Prevention of Kidney Injury Following Rhabdomyolysis: A Systematic Review

2013 ◽  
Vol 47 (1) ◽  
pp. 90-105 ◽  
Author(s):  
Elizabeth J Scharman ◽  
William G Troutman
Keyword(s):  
Sodium Bicarbonate ◽  
Urine Output ◽  
Single Case ◽  
Case Reports ◽  
Data Extraction ◽  
Kidney Injury ◽  
Fluid Administration ◽  
Controlled Study ◽  
Fluid Type ◽  
Significant Difference

OBJECTIVE To conduct a systematic literature review to evaluate evidence-based recommendations for the prevention of rhabdomyolysis-associated acute renal failure (ARF). DATA SOURCES PubMed (1966-December 2012), International Pharmaceutical Abstracts, Science Citation Index, and Cochrane databases (1970-December 2012) were searched. There were no language restrictions. STUDY SELECTION AND DATA EXTRACTION Studies selected dealt with treatment of rhabdomyolysis (crush syndrome) or prevention of ARF in patients with rhabdomyolysis. Articles excluded did not present original data or described only the management of ARF after it developed. Single case reports were excluded. Extracted data included study type; population; definitions of rhabdomyolysis and ARF; fluid, sodium bicarbonate, and mannitol dosages; and study findings. DATA SYNTHESIS Twenty-seven studies met the inclusion criteria. No controlled trials compared intravenous fluid administration plus sodium bicarbonate to fluid administration alone. Three concluded that there was no significant difference in the rates of ARF between patients receiving and those not receiving sodium bicarbonate; however, urine alkalinization was not documented. Eight investigations concluded that delayed fluid administration increased the risk of ARF. No controlled study compared volumes of fluid administered or targeted urine output goals. Fluid type, therapy duration, and monitoring parameters varied widely; 4 used a urine output goal in adults of more than 300 mL/h or 300 mL/h or more. No evidence supported a preferred fluid type or that sodium bicarbonate with or without mannitol was superior to fluid therapy alone. CONCLUSIONS Intravenous fluids should be initiated as soon as possible, preferably within the first 6 hours after muscle injury, at a rate that maintains a urine output in adults of 300 mL/h or more for at least the first 24 hours. Sodium bicarbonate should be administered only if necessary to correct systemic acidosis and mannitol only to maintain urine output of 300 mL/h or more despite adequate fluid administration.

scholarly journals 113 Improving Intravenous Fluid Therapy to Reduce the Incidence of Acute Kidney Injury in Elderly Hip Fracture Patients

2021 ◽  
Vol 50 (Supplement_1) ◽  
pp. i12-i42
Author(s):  
C McCann ◽  
A Hall ◽  
J Min Leow ◽  
A Harris ◽  
N Hafiz ◽  
...  
Keyword(s):  
Emergency Department ◽  
Acute Kidney Injury ◽  
Hip Fracture ◽  
Length Of Stay ◽  
Kidney Injury ◽  
Ward Round ◽  
Fluid Administration ◽  
Ward Staff ◽  
Intravenous Fluid Therapy ◽  
Significant Difference

Abstract Background Acute kidney injury (AKI) in hip fracture patients is associated with morbidity, mortality, and increased length of stay. To avoid this our unit policy recommends maintenance crystalloid IV fluids of >62.5 mL/Hr for hip fracture patients. However, audits have shown that many patients still receive inadequate IV fluids. Methods Three prospective audits, each including 100 consecutive acute hip fracture patients aged >55, were completed with interventional measures employed between each cycle. Data collection points included details of IV fluid administration and pre/post-operative presence of AKI. Interventions between cycles included a revised checklist for admissions with a structured ward round tool for post-take ward round and various educational measures for Emergency Department, nursing and admitting team staff with dissemination of infographic posters, respectively. Results Cycle 1: 64/100 (64%) patients received adequate fluids. No significant difference in developing AKI post operatively was seen in patients given adequate fluids (2/64, 3.1%) compared to inadequate fluids (4/36, 11.1%; p = 0.107). More patients with pre-operative AKI demonstrated resolution of AKI with appropriate fluid prescription (5/6, 83.3%, vs 0/4, 0%, p < 0.05) Cycle 2: Fewer patients were prescribed adequate fluids (54/100, 54%). There was no significant difference in terms of developing AKI post operatively between patients with adequate fluids (4/54, 7.4%) or inadequate fluids (2/46, 4.3%; p = 0.52). Resolution of pre-operative AKI was similar in patients with adequate or inadequate fluid administration (4/6, 67% vs 2/2, 100%). Cycle 3: More patients received adequate fluids (79/100, 79%, p < 0.05). Patients prescribed adequate fluids were less likely to develop post-operative AKI than those receiving inadequate fluids (2/79, 2.5% vs 3/21, 14.3%; p < 0.05). Discussion This audit demonstrates the importance of administering appropriate IV fluid in hip fracture patients to avoid AKI. Improving coordination with Emergency Department and ward nursing/medical ward staff was a critical step in improving our unit’s adherence to policy.

scholarly journals Sodium Bicarbonate Supplementation and Urinary TGF-β1 in Nonacidotic Diabetic Kidney Disease

2020 ◽  
Vol 15 (2) ◽  
pp. 200-208 ◽  
Author(s):  
Kalani L. Raphael ◽  
Tom Greene ◽  
Guo Wei ◽  
Tristin Bullshoe ◽  
Kunani Tuttle ◽  
...  
Keyword(s):  
Kidney Disease ◽  
Sodium Bicarbonate ◽  
Diabetic Kidney Disease ◽  
Kidney Injury ◽  
Normal Serum ◽  
Controlled Study ◽  
Ammonium Excretion ◽  
Diabetic Kidney ◽  
Kidney Fibrosis ◽  
Titratable Acid

Background and objectivesIn early-phase studies of individuals with hypertensive CKD and normal serum total CO2, sodium bicarbonate reduced urinary TGF-β1 levels and preserved kidney function. The effect of sodium bicarbonate on kidney fibrosis and injury markers in individuals with diabetic kidney disease and normal serum total CO2 is unknown.Design, setting, participants, & measurementsWe conducted a randomized, double-blinded, placebo-controlled study in 74 United States veterans with type 1 or 2 diabetes mellitus, eGFR of 15–89 ml/min per 1.73 m2, urinary albumin-to-creatinine ratio (UACR) ≥30 mg/g, and serum total CO2 of 22–28 meq/L. Participants received oral sodium bicarbonate (0.5 meq/kg lean body wt per day; n=35) or placebo (n=39) for 6 months. The primary outcome was change in urinary TGF-β1-to-creatinine from baseline to months 3 and 6. Secondary outcomes included changes in urinary kidney injury molecule-1 (KIM-1)-to-creatinine, fibronectin-to-creatinine, neutrophil gelatinase-associated lipocalin (NGAL)-to-creatinine, and UACR from baseline to months 3 and 6.ResultsKey baseline characteristics were age 72±8 years, eGFR of 51±18 ml/min per 1.73 m2, and serum total CO2 of 24±2 meq/L. Sodium bicarbonate treatment increased mean total CO2 by 1.2 (95% confidence interval [95% CI], 0.3 to 2.1) meq/L, increased urinary pH by 0.6 (95% CI, 0.5 to 0.8), and decreased urinary ammonium excretion by 5 (95% CI, 0 to 11) meq/d and urinary titratable acid excretion by 11 (95% CI, 5 to 18) meq/d. Sodium bicarbonate did not significantly change urinary TGF-β1/creatinine (difference in change, 13%, 95% CI, −10% to 40%; change within the sodium bicarbonate group, 8%, 95% CI, −10% to 28%; change within the placebo group, −4%, 95% CI, −19% to 13%). Similarly, no significant effect on KIM-1-to-creatinine (difference in change, −10%, 95% CI, −38% to 31%), fibronectin-to-creatinine (8%, 95% CI, −15% to 37%), NGAL-to-creatinine (−33%, 95% CI, −56% to 4%), or UACR (1%, 95% CI, −25% to 36%) was observed.ConclusionsIn nonacidotic diabetic kidney disease, sodium bicarbonate did not significantly reduce urinary TGF-β1, KIM-1, fibronectin, NGAL, or UACR over 6 months.

scholarly journals A Meta-Analysis of the Prevalence of Cardiac Valvulopathy in Patients With Hyperprolactinemia Treated With Cabergoline

2018 ◽  
Vol 104 (2) ◽  
pp. 523-538 ◽  
Author(s):  
Craig E Stiles ◽  
Eugene T Tetteh-Wayoe ◽  
Jonathan P Bestwick ◽  
Richard P Steeds ◽  
William M Drake
Keyword(s):  
Tricuspid Regurgitation ◽  
Clinical Symptoms ◽  
Single Case ◽  
Case Reports ◽  
Data Extraction ◽  
Meta Analysis ◽  
Pituitary Tumors ◽  
Inclusion Criteria ◽  
Case Control Studies ◽  
Meta Analyses

Abstract Context Cabergoline is first-line treatment for most patients with lactotrope pituitary tumors and hyperprolactinemia. Its use at high dosages in Parkinson disease (PD) has largely been abandoned because of its association with the development of a characteristic restrictive cardiac valvulopathy. Whether similar valvular changes occur in patients receiving lower dosages for treatment of hyperprolactinemia is unclear, although stringent regulatory recommendations for echocardiographic screening exist. Objective To conduct a meta-analysis exploring any link between the use of cabergoline for the treatment of hyperprolactinemia and clinically significant cardiac valvulopathy. Data Sources Full-text articles published through January 2017 were found via PubMed and selected according to strict inclusion criteria. Study Selection All case-control studies were included where patients had received ≥6 months of cabergoline treatment for hyperprolactinemia. Single case reports, previous meta-analyses, review articles, and articles pertaining solely to PD were excluded. Of 76 originally selected studies, 13 met inclusion criteria. Data Extraction Desired data were compiled and extracted from articles by independent observers. Each also independently graded article quality (bias) and met to reach consensus. Data Synthesis More tricuspid regurgitation was observed (OR 3.74; 95% CI, 1.79 to 7.8; P < 0.001) in the cabergoline-treated patients compared with controls. In no patient was tricuspid valve dysfunction diagnosed as a result of clinical symptoms. There was no significant increase in any other valvulopathy. Conclusions Treatment with low-dose cabergoline in hyperprolactinemia appears to be associated with an increased prevalence of tricuspid regurgitation. The clinical significance of this finding is unclear and warrants further investigation.

Intensive versus Minimal Standard Dosage for Peritoneal Dialysis in Acute Kidney Injury: A Randomized Pilot Study

2017 ◽  
Vol 37 (5) ◽  
pp. 523-528 ◽  
Author(s):  
Watanyu Parapiboon ◽  
Treechada Jamratpan
Keyword(s):  
Acute Kidney Injury ◽  
Peritoneal Dialysis ◽  
Hospital Mortality ◽  
Kidney Injury ◽  
Controlled Study ◽  
Apache Ii Score ◽  
Standard Group ◽  
Standard Dosage ◽  
Significant Difference ◽  
Minimal Standard

BackgroundDosage for peritoneal dialysis (PD) in acute kidney injury (AKI) is controversial. This study aims to find benefits and risks of intensive versus minimal standard dosage of PD in AKI.MethodsIn a tertiary-hospital, 93 AKI patients who required PD between May 2015 and January 2016 were enrolled in a randomized, open-label controlled study. Patients were randomized to intensive group (> 30 L) and minimal standard group (< 20 L) of PD volume per day for the first 2 consecutive days. The primary outcome was in-hospital mortality. The secondary outcomes were peritonitis rate, dialysis dependence, and PD leakage.ResultsSeventy-five patients were analyzed (intensive PD n = 39; minimal standard PD n = 36). Mean age was 60 years. Most patients were in critical care (72% unstable hemodynamic, mean APACHE II score 26.2). Kt/V delivery per session was 0.61 and 0.38 in intensive and minimal standard PD dosage for the first 2 consecutive sessions. According to intention-to-treat analysis, the in-hospital mortality rate of intensive PD dosage was not significantly different from the minimal standard PD dosage (79% vs 63%, relative risk [RR] 1.11, 95% confidence interval [CI] 0.80 to 1.51, p = 0.13). The dialysis dependence rate and PD leakage were not significantly different between the 2 groups. The rate of PD peritonitis was slightly higher in the intensive PD dosage group (15.3% vs 8.3%, p = 0.34).ConclusionAmong AKI patients who required PD, there was no significant difference in in-hospital mortality between intensive and minimal standard PD dosage.

scholarly journals Using pRIFLE criteria for acute kidney injury in critically ill children

2013 ◽  
Vol 53 (1) ◽  
pp. 32 ◽  
Author(s):  
Rina Amalia C. Saragih ◽  
Jose M. Mandei ◽  
Irene Yuniar ◽  
Rismala Dewi ◽  
Sudung O. Pardede ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Critically Ill ◽  
Kidney Function ◽  
Urine Output ◽  
Clinical Course ◽  
Kidney Injury ◽  
Critically Ill Children ◽  
Logistic Organ Dysfunction ◽  
Significant Difference ◽  
Output Only

Backgi-ound Incidence of acute kidney injury (AKI) in critically illchildren and its mortality rate is high. The lack of a uniform definitionfor AKI leads to failure in determining kidney injury, delayedtreatment, and the inability to generalize research results.Objectives To evaluate the pediatric RIFLE (pRIFLE) criteria (riskfor renal dysfunction, injury to the kidney, failure of kidney function,loss of kidney function, and end-stage renal disease) for diagnosingand following the clinical course of AKI in critically ill children. Wealso aimed to compare AKI severity on days 1 and 3 of pediatricintensive care unit (PICU) stay in critically ill pediatric patients.Methods This prospective cohort study was performed in PICUpatients. Urine output (UOP), serum creatinine (SCr) , andglomerular filtration rate on days 1 and 3 of PICU stay wererecorded. Classification of AKI was determined according topRIFLE criteria. We also recorded subjects' immune status,pediatric logistic organ dysfunction (PELOD) score, admissiondiagnosis, the use of vasoactive medications, diuretics, andventilators, as well as PICU length of stay and mortality.Results Forty patients were enrolled in this study. AKI wasfound in 13 patients (33%). A comparison of AKI severity onday 1 and day 3 revealed no statistically significant differences forattainment of pRIFLE criteria by urine output only (pRIFLfu0 p;P=0.087) and by both UOP and SCr (pRIFLEcr+uo p; P= 0.577).However, attainment of pRIFLE criteria by SCr only (pRIFLEcrlwas significantly improved between days 1 and 3 (P =0.026). Therewas no statistically significant difference in mortality or length ofstay between subjects with AKI and those without AKI.Conclusion The pRIFLE criteria is feasible for use in diagnosingand following the clinical course of AKI in critically ill children.

Phenytoin in the Treatment of Epidermolysis Bullosa

1997 ◽  
Vol 13 (1) ◽  
pp. 10-14
Author(s):  
Mersedeh Moshfeghi ◽  
Ghazala M Contractor
Keyword(s):  
Clinical Study ◽  
Epidermolysis Bullosa ◽  
English Language ◽  
Case Reports ◽  
Data Extraction ◽  
Controlled Trial ◽  
Controlled Study ◽  
Data Synthesis ◽  
Medline Search ◽  
Randomized Controlled

Objective: To review the efficacy of phenytoin in the treatment of epidermolysis bullosa (EB). Data Sources: English-language clinical study reports, abstracts, case reports, and review articles pertaining to the use of phenytoin in the treatment of EB (MEDLINE search, January 1973-August 1996). Data Extraction: Clinical study and case reports evaluating the effect of phenytoin in the treatment of EB were reviewed, and the methodology, results, and conclusions of the studies were evaluated. Because of the limited number of randomized, controlled study reports, all available case reports were reviewed, and information we considered pertinent was synthesized. Data Synthesis: Results of studies of EB suggest that the blister fluid and fibroblasts in patients with this disease produce an increased amount of collagenase, which is thought to induce blistering. Phenytoin inhibits collagenase synthesis and/or secretion and, therefore, is used to treat patients with EB. Data regarding the use of phenytoin in patients with EB, especially those with recessive dystrophic EB, revealed that phenytoin may reduce the number of blisters in these patients. Dosage recommendations and monitoring parameters are also discussed. Conclusions: More randomized, controlled trials are needed to determine the true efficacy of phenytoin in the treatment of EB. Although the only available report of a randomized, controlled trial reported a lack of phenytoin efficacy in patients with EB, it does not rule out the possibility of success in selected patients.

scholarly journals Association between Caffeine Citrate and Incidence of Acute Kidney Injury in Preterms

2021 ◽  
pp. 189-199
Author(s):  
Halah Tarek Mohammed Mansour ◽  
Hamed Mohamed Mohamed Elsharkawy ◽  
Sahar Mohey Eldin Hazzaa ◽  
Mohammed Abd-Ellatif Nassar
Keyword(s):  
Acute Kidney Injury ◽  
Serum Creatinine ◽  
Serum Albumin ◽  
Urine Output ◽  
Kidney Injury ◽  
Preterm Neonates ◽  
P Value ◽  
Significant Difference ◽  
Caffeine Citrate ◽  
Group A

Background: As a result of prematurity, Acute kidney injury (AKI) occurs commonly in preterm neonates and is associated with increased morbidity and mortality. (AKI) is defined as a rapid, potentially reversible deterioration in renal functions sufficient to result in accumulation of nitrogenous wastes in the body. Aim of the Study: the aim of this study was to determine whether preterm neonates who took caffeine citrate from the first day after birth were less likely to AKI within the first 7 days. Patients and Methods: This case control study was conducted on 100 preterm neonates at Neonatal Intensive Care Units (NICUS), Pediatric Department, Tanta University with gestational age less than (30 weeks) were grouped into group A and B. Group A 50 preterm neonates who received caffeine citrate from the first day after birth with dose (20 mg/kg) loading dose, and (5 mg/kg/dose) every 24hrs of maintenance dose, given as slow intravenous infusion over twenty to thirty minutes for a week. Group B 50 preterm neonates who did not receive caffeine citrate. Inclusion Criteria: all preterms <30 weeks admitted within first 24 hours after birth presented by respiratory distress according to Downes score. Exclusion Criteria: newborns with congenital heart disease except non-significant PDA, neonatal mortality < 48 h of life, clinical signs suggest chromosomal anomalies, newborns with congenital renal anomalies. Hematological Investigations: serum albumin, serum creatinine, blood urea. Urinary Investigations: measuring urine output. Results: There was a statistically significant difference between the two studied groups as regard serum creatinine in day (5,7) (p<0.001), urea in day 7 (p value <0.001), serum albumin in day (5,7) (p value ≤ 0.05), urine output in day (4,5,6,7) (p value ≤0.05), AKI incidence (p value <0.001). Conclusion: Caffeine Citrate administration in preterm neonates from the first day of life for one week was associated with reduced occurrence and severity of AKI.

scholarly journals Perioperative Use of Flurbiprofen Axetil on Renal Function after Transurethral Prostatectomy: A Prospective Randomized Controlled Study

2021 ◽  
Vol 2021 ◽  
pp. 1-7
Author(s):  
Dong Wang ◽  
Wenxiu Xie ◽  
Bo Li ◽  
Yufan Zhao ◽  
Xing Liu ◽  
...  
Keyword(s):  
Cystatin C ◽  
Kidney Injury ◽  
Controlled Study ◽  
Control Group ◽  
Renal Protection ◽  
Flurbiprofen Axetil ◽  
Time Points ◽  
Neutrophil Gelatinase Associated Lipocalin ◽  
Significant Difference ◽  
American Society

Objective. To explore the role of low-dose flurbiprofen axetil in perioperative renal protection. Methods. A total of 83 patients who underwent transurethral resection of the prostate (TURP) between August 2020 and November 2020 at the Third Xiangya Hospital of Central South University were selected, aged 60-85 years old, American Society of Anesthesia (ASA) physical status classes 1-3, BMI 18-30 kg/m2, randomly divided into the experimental group (group F, n = 42 ) and control group (group C, n = 41 ). 10 minutes before the operation, group F was injected with 100 mg (10 mL) flurbiprofen axetil, and group C was injected with 10 mL 0.9% saline, comparing the incidence of acute kidney injury (AKI) and changes in glomerular filtration rate (eGFR) between the two groups. Cystatin-C, Neutrophil Gelatinase-associated Lipocalin (NGAL), IL-6, and CRP were compared between the two groups at 4 time points (before surgery, 6 hours, 24 hours, and 48 hours after surgery). Results. A total of 80 cases were enrolled, 40 in group F and 40 in group C. There was no significant difference in baseline between the two groups ( P > 0.05 ). The NGAL of group F was significantly lower than group C at 6 hours after the operation ( 367.99 ± 311.83 vs. 243.02 ± 151.73 , P = 0.026 ), but there was no significant difference in NGAL and Cystatin-C at other time points ( P > 0.05 ). And there was no significant difference in the incidence of postoperative AKI between the two groups (0% vs. 2.5%, P = 0.314 ). Conclusion. 100 mg flurbiprofen axetil can reduce the NGAL at 6 hours after TURP, and it may have a protective effect on the kidney.

scholarly journals Open Heart Surgery Associated Acute Kidney Injury in Children

2013 ◽  
Vol 13 (2) ◽  
pp. 37-42
Author(s):  
Jekabs Krastins ◽  
Zane Straume ◽  
Janis Auzins ◽  
Aigars Petersons ◽  
Aivars Petersons
Keyword(s):  
Acute Kidney Injury ◽  
Cardiopulmonary Bypass ◽  
Urine Output ◽  
Heart Surgery ◽  
Tertiary Care ◽  
Open Heart Surgery ◽  
Kidney Injury ◽  
Open Heart ◽  
Significant Difference ◽  
Hospital Pediatric

Abstract Introduction. Cardiac surgery with cardiopulmonary bypass (CPB) is commonly perceived as a risk factor for decline in renal function. Hypothermia, hypoxia, hypotension, non-pulsatile blood flow during CPB, use of ACE inhibitors, inotropic and (or) vasoactive support affects kidney and contributes to the acute kidney injury (AKI). Aim of the study. The purpose of this study was to evaluate the incidence, severity and outcome of CPB related AKI in children after open heart surgery. Materials and methods. We conducted prospective, non-randomized observational study at the tertiary care University Children’s Hospital Pediatric ICU. We enrolled 30 patients, 12 boys and 18 girls with congenital heart disease (CHD). Their median body weight was 6,8 kg, (IQR 5,2<8,2 kg) and median age 7 months (IQR 5<10 months). SCr was determined and preoperative and postoperative creatinine clearance (ClCr) was estimated using Schwarz formula (eClCr). During surgical repair and till the end of the first 12 postoperative hours urine was collected to measure ClCr, using the difference in urine (UCr) and SCr concentrations (mClCr). Urine output, body temperature, duration of aortic cross clamping and cardiopulmonary bypass was recorded. Results. Median intraoperative urine output was 2,4 ml/kg/h (IQR 1,29<3,15 ml/kg/h). Median CPB time was 147 min., (IQR 116,75<205 min.), median aortic cross-clamping time was 95 min., (IQR 70,5<133 min.), cooling during CPB to 29,75°C. Postoperative SCr increased to 35 μmol/l (IQR 27,5<50,5 μmol/l) vs. preoperative SCr 29 μmol/l (IQR 24<32,9 μmol/l), P<0,0001. GFR declined from preoperative 98,4 ml/min./1,73 m2 (IQR 89,6<123,04) to postoperative 80,98 ml/min./1,73 m2, (IQR 60,73<97,97 ml/min./1,73 m2), P<0,0001. We find statistically significant difference (P=0,042) in measured 39,88 ml/min./1,73 m2 (IQR 21,96<67,82 ml/min./1,73 m2) versus estimated ClCr (eClCr) 80,98 ml/min./1,73 m2, (IQR 60,73<97,97 ml/min./1,73 m2). Observed prevalence of AKI was 46,6% (14/30 patients met KDIGO criteria for AKI). Conclusions.Open heart surgery in children has severe, but transient effect on expression of renal biomarkers. There was a marked difference between measured and estimated ClCr in our patients. Observed incidence of AKI was 46,6% (14 patients met KDIGO criteria of AKI from 30 of our patients). Before discharge from the hospital both biomarkers returned to normal values.

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