The Effect of Serum Calcium Levels on Uremic Encephalopathy in Patients with Acute Kidney Injury in the Emergency Department

Background and objectives: Uremic encephalopathy is the most important complication of renal failure and urgent dialysis treatment is required. Parathormone (PTH) contributes to the etiopathogenesis of uremic encephalopathy. PTH is a hormone that acts in the calcium balance in the organism. The aim of our study was to investigate the effect of serum adjusted and ionized calcium on the development of uremic encephalopathy in patients with acute renal injury (acute kidney injury network (AKIN) stage 3). Materials and Methods: Our study was supported by Canakkale Onsekiz Mart University Scientific Research Projects Unit (ID:1278). Three groups were formed for the study. The first group was acute renal failure AKIN stage 3 (N: 23), the second group was AKIN stage 3, and the patients who had emergency hemodialysis (N: 17) and the third group (N: 9) had AKIN stage 3 hemodialysis due to uremic encephalopathy. In these patient groups, 25-hydroxy vitamin D, PTH, calcium, albumin, urea, creatinine, and blood-gas-ionized calcium were observed in their serum during the first application. Calcium, albumin, urea, creatinine, and ionized calcium in blood gas were also examined in serum at 24th and 72th hours. Data were analyzed using SPSS version 19.0. Kruskal–Wallis test and Mann–Whitney U test were applied for the variables that did not comply with normal distribution. p < 0.005 was accepted statistically. Results: A statistically significant difference was found between the measurement creatinine values at the 24th and 72th hours of admission in AKIN stage 3 patients who applied to the emergency department (p = 0.008). A statistically significant difference was found in the measured calcium values (p = 0.013). A statistically significant difference was found in the measured ionized calcium values (p = 0.035). Conclusions: In our study, the effect of ionized calcium level on uremic encephalopathy in serum creatinine, calcium, and blood gas in patients presenting with acute renal injury, AKIN stage 3, was significant, but studies with new and large groups are needed.

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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.

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113 Improving Intravenous Fluid Therapy to Reduce the Incidence of Acute Kidney Injury in Elderly Hip Fracture Patients

Age and Ageing ◽

10.1093/ageing/afab030.74 ◽

2021 ◽

Vol 50 (Supplement_1) ◽

pp. i12-i42

Author(s):

C McCann ◽

A Hall ◽

J Min Leow ◽

A Harris ◽

N Hafiz ◽

...

Keyword(s):

Emergency Department ◽

Acute Kidney Injury ◽

Hip Fracture ◽

Length Of Stay ◽

Kidney Injury ◽

Ward Round ◽

Fluid Administration ◽

Ward Staff ◽

Intravenous Fluid Therapy ◽

Significant Difference

Abstract Background Acute kidney injury (AKI) in hip fracture patients is associated with morbidity, mortality, and increased length of stay. To avoid this our unit policy recommends maintenance crystalloid IV fluids of >62.5 mL/Hr for hip fracture patients. However, audits have shown that many patients still receive inadequate IV fluids. Methods Three prospective audits, each including 100 consecutive acute hip fracture patients aged >55, were completed with interventional measures employed between each cycle. Data collection points included details of IV fluid administration and pre/post-operative presence of AKI. Interventions between cycles included a revised checklist for admissions with a structured ward round tool for post-take ward round and various educational measures for Emergency Department, nursing and admitting team staff with dissemination of infographic posters, respectively. Results Cycle 1: 64/100 (64%) patients received adequate fluids. No significant difference in developing AKI post operatively was seen in patients given adequate fluids (2/64, 3.1%) compared to inadequate fluids (4/36, 11.1%; p = 0.107). More patients with pre-operative AKI demonstrated resolution of AKI with appropriate fluid prescription (5/6, 83.3%, vs 0/4, 0%, p < 0.05) Cycle 2: Fewer patients were prescribed adequate fluids (54/100, 54%). There was no significant difference in terms of developing AKI post operatively between patients with adequate fluids (4/54, 7.4%) or inadequate fluids (2/46, 4.3%; p = 0.52). Resolution of pre-operative AKI was similar in patients with adequate or inadequate fluid administration (4/6, 67% vs 2/2, 100%). Cycle 3: More patients received adequate fluids (79/100, 79%, p < 0.05). Patients prescribed adequate fluids were less likely to develop post-operative AKI than those receiving inadequate fluids (2/79, 2.5% vs 3/21, 14.3%; p < 0.05). Discussion This audit demonstrates the importance of administering appropriate IV fluid in hip fracture patients to avoid AKI. Improving coordination with Emergency Department and ward nursing/medical ward staff was a critical step in improving our unit’s adherence to policy.

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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.

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Too slow and too high

Hong Kong Journal of Emergency Medicine ◽

10.1177/1024907920931721 ◽

2020 ◽

pp. 102490792093172 ◽

Cited By ~ 1

Author(s):

Jonathan Chun-Hei Cheung ◽

Kam Leung Law ◽

Koon Ngai Lam

Keyword(s):

Blood Pressure ◽

Emergency Department ◽

Acute Kidney Injury ◽

Renal Failure ◽

Potassium Level ◽

Kidney Injury ◽

Vicious Cycle ◽

Dopamine Infusion ◽

Low Blood Pressure ◽

Electrocardiographic Changes

A 77-year-old woman on metoprolol and lisinopril presented to an emergency department with giddiness after vomiting for few hours. She was found to have low blood pressure and bradycardia 38 beats per minute due to atrioventricular nodal blockade. Her bradycardia was refractory to atropine and dopamine infusion; but improved with calcium gluconate. She was found to have acute kidney injury and hyperkalemia at 6.4 mEq/L. This is a case of Bradycardia, Renal Failure, Atrioventricular-Nodal Blockers, Shock, and Hyperkalemia (BRASH) syndrome, precipitated by dehydration and perpetuated by atrioventricular blockade, illustrating the degree of bradycardia and electrocardiographic changes being out of proportion to the potassium level. BRASH syndrome should be recognized and intervened early in the course to avoid the patient entering a vicious cycle that could be rapidly fatal.

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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

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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.

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896 Improving Intravenous Fluid Therapy to Reduce the Incidence of Acute Kidney Injury in Hip Fracture Patients

British Journal of Surgery ◽

10.1093/bjs/znab134.504 ◽

2021 ◽

Vol 108 (Supplement_2) ◽

Author(s):

C McCann ◽

A Hall ◽

J M Leow ◽

A Harris ◽

N Hafiz ◽

...

Keyword(s):

Emergency Department ◽

Acute Kidney Injury ◽

Hip Fracture ◽

Data Collection ◽

Length Of Stay ◽

Fluid Therapy ◽

Kidney Injury ◽

Ward Staff ◽

Intravenous Fluid Therapy ◽

Significant Difference

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Clinical Profile, Need for Dialysis and Mortality of Community Acquired versus Hospital Acquired Acute Kidney Injury

JOURNAL FOR CLINICAL AND DIAGNOSTIC RESEARCH ◽

10.7860/jcdr/2021/49408.15221 ◽

2021 ◽

Author(s):

B Dushyanth ◽

Archana Dambal ◽

. Siddaganga ◽

CP Vrushabhveer ◽

CS Hithashree

Keyword(s):

Acute Kidney Injury ◽

Renal Replacement Therapy ◽

Replacement Therapy ◽

Renal Injury ◽

Kidney Injury ◽

Developed Countries ◽

P Value ◽

Number Of Patients ◽

Significant Difference ◽

Hospital Acquired

Introduction: Occurrence of Acute Kidney Injury (AKI) is high in hospitalised and critically ill patients. Most of the cases reported by the developed countries are Hospital Acquired Acute Kidney Injury (HA-AKI). AKI is a major medical complication in the developing world also and is due to predominantly community acquired causes, where the epidemiology differs from that in developed countries. Many studies have reported that Community Acquired Acute Kidney Injury (CA-AKI) and HA-AKI differ in mortality, need for renal replacement and residual renal injury. Aim: To know the difference in need for renal replacement therapy and in-hospital mortality between patients diagnosed with CA-AKI and HA-AKI using Kidney Disease: Improving Global Outcomes (KDIGO) criteria. Materials and Methods: A prospective cohort study was conducted from January 2018-December 2018 after obtaining Institutional Ethical Clearance by comparing 50 cases of CA-AKI and 50 cases of HA-AKI admitted by the General Medicine Department as per the inclusion and exclusion criteria. Serum Creatinine (S.Cr) at admission, after 48 hours and at the time of discharge were measured. Serial urine output measurements were done. Need for dialysis was noted in both the groups. Both groups were compared based on need for dialysis, difference in mortality and residual renal injury at the time of discharge. Chi-square and student t-tests were applied respectively and p-value ≤0.05 was considered as significant. Statistical Package for Social Sciences (SPSS) version 17.0 was used for data entry and analysis. Results: the CA-AKI and HA-AKI groups were comparable in age and gender but differed in some co-morbidities. CA-AKI group had underlying hepatobiliary disorders and Non steroidal Anti-Inflammatory Drug (NSAID) abuse more often than HA- AKI group. There was a significant reduction in S.Cr over the duration of hospital stay in CA-AKI (mean S.Cr at admission was 4.85 mg/dL, at 48 hours 2.05 mg/dL and at discharge 1.20 mg/dL). S.Cr increased after 48 hours of admission from baseline and declined later in HA-AKI but did not reach baseline in many patients in comparison to CA-AKI group (mean S.Cr at admission was 1.10 mg/dL, at 48 hours 2.38 mg/dL, at discharge 1.57 mg/dL). The highest stage of AKI was stage 3 in CA-AKI group (22 vs 11 of HA-AKI). HA-AKI group had more number of patients in stage 2 AKI (26 vs 18 of CA-AKI). There was no significant difference in mortality and requirement of haemodialysis between CA-AKI and HA-AKI groups. Conclusion: There was no difference between the two groups in terms of mortality and need for renal replacement therapy but there was significant residual renal injury in HA-AKI group.

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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

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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.

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