Obstructed or Malpositioned Urethral Catheter Induced Acute Kidney Injury

A 42-year-old woman presented with chronic fever, abdominal pain, intermittent loose stools and dysuria for 3 months. She had recently developed acute dyspnoea with acute kidney injury. She was found to have a contracted, thick-walled bladder with bilateral hydroureteronephrosis. She underwent bilateral percutaneous nephrostomies, following which her renal function recovered. She satisfied the clinical and immunological features of the Systemic Lupus International Collaborating Clinics criteria for systemic lupus erythematosus (SLE). She was initiated on immunosuppression. Lupus cystitis with a contracted bladder is an uncommon presentation of SLE.

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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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Acute kidney injury

10.1093/med/9780199568741.003.0162 ◽

2018 ◽

Author(s):

Aron Chakera ◽

William G. Herrington ◽

Christopher A. O’Callaghan

Keyword(s):

Acute Kidney Injury ◽

Renal Failure ◽

Renal Function ◽

Acute Renal Failure ◽

Glomerular Filtration Rate ◽

Glomerular Filtration ◽

Filtration Rate ◽

Urine Volume ◽

Kidney Injury ◽

Rapid Decrease

Acute renal failure (also referred to as acute kidney injury) refers to a rapid decrease in renal function; it is reflected by an increase in blood urea and creatinine and is often associated with oliguria (a urine volume of less than 400 ml/24 hours). It usually develops over days to weeks. Acute kidney injury has been variously classified, but the current classifications are based on the glomerular filtration rate (or creatinine), looking at changes from baseline, and the presence of oliguria or anuria. The potential etiologies of acute kidney injury are usually considered anatomically under the headings prerenal, renal (intrinsic), and postrenal. This chapter looks at the etiology, symptoms, clinical features, demographics, complications, diagnosis, and treatment of acute kidney injury.

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Considerações sobre a Função Renal no Período Perioperatório

Cadernos UniFOA ◽

10.47385/cadunifoa.v8i22.6 ◽

2013 ◽

Vol 8 (22) ◽

pp. 93

Author(s):

Hellen Tatiane De Pontes ◽

Jady Elen De Pontes ◽

Fábio Dos Santos Cosso Martins

Keyword(s):

Acute Kidney Injury ◽

Renal Failure ◽

Renal Function ◽

Acute Renal Failure ◽

Kidney Injury ◽

Function Evaluation

A lesão renal aguda é observada especialmente nas cirurgias de grande porte, em especial as cirurgias cardíacas, podendo sua prevalência atingir até 40,2% na população adulta no período pós-operatório imediato. Nesta revisão, buscamos conhecer os aspectos fisiopatológicos envolvidos na lesão renal aguda, os critérios de classificação utilizados atualmente, fatores de risco associados para a disfunção no período pós-cirúrgico imediato e medidas profiláticas. Para tanto, foram pesquisados artigos originais e revisões indexados na base de dados Medline e Pubmed, compreendendo o período de 2002 até Junho de 2012, empregando-se os seguintes termos: acute kidney injury, acute renal failure e renal function evaluation. Verificamos que há necessidade uso de novos biomarcadores associados aos níveis séricos de creatinina e débito urinário atualmente utilizados para o diagnóstico, visto que a detecção precoce da lesão renal aguda por meio da creatinina sérica é difícil de ser estabelecida. Há necessidade de mais estudos que estabeleçam profilaxia farmacológica no tratamento da lesão renal aguda. Medidas como um método padronizado para estratificação de pacientes que apresentam maiores riscos no período pré-operatório, estabelecimento de terapêutica adequada precoce no período perioperatório, introdução nos critérios diagnósticos de novos biomarcadores séricos e urinários, serão úteis utilizados em conjuntos para o manejo clínico adequado nesses pacientes.

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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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Considerações sobre a Função Renal no Período Perioperatório

Cadernos UniFOA ◽

10.47385/cadunifoa.v8.n22.6 ◽

2013 ◽

Vol 8 (22) ◽

pp. 93-79

Author(s):

Hellen Tatiane De Pontes ◽

Jady Elen De Pontes ◽

Fábio dos Santos Cosso Martins

Keyword(s):

Acute Kidney Injury ◽

Renal Failure ◽

Renal Function ◽

Acute Renal Failure ◽

Kidney Injury ◽

Function Evaluation

A lesão renal aguda é observada especialmente nas cirurgias de grande porte, em especial as cirurgias cardíacas, podendo sua prevalência atingir até 40,2% na população adulta no período pós-operatório imediato. Nesta revisão, buscamos conhecer os aspectos fisiopatológicos envolvidos na lesão renal aguda, os critérios de classificação utilizados atualmente, fatores de risco associados para a disfunção no período pós-cirúrgico imediato e medidas profiláticas. Para tanto, foram pesquisados artigos originais e revisões indexados na base de dados Medline e Pubmed, compreendendo o período de 2002 até Junho de 2012, empregando-se os seguintes termos: acute kidney injury, acute renal failure e renal function evaluation. Verificamos que há necessidade uso de novos biomarcadores associados aos níveis séricos de creatinina e débito urinário atualmente utilizados para o diagnóstico, visto que a detecção precoce da lesão renal aguda por meio da creatinina sérica é difícil de ser estabelecida. Há necessidade de mais estudos que estabeleçam profilaxia farmacológica no tratamento da lesão renal aguda. Medidas como um método padronizado para estratificação de pacientes que apresentam maiores riscos no período pré-operatório, estabelecimento de terapêutica adequada precoce no período perioperatório, introdução nos critérios diagnósticos de novos biomarcadores séricos e urinários, serão úteis utilizados em conjuntos para o manejo clínico adequado nesses pacientes.

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Immunoglobulin-A Vasculitis With Renal Involvement in a Patient With COVID-19: A Case Report and Review of Acute Kidney Injury Related to SARS-CoV-2

Canadian Journal of Kidney Health and Disease ◽

10.1177/2054358121991684 ◽

2021 ◽

Vol 8 ◽

pp. 205435812199168

Author(s):

Nicholas L. Li ◽

Adam B. Papini ◽

Tiffany Shao ◽

Louis Girard

Keyword(s):

Acute Kidney Injury ◽

Renal Function ◽

Abdominal Pain ◽

Renal Biopsy ◽

Kidney Injury ◽

Iga Vasculitis ◽

Tubular Injury ◽

Raas Blockade ◽

Purpuric Rash ◽

New Onset

Rationale: Acute kidney injury is a common complication of COVID-19 and is associated with significantly increased mortality. The most frequent renal biopsy finding with SARS-CoV-2 infection is acute tubular injury; however, new onset glomerular diseases have been reported. The development of persistent urinary abnormalities in patients with COVID-19 should prompt consideration for renal biopsy to rule out glomerulonephritis. Presenting Concerns: A 30-year-old man with no prior medical history presented to the emergency department with symptoms of COVID-19 and new onset painful purpuric rash, arthralgia, and abdominal pain. SARS-CoV-2 infection was confirmed with nucleic acid testing and laboratory investigations revealed preserved renal function with dysmorphic hematuria and nephrotic range proteinuria. Diagnosis: A skin biopsy of the purpuric rash was performed, which demonstrated leukocytoclastic vasculitis. Renal biopsy revealed focally crescentic and segmentally necrotizing IgA nephropathy. Overall, given the clinical syndrome of glomerulonephritis with purpuric rash, arthralgia, and abdominal pain, the presentation is most in keeping with a diagnosis of IgA vasculitis in the setting of COVID-19. Interventions: The patient was treated conservatively for COVID-19 in the community. A 7-day course of prednisone was started for the vasculitic rash. IgA nephropathy was managed conservatively with blood pressure control and RAAS blockade with losartan. Outcomes: With conservative management, the patient’s COVID-19 symptoms resolved completely and he did not require hospital admission. Following prednisone therapy, the patient’s rash, arthralgia, and abdominal pain improved. However, despite resolution of COVID-19, hematuria and proteinuria persisted. With the initiation of RAAS blockade, renal function remained stable and proteinuria improved dramatically at 6 weeks. Novel Findings: De novo glomerulonephritis is a renal manifestation of SARS-CoV-2 infection beyond acute tubular injury. IgA vasculitis appears to be a rare complication of COVID-19.

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Tacrolimus trough monitoring guided by mass spectrometry without accounting for assay differences is associated with acute kidney injury in lung transplant recipients

American Journal of Health-System Pharmacy ◽

10.1093/ajhp/zxz243 ◽

2019 ◽

Vol 76 (24) ◽

pp. 2019-2027

Author(s):

Nicholas A Kolaitis ◽

Daniel R Calabrese ◽

Patrick Ahearn ◽

Aida Venado ◽

Rebecca Florez ◽

...

Keyword(s):

Mass Spectrometry ◽

Acute Kidney Injury ◽

Renal Failure ◽

Acute Renal Failure ◽

Lung Transplant ◽

Kidney Injury ◽

Transplant Recipients ◽

Onset Diabetes ◽

Lung Transplant Recipients ◽

New Onset

Abstract Purpose Tacrolimus is a nephrotoxic immunosuppressant historically monitored via enzyme-based immunoassay (IA). After 2011, the 2 largest laboratory companies in the United States implemented tacrolimus quantification by liquid chromatography–mass spectrometry (LC-MS); this method excludes metabolites, potentially resulting in lower quantified drug concentrations. We sought to determine if tacrolimus therapeutic drug monitoring via LC-MS, as performed using trough targets originally derived from IA values, influences clinical outcomes. Methods In a single-center retrospective cohort study of lung transplant recipients, risks of acute kidney injury, acute renal failure, and new-onset diabetes after transplantation, as well as chronic lung allograft dysfunction–free survival, were compared in 82 subjects monitored by LC-MS and 102 subjects monitored by IA using Cox proportional hazard models adjusted for age, sex, baseline renal function, and race. Results LC-MS–based monitoring was associated with a greater risk of acute kidney injury (adjusted hazard ratio, 1.65; 95% confidence interval, 1.02–2.67). No statistically significant differences in risks of acute renal failure and new-onset diabetes after transplantation were observed. Conclusion Although LC-MS provides a more accurate representation of the blood concentration of the parent compound tacrolimus exclusive of metabolite, established cut points for tacrolimus dosing may need to be adjusted to account for the increased risk of renal injury.

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Dyschloremia is associated with failure to restore renal function in survivors with acute kidney injury: an observation retrospective study

Scientific Reports ◽

10.1038/s41598-020-76798-5 ◽

2020 ◽

Vol 10 (1) ◽

Author(s):

Youn Kyung Kee ◽

Hee Jung Jeon ◽

Jieun Oh ◽

Dong Ho Shin

Keyword(s):

Acute Kidney Injury ◽

Renal Failure ◽

Renal Function ◽

Odds Ratio ◽

Kidney Injury ◽

Renal Recovery ◽

Renal Outcome ◽

Serum Chloride ◽

Group Serum ◽

Chloride Concentrations

AbstractDyschloremia is common in critically ill patients. However, little is known about the effects of dyschloremia on renal function in patients with acute kidney injury (AKI) requiring continuous renal replacement therapy (CRRT). A total of 483 patients who received CRRT for AKI were selected and divided into three groups according to their serum chloride concentrations at the time of CRRT initiation. At 90 days after initiating CRRT, renal outcome, i.e., non-complete renal recovery, or renal failure, was assessed in the three groups. The hypochloremia group (serum chloride concentrations < 96 mEq/L, n = 60), the normochloremia group (serum chloride concentrations, 96–111 mEq/L, n = 345), and the hyperchloremia group (serum chloride concentrations > 111 mEq/L, n = 78) were classified. The simplified acute physiology score III was higher in the hyperchloremia and hypochloremia groups than in the normochloremia group. Multivariate logistic regression analyses showed that hypochloremia (odds ratio, 5.12; 95% confidence interval [CI], 2.56–10.23; P < 0.001) and hyperchloremia (odds ratio, 2.53; 95% CI, 1.25–5.13; P = 0.01) were significantly associated with non-complete renal recovery. Similar trends were observed for renal failure. This study showed that dyschloremia was independently associated with failure in restoring renal function following AKI.

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