scholarly journals Acute kidney injury strongly influences renal function after radical nephroureterectomy for upper tract urothelial carcinoma: A single-centre experience

2021 ◽  
Vol 93 (1) ◽  
pp. 9-14
Author(s):  
Alessandro Tafuri ◽  
Katia Odorizzi ◽  
Giacomo Di Filippo ◽  
Clara Cerrato ◽  
Giulia Fassio ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Renal Function ◽  
Multivariate Analysis ◽  
Serum Creatinine ◽  
Urothelial Carcinoma ◽  
Clinical Evaluation ◽  
Kidney Injury ◽  
Radical Nephroureterectomy ◽  
Clinical Factors ◽  
Renal Function Decline

Objective: The aim of our study was to investigate frequency and predictors both of postoperative acute kidney injury (AKI) and renal function decline in a population of consecutive upper tract urothelial carcinoma (UTUC) patients who underwent radical nephroureterectomy (RNU). Materials and methods: Between October 2014 and February 2020, 93 patients underwent RNU at our Institution. After considered exclusion criteria, 89 patients were selected. Perioperative clinical factors were retrospectively collected. Estimated glomerular filtration rate (eGFR) was calculated using the Chronic Kidney Disease Epidemiology Collaboration (CKDEPI) equation. We defined AKI as an increase in serum creatinine by ≥ 0.3 mg/dl or a 1.5-1.9-fold increase in serum creatinine from baseline to I post-operative day (POD). A significant renal function reduction was defined as an eGFR reduction of 40% from baseline at discharge and at last clinical evaluation. Frequency of AKI and eGFR decline was investigated. Association between perioperative clinical factors and AKI and eGFR reduction at discharged and last follow-up was studied using univariate and multivariate models. Results: AKI was detected at I POD in 45 patients. On multivariate analysis, pre-operative eGFR was an independent predictor of AKI (OR 1.03; p = 0.042). Further, AKI was found to be a significant predictor of eGFR reduction ≥ 40% at discharge at univariate analysis (OR 19.42; p = 0.005) and at multivariate analysis (OR 12.49; p = 0.02). In a multivariate logistic regression model post-operative AKI (OR 5.18; p = 0.033), lack of ipsilateral preoperative hydronephrosis (OR 0.17; p = 0.016), preoperative eGFR (OR 1.04; p = 0.047) and antiplatelet therapy (OR 5.14; p = 0.018) were found to be independent predictors of an eGFR reduction higher than 40% at last clinical evaluation made at a median of 15 (IQR 5-30) months. Conclusions: In our cohort, AKI was present in almost 50% of patients after RNU and it was a strong predictor of renal function decline after RNU.

Urinary L-Type Fatty Acid-Binding Protein is a Predictor of Cisplatin-Induced Acute Kidney Injury.

2021 ◽  
Author(s):  
Masaaki Yanishi ◽  
Hidefumi Kinoshita
Keyword(s):  
Acute Kidney Injury ◽  
Renal Function ◽  
Serum Creatinine ◽  
Urothelial Carcinoma ◽  
Kidney Injury ◽  
Fatty Acid Binding ◽  
Renal Function Deterioration ◽  
Patients At Risk ◽  
Pre Treatment ◽  
Chemotherapy Patients

Abstract Background Although cisplatin-based chemotherapy is a standard treatment for urothelial carcinoma, it often causes acute kidney injury (AKI). AKI and dysfunction are observed in 25–35% of cisplatin-based chemotherapy patients, who may require treatment down-titration or withdrawal. In this study, we evaluated whether urinary L-FABP is a marker for early diagnosis of cisplatin-caused AKI. Methods We included 42 adult patients who underwent cisplatin-based chemotherapy for bladder cancer or upper tract urothelial carcinoma from January 2018 to March 2019. Urinary L-FABP and serum creatinine were measured at 2 and 6 hours, and 1, 2, 3, 7 and 28 days after taking cisplatin. Results In the first week after receiving cisplatin, 10 patients (23.8%) were diagnosed with AKI (AKI+ group). Pre-treatment (baseline) measurements did not significantly differ between the AKI+ and AKI− groups. However, urinary L-FABP concentrations rapidly increased in the AKI+ group and were significantly greater than in the AKI− group at Hour 2, Hour 6, Day 1 and Day 2. Serum creatinine also significantly differed between the AKI+ group and the AKI− group on Days 3 and 7. Conclusions Acute renal function deterioration was predicted by increased urinary L-FABP excretion within six hours after receiving CIS-CT and, in those with AKI, the increase in urinary L-FABP excretion preceded the rise in sCr by over 2 days. In contrast, no appreciable changes in urinary L-FABP levels were observed in patients with stable renal function throughout the whole observation period. So early increase in urinary L-FABP may identify patients at risk of cisplatin-induced AKI, who might benefit from treatment to prevent nephrotoxicity. Trial registration: This study was retrospectively registered.

Preoperative predictors of renal function decline after radical nephroureterectomy for upper tract urothelial carcinoma

2014 ◽  
Vol 114 (5) ◽  
pp. 674-679 ◽  
Author(s):  
Matthew Kaag ◽  
Landon Trost ◽  
R. Houston Thompson ◽  
Ricardo Favaretto ◽  
Vanessa Elliott ◽  
...  
Keyword(s):  
Renal Function ◽  
Urothelial Carcinoma ◽  
Upper Tract Urothelial Carcinoma ◽  
Radical Nephroureterectomy ◽  
Renal Function Decline ◽  
Upper Tract ◽  
Preoperative Predictors

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 < 0.0001) or 1 week [adjusted hazard ratio, 2.1 (1.7–2.8); P < 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 >2 mg/dL, both within the next 48 h [adjusted odds ratio, 0.31 (0.18–0.54), P < 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.

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 Acute Metabolic Emergencies in Diabetes and COVID-19: a systematic review and meta-analysis of case reports

2021 ◽  
Author(s):  
Vasileios Papadopoulos ◽  
Marios-Vasileios Koutroulos ◽  
Dimitra-Georgia Zikoudi ◽  
Stefania-Aspasia Bakola ◽  
Peny Avramidou ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Renal Function ◽  
Multivariate Analysis ◽  
Diabetic Ketoacidosis ◽  
Case Reports ◽  
Kidney Injury ◽  
Previous Treatment ◽  
Anion Gap ◽  
Diabetic Patients ◽  
List Type

AbstractBackgroundCOVID-19 is associated with DKA (Diabetic Ketoacidosis), HHS (Hyperglycaemic Hyperosmolar State) and EDKA (Euglycaemic DKA). High mortality has been observed in COVID-19-related diabetic ketoacidosis; however, evidence is scarce.MethodsA systematic literature review was conducted using EMBASE, PubMed/Medline, and Google Scholar from January to December 2020 to identify all case reports describing DKA, HHS, and EDKA, in COVID-19 patients. The Joanna Briggs Institute critical appraisal checklist for case reports was used for quality assessment. Univariate and multivariate analysis assessed correlations of study origin, combined DKA/HHS, age, BMI, HbA1c, administered antidiabetics, comorbidities, symptoms onset, disease status (DS), CRP, ferritin, d-dimers, glucose, osmolarity, pH, bicarbonates, ketones, lactates, β-hydroxybutyric acid, anion gap, and acute kidney injury (AKI) with outcome. The relevant protocol was submitted to PROSPERO database (ID: 229356).ResultsFrom 312 identified publications, 41 including 71 cases analyzed qualitatively and quantitatively. The types of acute metabolic emergencies observed were DKA (45/71, 63.4%), EDKA (6/71, 8.5%), combined DKA/HHS (19/71, 26.8%), and HHS (1/71, 1.4%). Overall mortality was 32.4% (22/68 patients; 3 missing). Multivariate analysis by classical regression demonstrated that COVID-19 DS4 (P=3•10−8), presence of DKA/HHS (P=0.021), and development of AKI (P=0.037) were all independently correlated with death. Increased DS (P=0.003), elevated lactates (P<0.001), augmented anion gap (P<0.001), and presence of AKI (P=0.002) were associated with DKA/HHS. SGLT-2i administration was linked with EDKA (P=0.004); however, a negative association with AKI was noted (P=0.023).ConclusionCOVID-19 intertwines with acute metabolic emergencies in diabetes leading to increased mortality. Key determinants are critical COVID-19 illness, coexistence of DKA/HHS and AKI. Awareness of clinicians to timely assess them might enable early detection and immediate treatment commencing. As previous treatment with was negatively associated with AKI, thus implying a prophylactic effect on renal function, the issue of discontinuation of SGLT-2i in COVID-19 patients remains to be further evaluated.Key messagesWhat is already known on this subject▸Diabetes mellitus (DM) is a risk factor for poor outcomes in COVID-19 patients.▸Diabetic ketoacidosis (DKA) and hyperglycaemic hyperosmolar state (HHS) are not rare in COVID-19 diabetic and non-diabetic patients; key determinants of outcome remain unknown.What this study adds▸COVID-19 intertwines with acute metabolic emergencies in diabetes leading to increased mortality; key determinants are critical COVID-19 illness, coexistence of DKA and HHS as well as development of acute kidney injury.▸SGLT2-i administration is linked with euglycaemic DKA in patients with COVID-19, though preserving renal function.

MO356THE INCIDENCE, MORTALITY AND RENAL OUTCOMES OF ACUTE KIDNEY INJURY IN PATIENTS WITH SUSPECTED INFECTION AT THE EMERGENCY DEPARTMENT

2021 ◽  
Vol 36 (Supplement_1) ◽  
Author(s):  
Meriem Khairoun ◽  
Jan Willem Uffen ◽  
Gurbey Ocak ◽  
Romy Koopsen ◽  
Saskia Haitjema ◽  
...  
Keyword(s):  
Emergency Department ◽  
Acute Kidney Injury ◽  
Renal Function ◽  
Emergency Department Visit ◽  
Kidney Injury ◽  
Renal Function Decline ◽  
Suspected Infection ◽  
Renal Outcomes ◽  
All Cause Mortality ◽  
One Year

Abstract Background and Aims Acute kidney injury (AKI) is a major health problem associated with considerable mortality and morbidity. The epidemiology of AKI in hospitalized and critically ill patients at the Intensive Care Unit with severe infection and sepsis has been well described, however data on mortality and clinical outcomes of AKI at the emergency department in patients with suspected infection are scarce. In this study, we investigated the incidence, mortality and renal outcomes after AKI up to one year after initial AKI-episode patients with suspected infection at the emergency department. Method We used data from the SPACE-cohort (SePsis in the ACutely ill patients in the Emergency department), which consisted of all consecutive patients that presented to the emergency department of the internal medicine with suspected infection in the period between 2016 and 2018 at the University Medical Center Utrecht. Clinical and laboratory data were prospectively collected of all patients. AKI was defined according to the Kidney Disease: Improving Global Outcomes criteria. Outcomes were 1-year all-cause mortality and renal function. Hazards ratios were assessed using Cox regression to investigate the association between AKI, 1-year mortality and renal function decline after AKI. HRs were adjusted for potential confounders including age, gender, Charlson Comorbidity Index, immune status, smoking status, medication use (diuretics, proton-pump inhibitors, non-steroidal anti-inflammatory drugs (NSAIDs) and angiotensin converting enzyme inhibitors (ACEi)), disease severity, diagnosis in the emergency department. Decline of renal function after AKI episode at emergency department visit was defined as Serum Creatinine (SCr) level ≥30% above baseline. Survival in patients with and without AKI was assessed using Kaplan-Meier analyses. Results Of the 3105 patients in the SPACE-cohort with suspected infection, we included 1716, who fulfilled the inclusion criteria and had a baseline SCr measurement. Patients without SCr at baseline (401 patients), at emergence department visit (113 patients), during follow-up (33 patients), on renal replacement therapy (66 patients) or had a repeated emergency department visit (776 patients) were excluded. Of the 1716 patients presenting with suspected infection patients (median age 62y, 52.9% male), 185 patients (10.8%) had an AKI episode. Mortality was 23.8% for the AKI group and 20.4% for the non-AKI group. The adjusted HR for all-cause mortality at 1-year after presentation at the emergency department in AKI patients was 2.1 (95% CI 1.5 – 3.1). Moreover, the cumulative incidence of renal function decline was 69.8% for patients with AKI and 39.3% for patients without AKI. Patients with an episode of AKI had higher risks of developing renal function decline (adjusted HR 3.3, 95% CI 2.4-4.5) at one year after initial AKI-episode at the emergency department. Conclusion Acute kidney injury is common in patients with suspected infection in the emergency department and is significantly associated with mortality and renal function decline one year after AKI.

scholarly journals Do lipid microemboli induce acute kidney injury during cardiopulmonary bypass?

Perfusion ◽  
2017 ◽  
Vol 32 (6) ◽  
pp. 466-473
Author(s):  
Richard Issitt ◽  
Tim James ◽  
Bronagh Walsh ◽  
David Voegeli
Keyword(s):  
Acute Kidney Injury ◽  
Renal Function ◽  
Cardiopulmonary Bypass ◽  
Serum Creatinine ◽  
Cystatin C ◽  
Bypass Graft ◽  
Surrogate Marker ◽  
Kidney Injury ◽  
Renal Vasculature ◽  
Filtration System

Background: Acute kidney injury (AKI) following cardiopulmonary bypass affects 5% of patients, representing significant postoperative morbidity and mortality. Animal models have shown an increased uptake of lipid microemboli (LME) into the renal vasculature, potentially indicating ischaemic causation. This study tested a new lipid filtration system (RemoweLL) against a conventional system with no lipid-depleting capacity to determine the efficacy of the filtration system and its effects on renal function. Methods: Thirty consecutive patients underwent coronary artery bypass graft surgery using either the RemoweLL filtration system (15 patients) or a conventional cardiopulmonary bypass circuit (15 patients). Renal function was assessed using cystatin C concentrations as a surrogate marker of glomerular injury, as well as perioperative glomerular filtration rate (GFR) and serum creatinine concentrations. Patients were defined as having acute renal injury if there was an increase in absolute serum creatinine ⩾3 mg/dL (26.4 µmol/L) or 1.5-fold increase from baseline as categorised using the AKIN criteria. Results: Postoperative differences in LME count between the two groups were highly significant [p<0.001]. Analysis of peak cystatin C concentrations showed significantly lower levels in the LME filtration group on the 2nd postoperative morning [p=0.04]. Two-factor ANOVA revealed a trend towards interaction, but this failed to reach significance [p=0.06]. There were no differences throughout the study period in serum creatinine or GFR [p>0.05]. There were no differences in any of the serum or urinary electrolytes. Conclusions: This study has shown a trend towards improved cystatin C removal with LME filtration; with significantly lower peak concentrations, although no further evidence of renoprotection could be demonstrated. Further research is warranted to establish possible renal benefits of LME filtration in patients undergoing cardiac surgery.

Sign in / Sign up

Export Citation Format

Share Document