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Objective To investigate the target achievement of serum trough concentration of vancomycin in elderly patients routinely treated with vancomycin,and to analyze the influencing factors for vancomycin-associated acute kidney injury(VA-AKI).Methods A single-center retrospective study was conducted by collecting clinical data of elderly inpatients from January 2016 to July 2017 who received intravenous vancomycin therapy and serum vancomycin trough concentration test.Logistic regression was used to analyze the risk factors for VA-AKI.Results A total of 141 patients were enrolled,including 74 males (52.5 ％) and 67 females (47.5 ％).The median (interquartile range)age was 77.0(13.5) years old.Patients with serum vancomycin trough concentrations within 10～ 20 mg/L accounted for 48.9 ％ (69 cases),while those lower than the target value accounted for 23.4 ％ (33 cases),and those higher than the target value accounted for 27.7％ (39 cases).Patients were divided into three groups according to the vancomycin serum trough concentration:＜10 mg/L group,10～20 mg/L group,and ＞20 mg/L group.There were statistically significant differences among the three groups in median(interquartile range) age[74.0 (14.0) years old,76.0 (11.5) years old vs.80.0 (14.0) years old,H =9.506,P =0.009] and the median (interquartile range) vancomycin daily dose [1.5(0.5) g/d,1.5 (0.8) g/d vs.1.5 (0.5) g/d,H =6.131,P =0.047].VA-AKI occurred in 23 patients(16.3 ％).Logistic regression analysis showed that the baseline serum creatinine levels (OR =1.022,95 ％CI:1.001 ～ 1.042,P =0.035)and vancomycin trough concentration(OR =1.058,95 ％CI:1.011～1.106,P=0.015)were influencing factors for VA-AKI.Conclusions The elderly patients with infection who received clinical vancomycin therapy have a low target achievement rate of serum trough concentration.Baseline serum creatinine level and serum vancomycin trough concentration are influencing factors for VA-AKI.
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Acute kidney injury (AKI) is defined as a sharp drop in glomerular filtration rate (GFR) and a rapid increase in serum creatinine and is one of the most serious complications of liver failure. Early diagnosis and treatment play a vital role in reducing the mortality and improving the prognosis of liver failure. This article elaborates on the research advances in the diagnostic criteria, pathogenesis, biomarkers, clinical features, and treatment of AKI and points out that constant modification of the definition and staging of AKI and research and development of efficient biomarkers for AKI are future research directions.
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Objective To evaluate the clinical significance of serum Klotho protein levels in the early diagnosis and prognosis of acute kidney injury (AKI) among adult patients in the intensive care units (ICU).Methods The study was prospective and observational.Blood samples and clinical data of AKI patients admitted to the ICU of the First Affiliated Hospital of Xinjiang Medical University between July 1 and August 31,2016 were collected.ELISA was used for the detection of Klotho and NGAL.Receiver operating characteristic curve (ROC) and the area under the curve (AUC) were used to compare the predictive performance among Klotho,NGAL and serum creatinine,evaluating the sensitivity and specificity of Klotho on the diagnosis of AKI.The correlation between Klotho and prognosis of AKI was investigated by comparing serum Klotho levels and early AKI predictors.Results The patients were divided into AKI group of 52 cases and non-AKI group of 98 cases.The baseline serum Klotho level in AKI group was significantly lower than that in non-AKI group (P ＜ 0.001).The AUC of Klotho predicting for AKI was 0.945(95％ CI:0.892-0.997) and the best cut off value was 1.76 μg/L(sensitivity 92％,specificity 94％).The predictive ability of Klotho was significantly higher than serum creatinine (Scr),and the sensitivity is higher than NGAL (sensitivity 87％,specificity 96％).Serum Klotho combined with Scr predicted better AKI (AUC=0.958,95％ CI:0.915-1.000,sensitivity 96％,sensitivity 92％).The level of Klotho in patients with AKI was significantly different between the renal function recovery group and non-recovery group (P=0.047),while there was no significant difference between the two groups in the level of NGAL and Scr (P ＞ 0.05).There was no significant correlation between the Klotho level at diagnosis of AKI and peak Scr,peak eGFR,Scr at discharge and eGFR at discharge (r=0.026,P=0.853;r=-0.127,P=0.368;r=0.243,P=0.082;r=-0.187,P=0.184).Conclusion Serum Klotho may be a potential biomarker for early diagnosis of AKI,but the association between serum klotho and the prognosis of AKI requires further study.
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Objective To evaluate the incidence and mortality of acute kidney injury (AKI) in coronary care unit (CCU),and to identify the risk factors of the incidence of AKI and the mortality of CCU patients.Methods A total of 414 patients in CCU from January 1,2014 to June 1,2015 at Zhongnan Hospital of Wuhan University were enrolled.Based on the KDIGO-AKI criteria,these patients were classified into two groups:NAKI group (patients without AKI) and AKI group.Clinical characteristics and laboratory data of two groups were compared.The risk factors of the incidence of AKI and the mortality of CCU patients was analyzed by logistic regression,and then the receiver operating characteristic (ROC) curve was drawn to evaluate the predictive value of these risk factors.Results (1) Among 414 patients,136(32.9％) patients fulfilled the criteria for AKI,and 14.0％ patients in AKI stage 1,10.9％ in AKI stage 2 and 8.0％ in AKI stage 3.(2) The total CCU mortality was 15.0％.Mortality of AKI patients in the CCU was 33.3％,higher than 6.1％ in patients without AKI (OR=7.735,95％CI 4.215-14.196,P ＜ 0.001).The mortality worsened with increasing severity of AKI (22.4％ for AKI stage 1 group,37.8％ for AKI stage 2 group,45.4％ for AKI stage 3 group).(3) Anemia (OR=8.274,95％ CI 4.363-15.689),history of chronic illness (OR=2.582,95％ CI 1.400-4.760),APACHE]Ⅱ seores (OR=1.813,95％CI 1.739-1.895),male (OR=3.666,95％CI 1.860-7.226) were the independent risk factors for AKI,while the normal mean arterial pressure (MAP) (OR=0.292,95％CI 0.153-0.556) and normal estimated glonerular filtration rate (eGFR) (OR=0.166,95％CI 0.090-0.306) are the protective factors for AKI (all P ＜ 0.05).(4) AKI was the most powerful independent factor associated with the mortality of CCU patients (OR=7.050,95％ CI 2.970-16.735,P ＜ 0.001).Other independent risk factors for CCU mortality included history of chronic illness,ejection fraction and APACHE Ⅱ ≥ 15 scores (all P ＜ 0.05),while the normal MAP and normal eGFR were the protective factors (all P ＜ 0.05).(5) For predicting AKI,eGFR displayed an excellent areas under the ROC curve (AUC=0.815,P ＜ 0.001),and for CCU mortality,APACHE Ⅱ scores had the highest overall correctness of prediction (AUC=0.757 P ＜ 0.001).Conclusions CCU patients have high morbidity of AKI,which is the most powerful independent factor associated with the increased CCU mortality.The eGFR is the best predictor for AKI,and then through the evaluation of eGFR for CCU patients,we can evaluate high-risk groups,make early interventions and then improve the prognosis of CCU patients.
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Objective:To investigate the incidence rate and risk factors of acute kidney injury (AKI) after off-pump coronary artery bypass grafting (CABG),and to compare the effects of AKI on complications after operation and major adverse cardiovascular and cerebrovascular events (MACCE) after 3 years' follow-up.Methods:In the study,299 consecutive patients who underwent scheduled off-pump CABG from January 2010 to March 2012 were included.The patients were divided into AKI group with AKI and control group without AKI after operation.The data during perioperative stage were compared,and multivariable Logistic regression modeling was used to identify the risk factors of AKI.The complications were compared after surgery and the patients were followed up for 3 years to observe the difference of MACCE between the two groups.Results:AKI occurred in 37.1％ patients (111/299).The elevated serum creatinine levels (Wald =9.276,P =0.002,95 ％ CI 1.006-1.028),chronic obstructive pulmonary disease(COPD) (Wald =3.469,P =0.063,95％ CI 0.950-7.630),decreased left ventricular ejection fraction (LVEF) (Wald =4.414,P =0.036,95 ％ CI 0.965-0.999),and implantation of intraaortic balloon pump (IABP) before or after operation(Wald =6.745,P =0.009,95％ CI 1.336-7.925)were risk factors of AKI in multivariable logistic regression modeling.More complications occurred in AKI group,such as the duration of mechanic ventilation,the time of ICU and the length of stay post operation,reintubation,pulmonary infection,stroke,hemorrhage of digestive tract,the volume of blood transfusion (plasma and red blood cell) and renal replacement therapy(P ＜ 0.05).The difference of mortality rate had no statistical significance between the AKI group and the control group,but two patients died in the AKI group.The difference of MACCE between the two groups had no statistical significance after 3 years' follow-up either.Conclusion:The incidence of AKI was high (37.1％) after off-pump CABG.The elevated serum creatinine levels,COPD,decreased LVEF,and implantation IABP before or after operation were independent risk factors of AKI in multivariable Logistic regression modeling.More complications occurred in AKI group during perioperative period,but the difference of MACCE between the two groups after 3 years' follow-up had no statistical significance.
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Objective To investigate the value of serum neutrophil gelatinase-associated lipocalin (sNGAL),urinary neutrophil gelatinase -associated lipocalin (uNGAL),and serun cystatin C (CysC) in the early diagnosis of acute kidney injury (AKI) in patients with liver cirrhosis.Methods A total of 236 patients with liver cirrhosis and normal renal function who visited The Red Cross hospital of Hannan District from January 2015 to March 2017 were enrolled,and according to the presence or absence of AKI within 48 hours after admission,these patients were divided into AKI group with 78 patients and non-AKI group with 158 patients.Another 100 healthy subjects who underwent physical examination were enrolled as control group.ELISA was used to measure sNGAL,uNGAL,and serum CysC,and serum creatinine (SCr) and glomerular filtration rate (GFR) were compared between groups.A one-way analysis of variance was used for comparison of continuous data between multiple groups,and the SNK-q test was used tor further comparison between two groups.A Pearson correlation analysis was also performed,and the receiver operating characteristic (ROC) curve was used to evaluate the diagnostic value of these indices.Results At 48 hours after admission,there were significant differences in sNGAL,uNGAL,and CysC between the AKI group and the non -AKI group/control group (all P ＜ 0.05).The patients in the AKI group were stratified by AKI stage based on the criteria for kidney injury,and the patients with a higher stage had significantly higher levels of sNGAL and uNGAL than those with a lower stage (both P ＜ 0.05).The levels of sNGAL,uNGAL,and CysC started to increase at 6 hours after admission,while Scr and GFR started to change at 48 hours after admission,i.e.,sNGAL and uNGAL increased significantly earlier than Scr and GFR (P ＜ 0.05).In the AKI group,sNGAL,uNGAL,and CysC were positively correlated with SCr (r =0.650,0.681,and 0.581,all P ＜ 0.05).According to the ROC curve analysis,sNGAL had an area under the ROC curve (AUC) of 0.845 ± 0.435,an optimal cut-off value of 542.68 μg/L,a sensitivity of 0.824,and a specificity of 0.794,uNGAL had an AUC of 0.836-±0.326,an optimal cut-off value of 75.12 μg/L,a sensitivity of 0.816,and a specificity of 0.766,and CysC had an AUC of 0.818 ±0.267,an optimal cut-off value of 1.48 mg/L,a sensitivity of 0.808,and a specificity of 0.732.Conclusion NGAL and CysC can be used as indices for the early diagnosis of AKI and have great significance in evaluating renal injury and developing treatment measures for patients with liver cirrhosis.
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Acute-on-chronic liver failure (ACLF) is the most common type of liver failure in China, and it has complicated clinical manifestations and high mortality. When the patients experience ACLF complicated by acute kidney injury (AKI), they tend to have a prolonged length of hospital stay and a high risk of multiple organ failure, which always suggests poor prognosis. This article briefly describes the advances in the definition, causative factors, prognostic evaluation, diagnostic markers, and treatment of ACLF complicated by AKI. It is pointed out that early identification, diagnosis, and intervention of AKI helps to reverse kidney injury and avoid the development of severe AKI.
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Objective To evaluate the role of acute kidney injury (AKI) in predicting the early (30-day) and late (30-day to 5-year) mortality of acute myocardial infarction (AMI) patients during hospitalization.Methods A total of 1371 adult patients diagnosed with AMI in the First People's Hospital of Changzhou from January 2008 to December 2012 were analyzed retrospectively with collecting their relevant clinical data from the hospital's database.AKI was categorized according to the 2012 KDIGO AKI criteria.To compare between death group and non-death group in AMI patients during 30-day and 30-day to 5-year.Different AKI stages of patients were compared,and their all-cause mortality were analyzed by Kaplan-Meier.Using multivariate COX regression analysis with two models to assess the factors for AMI patients in 30-day to 5-year.Results The prevalence of AKI after AMI in death group was higher than that in non-death group (the 30-day prevalence was 72.7％ vs 27.4％,P ＜ 0.001;the 5-year prevalence was 36.3％ vs 26.2％,P=0.013).In both early (30-day) and late (30-day to 5-year) follow up,the KDIGO grading distribution of AKI was different between death group and non-death group (P ＜ 0.001 in 30-day follow up and P=0.002 in 30-day to 5-year follow up).Among the 1371 AMI patients,410 (29.9％) developed AKI during the hospital stay.The 30-day and 30-day to 5-year mortality rates were 5.6％ (77/1371) and 11.3％ (146/1294) respectively.All-cause mortality and cardiovascular mortality were significantly higher in patients with AKI-Ⅰ stage,AKI-Ⅱ stage and AKI-Ⅲ stage than those with non-AKI (all P ＜ 0.001),especially in patients with AKI-Ⅲ stage.Further stroke history (HR=3.122,P=0.012),AKI severity (AKI-Ⅰ stage HR=3.034,P=0.028;AKI-Ⅱ stage HR=7.832,P＜0.001;AKI-Ⅲ stage HR=9.919,P＜0.001),and β-blocker therapy (HR=0.591,P=0.040) were independent predictors of 30-day mortality,while aging (HR=1.061,P ＜ 0.001),albumin (HR=0.943,P=0.023),AKI-Ⅲ stage (HR=3.944,P=0.007),β-blocker therapy (HR=0.660,P=0.041) and percutaneous coronary intervention (HR=0.256,P ＜ 0.001) were independent predictors of 30-day to 5-year mortality.Both at early (30-day) and late (30-day to 5-year) follow-up,AKI with or without baseline renal dysfunction were independent predictors of death in patients with AMI (all P ＜ 0.05).Conclusions AKI strongly correlated with short-and long-term allcause mortality of AMI patients,regardless of the baseline renal impairment.Specifically,the more severe AKI,the higher short-term mortality AMI patients have.
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Objective To evaluate the effect of dexmedetomidine on acute kidney injury after cardiac valve replacement with cardiopulmonary bypass (CPB).Methods One hundred patients of both sexes with rheumatic heart disease,aged 32-64 yr,weighing 46-75 kg,of American Society of Anesthesiologists physical status Ⅱ or Ⅲ (New York Heart Association class Ⅱ or Ⅲ),scheduled for elective cardiac valve replacement with CPB,were divided into 2 groups (n =50 each) using a random number table:control group (group C) and dexmedetomidine group (group D).Dexmedetomidine was intravenously infused in a loading dose of 1 μg/kg over 10 min before induction of anesthesia followed by an infusion of 0.4 μg · kg-1 · h-1 until 24 h after operation in group D,while the equal volume of normal saline was given in group C.The urine output per hour during the postoperative 48 h period was recorded.At 6,12,24,36 and 48 h after operation,blood samples were collected from the median cubital vein for determination of serum creatinine levels.The development and severity of acute kidney injury were determined according to the urine output and serum creatinine level.Results Compared with group C,the incidence and severity of acute kidney injury were significantly decreased in the postoperative 48 h period in group D (P＜0.05).Conclusion Dexmedetomidine infused in a loading dose of 1 μg/kg over 10 min before induction of anesthesia followed by an infusion of 0.4 μg · kg-1 · h-1 until 24 h after operation can reduce the development and severity of acute kidney injury after cardiac valve replacement with CPB in patients.
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Objective To evaluate the effect of 6% hydroxyethyl starch 130∕0. 4 on acute kidney injury in elderly patients in a prospective, multicenter, randomized, double?blind, controlled clinical tri?al. Methods A total of 120 patients of both sexes, aged 65-82 yr, weighing 56-83 kg, of American So?ciety of Anesthesiologists physical status Ⅰ or Ⅱ, scheduled for elective orthopaedics and hernia surgery, were divided into either hydroxyethyl starch group ( group HES) or lactated Ringer′s solution group ( group LR) , with 60 patients in each group. Hydroxyethyl starch and lactated Ringer′s solution were infused intra?venously at a rate of 7. 5 ml∕kg during 1st hour of surgery in HES and LR groups, respectively. Lactated Ringer′s solution was then infused at a rate of 5 ml∕kg starting from 2nd hour of surgery until the end of sur?gery in both groups. Before surgery, at the end of surgery and at 1, 3 and 5 days after surgery, blood sam?ples and urine specimens were collected for determination of the concentrations of neutrophil gelatinase?asso?ciated lipocalin, interleukin?18 (IL?18), plasma creatinine, urine β2 microglobulin and urine albumin. The estimated glomerular filtration rate was calculated. Results The level of urine IL?18 was significantly higher at each time point after surgery than before surgery and immediately after the end of surgery ( P0.05) . Conclusion Compared with lactated Ringer′s solution, 6% hydroxyethyl starch 130∕0.4 does not aggravate acute kidney injury in elderly patients.
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Objective To compare the clinical characteristics of community-acquired acute kidney injury (CA-AKI) and hospital-acquired acute kidney injury (HA-AKI) patients.Methods Hospital network system was employed to screen the clinical data of adult patients in the First Affiliated Hospital in Xinjiang Medical University in January to July 2013.A total of 19 528 patients were screened,and 544 AKI patients were identified based on KIDGO (Kidney Disease:Improving Global Outcomes) AKI guidelines.Three hundred and thirty patients were included in HA-AKI group and 214 patients in CA-AKI group.Clinical variables including mortality were analyzed retrospectively.Results The incidence of AKI in hospitalized patients was 2.8％ (544/19 528):1.7％ in CA-AKI group and 1.1％ in HA-AKI group.The mean age in CA-AKI group was significantly older than that in HA-AKI group [(62.9 ± 16.8) years vs (56.6± 15.9) years].Medical patients in CA-AKI group accounted for 62.4％,and surgical patients in HA-AKI group accounted for 64.1％.The co-morbid diseases were cardiac disease,hypertension,diabetes and chronic liver disease.Majority of AKI was caused by pre-renal etiologies.The length of hospitalization was significantly shorter in CA-AKI group compared to that in HA-AKI group [12(8,20) days vs 19 (12,27) days,P ＜ 0.01].Compared to that in HA-AKI group,all-cause mortality was significantly lower in CA-AKI group (11.5％ vs 20.1％,P=0.005).Results by multivariate logistic regression analysis demonstrated that the common independent risk factors of AKI in both groups were ICU hospitalization and shock.The independent risk factor of AKI in CA-AKI group was diabetes (OR=3.019).In contrary,the independent risk factors of AKI in HA-AKI group were elderly (≥65 years) (OR=3.303),oliguria (24 h urine volume ＜ 400 ml) (OR=6.906),use of antiinflammatory drugs (OR=13.079) and multiple organ dysfunction syndrome (OR=17.778).Conclusions The incidence of AKI in hospitalized patients is not rare,among which both communityacquired and hospital-acquired AKI are mainly caused by pre-renal etiologies.All-cause mortality is lower in community-acquired AKI compared to that in hospital-acquired AKI and the independent risk factors are different between CA-AKI and HA-AKI.
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Objective To discuss the influence of Danshen Chuanxiongqin injection on renal function and relevant indexes of urine in rats with sepsis -induced acute kidney injury(AKI))caused by cecal ligation and punc-ture (CLP).Methods Seventy male Sprague Dawley(SD)rats were randomly divided by random number table into normal group,sham -operation group,sepsis group and Danshen Chuanxiongqin group.The three latter groups were divided into groups of 6,12,24,48 -hour subgroups,five rats in each subgroup.Danshen Chuanxiongqin group was injected with Danshen Chuanxiongqin injection at 0,24,48h from caudal vein seperately,and the other groups were injected with saline solution.The blood and urine were collected in the set four time points.The relevant indexes like serum creatinine (SCr),blood urea nitrogen(BUN),IL -6 and TNF -αwere tested and kidney injury molecule -1 (KIM-1)and neutrophil gelatinase associated lipocalin (NGAL)were detected.Changes of renal pathology were observed under light microscope.Results In the sepsis group,the concentrations of SCr and BUN 6h after CLP star-ted to rise,reached peak in 24h to (96.31 ±12.64)μmol/L and (27.17 ±4.98)mmol/L,and decreased in 48 h, while concentrations of IL -6 and TNF -αwere reached peak in 12h (28.45 ±3.22)pg/mL and 6h (72.35 ± 10.84)pg/mL respectively,and then decreased,which were all higher than those in the normal group and sham -operation group (P <0.05).After Danshen Chuanxiongqin injection therapy,the concentrations of Scr,BUN,IL -6 and TNF -αin 6h,12h,24h and 48 h were all lower than those in the corresponding points in time in the sepsis mod-el group,and reached minimum values[(14.89 ±2.41)μmol/L,(17.29 ±3.37)mmol/L,(14.89 ±2.41)pg/mL, (17.29 ±3.37)pg/mL,all P <0.05].The contents of KIM-1 and NGAL 6 h after CLP started to increase,reached peak in 24h (5.47 ±0.39)ng/mL and 12h (6.35 ±0.81)ng/mL respectively,and decreased in the sepsis group were all remarkably higher than those in the normal group and sham -operation group.After given Danshen Chuanx-iongqin injection,the contents of KIM-1 and NGAL in 6h,12h,24h and 48h were greatly lower than those in the corresponding points in time in the sepsis group,reached minimum values[(2.27 ±0.16)ng/mL,(2.03 ±0.27)ng/mL,all P <0.05)].In the Danshen Chuanxiongqin group,the change of renal pathology was better than that of the sepsis group in 12h.Conclusion Danshen Chuanxiongqin injection plays the role of renal protection in AKI caused by sepsis.
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Objective To investigate the effect of pretreatment with U75302,antagonist of leukotriene B4 receptor 1 (BLT1),on cisplatin induced acute kidney injury in mice and its immunoregulatory mechanism.Methods Healthy C57BL/6 mice were randomized into four subgroups:1.healthy control group;2.cisplatin group;3.U75302 control group;4.cisplatin + U75302 group,n=6.Group 2 and 4 received intraperitoneal injection of cisplatin (20 mg/kg) on day 0,group 3 and 4received intraperitoneal injection of U75302 (5 μg/mouse) on day 0 and day 2.Mice were sacrificed on the 3rd day and blood and kidney were collected.Renal function and histological changes were estimated,the infiltration of immune cells were determined by flow cytometry,the level of peroxidase (MPO) in kidney were determined by colorimetry,relative expression of TNF-α,IL-1β,CXCL1,CXCL2 were detected by Real-time PCR.Results Compared with healthy control group,levels of BUN,Scr were higher in cisplatin group with serious tubular structural damage.There were more neutrophils,macrophages,CD4+ T lymphocytes,CD8+ T lymphocytes in kidneys of cisplatin group,the level of MPO and relative expression of TNF-α,IL-1β,CXCL1,CXCL2 were also higher in cisplatin group.Compared with cisplatin group,lower BUN [(17.75±1.80) mmol/L vs (42.6±6.66) mmol/L,P ＜0.05],Scr were found in cisplatin+ U75302 group with less tubular structural damage.Meanwhile,U75302 reduced infiltration of neutrophils [(146±13)×103/g vs (296±66) ×103/g,P ＜ 0.05],macrophages [(245± 13)× 103/g vs (420±78)× 103/g,P ＜ 0.05] in the kidney.Levels of MPO [(1.756±0.283) U/g vs (3.308±0.577) U/g,P＜0.05] and relative expression of TNF-α,IL-1β,CXCL1,CXCL2 were also lower.Conclusions BLT1 antagonist U75302 protects mice against AKI induced by cisplatin,and the mechanism is associated with reduced infiltration of inflammatory cells in kidney and the inhibition of kidney inflammation.
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Objective To investigate the effects of the fibrin-derived peptide Bβ15-42 (FgBβ 15-42) on renal inflammation in acute kidney injury (AKI) induced by renal ischemia reperfusion (IR).Methods SD rats were randomly divided into sham group (the abdominal cavity were closed after separating the renal artery),IRI group (renal arteries of rats were occluded with microvascular clamps for 60 min),negative treated group (rats were injected with 3.6 mg/kg random peptide by tail vein) and FgBβ15-42 treated group (rats were injected with 3.6 mg/kg FgBβ15-42 by tail vein).Rats were sacrificed at 24 h or 48 h after reperfusion.Blood and kidney samples were collected and histological changes and renal function were examed.The mRNA and protein expressions of intercellular cell adhesion molecule-1 (ICAM-1) and interleukin-1β (IL-1β) were examined by immunohistochemistry,real-time PCR and Western blotting.Results Compared with sham group,Scr and BUN were obviously increased in IRI group (all P ＜ 0.05),pathologic changes of kidney were more serious (P ＜ 0.05).Compared with IRI group,in FgBβ15-42 treated group Scr and BUN were obviously decreased (all P ＜ 0.05),the injury of kidney tubulointerstitial was less serious (P ＜ 0.05).Compared with sham group,there was increased ICAM-1 and IL-1β in IRI group (all P ＜ 0.05),and they all peaked at 24 h.After treated with FgBβ15-42,the expression of ICAM-1,IL-1β were significantly decreased in kidneys compared to IRI group (all P ＜ 0.05).The above indexes had no significant differences between negative treated group and IRI group (all P ＞ 0.05).Conclusions FgBβ15-42 can protect kidneys against ischemia reperfusion injury in rats.The mechanism may be associated with down-regulated expressions of ICAM-1 and IL-1 β in the kidney.
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Objective To raise the awareness of acute kidney injury (AKI) and improve the level of diagnosis.Methods All the hospitalized adult patients in the Affiliated People's Hospital of Shanxi Medical University from January 2012 to July 2013 were screened.Those patients diagnosed as AKI were retrospectively analyzed in terms of incidence,the rate of missed diagnosis,etiology,distribution and prognosis of AKI.Results (1) The incidence of AKI in the patients was 0.67％ (381/56 835),the ratio of male to female was 1.91 ∶ 1,and the average age was (63.45±16.95) years.(2)There were 321 cases diagnosed as pre-renal AKI (84.25％),42 cases diagnosed as renal AKI (11.02％) and 18 cases diagnosed as post-renal AKI (4.72％).(3)There were 189 cases(49.61％) missed diagnosed among all the screened cases.The rates of missed diagnosis in neurosurgery,general surgery and cardiac surgery department was 62.96％,59.09％ and 50.00％,in cardiology,respiratory and neurology department was 50.00％,50.00％ and 45.45％ respectively.(4) Multivariate Logistic regression analysis showed that hypertension [odds ratio(OR)=1.631],renal replacement therapy(RRT)(OR=23.256) and oliguria history (OR=1.936) were independent risk factors of missed AKI diagnosis.Conclusion The missed diagnosis rate of AKI is high and has certain characteristics in different departments.Hypertension,RRT and oliguria history are independent impact factors of missed AKI diagnosis.
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Objective Acute kidney injury(AKI) is a common and serious complication with high morbidity and mortality in patients undergoing surgery for Stanford type A aortic dissection.The purpose of this study is to investigate the mortality and risk factors for the prognosis of AKI requiring renal replacement therapy(RRT) in patients undergoing surgery for Stanford type A aortic dissection.Methods We retrospectively investigated 68 patients of AKI requiring RRT undergoing surgery for Stanford type A aortic dissection in Zhongshan Hospital from October 2005 to May 2013.The mean age was (55.31 ± 11.08) years.The patients were divided into two groups,survivors(n =40) and non-survivors(n =28).We observed the clinical data of the patients in both groups.Univariate and multivariate analyses were performed to investigate the risk factors for prognosis of AKI requiring RRT.Results Of the 68 patients,28 patients died.The in-hospital mortality was 41.18％.Univariate analysis showed the following as significant risk factors:APACHE Ⅱ score,hypotension,gastrointestinal bleeding,hepatic dysfunction,neurological deficits(P ＜ 0.05).Multivariable Cox regression analysis identified New York Heart Association (NYHA) functional class Ⅳ (HR 5.486,95 ％ CI 1.805-16.676),APACHE Ⅱ score (HR 1.123,95％ CI 1.055-1.196),hypotension (HR 3.328,95％ CI 1.180-9.382),hepatic dysfunction(HR 2.242,95％ CI 1.015-4.952) were independent predictors of in-hospital mortality (P ＜ 0.05).Conclusion AKI requiring RRT after Stanford type A aortic dissection surgery is associated with high mortality.Risk factors of death should be taken into consideration for perioperative care and may improve clinical outcome.
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Objective To investigate the incidence and risk factors of acute kidney injury (AKI) in patients with multiple soft tissue contusion.Methods A total of 513 patients diagnosed as multiple soft tissue contusion in the First Affiliated Hospital of Xinjiang Medical University from January 1,2008 to January 1,2013 were retrospectively analyzed.Demographics,clinical data and laboratory examinations before and after AKI were collected and analyzed.Results The age of all subjects was 31.30 (12-78) years old with the male to female ratio of 2.1∶ 1.AKI occurred in 74 cases with an incidence rate of 14.4％.No AKI was observed in patients with assault injuries,while AKI was found in 27 cases (36.5％) with car accident injuries and 4 cases (5.4％) with other injuries.AKI showed in 1 case(1.4％) with damaged area under 1％,in 4 cases(5.4％) with damaged area ranged from 1％ to ＜ 3％,10 cases (13.5％) with damaged area ranged from 3％ to 5％ and 19 cases (25.7％) with damaged area over 5％ with significant difference among the groups (P ＜ 0.01).Incidence rate of AKI was significantly higher in patients with chronic kidney disease (CKD) than those without CKD (54.5％ vs 20.3％,P ＜ 0.01).Two of the AKI cases died,with a mortality rate of 2.7％.Multivariate logistic regression analysis showed that the followings were the independent risk factors for the occurrence of AKI in patients with multiple soft tissue injuries:age (OR =1.996),basic serum creatinine (OR =0.976),basic evaluated GFR (eGFR) (OR =0.964),serum potassium (OR =2.117),myoglobin (OR =0.950) and damaged area (OR =1.811).Conclusions Incidence rate of AKI is quite high in multiple soft tissue contusion.Age,basic serum creatinine,basic eGFR,serum potassium,myoglobin and damaged area are the independent risk factors for the occurrence of AKI in patients with multiple soft tissue injury.
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Objective To evaluate the values of urinary liver-fatty acid binding protein (uL-FABP) and urinary neutrophil gelatinase-associated lipocalin (uNGAL) in diagnosis of acute kidney injury (AKI) caused by obstructive nephropathy and in the prediction of renal prognosis.Methods Clinical data of 30 patients with obstructive nephropathy were collected prospectively.uL-FABP and uNGAL were measured by ELISA at various time points.Risk factors of the renal outcome were evaluated.The patients were followed up for at least one year.Results Patients with AK1 had higher levels of uL-FABP and uNGAL compared to those without AKI [700.00(154.62-1216.14) μg/g· Cr vs 26.90 (16.77-41.38) μg/g·Cr; 1266.69 (671.57-3396.07) μg/g·Cr vs 179.12 (90.98-215.16) μg/g·Cr,all P ＜ 0.01].Positive correlations of uL-FABP and uNGAL with serum creatinine were found (r =0.552,0.553,all P ＜ 0.01).The AUCs of uL-FABP and uNGAL to detect AKI were 0.925 and 0.900.Patients with non complete renal recovery had higher levels of uL-FABP before operation and 72-hour after operation compared to those with complete renal recovery (all P ＜ 0.01).Before operation,the AUC of uL-FABP to detect renal prognosis was 0.948,sensitivity was 85.7％ and specificity was 90.9％.72-hour after operation,the AUC of uL-FABP to detect renal prognosis was 0.935,sensitivity was 85.7％ and specificity was 90.9％.Kaplan-Meier analysis revealed that uL-FABP before operation over 366.57 μg/g · Cr or uL-FABP 72-hour after operation over 223.60 μg/g · Cr were closely related to the poor progression of renal function.Conclusions uL-FABP and uL-NGAL have good accuracy in detecting AKI.The level of uL-FABP before operation and 72-hour after operation is helpful to predict the renal outcome of obstructive nephropathy.
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Objective To investigate the incidence and the prognosis of acute kidney injury (AKI) and to find out the risk factors associated with the outcome for better understanding and preventing AKI among inpatients. Methods All the hospitalized patients were screened by Lab Administration Network of Renji Hospital,Shanghai Jiaotong University School of Medicine from Jan.to Dec.2009.Study cohort was comprised of all the patients with AKI defined by Acute Kidney Injury Network (AKIN) and with complete clinical data recorded.The incidence,etiology and distribution characteristics, prognosis of AKI in hospitalized patients were retrospectively analyzed.Logistic regression analysis was used to investigate the risk factors of patients and renal outcome. Results A total of 934 patients with AKI were enrolled.The incidence of AKI in hospitalized patients was 2.41％ (934/38 734).The ratio of male to female was 1.88∶1.Age was (60.82±16.94) years old.Increasing incidence could be seen with age rising.There was 63.4％ AKI found in surgical department,35.4％ in internal medicine department and 1.2％ in obstetric and gynecologic department.Pre-AKI,acute tubular necrosis (ATN),acute glomerular and renal vascular injury (AGV),acute interstitial nephritis (AIN) and post-AKI were accounted for 51.7％,37.7％,3.8％,3.5％ and 3.3％ of the causes of AKI,respectively.On day 28,the survival rate was 71.8％,complete renal recovery rate was 65.7％,partial renal recovery rate was 16.9％ and renal loss rate was 17.4％ among all the patients with AKI.The mortality of AKI with stage Ⅰ,Ⅱ and Ⅲ among inpatients was 24.8％,31.2％ and 43.7％ respectively.Multivariate Logistic regression analysis showed that renal injury drugs [odds ratio (OR)=2.313],hypotension (OR=4.482),oliguria (OR =5.267),the number of failure organs except kidney (OR =1.376) and requiring renal replacement therapy (RRT)(OR=4.221) were independent risk factors for death among AKI patients.The number of failure organs except kidney (OR=1.529) and RRT (OR=2.117) were independent risk factors for kidney loss. Conclusions AKI is one of the most common complications in hospitalized patients.The mortality is high and renal outcome is poor after AKI.The prognosis is closely associated with the severity of AKI.Renal injury drugs,hypotension,oliguria,the number of failure organs except kidney and requiring RRT are independent risk factors for death among AKI patients,while the number of failure organs except kidney and requiring RRT are independent risk.factors for renal loss.