Acute Kidney Injury in Heroin Users

The article presents a case of severe necrotizing fasciitis and rhabdomyolysis-induced acute tubular necrosis resulting from the injection of heroin laced with a plant-fertilizer known as „Pure by magic”. We also review the literature data regarding the renal adverse effects of heroin. Due to the diversity of adulterants used by drug dealers for cutting heroin and the variety of substances patients mix the heroin with before injecting themselves, the effects of this practice are often unknown and the treatment lacks of antidote, being strictly symptomatic.

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Prognosis of Acute Kidney Injury and Hepatorenal Syndrome in Patients with Cirrhosis: A Prospective Cohort Study

International Journal of Nephrology ◽

10.1155/2015/108139 ◽

2015 ◽

Vol 2015 ◽

pp. 1-9 ◽

Cited By ~ 21

Author(s):

Andrew S. Allegretti ◽

Guillermo Ortiz ◽

Julia Wenger ◽

Joseph J. Deferio ◽

Joshua Wibecan ◽

...

Keyword(s):

Acute Kidney Injury ◽

Cohort Study ◽

Prospective Cohort Study ◽

Acute Tubular Necrosis ◽

Prospective Cohort ◽

Hepatorenal Syndrome ◽

Kidney Injury ◽

Multicenter Studies ◽

Urinary Sediment ◽

Tubular Necrosis

Background/Aims. Acute kidney injury is a common problem for patients with cirrhosis and is associated with poor survival. We aimed to examine the association between type of acute kidney injury and 90-day mortality.Methods. Prospective cohort study at a major US liver transplant center. A nephrologist’s review of the urinary sediment was used in conjunction with the 2007 Ascites Club Criteria to stratify acute kidney injury into four groups: prerenal azotemia, hepatorenal syndrome, acute tubular necrosis, or other.Results. 120 participants with cirrhosis and acute kidney injury were analyzed. Ninety-day mortality was 14/40 (35%) with prerenal azotemia, 20/35 (57%) with hepatorenal syndrome, 21/36 (58%) with acute tubular necrosis, and 1/9 (11%) with other (p=0.04overall). Mortality was the same in hepatorenal syndrome compared to acute tubular necrosis (p=0.99). Mortality was lower in prerenal azotemia compared to hepatorenal syndrome (p=0.05) and acute tubular necrosis (p=0.04). Ten participants (22%) were reclassified from hepatorenal syndrome to acute tubular necrosis because of granular casts on urinary sediment.Conclusions. Hepatorenal syndrome and acute tubular necrosis result in similar 90-day mortality. Review of urinary sediment may add important diagnostic information to this population. Multicenter studies are needed to validate these findings and better guide management.

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Continuous Peritoneal Dialysis Compared with Daily Hemodialysis in Patients with Acute Kidney Injury

Peritoneal Dialysis International ◽

10.1177/089686080902902s12 ◽

2009 ◽

Vol 29 (2_suppl) ◽

pp. 62-71 ◽

Cited By ~ 29

Author(s):

Daniela Ponce Gabriel ◽

Jacqueline Teixeira Caramori ◽

Luis Cuadrado Martin ◽

Pasqual Barretti ◽

Andre Luis Balbi

Keyword(s):

Acute Kidney Injury ◽

Renal Function ◽

Peritoneal Dialysis ◽

Survival Rate ◽

Acute Tubular Necrosis ◽

Kidney Injury ◽

Acid Base ◽

Tubular Necrosis ◽

Daily Hemodialysis ◽

Continuous Peritoneal Dialysis

Background In some parts of the world, peritoneal dialysis is widely used for renal replacement therapy (RRT) in acute kidney injury (AKI), despite concerns about its inadequacy. It has been replaced in recent years by hemodialysis and, most recently, by continuous venovenous therapies. We performed a prospective study to determine the effect of continuous peritoneal dialysis (CPD), as compared with daily hemodialysis (dHD), on survival among patients with AKI. Methods A total of 120 patients with acute tubular necrosis (ATN) were assigned to receive CPD or dHD in a tertiary-care university hospital. The primary endpoint was hospital survival rate; renal function recovery and metabolic, acid–base, and fluid controls were secondary endpoints. Results Of the 120 patients, 60 were treated with CPD (G1) and 60 with dHD (G2). The two groups were similar at the start of RRT with respect to age (64.2 ± 19.8 years vs 62.5 ± 21.2 years), sex (men: 72% vs 66%), sepsis (42% vs 47%), shock (61% vs 63%), severity of AKI [Acute Tubular Necrosis Individual Severity Score (ATNISS): 0.68 ± 0.2 vs 0.66 ± 0.22; Acute Physiology and Chronic Health Evaluation (APACHE) II: 26.9 ± 8.9 vs 24.1 ± 8.2], pre-dialysis blood urea nitrogen [BUN (116.4 ± 33.6 mg/dL vs 112.6 ± 36.8 mg/dL)], and creatinine (5.85 ± 1.9 mg/dL vs 5.95 ± 1.4 mg/dL). In G1, weekly delivered Kt/V was 3.59 ± 0.61, and in G2, it was 4.76 ± 0.65 ( p < 0.01). The two groups were similar in metabolic and acid–base control (after 4 sessions, BUN < 55 mg/dL: 46 ± 18.7 mg/dL vs 52 ± 18.2 mg/dL; pH: 7.41 vs 7.38; bicarbonate: 22.8 ± 8.9 mEq/L vs 22.2 ± 7.1 mEq/L). Duration of therapy was longer in G2 (5.5 days vs 7.5 days; p = 0.02). Despite the delivery of different dialysis methods and doses, the survival rate did not differ between the groups (58% in G1 vs 52% in G2), and recovery of renal function was similar (28% vs 26%). Conclusion High doses of CPD provided appropriate metabolic and pH control, with a rate of survival and recovery of renal function similar to that seen with dHD. Therefore, CPD can be considered an alternative to other forms of RRT in AKI.

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When acute kidney injury in the intensive care unit is not acute tubular necrosis: A case report of κ-light chain crystalline tubulopathy

Clinical Nephrology ◽

10.5414/cn109693 ◽

2019 ◽

Vol 91 (5) ◽

pp. 311-316

Author(s):

Neal Shah ◽

Ivy Rosales ◽

Rex Neal Smith ◽

Jacob E. Berchuck ◽

Andrew J. Yee ◽

...

Keyword(s):

Intensive Care Unit ◽

Acute Kidney Injury ◽

Intensive Care ◽

Case Report ◽

Light Chain ◽

Acute Tubular Necrosis ◽

Kidney Injury ◽

Tubular Necrosis

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MO134COVID-19-ASSOCIATED KIDNEY INJURY IS CHARACTERIZED BY ACUTE TUBULAR NECROSIS AND CAPILLARY CONGESTION WITH EVIDENCE FOR SARS-COV-2 IN THE NEPHRON

Nephrology Dialysis Transplantation ◽

10.1093/ndt/gfab092.0012 ◽

2021 ◽

Vol 36 (Supplement_1) ◽

Author(s):

Antoine Bouquegneau ◽

Pauline Erpicum ◽

Stéphanie Grosch ◽

Lionel Habran ◽

Olivier Hougrand ◽

...

Keyword(s):

Electron Microscopy ◽

Acute Kidney Injury ◽

In Situ Hybridization ◽

Acute Tubular Necrosis ◽

Kidney Injury ◽

Post Mortem ◽

Rt Pcr ◽

N Protein ◽

Tubular Necrosis

Abstract Background and Aims Kidney damage has been reported in COVID-19 patients. Despite numerous reports about COVID-19-associated nephropathy, the factual presence of the SARS-CoV-2 in the renal parenchyma remains controversial. Method We consecutively performed 16 immediate (≤3h) post-mortem renal biopsies in patients diagnosed with COVID-19. Kidney samples from 5 patients who died from sepsis and were free from COVID-19 were used as controls. Samples were methodically evaluated by 3 pathologists. Virus detection in the renal parenchyma was performed in all samples by bulk RNA RT-PCR (E and N1/N2 genes), immunostaining (nCoV2019 N-Protein), fluorescent in situ hybridization (nCoV2019-S) and electron microscopy. Results The mean age of our COVID-19 cohort was 68.2±12.8 years, most of whom were males (68.7%). Proteinuria was observed in 53.3% of cases, while acute kidney injury occurred in 60% of cases. Acute tubular necrosis of variable severity was found in all cases, with no tubular or interstitial inflammation. There was no difference in acute tubular necrosis severity between the patients with COVID-19 versus control samples. Congestion in glomerular and peri-tubular capillaries was respectively observed in 56.3 and 87.5% of patients with COVID-19 compared to 20% of controls, with no evidence of thrombi. The nCoV2019 N-Protein was detected in proximal tubules and also at the basolateral pole of scattered cells of the distal tubules in 9/16 cases. In situ hybridization confirmed these findings. RT-PCR of kidney total RNA detected SARS-CoV-2 N gene in one case. Electron microscopy did not show typical viral inclusions. Conclusion Our immediate post-mortem kidney samples from patients with COVID-19 highlight a congestive pattern of acute kidney injury, with no significant glomerular or interstitial inflammation. Immunostaining and in situ hybridization suggest that SARS-CoV-2 is present in various segments of the nephron.

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Biopsy-Proven Acute Tubular Necrosis due to Vancomycin Toxicity

International Journal of Nephrology ◽

10.4061/2011/436856 ◽

2011 ◽

Vol 2011 ◽

pp. 1-4 ◽

Cited By ~ 13

Author(s):

Farheen Shah-Khan ◽

Marc H. Scheetz ◽

Cybele Ghossein

Keyword(s):

Acute Kidney Injury ◽

Interstitial Nephritis ◽

Acute Tubular Necrosis ◽

Kidney Injury ◽

Acute Interstitial Nephritis ◽

Etiologic Factor ◽

Clinical Use ◽

Tubular Necrosis

Vancomycin (VAN) has been associated with acute kidney injury (AKI) since it has been put into clinical use in the 1950's. Early reports of AKI were likely linked to the impurities of the VAN preparation. With the advent of the more purified forms of VAN, the incidence of AKI related to VAN were limited to acute interstitial nephritis (AIN) or as a potentiating agent to other nephrotoxins such as Aminoglycosides. VAN as the sole etiologic factor for nephrotoxic acute tubular necrosis (ATN) has not been described. Here, we report a case of biopsy-proven ATN resulting from VAN.

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

Case Reports in Nephrology ◽

10.1155/2015/235982 ◽

2015 ◽

Vol 2015 ◽

pp. 1-4 ◽

Cited By ~ 6

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.

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Prolonged Recovery Time from Zoledronic Acid Induced Acute Tubular Necrosis: A Case Report and Review of the Literature

Case Reports in Nephrology ◽

10.1155/2013/651246 ◽

2013 ◽

Vol 2013 ◽

pp. 1-5

Author(s):

Frederic Rahbari-Oskoui ◽

Odicie Fielder ◽

Nima Ghasemzadeh ◽

Randolph Hennigar

Keyword(s):

Acute Kidney Injury ◽

Zoledronic Acid ◽

Acute Tubular Necrosis ◽

Recovery Time ◽

Metastatic Cancer ◽

Metastatic Breast ◽

Kidney Injury ◽

Tubular Necrosis ◽

Prolonged Recovery ◽

Caucasian Female

Acute tubular necrosis (ATN) due to bisphosphonates has been reported with Zoledronic acid but the time to recovery (if any) has been usually less than 4 months. Possible recovery time from ATN of any cause is usually less than 6 months. In this paper, we present the case of a 59-year-old Caucasian female with metastatic breast cancer who had received 16 monthly injections of Zoledronic acid for treatment of tumor induced hypercalcemia and developed several episodes of mild acute kidney injury which resolved by withholding treatment. Unfortunately, after the sixteenth injection, the patient experienced severe acute kidney injury, with a peak serum creatinine of 8.0 mg/dL. Although urinalysis showed muddy brown casts, because of atypical recovery time and presence of eosinophiluria and subnephrotic range proteinuria, a kidney biopsy was performed. Diagnosis of typical acute tubular necrosis was confirmed without any other concomitant findings. The course was remarkable for an unusually slow recovery of renal function over 15 months without need for renal replacement therapy until the patient expired from her metastatic cancer two years later. We reviewed all the published cases of acute kidney injury due to Zoledronic acid and suggest recommendations for clinicians and researchers.

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

The Open Urology & Nephrology Journal ◽

10.2174/1874303x01710010020 ◽

2017 ◽

Vol 10 (1) ◽

pp. 20-28 ◽

Cited By ~ 1

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.

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Automobile Paint Reducer Induced Acute Kidney Injury

Journal of Renal and Hepatic Disorders ◽

10.15586/jrenhep.v5i2.116 ◽

2021 ◽

Vol 5 (2) ◽

pp. 10-13

Author(s):

Muzamil Latief ◽

Zhahid Hassan ◽

Mohd Latief Wani ◽

Farhat Abbas ◽

Summyia Farooq

Keyword(s):

Acute Kidney Injury ◽

Metabolic Acidosis ◽

Renal Replacement Therapy ◽

Replacement Therapy ◽

Organic Solvents ◽

Acute Tubular Necrosis ◽

Kidney Injury ◽

Solvent Exposure ◽

The Third ◽

Tubular Necrosis

The various aspects of the automobile industry also carry with it the risk for occupational health hazards with it. Toluene has also evolved as a commonly used drug by substance abusers. Accidental exposure or self-poisoning with these substances has been reported in literature. These substances can also cause distal renal tubular acidosis (RTA), acute tubular necrosis, glomerulonephritis and interstitial nephritis, rhabdomyolysis and myoglobinemia.In this series, we report about three patients who developed renal manifestations because of organic solvents. Two of the three patients had ingested the paint reducer substance and the third one was addicted to sniffing the toluene based paint reducer. All the patients had in taken these substances with suicidal intent and developed acute kidney injury (AKI) and severe metabolic acidosis. One of the patients had features of rhabdomyolysis as well. The third patient was a substance abuser and had inhaled higher than usual dose and developed severe and refractory acidosis and mild kidney injury and required Renal Replacement Therapy (RRT) for acidosis. All the patients eventually recovered their kidney functions and were doing well during their follow-up.Toluene based organic solvents lead to acute neurological symptoms, accompanied by severe metabolic alterations, organ injury and dysfunc-tion. An association of the development of hypokalemic paralysis and metabolic acidosis with toluene intoxication has been observed. The management of acute toluene toxicity is mainly conservative, consisting of electrolytes correction, acid-base and fluid abnormalities and renal replacement therapy in severe AKI.Organic solvent exposure may result in acute tubular necrosis, rhabdomyolysis, RTA and AKI irrespective of the intake route. Clinical suspicion of organ dysfunction and failure and timely induction of supportive care leads to a good outcome.

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Histopathology and Long-Term Outcome of Kidneys Transplanted From Donors With Severe Acute Kidney Injury

Progress in Transplantation ◽

10.1177/1526924818817054 ◽

2018 ◽

Vol 29 (1) ◽

pp. 36-42 ◽

Cited By ~ 2

Author(s):

Luca Cima ◽

Francesco Nacchia ◽

Claudio Ghimenton ◽

Giovanni Valotto ◽

Luigino Boschiero ◽

...

Keyword(s):

Acute Kidney Injury ◽

Kidney Transplantation ◽

Acute Tubular Necrosis ◽

Statistical Significance ◽

Graft Function ◽

Kidney Injury ◽

Long Term Outcome ◽

Tubular Necrosis ◽

Level 3

Background: Acute kidney injury is a treatable entity although difficult to recognize without diagnostic biopsy. We investigated the potential association between clinically defined deceased donors and acute kidney injury with preimplantation histological findings and recipient outcomes. Methods: Kidney biopsies from donors were classified using the Acute Kidney Injury Network criteria and assessed for percentage glomerulosclerosis, tubular atrophy, interstitial fibrosis, and vascular narrowing with the Remuzzi score and for acute tubular necrosis. Differences in incidence rates of delayed graft function (DGF) and cumulative rejection episodes were compared between recipients transplanted with normal and 3 levels of acute kidney injury using the analysis of variance with Bonferroni correction ( P = .0012). Results: Sixteen out of 335 donors showed a severe acute kidney injury level 3 with a median serum creatinine of 458 µmol/L. Fourteen (88%) had 0-3 Remuzzi score and were used for single kidney transplantation and 2 (12%) were used for dual kidney transplantation (score: 4-6). Recipients who received a kidney from a donor with level 3 acute kidney injury had a higher percentage of DGF (47%) without statistical significance ( P = .008). The rate of cumulative rejection (45%) at 2 years was not significantly increased ( P = .09). Conclusions: Recipients receiving level 3 acute kidney injury kidneys, selected with Remuzzi histopathological score and acute tubular necrosis assessment, had a greater incidence of DGF but a similar long-term cumulative rejection compared to no injury and level 1 and level 2 acute kidney injury donors. The application of the histopathological examination allowed expansion of the kidney donor pool.

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