Clinical profile and outcome of acute kidney injury in neonatal sepsis in a tertiary care centre

Background: Septicemia remains a leading cause of morbidity and mortality among neonates with AKI complicating as many as 3.4 to 24% of them. The actual incidence of renal failure in all sepsis cases is not documented. There are several studies in the literature on renal failure in neonates which were based on older definitions using blood urea and urine output as parameters. The major limitation of the older studies was that they did not use the current acute kidney injury network (AKIN) definition. In the present study, we have attempted to investigate AKI in neonatal sepsis using the AKIN definition based on serum creatinine (Table1). We also attempted to determine the predictors of AKI in neonatal sepsis.Methods: The present study was an explorative study conducted in the neonatal unit of Cheluvamba hospital attached to Mysore Medical College and Research Institute in which a total of 50 neonates with clinical/ culture positive sepsis were enrolled during the period of June 2014 to June 2015.Results: These neonates were investigated for the presence of AKI based on serum creatinine values of three consecutive days and were divided into two groups. Group 1 consisted of septic neonates with AKI and group 2 consisted of septic neonates without AKI. Both the groups were followed up till discharge or death. The risk factors associated with sepsis were compared in both the groups and predictors of morbidity and mortality associated with AKI in sepsis were also determined.Conclusions: Incidence and mortality associated with AKI in sepsis was found to be 24% and 75% respectively. Factors like PROM, foul smelling liquor, > 3 unclean vaginal examinations during labour were significant risk factors for development of AKI in sepsis. Culture positivity, associated meningitis, DIC, shock and need for assisted ventilation were poor prognostic indicators and were significantly associated with mortality.

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MO370PREGNANCY-RELATED ACUTE KIDNEY INJURY IN TUNISIA: A CLINICAL CHALLENGE

Nephrology Dialysis Transplantation ◽

10.1093/ndt/gfab082.0024 ◽

2021 ◽

Vol 36 (Supplement_1) ◽

Author(s):

Menel Msehli ◽

Hela Jbali ◽

Mami Ikram ◽

Badreddine Ben kaab ◽

Fethi Ben hamida ◽

...

Keyword(s):

Risk Factors ◽

Acute Kidney Injury ◽

Renal Failure ◽

Prenatal Care ◽

Clinical Manifestations ◽

Kidney Injury ◽

Morbidity And Mortality ◽

Renal Outcome ◽

Clinical Feature ◽

High Morbidity

Abstract Background and Aims Acute kidney injury (AKI) is a complex disorder that occurs in several clinical settings. During pregnancy, there are additional unique conditions that contribute to AKI. The clinical manifestations of Pregnancy related acute kidney injury(PRAKI) range from a minimal elevation in serum creatinine to severe renal failure requiring renal replacement therapy and may be associated with significant morbidity and mortality in young healthy women. This study aims to describe epidemiologic features, study clinical profile and outcomes of women with PRAKI and identify risk factors related to requiring hemodialysis among patients. Method We performed a retrospective study over a 5-year period (2015–2019) in a Tunisian intensive care unit. All patients presenting PRAKI were included. Results Ninety-six cases of PRAKI were listed. The rate of AKI during pregnancy-related hospitalizations was 16% .the average age was 31 ± 5 years. Most women were from urban areas (62%) but with insufficient prenatal care (57%).Seventy-eight percent underwent cesarean section delivery. PRAKI occurred in the postpartum in 79%of the cases. Oligo-anuria was the most common clinical feature of PRAKI, noted in 82% of our patients. The leading etiological causes were pre eclampsia, eclampsia, postpartum haemorrhage and sepsis respectively, in 49%, 38%, and 24% of the cases. Hemodialysis was required in 23% of cases. In the adjusted regression analysis, factors associated with dialysis were insufficient prenatal care (p=0,010 ; O Ra=24,113), HELLP syndrome (p=0,003 ; ORa=35,129), disseminated intravascular coagulation (p=0,007 ; OR=11,854), average duration of oliguria (p=0,001; ORa=3,025) , Failure stage of RIFLE criteria while admitted (p=0,009; ORa=2,09) and length of ICU stay (p=0,042 ; ORa=1,118). Renal outcome was favorable, with a complete renal function recovery for 72 patients (75%). Only four patients (4%) developed chronic renal failure. Mortality rate was 13%. Conclusion PRAKI is a dreaded complication of pregnancy with high morbidity and mortality. Prevention of PRAKI requires an improvement of the sanitary infrastructures with the implementation of an obligatory prenatal consultation in order to prompt management of the underlying risk factors

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Acute Kidney Injury Impairs Postnatal Renal Adaptation and Increases Morbidity and Mortality in Very Low-Birth-Weight Infants

American Journal of Perinatology ◽

10.1055/s-0037-1604470 ◽

2017 ◽

Vol 35 (01) ◽

pp. 039-047 ◽

Cited By ~ 5

Author(s):

Alan Schwartz ◽

Eunice John ◽

Ross Price ◽

Sachin Amin ◽

Nishant Srinivasan

Keyword(s):

Risk Factors ◽

Acute Kidney Injury ◽

Birth Weight ◽

Low Birth Weight ◽

Serum Creatinine ◽

Very Low Birth Weight ◽

Kidney Injury ◽

Morbidity And Mortality ◽

Vlbw Infants ◽

Renal Adaptation

Objective This study aims to estimate the impact of acute kidney injury (AKI) on postnatal renal adaptation, morbidity, and mortality in very low-birth-weight (VLBW) infants. Design We conducted a retrospective study of 457 VLBW infants admitted to a tertiary level neonatal intensive care unit (NICU) between July 2009 and April 2015. We compared patient characteristics, risk factors, serum creatinine trends, and adverse outcomes in infants with and without AKI using multivariate logistic regression analysis. Results Incidence of AKI was 19.5%. On multivariate analysis, postnatal risk factors such as patent ductus arteriosus and vancomycin use were significantly associated with AKI. Infants with AKI had significantly higher mortality; 25/89 (28%) versus 15/368 (4%) (p < 0.001). Among survivors with AKI, bronchopulmonary dysplasia (BPD) was more prevalent (52.8 vs. 23.9%, p < 0.001), serum creatinine remained elevated for a longer duration and median length of stay extended by 38 days. Conclusion Presence of AKI was associated with impaired postnatal renal adaptation, BPD, significantly longer stay in the NICU and higher mortality.

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Diclofenac--Acetaminophen Combination Induced Acute Kidney Injury In Postoperative Pain Relief

Journal of Pharmacy & Pharmaceutical Sciences ◽

10.18433/j3sh21 ◽

2018 ◽

Vol 21 (1) ◽

pp. 19 ◽

Cited By ~ 1

Author(s):

Yan Zhu ◽

Ping Xu ◽

Qing Wang ◽

Jian-quan Luo ◽

Yi-wen Xiao ◽

...

Keyword(s):

Risk Factors ◽

Acute Kidney Injury ◽

Postoperative Pain ◽

Pain Relief ◽

Serum Creatinine ◽

Single Agent ◽

Significant Risk ◽

Kidney Injury ◽

Postoperative Pain Relief ◽

Length Of Hospitalization

Purpose: The objective of this study was to determine: 1) the incidence and the risk factors of diclofenac/acetaminophen combination as a single agent induced Acute Kidney Injury (AKI) in postoperative pain relief 2) the average cost and length of hospital stay for patients in AKI group and non-AKI group. Methods: All patients with no prior history of chronic kidney disease (CKD) and normal serum creatinine [44~130 μmol /l] who received diclofenac and acetaminophen combination as a single agent intramuscularly (IM) between January and December 2015 in The Second Xiangya Hospital, Changsha, Hunan, China were included in this retrospective own-control study. Baseline serum creatinine (SCr) and SCr during NSAID use were collected. AKI is defined as an increased of Scr over 1.5 times the baseline. Multivariate analyses were performed with a logistic regression model to assess the significant risk factors of AKI. Results: A total of 821 patients were included in the study with 63 [7.7%] patients had diclofenac/acetaminophen combination single agent induced AKI. Multivariate analysis confirmed that using diclofenac/acetaminophen combination after surgeries within 24 h were significantly associated with AKI [odds ratio, OR, 2.173; 95% CI, 1.113-4.243; P=0.023]. The average cost and length of hospitalization in AKI group was 1.87 times [p=0.000] and 1.2 times [p=0.043] comparison than non-AKI group, respectively. Conclusions: The incidence of diclofenac/acetaminophen combination single agent induced AKI in postoperative pain relief was 7.7%. Patients with hypertension or liver cirrhosis was more likely to develop AKI and using diclofenac/acetaminophen combination after surgeries within 24 h was significant risk factors for AKI. AKI prolonged the cost and length of hospitalization. This article is open to POST-PUBLICATION REVIEW. Registered readers (see “For Readers”) may comment by clicking on ABSTRACT on the issue’s contents page.

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Definitions, Classification, and Screening of Acute Kidney Injury

10.2310/nephro.12034 ◽

2017 ◽

Author(s):

Andrew Davenport

Keyword(s):

Risk Factors ◽

Acute Kidney Injury ◽

Renal Failure ◽

Acute Renal Failure ◽

Glomerular Filtration Rate ◽

Serum Creatinine ◽

Glomerular Filtration ◽

Filtration Rate ◽

Kidney Injury ◽

Creatinine Concentration

Acute kidney injury (AKI; previously acute renal failure) is defined as an acute and sustained deterioration in kidney function. As AKI is a descriptive term, an attempt should be made to establish a diagnosis in patients with AKI. There are numerous causes of AKI, and all or part of the kidney may be affected. This review discusses the definitions of AKI, measurement of renal function, incidence of AKI, baseline serum creatinine, grading and severity of AKI, and screening for AKI. Figures show renal reserve and renal tubule. Tables list consensus definitions of AKI, effect of patient demographics on serum creatinine concentration, endogenous compounds that can interfere with colorimetric modified Jaffe-based reactions for determining serum creatinine concentration, risk factors for developing AKI in adult patients proposed by the Renal Angina Index, and risk factors for developing acute contrast-induced kidney injury in adult patients. Key Words: Acute kidney injury; Acute renal failure; Glomerular filtration rate; Serum creatinine; Kidney function; Estimated glomerular filtration rate; Biomarkers of AKI

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Preoperative Albuminuria and Intraoperative Chloride Load: Predictors of Acute Kidney Injury Following Major Abdominal Surgery

Journal of Clinical Medicine ◽

10.3390/jcm7110431 ◽

2018 ◽

Vol 7 (11) ◽

pp. 431 ◽

Cited By ~ 5

Author(s):

Diamantina Marouli ◽

Kostas Stylianou ◽

Eleftherios Papadakis ◽

Nikolaos Kroustalakis ◽

Stavroula Kolyvaki ◽

...

Keyword(s):

Risk Factors ◽

Acute Kidney Injury ◽

Abdominal Surgery ◽

Care Center ◽

Chronic Kidney Disease Stage ◽

Tertiary Care ◽

Kidney Injury ◽

Major Abdominal Surgery ◽

Disease Stage ◽

Postoperative Aki

Background: Postoperative Acute Kidney Injury (AKI) is a common and serious complication associated with significant morbidity and mortality. While several pre- and intra-operative risk factors for AKI have been recognized in cardiac surgery patients, relatively few data are available regarding the incidence and risk factors for perioperative AKI in other surgical operations. The aim of the present study was to determine the risk factors for perioperative AKI in patients undergoing major abdominal surgery. Methods: This was a prospective, observational study of patients undergoing major abdominal surgery in a tertiary care center. Postoperative AKI was diagnosed according to the Acute Kidney Injury Network criteria within 48 h after surgery. Patients with chronic kidney disease stage IV or V were excluded. Logistic regression analysis was used to evaluate the association between perioperative factors and the risk of developing postoperative AKI. Results: Eleven out of 61 patients developed postoperative AKI. Four intra-operative variables were identified as predictors of AKI: intra-operative blood loss (p = 0.002), transfusion of fresh frozen plasma (p = 0.004) and red blood cells (p = 0.038), as well as high chloride load (p = 0.033, cut-off value > 500 mEq). Multivariate analysis demonstrated an independent association between AKI development and preoperative albuminuria, defined as a urinary Albumin to Creatinine ratio ≥ 30 mg·g−1 (OR = 6.88, 95% CI: 1.43–33.04, p = 0.016) as well as perioperative chloride load > 500 mEq (OR = 6.87, 95% CI: 1.46–32.4, p = 0.015). Conclusion: Preoperative albuminuria, as well as a high intraoperative chloride load, were identified as predictors of postoperative AKI in patients undergoing major abdominal surgery.

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1244. Evaluation of Intraoperative Topical Vancomycin and the Incidence of Acute Kidney Injury

Open Forum Infectious Diseases ◽

10.1093/ofid/ofz360.1107 ◽

2019 ◽

Vol 6 (Supplement_2) ◽

pp. S448-S448

Author(s):

Alison L Blackman ◽

Sabeen Ali ◽

Xin Gao ◽

Rosina Mesumbe ◽

Carly Cheng ◽

...

Keyword(s):

Risk Factors ◽

Acute Kidney Injury ◽

Logistic Regression ◽

Serum Creatinine ◽

Regression Model ◽

Logistic Regression Model ◽

Kidney Injury ◽

Topical Formulation ◽

Multivariable Logistic Regression Model ◽

Multivariable Logistic Regression

Abstract Background The use of intraoperative topical vancomycin (VAN) is a strategy aimed to prevent surgical site infections (SSI). Although there is evidence to support its efficacy in SSI prevention following orthopedic spine surgeries, data describing its safety, specifically acute kidney injury (AKI) risk, is limited. The purpose of this study was to determine the AKI incidence associated with intraoperative topical VAN. Methods This is a retrospective cohort study reviewing patient encounters where intraoperative topical VAN was administered from February 2018 to July 2018. All adult patients ( ≥18 years) that received topical VAN in the form of powder, beads, rods, paste, cement spacers, or unspecified topical routes were included. Patient encounters were excluded for AKI or renal replacement therapy (RRT) at baseline, ≤ 2 serum creatinine values drawn after surgery, and/or if irrigation was the only topical formulation given. The primary outcome was the percentage of patients who developed AKI after intraoperative topical VAN administration. AKI was defined as an increase in serum creatinine (SCr) ≥50% from baseline, an increase in SCr >0.5 from baseline, or0 if RRT was initiated after topical VAN was given. Secondary outcomes included analysis of AKI risk factors and SSI incidence. AKI risk factors were analyzed using a multivariable logistic regression model. Results A total of 589 patient encounters met study criteria. VAN powder was the most common formulation (40.9%), followed by unspecified topical routes (30.7%) and beads (9.9%%). Nonspinal orthopedic surgeries were the most common procedure performed 46.7%. The incidence of AKI was 8.7%. In a multivariable logistic regression model, AKI was associated with concomitant systemic VAN (OR 3.39, [3.39–6.22]) and total topical VAN dose. Each doubling of the topical dose was associated with increased odds of developing AKI (OR = 1.42, [1.08–1.86]). The incidence of SSI was 5.3%. Conclusion AKI rates associated with intraoperative topical VAN are comparable to that of systemic VAN. Total topical vancomycin dose and concomitant systemic VAN was associated with an increased AKI risk. Additional analysis is warranted to compare these patients to a similar population that did not receive topical VAN. Disclosures All authors: No reported disclosures.

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1481. A Study for Risk Factors of Acute Kidney Injury in Leptospirosis in a Tertiary Health Center in South India

Open Forum Infectious Diseases ◽

10.1093/ofid/ofz360.1345 ◽

2019 ◽

Vol 6 (Supplement_2) ◽

pp. S540-S540

Author(s):

Bhavana Surapareddy ◽

Muralidhar Varma ◽

Shashidhar V

Keyword(s):

Risk Factors ◽

Acute Kidney Injury ◽

Early Recognition ◽

Care Center ◽

Tertiary Care ◽

Laboratory Data ◽

Kidney Injury ◽

Serum Lactate ◽

Significant Difference ◽

Serum Bicarbonate Level

Abstract Background Leptospirosis is the most widespread zoonotic disease in the world. In India, it is endemic in coast lined states. Renal failure is a severe complication with mortality approaching 22%, early recognition of which helps clinicians in acting fast. This study aimed to investigate the predictors of Acute Kidney Injury (AKI) in Leptospirosis Methods This is a prospective, case–control study done in a tertiary care center in Southern India carried out between October 2017 and December 2018. Patients with confirmed Leptospirosis as per CDC 2013 and Faine’s criteria (2012) having AKI as per KDIGO criteria were defined as cases. Subjects without AKI were controls. Demographic, clinical and laboratory data were compared between the groups and analyzed. Logistic regression was performed to analyze the possible risk factors associated with AKI in Leptospirosis. Results A total of 329 subjects met the inclusion criteria of the study. 187 patients with AKI (CASES) and 142 patients without AKI (CONTROLS) were studied. Patients with AKI were older, (mean age- 46.99 ± 13.21 vs. 42.99 ± 15.15 years) had longer hospital stay (9.04 ± 5.62 vs. 6.27 ± 3.27 days) had higher SOFA (7.97 ±2.9 vs. 3.37 ± 2.6) and APACHE 2 scores (14.37±5.93 vs. 4.66 ± 4.4), lower mean arterial pressure (84.01 ± 14.45 vs. 89.01 ± 10.63 mmHg; P = 0.001) lower serum bicarbonate level (21.70 ± 2.35 vs. 18.73 ± 3.78 mEq/dL; P < 0.001). Factors like serum lactate, AST, ALT had no significant difference between the groups. Serovar identification was done in 88 patients, of which 57 had AKI. Australis (16.7%), Pyrogenes (16.7%) and Grippotyphosa (11.1%) were the commonest serovars isolated. Serovar most commonly associated with AKI was Pyrogenes (17.5%) Predictors for AKI were jaundice (P = 0.01, OR 2.25; CI 1.21 –3.26), vomiting (P = 0.017, OR 1.9, CI 1.12- 3.26) Hypotension (P = 0.02, OR = 12.3, CI 1.85 – 107.2), tachypnea (P = 0.006, OR = 2.55, CI 1.11- 3.24), leukocytosis (P < 0.001, OR 5.45, CI 1.86- 4.89), thrombocytopenia (P < 0.001, OR 6.49, CI 2.33 – 6.75) Conclusion Identification of features like hypotension, tachypnea, acidosis, leukocytosis, thrombocytopenia, the occurrence of serovar Pyrogenes should alert the clinician on risk of developing AKI Disclosures All authors: No reported disclosures.

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Acute kidney injury calculated using admission serum creatinine underestimates 30-day and 1-year mortality after acute stroke

Clinical Kidney Journal ◽

10.1093/ckj/sfz049 ◽

2019 ◽

Vol 13 (1) ◽

pp. 46-54

Author(s):

Julia Arnold ◽

Don Sims ◽

Paramjit Gill ◽

Paul Cockwell ◽

Charles Ferro

Keyword(s):

Risk Factors ◽

Acute Kidney Injury ◽

Confidence Interval ◽

Serum Creatinine ◽

Acute Stroke ◽

Odds Ratio ◽

Kidney Injury ◽

Regression Analyses ◽

Mortality Hazard ◽

Mortality Hazard Ratio

AbstractBackgroundAcute kidney injury (AKI) diagnosis requires ascertainment of change from a known baseline. Although pre-admission serum creatinine (SCr) is recommended, to date, all studies of AKI in acute stroke have used the first SCr on admission.MethodsAll patients admitted with an acute stroke to an emergency hospital were recruited. We compared use of pre-admission SCr with admission SCr to diagnose AKI. Regression analyses were used to identify risk factors for 30-day and 1-year mortality, respectively.ResultsA total of 1354 patients were recruited from December 2012 to September 2015. Incidence of AKI was 18.7 and 19.9% using pre-admission SCr and admission SCr, respectively. Diagnosis of AKI was associated with significantly increased 30-day and 1-year mortality. Diagnosis of AKI using pre-admission SCr had a stronger relationship with both 30-day and 1-year mortality. In 443 patients with a pre-admission SCr and at least two SCr during admission, AKI diagnosed using pre-admission SCr had a stronger relationship than AKI diagnosed using admission SCr with 30-day mortality [odds ratio (OR) = 2.64; 95% confidence interval (CI) 1.36–5.12; P = 0.004 versus OR = 2.10; 95% CI 1.09–4.03; P = 0.026] and 1-year mortality [hazard ratio (HR) = 1.90, 95% CI 1.32–2.76; P = 0.001 versus HR = 1.47; 95% CI 1.01–2.15; P = 0.046] in fully adjusted models.ConclusionsAKI after stroke is common and is associated with increased 30-day and 1-year mortality. Using first SCr on admission gives a comparable AKI incidence to pre-admission SCr, but underestimates 30-day and 1-year mortality risk.

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Long-Term Outcomes and Risk Factors of Renal Failure Requiring Dialysis after Heart Transplantation: A Nationwide Cohort Study

Journal of Clinical Medicine ◽

10.3390/jcm9082455 ◽

2020 ◽

Vol 9 (8) ◽

pp. 2455 ◽

Cited By ~ 1

Author(s):

Tsai-Jung Wang ◽

Ching-Heng Lin ◽

Hao-Ji Wei ◽

Ming-Ju Wu

Keyword(s):

Risk Factors ◽

Acute Kidney Injury ◽

Renal Failure ◽

Heart Transplantation ◽

Renal Dysfunction ◽

Heart Transplant ◽

Kidney Injury ◽

Dialysis Patients ◽

Term Survival

Acute kidney injury and renal failure are common after heart transplantation. We retrospectively reviewed a national cohort and identified 1129 heart transplant patients. Patients receiving renal replacement therapy after heart transplantation were grouped into the dialysis cohort. The long-term survival and risk factors of dialysis were investigated. Patients who had undergone dialysis were stratified to early or late dialysis for subgroup analysis. The mean follow-up was five years, the incidence of dialysis was 28.4% (21% early dialysis and 7.4% late dialysis). The dialysis cohort had higher overall mortality compared with the non-dialysis cohort. The hazard ratios of mortality in patients with dialysis were 3.44 (95% confidence interval (CI), 2.73–4.33) for all dialysis patients, 3.58 (95% CI, 2.74–4.67) for early dialysis patients, and 3.27 (95% CI, 2.44–4.36; all p < 0.001) for late dialysis patients. Patients with diabetes mellitus, chronic kidney disease, acute kidney injury, and coronary artery disease were at higher risk of renal failure requiring dialysis. Cardiomyopathy, hepatitis B virus infection, and hyperlipidemia treated with statins were associated with a lower risk of renal dysfunction requiring early dialysis. The use of Sirolimus and Mycophenolate mofetil was associated with a lower incidence of late dialysis. Renal dysfunction requiring dialysis after heart transplantation is common in Taiwan. Early and late dialysis were both associated with an increased risk of mortality in heart transplant recipients.

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