Predictors of Acute Kidney Injury in Patients with High-degree Atrioventricular Block

OBJECTIVES: This study compared vancomycin trough concentrations and pharmacokinetic parameters in pediatric cardiothoracic surgery (CTS) patients versus those in controls receiving 20 mg/kg/dose, intravenously, every 8 hours. METHODS: A retrospective study was conducted in children <18 years of age, following CTS, versus an age-and sex-matched control group. The primary objective was to determine differences in trough concentrations between groups. Secondary objectives included comparisons of pharmacokinetics between groups and development of vancomycin-associated acute kidney injury (AKI), defined as a doubling in serum creatinine from baseline. Also dosing projections were developed to target an area-under-the-curve-to-minimum inhibitory concentration (AUC:MIC) ratio of ≥400. RESULTS: Twenty-seven patients in each group were evaluated. Mean trough concentrations were significantly different between groups (CTS: 18.4 mg/L; control: 8.8 mg/L; p < 0.01). Vancomycin-associated acute kidney injury AKI was significantly higher in the CTS group than in controls (25.9% versus 0%, respectively, p<0.01). There were significant differences in vancomycin elimination rates, with a high degree of variability, but no statistical differences in other parameters. Based on dosing projections, CTS patients would require 21 to 88 mg/kg/day, with a dosage interval determined by the child's glomerular filtration rate to achieve the target AUC:MIC ≥400. CONCLUSIONS: Vancomycin dosage of 20 mg/kg/dose intravenously every 8 hours achieved significantly higher trough concentrations in CTS patients than in controls. Pharmacokinetic parameters were highly variable in CTS patients, indicating more individualization of dosage is needed. A future prospective study is needed to determine whether the revised dosage projections achieve the AUC:MIC target and to determine whether these regimens are associated with less vancomycin-associated AKI.

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Addisonian crisis complicated by rhabdomyolysis and acute kidney injury

International Journal of Research in Medical Sciences ◽

10.18203/2320-6012.ijrms20173592 ◽

2017 ◽

Vol 5 (8) ◽

pp. 3717

Author(s):

Hassan Tahir ◽

Nagadarshini Ramagiri Nagadarshini ◽

Saad Ullah ◽

Arslan Ahmed

Keyword(s):

Acute Kidney Injury ◽

Adrenal Insufficiency ◽

Rare Complication ◽

Kidney Injury ◽

Primary Adrenal Insufficiency ◽

Nonspecific Sign ◽

High Degree

Addisonian Crisis is an endocrine emergency requiring hospitalization and urgent management. The diagnosis is usually complicated by nonspecific sign and symptoms of primary adrenal insufficiency. A high degree of suspicion Is required in such cases. Rhabdomyolysis caused by addisonian crisis is a rare complication which was seen in our patient.

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Acute Kidney Injury in Children

10.53902/sojpcn.2021.01.000507 ◽

2021 ◽

Vol 1 (2) ◽

Author(s):

Nilzete Liberato Bresolin

Keyword(s):

Acute Kidney Injury ◽

Specific Treatment ◽

Kidney Injury ◽

Critically Ill Children ◽

Patients At Risk ◽

Underlying Causes ◽

Diagnosis And Classification ◽

New Biomarkers ◽

High Degree

Recent literature data has shown that acute kidney injury (AKI) is a common occurrence in critically ill children and that it is associated with high rates of morbidity and mortality, even after adjusting for other risk factors. In addition, it can result in long-term sequelae translated by the development of arterial hypertension, microalbuminuria and chronic renal dysfunction. High degree of suspicion, early diagnosis based on the recognition of patients at risk and the use of new criteria for the diagnosis and classification of AKI and, whenever possible, using the new biomarkers can positively alter the prognosis of these patients. Although there is still no specific treatment for AKI, it is recommended to focus on the immediate institution of preventive measures in order to maintain renal hemodynamics, early treatment of septic patients, elimination of exogenous nephrotoxins, recognition and management of patients with AKI secondary to high levels of endotoxins, control and normalization of volume after the initial phase of fluid resuscitation, sufficient nutritional support, and recognition and treatment of the underlying causes are necessary. Patients that fail with conservative care will need renal replacement therapy.

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Mouse Models of Acute Kidney Injury

10.5772/intechopen.97523 ◽

2021 ◽

Author(s):

Navjot Pabla ◽

Yogesh Scindia ◽

Joseph Gigliotti ◽

Amandeep Bajwa

Keyword(s):

Chronic Kidney Disease ◽

Acute Kidney Injury ◽

Mouse Models ◽

Poor Prognosis ◽

Ischemia Reperfusion Injury ◽

Ischemia Reperfusion ◽

Cecal Ligation ◽

Kidney Injury ◽

Cecal Ligation And Puncture ◽

High Degree

Acute Kidney Injury (AKI) is a poor prognosis in hospitalized patients that is associated with high degree of mortality. AKI is also a major risk factor for development of chronic kidney disease. Despite these serious complications associated with AKI there has not been a great amount of progress made over the last half-century. Here we have outlined and provided details on variety of mouse models of AKI. Some of the mouse models of AKI are renal pedicle clamping (ischemia reperfusion injury), Cisplatin induced nephrotoxicity, sepsis (LPS, cecal slurry, and cecal ligation and puncture), folic acid, and rhabdomyolysis. In this chapter we describe in detail the protocols that are used in our laboratories.

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