scholarly journals Clinical Characteristics and Prognostic Analysis of Pregnancy-Related Acute Kidney Injury

2021 ◽  
Author(s):  
Minjie Hu ◽  
Haidong Huang ◽  
Xuantong Dai ◽  
Fujun Lin ◽  
Junfeng Shi ◽  
...  
Keyword(s):  
Renal Function ◽  
Pregnancy Outcomes ◽  
Clinical Characteristics ◽  
Causes Of Death ◽  
Kidney Injury ◽  
Infant Outcomes ◽  
Acute Fatty Liver ◽  
The Mean ◽  
Stage 1 ◽  
Maternal And Infant Outcomes

Abstract Objective: To investigate the clinical characteristics and prognosis of pregnancy-related acute kidney injury (PR-AKI) and provide a basis for improving maternal and infant outcomes. Methods: Seventy pregnant women admitted to the surgical intensive care unit of Xinhua Hospital affiliated to Shanghai Jiaotong University School of Medicine from January 2010 to December 2020 were included; 31 were screened out according to KDIGO-AKI criteria. We retrospectively analyzed their clinical characteristics and prognosis and analyzed risk factors for different pregnancy outcomes with logistic regression analysis. Results: A total of 31 PR-AKI patients were enrolled. The mean age of onset was 30.08±0.63 years, and the mean gestational age was 33.02±7.64 weeks. Six cases (19.45%) were in stage 1, six cases (19.35%) were in stage 2, and 19 cases (61.29%) were in stage 3. The continuous renal replacement therapy (CRRT) group comprised 13 cases (41.94%): one (7.69%) in stage 1, one (7.69%) in stage 2, and 11 (84.62%) in stage 3. The non-CRRT group comprised 18 cases (58.06%): five (27.78%) in stage 1, five (27.78%) in stage 2, and eight (44.44%) in stage 3. The mean time of commencing renal replacement therapy was 2.08±1.26 days after admission, and the serum creatinine (SCr) level at the beginning of treatment was 352.68±196.58 μmol/L. Renal function recovered completely in 18 cases (58.06%), comprising four (22.22%) in the CRRT group and 14 (77.78%) in the non-CRRT group, and three cases of partial renal function recovery occurred in the CRRT group. Eventually, seven patients (22.58%) died, of whom four (57.14%) were in the non-CRRT group, and all were in stage 3. The causes of death were postpartum hemorrhage, septic shock, and acute fatty liver during pregnancy. Three patients (42.86%) died in the non-CRRT group: two in stage 3 and one case in stage 1. The causes of death were severe preeclampsia and acute fatty liver during pregnancy. Multi-factor logistic regression analysis showed that gestational weeks (OR=0.456, P=0.023), platelet count (OR=0.989, P=0.02), hemoglobin (OR=1.017, P=0.022), and uric acid (OR=1.017, P=0.022) were associated risk factors for maternal adverse pregnancy outcomes of PR-AKI (P<0.05). Conclusions: The incidence of PR-AKI is high, the outcomes of maternal renal function are better, and the proportion of adverse fetal outcomes is higher. CRRT can effectively improve the prognosis of patients with PR-AKI, stabilize the internal environment, and affect hemodynamics slightly. It is currently one of the main ways to treat severe PR-AKI. Maternal and infant outcomes are related to the severity of PR-AKI.

Effect of HELLP syndrome on acute kidney injury in pregnancy and pregnancy outcomes: a systematic review and meta-analysis

2019 ◽  
Author(s):  
Qiang Liu ◽  
Guan-jun LING ◽  
Shao-quan ZHANG ◽  
Wen-qing ZHAI ◽  
Yi-juan CHEN
Keyword(s):  
Acute Kidney Injury ◽  
Cohort Studies ◽  
Pregnancy Outcomes ◽  
Hellp Syndrome ◽  
Meta Analysis ◽  
Kidney Injury ◽  
Fetal Mortality ◽  
Infant Outcomes ◽  
Maternal And Infant Outcomes ◽  
In Pregnancy

Abstract Background HELLP syndrome is a common complication during pregnancy,especially among those who with gestational hypertension. At present, the impact of HELLP syndrome on AKI（acute kidney injury） and maternal and infant outcomes is controversial. Thus, we conducted a meta-analysis to find out more about the relationship between HELLP syndrome and acute kidney injury during pregnancy and pregnancy outcomes. Methods We systematically searched PubMed , Embase and Cochrane Databases for cohort studies to assess the effect of HELLP syndrome on P-AKI(acute kidney injury in pregnancy) and maternal and infant outcomes. Using odds ratio (OR) with 95% confidence interval (CI) were pooled with a random- or fixed-effect models when appropriate. Results This meta-analysis included 11 cohort studies with a total of 6333 Participants, including 355 cases of pregnant women with HELLP syndrome and 5979 cases that without. HELLP syndrome has been associated with relatively higher risk of AKI during pregnancy（OR4.87 95% CI 3.31～7.17，P＜0.001）, fetal mortality（OR1.56 95% CI 1.45～2.11，P＜0.001） and Maternal death（OR3.70 95% CI 1.72～7.99，P＜0.001）. Conclusions HELLP syndrome has been associated with relatively higher risk of P-AKI, fetal mortality and Maternal death .

scholarly journals Effect of HELLP syndrome on acute kidney injury in pregnancy and pregnancy outcomes: a systematic review and meta-analysis

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Qiang Liu ◽  
Guan-jun Ling ◽  
Shao-quan Zhang ◽  
Wen-qing Zhai ◽  
Yi-juan Chen
Keyword(s):  
Acute Kidney Injury ◽  
Cohort Studies ◽  
Maternal Death ◽  
Pregnancy Outcomes ◽  
Hellp Syndrome ◽  
Meta Analysis ◽  
Kidney Injury ◽  
Fetal Mortality ◽  
Infant Outcomes ◽  
Maternal And Infant Outcomes

Abstract Background HELLP syndrome may increase adverse pregnancy outcomes, though the incidence of it is not high. At present, the impact of HELLP syndrome on P-AKI (acute kidney injury during pregnancy) and maternal and infant outcomes is controversial. Thus, we conducted a meta-analysis to find out more about the relationship between HELLP syndrome and P-AKI and pregnancy outcomes. Methods We systematically searched PubMed, Embassy and Cochrane Databases for cohort studies and RCT to assess the effect of HELLP syndrome on P-AKI and maternal and infant outcomes. Study-specific risk estimates were combined by using fixed-effect or random-effect models. Results This meta-analysis included 11 cohort studies with a total of 6333 Participants, including 355 cases of pregnant women with HELLP syndrome and 5979 cases that without. HELLP syndrome was associated with relatively higher risk of P-AKI (OR4.87 95% CI 3.31 ~ 7.17, P<0.001), fetal mortality (OR1.56 95% CI 1.45 ~ 2.11, P<0.001) and Maternal death (OR3.70 95% CI 1.72 ~ 7.99, P<0.001). Conclusions HELLP syndrome is associated with relatively higher risk of P-AKI, fetal mortality and maternal death.

MO403ACUTE KIDNEY INJURY IN ELDERLY: EPIDEMIOLOGICAL, CLINICAL AND ETIOLOGICAL FEATURES

2021 ◽  
Vol 36 (Supplement_1) ◽  
Author(s):  
Mouna Malki abidi ◽  
Rajaa Aoudia ◽  
Soumaya Chargui ◽  
Imen Gorsane ◽  
Mouna Jerbi ◽  
...  
Keyword(s):  
Chronic Kidney Disease ◽  
Renal Function ◽  
Kidney Injury ◽  
The Elderly ◽  
Major Interest ◽  
The Mean ◽  
Renal Aging ◽  
End Stage ◽  
Iatrogenic Origin

Abstract Background and Aims Acute kidney injury (AKI) is common in the elderly due to physiologic renal aging and underlying pathologies. Few studies focused on AKI in Tunisian elderly. The aim of our study was to highlight the epidemiological, clinical, etiological, therapeutic, and progressive characteristics of AKI in elderly. Method We conducted a descriptive retrospective study of AKI in patients admitted to our department over a period of 04 years from 01/01/2014 to 31/12/2017. Results We collected 40 patients including 25 women and 15 men with a sex ratio of 1.66. The mean age was 74 [65-87] years. We noted the presence of pre-existing chronic kidney disease in 58% of cases, diabetes in 50% of cases and hypertension in 73% of cases. Polypharmacy was found in 40% of cases. AKI was symptomatic in 80% of cases and found on a routine check-up in 20% of cases. Mean creatinine was 612+/-334 µmol/l. AKI was pre-renal in 37% and parenchymal in 63% of cases. Iatrogenic origin was found in 33% of cases. Renal biopsy was performed for diagnostic purposes in 6 cases. Haemodialysis was necessary in 50% of cases. Etiopathogenic treatment was initiated in 73% of cases. Intra-hospital mortality was 10%, recovery of renal function (RF) was partial in 40 % of cases and total in 20 % of cases. Follow-up time was 16 +/- 23.2 months. And at the last news, recovery of renal function (RF) was partial in 7 cases and total in 10 cases, 6 patients kept a chronic renal failure (CRF), among them 3 cases had and end-stage of CRF. Conclusion AKI is a frequent pathology in the elderly and its severity is linked to mortality and the transition to chronicity. Iatrogenic causes are frequent and preventable in this population, hence the major interest of prevention.

scholarly journals Intermittent Hemodialysis For Patients With Acute Kidney Injury (AKI): Outcome In A Tertiary Level Hospital

2018 ◽  
Vol 17 (1) ◽  
pp. 25-30
Author(s):  
Arun Sharma ◽  
Binod Karki ◽  
Ajay Rajbhandari
Keyword(s):  
Acute Kidney Injury ◽  
Renal Function ◽  
Renal Replacement Therapy ◽  
Replacement Therapy ◽  
Acute Gastroenteritis ◽  
Kidney Injury ◽  
Tertiary Level ◽  
Intermittent Hemodialysis ◽  
The Mean ◽  
Level Hospital

INTRODUCTION: Acute kidney injury (AKI) is the sudden loss of renal function with accumulation of nitrogenous waste compounds. In developing countries, community acquired AKI is common than AKI in hospitalized septic patients. With conservative management many patients recover renal function however few require renal support with intermittent Hemodialysis (HD). We conducted a study to find out the etiology and outcome of the patients presenting with AKI who required dialysis.METHODS: This is a descriptive follow up study of the patients who needed renal replacement therapy in the form of HD presenting to our Nephrology unit of the hospital over a period of two years. Patients were followed up for three months post discharge. Data were tabulated and analyzed using SPSS software.RESULTS: Total 50 patients were included in study with 67% male. The commonest etiologies were urinary tract infection (30%) and  acute gastroenteritis (24%).The mean creatinine at the time of nephrology consultation, maximum level and at the time of discharge were 6.5(SD± 2.62), 7.3(SD ±2.13) and 2.2(SD ±1.75) respectively. Uremia with anuria was the most common reason for the initiation of HD in 54% cases. The mean number of intermittent HD used was 3.36. Complete recovery was seen in 68%, death in 26% and CKD in 6%.CONCLUSION: UTI followed by acute gastroenteritis are the leading cause of AKI in our tertiary level hospital. Timely initiated renal replacement therapy in the form of intermittent HD could lead to substantial renal recovery in almost three fourth of patients.

scholarly journals P0601SAFETY AND EFFICACY OF INTRAVENOUS ADMINISTRATION OF RINGER'S LACTATE VERSUS NORMAL SALINE 0.9% SOLUTION IN PATIENTS WITH ACUTE KIDNEY INJURY AND ESTABLISHED CHRONIC KIDNEY DISEASE

2020 ◽  
Vol 35 (Supplement_3) ◽  
Author(s):  
Marios Papasotiriou ◽  
Adamantia Mpratsiakou ◽  
Georgia Georgopoulou ◽  
Lamprini Balta ◽  
Paraskevi Pavlakou ◽  
...  
Keyword(s):  
Chronic Kidney Disease ◽  
Acute Kidney Injury ◽  
Renal Function ◽  
Kidney Injury ◽  
Acid Base Balance ◽  
Acid Base ◽  
Safety And Efficacy ◽  
Ringer’S Lactate ◽  
Base Balance ◽  
The Mean

Abstract Background and Aims Crystalline solutions, such as normal saline 0.9% (N/S 0.9%) and Ringer's Lactate (L/R), are readily administered for increasing plasma volume. Despite the utility of administering N/S 0.9% to hypovolemic patients, the dose of 154 mmol of sodium (Na) contained in 1 L exceeds the recommended daily dose increasing the risk of sodium overload and hyperchloremic metabolic acidosis. In contrast, L/R solution has the advantage of lower Na content, significantly less chlorine and contains lactates which may be advantageous in patients with significant acidemia such as patients with acute kidney injury (AKI) and chronic kidney disease (CKD). The aim of the present study is to investigate the safety and efficacy of administration of L/R versus N/S 0.9% in patients with prerenal AKI and established CKD. Method The study included adult patients with known CKD stage II to V without need for dialysis, with prerenal AKI (AKIN Stage I to III Criteria). Patients with other forms of AKI as well as hypervolemia, heart congestion or hyperkalemia (serum K&gt;5.5 meq/l) were excluded from the study. Patients were randomized in 1:1 ratio to receive intravenously either N/S 0.9% or L/R solution at a dose of 20 ml/kg body weight/day. We studied kidney function (eGFR: CKD-EPI) and response to treatment at discharge and at 30 days after discharge, duration of hospitalization, improvement in serum bicarbonate levels (HCO3), acid-base balance, serum potassium levels and the need for dialysis. Results The study included 26 patients (17 males) with a mean age of 59.1 ± 16.1 years. Thirteen patients received treatment with N/S 0.9% and the rest with L/R solution. Baseline demographic and clinical characteristics at hospital admission and historical data did not show any significant differences in both groups of patients. Renal function at the onset of AKI did not show significant differences between the two groups (16.4 ± 5.8 vs 16.9 ± 5.7 ml/min/1.73 m2, p=ns, treatment with N/S and L/R respectively). The mean volume of solutions received by the two groups (N/S 0.9% 1119 ± 374 vs L/R 1338 ± 364 ml/day, p=ns) as well as the mean total volume of liquids received per day, did not differ significantly (2888 ± 821 vs 3069 ± 728 ml/d, p=ns). Patients treated with L/R were discharged 1 day earlier than patients treated with N/S (5.2 ± 3.2 vs 6.2 ± 4.9 days of hospitalization, p=ns). Renal function improvement during hospitalization and 30 days after discharge did not differ significantly between the two groups. Patients that received L/R showed a higher increase in plasma HCO3 (ΔHCO3) concentration at discharge than those that received N/S 0.9% (4.9 ± 4.1 vs 2.46 ± 3.7 meq/l, p=ns) and pH increase (ΔpH) was slightly higher in those that received L/R solution (0.052 ± 0.066 vs 0.023 ± 0.071, p=ns). Patients treated with N/S 0.9% showed a greater decrease in serum potassium (ΔK) at discharge compared to those treated with L/R (-0.39 ± 1.03 vs -0.17 ± 0.43 meq/l, p=ns, respectively). No patient received acute dialysis treatment. Conclusion Administration of L/R solution as a hydration treatment to patients with prerenal AKI and established CKD is not inferior concerning safety and efficacy to N/S 0.9% solution. In addition, L/R administration seems to marginally improve acid-base balance in this specific group of patients.

The Epidemic of Chronic Kidney Disease in Patients Referred to a Hematologist for Anemia.

Blood ◽  
2006 ◽  
Vol 108 (11) ◽  
pp. 5521-5521
Author(s):  
Brian Zimmer ◽  
Dana Wentzel ◽  
James Reed ◽  
Sherrine Eid ◽  
Eliot Friedman ◽  
...  
Keyword(s):  
Chronic Kidney Disease ◽  
Renal Function ◽  
Kidney Disease ◽  
General Population ◽  
Serum Creatinine ◽  
Strong Association ◽  
Chart Audit ◽  
Stage 4 ◽  
The Mean ◽  
Stage 1

Abstract NHANES survey estimates the prevalence of CKD to be approximately 11% in the general population and 25% in the population over 65 years of age, and the prevalence of Chronic Kidney Disease (CKD) associated anemia approaches 75% in Stage 5 CKD. Despite the high prevalence of CKD, and its strong association with anemia, many patients diagnosed with anemia and referred to a hematologist for evaluation frequently have the diagnosis of CKD overlooked, especially if one is using a serum creatinine to assess renal function. A more accurate method of assessing renal function and to appropriately stage CKD is the use of an estimated glomerular filtration rate (eGFR) utilizing the modified MDRD equation. With the realization that CKD clearly has become known as a significant magnifier of cardiovascular risk (CVR), the importance of making the diagnosis of CKD has become quite apparent. Hypothesis: Patients referred to a hematologist for evaluation of anemia represent a population enriched with CKD. A retrospective chart audit was performed on patients being referred to a hematology practice from community physicians for the evaluation of anemia from January 2004 through December 31, 2005. All patients with a prior knowledge of CKD and a history of malignancy or myelodysplastic process were excluded from the study. The cohort consisted of 256 patients (37.5 % male and 62.5 % female) with a mean age of 67.56 ± 15.9 years. The mean serum creatinine was 1.16 ± .74 mg/dL with a mean calculated GFR by the modified MDRD (4 variable) equation of 69.9 ± 34.2 ml/min/1.73 m2. The mean ± SEM serum creatinine by stage of CKD in our patient population is: Stage 1: 0.67 ± 0.14 mg/dL, Stage 2: 0.92 ± 0.15 mg/dL, Stage 3: 1.40 ± 0.29 mg/dL, Stage 4: 2.23 ± 0.53 mg/dL, and Stage 5: 5.2 ± 2.89 mg/dL. Conservatively, we defined CKD as GFR <60 as urinalysis, imaging, or biopsy data were not available. In conclusion, an astounding 42.2 % of patients referred to a hematologist for the evaluation of anemia have CKD as compared to an estimated prevalence of 11 % in the general population reported by K/DOQI. Not only were these patients not aware of their diagnosis of CKD, but, of note also is the fact that 5.1 % were not aware of the presence of advanced CKD (GFR < 30) and 4 patients had Stage 5 CKD without awareness. 55.8 % of the patients over the age of 65 with anemia have CKD as compared to an estimated 25 % of the general population over the age of 65. This information stresses the need to assess all anemia patients for CKD and to appropriately stage them. Given the well accepted association between CKD and CVR, physicians caring for these patients can then stress the need for aggressive pursuit of both traditional and non traditional risk factor reduction to circumvent the significant CVR that is present in this population. Prevalence of Abnormal Renal Function by GFR Frequency Percent *K/DOQI = National Kidney Foundation’s Kidney Disease Outcome Quality Initiative GFR > 90 (Normal /K/DOQI* Stage 1) 51 19.9 GFR 89 - 60 (K/DOQI Stage 2) 97 37.9 GFR 59 - 30 (K/DOQI Stage 3) 95 37.1 GFR 29 - 15 (K/DOQI Stage 4) 9 3.5 GFR < 15 (K/DOQI Stage 5) 4 1.6

Uncovering Lymphatic Transport Abnormalities in Patients with Primary Lipedema

2019 ◽  
Vol 36 (02) ◽  
pp. 136-141 ◽  
Author(s):  
Daniel J. Gould ◽  
Bassim El-Sabawi ◽  
Pedram Goel ◽  
Ido Badash ◽  
Patrick Colletti ◽  
...  
Keyword(s):  
Body Mass Index ◽  
Clinical Characteristics ◽  
Lymphatic Transport ◽  
Lymphatic Flow ◽  
Patient Demographics ◽  
Severe Stage ◽  
Included Patient ◽  
Stage 4 ◽  
The Mean ◽  
Stage 1

Abstract Background Although lipedema is often clinically distinguished from lymphedema, there is considerable overlap between the two entities. The purpose of this study was to evaluate lymphoscintigraphic findings in patients with lipedema to better characterize lymphatic flow in this patient population. Methods Patients with lipedema receiving lymphoscintigraphy between January 2015 and October 2017 were included. Patient demographics, clinical characteristics, and lymphoscintigraphic findings were extracted. Klienhan's transport index (TI) was utilized to assess lymphatic flow in patient's lower extremities (LEs).Scores ranged from 0 to 45, with values > 10 denoting pathologic lymphatic transport. Results A total of 19 total patients with lipedema underwent lymphoscintigraphic evaluation. Mean age was 54.8 years and mean body mass index was 35.9 kg/m2. Severity of lipedema was classified as stage 1 in five patients (26.3%), stage 2 in four patients (21.1%), stage 3 in four patients (21.1%), and stage 4 in six patients (31.6%). The mean TI for all extremities was 12.5; 24 (63.2%) LEs had a pathologic TI, including 7 LEs with stage 1 (29.2%), 3 LEs with stage 2 (12.5%), 6 LEs with stage 3 (25.0%), and 8 LEs with stage 4 lipedema (33.3%). The mean TI was significantly greater for extremities with severe (stage 3/4) lipedema than those with mild or moderate (stage 1/2) lipedema (15.1 vs. 9.7, p = 0.049). Mean difference in TI scores between each LE for individual patients was 6.43 (standard deviation +7.96). Conclusion Our results suggest that patients with lipedema have impaired lymphatic transport, and more severe lipedema may be associated with greater lymphatic transport abnormalities.

P0654INTEREST OF SCREENING FOR CKD AFTER AKI IN ICU AND THE PLACE OF CYSTATIN C IN THIS POPULATION

2020 ◽  
Vol 35 (Supplement_3) ◽  
Author(s):  
Guillaume Claisse ◽  
Nicolas Maillard ◽  
Miriana Dinic ◽  
Christophe Mariat
Keyword(s):  
Renal Function ◽  
Multivariate Analysis ◽  
Cystatin C ◽  
Kidney Injury ◽  
Volume Of Distribution ◽  
Icu Patients ◽  
Factors Associated ◽  
Icu Discharge ◽  
The Mean ◽  
Gfr Estimation

Abstract Background and Aims Acute Kidney Injury (AKI) is one of the most frequent complications in Intensive Care Unit (ICU). It’s now clearly established that AKI may be associated with the installation and/or worsening of Chronic Kidney Disease (CKD). However, few patients are currently screened for CKD after hospitalization in the ICU. In addition, ICU patients often have changes in their volume of distribution and muscle mass that may interfere with plasma Creatinine (pCreat) dosing and thus the estimated GFR (eGFR) value using CKD-Epi equation. Method Since 2019, we are prospectively screening for CKD patients who developed moderate-to-severe AKI (KDIGO 2 and 3) in ICU. Patients are referred to Nephrology consultation within 2 to 3 months after discharge from the ICU. The screening for CKD is performed according to the GFR estimation using the CKD-Epi equation. In this cohort, we will assess the incidence of CKD after ICU discharge and factors associated with CKD installation and worsening (univariate and multivariate analysis). In addition, for some patients, we planned to measure GFR using Iohexol clearance to compare measured GFR (mGFR) to eGFR using both CKD-Epi equation and Cystatin C-based equations. Results So far, 43 patients have been referred in Nephrology consultation, 72% of male and a mean age of 62 (±16) years. The time between the ICU discharge and the consultation was 55 (±21) days. The main co-morbidities were diabetes (37%) and hypertension (58%). The mean eGFR before the ICU (basal renal function) was 78 (±24) ml/min/1.73m2 and the pCreat was 89 (±21) µmol/l. At baseline, twenty-one percent of the patients had an eGFR &lt; 60 ml/min/1.73m2. The length of stay in the ICU was 14 (±14) days. Nearly half of the patients (47%) were ventilated and 56% received vasopressive drugs. Most of the patients (74%) developed KDIGO Stage 3 AKI and 26% developed Stage 2 AKI. The mean entry pCreat was 252 (± 178) µmol/l, reaching a maximum of 382 (± 198) µmol/l during the hospitalization. Sixty percent of the patients underwent renal replacement therapy. The patients lost in average 10 kgs during the hospitalization. The pCreat at discharge was 175 µmol/l (± 175). At the time of the consultation, the eGFR was 70 (± 27) ml/min/1.73m2 with 35% of the patients with an eGFR &lt; 60 ml/min/1.73m2. Univariate and multivariate analysis will be performed to evaluate the mains factors associated with CKD. At this time, 8 patients had a GFR measure using Iohexol. Mean mGFR was 32,8 (±14) ml/min/1,73m2, lower than the CKD-Epi (57±19), the CKD-Epi Cystatin (35±13) and the CKD-Creatinine-Cystatin (43±14). Compared to the mGFR, the CKD-Epi Cystatin equation appears to perform better with a bias of 4 ml/min/1.73m2 versus a bias of 24 ml/min/1.73m2 for the CKD-Epi equation and 12.7 ml/min/1.73m2 for the CKD-Epi Creatinine-Cystatin equation. Based on the Iohexol measure and the CKD-Epi Cystatin equation, all the patients (100%) had a GFR &lt; 60 ml/min/1,73m2 against only 33% with the CKD-Epi equation. Conclusion In this analysis on the first 43 patients of our cohort, AKI seems to be associated with an increase of CKD 2 months after ICU discharge with 35% of patients with an eGFR below 60 ml/min/1,73m2. This proportion of CKD patients may be underestimated by the GFR estimation based on pCreat. Given the results of the analysis of our first 8 patients who have benefited from GFR measurement, Cystatin C-based equations may be an interesting tool to better assess renal function in this specific population.

scholarly journals Comparing the Clinical and Laboratory Features of Remitting Seronegative Symmetrical Synovitis with Pitting Edema and Seronegative Rheumatoid Arthritis: Stage 1

2021 ◽  
Vol 10 (2) ◽  
pp. 340
Author(s):  
Misako Higashida-Konishi ◽  
Keisuke Izumi ◽  
Satoshi Hama ◽  
Hiroshi Takei ◽  
Hisaji Oshima ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
Associated Factors ◽  
Clinical Characteristics ◽  
Seronegative Arthritis ◽  
Laboratory Features ◽  
The Mean ◽  
Male Sex ◽  
Stage 1 ◽  
Pitting Edema ◽  
Age And Sex

In seronegative arthritis with extremity edema, the differential diagnosis between remitting seronegative symmetrical synovitis with pitting edema syndrome (RS3PE) and seronegative rheumatoid arthritis (SNRA) is difficult. We compared the clinical characteristics of RS3PE and SNRA and those of such patients with and without malignancies. We retrospectively examined patients diagnosed with RS3PE (McCarty criteria) and SNRA at our hospital in 2007–2020. Malignancy was diagnosed within 2 years before or after RS3PE or SNRA diagnosis. Overall, 24 RS3PE and 124 SNRA patients were enrolled. The mean ages were 79.0 and 66.5 years, and men comprised 54.2% and 37.1% of RS3PE and SNRA patients, respectively. RS3PE patients had higher inflammation levels (p < 0.01) and more incidences of malignancy (p < 0.01). Matching for age and sex, RS3PE patients had higher inflammation levels (p < 0.01) and more incidences of malignancy (p = 0.02). Overall, odds ratios (ORs) for malignancy were higher for older age (OR 1.06, p = 0.04), male sex (OR 4.34, p = 0.02), RS3PE patients (OR 4.83, p = 0.01), and patients with extremity edema (OR 4.83, p = 0.01). RS3PE patients had higher inflammation levels and associated factors of malignancy than SNRA patients. Patients who are older, male, with extremity edema, or with RS3PE should be screened for malignancies.

scholarly journals Effect of acute kidney injury on the patients with hepatocellular carcinoma undergoing transarterial chemoembolization

PLoS ONE ◽  
2020 ◽  
Vol 15 (12) ◽  
pp. e0243780
Author(s):  
Won Sohn ◽  
Cheol Bae Ham ◽  
Nam Hee Kim ◽  
Hong Joo Kim ◽  
Yong Kyun Cho ◽  
...  
Keyword(s):  
Risk Factors ◽  
Hepatocellular Carcinoma ◽  
Overall Survival ◽  
Acute Kidney Injury ◽  
Transarterial Chemoembolization ◽  
Multivariable Analysis ◽  
Kidney Injury ◽  
Tumor Location ◽  
The Mean ◽  
Stage 1

The purpose of this study was to investigate the effect of acute kidney injury (AKI) on the prognosis of patients with hepatocellular carcinoma (HCC) undergoing transarterial chemoembolization (TACE). A total of 347 HCC patients with Child-Pugh class A and pre-TACE serum creatinine (SCr) ≤1.5 mg/dL undergoing TACE as an initial therapy 2000–2014 were analyzed. Overall survival with related risk factors including AKI was investigated. We assessed AKI based on the International Club of Ascites (ICA)-AKI criteria. The mean age was 60.9 years. Of 347 patients, death was observed in 109 patients (31.4%). The mean SCr levels at pre-TACE, one day, two months, and four months after TACE were 0.9, 0.9, 0.9, and 1.1 mg/dL, respectively. The AKI within four months after TACE developed in 37 patients (11%). The AKI stages were non-AKI in 310 (89%), stage 1 in 10 (3%), stage 2 in 10 (3%), and stage 3 in 17 patients (5%). Multivariable analysis showed that the risk factors for overall survival were serum albumin ≤3.5 g/dL (hazard ratio [HR] 1.58, p = 0.027), BCLC stage B (HR 2.07, p = 0.008), BCLC stage C (HR 3.96, p<0.001), bilobar tumor location (HR 1.66, p = 0.022), AKI stage 1 (HR 6.09, p<0.001), AKI stage 2 (HR 8.51, p<0.001), and AKI stage 3 (HR 17.64, p<0.001). AKI is a crucial prognostic factor for overall survival in HCC patients undergoing TACE. The assessment of AKI based on the ICA-AKI criteria can facilitate evaluation of the prognosis of HCC patients undergoing TACE.

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