90 day and 1-year mortality and renal outcomes of patients who started hemodialysis treatment for the first time / Mortalidad a los 90 días y al año y resultados renales de pacientes que iniciaron tratamiento con hemodiálisis por primera vez

ABSTRACT Aim: This study aims to investigate the 90-day and 1-year mortality and the affecting factors of mortality in patients who have started dialysis treatment for the first time. Methods: Patients who started intermittent hemodialysis for the first time in the hemodialysis unit were evaluated. Patients who received hemodialysis treatment for any reason before, patients who underwent hemodialysis due to methyl alcohol, lithium, or mushroom poisoning, and patients who started dialysis in the intensive care unit were excluded from the study. The clinical and laboratory data were obtained from the patients, at admission time, from the electronic data record system and patients' charts.Univariate and multivariate logistic regression analyses were used to identify predictive factors for 90-days and 1-year mortality-dependent variables. Results: 229 patients were included in this study. 133(58.8%) of the patients were male, 96(41.9%) were female, and the median age was 64 years. While 166 patients had pre-existing renal disease, 63 patients had no prior renal disease. The number of patients who died within 90 days, which refers to short-term mortality, was 49 (21.4%). 73 patients (31.9%) died in one year (long-term mortality). At the end of one year, 38% of the whole group of patients continued receiving renal replacement therapy, while 10% of all CKD patients had not a requirement of dialysis, and only 9.17% of the patients had renal recovery. In the multivariate analysis established for short-term mortality, the following parameters showed significant predictive features: ejection fraction (OR = 3.80, 95% CI: 1.05-13.72, p=0.042), CRP (OR = 0.20, 95% CI: 0.04-0.92, p= 0.039), age (OR = 0.21, 95% CI: 0.05-0.91, p= 0.038), and diastolic blood pressure (OR = 0.08, 95% CI: 0.02-0.28, p< 0.001). The multivariate analysis for long-term mortality indicated that systolic blood pressure (OR = 0.26, 95% CI: 0.08-0.82, p= 0.022), diastolic blood pressure (OR = 0.21, 95% CI: 0.68-0.66, p= 0.008), and potassium (OR = 0.27, 95% CI: 0.10-0.70, p= 0.007) were independent predictive markers. Conclusion: Patients with CKD who have not yet started hemodialysis treatment should be followed closely, as hypervolemia, hypotension, and hemodynamic instability increase the risk of death, according to our study. In addition, we recommend that clinical conditions such as hemodynamic instability or sepsis, which may cause hypotension in AKI-D, should be addressed as soon as possible, and optimizing the fluid-electrolyte balance carefully in those patients we determined to be at risk.

RESUMEN Objetivo: Este estudio tiene como objetivo investigar la mortalidad a 90 días y 1 año y los factores que afectan la mortalidad en pacientes que han iniciado tratamiento de diálisis por primera vez. Métodos: Se evaluaron pacientes que iniciaron hemodiálisis intermitente por primera vez en la unidad de hemodiálisis. Se excluyeron del estudio los pacientes que recibieron tratamiento de hemodiálisis por cualquier motivo anteriormente, los pacientes que se sometieron a hemodiálisis por intoxicación con alcohol metílico, litio o hongos y los pacientes que iniciaron diálisis en la unidad de cuidados intensivos. Los datos clínicos y de laboratorio se obtuvieron de los pacientes al momento del ingreso, del sistema de registro electrónico de datos y de las historias clínicas de los pacientes. Se utilizaron análisis de regresión logística univariados y multivariados para identificar factores predictivos para variables dependientes de mortalidad a 90 días y 1 año. Resultados: 229 pacientes fueron incluidos en este estudio. 133 (58,8%) de los pacientes eran hombres, 96 (41,9%) eran mujeres y la mediana de edad fue de 64 años. Mientras que 166 pacientes tenían enfermedad renal preexistente, 63 pacientes no tenían enfermedad renal previa. El número de pacientes que fallecieron dentro de los 90 días, que se refiere a la mortalidad a corto plazo, fue de 49 (21,4%). 73 pacientes (31,9%) fallecieron en un año (mortalidad a largo plazo). Al cabo de un año, el 38% de todo el grupo de pacientes continuaba recibiendo terapia de reemplazo renal, mientras que el 10% de todos los pacientes con ERC no requerían diálisis y solo el 9,17% de los pacientes presentaban recuperación renal. En el análisis multivariante establecido para la mortalidad a corto plazo, los siguientes parámetros mostraron características predictivas significativas: fracción de eyección (OR = 3,80, IC 95%: 1,05-13,72, p=0,042), PCR (OR = 0,20, IC 95%: 0,04 -0,92, p= 0,039), edad (OR = 0,21, IC 95%: 0,05-0,91, p= 0,038) y presión arterial diastólica (OR = 0,08, IC 95%: 0,02-0,28, p< 0,001). El análisis multivariado para la mortalidad a largo plazo indicó que la presión arterial sistólica (OR = 0,26, IC 95%: 0,08-0,82, p= 0,022), la presión arterial diastólica (OR = 0,21, IC 95%: 0,68-0,66, p= 0,008), y el potasio (OR = 0,27, IC 95%: 0,10-0,70, p= 0,007) fueron marcadores predictivos independientes. Conclusión: Los pacientes con ERC que aún no han iniciado tratamiento con hemodiálisis deben ser seguidos de cerca, ya que la hipervolemia, la hipotensión y la inestabilidad hemodinámica aumentan el riesgo de muerte, según nuestro estudio. Además, recomendamos que las condiciones clínicas como la inestabilidad hemodinámica o la sepsis, que pueden causar hipotensión en AKI-D, deben abordarse lo antes posible y optimizar cuidadosamente el balance de líquidos y electrolitos en aquellos pacientes que determinamos que están en riesgo.

Management of Acute Kidney Injury in Critically Ill Children

Acute kidney injury (AKI) is common in critically ill patients, afecting almost one in four critically ill children and one in three neonates. Higher stages of AKI portend worse outcomes. Identifying AKI timely and instituting appropriate measures to prevent and manage severe AKI is important, since it is independently associated with mortality. Methods to predict severe AKI should be applied to all critically ill patients. Assessment of volume status to prevent the development of fuid overload is useful to prevent adverse outcomes. Patients with metabolic or clinical complications of AKI need prompt kidney replacement therapy (KRT). Various modes of KRT are available, and the choice of modality depends most on the technical competence of the center, patient size, and hemodynamic stability. Given the signifcant risk of chronic kidney disease, patients with AKI require long-term follow-up. It is important to focus on improving awareness about AKI, incorporate AKI prevention as a quality initiative, and improve detection, prevention, and management of AKI with the aim of reducing acute and long-term morbidity and mortality

Acute Kidney Injury among Post Cardiac Surgery Patients : A Retrospective Study

Background : Acute Kidney Injury (AKI) is a common complication Post Cardiac Surgery with reported incidence of 20-70%. Various studies have been conducted worldwide on risk factors contributing to the etiology of AKI in Cardiac surgery patients. We undertook similar study to understand the etiology and risk factors associated with AKI at Goa Medical College hence we undertook this study. Methodology : A retrospective record based observational study was conducted at Goa Medical College; wherein records of 419 patients who underwent Cardiac Surgery during the study period were analyzed for pre-operative, intra-operative and postoperative variables. Kidney Disease Improving Global Outcomes criteria were used to study the incidence of AKI. The Data was entered in Microsoft Excel and analysed using SPSS version 22.0. Chi-square test and Student t test were used as a test of significance. Results : Out of 419 patient records reviewed; 40.3% patients developed AKI after Cardiac Surgery. Age, Sex, h/o previous Cardiac Surgery, CPB duration, Aortic Cross Clamp Time, addition of vasopressor etc. were some of the significant risk factors associated. AKI associated with Cardiac Surgery was associated with a mortality of 8.3%. Mean duration of ventilation 38.48�.27 hrs. and ICU stay 6.12�15 days was comparatively longer than patients without AKI (P<0.001). Conclusion : We concur that AKI is a serious complication in patients undergoing Cardiac Surgery and has significant impact on the outcome of the patients in terms of duration of ICU stay, duration of ventilation and mortality. There is need to identify modifiable risk factors at the earliest and develop approaches to improve the outcome and decrease the AKI associated morbidity and mortality

Targeting TLR-4 Signaling to Treat COVID-19-induced Acute Kidney Injury

The newly discovered severe acute respiratory syndrome coronavirus 2 (SARS-CoV2) has turned into a potentially fatal pandemic illness. Numerous acute kidney injury (AKI) cases have been reported, although diffuse alveolar destruction and acute respiratory failure are the major symptoms of SARS-CoV-2 infection. The AKI, often known as a sudden loss of kidney function, carries a greater risk of mortality and morbidity. AKI was the second most frequent cause of death after acute respiratory distress syndrome (ARDS) in critically ill patients with coronavirus disease 2019 (COVID-19). While most patients with COVID-19 have moderate symptoms, some have severe symptoms, such as septic shock and ARDS. Also, it has been proven that some patients have severe symptoms, such as the failure of several organs. The kidneys are often affected either directly or indirectly. The major signs of kidney involvement are proteinuria and AKI. It is hypothesized that multiple mechanisms contribute to kidney injury in COVID-19. Direct infection of podocytes and proximal tubular cells in the kidneys may lead to acute tubular necrosis and collapsing glomerulopathy. SARS-CoV2 may also trigger a cascade of immunological responses that lead to AKI, including cytokine storm (CS), macrophage activation syndrome, and Toll-like receptor type 4 activation (TLR-4). Other proposed processes of AKI include interactions between organs, endothelial failure, hypercoagulability, rhabdomyolysis, and sepsis. Furthermore, ischemic damage to the kidney might result from the decreased oxygen supply. This article focuses on kidney injury’s epidemiology, etiology, and pathophysiological processes. Specifically, it focuses on the CS and the role of TLR-4 in this process. To effectively manage and treat acute kidney damage and AKI in COVID-19, it is crucial to understand the underlying molecular pathways and pathophysiology.

Acute kidney injury among hospitalised patients who died due to COVID-19 in the Eastern Cape, South Africa

Background: Acute kidney injury (AKI) commonly occurs in coronavirus disease 2019 (COVID-19) patients who have been hospitalised and is associated with a poor prognosis. This study aimed to determine the incidence of AKI among COVID-19 patients who died in a regional hospital in South Africa. Methods: This retrospective record review was conducted at the Mthatha Regional Hospital in South Africa's Eastern Cape province. Data were collected between 10 July 2020 and 31 January 2021. Results: The incidence of AKI was 38% among the hospitalised patients who died due to COVID-19. Most study participants were female, with a mean age of 63.3 ± 16 years. The most common symptom of COVID-19 at the time of hospitalisation was shortness of breath, followed by fever and cough. Half of the patients had hypertension, while diabetes, human immunodeficiency viruses (HIV) and tuberculosis (TB) were other comorbidities. At admission, the average oxygen saturation was 75.5% ± 17. Conclusion: The study revealed a high incidence of AKI among hospitalised patients who died due to COVID-19. It also found that those received adequate crystalloid fluids at the time of admission had a lower incidence of AKI. Contribution: Acute kidney injury can be prevented by adequate fluid management during early stage of COVID-19. Majority of COVID-19 patients were referred from lower level of care and primary care providers have their first encounter with these patients. Adequate fluid resuscitation in primary care settings can improve the outcome of hospitalised COVID-19 patients.

Comparison of Outcomes Between High and Standard Dose of N-acetylcysteine in Prevention of AKI in Patients with CKD

Background: Patients with chronic kidney disease (CKD) are at a common risk for contrast-induced acute kidney damage (CI-AKI) because of various complications. Intravenous N-acetylcysteine (NAC) in high doses (1200mg) is considered more effective than its conventional dose (600mg) to prevent CIN and related complications. Objective: The study aimed to compare the effectiveness of high dose versus standard dose of intravenous N-acetylcysteine (NAC) in the prevention of Acute Kidney Injury in patients with chronic kidney disease.Material & Methods:A total of 60 (sixty) patients diagnosed with CKD went to coronary angiography and/or percutaneous coronary intervention (PCI) were selected by simple random technique and categorized into two groups – Group A (30 patients) received high dose NAC (1200mg) and Group B (30 patients) – received standard dose NAC (600mg). For evaluation of renal damage serum creatinine level for at least >3 months, renal imaging revealed bilateral small echogenic kidneys, eGFR (<60 to 15ml/min/1.73m², measured by MDRD formula) and also by ACR >30 mg/gm, associated with IHD, admitted for percutaneous intervention (PCI) were taken in account. Statistical analysis was done by SPSS version 20 with taking 95% confidence interval. The quantitative data were expressed as mean and standard deviation and qualitative data were expressed as frequency distribution and unpaired t-test, Chi-square test, and Fisher exact analytic test were done.Results:The observed mean age group of the patients was 65 ± 8 years and 62 ± 7 years in group A and group B respectively with male predominance in both groups. Primary renal disease diabetic nephropathy (DN) more (36.66%) in group A than in group B (30.00%) but patients with Hypertensive nephropathy were the same (33.33%) in both groups. After interventions, S. Creatinine (mg/dl) level, e, GFR (ml/min/1.73m²), were statistically significant in cases of group A patients (P-value 0.001& 0.003 correspondingly) compared to group B Patients (P-value 0.075 & 0.001 respectively). Again, the mean of pre-intervention S. Creatinine was 1.7 ±0.5 in group A whereas this was 1.9 ± 0.8 (p-value, 0.599) in group B and after 48 hours of intervention this was 1.6 ± 0.5 and 2.0 ± 0.5 (p-value, 0.697) In group A and group B respectively. Overall, no patients were detected with nephropathy for high dose NAC whereas 27 (90%) out of 30 had developed CIN in standered dose.Conclusion:High-dose N-acetylcysteine (1200mg) is more potent and effective than the standard dose (600mg) in reducing contrast-induced acute kidney injury (CI-AKI) in patients with CKD.

Pathophysiology of acute kidney injury on a molecular level: A brief review

Acute Kidney Injury (AKI) is a clinical condition with various etiologies. It is also known as acute renal failure, which is a sudden episode of kidney failure or kidney damage that happens within a few hours or a few days in patients. It causes an increase of waste products in blood and makes it hard for the patient kidneys to keep the right balance of fluid in the body. It can also affect other vital organs such as the brain, heart, and lungs. AKI is common in patients who are in the hospital, in intensive care units, and especially in older adults. It results in increased accumulation of a nitrogenous surplus in blood and a reduction in urine volume. The pathophysiology of various types of AKI is different. The earlier we can identify the causes the more effective treatment can be administered. This review attempts to identify changes on a molecular level during different stages of the disease and further discussed understanding the pathophysiology of AKI to find important molecules involved in various metabolic pathways, various phases and types of AKI, and the effect of drugs on kidneys and cellular level changes. This review article would help to design new drugs and the consequences of their metabolites to avoid Acute Kidney Injury.

Clinical characteristics and factors associated with acute kidney injury among patients hospitalized with coronavirus disease: an observational retrospective study

ABSTRACT BACKGROUND: Coronavirus disease 19 (COVID-19) is a multisystemic disease with high incidence of acute kidney injury (AKI). OBJECTIVE: To describe the clinical characteristics and factors associated with AKI among patients hospitalized with COVID-19. DESIGN AND SETTING: Retrospective cohort conducted at Hospital Civil de Culiacan, Mexico. METHODS: We included 307 patients hospitalized due to COVID-19. AKI was defined and staged based on serum creatinine levels in accordance with the criteria of the Acute Kidney Injury Network (AKIN). Multivariate logistic regression analysis was used to determine factors associated with AKI. RESULTS: The patients' age was 56 ± 15 years (64.5% male). The incidence of AKI was 33.6% (n = 103). Overall, 53.4% of patients had community-acquired AKI, and 46.6% had hospital-acquired AKI. Additionally, 15.5% of them presented AKIN stage 1; 34% had AKIN stage 2; and 50.5% had AKIN stage 3. Hemodialysis was required for 10.7% of the patients. The factors associated with AKI were chronic kidney disease (odds ratio, OR: 10.8; P = 0.04), use of norepinephrine (OR: 7.3; P = 0.002), diabetes mellitus (OR: 2.9; P = 0.03), C-reactive protein level (OR: 1.005; P = 0.01) and COVID-19 severity index based on chest tomography (OR: 1.09; statistical trend, P = 0.07). Hospital stay (11 ± 7 days; P < 0.001) and mortality (83.5 versus 31.4%; P < 0.05) were greater among patients with AKI. CONCLUSION: AKI was a frequent and serious complication in our cohort of patients hospitalized with COVID-19, which was associated with high mortality and long hospital stay.

Serum Cystatin C as a predictor of acute kidney injury in neonates: a meta-analysis

Abstract Objective: The objective of this meta-analysis is to evaluate the diagnostic value of serum Cystatin C in acute kidney injury (AKI) in neonates Sources: PubMed, Embase, Cochrane Library, Web of Science, China National Knowledge Infrastructure (CNKI), and WanFang Database were searched to retrieve the literature related to the diagnostic value of Cystatin C for neonatal AKI from inception to May 10, 2021. Subsequently, the quality of included studies was determined using the QUADAS-2 tool. Stata 15.0 statistical software was used to calculate the combined sensitivity (SEN), specificity (SPE), positive likelihood ratio (PLR), negative likelihood ratio (NLR), and diagnostic odds ratio (DOR). Additionally, meta-regression analysis and subgroup analysis contributed to explore the sources of heterogeneity Summary of the findings: Twelve articles were included. The pooled sensitivity was 0.84 (95%CI: 0.74-0.91), the pooled specificity was 0.81 (95%CI: 0.75-0.86), the pooled PLR was 4.39 (95%CI: 3.23-5.97), the pooled NLR was 0.19 (95%CI: 0.11-0.34), and the DOR was 22.58 (95%CI: 10.44-48.83). The area under the receiver operating characteristic curve (AUC) was 0.88 (95%CI: 0.85-0.90). No significant publication bias was identified (p > 0.05).

Assessment of urinary interleukin-18 in the early post-burn period to predict acute kidney injury of various degrees of burn patients

Background:Early detection of acute kidney injury (AKI) in burn-injured patients can help modify the treatment to prevent progression of acute renal failure and reduce the need for renal replacement therapy. The aim of the study was to evaluateurinary interleukin-18 in the early post-burn period to predict the AKIfor the various degrees of burn patients. Methods:This prospective observational study was conducted in the department of nephrology, Dhaka medical college in collaboration with burn and plastic surgery unit of the same medical college hospital, from July 2017 to June 2018 for a period of one year. The 48 burn patients (Age>18 years) who attended in the burn unit of Dhaka medical college, Dhaka of both sexes were enrolled in this study. Data were analyzedby using SPSS 22.0. A value of p<0.05 was considered statistically significant for all tests. Results:In this study, mean age of the burn patients was 32.41�.59 years. Male female ratio was 3.36:1. Urinary IL-18 in diagnosis of AKI showed accuracy, sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) were 93.8%, 91.7%, 94.4%, 84.6% and 97.1% respectively. AUC for urinary IL-18 at admission was 0.968 (CI, 0.921-1.000) and AUC for serum creatinine at admission was0.937 (CI, 0.871-1.000).Conclusions:According to Kappa value, AUC and sensitivity and specificity urinary IL-18 is a good biomarker in predicting of early AKI in burn patients

Can paricalcitol increase the effectiveness of n-acetylcysteine in contrast induced acute kidney prophylaxis in rats? A biochemical and histopathological study / ¿Puede el paricalcitol aumentar la eficacia de la n-acetilcisteína en la profilaxis renal aguda inducida por contraste en ratas? Un estudio bioquímico e histopatológico

SUMMARY: N-Acetylcysteine (NAC) is used for contrast induced acut kidney injury (CI-AKI) prophylaxis because of its antioxidant effects. Paricalcitol, which has reno-protective effects, is likely to provide a more effective prophylaxis when added to NAC treatment. The study was designed based on this hypothesis. The study was organised to include 4 groups each consisting of 7 rats. Group 1 was the control group, and Group 2 included rats with CI-AKI. Rats in Group 3 were administered NAC at a dose of 100 mg/kg via oral gavage once a day for 5 days. Rats in group 4 were administered paricalcitol at a dose of 0.4 mcg/kg once a day for 5 days in addition to NAC. CI-AKI was induced after the treatments in both groups. The study was terminated on the sixth day. Samples were collected from the rats' sera and kidney tissues to study oxidant and antioxidant parameters; kidney function tests were also studied. There were significant differences between the contrast nephropathy group (Group 2) and NAC and NAC+paricalcitol groups with respect to serum urea and creatinine levels. When the same groups were compared regarding oxidant (TOS-MDA) and antioxidant (TAC-Paraoxonase) parameters, we observed that the oxidant parameters increased in serum and kidney tissue samples with NAC use, and that effect was strengthened by the addition of paricalcitol to NAC treatment. However, despite increased antioxidant effectiveness, we observed no decrease in urea and creatinine levels when paricalcitol was added for CI-AKI in rats. There was no significant difference between Group 3 and Group 4. Paricalcitol provides a more potent antioxidant effect in both serum and kidney tissue samples when added to NAC treatment in rats with CI-AKI. Despite increased antioxidant parameters, however, paricalcitol does not provide a significant decrease in urea and creatinine levels.

RESUMEN: Debido a sus efectos atioxidantes la N- acetilcisteína (NAC) se usa para la profilaxis de la lesión renal aguda inducida por contraste (CI-AKI). Es probable que el paricalcitol, que tiene efectos renoprotectores, proporcione una profilaxis más eficaz cuando se agrega al tratamiento con NAC. En base a esta hipótesis el estudio fue diseñado para incluir cuatro grupos cada uno compuesto por siete ratas. El grupo 1 fue el grupo control y el grupo 2 incluyó ratas con CI-AKI. A las ratas del Grupo 3 se les administró NAC con una dosis de 100 mg/kg por sonda oral una vez al día, durante 5 días. A las ratas del grupo 4 se les administró paricalcitol a una dosis de 0,4 mcg/kg una vez al día durante 5 días, además de NAC. Se indujo CI-AKI después de los tratamientos en ambos grupos. El estudio finalizó el sexto día. Se recolectaron muestras de suero y tejidos renales de ratas para estudiar los parámetros oxidantes y antioxidantes; También se estudiaron las pruebas de función renal. Hubo diferencias significativas entre el grupo de nefropatía por contraste (Grupo 2) y los grupos NAC y NAC+paricalcitol con respecto a los niveles séricos de urea y creatinina. Cuando se compararon los mismos grupos con respecto a los parámetros oxidantes (TOS-MDA) y antioxidantes (TAC-Paraoxonase), observamos que los parámetros oxidantes aumentaron en muestras de suero y tejido renal con el uso de NAC, y ese efecto se vio reforzado por la adición de paricalcitol a tratamiento NAC. Sin embargo, a pesar de una mayor eficacia antioxidante, no observamos una disminución en los niveles de urea y creatinina cuando se agregó paricalcitol para CI-AKI en ratas. No hubo diferencias significativas entre el Grupo 3 y el Grupo 4. El paricalcitol proporciona un efecto antioxidante más potente tanto en muestras de suero como de tejido renal cuando se agrega al tratamiento con NAC en ratas con CI-AKI. Sin embargo, a pesar del aumento de los parámetros antioxidantes, el paricalcitol no proporciona una disminución sig- nificativa en los niveles de urea y creatinina.

Extracellular vesicle activities regulating macrophage- and tissue-mediated injury and repair responses

Macrophages are typically identified as classically activated (M1) macrophages and alternatively activated (M2) macrophages, which respectively exhibit pro- and anti-inflammatory phenotypes, and the balance between these two subtypes plays a critical role in the regulation of tissue inflammation, injury, and repair processes. Recent studies indicate that tissue cells and macrophages interact

Analysis of risk factors and clinical prognosis of acute kidney injury early after lung transplantation / 器官移植

Objective To analyze the risk factors and clinical prognosis of acute kidney injury (AKI) early after lung transplantation. Methods Clinical data of 155 recipients undergoing lung transplantation or combined heart-lung transplantation were retrospectively analyzed, and they were divided into the AKI group (n=104) and non-AKI group (n=51) according to the 2012 Kidney Disease: Improving Global Outcomes Clinical Practice Guideline. The incidence of AKI early after lung transplantation was summarized. The main indexes of recipients were collected. The risk factors of the occurrence of AKI early after lung transplantation were subjected to univariate and multivariate analysis. The clinical prognosis of lung transplant recipients was evaluated and the survival curve was delineated. Results The incidence of AKI early after lung transplantation was 67.1%(104/155), including 47 recipients with stage 1 AKI, 34 recipients with stage2 AKI and 23 recipients with stage 3 AKI, respectively. Sixteen recipients required continuous renal replacement therapy (CRRT) early after lung transplantation. Preoperative complication with diabetes mellitus, preoperative complication with pulmonary hypertension, intraoperative mean arterial pressure (MAP) < 60 mmHg, intraoperative massive blood transfusion, and treatment with excessive therapeutic concentration of tacrolimus (Tac) within postoperative 1 week were the independent risk factors for the occurrence of AKI early after lung transplantation. Up to the end of follow-up, 66 recipients (42.6%) died, including 50 recipients in the AKI group and 16 recipients in the non-AKI group. The cumulative survival rate in the AKI group was significantly lower than that in the non-AKI group (40% vs. 66%, P < 0.05). With the increase of AKI severity, the cumulative survival rate of lung transplant recipients was decreased. Conclusions AKI develops early after lung transplantation with high incidence and poor clinical prognosis. Preoperative complication with diabetes mellitus and pulmonary hypertension, intraoperative MAP < 60 mmHg and massive blood transfusion, and treatment with excessive therapeutic concentration of Tac within postoperative 1 week are the independent risk factors for the occurrence of AKI early after lung transplantation.

Clinical assessment and pathophysiology of Bothrops venom-related acute kidney injury: a scoping review

Bothrops are one of the most common medically important snakes found in Latin America. Its venom is predominantly hemotoxic and proteolytic, which means that local lesion (edema and redness) and hemorrhagic symptoms are recurrent in envenoming by this snake. Although hemorrhage is usually the major cause of death, snakebite-related acute kidney injury is another potentially fatal clinical complication that may lead to chronic kidney disease. The present review highlights the main studies on Bothrops venom-related acute kidney injury, including observational, cross-sectional, case-control and cohort human studies available up to December 2019. The following descriptors were used according to Medical Subject Headings (MeSH): on Medline/Pubmed and Google Scholar "acute kidney injury" or "kidney disease" and "Bothrops"; on Lilacs and SciELO "kidney disease" or "acute kidney injury" and "Bothrops". Newcastle-Ottawa quality assessment scale was used to appraise the quality of the cross-sectional and cohort studies included. The selection of more severe patients who looked for health care units and tertiary centers is a risk of bias. Due to the methodological heterogeneity of the studies, a critical analysis of the results was performed based on the hypothesis that the design of the included studies influences the incidence of acute kidney injury. Fifteen human studies (total participants 4624) were included according to stablished criteria. The coagulation abnormalities (hemorrhagic symptoms, abnormal fibrinogen and activated partial thromboplastin time) were associated with acute kidney injury in the most recent studies reported. The findings observed in this review provide up-to-date evidence about the acute kidney injury pathogenesis following Bothrops syndrome. Studies pointed out that coagulation abnormalities comprise the major pathway for acute kidney injury development. This review may improve patient management by primary healthcare providers, allowing earlier diagnosis and treatment of Bothrops venom-related acute kidney injury.(AU)

Acute Kidney Injury in COVID-19 is Associated with Mortality: A Meta-Analysis

@#BACKGROUND: By March 2020, The World Health Organization (WHO) has declared Coronavirus disease-19 (COVID-19) as a global pandemic. Further investigations found that COVID-19 may lead to acute kidney injury (AKI). Some studies have been done, but the incidence and outcome of AKI in COVID-19 are variable between studies. Moreover, given the high number of COVID-19 cases in our country, we aimed to perform a systematic review and meta-analysis regarding the detailed outcome of AKI in COVID-19 patients as reported in the available literature. METHODS: We performed a comprehensive literature search from several databases, such as Europe PMC, PubMed, ProQuest, Directory of Open Access Journal (DOAJ), and related references between December 1, 2019, and December 5, 2020. The primary outcome was mortality, and the secondary outcomes were the need for Intensive Care Unit (ICU) care, severe and critical COVID-19 infection, and Acute Respiratory Distress Syndrome (ARDS). RESULTS: There were a total of 25,990 patients from 21 studies. Acute kidney injury was associated with increased odds of mortality (OR 13.43 [8.35, 21.60], p < 0.00001; I2 : 82%, p < 0.00001), need for ICU care (OR 14.57 [8.51, 24.94], p < 0.00001; I2: 84%; p < 0.0001), critical COVID-19 (OR 10.41 [3.88, 27.90], p < 0.00001; I2: 67%; p = 0.02), and ARDS (OR 2.84 [1.30, 6.22], p = 0.009; I2: 91%; p = 0.001). CONCLUSION: Acute kidney injury is associated with mortality, need for ICU care, critical COVID-19 patients, and ARDS.

Frequency of etiologies of acute kidney injury in Faisalabad and surrounding districts

Background: To find out the causes of Acute Kidney Injury (AKI) in population.Methods: A total of 150 patients were enrolled from medical, surgical, gynecology and obstetrics units of Allied Hospital and Madinah Teaching Hospital, Faisalabad, Pakistan. History, physical examination and investigations were recorded on specially designed proforma. Patients were evaluated to find out the etiologies of AKI. All patients were subjected to urine analysis, complete blood count, blood biochemistry (urea, creatinine, electrolytes, uric acid, calcium and phosphorus) and ultrasound scan of the abdomen and pelvis. Renal biopsy, immunological assays, such as hepatitis B surface antigen, anti-hepatitis C virus antibody, complements level, antinuclear antibody, anti-double-stranded DNA, anti-neutrophil cytoplasmic antibody and anti-glomerular basement membrane antibody were performed in selected cases.Results: Male (36%) and female (64%). Pre-renal AKI was most common and was reported in 80 patients (53.33%). Intrinsic Renal azotemia in 56 patients (37.33%). Post renal azotemia in 14 patients (9.33%). Among 80 patients of prerenal AKI, hemorrhage in 45(56.25%), gastroenteritis in 16(20%), sepsis in 8(10%), cardiac diseases in 4(5%), hepatorenal syndrome in 3 (3.75%), peritonitis in 2 (2.50%) and burns in 2(2.50%) were the main causes of Pre-renal AKI. Among 56 patients of intrinsic renal AKI, 40(71.4%) had acute tubular necrosis (ATN), 12(21.4%) with multifactorial causes and 4(7.14%) were found to have glomerulonephritis. Among 14 patients of post renal AKI, 6(42.9%) were having calculi, 6(42.9%) were to have enlarged prostate and 2(4.3%) were having stricture urethra. In this study, contribution of obstetrical, medical and surgical etiologies were recorded as 40%, 36% and 20% respectively.Conclusions: In contrast to study reported from neighbouring country, this study shows rather increase in pregnancy related AKI.

A Study on Actue Kidney Injury in Patients of Dengue Fever in Western Uttar Pradesh Population

Introduction: Dengue fever is a systemic acute viral illnesscaused by Arbo virus from genus flavivirus highly prevalentin the tropics and subtropics, transmitted by Aedes (aegyptiand albopictus) mosquito. Pathogenesis of AKI due to dengueinclude direct action by the virus, hemodynamic instability,rhabdomyolysis, hemolysis and acute glomerular injury.Thisstudy was planned to know the incidence and severity of AKIin patients of Dengue fever.Material and methods: Our study was an observationalretrospective study, done in Subharti Medical College, Deptt.Of Medicine, Meerut between july 2017-December 2018.Medical records of 320 Dengue IgM+ patients admitted duringthis period were studied. Patients were classified into denguefever, dengue hemmorhagic fever, dengue shock syndrome.Results: Out of total 320 patients positive for dengue IgM,48 patients (15%) were found to develop AKI. Out of thetotal 48 patients developing AKI, 26 patients presented withDengue fever, 16 were with Dengue Hemmorhagic Fever and 6presented with dengue shock syndrome. Out of the 48 patientsdiagnosed with AKI, 34 patients fall under KDIGO criteria I, 10patients fall under KDIGO II, 4 patients fall under KDIGO III.Conclusion: Our study concluded that AKI is a major andserious complication,and it is the major cause of Mortality andmorbidity in dengue fever.

A Prospective Study of AKI by Using Koralkar Criteria in Hospital Born Preterm Babies

Background: Acute kidney injury (AKI) is a clinical conditionoften seen in the neonatal intensive care units. The incidenceof AKI in neonates treated at the NICU ranges from 2.4 to 56%. Many etiological factors predispose development of AKI inneonates. AKI has a significant impact on survival rates,especially in preterm infants and Neonates with AKI have veryhigh mortality rates (4.5–78 %). Our understanding of AKI inLBW newborns is mostly limited to retrospective studies. So weplanned a prospective study in preterm babies with AKIdiagnosed by Koralkar criteria.Objectives: To find proportion of preterm babies (<37 weeksof gestation) with acute kidney injury born in the hospitals andto find out demographics, co-morbidities, clinical presentation,risk factors, and outcome in preterm newborns with AKI.Materials & Methods: A Prospective study on 215 pretermbabies was conducted at Neonatal units attached to SMSMedical College, Jaipur during Feb 2015 to March 2017. Thestudy variables were analyzed using Epi-Info7 software withapplication of Mean, Proportion, Chi-square, t- test, regressionanalysis and Kaplan-Meier Survival analysis.Results and Conclusion: Out of 215 pre-term infants 36(16.7%) had AKI with maximum patients in cat.1 (11.1%). Outof 36 preterm infants with AKI 13 died and no statisticallysignificant association was found between AKI and mortalityamong preterm infants. Statistically significant association wasfound between birth weight, sepsis, HMD, MV, NEC andmortality among preterm infants. Logistic regression wasperformed to eliminate potential confounders. Our final modelincluded variables with p<0.10. After regression analysis onlybirth weight was associated with mortality among preterminfants with p=0.028. On comparing survival among pretermwith AKI and without AKI the Average Hazard Rate was moreamong preterm infants with AKI but on applying Log Rank Testno statistically significant difference was found between thesurvival probabilities of the two groups.

Clinical profile of neonates with acute renal injury in neonatal intensive care unit at GMERS Medical College and General Hospital, Gotri, Vadodara, Gujarat, India

Background: Acute kidney injury (AKI) is defined as an acute deterioration in ability of the kidneys to maintain homeostasis of body fluids and electrolytes leading to retention of wasted and toxic metabolic end products. It is fairly common in newborn population and is a major contributor of neonatal mortality and morbidity. The aim was to study the incidence of renal failure in high risk neonates and risk factors for renal failure.Methods: A prospective observational study was done to evaluate renal profile in high risk neonates admitted to neonatal intensive care unit, GMERS Medical College and General Hospital, Gotri, Vadodara, Gujarat, India over a 1-year period. nRifle criteria was used for classification of acute kidney injury.Results: The incidence of AKI in high risk newborns admitted in this study was 52 (37.14%). The male to female ratio in current study was 2.46:1. Majority of neonates with AKI were out born 44 (84.6%). The incidence of AKI was higher in term newborns. Mean weight in AKI group was 2048 grams. The highest incidence of AKI was found in AFD newborns (57.69%). nRifle criteria was used to diagnose AKI in this study. Out of 52 neonates who had AKI, 27 (51.9%) were in risk category, 21 (40.4%) were in injury group and 4 (7.7%) were in failure group. Mortality in these groups were 5 (18.51%), 7 (33.33%) and 3 (75%) respectively. Highest correlation of risk factors for AKI was found with birth asphyxia 18 (34.9%) followed by sepsis 12 (23.1%) and shock 15 (28.5%). 29 (55.76%) neonates had non oliguric AKI. 28 (53.8%) neonates with AKI developed dyselectrolytemia.Conclusions: Early recognition and management of risk factors can help in reducing the occurrence and improve outcomes in them.

Outcome of patients of acute kidney injury in chronic liver disease

Introduction: Chronic liver disease (CLD) is also a common clinical problem afflicting mankind. Occurrence of Acute kidney injury in patients with chronic liver disease is frequent finding which makes prognosis of CLD even poorer. Material and methods: A prospective cohort observational study on 100 adult patients of chronic liver disease with AKI conducted over a period of 24 months from August 2016 to August 2018 at Sri Aurobindo medical college and postgraduate institute. Detailed clinical examination and biochemical tests were done. Univariate and multivariate logistic regression (odds ratio) analyses were used. Results: 87% were males and 13% were females. Maximum no. of patients found in AKI stage III 40% followed by stage I 36% then stage II 24%. Among these 31% patient recover after treatment, 26% partially recovered and 43% patient didn’t response to treatment. Overall 75% survived while 25% died in this study. Conclusion: Majority of Patients with Prerenal AKI had full recovery, as compared to HRS-AKI and intrinsic AKI where full recovery was less common. Patients in stage 1 AKI had more proportion of patients with full recovery than stages 2 and 3. Regarding outcome, Patients in stage 1 and stage 2 has higher survival rates as compared to stage 3, which is statistically significant.