scholarly journals Renal impairment in patients admitted due to COVID-19 — the experience of University Hospital No 1 in Bydgoszcz

2021 ◽  
Vol 6 (4) ◽  
pp. 330-333
Author(s):  
Małgorzata Jasiewicz ◽  
Klaudyna Grzelakowska ◽  
Agata Sobacka ◽  
Michał Kasprzak ◽  
Jacek Kryś ◽  
...  
Keyword(s):  
Renal Impairment ◽  
University Hospital

scholarly journals SARS-CoV-2 Renal Impairment in Critical Care: An Observational Study of 42 Cases (Kidney COVID)

2021 ◽  
Vol 10 (8) ◽  
pp. 1571
Author(s):  
Antoine-Marie Molina Barragan ◽  
Emmanuel Pardo ◽  
Pierre Galichon ◽  
Nicolas Hantala ◽  
Anne-Charlotte Gianinazzi ◽  
...  
Keyword(s):  
Renal Impairment ◽  
Renal Injury ◽  
Kidney Injury ◽  
Critical Factor ◽  
University Hospital ◽  
Co2 Partial Pressure ◽  
Icu Admission ◽  
Icu Stay ◽  
Arterial Blood ◽  
Mixed Pattern

The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection leads to 5% to 16% hospitalization in intensive care units (ICU) and is associated with 23% to 75% of kidney impairments, including acute kidney injury (AKI). The current work aims to precisely characterize the renal impairment associated to SARS-CoV-2 in ICU patients. Forty-two patients consecutively admitted to the ICU of a French university hospital who tested positive for SARS-CoV-2 between 25 March 2020, and 29 April 2020, were included and classified in categories according to their renal function. Complete renal profiles and evolution during ICU stay were fully characterized in 34 patients. Univariate analyses were performed to determine risk factors associated with AKI. In a second step, we conducted a logistic regression model with inverse probability of treatment weighting (IPTW) analyses to assess major comorbidities as predictors of AKI. Thirty-two patients (94.1%) met diagnostic criteria for intrinsic renal injury with a mixed pattern of tubular and glomerular injuries within the first week of ICU admission, which lasted upon discharge. During their ICU stay, 24 patients (57.1%) presented AKI which was associated with increased mortality (p = 0.007), hemodynamic failure (p = 0.022), and more altered clearance at hospital discharge (p = 0.001). AKI occurrence was associated with lower pH (p = 0.024), higher PaCO2 (CO2 partial pressure in the arterial blood) (p = 0.027), PEEP (positive end-expiratory pressure) (p = 0.027), procalcitonin (p = 0.015), and CRP (C-reactive protein) (p = 0.045) on ICU admission. AKI was found to be independently associated with chronic kidney disease (adjusted OR (odd ratio) 5.97 (2.1–19.69), p = 0.00149). Critical SARS-CoV-2 infection is associated with persistent intrinsic renal injury and AKI, which is a risk factor of mortality. Mechanical ventilation settings seem to be a critical factor of kidney impairment.

Feto-Maternal Outcome in Patients with Jaundice During Pregnancy

2021 ◽  
Vol 15 (10) ◽  
pp. 3452-3454
Author(s):  
Gulfareen Haider ◽  
Momna Khan ◽  
Fozia Shaikh ◽  
Asma Jabeen
Keyword(s):  
Renal Impairment ◽  
Viral Hepatitis ◽  
Hepatic Coma ◽  
Fetal Distress ◽  
Maternal Outcome ◽  
University Hospital ◽  
Maternal Complications ◽  
Singleton Pregnancy ◽  
Vaginal Deliveries ◽  
Abruptio Placenta

Objective: To find out causes and feto-maternal outcome among patients presented with jaundice during pregnancy. Material and methods: This study was conducted at Isra university Hospital over period of one year from January 2018 to December 2019 in OBS and gynecology department. A total of 50 females having singleton pregnancy and having jaundice were included in the study after taking verbal informed consent. All the patients underwent normal vaginal deliveries and cesarean section as per indications and Hospital protocol. All the information regarding demographic characteristics including maternal and fetal outcome in terms of complications and mortality was collected via self-made study proforma and data was analyzed by SPSS version 20. Results: Total 50 patients were included in this study and 50% belonged to the age group of more than 30 years. 50% were un-booked, multigravida were 80% and 60% women poor socioeconomically. Most of the females had jaundice occurrence during the third trimester. Most patients 40% had jaundice due to viral hepatitis. Major maternal complications were the coagulation failure and renal impairment among 40% and 20% of the cases respectively, followed by septicemia, hepatic coma, hepatic coma, ICU admission, Abruptio placenta, PPH and maternal mortality were found with the percentage of 12.0%, 10.0%, 20.0%, 28.0%, 30.0% and 4.0% respectively. As per neonatal complications, fetal distress was 20.0%, still births were 10.0% and IUD were 10.0%. Conclusion: As per study conclusion the most common cause of jaundice was viral hepatitis. Coagulation failure, renal impairment, abruptio placenta and PPH were observed to be the commonest maternal complications, while fetal distress, IUD and still birth were the frequent fetal complication among patients presenting with jaundice during pregnancy. Keywords: Jaundice, feto-maternal outcome, viral hepatitis

scholarly journals Risk of higher dose methotrexate for renal impairment in patients with rheumatoid arthritis

2020 ◽  
Vol 10 (1) ◽  
Author(s):  
Keigo Hayashi ◽  
Ken-Ei Sada ◽  
Yosuke Asano ◽  
Sumie Hiramatsu Asano ◽  
Yuriko Yamamura ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
Renal Function ◽  
Renal Impairment ◽  
Disease Duration ◽  
Linear Regression Analysis ◽  
University Hospital ◽  
High Dose ◽  
Concomitant Treatment ◽  
Confounding Factors ◽  
Dose Methotrexate

Abstract Renal impairment is a major concern in patients taking high-dose methotrexate (MTX) for malignancy, but it has not been fully explored in rheumatoid arthritis (RA) patients taking low-dose MTX. This study aimed to elucidate the dose-dependent effects of MTX on the renal function of patients with RA. We retrospectively reviewed 502 consecutive RA patients who were prescribed MTX for ≥ 1 year at Okayama University Hospital between 2006 and 2018. The primary outcome was the change in estimated glomerular filtration rate (eGFR) over 1 year. The association between MTX dosage (< 8, 8–12, and ≥ 12 mg/week) and the change in eGFR was evaluated using multiple linear regression analysis with adjustment for possible confounding factors including age, sex, disease duration, body weight, comorbidity, baseline eGFR, concomitant treatment, and disease activity. Mean patient age was 63 years; 394 (78%) were female. Median disease duration was 77 months, while mean MTX dosage was 8.6 mg/week. The last 1-year change of eGFR (mean ± SD) in patients treated with MTX < 8 (n = 186), 8–12 (n = 219), ≥ 12 mg/week (n = 97) decreased by 0.2 ± 7.3, 0.6 ± 8.6, and 4.5 ± 7.9 mL/min/1.73 m2/year, respectively (p < 0.0001). After adjustment for the confounding factors, MTX ≥ 12 mg/week was still correlated with a decrease in 1-year eGFR (beta-coefficient: − 2.5; 95% confidence interval, − 4.3 to − 0.6; p = 0.0089) in contrast to MTX 8–12 mg/week. Careful monitoring of renal function is required in patients with MTX ≥ 12 mg/week over the course of RA treatment regardless of disease duration.

Preliminary Report on the Association of Apolipoprotein E Polymorphisms, with Postoperative Peak Serum Creatinine Concentrations in Cardiac Surgical Patients

2000 ◽  
Vol 93 (2) ◽  
pp. 325-331 ◽  
Author(s):  
Sophia T. H. Chew ◽  
Mark F. Newman ◽  
William D. White ◽  
Peter J. Conlon ◽  
Ann M. Saunders ◽  
...  
Keyword(s):  
Cardiac Surgery ◽  
Renal Impairment ◽  
Serum Creatinine ◽  
Apolipoprotein E ◽  
Genetic Basis ◽  
University Hospital ◽  
Surgical Patients ◽  
Postoperative Changes ◽  
Apolipoprotein E Genotypes ◽  
Postoperative Serum

Background Renal dysfunction after cardiac surgery occurs in up to 8% of patients and is associated with major increases in morbidity, mortality, and cost. Genetic polymorphisms have been implicated as a factor in the progression of chronic renal disease, but a genetic basis for the development of acute renal impairment has not been investigated. The authors therefore tested the hypothesis that apolipoprotein E alleles are associated with different postoperative changes in serum creatinine after cardiac surgery. Methods The authors performed a prospective observational study with use of data from 564 coronary bypass surgical patients who were enrolled in an ongoing investigation of apolipoprotein E genotypes and organ dysfunction at a university hospital between 1989-1999. Renal function was assessed among apolipoprotein E genotype groups by comparisons of preoperative (CrPre), peak in-hospital postoperative (CrMax) and perioperative change (DCr) in serum creatinine values. Results The epsilon4 allele grouping (E2 = 2/2,2/3,2/4; E3 = 3/3; E4 = 3/4,4/4) was associated with a smaller increase in postoperative serum creatinine (perioperative change: E4, +0.17; E3, +0.26; E4, +0.27 mg/dl) and a lower peak postoperative creatinine than the epsilon2 and epsilon3 in univariate and multivariate analysis (peak in-hospital postoperative serum creatinine multivariate P = 0.015 vs. epsilon3, P = 0.038 vs. epsilon2). There was no difference in baseline creatinine among allele groups. Conclusions Inheritance of the apolipoprotein epsilon4 allele is associated with reduced postoperative increase in serum creatinine after cardiac surgery, compared with the epsilon3 or epsilon2 allele. This is the first report of a possible genetic basis for acute renal impairment. These data may contribute to renal risk stratification for cardiac surgery and raise questions regarding apolipoprotein E and the pathophysiology of acute renal injury.

scholarly journals Viršutinių šlapimo takų obstrukcijos sukelto inkstų funkcijos pažeidimo gydymas drenuojant viršutinius šlapimo takus

2005 ◽  
Vol 3 (4) ◽  
pp. 0-0
Author(s):  
Henrikas Ramonas
Keyword(s):  
Urinary Tract ◽  
Renal Impairment ◽  
Treatment Option ◽  
Cortical Thickness ◽  
Functional Recovery ◽  
Urinary Tract Obstruction ◽  
Severe Renal Impairment ◽  
Obstructive Uropathy ◽  
Upper Urinary Tract ◽  
University Hospital

Henrikas RamonasVilniaus universiteto Gastroenterologijos,nefrologijos, urologijos ir pilvo chirurgijos klinika,Vilniaus universiteto ligoninės Santariškių klinikosNefrologijos ir urologijos centras,I Nefrourologijos skyrius,Santariškių g. 2, LT-08661 VilniusEl paštas: [email protected] Įvadas / tikslas Šiame darbe siekiama nustatyti šlapimo takų pokyčių reikšmę inkstų funkcijos atsitaisymui, drenavus viršutinius šlapimo takus dėl jų obstrukcijos ir ryškaus inkstų pažeidimo. Tai padėtų planuoti optimalų gydymą po drenavimo. Ligoniai ir metodai Retrospektyviai išanalizuota 60 ligonių, kuriems 1999–2004 metais drenuoti viršutiniai šlapimo takai dėl obstrukcijos ir koreguota ryškiai pažeista inkstų funkcija. Statistinės analizės būdu nustatyta ikioperacinių šlapimo takų funkcinių ir morfologinių pokyčių įtaka inkstų funkcijos atsitaisymui po drenuojamųjų operacijų. Rezultatai Vidutinis ligonių amžius – 66,38 ± 1,54 metų. Nuo abiejų inkstų obstrukcijos gydyti 35 (58,33%), nuo vienintelio funkcionuojančio inksto – 25 (41,67%) ligoniai. Perkutaninė nefrostomija atlikta 48 (80,0%), operacinė nefrostomija – 5 (8,33%), šlapimtakių stentavimas – 7 (11,67%) ligoniams. Paliatyvus inkstų drenavimas atliktas 31 (51,67%) ligoniui. Pacientams, kuriems kliniškai nustatyta greita obstrukcijos eiga, vidutinė kreatinino koncentracija po gydymo daug geresnė, palyginti su lėtinės obstrukcijos atvejais, – atitinkamai 240,48 ± 25,7 µmol/l ir 395,83 ± 22,3 µmol/l (p < 0,05). Iš morfologinių parametrų geriausiai koreliuoja vidutinis inkstų parenchimos storis ir pooperacinis kasdienis kreatinino mažėjimo rodiklis, ypač pacientų, sergančių inkstų akmenlige (r = 0,55). Diagnozavus abipusę obstrukciją 31 onkologiniam ligoniui, vienpusė nefrostomija buvo pakankama koreguojant inkstų funkciją 27 (87,1%) ligoniams. Išvados Viršutinių šlapimo takų drenažas dėl obstrukcijos ir inkstų funkcijos pažeidimo visais atvejais šią funkciją pagerino. Greičiau ji atsitaiso ligonių, kuriems kliniškai nustatyta greita obstrukcijos eiga ir kuriems iki drenažo rasta storesnė parenchima. Vienpusis paliatyvus viršutinių šlapimo takų drenažas pagerino inkstų funkciją 87% ligonių. Reikšminiai žodžiai: obstrukcinė uropatija, inkstų nepakankamumas, nefrostomija Treatment of renal impairment in patients with obstructive upper urinary tract by draining procedures Henrikas RamonasVilnius University, Clinic of Gastroenterology,Urology and Abdominal Surgery,Center of Nephrology and Urology,Vilnius University Hospital "Santariškių klinikos",Santariškių str. 2, LT-08661 Vilnius, LithuaniaE-mail: [email protected] Background / objective To evaluate the influence of urinary tract changes on renal functional recovery when drainage of the upper urinary tract is performed in the case of ureteric obstruction and severe renal impairment, looking for options of more optimal postoperative therapy. Patients and methods In 60 consecutive patients with upper urinary tract obstruction and severe renal impairment, treated in the urological department from 1999 until 2004, a retrospective analysis of treatment cases was done. Statistical analysis of preoperative functional and morphological changes of the urinary tract, evaluation of their influence on postoperative renal functional recovery was done. Results The patients’ age was 66.38 ± 1.54 years. Bilateral obstruction was found in 35 (58.33%), solitary kidney obstruction in 25 (41.67%) patients. Percutaneous nephrostomy was performed in 48 (80.0%), operative nephrostomy in 5 (8.33%), ureteric stenting in 7 (11.67%) cases. Palliative kidney drainage was employed for 31 (51,67%) patients. In the patients in whom obstruction development was clinically defined as rapid, the mean plasma creatinine concentration after treatment was lower in comparison with chronic obstruction, reaching respectively 240.48 ± 25.7 µmol/l and 395.83 ± 22.3 µmol/l (p < 0.05). A positive correlation was found among renal cortical thickness and daily postoperative creatinine level decrease, especially in cases of nephrolithiasis (r = 0.55). When bilateral obstruction was diagnosed in 31 oncological patients, unilateral nephrostomy was a sufficient treatment option in 27 (87.1%) cases. Conclusions Drainage of the obstructed upper urinary tract influences renal functional recovery in all cases. In clinically defined rapid obstruction cases, renal functional recovery is better in comparison with chronic obstruction. Renal functional recovery postively corellated with renal cortical thickness. Unilateral nephrostomy was a sufficient treatment option in the palliative obstructive treatment course in 87% of patients. Keywords: obstructive uropathy, renal failure, nephrostomy

scholarly journals Clinical impact of baseline renal function on safety and early discontinuation of adjuvant capecitabine plus oxaliplatin in elderly patients with resected colon cancer: a multicenter post-marketing surveillance study

2019 ◽  
Author(s):  
Kentaro Yamazaki ◽  
Shigemi Matsumoto ◽  
Chiyo K Imamura ◽  
Chiemi Yamagiwa ◽  
Ayaka Shimizu ◽  
...  
Keyword(s):  
Colon Cancer ◽  
Renal Function ◽  
Renal Impairment ◽  
Elderly Patients ◽  
Significant Risk ◽  
University Hospital ◽  
Early Discontinuation ◽  
Post Marketing Surveillance ◽  
The Impact ◽  
Baseline Renal Function

Abstract Background Adjuvant capecitabine and oxaliplatin (CAPOX) is a standard treatment for resected colon cancer; however, in patients with moderate renal impairment, the incidence of CAPOX-related adverse events (AEs) and the rate of early discontinuation are higher than in patients with no or mild renal impairment. The aim of this retrospective study was to assess the impact of baseline renal function on the safety and discontinuation of adjuvant CAPOX therapy started with the standard dose of capecitabine in elderly patients with colon cancer. Methods Data from patients aged ≥65 years old who received CAPOX at the standard starting dose as adjuvant therapy for stage II/III colon cancer were collected and analyzed retrospectively. Patients were divided into two groups based on their renal function: CLcr-H (patients with a creatinine clearance [CLcr] ≥50 ml/min) and CLcr-L (CLcr <50 ml/min), and AEs and discontinuations were assessed. Results Overall, 189 patients were assessed (CLcr-H group = 137 and CLcr-L group = 52). No patients experienced grade 4 AEs. The incidence of grade 3 CAPOX-related AEs was higher in the CLcr-L group (42.3%) than in the CLcr-H group (31.3%). The proportion of patients who discontinued treatment within four cycles due to AEs was also higher in the CLcr-L group (21.1%) than in the CLcr-H group (2.9%). Multivariate analysis identified that CLcr <50 ml/min was the only significant risk factor for CAPOX therapy discontinuation due to AEs (P = 0.0008). Conclusions This study demonstrates that the tolerability of adjuvant CAPOX therapy was decreased in elderly patients with impaired renal function. Clinical trial registration University Hospital Medical Information Network Clinical Trials Registry number UMIN000016446.

scholarly journals Colistin Use Patterns and Toxicity in Critically Ill Patients in Pauls Stradiņš Clinical University Hospital

2018 ◽  
Vol 72 (4) ◽  
pp. 201-206 ◽  
Author(s):  
Aleksandra Aitullina ◽  
Angelika Krūmiņa ◽  
Vinita Cauce ◽  
Santa Purviņa
Keyword(s):  
Renal Impairment ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Kidney Injury ◽  
University Hospital ◽  
Gram Negative Bacteria ◽  
Acinetobacter Baumanii ◽  
Use Patterns ◽  
Renal Replacement Therapies ◽  
Median Cumulative Dose

Abstract Colistin is used systemically in critically ill patients for treatment of infections caused by multi-drug resistant (MDR) Gram-negative bacteria, e.g., Acinetobacter baumanii. It is potentially nephro- and neurotoxic. It is recommended to decrease the dose of colistin in case of renal impairment or renal replacement therapies (RRT) but clear recommendations are not available yet. The aim of this retrospective study was to determine colistin use patterns in critically ill patients in Pauls Stradiņš University Hospital. Forty patients were included in this study. The most common indications for colistin were pneumonia associated with mechanical ventilation or sepsis caused by MDR A. baumanii. Median duration of colistin therapy was 11.5 (IQR 7.0; 17.0) days and median cumulative dose was 91.5 (43.0; 150.0) million units (MU). The usual regimen was 9 MU as loading dose and 3 MU three times daily as maintenance dose, but in case of renal impairment and RRT colistin regimens varied a lot between the patients. In 21% (7 from 33) of cases, acute kidney injury (AKI) was observed during colistin therapy (serum creatinine increases more than twice from baseline). All these AKI cases occurred in patients with previously normal renal function and none of the patients in this group needed RRT.

scholarly journals SARS-COV2 Renal Impairment in Critical Care: A Retrospective Study of 42 Cases - Kid COVID Study

2020 ◽  
Author(s):  
Antoine-Marie Molina Barragan ◽  
Emmanuel Pardo ◽  
Pierre Galichon ◽  
Nicolas Hantala ◽  
Anne-Charlotte Gianinazzi ◽  
...  
Keyword(s):  
Renal Impairment ◽  
Renal Injury ◽  
Univariate Analysis ◽  
Kidney Injury ◽  
University Hospital ◽  
Icu Admission ◽  
Icu Stay ◽  
Institutional Review ◽  
Patients At Risk ◽  
Mixed Pattern

Abstract BackgroundThe new coronavirus (SARS-CoV-2) infection leads to 5% to 16% hospitalization in Intensive Care Units (ICU) and is associated with 23% to 75% of kidney impairments, including acute kidney injury (AKI), as a major prognosis factor. The current work aims to characterize the renal impairment associated to SARS-CoV-2 in ICU patients, to evaluate its risk factors and its relationship with morbidity and mortality. Methods Forty-two patients consecutively admitted to the ICU of a university hospital (Paris, France) who tested positive for SARS-CoV-2 between March 25, 2020 and April 29, 2020 were included and classified in categories according to their renal function. Complete renal profiles and their evolution during ICU stay were fully characterized in 34 patients. Factors associated with AKI were identified through univariate analysis.ResultsThirty-two patients (94,1%) met diagnostic criteria for intrinsic renal injury with a mixed pattern of tubular and glomerular injuries within the first week of ICU admission, that lasted upon discharge. During their ICU stay, 24 patients (57.1%) presented AKI which was associated with increased mortality (p = 0.007), hemodynamic failure (p = 0.022), and more altered clearance at hospital discharge (p = 0.001). AKI occurrence was associated with lower pH (p = 0.024), higher PaCO2 (p = 0.027), PEEP (p = 0.027), procalcitonin (p = 0.015), and CRP (p = 0.045) on ICU admission.ConclusionsCritical SARS-CoV-2 is associated with persistent intrinsic renal injury and AKI, which is a risk factor of mortality. Identifying SARS-CoV-2 patients at risk of AKI will help in modifying clinical practice in ICU. Trial registration In accordance with the French law on biomedical research, this study obtained the approval of an Institutional Review Board (“Comité d’Éthique de la Recherche en Anesthésie-Réanimation” under the reference IRB 00010254 ‐ 2020 ‐ 106). Patients were all informed of the possible use of their data in researches as well as their right and terms of objection. Data were collected and integrated anonymously into a secure database in accordance with the French CNIL MR-004 methodology (registration number 20200803123416).

scholarly journals PORTO-SYSTEMIC ENCEPHALOPATHY (PSE);

2012 ◽  
Vol 19 (05) ◽  
pp. 672-678
Author(s):  
ATIF SITWAT HAYAT ◽  
MOHAMMAD ADNAN BAWANY ◽  
FURRUKH NAZ SILAWAT ◽  
Mohammad Akber Memon
Keyword(s):  
Renal Impairment ◽  
Tertiary Care ◽  
Case Series ◽  
University Hospital ◽  
Medical Emergency ◽  
Precipitating Factors ◽  
Case Series Study ◽  
Statistical Program ◽  
Series Study ◽  
Study Setting

Background: Porto-systemic encephalopathy (PSE) is a common medical emergency at our settings due to increasedprevalence of chronic liver disease. Objective: To determine frequency of common precipitating factors in patients having porto-systemicencephalopathy (PSE) at tertiary care settings in Hyderabad. Study design: Descriptive case series study. Setting: Department of MedicineIsra University Hospital Hyderabad. Period: 1st April 2011 to 31st December 2011. Methods: A total 100 patients manifesting clinical featuresof PSE were included in this study by non-probability convenience sampling. The data was evaluated in statistical program SPSS version 16.Results: As 100 patients with PSE were enrolled in the current study, out of these 96 patients have precipitating factors involved while only 4patients have no such factors. Out of these 96 patients, 36 patients have only single risk factor found while in 64 cases multiple factors wereimplicated. Constipation, infections (except SBP) and renal impairment were noted in 36%, 24% and 22% respectively. Conclusions:Constipation, infections (except SBP) and renal impairment were the most common precipitating factors of porto-systemic encephalopathy inour study. Hence priority should be given to them in terms of hospital funds, medicines and human efforts.

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