scholarly journals Acute and long-term kidney function after parathyroidectomy for primary hyperparathyroidism

PLoS ONE ◽  
2020 ◽  
Vol 15 (12) ◽  
pp. e0244162
Author(s):  
Marcelo Belli ◽  
Regina Matsunaga Martin ◽  
Marília D’Elboux Guimarães Brescia ◽  
Climério Pereira Nascimento ◽  
Ledo Mazzei Massoni Neto ◽  
...  
Keyword(s):  
Renal Function ◽  
Primary Hyperparathyroidism ◽  
Serum Creatinine ◽  
Univariate Analysis ◽  
Kidney Injury ◽  
Ionized Calcium ◽  
Hydroxyvitamin D ◽  
Preoperative Serum ◽  
Permanent Reduction ◽  
Preoperative Creatinine

Background In kidney transplant patients, parathyroidectomy is associated with an acute decrease in renal function. Acute and chronic effects of parathyroidectomy on renal function have not been extensively studied in primary hyperparathyroidism (PHPT). Methods This retrospective cohort study included 494 patients undergoing parathyroidectomy for PHPT. Acute renal changes were evaluated daily until day 4 post-parathyroidectomy and were stratified according to acute kidney injury (AKI) criteria. Biochemical assessment included serum creatinine, total and ionized calcium, parathyroid hormone (PTH), and 25-hydroxyvitamin D (25OHD). The estimated glomerular filtration rate (eGFR) was calculated using the CKD-EPI equation. We compared preoperative and postoperative renal function up to 5 years of follow-up. Results A total of 391 (79.1%) patients were female, and 422 (85.4%) were non-African American. The median age was 58 years old. The median (first and third quartiles) preoperative serum creatinine, PTH and total calcium levels were 0.81 mg/dL (0.68–1.01), 154.5 pg/mL (106–238.5), and 10.9 mg/dL (10.3–11.5), respectively. The median (first and third quartiles) preoperative eGFR was 86 mL/min/1.73 m2 (65–101.3). After surgery, the median acute decrease in the eGFR was 21 mL/min/1.73 m2 (p<0.0001). Acutely, 41.1% of patients developed stage 1 AKI, 5.9% developed stage 2 AKI, and 1.8% developed stage 3 AKI. The acute eGFR decrease (%) was correlated with age and PTH, calcium and preoperative creatinine levels in univariate analysis. Multivariate analysis showed that the acute change was related to age and preoperative values of ionized calcium, phosphorus and creatinine. The change at 12 months was related to sex, preoperative creatinine and 25OHD. Permanent reduction in the eGFR occurred in 60.7% of patients after an acute episode. Conclusion There was significant acute impairment in renal function after parathyroidectomy for PHPT, and almost half of the patients met the criteria for AKI. Significant eGFR recovery was observed during the first month after surgery, but a small permanent reduction may occur. Patients treated for PHPT seemed to present with prominent renal dysfunction compared to patients who underwent thyroidectomy.

MO411ACUTE KIDNEY INJURY AFTER PARATHYROIDECTOMY FOR PRIMARY HYPERPARATHYROIDISM: PREVALENCE, PREDICTORS AND RISK ASSESSEMENT

2021 ◽  
Vol 36 (Supplement_1) ◽  
Author(s):  
Ekaterina Parshina ◽  
Aleksei Zulkarnaev ◽  
Pavel Kislyy ◽  
Roman Chernikov ◽  
Svetlana Mikhailova
Keyword(s):  
Risk Factors ◽  
Primary Hyperparathyroidism ◽  
Kidney Function ◽  
Univariate Analysis ◽  
Significant Risk ◽  
Kidney Injury ◽  
Definitive Treatment ◽  
Serum Total Calcium ◽  
Preoperative Serum ◽  
Youden’S Index

Abstract Background and Aims Surgery is the most effective and the only definitive treatment of primary hyperparathyroidism (PHPT). We aimed to assess the prevalence of acute kidney injury (AKI) among patients underwent surgery for PHPT, to determine the possible risk factors. Method A retrospective cohort study included 290 patients who underwent successful selective parathyroidectomy (PTx) for PHPT. We did not include patients who underwent re-operative surgeries. AKI was defined according to KDIGO-2012 criteria. Results In our cohort, 106 patients (36,6%) met AKI criteria after PTx. Most of the patients developed AKI stage 1. In univariate analysis preoperative serum PTH level (р=0,0004) aa well as degree of its decrease before/after PTx (р&lt;0,0001), preoperative serum total calcium level (р=0,0158), size of the parathyroid adenoma (р=0,0184), presence of proteinuria (RR=1,9 [95%CI: 1,19; 3,54], р=0,0061), hypertension (р=0,019) and anemia (р=0,0313), older age (RR=1,32 [95%CI: 1,03; 1,72], р=0,0265) were significant risk factors of AKI development. In multivariate analysis age (OR 1,05 [95%CI: 1,02; 1,08] per a year, р=0,002), body-mass index (OR 1,07 [95%CI: 1,02; 1,13] per each kg/m2, р=0,005), anemia (yes/no OR 3,38 [95%CI: 1,38; 8,2], р=0,008), preoperative PTH (OR 1,03 [95%CI: 1,01; 1,05] per each pmol/l, р=0,002), proteinuria (yes/no OR 3,45 [95%CI: 1,34; 8,93], р=0,011), use of ACE inhibitors/ARBs (yes/no OR 2,84 [95%CI: 1,58; 5,12], р=0,001) were discovered as independent predictors of AKI. Considering the most significant risk factors we developed two regression models for AKI risk assessment: the model 1 for patients with preserved kidney function (estimated glomerular filtration rate (eGFR ≥60 ml/min/1,73 m2) and the model 2 for those with decreased kidney function (eGFR less than 60 ml/min/1,73 m2) – tab. 1 and 2. Both models were statistically significant: χ2=25,39, df=5, р&lt;0,001, RN2=0,341 for the model 1, χ2=19,355, df=3, р&lt;0,001, RN2=0,428 for the model 2. The proposed models had good discrimination to predict AKI with area under the receiver operating characteristic curves (AUC-ROC) of 0,792 [95%CI: 0,691; 0,894], р&lt;0,001 for the model 1 (normal kidney function) and 0,84 [95%CI: 0,73; 0,951], р&lt;0,001 for the model 2 (decreased kidney function). Optimal cut-off values for predicted probability of AKI to define high-risk individuals were &gt; 0,57 (Youden’s index 0,525) for the model 1 and &gt; 0,439 (Youden’s index 0,589) for the model 2. Conclusion We observed high prevalence of AKI in patients after PTx for primary HPT. Developed risk models predict AKI with adequate accuracy. Risk factors of AKI should be considered when planning PTx, special attention should be paid to modifiable ones.

scholarly journals Off-Pump Technique May Prevent Worsening of Renal Function in CAD with CKD Undergoing CABG

2021 ◽  
Vol 05 (01) ◽  
pp. 007-011
Author(s):  
Shaheen Afsal ◽  
K. Sujani ◽  
Shashank Viswanathan ◽  
Akshay Bhati ◽  
Harish BR ◽  
...  
Keyword(s):  
Renal Function ◽  
Cardiac Surgery ◽  
Serum Creatinine ◽  
Renal Dysfunction ◽  
Normal Renal Function ◽  
Artery Bypass ◽  
Significant Proportion ◽  
Renal Dialysis ◽  
Off Pump ◽  
Preoperative Serum

AbstractCardiovascular disease (CVD) is a major cause for a significant proportion of all deaths and disability worldwide. Postoperative renal dysfunction following cardiac surgery is not an uncommon complication of cardiac surgery, which has serious implications with regard to morbidity, mortality, financial expenditure, and resource utilization. This study was performed to compare outcomes of patients with preoperative renal dysfunction with those having normal renal function undergoing off-pump coronary artery bypass grafting (OPCABG). Patients were divided into two categories, depending on their preoperative serum creatinine and glomerular filtration rate (GFR). The preoperative renal dysfunction was defined as serum creatinine >1.3 mg/dL and/or estimated GFR (eGFR) of <60 mL/min/1.73 m2. The category A patients had normal renal function defined as serum creatinine ≤1.3 mg/dL and/or eGFR of ≥60 mL/min/1.73 m2 while the category B patients had preoperative renal dysfunction that did not necessitate renal dialysis. Blood samples were collected from both category patients for serum creatinine prior to surgery, following surgery, on postoperative days 1, 2, 3, 4, 5, and on the day of discharge. The occurrence of acute kidney injury (AKI) was defined as an increase in the serum creatinine levels of ≥0.3 mg/dL within 48 hours or an increase of ≥1.5 above baseline known or presumed to have occurred within the previous 7 days based on Kidney Disease Improving Global Outcomes criteria. This study demonstrated that there was worsening of renal function in 7.4% of patients with normal renal function and 10.74% of patients with renal dysfunction that was not statistically different. Based on the results, we conclude that preoperative renal dysfunction may be a contributing predictor of AKI following OPCABG, and we recommend that the patients with more severe renal dysfunction with eGFR of 45–60 mL/min should be studied to demonstrate this hypothesis.

scholarly journals Renal Recovery following Liposomal Amphotericin B-Induced Nephrotoxicity

2019 ◽  
Vol 2019 ◽  
pp. 1-8 ◽  
Author(s):  
Heather A. Personett ◽  
Bryce M. Kayhart ◽  
Erin F. Barreto ◽  
Pritish Tosh ◽  
Ross Dierkhising ◽  
...  
Keyword(s):  
Renal Function ◽  
Serum Creatinine ◽  
Amphotericin B ◽  
Liposomal Amphotericin ◽  
Multivariable Analysis ◽  
Kidney Injury ◽  
Complete Recovery ◽  
Renal Recovery ◽  
Cumulative Exposure ◽  
Liposomal Amphotericin B

Background. Acute kidney injury (AKI) is a common complication of treatment with liposomal amphotericin B (LAmB). The trajectory of renal recovery after LAmB-associated AKI has not been well described, nor has effect of LAmB dose on recovery of renal function been explored. Objective. Characterize the pattern of renal recovery after incident AKI during LAmB and determine potential influencing factors. Methods. This retrospective cohort study analyzed patients who developed a ≥50% increase in serum creatinine while on LAmB. Patients were followed up until complete renal recovery or death or for 30 days, whichever occurred first. The primary outcome was complete renal recovery, defined as serum creatinine convalescence to within 10% of the patient’s pretreatment baseline. Multivariable modeling was used to identify independent predictors of renal recovery. Results. Ninety-eight patients experienced nephrotoxicity during LAmB, 94% of which received doses <7 mg/kg/day. Fifty-one patients at least partially recovered renal function and, of these, 32 exhibited complete recovery after a mean 9.8 ± 7.8 days. No statistical relationship was found between LAmB dose at the time of AKI or cumulative exposure to LAmB and the likelihood of renal recovery. Concomitant nephrotoxins, age, and pretreatment renal function did not modify this effect in multivariable analysis. Conclusion and Relevance. Our data suggests that LAmB dose did not impact the likelihood of renal recovery. Additional investigation is needed to confirm these findings when aggressive dosing strategies are employe. Additional research is also warranted to further characterize the course of recovery after LAmB-associated nephrotoxicity and comprehensive spectrum of renal outcomes.

Acute Kidney Injury in Children with Severe Malaria Is Common and Associated with Adverse Hospital Outcomes

2019 ◽  
Vol 66 (2) ◽  
pp. 218-225
Author(s):  
Eunice O Oshomah-Bello ◽  
Christopher I Esezobor ◽  
Adaobi U Solarin ◽  
Fidelis O Njokanma
Keyword(s):  
Acute Kidney Injury ◽  
Serum Creatinine ◽  
Severe Malaria ◽  
Complete Blood Count ◽  
Univariate Analysis ◽  
Elevated Serum ◽  
Kidney Injury ◽  
Hospital Outcomes ◽  
Elevated Serum Creatinine ◽  
Sub Saharan

Abstract Background The prevalence of acute kidney injury (AKI) in children with severe malaria in sub-Saharan African may have been underestimated. The study aimed to determine the prevalence of AKI in children with severe malaria and its association with adverse hospital outcomes. Methods At presentation, we measured complete blood count, serum bilirubin, and serum electrolytes, urea and creatinine in children with severe malaria. At 24 h after hospitalization, we repeated serum creatinine measurement. Urine passed in the first 24 h of hospitalization was also measured. We defined AKI and its severity using the Kidney Disease: Improving Global Outcome AKI guidelines. Results The study involved 244 children (53.3% males) with a median age of 3.5 (1.9–7.0) years. One hundred and forty-four (59%) children had AKI, and it reached maximum Stages 1, 2 and 3 in 56 (23%), 45 (18.4%) and 43 (17.6%) children, respectively. The majority (86.1%) with AKI had only elevated serum creatinine. Mortality increased with increasing severity of AKI on univariate analysis but weakened on multiple logistic regression. Mortality was also higher in those with both oliguria and elevated serum creatinine than in those with elevated serum creatinine only (50% vs. 4.8%, p &lt; 0.001). Furthermore, children with AKI spent three days more in hospital than those without AKI (p &lt; 0.001). Conclusions Acute kidney injury complicates severe malaria in 6 out of every 10 children and is commonly identified using elevated serum creatinine. It is also associated with adverse hospital outcome.

scholarly journals A patient with severe rhabdomyolysis and high levels of creatinine kinase had renal functions fully recovered after haemodialysis: a case report

2019 ◽  
Vol 48 (4) ◽  
pp. 030006051988810 ◽  
Author(s):  
Shang-Feng Tsai ◽  
Jun-Li Tsai ◽  
Cheng-Hsu Chen
Keyword(s):  
Renal Function ◽  
Serum Creatinine ◽  
Predictive Power ◽  
Kidney Injury ◽  
Blood Biomarkers ◽  
History Of ◽  
Very High ◽  
Current Report

Rhabdomyolysis is diagnosed based on the levels of blood biomarkers such as creatine kinase (CK), but the use of CK levels to predict long-term renal function remains controversial. This current report presents a case with a very high CK level with the presentation of acute kidney injury (AKI) who regained full renal function. A 29-year-old man, in a manic mood and presenting with dyspnoea, was admitted to hospital following an episode of ketamine use along with a history of drug abuse. The laboratory analyses identified rhabdomyolysis (CK, 35 266 U/l) and AKI (serum creatinine, 3.96 mg/dl). Despite treatment with intravenous normal saline (4000 ml/day), his CK level reached at least 300 000 U/l. He underwent 13 sessions of haemodialysis and his renal function fully recovered. The final measurements were serum creatinine 1.0 mg/dl and CK 212 U/l. These findings support the view that the predictive power of CK level on AKI is limited, especially regarding long-term renal function. Close follow-up examinations of renal function after haemodialysis are mandatory for patients with rhabdomyolysis.

Renal Disease In Patients With Chronic Lymphocytic Leukemia (CLL)

Blood ◽  
2013 ◽  
Vol 122 (21) ◽  
pp. 5302-5302 ◽  
Author(s):  
Tait D Shanafelt ◽  
Kari G. Rabe ◽  
Curtis A Hanson ◽  
Timothy G. Call ◽  
Susan Schwager ◽  
...  
Keyword(s):  
Renal Function ◽  
Chronic Lymphocytic Leukemia ◽  
Renal Insufficiency ◽  
Serum Creatinine ◽  
Research Funding ◽  
Univariate Analysis ◽  
Lymphocytic Leukemia ◽  
Disease Course ◽  
To Receive

Abstract Background Chronic lymphocytic leukemia (CLL) can effect renal function in a variety of ways including direct infiltration of the kidney, ureteral obstruction by lymphadenopathy, and treatment related tumor lysis syndrome (uric acid nephropathy). Rarely, CLL has also been reported to be associated with light chain nephropathy, renal amyloidosis, membranoproliferative glomerulonephritis (MPGN), granulomatous interstitial nephritis (GIN), and minimal change disease (MCD). Nearly all the data on the effects of CLL on renal function is at the case report level. We systematically evaluated the prevalence of renal insufficiency at diagnosis as well the incidence of acquired renal insufficiency during follow-up in a large cohort of patients with newly diagnosed CLL to more accurately define the effects of CLL on the kidney and its impact on clinical outcomes. Methods Between January 1995 -February 2013, previously untreated CLL patients seen in the Division of Hematology at Mayo Clinic at diagnosis (<12 months) and who had baseline assessment of serum creatinine were included in this analysis. Patients with serum creatinine (Cr) ≥1.5 mg/dL at baseline were classified as having renal insufficiency at diagnosis. Patients who initially had baseline creatinine <1.5 mg/dL but who developed a Cr≥1.5 mg/dL during the course of their disease were considered to have acquired renal insufficiency. Results Existing renal insufficiency at the time of CLL diagnosis: Of 2047 patients who met the eligibility criteria, 153 (7.5%) patients had renal insufficiency (Cr≥1.5 mg/dL) at the time of CLL diagnosis including 15 (0.7%) with a Cr≥3 mg/dL. Renal insufficiency was also more common among men (9.3% vs. 3.9%; p<0.00001), those with advanced stage disease (Rai 0=7.0%; Rai I-II=6.4%, Rai III-IV=20.2%; p<0.0001), and CD49d positive patients (6.8% vs. 3.8%; p<0.038). Patients with renal insufficiency at diagnosis were also older (median age 72.2 vs. 63.9; p<0.0001). No difference in the prevalence of renal insufficiency at diagnosis was observed based on cytogenetic abnormalities detected by FISH or CD38, ZAP-70 or IGHV gene mutation status. Although renal insufficiency at diagnosis was strongly associated with OS on univariate analysis (p<0.001), no association was observed between renal insufficiency and TTT or OS on multi-variate analysis adjusting for age, sex, and Rai stage. Acquired renal insufficiency during CLL disease course: Among the 1894 patients with normal renal function at diagnosis, 304 (16.1%) acquired renal insufficiency (Cr≥1.5 mg/dL) during the course of their CLL disease course including 43 (2.3%) with peak Cr≥3 mg/dL. In addition to age (older) and male sex, a number of CLL disease characteristics were associated with a higher likelihood of acquired renal insufficiency including: IGHV UM (OR=2.0; p=0.0001), unfavorable FISH (del17p- or 11q-; OR=2.0; p=0.001), and being CD49d+ (OR=1.8; p=0.002), ZAP-70+ (OR=1.6; p=0.004), or CD38+ (OR=1.4; p=0.0.032),. Shorter TTT (p<0.001) and OS (P<0.001) was observed among patients with initially normal creatinine who acquired renal insufficiency (Figure 1A and 1B). On MV analysis adjusting for age, sex, and stage at diagnosis, acquired renal insufficiency remained an independent predictor of TTT (OR=1.77; p=0.001) and OS (OR=2.67; p<0.001). Renal insufficiency and therapy selection After median follow-up of 4.5 years (range 0-18.0), 620 of 2047 (30.3%) patients have progressed to require treatment. Patients with renal insufficiency prior to treatment were less likely to receive purine nucleoside analogue based therapy and more likely to receive single agent alkylator based treatment. Conclusions Approximately 1 in every 13 patients (7.5%) with CLL has renal insufficiency at the time of diagnosis and an additional 16.1% acquire renal insufficiency during the course of the disease. The risk of developing renal insufficiency is associated with a variety of CLL B-cell characteristics and is associated with TTT and OS. Data on causes of acquired renal insufficiency is being abstracted and will be presented at the meeting. Disclosures: Shanafelt: Genentech: Research Funding; Glaxo-Smith-Kline: Research Funding; Cephalon: Research Funding; Hospira: Research Funding; Celgene: Research Funding; Polyphenon E International: Research Funding. Off Label Use: MK2206 in a phase 1 trial of CLL.

scholarly journals Circulating Proenkephalin, Acute Kidney Injury, and Its Improvement in Patients with Severe Sepsis or Shock

2018 ◽  
Vol 64 (9) ◽  
pp. 1361-1369 ◽  
Author(s):  
Pietro Caironi ◽  
Roberto Latini ◽  
Joachim Struck ◽  
Oliver Hartmann ◽  
Andreas Bergmann ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Septic Shock ◽  
Acute Kidney Injury ◽  
Renal Function ◽  
Intensive Care ◽  
Serum Creatinine ◽  
Odds Ratio ◽  
Adjusted Odds Ratio ◽  
Kidney Injury ◽  
Baseline Serum

Abstract BACKGROUND Acute kidney injury (AKI) occurs in many critically ill patients and is associated with high mortality. We examined whether proenkephalin could predict incident AKI and its improvement in septic patients. METHODS Plasma proenkephalin A 119–159 (penKid) was assayed in 956 patients with sepsis or septic shock enrolled in the multicenter Albumin Italian Outcome Sepsis (ALBIOS) trial to test its association with incident AKI, improvement of renal function, need for renal replacement therapy (RRT), and mortality. RESULTS Median [Q1–Q3] plasma penKid concentration on day 1 [84 (20–159) pmol/L[ was correlated with serum creatinine concentration (r = 0.74); it was higher in patients with chronic renal failure and rose progressively with the renal Sequential Organ Failure Assessment subscore. It predicted incident AKI within 48 h (adjusted odds ratio, 3.3; 95% CI, 2.1–5.1; P &lt; 0.0001) or 1 week [adjusted hazard ratio, 2.1 (1.7–2.8); P &lt; 0.0001] and future RRT during the intensive care unit stay [odds ratio, 4.0 (3.0–5.4)]. PenKid was also associated with improvements in renal function in patients with baseline serum creatinine &gt;2 mg/dL, both within the next 48 h [adjusted odds ratio, 0.31 (0.18–0.54), P &lt; 0.0001] and 1 week [0.23 (0.12–0.45)]. The time course of penKid concentrations predicted AKI and 90-day mortality. CONCLUSIONS Early measurement and the trajectory of penKid predict incident AKI, improvement of renal function, and the need for RRT in the acute phase after intensive care unit admission during sepsis or septic shock. PenKid measurement may be a valuable tool to test early therapies aimed at preventing the risk of AKI in sepsis.

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