Serum Creatinine, Urea and Their CD4+ T-lymphocyte Count among HIV Positive Patients before and after Initiation of HAART at St. Paul’s General Specialized Hospital In Addis Ababa, Ethiopia.

Objective: To describe the serum level of urea and creatinine, and as well as CD4+ T cell count of blood among HIV positive patients before and after initiation of HAART in St. Paulo’s general specialized hospital. Methods: A retrospective follow up study was conducted among HIV infected individuals who take HAART drug combination regimens such as (TDF/3TC/EFV), (TDF/3TC/NVP), (AZT/3TC/NVP), (D4T/3TC/EFV) and (D4T/3TC/NVP) and visit St. Paulo’s generalized hospital laboratory for renal function testing from 2007-2009G.C. Results: A total of 2026 HIV positive patients started HAART between 2007-2009G.C in St. Paulo’s ART clinic. Among them 380 HIV patients, with two and three visits for CD4+ and renal function test (creatinine & urea), were recruited to the study. Of whom 240 (63.2%) were female and 140(36.8%) male. Out of 380 patients, 104(27.4%) were taking 1b30, 94(24.7%) were using 1a30, 77(20.3%) were taking 1d, 57(15%) 1c, 14(3.7%) tdf/3tc/efv, 12(3.2%) use tdf/3tc/nvp and 22(5.7%) were taking other drug types. The statuses of CD4+ T cell count of patients become improved as they are using HAART drug through visit. These were 115, 266 and 298 out of 380 have greater than 200 CD4+ T cell count on 6th, 12th, 18th months time difference respectively. But the numbers of patients who have renal dysfunction were increased as they were using HAART drug as treatment through visits. These might indicate that, use of HAART drug combination may improve the immune status HIV positive patients even though some renal side effects are there. Therefore, patients (HAART drug user) should have a follow up on renal function to monitor side effects of drug. Conclusion: HAART resulted in improved Immune status of HIV patients with remarkable increase in CD4 T lymphocyte count but at the same time there was an increase in Azotemia after the introduction part of HAART which suggests the impact of drug in renal function. This is especially true for TDF containing drug regimens (TDF/3TC/NVP) which dramatically improve CD4 T lymphocyte count and show significant Azotemia over times.

Renal Recovery from Severe Acute Kidney Injury Requiring Renal Replacement Therapy / 대한신장학회지

PURPOSE: Acute tubular necrosis (ATN) is a serious complication in critically ill patients. This study investigated the renal outcome of severe ATN requiring RRT and prognostic factors for renal recovery. METHODS: Between January 2000 and May 2008, surviving patients with presumed ATN requiring dialysis were analyzed retrospectively. Patients with pre-existing chronic kidney disease and other causes of ARF rather than ATN were excluded. Primary outcomes were complete renal recovery (CR) and dialysis withdrawal. CR was defined as a return to basal serum creatinine level or creatinine <1.5 mg/dL (male) or <1.3 mg/dL (female) without dialysis. RESULTS: Of one hundred twenty two patients, 79 (65%) patients were male. The mean age was 54+/-16 years and 87 patients (71%) received continuous renal replacement therapy. 55% had ischemic ATN, 29% had septic ATN, and 16% had nephrotoxic ATN. Mean duration of dialysis was 12 (6-29) days. Dialysis withdrawal rate at 30 days and at 60 days after initiation of dialysis were 51% and 77 %, respectively. CR at 60 days after initiation was 50%. Multivariate analysis revealed that older age (per year, Hazard ratio (HR)=0.981, 95% Confidence interval (CI) 0.963 to 0.999), ischemic ATN (vs. toxic ATN, HR=0.481, 95% CI 0.238 to 0.974),and longer duration of oliguria (per day, HR=0.979, 95 % CI 0.962 to 0.996) were independent prognostic factors of renal recovery. CONCLUSION: Young age and short duration of oliguria were favorable factors for renal recovery from ATN requiring dialysis. The cause of ATN might be also an independent prognostic factor.

Cardiovascular disease and renal insufficiency:special considerations with cardiac surgery / 老年心脏病学杂志（英文版）

Cardiovascular disease is an important cause of mortality in the chronic kidney disease (CKD) population. This review discusses cardiac surgery in the CKD population and considers ostoperative acute renal failure (ARF). CKD patients have worse outcomes following coronary artery bypass grafting (CABG) and cardiac valvular surgery than the general population. However,surgical revascularization is an effective treatment for coronary artery disease (CAD) in this population and may be associated with improved survival over percutaneous intervention (PCI) in advanced CKD. Cardiac surgery in the CKD population requires careful perioperative planning and management. Acute renal failure (ARF) is a serious complication following cardiac surgery, occurring in 1 to 8% of cases. Management of postoperative ARF is largely supportive and emphasis is placed on preoperative risk stratification and prevention.

A Case of Dicamba Poisoning with Rhabdomyolysis and Acute Renal Failure Treated by Hemodialysis / 대한신장학회잡지

Dicamba is 3, 6-dichloro-2-methoxybenzoic acid and classified as a chemically related chlorophenoxy herbicide. This herbicide has been widely used for control of broad-leaved weeds. The poisoning is uncommon and of low toxicity, but massive self-ingestion may be fatal. We experienced a case of dicamba poisoning with rhabdomyolysis and acute renal failure in a 53-year-old male. This patient showed vomiting, confused mental status, and myotonia. Electrolyte abnormalities, rhabdomyolysis, and acute renal failure also developed together with fever, hepatotoxicity, pancreatic toxicity, hematologic abnormalities and cardiac ischemia. He was treated by 7 sessions of hemodialysis with supportive treatment and recovered.

The Clinical Outcome and Related Factors of ARF in Survived Patients after CPR / 대한신장학회잡지

BACKGROUND: The purpose of the study was to evaluate the prevalence, related factors, and outcome of acute renal failure (ARF) developed in the patients who survived following a cardiac arrest. METHODS: A retrospective analysis of medical records was underwent in 24 patients who survived among 68 patients receiving cardiopulmonary resuscitation (CPR) at the emergency center of Inha-hospital, Sungnam, Korea, from January 1999 to February 2001. Clinical factors before, during and after CPR were compared and contrasted between the patients who manifested ARF after CPR and those who did not. RESULTS: ARF occurs at 33% following CPR. ARF group showed high baseline creatine kinase (CK) level, longer duration of resuscitation, and larger dosages of epinephrine usage during CPR. During 24 hours after CPR, mean arterial pressure and hourly urine output were significantly lower and dopamine was administered significantly higher in ARF group. Among them seven patients died in 2.3+/-0.8 hospital day with a mean serum creatinine of 2.8+/-1.7 mg/dL. None required renal replacement therapy in ARF group. Mean admission durations were 4.4+/-2.8 and 14.0+/-11.5 days. Survival rate was 12.5% in ARF group, which was significantly low compared to 75% in non-ARF group. CONCLUSION: In spite of high mortality rate in ARF group, ARF by itself was not a direct cause of death. We suggest that the development of ARF is a predicting but not a causative factor of death in the survivors following CPR.

The Clinical Outcome and Related Factors of ARF in Survived Patients after CPR / 대한신장학회잡지

BACKGROUND: The purpose of the study was to evaluate the prevalence, related factors, and outcome of acute renal failure (ARF) developed in the patients who survived following a cardiac arrest. METHODS: A retrospective analysis of medical records was underwent in 24 patients who survived among 68 patients receiving cardiopulmonary resuscitation (CPR) at the emergency center of Inha-hospital, Sungnam, Korea, from January 1999 to February 2001. Clinical factors before, during and after CPR were compared and contrasted between the patients who manifested ARF after CPR and those who did not. RESULTS: ARF occurs at 33% following CPR. ARF group showed high baseline creatine kinase (CK) level, longer duration of resuscitation, and larger dosages of epinephrine usage during CPR. During 24 hours after CPR, mean arterial pressure and hourly urine output were significantly lower and dopamine was administered significantly higher in ARF group. Among them seven patients died in 2.3+/-0.8 hospital day with a mean serum creatinine of 2.8+/-1.7 mg/dL. None required renal replacement therapy in ARF group. Mean admission durations were 4.4+/-2.8 and 14.0+/-11.5 days. Survival rate was 12.5% in ARF group, which was significantly low compared to 75% in non-ARF group. CONCLUSION: In spite of high mortality rate in ARF group, ARF by itself was not a direct cause of death. We suggest that the development of ARF is a predicting but not a causative factor of death in the survivors following CPR.

Clinical Efficacy of Xuebijing Injection for Hemorrhagic Fever with Renal Syndrome Complicating Acute Renal Failure:Observation of 42 Cases / 中国药房

OBJECTIVE:To observe the clinical efficacy of Xuebijing injection for hemorrhagic fever with renal syndrome(HFRS) complicating acute renal failure(ARF). METHODS:A total of 72 patients with HFRS complicating ARF were randomly assigned to receive combined therapy of western medicines(control group,n=30) or combined therapy of western medicines in combination with Xuebijing injection(trial group,n=42). RESUTLS:There were significant differences between the trial group and the control group in total effective rate (95.24% vs.80.00%) (P

Attach importance to the acute renal failure caused by multiple myelome / 重庆医科大学学报

Objective:Probing the clinical characteristic,ARF caused by MM.Method:Reviewing the diagnostic process and evolution of 16 MM patients in recent 10 years,which reflected as ARF at first and be diagnosed as MM at last.Result:ARF could be the prime symptom.Bence-Jones proteinuria,protein electrophoresis,X-ray to the bone have low positive finding in MM diagnose,pathological examination is directly diagnostic method.Conclusion:Diagnosing ARF patients,whose cause of disease is unclear,we should think of MM,and pathological examination is necessary,so we could cure these patients better.

The changes of D-D, t-PA and PAI in acute renal failure patients during blood purification and its clinical significance / 西安交通大学学报(医学版)

Objective To study the dynamic changes and clinical significance of D-D, t-PA and PAI in patients with acute renal failure during the process of different methods of blood purification. Methods Thirty-seven ARF patients were divided into three groups: HD group, HDF group and HF group. Plasma D-D level, t-PA and PAI activity were determined 1 hour, 4 hours before and after treatment. Normal control group consisted of fourteen healthy people. Results ① Plasma D-D level and PAI activity in ARF patients were obviously higher than those in control group, while t-PA activity was lower(P0.05). ③ After 4 hours of the treatment, compared with HD group, HDF and HF groups had significant difference in plasma D-D level, t-PA and PAI activity(P