scholarly journals Acute kidney injury requiring dialysis in obstetric patients: management and clinical outcome in case series of 30 patients in a tertiary care centre

2017 ◽  
Vol 6 (7) ◽  
pp. 2997
Author(s):  
Molina U. Patel ◽  
Yuvraj Jadeja ◽  
Niket Patel ◽  
Nayana Patel ◽  
Smruti Vaishnav ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Tertiary Care ◽  
Case Series ◽  
Kidney Injury ◽  
Therapeutic Interventions ◽  
Risk Category ◽  
Care Hospital ◽  
Tertiary Care Centre ◽  
Significant Difference ◽  
The Impact

Background: Acute Kidney Injury is a common medical problem affecting approximately 5% of all hospitalized and 30% of critically ill patients. The incidence in obstetric patients ranges from 1 in 2000 to 1 in 25000 pregnancies. In India till date, the impact of AKI on fetomaternal outcome and pertaining therapeutic interventions is only sparsely studied.Methods: It is a retrospective cross-sectional study. All obstetric patients with AKI on dialysis, admitted to Shree Krishna Hospital, a tertiary care hospital in Karamsad village in Gujarat from January 2013 to August 2015. Multivariate statistical analysis of clinical and laboratory parameters was performed using SPSS program to obtain the results.Results: The incidence of dialysis was 1.6%. HELLP syndrome and pre-eclampsia (80%) was found to be the most common etiology of AKI followed by Congestive cardiac failure (34.5%), hemorrhage and sepsis in 30% resp. All patients were admitted to ICU care. No significant difference was found between SAP II and SOFA monitoring system. Mechanical ventilation was done to support 53.3% and inotropic support was needed by 56.7% patients. According to the RIFLE criteria, majority of the patients fall under risk category followed by injury. 18% of the patients developed End Stage Renal Disease.Conclusions: In view of the multifaceted etiologies and complexity of management of AKI, a multi-disciplinary approach involving nephrologist, intensivists, obstetricians and neonatologists is extremely important.

scholarly journals Pattern of acute kidney injury and its outcome in a tertiary care centre

2020 ◽  
Vol 8 (2) ◽  
pp. 618
Author(s):  
Jennie Santhanam ◽  
Meenakshi Sundari Subramaniyan Natarajan ◽  
Annam Lakshmanan ◽  
Rajeswari K. Balakrishnan
Keyword(s):  
Acute Kidney Injury ◽  
Kidney Disease ◽  
Serum Creatinine ◽  
Tertiary Care ◽  
Kidney Injury ◽  
Risk Category ◽  
Care Hospital ◽  
Tertiary Care Centre ◽  
Disease Category ◽  
The Mean

Background: Acute kidney injury is a multiplex disease with severe morbidity and mortality. The trends of acute kidney injury vary according to the regions and the population under study. The aim of this study is to evaluate the trends of acute kidney injury and its outcome in a tertiary care hospital.Methods: The study was a prospective observational study conducted at a tertiary care hospital in a metropolitan city. A total of 102 patients of acute kidney injury were selected based on the Kidney Disease Improving Global Outcomes guidelines of acute kidney injury. The main trends of acute kidney injury presentation and its outcome were assessed.Results: Of 102 patients admitted, 42 had a sepsis related diagnosis (42.41%), 17 patients (17.16%) had cardiovascular disease related acute kidney injury and 12 patients (12.12%) had developed acute kidney injury due to drugs and poisons. According to RIFLE (risk of renal failure, injury to kidney, failure and loss of function and end-stage kidney disease) category, 43.96% of patients belonged to the risk category and 30.77% to the injury category. Of 34 patients in failure category, 23 recovered and 11 did not recover. Authors compared the trends of acute kidney injury in patients who recovered and who deteriorated. The mean serum creatinine values were 3.42 mg/dl in patients who didn’t recover from acute kidney injury and 2.05 mg/dl in patients who recovered. In patients of the recovered group, the mean urine output value is 783 ml/day; in deterioration group, 445 ml/day.Conclusions: Most common etiologies of acute kidney injury in this study include sepsis, drugs and poisons, cardiovascular diseases and diarrheal diseases in order of occurrence. High serum creatinine at admission and oliguria were the most common factors that contributed to deterioration in acute kidney injury.

scholarly journals HEARING LOSS IN BLAST TRAUMA VICTIMS. A MULTICENTRE RETROSPECTIVE STUDY

2021 ◽  
Vol 71 (Suppl-1) ◽  
pp. S130-35
Author(s):  
Kamran Ashfaq Ahmed Butt ◽  
Naeem Riaz Bhalli ◽  
Wasif Siddique ◽  
Attique Ahmed ◽  
Maryam Khan ◽  
...  
Keyword(s):  
Hearing Loss ◽  
Tertiary Care ◽  
Case Series ◽  
Symptom Assessment ◽  
Tympanic Membrane Perforation ◽  
Care Hospital ◽  
Tertiary Care Centre ◽  
Ear Injury ◽  
Blast Trauma ◽  
The Impact

Objective: To describe the resultant Otologic morbidity and report on the early outcomes following blasts occurring in twin cities of Quetta and Peshawar. Study Design: Case series. Place and Duration of Study: ENT department Tertiary Care Centre Quetta and Tertiary Care Hospital Peshawar. Study period was, from Jan 2013 to Dec 2013. Methodology: All bomb blast patients brought to the hospitals were included in study. Participants completed Symptom Assessment Forms followed by detailed ENT examination and Pure Tone Audiograms on arrival and after 6 weeks. Results: A total of 504 patients were included initially of which 80% of the patients were male. About 57.8% of the patients complained of ear injury, 21.6% of the total patients had tympanic membrane perforation on initial presentation. Chances of spontaneous closure of perforation were 20.9% in our study. Chances of hearing improvement were 17.9% in our study at the end of the study period. Conclusion: Blast related otologic injuries constituted a major source of morbidity The most common type of hearing loss following a blast trauma was mild to moderate conductive type. Chances of recovery of hearing following blast do exist (17.9%). Suspected patients should be regularly assessed and followed up. Much work needs to be done to study the impact of blast trauma on hearing in our country.

scholarly journals A comparative study of in clinico-pathological profile in dengue shock syndrome versus other types children's at tertiary health care center

2017 ◽  
Vol 5 (10) ◽  
pp. 4330
Author(s):  
Bhavesh Shah ◽  
Deepa Sachin Phirke
Keyword(s):  
Health Care ◽  
Acute Kidney Injury ◽  
Dengue Fever ◽  
Tertiary Care ◽  
Kidney Injury ◽  
Dengue Shock Syndrome ◽  
Total Leukocyte Count ◽  
Care Hospital ◽  
Health Care Center ◽  
Significant Difference

Background: Dengue a mosquito borne arboviral disease is caused by one of the serotypes of dengue virus (DEN-1, DEN-2, Den-3, DEN-4) belonging to the family Flaviviridae. The objective of this study was to study clinco-pathological profile of Dengue shock syndrome versus Other types children's at tertiary health care center.Methods: This was Cross sectional observational study was conducted in a tertiary care hospital in the Department of Pediatrics after obtaining approval from the institutional Ethical Committee. The study was carried out over a period of one & half years from January 2015 to June 2016 Statistical analysis done by Chi-square, ANOVA, Paired t test SPSS version 22 (IBM SPSS Statistics, Somers NY, USA) was used to analyze data.Results: Mean age of patients were 8.08±2.72 years, majority of cases were females (51.9%) and 48.1% were males, the clinical features like hepatomegaly, Ascites Pleural Effusion significantly present in DSS (P<0.001). In the study, there was no significant difference in symptoms and severity of dengue fever except for convulsion Thrombocytopenia (platelet<1lakh/cmm) was observed in 74% of cases, leucopenia (total leukocyte count <4000/cmm) was observed in 56% of cases, haemocrit more than 40 was observed in 21.27% cases. Dengue shock syndrome had acute kidney injury, CCF and encephalopathy. This observation of complications between dengue severity was statistically significant. There was significant difference in haematocrit values between three diagnoses of dengue fever from day 1 till day 4. Initially higher haematocrit was observed in Dengue shock syndrome, later goes on decreasing.Conclusions: It can be concluded from our study that significantly dengue shock syndrome had acute kidney injury, CCF and encephalopathy. There was significant difference in hematocrit values between three diagnoses of dengue fever from day 1 till day 4. Initially higher hematocrit was observed in dengue shock syndrome.

The impact of e-alerts on inpatient diagnosis and management of acute kidney injury

2021 ◽  
pp. 1-11
Author(s):  
Sebastian Spencer ◽  
Fay Dickson ◽  
Sofia Sofroniadou ◽  
Sarah Naudeer ◽  
Sunil Bhandari ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Patient Care ◽  
Tertiary Care ◽  
Kidney Injury ◽  
Information Management System ◽  
Care Hospital ◽  
Injury Management ◽  
Hospitalised Patients ◽  
Electronic Alerts ◽  
The Impact

Aims/Background Electronic alerts can help with the early detection of acute kidney injury in hospitalised patients. Evidence for their role in improving patient care is limited. The authors have completed an audit loop to evaluate the impact of electronic alerts, and an associated acute kidney injury management pathway, on patient care. Methods The audits were conducted at a large tertiary care hospital in the UK. Case notes were reviewed for 99 patients over two periods: pre-alert (in 2013; n=55) and post-alert (in 2018; n=44), using the same methodology. Patients for case note reviews were randomly chosen from the list of acute kidney injury alerts generated by the local laboratory information management system. Results Recognition of acute kidney injury, as documented in the case notes, increased from 15% to 43% between the two periods. Time to first medical review (following electronic alerts) improved by 17 minutes (median 4 hours 4 minutes in 2013 vs 3 hours 47 minutes in 2018). Completion of pre-defined acute kidney injury assessment tasks (review of vital signs, biochemistry and acid–base parameters, evidence of fluid balance assessment, consideration of possible sepsis, and examination or requesting urinalysis) improved in 2018. However, acute kidney injury management tasks (correction of hypovolaemia, addressing or investigating obstruction, medications review, renal referral, requesting of further biochemical tests, addressing possible sepsis) showed very little or no improvement. Conclusions The introduction of acute kidney injury electronic alerts and management pathway resulted in improved recognition and initial assessment of patients with acute kidney injury. Further steps are needed to translate this in to improved patient management.

scholarly journals MO399PROFILE OF ACUTE KIDNEY INJURY IN CRITICAL CARE PATIENTS

2021 ◽  
Vol 36 (Supplement_1) ◽  
Author(s):  
Jayannan J ◽  
Kevin T John Keeppallil ◽  
Georgi Abraham
Keyword(s):  
Acute Kidney Injury ◽  
Critical Care ◽  
Regression Analysis ◽  
South India ◽  
Tertiary Care ◽  
Kidney Injury ◽  
Systemic Hypertension ◽  
Care Hospital ◽  
Tertiary Care Centre ◽  
Poor Outcome

Abstract Background and Aims Acute kidney injury is a global health problem. This study aims to determine the risk factors for poor outcome and to describe the clinical profile, etiology & outcomes of patients with Acute Kidney Injury (AKI) admitted to the Critical Care Unit from a tertiary care centre in South India. Method It was a prospective cohort study conducted in a tertiary care hospital in South India from December 2016 to Novemeber 2019. All patients in the ICU were screened for enrolment in AKI using RIFLE criteria with creatinine, GFR and urine output daily for a period of seven days. Results A total of 152 patients were taken for final analysis after exclusions. The mean age of the subjects was 44.15 years. Majority of the study subjects (55.9%) belonged to 26 – 50 years of age. Majority of the study subjects were females (51.3%) and the rest were males. Sepsis was found to be present in 52% (79) of the study subjects followed by Gastrointestinal loss 36.2% (55), crush injury 9.03% (15), snake bite 3.3% (5), poisoning 4.6% (7) and acute liver failure 1.3% (2). It was found that 62.5% (95) of the study subject’s AKI had resolved after appropriate management. Among the rest of the study subjects,27.6% required haemodialysis for recovery, 3.3% had persistence of AKI, 3.9% progressed to CKD and 2.6% died. The latter three categories were considered as poor outcomes of AKI. In our study, 29.8%people who had systemic hypertension and 28.2%people who had diabetes mellitus had poor outcome. It was found that in our study, sepsis and GI loss both contributes to poor outcome of AKI in univariate regression analysis whereas Gastrointestinal loss alone contributes to poor outcome of AKI with multivariate regression analysis. Conclusion In conclusion, even though sepsis is the commonest cause of AKI, Gastrointestinal loss independently contributes to poor outcome of AKI. Majority of the people recovered from AKI spontaneously with conservative management. Few people required dialysis for recovery of AKI & very few people progressed to CKD.

scholarly journals SPECTRUM OF ACUTE KIDNEY INJURY IN THE MEDICINE WARDS OF A TERTIARY CARE HOSPITAL IN GOA

2020 ◽  
pp. 69-71
Author(s):  
Ana Soraya Monteiro ◽  
Edwin Gomes ◽  
Tabitha Lobo
Keyword(s):  
Acute Kidney Injury ◽  
Tertiary Care ◽  
Age Groups ◽  
Case Series ◽  
Kidney Injury ◽  
Care Hospital ◽  
Health Care Centre ◽  
Female Ratio ◽  
Direct Injury ◽  
Male To Female

Background: Acute kidney injury is characterized by an increase in serum creatinine and/or a decrease in urine output. It can be classified as pre-renal, renal, or postrenal in cause and can be attributed to a local or systemic event - due to direct injury to the kidney or through indirect impediment of renal function. Objective: To determine the prevalence and spectrum of acute kidney injury in the medicine wards of a tertiary health care centre in Goa. Method: A case series was conducted on 100 patients admitted for AKI, or developed it during the hospital stay. Results: AKI was more common in males, with a male to female ratio of 3.5:1, and more prevalent in the age groups of 25-34 and 45-64 years. The dialysis requirement was 28% and mortality was 28.12%. There was no significant association between dialysis and survival rate. Conclusion: Acute Kidney Injury contributes to the morbidity and mortality of hospitalized patients as well as a burden of cost to the community at large. If anticipated, it is easily prevented and if detected early, it can be skilfully treated and reversed.

Acute Kidney Injury in Pediatric Acute Respiratory Distress Syndrome

2020 ◽  
pp. 088506662094404
Author(s):  
Shubhi Kaushik ◽  
Sindy Villacres ◽  
Ruth Eisenberg ◽  
Shivanand S. Medar
Keyword(s):  
Acute Kidney Injury ◽  
Acute Respiratory Distress Syndrome ◽  
Respiratory Distress Syndrome ◽  
Respiratory Distress ◽  
Distress Syndrome ◽  
Invasive Mechanical Ventilation ◽  
Tertiary Care ◽  
Kidney Injury ◽  
Oxygenation Index ◽  
Significant Difference

Objectives: To describe the incidence of and risk factors for acute kidney injury (AKI) in children with acute respiratory distress syndrome (ARDS) and study the effect of AKI on patient outcomes. Design: A single-center retrospective study. Setting: A tertiary care children’s hospital. Patients: All patients less than 18 years of age who received invasive mechanical ventilation (MV) and developed ARDS between July 2010 and July 2013 were included. Acute kidney injury was defined using p-RIFLE (risk, injury, failure, loss, and end-stage renal disease) criteria. Interventions: None. Measurements and Main Results: One hundred fifteen children met the criteria and were included in the study. Seventy-four children (74/115, 64%) developed AKI. The severity of AKI was risk in 34 (46%) of 74, injury in 19 (26%) of 74, and failure in 21 (28%) of 74. The presence of AKI was associated with lower Pao 2 to Fio 2 (P/F) ratio ( P = .007), need for inotropes ( P = .003), need for diuretics ( P = .004), higher oxygenation index ( P = .03), higher positive end-expiratory pressure (PEEP; P = .01), higher mean airway pressure ( P = .008), and higher Fio 2 requirement ( P = .03). Only PEEP and P/F ratios were significantly associated with AKI in the unadjusted logistic regression model. Patients with AKI had a significantly longer duration of hospital stay, although there was no significant difference in the intensive care unit stay, duration of MV, and mortality. Recovery of AKI occurred in 68% of the patients. A multivariable model including PEEP, P/F ratio, weight, need for inotropes, and need for diuretics had a better receiver operating characteristic (ROC) curve with an AUC of 0.75 compared to the ROC curves for PEEP only and P/F ratio only for the prediction of AKI. Conclusions: Patients with ARDS have high rates of AKI, and its presence is associated with increased morbidity and mortality.

scholarly journals Evaluation of Aetiology and Outcome of Acute Kidney Injury in a Tertiary Care Hospital of India- A Prospective Observational Study

2020 ◽  
Author(s):  
VS Gaurav Narayan ◽  
SG Ramya ◽  
Sonal Rajesh Kumar ◽  
SK Nellaiappa Ganesan
Keyword(s):  
Acute Kidney Injury ◽  
Intensive Care ◽  
Observational Study ◽  
Prospective Observational Study ◽  
Tertiary Care ◽  
Kidney Injury ◽  
Rapid Decline ◽  
Care Hospital ◽  
Medical Intensive Care

Introduction: The Acute Kidney Injury (AKI) is a rapid decline in renal filtration function. The aetiological spectrum, prevalence of AKI and outcome is highly variable. This variation exists due to the difference in the criteria used, study population and demographic features. Huge differences are noted when AKI is compared in developing and developed countries. Hence, it is important to analyse the spectrum of AKI to facilitate earlier diagnosis and treatment which shall help in improving the outcome. Aim: To study the prevalence, aetiology and outcome of AKI in the medical intensive care. Materials and Methods: This was a prospective observational study conducted in a medical intensive care for 18 months where 1490 patients were screened and 403 patients were included as AKI by KDIGO criteria. History, examination, appropriate investigations and treatment details including dialysis were noted. The serum creatinine levels were obtained every day, to know the time of onset of AKI, at the time of death or discharge, and after one month for patients who turned up for follow-up. Patients were categorised based on outcome as survivors and nonsurvivors. Survivors were divided into as fully recovered and partially recovered and those who left the Intensive Care Unit (ICU) against medical advice were termed as lost to follow-up. Results: A total of 403 patients (27.04% of 1490) of medical intensive care admissions were found to have AKI. Sepsis was the most common cause of AKI. At the end of the month, 78.4% of AKI patients fully recovered, 1.2% partially recovered and the mortality was 14.9%. Mortality was higher in AKI associated with chronic medical conditions like cardiac failure, chronic liver disease and stroke. Conclusion: If treated early, AKI is mostly reversible. Regional differences in AKI should be studied extensively and local guidelines should be formulated by experts for prevention and early treatment, to improve the disease outcome.

A CLINICAL STUDY OF ETIOLOGY, OUTCOME AND PROGNOSTIC FACTORS OF ACUTE KIDNEY INJURY AMONG ICU ADMISSIONS IN RURAL TERTIARY CARE HOSPITAL

2021 ◽  
pp. 201-204
Author(s):  
Shashikantha Shashikantha ◽  
Sohil Sharda. ◽  
Bernice Robert ◽  
Gangurde Bhushan Daulatrao
Keyword(s):  
Acute Kidney Injury ◽  
Prognostic Factors ◽  
Renal Disease ◽  
Tertiary Care Hospital ◽  
Chronic Renal Disease ◽  
Tertiary Care ◽  
Ventilatory Support ◽  
Kidney Injury ◽  
Care Hospital ◽  
Study Results

INTRODUCTION: Acute kidney injury is a common occurrence in ICU admissions causing increased morbidity and mortality. Present study aimed to determine the causes and prognostic factors of acute kidney injury in intensive care unit. MATERIAL AND METHODS: This Hospital based Cross sectional Study was conducted at a tertiary care Hospital and Research Center, including 100 patients aged >18 years with Acute Kidney Injury admitted in ICU from the period of October 2018 to June 2020. Patients with chronic renal disease, previous renal transplantation, congenital renal disease were excluded from the study. RESULTS: Most of the patients (63%) were aged above 50 years. Diabetes was found in 55% and hypertension in 26% of AKI cases. Most common cause identied were sepsis, CLD, renal, CNS and CVD. Hypotension occurred in 48% patients, while oliguria occurred in 45% patients. Ventilatory support was required by 43% patients, while 31% patients required haemodialysis. Mortality rate in AKI was 51%. Mortality was signicantly associated with advanced age, presence of Diabetes, and RIFLE criteria. Spot urine <40 meq/L, hyperkalemia, serum creatinine >4 mg/dl, blood urea >100 mg/dl and acidosis were associated with higher mortality. CONCLUSION: Continuous monitoring parameters like Spot Fe Na, Serum Potasium and pH especially in patients at risk, like elderly patients with diabetes, those with sepsis, can help in early identication and appropiate management, thus reduce the incidence or severity of AKI.

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