scholarly journals Sepse em pacientes com lesão renal aguda severa

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.

Indications for Dialysis in Acute Kidney Injury

2020 ◽  
Author(s):  
Ankit Patel ◽  
Kenneth B Christopher
Keyword(s):  
Acute Kidney Injury ◽  
Renal Replacement Therapy ◽  
Replacement Therapy ◽  
High Efficiency ◽  
Kidney Injury ◽  
Intermittent Hemodialysis ◽  
Continuous Venovenous Hemofiltration ◽  
Continuous Venovenous Hemodialysis ◽  
Low Efficiency ◽  
The Impact

Renal replacement therapy (RRT) can be used to support patient’s kidney function in cases of acute kidney injury (AKI). However, timing, modality, and dosing of RRT continue to remain in question. Recent studies have begun to provide data to help guide clinicians on when to initiate RRT, what form of RRT to use ranging from continuous venovenous hemofiltration (VVH) to intermittent hemodialysis, and the impact of high versus low-intensity dosing. Additionally, the risks associated with temporary vascular access with regard to thrombosis and infection, the impact of high efficiency and flux versus low efficiency and flux membranes, and options for anticoagulation in RRT for AKI are also discussed. This review contains 75 references.  Key words: acute kidney injury, chronic kidney disease, continuous venovenous hemofiltration, continuous venovenous hemodialysis, renal replacement therapy, venovenous hemofiltration, 

Intensity of Renal Support in Critically Ill Patients with Acute Kidney Injury

2018 ◽  
pp. 221-226
Author(s):  
Eric Ehieli ◽  
Yuriy Bronshteyn
Keyword(s):  
Acute Kidney Injury ◽  
Renal Replacement Therapy ◽  
Replacement Therapy ◽  
Statistical Difference ◽  
Kidney Injury ◽  
Intermittent Hemodialysis ◽  
Replacement Strategy ◽  
Therapy Regimen ◽  
Continuous Venovenous Hemodiafiltration ◽  
Multicenter Prospective Study

Patients with severe acute kidney injury who require renal replacement therapy have high mortality rates. Controversy exists over whether a mortality benefit occurs with use of a more intensive renal replacement therapy regimen. In this multicenter, prospective study, 1124 patients requiring renal replacement therapy for severe acute kidney injury were randomized to a more and a less intensive renal replacement therapy regimen and were followed for 60 days. There was no statistical difference in mortality at 60 days (53.6% intensive, 51.5% less intensive, P = 0.47) and no difference in kidney recovery or non-renal organ failure. Hypotension and electrolyte abnormalities were more common in the intensive renal replacement regimen. A less intensive renal replacement regimen (intermittent hemodialysis 3 times a week or continuous venovenous hemodiafiltration at 20ml/kg/hour) was found noninferior to a more intensive renal replacement strategy (dialysis 6 times per week or continuous venovenous hemodiafiltration at 35 ml/kg/hour).

scholarly journals Intermittent Hemodialysis For Patients With Acute Kidney Injury (AKI): Outcome In A Tertiary Level Hospital

2018 ◽  
Vol 17 (1) ◽  
pp. 25-30
Author(s):  
Arun Sharma ◽  
Binod Karki ◽  
Ajay Rajbhandari
Keyword(s):  
Acute Kidney Injury ◽  
Renal Function ◽  
Renal Replacement Therapy ◽  
Replacement Therapy ◽  
Acute Gastroenteritis ◽  
Kidney Injury ◽  
Tertiary Level ◽  
Intermittent Hemodialysis ◽  
The Mean ◽  
Level Hospital

INTRODUCTION: Acute kidney injury (AKI) is the sudden loss of renal function with accumulation of nitrogenous waste compounds. In developing countries, community acquired AKI is common than AKI in hospitalized septic patients. With conservative management many patients recover renal function however few require renal support with intermittent Hemodialysis (HD). We conducted a study to find out the etiology and outcome of the patients presenting with AKI who required dialysis.METHODS: This is a descriptive follow up study of the patients who needed renal replacement therapy in the form of HD presenting to our Nephrology unit of the hospital over a period of two years. Patients were followed up for three months post discharge. Data were tabulated and analyzed using SPSS software.RESULTS: Total 50 patients were included in study with 67% male. The commonest etiologies were urinary tract infection (30%) and  acute gastroenteritis (24%).The mean creatinine at the time of nephrology consultation, maximum level and at the time of discharge were 6.5(SD± 2.62), 7.3(SD ±2.13) and 2.2(SD ±1.75) respectively. Uremia with anuria was the most common reason for the initiation of HD in 54% cases. The mean number of intermittent HD used was 3.36. Complete recovery was seen in 68%, death in 26% and CKD in 6%.CONCLUSION: UTI followed by acute gastroenteritis are the leading cause of AKI in our tertiary level hospital. Timely initiated renal replacement therapy in the form of intermittent HD could lead to substantial renal recovery in almost three fourth of patients.

scholarly journals Novel coronavirus infection and acute kidney injury in two renal transplant recipients: a case report

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.

scholarly journals The role of biomarkers of acute kidney injury in predicting functional outcomes of surgical treatment of patients with localized kidney cancer

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

Refractory Dabigatran-Induced Hemorrhage Despite Multiple Idarucizumab Administration and Renal Replacement Therapy

2020 ◽  
pp. 089719002096169
Author(s):  
Francis Flynn ◽  
Guillaume Richard ◽  
Marc A. Dobrescu ◽  
Josée Bouchard ◽  
David Williamson ◽  
...  
Keyword(s):  
Chronic Kidney Disease ◽  
Acute Kidney Injury ◽  
Renal Replacement Therapy ◽  
Kidney Disease ◽  
Replacement Therapy ◽  
Dabigatran Etexilate ◽  
Rebound Effect ◽  
Kidney Injury ◽  
Intermittent Hemodialysis ◽  
Thrombin Time

Purpose: This case report describes a patient with dabigatran accumulation due to acute kidney injury on chronic kidney disease, requiring multiple administration of idarucizumab along with renal replacement therapy because of rebound effect causing numerous episodes of bleeding. Summary: An 86-year-old man on dabigatran etexilate 110 mg twice daily for stroke prevention with atrial fibrillation was admitted to the hospital for bowel obstruction and severe acute kidney injury on chronic kidney disease. The patient had an abnormal coagulation profile and no history of bleeding. Initial laboratory values revealed a hemoglobin concentration of 10.7 g/dL, a platelet count of 115 × 103 platelets/μL, an activated partial thromboplastin time of 150.4 seconds, an international normalized ratio of 10.28, a thrombin time greater than 100 seconds and a serum creatinine of 5.54 mg/dL (490 μmol/L). An initial dose of idarucizumab was administered 1 hour prior to surgery to prevent bleeding. Significant bleeding and hemodynamic instability occurred following surgery. Three additional doses of idarucizumab, 2 sessions of intermittent hemodialysis, continuous venovenous hemofiltration and blood products were required to achieve normalization of coagulation parameters and hemodynamic stability due to rebound coagulopathy after each dose of idarucizumab. Conclusion: Acute kidney injury on chronic kidney disease and third-space redistribution could have led to important dabigatran accumulation and favored rebound coagulopathy. Multiple therapeutic approaches may be required in the management of complex dabigatran intoxication.

scholarly journals A Case of Upper Ureter Rupture With Acute Kidney Injury

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.

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

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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