Prevention, diagnosis and management of acute kidney injury: Adapted clinical guidelines of the Ukrainian Association of Nephrologists and Kidney Transplant Specialists

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

Journal of International Medical Research ◽

10.1177/0300060520964009 ◽

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.

Management of acute kidney injury in patients with COVID-19 or CKD stage 1-4 patients with acute kidney injury in the COVID-19 pandemic: Adapted clinical guidelines of the Ukrainian Association of Nephrologists and Kidney Transplant Specialists

Ukrainian Journal of Nephrology and Dialysis ◽

10.31450/ukrjnd.3(67).2020.04 ◽

2020 ◽

pp. 20-27

Author(s):

M. Kolesnyk ◽

I. Dudar ◽

N. Stepanova ◽

E. Krasyuk ◽

Yu. Gonchar ◽

...

Keyword(s):

Infectious Disease ◽

Acute Kidney Injury ◽

Mortality Rate ◽

Medical Care ◽

Kidney Transplant ◽

Clinical Guidelines ◽

Kidney Injury ◽

Ckd Stage ◽

Infectious Disease Specialists ◽

Stage 1

Acute kidney injury (AKI) is diagnosed in 1–40% of the COVID-19 patients; from 2% to 10% of the patients are required renal replacement therapy (RRT). The mortality rate in this category of patients reached 88%. Early AKI detection in the patients with COVID-19, followed by the use of preventive and therapeutic measures to minimize the incidence or progression is a significant key to reduce the mortality rate and transformation of AKI into chronic kidney disease (CKD). The expert group of the Ukrainian Association of Nephrologists and Kidney Transplant Specialists has created the adapted clinical guidelines for the management of acute kidney injury in patients with COVID-19 or CKD stage 1-4 patients with acute kidney injury in the COVID-19 pandemic. These guidelines are intended for family physicians, general practitioners, physicians, cardiologists, nephrologists, intensivists, endocrinologists, infectious disease specialists and other professionals involved in the provision of specialized medical care to the patients with COVID-19. Specialized medical care for AKI patients infected COVID-19 should be provided by a multidisciplinary team, which has to involve nephrologists, infectious disease specialists and intensivists.

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

Research n Practical Medicine Journal ◽

10.17709/2410-1893-2021-8-3-9 ◽

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

A Case of Upper Ureter Rupture With Acute Kidney Injury

Clinical Medicine Insights Case Reports ◽

10.1177/1179547618785134 ◽

2018 ◽

Vol 11 ◽

pp. 117954761878513

Author(s):

Yuko Mutsuyoshi ◽

Shohei Kaneko ◽

Saori Minato ◽

Katsunori Yanai ◽

Hiroki Ishii ◽

...

Keyword(s):

Acute Kidney Injury ◽

Renal Function ◽

Renal Injury ◽

Urine Output ◽

Urinary Catheter ◽

Kidney Injury ◽

Benign Prostatic Hypertrophy ◽

Acute Renal Injury ◽

Surgical Operation ◽

Normal Range

We herein report a case of ureter rupture with severe oliguric acute renal injury due to benign prostatic hypertrophy. After insertion of an indwelling urinary catheter, the patient’s urine output immediately increased. His symptoms and renal function also rapidly improved to the normal range without a surgical operation. Clinicians should note this complication in patients with oliguria.

Acute kidney injury in cardiac surgery: definition, epidemiology, outcomes and socio-economic significance

Patologiya krovoobrashcheniya i kardiokhirurgiya ◽

10.21688/1681-3472-2020-4-11-21 ◽

2020 ◽

Vol 24 (4) ◽

pp. 11

Author(s):

N. O. Kamenshchikov ◽

Yu. K. Podoksenov ◽

M. L. Diakova ◽

A. M. Boyko ◽

B. N. Kozlov

Keyword(s):

Acute Kidney Injury ◽

Cardiac Surgery ◽

Conflict Of Interest ◽

Renal Injury ◽

Kidney Injury ◽

Prolonged Treatment ◽

Acute Renal Injury ◽

Term Survival ◽

Clinical Practise

Surgical intervention on an ‘open’ heart during cardio-pulmonary bypass is the method of choice for patients with valvular defects, complicated forms of coronary heart disease and combined pathology. The level of perioperative mortality in these interventions range from 2 % to 10 %. Acute kidney injury associated with cardiac surgery is a common and serious complication which dramatically worsens operative prognoses and results. According to several major studies, the incidence of acute renal injury in cardiac surgery is comparable with the incidence of myocardial infarction, with corresponding unsatisfactory outcomes. The introduction of the term ‘acute kidney injury’ into clinical practise, replacing the concept of acute renal failure, occurred relatively recently. This facilitated a universal definition for this condition, and unified the criteria for diagnosis and stratification of acute renal dysfunction severity. The article defines acute kidney injury using RIFLE, AKIN and KDIGO criteria. Acute kidney injury in cardiac surgery dramatically worsens short-term results and long-term outcomes, and thus increases the economic cost of treating patients. According to some reports, in industrialised countries, the health costs associated with acute kidney injury are estimated at $ 1 billion. Acute kidney injury is associated with approximately 300,000 deaths per annum, as well as approximately 300,000 new cases of chronic kidney disease. Cumulative expenses associated with acute renal injury in cardiac surgery are not directly limited to the hospitalisation period, but are often prolonged and/or deferred. These patients require additional financial expenses after discharge from hospital, which once again exemplifies this problem in cardiac surgery. Manifest acute kidney injury in the postoperative period of cardiac surgery leads to an increased number of extrarenal complications, reduced short-and long-term survival rates, increased economic costs in hospitals and prolonged treatment effects in the long-term. The introduction of a single definition of cardiac acute renal injury according to KDIGO criteria into clinical practise will identify patient groups with a high risk of developing this pathology. Similarly, it will also facilitate timely measures to prevent the development of complications in postoperative periods, which will reduce the risk of complications in cardiac patients.Received 10 July 2020. Revised 2 September 2020. Accepted 9 September 2020.Funding: The study did not have sponsorship.Conflict of interest: Authors declare no conflict of interest.Author contributions Conception and design: N.O. Kamenshchikov, Y.K. Podoksenov, M.L. Diakova Data collection and analysis: N.O. Kamenshchikov, A.M. Boyko, M.L. Diakova Drafting the article: N.O. Kamenshchikov, M.L. Diakova, A.M. Boyko Critical revision of the article: M.L. Diakova, Y.K. Podoksenov Final approval of the version to be published: N.O. Kamenshchikov, Y.K. Podoksenov, M.L. Diakova, A.M. Boyko, B.N. Kozlov

Preconditioning strategies to prevent acute kidney injury

F1000Research ◽

10.12688/f1000research.21406.1 ◽

2020 ◽

Vol 9 ◽

pp. 237 ◽

Cited By ~ 3

Author(s):

Martin Richard Späth ◽

Felix Carlo Koehler ◽

Karla Johanna Ruth Hoyer-Allo ◽

Franziska Grundmann ◽

Volker Burst ◽

...

Keyword(s):

Acute Kidney Injury ◽

Clinical Trials ◽

Clinical Practice ◽

Calorie Restriction ◽

Kidney Injury ◽

Routine Clinical Practice ◽

Research Strategies ◽

Clinical Disorder ◽

Clinical Tools ◽

Underlying Mechanisms

Acute kidney injury is a common clinical disorder resulting in significantly increased morbidity and mortality. However, despite extensive research, strategies for prevention or treatment are still lacking in routine clinical practice. Already decades ago, several preconditioning strategies (e. g. ischemic/hypoxic preconditioning and calorie restriction) have been published and their extraordinary effectiveness - especially in rodents - has raised the hope for powerful clinical tools to prevent acute kidney injury. However, the underlying mechanisms are still not completely understood and translation to the clinics has not been successful yet. In this review, the most attractive strategies and the current mechanistic concepts are introduced and discussed. Furthermore, we present clinical trials evaluating the feasibility of preconditioning in the clinical setting.

Sepse em pacientes com lesão renal aguda severa

Revista de Enfermagem UFPE on line ◽

10.5205/1981-8963-v11i12a23142p4845-4853-2017 ◽

2017 ◽

Vol 11 (12) ◽

pp. 4845

Author(s):

Rafael Lemes de Aquino ◽

Ana Cristina Rocha Inacio ◽

Augusto Diogo Filho ◽

Lúcio Borges Araújo

Keyword(s):

Acute Kidney Injury ◽

Standard Deviation ◽

Renal Replacement Therapy ◽

Renal Injury ◽

Medical Records ◽

Kidney Injury ◽

Intermittent Hemodialysis ◽

Acute Renal Injury ◽

Cross Sectional ◽

Length Of Icu Stay

RESUMOObjetivo: analisar a prevalência de sepse e mortalidade dos pacientes com lesão renal aguda em tratamento renal substitutivo hemodialítico. Método: estudo quantitativo, transversal, com 44 pacientes. Os dados foram coletados com questionários e em prontuários, analisados por meio de medidas descritivas (média, mediana, desvio padrão e porcentagens) e apresentados em tabelas. Resultados: as variáveis sociodemográficas revelaram que 63,6% são do sexo masculino, com idade média 63,3 anos. A sepse foi a principal causa de lesão renal aguda em 65,9% dos pacientes e a mortalidade foi de 79,5%. O tempo de internação na UTI foi 22,45 ± 13,5 dias e o tempo total de hospitalização foi 31,30 ± 21,4 dias. A hemodiálise intermitente foi a mais utilizada em 61,4% dos casos. Conclusão: apesar de campanhas internacionais, a sepse e a sua mortalidade permanecem altas. Descritores: Lesão Renal Aguda; Sepse; Terapia de Substituição Renal.ABSTRACTObjective: to analyze the prevalence of sepsis and mortality of patients with acute renal injury in hemodialysis renal replacement therapy. Method: quantitative study, cross-sectional, with 44 patients. Data were collected with questionnaires and in medical records, analyzed through descriptive measures (mean, median, standard deviation and percentages) and presented in tables. Results: sociodemographic variables revealed that 63.6% are males, with a mean age of 63.3 years. Sepsis was the main cause of acute renal injury in 65.9% of patients and mortality was 79.5%. The length of ICU stay was 22.45 ± 13.5 days and the total hospitalization time was 31.30 ± 21.4 days. Intermittent hemodialysis was the most used in 61.4% of the cases. Conclusion: despite international campaigns, sepsis and its mortality remain high. Descriptors: Acute Kidney Injury; Sepis; Renal Replacement Therapy.RESUMENObjetivo: analizar la prevalencia de sepsis y mortalidad de los pacientes con lesión renal aguda en tratamiento renal sustitutivo hemodialítico. Método: estudio cuantitativo, transversal, con 44 pacientes. Los datos fueron recolectados con cuestionarios y en prontuarios, analizados por medio de medidas descriptivas (media, mediana, desviación estándar y porcentajes) y presentados en tablas. Resultados: de las variables sociodemográficas, revelaron que 63,6% son del sexo masculino, con edad media 63,3 años. La sepsis fue la principal causa de lesión renal aguda en el 65,9% de los pacientes y la mortalidad fue del 79,5%. El tiempo de internación en la UTI fue de 22,45 ± 13,5 días y el tiempo total de hospitalización fue 31,30 ± 21,4 días. La hemodiálisis intermitente fue la más utilizada en el 61,4% de los casos. Conclusión: a pesar de las campañas internacionales, la sepsis y su mortalidad siguen siendo altas. Descriptores: Lesão Renal Aguda; Sepse; Terapia de Substituição Renal.

Rhabdomyolisys as a Cause of Acute Renal Injury

Acta Medica Bulgarica ◽

10.2478/amb-2018-0019 ◽

2018 ◽

Vol 45 (2) ◽

pp. 49-54

Author(s):

M. Nikolova ◽

N. Guerguinova ◽

T. Tsocheva ◽

D. Vasilieou ◽

M. Hristova ◽

...

Keyword(s):

Acute Kidney Injury ◽

Renal Injury ◽

Current Knowledge ◽

Cell Damage ◽

Clinical Manifestations ◽

Kidney Injury ◽

Acute Renal Injury ◽

Striate Muscle Cell ◽

Muscle Groups ◽

Substantial Morbidity

Abstract Rhabdomyolysis (RM) is defined as striate muscle-cell damage with disintegration of skeletal muscles and release of intracellular constituents to the circulation, with or without subsequent kidney injury. RM is one of the leading causes of acute kidney injury and is associated with substantial morbidity. The major signs of acute kidney injury in rhabdomyolysis are: pain, weakness and swelling of the injured muscle or muscle groups and myoglobinuria with reddish discoloration of the urine and decrease in urine output to anuria. The authors describe three cases of rhabdomyolysis with acute renal injury and discuss the current knowledge on the etiopathogenesis, clinical manifestations, diagnosis and treatment of this condition.

Tongfu Huoxue Decoction Reduces Autophagy and Apoptosis to Protect Against Acute Renal Injury in a Rat Model of Sepsis

10.21203/rs.3.rs-117890/v1 ◽

2020 ◽

Author(s):

Yan Wang ◽

Zixuan Wang ◽

Qianlan Yang ◽

Yuxin Fan ◽

Lu Wang ◽

...

Keyword(s):

Acute Kidney Injury ◽

Rat Model ◽

Renal Injury ◽

Dose Group ◽

Kidney Tissue ◽

Kidney Injury ◽

Control Group ◽

Acute Renal Injury ◽

Related Proteins ◽

Dose Dependent

Abstract Background: To investigate the mechanism by which Tongfu Huoxue decoction protects against acute kidney injury in sepsis in rats, and provide a new therapeutic strategy for clinical intervention.Methods: Thirty-two Sprague–Dawley rats were randomly divided into a control group (saline), model group (lipopolysaccharide LPS group), LPS group+Tongfu Huoxue Decoction high-dose group (H group), and LPS group +Tongfu Huoxue Decoction low-dose group (L group). A rat model of acute kidney injury in sepsis was established by administration of LPS, and Tongfu Huoxue decoction was administered by gavage. The pathological and morphological changes of the kidneys were evaluated according to the levels of urea nitrogen (BUN) and blood creatinine (SCr). The expression of the inflammation-related factors IL-1b, IL-6 and TNF-a was determined by quantitative real-time PCR. Changes in the phosphorylation levels of the autophagy and apoptosis-related proteins LC3, beclin-1, caspase-3 and Akt were detected by Western blot analysis. Results: Compared with the model LPS group, kidney tissue damage was reduced in rats treated with Tongfu Huoxue decoction. The expression levels of inflammation-related and autophagy-related proteins in the kidney tissue of rats treated with Tongfu Huoxue decoction were significantly lower than those in the LPS group, which was showed a dose-dependent decrease in expression. After stimulation of HK-2 cells with LPS, the expression levels of the autophagy and apoptosis in the groups treated with Tongfu Huoxue decoction decreased in a dose-dependent manner. Furthermore, the rate of HK-2 cell apoptosis was higher in the LPS group than that in the control group, with lower rates in the H and L groups than that in the LPS group and were dose-dependent.Conclusion: Tongfu Huoxue decoction protects against acute renal injury in sepsis by reducing autophagy and apoptosis.

Acute Kidney Injury in Perinatal Asphyxia: Comparison Between Term and Preterm Neonates

Journal of Neonatology ◽

10.1177/0973217918795229 ◽

2018 ◽

Vol 32 (2-3) ◽

pp. 50-59

Author(s):

Preeti Malhotra ◽

Simran Kaur Syal ◽

Ankush Singh ◽

Karuna Thapar

Keyword(s):

Acute Kidney Injury ◽

Serum Creatinine ◽

Renal Injury ◽

Perinatal Asphyxia ◽

Kidney Injury ◽

Preterm Neonates ◽

Acute Renal Injury ◽

Sodium Potassium ◽

Significant Difference ◽

Ischemic Encephalopathy

Objective: To investigate asphyxiated neonates for acute kidney injury, compare the occurrence between preterms and terms and to correlate the severity and type of renal injury with the degree of asphyxia and hypoxic ischemic encephalopathy (HIE) grading. Materials and Methods: Renal functions were assessed using urine output and biochemical parameters such as blood urea, serum creatinine, serum sodium, potassium, and calcium. These were evaluated on alternate days till day 7 or recovery or death. Results: Total 108 asphyxiated neonates were enrolled: 63 term and 45 preterm. A total of 28 (25.9%) developed acute kidney injury: 9 (32.1%) had oliguric acute renal injury and the rest 19 (67.8%) had nonoliguric acute renal injury. A total of 77.7% neonates had a prerenal cause and the other 22.2% had an intrinsic cause for the kidney injury. Levels of blood urea and serum creatinine were maximally elevated on day 5 of life. Biochemical derangements correlated well with the Apgar score at birth and severity of HIE. No statistically significant difference was observed in the incidence of renal injury between preterm and term asphyxiated neonates. Conclusion: Perinatal asphyxia is an important cause of renal injury in neonates. A majority of neonates had nonoliguric and pre renal type of acute kidney injury. The more severe the degree of asphyxia, the more prone they were to develop renal complications.