Urinary cytology: a potential tool for differential diagnosis of acute kidney injury in patients with nephrotic syndrome

Abstract Objective Acute tubular necrosis (ATN) is a frequent cause of acute kidney injury (AKI). In patients with nephrotic syndrome (NS), AKI demands the differential diagnosis between ATN and rapidly progressive glomerulonephritis. In some cases, conclusive diagnosis is possible only by kidney biopsy. We aimed to study the potential use of urine cytology in the differential diagnosis between ATN and proliferative glomerular lesion in patients with NS.Results Cell size analysis showed a higher proportion of small cells and a lower proportion of large cells in the urine of patients with AKI. Cells phenotypes were easily defined using cytological preparations. Leukocytes were found to be a primary classifier of NS groups, with higher number in patients with AKI and patients with proliferative glomerular lesions. Our data suggests that urinary cytology can be readily performed and support the differential diagnosis between proliferative glomerular lesion and ATN in patients with NS and AKI.

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The beneficial effects of plasma exchange for treatment of acute kidney injury in minimal change nephrotic syndrome

Nihon Toseki Igakkai Zasshi ◽

10.4009/jsdt.45.179 ◽

2011 ◽

Vol 45 (2) ◽

pp. 179-185

Author(s):

Hideyo Oguchi ◽

Marohito Murakami ◽

Takashi Araki ◽

Mariko Meguro ◽

Akinori Hashiguchi ◽

...

Keyword(s):

Acute Kidney Injury ◽

Nephrotic Syndrome ◽

Plasma Exchange ◽

Kidney Injury ◽

Minimal Change Nephrotic Syndrome ◽

Minimal Change ◽

Beneficial Effects

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Acute kidney injury and nephrotic syndrome associated with eltrombopag therapy in chronic idiopathic thrombocytopenic purpura

BMJ Case Reports ◽

10.1136/bcr-2020-241462 ◽

2021 ◽

Vol 14 (4) ◽

pp. e241462

Author(s):

Suchi Anindita Ghosh ◽

Jean Patrick ◽

Kyaw Zin Maw

Keyword(s):

Acute Kidney Injury ◽

Renal Failure ◽

Nephrotic Syndrome ◽

Idiopathic Thrombocytopenic Purpura ◽

Kidney Injury ◽

High Dose ◽

Chronic Idiopathic Thrombocytopenic Purpura ◽

Thrombocytopenic Purpura ◽

Antibody Screen ◽

Auto Antibody

A 77-year-old man was admitted with severe acute kidney injury and nephrotic syndrome. He was started on eltrombopag for chronic idiopathic thrombocytopenic purpura 6 weeks earlier. An ultrasound of the kidneys was normal and an auto-antibody screen was negative. The use of the Naranjo adverse drug reaction probability scale indicated a probable relationship (score of 5) between the patient’s development of acute renal failure and eltrombopag therapy. Literature review identified only one other case of nephrotic syndrome and acute kidney injury associated with eltrombopag therapy in which a kidney biopsy revealed focal segmental glomerulosclerosis. Due to the challenges faced during the prevailing SARS-CoV-2 pandemic and persistent low platelet counts a renal biopsy was not undertaken. On stopping eltrombopag, the patients renal function stabilised and he successfully went into remission following treatment with high dose corticosteroids and diuretics. This report of a serious case of reversible renal failure and nephrotic syndrome after treatment with eltrombopag may serve to inform clinicians about the possible severe renal adverse effects of eltrombopag before its commencement for future use.

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The Significance of “Fractional Excretion of Urea” in The Differential Diagnosis of Acute Kidney Injury in Cirrhotic Patients

QJM ◽

10.1093/qjmed/hcab100.028 ◽

2021 ◽

Vol 114 (Supplement_1) ◽

Author(s):

Sameh Mohamed Ghaly ◽

Moataz Serry Seyam ◽

Mohamed Osama Aly ◽

Ahmed Mohamed Hesham Abdelfattah ◽

Ahmed R. Mashaal

Keyword(s):

Acute Kidney Injury ◽

Differential Diagnosis ◽

Kidney Injury ◽

Fractional Excretion ◽

Final Diagnosis ◽

Good Alternative ◽

Decompensated Cirrhosis ◽

Eligibility Criteria ◽

Significant Difference ◽

Cirrhotic Patients

Abstract Background Patients with cirrhosis are more susceptible to develop AKI than the non-cirrhotic individuals. AKI has an estimated prevalence of approximately 20% to 50% among hospitalized patients with cirrhosis. Physicians caring for patients with cirrhosis should recognize the acute or chronic character of renal disease, the causes of renal injury, the clinical conditions leading concomitantly to AKI and liver dysfunction, and the prognostic factors associated with the progression of AKI. Hypovolemia (due to diuretics, hemorrhage and diarrhea), acute tubular necrosis (ATN), sepsis, nephrotoxic agents (such as nonsteroidal anti-inflammatory drugs, aminoglycosides and/or radiological contrasts) and hepatorenal syndrome (HRS)-type 1 are the most common causes of AKI in cirrhotic patients. Objective To evaluate the sensitivity of fractional excretion of urea (FEUrea) vas a diagnostic biomarker for different causes of acute kidney injury in liver cirrhosis. Patients and Methods This study was conducted in co-operation between Tropical Medicine Department, Ain-Shams University and the Gastroenterology and Hepatology Department, Theodor Bilharz Research Institute between July 2019 to January 2020. It included 70 adult Egyptian patients admitted for treatment of complications of cirrhosis who fulfilled the eligibility criteria and compared to 10 cirrhotic patients without renal impairment. All patients were subjected to; full history taking, thorough clinical examination, laboratory investigations, Child-Pugh score was calculated for admission and urine samples were collected for urinary urea and creatinine levels to calculate FEUrea. Results Concerning the gender distribution in this study, male to female percent was 40 (57.10%) males and 30 (42.90%) females for gender, respectively. As regards to the causes of AKI, there were 24 (34.30%) PRA, 7 (10.00%) HRS and 39 (55.70%) ATN for final diagnosis. In the current study, there was significant difference (P = 0.0001; P < 0.05) in FE urea % among PRA, HRS and ATN groups (26.28±2.89, 11.76±3.44, and 47.37±10.53, respectively). Findings showed a higher FEUrea cut-off for ATN (>33%) compared to lower cut-off values for PRA (<33% and >21%) and HRS (<21%). Conclusion FEUrea was found to be an excellent simple tool for the differential diagnosis of AKI in patients with decompensated cirrhosis and ascites. FEUrea has also proven to be a useful “tubular injury” marker by differentiating ATN from non-ATN with high diagnostic accuracy (Sensitivity and Specificity exceeding >90%). FEUrea was found to be a good alternative and noninvasive tool for differentiating causes of AKI in cirrhotic patients instead of other non-available or expensive markers.

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The main clinical condition of acute kidney injury in nephrotic syndrome (NSAKI) is parenchymal edema of the kidney

Nihon Shoni Jinzobyo Gakkai Zasshi ◽

10.3165/jjpn.rv.2016.0006 ◽

2016 ◽

Vol 29 (2) ◽

pp. 114-121

Author(s):

Satoshi Yamakawa

Keyword(s):

Acute Kidney Injury ◽

Nephrotic Syndrome ◽

Clinical Condition ◽

Kidney Injury

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Clinical Characteristics and Outcomes of Adults with Nephrotic Syndrome Due to Minimal Change Disease

Journal of Clinical Medicine ◽

10.3390/jcm10163632 ◽

2021 ◽

Vol 10 (16) ◽

pp. 3632

Author(s):

Sophia Lionaki ◽

Evangelos Mantios ◽

Ioanna Tsoumbou ◽

Smaragdi Marinaki ◽

George Makris ◽

...

Keyword(s):

Acute Kidney Injury ◽

Nephrotic Syndrome ◽

Minimal Change Disease ◽

Kidney Injury ◽

Spontaneous Remission ◽

Minimal Change ◽

Adult Onset ◽

Potential Risk Factors ◽

The Mean ◽

End Stage

Purpose: Minimal change disease (MCD) is considered a relatively benign glomerulopathy, as it rarely progresses to end-stage kidney disease. The aim of this study was to describe the characteristics and outcomes of adults with MCD and identify potential risk factors for relapse. Patients & Methods: We retrospectively studied a cohort of adults with biopsy-proven MCD in terms of clinical features and treatment outcomes. Baseline characteristics and outcomes were recorded and predictors of relapse were analyzed using logistic regression multivariate analysis. Results: 59 patients with adult-onset primary MCD with nephrotic syndrome were included. Mean serum creatinine at diagnosis was 0.8 mg/dL (±2.5) and estimated GFR (eGFR) was 87 mL/min/1.73 m2 (±29.5). Mean serum albumin was 2.5 g/dL (±0.8) and 24 h proteinuria 6.8 g (±3.7). Microscopic hematuria was detected in 35 (58.5%) patients. 42 patients received prednisone alone, six patients received prednisone plus cyclophosphamide, five patients received prednisone plus cyclosporine, one patient received prednisone plus rituximab and five patients did not receive immunosuppression at all since they achieved spontaneous remission. During a mean follow up time of 34.7(22.1) months, 46.1% of patients experienced at least one episode of relapse. The mean age of patients who did not experience a relapse was significantly higher than that of patients who relapsed while relapsers had a significantly longer duration of 24 h proteinuria prior to biopsy compared to non-relapsers. Overall, 10% of patients experienced acute kidney injury while the mean eGFR at the end was 82 mL/min/1.73 m2 (±29.1) and one patient ended up in chronic dialysis. Overall, the proportion of non-relapsers, who experienced acute kidney injury (17%) was significantly higher than the one recorded among relapsers (0%).Conclusion: In this series of patients, almost 46% of adult-onset nephrotic MCD patients experienced a relapse, although their renal progression was rare. Younger onset age was an independent risk factor for relapse in adult-onset MCD patients.

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COVID-19- or Tramadol-induced Seizure: A Differential Diagnosis in Young People

International Journal of Medical Toxicology and Forensic Medicine ◽

10.32598/ijmtfm.v10i4.32009 ◽

2020 ◽

Vol 10 (4) ◽

pp. 32009.1-32009.2

Author(s):

Solmaz Nekoueifard ◽

◽

Mohammad Majidi ◽

Keyword(s):

Myocardial Infarction ◽

Acute Kidney Injury ◽

Differential Diagnosis ◽

Acute Respiratory Distress Syndrome ◽

Distress Syndrome ◽

Kidney Injury ◽

World Health ◽

The World ◽

Life Threatening ◽

Health Organization

Coronavirus disease 2019 (COVID-19) was first declared in December 2019 from Wuhan, China [1, 2]. It then has been reported a pandemic in March 2020 by the World Health Organization [3]. Clinical features of COVID-19 are different from asymptomatic to mild to moderate symptoms, such as fever, headache, myalgia, sore throat, anosmia, cough, fatigue headache, hemoptysis, and dyspnea to the life-threatening complications, including shock, pneumonia, acute respiratory distress syndrome, myocarditis, myocardial infarction, acute kidney injury, multi-organ failure, and even death [1, 2].

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Renal disease

Oxford Handbook of Nutrition and Dietetics ◽

10.1093/med/9780199585823.003.0029 ◽

2011 ◽

pp. 631-656

Keyword(s):

Chronic Kidney Disease ◽

Acute Kidney Injury ◽

Nephrotic Syndrome ◽

Kidney Disease ◽

Renal Disease ◽

Nutritional Assessment ◽

Kidney Injury ◽

Nutritional Requirements ◽

P Nutrition ◽

Disease Stages

Introduction 632 Nutritional assessment 634 Malnutrition in renal disease 636 Nutritional considerations in chronic kidney disease 638 Nutrition in acute kidney injury 641 Nutrition in chronic kidney disease stages 3 and 4 642 Nephrotic syndrome 644 Nutritional requirements in dialysis 646 Nutritional requirements in haemodialysis ...

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Incidence and determinants of acute kidney injury in patients with nephrotic syndrome

Asian Journal of Pediatric Nephrology ◽

10.4103/ajpn.ajpn_25_19 ◽

2019 ◽

Vol 2 (2) ◽

pp. 75

Author(s):

Arvind Bagga ◽

Sunil Kushwah ◽

Menka Yadav ◽

Pankaj Hari ◽

Jitendra Meena ◽

...

Keyword(s):

Acute Kidney Injury ◽

Nephrotic Syndrome ◽

Kidney Injury

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Acute Kidney Injury Associated with Minimal Change Nephrotic Syndrome in an Elderly Patient Successfully Treated with both Fluid Management and Specific Therapy Based on Kidney Biopsy Findings

Case Reports in Nephrology and Dialysis ◽

10.1159/000507426 ◽

2020 ◽

Vol 10 (1) ◽

pp. 42-50 ◽

Cited By ~ 2

Author(s):

Yuko Oyama ◽

Yoichi Iwafuchi ◽

Tetsuo Morioka ◽

Ichiei Narita

Keyword(s):

Elderly Patient ◽

Acute Kidney Injury ◽

Nephrotic Syndrome ◽

Kidney Biopsy ◽

Fluid Management ◽

Kidney Injury ◽

Oral Prednisolone ◽

Minimal Change Nephrotic Syndrome ◽

Minimal Change ◽

Fluid Removal

Oliguric acute kidney injury (AKI) with minimal change nephrotic syndrome (MCNS) has long been recognized. Several mechanisms such as hypovolemia due to hypoalbuminemia and the nephrosarca hypothesis have been proposed. However, the precise mechanism by which MCNS causes AKI has not been fully elucidated. Herein, we describe an elderly patient with AKI caused by MCNS who fully recovered after aggressive volume withdrawal by hemodialysis and administration of a glucocorticoid. A 75-year-old woman presented with diarrhea and oliguria, and laboratory examination revealed nephrotic syndrome (NS) and severe azotemia. Fluid administration had no effect on renal dysfunction, and hemodialysis was initiated. Her renal function improved upon aggressive fluid removal through hemodialysis. Renal pathological findings revealed minimal change disease with faint mesangial deposits of IgA. After administration of methylprednisolone pulse therapy followed by oral prednisolone, she achieved complete remission from NS. The clinical course of this case supports the nephrosarca hypothesis regarding the mechanism of AKI caused by MCNS. Furthermore, appropriate fluid management and kidney biopsy are also important in elderly patients with AKI caused by NS.

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