure are common after heart transplantation. We retrospectively reviewed a national cohort and identified 1129 heart transplant patients. Patients receiving renal replacement therapy after heart transplantation were grouped into the dialysis cohort. The long-term survival and risk factors of dialysis were investigated. Patients who had undergone dialysis were stratified to early or late dialysis for subgroup analysis. The mean follow-up was five years, the incidence of dialysis was 28.4% (21% early dialysis and 7.4% late dialysis). The dialysis cohort had higher overall mortality compared with the non-dialysis cohort. The hazard ratios of mortality in patients with dialysis were 3.44 (95% confidence interval (CI), 2.73–4.33) for all dialysis patients, 3.58 (95% CI, 2.74–4.67) for early dialysis patients, and 3.27 (95% CI, 2.44–4.36; all p < 0.001) for late dialysis patients. Patients with diabetes mellitus, chronic kidney disease, acute kidney injury, and coronary artery disease were at higher risk of renal failure requiring dialysis. Cardiomyopathy, hepatitis B virus infection, and hyperlipidemia treated with statins were associated with a lower risk of renal dysfunction requiring early dialysis. The use of Sirolimus and Mycophenolate mofetil was associated with a lower incidence of late dialysis. Renal dysfunction requiring dialysis after heart transplantation is common in Taiwan. Early and late dialysis were both associated with an increased risk of mortality in heart transplant recipients.

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Influence of acute kidney injury on short- and long-term outcomes in patients undergoing cardiac surgery: risk factors and prognostic value of a modified RIFLE classification

Critical Care ◽

10.1186/cc13159 ◽

2013 ◽

Vol 17 (6) ◽

pp. R293 ◽

Cited By ~ 58

Author(s):

Juan C Lopez-Delgado ◽

Francisco Esteve ◽

Herminia Torrado ◽

David Rodríguez-Castro ◽

Maria L Carrio ◽

...

Keyword(s):

Risk Factors ◽

Acute Kidney Injury ◽

Cardiac Surgery ◽

Prognostic Value ◽

Kidney Injury ◽

Long Term Outcomes ◽

Rifle Classification ◽

Short And Long Term

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Bilateral renal infarction with COVID-19 pneumonia: a case report

Oxford Medical Case Reports ◽

10.1093/omcr/omab121 ◽

2021 ◽

Vol 2021 (11-12) ◽

Author(s):

Kundan Jana ◽

Kalyana C Janga ◽

Sheldon Greenberg ◽

Kamlesh Kumar

Keyword(s):

Risk Factors ◽

Acute Kidney Injury ◽

Case Report ◽

Young Patients ◽

Treatment Strategies ◽

Kidney Injury ◽

Current Treatment ◽

Renal Infarction ◽

Patient Reported

ABSTRACT Acute renal infarction is a rare and often underdiagnosed condition with estimated incidence of 0.5–1.5%. Coronavirus disease 2019 (COVID-19) has been shown to cause a hypercoagulable state in patients leading to arterial and venous thromboembolism. Renal infarction as a consequence of COVID-associated coagulopathy has been reported, sometimes resulting in acute kidney injury. Most of the patients so far reported had other existing comorbidities and risk factors that compounded the risk of precipitating an infarction. Here, we present a 37-year-old, the youngest patient reported so far, with no pre-existing comorbidities or risk factors, who developed bilateral renal infarction with COVID-19 pneumonia. The patient was treated with anticoagulation for renal infarction and discharged on apixaban. Anticoagulation is an important part of current treatment strategies for COVID-19 pneumonia and should extend beyond the acute phase of the disease to prevent long-term sequelae, especially in young patients.

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