scholarly journals Severe Hyperphosphatemia in a Patient with Mild Acute Kidney Injury

2021 ◽  
Vol 2021 ◽  
pp. 1-5
Author(s):  
Phuong Chi Pham ◽  
Raghu Konanur Ventakaram ◽  
Jimmy Pham ◽  
Harpreet Sidhu ◽  
Nada Bader ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Liposomal Amphotericin ◽  
Measurement Techniques ◽  
Kidney Injury ◽  
Pregnant Patient ◽  
Phosphate Binding ◽  
Contributing Factors ◽  
Acid Base Status ◽  
Reduced Kidney Function ◽  
Full Investigation

Hyperphosphatemia may arise from various conditions including exogenous ingestion, extracellular shifts due to cell death or alterations in acid-base status, increased bone resorption, hormonal dysregulations leading to reduced renal excretion, reduced kidney function, or faulty measurement techniques. We herein present a case of a young pregnant woman who presented with mild acute kidney injury (AKI), invasive mucormycosis receiving liposomal amphotericin, and hyperphosphatemia out of proportion to the degree of kidney injury. While the patient was given routine phosphate-binding agent by her primary care team for presumed AKI-associated hyperphosphatemia, a full investigation by the renal consulting team for contributing factors other than kidney injury revealed that she actually had pseudohyperphosphatemia associated with the use of liposomal amphotericin. Erroneous treatment of pseudohyperphosphatemia may have been detrimental to this pregnant patient. A literature review for conditions associated with pseudohyperphosphatemia other than the use of liposomal amphotericin will be discussed.

scholarly journals When azoles cannot be used: the clinical effectiveness of intermittent liposomal amphotericin prophylaxis in haematology patients

2021 ◽  
Author(s):  
R Batchelor ◽  
C Thomas ◽  
B J Gardiner ◽  
S J Lee ◽  
S Fleming ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Acute Myeloid Leukaemia ◽  
Myeloid Leukaemia ◽  
Liposomal Amphotericin ◽  
Kidney Injury ◽  
Antifungal Prophylaxis ◽  
High Rate ◽  
Clinical Scenarios ◽  
Haematology Patients ◽  
Acute Myeloid

Abstract Background Patients unable to take azoles are a neglected group lacking a standardized approach to antifungal prophylaxis. We evaluated the effectiveness and safety of intermittent liposomal amphotericin (L-AMB) prophylaxis in a heterogenous group of haematology patients. Methods A retrospective cohort of all haematology patients who received a course of intravenous L-AMB defined as 1mg/kg thrice weekly, from 1 July 2013-30 June 2018 were identified from pharmacy records. Outcomes included breakthrough-invasive fungal disease (BIFD), reasons for premature discontinuation and acute kidney injury. Results There were 198 patients who received 273 courses of L-AMB prophylaxis. Using a conservative definition, the BIFD rate was 9.6% (n=19/198) occurring either during L-AMB prophylaxis or up to 7 days from cessation in patients who received a course. Probable/proven-BIFD occurred in 13 patients (6.6%, 13/198), including molds in 54% (n=7) and non-albicans Candidaemia in 46% (n=6). Cumulative incidence of BIFD was highest in patients with acute myeloid leukaemia (6.8%) followed by acute lymphoblastic leukaemia (2.7%) and allogeneic stem cell transplantation (2.5%). The most common indication for L-AMB was chemotherapy or anticancer drug-azole interactions (75% of courses) dominated by vincristine or acute myeloid leukaemia clinical trials, followed by gut absorption concerns (13%) and liver function abnormalities (8.8%). Acute kidney injury using a modified international definition, complicated 27% of courses but was not clinically significant accounting for only 3.3% (9/273) of discontinuations. Conclusions Our findings demonstrate a high rate of BIFD among patients receiving L-AMB prophylaxis. Pragmatic trials will help find the optimal regimen of L-AMB prophylaxis for the many clinical scenarios where azoles are unsuitable, especially as targeted anticancer drugs increase in use.

scholarly journals POS-187 ACUTE KIDNEY INJURY IN A PREGNANT PATIENT WITH COVID-19: CASE REPORT

2021 ◽  
Vol 6 (4) ◽  
pp. S78
Author(s):  
M. WILOT HETTWER ◽  
T. Bueno Batista ◽  
L. Zanetti ◽  
S. Okubu ◽  
M. Batista Pereira ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Case Report ◽  
Kidney Injury ◽  
Pregnant Patient

scholarly journals Acute kidney injury and its outcome in obstetrics

2020 ◽  
Vol 9 (6) ◽  
pp. 2508
Author(s):  
Dipal C. Shah ◽  
Babulal S. Patel ◽  
Akshay C. Shah ◽  
Shashwat K. Jani ◽  
Saumya P. Agrawal ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Placenta Previa ◽  
Kidney Injury ◽  
Causative Factor ◽  
Loss Of Function ◽  
Contributing Factors ◽  
Early Management ◽  
Study Association ◽  
Stage Renal Disease ◽  
End Stage

Background: Acute kidney injury occurring during pregnancy, labour, delivery, and/or postpartum period. Proper management of AKI (acute kidney injury) is challenging because (i) both maternal and fetal health must be considered and (ii) the cardiovascular and renal adaptations of pregnancy add to the complexity for management.Methods: The objective of this study was to study association and contributing factors in AKI, a retrospective study of 20 cases of AKI complicating pregnancies carried out in department of obstetrics and gynecology, SVPIMSR over a period of 12 months and results were studied and analysed. Etiological factors, associated liver pathology, coagulation abnormality, thrombocytopenia, sepsis, recovery status and fetomaternal outcome were studied and tabulated. AKI was analysed in terms of maximal stage of renal injury attained as per risk, injury, failure, loss of function, and end-stage renal disease (RIFLE) criteria.Results: The incidence of ARF (acute renal failure) in pregnancy was about 0.3%. Hypertensive disorders were the major causative factor. Amongst the 20 cases, 8 cases were referred from outside and two of them died. Total 5 of 20 cases required hemodialysis and two of them had partial recovery.Conclusions: AKI complicating pregnancies are not uncommon. If recognized and treated promptly, recovery is assured in majority of cases. Early identification and prompt management of pre-eclampsia and sepsis can prevent majority of cases. Ultrasonography revelation of placenta previa or abruption helps in early management eventually decreases the chances of bleeding which is one of the causes of AKI (pre-renal cause).

scholarly journals Proenkephalin: A New Biomarker for Glomerular Filtration Rate and Acute Kidney Injury

Nephron ◽  
2020 ◽  
Vol 144 (12) ◽  
pp. 655-661
Author(s):  
Mina Khorashadi ◽  
Remi Beunders ◽  
Peter Pickkers ◽  
Matthieu Legrand
Keyword(s):  
Acute Kidney Injury ◽  
Glomerular Filtration Rate ◽  
Glomerular Filtration ◽  
Kidney Function ◽  
Filtration Rate ◽  
Kidney Injury ◽  
Peptide Family ◽  
Estimate Glomerular Filtration Rate ◽  
Reduced Kidney Function ◽  
Proenkephalin A

Assessment of kidney function is primarily based on urine output and Creatinine (Cr)-based methods to estimate glomerular filtration rate (GFR). The latter is confounded as Cr is not exclusively filtered by the kidney and rises relatively late after the onset of acute kidney injury (AKI). This leads to delays in recognition of reduced kidney function and diagnosis of AKI, particularly in critically ill patients where kidney function can change rapidly. The gold standard methods of GFR determination, such as inulin or iohexol clearance, are labor intensive and unfeasible in acute clinical settings. Proenkephalin A 119–159 (PENK) has been intensively studied as a novel biomarker of kidney function. PENK belongs to the enkephalin peptide family and is freely filtrated in the glomerulus. Plasma PENK concentration appears to correlate strongly with GFR. Moreover, increased plasma PENK concentrations are found to be associated with long-term kidney outcomes and mortality. In this review, we summarize the role of PENK in assessment of kidney function and its capacity to predict various clinical outcomes.

scholarly journals Time and the etiology of Acute Kidney Injury define prognosis in the course of COVID-19

2021 ◽  
Author(s):  
Ahmet Murt ◽  
Mevlut Tamer Dincer ◽  
Cebrail Karaca ◽  
Sinan Trabulus ◽  
Ridvan Karaali ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Inflammatory Markers ◽  
Kidney Injury ◽  
Final Analysis ◽  
Disease Stage ◽  
Inclusion Criteria ◽  
Acid Base ◽  
Acid Base Status ◽  
Worse Prognosis ◽  
D Dimer

Abstract Aim Kidneys are among the affected organs in COVID-19 and there may be different etiologies resulting in acute kidney injury (AKI) in different stages of the disease. This study aimed to analyze AKI among hospitalized COVID-19 patients in relation to the time and etiologies of AKI. Methods 1056 patients who were hospitalized with COVID-19 diagnosis in our institution were retrospectively evaluated and 383 of them met the inclusion criteria. Eighty-nine patients who developed AKI were involved in the final analysis. Patients were classified into three groups, those who had AKI on admission, those who developed AKI in the first week and those who developed AKI starting from 7th day. Initial lymphocyte counts, creatinine levels, electrolytes, acid-base status and changes in the inflammatory markers were compared between the groups. A comparison between patients who survived and who died was also performed.Results AKI had 24% mortality in COVID-19 patients who had eGFRs of over 60 ml/min/1,73 m2. Patients who developed AKI later had higher peak CRP and D-dimer levels with lower nadir lymphocyte counts (p=0,000, 0,004 and 0,003 respectively). Mortality of patients who had AKI on hospital admission (13%) was similar to the overall COVID-19 mortality for inpatients, however it was 44% for those who developed AKI after 7th day. Early AKI was related to pre-renal causes and had a milder course. However, later AKIs were more related to immunologic response and had significantly higher mortality. Conclusions AKI in COVID-19 is not of one kind. When developed, AKI should be evaluated in conjunction with the disease stage and possible etiologies. AKI that develops later has a worse prognosis.

Metabolic alkalosis following mitral valvuloplasty in a dog with preoperative acute kidney injury

2021 ◽  
pp. 1-5
Author(s):  
Katsuhiro Matsuura ◽  
Tomohiko Yoshida ◽  
Takuya Uehara ◽  
Shusaku Yamada ◽  
Hideki Yotsuida ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Mitral Valve ◽  
Metabolic Alkalosis ◽  
Kidney Injury ◽  
Clinical Findings ◽  
Mitral Valve Surgery ◽  
Valve Surgery ◽  
Intact Male ◽  
Plasma Urea ◽  
Acid Base Status

Abstract CASE DESCRIPTION An 11-year-old sexually intact male Shih Tzu diagnosed with acute kidney injury and left-sided congestive heart failure that had nonelective mitral valve surgery. CLINICAL FINDINGS Metabolic alkalosis developed postoperatively, and plasma bicarbonate concentration peaked 2 days after surgery (40.2 mmol/L; pH, 7.550). TREATMENT AND OUTCOME Acetazolamide administration increased the urinary excretion of bicarbonate and contributed to the improvement of the dog’s acid-base status and oxygenation capacity. Metabolic alkalosis persisted for 4 days after surgery, and no treatment was required after resolution. Plasma urea nitrogen and creatinine concentrations normalized 2 days after surgery. CLINICAL RELEVANCE Severe metabolic alkalosis can occur as a complication following mitral valve surgery. Acetazolamide may be suitable for the treatment of severe metabolic alkalosis.

Renal disease in pregnancy

2020 ◽  
pp. 2589-2596
Author(s):  
Kate Wiles
Keyword(s):  
Chronic Kidney Disease ◽  
Acute Kidney Injury ◽  
Kidney Disease ◽  
Post Partum ◽  
Asymptomatic Bacteriuria ◽  
Kidney Injury ◽  
Pregnant Patient ◽  
Symptomatic Infection ◽  
Renal System ◽  
In Pregnancy

Pregnancy leads to extensive and complex physiological changes in the kidney and renal system. This chapter explores the various complications that can occur in the renal system of the pregnant woman, including acute kidney injury, chronic kidney disease, and urinary tract infection. The causes of acute kidney injury in pregnancy are as those in the non-pregnant patient, but additional pregnancy-related pathologies must be considered, including pre-eclampsia and HELLP syndrome. Microangiopathic haemolytic anaemias (haemolytic uraemic syndrome and thombotic thrombocytopenic purpura) are rare but can be triggered by pregnancy or the post-partum state. Failure of the renal system to adapt to pregnancy is hypothesized to lead to the increase in adverse maternal and fetal outcomes seen in women with chronic kidney disease. Asymptomatic bacteriuria affects 2–10% of pregnant women and is associated with increased risks of symptomatic infection, preterm birth, low birth weight, and perinatal mortality. Antibiotic treatment mitigates these risks.

Acute kidney injury in the pregnant patient

2012 ◽  
Vol 78 (12) ◽  
pp. 478-486 ◽  
Author(s):  
Rosemary Nwoko ◽  
Darko Plecas ◽  
Vesna D. Garovic
Keyword(s):  
Acute Kidney Injury ◽  
Kidney Injury ◽  
Pregnant Patient

scholarly journals Optimal management of acute kidney injury in critically ill patients with invasive fungal infections being treated with liposomal amphotericin B

2020 ◽  
Vol 13 (5) ◽  
pp. e233072 ◽  
Author(s):  
Darius Armstrong-James ◽  
Mickey Koh ◽  
Marlies Ostermann ◽  
Paul Cockwell
Keyword(s):  
Acute Kidney Injury ◽  
Amphotericin B ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Liposomal Amphotericin ◽  
Fungal Infections ◽  
Kidney Injury ◽  
Invasive Fungal Infections ◽  
Liposomal Amphotericin B ◽  
Cell Transplant

Critically ill patients are at risk of developing both acute kidney injury (AKI) and invasive fungal infections (IFIs). Prompt and efficient treatment of the IFI is essential for the survival of the patient. This article examines three distinct clinical situations where liposomal amphotericin B, a broad-spectrum antifungal agent, was successfully used in the setting of AKI. The first was Aspergillus infection in a 63-year-old man with bleeding oesophageal varices related to advanced liver disease. The second was gastrointestinal mucormycosis in a 74-year-old man who developed a small bowel obstruction following an autologous stem cell transplant for mantle cell lymphoma. The third was a Fusarium infection in a 32-year-old woman on immunosuppression for a bilateral lung transplant for cystic fibrosis. In all three cases, liposomal amphotericin B was required for urgent management of the patient’s IFI. We discuss the rationale for treatment with a potentially nephrotoxic agent in this setting.

scholarly journals Factor analysis of acute kidney injury in patients administered liposomal amphotericin B in a real-world clinical setting in Japan

2020 ◽  
Vol 10 (1) ◽  
Author(s):  
Takahiro Takazono ◽  
Masato Tashiro ◽  
Yuki Ota ◽  
Yoko Obata ◽  
Tomotaro Wakamura ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Amphotericin B ◽  
Liposomal Amphotericin ◽  
Fungal Infections ◽  
Angiotensin Receptor Blockers ◽  
Laboratory Data ◽  
Kidney Injury ◽  
Fold Increase ◽  
Liposomal Amphotericin B ◽  
Converting Enzyme Inhibitors

Abstract Liposomal amphotericin B (L-AMB) is a broad-spectrum antifungal drug that is used to treat fungal infections. However, clinical evidence of its use in patients with renal failure is limited. Here, we aimed to identify factors associated with acute kidney injury (AKI) in patients administered L-AMB. We retrospectively utilized a combination of Diagnosis Procedure Combination data and laboratory data obtained from hospitals throughout Japan between April 2008 and January 2018. In total, 507 patients administered L-AMB were identified. After L-AMB treatment initiation, AKI, which was defined as a ≥ 1.5-fold increase within 7 days or ≥ 0.3 mg/dL increase within 2 days in serum creatinine according to the KDIGO criteria, was recognized in 37% of the total patients (189/507). The stages of AKI were stage 1 in 20%, stage 2 in 11%, and stage 3 in 7%. Five factors were associated with AKI of all stages: prior treatment with angiotensin-converting enzyme inhibitors/angiotensin-receptor blockers or carbapenem; concomitant administration of catecholamines or immunosuppressants; and ≥ 3.52 mg/kg/day of L-AMB dosing. Serum potassium < 3.5 mEq/L before L-AMB therapy was associated with severe AKI of stage 2 and 3. Altogether, these factors should be carefully considered to reduce the occurrence of AKI in patients administered L-AMB.

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