scholarly journals Urinary Sodium/Potassium Ratio in Acute Kidney Injury Accurately Differentiates Prerenal Azotemia from Acute Tubular Necrosis

2019 ◽  
Vol 65 (3) ◽  
pp. 103-110
Author(s):  
Theodore Shankel ◽  
Stewart Shankel
Keyword(s):  
Acute Kidney Injury ◽  
Renal Failure ◽  
Serum Creatinine ◽  
Kidney Injury ◽  
Cost Effective ◽  
Creatinine Ratio ◽  
Urine Sodium ◽  
Sodium Potassium ◽  
Non Invasive ◽  
Tubular Necrosis

AbstractObjective: To develop a more accurate, cost effective, non-invasive test to differentiate between pre-renal renal failure (PRA) and acute tubular necrosis (ATN) in acute kidney injury (AKI).Methods: Urine sodium/potassium (Na/K) ratios were compared with fractional excretion of sodium (FeNa) and renal failure index (RFI) as well as other commonly used indices to differentiate patients with PRA from ATN. Patients with a rise in serum creatinine > 0.5 mg/d identified from medical records for a six- to eighteen-month period, were reviewed and categorized either as PRA or ATN based on presenting findings, course in hospital or renal biopsy. All patients had urinary sodium and potassium, creatinine, and serum creatinine done.Results: The Na/K was < 1 in PRA and > 1 in ATN, correctly identifying all 42 cases of PRA and all 28 patients with ATN. The FeNa was >1 and misdiagnosed 9 of 42 patients with PRA and was >1 and correctly diagnosed all patients with ATN. The RFI was >1 and misdiagnosed 11 of 42 patients with PRA but was >1 and correctly diagnosed all patients with ATN. The BUN/creatinine ratio, urine sodium concentration and U/P creatinine ratio all had a very poor correlation with the correct diagnosis.Conclusion: The Na/K ratio correctly diagnosed all 42 cases of PRA and all 28 cases of ATN. It is easy to do, is cost effective, non-invasive, and is useful for following patients with PRA to see if and when they develop ATN.

scholarly journals Hepatorenal Syndrome

2021 ◽  
Author(s):  
Arshpal Gill ◽  
Ra’ed Nassar ◽  
Ruby Sangha ◽  
Mohammed Abureesh ◽  
Dhineshreddy Gurala ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Renal Failure ◽  
Blood Flow ◽  
Mortality Rate ◽  
Kidney Injury ◽  
Type I ◽  
Tubular Necrosis ◽  
Cirrhotic Patients

Hepatorenal Syndrome (HRS) is an important condition for clinicians to be aware of in the presence of cirrhosis. In simple terms, HRS is defined as a relative rise in creatinine and relative drop in serum glomerular filtration rate (GFR) alongside renal plasma flow (RPF) in the absence of other competing etiologies of acute kidney injury (AKI) in patients with hepatic cirrhosis. It represents the end stage complication of decompensated cirrhosis in the presence of severe portal hypertension, in the absence of prerenal azotemia, acute tubular necrosis or others. It is a diagnosis of exclusion. The recognition of HRS is of paramount importance for clinicians as it carries a high mortality rate and is an indication for transplantation. Recent advances in understanding the pathophysiology of the disease improved treatment approaches, but the overall prognosis remains poor, with Type I HRS having an average survival under 2 weeks. Generally speaking, AKI and renal failure in cirrhotic patients carry a very high mortality rate, with up to 60% mortality rate for patients with renal failure and cirrhosis and 86.6% of overall mortality rates of patients admitted to the intensive care unit. Of the various etiologies of renal failure in cirrhosis, HRS carries a poor prognosis among cirrhotic patients with acute kidney injury. HRS continues to pose a diagnostic challenge. AKI can be either pre-renal, intrarenal or postrenal. Prerenal causes include hypovolemia, infection, use of vasodilators and functional due to decreased blood flow to the kidney, intra-renal such as glomerulopathy, acute tubular necrosis and post-renal such as obstruction. Patients with cirrhosis are susceptible to developing renal impairment. HRS may be classified as Type 1 or rapidly progressive disease, and Type 2 or slowly progressive disease. There are other types of HRS, but this chapter will focus on Type 1 HRS and Type 2 HRS. HRS is considered a functional etiology of acute kidney injury as there is an apparent lack of nephrological parenchymal damage. It is one several possibilities for acute kidney injury in patients with both acute and chronic liver disease. Acute kidney injury (AKI) is one of the most severe complications that could occur with cirrhosis. Up to 50% of hospitalized patients with cirrhosis can suffer from acute kidney injury, and as mentioned earlier an AKI in the presence of cirrhosis in a hospitalized patient has been associated with nearly a 3.5-fold increase in mortality. The definition of HRS will be discussed in this chapter, but it is characterized specifically as a form of acute kidney injury that occurs in patients with advanced liver cirrhosis which results in a reduction in renal blood flow, unresponsive to fluids this occurs in the setting of portal hypertension and splanchnic vasodilation. This chapter will discuss the incidence of HRS, recognizing HRS, focusing mainly on HRS Type I and Type II, recognizing competing etiologies of renal impairment in cirrhotic patients, and the management HRS.

scholarly journals Rhabdomyolysis and Acute Kidney Injury Requiring Dialysis as a Result of Concomitant Use of Atypical Neuroleptics and Synthetic Cannabinoids

2015 ◽  
Vol 2015 ◽  
pp. 1-4 ◽  
Author(s):  
Aiyu Zhao ◽  
Maybel Tan ◽  
Aung Maung ◽  
Moro Salifu ◽  
Mary Mallappallil
Keyword(s):  
Acute Kidney Injury ◽  
Differential Diagnosis ◽  
Adverse Effects ◽  
Serum Creatinine ◽  
Synthetic Cannabinoids ◽  
Kidney Injury ◽  
Atypical Neuroleptics ◽  
Unique Case ◽  
Urine Metabolites ◽  
Tubular Necrosis

The use of synthetic cannabinoids (SCBs) is associated with many severe adverse effects that are not observed with marijuana use. We report a unique case of a patient who developed rhabdomyolysis and acute kidney injury (AKI) requiring dialysis after use of SCBs combined with quetiapine. Causes for the different adverse effects profile between SCBs and marijuana are not defined yet. Cases reported in literature with SCBs use have been associated with reversible AKI characterized by acute tubular necrosis and interstitial nephritis. Recent studies have showed the involvement of cytochromes P450s (CYPs) in biotransformation of SCBs. The use of quetiapine which is a substrate of the CYP3A4 and is excreted (73%) as urine metabolites may worsen the side effect profiles of both quetiapine and K2. SCBs use should be included in the differential diagnosis of AKI and serum Creatinine Phosphokinase (CPK) level should be monitored. Further research is needed to identify the mechanism of SCBs nephrotoxicity.

scholarly journals Maternal-Perinatal Variables in Patients with Severe Preeclampsia Who Develop Acute Kidney Injury

2021 ◽  
Vol 10 (23) ◽  
pp. 5629
Author(s):  
Patrocinio Rodríguez-Benitez ◽  
Irene Aracil Moreno ◽  
Cristina Oliver Barrecheguren ◽  
Yolanda Cuñarro López ◽  
Fátima Yllana ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Renal Failure ◽  
Renal Function ◽  
Uric Acid ◽  
Caesarean Section ◽  
Serum Creatinine ◽  
Kidney Injury ◽  
Severe Preeclampsia ◽  
History Of ◽  
Nicu Admission

Introduction: At present, we are witnessing an increase in preeclampsia, especially the most severe forms, which are associated with an increased risk of maternal-perinatal morbidity and mortality. As a severity criterion, acute kidney injury (AKI) has been associated with a worse prognosis, and for this reason, the maternal and perinatal variables associated with AKI in patients with severe preeclampsia (SP) were analysed in this study. Methods: An observational, retrospective, single-centre study of patients with SP treated at a tertiary hospital between January 2007 and December 2018 was conducted. The case criteria based on the criteria established by the ACOG Practice Guidelines for Gestational Hypertension and Preeclampsia. AKI is considered when serum creatinine exceeds 1.1 mg/dL in a pregnant woman with previously normal renal function. In patients with existing chronic kidney disease (CKD), it is referred to as AKI if the baseline serum creatinine increases by 1.5 fold. Pregestational, gestational and postpartum variables were analysed up to 12 weeks postpartum using univariate and multivariate logistic regression analysis. Results: During the study period, 76,828 births were attended, and 303 pregnant women were diagnosed with SP. The annual incidence of SP increased gradually throughout the study period, reaching 1.79/100 births/year in 2018. Acute kidney injury (AKI) occurred in 24.8% of the patients. The multivariate analysis revealed an increased association with a history of previous CKD, the use of assisted reproductive techniques and caesarean section. Uric acid and thrombotic microangiopathy (TMA) had a high correlation with AKI. Indications for caesarean section are associated with AKI in SP. Regarding perinatal outcomes in cases of AKI, there was a higher percentage of neonates who required foetal lung maturation with steroids and an increased need for NICU admission. No case of maternal death was recorded; however, an increase in neonatal mortality was found among patients who did not develop AKI. After 12 weeks postpartum, 72 patients were referred to the nephrology consultation for persistent hypertension, proteinuria or renal failure. Conclusions: In preeclampsia, AKI is a common complication, especially among patients with a history of CKD, those who became pregnant using assisted reproduction techniques and those who delivered via caesarean section. The perinatal impact of AKI is mainly centred on a higher rate of NICU admission and a lower mortality rate. Among biochemical and haematological markers, the uric acid level prior to renal failure has a direct and significant correlation with the risk of AKI, as does the development of TMA in patients with preeclampsia. Therefore, the monitoring of renal function in cases of preeclampsia should be strict, and referral for a nephrology consultation may be necessary in some cases.

scholarly journals Community Acquired Acute Kidney Injury from Edible Agents: Report from a Developing Country, Bangladesh

2017 ◽  
Vol 10 (1) ◽  
pp. 20-28 ◽  
Author(s):  
Tabassum Samad ◽  
Wasim M. Mohosin ul Haque ◽  
Muhammad A. Rahim ◽  
Sarwar Iqbal ◽  
Palash Mitra
Keyword(s):  
Acute Kidney Injury ◽  
Serum Creatinine ◽  
Acute Tubular Necrosis ◽  
Public Awareness ◽  
Kidney Injury ◽  
Energy Drink ◽  
Renal Tubules ◽  
Tubular Necrosis ◽  
Oxalate Crystals ◽  
Star Fruit

Toxin is a common cause of community acquired acute kidney injury (AKI) which includes environmental toxins like plant toxins as well as various drugs and chemicals which are usually ingested for medicinal as well as recreational purposes.Averrhoa carambola(Star fruit/ Kamranga) andAvorrhoa bilimbiare two such commonly used traditional remedies. They belong to familyOxalidaecaeand contain high-levels of oxalic acid. AKI may occur after consuming concentrated juice due to deposition of oxalate crystals in the renal tubules.Here we present two patients who developed AKI after ingestion of freshly made juice from A. bilimbi and star fruit. Both patients were diabetic and the juice was ingested on empty stomach with the belief of improving glycemic status. Initial presentation was GI upset in both scenarios. Patient with A. bilimbi toxicity had diabetic nephropathy and required hemodialysis. Renal biopsy revealed deposition of polarizable oxalate crystals in the patient who consumed A. bilimbi and acute tubular necrosis in the patient with star fruit toxicity. All cases regained normal renal function within three months.We also present a patient who ingested raw fish gallbladder as a remedy for asthma. The patient presented with AKI within five days of ingestion and required hemodialysis. His highest serum creatinine was 10.4mg/dl and fell to 1.7 mg/dl after four weeks. Cyprinol and related compounds in fish gallbladder are thought to be the cause of acute tubular necrosis in such cases.The fourth patient developed AKI with rhabdomyolysis after consuming a locally made energy drink. He also required dialysis and serum creatinine gradually improved from 7.2mg/dl to 1.4mg/dl at discharge. The possibility of toxicity of caffeine, adulteration with other chemicals or ascorbic acid toxicity causing oxalate nephropathy could not be excluded.All four patients developed AKI caused after ingesting easily available products and are presented here for public awareness. We believe proper knowledge and education can reduce toxin induced AKI in our society.

scholarly journals Clinical profile of acute kidney injury in neonates with perinatal asphyxia

2021 ◽  
Author(s):  
Revanasiddappa Bhosgi ◽  
Kirankumar Harwalkar
Keyword(s):  
Acute Kidney Injury ◽  
Renal Failure ◽  
Serum Creatinine ◽  
Early Recognition ◽  
Perinatal Asphyxia ◽  
Kidney Injury ◽  
Term Neonates ◽  
Renal Functions ◽  
Appropriate Treatment ◽  
Stage 1

Background: Acute kidney injury (AKI) is one of the most common complication observed in perinatal asphyxia. Early recognition is required for appropriate treatment and improve the outcome.Methods: It is a hospital based retrospective study conducted from august 2019 to December 2019. Total 85 full term neonates with perinatal asphyxia were included in the study. Renal functions were assessed by monitoring urine output, serum creatinine and ultrasonography. Acute kidney injury assessed by pRIFLE criteria and HIE staging is done by modified Sarnat and Sarnat staging. Severity of AKI is correlated with stages of HIE. AKI is managed as per unit protocol.Results: Total 85 perinatal asphyxia neonates were included in the study. Out of total 85 neonates, 25 (29.4%) neonates had evidence of acute kidney injury. Among 25 neonates with acute kidney injury, higher percentage was observed in male neonates which was 14 (56%) against 11 (44%) among female neonates. Predominantly, non oligouric acute kidney injury was observed among acute kidney injury neonates which accounted to 20 neonates (80%) (p-0.258). Serum creatinine between 1.5-2 mg/dl was observed in 18 (21.1%) neonates and 7 (8.2%) neonates had creatinine between 2-3 mg/dl. Sonological abnormality was noted in 2 (2.3%) neonates. Among neonates with non oligouric AKI, 3 (12%) neonates had HIE stage 1, 15 (60%) had HIE-2 and 7 (28%) had HIE-3. However, neonates with non oligouric AKI were higher among HIE 2 when compared to neonates with oligouric renal failure who were higher in HIE 3. No mortality occurred among these neonates.Conclusions: Majority of the neonates with perinatal asphyxia had non oliguric AKI which responded well to conservative treatment. AKI is most commonly seen in HIE stage 2 babies. Since non oligouric renal failure was a predominant finding among asphyxiated neonates, Serum creatinine monitoring remains main stay of diagnosis. 

scholarly journals Acute Kidney Injury after ingestion of Star fruit juice in patients with previous history of acute kidney injury: Two case reports

2017 ◽  
Vol 7 (1) ◽  
pp. 33-35
Author(s):  
Sayed Fazlul Islam ◽  
KBM Hadizzaman ◽  
Syed Mahbub Morshed ◽  
Md Omar Faroque ◽  
AH Hamid Ahmed ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Case Report ◽  
Serum Creatinine ◽  
Case Reports ◽  
Previous History ◽  
Kidney Injury ◽  
Normal Serum ◽  
Tubular Necrosis ◽  
Mild Degree ◽  
Star Fruit

Acute kidney injury can occur due to various reasons. In this case report two cases of acute kidney injury (AKI) were reported after ingestion of 250 ml of starfruit juice presented. In both cases features of nephrotoxicity and neurotoxicity were found and there was mild to moderate rise in serum creatinine. Routine and microscopic examination of urine showed mild degree of proteinuria, no other active urinary sediment was found except calcium oxalate crystals. Renal biopsy was done in both cases which showed features of acute tubular necrosis. These two patients were treated symptomatically and discharged with normal serum creatinine. There is no case report of acute kidney injury due to star fruit ingestion in Bangladesh. Star fruit is very popular, cheap and easily available. But its nephrotoxic effect is not known to general population. These two case reports might be a first time message to the nation.J Shaheed Suhrawardy Med Coll, 2015; 7(1):33-35

scholarly journals Acute Kidney Injury Epidemiology in pediatrics

2019 ◽  
Vol 41 (2) ◽  
pp. 275-283 ◽  
Author(s):  
Thais Lira Cleto-Yamane ◽  
Conrado Lysandro Rodrigues Gomes ◽  
Jose Hermogenes Rocco Suassuna ◽  
Paulo Koch Nogueira
Keyword(s):  
Acute Kidney Injury ◽  
Renal Failure ◽  
Acute Renal Failure ◽  
Regional Differences ◽  
Kidney Injury ◽  
Developed Countries ◽  
Mesh Term ◽  
Renal Diseases ◽  
Tubular Necrosis ◽  
Related Mortality

Abstract We performed a search in the MEDLINE database using the MeSH term: "Acute Kidney Injury", selecting the subtopic "Epidemiology", and applying age and year of publication filters. We also searched for the terms: "acute renal failure" and "epidemiology" "acute tubular necrosis" and "epidemiology" in the title and summary fields with the same filters. In a second search, we searched in the LILACS database, with the terms: "acute renal injury", or "acute renal failure" or "acute kidney injury" and the age filter. All abstracts were evaluated by the authors and the articles considered most relevant, were examined in their entirety. Acute Kidney Injury (AKI) -related mortality ranged from 3-63% in the studies included in this review. AKI etiology has marked regional differences, with sepsis being the main cause in developed countries. In developing countries, primary renal diseases and hypovolemia are still a common cause of AKI.

scholarly journals Outcome of Continuous Peritoneal Dialysis in Patient with Acute Kidney Injury

2019 ◽  
Vol 2 (3) ◽  
pp. 164-168
Author(s):  
Amrit KC ◽  
Rahman Tanvir ◽  
Alam Muhammad Rafiqul ◽  
Ahmed A.H. Hamid ◽  
Noor Towhida
Keyword(s):  
Acute Kidney Injury ◽  
Renal Function ◽  
Peritoneal Dialysis ◽  
Serum Creatinine ◽  
Kidney Injury ◽  
Electrolyte Imbalance ◽  
Drug Induced ◽  
Low Socioeconomic ◽  
Tubular Necrosis ◽  
Continuous Peritoneal Dialysis

Background: Though peritoneal dialysis has several limitations, it is still used in acute kidney injury (AKI) patients as an alternative method of Renal Replacement Therapy (RRT), especially in low socioeconomic countries. Materials and Method: This study included thirty patients diagnosed as AKI. Peritoneal access was established through flexible Tenckhoff catheter for Continuous Peritoneal Dialysis (CPD) and 6-8 exchanges were done in 24 hours. Results: Among 30 patients mean age was (mean±SD) 49.93±14.42 years. Seven (23.33%) patients were hemodynamically unstable. The cause of AKI was drug induced in 6(20.7%), hypovolemia/Acute Tubular Necrosis in 6(20.0%), sepsis in 5(16.7%), heart failure in 2(6.7%) and 11(36.7%) had multiple causes. In initial presentation, mean serum creatinine was 683.42 μmol/L, and the number of sessions required for stabilization of serum creatinine was 7.5±1.43, sessions required for correction of hyperkalemia and metabolic acidosis were 2.15±0.69 and 2.5±0.76 respectively. The delivered Kt/V urea was 1.95±0.14 weekly. Six (20.0%) patients had peritonitis, five (16.7%) had pericatheter leakage and four (13.33%) had catheter blockage. Among 30 patients, three patients (10%) had died, sixteen (59.3%) had recovery of renal function and rest did not recover renal function. Conclusion: CPD was effective for correction of metabolic and electrolyte imbalance.  

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

2017 ◽  
Vol 4 (2) ◽  
pp. 635
Author(s):  
Divya Durga ◽  
Sudha Rudrappa
Keyword(s):  
Risk Factors ◽  
Acute Kidney Injury ◽  
Renal Failure ◽  
Serum Creatinine ◽  
Neonatal Sepsis ◽  
Tertiary Care ◽  
Significant Risk ◽  
Kidney Injury ◽  
Morbidity And Mortality ◽  
Incidence And Mortality

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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