Acute Renal Failure after Cardiopulmonary Bypass Is Related to Decreased Serum Ferritin Levels

Abstract. Acute renal failure (ARF) requiring dialysis occurs in up to 4% of patients after cardiopulmonary bypass (CPB). CPB leads to the generation of intravascular free hemoglobin, resulting in increased endothelial and renal tubular cell free iron, which is associated with renal injury. Conversely, renoprotection is conferred by processes that upregulate heme and iron sequestration pathways, such as ferritin. This study evaluates the influence of free hemoglobin generation during CPB and the capacity to sequester free iron on the occurrence of post-CPB renal insufficiency. Thirty consecutive patients undergoing CPB were enrolled in the study. Serum creatinine, free hemoglobin, and ferritin were measured preoperatively, at the end of bypass, and 24 and 48 h after surgery. Renal injury, as determined by an increase in the serum creatinine of ≥25% (ARF) by 48 h after surgery, occurred in 40% (12 of 30) of patients, and dialysis was necessary in 6.6% (2 of 30). Free hemoglobin levels increased in all patients but did not correlate with postoperative ARF. However, patients with preoperative serum ferritin levels ≤130 μg/L, the median value for the group, had a sixfold greater likelihood of developing ARF compared to patients with levels above this value (P = 0.03). Lower serum ferritin levels appear to be associated with the development of ARF. Serum ferritin levels may signify intravascular as well as endothelial and renal epithelial cell ability to bind free iron generated during CPB-induced hemolysis, and thus may help provide information regarding the risk for ARF.

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Incidence of Acute Renal Failure in Full Term Neonates with Birth Asphyxia

Birat Journal of Health Sciences ◽

10.3126/bjhs.v4i1.23950 ◽

2019 ◽

Vol 4 (1) ◽

pp. 671-674

Author(s):

Chandra Bhushan Jha ◽

Akhil Tamrakar

Keyword(s):

Renal Failure ◽

Acute Renal Failure ◽

Serum Creatinine ◽

Renal Injury ◽

Urine Output ◽

Birth Asphyxia ◽

Full Term ◽

Acute Renal Injury ◽

Term Neonates ◽

Oliguric Renal Failure

Introduction: Birth asphyxia is an eventuality having far reaching consequences in the neonatal period. Hypoxia and ischemia can cause damage to almost every tissue and organ in the body and various target organs involved. Renal insult is a recognized complication of birth asphyxia and carries a poor prognosis. Timely detection of renal dysfunction and appropriate management may favorably alter the prognosis in many neonates with birth asphyxia. Objective: The present study was done to find out the incidence of acute renal failure in the full term neonates with birth asphyxia. Methodology: A cross sectional study was conducted at Birat Medical College Teaching Hospital, Morang, Nepal from 1st September 2017 to 28th February 2018. Fifty full term neonates born with Apgar score of <6 at 5 minutes and fulfilling inclusion criteria were enrolled in the study. Asphyxiated neonates having Serum creatinine >1.5gm/dl or urine output<1ml/kg/hr were labeled as cases of Acute Renal Failure. Blood sample for serum creatinine was collected at 24hrs, 48 hrs and 72 hrs of life. Results A total of 50 term asphyxiated neonates were enrolled in the present study. Among them 54% and 46% were males and females respectively with male to female ratio of 1.2:1. In the present study 62% of cases developed acute renal failure in either of the first three days of life with mean urine output 1.02±0.27ml/kg/hr and mean serum creatinine of 1.49±0.32 mg/dL. The incidence of oliguric renal failure was 52% and non oliguric renal failure was 48%.The association between serum creatinine and urine output was statistically significant. Conclusion: In the present study birth asphyxia has been an important cause of neonatal acute renal injury, revealing 31 (62%) cases. Monitoring urine output and serum creatinine has helped in detecting the asphyxiated neonates with acute renal injury in the early stage.

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A Healthy Active Duty Soldier with an Elevated Serum Creatinine

Military Medicine ◽

10.1093/milmed/usab163 ◽

2021 ◽

Author(s):

Trevor W Tobin ◽

John S Thurlow ◽

Christina M Yuan

Keyword(s):

Renal Failure ◽

Acute Renal Failure ◽

Serum Creatinine ◽

Renal Injury ◽

Elevated Serum ◽

Active Duty ◽

Medical Problems ◽

Sports Supplements ◽

Elevated Serum Creatinine ◽

Elevated Creatinine

ABSTRACT Creatine products and sports supplements are widely used by active duty soldiers. These products are associated with both acute renal failure and elevated serum creatinine levels without renal injury. We present a case involving an active duty, 26-year-old Caucasian soldier who was evaluated in our clinic for elevated creatinine levels. This patient had no active medical problems and was noted on repeat labs to have significantly elevated creatinine levels. Subsequent investigations led us to conclude these values were not associated with renal injury and were due to ingested supplements.

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Relationship Between Level of Heart Type Fatty Acid Binding Protein (Before and after Procedures) with Acute Renal Failure after PCI in Patients Under PCI

Cardiovascular & Haematological Disorders - Drug Targets ◽

10.2174/1871529x19666190206153012 ◽

2020 ◽

Vol 20 (1) ◽

pp. 41-46

Author(s):

Habib Haybar ◽

Ahmad R. Assareh ◽

Mina Mohammadzadeh ◽

Shahla A. Hovyzian

Keyword(s):

Renal Failure ◽

Acute Renal Failure ◽

Serum Creatinine ◽

Fatty Acid Binding Protein ◽

Coronary Intervention ◽

Good Test ◽

Fatty Acid Binding ◽

Percutaneous Coronary ◽

Before And After ◽

Specific Factors

Background & Objective: Acute renal failure (AKI) is one of the most important complications of PCI. Due to delay in creatinine increase, we need specific factors to detect AKI earlier. The aim of this study is to evaluate the valuable factors by focusing on HFAB-P that can be predictive for AKI after Percutaneous Coronary Intervention (PCI). Methods: This prospective study was performed on 95 patients (55 males and 44 females aged between 49-78 years) under PCI in Golestan and Imam Khomeini hospitals in Ahvaz. Patients were divided into three groups based on the development of AKI after the procedure: no AKI, severe AKI (doubling of serum creatinine or needing dialysis) and any type of AKI (increased creatinine ≥ 0/3 mg/dl or a 50% increase in the means of 1/5 times serum creatinine). The demographic and clinical characteristics of the patients, the medical history and the results of the HFABP marker, GFR, and creatinine before and after PCI were evaluated for all patients. Results: The progenies showed 6 patients with severe AKI, 17 patients with any type of AKI, and 72 patients without AKI. Diabetes (P = 0.003), hypertension (P = 0.027), gender of patients (P = 0.025) and hospital admission days (P <0.001) were significantly different among the groups. Patients' age and positive troponin were significantly higher in patients with AKI. HFABP was the only factor that had significant changes before and after PCI (P <0.001). The cut-off value of HFABP was 4.69 with 95.6% sensitivity and 84.7% specificity. It has a good negative predictive value of 98.39% which suggests it to be a good test for the AKI prediction. Glomerular Filtration Rate (GFR) and creatinine (Cr) were significantly different after PCI (P <0.001). Conclusion: HFABP can be considered as a predictor for AKI after PCI. Moreover, our study suggests that evaluating several parameters such as Cr and GFR before and after PCI can predict the AKI development after PCI.

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Induction of heme oxygenase-1 in toxic renal injury: mercuric chloride-induced acute renal failure in rat

Toxicology Letters ◽

10.1016/s0378-4274(97)00103-3 ◽

1998 ◽

Vol 94 (1) ◽

pp. 57-64 ◽

Cited By ~ 14

Author(s):

Saburo Horikawa ◽

Koji Ito ◽

Satoru Ikeda ◽

Toshikazu Shibata ◽

Shino Ishizuka ◽

...

Keyword(s):

Renal Failure ◽

Acute Renal Failure ◽

Heme Oxygenase ◽

Mercuric Chloride ◽

Renal Injury ◽

Heme Oxygenase 1

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Frequency of factors leading to acute renal failure in obstetric patients.

The Professional Medical Journal ◽

10.29309/tpmj/2021.28.06.4204 ◽

2021 ◽

Vol 28 (05) ◽

pp. 640-646

Author(s):

Shaheena Zafar ◽

Riffat Jaleeel ◽

Kouser Karim Lodhani

Keyword(s):

Renal Failure ◽

Acute Renal Failure ◽

Serum Creatinine ◽

Placental Abruption ◽

Post Partum ◽

Common Factor ◽

Tertiary Care ◽

Cross Sectional Study ◽

Care Hospital ◽

Cross Sectional

Objective: To determine the frequency of factors leading to acute renal failure in obstetric patients. Study Design: Cross Sectional study. Setting: Department of Obstetrics and Gynecology, Civil Hospital Karachi, Tertiary Care Hospital. Period: July 2015- Jan 2016. Material & Methods: Total 250 women during pregnancy and within 42 days after delivery who were diagnosed as ARF were included. Serum creatinine was done on admission and then after 24 hours of delievery. Those with urine output < 30ml / hour and serum creatinine > 1.5 mg / dl were recruited. All data was recorded on proforma. Results: The average age of the women was 29.36±5.87 years. Post-partum hemorrhage was the important and common factor i.e. 40.4%, followed by placental abruption 25.6%, Severe pre-eclampsia 18.4%, puerperal sepsis 8.4% and eclampsia 7.2%. Conclusion: Ante partum hemorrhage like placental abruption, eclampsia and preeclampsia, and postpartum hemorrhages’ are the major causes of obstetrical ARF. Good antenatal care and provision of universal health facility can prevent this dangerous condition. Though it is a treatable and curable complication, but if not diagnosed and treated timely, it can lead to significant maternal morbidity and mortality.

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Pre-operative and peri operative predictors of acute renal failure after cardiac surgery

International Journal of Advances in Medicine ◽

10.18203/2349-3933.ijam20192112 ◽

2019 ◽

Vol 6 (3) ◽

pp. 756

Author(s):

Praveen Dhaulta ◽

Vikas Panwar

Keyword(s):

Renal Failure ◽

Acute Renal Failure ◽

Cardiac Surgery ◽

Cardiopulmonary Bypass ◽

Ejection Fraction ◽

Heart Surgery ◽

Open Heart Surgery ◽

Clinical Variable ◽

Open Heart ◽

Multiple Variables

Background: Acute kidney injury (AKI) is one of the most serious complications during the postoperative period of cardiac surgery. Multiple variables predict the ARF after cardiac surgery. Objective of this study was to evaluate the significance of pre and peri-operative variables which may help in predicting the chances of developing ARF after cardiac surgery.Methods: This study was an observational, prospective study conducted among patients who were scheduled to undergo open heart surgery under cardiopulmonary bypass.Results: In total, 50 patients who underwent open-heart surgery, ARF was seen in 5 patients, with the incidence rate of 10%. Acute renal failure was present in one patient with ejection fraction <35, 2 patients had ejection fraction between 35 to 50 and 2 patients with ejection fraction >50. It was seen in 4 patients with 1-2 hrs of cardiopulmonary bypass and in 1 patient with >2 hrs of cardiopulmonary bypass. ARF was also seen in 4 patients with hematocrit between 22-26% and in 1 patient with >26%.Conclusions: The study provided a clinical variable score that can predict ARF after open-heart surgery. The score enhances the accuracy of prediction by accounting for the effect of all major risk factors of ARF.

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Delayed onset of acute renal failure after significant paracetamol overdose: A case series

Human & Experimental Toxicology ◽

10.1177/0960327109350799 ◽

2009 ◽

Vol 29 (1) ◽

pp. 63-68 ◽

Cited By ~ 29

Author(s):

WS Waring ◽

H. Jamie ◽

GE Leggett

Keyword(s):

Renal Failure ◽

Acute Renal Failure ◽

Serum Creatinine ◽

Alanine Aminotransferase ◽

Paracetamol Overdose ◽

Peak Serum ◽

Wilcoxon Test ◽

Aminotransferase Activity ◽

Baseline Serum ◽

Alanine Aminotransferase Activity

Acute renal failure is a recognized manifestation of paracetamol toxicity, but comparatively little data is available concerning its onset and duration. The present study sought to characterize the time course of rising serum creatinine concentrations in paracetamol nephrotoxicity. Renal failure was defined by serum creatinine concentration ≥150 μmol/L (1.69 mg/dL) or ≥50% increase from baseline. Serum creatinine concentrations and alanine aminotransferase activity were considered with respect to the interval after paracetamol ingestion. There were 2068 patients with paracetamol overdose between March 2005 and October 2007, and paracetamol nephrotoxicity occurred in 8 (0.4%). All had significant hepatotoxicity, and peak serum alanine aminotransferase activity occurred at 2.5 days (2.2 to 2.9 days) after ingestion. Peak serum creatinine concentrations did not occur until 5.5 days (4.4 to 5.9 days) after ingestion (p = .031 by Wilcoxon test). Serum creatinine concentrations slowly restored to normal, and renal replacement was not required. In this patient series, rising serum creatinine concentrations only became detectable after more than 48 hours after paracetamol ingestion. Therefore, renal failure might easily be missed if patients are discharged home before this. Further work is required to establish the prevalence of paracetamol-induced nephrotoxicity, and its clinical significance.

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Prognostic Factors in Neonatal Acute Renal Failure

PEDIATRICS ◽

10.1542/peds.74.2.265 ◽

1984 ◽

Vol 74 (2) ◽

pp. 265-272

Author(s):

Robert L. Chevalier ◽

Fern Campbell ◽

A. Norman A. G. Brenbridge

Keyword(s):

Renal Failure ◽

Acute Renal Failure ◽

Serum Creatinine ◽

Perinatal Asphyxia ◽

Urine Flow ◽

Peak Serum ◽

Serum Creatinine Concentration ◽

Creatinine Concentration ◽

Renal Anomalies ◽

Renal Uptake

Sixteen infants, 2 to 35 days of age, had acute renal failure, a diagnosis based on serum creatinine concentrations > 1.5 mg/dL for at least 24 hours. Eight infants were oliguric (urine flow < 1.0 mL/kg/h) whereas the remainder were nonoliguric. To determine clinical parameters useful in prognosis, urine flow rate, duration of anuria, peak serum creatinine, urea (BUN) concentration, and nuclide uptake by scintigraphy were correlated with recovery. Nine infants had acute renal failure secondary to perinatal asphyxia, three had acute renal failure as a result of congenital cardiovascular disease, and four had major renal anomalies. Four oliguric patients died: three of renal failure and one of heart failure. All nonoliguric infants survived with mean follow-up serum creatinine concentration of 0.8 ± 0.5 (SD) mg/dL whereas that of oliguric survivors was 0.6 ± 0.3 mg/dL. Peak serum creatinine concentration did not differ between those patients who were dying and those recovering. All infants who were dying remained anuric at least four days and revealed no renal uptake of nuclide. Eleven survivors were anuric three days or less, and renal perfusion was detectable by scintigraphy in each case. However, the remaining survivor (with bilateral renal vein thrombosis) recovered after 15 days of anuria despite nonvisualization of kidneys by scintigraphy. In neonates with ischemic acute renal failure, lack of oliguria and the presence of identifiable renal uptake of nuclide suggest a favorable prognosis.

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Cardiopulmonary bypass management and acute renal failure: risk factors and prognosis

Perfusion ◽

10.1177/0267659109105251 ◽

2008 ◽

Vol 23 (6) ◽

pp. 323-327 ◽

Cited By ~ 43

Author(s):

E Sirvinskas ◽

J Andrejaitiene ◽

L Raliene ◽

L Nasvytis ◽

A Karbonskiene ◽

...

Keyword(s):

Risk Factors ◽

Renal Failure ◽

Acute Renal Failure ◽

Cardiac Surgery ◽

Cardiopulmonary Bypass ◽

Urine Output ◽

Perfusion Pressure ◽

Venous Pressure ◽

Lung Ventilation ◽

Early Postoperative Period

The aim of the study was to investigate if acute renal failure (ARF) following cardiac surgery is influenced by CPB perfusion pressure and to determine risk factors of ARF. Our research consisted of two studies. In the first study, 179 adult patients with normal preoperative renal function who had been subjected to cardiac surgery on CPB were randomized into three groups. The mean perfusion pressure (PP) during CPB in Group 65 (68 patients) was 60–69.9 mmHg, in Group 55 (59 patients) – lower than 60 mmHg and in Group 75 (52 patients) – 70 mmHg and higher. We have analyzed postoperative variables: central venous pressure, the need for diuretics, urine output, fluid balance, acidosis, potassium level in blood serum, the need for hemotransfusions, nephrological, cardiovascular and respiratory complications, duration of artificial lung ventilation, duration of stay in ICU and in hospital, and mortality. In the second study, to identify the risk factors for the development of ARF following CPB, we retrospectively analysed data of all 179 patients, divided into two groups: patients who developed ARF after surgery (group with ARF, n = 19) and patients without ARF (group without ARF, n = 160). We found that urine output during surgery was statistically significantly lower in Group 55 than in Groups 65 and 75. The incidence of ARF in the early postoperative period did not differ among the groups: it developed in 6% of all patients in Group 65, 4% in Group 55 and 6% in Group 75. There were no differences in the rate of other complications (cardiovascular, respiratory, neurological disorders, bleeding, etc) among the groups. There were 19 cases of ARF (10.6%), but none of these patients needed dialysis. We found that age (70.0 ± 7.51 vs. 63.5 ± 10.54 [standard deviation, SD], P = 0.016), valve replacement and/or reconstruction surgery (57.9% vs. 27.2%, P = 0,011), combined valve and CABG surgery (15.8% vs. 1.4%, P = 0.004), duration of CPB (134.74 ± 62.02 vs. 100.59 ± 43.99 min., P = 0.003) and duration of aortic cross-clamp (75.11 ± 35.78 vs. 53.45 ± 24.19 min., P = 0.001) were the most important independent risk factors for ARF. Cardiopulmonary bypass perfusion pressure did not cause postoperative renal failure. The age of patient, valve surgery procedures, duration of cardiopulmonary bypass and duration of aorta cross-clamp are potential causative factors for acute renal failure after cardiac surgery.

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