Factores de riesgo para el desarrollo de lesión renal aguda en el posoperatorio inmediato / Risk factors for the development of acute renal lesion in the immediate posoperative period

Introducción: La disfunción renal aguda es frecuente en pacientes quirúrgicos. Objetivo: Identificar los factores de riesgo que influyen en el desarrollo de lesión renal aguda durante el postoperatorio inmediato en cuatro años. Métodos: Se realizó un estudio de tipo casos y controles. (750 controles y 230 casos). Fue empleado el Chi Cuadrado (α< 0,05), el OR con IC 95 por ciento y el cálculo de valores predictivos. Resultados: La frecuencia fue de un 23,4 por ciento. Los factores de riesgo en el posoperatorio fueron: mayores de 60 años (OR 4,0 IC 95 por ciento 2,9-5,6) (p=0,00), cirugía de urgencia (OR 2,7 IC 95 por ciento 2,1-3,6) (p=0,00), ASA clase 4 (OR 2,0 IC 95 por ciento 1,4-2,8,) (p=0,00). En el intra y posoperatorio: cirugía de fractura de cadera (OR 4,9 IC 95 por ciento 3,2-7,5), anestesia general (OR 3,0 IC 95 por ciento 2,2-4,2), administración mayor de 2500 mL de cristaloides (OR 186,1 IC 95 por ciento 107,4-321,9) (p=0,00), más de 60 mg de furosemida (OR 3,3 IC 95 por ciento 2,4-4,6) (p=0,00), APACHE II inicial ≥ 15 puntos (OR 46 IC 95 por ciento 28,1-74,8) (p=0,00). El mayor valor predictivo lo obtuvo el APACHE II inicial (sensibilidad 92,0 por cientoy especificidad 80,0 por ciento). Conclusiones: El control de los factores de riesgo en el posoperatorio inmediato disminuiría de forma significativa la incidencia de lesión renal aguda, en especial en aquellos mayores de 60 años, con cirugía de urgencia, anestesia general, fractura de cadera y APACHE II por encima de 15 puntos. Debe garantizarse la normovolemia, individualizar y optimizar dosis-tiempo de exposición de la furosemida, hemoderivados y aminas vasoactivas(AU)

Introduction: Acute renal dysfunction is frequent in surgical patients. Objective: To identify the risk factors that influence the development of acute kidney injury during the immediate postoperative period in four years. Methods: A case-control study was carried out, with 750 controls and 230 cases. Chi-square (α<0.05), odds ratio [OR] (95 percent confidence interval [95 percent CI]) and calculation of predictive values ​​were used. Results: The frequency was 23.4 percent. The postoperative risk factors were age over 60 years (OR: 4.0; 95 percent CI: 2.9-5.6) (P=0.00), emergency surgery (OR: 2.7; 95 percent CI: 2.1-3.6) (P=0.00), and American Society of Anesthesiologists (ASA) class IV (OR: 2.0; 95 percent CI: 1.4-2.8) (P=0.00). In the intraoperative and postoperative periods, the risk factors were hip fracture surgery (OR: 4.9; 95 percent CI: 3.2-7.5), general anesthesia (OR: 3.0; 95 percent CI 2.2-4.2), administration of more than 2500 mL of crystalloids (OR: 186.1; 95 percent CI: 107.4-321.9) (P=0.00), more than 60 mg of furosemide (OR: 3.3; 95 percent CI: 2.4-4.6) (p=0.00), initial acute physiology and chronic health evaluation (APACHE) II score ≥ 15 points (OR: 46; 95 percent CI: 28.1-74.8) (p=0.00). The highest predictive value was obtained by the initial APACHE II (sensitivity of 92.0 percent and specificity of 80.0 percent). Conclusions: The control of risk factors in the immediate postoperative period would reduce the incidence of acute renal injury significantly, especially in patients aged over 60 years, who underwent emergency surgery, received general anesthesia, with hip fracture and APACHE II above 15 points. Normovolemia must be guaranteed, as well as individualizing and optimizing the relationship dose-time of exposure of furosemide, blood products and vasoactive amines(AU)

Disfunción renal en el paciente cirrótico / Renal dysfunction in the cirrhotic patient

La disfunción renal es una complicación común en pacientes con cirrosis avanzada y está asociadaa un incremento significativo en la mortalidad. Este deterioro de la función renal puede ser reversible en algunos casos, si se identifica y se trata su etiología. La lesión renal aguda (LRA) de origen prerrenal y la necrosis tubular aguda (NTA) son las entidades más frecuentes en pacientes con enfermedad hepática crónica y cirrosis, constituyendo un desafío en los escenarios clínicos actuales. La aparición de nuevos biomarcadores como la lipocalina asociada a la gelatinasa de neutrófilos (NGAL), puede ser un factor determinante para esclarecer el origen de estas dos entidades. En la actualidad, la clasificación de la enfermedad renal establece que un aumento en la creatinina sérica basal >0,3 mg/dL dentro de las primeras 48 horas, o un incremento mayor al 50% desde la línea de base, son suficientes para definir lesión renal aguda, por lo cual, cambios leves en la creatinina sérica en un periodo corto de tiempo, contribuyen a una identificación temprana y previenen desenlaces negativos. Esta revisión de tema abordará la lesión renal aguda en cirrosis desde la fisiopatología, la clasificación actual según guías internacionales, los avances en biomarcadores y las principales etiologías, finalizando con un abordaje general y estrategias de prevención.

Kidney dysfunction is a common complication in patients with advanced cirrhosis and is associated with a significant increase in mortality. This deterioration of kidney function may be reversible in some cases, if its etiology is identified and treated. Acute kidney injury (AKI) of prerenal origin and acute tubular necrosis (ATN) are the most frequent entities in patients with chronic liver disease and cirrhosis, constituting a challenge in current clinical scenarios. The emergence of new biomarkers such as neutrophil gelatinase-associated lipocalin (NGAL), may be a determining factor in clarifying the origin of these two entities. Currently, the classification of renal disease establishes that an increase in basal serum creatinine >0,3 mg/dL within the first 48 hours, or an increase higher than 50% from the baseline, are enough to define acute kidney injury, therefore slight changes in serum creatinine in a short period of time contribute to an early identification and prevent negative outcomes. This literature review will address acute kidney injury in cirrhosis from its pathophysiology, current classification according to international guidelines, advances in biomarkers and the main etiologies associated with it, ending with a general approach and prevention strategies.

Daño renal agudo luego del empleo de la coronariografía percutánea: factores de riesgo relacionados / Acute renal damage after using percutaneous coronariography: related risk factors

Introducción: El daño renal agudo producido por el empleo de medios de contraste es una complicación que a menudo se subestima desde el punto de vista clínico. En general, existen bajos índices de presunción y de diagnóstico y se asocia a intervenciones diagnósticas y terapéuticas, como la coronariografía percutánea. Objetivo: Evaluar los factores de riesgo relacionados con la aparición de nefropatía en pacientes que recibieron coronariografía percutánea.Métodos: Se realizó un estudio descriptivo y analítico de 37 pacientes que requirieron coronariografía percutánea en el Cardiocentro del Hospital Clínico-Quirúrgico Carlos J. Finlay de La Habana, desde octubre de 2009 hasta enero de 2010. Para ello se conformaron tres grupos de riesgo (bajo, mediano o alto) de acuerdo al número de factores presentes, y todos los integrantes fueron tratados con solución salina fisiológica a 1 mL/kg/h. Se determinó la existencia de daño renal agudo si se producía un incremento de la creatinina sérica de 25 por ciento o más a las 72 horas de practicado el procedimiento, en comparación con las cifras obtenidas inicialmente.Resultados: Se indujo la nefropatía solo en 4 pacientes (10,8 por ciento ), 3 de los cuales pertenecían al grupo de alto riesgo. No existió afectación alguna en los integrantes del grupo de bajo riesgo. Conclusiones: Los resultados de este estudio sugirieron la presencia de factores de riesgo que condicionan la aparición de una nefropatía luego del uso de la coronariografía percutánea, sobre todo si convergen dos o más de ellos en un mismo paciente.

Introduction: Acute renal damage provoked due to the use of contrast means is a complication that is often underestimated from the clinical point of view. In general, there are low rates of presumption and diagnosis and it is associated with diagnostic and therapeutic interventions, as the percutaneous coronariography. Objective: To evaluate risk factors related to the emergence of nephropathy in patients that received percutaneous coronariography. Methods: A descriptive and analytic study of 37 patients that required percutaneous coronariography was carried out in the Cardiology Center of Carlos J. Finlay Clinical-Surgical Hospital in Havana, from October, 2009 to January, 2010. Three risk groups (low, medium or high) were conformed for that purpose according to the number of present factors, and all the members were treated with physiologic saline solution to 1 mL/kg/h. The existence of acute renal damage was determined if a 25 percent increment or more of seric creatinin took place at 72 hours of having practiced the procedure, in comparison with the figures obtained initially. Results: Nephropathy was just induced in 4 patients (10.8 percent), 3 of which belonged to the high risk group. There was no affectation in the members of the low risk group. Conclusions: The results of this study suggested the presence of risk factors that condition the emergence of a nephropathy after using percutaneous coronariography, mainly if two or more converge in the same patient.

The mRNA Expression Change of BKCa Channel in Renal Artery in T2DM Nephropathy Rats / 中国药学杂志

OBJECTIVE: To reveal the mRNA expression change of BKCa channel in renal artery in different course in T2DM nephropathy rats. METHODS: T2DM nephropathy models were induced by one side nephrotomy, high-fat diet in rats and small doses of streptozotocin through intraperitoneal injection; Real-time PCR were performed to verify mRNA expression. Then body weight, 24 h urinary albumin, blood urea nitrogen(BUN), serum creatinine(Scr), kidney weight are measured. Renal tissue was observed under optical and electron microscope. RESULTS: Blood glucose, blood insulin, serum creatinine, urea nitrogen, 24 h urinary albumin, kidney hypertrophy index of T2DM nephropathy rats in 8 weeks and 12 weeks, were significantly higher than that of control group (P<0.05, P<0.01);the rat kidney pathological morphological changes were obvious. Compared with the control group, ɑ subunit expression of BKCa in the model group at 8 weeks and 12 weeks were obviously unchanged;β1 subunit expression of BKCa were reduced(P<0.05, P<0.01). CONCLUSION: The mRNA expression of BKCa are reduced in renal artery in different course, and this chang is consistent with the pathological changes degree of kidney in T2DM nephropathy rats.

Mice deficient in IL-12p35 or IL-12p40 develop renal lesions during Chlamydia muridarum urogenital infection / 中华微生物学和免疫学杂志

Abstract] Objective To study the roles of IL-12 and IL-23 in the development of protective im-munity and pathological changes during chlamydial urogenital infection.Methods C57BL/6J wild type (wt) mice and mice deficient in IL-12p35 (IL-12p35 KO) or IL-12p40 (IL-12p40 KO)were inoculated in-travaginally with 1×104 IFU of live Chlamydia muridarum ( C.muridarum) organisms.Half mice of each group were reinfected on day 114 after primary infection.Vaginal swabs were taken every 3 or 4 days to mo-nitor live organism shedding.The mice were sacrificed after 114 or 143 days of primary infection and the va-ginal tract and kidney samples were collected for pathological analysis.The numbers of chlamydial inclusion bodies and bacteria in kidney homogenates were titrated after 100 days of primary infection.Results The infection time courses of mice deficient in either IL-12p35 or IL-12p40 were similar after primary infection, but were prolonged as compared with the wild type mice.All mice regardless of genotypes developed severe pathological damages in upper genital tracts with no significant difference among different groups.Almost all IL-12p40 KO mice and some IL-12p35 KO mice showed pathological changes in kidney samples.No obvious abnormality was observed in any of the kidneys from wild type mice.Neither the age-matched IL-12p35 KO nor IL-12p40 KO mice developed any gross pathological changes in kidney in the absence of chlamydial in-fection.C.muridarum inclusions were detected in kidney samples with gross pathological damages from IL-12p35 KO mice and IL-12p40 KO mice.No inclusions were ever detected in kidneys from the wild type mice.The numbers of chlamydial inclusions in the IL-12p40 KO mice were much higher than those of the IL-12p35 KO mice.Live bacteria were detected in mice deficient in either IL-12p35 or IL-12p40, but not in the wild type mice.No significant difference with the number of live bacteria was found between IL-12p35 KO mice and IL-12p40 KO mice.Conclusion IL-12 and IL-23 could inhibit the spread of C.muridarum in-fection from genital tract to kidney.The deficiency of IL-12 or IL-23 might relate to the renal lesions induced by Chlamydia infection.

Estudo da proteção renal com antioxidantes durante isquemia e reperfusão e hiperglicemia transitória / Study of kidney protection with antioxidant in ratas ischemia and reperfusion model with transient hyperglycemia

Justificativa e Objetivo: A isquemia/reperfusão (I/R) provoca lesão nas células renais, que pode ser potencializada pela ocorrência de hiperglicemia, em ratos anestesiados com isoflurano. Sabe-se que a melatonina apresenta efeito protetor em órgãos, atuando nos produtos do estresse oxidativo. Os objetivos foram avaliar se a melatonina oferece proteção renal na I/R associada à hiperglicemia transitória e se potencializa a ação protetora do isoflurano. Método: Foram estudados 36 ratos Wistar machos distribuídos, aleatoriamente, em seis Grupos: MH – Melatonina e Hiperglicemia; M - Melatonina; H - Hiperglicemia; I - Isoflurano SH – Sham e Hiperglicemia e S - Sham. Todos os ratos foram anestesiados com isoflurano em concentrações entre 1 a 3%. A pressão arterial média (PAM), a temperatura e saturação de oxigênio foram aferidas ao longo do experimento. Hiperglicemia foi induzida com 2,5 g.kg-1 de solução de glicose a 50% e a melatonina utilizada na dose de 20 mg.kg-1, ambas por via intraperitoneal. Todos os animais foram submetidos à nefrectomia direita. Nos grupos SH e S não houve isquemia...

Backgroud and objective: Ischemia/reperfusion (I/R) cause renal cell injury that may be worsened by hyperglycemia in rats anesthetized with isoflurane. N-acetyl-5-methoxytryptamine (melatonin) is known to have a protective effect on multiple organs by acting on the products of oxidative stress. The objectives of this study were to determine whether melatonin provides renal protection during I/R associated with transient hyperglycemia, and whether it enhances isoflurane protective action. Method: Thirty-six Wistar male rats were randomly allocated into six groups: MH – hyperglycemia and melatonin; M - melatonin; H - hyperglycemia; I – isoflurane, SH – sham and hyperglycemia, and S - sham. All rats were anesthetized with isoflurane at concentrations of 1 to 3%. Mean arterial pressure (MAP), temperature and oxygen saturation were measured throughout the experiment. Hyperglycemia was induced by intraperitoneal 2.5 g.kg-1 of glucose solution at 50%, and 20 mg.kg-1 of melatonin. All animals underwent right side nephrectomy...

Influência da monofenilbutazona associada ou não ao omeprazol sobre o sistema digestório e renal de pôneis hígidos / Influence of mofebutazone associated or not to omeprazole on the digestive and renal tracts of healthy ponies

Os objetivos deste trabalho foram averiguar se a monofenilbutazona causa efeitos colaterais no trato digestório e lesões renais em pôneis hígidos e verificar a capacidade do omeprazol em inibir a gênese de úlceras gástricas. O experimento foi executado em duas etapas. Na primeira foram utilizados seis pôneis, sendo três deles tratados diariamente por via intravenosa (IV) com as doses de 3, 4,5 ou 6mg kg-1 de monofenilbutazona durante 12 dias. Os demais, além de antiinflamatório, também receberam 3mg kg-1 de omeprazol. Já na segunda etapa foram incluídos quatro pôneis hígidos, sendo dois tratados com doses diárias de 4,5mg kg-1 de monofenilbutazona durante 12 dias e os demais com 5mL de NaCl a 0,9 por cento, por via IV. Todos os pôneis foram submetidos à gastroscopia antes e após cada etapa experimental. Adicionalmente, na primeira etapa, foram realizadas urinálise e determinação dos valores de variáveis hematológicas (hematócrito e proteína plasmática total) e bioquímicas (creatinina, albumina, Ca+2 e P+3). Na primeira etapa, apenas os dois pôneis tratados com 6mg kg-1 de monofenilbutazona apresentaram úlceras na região aglandular, ao longo da margo plicatus. Na segunda etapa, dois animais também apresentaram úlceras gástricas, sendo que um deles havia recebido apenas NaCl a 0,9 por cento. A ocorrência das úlceras não foi influenciada (P>0,05) pela administração e pela dose da monofenilbutazona, nem pela presença do omeprazol. O efeito da monofenilbutazona sobre as variáveis hematológicas e bioquímicas foi inexpressivo (P+3) ou ausente (hematócrito, proteína plasmática total, creatinina, albumina, Ca+2) (P>0,05). Os resultados obtidos permitem concluir que: a ocorrência de úlceras na região aglandular de pôneis hígidos não sofre a influência da aplicação e da dose de monofenilbutazona, quando administrada durante 12 dias; úlceras em grau 4 na região aglandular de pôneis não necessariamente estão acompanhadas de sintomatologia clínica...

This research aimed to investigate whether mofebutazone causes gastrointestinal and renal side effects in healthy ponies as well as to verify the capacity of omeprazole to inhibit the genesis of gastric ulcers. The experiment was carried out in two phases. In the first, six ponies were used, with three of them being treated daily with different doses (3, 4.5 and 6mg kg-1) of intravenous (IV) mofebutazone for 12 days. The other ponies were given 3mg kg-1 of omeprazole in addition to the anti-inflammatory drug. In the second phase, four ponies were included, with two of them being treated daily with 4.5mg kg-1 of mofebutazone for 12 days and the two remainders with 5mL of IV NaCl at 0.9 percent. All ponies underwent gastroscopy before and after each experimental phase. Additionally, in the first phase, urine, hematological (hematocrit, and total plasma protein) and biochemical (creatinine, albumin, Ca+2 and P+3) analysis were determined. In the first phase, only the two ponies treated with 6mg kg-1 of mofebutazone presented ulcers in the aglandular region along the margo plicatus. In the second phase, two animals also presented gastric ulcers, with one having received only NaCl at 0.9 percent solution. Ulcers occurrence was neither influenced (P>0.05) by the administration and dose of mofebutazone, nor by the presence of omeprazole. Mofebutazone effect on the hematological and biochemical variables was unremarkable (P+3) or absent (hematocrit, total plasma protein, creatinine, albumin, Ca+2) (P>0.05). Based on these results the following conclusions could be drawn: the occurrence of gastric ulcers in the aglandular region of healthy ponies was not influenced by application and dose of mofebutazone when administered for 12 days; grade four ulcers in the aglandular region of ponies may not be accompanied by clinical signs; healthy ponies tolerate application of up to 6mg kg-1 of IV mofebutazone for 12 days without the occurrence of renal...

Renal Lesion Induced by Oral Preparations of Traditional Chinese Medicines:Analysis of 619 Cases / 中国药房

OBJECTIVE:To analyze the renal lesions induced by oral preparations of traditional Chinese medicines so as to provide theoretic basis for clinical rational drug use.METHODS:The CNKI full-text database between January 1991 and December 2008 were retrieved for clinical reports of renal lesions induced by oral preparations of traditional Chinese medicines.And the pertinent literature was sorted,analyzed and compared.RESULTS:176 reports(totaled 619 cases)were collected.Repeated long-term medication and overdosing etc were the major factors accountable for the renal lesion.CONCLUSION:Importance should be attached to the nephrotoxicity of oral preparations of traditional Chinese medicines,and which should be used rationally in the clinic and periodic examination of patients' renal function should be performed in taking oral preparations of traditional Chinese medicines.

CLINICAL SIGNIFICANCE OF DETERMINATION OF TRACE PROTEINURIA IN CHRONIC B HEPATITIS AND LIVER CIRRHOSIS / 解放军医学杂志

Urinary microquantitative albumin (UALb), immunoglobulin G (UIgG) ?2-microglo-bulin (U?2m), and Tamm-Horsfall protein (THP) were measured in 36 chronic B hepatitis (CHB) and 23 liver cirrhosis (LC) patients with radioimmunoassay. 109 healthy normal subjects served as controls. The results showed that the excretion of UALb was significantly increased in 17 patients. Out of 17 patients,the excretion of UIgG in 5 and U?2m in 16 were increased and the excretion of THP in 9 patients were decreased. Compared with normal controls there was a significant difference (P