scholarly journals Mortality and Recovery of Renal Function in Acute Kidney Injury Patients Treated with Prolonged Intermittent Hemodialysis Sessions Lasting 10 versus 6 Hours: Results of a Randomized Clinical Trial

2018 ◽  
Vol 2018 ◽  
pp. 1-10
Author(s):  
Bianca Ballarin Albino ◽  
Mariele Gobo-Oliveira ◽  
André Luís Balbi ◽  
Daniela Ponce
Keyword(s):  
Clinical Trial ◽  
Acute Kidney Injury ◽  
Renal Function ◽  
Kidney Injury ◽  
Volume Overload ◽  
Complete Recovery ◽  
Treatment Discontinuation ◽  
Intermittent Hemodialysis ◽  
Significant Difference ◽  
Before And After

Purpose. This trial aimed to compare mortality and recovery of renal function in acute kidney injury (AKI) patients treated with different durations of prolonged hemodialysis (PHD) sessions (6 h versus 10 h). Methodology. We included patients with sepsis-associated AKI, >18 years, who are in use of a norepinephrine (lower than 0.7 ucg/kg/min). Results. One hundred and ninety-four patients were treated with 531 sessions of PHD (G1=104 and G2=90 patients). The two groups were similar in age and SOFA. There was no significant difference in hypotension, hypokalemia, and anticoagulation during PHD sessions. The two groups showed differences in filter clotting, hypophosphatemia, and treatment discontinuation (12.3 versus 23.1%, p=0.002; 15.5 versus 25.8%, p=0.005; and 7.9 versus 15.6%, p=0.008, respectively). There was no difference in fluid balance (FB) before and after PHD sessions. Death and complete recovery of renal function were similar (81.3 versus 82.2%, p=0.87 and 21 versus 31.2%, p=0.7, respectively). At logistic regression, the positive FB before and after dialysis was identified as risk factor for death, while volume overload after three PHD sessions and predialysis creatinine were negatively associated with recovery of renal function in 28 days. Conclusion. There was no difference in the mortality and recovery of renal function of AKI patients submitted to different durations of PHD and sessions lasting 10 h presented higher filter clotting, hypophosphatemia, and treatment discontinuation. ISRCTN Registry number is ISRCTN33774458.

scholarly journals Aqp2 may affect the occurrence of acute kidney injury after cardiopulmonary bypass

2020 ◽  
Author(s):  
Yingjie Xiao ◽  
Yanli Li ◽  
Wenpeng Dong ◽  
Long Gui ◽  
Xu Yu ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Renal Function ◽  
Cardiac Surgery ◽  
Cardiopulmonary Bypass ◽  
Postoperative Complications ◽  
Kidney Injury ◽  
Complete Recovery ◽  
Upward Trend ◽  
Before And After ◽  
Postoperative Aki

Abstract BACKGROUND Acute kidney injury (AKI) is one of the most important postoperative complications of cardiac surgery, and despite complete recovery of renal function after surgery, AKI is independently associated with high mortality within 10 years after surgery. Experiments show that Aquaporin 2(AQP2) is associated with postoperative AKI. Results of AQP2 release patterns after acute kidney injury have not been the same in different studies. METHODS We selected all patients undergoing extracorporeal circulation surgery, collected their urine samples before and after surgery, centrifuged at 3000 rpm for ten minutes, and detected the expression of AQP2 in urine by ELISA. RESULTS Most of the patients without AKI showed an upward trend of AQP2, while the patients with AKI showed a downward trend of AQP2. Patients with lower AQP2 levels before surgery have a lower chance of developing AKI. CONCLUSION AQP2 can be used to predict and prevent postoperative AKI.

scholarly journals Intermittent Hemodialysis For Patients With Acute Kidney Injury (AKI): Outcome In A Tertiary Level Hospital

2018 ◽  
Vol 17 (1) ◽  
pp. 25-30
Author(s):  
Arun Sharma ◽  
Binod Karki ◽  
Ajay Rajbhandari
Keyword(s):  
Acute Kidney Injury ◽  
Renal Function ◽  
Renal Replacement Therapy ◽  
Replacement Therapy ◽  
Acute Gastroenteritis ◽  
Kidney Injury ◽  
Tertiary Level ◽  
Intermittent Hemodialysis ◽  
The Mean ◽  
Level Hospital

INTRODUCTION: Acute kidney injury (AKI) is the sudden loss of renal function with accumulation of nitrogenous waste compounds. In developing countries, community acquired AKI is common than AKI in hospitalized septic patients. With conservative management many patients recover renal function however few require renal support with intermittent Hemodialysis (HD). We conducted a study to find out the etiology and outcome of the patients presenting with AKI who required dialysis.METHODS: This is a descriptive follow up study of the patients who needed renal replacement therapy in the form of HD presenting to our Nephrology unit of the hospital over a period of two years. Patients were followed up for three months post discharge. Data were tabulated and analyzed using SPSS software.RESULTS: Total 50 patients were included in study with 67% male. The commonest etiologies were urinary tract infection (30%) and  acute gastroenteritis (24%).The mean creatinine at the time of nephrology consultation, maximum level and at the time of discharge were 6.5(SD± 2.62), 7.3(SD ±2.13) and 2.2(SD ±1.75) respectively. Uremia with anuria was the most common reason for the initiation of HD in 54% cases. The mean number of intermittent HD used was 3.36. Complete recovery was seen in 68%, death in 26% and CKD in 6%.CONCLUSION: UTI followed by acute gastroenteritis are the leading cause of AKI in our tertiary level hospital. Timely initiated renal replacement therapy in the form of intermittent HD could lead to substantial renal recovery in almost three fourth of patients.

scholarly journals Effects of Liberal Versus Restrictive Fluid Therapy on Renal Function Indices in Laparoscopic Bariatric Surgery

2020 ◽  
Vol 10 (5) ◽  
Author(s):  
Mahzad Alimian ◽  
Masood Mohseni ◽  
Omid Moradi Moghadam ◽  
Seyed Alireza Seyed Siamdoust ◽  
Javad Moazzami
Keyword(s):  
Bariatric Surgery ◽  
Clinical Trial ◽  
Fluid Therapy ◽  
Gastric Bypass Surgery ◽  
Kidney Injury ◽  
Laparoscopic Bariatric Surgery ◽  
Significant Difference ◽  
Conflicting Objectives ◽  
Before And After ◽  
Double Blinded

Background: Earlier studies have suggested the liberal administration of fluids in favor of reducing the risk of rhabdomyolysis in obese patients, but the results are conflicting. Objectives: The present study aimed at comparing the effects of liberal and restrictive fluid therapy on renal indices in laparoscopic gastric bypass surgery. Methods: In a double-blinded randomized clinical trial, 72 candidates of bariatric surgery were randomly assigned into two groups of restrictive and liberal fluid therapy. Indices, including BUN, creatinine, creatine kinase, GFR, and urine output were measured before and 24 hours after the surgery. The clinical trial was registered at IRCT.ir under code IRCT20170109031852N3. Results: There was no significant difference in BUN, creatinine, creatinine kinase, and GFR indices between the two groups of liberal and restrictive fluid therapy both before and 24 hours after surgery (P > 0.05). Intragroup comparisons before and after surgery revealed that BUN decreased in both groups after the surgery (P < 0.05). Also, creatinine and GFR values improved in patients who received a liberal fluid regimen, whereas these indices remained statistically unchanged in the restrictive group before and 24 hours after the surgery (P > 0.05). Conclusions: Two methods of liberal and restrictive fluid therapy have comparable effects on traditional renal functional indices in laparoscopic bariatric surgery. The clinical significance of observed differences in outcomes should be investigated in further studies. The use of early biomarkers of acute kidney injury is warranted.

scholarly journals Complete Recovery of Renal Function among Obstetric Patients with Acute Kidney Injury at a Tertiary Care Hospital: A Descriptive Cross-sectional Study

2021 ◽  
Vol 59 (244) ◽  
pp. 1289-1292
Author(s):  
Rakina Bhansakarya ◽  
Gehanath Baral ◽  
Shailendra Shrestha ◽  
Shanti Subedi ◽  
Sita Ghimire ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Renal Function ◽  
Tertiary Care Hospital ◽  
Tertiary Care ◽  
Kidney Injury ◽  
Complete Recovery ◽  
Cross Sectional Study ◽  
Care Hospital ◽  
Sectional Study ◽  
Cross Sectional

Introduction: Acute kidney injury  is a rare complication of pregnancy and is associated with high maternal morbidity and mortality. Obstetric factors associated with it are preeclampsia/eclampsia, sepsis, hemorrhage and dehydration. Here, we aim to find out the prevalence of complete recovery of renal function among obstetric patients with acute kidney injury. Methods: This is a descriptive cross-sectional study conducted in a tertiary care hospital from 1st July 2020 to 30th June 2021 where obstetric patients who had developed acute kidney injury were included and followed till 6 weeks of diagnosis. Ethical approvalwas obtained from Institutional Review Committee of Nobel Medical College and Teaching Hospital (IRC- NMCTH 437/2020). The convenience sampling method was used. Data entry and analysis were done using Statistical Package for Social Sciences version 21. Point estimate at 95% Confidence Interval was calculated along with frequency and proportion for binary data. Results: Out of total 66 obstetric patients with acute kidney injury, 45 (68.2%) (57-79.3 at 95% Confidence Interval) had complete recovery of renal function. Rate of renal function recovery in Stage 1, Stage 2 and Stage 3 acute kidney injury were 19 (90%), 19 (86%) and 7 (58%) respectively. The most common causes of acute kidney injury were Preeclampsia/eclampsia 18 (40%), sepsis 23 (28.8%) and hemorrhage 10 (22.2%). Conclusions: The prevalence of complete recovery in obstetric patients with acute kidney injury was similar to findings from other studies done in similar settings.

Characteristics and Outcomes of Adults Hospitalized with Dengue Viral Infection and Acute Kidney Injury in Southern Thailand

2021 ◽  
Author(s):  
Smonrapat Surasombatpattana ◽  
Pornpen Sangthawan ◽  
Thanaporn Hortiwakul ◽  
Boonsri Charoenmak ◽  
Sarunyou Chusri
Keyword(s):  
Acute Kidney Injury ◽  
Renal Function ◽  
Mortality Rate ◽  
Viral Infection ◽  
Kidney Diseases ◽  
Kidney Injury ◽  
Volume Overload ◽  
Adult Patients ◽  
Southern Thailand

Dengue viral infection (DVI) among adult patients is increasingly problematic in tropical and subtropical regions. Acute kidney injury (AKI) after DVI poses substantial clinical outcomes and economic impact. This prospective study focused on the characteristics, risk factors, and outcomes of adult patients with AKI due to DVI hospitalized in nine network hospitals within Southern Thailand from January 2017 to December 2019. Among 120 adult patients hospitalized due to DVI without preexisting kidney diseases, 17 patients (14%) presented with AKI. During hospitalization, four patients required acute hemodialysis. The predominant characteristic of urinalysis was proteinuria, followed by pyuria and hematuria with remarkable dysmorphic red blood cells. Complications included acidosis, followed by hyperkalemia and volume overload. Most complications and deterioration of renal function occurred within the first week, but renal function recovered in second week of hospitalization. Stability of renal function was regained within the fourth week to the third month. However, four AKI patients recovered, with estimated glomerular filtration rate >60 mL/min/1.73 m2 within 3 months. Forty-day mortality rate and resource utilization, including hospital cost and length of hospitalization, among those with AKI were significantly higher than those without AKI. Thirty-day and in-hospital mortality rate among those with AKI was also higher than those without AKI. High APACHE II scores due to bleeding disorder and current use of non-steroidal anti-inflammatory agent were significantly associated with the emergence of AKI. Acute kidney injury among adult patients hospitalized due to DVI should be a concern and should be monitored for prompt treatment and follow-up.

The incidence of treatment related acute kidney injury in cancer patients: A retrospective analysis.

2020 ◽  
Vol 38 (15_suppl) ◽  
pp. e14150-e14150
Author(s):  
Bohdan Baralo ◽  
Samia Hossain ◽  
Muhammad Hanif ◽  
Suhail Khokhar ◽  
Sana Mulla ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Renal Function ◽  
Kidney Injury ◽  
Close Monitoring ◽  
Repeat Test ◽  
Significant Incidence ◽  
Improved Outcomes ◽  
Platinum Based Chemotherapy ◽  
Before And After

e14150 Background: Development of the Acute kidney injury (AKI) in the patients receiving chemotherapy and immunotherapy is a factor associated with higher admission to the hospital, prolonged hospitalization, increased morbidity and mortality, dose reduction, moving to less effective regimens, inability to enroll in clinical trials. Methods: A retrospective cohort of the 95 patients, who received chemo immunotherapy in the infusion center of Mercy Fitzgerald Hospital in 2018-2020 were analysed. The pool of the patients had multiple oncological pathologies and were on different chemo immunotherapeutic regimens. All creatinine levels before starting chemotherapy, before and after each cycle were assessed. We used a Kidney Disease: Improving Global Outcomes criteria to define AKI (at least 1.5 increase in creatinine within 7 days of cycle or 0.3 creatinine increase in 48 hours) and grades of AKI. We considered AKI related to chemotherapy, if it developed in specified timeframe after chemotherapy defined above. The cases when patient did not meet criteria for AKI, but had a patterns suggestive of it (no repeat test within 7 days, but repeat test within 3 weeks, with increase in creatinine > 37.5%) were defined as potentially missed AKI. Results: 12 patients developed chemoimmunotherapy related AKI (12.63%). 1 patient had 3 episodes of the AKI related to chemotherapy. 4 patients received platinum-based chemotherapy. On average every patient received 12cycles of chemotherapy. After the first two cycles of chemotherapy AKI developed in 7 Patients (58.33%). 10patients had AKI after 7 cycles (83.33%). It worth mentioning that only 42% of the chemotherapeutic cycles had follow-up creatinine within 7 days. 7 patients (7.37%) had fallen under a potentially missed AKI criteria. 2 more patients were diagnosed with AKI that was not related to the chemotherapy. Conclusions: In our study there was a significant incidence of AKI in the patients receiving chemoimmunotherapy. Current guidelines do not advocate close monitoring(weekly) of renal function in patients receiving chemoimmunotherapy unless the patient receives an chemotherapeutic agent known to cause nephrotoxicity. Repeat creatinine within 7 days after chemotherapy may be necessary to allow early detection of AKI, that can potentially to improved outcomes. Large prospective studies may be necessary to confirm our findings that very close monitoring of renal function can improve detection of the AKI and outcomes due to possibility of early intervention.

scholarly journals Intermittent hemodialysis for patients with acute kidney injury (AKI): Outcome in a tertiary level hospital

2018 ◽  
Vol 17 (2) ◽  
pp. 25
Author(s):  
Arun Sharma ◽  
Binod Karki ◽  
Ajay Rajbhandari
Keyword(s):  
Acute Kidney Injury ◽  
Renal Function ◽  
Renal Replacement Therapy ◽  
Replacement Therapy ◽  
Acute Gastroenteritis ◽  
Kidney Injury ◽  
Tertiary Level ◽  
Intermittent Hemodialysis ◽  
The Mean ◽  
Level Hospital

<p><strong>INTRODUCTION:</strong> Acute kidney injury (AKI) is the sudden loss of renal function with accumulation of nitrogenous waste compounds. In developing countries, community acquired AKI is common than AKI in hospitalized septic patients. With conservative management many patients recover renal function however few require renal support with intermittent Hemodialysis (HD). We conducted a study to find out the etiology and outcome of the patients presenting with AKI who required dialysis.</p><p><strong>METHODS: </strong>This is a descriptive follow up study of the patients who needed renal replacement therapy in the form of HD presenting to our Nephrology unit of the hospital over a period of two years. Patients were followed up for three months post discharge. Data were tabulated and analyzed using SPSS software.</p><p><strong>RESULTS: </strong>Total 50 patients were included in study with 67% male. The commonest etiologies were urinary tract infection (30%) and  acute gastroenteritis (24%).The mean creatinine at the time of nephrology consultation, maximum level and at the time of discharge were 6.5(SD± 2.62), 7.3(SD ±2.13) and 2.2(SD ±1.75) respectively. Uremia with anuria was the most common reason for the initiation of HD in 54% cases. The mean number of intermittent HD used was 3.36. Complete recovery was seen in 68%, death in 26% and CKD in 6%.</p><p><strong>CONCLUSION: </strong>UTI followed by acute gastroenteritis are the leading cause of AKI in our tertiary level hospital. Timely initiated renal replacement therapy in the form of intermittent HD could lead to substantial renal recovery in almost three fourth of patients.</p>

Acute tubulointerstitial nephritis

2015 ◽  
Author(s):  
Richard Baker
Keyword(s):  
Acute Kidney Injury ◽  
Renal Function ◽  
Drug Reaction ◽  
Early Treatment ◽  
Tubulointerstitial Nephritis ◽  
Kidney Injury ◽  
Complete Recovery ◽  
The Elderly ◽  
Renal Outcome ◽  
Acute Tubulointerstitial Nephritis

Acute tubulointerstitial nephritis (ATIN) is an important cause of acute kidney injury which has a diverse aetiology but is most frequently caused by either an infection or drug reaction. Clinical features are usually non-specific or absent, although early accounts emphasized fever, rash, and eosinophilia. ATIN should be considered in all cases of acute kidney injury, especially when there is no obvious precipitant. If deemed clinically safe an early renal biopsy is recommended for diagnosis. Renal outcome will usually be good but in a significant minority, particularly the elderly, the outcome may be poor. There is evidence from a number of series that early treatment with corticosteroids leads to a more rapid and complete recovery of renal function.

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