CLINICAL OBSERVATION OF THE DEVELOPMENT OF ACUTE RENAL INJURY IN ADOLESCENTS AGAINST A BACKGROUND OF DIFFICULT TO DIAGNOSE STOMACH ULCER

2021 ◽  
Vol 100 (4) ◽  
pp. 182-184
Author(s):  
S.O. Falaleeva ◽  
◽  
V.V. Chikunov ◽  
L.N. Antsiferova ◽  
L.A. Monakova ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Social Factors ◽  
Clinical Observation ◽  
Delayed Diagnosis ◽  
Kidney Injury ◽  
The Body ◽  
Infusion Therapy ◽  
Acute Renal Injury ◽  
Pathogenetic Therapy ◽  
Lesser Curvature

A clinical observation of the development of acute kidney injury (AKI) (stage III) in a 17-year-old girl is presented. The cause of AKI was dehydration of the body against the background of ulcer of the lesser curvature of the stomach. This localization of ulcerative damage and certain social factors caused the delayed diagnosis of the disease, which led to the development of AKI. Duration of anuria was 20 hours. The creatinine level reached 902 μmol/l. Appointment of adequate infusion therapy led to the restoration of renal function, and pathogenetic therapy to ulcer scarring.

scholarly journals P0517RENAL STEM CELLS (ARPCS) AS A NEPHROPROTECTIVE APPROACH DURING CISPLATIN-INDUCED ACUTE KIDNEY INJURY: A DEFENSE MECHANISM BY EXTRACELLULAR VESICLES CARRYING THE CYP1B1 GENE

2020 ◽  
Vol 35 (Supplement_3) ◽  
Author(s):  
ROSSANA FRANZIN ◽  
Fabio Sallustio ◽  
Claudia Curci ◽  
Simona Simone ◽  
Angela Picerno ◽  
...  
Keyword(s):  
Gene Expression ◽  
Acute Kidney Injury ◽  
Extracellular Vesicles ◽  
Caspase 3 ◽  
Defense Mechanism ◽  
Kidney Injury ◽  
The Body ◽  
Cell Culture Supernatant ◽  
Protective Agent ◽  
Cyp1b1 Gene

Abstract Background and Aims Cisplatin, is a nonspecific cytotoxic agent that primarily interferes with cellular DNA replication and the cell cycle, nevertheless it lacks tumor selectivity and acts also in normal cells. The most serious adverse reaction of cisplatin is Acute Kidney Injury (AKI), limiting its use and efficacy in chemotherapy. Cisplatin nephrotoxicity is observed in more than 30% of older patients, however the mechanism of nephrotoxicity remains unclear and specific preventive measures are not available. Today, there is an urgent need for specific nephroprotective strategies to be used during cisplatin chemotherapy. Recently, we found that tubular stem/progenitor cells (tARPC) are able to protect the tubular epithelial (RPTEC) from cisplatin induced injury, preserving their proliferation and inhibiting apoptosis. The aim of this study was to identify the molecular mechanisms involved in tARPC-mediated resistance to cisplatin. Method Co-cultures of RPTEC cells and tARPCs were exposed to cisplatin (2.5 µM) for 6 h and then kept in culture for 96 h. Gene expression profile was obtained from tARPCs and RPTECs by Agilent SurePrint G3 Human Gene Expression Microarrays. Genespring and R software were used for the analysis. Gene expression data were validated by Real-time PCR. Extracellular vesicles were isolated from cell culture supernatant by miRCURY Exosome Cell/Urine/CSF Kit (Qiagen) and RNA contained in extracellular vesicles was purified, analyzed in quality by Bioanalyzer (RNA nano) and evaluated by qPCR. The BrdU assay and caspase 3 were used to measure proliferation and apoptosis levels. Immunohistochemical expression of activated caspase-3 was used as a marker of apoptosis in RPTECs. Results By a whole-genome gene expression analysis, we found 107 genes specifically modulated by RPTECs in response to cisplatin and, among these, 30 genes induced by ARPCs following the cisplatin damage. In particular, we found a strong upregulation of the CYP1B1 gene (false discovery rate corrected p value <0.05; fold change=4,1). The qPCR confirmed the increase in CYP1B1 levels in the co-cultures with respect to the respective basal conditions (p <0.05). Interestingly, the CYP1B1 mRNA was also enveloped in Extracellular Vesicles released in the cell co-culture media by tARPC and RPTEC after cisplatin exposition. The CYP1B1 gene encodes a member of the cytochrome P450 superfamily of enzymes and the produced enzyme metabolizes procarcinogens, such as polycyclic aromatic hydrocarbons. CYP1B1 has been shown to be active within tumors and is also capable of metabolizing a structurally diverse range of anticancer drugs. It is responsible for the resistance to docetaxel, cisplatin, tamoxifen and nucleoside analogues. CYP1B1 is involved in the detoxification of the body by various exogenous toxic agents, including cisplatin. We found that CYP1B1 gene was expressed at low levels in RPTECs and in cisplatin-damaged RPTECs. Moreover, 96 h days after 2.5 μM exposure to cisplatin, RPTECs reduced the proliferation and underwent in apoptosis, as showed by caspase 3. However, in co-culture with ARPCs, ARPC cellular and extracellular vesicles CYP1B1 gene expression significantly increased, the apoptotic process was stopped and RPTECs increased their proliferation rate. These data support the hypothesis that ARPCs are sensor of cisplatin damaged-RPTEC and confers cisplatin resistance by transferring CYP1B1 gene in extracellular vesicles. Conclusion This is the first evidence of a cisplatin-induced overexpression of CYP1b1 in renal epithelial cells as a defense mechanism against cisplatin toxicity. This is consistent with our previous data showing that renal progenitors are resistant to cisplatin. The findings may have biological and clinical significance in terms of their implications in cellular communications and potential use of CYP1B1 as biomarkers for AKI induced by cisplatin or as protective agent.

scholarly journals Acute Kidney Injury in Patients With Acute Chemical Poisoning: the Experience of the Toxicological Center in Ryazan

2021 ◽  
Vol 9 (4) ◽  
pp. 639-645
Author(s):  
N. V. Shatrova ◽  
M. N. Rudakova ◽  
L. G. Zaytseva ◽  
Zh. A. Varenova
Keyword(s):  
Acute Kidney Injury ◽  
Kidney Injury ◽  
Acute Poisoning ◽  
Annual Reports ◽  
Infusion Therapy ◽  
Chi Square ◽  
Exact Test ◽  
Risk Of Death ◽  
Increased Risk ◽  
Microsoft Office

Relevance. Acute kidney injury (AKI) is one of the leading causes of death worldwide. However, the epidemiology of AKI is not well understood. In Russia, toxic kidney damage plays a significant role in the nosological structure of AKI — 12.2%.Aim of study. To study the features of AKI in patients with acute chemical poisoning.Material and methods. We analyzed 26 case histories of patients with acute chemical poisoning with AKI (according to KDIGO). The comparison group included 25 patients with acute chemical poisoning without AKI. All patients were hospitalized in a toxicological center on the basis of the emergency department of the Ryazan Region State Budgetary Institution “City Clinical Emergency Hospital” (SBI RR “CCH EMC”) in 2016–2018. The analysis of the annual reports of the chief toxicologist of the Ministry of Health of the Ryazan Region for 2016–2018 was carried out. Data processing was performed using Microsoft Office Excel 2013 and on the website medstatistic.ru (Pearson’s chi-square test and Fisher’s exact test).Results. In most patients AKI developed during poisoning with cauterizing action substances - 38.4% (23% - vinegar essence, 15.4% - unidentified cauterizing action substance). The poisoning with alcohol substitutes (12%) took the 2nd place, with narcotic substances (8%) – the 3 rd place. Also, isolated cases of AKI (4% each) were reported in case of poisoning with pregabalin, tramadol, ketorol and ethanol. Poisoning with an unknown toxicant was noted in 29.6% of cases. Most patients (69.2%.) had stage 3 AKI. The second stage was registered in 7.7% of patients, the first — in 23.1%. Proteinuria was detected in all patients who underwent common urine test (CUT). Infusion therapy using crystalloids was performed in 100% of cases.Conclusion. Acute renal injury most often develops in acute poisoning with cauterizing poisons. The development of acute kidney injury in acute chemical poisoning leads to an increased risk of death. Acute kidney injury is the second most common immediate cause of death in acute chemical poisoning. Infusion therapy is an integral part of the management of toxicological patients with acute kidney injury.

scholarly journals Novel coronavirus infection and acute kidney injury in two renal transplant recipients: a case report

2020 ◽  
Vol 48 (10) ◽  
pp. 030006052096400
Author(s):  
Qiuyu Li ◽  
Qin Cheng ◽  
Zhiling Zhao ◽  
Nini Dai ◽  
Lin Zeng ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Kidney Transplantation ◽  
Renal Transplantation ◽  
Renal Injury ◽  
Gamma Globulin ◽  
Kidney Injury ◽  
Severe Pneumonia ◽  
Asymptomatic Infection ◽  
Renal Transplant Recipients ◽  
Acute Renal Injury

Background The causative virus of coronavirus disease 2019 (COVID-19) may cause severe fatal pneumonia. The clinical presentation includes asymptomatic infection, severe pneumonia, and acute respiratory failure. Data pertaining to acute renal injury due to COVID-19 in patients who have undergone renal transplantation are scarce. We herein report two cases of COVID-19 along with acute kidney injury following kidney transplantation. Case presentation: Two patients with COVID-19 underwent renal transplantation and were subsequently diagnosed with acute kidney injury. The first patient presented with progressive respiratory symptoms and acute renal injury. He was treated with diuretics and suspension of immunosuppressive therapy; however, the patient died. The second patient presented with respiratory tract symptoms, hypoxemia, and progressive deterioration of renal function followed by improvement. Her mycophenolate mofetil was stopped after admission, and tacrolimus was discontinued 10 days later. Moxifloxacin and methylprednisolone were continued in combination with albumin and gamma globulin infusion. A diuretic was administered, and prednisone was gradually reduced along with tacrolimus. The patient exhibited a satisfactory clinical recovery. Conclusion Patients who develop COVID-19 after kidney transplantation are at risk of acute kidney injury, and their prednisone, immunosuppressant, and gamma globulin treatment must be adjusted according to their condition.

scholarly journals Development of Rhabdomyolysis in the Long-term Period of Previous New Coronavirus Infection COVID-19 (Clinical Case Report)

2021 ◽  
Vol 10 (3) ◽  
pp. 452-459
Author(s):  
G. A. Berdnikov ◽  
N. Y. Kudryashova ◽  
E. V. Migunova ◽  
S. I. Rey ◽  
E. V. Gurok ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Renal Function ◽  
Kidney Injury ◽  
Infusion Therapy ◽  
Dynamic Observation ◽  
Three Phase ◽  
One Step ◽  
Coronavirus Infection ◽  
The Right

Relevance. Rhabdomyolysis is one of the complications of the new coronavirus infection COVID-19, which may cause acute kidney injury (AKI). The reason for the development of rhabdomyolysis in our observation in a patient after suffering COVID-19 in the long-term period was an increased muscle load.Aim of study. Presentation of a case of rhabdomyolysis with AKI in a patient after COVID-19 in the long-term period.Material and methods. In clinical observation, a 25-year-old patient L. is presented, who was being treated in the Department for the Treatment of Acute Endotoxicosis of the N.V. Sklifosovsky Research Institute for Emergency Medicine. In 2020, he developed COVID-19, complicated by rhabdomyolysis and AKI in the long term period.Results. Examination revealed an increase in creatinine phosphokinase (CPK) — 106,000.0 U/L, alanine aminotransferase (ALT) — 553.0 U/L, aspartate aminotransferase (AST) — 1582.0 U/L, lactate dehydrogenase (LDH) — 2809.0 U/L, levels of serum creatinine 164 μmol/L and myoglobin — 201 ng/ml. Virological research: IgM — 0.27 units per ml; IgG — 7.28 units per ml. 3 Three-phase scintigraphy with 99mTc-pyrfotech revealed signs of necrotic changes in the muscles of the upper half of the back, muscles of the chest (mainly on the right), muscles of the shoulder and upper half of the forearm on both sides. Kidneys: decreased perfusion of the right kidney (relative to the left), moderate slowdown of urodynamics at the level of the calyx-pelvis complex on both sides.Conclusions. The reason for the development of rhabdomyolysis in the long-term period in the patient after suffering from COVID-19 was an increased muscle load. Targeted research and medical history can help identify signs of rhabdomyolysis. The use of the radionuclide diagnostic method makes it possible to identify areas of soft tissue damage with a one-step assessment of renal function in rhabdomyolysis in the acute period of the disease, as well as to evaluate the effectiveness of treatment with dynamic observation. When rhabdomyolysis is confirmed, it is necessary to carry out detoxification and infusion therapy, to monitor renal function in order to detect acute kidney injury, and in case of deterioration of renal function and intoxication, renal replacement therapy is indicated.

scholarly journals Elevated serum galectin-1 concentrations are associated with increased risks of mortality and acute kidney injury in critically ill patients

PLoS ONE ◽  
2021 ◽  
Vol 16 (9) ◽  
pp. e0257558
Author(s):  
Ruey-Hsing Chou ◽  
Chuan-Tsai Tsai ◽  
Ya-Wen Lu ◽  
Jiun-Yu Guo ◽  
Chi-Ting Lu ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Critically Ill ◽  
Sofa Score ◽  
Critically Ill Patients ◽  
Medical Center ◽  
Elevated Serum ◽  
Kidney Injury ◽  
The Body ◽  
Icu Admission ◽  
Increased Risk

Background Galectin-1 (Gal-1), a member of the β-galactoside binding protein family, is associated with inflammation and chronic kidney disease. However, the effect of Gal-1 on mortality and acute kidney injury (AKI) in critically-ill patients remain unclear. Methods From May 2018 to March 2020, 350 patients admitted to the medical intensive care unit (ICU) of Taipei Veterans General Hospital, a tertiary medical center, were enrolled in this study. Forty-one patients receiving long-term renal replacement therapy were excluded. Serum Gal-1 levels were determined within 24 h of ICU admission. The patients were divided into tertiles according to their serum Gal-1 levels (low, serum Gal-1 < 39 ng/ml; median, 39–70 ng/ml; high, ≥71 ng/ml). All patients were followed for 90 days or until death. Results Mortality in the ICU and at 90 days was greater among patients with elevated serum Gal-1 levels. In analyses adjusted for the body mass index, malignancy, sepsis, Sequential Organ Failure Assessment (SOFA) score, and serum lactate level, the serum Gal-1 level remained an independent predictor of 90-day mortality [median vs. low: adjusted hazard ratio (aHR) 2.11, 95% confidence interval (CI) 1.24–3.60, p = 0.006; high vs. low: aHR 3.21, 95% CI 1.90–5.42, p < 0.001]. Higher serum Gal-1 levels were also associated with a higher incidence of AKI within 48 h after ICU admission, independent of the SOFA score and renal function (median vs. low: aHR 2.77, 95% CI 1.21–6.34, p = 0.016; high vs. low: aHR 2.88, 95% CI 1.20–6.88, p = 0.017). The results were consistent among different subgroups with high and low Gal-1 levels. Conclusion Serum Gal-1 elevation at the time of ICU admission were associated with an increased risk of mortality at 90 days, and an increased incidence of AKI within 48 h after ICU admission.

scholarly journals The role of biomarkers of acute kidney injury in predicting functional outcomes of surgical treatment of patients with localized kidney cancer

2021 ◽  
Vol 8 (3) ◽  
pp. 97-107
Author(s):  
I. O. Dementev ◽  
K. M. Nyushko ◽  
O. B. Karyakin ◽  
V. S. Chaikov ◽  
A. V. Troyanov ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Surgical Treatment ◽  
Kidney Disease ◽  
Kidney Cancer ◽  
Renal Injury ◽  
Functional Outcomes ◽  
Postoperative Mortality ◽  
Kidney Injury ◽  
Clinical Aspects ◽  
Acute Renal Injury

Currently, due to the dynamic development of surgical technologies, indications for organ-sparing treatment of kidney cancer are expanding. Acute kidney injury is a serious complication that leads to chronic kidney disease, increased postoperative mortality, deterioration of long-term functional outcomes, and increased hospitalization. At present, it is known that even a slight damage to kidneys or their impairment, presented by a decreased urine output and change in blood biochemical parameters, entails serious clinical consequences and is associated with a poor prognosis. Damaging factors, when the kidney is exposed, initially induce molecular changes, which entail the production of certain biomarkers, and only after that clinical aspects of kidney damage develop. The causes of acute kidney injury can be different, from specific renal disorders (acute interstitial nephritis, vascular and glomerular lesions, prerenal azotemia, obstructive disorders) to toxic damages, direct trauma and surgical treatment. The development of acute renal injury in the postoperative period is a serious complication of the surgical treatment of kidney disease, and, according to various authors, the frequency of its occurrence varies from 5.5 % to 34 %. An active study of this problem made it possible to find specific biomarkers that give the possibility to predict and diagnose acute renal injury in the early stages, to optimize the treatment strategy, to reduce the incidence of postoperative complications, and to shorten the period of postoperative rehabilitation. Currently, the most studied of acute kidney injury (AKI) biomarkers are cystatin C, neutrophil gelatinase-associated lipocalin‑2 (NGAL), hepatic protein L-FABP, KIM‑1 (Kidney injury molecule‑1), Interleukin – 18. Further study of AKI biomarkers will make it possible to determine the most significant ones for subsequent use in everyday practice

scholarly journals ACUTE KIDNEY INJURY DURING CRITICAL ILLNESS – A GLOBAL CHALLENGE

2019 ◽  
Vol 16 (2) ◽  
pp. 83-95
Author(s):  
M. Ostermann
Keyword(s):  
Acute Kidney Injury ◽  
Drug Therapy ◽  
Critically Ill ◽  
Kidney Injury ◽  
Critically Ill Patient ◽  
Infusion Therapy ◽  
Global Challenge ◽  
Nephrotoxic Drugs ◽  
Definition Of

The report is devoted to the problem of acute kidney injury (AKI) in critically ill patients. Currently, the clinical definition of AKI is based on the assessment of increasing serum creatinine, but this method has a number of significant drawbacks. Perhaps the use of biomarkers for early detection of renal injury will improve diagnostic results. Up to date, no specific drug therapy for AKI has no available. The therapeutic tactics are based on the assessment of the risk of development AKI in critically ill patient, hemodynamic optimization, revision of drug therapy to exclude nephrotoxic drugs and the use of renal replacement therapy (RRT). Despite the numerous studies and the presence of multiple researches of AKI, there are many unclear issues related, for example, how to choose tactics of infusion therapy, the use of vasopressor support in patients with AKI, the time of the beginning and the choice of the mode of RRT, the feasibility of combining several technologies of extracorporeal hemocorrection. It is important to define how to improve the short-term prognosis and the long-term consequences of renal dysfunction.

Different Biomarkers of Acute kidney Injury in Cancer Patients

2021 ◽  
Author(s):  
Reza Kazemi ◽  
Shirin Saberianpour ◽  
Hanieh Salehi ◽  
Mohammad Hatampour ◽  
Elnaz Sheikhpour
Keyword(s):  
Acute Kidney Injury ◽  
Cancer Patients ◽  
Early Stage ◽  
Kidney Injury ◽  
The Body ◽  
Main Task ◽  
Waste Products ◽  
Fatty Acid Binding ◽  
Neutrophil Gelatinase Associated Lipocalin ◽  
Kidney Injury Molecule 1

Acute Kidney Injury (AKI) occurs if the kidneys suddenly lose their ability to remove waste products. When the kidneys lose their ability to filter, dangerous levels of waste products can accumulate, which can upset the chemical composition of the blood and urine. Chemotherapy is one of the methods used to treat or temporarily reduce cancer by using certain medications. The main task of this treatment is to kill cancer cells without seriously damaging the surrounding tissues. However, this type of treatment also has destructive effects on healthy cells and tissues in the body. Researchers studying cancer patients undergoing chemotherapy found that people undergoing this type of treatment may develop serious kidney problems and be forced to use treatments such as dialysis and kidney transplants. Research showed that people with more severe cancers and advanced tumors are more likely to have acute kidney injury than those with early-stage cancer. AKI biomarkers can be selected from the patient's serum, urine, or body imaging components. Various studies showed that urine is a source of the best markers in AKI. Biomarkers in plasma and urine, such as N-acetyl-β-glucosaminidase, Cystatin-C, β2-microglobulin , Cysteine-Rich Protein, Osteopontin, Fetuin-A, Kidney Injury Molecule-1, Liver-type fatty acid-binding protein, Netrin-1, Neutrophil gelatinase-associated lipocalin, and interleukin-18 are effective tools for early detection of AKI. In this review study, an attempt was made to collect biomarkers related to AKI disease.

scholarly journals P0612UTILITY OF BODY COMPOSITION MONITORING (BCM) TO CORRELATE FLUID STATUS AND AKI IN PATIENTS UNDERGOING MAJOR CARDIAC SURGERY AND OUTCOMES

2020 ◽  
Vol 35 (Supplement_3) ◽  
Author(s):  
Rajeevalochana Parthasarathy ◽  
Madhusri Babu ◽  
Merina Alex ◽  
Preethi Nagesh ◽  
Milly Mathew ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Body Composition ◽  
Cardiac Surgery ◽  
Informed Consent ◽  
Fluid Overload ◽  
Statistical Significance ◽  
Extracellular Volume ◽  
Kidney Injury ◽  
The Body ◽  
Fluid Status

Abstract Background and Aims Technically assisted assessment of volume status before cardiac surgery may be useful to direct intraoperative fluid administration. Using a three-compartment physiologic tissue model, the body composition monitor (BCM, In Body) measures total body fluid volume, extracellular volume, intracellular volume and fluid overload as surplus or deficit of ‘normal’ extracellular volume. Fluid overload is a risk factor for infection, increased re intubation rates, pneumonia and acute kidney injury in these high risk patients. This study is planned to use BCM to assess fluid status in patients undergoing cardiac surgery and correlating it with the risk of AKI AIMS: To do BCM analysis of patients undergoing major cardiac surgery to assess fluid status and renal outcomes Primary Objective To use BCM to assess fluid status in patients undergoing cardiac surgery and correlate it with the risk of acute kidney injury Secondary Objectives To assess the correlation of fluid status obtained by BCM to assess 1. In hospital mortality in patients with and without AKI Method The studyis being conducted at Madras Medical Mission, Chennai. Time period : 1 year ( June 1 2019- May 31 2020) Inclusion criteria All consecutive patients above 18 years of age undergoing cardiac surgery Exclusion criteria 1. No informed consent 2. Patients having metal implants, pace makers 3. Pregnant and lactating mothers After informed consent, all adult patients undergoing cardiac surgery will have a BCM analysis done by the dietician .( Free of Charge) The BCM analysisInbody S10) will be done on Day 0( preoperative), Day 2 and Day 5 . Data will be collected according to a set proforma ( Attached) . Analysis will be performed using the SPSS platform. Results In this pilot study, 134 patients who underwent major cardiac surgery were enrolled. Of these 44 patients developed AKI as defined by KDIGO criteria( 22 Stage 1, 15 stage 2, and 7 stage 3). There was no statistical significance in the baseline characteristics when compared to age, gender, htn, ckd between patients with and without aki. Overhydration as measured by ECW/TBW ration of &gt; 0.38 was significantly higher on day 2 and 5 in patients who developed AKI .(P&lt;0.00, All 44 patients in aki versus 40 in the non aki group). The PBF, ICW, BMI nad overall BCM score was higher in patient with AKI ( p&lt;0.00). 7 patients required RRT( 6 SLED and 1 Acute PD). There was 1 death in theAKI group. The mean duration of hospital stay was longer ( 14 +/- 5 vs 7 +/- 3.5 ) in the AKI grroup Conclusion There is not much data on BCM and fluid assessment in cardiac surgery patients. These patients have many risk factors and a failing heart and associated renal dysfunction in many makes it very difficult to guide volume therapy in these patients. Many of the so called standard objective measures in assessing volume are not fool- proof . This study will be one of the firsts from India to assess fluid status in these patients and help in guiding therapy and also knowing the outcomes of such an objective measurement

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