Secondary Oxalate Nephropathy: Causes and Clinicopathological Characteristics of a Case Series

Nephron ◽  
2021 ◽  
pp. 1-8
Author(s):  
Shaoshan Liang ◽  
Lijuan Li ◽  
Dacheng Chen ◽  
Dandan Liang ◽  
Feng Xu ◽  
...  
Keyword(s):  
Renal Function ◽  
Renal Replacement Therapy ◽  
Renal Biopsy ◽  
Replacement Therapy ◽  
Case Series ◽  
Common Cause ◽  
Renal Function Recovery ◽  
Function Recovery ◽  
Renal Biopsies ◽  
Oxalate Nephropathy

<b><i>Introduction:</i></b> Secondary oxalate nephropathy (OxN) is associated with a variety of causes and has not been well characterized in Chinese population. To investigate the etiology, clinicopathological features, and outcomes of secondary OxN, we report a case series from a single center in China. <b><i>Methods:</i></b> A retrospective analysis of 68 patients diagnosed with secondary OxN by renal biopsy from January 2013 to February 2019 in Jinling Hospital was performed. <b><i>Results:</i></b> Secondary OxN accounted for 0.23% of the renal biopsies and 2.31% of patients who received renal biopsies due to acute kidney injury (AKI). A total of 49 men and 19 women with an average age of 51.6 ± 11.8 years were enrolled. The most common cause was iatrogenic medication, followed by oxalate-rich diet and industry exposure. Stage 1, 2, and 3 AKI and AKI on chronic kidney disease (ACKD) were found in 4.4, 8.8, 69.1, and 17.6% of the patients, respectively. The peak serum creatinine during hospitalization was 8.62 ± 4.67 mg/dL. The median urinary oxalate excretion was 51.5 (23.2–147.1) mg/24 h. Kidney biopsy showed extensive calcium oxalate crystal deposits with acute tubulointerstitial nephritis. Thirty-four patients (50.0%) required renal replacement therapy. At the end of a follow-up that lasted 8.7 (0.1–72.1) months, 81.0% of patients achieved renal function recovery in 50 (14–432) days. Patients with renal function recovery had a lower rate of ACKD, a higher level of hemoglobin, a lower level of urine lysozyme, and a lower degree of interstitial fibrosis/tubular atrophy, interstitial inflammation, and global glomerulosclerosis than those in the nonrecovery group. <b><i>Conclusions:</i></b> In this case series of secondary OxN, the most common cause was iatrogenic medication, and it presented with AKI or ACKD. Half of the patients required renal replacement therapy, and in most of them, the renal function was reversible. Renal biopsy played an important role in diagnosis and prognosis evaluation.

scholarly journals Predictors of renal function recovery among patients undergoing renal replacement therapy following orthotopic liver transplantation

PLoS ONE ◽  
2017 ◽  
Vol 12 (6) ◽  
pp. e0178229 ◽  
Author(s):  
Maria Claudia Cruz Andreoli ◽  
Nádia Karina Guimarães de Souza ◽  
Adriano Luiz Ammirati ◽  
Thais Nemoto Matsui ◽  
Fabiana Dias Carneiro ◽  
...  
Keyword(s):  
Liver Transplantation ◽  
Renal Function ◽  
Renal Replacement Therapy ◽  
Replacement Therapy ◽  
Orthotopic Liver Transplantation ◽  
Renal Function Recovery ◽  
Function Recovery

scholarly journals Hematuria Is Associated with More Severe Acute Tubulointerstitial Nephritis

2020 ◽  
Vol 9 (7) ◽  
pp. 2135
Author(s):  
Raquel Esteras ◽  
Jonathan G. Fox ◽  
Colin C. Geddes ◽  
Bruce Mackinnon ◽  
Alberto Ortiz ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Renal Function ◽  
Renal Replacement Therapy ◽  
Replacement Therapy ◽  
Tubulointerstitial Nephritis ◽  
Kidney Injury ◽  
Common Cause ◽  
Acute Tubulointerstitial Nephritis ◽  
Acute Dialysis

Acute tubulointerstitial nephritis (ATIN) is a common cause of acute kidney injury. Although haematuria is a risk factor for the development of renal disease, no previous study has analyzed the significance of haematuria in ATIN. Retrospective, observational analysis of 110 patients with biopsy-proven ATIN was conducted. Results: Haematuria was present in 66 (60%) ATIN patients. A higher percentage of ATIN patients with haematuria had proteinuria than patients without haematuria (89.4% vs. 59.1%, p = 0.001) with significantly higher levels of proteinuria (median (interquartile range) protein:creatinine ratio 902.70 (513–1492) vs. 341.00 (177–734) mg/g, p <0.001). Moreover, those patients with more haematuria intensity had a higher urinary protein:creatinine ratio (1352.65 (665–2292) vs. 849.60 (562–1155) mg/g, p = 0.02). Those patients with higher proteinuria were more likely to need renal replacement therapy (22.7 vs. 0%, p = 0.03) and to suffer relapse (4 vs. 0%, p = 0.03). At the end of follow up, haematuric ATIN patients had higher serum creatinine levels (3.19 ± 2.91 vs. 1.91 ± 1.17 mg/dL, p = 0.007), and a trend towards a higher need for acute dialysis (7 vs. 1%, p = 0.09) and renal replacement therapy (12.1 vs. 2.3%, p = 0.12). Haematuria is common in ATIN and it is associated with worse renal function outcomes.

scholarly journals P0600LONG-TERM PROGNOSIS OF PATIENTS WITH METFORMIN -ASSOCIATED LACTIC ACIDOSIS(MALA) AND ACUTE KIDNEY FAILURE

2020 ◽  
Vol 35 (Supplement_3) ◽  
Author(s):  
Maria Rosa Melero Martin ◽  
Alejandra Muñoz de Morales ◽  
Alberto Tejedor Jorge ◽  
Rodriguez benitez Patrocinio ◽  
Arturo Bascuñana ◽  
...  
Keyword(s):  
Renal Function ◽  
Renal Replacement Therapy ◽  
Lactic Acidosis ◽  
Serum Creatinine ◽  
Replacement Therapy ◽  
Rare Event ◽  
Case Series ◽  
Renal Outcomes ◽  
Iodinated Contrast

Abstract Background and Aims Although metformin-associated lactic acidosis (MALA) is a very rare event, is frequently seen in patients on metformin with risk factors for developing acute kidney injury (AKI). The long-term prognosis in patients with metformin-associated lactic acidosis (MALA) and renal failure remains unknown. To describe the characteristics and prognosis of AKI in patients with MALA and investigate whether prescription of RRT and previous renal function are associated with long-term outcomes. Method A retrospective single-centre case series. One hundred and nine patients affected with MALA and AKI admitted between Marx 2007 and February 2019 were included. We analysed comorbidities, laboratory tests, clinical parameters and prescription pattern of RRT at admission. After discharging, renal outcomes (doubling serum creatinine or starting dialysis) and mortality were assessed in the long-term. Results We included 109 patients (59 males and 50 females), mean age of 74.2±8.6 years and mean Charlson comorbidity index of 8.0±2.4. 54 out of 109 patients had previous chronic kidney disease (eGFR &lt; 60 ml/min/1.72 m2). Precipitating causes of AKI associated MALA included; acute dehydration (84.4%), exposure to iodinated contrast (7.3%) and non-specified causes (8.3%). During the admission, renal replacement therapy (RRT) was performed in 72 patients (continuous renal replacement therapy in 47 and dialysis in 25). RRT requirements was significantly associated with lactate, acidosis and serum creatinine levels, but not was associated with higher mortality rate during admission. The patients were followed a median time of 33 (10-65) months after discharging. 33 patients had a renal event and 55 patients died. The patients with CKD before admission had higher number of renal events (log Rank 6.346, p=0.012) and higher mortality (log Rank 12.943, p&lt;0.001). In a model adjusted by age and RRT at admission, women were less likely to develop (HR 0.315(0.136-0.730, p=0.007) long-term renal events and previous CKD increased this probability (HR 2,532 (1.190-5.385), p=0.016). Previous CKD and RRT during admission increased mortality in a model adjusted by age, gender and comorbidity (HR 2.315(1.177-4.553), p=0.015 and HR 1.895(1.003-3.580), p=0.049, respectively). Conclusion The renal function prior to the episode of AKI associated to MALA and the RRT at admission are the main factors related to renal outcomes and mortality in the long-term.

scholarly journals Urine neutrophil gelatinase-associated lipocalin and urine output as predictors of the successful discontinuation of continuous renal replacement therapy in critically ill patients with acute kidney injury

2020 ◽  
Author(s):  
Josefine Thomsen ◽  
Ulrik Sprogøe ◽  
Palle Toft
Keyword(s):  
Renal Function ◽  
Renal Replacement Therapy ◽  
Continuous Renal Replacement Therapy ◽  
Kidney Failure ◽  
Urine Output ◽  
Predictive Values ◽  
Neutrophil Gelatinase Associated Lipocalin ◽  
Renal Function Recovery ◽  
Function Recovery ◽  
Neutrophil Gelatinase

Abstract Background: Continuous renal replacement therapy (CCRT) is a frequently used modality for the support of intensive care patients with acute kidney failure (AKI). Nevertheless, there are no objective criteria for the discontinuation of CRRT. The purpose of this study was to investigate whether urine neutrophil gelatinase-associated lipocalin (uNGAL) alone or in combination with urine output could be used as a diagnostic test for renal function recovery in ICU patients on CRRT.Methods: This was a single-centre prospective observational study including patients with acute kidney failure needing CRRT. Sixty-nine patients were enrolled, and 54 completed the study. Of the 54 patients, 22 recovered renal function (REC), defined as dialysis independency at 72 hours from discontinuation, while 32 patients did not (NREC). Urine NGAL was measured at 0, 6, 12, and 24 hours after CRRT discontinuation. The cumulated urine output was measured for 24 hours prior to discontinuation and at 6, 12, and 24 hours after discontinuation. Logistic regression was used to calculate the missing 6-hour uNGAL values by interpolation. The Youden index was used to calculate cut-off values. A P-value <0.05 was considered statistically significant.Results: Baseline characteristics at CRRT initiation were similar between groups. Compared to the NREC group, REC patients had significantly higher urine output (p<0.0001) and lower uNGAL (p<0.001) at all time points, except for uNGAL at 24 hours (p<0.24). The best single predictor for renal recovery was the cumulated urine output 24 hours after discontinuation (predictive value 83%). Combining uNGAL at 6 hours (cut-off 1650 µg/L) with the cumulated urine output during the 24 hours prior to discontinuation (cut-off 210 ml) proved superior, with predictive values of 92% (CRRT dependency) and 93% (renal function recovery).Conclusions: With predictive values up to 93%, the combination of uNGAL at 6 hours and the cumulatated urine output during the 24 hours prior to CRRT cessation proved to be the best diagnostic test for renal function recovery in ICU patients.Clinical trial registration: N/A

scholarly journals Systemic hemodynamics and renal function in hemorrhaged dogs resuscitated with cross-linked hemoglobin

2000 ◽  
Vol 278 (1) ◽  
pp. R28-R33 ◽  
Author(s):  
John M. Stulak ◽  
Luis A. Juncos ◽  
John A. Haas ◽  
J. Carlos Romero
Keyword(s):  
Nitric Oxide ◽  
Renal Function ◽  
Cardiac Output ◽  
Sodium Excretion ◽  
Systemic Hemodynamics ◽  
Urinary Flow ◽  
Excretory Function ◽  
Renal Function Recovery ◽  
Function Recovery ◽  
Hormonal Milieu

Cross-linked hemoglobin (XL-Hb) infused into dogs increases mean arterial pressure (MAP) but decreases blood flow to the renal (RBF), mesenteric (MBF), and iliac (IBF) circulations. These actions differ markedly from dextran infusion (which increases RBF, MBF, and IBF without altering MAP) and may be due to scavenging of nitric oxide by XL-Hb. However, because the hormonal milieu regulating regional circulation is altered during hemorrhage (when XL-Hb may be used), we studied whether systemic hemodynamics, RBF, MBF, IBF, and renal excretory function in hemorrhaged dogs was altered when resuscitated with XL-Hb compared with dextran ( n = 6 each). Hemorrhage decreased MAP by 25% due to a 75% decline in cardiac output. RBF, MBF, and IBF all fell by 33, 64, and 72%, respectively ( P < 0.05 each). There was also a fall in glomerular filtration rate (GFR), urinary flow, and sodium excretion ( P < 0.05 each). After resuscitation, MAP, cardiac output, RBF, MBF, IBF, and GFR all recovered to basal values with either XL-Hb or dextran. Urinary flow and sodium excretion increased to above basal levels with dextran (both by 3.5-fold; P < 0.05) or XL-Hb (by 7.5- and 10-fold, respectively; P < 0.05). We conclude that resuscitation with XL-Hb after hemorrhage not only increases MAP, but also restores RBF, MBF, IBF, GFR, and urinary sodium and volume excretion analogously to dextran. The results contrast with those in normal dogs and suggest that nitric oxide inhibition does not impair hemodynamic and renal function recovery during hemorrhage.

High Cut-Off Renal Replacement Therapy for Removal of Myoglobin in Severe Rhabdomyolysis and Acute Kidney Injury: A Case Series

Nephron ◽  
2013 ◽  
Vol 121 (3-4) ◽  
pp. c159-c164 ◽  
Author(s):  
Nils Heyne ◽  
Martina Guthoff ◽  
Julia Krieger ◽  
Michael Haap ◽  
Hans-Ulrich Häring
Keyword(s):  
Acute Kidney Injury ◽  
Renal Replacement Therapy ◽  
Replacement Therapy ◽  
Case Series ◽  
Kidney Injury
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