Acute Kidney Injury: New Concepts, Renal Recovery

Objective To investigate the clinical characteristics and prognoses of patients with postpartum acute kidney injury (PPAKI). Methods We retrospectively reviewed the clinical presentations, laboratory examinations, treatments, and outcomes of patients with PPAKI admitted to our hospital from January 2013 to December 2017. We then analyzed the clinical characteristics and prognoses of the mothers and their infants. Results Of 37 patients diagnosed with PPAKI, 26 (70.3%) received treatment in the intensive care unit, mainly for hemolysis, elevated liver enzymes, low platelet count (HELLP) syndrome (28/37, 75.7%), pre-eclampsia (26/37, 70.3%), and postpartum hemorrhage (22/37, 59.5%). Twenty patients required renal replacement treatment (RRT), but renal recovery times were similar in the RRT and non-RRT groups. Renal function recovered completely in 30 patients (81.1%) and partially in one patient (2.7%), and was not re-examined in two patients (5.4%). Three patients (8.1%) were lost to follow-up. Only one patient (2.7%) remained dialysis-dependent, and no maternal deaths occurred. The preterm birth, low birth weight, and infant survival rates were 70.7% (29/41), 68.3% (28/41), and 78.0% (32/41), respectively. Conclusion RRT does not reduce renal recovery time compared with non-RRT. Overall, the prognoses of both mothers and their fetuses are good following treatment for PPAKI.

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pSerum phosphorus, a simple biomarker of acute kidney injury severity and renal recovery after cardiac surgery

Journal of Cardiothoracic and Vascular Anesthesia ◽

10.1053/j.jvca.2017.02.093 ◽

2017 ◽

Vol 31 ◽

pp. S26-S27 ◽

Cited By ~ 1

Author(s):

Marine Saour ◽

J Ridolfo ◽

N Zéroual ◽

P Gaudard ◽

P Colson

Keyword(s):

Acute Kidney Injury ◽

Cardiac Surgery ◽

Injury Severity ◽

Kidney Injury ◽

Renal Recovery ◽

Acute Kidney Injury Severity

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POS-173 ACUTE KIDNEY INJURY AND RENAL RECOVERY IN UGANDAN CHILDREN WITH SEVERE MALARIA

Kidney International Reports ◽

10.1016/j.ekir.2021.03.184 ◽

2021 ◽

Vol 6 (4) ◽

pp. S70

Author(s):

A. CONROY ◽

R. Namazzi ◽

A. Batte ◽

J. Ssenkusu ◽

O.R. Opoka ◽

...

Keyword(s):

Acute Kidney Injury ◽

Severe Malaria ◽

Kidney Injury ◽

Renal Recovery

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MO376CLINICAL OUTCOMES OF ACUTE KIDNEY INJURY FOLLOWING SNAKE BITE INJURIES

Nephrology Dialysis Transplantation ◽

10.1093/ndt/gfab082.0030 ◽

2021 ◽

Vol 36 (Supplement_1) ◽

Author(s):

Weerakit Naweera ◽

Thapat Wannarong

Keyword(s):

Acute Kidney Injury ◽

Logistic Regression ◽

Kidney Injury ◽

Binary Logistic Regression ◽

Cross Sectional Study ◽

Renal Recovery ◽

Binary Logistic Regression Analysis ◽

Cross Sectional ◽

Hospital Arrival ◽

Russell’S Viper

Abstract Background and Aims Snakebite is a common animal bite injury in tropical countries. Acute kidney injury (AKI) is an important complication in snakebite patients. This study aimed to comprehensively investigate the clinical profiles and outcomes of patients following hematotoxin-related snakebite associated with kidney impairment. Method We conducted a hospital-based, cross-sectional study of 238 patients with hematotoxin-related snakebite injuries. Data were retrieved from the King Narai Hospital Registry from October 2014 to August 2020. The prevalence of complications associated with snakebite injuries, including acute kidney injury (AKI) and its severity, was determined. Univariate and Multivariate predictors of AKI diagnosis were evaluated using binary logistic regression analysis Results A total of 238 patients, with 63.4% men, median (IQR) age 49.8 (39-61) years and median duration from injury to a hospital arrival of 1 hour (0.5-2) hours, were injured by Green pit viper (85.7%), Russell’s viper (12.6%) and Malayan pit viper (1.7%). AKI mostly occurred in Russell’s viper group 66.7%. An AKI was reported in thirty (12.6%, 95% CI: 8.7 % - 17.5%) patients, with the severity of 66.7% stage one, 6.7% stage two, 26.6% stage three by KDIGO classifications, and 13.3% requiring hemodialysis. Complete renal recovery was seen in twenty-two patients (73.3%), while partial renal recovery was 23.3%. Other complications included 84.4 % limb cellulitis, 4.6% significantly bleeding, 2.5% hypotension, 25.6% prolonged venous clotting time (VCT), 46.7% prolonged prothrombin time (PT), and 14.3% prolonged partial thromboplastin time (PTT). Of total patients, 60.1% were treated with anti-venom. Mortality was relatively low (0.4%). In multivariable logistic regression analyses, AKI was significantly associated with time to hospital arrival more than 3 hours (p = 0.04), Russell’s viper bitten (p = 0.01), clinical bleeding (p = 0.01), and prolonged PT (p < 0.01). Conclusion The prevalence of AKI in patients bitten by hematotoxin snakes was 12.6%, mostly from Russell’s viper. Factors associated with AKI outcomes were time to hospital arrival more than 3 hours, Russell’s viper bitten, clinical bleeding, and prolonged PT. Besides, one-fourth of AKI patients turned to chronic kidney disease.

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Derivation and validation of plasma endostatin for predicting renal recovery from acute kidney injury: a prospective validation study

Critical Care ◽

10.1186/s13054-018-2232-5 ◽

2018 ◽

Vol 22 (1) ◽

Cited By ~ 9

Author(s):

Hui-Miao Jia ◽

Yue Zheng ◽

Li-Feng Huang ◽

Xin Xin ◽

Wen-Liang Ma ◽

...

Keyword(s):

Acute Kidney Injury ◽

Validation Study ◽

Kidney Injury ◽

Renal Recovery

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Acute Kidney Injury: New Concepts

Nephron Physiology ◽

10.1159/000142939 ◽

2008 ◽

Vol 109 (4) ◽

pp. p73-p79 ◽

Cited By ~ 23

Author(s):

Richard Moreau ◽

Didier Lebrec

Keyword(s):

Acute Kidney Injury ◽

Kidney Injury ◽

New Concepts

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Acute Kidney Injury Relevant to Tubulointerstitial Nephritis with Late-Onset Uveitis Superimposed by Thrombotic Microangiopathy: A Case Report and Review of the Literature

Kidney Diseases ◽

10.1159/000507668 ◽

2020 ◽

Vol 6 (6) ◽

pp. 414-421

Author(s):

Youlu Zhao ◽

Junwen Huang ◽

Tao Su ◽

Zhikai Yang ◽

Xizi Zheng ◽

...

Keyword(s):

Acute Kidney Injury ◽

Thrombotic Microangiopathy ◽

Tubulointerstitial Nephritis ◽

Late Onset ◽

Drug Hypersensitivity ◽

Oral Prednisone ◽

Kidney Injury ◽

Renin Angiotensin System ◽

Renal Recovery

Background: The syndrome of tubulointerstitial nephritis and uveitis (TINU) is an uncommon and multisystemic autoimmune disorder. This review reports a rare case of TINU being superimposed on thrombotic microangiopathy (TMA) and, by comparing with the available literature, also summarizes the clinical features, associated conditions, treatment, and outcome of patients with TINU. Summary: Herein, we report the case of a 37-year-old male patient with acute kidney injury (AKI) clinicopathologically identified as malignant hypertension-induced TMA superimposed by acute tubulointerstitial nephritis, which was suspected to be related to drug hypersensitivity. After treatment with oral prednisone combined with a renin-angiotensin system inhibitor, the patient achieved partial renal recovery and was withdrawn from hemodialysis. Recurrent AKI concomitant with new-onset asymptomatic uveitis was detected during routine clinical follow-up after cessation of prednisone. TINU was then diagnosed, and prednisone followed by cyclophosphamide was prescribed. The patient achieved better renal recovery than in the first round of treatment and maintained stable renal function afterward. By reviewing the literature, 36 cases were reported as TINU superimposed on other conditions, including thyroiditis, osteoarthropathy, and sarcoid-like noncaseating granulomas. Key messages: TINU could be complicated by many other conditions, among which TMA is very rare. When presented as AKI, kidney biopsy is important for differential diagnosis. The case also shows that recurrent AKI with concomitant uveitis after prednisone withdrawal strongly suggested the need for long-term follow-up and elongated prednisone therapy for TINU syndrome.

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