scholarly journals Expanding the pool of kidney donors: use of kidneys with acute renal dysfunction

2015 ◽  
Vol 13 (2) ◽  
pp. 319-325 ◽  
Author(s):  
Ana Cristina Carvalho de Matos ◽  
Lúcio Roberto Requião-Moura ◽  
Gabriela Clarizia ◽  
Marcelino de Souza Durão Junior ◽  
Eduardo José Tonato ◽  
...  
Keyword(s):  
Renal Failure ◽  
Acute Renal Failure ◽  
Renal Dysfunction ◽  
Patient Survival ◽  
Machine Perfusion ◽  
Acute Renal Dysfunction ◽  
Morphological Findings ◽  
History Of ◽  
Expanded Criteria ◽  
Support Decision Making

ABSTRACT Given the shortage of organs transplantation, some strategies have been adopted by the transplant community to increase the supply of organs. One strategy is the use of expanded criteria for donors, that is, donors aged >60 years or 50 and 59 years, and meeting two or more of the following criteria: history of hypertension, terminal serum creatinine >1.5mg/dL, and stroke as the donor´s cause of death. In this review, emphasis was placed on the use of donors with acute renal failure, a condition considered by many as a contraindication for organ acceptance and therefore one of the main causes for kidney discard. Since these are well-selected donors and with no chronic diseases, such as hypertension, renal disease, or diabetes, many studies showed that the use of donors with acute renal failure should be encouraged, because, in general, acute renal dysfunction is reversible. Although most studies demonstrated these grafts have more delayed function, the results of graft and patient survival after transplant are very similar to those with the use of standard donors. Clinical and morphological findings of donors, the use of machine perfusion, and analysis of its parameters, especially intrarenal resistance, are important tools to support decision-making when considering the supply of organs with renal dysfunction.

Contrast-induced nephropathy (Pharmacology of X-ray contrast agents)

2016 ◽  
Vol 7 (1) ◽  
pp. 97-105 ◽  
Author(s):  
Vladislava A Raptanova ◽  
Alexandra A Speranskaya ◽  
Sergei N Proshin
Keyword(s):  
Renal Failure ◽  
Acute Renal Failure ◽  
Serum Creatinine ◽  
Renal Dysfunction ◽  
Urine Volume ◽  
Contrast Induced Nephropathy ◽  
Acute Renal Dysfunction ◽  
X Ray ◽  
Sustained Reduction ◽  
Nephrotoxic Drugs

In the last 30 years the use of X-ray contrast media (RCM) has increased significantly during urography, angiography, computed tomography, and operating procedures. Every year the world uses about 60 million doses of PKM, but, despite the use of newer and less nephrotoxic drugs, the risk of contrast-induced nephropathy (CIN) is still significant, especially among patients with prior renal impairment. Contrast induced nephropathy is a major cause of acute renal injury and is a huge problema in clinical practice. So far, con-tradictions remain in the understanding of many aspects of CIN. Contrast-induced nephropathy is acute renal failure (ARF) occurs within 48-72 hours after intravenous administration of contrast sub-stances. Toxicity PKC determined their molecular structure and its ability to dissociate in aqueous solution into ions which consist of salts which dissociate into cations and anions. The contrast-induced nephropathy is manifested in the increase of serum creatinine of 44 mmol/L (0.5 mg / dl) or more and the same rise in serum creatinine of more than 25 % compared to baseline in the absence of other possible causes. ARF is a sudden and sustained reduction in glomerular filtration rate and urine volume, or both together. Thus renal dysfunction existing even more than 1 month can be regarded as acute renal dysfunction. Usually the development of acute renal failure occurs within 1-7 days. The criteria of sustainability is a dysfunction of its registration within 24 hours or more. The aim: to consider different approaches to the pathogenesis, risk factors and achievements in the prevention of contrast-induced nephropathy.

Oestrogen protects against ischaemic acute renal failure in rats by suppressing renal endothelin-1 overproduction

2002 ◽  
Vol 103 (s2002) ◽  
pp. 434S-437S ◽  
Author(s):  
Masanori TAKAOKA ◽  
Mikihiro YUBA ◽  
Toshihide FUJII ◽  
Mamoru OHKITA ◽  
Yasuo MATSUMURA
Keyword(s):  
Renal Failure ◽  
Renal Function ◽  
Acute Renal Failure ◽  
Renal Dysfunction ◽  
Tissue Injury ◽  
Male Rats ◽  
Left Renal Artery ◽  
Protective Effects ◽  
Endothelin 1 ◽  
Ischaemia Reperfusion

We investigated whether the treatment with 17β-oestradiol has renal protective effects in male rats with ischaemic acute renal failure (ARF). We also examined if the effect of 17β-oestradiol is accompanied by suppression of enhanced endothelin-1 production in postischaemic kidneys. Ischaemic ARF was induced by clamping the left renal artery and vein for 45min followed by reperfusion, 2 weeks after contralateral nephrectomy. Renal function parameters such as blood urea nitrogen, plasma creatinine and creatinine clearance were measured to test the effectiveness of the steroid hormone. Renal function in ARF rats markedly decreased 24h after reperfusion. The ischaemia/reperfusion-induced renal dysfunction was dose-dependently improved by pretreatment with 17β-oestradiol (20 or 100µg/kg, intravenously). Histopathological examination of the kidney of untreated ARF rats revealed severe lesions, such as tubular necrosis, proteinaceous casts in tubuli and medullary congestion, all of which were markedly improved by the higher dose of 17β-oestradiol. In addition, endothelin-1 content in the kidney after the ischaemia/reperfusion increased significantly by approx. 2-fold over sham-operated rats, and this elevation was dose-dependently suppressed by the 17β-oestradiol treatment. These results suggest that oestrogen exhibits protective effects against renal dysfunction and tissue injury induced by ischaemia/reperfusion, possibly through the suppression of endothelin-1 overproduction in postischaemic kidneys.

scholarly journals Ascites, a New Cause for Bilateral Hydronephrosis: Case Report

2009 ◽  
Vol 9 ◽  
pp. 1035-1039 ◽  
Author(s):  
Deepika Jain ◽  
Smrita Dorairajan ◽  
Madhukar Misra
Keyword(s):  
Renal Failure ◽  
Renal Function ◽  
Acute Renal Failure ◽  
Liver Cirrhosis ◽  
Case Report ◽  
Abdominal Ultrasound ◽  
Back Pressure ◽  
Alcoholic Liver Cirrhosis ◽  
Bilateral Hydronephrosis ◽  
History Of

Bilateral hydronephrosis secondary to urinary obstruction leads to a buildup of back pressure in the urinary tract and may lead to impairment of renal function. We present a case of a 57-year-old male with a history of alcoholic liver cirrhosis, who presented with tense ascites and acute renal failure. Bilateral hydronephrosis was seen on abdominal ultrasound. Multiple large-volume paracenteses resulted in resolution of hydronephrosis and prompt improvement in renal function.

Risk of acute renal failure among breast cancer patients and chemotherapy treatment of breast cancer patients with a history of renal insufficiency in a commercially-insured population in the United States

2009 ◽  
Vol 27 (15_suppl) ◽  
pp. e22104-e22104 ◽  
Author(s):  
W. J. Langeberg ◽  
C. D. O'Malley ◽  
C. W. Critchlow ◽  
J. P. Fryzek
Keyword(s):  
Breast Cancer ◽  
Renal Failure ◽  
Acute Renal Failure ◽  
Renal Insufficiency ◽  
Cancer Patients ◽  
Cancer Diagnosis ◽  
The United States ◽  
First Year ◽  
Breast Cancer Patients ◽  
History Of

e22104 Background: Risk of acute renal failure (ARF) among breast cancer (BC) patients may increase with nephrotoxic chemotherapy and other exposures, but this risk is not well characterized. Furthermore, among patients who present with renal insufficiencies (RI) at cancer diagnosis, subsequent treatment patterns are not well described. Methods: We performed a retrospective cohort study using a large national commercial claims database. The cohort included all women diagnosed with BC from 2000 to 2007 who were 18–64 years at diagnosis with no history of cancer (n=13,296). We defined a diagnosis of BC as at least one inpatient or two outpatient claims more than 30 days apart with an ICD-9 code of 174. Among patients with no history of RI (n=13,150), we calculated the cumulative incidence (CI) of ARF_the proportion with at least one inpatient or two outpatient claims with an ICD-9 code of 584 or 586 in the first year following cancer diagnosis. Treatment for BC patients with a history of RI (n=146) was also assessed. Results: Among BC patients with no history of RI, 0.3% were diagnosed with ARF within a year after cancer diagnosis. The CI of ARF was higher in patients with metastases: 0.7% for any metastasis, 2.3% for bone metastasis, and 0.1% for no metastasis. The CI of ARF among patients undergoing radiation or mastectomy was similar to the overall rate (0.3%) but was higher in patients receiving nephrotoxic chemotherapy (1.0%) or intravenous bisphosphonates (IV BPs) (2.1%). The CI of ARF was higher in patients with congestive heart failure (1.4%), diabetes (0.9%), and/or hypertension (0.8%) at cancer diagnosis compared to patients without these comorbidities (0.2%). Among BC patients with a history of RI, 7.5% were administered nephrotoxic chemotherapy, 30.1% received potentially nephrotoxic chemotherapy, and 1.4% were given IV BPs. Conclusions: Breast cancer patients who present with comorbidities, develop metastases, or are given nephrotoxic chemotherapy or IV bisphosphonates are at higher risk of acute renal failure in the first year after breast cancer diagnosis. More research is warranted on the treatment of breast cancer patients with a history of renal insufficiency. [Table: see text]

scholarly journals A Rare Case of Acute Renal Failure Secondary to Rhabdomyolysis Probably Induced by Donepezil

2014 ◽  
Vol 2014 ◽  
pp. 1-3
Author(s):  
Osman Zikrullah Sahin ◽  
Teslime Ayaz ◽  
Suleyman Yuce ◽  
Fatih Sumer ◽  
Serap Baydur Sahin
Keyword(s):  
Emergency Department ◽  
Renal Failure ◽  
Creatine Kinase ◽  
Acute Renal Failure ◽  
Rare Case ◽  
Laboratory Studies ◽  
Case Presentation ◽  
History Of ◽  
One Year ◽  
Renal Function Tests

Introduction. Acute renal failure (ARF) develops in 33% of the patients with rhabdomyolysis. The main etiologic factors are alcoholism, trauma, exercise overexertion, and drugs. In this report we present a rare case of ARF secondary to probably donepezil-induced rhabdomyolysis.Case Presentation. An 84-year-old male patient was admitted to the emergency department with a complaint of generalized weakness and reduced consciousness for two days. He had a history of Alzheimer’s disease for one year and he had taken donepezil 5 mg daily for two months. The patient’s physical examination revealed apathy, loss of cooperation, and decreased muscle strength. Laboratory studies revealed the following: urea: 128 mg/dL; Creatinine 6.06 mg/dL; creatine kinase: 3613 mg/dL. Donepezil was discontinued and the patient’s renal function tests improved gradually.Conclusion. Rhabdomyolysis-induced acute renal failure may develop secondary to donepezil therapy.

scholarly journals Acute Renal Failure During a Trial of Spinal Cord Stimulation: Theories as to a Possible Connection

2008 ◽  
Vol 3;11 (5;3) ◽  
pp. 681-686
Author(s):  
Thomas M. Larkin
Keyword(s):  
Spinal Cord ◽  
Renal Failure ◽  
Acute Renal Failure ◽  
Spinal Cord Stimulation ◽  
Clinical Presentation ◽  
Urinary Catheter ◽  
Spinal Cord Stimulator ◽  
Secondary Effects ◽  
First Case ◽  
History Of

Objective: This is the first case describing an episode of acute renal failure occurring during a spinal cord stimulation trial. Clinical Presentation: A 48-year-old male with a history of hypertension and 3 prior failed spine surgeries underwent a trial of spinal cord stimulation for uncontrolled bilateral lower extremity neuropathic pain. Two days after the placement of the percutaneous stimulator lead the patient returned complaining of 3 syncopal episodes. He was found to be hypotensive and in acute renal failure with a creatinine of 8.1 and a BUN of 83. Intervention: The stimulator lead was immediately removed. The patient was admitted to the intensive care unit and responded promptly to rehydration and placement of a urinary catheter. His renal and urological work-ups revealed no significant abnormalities. Conclusion: The development of the episode of acute renal failure may have been influenced by the secondary effects of spinal cord stimulation. Since acute renal failure has never been associated with the use of spinal cord stimulation, this singular example does not by itself demonstrate a relationship. However, if future episodes are seen, a link between the 2 events could be drawn. For now, it is not clear if the development of this patient’s acute renal failure could, in part, be attributed to the use of the spinal cord stimulator or if it was merely coincidental in nature. We do feel it is useful for the clinician to understand the pathophysiologic changes associated with spinal cord stimulation and to see how, at least in theory, there could be a connection. Key words: acute renal failure, spinal cord stimulation

scholarly journals P. falciparum Malaria induced Renal impairment

2019 ◽  
Vol 5 (6) ◽  
pp. 220-223
Author(s):  
Tarkeswar Aich ◽  
Keyword(s):  
Renal Failure ◽  
Acute Renal Failure ◽  
Serum Creatinine ◽  
Renal Dysfunction ◽  
Falciparum Malaria ◽  
Acute Tubular Necrosis ◽  
Mean Value ◽  
Intravascular Haemolysis ◽  
Tubular Necrosis ◽  
Oliguric Renal Failure

Introduction: The involvement of the kidney in falciparum malaria has been known for decades. In 1944, Spitz observed acute renal failure due to falciparum infection in soldiers during World War II. This observation was later supported by other workers who detected oliguria developing in patients with black water fever. The initial clinical pattern is that of reversible renal dysfunction or pre-renal azotemia, which rapidly progresses to acute tubular necrosis if treatment is not started early. Patients with malaria induced renal failure are hypercatabolic with blood urea and serum creatinine levels rising rapidly.Oliguric as well non-oliguric renal failure are observed and duration of oliguric renal failure ranges from a few days to several weeks depending on the severity of renal dysfunction. Acute renal failure in falciparum malaria is usually associated either with acute intravascular haemolysis or heavy parasitemia. Acute renal failure in falciparum malaria is also observed in patients with severe intravascular haemolysis resulting in haemoglobinuria. It may be induced by malarial fever or by anti-malarial drugs in a patient with or without G6-PD deficiency. Materials and Methods: This is a hospital based cross sectional study carried out in a total of 50 cases of acute renal failure who were selected from diagnosed patients of P. falciparum malaria. Cases were confirmed either by P. falciparum antigen test and/or peripheral blood smear test(both thick and thin smear).Malarial ARF (MARF) is diagnosed when serum creatinine level > 3 mg/dl, and/or urine output < 400 ml/24hrs despite adequate rehydration. Result: Out of 174 cases of falciparum malaria 50 patients (28.7%) had acute renal failure in falciparum malaria. 36 (72%) cases were males and 14 (28%) were females, indicating a much higher incidence in males. Approximately 78% of the cases in the present study were below the age of 40 years. The youngest was 15 years old and the oldest was 61 years old (Mean age – 32 ± 11.6 years). All were febrile (100%) and a majority had oliguria or anuria (72%); jaundice was detected in 30 (60%) patients on presentation. Hepatomegaly & Splenomegaly were found in 76% & 66% of the cases respectively. Out of the total 50 cases of malaria induced ARF, 14 cases (28%) had pre-renal ARF while in the majority, 72% the clinical course was that of ATN. The pathogenesis of ATN in the 36 cases was found to be heavy parasitaemia in 40% of the cases, IV hemolysis with haemoglobinuria in 3 (6%) of cases; and cholestatic jaundice in 26% of falciparum patients. Examination of the urinary sediments revealed that albumin was present in urine in 40 cases (80%). Majority of the patients had significant rise in blood urea level with a mean value of 177 mg. S. creatinine levels ranged between 3.2 - 13.6 mg with a mean value of 7.83 mg. The mean creatinine clearance rate was 11.71 ml/min. The overall mortality rate was 26%. Conclusion: AKI is common in Falciparum malaria. The pathogenesis of AKI is largely unknown but may be related to the erythrocyte sequestration and agglutination within the renal microcirculation interfering with flow and metabolism. Clinically and pathologically, this syndrome manifests as Pre-renal azotemia and acute tubular necrosis. Acute renal failure may occur simultaneously with other vital-organ dysfunction (in which case the mortality risk is high) or may progress as other disease manifestations resolve. Early dialysis or hemofiltration considerably enhances the likelihood of a patient’s survival, particularly in acute hypercatabolic renal failure. Severity of oliguria and presence of one or more associated complications like pulmonary oedema, acidosis, and altered sensorium have considerable influence on the outcome of the patients.

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