Predictors of renal function recovery among patients undergoing renal replacement therapy following orthotopic liver transplantation

Introduction: Secondary oxalate nephropathy (OxN) is associated with a variety of causes and has not been well characterized in Chinese population. To investigate the etiology, clinicopathological features, and outcomes of secondary OxN, we report a case series from a single center in China. Methods: A retrospective analysis of 68 patients diagnosed with secondary OxN by renal biopsy from January 2013 to February 2019 in Jinling Hospital was performed. Results: Secondary OxN accounted for 0.23% of the renal biopsies and 2.31% of patients who received renal biopsies due to acute kidney injury (AKI). A total of 49 men and 19 women with an average age of 51.6 ± 11.8 years were enrolled. The most common cause was iatrogenic medication, followed by oxalate-rich diet and industry exposure. Stage 1, 2, and 3 AKI and AKI on chronic kidney disease (ACKD) were found in 4.4, 8.8, 69.1, and 17.6% of the patients, respectively. The peak serum creatinine during hospitalization was 8.62 ± 4.67 mg/dL. The median urinary oxalate excretion was 51.5 (23.2–147.1) mg/24 h. Kidney biopsy showed extensive calcium oxalate crystal deposits with acute tubulointerstitial nephritis. Thirty-four patients (50.0%) required renal replacement therapy. At the end of a follow-up that lasted 8.7 (0.1–72.1) months, 81.0% of patients achieved renal function recovery in 50 (14–432) days. Patients with renal function recovery had a lower rate of ACKD, a higher level of hemoglobin, a lower level of urine lysozyme, and a lower degree of interstitial fibrosis/tubular atrophy, interstitial inflammation, and global glomerulosclerosis than those in the nonrecovery group. Conclusions: In this case series of secondary OxN, the most common cause was iatrogenic medication, and it presented with AKI or ACKD. Half of the patients required renal replacement therapy, and in most of them, the renal function was reversible. Renal biopsy played an important role in diagnosis and prognosis evaluation.

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Serum Cystatin C is Associated with Renal Function Recovery in Critically Ill Patients Undergoing Continuous Renal Replacement Therapy

Nephron Clinical Practice ◽

10.1159/000350245 ◽

2012 ◽

Vol 122 (3-4) ◽

pp. 86-92 ◽

Cited By ~ 5

Author(s):

Z. Zhang ◽

X. Xu ◽

H. Ni ◽

N. Jin

Keyword(s):

Renal Function ◽

Renal Replacement Therapy ◽

Continuous Renal Replacement Therapy ◽

Replacement Therapy ◽

Critically Ill ◽

Critically Ill Patients ◽

Serum Cystatin C ◽

Serum Cystatin ◽

Renal Function Recovery ◽

Function Recovery

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Total IVC Occlusion as an Unusual Cause of Acute Renal Failure After Orthotopic Liver Transplantation

International Surgery ◽

10.9738/intsurg-d-14-00308.1 ◽

2017 ◽

Vol 102 (5-6) ◽

pp. 227-232

Author(s):

Annette Rebel ◽

Laura C. Duling ◽

Erin C. Maynard ◽

Tyler A. Crisp ◽

Zaki-Udin Hassan

Keyword(s):

Liver Transplantation ◽

Renal Failure ◽

Renal Function ◽

Acute Renal Failure ◽

Renal Replacement Therapy ◽

Renal Dysfunction ◽

Replacement Therapy ◽

Orthotopic Liver Transplantation ◽

Refractory Ascites ◽

Intraoperative Management

Renal dysfunction before and after orthotopic liver transplantation (OLT) has significant implications for morbidity and mortality of these patients. We describe the management of a 72-year-old male patient with history of alcoholic liver cirrhosis (MELD 38) undergoing OLT. The patient presented with declining renal function prior to OLT (baseline GFR <25 mL/min) due to diuretic therapy for refractory ascites, hypovolemia postgastrointestinal bleed, and possible hepatorenal syndrome. The intraoperative management was complicated by preexisting anemia (hematocrit, 22%), unusual RBC antibody (anti-JKa) and significant surgical blood loss. To achieve surgical hemostasis, temporary clamping of the inferior vena cava (IVC) caudal to the transplanted liver was necessary. Postoperatively, the patient remained anuric despite appropriate fluid resuscitation. Renal replacement therapy was initiated to balance volume and acid-base status. A venogram on postoperative day (POD) 5 indicated a complete IVC occlusion and caval thrombectomy was performed on POD 6. After restoration of venous renal drainage, renal function improved and renal replacement therapy was weaned. Renal function indicators normalized in 8 weeks, and remained unimpaired up to 3 months post-OLT. Unintended complete obstruction of the suprarenal IVC may occur during OLT to control surgical bleeding, and should be considered as a cause for acute renal failure after liver transplant. Despite the preexisting renal dysfunction, renal function quickly improved after restoration of blood flow drainage and normalized in less than 8 weeks post obstruction.

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