Clinical Acute Kidney Injury and Histologic Acute Tubular-Interstitial Injury and Their Prognosis in Diabetic Nephropathy

Nephron ◽  
2021 ◽  
pp. 1-9
Author(s):  
Qunjuan Lei ◽  
Feng Xu ◽  
Shaoshan Liang ◽  
Dandan Liang ◽  
Jingru Lu ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Diabetic Nephropathy ◽  
Cox Regression ◽  
Survival Rates ◽  
Kidney Injury ◽  
Tubular Injury ◽  
Cox Models ◽  
Kaplan Meier ◽  
The Relationship ◽  
Significant Covariates

<b><i>Introduction:</i></b> Histologic acute tubular-interstitial injury (hATI) is often observed in patients with diabetic nephropathy (DN). This study aimed to determine the relationship between hATI and clinical acute kidney injury (cAKI) and evaluate significance of hATI in patients with DN. <b><i>Methods:</i></b> Patients with biopsy-proven DN through 2003–2018 in our center were selected. The prevalence of hATI and its correlations with cAKI, tubular injury biomarkers, and serum creatinine were investigated. The renal survival rates and prognostic factors were analyzed by Kaplan-Meier curve and Cox regression model, respectively. <b><i>Results:</i></b> Of 1,414 patients with DN, 70.4% were male, with a median age of 50.0 years. The incidences of cAKI and hATI were 8.6% and 57.8%, respectively. The severities of most hATI were mild (91.0%). The incidence of cAKI in those with hATI was only 12.2%. The incidences of cAKI positively correlated with the scores of hATI (Kendall <i>r</i> = 0.273, <i>p</i> &#x3c; 0.001). The presence of hATI was related to rapid creatinine rise and increased tubular injury biomarkers although without cAKI. After adjusting for significant covariates, multivariate Cox models showed that patients with hATI alone were one and a half times more likely to develop ESRD (hazard ratio [HR]: 1.46; 95% CI, 1.05–2.02) than those without hATI or cAKI, and patients with hATI plus cAKI were 3 times more likely to develop ESRD (HR: 2.96; 95% CI, 1.85–4.72). <b><i>Conclusion:</i></b> Our findings indicated that hATI was common in patients with DN where the majorities were mild hATI and without cAKI. hATI was an independent risk factor of DN progression, regardless of episodes of cAKI.

scholarly journals Duration of Acute Kidney Injury and in-hospital Mortality in Elder Patients With Severe COVID-19: a Retrospective Cohort Study

2021 ◽  
Author(s):  
Yue Cai ◽  
Qinglin Li ◽  
Shanshan Guo ◽  
Yanyan Chen ◽  
Fang Wang ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Hospital Mortality ◽  
Cox Regression ◽  
Kidney Injury ◽  
Final Analysis ◽  
Prognostic Impact ◽  
Cox Regression Analysis ◽  
Elder Patients ◽  
Kaplan Meier ◽  
Transient Aki

Abstract Background Patients with severe coronavirus disease 2019 (COVID-19) who develop acute kidney injury (AKI) in the intensive care unit (ICU) have extremely high rates of mortality. This study evaluated the prognostic impact of AKI duration on in-hospital mortality in elder patients.Methods We performed a retrospective study of 126 patients with confirmed COVID-19 with severe or critical disease who treated in the ICU from February 4, 2020, to April 16, 2020. AKI was defined according to the Kidney Disease Improving Global Outcomes serum creatinine (Scr) criteria. AKI patients were divided into transient AKI and persistent AKI groups based on whether Scr level returned to baseline within 48 h post-AKI.Results In total, 107 patients were included in the final analysis. The mean age was 70 (64–78) years, and 69 (64.5%) patients were men. AKI occurred in 48 (44.9%) during their ICU stay. Of these, 11 (22.9%) had transient AKI, 37 (77.9%) had persistent AKI. In-hospital mortality was 18.6% (n =11) for patients without AKI, 72.7% (n=8) for patients with transient AKI, and 86.5% (n=32) for patients with persistent AKI (P<0.001). Kaplan–Meier curve analysis revealed that patients with both transient AKI and persistent AKI had significantly higher death rates than those without AKI (log-rank P<0.001). Multivariate Cox regression analysis revealed that transient and persistent AKI were an important risk factor for in-hospital mortality in older patients with severe COVID-19 even after adjustment for variables (hazard ratio [HR]=2.582; 95% CI: 1.025–6.505; P=0.044; and HR=6.974; 95% CI: 3.334–14.588; P<0.001).Conclusions AKI duration is a useful parameter to predict of worse clinical outcomes in elder patients with COVID-19 in the ICU. Among AKI patients, those persistent AKI have a lower in-hospital survival rate than those transient AKI, emphasizing the importance of identifying an appropriate treatment window for early intervention.

Acute Kidney Injury in Sub-Sahara Africa: A Single-Center Experience from Khartoum, Sudan

2018 ◽  
Vol 45 (1-3) ◽  
pp. 201-207 ◽  
Author(s):  
Dalia E. Yousif ◽  
Alice R. Topping ◽  
Maha F. Osman ◽  
Jochen G. Raimann ◽  
Elfadil M. Osman ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Cox Regression ◽  
Kidney Injury ◽  
University Hospital ◽  
Hair Dye ◽  
Cox Regression Analysis ◽  
Tertiary Referral Center ◽  
Single Center Experience ◽  
Kaplan Meier ◽  
Poor Outcomes

Background: The burden of acute kidney injury (AKI) is high in Africa. While there are no reliable statistics about AKI in Africa, the Global Snapshot Study of the 0by25 initiative of the International Society of Nephrology has determined dehydration, infections, animal envenomation, and complications during pregnancy as the main causes. Methods: This study was conducted at the Soba University Hospital (SUH), Khartoum, Sudan, a tertiary referral center. We included all hemodialysis patients treated for AKI at SUH between ­January 1, 2013 and December 31, 2014 in the study. We reviewed patients’ hospital records and characterized pathogenesis, treatment, and patient outcomes. In addition, we investigated survival by Kaplan-Meier and Cox regression analysis. Results: Out of 520 patients who received emergency HD, 71 patients (14%) had AKI (age 40.6 ± 17.3 years, 56.5% were males). Glomerular and tubular-interstitial diseases were the leading cause of AKI, followed by envenomation and intoxication by hair dye. Patients received a median of 5 dialysis sessions for a median of 8 days. In 32 patients (45%) renal function recovered, 10 patients (14%) died, and 29 patients (41%) remained dialysis-dependent. Mortality was significantly higher in females compared to men (hazard ratio 4.1 [95% CI 1.02–16.67]). Outcomes were worse in patients with pre-renal AKI and intoxications. Conclusion: Our results indicate a higher mortality in females and in patients with pre-renal AKI and intoxications. Awareness of factors associating with poor outcomes is central to diagnostic and therapeutic efforts, and must be considered in the design of initiatives to reduce risk factors and improve outcomes of AKI in developing countries.

scholarly journals Granulomatous interstitial nephritis in a patient with SARS-CoV-2 infection

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Katarzyna Szajek ◽  
Marie-Elisabeth Kajdi ◽  
Valerie A. Luyckx ◽  
Thomas Hans Fehr ◽  
Ariana Gaspert ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Interstitial Nephritis ◽  
Kidney Biopsy ◽  
Kidney Diseases ◽  
Case Reports ◽  
Kidney Injury ◽  
Maculopapular Rash ◽  
Tubular Injury ◽  
Granulomatous Interstitial Nephritis ◽  
First Case

Abstract Background Acute kidney injury (AKI) associated with severe coronavirus disease 19 (COVID-19) is common and is a significant predictor of morbidity and mortality, especially when dialysis is required. Case reports and autopsy series have revealed that most patients with COVID-19 – associated acute kidney injury have evidence of acute tubular injury and necrosis - not unexpected in critically ill patients. Others have been found to have collapsing glomerulopathy, thrombotic microangiopathy and diverse underlying kidney diseases. A primary kidney pathology related to COVID-19 has not yet emerged. Thus far direct infection of the kidney, or its impact on clinical disease remains controversial. The management of AKI is currently supportive. Case Presentation The patient presented here was positive for SARS-CoV-2, had severe acute respiratory distress syndrome and multi-organ failure. Within days of admission to the intensive care unit he developed oliguric acute kidney failure requiring dialysis. Acute kidney injury developed in the setting of hemodynamic instability, sepsis and a maculopapular rash. Over the ensuing days the patient also developed transfusion-requiring severe hemolysis which was Coombs negative. Schistocytes were present on the peripheral smear. Given the broad differential diagnoses for acute kidney injury, a kidney biopsy was performed and revealed granulomatous tubulo-interstitial nephritis with some acute tubular injury. Based on the biopsy findings, a decision was taken to adjust medications and initiate corticosteroids for presumed medication-induced interstitial nephritis, hemolysis and maculo-papular rash. The kidney function and hemolysis improved over the subsequent days and the patient was discharged to a rehabilitation facility, no-longer required dialysis. Conclusions Acute kidney injury in patients with severe COVID-19 may have multiple causes. We present the first case of granulomatous interstitial nephritis in a patient with COVID-19. Drug-reactions may be more frequent than currently recognized in COVID-19 and are potentially reversible. The kidney biopsy findings in this case led to a change in therapy, which was associated with subsequent patient improvement. Kidney biopsy may therefore have significant value in pulling together a clinical diagnosis, and may impact outcome if a treatable cause is identified.

scholarly journals Clinical characteristics and prognosis of postpartum acute kidney injury

2021 ◽  
Vol 49 (2) ◽  
pp. 030006052098838
Author(s):  
Hong Shu ◽  
Fang Nie
Keyword(s):  
Acute Kidney Injury ◽  
Clinical Characteristics ◽  
Survival Rates ◽  
Kidney Injury ◽  
Renal Recovery ◽  
Replacement Treatment ◽  
Elevated Liver Enzymes ◽  
Recovery Times ◽  
Low Platelet Count ◽  
Lost To Follow Up

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.

Association between Procalcitonin and Acute Kidney Injury in Patients with Bacterial Septic Shock

2021 ◽  
pp. 1-10
Author(s):  
Guang Fu ◽  
Hai-chao Zhan ◽  
Hao-li Li ◽  
Jun-fu Lu ◽  
Yan-hong Chen ◽  
...  
Keyword(s):  
Septic Shock ◽  
Acute Kidney Injury ◽  
Logistic Regression ◽  
Piecewise Linear ◽  
Kidney Injury ◽  
Multiple Logistic Regression ◽  
Primary Analysis ◽  
Female Patients ◽  
Potential Biomarker ◽  
The Relationship

Objective: The objective of this study was to assess the relationship between serum procalcitonin (PCT) and acute kidney injury (AKI) induced by bacterial septic shock. Methods: A retrospective study was designed which included patients who were admitted to the ICU from January 2015 to October 2018. Multiple logistic regression and receiver operating characteristic (ROC) as well as smooth curve fitting analysis were used to assess the relationship between the PCT level and AKI. Results: Of the 1,631 patients screened, 157 patients were included in the primary analysis in which 84 (53.5%) patients were with AKI. Multiple logistic regression results showed that PCT (odds ratio [OR] = 1.017, 95% confidence interval [CI] 1.009–1.025, p < 0.001) was associated with AKI induced by septic shock. The ROC analysis showed that the cutoff point for PCT to predict AKI development was 14 ng/mL, with a sensitivity of 63% and specificity 67%. Specifically, in multivariate piecewise linear regression, the occurrence of AKI decreased with the elevation of PCT when PCT was between 25 ng/mL and 120 ng/mL (OR 0.963, 95% CI 0.929–0.999; p = 0.042). The AKI increased with the elevation of PCT when PCT was either <25 ng/mL (OR 1.077, 95% CI 1.022–1.136; p = 0.006) or >120 ng/mL (OR 1.042, 95% CI 1.009–1.076; p = 0.013). Moreover, the PCT level was significantly higher in the AKI group only in female patients aged ≤75 years (p = 0.001). Conclusions: Our data revealed a nonlinear relationship between PCT and AKI in septic shock patients, and PCT could be used as a potential biomarker of AKI in female patients younger than 75 years with bacterial septic shock.

scholarly journals NDRG3 overexpression is associated with a poor prognosis in patients with hepatocellular carcinoma

2018 ◽  
Vol 38 (6) ◽  
Author(s):  
Ji-sheng Jing ◽  
Hongbo Li ◽  
Shun-cai Wang ◽  
Jiu-ming Ma ◽  
La-qing Yu ◽  
...  
Keyword(s):  
Hepatocellular Carcinoma ◽  
Cox Regression ◽  
Survival Curve ◽  
Disease Free Survival ◽  
Prognostic Indicator ◽  
Clinicopathological Characteristics ◽  
Pcr Analysis ◽  
Kaplan Meier ◽  
Tumor Tissues ◽  
The Relationship

N-myc downstream-regulated gene 3 (NDRG3), an important member of the NDRG family, is involved in cell proliferation, differentiation, and other biological processes. The present study analyzed NDRG3 expression in hepatocellular carcinoma (HCC) and explored the relationship between expression of NDRG3 in HCC patients and their clinicopathological characteristics. We performed quantitative real-time reverse-transcription polymerase chain reaction (qRT-PCR) analysis and immunohistochemistry (IHC) analyses on HCC tissues to elucidate NDRG3 expression characteristics in HCC patients. Kaplan–Meier survival curve and Cox regression analyses were used to evaluate the prognoses of 102 patients with HCC. The results revealed that compared with non-tumor tissues, HCC tissues showed significantly higher NDRG3 expression. In addition, our analyses showed that NDRG3 expression was statistically associated with tumor size (P=0.048) and pathological grade (P=0.001). Survival analysis and Kaplan–Meier curves revealed that NDRG3 expression is an independent prognostic indicator for disease-free survival (P=0.002) and overall survival (P=0.005) in HCC patients. The data indicate that NDRG3 expression may be considered as a oncogenic biomarker and a novel predictor for HCC prognosis.

scholarly journals The prognosis of hepatoid adenocarcinoma of the stomach: a propensity score-based analysis

2020 ◽  
Author(s):  
Kai Zhou ◽  
Anqiang Wang ◽  
Sheng Ao ◽  
Jiahui Chen ◽  
Ke Ji ◽  
...  
Keyword(s):  
Propensity Score ◽  
Cox Regression ◽  
Radical Surgery ◽  
Survival Rates ◽  
Cancer Type ◽  
Radical Gastrectomy ◽  
Hepatoid Adenocarcinoma ◽  
Kaplan Meier ◽  
Significant Difference ◽  
Propensity Matching

Abstract Background : To investigate whether there is a distinct difference in prognosis between hepatoid adenocarcinoma of the stomach ( HAS) and non-hepatoid adenocarcinoma of the stomach (non-HAS) and whether HAS can benefit from radical surgery. Methods : We retrospectively reviewed 722 patients with non-HAS and 75 patients with HAS who underwent radical gastrectomy between 3 November 2009 and 17 December 2018. Propensity score matching (PSM) analysis was used to eliminate the bias among the patients in our study. The relationships between gastric cancer type and overall survival (OS) were evaluated by the Kaplan-Meier method and Cox regression. Results : Our data demonstrate that there was no statistically significant difference in the OS between HAS and non-HAS {K-M, P=log rank (Mantel-Cox), (before PSM P=0.397); (1:1 PSM P=0.345); (1:2 PSM P=0.195)}. Moreover, there were no significant differences in the 1-, 2-, or 3-year survival rates between patients with non-HAS and patients with HAS (before propensity matching, after 1:1 propensity matching, and after 1:2 propensity matching). Conclusion : HAS was generally considered to be an aggressive gastric neoplasm, but its prognosis may not be as unsatisfactory as previously believed.

scholarly journals Identification and Analysis of Three Hub Prognostic Genes Related to Osteosarcoma Metastasis

2021 ◽  
Vol 2021 ◽  
pp. 1-16
Author(s):  
Jianye Tan ◽  
Haofeng Liang ◽  
Bingsheng Yang ◽  
Shuang Zhu ◽  
Guofeng Wu ◽  
...  
Keyword(s):  
Regression Analysis ◽  
Cox Regression ◽  
Survival Rates ◽  
Prognostic Biomarkers ◽  
Messenger Rnas ◽  
Hub Genes ◽  
Cox Regression Analysis ◽  
Expression Levels ◽  
Kaplan Meier ◽  
Before And After

Osteosarcoma (OS) often occurs in children and often undergoes metastasis, resulting in lower survival rates. Information on the complexity and pathogenic mechanism of OS is limited, and thus, the development of treatments involving alternative molecular and genetic targets is hampered. We categorized transcriptome data into metastasis and nonmetastasis groups, and 400 differential RNAs (230 messenger RNAs (mRNAs) and 170 long noncoding RNAs (lncRNAs)) were obtained by the edgeR package. Prognostic genes were identified by performing univariate Cox regression analysis and the Kaplan–Meier (KM) survival analysis. We then examined the correlation between the expression level of prognostic lncRNAs and mRNAs. Furthermore, microRNAs (miRNAs) corresponding to the coexpression of lncRNA-mRNA was predicted, which was used to construct a competitive endogenous RNA (ceRNA) regulatory network. Finally, multivariate Cox proportional risk regression analysis was used to identify hub prognostic genes. Three hub prognostic genes (ABCG8, LOXL4, and PDE1B) were identified as potential prognostic biomarkers and therapeutic targets for OS. Furthermore, transcriptions factors (TFs) (DBP, ESX1, FOS, FOXI1, MEF2C, NFE2, and OTX2) and lncRNAs (RP11-357H14.16, RP11-284N8.3, and RP11-629G13.1) that were able to affect the expression levels of genes before and after transcription were found to regulate the prognostic hub genes. In addition, we identified drugs related to the prognostic hub genes, which may have potential clinical applications. Immunohistochemistry (IHC) and quantitative real-time polymerase chain reaction (qRT-PCR) confirmed that the expression levels of ABCG8, LOXL4, and PDE1B coincided with the results of bioinformatics analysis. Moreover, the relationship between the hub prognostic gene expression and patient prognosis was also validated. Our study elucidated the roles of three novel prognostic biomarkers in the pathogenesis of OS as well as presenting a potential clinical treatment for OS.

scholarly journals Impact of nephron sparing surgery on survival in upper urinary tract urothelial carcinoma patients stratified by tumor characteristics

2020 ◽  
Author(s):  
Liang Jin ◽  
Ting-shuai Zhai ◽  
Zhen Zhou ◽  
Xiang Liu ◽  
Jia-xin Zhang ◽  
...  
Keyword(s):  
Urinary Tract ◽  
Urothelial Carcinoma ◽  
Cox Regression ◽  
Survival Rates ◽  
Upper Urinary Tract ◽  
Regression Analyses ◽  
Ajcc Stage ◽  
Kaplan Meier ◽  
Nephron Sparing ◽  
Urinary Tract Urothelial Carcinoma

Abstract Background: We aimed to evaluate the impact of nephron sparing surgery (NSS) on survival in upper urinary tract urothelial carcinoma (UTUC) patients stratified by tumor grade and stage compared to radical nephroureterectomy (RNU) or no surgery. Methods: Overall, 10319 UTUC patients between 2004 and 2015 were extracted from the SEER database. Patients were divided into no surgery group, NSS group and RNU group. Kaplan-Meier plots illustrated survival rates according to surgical method. Multivariable Cox regression analyses assessed the effect of different surgical methods on survival rates. Result: Among the 10319 UTUC patients. Kaplan-Meier plots showed that NSS was associated with a higher overall survival (OS) and cancer-specific survival (CSS) in grade Ⅲ and Ⅳ and AJCC stage Ⅳ patients (all p <0.05). In multivariable Cox regression analyses, NSS was prone to a higher OS or CSS in grade Ⅲ ( p > 0.05). Moreover, NSS predisposed to a higher OS only in AJCC stage Ⅳ ( p <0.05). Conclusion: The beneficial effect of NSS was evident in grade Ⅲ or AJCC stage Ⅳ. NSS can be considered in grade Ⅲ or stage Ⅳ, for other grades or stages remains to be seen, both of which will be verified by further prospective research.

scholarly journals Defining Baseline Creatinine for Identification of Acute Kidney Injury in Population-based Laboratory Databases - A Danish Nationwide Cohort Study

Kidney360 ◽  
2021 ◽  
pp. 10.34067/KID.0006082021
Author(s):  
Henriette V. Graversen ◽  
Simon K. Jensen ◽  
Søren V. Vestergaard ◽  
Uffe Heide-Jorgensen ◽  
Christian F. Christiansen
Keyword(s):  
Acute Kidney Injury ◽  
Cohort Study ◽  
Creatinine Level ◽  
Kidney Injury ◽  
Population Based ◽  
Kaplan Meier ◽  
All Cause Mortality ◽  
Baseline Creatinine ◽  
Creatinine Measurement

Background: The baseline creatinine level is central in the KDIGO criteria of acute kidney injury (AKI), but baseline creatinine is often inconsistently defined or unavailable in AKI research. We examined the rate, characteristics, and 30-day mortality of AKI in five AKI cohorts created using different definitions of baseline creatinine. Methods: This nationwide cohort study included all individuals aged ≥18 in Denmark with a creatinine measurement in year 2017. Applying the KDIGO criteria, we created four AKI cohorts using four different baseline definitions (most recent, mean, or median value of outpatient creatinine 365-8 days before, or median value 90-8 days before if available otherwise median value 365-91 days before) and one AKI cohort not using a baseline value. AKI rate and the distribution of age, sex, baseline creatinine, and comorbidity was described for each AKI cohort, and the 30-day all-cause mortality was estimated using the Kaplan-Meier method. Results: The study included 2,095,850 adults with at least one creatinine measurement in 2017. The four different baseline definitions identified between 61,189 and 62,597 AKI episodes. The AKI rate in these four cohorts was 13-14 per 1,000 person-years, and 30-day all-cause mortality was 17-18%. The cohort created without using a baseline creatinine included 37,659 AKI episodes, corresponding to an AKI rate of 8.2 per 1,000 person-years, and a 30-day mortality of 23%. All five cohorts were similar regarding age, sex, and comorbidity. Conclusions: In a population-based setting with available outpatient baseline creatinine, different baseline creatinine definitions revealed comparable AKI cohorts, while the lack of a baseline creatinine when defining AKI led to a smaller AKI cohort with a higher mortality. These findings underscore the importance of availability and consistent use of an outpatient baseline creatinine, in particular in studies of community-acquired AKI.

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