Clinical Characteristics Analysis on Acute Kidney Injury of Patients in Department of Critical Care Medicine

A thirty-year-old pregnant woman was admitted to hospital with headache and gastrointestinal discomfort. She developed peripheral oedema and had an emergency caesarean section following an episode of tonic-clonic seizures. Her delivery was further complicated by postpartum haemorrhage and she was admitted to the Intensive Care Unit (ICU) for further resuscitation and seizure control which required infusions of magnesium and multiple anticonvulsants. Despite haemodynamic optimisation she developed an acute kidney injury with evidence of liver damage, thrombocytopenia and haemolysis. Haemolysis, Elevated Liver enzymes and Low Platelets (HELLP) syndrome, a multisystem disease of advanced pregnancy which overlaps with pre-eclampsia, was diagnosed. HELLP syndrome is associated with a range of complications which may require critical care support, including placental abruption and foetal loss, acute kidney injury, microangiopathic haemolytic anaemia, acute liver failure and liver capsule rupture. Definitive treatment of HELLP is delivery of the fetus and in its most severe forms requires admission to the ICU for multiorgan support. Therapeutic strategies in ICU are mainly supportive and include blood pressure control, meticulous fluid balance and possibly escalation to renal replacement therapy, mechanical ventilation, neuroprotection, seizure control, and management of liver failure-related complications. Multidisciplinary input is essential for optimal treatment.

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Clinical characteristics and prognosis of postpartum acute kidney injury

Journal of International Medical Research ◽

10.1177/0300060520988388 ◽

2021 ◽

Vol 49 (2) ◽

pp. 030006052098838

Author(s):

Hong Shu ◽

Fang Nie

Keyword(s):

Acute Kidney Injury ◽

Clinical Characteristics ◽

Survival Rates ◽

Kidney Injury ◽

Renal Recovery ◽

Replacement Treatment ◽

Elevated Liver Enzymes ◽

Recovery Times ◽

Low Platelet Count ◽

Lost To Follow Up

Objective To investigate the clinical characteristics and prognoses of patients with postpartum acute kidney injury (PPAKI). Methods We retrospectively reviewed the clinical presentations, laboratory examinations, treatments, and outcomes of patients with PPAKI admitted to our hospital from January 2013 to December 2017. We then analyzed the clinical characteristics and prognoses of the mothers and their infants. Results Of 37 patients diagnosed with PPAKI, 26 (70.3%) received treatment in the intensive care unit, mainly for hemolysis, elevated liver enzymes, low platelet count (HELLP) syndrome (28/37, 75.7%), pre-eclampsia (26/37, 70.3%), and postpartum hemorrhage (22/37, 59.5%). Twenty patients required renal replacement treatment (RRT), but renal recovery times were similar in the RRT and non-RRT groups. Renal function recovered completely in 30 patients (81.1%) and partially in one patient (2.7%), and was not re-examined in two patients (5.4%). Three patients (8.1%) were lost to follow-up. Only one patient (2.7%) remained dialysis-dependent, and no maternal deaths occurred. The preterm birth, low birth weight, and infant survival rates were 70.7% (29/41), 68.3% (28/41), and 78.0% (32/41), respectively. Conclusion RRT does not reduce renal recovery time compared with non-RRT. Overall, the prognoses of both mothers and their fetuses are good following treatment for PPAKI.

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Diagnostic Approach to Acute Kidney Injury in the Critical Care Unit

Infectious Diseases and Antimicrobial Stewardship in Critical Care Medicine ◽

10.1201/9781315099538-26 ◽

2020 ◽

pp. 293-303

Author(s):

Sonali Gupta ◽

Divyansh Bajaj ◽

Sana Idrees ◽

Joseph Mattana

Keyword(s):

Acute Kidney Injury ◽

Critical Care ◽

Critical Care Unit ◽

Kidney Injury ◽

Diagnostic Approach

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The risk factors and outcome of early identified acute kidney injury among critically ill obstetric patients

International Journal of Advanced Nursing Studies ◽

10.14419/ijans.v6i1.7170 ◽

2017 ◽

Vol 6 (1) ◽

pp. 11

Author(s):

Amal Abd El-Hafez1 ◽

Asmaa Mahjoub ◽

Eman Ahmad

Keyword(s):

Risk Factors ◽

Acute Kidney Injury ◽

Critical Care ◽

Sofa Score ◽

Postpartum Hemorrhage ◽

Kidney Injury ◽

Total Sample ◽

Critical Care Nurses ◽

Cross Sectional ◽

Pregnancy And Postpartum

Background: Acute kidney injury (AKI) is one of the most challenging and serious complications of pregnancy and postpartum period that facing critical care nurses in Intensive Care Unit (ICU). Having a uniform standard for identifying and classifying AKI would enhance critical care nurses’ ability to recognize these patients and leading to better outcomes.Objective: This work aimed to explore the risk factors and outcome of early identified acute kidney injury of critically obstetric patients in Obstetric ICU. Design. A descriptive cross sectional research design was used in this study. Participants: A total sample of 338 women admitted to Obstetric ICU at Woman Health Hospital, Assiut City, Egypt. Method: Three tools were used.Tool I was developed by the researcher and included demographic and obstetric history, lab parameters, complications and outcomes arising from AKI. The Sequential Organ Failure Assessment (SOFA) score as tool II to determine the extent of a patient's organ function or rate of failure. Measurement of serum creatinine and urine output were used to early identify AKI stages according to Acute Kidney Injury Network (AKIN) Criteria (tool III). Results: The prevalence of AKI among obstetric patients admitted to obstetric ICU was 10.1%; of them 52.9% needed renal replacement therapy and the mortality rate was 29.4%. Postpartum hemorrhage was the most common cause of AKI and its prevalence was 41.2%. It was also found that 74.5% of AKI patients developed complications. Conclusion: AKI complicated 10.1% of total admitted women to the OICU in the studied period. Postpartum hemorrhage represents the most prevalent risk factors with a highly significant SOFA score compared to other risk factors as sever preeclampsia, eclampsia, HEELP & APH with acute fatty liver.

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Clinical characteristics and outcomes of patients with acute kidney injury: A single-center study

Saudi Journal of Kidney Diseases and Transplantation ◽

10.4103/1319-2442.113903 ◽

2013 ◽

Vol 24 (4) ◽

pp. 813

Author(s):

Nadeeka Rathnamalala

Keyword(s):

Acute Kidney Injury ◽

Clinical Characteristics ◽

Kidney Injury ◽

Single Center ◽

Single Center Study ◽

Center Study

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Clinical characteristics and mortality risk prediction in children with acute kidney injury

Nigerian Medical Journal ◽

10.4103/0300-1652.170381 ◽

2015 ◽

Vol 56 (5) ◽

pp. 327 ◽

Cited By ~ 2

Author(s):

Alireza Teimouri ◽

Simin Sadeghi-Bojd ◽

NoorMohammad Noori ◽

Mehdi Mohammadi

Keyword(s):

Acute Kidney Injury ◽

Risk Prediction ◽

Mortality Risk ◽

Clinical Characteristics ◽

Kidney Injury

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Are Blacks at Higher Risk for Vancomycin-Related Acute Kidney Injury?

Journal of Pharmacy Practice ◽

10.1177/0897190018800093 ◽

2019 ◽

Vol 33 (5) ◽

pp. 592-597 ◽

Cited By ~ 1

Author(s):

Mamta Sharma ◽

Kaylin Braekevelt ◽

Pramodini Kale-Pradhan ◽

Susan Szpunar ◽

Riad Khatib

Keyword(s):

Acute Kidney Injury ◽

Clinical Characteristics ◽

Trough Level ◽

Kidney Injury ◽

Comorbid Conditions ◽

Black Race ◽

Source Of Infection ◽

Vancomycin Trough ◽

Nephrotoxic Drugs ◽

Trough Levels

Background: Black individuals have a higher lifetime risk of acute kidney injury (AKI) and chronic kidney disease than whites. Vancomycin has a potential for nephrotoxicity. The objective of this study was to determine whether the incidence of AKI among patients being treated with vancomycin differs by race. Methods: Retrospective study of adult (3 ≥18 years) inpatients who were on vancomycin for 348 hours between January 2012 and December 2014. Data on demographics, comorbid conditions, clinical characteristics, vancomycin dose, duration, and nephrotoxic drugs were collected. Patients with a creatinine clearance <30 mL/min or undergoing dialysis were excluded. Results: We identified 1130 patients during the study period; 48.1% (544) were black. The overall incidence of AKI was 8.2% (10.1% blacks, 6.5% whites; P = .03). Independent predictors of AKI included black race ( P = .011); higher Charlson score ( P = .006); higher body mass index (BMI; P = .002); higher vancomycin trough level ( P < .0001); and sepsis/systemic inflammatory response syndrome (<.0001), pneumonia ( P = .001) or gastrointestinal/genitourinary ( P = .025) as the source of infection. Conclusion: The incidence of vancomycin-related AKI was higher in blacks, independent of other risk factors. Based on our study, vancomycin trough levels and renal function need to be closely monitored in blacks.

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