Early Renal Ultrasound in Congenital Solitary Kidney May Help to Select Patients at Lower Risk of Associated Vesicoureteral Reflux

Neonatology ◽  
2021 ◽  
pp. 1-5
Author(s):  
Pierluigi Marzuillo ◽  
Stefano Guarino ◽  
Davide Ursi ◽  
Anna Di Sessa ◽  
Pier Francesco Rambaldi ◽  
...  
Keyword(s):  
Vesicoureteral Reflux ◽  
Lower Risk ◽  
Standard Deviation Score ◽  
Kidney Injury ◽  
Renal Dysplasia ◽  
Solitary Kidney ◽  
Lower Probability ◽  
Renal Ultrasound ◽  
Cumulative Proportion ◽  
Patients At Risk

<b><i>Background:</i></b> Vesicoureteral reflux (VUR) may be associated with renal dysplasia and reduced renal length (RL). The diagnosis of VUR in children with congenital solitary functioning kidney (CSFK) identifies patients at risk of kidney injury but exposes to invasive procedures. <b><i>Objective:</i></b> We aimed to test the hypothesis that an RL &#x3e;2 standard deviation score (SDS) in the first months of life – reflecting renal hyperplasia – could identify CSFK patients with lower probability of presenting VUR. <b><i>Method:</i></b> We retrospectively selected 207 CSFK patients with prenatal diagnosis of CSFK and having undergone renal ultrasound (RUS) both at 0–3 and 10–13 months of life, renal scintigraphy, and cystourethrography/cysto­scintigraphy. We compared the cumulative proportion of an RL &#x3e;2 SDS by Kaplan-Meier analysis and evaluated the odds to present VUR of patients with an RL &#x3e;2 SDS both at the first and second RUS. <b><i>Results:</i></b> Overall, 3.3% of patients with VUR and 22.0% of patients without VUR presented an RL &#x3e;2 SDS at the first RUS (<i>p</i> = 0.02). At the second RUS, 53.3% of patients with VUR and 52.5% of patients without VUR presented an RL &#x3e;2 SDS (<i>p</i> = 0.93). Patients without VUR presented higher cumulative proportion of an RL &#x3e;2 SDS at 3 months of life than those with VUR (<i>p</i> = 0.02). This difference however disappeared at 11 and 13 months of age (<i>p</i> = 0.17 and <i>p</i> = 0.54, respectively). An RL &#x3e;2 SDS within 3 months of life presented an OR for VUR of 0.12 (95% CI: 0.02–0.92; <i>p</i> = 0.005), while an RL &#x3e;2 SDS at 12 months of life presented an OR for VUR of 0.96 (95% CI: 0.45–2.1; <i>p</i> = 0.93). <b><i>Conclusion:</i></b> Only an RUS made in the first months of life could identify CSFK patients at lower risk of presenting an associated VUR.

scholarly journals Spontaneous one-kidney rats are more susceptible to develop hypertension by DOCA-NaCl and subsequent kidney injury compared with uninephrectomized rats

2016 ◽  
Vol 310 (10) ◽  
pp. F1054-F1064 ◽  
Author(s):  
Xuexiang Wang ◽  
Ashley C. Johnson ◽  
Jennifer M. Sasser ◽  
Jan M. Williams ◽  
Leah C. Solberg Woods ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Kidney Function ◽  
Time Course ◽  
Kidney Injury ◽  
Solitary Kidney ◽  
Course Evaluation ◽  
Significant Rise ◽  
Kidney Weight ◽  
Unilateral Renal Agenesis ◽  
Single Kidney

There is little clinical data of how hypertension may influence individuals with nephron deficiency in the context of being born with a single kidney. We recently developed a new rat model (the heterogeneous stock-derived model of unilateral renal agenesis rat) that is born with a single kidney and exhibits progressive kidney injury and decline in kidney function with age. We hypothesized that DOCA-salt would induce a greater increase in blood pressure and therefore accelerate the progression of kidney injury in rats born with a solitary kidney compared with rats that have undergone unilateral nephrectomy. Time course evaluation of blood pressure, kidney injury, and renal hemodynamics was performed in the following six groups of animals from weeks 13 to 18: 1) DOCA-treated rats with a solitary kidney (DOCA+S group), 2) placebo-treated rats with a solitary kidney, 3) DOCA-treated control rats with two kidneys (DOCA+C group), 4) placebo-treated control rats with two kidneys, 5) DOCA-treated rats with two kidneys that underwent uninephrectomy (DOCA+UNX8 group), and 6) placebo-treated rats with two kidneys that underwent uninephrectomy. DOCA+S rats demonstrated a significant rise ( P < 0.05) in blood pressure (192 ± 4 mmHg), proteinuria (205 ± 31 mg/24 h), and a decline in glomerular filtration rate (600 ± 42 μl·min−1·g kidney weight−1) relative to the DOCA+UNX8 (173 ± 3 mmHg, 76 ± 26 mg/24 h, and 963 ± 36 μl·min−1·g kidney weight−1) and DOCA+C (154 ± 2 mmHg, 7 ± 1 mg/24 h, and 1,484 ± 121 μl·min−1·g kidney weight−1) groups. Placebo-treated groups showed no significant change among the three groups. An assessment of renal injury markers via real-time PCR/Western blot analysis and histological analysis was concordant with the measured physiological parameters. In summary, congenital solitary kidney rats are highly susceptible to the induction of hypertension compared with uninephrectomized rats, suggesting that low nephron endowment is an important driver of elevated blood pressure, hastening nephron injury through the transmission of elevated systemic blood pressure and thereby accelerating decline in kidney function.

Angiopoietins as Prognostic Markers for Future Kidney Disease and Heart Failure Events After Acute Kidney Injury

2022 ◽  
pp. ASN.2021060757
Author(s):  
Sherry Mansour ◽  
Pavan Bhatraju ◽  
Steven Coca ◽  
Wassim Obeid ◽  
Francis Wilson ◽  
...  
Keyword(s):  
Heart Failure ◽  
Acute Kidney Injury ◽  
Kidney Disease ◽  
Lower Risk ◽  
Kidney Injury ◽  
Early Response ◽  
Secondary Outcome ◽  
Ckd Progression ◽  
Angiopoietin 2 ◽  
Vessel Stability

Background The mechanisms underlying long-term sequelae following acute kidney injury (AKI) remain unclear. Vessel instability, an early response to endothelial injury, may reflect a shared mechanism and early trigger for chronic kidney disease (CKD) and heart failure. Methods To investigate whether plasma angiopoietins, markers of vessel homeostasis, are associated with CKD progression and heart failure admissions after hospitalization in patients with and without AKI, we conducted a prospective cohort study to analyze the balance between angiopoietin-1 (Angpt-1), which maintains vessel stability, and angiopoietin-2 (Angpt-2), which increases vessel destabilization. Three months after discharge, we evaluated the associations between angiopoietins and development of the primary outcomes of CKD progression and heart failure, as well as the secondary outcome of all-cause mortality 3 months after discharge or later. Results Median age for the 1503 participants was 65.8 years; 746 (50%) had AKI. Compared with the lowest quartile, the highest quartile of the Angpt-1:Angpt-2 ratio was associated with 72% lower risk of CKD progression (adjusted hazard ratio [aHR], 0.28; 95% confidence interval [95% CI], 0.15 to 0.51), 94% lower risk of heart failure (aHR, 0.06; 95% CI, 0.02 to 0.15), and 82% lower risk of mortality (aHR, 0.18; 95% CI, 0.09 to 0.35) for those with AKI. Among those without AKI, the highest quartile of Angpt-1:Angpt-2 ratio was associated with 71% lower risk of heart failure (aHR, 0.29; 95% CI, 0.12 to 0.69) and 68% less mortality (aHR, 0.32; 95% CI, 0.15 to 0.68). There were no associations with CKD progression. Conclusions A higher Angpt-1:Angpt-2 ratio was strongly associated with less CKD progression, heart failure, and mortality in the setting of AKI.

Transient ureteric obstruction following pelvic floor reconstruction

2021 ◽  
Vol 14 (5) ◽  
pp. e238669
Author(s):  
Liam Joseph Beamer ◽  
Sarah Neary ◽  
Thomas McCormack ◽  
David Ankers
Keyword(s):  
Pelvic Floor ◽  
Kidney Injury ◽  
Solitary Kidney ◽  
Percutaneous Nephrostomy ◽  
Pelvic Organ ◽  
Ureteric Obstruction ◽  
Pelvic Floor Reconstruction ◽  
Transient Nature ◽  
Recurrent Pelvic Organ Prolapse ◽  
History Of

We describe the first reported case of transient distal ureteric obstruction attributed to post-surgical oedema in a patient with a solitary kidney. This occurred following combined pelvic floor repair and sacrospinous fixation for recurrent pelvic organ prolapse and manifested clinically as anuria, radiological hydroureter and acute kidney injury in the postoperative period. The transient nature of this obstruction, which was managed by a temporary percutaneous nephrostomy, indicates that it was caused by ureteric compression secondary to soft tissue oedema following surgery. We highlight the importance of this potential complication in females with a history of nephrectomy, unilateral renal tract anomalies or severely diminished renal reserve.

scholarly journals Preventing Contrast-induced Renal Failure: A Guide

2016 ◽  
Vol 11 (2) ◽  
pp. 98 ◽  
Author(s):  
Michela Faggioni ◽  
◽  
Roxana Mehran ◽  
Keyword(s):  
Risk Factors ◽  
Renal Damage ◽  
Preventive Measures ◽  
Kidney Injury ◽  
Coronary Intervention ◽  
Kidney Dysfunction ◽  
Percutaneous Coronary ◽  
Patients At Risk ◽  
Short And Long Term

Contrast-induced acute kidney injury (CI-AKI) is characterised by a rapid deterioration of renal function within a few days of parenteral administration of contrast media (CM) in the absence of alternative causes. CI-AKI is the most common form of iatrogenic kidney dysfunction with an estimated prevalence of 12 % in patients undergoing percutaneous coronary intervention. Although usually selfresolving, in patients with pre-existing chronic kidney disease (CKD) or concomitant risk factors for renal damage, CI-AKI is associated with increased short- and long-term morbidity and mortality. Therefore, risk stratification based on clinical and peri-procedural characteristics is crucial in selecting patients at risk of CI-AKI who would benefit the most from implementation of preventive measures.

Utilization of Renal Ultrasound for Predicting Obstructive Uropathy in ICU Patients With Acute Kidney Injury

CHEST Journal ◽  
2014 ◽  
Vol 146 (4) ◽  
pp. 223A ◽  
Author(s):  
Syed Amin ◽  
Reejis Stephen ◽  
David Morris ◽  
David Kaufman
Keyword(s):  
Acute Kidney Injury ◽  
Obstructive Uropathy ◽  
Kidney Injury ◽  
Renal Ultrasound ◽  
Icu Patients

scholarly journals Atrial Fibrillation and Chronic Kidney Disease—A Risky Combination for Post-Contrast Acute Kidney Injury

2021 ◽  
Vol 10 (18) ◽  
pp. 4140
Author(s):  
Łukasz Kuźma ◽  
Anna Tomaszuk-Kazberuk ◽  
Anna Kurasz ◽  
Małgorzata Zalewska-Adamiec ◽  
Hanna Bachórzewska-Gajewska ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Chronic Kidney Disease ◽  
Acute Kidney Injury ◽  
Kidney Disease ◽  
Coronary Angiography ◽  
Kidney Injury ◽  
Post Contrast ◽  
Acute Kidney Disease ◽  
Patients At Risk ◽  
Kidney Impairment

Atrial fibrillation (AF) symptoms may mimic coronary artery disease (CAD) which reflects the difficulties in qualifying AF patients for invasive diagnostics. A substantial number of coronary angiographies may be unnecessary or even put patients at risk of post-contrast acute kidney injury (PC-AKI), especially patients with chronic kidney disease (CKD). We aimed to investigate the hypothesis indicating higher prevalence of PC-AKI in patients with AF scheduled for coronary angiography. The study population comprised of 8026 patients referred for elective coronarography including 1621 with AF. In the comparison of prevalence of PC-AKI in distinguished groups we can see that kidney impairment was twice more frequent in patients with AF in both groups with CKD (CKD (+)/AF (+) 6.24% vs. CKD (+)/AF (−) 3.04%) and without CKD (CKD (−)/AF (+) 2.32% vs. CKD (−)/AF (−) 1.22%). In our study, post-contrast acute kidney disease is twice more frequent in patients with AF, especially in subgroup with chronic kidney disease scheduled for coronary angiography. Additionally, having in mind results of previous studies stating that AF is associated with non-obstructive coronary lesions on angiography, patients with AF and CKD may be unnecessarily exposed to contrast agent and possible complications.

scholarly journals Stratifying risk of acute kidney injury in pre and post cardiac surgery patients using a novel biomarker-based algorithm and clinical risk score

2019 ◽  
Vol 9 (1) ◽  
Author(s):  
William T. McBride ◽  
Mary Jo Kurth ◽  
Gavin McLean ◽  
Anna Domanska ◽  
John V. Lamont ◽  
...  
Keyword(s):  
At Risk ◽  
Acute Kidney Injury ◽  
Cardiac Surgery ◽  
Risk Score ◽  
Kidney Injury ◽  
Predictive Ability ◽  
Clinical Risk Score ◽  
Clinical Risk ◽  
Patients At Risk ◽  
Post Cardiac Surgery

AbstractAcute kidney injury (AKI) following cardiac surgery significantly increases morbidity and mortality risks. Improving existing clinical methods of identifying patients at risk of perioperative AKI may advance management and treatment options. This study investigated whether a combination of biomarkers and clinical factors pre and post cardiac surgery could stratify patients at risk of developing AKI. Patients (n = 401) consecutively scheduled for elective cardiac surgery were prospectively studied. Clinical data was recorded and blood samples were tested for 31 biomarkers. Areas under receiver operating characteristic (AUROCs) were generated for biomarkers pre and postoperatively to stratify patients at risk of AKI. Preoperatively sTNFR1 had the highest predictive ability to identify risk of developing AKI postoperatively (AUROC 0.748). Postoperatively a combination of H-FABP, midkine and sTNFR2 had the highest predictive ability to identify AKI risk (AUROC 0.836). Preoperative clinical risk factors included patient age, body mass index and diabetes. Perioperative factors included cardio pulmonary bypass, cross-clamp and operation times, intra-aortic balloon pump, blood products and resternotomy. Combining biomarker risk score (BRS) with clinical risk score (CRS) enabled pre and postoperative assignment of patients to AKI risk categories. Combining BRS with CRS will allow better management of cardiac patients at risk of developing AKI.

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