Acute kidney injury in patients with H1N1 admitted to ICU: Incidence, patient and renal outcomes. a multi-center perspective

Acute kidney injury [AKI] is a commonly sequel of sepsis associated with critical illness; hence, it could be anticipated to occur in H1N1 infected patients who suffer a rapidly progressive course complicated by multi-organ failure. To evaluate the rate of AKI in patients admitted to ICU with H1N1 and their outcome. We retrospectively reviewed the files of 24 consecutive patients admitted to ICU with H1N1 infection between June 1st and December 31st 2009. Signs of AKI, relevant co-morbidities and co-infections as well as outcome measures were collected. H1N1 infection was confirmed with PCR level measurements. Out of 523 patients, who presented with confirmed H1N1 infection during the study period, 24 [4.6%] were admitted to ICU. Thirteen [54%] had AKI of which 4 were previously known to have chronic renal disease, 11 had acute respiratory distress syndrome [ARDS], and 5 required hemodialysis. Four out of the 13 patients with AKI died, 5 recovered completely, 3 had partial recovery and one remained dependent on hemodialysis. Our results indicate that varying degrees of AKI occur in more than half of H1N1 patients admitted to ICU. This represents a serious complication predicting worsened outcome. Though the mortality rate was high, the majority of patients recovered partially or completely with early aggressive treatment

Osteoporosis in renal failure: how accurate is the diagnosis and is there any role for bisphosphonates?

Patients with chronic renal failure [CRF] may be at a particularly increased risk for osteoporosis and its related fractures given the high prevalence of some of the known risk factors for osteoporosis. The challenge is how to accurately make the diagnosis of osteoporosis in subjects with CRF since low bone mineral density and fractures could result from secondary hyperparathyroidism, adynamic bone disease, osteomalacia, as well as osteoporosis. Helpful tests include bone turnover markers and double tetracycline-labeled bone biopsy. In patients with confirmed osteoporosis, preliminary data suggest that bisphosphonates seem to be safe and effective down to glomerular filtration rates of 15 mL/min. Low to moderate doses of vitamin D analogues are also helpful in such patients

Ibn'Sina rounds

We continue these excerpts from the case records of Dr Abubakr, current resident to that august, testy and infinitely wise consultant physician, Dr Ibn 'Sina The Ibn'Sina Rounds are presentations of actual clinical situations with a moral and teaching value