scholarly journals ACUTE KIDNEY INJURY CAUSED BY Crotalus AND Bothrops SNAKE VENOM: A REVIEW OF EPIDEMIOLOGY, CLINICAL MANIFESTATIONS AND TREATMENT

2013 ◽  
Vol 55 (5) ◽  
pp. 295-301 ◽  
Author(s):  
Polianna L.M.M. Albuquerque ◽  
Camilla N. Jacinto ◽  
Geraldo B. Silva Junior ◽  
Juliana B. Lima ◽  
Maria do Socorro B. Veras ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Snake Venom ◽  
Rural Areas ◽  
Renal Involvement ◽  
Clinical Manifestations ◽  
Kidney Injury ◽  
Public Health Problem ◽  
Important Public Health Problem ◽  
Young Males ◽  
Clinical Complications

SUMMARY Ophidic accidents are an important public health problem due to their incidence, morbidity and mortality. An increasing number of cases have been registered in Brazil in the last few years. Several studies point to the importance of knowing the clinical complications and adequate approach in these accidents. However, knowledge about the risk factors is not enough and there are an increasing number of deaths due to these accidents in Brazil. In this context, acute kidney injury (AKI) appears as one of the main causes of death and consequences for these victims, which are mainly young males working in rural areas. Snakes of the Bothrops and Crotalus genera are the main responsible for renal involvement in ophidic accidents in South America. The present study is a literature review of AKI caused by Bothrops and Crotalus snake venom regarding diverse characteristics, emphasizing the most appropriate therapeutic approach for these cases. Recent studies have been carried out searching for complementary therapies for the treatment of ophidic accidents, including the use of lipoic acid, simvastatin and allopurinol. Some plants, such as Apocynaceae, Lamiaceae and Rubiaceae seem to have a beneficial role in the treatment of this type of envenomation. Future studies will certainly find new therapeutic measures for ophidic accidents.

Renal tubular injury as an uncommon presentation of Wilson’s disease

2021 ◽  
Vol 2 (3) ◽  
Author(s):  
Hadar Mudrik-Zohar ◽  
◽  
Keren Cohen-Hagai ◽  
Danny Alon ◽  
◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Wilson’S Disease ◽  
Renal Involvement ◽  
Clinical Manifestations ◽  
Kidney Injury ◽  
Wilson's Disease ◽  
Tubular Dysfunction ◽  
Tubular Injury ◽  
Uncommon Presentation ◽  
Renal Tubular

Wilson's disease is an autosomal recessive disorder caused by a mutant ATP7B gene on chromosome 13. This mutation causes a reduction in hepatic copper excretion, which accumulates in hepatocytes and deposits in other tissues and organs (brain, cornea, kidney, etc.) as the disease progresses. Wilson's disease was described worldwide, with estimated prevalence of one case per 30,000 live births. Age of presentation is usually 4-60 years; however, the disease may present at any age. Clinical manifestations are predominantly hepatic, neurologic and psychiatric. Renal involvement is less common and characterized by proximal tubular dysfunction, Glomerular Filtration Rate (GFR) decline, renal tubular acidosis, aminoaciduria and nephrolithiasis. Herein, we aimed to report a case which describes an uncommon path to the diagnosis of this rare, yet well-known disease. The diagnosis resulted from an investigation of acute kidney injury in a 48-year-old man. Keywords: Wilson’s disease; Acute kidney injury; Renal tubular injury.

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.

MO412THE RISK FACTORS OF ACUTE KIDNEY INJURY CAUSED BY HEMOPHAGOCYTIC LYMPHOHISTIOCYTOSIS

2021 ◽  
Vol 36 (Supplement_1) ◽  
Author(s):  
Siwen Wang ◽  
Jia Yang ◽  
Chen Xuelian ◽  
Jiaojiao Zhou ◽  
Lichuan Yang
Keyword(s):  
Risk Factors ◽  
Acute Kidney Injury ◽  
Hemophagocytic Lymphohistiocytosis ◽  
Strong Predictor ◽  
Laboratory Data ◽  
Clinical Manifestations ◽  
Gastrointestinal Symptoms ◽  
Kidney Injury ◽  
Total Bilirubin Level ◽  
Risk Of Death

Abstract Background and Aims Hemophagocytic lymphohistiocytosis (HLH) is a syndrome characterized by overproduction of proinflammatory cytokines and hemophagocytosis. Acute kidney injury (AKI) is the most common complication of HLH in the kidney, which is a strong predictor of poor prognosis. In this retrospective study, we aimed to find the risk factors of AKI in patients with HLH. Method We screened all adult patients with HLH admitted to West China Hospital of Sichuan University from January 2009 to June 2019. Patients in this study were secondary HLH according to the HLH diagnostic criteria revised by the Histocyte Society in 2004. Patients with HLH were excluded from the study if they had a functioning kidney transplant, received renal replacement therapy (RRT) in the past month, suffered from end-stage renal disease (ESRD), or had the renal malignant tumor. We collected basic information, clinical manifestations, and laboratory data of patients from electronic medical records. Results A total of 600 patients with confirmed diagnosis of secondary HLH are included in our analysis. There are 199(33.2%)HLH-induced AKI patients, among whom 37.2%, 32.7%, and 30.2% are classified as AKI I, II, and III, respectively, according to the 2012 KDIGO (Kidney Disease: Improving Global Outcomes) guideline. Overall hospital mortality is 176(29.3%), and the number of deaths in patients with AKI was much higher than that in patients without AKI (53.3% versus 17.5%, P < 0.001). The risk factors of AKI in patients with HLH were hyperphosphatemia (P<0.001, OR 5.448, 95%CI 2.951-10.059) , vasopressor(P<0.001, OR 3.485, 95%CI 2.114-5.746), heart failure (P=0.044, 0R 2.336, 95%CI 1.022-5.340), gastrointestinal symptoms (P=0.043, OR 1.877, 95%CI 1.021-3.453), increased heart rate (P=0.005, OR 1.017, 95%CI 1.005-1.029), elevated total bilirubin level(P<0.001, OR 1.004, 95%CI 1.002-1.007), and hypoproteinemia (P=0.034, OR 0.939, 95%CI 0.886-0.995). Conclusion The incidence of AKI was higher in patients with HLH, and the risk of death was significantly higher in HLH patients with AKI. A variety of risk factors are related to the occurrence of HLH-induced AKI. Identifying and correcting them early in clinical diagnosis and treatment may reduce the incidence of AKI in patients with HLH and improve the prognosis of them.

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.

scholarly journals Acute kidney injury as initial presentation of renal lymphoma: Diagnostic and therapeutic challenges in a resource-limited setting

2019 ◽  
Vol 7 ◽  
pp. 2050313X1984525 ◽  
Author(s):  
Jeannine Anyingu Aminde ◽  
Nkweta Eugene Adze ◽  
Guisilla Ankwatia Dedino ◽  
Leopold Ndemnge Aminde
Keyword(s):  
Acute Kidney Injury ◽  
State Of The Art ◽  
Renal Involvement ◽  
Kidney Injury ◽  
Abdominal Distension ◽  
Lymphoma Patient ◽  
Limited Data ◽  
Resource Limited ◽  
History Of ◽  
Limited Setting

Non-Hodgkin’s lymphoma is reportedly common in Africa; however, there is limited data on renal involvement. Acute kidney injury only at presentation is rare for lymphoproliferative malignancies. A 7-year old presented to our facility with a 2-week history of progressive abdominal distension and pain, examination revealed anasarca and hypertension. On further evaluation, there were bilateral nephromegaly, acute kidney injury (AKI) and cytomorphological findings suggestive of lymphoma. Patient management was mostly supportive, and evolution was unfavourable leading to his demise. We discuss diagnostic and therapeutic challenges due to unavailability of state-of-the-art facilities in resource-constrained settings.

The patient with sarcoidosis

2015 ◽  
Author(s):  
Ravindra Rajakariar ◽  
Muhammad M. Yaqoob
Keyword(s):  
Acute Kidney Injury ◽  
Renal Impairment ◽  
Renal Disease ◽  
Low Dose ◽  
Clinical Presentation ◽  
Tubulointerstitial Nephritis ◽  
Renal Involvement ◽  
Kidney Injury ◽  
Chronic Renal Impairment

Renal involvement in sarcoidosis is common and often under-recognized. The most frequent manifestation is acute kidney injury secondary to hypercalcaemia and granulomatous tubulointerstitial nephritis. The latter can lead to both acute kidney injury and to slowly progressive chronic renal impairment with concomitant chronic damage seen on histology. This chapter describes the types of renal disease that may occur in sarcoidosis and the pathogenesis, clinical presentation, diagnosis, and treatment of the patient with sarcoidosis. Corticosteroid therapy is the cornerstone of therapy. In patients with granulomatous tubulointerstitial nephritis, the authors recommend long-term, low-dose maintenance steroids.

Bothrops pauloensis snake venom-derived Asp-49 and Lys-49 phospholipases A2 mediates acute kidney injury by oxidative stress and release of inflammatory cytokines

Toxicon ◽  
2021 ◽  
Vol 190 ◽  
pp. 31-38
Author(s):  
Aline Diogo Marinho ◽  
João Alison de Moraes Silveira ◽  
Adriano José Maia Chaves Filho ◽  
Antônio Rafael Coelho Jorge ◽  
Francisco Assis Nogueira Júnior ◽  
...  
Keyword(s):  
Oxidative Stress ◽  
Acute Kidney Injury ◽  
Inflammatory Cytokines ◽  
Snake Venom ◽  
Kidney Injury ◽  
Phospholipases A2

scholarly journals P0494UNUSUAL CASE OF ACUTE KIDNEY INJURY (HISTOLOGICAL EVALUATION: COLLAPSING GLOMERULOPATHY) IN HEMOPHAGOCYTIC SYNDROME ASSOCIATED WITH NK/T LYMPHOMA

2020 ◽  
Vol 35 (Supplement_3) ◽  
Author(s):  
Elisabetta Ascione ◽  
Riccardo Magistroni ◽  
Marco Leonelli ◽  
Gianni Cappelli
Keyword(s):  
Bone Marrow ◽  
Acute Kidney Injury ◽  
Clinical Judgment ◽  
Antimicrobial Agents ◽  
Early Recognition ◽  
Cytotoxic T Cells ◽  
Renal Involvement ◽  
Kidney Injury ◽  
Histological Evaluation ◽  
Collapsing Glomerulopathy

Abstract Background and Aims Hemophagocytic lymphohistiocytosis (HLH) is a severe hyperinflammatory syndrome induced by aberrantly activated macrophages and cytotoxic T cells. The primary (genetic) form, caused by mutations affecting lymphocyte cytotoxicity and immune regulation, is most common in children, whereas the secondary (acquired) form is most frequent in adults. Secondary HLH is commonly triggered by infections or malignancies but may also be induced by autoinflammatory/autoimmune disorders, in which case it is called macrophage activation syndrome. The diagnosis of HLH in adults should be based on the HLH-2004 diagnostic criteria in conjunction with clinical judgment and the patient’s history. Renal involvement has previously been reported in 24 adult cases, mostly as acute renal failure. Collapsing glomerulopathy is extremely rare with only six previous cases reported in the literature. Case presentation We report the case of an African man, 31 years old, presented with fever, acute kidney injury: serum creatinine 10.3 mg/dl; urine protein 600 mg/dl, macrohematuria, ANA/ANCA were negative, low serum C3, organomegaly, anemia, thrombocytopenia, hypertriglyceridemia, hypofibrinogenemia, hyperferritinemia, direct and indirect antiglobulin (Coombs) tests were negative, low haptoglobin; elevated LDH; normal partial thromboplatin time. Peripheral blood smear examination reveal few schistocytes. ADAMTS13 activity was found to be 25%. HBV-DNA and HIV were negative. Anticardiolipin antibodies were negative. Lab exam suggested the relapse of an EBV infection and primary mycoplasma infection. Because of uremic symptoms and persisting oliguria we started replacement therapy by hemodialysis. Plasmapheresis was started because of suspected thrombotic microangiopathy. Suprisingly the kidney biopsy was consistent with collapsing glomerulopathy with evidence of tubular injury while the bone marrow biopsy diagnosed an EBV NK/T-Cell lymphoma. During the course of his hospitalization, the patient suffered high fever. C-reactive protein, WBC and procalcitonin levels were elevated. Antimicrobial agents were initiated, starting with ceftriaxone then upgraded to piperacillin/tazobactam and then the shifted to teicoplanin and meropenem. Blood, urine and stool cultures were negative.VRE positive, IgM Mycoplasma pneumoniae were positive; EBV PCR on bone marrow blood was positive. Malaria screening was negative. The antibiotic therapy was finally switched to doxycycline as unique agent. Steroid therapy (dexamethasone daily 40 mg) and IVIG (daily 35g) were initiated then these drug were stopped. CHOP-like regimen ( Etoposide 75 mg/m2, twice a week for two weeks then once a week until the seventh week) and Rituximab (375 mg/m2, once a week for 4 weeks) were initiated and continued for two weeks. Later on the patient died because of sepsis and multi-organ failure. Conclusions The multidisciplinary approach is very important. Physicians should be aware of HLH, because early recognition may prevent irreversible organ damage and subsequent death.4,5 In adults, HLH-associated mortality remains high, especially in patients with underlying malignancies. Collapsing glomerulopathy is the most commonly reported finding on renal biopsy. Renal prognosis appears to be poor with most patients remaining dialysis-dependent. The increased awareness of HLH, together with a more rapid diagnostic workup and new therapeutic approaches, will improve the prognosis of HLH in adults.

scholarly journals Clinical presentation of scrub typhus during a major outbreak in central Nepal

2017 ◽  
Vol 8 (4) ◽  
pp. 27-31 ◽  
Author(s):  
Arun Sedhain ◽  
Gandhi R. Bhattarai
Keyword(s):  
Acute Kidney Injury ◽  
Scrub Typhus ◽  
Clinical Manifestations ◽  
Kidney Injury ◽  
Continuous Variables ◽  
Neurologic Manifestation ◽  
Igm Elisa ◽  
Clinical Presentations ◽  
Tertiary Teaching ◽  
Major Outbreak

Background: Scrub typhus, an emerging rickettsial disease caused by the organism Orientiatsutsugamushi, is associated with multi-organ involvement. We prospectively studied the clinical manifestations of the disease during a major outbreak in central part of Nepal.Aims and Objective: This study was carried out with an aim to analyze the clinical presentations, laboratory parameters, complications and outcomes of scrub typhus.Materials and Methods: A prospective observational study was conducted in the Department of Medicine in a tertiary teaching hospital. A total of 1398 patients admitted with acute febrile illness were subjected for Scrub Typhus Detect™ IgM ELISA test, among which 502 (35.90%) patients tested positive and were included in the study. Acute kidney injury was defined according to KDIGO guideline. Statistical analysis was done with SAS University Studio package using t-test for continuous variables and chi-square test for categorical variables.Results: Mean age of the patients was 30.37±18.81 years with 26.29% in the pediatric age group (<14 years). Females comprised of 55.98% of the patients. Majority (97.98%) of the patients were seen between July to November. Clinical presentations in the descending order of frequency were anorexia (55.18%), headache (53.39%), lymphadenopathy (15.73%), jaundice (13.35) and eschar (6.57%). Mean scrub typhus IgM ELISA value was 2.17. Leukocytosis was seen in 5.78% and thrombocytopenia in 66.73% of patients. Transaminitis was found in 80.68% of patients. Urinary abnormalities were recorded in 42.3% of patients. Acute kidney injury (AKI) was seen in 35.8% of patients followed by acute respiratory distress syndrome (24.1%), pneumonia (22.1%), shock (14.74%), neurologic manifestation (6.37%) and cardiac manifestations (4.38%). ICU admission was required for 18.73% of patients and 8.57% required ventilator support. Mortality rate was 1.79%.Conclusion: Scrub typhus, being an emerging vector borne infectious disease in Nepalese context, is associated with multiple organ involvement.Asian Journal of Medical Sciences Vol.8(4) 2017 27-31

scholarly journals Acute Kidney Injury in Children with Plasmodium Falciparum Malaria: Determinants for Mortality

2016 ◽  
Vol 36 (2) ◽  
pp. 213-217 ◽  
Author(s):  
Rajniti Prasad ◽  
Om P. Mishra
Keyword(s):  
Acute Kidney Injury ◽  
Falciparum Malaria ◽  
Disseminated Intravascular Coagulation ◽  
Renal Involvement ◽  
Kidney Injury ◽  
Plasmodium Falciparum Malaria ◽  
Peripheral Blood Smear ◽  
Systemic Complications ◽  
Intravascular Coagulation ◽  
Duration Of Illness

Background Acute kidney injury (AKI) in P. falciparum malaria infection is an important morbidity in children. The purpose of the present study was done to observe the renal involvement, associated morbidities and outcome. Methods Out of 156 patients with severe P. falciparum malaria, diagnosed on the basis of compatible clinical presentations and positive malarial parasites in the peripheral blood smear and/or histidine rich protein 2 antigen, 31 had AKI at presentation and were analyzed. Results Of 31 (19.9%) patients with AKI, 4 were classified at risk, 11 injury, and 16 failure stage, as per pRIFLE criteria (pediatric version of RIFLE [R = risk, I = injury, F = failure, L = loss E = end-stage kidney disease]). Mean age of children with AKI was 7.7 ± 3.2 years. A significantly higher proportion of patients with AKI had hypoglycemia (41.9%), pulmonary edema (32.2%), and disseminated intravascular coagulation (DIC) (29.0%) compared to those without AKI (18.4%, 4.8%, and 3.2%, respectively). Twelve patients (38.7%) required peritoneal dialysis (PD), 8 (25.8%) died, and all were in failure stage. The non-survivors had significantly higher blood urea ( p = 0.005) and serum creatinine levels ( p = 0.042), lower glomerular filtration rate ( p < 0.001), longer duration of illness ( p = 0.003), and oliguria/anuria ( p = 0.001) than survivors at admission. On logistic regression analysis, the disseminated intravascular coagulation (DIC), jaundice and parasite density (≥ 3+) were found to be significant factors contributing to mortality in children with AKI. Conclusions Acute kidney injury in falciparum malaria is one of the severe systemic complications. Duration of illness and presence of comorbidities adversely affected the outcome.

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