scholarly journals A case report of peritoneal dialysis for management of acute kidney injury caused by Russell’s viper envenomation in a dog

2021 ◽  
Vol 20 (1) ◽  
Author(s):  
Tanamon Poppinit ◽  
◽  
Chanakarn SungThong ◽  
Keyword(s):  
Acute Kidney Injury ◽  
Peritoneal Dialysis ◽  
Normal Limit ◽  
Clinical Signs ◽  
Kidney Injury ◽  
Test Results ◽  
Effective Management ◽  
Laboratory Test Results ◽  
Serum Blood Urea Nitrogen ◽  
Russell’S Viper

This report describes a five-year-old dog who had been bitten by a Russell’s viper. The patient presented clinical signs of anorexia, vomiting, lethargy, and anuria. Collectively with the laboratory test results of azotemia and hyperkalemia, acute kidney injury was diagnosed. Peritoneal dialysis (PD) was instigated when the azotemia became worse and anuria persisted, despite aggressive medical and fluid therapy. After 14 days of PD, the anuria was resolved, and the patient was discharged 7 days later. At the end of the last dialysis cycle, there was a significant reduction in the severity of the azotemia, and the serum hyperkalemia had returned to normal. One month after PD, the patient no longer had any abnormal clinical signs. Both the patient’s serum blood urea nitrogen level and creatinine levels returned to within the normal limit. PD proved to be an effective management of acute kidney injury in Russell’s viper envenomation in the reported dog. This report also describes a detailed procedure of PD which can be instigated in any veterinary practice

scholarly journals Coronavirus Disease 19 Infection Does Not Result in Acute Kidney Injury: An Analysis of 116 Hospitalized Patients from Wuhan, China

2020 ◽  
Vol 51 (5) ◽  
pp. 343-348 ◽  
Author(s):  
Luwen Wang ◽  
Xun Li ◽  
Hui Chen ◽  
Shaonan Yan ◽  
Dong Li ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Renal Function ◽  
Demographic Data ◽  
Pulmonary Inflammation ◽  
Stable State ◽  
Kidney Injury ◽  
Test Results ◽  
Reading Frame ◽  
Laboratory Test Results ◽  
Treatment Measures

Background: Whether the patients with coronavirus disease 19 (COVID-19) infected by severe acute respiratory syndrome (SARS)-CoV-2 would commonly develop acute kidney injury (AKI) is an important issue worthy of clinical attention. This study aimed to explore the effects of SARS-CoV-2 infection on renal function through analyzing the clinical data of 116 hospitalized COVID-19-confirmed patients. Methods: One hundred sixteen COVID-19-confirmed patients enrolled in this study were hospitalized in the Department of Infectious Diseases, Renmin Hospital of Wuhan University from January 14 to February 13, 2020. The recorded information includes demographic data, medical history, contact history, potential comorbidities, symptoms, signs, laboratory test results, chest computer tomography scans, and treatment measures. SARS-CoV-2 RNA in 53 urine sediments of enrolled patients was detected by real-time reverse transcription-polymerase chain reaction. Results: Twelve (10.8%) patients showed mild increase of blood urea nitrogen or creatinine (<26 μmol/L within 48 h), and 8 (7.2%) patients showed trace or 1+ albuminuria in 111 COVID-19-confirmed patients without chronic kidney disease (CKD). All these patients did not meet the diagnostic criteria of AKI. In addition, 5 patients with CKD who were undergone regular continuous renal replacement therapy (CRRT) before admission were confirmed infection of SARS-CoV-2 and diagnosed as COVID-19. In addition to therapy for COVID-19, CRRT was also applied 3 times weekly during hospitalization for these 5 patients with CKD. In the course of treatment, the renal function indicators showed stable state in all 5 patients with CKD, without exacerbation of CKD, and pulmonary inflammation was gradually absorbed. All 5 patients with CKD were survived. Moreover, SARS-CoV-2 RNA in urine sediments was positive only in 3 patients from 48 cases without CKD, and 1 patient had a positive for SARS-CoV-2 open reading frame 1ab from 5 cases with CKD. Conclusion: AKI was uncommon in COVID-19. SARS-CoV-2 infection does not result in AKI, or aggravate CKD in the COVID-19 patients.

scholarly journals ISPD guidelines for peritoneal dialysis in acute kidney injury: 2020 Update (paediatrics)

2021 ◽  
pp. 089686082098212
Author(s):  
Peter Nourse ◽  
Brett Cullis ◽  
Fredrick Finkelstein ◽  
Alp Numanoglu ◽  
Bradley Warady ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Peritoneal Dialysis ◽  
Continuous Flow ◽  
Kidney Injury ◽  
Close Monitoring ◽  
Minimum Standard ◽  
Acceptable Alternative ◽  
Dialysis Solution ◽  
Days Of Therapy ◽  
Dialysis Solutions

Peritoneal dialysis (PD) for acute kidney injury (AKI) in children has a long track record and shows similar outcomes when compared to extracorporeal therapies. It is still used extensively in low resource settings as well as in some high resource regions especially in Europe. In these regions, there is particular interest in the use of PD for AKI in post cardiac surgery neonates and low birthweight neonates. Here, we present the update of the International Society for Peritoneal Dialysis guidelines for PD in AKI in paediatrics. These guidelines extensively review the available literature and present updated recommendations regarding peritoneal access, dialysis solutions and prescription of dialysis. Summary of recommendations 1.1 Peritoneal dialysis is a suitable renal replacement therapy modality for treatment of acute kidney injury in children. (1C) 2. Access and fluid delivery for acute PD in children. 2.1 We recommend a Tenckhoff catheter inserted by a surgeon in the operating theatre as the optimal choice for PD access. (1B) (optimal) 2.2 Insertion of a PD catheter with an insertion kit and using Seldinger technique is an acceptable alternative. (1C) (optimal) 2.3 Interventional radiological placement of PD catheters combining ultrasound and fluoroscopy is an acceptable alternative. (1D) (optimal) 2.4 Rigid catheters placed using a stylet should only be used when soft Seldinger catheters are not available, with the duration of use limited to <3 days to minimize the risk of complications. (1C) (minimum standard) 2.5 Improvised PD catheters should only be used when no standard PD access is available. (practice point) (minimum standard) 2.6 We recommend the use of prophylactic antibiotics prior to PD catheter insertion. (1B) (optimal) 2.7 A closed delivery system with a Y connection should be used. (1A) (optimal) A system utilizing buretrols to measure fill and drainage volumes should be used when performing manual PD in small children. (practice point) (optimal) 2.8 In resource limited settings, an open system with spiking of bags may be used; however, this should be designed to limit the number of potential sites for contamination and ensure precise measurement of fill and drainage volumes. (practice point) (minimum standard) 2.9 Automated peritoneal dialysis is suitable for the management of paediatric AKI, except in neonates for whom fill volumes are too small for currently available machines. (1D) 3. Peritoneal dialysis solutions for acute PD in children 3.1 The composition of the acute peritoneal dialysis solution should include dextrose in a concentration designed to achieve the target ultrafiltration. (practice point) 3.2  Once potassium levels in the serum fall below 4 mmol/l, potassium should be added to dialysate using sterile technique. (practice point) (optimal) If no facilities exist to measure the serum potassium, consideration should be given for the empiric addition of potassium to the dialysis solution after 12 h of continuous PD to achieve a dialysate concentration of 3–4 mmol/l. (practice point) (minimum standard) 3.3  Serum concentrations of electrolytes should be measured 12 hourly for the first 24 h and daily once stable. (practice point) (optimal) In resource poor settings, sodium and potassium should be measured daily, if practical. (practice point) (minimum standard) 3.4  In the setting of hepatic dysfunction, hemodynamic instability and persistent/worsening metabolic acidosis, it is preferable to use bicarbonate containing solutions. (1D) (optimal) Where these solutions are not available, the use of lactate containing solutions is an alternative. (2D) (minimum standard) 3.5  Commercially prepared dialysis solutions should be used. (1C) (optimal) However, where resources do not permit this, locally prepared fluids may be used with careful observation of sterile preparation procedures and patient outcomes (e.g. rate of peritonitis). (1C) (minimum standard) 4. Prescription of acute PD in paediatric patients 4.1 The initial fill volume should be limited to 10–20 ml/kg to minimize the risk of dialysate leakage; a gradual increase in the volume to approximately 30–40 ml/kg (800–1100 ml/m2) may occur as tolerated by the patient. (practice point) 4.2 The initial exchange duration, including inflow, dwell and drain times, should generally be every 60–90 min; gradual prolongation of the dwell time can occur as fluid and solute removal targets are achieved. In neonates and small infants, the cycle duration may need to be reduced to achieve adequate ultrafiltration. (practice point) 4.3 Close monitoring of total fluid intake and output is mandatory with a goal to achieve and maintain normotension and euvolemia. (1B) 4.4 Acute PD should be continuous throughout the full 24-h period for the initial 1–3 days of therapy. (1C) 4.5  Close monitoring of drug dosages and levels, where available, should be conducted when providing acute PD. (practice point) 5. Continuous flow peritoneal dialysis (CFPD) 5.1   Continuous flow peritoneal dialysis can be considered as a PD treatment option when an increase in solute clearance and ultrafiltration is desired but cannot be achieved with standard acute PD. Therapy with this technique should be considered experimental since experience with the therapy is limited. (practice point) 5.2  Continuous flow peritoneal dialysis can be considered for dialysis therapy in children with AKI when the use of only very small fill volumes is preferred (e.g. children with high ventilator pressures). (practice point)

scholarly journals A Biochemical and Pharmacological Characterization of Phospholipase A2 and Metalloproteinase Fractions from Eastern Russell’s Viper (Daboia siamensis) Venom: Two Major Components Associated with Acute Kidney Injury

Toxins ◽  
2021 ◽  
Vol 13 (8) ◽  
pp. 521
Author(s):  
Janeyuth Chaisakul ◽  
Orawan Khow ◽  
Kulachet Wiwatwarayos ◽  
Muhamad Rusdi Ahmad Rusmili ◽  
Watcharamon Prasert ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Phospholipase A2 ◽  
Protein Identification ◽  
Clinical Manifestations ◽  
Kidney Injury ◽  
Factor X ◽  
Pharmacological Characterization ◽  
Russell’S Viper

Acute kidney injury (AKI) following Eastern Russell’s viper (Daboia siamensis) envenoming is a significant symptom in systemically envenomed victims. A number of venom components have been identified as causing the nephrotoxicity which leads to AKI. However, the precise mechanism of nephrotoxicity caused by these toxins is still unclear. In the present study, we purified two proteins from D. siamensis venom, namely RvPLA2 and RvMP. Protein identification using LCMS/MS confirmed the identity of RvPLA2 to be snake venom phospholipase A2 (SVPLA2) from Thai D. siamensis venom, whereas RvMP exhibited the presence of a factor X activator with two subunits. In vitro and in vivo pharmacological studies demonstrated myotoxicity and histopathological changes of kidney, heart, and spleen. RvPLA2 (3–10 µg/mL) caused inhibition of direct twitches of the chick biventer cervicis muscle preparation. After administration of RvPLA2 or RvMP (300 µg/kg, i.p.) for 24 h, diffuse glomerular congestion and tubular injury with minor loss of brush border were detected in envenomed mice. RvPLA2 and RvMP (300 µg/kg; i.p.) also induced congestion and tissue inflammation of heart muscle as well as diffuse congestion of mouse spleen. This study showed the significant roles of PLA2 and SVMP in snake bite envenoming caused by Thai D. siamensis and their similarities with observed clinical manifestations in envenomed victims. This study also indicated that there is a need to reevaluate the current treatment strategies for Thai D. siamensis envenoming, given the potential for irreversible nephrotoxicity.

scholarly journals Development of guidance on the timeliness in response to acute kidney injury warning stage test results for adults in primary care: an appropriateness ratings evaluation

BMJ Open ◽  
2016 ◽  
Vol 6 (10) ◽  
pp. e012865 ◽  
Author(s):  
Tom Blakeman ◽  
Kathryn Griffith ◽  
Dan Lasserson ◽  
Berenice Lopez ◽  
Jung Y Tsang ◽  
...  
Keyword(s):  
Primary Care ◽  
Acute Kidney Injury ◽  
Kidney Injury ◽  
Test Results

Use of Peritoneal Dialysis in Acute Kidney Injury: How Far Away?

2020 ◽  
Vol 40 (5) ◽  
pp. 506-515
Author(s):  
Zhikai Yang ◽  
Jie Dong ◽  
Li Yang
Keyword(s):  
Acute Kidney Injury ◽  
Peritoneal Dialysis ◽  
Kidney Injury

MO376CLINICAL OUTCOMES OF ACUTE KIDNEY INJURY FOLLOWING SNAKE BITE INJURIES

2021 ◽  
Vol 36 (Supplement_1) ◽  
Author(s):  
Weerakit Naweera ◽  
Thapat Wannarong
Keyword(s):  
Acute Kidney Injury ◽  
Logistic Regression ◽  
Kidney Injury ◽  
Binary Logistic Regression ◽  
Cross Sectional Study ◽  
Renal Recovery ◽  
Binary Logistic Regression Analysis ◽  
Cross Sectional ◽  
Hospital Arrival ◽  
Russell’S Viper

Abstract Background and Aims Snakebite is a common animal bite injury in tropical countries. Acute kidney injury (AKI) is an important complication in snakebite patients. This study aimed to comprehensively investigate the clinical profiles and outcomes of patients following hematotoxin-related snakebite associated with kidney impairment. Method We conducted a hospital-based, cross-sectional study of 238 patients with hematotoxin-related snakebite injuries. Data were retrieved from the King Narai Hospital Registry from October 2014 to August 2020. The prevalence of complications associated with snakebite injuries, including acute kidney injury (AKI) and its severity, was determined. Univariate and Multivariate predictors of AKI diagnosis were evaluated using binary logistic regression analysis Results A total of 238 patients, with 63.4% men, median (IQR) age 49.8 (39-61) years and median duration from injury to a hospital arrival of 1 hour (0.5-2) hours, were injured by Green pit viper (85.7%), Russell’s viper (12.6%) and Malayan pit viper (1.7%). AKI mostly occurred in Russell’s viper group 66.7%. An AKI was reported in thirty (12.6%, 95% CI: 8.7 % - 17.5%) patients, with the severity of 66.7% stage one, 6.7% stage two, 26.6% stage three by KDIGO classifications, and 13.3% requiring hemodialysis. Complete renal recovery was seen in twenty-two patients (73.3%), while partial renal recovery was 23.3%. Other complications included 84.4 % limb cellulitis, 4.6% significantly bleeding, 2.5% hypotension, 25.6% prolonged venous clotting time (VCT), 46.7% prolonged prothrombin time (PT), and 14.3% prolonged partial thromboplastin time (PTT). Of total patients, 60.1% were treated with anti-venom. Mortality was relatively low (0.4%). In multivariable logistic regression analyses, AKI was significantly associated with time to hospital arrival more than 3 hours (p = 0.04), Russell’s viper bitten (p = 0.01), clinical bleeding (p = 0.01), and prolonged PT (p &lt; 0.01). Conclusion The prevalence of AKI in patients bitten by hematotoxin snakes was 12.6%, mostly from Russell’s viper. Factors associated with AKI outcomes were time to hospital arrival more than 3 hours, Russell’s viper bitten, clinical bleeding, and prolonged PT. Besides, one-fourth of AKI patients turned to chronic kidney disease.

Acute Pituitary Apoplexy following Snake Bite: A Rare but Treatable Complication

2017 ◽  
Vol 16 (06) ◽  
pp. 397-399
Author(s):  
Narendrakumar Barad
Keyword(s):  
Public Health ◽  
Acute Kidney Injury ◽  
Developing Countries ◽  
Rural Areas ◽  
Pituitary Apoplexy ◽  
Kidney Injury ◽  
Snake Bite ◽  
Important Public Health ◽  
Russell’S Viper ◽  
Public Health Hazards

AbstractPoisonous snake bite is one of the important public health hazards in developing countries, such as India, where majority of the population resides in rural areas. Among various poisonous species of snakes, Russell's viper venom causes neurotoxicity, myotoxicity, hemolysis, and coagulopathies leading to shock and acute kidney injury. Pituitary apoplexy causing acute hypopituitarism is an extremely rare but treatable complication following viper bite. Here in, we report the case of a 14-year-old boy admitted with Russell's viper bite complicated by disseminated intravascular coagulation (DIC), acute kidney injury, and pituitary apoplexy with secondary acute hypopituitarism.

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