Rhabdomyolysis cases and acute kidney injury: a 10-year experience at a regional tertiary centre

Abstract Background Acute kidney injury (AKI) in pregnancy (Pr-AKI) is associated with substantial maternal morbidity and mortality. E-alerts are routinely used for detection of AKI in non-pregnant patients but their role in maternity care has not been explored. Methods All pregnant or postpartum women with AKI e-alerts for AKI Stages 1–3 (Kidney Disease Improving Global Outcomes (KDIGO) criteria) were identified at a tertiary centre >2 years. Two women matched by delivery date for each case were selected as controls. AKI stage, recognition of AKI, pregnancy outcomes, renal recovery, AKI aetiology and risk factors were extracted from electronic patient records. Results 288 of 11 922 (2.4%) women had AKI e-alerts, of which only 118 (41%) were recognized by the obstetric team. Common Pr-AKI causes included infection (48%), pre-eclampsia (26%) and haemorrhage (25%), but no cause was identified in 15% of women. Renal function recovered in 213 (74%) women, but in 47 (17%) repeat testing was not undertaken and 28 (10%) did not recover function. Hypertensive disorders of pregnancy and Caesarean section were associated with increased incidence of Pr-AKI compared with controls. Conclusions Pr-AKI e-alerts were identified in ∼1 in 40 pregnancies. However, a cause for Pr-AKI was not identified in many cases and e-alerts may have been triggered by gestational change in serum creatinine. Pregnancy-specific e-alert algorithms may be required. However, 1 in 10 women with Pr-AKI had not recovered kidney function on repeat testing. Better understanding of long-term impacts of Pr-AKI on pregnancy and renal outcomes is needed to inform relevant Pr-AKI e-alert thresholds.

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Aetiologies and Short-term Outcomes of Acute Kidney Injury in a Tertiary Centre in Southwest Nigeria

Ethiopian Journal of Health Sciences ◽

10.4314/ejhs.v26i1.8 ◽

2016 ◽

Vol 26 (1) ◽

pp. 37 ◽

Cited By ~ 3

Author(s):

Adejumo Oluseyi ◽

Akinbodewa Ayodeji ◽

Fasaanu Ayodeji

Keyword(s):

Acute Kidney Injury ◽

Kidney Injury ◽

Short Term ◽

Tertiary Centre ◽

Southwest Nigeria

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COVID-19-related acute kidney injury; incidence, risk factors and outcomes in a large UK cohort

BMC Nephrology ◽

10.1186/s12882-021-02557-x ◽

2021 ◽

Vol 22 (1) ◽

Author(s):

Paul D. Jewell ◽

Kate Bramham ◽

James Galloway ◽

Frank Post ◽

Sam Norton ◽

...

Keyword(s):

Risk Factors ◽

Acute Kidney Injury ◽

Renal Impairment ◽

Strong Predictor ◽

Kidney Injury ◽

Injury Incidence ◽

Tertiary Centre ◽

Incidence Risk ◽

Stage 1 ◽

Worse Prognosis

Abstract Background Acute kidney injury (AKI) is common among patients hospitalised with COVID-19 and associated with worse prognosis. The aim of this study was to investigate the epidemiology, risk factors and outcomes of AKI in patients with COVID-19 in a large UK tertiary centre. Methods We analysed data of consecutive adults admitted with a laboratory-confirmed diagnosis of COVID-19 across two sites of a hospital in London, UK, from 1st January to 13th May 2020. Results Of the 1248 inpatients included, 487 (39%) experienced AKI (51% stage 1, 13% stage 2, and 36% stage 3). The weekly AKI incidence rate gradually increased to peak at week 5 (3.12 cases/100 patient-days), before reducing to its nadir (0.83 cases/100 patient-days) at the end the study period (week 10). Among AKI survivors, 84.0% had recovered renal function to pre-admission levels before discharge and none required on-going renal replacement therapy (RRT). Pre-existing renal impairment [odds ratio (OR) 3.05, 95%CI 2.24–4,18; p < 0.0001], and inpatient diuretic use (OR 1.79, 95%CI 1.27–2.53; p < 0.005) were independently associated with a higher risk for AKI. AKI was a strong predictor of 30-day mortality with an increasing risk across AKI stages [adjusted hazard ratio (HR) 1.59 (95%CI 1.19–2.13) for stage 1; p < 0.005, 2.71(95%CI 1.82–4.05); p < 0.001for stage 2 and 2.99 (95%CI 2.17–4.11); p < 0.001for stage 3]. One third of AKI3 survivors (30.7%), had newly established renal impairment at 3 to 6 months. Conclusions This large UK cohort demonstrated a high AKI incidence and was associated with increased mortality even at stage 1. Inpatient diuretic use was linked to a higher AKI risk. One third of survivors with AKI3 exhibited newly established renal impairment already at 3–6 months.

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Pseudoaneurysm of the Inferior Pancreaticoduodenal Artery Due to Cholecystitis

Reports ◽

10.3390/reports2010011 ◽

2019 ◽

Vol 2 (1) ◽

pp. 11 ◽

Cited By ~ 1

Author(s):

Jayan George ◽

Samuel Besant ◽

Trevor Cleveland ◽

Ahmed Al-Mukhtar

Keyword(s):

Acute Kidney Injury ◽

Conservative Treatment ◽

Epigastric Pain ◽

Kidney Injury ◽

Visceral Artery ◽

Intravenous Fluids ◽

Rare Occurrence ◽

Pancreaticoduodenal Artery ◽

Tertiary Centre ◽

Visceral Artery Aneurysms

Inferior pancreaticoduodenal artery pseudoaneurysms and aneurysms are a rare occurrence, comprising of approximately 10% of visceral artery aneurysms and pseudoaneurysms. The cause is normally due to trauma, iatrogenic or pancreatitis. We present a case of a patient re-presenting to hospital following treatment of acute cholecystitis with epigastric pain, dysphagia, pyrexia, nausea, vomiting and an acute kidney injury. Following cholecystostomy, intravenous fluids and conservative treatment for her symptoms, she failed to improve significantly and was found to have a 6 mm pseudoaneurysm of the inferior pancreaticoduodenal artery on day twenty of her admission. She was transferred to a tertiary centre and was treated with an embolisation and recovered well from the procedure.

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Acute kidney injury in obstetrics: a five-year study in a tertiary centre

International Journal of Reproduction Contraception Obstetrics and Gynecology ◽

10.18203/2320-1770.ijrcog20196007 ◽

2019 ◽

Vol 9 (1) ◽

pp. 113

Author(s):

Sushma H. Papegowda ◽

Pratima K. Devi ◽

Ranjit L. Singh ◽

Agalya Muruganadam ◽

Zikpuii L. Tochhawng

Keyword(s):

Acute Kidney Injury ◽

Hospital Stay ◽

Maternal Morbidity ◽

Mode Of Delivery ◽

Kidney Injury ◽

Renal Perfusion ◽

Exclusion Criteria ◽

Tubular Necrosis ◽

Tertiary Centre ◽

Foetal Outcome

Background: Pregnancy Related Acute Kidney Injury (PRAKI) is a major cause of maternal and foetal morbidity and mortality in developing countries. The incidence has declined due to improvements in reproductive health but it is still associated with significant perinatal mortality and maternal morbidity. It may be due to decrease in renal perfusion or ischemic tubular necrosis from a variety of conditions encountered during pregnancy. Our study aims at determining the predisposing factors and causes of AKI during pregnancy and its impact on maternal and foetal outcome.Methods: A retrospective cohort study over a period of 5 years was conducted on pregnant women with AKI as per inclusion and exclusion criteria. The detailed history, events, mode of delivery, cause leading to AKI, management, hospital stay, maternal and foetal outcome were studied in detail and evaluated. These patients were classified according to RIFLE criteria and were followed up for hospital stay and residual morbidities.Results: The incidence of PRAKI in the study was 0.07% (36 out of 50,735 deliveries) and among obstetric ICU patients, it was 6.8%. Most of the majority of the cases were unbooked (66.7%) and multipara (61.1%). Maternal morbidity was seen in 66.7% and mortality was 27.8%. Poor foetal outcome was seen in 44.4%.Conclusions: Haemorrhage is the most common cause of PRAKI, followed by toxaemia of pregnancy and sepsis. Early detection and meticulous management of haemorrhage, hypertension and sepsis reduce the incidence of PRAKI and associated maternal mortality.

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077 A STUDY ON ACUTE KIDNEY INJURY AMONG DENGUE PATIENTS: A TERTIARY CENTRE EXPERIENCE

Kidney International Reports ◽

10.1016/j.ekir.2017.06.040 ◽

2017 ◽

Vol 2 (4) ◽

pp. S8 ◽

Cited By ~ 1

Author(s):

S.A. Hamid ◽

N.F.N. Ali ◽

D. Muhamad ◽

X.R. Tan ◽

M.K. Ahmad ◽

...

Keyword(s):

Acute Kidney Injury ◽

Kidney Injury ◽

Tertiary Centre

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Acute Peritoneal Dialysis with Percutaneous Catheter Insertion for COVID-19-associated Acute Kidney Injury in Intensive Care: Experience from a UK Tertiary Centre

Kidney International Reports ◽

10.1016/j.ekir.2020.11.038 ◽

2020 ◽

Author(s):

Elaine Bowes ◽

Jennifer Joslin ◽

Dandisonba Chinwe Bamidele Braide-Azikiwe ◽

Caroline Tulley ◽

Kate Bramham ◽

...

Keyword(s):

Acute Kidney Injury ◽

Intensive Care ◽

Peritoneal Dialysis ◽

Kidney Injury ◽

Catheter Insertion ◽

Care Experience ◽

Tertiary Centre ◽

Percutaneous Catheter

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Incidence and Outcome of Acute Kidney Injury in Hospitalised Children

Journal of Nepal Paediatric Society ◽

10.3126/jnps.v41i1.30138 ◽

2021 ◽

Vol 41 (1) ◽

pp. 80-86

Author(s):

Rajan Paudel ◽

Gauri Shankar Shah ◽

Shipra Chaudhary ◽

Dinesh Dharel ◽

Anuradha Timilsina

Keyword(s):

Mechanical Ventilation ◽

Acute Kidney Injury ◽

Hospital Stay ◽

Kidney Injury ◽

Inotropic Support ◽

Term Outcome ◽

Therapeutic Modalities ◽

Duration Of Hospital Stay ◽

Tertiary Centre ◽

Short And Long Term

Introduction: Acute kidney injury (AKI) is common in hospitalised children with adverse short and long term outcomes. Detection of the incidence, etiological profile and outcome of AKI is important for starting preventive and therapeutic modalities. This study aimed to determine the incidence, etiology and short term outcome of AKI at a tertiary centre in Eastern Nepal. Methods: A prospective observational study was conducted in children from two months to 14 years of age admitted in paediatric wards and paediatric intensive care unit (PICU) of a tertiary centre of Eastern Nepal. AKI was defined according to pRIFLE criteria. Results: From May 2015 to March 2016, 942 patients enrolled in Paediatric wards and PICU were evaluated. The overall incidence of AKI was found to be 5.9% and 18.23% in patients admitted in PICU. AKI was commonest among cases having infectious etiology compromising 73.2% (n = 41), 17.85% (n = 10) due to primary renal disease, 5.35% (n = 3) secondary to congenital heart disease, and 3.57% due to other causes. Among AKI patients, 55.4% (n = 31) required inotropic support, 33.9% (n = 19) required mechanical ventilation while 5.36% (n = 3) underwent dialysis. Out of 56 AKI patients 71.4% (n = 40) had improved clinical outcome and 28.6% (n = 16) expired. Patient with AKI had significant longer duration of hospital stay as compared to non AKI (Seven days vs. three days, p < 0.001). Mortality was high among AKI patients on injury and failure stage (p = 0.003) and those requiring mechanical ventilation and inotropic support (p < 0.001). Conclusions: The incidence of AKI was found to be high in paediatric patients. Presence of AKI increased the duration of hospital stay and mortality in hospitalised children often requiring mechanical ventilation and inotropic support.

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