scholarly journals Hyperuricaemia as a predictor of hospital outcome in patients with sepsis: results of a prospective study

2021 ◽  
Vol 33 (1) ◽  
Author(s):  
Mir Nadeem ◽  
Bilal Ahmad Mir ◽  
Mir Waseem ◽  
Tabinda Ayub Shah ◽  
Rameez Raja
Keyword(s):  
Emergency Department ◽  
Mechanical Ventilation ◽  
Acute Kidney Injury ◽  
Uric Acid ◽  
Respiratory Failure ◽  
Serum Uric Acid ◽  
Kidney Injury ◽  
Study Cohort ◽  
Early Management ◽  
Hospital Outcome

Abstract Background Early management of sepsis in the emergency department improves patient outcomes. The identification of at-risk patients for aggressive management by an easily available biomarker could go a long way in the triage of patients in the emergency department. It is postulated that during sepsis, the majority of patients undergo ischaemic reperfusion injury or inflammation, and uric acid with its oxidant and antioxidant properties may be playing some role and, hence, the measurement of uric acid could possibly predict the hospital course in patients with sepsis. We were prompted to undertake this study as serum uric acid estimation is readily available and economical compared to newly evolving biomarkers in sepsis. Estimation of serum uric acid levels on arrival to the emergency department may prove a useful predictor of hospital outcome in patients with sepsis especially in regions with limited resources. Results Of 102 patients, 55 (53.9%) were males. The mean age of the study cohort was 63.2 ± 10.48. Patients with higher qSOFA scores had higher uric acid levels on admission. While 12 (11.8%) patients had a septicaemic shock, acute kidney injury was recorded in 48 (47.1%) patients and 11 (10.8%) patients required dialysis. Thirty-four (33.3%) patients had respiratory failure, and of these, 21 (20.6%) patients required mechanical ventilation. The overall median stay in the medical intensive care (MICU) was 3days (range 2–7 days). The patients with higher uric acid levels had higher rates of respiratory failure but did not reach significant levels. In 15 (14.7%) patients, 7 males expired (mortality rate of 14.7%). There was a significant association between SOFA score and mortality. Patients who succumbed to sepsis had higher serum uric acid levels on arrival. Conclusions Patients with higher qSOFA scores had higher uric acid levels on admission. Hyperuricaemia predicted acute kidney injury, a requirement of mechanical ventilation and mean hospital stay in patients with sepsis. Further studies may be required to confirm the association.

scholarly journals Rhabdomyolysis and acute kidney injury in severe COVID-19 infection

2020 ◽  
Vol 13 (9) ◽  
pp. e237616 ◽  
Author(s):  
Knut Taxbro ◽  
Hannes Kahlow ◽  
Hannes Wulcan ◽  
Anna Fornarve
Keyword(s):  
Intensive Care Unit ◽  
Emergency Department ◽  
Mechanical Ventilation ◽  
Acute Kidney Injury ◽  
Acute Respiratory Distress Syndrome ◽  
Intensive Care ◽  
Abdominal Pain ◽  
Distress Syndrome ◽  
Kidney Injury ◽  
Forced Diuresis

We report the case of a 38-year-old man who presented to the emergency department with fever, myalgia, nausea, vomiting, dry cough, breathlessness and abdominal pain. He was admitted due to hypoxaemia and was diagnosed with SARS-CoV-2 and was subsequently referred to the intensive care unit for intubation and mechanical ventilation. Severe rhabdomyolysis and acute kidney injury developed 4 days later and were suspected after noticing discolouration of the urine and a marked increase in plasma myoglobin levels. Treatment included hydration, forced diuresis and continuous renal replacement therapy. In addition to the coronavirus disease acute respiratory distress syndrome, he was diagnosed with possible SARS-CoV-2-induced myositis with severe rhabdomyolysis and kidney failure. The patient survived and was discharged from intensive care after 12 days, returning home 23 days after hospitalisation, fully mobilised with a partially restored kidney function.

Lowering serum uric acid to prevent acute kidney injury

2012 ◽  
Vol 78 (6) ◽  
pp. 796-799 ◽  
Author(s):  
A. Ahsan Ejaz ◽  
Bhagwan Dass ◽  
Ganesh Kambhampati ◽  
Noel I. Ejaz ◽  
Natallia Maroz ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Uric Acid ◽  
Serum Uric Acid ◽  
Kidney Injury

scholarly journals Bilateral renal infarction in a patient with severe COVID-19 infection

2021 ◽  
Author(s):  
Percy Herrera Añazco ◽  
Fernando Mayor Balta ◽  
Liz Córdova-Cueva
Keyword(s):  
Diabetes Mellitus ◽  
Emergency Department ◽  
Acute Kidney Injury ◽  
Low Back Pain ◽  
Back Pain ◽  
Respiratory Failure ◽  
Kidney Injury ◽  
Renal Infarction ◽  
Low Back ◽  
Thromboembolic Events

Abstract Thromboembolic events are frequent in patients with COVID-19 infection, and no cases of bilateral renal infarctions have been reported. We present the case of a 41-year-old female patient with diabetes mellitus and obesity who attended the emergency department for low back pain, respiratory failure associated with COVID-19 pneumonia, diabetic ketoacidosis, and shock. The patient had acute kidney injury and required hemodialysis. Contrast abdominal tomography showed bilateral renal infarction and anticoagulation was started. Kidney infarction cases require high diagnostic suspicion and possibility of starting anticoagulation.

scholarly journals Serum uric acid and acute kidney injury: A mini review

2017 ◽  
Vol 8 (5) ◽  
pp. 529-536 ◽  
Author(s):  
Kai Hahn ◽  
Mehmet Kanbay ◽  
Miguel A. Lanaspa ◽  
Richard J. Johnson ◽  
A. Ahsan Ejaz
Keyword(s):  
Acute Kidney Injury ◽  
Uric Acid ◽  
Serum Uric Acid ◽  
Kidney Injury

Post-operative serum uric acid and acute kidney injury

2012 ◽  
Vol 25 (4) ◽  
pp. 497-505 ◽  
Author(s):  
A. Ahsan Ejaz ◽  
Ganesh Kambhampati ◽  
Noel I. Ejaz ◽  
Bhagwan Dass ◽  
Vijay Lapsia ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Uric Acid ◽  
Serum Uric Acid ◽  
Kidney Injury

scholarly journals Association of Hyperuricemia With Acute Kidney Injury: Case Series Report Among Patients Hospitalized With General Tonic-Clonic Seizures

2020 ◽  
Vol 7 ◽  
pp. 205435812097738
Author(s):  
Jean Maxime Côté ◽  
Arline-Aude Bérubé ◽  
Guillaume Bollée
Keyword(s):  
Acute Kidney Injury ◽  
Uric Acid ◽  
Serum Creatinine ◽  
Serum Uric Acid ◽  
Case Series ◽  
Kidney Injury ◽  
Clonic Seizure ◽  
Tonic Clonic Seizure ◽  
Median Serum ◽  
Urate Nephropathy

Background: Urate nephropathy is a rare cause of acute kidney injury. Although most risk factors are associated with chemotherapy, tumor lysis syndrome or rhabdomyolysis, occurrence following severe seizure has also been reported. Uric acid measurement following convulsion is rarely performed and, therefore, the incidence of hyperuricemia in this context is unknown. Objective: The objective is to present a case of urate nephropathy following generalized tonic-clonic seizure (GTCS) and to investigate the kinetics of serum uric acid and creatinine levels in a series of patients admitted for severe seizures. Design: Retrospective case report and prospective case series. Setting: Emergency room department and neurology unit of a tertiary care hospital. Patients: The study included 13 hospitalized patients for severe GTCS. Measurements: Type, timing, and duration of seizure episodes were documented. Demographic data, weight, hypouricemic therapy, and baseline serum creatinine were recorded. Blood samples (uric acid, creatinine, blood gas, lactate, and creatinine kinase) and urine samples (uric acid, creatinine, and dipstick) were prospectively collected at Day 0, 1, 2, and 3 following the GTCS episode. Methods: We identified and described one rare case of urate nephropathy following GTCS. Then, we presented the kinetic of uric acid and creatinine levels and the acute kidney injury incidence over the follow-up period. All analyses were using descriptive statistics. Results: During the study period, 13 patients with a median tonic-clonic seizure duration of 5.0 minutes (interquartile range [IQR], 2.0–12.5) were included. From day 0 to day 3, the median serum uric acid level decreased from 346.0 µmol/L (IQR, 155.0–377.5) to 178.0 µmol/L (IQR, 140.0–297.5) and median serum creatinine from 73.0 µmol/L (IQR, 51.0–80.0) to 57.0 µmol/L (IQR, 44.0–70.0). Acute kidney injury occurred in four patients. Limitations: This is a single-center observational study with small sample size, which does not allow us to demonstrate causality between the increase of uric acid levels observed and the occurrence of acute kidney injury. A delay between the first sampling and seizure episodes was observed and could explain the limited increase of uric acid levels captured. Conclusions: There is a signal for an acute increase of uric acid levels following a severe seizure before returning to baseline within 3 days. During that period, there might be an increased risk of acute kidney injury, although these changes seem to be usually mild and reversible. Our findings suggest that routine serum uric acid measurement in patients presenting with GTCS could help to identify those patients at risk of developing acute kidney injury as a result of acute hyperuricemia. Further larger studies are required to confirm the effectiveness of such screening in acute kidney injury prevention. Trial Registration: As an observational noninterventional study, no registration was required.

scholarly journals Two cases of acute urate nephropathy in women with asymptomatic hyperuricemia

2021 ◽  
Vol 59 (1) ◽  
pp. 103-107
Author(s):  
L. N. Yeliseyeva ◽  
V. P. Kurinnaya ◽  
O. N. Ponkina ◽  
I. V. Semizarova ◽  
Z. A. Baste
Keyword(s):  
Acute Kidney Injury ◽  
Uric Acid ◽  
Serum Uric Acid ◽  
Clinical Manifestations ◽  
Kidney Injury ◽  
Pathological Examination ◽  
Biopsy Material ◽  
Morphological Picture ◽  
Urate Nephropathy

The article presents a description of two own observations of the development of acute urate nephropathy in women with asymptomatic hyperuricemia. Clinical data and the results of additional laboratory and instrumental studies are presented; in one of the observations, the morphological picture of intravital biopsy material against the background of prolonged use of diuretics is described. The second case characterizes tophus kidney damage (according to the pathological examination data) without characteristic clinical manifestations of gout in vivo. The authors draw attention to the need to study serum uric acid levels in all cases of acute kidney injury.

scholarly journals Acute Kidney Injury Post-Percutaneous Nephrolithotomy (PNL): Prospective Outcomes from a University Teaching Hospital

2021 ◽  
Vol 10 (7) ◽  
pp. 1373
Author(s):  
Sunil Pillai ◽  
Akshay Kriplani ◽  
Arun Chawla ◽  
Bhaskar Somani ◽  
Akhilesh Pandey ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Acute Kidney Injury ◽  
Uric Acid ◽  
Serum Uric Acid ◽  
Percutaneous Nephrolithotomy ◽  
Ace Inhibitors ◽  
Operative Time ◽  
Laboratory Data ◽  
Kidney Injury ◽  
Postoperative Aki

Acute Kidney Injury (AKI) after percutaneous nephrolithotomy (PNL) is a significant complication, but evidence on its incidence is bereft in the literature. The objective of this prospective observational study was to analyze the incidence of post-PNL AKI and the potential risk factors and outcomes. Demographic data collected included age, gender, body mass index (BMI), comorbidities (hypertension, diabetes mellitus), and drug history—particularly angiotensin converting enzyme inhibitors (ACE inhibitors), angiotensin II receptor blockers and beta blockers. Laboratory data included serial serum creatinine measured pre- and postoperation (12, 24, and 48 h), hemoglobin (Hb), total leucocyte count (TLC), Prothrombin time (PT), serum uric acid and urine culture. Stone factors were assessed by noncontrast computerized tomography of kidneys, ureter and bladder (NCCT KUB) and included stone burden, location and Hounsfield values. Intraoperative factors assessed were puncture site, tract size, tract number, operative time, the need for blood transfusion and stone clearance. Postoperative complications were documented using the modified Clavien–Dindo grading system and patients with postoperative AKI were followed up with serial creatinine measurements up to 1 year. Among the 509 patients analyzed, 47 (9.23%) developed postoperative AKI. Older patients, with associated hypertension and diabetes mellitus, those receiving ACE inhibitors and with lower preoperative hemoglobin and higher serum uric acid, had higher incidence of AKI. Higher stone volume and density, staghorn stones, multiple punctures and longer operative time were significantly associated with postoperative AKI. Patients with AKI had an increased length of hospital stay and 17% patients progressed to chronic kidney disease (CKD). Cut-off values for patient age (39.5 years), serum uric acid (4.05 mg/dL) and stone volume (673.06 mm3) were assessed by receiver operating characteristic (ROC) curve analysis. Highlighting the strong predictors of post-PNL AKI allows early identification, proper counseling and postoperative planning and management in an attempt to avoid further insult to the kidney.

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