scholarly journals Valacyclovir Neurotoxicity and Nephrotoxicity in an Elderly Patient Complicated by Hyponatremia

2018 ◽  
Vol 12 (1) ◽  
Author(s):  
Takuya Murakami ◽  
Tetsu Akimoto ◽  
Mari Okada ◽  
Erika Hishida ◽  
Taro Sugase ◽  
...  
Keyword(s):  
Elderly Patient ◽  
Acute Kidney Injury ◽  
Renal Function ◽  
Serum Creatinine ◽  
Serum Creatinine Level ◽  
Creatinine Level ◽  
Kidney Injury ◽  
Blood Purification ◽  
Standard Dosage ◽  
History Of

A 66-year-old women with no history of renal disease was admitted due to a coma and acute kidney injury with a serum creatinine level of 7.44 mg/dL which were ascribed to valacyclovir neurotoxicity and nephrotoxicity, respectively. She had received valacyclovir at a standard dosage for the treatment of herpes zoster and was finally discharged, having fully returned to her normal baseline mental status with a recovered serum creatinine level of 0.68 mg/dL. We feel that awareness of this pathology remains a challenge for physicians and therefore strongly recommend the further accumulation of experiences similar to our own. Our experience underscores the pitfalls of administering valacyclovir to elderly patients who barely appear to have a favorable renal function. Several concerns regarding the therapeutic management, including blood purification strategies, that emerged in this case are also discussed.

Risk of acute kidney injury associated with neuroimaging obtained during triage and treatment of patients with acute ischemic stroke symptoms

2016 ◽  
Vol 8 (12) ◽  
pp. 1231-1234 ◽  
Author(s):  
Shelby L Hall ◽  
Stephan A Munich ◽  
Marshall C Cress ◽  
Leonardo Rangel-Castilla ◽  
Elad I Levy ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Ischemic Stroke ◽  
Serum Creatinine ◽  
Serum Creatinine Level ◽  
Acute Ischemic Stroke ◽  
Creatinine Level ◽  
Kidney Injury ◽  
Vascular Pathology ◽  
Baseline Serum ◽  
Iodinated Contrast

BackgroundCombining non-contrast CT (NCCT), CT angiography (CTA), and CT perfusion (CTP) imaging (referred to as a CT stroke study, CTSS) provides a rapid evaluation of the cerebrovascular axis during acute ischemic stroke. Iodinated contrast-enhanced CT imaging is not without risk, which includes renal injury. If a patient's CTSS identifies vascular pathology, digital subtraction angiography (DSA) is often performed within 24–48 h. Such patients may receive multiple administrations of iodinated contrast material over a short time period.ObjectiveWe aimed to evaluate the incidence of acute kidney injury (AKI) in patients who underwent a CTSS and DSA for evaluation of acute ischemic symptoms or for stroke intervention within a 48 h period between August 2012 and December 2014.MethodsWe identified 84 patients for inclusion in the analysis. Patients fell into one of two cohorts: AKI, defined as a rise in the serum creatinine level of ≥0.5 mg/dL from baseline, or non-AKI. Clinical parameters included pre- and post-imaging serum creatinine level, time between CTSS and DSA, and type of angiographic procedure (diagnostic vs intervention) performed.ResultsFour patients (4.7%) experienced AKI, one of whom had baseline renal dysfunction (defined as baseline serum creatinine level ≥1.5 mg/dL). The mean difference between baseline and peak creatinine values was found to be significantly greater in patients with AKI than in non-AKI patients (1.65 vs −0.09, respectively; p=0.0008).ConclusionsThis study provides preliminary evidence of the safety and feasibility of obtaining CTSS with additional DSA imaging, whether for diagnosis or intervention, to identify possible acute ischemic stroke.

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.

Results of Autologous Stem Cell Transplantation in Multiple Myeloma Patients with Renal Failure

Blood ◽  
2020 ◽  
Vol 136 (Supplement 1) ◽  
pp. 1-1
Author(s):  
Maiia Firsova ◽  
Larisa Mendeleeva ◽  
Maxim Solovev ◽  
Daria Mironova ◽  
Valery Savchenko
Keyword(s):  
Acute Kidney Injury ◽  
Renal Failure ◽  
Renal Impairment ◽  
Serum Creatinine ◽  
Serum Creatinine Level ◽  
Creatinine Level ◽  
Induction Therapy ◽  
Kidney Injury ◽  
Platelet Recovery ◽  
Renal Response

Introduction According to the Russian register renal impairment at the time of diagnosis was noted in every fifth patient with multiple myeloma (MM). Timely induction therapy followed by autologous stem cell transplantation (ASCT) in some cases contributes to the reversibility of renal failure. Although ASCT appears safe in patients with mild and moderate renal impairment, there are limited data in those with severe acute kidney injury. These patients are often considered to be unfit for ASCT. The aim of the study To study the efficacy and safety of high dose therapy followed by ASCT in patients with MM and renal failure and to evaluate the results of the treatment depending on the severity of acute kidney injury. Materials and methods A retrospective single-center study was performed, including 59 (28 males, 31females) MM patients with renal failure at the time of diagnosis aged 19 to 65 years (median 53) underwent ASCT during a period from 2014 to 2019. Hematologic response and renal response was defined according to International Myeloma Working Group criteria. At the time of diagnosis median of serum creatinine level was 450 μmol/L, and median of glomerular filtration rate (GFR) was 10 ml/min/1.73 m2 (CKD-EPI). 18 patients (30,5%) were dialysis-dependent. Induction therapy included bortezomib-containing regimens in all patients, immunomodulatory drugs were used in 9 patients (15%). Before ASCT overall response rate (CR, VGPR, PR) was documented in 55 patients (93%), median of serum creatinine level was 143 μmol/L, median of GFR increased to 40 ml/min/1.73 m2. Renal response was achieved in 48 patients (81%), in 10 cases dialysis was stopped. 8 patients (13,5%) were dialysis-dependent at the time of ASCT. 43 patients (73%) underwent a single and 16 patients (27%) underwent a tandem ASCT (Mel 140-200 mg/m2). The analysis of such parameters as neutrophil and platelet recovery, a requirement for transfusion therapy was carried out in 2 subgroups: subgroup A - patients without dialysis at the time of ASCT (n = 51), subgroup B - dialysis-dependent patients at the time of ASCT (n = 8). Statistical analysis was done using Statistica 10. Survival curves were constructed using the Kaplan-Meier method. Frequency analysis (Fisher's test) was used. Results Median delay for neutrophil recovery was 14 days and 15 days for platelet recovery in subgroups A and B. Platelet concentrate transfusion was required for all patients of both subgroups in a comparable amount. In patients from subgroup B (dialysis-dependent) compared to those from subgroup A (dialysis independent) significant differences was observed in a requirement of red blood cell transfusions (100% vs 37%, p = 0.001). There was no transplant-related mortality. At 100 days after ASCT overall response rate (CR, VGPR, PR) was achieved in 57 patients (96,6%), median of serum creatinine level was 130 μmol/L, and median of GFR was 50 ml/min/1.73 m2. Renal response was achieved in 49 patients (83%); in one case dialysis was stopped after ASCT (Fig. 1). At one year after ASCT median of serum creatinine level was 127 μmol /L, and median of GFR was 46 ml/min/1.73 m2 (Table 1). Seven patients (12%) remained dialysis-dependent. After a median follow-up of 36 months 5-year overall survival was 60%, and 5-year progression-free survival (PFS) was 40%. The analysis of PFS dependent on the severity of acute kidney injury demonstrated that the 5-year PFS of patients who were dialysis-dependent at the time of diagnosis did not differ from that in patients with mild and moderate renal impairment (42% vs 39%, respectively). Conclusion ASCT is feasible and safe method of treatment in MM patients with severe kidney injury. Dialysis-dependent patients during the early post-transplant period significantly more often require red blood cell transfusions (p = 0.001). Induction therapy followed by ASCT allowed reducing a requirement for dialysis from 30.5% at the time of diagnosis to 12% after ASCT (Fig. 2). In our study 11 of 18 MM patients (61%) became dialysis independent. Overall, this work confirmed no difference in PFS dependent on the severity of acute kidney injury; dialysis-dependent myeloma patients should not be excluded from high dose therapy followed by ASCT. Disclosures No relevant conflicts of interest to declare.

Assessment of the diagnostic ability of RIFLE and SOFA scoring systems in comparison with protein biomarkers in acute kidney injury

2019 ◽  
Vol 0 (0) ◽  
Author(s):  
Siavash Abedi ◽  
Atieh Makhlough ◽  
Alireza Rafie ◽  
Ali Sharifpour ◽  
Masoud Aliyali ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Serum Creatinine ◽  
Serum Creatinine Level ◽  
Creatinine Level ◽  
Urine Output ◽  
Kidney Injury ◽  
Scoring Systems ◽  
Risk Level ◽  
Control Group ◽  
Diagnostic Ability

AbstractBackgroundWe aimed to assess the diagnostic sensitivity of Risk, Injury, Failure, Loss, and End-stage (RIFLE) and Sequential Organ Failure Assessment (SOFA) scoring systems regarding the serum creatinine level in acute kidney injury (AKI) patients hospitalized in the intensive care unit (ICU). This study also aims to compare the sensitivity of these scoring systems with that of mitochondrial pyruvate carrier 1 (MPC-1), interleukin-10 (IL-10) and neutrophil gelatinase-associated lipocalin (NGAL) as biomarkers.MethodsThis is a cross-sectional study. Thirty patients with increased creatinine level and decreased urine output were recognized as AKI patients, and 30 patients were selected as the control group. The serum levels of each of the proteins of interest were measured at the initial state (moment of entrance) and final state (14th day in the ICU). Statistical analysis was performed with respect to t-test, and a p-value < 0.05 was considered significant. The diagnostic ability of biomarkers was assessed using receiver operating characteristic (ROC) curve.ResultsThe majority of patients were recognized in the risk level of RIFLE, and level 1 of SOFA scoring system. There was no correlation between RIFLE and SOFA (p = 0.123). The expression of MPC-1, IL-10 and NGAL was more remarkable compared with the serum creatinine level. The ROC area change for MPC-1 and IL-10 was higher compared with that for NGAL. As a result, MPC-1 and IL-10 are more reliable biomarkers than NGAL to predict the incidence of AKI in the earlier stage.ConclusionsThere was no significant correlation between SOFA and RIFLE classification, and also the sensitivity of these scoring systems was identified at the risk level for AKI patients. Instead, the level of biomarkers alters earlier, and in higher concentration, than creatinine and urine output changes; therefore, they are more reliable than RIFLE and SOFA scoring systems for prognosis purposes.

scholarly journals A patient with severe rhabdomyolysis and high levels of creatinine kinase had renal functions fully recovered after haemodialysis: a case report

2019 ◽  
Vol 48 (4) ◽  
pp. 030006051988810 ◽  
Author(s):  
Shang-Feng Tsai ◽  
Jun-Li Tsai ◽  
Cheng-Hsu Chen
Keyword(s):  
Renal Function ◽  
Serum Creatinine ◽  
Predictive Power ◽  
Kidney Injury ◽  
Blood Biomarkers ◽  
History Of ◽  
Very High ◽  
Current Report

Rhabdomyolysis is diagnosed based on the levels of blood biomarkers such as creatine kinase (CK), but the use of CK levels to predict long-term renal function remains controversial. This current report presents a case with a very high CK level with the presentation of acute kidney injury (AKI) who regained full renal function. A 29-year-old man, in a manic mood and presenting with dyspnoea, was admitted to hospital following an episode of ketamine use along with a history of drug abuse. The laboratory analyses identified rhabdomyolysis (CK, 35 266 U/l) and AKI (serum creatinine, 3.96 mg/dl). Despite treatment with intravenous normal saline (4000 ml/day), his CK level reached at least 300 000 U/l. He underwent 13 sessions of haemodialysis and his renal function fully recovered. The final measurements were serum creatinine 1.0 mg/dl and CK 212 U/l. These findings support the view that the predictive power of CK level on AKI is limited, especially regarding long-term renal function. Close follow-up examinations of renal function after haemodialysis are mandatory for patients with rhabdomyolysis.

scholarly journals Circulating Proenkephalin, Acute Kidney Injury, and Its Improvement in Patients with Severe Sepsis or Shock

2018 ◽  
Vol 64 (9) ◽  
pp. 1361-1369 ◽  
Author(s):  
Pietro Caironi ◽  
Roberto Latini ◽  
Joachim Struck ◽  
Oliver Hartmann ◽  
Andreas Bergmann ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Septic Shock ◽  
Acute Kidney Injury ◽  
Renal Function ◽  
Intensive Care ◽  
Serum Creatinine ◽  
Odds Ratio ◽  
Adjusted Odds Ratio ◽  
Kidney Injury ◽  
Baseline Serum

Abstract BACKGROUND Acute kidney injury (AKI) occurs in many critically ill patients and is associated with high mortality. We examined whether proenkephalin could predict incident AKI and its improvement in septic patients. METHODS Plasma proenkephalin A 119–159 (penKid) was assayed in 956 patients with sepsis or septic shock enrolled in the multicenter Albumin Italian Outcome Sepsis (ALBIOS) trial to test its association with incident AKI, improvement of renal function, need for renal replacement therapy (RRT), and mortality. RESULTS Median [Q1–Q3] plasma penKid concentration on day 1 [84 (20–159) pmol/L[ was correlated with serum creatinine concentration (r = 0.74); it was higher in patients with chronic renal failure and rose progressively with the renal Sequential Organ Failure Assessment subscore. It predicted incident AKI within 48 h (adjusted odds ratio, 3.3; 95% CI, 2.1–5.1; P &lt; 0.0001) or 1 week [adjusted hazard ratio, 2.1 (1.7–2.8); P &lt; 0.0001] and future RRT during the intensive care unit stay [odds ratio, 4.0 (3.0–5.4)]. PenKid was also associated with improvements in renal function in patients with baseline serum creatinine &gt;2 mg/dL, both within the next 48 h [adjusted odds ratio, 0.31 (0.18–0.54), P &lt; 0.0001] and 1 week [0.23 (0.12–0.45)]. The time course of penKid concentrations predicted AKI and 90-day mortality. CONCLUSIONS Early measurement and the trajectory of penKid predict incident AKI, improvement of renal function, and the need for RRT in the acute phase after intensive care unit admission during sepsis or septic shock. PenKid measurement may be a valuable tool to test early therapies aimed at preventing the risk of AKI in sepsis.

Drug-Induced Kidney Injury Caused by Osimertinib: Report of a Rare Case

Nephron ◽  
2021 ◽  
pp. 1-6
Author(s):  
Takayuki Niitsu ◽  
Terumasa Hayashi ◽  
Junji Uchida ◽  
Takafumi Yanase ◽  
Satoshi Tanaka ◽  
...  
Keyword(s):  
Adverse Effects ◽  
Serum Creatinine ◽  
Serum Creatinine Level ◽  
Creatinine Level ◽  
Lower Lobe ◽  
Kidney Injury ◽  
Tubular Injury ◽  
Male Smoker ◽  
Crescent Formation ◽  
First Case

Tyrosine kinase inhibitors (TKIs) that target the epidermal growth factor receptor (EGFR) have shown highly favourable outcomes in patients with advanced-stage non-small-cell lung cancer (NSCLC). The adverse effects of EGFR-TKIs are generally less severe than those of conventional cytotoxic therapies. We report a patient with NSCLC who presented with acute kidney injury associated with biopsy-proven acute tubular injury during osimertinib treatment and whose renal function recovered after reducing the osimertinib dose. A 61-year-old male smoker complained of dyspnoea on exertion for 1 month before his visit to the medical centre. He was diagnosed with lung adenocarcinoma of the left lower lobe (cT4N3M1a, stage IVA) and was positive for an <i>EGFR</i> mutation (exon 19 deletion). Osimertinib was initiated at 80 mg/day. At treatment initiation, the patient’s serum creatinine level was 0.64 mg/dL, with microscopic haematuria; by day 83, this level had increased to 1.33 mg/dL, with proteinuria. On day 83, we reduced the osimertinib dose to 40 mg/day and performed a kidney biopsy on day 98. The histological diagnosis was tubular injury with IgA deposition. Based on the clinical course and histological findings, we speculated that the kidney injury was associated with osimertinib. After dose reduction, the patient’s serum creatinine level decreased to 1.07 mg/dL, and proteinuria disappeared. He maintained a partial response for &#x3e;6 months after osimertinib administration. We report the first case of biopsy-proven mild IgA deposition, crescent formation, and tubular injury probably caused by osimertinib and demonstrate how reducing the osimertinib dose could strike a balance between its anti-cancer efficacy and adverse effects.

Endovascular Treatment of Transplant Renal Artery Stenosis: A Systematic Review and Meta-analysis

2021 ◽  
pp. 152660282110385
Author(s):  
David Eugenio Hinojosa-Gonzalez ◽  
Gustavo Salgado-Garza ◽  
Mauricio Torres-Martinez ◽  
Sergio Uriel Villegas-De Leon ◽  
Luis Carlos Bueno-Gutierrez ◽  
...  
Keyword(s):  
Systematic Review ◽  
Renal Function ◽  
Serum Creatinine ◽  
Renal Artery ◽  
Serum Creatinine Level ◽  
Endovascular Treatment ◽  
Renal Artery Stenosis ◽  
Creatinine Level ◽  
Mean Difference ◽  
Artery Stenosis

Objective Endovascular treatment through either percutaneous transluminal angioplasty (PTA) alone or stenting has been previously used as a treatment for transplant renal artery stenosis (TRAS). This review aimed to investigate the results of endovascular treatment for renal artery stenosis in transplanted kidneys as compared with the outcomes of interventions, medical management, and graft survival in non-TRAS patients. Methods A systematic review of PubMed, Google Scholar, Cochrane, and Scopus was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines in which studies that reported outcomes of the treatment of TRAS via the endoluminal approach were identified, and their results were meta-analyzed. Results Fifty-four studies with a total of 1522 patients were included. A significant reduction of serum creatinine level was found, favoring the stenting group, with a mean difference of 0.68 mg/dL (95% confidence interval (CI), 0.17–1.19; Z=2.60, p=0.0009). Comparison of pre- and post-intervention values of any intervention revealed a significant decrease in overall serum creatinine level (0.65 mg/dL; 95% CI, 0.40–0.90; Z=5.09, p=0.00001), overall blood pressure, with a mean difference of 11.12 mmHg (95% CI, 7.29–14.95; Z=5.59, p=0.00001), mean difference in the use of medications (0.77; 95% CI, 0.29–1.24; p=0.002), and peak systolic velocity (190.05; 95% CI, 128.41–251.69; p<0.00001). The comparison of serum creatinine level between endovascular interventions and best medical therapy favored endovascular intervention, with a mean difference of 0.23 mg/dL (95% CI, 0.14–0.32; Z=5.07, p<0.00001). Graft survival was similar between the treated patients and those without TRAS (hazard ratio, 0.98; 95% CI, 0.75–1.28; p=0.091). The overall pooled success rate was 89%, and the overall complication rate was 10.4%, with the most prevalent complication being arterial dissection. Conclusion The endovascular treatment of TRAS improves graft preservation and renal function and hemodynamic parameters. PTA + stenting appears to be a more effective option to PTA alone in the stabilization of renal function, with additional benefits from decreased restenosis rates. Further high-quality studies could expand on these findings.

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