Renal Impairment in Young Patients with Unilateral Ureteral Lithiasis Obstruction: What Factors can be Responsible?

2018 ◽  
Vol 69 (2) ◽  
pp. 375-378
Author(s):  
Catalin Pricop ◽  
Ileana Adela Vacaroiu ◽  
Daniela Radulescu ◽  
Daniel Andone ◽  
Dragos Puia
Keyword(s):  
Renal Impairment ◽  
Serum Creatinine ◽  
Young Patients ◽  
Kidney Injury ◽  
Contralateral Kidney ◽  
Reactive Protein ◽  
Ureteral Lithiasis ◽  
Unilateral Hydronephrosis ◽  
Duration Of Hospitalization ◽  
History Of

In the literature, occurrence of acute kidney injury (AKI) in young patients with unilateral ureteral lithiasic obstruction and without previous renal impairment is not very often reported, and the underlined pathophysiological mechanisms are poorly known; according to some studies, it is a false kidney failure, the increase in serum creatinine being due to absorbtion of obstructed urine in the affected kidney. We have conducted a retro and prospective study in order to identify the possible risk factors that can cause renal function impairment in young patients (18-40 years) with unilateral ureteral lithiasis obstruction and a normal contralateral kidney. Results. From 402 patients included in the study, 20.64% (83 cases) presented with serum creatinine ] 1.3 mg/dL. In patients with renal impairment, prevalence of male gender and history of NSAIDS use before admission were significantly higher than in non-AKI group. Serum urea/creatinine ratio, and estimated glomerular filtration rate (MDRD formula) were significantly higher, and respectively lower in AKI group. We found no significant differences between the two groups regarding age, prevalence of urinary tract infection after relief of obstruction, C-reactive protein value, and the duration of hospitalization. Conclusions. AKI in young patients with unilateral ureteral lithiasis obstruction and normal contralateral kidney is not quite a rare finding in our region. NSAIDs use can influence development of AKI, and should be used cautiously even in young patients with renal colic. In our opinion, the presence of AKI in patients with unilateral hydronephrosis demands urgent endourological intervention. Choosing conservative therapy in these patients, especially treatment with NSAIDS may aggravate the renal dysfunction.

P2755Acute kidney injury risk calculator in patients with infective endocarditis

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
A Pisaryuk ◽  
N Povalyaev ◽  
M Sorokina ◽  
M Teterina ◽  
E Kotova ◽  
...  
Keyword(s):  
Injury Risk ◽  
Kidney Injury ◽  
White Blood Count ◽  
Risk Calculator ◽  
C Reactive Protein ◽  
Treatment Frequency ◽  
Reactive Protein ◽  
Kidney Involvement ◽  
Duration Of Hospitalization ◽  
History Of

Abstract Background Kidney involvement in IE has a huge contribution in failure of the treatment. Frequency of kidney lesions is still high. There are several risk calculators for prognosing embolic events, perioperational mortality, 6-month mortality, but there is none for prognosing kidney events in IE. Materials/Methods 209 patients with verified IE (DUKE 2009, 2015), hospitalized from 2010 to 2018, were included in the study. Kidney function was assessed using CKD-EPI formula. AKI was diagnosed according to current guidelines (KDIGO 2012). Clinical, hematological and echocardiographic features were analysed to look for predictors of AKI. To create a simple risk calculator independent predictors obtained from log-regression analysis were used. The risk formula was derived using the coefficients: Pr(Y) = 1/[1 + exp(−XB)] where Pr(Y) = prognosed risk of AKI, XB = coef1*predictor1 + ... + logit-regression constant. Results AKI was presented in 66% cases and mainly was I (41%) and III (37%) stages. Predictors for AKI were established: MRSA OR 8.0 (95% CI 1.01–68.48; p=0.054), emergence or worsening of the HF sympthoms OR 2.83 (95% CI 1.27–6.32; p=0.011), gentamycin OR 2.71 (95% CI 1.33–5.53, p=0.006), history of CAD OR 2.35 (95% CI 1.05–5.27) p=0.038, WBC at admission >11.5x109/l OR 1.07 (95% CI 1.01–1.13), duration of hospitalization >20.7 days OR 1.03 (95% CI 1.01–1.05) p=0.005, C-reactive protein >90 mg/l OR 1.01 (95% CI 1.01–1.02) p=0.001. Simple risk calculator Coef OR Indicator MRSA 2.0755 8 0 Emergence or worsening of the heart failure sympthoms 1.04041 2.83 0 Gentamycin 0.3640833 2.71 1 History of coronary artery disease 0.8542633 2.35 1 White blood count at admission 0.0691979 1.07 13 Duration of hospitalization 0.0308953 1.03 2 C-reactive protein 0.0075288 1.01 180 Constant −3.275098 0.0378132 Logit 0.259795900 P 0.564586119 Scaling parameter 100 Points 56 Result 56 Conclusions A simple risk calculator for AKI is developed for patients with IE.

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 Acute Renal Injury: Revisited

2020 ◽  
Vol 10 (4) ◽  
pp. 221-224
Author(s):  
Kamel El-Reshaid ◽  
Shaikha Al-Bader
Keyword(s):  
Serum Creatinine ◽  
Fluid Overload ◽  
Kidney Injury ◽  
Hydration Status ◽  
Acute Renal Injury ◽  
Potassium Accumulation ◽  
Life Threatening ◽  
History Of ◽  
Stage 1 ◽  
Morbid Conditions

Acute kidney injury (AKI) indicates its abrupt deterioration and is defined as an increase in serum creatinine more than the baseline by > 26 umol/L within 48 hours or > 50% within 1 week.  The latter since glomerular failure is the life-threatening one with: (a) uremic intoxication, (b) water and salt retention with fluid overload, and (c) potassium accumulation with cardiac arrest.  The etiology can be pre-renal, post-renal or intrinsic.  Diagnosis is established by history of new insults, physical examination for hydration status, systemic stability and manifestations of autoimmune diseases/infections as well as an initial laboratory testing for renal function (serum creatinine, electrolytes and urine routine) and kidney ultrasound.  Additional specific tests are indicated to assess etiology of AKI and its associated co-morbid conditions that interacts with its management.  Severity of AKI ranges from mild (stage 1) to advanced (stage 5) that requires dialytic support.  Moreover, it depends on the type and duration of the insult.  Prognosis depends on etiology of AKI, its co-morbid conditions and the timely interventions by the supportive medical team.  Keywords: acute, causes, epidemiology, injury, kidney, management.

scholarly journals Therapeutic Lowering of C-Reactive Protein

2021 ◽  
Vol 11 ◽  
Author(s):  
Rachel V. Jimenez ◽  
Alexander J. Szalai
Keyword(s):  
Biological Activities ◽  
Biological Effects ◽  
Neointimal Hyperplasia ◽  
Kidney Injury ◽  
Serum Levels ◽  
Response To Therapy ◽  
C Reactive Protein ◽  
Reactive Protein ◽  
Subsequent Response ◽  
History Of

In the blood of healthy individuals C-reactive protein (CRP) is typically quite scarce, whereas its blood concentration can rise robustly and rapidly in response to tissue damage and inflammation associated with trauma and infectious and non-infectious diseases. Consequently, CRP plasma or serum levels are routinely monitored in inpatients to gauge the severity of their initial illness and injury and their subsequent response to therapy and return to health. Its clinical utility as a faithful barometer of inflammation notwithstanding, it is often wrongly concluded that the biological actions of CRP (whatever they may be) are manifested only when blood CRP is elevated. In fact over the last decades, studies done in humans and animals (e.g. human CRP transgenic and CRP knockout mice) have shown that CRP is an important mediator of biological activities even in the absence of significant blood elevation, i.e. even at baseline levels. In this review we briefly recap the history of CRP, including a description of its discovery, early clinical use, and biosynthesis at baseline and during the acute phase response. Next we overview evidence that we and others have generated using animal models of arthritis, neointimal hyperplasia, and acute kidney injury that baseline CRP exerts important biological effects. In closing we discuss the possibility that therapeutic lowering of baseline CRP might be a useful way to treat certain diseases, including cancer.

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.

scholarly journals Favorable outcomes of elderly COVID-19 patients in Guangzhou, China: a retrospective, observational study

2020 ◽  
Author(s):  
Gang Xu ◽  
Jun Zhao ◽  
Fuchun Zhang ◽  
Feng Liu ◽  
Congrui Feng ◽  
...  
Keyword(s):  
Elderly Patients ◽  
Medical Records ◽  
Myocardial Injury ◽  
Young Patients ◽  
Kidney Injury ◽  
The Elderly ◽  
Cure Rate ◽  
Death Case ◽  
Acute Myocardial Injury ◽  
Duration Of Hospitalization

Abstract Objective: To clarify the outcomes of elderly patients with COVID-19.Methods: All 265 confirmed adult patients with COVID-19 were included in this retrospective study, 43 (16.2%) of whom were 65 years and older. Electronic medical records of the subjects were reviewed to obtain information on clinical characteristics and outcomes. The allocations of medical resource were also recorded.Results: Only one death case occurred in the elderly. The mortality of elderly patients was no higher than that of young patients (2.3% vs. 0%, P = 0.126). The cure rate was 95.3% in elderly patients and 99.5% in young patients (P = 0.067), and the duration of hospitalization is 27 days in elderly patients and 18 days in young patients (P = 0.001). The elderly suffered from more comorbidities (67.4% vs. 24.8%, P < 0.001), most of which is hypertension. Significantly more severe cases occurred in elderly patients compared with young patients (37.2% vs. 16.7%, P = 0.004). The elderly were more likely to present with complications including acute respiratory distress syndrome, acute myocardial injury, septic shock and acute kidney injury (all P < 0.05), respectively. No medical staffs were infected during the treatment of COVID-19.Conclusion: The cure rate and the mortality of the elderly seemed to be no worse than that of the young, though the elderly were with longer hospitalization. Elderly patients with COVID-19 could be treatable if handled properly. More severe cases and complications in elderly patients should prompt for more complex treatment and special considerations.

scholarly journals The Management of Erythrodermic Psoriasis Complicated by Cyclosporine

2020 ◽  
Vol 2020 ◽  
pp. 1-3
Author(s):  
Suman Rao ◽  
Michelle Bernshteyn ◽  
Raman Sohal ◽  
Rachael Proumen ◽  
Alexandra Goodman ◽  
...  
Keyword(s):  
Serum Creatinine ◽  
Filtration Rate ◽  
Oral Prednisone ◽  
Kidney Injury ◽  
Past Medical History ◽  
First Line ◽  
Erythrodermic Psoriasis ◽  
History Of ◽  
Steroid Sparing ◽  
First Line Treatment

We present a 64-year-old woman with past medical history of psoriasis and alcoholic liver cirrhosis who presented with a diffuse, erythematous, and scaly rash. Pertinent medications included topical triamcinolone 0.1% cream. She was started on oral prednisone 40 milligrams (mg) and oral cyclosporine 150 mg daily and was continued on topical triamcinolone. After the administration of two doses of this regimen, the serum creatinine increased to 1.76 mg/dL, and serum potassium increased to 6.7 mEq/L. The serum creatinine continued to uptrend to 2.42 mg/dL, and the glomerular filtration rate (GFR) decreased to 20 mL/min. The patient was emergently hemodialyzed. The patient was placed on an extended steroid taper, alleviating the psoriatic rash. However, the patient needed to be placed on a steroid-sparing regimen. Because of its rarity and ensuing complications, erythrodermic psoriasis must be identified and managed promptly. Cyclosporine is currently the first-line treatment. However, initiation of this therapy in our patient resulted in an acute kidney injury (AKI). Even though a steroid taper assisted in alleviating erythroderma, a steroid-sparing regimen needed to be started. This led to the consideration of alternate methods of therapy for further management of erythrodermic psoriasis with renal impairment.

scholarly journals Evaluation of the Results of Conservative Management of Women with Tuboovarian Abscess; Single Tertiary Center Experience

2016 ◽  
Author(s):  
Cenk Yasa ◽  
Ozlem Dural ◽  
Ercan Bastu ◽  
Harika Yumru ◽  
Omer Demir ◽  
...  
Keyword(s):  
Conservative Management ◽  
Ca 125 ◽  
Reactive Protein ◽  
Tuboovarian Abscess ◽  
Hospitalization Period ◽  
Tertiary Center ◽  
Duration Of Hospitalization ◽  
History Of ◽  
Device Use ◽  
Wbc Count

<p><strong>OBJECTIVE</strong>: To evaluate results of patients with conservative management of tuboovarian abscess (TOA).<br /><strong>STUDY DESIGN:</strong> A retrospective cohort study of women with TOA. Between January 2012 and February 2015, all women that hospitalized with diagnosis of TOA enrolled in this study. Cases were analyzed with respect to age, parity, medical conditions, history of intra-uterine device use, size of TOA, C-reactive protein (CRP) levels, white blood cell (WBC) count, CA-125 levels, antibiotic usage, hospitalization period.<br /><strong>RESULTS:</strong> Thirty-nine patients with TOA included in to this study. Mean age was 38.2 ± 11.5 years. Mean size of TOA was 5. 7 ± 2.1 cm. In comparison between patients with abscesses ≤ 6cm or &gt;6cm, TOA size is not associated with important outcomes including duration of antibiotherapy and duration of hospitalization.<br /><strong>CONCLUSION:</strong> Women with TOAs should be admitted to the hospital and immediately started in parenteral antibiotics. Due to high levels of success with antibiotherapy, immediate surgical management should always be performed in cases of rupture.</p>

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.

scholarly journals Acute Kidney Injury in Children with COVID-19

2020 ◽  
Author(s):  
Jameela A kari ◽  
Mohamed Shalaby ◽  
Amr S Albanna ◽  
Turki Alahmadi ◽  
Adi Alherbish ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Renal Impairment ◽  
Hospital Admission ◽  
Respiratory Distress ◽  
Kidney Injury ◽  
Pediatric Intensive Care ◽  
Mortality And Morbidity ◽  
Reactive Protein ◽  
Renal Angina Index ◽  
Renal Angina

Abstract Background: Acute kidney injury (AKI) is a complication of coronavirus disease 2019 (COVID-19). The reported incidence of AKI, however, varies among studies. We aimed to evaluate the incidence of AKI and its association with mortality and morbidity in children infected with severe acute respiratory distress syndrome coronavirus 2 (SARS-CoV-2) who required hospital admission.Methods: This was a multicenter retrospective cohort study from three tertiary centers, which included children with confirmed COVID-19. All children were evaluated for AKI using the Kidney Disease Improving Global Outcomes (KDIGO) definition and staging. Results: Of 89 children included, 19 (21%) developed AKI (52.6% stage I). A high renal angina index score was correlated with severity of AKI. Also, multisystem inflammatory syndrome in children (MIS-C) was increased in children with AKI compared to those with normal kidney function (15% vs 1.5%). Patients with AKI had significantly more pediatric intensive care admissions (PICU) (32% vs. 2.8%, p< 0.001) and mortality (42% vs. 0%, p< 0.001). However, AKI was not associated with prolonged hospitalization (58% vs. 40%, p=0.163) or development of MIS-C (10.5% vs. 1.4%, p=0.051). Residual renal impairment at discharge occurred in 9% of patients. This was significantly influenced by the presence of comorbidities, hypotension, hypoxia, heart failure, acute respiratory distress, hypernatremia, abnormal liver profile, high C-reactive protein, and positive blood culture.Conclusions: AKI occurred in one-fifth of children with SARS-CoV-2 infection requiring hospital admission, with one-third of those requiring PICU. AKI was associated with increased morbidity and mortality, and residual renal impairment at time of discharge.

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