scholarly journals Rhabdomyolysis and Acute Kidney Injury Requiring Dialysis as a Result of Concomitant Use of Atypical Neuroleptics and Synthetic Cannabinoids

2015 ◽  
Vol 2015 ◽  
pp. 1-4 ◽  
Author(s):  
Aiyu Zhao ◽  
Maybel Tan ◽  
Aung Maung ◽  
Moro Salifu ◽  
Mary Mallappallil
Keyword(s):  
Acute Kidney Injury ◽  
Differential Diagnosis ◽  
Adverse Effects ◽  
Serum Creatinine ◽  
Synthetic Cannabinoids ◽  
Kidney Injury ◽  
Atypical Neuroleptics ◽  
Unique Case ◽  
Urine Metabolites ◽  
Tubular Necrosis

The use of synthetic cannabinoids (SCBs) is associated with many severe adverse effects that are not observed with marijuana use. We report a unique case of a patient who developed rhabdomyolysis and acute kidney injury (AKI) requiring dialysis after use of SCBs combined with quetiapine. Causes for the different adverse effects profile between SCBs and marijuana are not defined yet. Cases reported in literature with SCBs use have been associated with reversible AKI characterized by acute tubular necrosis and interstitial nephritis. Recent studies have showed the involvement of cytochromes P450s (CYPs) in biotransformation of SCBs. The use of quetiapine which is a substrate of the CYP3A4 and is excreted (73%) as urine metabolites may worsen the side effect profiles of both quetiapine and K2. SCBs use should be included in the differential diagnosis of AKI and serum Creatinine Phosphokinase (CPK) level should be monitored. Further research is needed to identify the mechanism of SCBs nephrotoxicity.

scholarly journals Community Acquired Acute Kidney Injury from Edible Agents: Report from a Developing Country, Bangladesh

2017 ◽  
Vol 10 (1) ◽  
pp. 20-28 ◽  
Author(s):  
Tabassum Samad ◽  
Wasim M. Mohosin ul Haque ◽  
Muhammad A. Rahim ◽  
Sarwar Iqbal ◽  
Palash Mitra
Keyword(s):  
Acute Kidney Injury ◽  
Serum Creatinine ◽  
Acute Tubular Necrosis ◽  
Public Awareness ◽  
Kidney Injury ◽  
Energy Drink ◽  
Renal Tubules ◽  
Tubular Necrosis ◽  
Oxalate Crystals ◽  
Star Fruit

Toxin is a common cause of community acquired acute kidney injury (AKI) which includes environmental toxins like plant toxins as well as various drugs and chemicals which are usually ingested for medicinal as well as recreational purposes.Averrhoa carambola(Star fruit/ Kamranga) andAvorrhoa bilimbiare two such commonly used traditional remedies. They belong to familyOxalidaecaeand contain high-levels of oxalic acid. AKI may occur after consuming concentrated juice due to deposition of oxalate crystals in the renal tubules.Here we present two patients who developed AKI after ingestion of freshly made juice from A. bilimbi and star fruit. Both patients were diabetic and the juice was ingested on empty stomach with the belief of improving glycemic status. Initial presentation was GI upset in both scenarios. Patient with A. bilimbi toxicity had diabetic nephropathy and required hemodialysis. Renal biopsy revealed deposition of polarizable oxalate crystals in the patient who consumed A. bilimbi and acute tubular necrosis in the patient with star fruit toxicity. All cases regained normal renal function within three months.We also present a patient who ingested raw fish gallbladder as a remedy for asthma. The patient presented with AKI within five days of ingestion and required hemodialysis. His highest serum creatinine was 10.4mg/dl and fell to 1.7 mg/dl after four weeks. Cyprinol and related compounds in fish gallbladder are thought to be the cause of acute tubular necrosis in such cases.The fourth patient developed AKI with rhabdomyolysis after consuming a locally made energy drink. He also required dialysis and serum creatinine gradually improved from 7.2mg/dl to 1.4mg/dl at discharge. The possibility of toxicity of caffeine, adulteration with other chemicals or ascorbic acid toxicity causing oxalate nephropathy could not be excluded.All four patients developed AKI caused after ingesting easily available products and are presented here for public awareness. We believe proper knowledge and education can reduce toxin induced AKI in our society.

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

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

scholarly journals Outcome of Continuous Peritoneal Dialysis in Patient with Acute Kidney Injury

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.  

Delayed seizure-like activity following analytically confirmed use of previously unreported synthetic cannabinoid analogues

2014 ◽  
Vol 34 (5) ◽  
pp. 557-560 ◽  
Author(s):  
LJ Schep ◽  
RJ Slaughter ◽  
S Hudson ◽  
R Place ◽  
M Watts
Keyword(s):  
Health Care ◽  
Acute Kidney Injury ◽  
Adverse Effects ◽  
Blood Sample ◽  
Health Care Providers ◽  
Synthetic Cannabinoids ◽  
Kidney Injury ◽  
Synthetic Cannabinoid ◽  
Care Providers ◽  
Low Concentrations

Synthetic cannabinoid use has become widespread, leading to increased burdens on health care providers. Symptoms range from agitation and psychosis to seizures and acute kidney injury. We report a case where a patient was assessed and treated twice within 12 h for seizures following synthetic cannabinoid intoxication. Blood sample determinations showed low concentrations of analogues not previously reported, some of which are legal. Clinicians should be aware that synthetic cannabinoids may cause an array of severe health consequences. Given the ever evolving structure of available analogues, clinicians must also be prepared for other unexpected adverse effects.

scholarly journals Acute Kidney Injury in Heroin Users

2021 ◽  
Vol 28 (1) ◽  
pp. 103-107
Author(s):  
Ileana Adela VACAROIU ◽  
◽  
Daniela RADULESCU ◽  
Anca Ioana STANESCU ◽  
◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Adverse Effects ◽  
Necrotizing Fasciitis ◽  
Acute Tubular Necrosis ◽  
Kidney Injury ◽  
Heroin Users ◽  
Tubular Necrosis

The article presents a case of severe necrotizing fasciitis and rhabdomyolysis-induced acute tubular necrosis resulting from the injection of heroin laced with a plant-fertilizer known as „Pure by magic”. We also review the literature data regarding the renal adverse effects of heroin. Due to the diversity of adulterants used by drug dealers for cutting heroin and the variety of substances patients mix the heroin with before injecting themselves, the effects of this practice are often unknown and the treatment lacks of antidote, being strictly symptomatic.

scholarly journals Urinary cytology as a tool for differential diagnosis between acute tubular necrosis and proliferative glomerulonephritis in patients with nephrotic syndrome and acute kidney injury

2020 ◽  
Author(s):  
Caroline Vilas Boas de Melo ◽  
Maria Brandão Tavares ◽  
Paula Neves Fernandes ◽  
Carlos Alberto Santos Silva ◽  
Ricardo David Couto ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Differential Diagnosis ◽  
Nephrotic Syndrome ◽  
Acute Tubular Necrosis ◽  
Rapidly Progressive Glomerulonephritis ◽  
Kidney Injury ◽  
Small Cells ◽  
Urinary Cytology ◽  
Glomerular Lesion ◽  
Tubular Necrosis

Abstract Objective Acute tubular necrosis (ATN) is a frequent cause of acute kidney injury (AKI). In patients with nephrotic syndrome (NS), AKI demands the differential diagnosis between ATN and rapidly progressive glomerulonephritis. In some cases, conclusive diagnosis is possible only by kidney biopsy. We aimed to study the potential use of urine cytology in the differential diagnosis between ATN and proliferative glomerular lesion in patients with NS.Results Cell size analysis showed a higher proportion of small cells and a lower proportion of large cells in the urine of patients with AKI. Cells phenotypes were easily defined using cytological preparations. Leukocytes were found to be a primary classifier of NS groups, with higher number in patients with AKI and patients with proliferative glomerular lesions. Our data suggests that urinary cytology can be readily performed and support the differential diagnosis between proliferative glomerular lesion and ATN in patients with NS and AKI.

The role of novel biomarkers in acute kidney injury

2018 ◽  
Author(s):  
Norbert Lameire
Keyword(s):  
Intensive Care Unit ◽  
Acute Kidney Injury ◽  
Differential Diagnosis ◽  
Kidney Injury ◽  
Limited Information ◽  
Prognostic Performance ◽  
Tubular Necrosis ◽  
Novel Biomarkers ◽  
Transient Aki

Although there is a growing literature on the performance of various biomarkers in clinical studies, there is limited information on how these biomarkers would be utilized by clinicians to manage patients with acute kidney injury (AKI). The majority of investigations have focused on the ability of biomarkers to detect early either incipient or established AKI. Other studies have prospectively explored their prognostic performance in predicting either need for renal replacement therapy or intensive care unit (ICU) or hospital mortality or duration of either ICU or hospital stay. A few studies have also investigated their potential in the differential diagnosis between ‘transient AKI’, ‘prerenal AKI’, and established intrinsic AKI, mostly acute tubular necrosis.

scholarly journals Urinary Sodium/Potassium Ratio in Acute Kidney Injury Accurately Differentiates Prerenal Azotemia from Acute Tubular Necrosis

2019 ◽  
Vol 65 (3) ◽  
pp. 103-110
Author(s):  
Theodore Shankel ◽  
Stewart Shankel
Keyword(s):  
Acute Kidney Injury ◽  
Renal Failure ◽  
Serum Creatinine ◽  
Kidney Injury ◽  
Cost Effective ◽  
Creatinine Ratio ◽  
Urine Sodium ◽  
Sodium Potassium ◽  
Non Invasive ◽  
Tubular Necrosis

AbstractObjective: To develop a more accurate, cost effective, non-invasive test to differentiate between pre-renal renal failure (PRA) and acute tubular necrosis (ATN) in acute kidney injury (AKI).Methods: Urine sodium/potassium (Na/K) ratios were compared with fractional excretion of sodium (FeNa) and renal failure index (RFI) as well as other commonly used indices to differentiate patients with PRA from ATN. Patients with a rise in serum creatinine > 0.5 mg/d identified from medical records for a six- to eighteen-month period, were reviewed and categorized either as PRA or ATN based on presenting findings, course in hospital or renal biopsy. All patients had urinary sodium and potassium, creatinine, and serum creatinine done.Results: The Na/K was < 1 in PRA and > 1 in ATN, correctly identifying all 42 cases of PRA and all 28 patients with ATN. The FeNa was >1 and misdiagnosed 9 of 42 patients with PRA and was >1 and correctly diagnosed all patients with ATN. The RFI was >1 and misdiagnosed 11 of 42 patients with PRA but was >1 and correctly diagnosed all patients with ATN. The BUN/creatinine ratio, urine sodium concentration and U/P creatinine ratio all had a very poor correlation with the correct diagnosis.Conclusion: The Na/K ratio correctly diagnosed all 42 cases of PRA and all 28 cases of ATN. It is easy to do, is cost effective, non-invasive, and is useful for following patients with PRA to see if and when they develop ATN.

scholarly journals Perioperative use of serum creatinine and postoperative acute kidney injury: a single-centre, observational retrospective study to explore physicians’ perception and practice

2021 ◽  
Vol 10 (1) ◽  
Author(s):  
Gianluca Villa ◽  
Silvia De Rosa ◽  
Caterina Scirè Calabrisotto ◽  
Alessandro Nerini ◽  
Thomas Saitta ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Retrospective Study ◽  
High Risk ◽  
Abdominal Surgery ◽  
Serum Creatinine ◽  
Malignant Disease ◽  
Kidney Injury ◽  
Major Surgery ◽  
Single Centre

Abstract Background Postoperative acute kidney injury (PO-AKI) is a leading cause of short- and long-term morbidity and mortality, as well as progression to chronic kidney disease (CKD). The aim of this study was to explore the physicians’ attitude toward the use of perioperative serum creatinine (sCr) for the identification of patients at risk for PO-AKI and long-term CKD. We also evaluated the incidence and risk factors associated with PO-AKI and renal function deterioration in patients undergoing major surgery for malignant disease. Methods Adult oncological patients who underwent major abdominal surgery from November 2016 to February 2017 were considered for this single-centre, observational retrospective study. Routinely available sCr values were used to define AKI in the first three postoperative days. Long-term kidney dysfunction (LT-KDys) was defined as a reduction in the estimated glomerular filtration rate by more than 10 ml/min/m2 at 12 months postoperatively. A questionnaire was administered to 125 physicians caring for the enrolled patients to collect information on local attitudes regarding the use of sCr perioperatively and its relationship with PO-AKI. Results A total of 423 patients were observed. sCr was not available in 59 patients (13.9%); the remaining 364 (86.1%) had at least one sCr value measured to allow for detection of postoperative kidney impairment. Among these, PO-AKI was diagnosed in 8.2% of cases. Of the 334 patients who had a sCr result available at 12-month follow-up, 56 (16.8%) developed LT-KDys. Data on long-term kidney function were not available for 21% of patients. Interestingly, 33 of 423 patients (7.8%) did not have a sCr result available in the immediate postoperative period or long term. All the physicians who participated in the survey (83 out of 125) recognised that postoperative assessment of sCr is required after major oncological abdominal surgery, particularly in those patients at high risk for PO-AKI and LT-KDys. Conclusion PO-AKI after major surgery for malignant disease is common, but clinical practice of measuring sCr is variable. As a result, the exact incidence of PO-AKI and long-term renal prognosis are unclear, including in high-risk patients. Trial registration ClinicalTrials.gov, NCT04341974.

The Effect of a Short Course of Tocolytic Indomethacin on Urinary Biomarkers in Premature Infants

2021 ◽  
Author(s):  
Ahmad El Samra ◽  
Ayesa Mian ◽  
Marc Lande ◽  
Hongyue Wang ◽  
Ronnie Guillet
Keyword(s):  
Acute Kidney Injury ◽  
Serum Creatinine ◽  
Kidney Injury ◽  
Urinary Biomarkers ◽  
Bivariate Analysis ◽  
Neutrophil Gelatinase Associated Lipocalin ◽  
Short Course ◽  
Medication Exposure ◽  
Epidermal Growth ◽  
Neutrophil Gelatinase

Objective The aim of this study was to determine the effects of a 2-day prenatal course of indomethacin on the premature kidney as reflected by serum creatinine and urinary biomarkers. Study Design Urine of infants ≤ 32 weeks was collected for the first 14 days and analyzed for cystatin C, neutrophil gelatinase-associated lipocalin, osteopontin, β2 microglobulin, epidermal growth factor, uromodulin, and microalbumin. Bivariate analysis compared serum creatinine and biomarkers of exposed (INDO) and unexposed (CONT) subjects. Results Fifty-seven infants (35 CONT and 22 INDO) were studied. The cohorts were similar in gestational age, birthweight, race, gender, nephrotoxic medication exposure, and Apgar scores. CONT had more dopamine exposure and included more pre-eclamptic mothers (p = 0.005). No difference in creatinine-based acute kidney injury or the log transformed mean, maximum, and minimum values of urinary biomarkers was detected. Conclusion Our findings suggest that a short course of tocolytic indomethacin does not result in neonatal acute kidney injury. Key Points

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