Acyclovir Nephrotoxicity: A Case Report Highlighting the Importance of Prevention, Detection, and Treatment of Acyclovir-Induced Nephropathy

Acute kidney injury is an unfortunate complication of acyclovir therapy secondary to crystal-induced nephropathy. It is characterized by a decrease in renal function that develops within 24–48 hours of acyclovir administration indicated by a rapid rise in the serum creatinine. Failure to quickly realize this as an etiology of acute kidney injury can lead to excessive morbidity to the patient. The case described in this vignette is an example of the clinical manifestation of acyclovir crystal obstructive nephrotoxicity. We will briefly discuss the pathophysiology, diagnosis, prevention, and management of patients that present with acyclovir nephrotoxicity.

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Nitrofurantoin-Associated Acute Granulomatous Interstitial Nephritis

Journal of Investigative Medicine High Impact Case Reports ◽

10.1177/23247096211001659 ◽

2021 ◽

Vol 9 ◽

pp. 232470962110016

Author(s):

B. K. Anupama ◽

Parth Sampat ◽

Harvir S. Gambhir

Keyword(s):

Acute Kidney Injury ◽

Renal Function ◽

Case Report ◽

Interstitial Nephritis ◽

Visual Hallucination ◽

Kidney Injury ◽

Corticosteroid Administration ◽

Granulomatous Interstitial Nephritis ◽

Rare Association ◽

New Onset

We report the case of a 71-year-old female who was incidentally found to have nonoliguric acute kidney injury on a routine workup for new-onset visual hallucination. Further history revealed inadvertent usage of nitrofurantoin for 3 months for an anticipated urological procedure. Renal biopsy demonstrated acute granulomatous interstitial nephritis. The renal function significantly improved following discontinuation of nitrofurantoin and corticosteroid administration. We highlight a rare association of nitrofurantoin with acute granulomatous interstitial nephritis through this case report.

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Circulating Proenkephalin, Acute Kidney Injury, and Its Improvement in Patients with Severe Sepsis or Shock

Clinical Chemistry ◽

10.1373/clinchem.2018.288068 ◽

2018 ◽

Vol 64 (9) ◽

pp. 1361-1369 ◽

Cited By ~ 8

Author(s):

Pietro Caironi ◽

Roberto Latini ◽

Joachim Struck ◽

Oliver Hartmann ◽

Andreas Bergmann ◽

...

Keyword(s):

Intensive Care Unit ◽

Septic Shock ◽

Acute Kidney Injury ◽

Renal Function ◽

Intensive Care ◽

Serum Creatinine ◽

Odds Ratio ◽

Adjusted Odds Ratio ◽

Kidney Injury ◽

Baseline Serum

Abstract BACKGROUND Acute kidney injury (AKI) occurs in many critically ill patients and is associated with high mortality. We examined whether proenkephalin could predict incident AKI and its improvement in septic patients. METHODS Plasma proenkephalin A 119–159 (penKid) was assayed in 956 patients with sepsis or septic shock enrolled in the multicenter Albumin Italian Outcome Sepsis (ALBIOS) trial to test its association with incident AKI, improvement of renal function, need for renal replacement therapy (RRT), and mortality. RESULTS Median [Q1–Q3] plasma penKid concentration on day 1 [84 (20–159) pmol/L[ was correlated with serum creatinine concentration (r = 0.74); it was higher in patients with chronic renal failure and rose progressively with the renal Sequential Organ Failure Assessment subscore. It predicted incident AKI within 48 h (adjusted odds ratio, 3.3; 95% CI, 2.1–5.1; P < 0.0001) or 1 week [adjusted hazard ratio, 2.1 (1.7–2.8); P < 0.0001] and future RRT during the intensive care unit stay [odds ratio, 4.0 (3.0–5.4)]. PenKid was also associated with improvements in renal function in patients with baseline serum creatinine >2 mg/dL, both within the next 48 h [adjusted odds ratio, 0.31 (0.18–0.54), P < 0.0001] and 1 week [0.23 (0.12–0.45)]. The time course of penKid concentrations predicted AKI and 90-day mortality. CONCLUSIONS Early measurement and the trajectory of penKid predict incident AKI, improvement of renal function, and the need for RRT in the acute phase after intensive care unit admission during sepsis or septic shock. PenKid measurement may be a valuable tool to test early therapies aimed at preventing the risk of AKI in sepsis.

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Maternal-Perinatal Variables in Patients with Severe Preeclampsia Who Develop Acute Kidney Injury

Journal of Clinical Medicine ◽

10.3390/jcm10235629 ◽

2021 ◽

Vol 10 (23) ◽

pp. 5629

Author(s):

Patrocinio Rodríguez-Benitez ◽

Irene Aracil Moreno ◽

Cristina Oliver Barrecheguren ◽

Yolanda Cuñarro López ◽

Fátima Yllana ◽

...

Keyword(s):

Acute Kidney Injury ◽

Renal Failure ◽

Renal Function ◽

Uric Acid ◽

Caesarean Section ◽

Serum Creatinine ◽

Kidney Injury ◽

Severe Preeclampsia ◽

History Of ◽

Nicu Admission

Introduction: At present, we are witnessing an increase in preeclampsia, especially the most severe forms, which are associated with an increased risk of maternal-perinatal morbidity and mortality. As a severity criterion, acute kidney injury (AKI) has been associated with a worse prognosis, and for this reason, the maternal and perinatal variables associated with AKI in patients with severe preeclampsia (SP) were analysed in this study. Methods: An observational, retrospective, single-centre study of patients with SP treated at a tertiary hospital between January 2007 and December 2018 was conducted. The case criteria based on the criteria established by the ACOG Practice Guidelines for Gestational Hypertension and Preeclampsia. AKI is considered when serum creatinine exceeds 1.1 mg/dL in a pregnant woman with previously normal renal function. In patients with existing chronic kidney disease (CKD), it is referred to as AKI if the baseline serum creatinine increases by 1.5 fold. Pregestational, gestational and postpartum variables were analysed up to 12 weeks postpartum using univariate and multivariate logistic regression analysis. Results: During the study period, 76,828 births were attended, and 303 pregnant women were diagnosed with SP. The annual incidence of SP increased gradually throughout the study period, reaching 1.79/100 births/year in 2018. Acute kidney injury (AKI) occurred in 24.8% of the patients. The multivariate analysis revealed an increased association with a history of previous CKD, the use of assisted reproductive techniques and caesarean section. Uric acid and thrombotic microangiopathy (TMA) had a high correlation with AKI. Indications for caesarean section are associated with AKI in SP. Regarding perinatal outcomes in cases of AKI, there was a higher percentage of neonates who required foetal lung maturation with steroids and an increased need for NICU admission. No case of maternal death was recorded; however, an increase in neonatal mortality was found among patients who did not develop AKI. After 12 weeks postpartum, 72 patients were referred to the nephrology consultation for persistent hypertension, proteinuria or renal failure. Conclusions: In preeclampsia, AKI is a common complication, especially among patients with a history of CKD, those who became pregnant using assisted reproduction techniques and those who delivered via caesarean section. The perinatal impact of AKI is mainly centred on a higher rate of NICU admission and a lower mortality rate. Among biochemical and haematological markers, the uric acid level prior to renal failure has a direct and significant correlation with the risk of AKI, as does the development of TMA in patients with preeclampsia. Therefore, the monitoring of renal function in cases of preeclampsia should be strict, and referral for a nephrology consultation may be necessary in some cases.

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Acute Kidney Injury after ingestion of Star fruit juice in patients with previous history of acute kidney injury: Two case reports

Journal of Shaheed Suhrawardy Medical College ◽

10.3329/jssmc.v7i1.31788 ◽

2017 ◽

Vol 7 (1) ◽

pp. 33-35

Author(s):

Sayed Fazlul Islam ◽

KBM Hadizzaman ◽

Syed Mahbub Morshed ◽

Md Omar Faroque ◽

AH Hamid Ahmed ◽

...

Keyword(s):

Acute Kidney Injury ◽

Case Report ◽

Serum Creatinine ◽

Case Reports ◽

Previous History ◽

Kidney Injury ◽

Normal Serum ◽

Tubular Necrosis ◽

Mild Degree ◽

Star Fruit

Acute kidney injury can occur due to various reasons. In this case report two cases of acute kidney injury (AKI) were reported after ingestion of 250 ml of starfruit juice presented. In both cases features of nephrotoxicity and neurotoxicity were found and there was mild to moderate rise in serum creatinine. Routine and microscopic examination of urine showed mild degree of proteinuria, no other active urinary sediment was found except calcium oxalate crystals. Renal biopsy was done in both cases which showed features of acute tubular necrosis. These two patients were treated symptomatically and discharged with normal serum creatinine. There is no case report of acute kidney injury due to star fruit ingestion in Bangladesh. Star fruit is very popular, cheap and easily available. But its nephrotoxic effect is not known to general population. These two case reports might be a first time message to the nation.J Shaheed Suhrawardy Med Coll, 2015; 7(1):33-35

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Acute kidney injury due to star fruit ingestion: A case report

Bangabandhu Sheikh Mujib Medical University Journal ◽

10.3329/bsmmuj.v7i2.29453 ◽

2016 ◽

Vol 7 (2) ◽

pp. 151 ◽

Cited By ~ 2

Author(s):

Mehruba Alam Ananna ◽

Rubayet Hasan ◽

Tabassum Samad ◽

Mohammad Abdur Rahim ◽

Mohammad Erfanur Rahman ◽

...

Keyword(s):

Chronic Kidney Disease ◽

Acute Kidney Injury ◽

Renal Function ◽

Case Report ◽

Fruit Juice ◽

Kidney Injury ◽

Renal Function Impairment ◽

Star Fruit ◽

Function Impairment ◽

The World

<p>Star fruit (Avarrhoa carambola) is a fruit from oxalidace family. lt is found in many countries of the world including Bangladesh. But its ingestion or drinking star fruit juice may lead to intoxication especially in patients with chronic kidney disease and manifestations might be neurological or nephrological. lt may also cause acute kidney injury in patients with previously normal renal function. Here we are presenting a case who presented with acute kidney injury after star fruit ingestion with previously unknown renal function impairment. The etiology was confirmed by histopathological examination after doing renal biopsy. This renal function impairment is mainly due to oxalate crystal induce nephropathy which is richly abundant in star fruit. His renal function was improved ·with conservative management. Physicians should be alert to consider the ingestion of star fruit as a cause of acute kidney injury in a patient even in the absence of previous renal function impairment.</p>

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Urinary L-Type Fatty Acid-Binding Protein is a Predictor of Cisplatin-Induced Acute Kidney Injury.

10.21203/rs.3.rs-947945/v1 ◽

2021 ◽

Author(s):

Masaaki Yanishi ◽

Hidefumi Kinoshita

Keyword(s):

Acute Kidney Injury ◽

Renal Function ◽

Serum Creatinine ◽

Urothelial Carcinoma ◽

Kidney Injury ◽

Fatty Acid Binding ◽

Renal Function Deterioration ◽

Patients At Risk ◽

Pre Treatment ◽

Chemotherapy Patients

Abstract Background Although cisplatin-based chemotherapy is a standard treatment for urothelial carcinoma, it often causes acute kidney injury (AKI). AKI and dysfunction are observed in 25–35% of cisplatin-based chemotherapy patients, who may require treatment down-titration or withdrawal. In this study, we evaluated whether urinary L-FABP is a marker for early diagnosis of cisplatin-caused AKI. Methods We included 42 adult patients who underwent cisplatin-based chemotherapy for bladder cancer or upper tract urothelial carcinoma from January 2018 to March 2019. Urinary L-FABP and serum creatinine were measured at 2 and 6 hours, and 1, 2, 3, 7 and 28 days after taking cisplatin. Results In the first week after receiving cisplatin, 10 patients (23.8%) were diagnosed with AKI (AKI+ group). Pre-treatment (baseline) measurements did not significantly differ between the AKI+ and AKI− groups. However, urinary L-FABP concentrations rapidly increased in the AKI+ group and were significantly greater than in the AKI− group at Hour 2, Hour 6, Day 1 and Day 2. Serum creatinine also significantly differed between the AKI+ group and the AKI− group on Days 3 and 7. Conclusions Acute renal function deterioration was predicted by increased urinary L-FABP excretion within six hours after receiving CIS-CT and, in those with AKI, the increase in urinary L-FABP excretion preceded the rise in sCr by over 2 days. In contrast, no appreciable changes in urinary L-FABP levels were observed in patients with stable renal function throughout the whole observation period. So early increase in urinary L-FABP may identify patients at risk of cisplatin-induced AKI, who might benefit from treatment to prevent nephrotoxicity. Trial registration: This study was retrospectively registered.

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Do lipid microemboli induce acute kidney injury during cardiopulmonary bypass?

Perfusion ◽

10.1177/0267659117705194 ◽

2017 ◽

Vol 32 (6) ◽

pp. 466-473

Author(s):

Richard Issitt ◽

Tim James ◽

Bronagh Walsh ◽

David Voegeli

Keyword(s):

Acute Kidney Injury ◽

Renal Function ◽

Cardiopulmonary Bypass ◽

Serum Creatinine ◽

Cystatin C ◽

Bypass Graft ◽

Surrogate Marker ◽

Kidney Injury ◽

Renal Vasculature ◽

Filtration System

Background: Acute kidney injury (AKI) following cardiopulmonary bypass affects 5% of patients, representing significant postoperative morbidity and mortality. Animal models have shown an increased uptake of lipid microemboli (LME) into the renal vasculature, potentially indicating ischaemic causation. This study tested a new lipid filtration system (RemoweLL) against a conventional system with no lipid-depleting capacity to determine the efficacy of the filtration system and its effects on renal function. Methods: Thirty consecutive patients underwent coronary artery bypass graft surgery using either the RemoweLL filtration system (15 patients) or a conventional cardiopulmonary bypass circuit (15 patients). Renal function was assessed using cystatin C concentrations as a surrogate marker of glomerular injury, as well as perioperative glomerular filtration rate (GFR) and serum creatinine concentrations. Patients were defined as having acute renal injury if there was an increase in absolute serum creatinine ⩾3 mg/dL (26.4 µmol/L) or 1.5-fold increase from baseline as categorised using the AKIN criteria. Results: Postoperative differences in LME count between the two groups were highly significant [p<0.001]. Analysis of peak cystatin C concentrations showed significantly lower levels in the LME filtration group on the 2nd postoperative morning [p=0.04]. Two-factor ANOVA revealed a trend towards interaction, but this failed to reach significance [p=0.06]. There were no differences throughout the study period in serum creatinine or GFR [p>0.05]. There were no differences in any of the serum or urinary electrolytes. Conclusions: This study has shown a trend towards improved cystatin C removal with LME filtration; with significantly lower peak concentrations, although no further evidence of renoprotection could be demonstrated. Further research is warranted to establish possible renal benefits of LME filtration in patients undergoing cardiac surgery.

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Acute Kidney Injury following Ingestion of Henna Leaf Extract: A Case Report from Myanmar

Blood Purification ◽

10.1159/000479618 ◽

2017 ◽

Vol 44 (Suppl. 1) ◽

pp. 41-45 ◽

Cited By ~ 2

Author(s):

Yi Yi Khine

Keyword(s):

Acute Kidney Injury ◽

Renal Function ◽

Case Report ◽

Leaf Extract ◽

Herbal Remedy ◽

Kidney Injury ◽

Herbal Remedies ◽

Public Knowledge ◽

Lost To Follow Up

Alternative medicine is gaining popularity worldwide. In Asia, particularly Southeast Asia, herbal medicine plays an important role in healthcare. A 34-year-old man from Yangon, Myanmar, was admitted to the medical ward of our hospital after ingesting a herbal remedy of boiled henna leaves (Dan Ywet in Burmese). He developed hemoglobinuria leading to acute kidney injury (AKI). The insult was severe, and he underwent 5 sessions of hemodialysis. His condition improved and within 7 weeks of injury, he made a full recovery. However, he was lost to follow-up when renal function became normal. Our diagnosis was AKI from hemoglobinuria secondary to henna leaf extract nephrotoxicity in G6PD deficiency. This case highlights the steps required to achieve the International Society of Nephrology's goal of 0 preventable deaths from AKI by 2025 and the efforts needed to increase public knowledge about herbal remedies and AKI, medication adherence, and compliance with follow-up.

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Outcome of Continuous Peritoneal Dialysis in Patient with Acute Kidney Injury

Medical Journal of Pokhara Academy of Health Sciences ◽

10.3126/mjpahs.v2i3.26113 ◽

2019 ◽

Vol 2 (3) ◽

pp. 164-168

Author(s):

Amrit KC ◽

Rahman Tanvir ◽

Alam Muhammad Rafiqul ◽

Ahmed A.H. Hamid ◽

Noor Towhida

Keyword(s):

Acute Kidney Injury ◽

Renal Function ◽

Peritoneal Dialysis ◽

Serum Creatinine ◽

Kidney Injury ◽

Electrolyte Imbalance ◽

Drug Induced ◽

Low Socioeconomic ◽

Tubular Necrosis ◽

Continuous Peritoneal Dialysis

Background: Though peritoneal dialysis has several limitations, it is still used in acute kidney injury (AKI) patients as an alternative method of Renal Replacement Therapy (RRT), especially in low socioeconomic countries. Materials and Method: This study included thirty patients diagnosed as AKI. Peritoneal access was established through flexible Tenckhoff catheter for Continuous Peritoneal Dialysis (CPD) and 6-8 exchanges were done in 24 hours. Results: Among 30 patients mean age was (mean±SD) 49.93±14.42 years. Seven (23.33%) patients were hemodynamically unstable. The cause of AKI was drug induced in 6(20.7%), hypovolemia/Acute Tubular Necrosis in 6(20.0%), sepsis in 5(16.7%), heart failure in 2(6.7%) and 11(36.7%) had multiple causes. In initial presentation, mean serum creatinine was 683.42 μmol/L, and the number of sessions required for stabilization of serum creatinine was 7.5±1.43, sessions required for correction of hyperkalemia and metabolic acidosis were 2.15±0.69 and 2.5±0.76 respectively. The delivered Kt/V urea was 1.95±0.14 weekly. Six (20.0%) patients had peritonitis, five (16.7%) had pericatheter leakage and four (13.33%) had catheter blockage. Among 30 patients, three patients (10%) had died, sixteen (59.3%) had recovery of renal function and rest did not recover renal function. Conclusion: CPD was effective for correction of metabolic and electrolyte imbalance.

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Acute kidney injury strongly influences renal function after radical nephroureterectomy for upper tract urothelial carcinoma: A single-centre experience

Archivio Italiano di Urologia e Andrologia ◽

10.4081/aiua.2021.1.9 ◽

2021 ◽

Vol 93 (1) ◽

pp. 9-14

Author(s):

Alessandro Tafuri ◽

Katia Odorizzi ◽

Giacomo Di Filippo ◽

Clara Cerrato ◽

Giulia Fassio ◽

...

Keyword(s):

Acute Kidney Injury ◽

Renal Function ◽

Multivariate Analysis ◽

Serum Creatinine ◽

Urothelial Carcinoma ◽

Clinical Evaluation ◽

Kidney Injury ◽

Radical Nephroureterectomy ◽

Clinical Factors ◽

Renal Function Decline

Objective: The aim of our study was to investigate frequency and predictors both of postoperative acute kidney injury (AKI) and renal function decline in a population of consecutive upper tract urothelial carcinoma (UTUC) patients who underwent radical nephroureterectomy (RNU). Materials and methods: Between October 2014 and February 2020, 93 patients underwent RNU at our Institution. After considered exclusion criteria, 89 patients were selected. Perioperative clinical factors were retrospectively collected. Estimated glomerular filtration rate (eGFR) was calculated using the Chronic Kidney Disease Epidemiology Collaboration (CKDEPI) equation. We defined AKI as an increase in serum creatinine by ≥ 0.3 mg/dl or a 1.5-1.9-fold increase in serum creatinine from baseline to I post-operative day (POD). A significant renal function reduction was defined as an eGFR reduction of 40% from baseline at discharge and at last clinical evaluation. Frequency of AKI and eGFR decline was investigated. Association between perioperative clinical factors and AKI and eGFR reduction at discharged and last follow-up was studied using univariate and multivariate models. Results: AKI was detected at I POD in 45 patients. On multivariate analysis, pre-operative eGFR was an independent predictor of AKI (OR 1.03; p = 0.042). Further, AKI was found to be a significant predictor of eGFR reduction ≥ 40% at discharge at univariate analysis (OR 19.42; p = 0.005) and at multivariate analysis (OR 12.49; p = 0.02). In a multivariate logistic regression model post-operative AKI (OR 5.18; p = 0.033), lack of ipsilateral preoperative hydronephrosis (OR 0.17; p = 0.016), preoperative eGFR (OR 1.04; p = 0.047) and antiplatelet therapy (OR 5.14; p = 0.018) were found to be independent predictors of an eGFR reduction higher than 40% at last clinical evaluation made at a median of 15 (IQR 5-30) months. Conclusions: In our cohort, AKI was present in almost 50% of patients after RNU and it was a strong predictor of renal function decline after RNU.

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