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Background: In general, there is a propensity among the physicians to label a patient with cirrhosis developing a raised creatinine level as HRS and treat it as such thereby ignoring the other causes particularly in this part of the country. This study was undertaken to find out the causes of acute renal failure and their outcome in cirrhotic patients.Methods: One forty three cirrhotic patients with acute renal failure were enrolled and investigated for causes of renal failure and their outcomes.Results: 92 (64.33%) patients had single factor whereas 51 (35.66%) patients had multiple factors (two or more), causing renal failure. Hypovolemia (34.27%) was the most common cause of renal failure followed by herbal medications (11.19%), HRS (11.19%) and infections (7.69%) as a single factor. Among multiple factors, 45 (31.46%) patients had hypovolemia followed by 36 (25.17%), 18 (12.58%) and 8 (5.59%) patients having infections, herbal medications and use of nephrotoxic drugs respectively. Reversibility was seen in 72 (50.35%) patients and more common in hypovolemia (85.71%) as a single factor. Total all-cause mortality was 33 (23%) and highest mortality was seen in HRS 75% (n=12) followed by infections (45.45%) and herbal medications (25%).Conclusions: Hypovolemia was the most common cause of renal failure followed by infections, herbal medications and hepatorenal syndrome. Early detection and proper volume replacement are the key points in the management. Detailed history regarding use of herbal medications is also very important issue.
ABSTRACT
Background: Acute kidney injury (AKI), previously called acute renal failure (ARF), is an abrupt loss of kidney function that develops within 7 days. Its causes are numerous. Generally it occurs because of damage to the kidney tissue caused by decreased renal blood flow (kidney ischemia) from any cause such as low blood pressure, exposure to substances harmful to the kidney, an inflammatory process in the kidney, or an obstruction of the urinary tract that impedes the flow of urine. AKI is diagnosed on the basis of characteristic laboratory findings, such as elevated blood urea nitrogen and creatinine, or inability of the kidneys to produce sufficient quantity if urine. Materials and methods: All patients aged above 18 years with features of AKI as per AKIN (Acute Kidney Injury Network) criteria which is defined as an increase in serum creatinine of 0.3 mg/dl or more within 48 hours of observation or 1.5 times baseline or greater, which is known or presumed to have occurred within 7 days, or a reduction in urine volume below 0.5 ml/kg/h for 6 hours were included in this study. A total of 146 patients were included in this study. Results: Causative factors of AKI were decreased renal perfusion, nephrotoxic drugs, septicemia, intravascular hemolysis, hepato-renal syndrome, urinary catheterization and volume depletion. In this study, thirty four deaths out of 146 cases were documented and most common cause was septicemia followed by peripheral circulatory failure and uremia. Most common organisms involved were pseudomonas and acinetobacter. Mangesh Dorai, Soumyadeb Roy. Causes of mortality in patients with acute kidney injury at Mahatma Gandhi Medical (MGM) College and Hospital, Jamshedpur - A tertiary care centre in Jharkhand. IAIM, 2018; 5(5): 167-173. Page 168 Conclusion: Drug induced AKI can be prevented if used with discretion in patients with associated risk factors. The meticulous and appropriate monitoring of hydration status, fluid and electrolyte imbalance, use of nephrotoxic drugs particularly aminoglycosides, efficient control of infection and sepsis maintenance of adequate diuresis and hydration in surgical settings and patients undergoing radio contrast study are the main steps towards the prevention of hospital acquired acute renal failure.
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Objectives To investigate the etiology, renal pathology, treatment, and prognosis of children's urinary system injury after hematopoietic stem cell transplantation (HSCT). Methods Clinical data of 81 children with urinary dysfunction after HSCT admitted to the Hematology Department in Children's Hospital of Soochow University were analyzed, and relevant literatures were reviewed. Results In 81 cases (50 males and 31 females), the age ranges from 8 months to 17 years old. Thirty cases (37%) with prerenal injury were recovered after active rehydration and other symptom specific treatment. There were 9 (11.1%) children with renal injury, four cases were given up therapy or transferred to other hospitals, thus lead to an unknown prognosis. Kidney biopsy was performed in the remaining five cases for pathological investigation. After active symptom-speific and etiology-based treatment, serum creatinine and glomerular filtration rate of four cases return to normal. But in the long-term follow-up,one case died of recurrence of primary disease, reinfusion of hematopoietic stem cell combined with renal failure. The remaining 3 patients were with chronic kidney disease (CKD). One case with renal thrombotic microangiopathy was in the chronic dialysis. Postrenal renal injuries were mainly hemorrhagic cystitis (28.4%) and urinary tract infection (16%). After a large dose of rehydration, urine alkalization and anti-infection therapy, they were recovered in the short term with a good prognosis. Conclusions Urinary injury after HSCT is mainly divided into three categories: prerenal, renal and postrenal, in which renal injury is prone to frequent recurrence.
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Background: Elevation of serum creatinine (SCr) more than 0.5 mg/dl or 25% or more of the baseline value in 3 days after contrast administration is considered as contrast-induced nephropathy (CIN). Contrast material (CM) used in the radiological studies like contrast-enhanced computed tomography (CECT) and intravenous urogram (IVU) are nephrotoxic and their ability to cause renal damage is increased when other potential nephrotoxic drugs are given simultaneously. The present study aimed to demonstrate the effects of CM on patients who are on nephrotoxic drugs by studying the incidence of CIN in patients who are on nephrotoxic drugs and need a CECT or IVU (cases presenting with an emergency). The study compares the incidence of CIN in patients on nephrotoxic drugs with that in those not on nephrotoxic drugs and evaluates the importance of withdrawal of nephrotoxic drugs (3 days) in non-emergency contrast studies. Methods: The study population is divided into three groups. Group A consists of 40 cases undergoing emergency CECT or IVU, who are on nephrotoxic drugs. 40 cases undergoing CECT or IVU after 3 days of holding of nephrotoxic drugs are included in Group B. Group C consists of 40 cases undergoing CECT or IVU who are not on any nephrotoxic drugs. Patients with parenchymal renal disease, renal injury, and renal mass are excluded from the study. All cases having SCr <1.4 mg/dl are included in the study. SCr investigation is repeated 3 days after the contrast study. Results: The incidence of CIN is more in the patients who are on nephrotoxic drugs (15%) than in those who are not on nephrotoxic drugs (5%). There is no significant difference in the incidence of CIN between Groups B and C. p=0.045 between Groups A and B was noted showing the significance of waiting period in reducing the incidence of CIN. Conclusions: The incidence of CIN is more in patients who underwent contrast studies without stopping nephrotoxic drugs and stoppage of nephrotoxic drugs for 3 days prior to the procedure is beneficial by reducing the incidence of CIN among them.
ABSTRACT
Las alteraciones renales producidas por el uso crónico de analgésicos antiinflamatorios no esteroideos (AINE) son diversas, la principal corresponde a nefropatía tubulointersticial que resulta en la necrosis papilar renal. También se han reportado casos de síndrome nefrótico con biopsias que revelan enfermedad de cambios mínimos y muy excepcionalmente una glomerulonefritis membranosa, la cual desaparece al suspender el medicamento. Se presenta el caso de una paciente remitida al Servicio de Nefrología del Hospital Militar Central (HMC) de Bogotá por presentar elevación de los azoados durante una valoración prequirúrgica. Sin evidencia de causa secundaria y después de ser estudiada fue llevada a biopsia renal, encontrando una nefropatía membranosa y como único antecedente el uso crónico de AINE.
The renal effects caused by chronic use of non-steroidal anti-inflammatory drugs (NSAIDs) are diverse; the main corresponds to tubulointerstitial nephropathy resulting in renal papillary necrosis. There have also been reported cases of nephrotic syndrome with biopsy that revealed minimal change disease and exceptionally membranous glomerulonephritis, which resolves after discontinuation of medication. There is a report of a case in Bogota in which a patient was referred to the Nephrology Service of the Central Military Hospital due to elevation of nitrogen compounds during preoperative assessment. No evidence of secondary cause was present and after being studied, a renal biopsy was carried out, membranous nephropathy located; the only positive finding in the past medical history is the chronic use of NSAIDs.