Acute Kidney Injury - Part II: Special Situations

Waste Products ◽

Acute renal failure (ARF) has been defined as a syndrome in which an abrupt decrease in renal function produces retention of nitrogenous waste products. Translating this abstract description into a clinically useful, accurate, and widely accepted definition has been challenging, in large part because of the focus on serum creatinine concentration, which is easily obtained but has the inherent limitation of poor detection of rapid or subtle, but clinically important, changes in the glomerular filtration rate (GFR). In recent years, therefore, the term acute kidney injury (AKI) has replaced ARF because AKI denotes the entire clinical spectrum from mild increases in serum creatinine to overt renal failure. AKI is defined by the Risk-Injury-Failure-Loss-ESRD (RIFLE) criteria, based on serum creatinine concentration and urine flow rate. The Acute Kidney Injury Network (AKIN) subsequently modified the definition further and divided AKI into three stages. This part of the AKI review specifically discusses special situations: rhabdomyolysis, aristolochic acid nephropathy, acute urate nephropathy, acute phosphate nephropathy, AKI in multiple myeloma, ehytlene glycol poisoning, contrast-induced nephropathy, AKI in sepsis, hepatorenal syndrome, and AKI in pregnancy. This review contains 10 tables, and 47 references. Keywords:Acute kidney injury, dialysis, contrast, rhabdomyolysis, nephropathy, urinalysis, multiple myeloma, ethylene glycol, sepsis, hepatorenal syndrome

Acute Kidney Injury - Part II: Special Situations

10.2310/im.1631 ◽

2019 ◽

Author(s):

Paul W Sanders ◽

Anupam Agarwal

Keyword(s):

Multiple Myeloma ◽

Acute Kidney Injury ◽

Renal Failure ◽

Serum Creatinine ◽

Hepatorenal Syndrome ◽

Kidney Injury ◽

Waste Products ◽

Acute renal failure (ARF) has been defined as a syndrome in which an abrupt decrease in renal function produces retention of nitrogenous waste products. Translating this abstract description into a clinically useful, accurate, and widely accepted definition has been challenging, in large part because of the focus on serum creatinine concentration, which is easily obtained but has the inherent limitation of poor detection of rapid or subtle, but clinically important, changes in the glomerular filtration rate (GFR). In recent years, therefore, the term acute kidney injury (AKI) has replaced ARF because AKI denotes the entire clinical spectrum from mild increases in serum creatinine to overt renal failure. AKI is defined by the Risk-Injury-Failure-Loss-ESRD (RIFLE) criteria, based on serum creatinine concentration and urine flow rate. The Acute Kidney Injury Network (AKIN) subsequently modified the definition further and divided AKI into three stages. This part of the AKI review specifically discusses special situations: rhabdomyolysis, aristolochic acid nephropathy, acute urate nephropathy, acute phosphate nephropathy, AKI in multiple myeloma, ehytlene glycol poisoning, contrast-induced nephropathy, AKI in sepsis, hepatorenal syndrome, and AKI in pregnancy. This review contains 10 tables, and 47 references. Keywords:Acute kidney injury, dialysis, contrast, rhabdomyolysis, nephropathy, urinalysis, multiple myeloma, ethylene glycol, sepsis, hepatorenal syndrome

Acute Kidney Injury - Part I

10.2310/fm.1164 ◽

2019 ◽

Author(s):

Paul W Sanders ◽

Anupam Agarwal

Keyword(s):

Acute Kidney Injury ◽

Renal Failure ◽

Serum Creatinine ◽

Kidney Injury ◽

Cardiac Conduction ◽

Waste Products ◽

Acute renal failure (ARF) has been defined as a syndrome in which an abrupt decrease in renal function produces retention of nitrogenous waste products. Translating this abstract description into a clinically useful, accurate, and widely accepted definition has been challenging, in large part because of the focus on serum creatinine concentration, which is easily obtained but has the inherent limitation of poor detection of rapid or subtle, but clinically important, changes in the glomerular filtration rate (GFR). In recent years, therefore, the term acute kidney injury (AKI) has replaced ARF because AKI denotes the entire clinical spectrum from mild increases in serum creatinine to overt renal failure. AKI is defined by the Risk-Injury-Failure-Loss-ESRD (RIFLE) criteria, based on serum creatinine concentration and urine flow rate. The Acute Kidney Injury Network (AKIN) subsequently modified the definition further and divided AKI into three stages. This chapter includes discussions of the etiology and diagnosis of AKI in hospitalized patients and community-acquired AKI. The specific causes, management, and complications of AKI are also discussed. Figures illustrate the pathophysiologic classification of AKI and the effect of hyperkalemia on cardiac conduction—electrocardiogram (ECG) changes. A worksheet for following patients with AKI is provided. This review contains 3 figures, 20 tables, and 46 references. Keywords:Acute kidney injury, dialysis, contrast, rhabdomyolysis, nephropathy, urinalysis, multiple myeloma, ethylene glycol, sepsis, hepatorenal syndrome

Acute Kidney Injury - Part I

10.2310/im.1164 ◽

2019 ◽

Author(s):

Paul W Sanders ◽

Anupam Agarwal

Keyword(s):

Acute Kidney Injury ◽

Renal Failure ◽

Serum Creatinine ◽

Kidney Injury ◽

Cardiac Conduction ◽

Waste Products ◽

Acute renal failure (ARF) has been defined as a syndrome in which an abrupt decrease in renal function produces retention of nitrogenous waste products. Translating this abstract description into a clinically useful, accurate, and widely accepted definition has been challenging, in large part because of the focus on serum creatinine concentration, which is easily obtained but has the inherent limitation of poor detection of rapid or subtle, but clinically important, changes in the glomerular filtration rate (GFR). In recent years, therefore, the term acute kidney injury (AKI) has replaced ARF because AKI denotes the entire clinical spectrum from mild increases in serum creatinine to overt renal failure. AKI is defined by the Risk-Injury-Failure-Loss-ESRD (RIFLE) criteria, based on serum creatinine concentration and urine flow rate. The Acute Kidney Injury Network (AKIN) subsequently modified the definition further and divided AKI into three stages. This chapter includes discussions of the etiology and diagnosis of AKI in hospitalized patients and community-acquired AKI. The specific causes, management, and complications of AKI are also discussed. Figures illustrate the pathophysiologic classification of AKI and the effect of hyperkalemia on cardiac conduction—electrocardiogram (ECG) changes. A worksheet for following patients with AKI is provided. This review contains 3 figures, 21 tables, and 46 references. Keywords:Acute kidney injury, dialysis, contrast, rhabdomyolysis, nephropathy, urinalysis, multiple myeloma, ethylene glycol, sepsis, hepatorenal syndrome

Acute Kidney Injury - Part I

10.2310/tywc.1164 ◽

2019 ◽

Author(s):

Paul W Sanders ◽

Anupam Agarwal

Keyword(s):

Acute Kidney Injury ◽

Renal Failure ◽

Serum Creatinine ◽

Kidney Injury ◽

Cardiac Conduction ◽

Waste Products ◽

Acute renal failure (ARF) has been defined as a syndrome in which an abrupt decrease in renal function produces retention of nitrogenous waste products. Translating this abstract description into a clinically useful, accurate, and widely accepted definition has been challenging, in large part because of the focus on serum creatinine concentration, which is easily obtained but has the inherent limitation of poor detection of rapid or subtle, but clinically important, changes in the glomerular filtration rate (GFR). In recent years, therefore, the term acute kidney injury (AKI) has replaced ARF because AKI denotes the entire clinical spectrum from mild increases in serum creatinine to overt renal failure. AKI is defined by the Risk-Injury-Failure-Loss-ESRD (RIFLE) criteria, based on serum creatinine concentration and urine flow rate. The Acute Kidney Injury Network (AKIN) subsequently modified the definition further and divided AKI into three stages. This chapter includes discussions of the etiology and diagnosis of AKI in hospitalized patients and community-acquired AKI. The specific causes, management, and complications of AKI are also discussed. Figures illustrate the pathophysiologic classification of AKI and the effect of hyperkalemia on cardiac conduction—electrocardiogram (ECG) changes. A worksheet for following patients with AKI is provided. This review contains 3 figures, 20 tables, and 46 references. Keywords:Acute kidney injury, dialysis, contrast, rhabdomyolysis, nephropathy, urinalysis, multiple myeloma, ethylene glycol, sepsis, hepatorenal syndrome

Effects of Hydroxyethyl Starch 130/0.4 on Serum Creatinine Concentration and Development of Acute Kidney Injury in Nonazotemic Cats

Journal of Veterinary Internal Medicine ◽

10.1111/jvim.14813 ◽

2017 ◽

Vol 31 (6) ◽

pp. 1749-1756 ◽

Cited By ~ 2

Author(s):

N.E. Sigrist ◽

N. Kälin ◽

A. Dreyfus

Keyword(s):

Acute Kidney Injury ◽

Serum Creatinine ◽

Hydroxyethyl Starch ◽

Kidney Injury ◽

Creatinine Concentration

Changes in Serum Creatinine Concentration and Acute Kidney Injury (AKI) Grade in Dogs Treated with Hydroxyethyl Starch 130/0.4 From 2013 to 2015

Journal of Veterinary Internal Medicine ◽

10.1111/jvim.14645 ◽

2017 ◽

Vol 31 (2) ◽

pp. 434-441 ◽

Cited By ~ 17

Author(s):

N.E. Sigrist ◽

N. Kälin ◽

A. Dreyfus

Keyword(s):

Acute Kidney Injury ◽

Serum Creatinine ◽

Hydroxyethyl Starch ◽

Kidney Injury ◽

Creatinine Concentration

Contrast‐Induced Acute Kidney Injury in Patients Undergoing TAVI Compared With Coronary Interventions

Journal of the American Heart Association ◽

10.1161/jaha.120.017194 ◽

2020 ◽

Vol 9 (16) ◽

Cited By ~ 2

Author(s):

Gabriele Venturi ◽

Michele Pighi ◽

Gabriele Pesarini ◽

Valeria Ferrero ◽

Mattia Lunardi ◽

...

Keyword(s):

Acute Kidney Injury ◽

Aortic Valve ◽

Serum Creatinine ◽

Contrast Medium ◽

Kidney Function ◽

Kidney Injury ◽

Emergency Procedures ◽

The Impact

Background Differences in the impact of contrast medium on the development of contrast‐induced acute kidney injury (CI‐AKI) in patients undergoing transcatheter aortic valve implantation (TAVI) or a coronary angiography/percutaneous coronary intervention (CA/PCI) have not been previously investigated. Methods and Results Patients treated with TAVI or elective CA/PCI were retrospectively analyzed in terms of baseline and procedural characteristics, including preprocedural and postprocedural kidney function. CI‐AKI was defined as a relative increase in serum creatinine concentration of at least 0.3 mg/dL within 72 hours of contrast‐medium administration compared with baseline. The incidence of CI‐AKI in the TAVI versus CA/PCI group was compared. After the exclusion of patients in dialysis and emergency procedures, 977 patients were analyzed; there were 489 patients who had undergone TAVI (50.1%) and 488 patients who had undergone CA/PCI (49.9%). Patients treated by TAVI were older, presenting a higher rate of anemia and chronic kidney disease ( P <0.001 for all comparisons). Consistently, they also had a significantly lower glomerular filtration rate and higher serum creatinine concentration ( P <0.001 for all). However, the occurrence of CI‐AKI was significantly lower in these patients compared with patients treated by a CA/PCI (6.7% versus 14.5%, P <0.001). At multivariate analysis, the TAVI procedure had an independent protective effect on CI‐AKI incidence among total population (odds ratio, 0.334; 95% CI, 0.193–0.579; P <0.001). This observation was confirmed after propensity score matching among 360 patients (180 by TAVI and 180 by CA/PCI; P =0.002). Conclusions CI‐AKI occurred less frequently in patients undergoing TAVI than in patients undergoing a CA/PCI, despite a worse‐risk profile. The impact of contrast administration on kidney function in patients who had undergone TAVI may be better tolerated because of the hemodynamic changes following aortic valve replacement.

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

Acute Kidney Injury in Poisoned Patients Admitted to ICU

International Journal of Medical Toxicology and Forensic Medicine ◽

10.32598/ijmtfm.v10i4.30471 ◽

2020 ◽

Vol 10 (4) ◽

pp. 30471.1-30471.9

Author(s):

Roghayeh Rashidi ◽

Keyword(s):

Acute Kidney Injury ◽

Kidney Function ◽

Kidney Injury ◽

Aluminum Phosphide ◽

Waste Products ◽

Abrupt Decrease ◽

Significant Difference ◽

Multiple Drugs ◽

End Stage

Background: Acute Kidney Injury (AKI) is an abrupt decrease in kidney function, leading to the retention of urea and other nitrogenous waste products. Poisoned patients admitted to the Intensive Care Unit (ICU) may develop AKI due to some reasons. This study was done to evaluate the AKI in poisoned patients admitted to ICU. Methods: 146 patients, admitted to the ICU of Imam Reza Hospital from March 2017 to March 2018 were studied. AKI status was assessed using Acute Kidney Injury Network (AKIN) and Risk, Injury, Failure, Loss of kidney function and End-stage kidney disease (RIFLE) classification. Data analysis was done through SPSS V. 22 software. Results: Opioids, organophosphates, aluminum phosphide, multiple drugs, and other types of poisoning were the main five poisoning classes. Opioid toxicity was had the highest frequency with 51 patients; cases in this group experienced longer length of hospitalization stay and higher serum creatinine level than others did. Among 146 patients, 19 patients (12.8%) died, and 97 patients (66%) were transferred to the ICU. Of all cases, 18 patients (12.3%) had renal dysfunction (six patients were at risk, five patient at injury, and seven patients were at failure phase based on the RIFLE criteria). Renal replacement therapy was required in 24 cases (16.4%). Conclusion: It is unlikely to detect a significant difference in the occurrence of AKI between the main poisoning classes. Being the largest group of intoxicated patients admitted to the ICU, the opioid poisoning had the highest rate of AKI