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.

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.

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.

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

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.

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.

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

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.

CONSERVATIVE MANAGEMENT OF ACUTE RENAL FAILURE

PEDIATRICS ◽  
1960 ◽  
Vol 25 (3) ◽  
pp. 409-418
Author(s):  
S. A. Kaplan ◽  
J. Strauss ◽  
A. M. Yuceoglu
Keyword(s):  
Renal Failure ◽  
Acute Renal Failure ◽  
Fluid Intake ◽  
Sodium Intake ◽  
Caloric Intake ◽  
Urine Volume ◽  
Proximal Tubules ◽  
Cation Exchange Resins ◽  
Exchange Resins ◽  
Insensible Loss

The observations during treatment of three children with acute renal failure by a conservative regimen of therapy are presented. One patient died. The regimen has also been applied to six adults with renal failure; one died. The urine in the early stages of renal failure may be iso-osmotic with plasma and may represent unmodified fluid from the proximal tubules. Cardiac failure associated with hyperkalemia or administration of excessive quantities of fluids is the most frequent cause of death in this disorder. A regimen of therapy is described which embodies the following principles: a) Limitation of daily fluid intake to insensible loss plus the urine volume of the previous day. b) Restriction of sodium intake from the beginning to anticipate the development of acidosis. c) Use of cation exchange resins to prevent excessive increase in the concentration of potassium in the serum. d) Provision of adequate caloric intake through the administration of emulsified fat intravenously. e) Treatment of hyperphosphatemia and hypocalcemia when they occur. f) Continuation of careful supervision and therapy, even after the diuretic phase begins, since renal function continues to be severely restricted for several days afterwards.

Xanthine lithiasis, nephrocalcinosis, and renal failure in a leukemia patient treated with allopurinol.

1987 ◽  
Vol 33 (12) ◽  
pp. 2314-2316 ◽  
Author(s):  
J L Potter ◽  
A A Silvidi
Keyword(s):  
Renal Failure ◽  
Acute Renal Failure ◽  
Tumor Cell ◽  
Lymphoblastic Leukemia ◽  
Obstructive Uropathy ◽  
X Ray Diffraction ◽  
X Ray ◽  
Leukemia Patient ◽  
Similar Episode ◽  
Tumor Cell Lysis

Abstract An 11-year-old boy who presented in acute renal failure with significant increases of uric acid and phosphorus in his serum was discovered to have acute lymphoblastic leukemia. Five years later, he had a second and similar episode of acute renal failure, which was responsive to hemodialysis. After three months of daily therapy with allopurinol, a third and final episode of renal failure was unresponsive to peritoneal dialysis. Autopsy revealed an obstructive uropathy; focal nephrocalcinosis; and multiple, small, tan calculi in the calyces of both kidneys. Systemic cryptococcosis was also discovered. The stones, characterized by paper chromatography, electrophoresis, x-ray diffraction, and infrared spectroscopy, were 82% xanthine, 15% oxypurinol, and 3% hypoxanthine. We suggest that attention to the effects of accelerated tumor-cell lysis may protect renal function in patients with a large and drug-sensitive tumor cell load. Similarly, early detection of the fungal complications of leukemic therapy is an essential component of the treatment program.

scholarly journals Risk factors for death among critically ill patients with acute renal failure

2006 ◽  
Vol 124 (5) ◽  
pp. 257-263 ◽  
Author(s):  
Geraldo Bezerra da Silva Júnior ◽  
Elizabeth De Francesco Daher ◽  
Rosa Maria Salani Mota ◽  
Francisco Albano Menezes
Keyword(s):  
Risk Factors ◽  
Blood Pressure ◽  
Mechanical Ventilation ◽  
Renal Failure ◽  
Acute Renal Failure ◽  
Intensive Care ◽  
Liver Failure ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Urine Volume

CONTEXT AND OBJECTIVE: Acute renal failure is a common medical problem, with a high mortality rate. The aim of this work was to investigate the risk factors for death among critically ill patients with acute renal failure. DESIGN AND SETTING: Retrospective cohort at the intensive care unit of Hospital Universitário Walter Cantídio, Fortaleza. METHODS: Survivors and non-survivors were compared. Univariate and multivariate analyses were performed to establish risk factors for death. RESULTS: Acute renal failure occurred in 128 patients (33.5%), with mean age of 49 ± 20 years (79 males; 62%). Death occurred in 80 (62.5%). The risk factors most frequently associated with death were hypotension, sepsis, nephrotoxic drug use, respiratory insufficiency, liver failure, hypovolemia, septic shock, multiple organ dysfunction, need for vasoactive drugs, need for mechanical ventilation, oliguria, hypoalbuminemia, metabolic acidosis and anemia. There were negative correlations between death and: prothrombin time, hematocrit, hemoglobin, systolic blood pressure, diastolic blood pressure, arterial pH, arterial bicarbonate and urine volume. From multivariate analysis, the independent risk factors for death were: need for mechanical ventilation (OR = 3.15; p = 0.03), hypotension (OR = 3.48; p = 0.02), liver failure (OR = 5.37; p = 0.02), low arterial bicarbonate (OR = 0.85; p = 0.005), oliguria (OR = 3.36; p = 0.009), vasopressor use (OR = 4.83; p = 0.004) and sepsis (OR = 6.14; p = 0.003). CONCLUSIONS: There are significant risk factors for death among patients with acute renal failure in intensive care units, which need to be identified at an early stage for early treatment.

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

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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