scholarly journals Impact on Outcomes across KDIGO-2012 AKI Criteria According to Baseline Renal Function

2019 ◽  
Vol 8 (9) ◽  
pp. 1323 ◽  
Author(s):  
Isabel Acosta-Ochoa ◽  
Juan Bustamante-Munguira ◽  
Alicia Mendiluce-Herrero ◽  
Jesús Bustamante-Bustamante ◽  
Armando Coca-Rojo
Keyword(s):  
Chronic Kidney Disease ◽  
Acute Kidney Injury ◽  
Renal Function ◽  
Kidney Disease ◽  
Hospital Mortality ◽  
Kidney Injury ◽  
Clinical Syndrome ◽  
Increment Rate ◽  
Associated Risk Factors ◽  
Baseline Renal Function

Acute kidney injury (AKI) and Chronic Kidney Disease (CKD) are global health problems. The pathophysiology of acute-on-chronic kidney disease (AoCKD) is not well understood. We aimed to study clinical outcomes in patients with previous normal (pure acute kidney injury; P-AKI) or impaired kidney function (AoCKD) across the 2012 Kidney Disease Improving Global Outcomes (KDIGO) AKI classification. We performed a retrospective study of patients with AKI, divided into P-AKI and AoCKD groups, evaluating clinical and epidemiological features, distribution across KDIGO-2012 criteria, in-hospital mortality and need for dialysis. One thousand, two hundred and sixty-nine subjects were included. AoCKD individuals were older and had higher comorbidity. P-AKI individuals fulfilled more often the serum creatinine (SCr) ≥ 3.0× criterion in AKI-Stage3, AoCKD subjects reached SCr ≥ 4.0 mg/dL criterion more frequently. AKI severity was associated with in-hospital mortality independently of baseline renal function. AoCKD subjects presented higher mortality when fulfilling AKI-Stage1 criteria or SCr ≥ 3.0× criterion within AKI-Stage3. The relationship between mortality and associated risk factors, such as the net increase of SCr or AoCKD status, fluctuated depending on AKI stage and stage criteria sub-strata. AoCKD patients that fulfil SCr increment rate criteria may be exposed to more severe insults, possibly explaining the higher mortality. AoCKD may constitute a unique clinical syndrome. Adequate staging criteria may help prompt diagnosis and administration of appropriate therapy.

scholarly journals Acute kidney injury pathology and pathophysiology: a retrospective review

2020 ◽  
Author(s):  
Joseph P Gaut ◽  
Helen Liapis
Keyword(s):  
Chronic Kidney Disease ◽  
Acute Kidney Injury ◽  
Renal Function ◽  
Kidney Disease ◽  
Renal Biopsy ◽  
Retrospective Review ◽  
Patient Management ◽  
Kidney Injury ◽  
High Morbidity ◽  
Underlying Pathology

Abstract Acute kidney injury (AKI) is the clinical term used for decline or loss of renal function. It is associated with chronic kidney disease (CKD) and high morbidity and mortality. However, not all causes of AKI lead to severe consequences and some are reversible. The underlying pathology can be a guide for treatment and assessment of prognosis. The Kidney Disease: Improving Global Outcomes guidelines recommend that the cause of AKI should be identified if possible. Renal biopsy can distinguish specific AKI entities and assist in patient management. This review aims to show the pathology of AKI, including glomerular and tubular diseases.

Acute kidney injury

2016 ◽  
Vol 9 (12) ◽  
pp. 732-740
Author(s):  
Kirsty Gillies ◽  
Thomas Blakeman ◽  
Daniel Lasserson
Keyword(s):  
Chronic Kidney Disease ◽  
Acute Kidney Injury ◽  
General Practice ◽  
Cardiovascular Risk ◽  
Kidney Disease ◽  
Kidney Injury ◽  
Severity Of Illness ◽  
Clinical Syndrome ◽  
Sick Patient

Acute kidney injury is a clinical syndrome that has become increasingly recognised as a marker of severity of illness in the acutely sick patient. It can lead to, or worsen, chronic kidney disease, and as a result, increase cardiovascular risk. This article sets out the relevance of acute kidney injury for general practice, detailing the identification, management, follow-up and strategies for prevention.

scholarly journals Star fruit intoxication leading to acute kidney injury

2016 ◽  
Vol 48 (1-2) ◽  
pp. 37-39 ◽  
Author(s):  
Md Arshad Ul Azim ◽  
Abdus Salam
Keyword(s):  
Chronic Kidney Disease ◽  
Acute Kidney Injury ◽  
Renal Function ◽  
Kidney Disease ◽  
Normal Renal Function ◽  
Case Reports ◽  
Kidney Injury ◽  
Young Male ◽  
Star Fruit ◽  
Oxalate Nephropathy

There are few case reports regarding star fruit's nephrotoxicity and neurotoxicity in chronic kidney disease patients. Recently cases are found in people with normal renal function Star fruit nephrotoxicity is believed to be due to its high oxalate content which causes acute obstructive oxalate nephropathy. A neurotoxin (caramboxin) present in the fruit is responsible for neurotoxic features. Here we present a young male who developed acute kidney injury following star fruit ingestion in empty stomach. After admission, patient was treated conservatively and recovered completely.Bang Med J (Khulna) 2015; 48 : 37-39

scholarly journals Clinical Characteristics of Hospitalized Patients with Drug-Induced Acute Kidney Injury and Associated Risk Factors: A Case-Control Study

2020 ◽  
Vol 2020 ◽  
pp. 1-8 ◽  
Author(s):  
Chengxuan Yu ◽  
Daihong Guo ◽  
Chong Yao ◽  
Hongyi Yang ◽  
Siyuan Liu ◽  
...  
Keyword(s):  
Risk Factors ◽  
Chronic Kidney Disease ◽  
Acute Kidney Injury ◽  
Kidney Disease ◽  
Alcohol Abuse ◽  
Clinical Characteristics ◽  
Kidney Injury ◽  
Hospitalized Patients ◽  
Drug Induced ◽  
Associated Risk Factors

Background. Drug-induced acute kidney injury (D-AKI) is increasingly common and can extend the hospital length of stay and increase mortality. This study is aimed at analyzing the clinical characteristics of hospitalized patients with D-AKI and the associated risk factors in a multidrug environment. Methods. A retrospective study among hospitalized patients was conducted in July 2019 based on the Adverse Drug Events Active Surveillance and Assessment System-2 developed by the authors. Four controls were matched with each case according to the matching criteria. The risk factors for D-AKI were identified by binary multivariate logistic regression. Results. A total of 23,073 patients were hospitalized in July 2019, 21,131 of whom satisfied the inclusion criteria. The independent risk factors for D-AKI consisted of alcohol abuse (odds ratio (OR), 2.05; 95% confidence interval (CI), 1.04-4.07), nonsteroidal anti-inflammatory drug (NSAID) use (OR, 2.39; 95% CI, 1.25-4.58), diuretic use (OR, 2.64; 95% CI, 1.42-4.92), prior anemia (OR, 4.10; 95% CI, 1.94-8.67), and prior chronic kidney disease (OR, 2.33; 95% CI, 1.07-5.08). Conclusions. The occurrence of D-AKI in hospitalized patients had significant associations with alcohol abuse, combination therapy with NSAIDs or diuretics, and prior anemia or chronic kidney disease. Clinicians should meticulously follow patients with the above characteristics.

scholarly journals Epidemiology and Outcomes of Acute Kidney Injury in COVID-19 Patients with Acute Respiratory Distress Syndrome: A Multicenter Retrospective Study

2020 ◽  
pp. 1-7
Author(s):  
Feilong Wang ◽  
Linyu Ran ◽  
Chenchen Qian ◽  
Jing Hua ◽  
Zhibing Luo ◽  
...  
Keyword(s):  
Chronic Kidney Disease ◽  
Acute Kidney Injury ◽  
Acute Respiratory Distress Syndrome ◽  
Retrospective Study ◽  
Kidney Disease ◽  
Hospital Mortality ◽  
Respiratory Distress Syndrome ◽  
Respiratory Distress ◽  
Distress Syndrome ◽  
Kidney Injury

<b><i>Background:</i></b> Acute kidney injury (AKI) is associated with increased mortality in patients with acute respiratory distress syndrome (ARDS). However, the epidemiological features and outcomes of AKI among COVID-19 patients with ARDS are unknown. <b><i>Methods:</i></b> We retrospectively recruited consecutive adult COVID-19 patients who were diagnosed with ARDS according to Berlin definition from 13 designated intensive care units in the city of Wuhan, China. Potential risk factors of AKI as well as the relation between AKI and in-hospital mortality were investigated. <b><i>Results:</i></b> A total of 275 COVID-19 patients with ARDS were included in the study, and 49.5% of them developed AKI during their hospital stay. In comparison with patients without AKI, patients who developed AKI were older, tended to have chronic kidney disease, had higher Sepsis-Related Organ Failure Assessment score on day 1, and were more likely to receive invasive ventilation and develop acute organ dysfunction. Multivariate analysis showed that age, history of chronic kidney disease, neutrophil-to-lymphocyte ratio, and albumin level were independently associated with the occurrence of AKI. Importantly, increasing AKI severity was associated with increased in-hospital mortality when adjusted for other potential variables: odds ratio of stage 1 = 5.374 (95% CI: 2.147–13.452; <i>p</i> &#x3c; 0.001), stage 2 = 6.216 (95% CI: 2.011–19.210; <i>p</i> = 0.002), and stage 3 = 34.033 (95% CI: 9.723–119.129; <i>p</i> &#x3c; 0.001). <b><i>Conclusion:</i></b> In this multicenter retrospective study, we found that nearly half of COVID-19 patients with ARDS experienced AKI during their hospital stay. The coexistence of AKI significantly increased the mortality of these patients.

Increased progression to kidney fibrosis after erythropoietin is used as a treatment for acute kidney injury

2014 ◽  
Vol 306 (6) ◽  
pp. F681-F692 ◽  
Author(s):  
Glenda C. Gobe ◽  
Nigel C. Bennett ◽  
Malcolm West ◽  
Paul Colditz ◽  
Lindsay Brown ◽  
...  
Keyword(s):  
Oxidative Stress ◽  
Chronic Kidney Disease ◽  
Acute Kidney Injury ◽  
Renal Function ◽  
Kidney Disease ◽  
Kidney Injury ◽  
Renal Ischemia ◽  
Acute Injury

Treatment of renal ischemia-reperfusion (IR) injury with recombinant human erythropoietin (rhEPO) reduces acute kidney injury and improves function. We aimed to investigate whether progression to chronic kidney disease associated with acute injury was also reduced by rhEPO treatment, using in vivo and in vitro models. Rats were subjected to bilateral 40-min renal ischemia, and kidneys were studied at 4, 7, and 28 days postreperfusion for renal function, tubular injury and repair, inflammation, and fibrosis. Acute injury was modulated using rhEPO (1,000 or 5,000 IU/kg, intraperitoneally) at the time of reperfusion. Renal tubular epithelial cells or fibroblasts in culture were subjected to hypoxia or oxidative stress, with or without rhEPO (200 IU/ml), and fibrogenesis was studied. The results of the in vivo model confirmed functional and structural improvement with rhEPO at 4 days post-IR ( P < 0.05). At 7 days post-IR, fibrosis and myofibroblast stimulation were increased with IR with and without rhEPO ( P < 0.01). However, at 28 days post-IR, renal fibrosis and myofibroblast numbers were significantly greater with IR plus rhEPO ( P < 0.01) compared with IR only. Mechanistically, rhEPO stimulated profibrotic transforming growth factor-β, oxidative stress (marker 8-hydroxy-deoxyguanosine), and phosphorylation of the signal transduction protein extracellular signal-regulated kinase. In vitro, rhEPO protected tubular epithelium from apoptosis but stimulated epithelial-to-mesenchymal transition and also protected and activated fibroblasts, particularly with oxidative stress. In summary, although rhEPO was protective of renal function and structure in acute kidney injury, the supraphysiological dose needed for renoprotection contributed to fibrogenesis and stimulated chronic kidney disease in the long term.

Evaluation of renal function in primary care

2018 ◽  
Vol 8 (2) ◽  
pp. 202-205
Author(s):  
B. Musiałowska ◽  
M. Rudzińska ◽  
E. Koc-Żórawska ◽  
M. Żórawski
Keyword(s):  
Primary Care ◽  
Chronic Kidney Disease ◽  
Acute Kidney Injury ◽  
Renal Function ◽  
Kidney Disease ◽  
Chronic Diseases ◽  
Kidney Injury ◽  
Treatment Monitoring ◽  
Primary Care Patients ◽  
Drug Doses

Evaluation of renal function is one of the primary tools used in treatment and monitoring kidney injury such as acute kidney injury (AKI) or chronic kidney disease (CKD) in Primary Care patients. Accompanying chronic diseases also have an impact on the assessment of renal function, treatment monitoring and adjustment of drug doses.

scholarly journals Using circulating O-sulfotyrosine in the differential diagnosis of acute kidney injury and chronic kidney disease

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Shuai Chen ◽  
Yong-Hua Liu ◽  
Dao-Peng Dai ◽  
Zheng-Bin Zhu ◽  
Yang Dai ◽  
...  
Keyword(s):  
Chronic Kidney Disease ◽  
Acute Kidney Injury ◽  
Renal Function ◽  
Differential Diagnosis ◽  
Kidney Disease ◽  
Linear Regression Analysis ◽  
Kidney Injury ◽  
Serum Levels ◽  
Multivariate Linear Regression Analysis ◽  
Post Translational Modification

Abstract Background Sulfation of tyrosine, yielding O-sulfotyrosine, is a common but fixed post-translational modification in eukaryotes. Patients with increased circulating O-sulfotyrosine levels experience a faster decline in renal function with progression to end-stage renal disease (ESRD). In the present study, we measured serum O-sulfotyrosine levels in individuals with chronic kidney disease (CKD) and acute kidney injury (AKI) to explore its ability to differentiate AKI from CKD. Methods A total of 135 patients (20 with AKI and 115 with CKD) were recruited prospectively for liquid chromatography-mass spectrometry assessment of circulating O-sulfotyrosine. We also studied C57BL/6 mice with CKD after 5/6 nephrectomy (Nx). Blood samples were drawn from the tail vein on Day 1, 3, 5, 7, 14, 30, 60, and 90 after CKD. Serum separation and characterization of creatinine, blood urea nitrogen (BUN), and O-sulfotyrosine was performed. Thus, the time-concentration curves of the O-sulfotyrosine level demonstrate the variation of kidney dysfunction. Results The serum levels of O-sulfotyrosine were markedly increased in patients with CKD compared with AKI. Median O-sulfotyrosine levels in CKD patients versus AKI, respectively, were as follows:243.61 ng/mL(interquartile range [IQR] = 171.90–553.86) versus 126.55 ng/mL (IQR = 48.19–185.03, P = 0.004). In patients with CKD, O-sulfotyrosine levels were positively correlated with creatinine, BUN, and Cystatin C (r = 0.63, P < 0.001; r = 0.49, P < 0.001; r = 0.61, P < 0.001, respectively) by the multivariate linear regression analysis (β = 0.71, P < 0.001; β = 0.40, P = 0.002; β = 0.73, P < 0.001, respectively). However, this association was not statistically significant in patients with AKI (r = − 0.17, P = 0.472; r = 0.11, P = 0.655; r = 0.09, P = 0.716, respectively). The receiver operating characteristic (ROC) analysis illustrated that the area under the curve was 0.80 (95% confidence interval [CI] 0.71–0.89; P < 0.001) and the optimal cut-off value of serum O-sulfotyrosine suggesting AKI was < 147.40 ng/mL with a sensitivity and specificity of 80.90 and 70.00% respectively. In animal experiments, serum levels of O-sulfotyrosine in mice were elevated on Day 7 after 5/6 nephrectomy (14.89 ± 1.05 vs. 8.88 ± 2.62 ng/mL, P < 0.001) until Day 90 (32.65 ± 5.59 vs. 8.88 ± 2.62 ng/mL, P < 0.001). Conclusion Serum O-sulfotyrosine levels were observed correlated with degrading renal function and in CKD patients substantially higher than those in AKI patients. Thus serum O-sulfotyrosine facilitated the differential diagnosis of AKI from CKD.

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