Acute renal failure in cirrhosis of liver: a hospital based observational study

Background: In general, there is a propensity among the physicians to label a patient with cirrhosis developing a raised creatinine level as HRS and treat it as such thereby ignoring the other causes particularly in this part of the country. This study was undertaken to find out the causes of acute renal failure and their outcome in cirrhotic patients.Methods: One forty three cirrhotic patients with acute renal failure were enrolled and investigated for causes of renal failure and their outcomes.Results: 92 (64.33%) patients had single factor whereas 51 (35.66%) patients had multiple factors (two or more), causing renal failure. Hypovolemia (34.27%) was the most common cause of renal failure followed by herbal medications (11.19%), HRS (11.19%) and infections (7.69%) as a single factor. Among multiple factors, 45 (31.46%) patients had hypovolemia followed by 36 (25.17%), 18 (12.58%) and 8 (5.59%) patients having infections, herbal medications and use of nephrotoxic drugs respectively. Reversibility was seen in 72 (50.35%) patients and more common in hypovolemia (85.71%) as a single factor. Total all-cause mortality was 33 (23%) and highest mortality was seen in HRS 75% (n=12) followed by infections (45.45%) and herbal medications (25%).Conclusions: Hypovolemia was the most common cause of renal failure followed by infections, herbal medications and hepatorenal syndrome. Early detection and proper volume replacement are the key points in the management. Detailed history regarding use of herbal medications is also very important issue.

Intravenous Colistin Therapy for Multidrug-Resistant Gram-Negative Bacterial Infections in Major Burn Injuries

PURPOSE: The aim of this study was to investigate the characteristics of Acute Kidney Injury Network (AKIN)-defined nephrotoxicity in patients undergoing intravenous colistimethate sodium (CMS) therapy for major burns. METHODS: This retrospective study included burn patients who received more than 48 h of intravenous CMS between September 2009 and December 2015. Data collection was performed using the institution's electronic medical record system. Patients assigned to the developed nephrotoxic group experienced aggravation of current AKIN stage during CMS treatment; those assigned to the non-nephrotoxic group experienced no change in current or exhibited improved AKIN stage during CMS therapy. RESULTS: A total of 306 patients were included in this study. All patients were grouped according to AKIN stage: AKIN 0 (n=152); AKIN 1 (n=6); AKIN 2 (n=9); AKIN 3 (n=139). The baseline creatinine (Cr) level was 0.73 mg/dL. The incidence of nephrotoxicity was 50.3% according to AKIN stage; overall mortality was 45.8%. The non-nephrotoxic group consisted of 127 (74.7%) patients and 43 (25.3%) were in the developed nephrotoxic group. In patients requiring continuous renal replacement therapy (CRRT), baseline Cr level was 0.83 mg/dL, pre-CMS Cr level was 1.17 mg/dL, and post-CMS Cr level was 1.34 mg/dL. CONCLUSION: CMS can be administered without signs of nephrotoxicity for a certain period (approximately 1 week), it can be used relatively safely for 2 weeks. Application of CMS is a reasonable option for treating infections caused by multi-drug resistant gram-negative bacteria in patients with major burns. The caution should be exercised nevertheless.

Hepatic and Renal Biochemical Profile of Albino Rats Exposed to Chloroform and Methanol Leaf Extracts of Portulaca oleracea Linn.

Portulaca oleracea Linn. is among the medicinal plants used globally in the treatment of diseases and management of health challenges. The dearth of information on the long term effect of Portulaca oleracea on hepatic and renal toxicity prompted this study. The study investigated the subchronic effect of the oral administration of chloroform leaf extracts of Portulaca oleracea (CLEPO) and methanol leaf extracts of Portulaca oleracea (MLEPO) on plasma activity of some enzymes (ALT, ALP & AST) and levels of other biochemical parameters such as blood electrolytes, total protein, albumin, bilirubin, urea and creatinine in male albino rats. One hundred and twelve (112) animals were randomly divided into seven (7) groups of sixteen (16) rats each. Group A (Control) received 0.5ml/kg of 20% Tween 80 (vehicle), Groups B, C & D received 125, 250 & 500 mg/kg of CLEPO respectively and Groups E, F & G received 125, 250 & 500 mg/kg of MLEPO respectively for 60 days. On days 14, 28, 42 and 60; four rats from each group were anaesthetized and blood samples were collected for plasma biochemical assay. MLEPO caused a significant (p<0.05) decrease in plasma AST and ALP level while CLEPO significantly (p<0.05) decreased the plasma AST level. MLEPO produced a highly significant (p<0.01) reduction in both total bilirubin and conjugated bilirubin levels as well as significant (p<0.05) decline in urea level. CLEPO produced a significant (p<0.05) decrease on conjugated bilirubin. Both extracts significantly (p<0.05) reduced the chloride level. Oral administration of CLEPO and MLEPO over a 60 day period is neither hepatotoxic nor nephrotoxic.

Causes of mortality in patients with acute kidney injury at Mahatma Gandhi Medical (MGM) College and Hospital, Jamshedpur – A tertiary care centre in Jharkhand

Background: Acute kidney injury (AKI), previously called acute renal failure (ARF), is an abrupt loss of kidney function that develops within 7 days. Its causes are numerous. Generally it occurs because of damage to the kidney tissue caused by decreased renal blood flow (kidney ischemia) from any cause such as low blood pressure, exposure to substances harmful to the kidney, an inflammatory process in the kidney, or an obstruction of the urinary tract that impedes the flow of urine. AKI is diagnosed on the basis of characteristic laboratory findings, such as elevated blood urea nitrogen and creatinine, or inability of the kidneys to produce sufficient quantity if urine. Materials and methods: All patients aged above 18 years with features of AKI as per AKIN (Acute Kidney Injury Network) criteria which is defined as an increase in serum creatinine of 0.3 mg/dl or more within 48 hours of observation or 1.5 times baseline or greater, which is known or presumed to have occurred within 7 days, or a reduction in urine volume below 0.5 ml/kg/h for 6 hours were included in this study. A total of 146 patients were included in this study. Results: Causative factors of AKI were decreased renal perfusion, nephrotoxic drugs, septicemia, intravascular hemolysis, hepato-renal syndrome, urinary catheterization and volume depletion. In this study, thirty four deaths out of 146 cases were documented and most common cause was septicemia followed by peripheral circulatory failure and uremia. Most common organisms involved were pseudomonas and acinetobacter. Mangesh Dorai, Soumyadeb Roy. Causes of mortality in patients with acute kidney injury at Mahatma Gandhi Medical (MGM) College and Hospital, Jamshedpur - A tertiary care centre in Jharkhand. IAIM, 2018; 5(5): 167-173. Page 168 Conclusion: Drug induced AKI can be prevented if used with discretion in patients with associated risk factors. The meticulous and appropriate monitoring of hydration status, fluid and electrolyte imbalance, use of nephrotoxic drugs particularly aminoglycosides, efficient control of infection and sepsis maintenance of adequate diuresis and hydration in surgical settings and patients undergoing radio contrast study are the main steps towards the prevention of hospital acquired acute renal failure.

Clinical analysis of 81 children with urinary system injury after hematopoietic stem cell transplantation / 临床儿科杂志

Objectives To investigate the etiology, renal pathology, treatment, and prognosis of children's urinary system injury after hematopoietic stem cell transplantation (HSCT). Methods Clinical data of 81 children with urinary dysfunction after HSCT admitted to the Hematology Department in Children's Hospital of Soochow University were analyzed, and relevant literatures were reviewed. Results In 81 cases (50 males and 31 females), the age ranges from 8 months to 17 years old. Thirty cases (37%) with prerenal injury were recovered after active rehydration and other symptom specific treatment. There were 9 (11.1%) children with renal injury, four cases were given up therapy or transferred to other hospitals, thus lead to an unknown prognosis. Kidney biopsy was performed in the remaining five cases for pathological investigation. After active symptom-speific and etiology-based treatment, serum creatinine and glomerular filtration rate of four cases return to normal. But in the long-term follow-up,one case died of recurrence of primary disease, reinfusion of hematopoietic stem cell combined with renal failure. The remaining 3 patients were with chronic kidney disease (CKD). One case with renal thrombotic microangiopathy was in the chronic dialysis. Postrenal renal injuries were mainly hemorrhagic cystitis (28.4%) and urinary tract infection (16%). After a large dose of rehydration, urine alkalization and anti-infection therapy, they were recovered in the short term with a good prognosis. Conclusions Urinary injury after HSCT is mainly divided into three categories: prerenal, renal and postrenal, in which renal injury is prone to frequent recurrence.

Role of nephrotoxic drugs in contrast-induced nephropathy.

Background: Elevation of serum creatinine (SCr) more than 0.5 mg/dl or 25% or more of the baseline value in 3 days after contrast administration is considered as contrast-induced nephropathy (CIN). Contrast material (CM) used in the radiological studies like contrast-enhanced computed tomography (CECT) and intravenous urogram (IVU) are nephrotoxic and their ability to cause renal damage is increased when other potential nephrotoxic drugs are given simultaneously. The present study aimed to demonstrate the effects of CM on patients who are on nephrotoxic drugs by studying the incidence of CIN in patients who are on nephrotoxic drugs and need a CECT or IVU (cases presenting with an emergency). The study compares the incidence of CIN in patients on nephrotoxic drugs with that in those not on nephrotoxic drugs and evaluates the importance of withdrawal of nephrotoxic drugs (3 days) in non-emergency contrast studies. Methods: The study population is divided into three groups. Group A consists of 40 cases undergoing emergency CECT or IVU, who are on nephrotoxic drugs. 40 cases undergoing CECT or IVU after 3 days of holding of nephrotoxic drugs are included in Group B. Group C consists of 40 cases undergoing CECT or IVU who are not on any nephrotoxic drugs. Patients with parenchymal renal disease, renal injury, and renal mass are excluded from the study. All cases having SCr <1.4 mg/dl are included in the study. SCr investigation is repeated 3 days after the contrast study. Results: The incidence of CIN is more in the patients who are on nephrotoxic drugs (15%) than in those who are not on nephrotoxic drugs (5%). There is no significant difference in the incidence of CIN between Groups B and C. p=0.045 between Groups A and B was noted showing the significance of waiting period in reducing the incidence of CIN. Conclusions: The incidence of CIN is more in patients who underwent contrast studies without stopping nephrotoxic drugs and stoppage of nephrotoxic drugs for 3 days prior to the procedure is beneficial by reducing the incidence of CIN among them.

Effects of 10 Kinds of Nephrotoxic TCM on Kidney Organic Anion Transporter in Mice / 中国药房

OBJECTIVE:To study the effects of 10 kinds of nephrotoxic TCM on three main subtypes(Oat1,Oat2 and Oat3) of kidney organic anion transporter(Oats)in mice. METHODS:A total of 1 840 SPF NIH mice were randomly divided into nor-mal control group(isovolumic pure water),probenecid group(30 kg/mg),sodium carboxymethyl cellulose(CMC)group,Pulsa-tillae radix,Corydalis rhizoma,Aconiti kusnezoffii radix,Aconiti radix,Angelicae pubescentis radix,Gleditsiae spina,Polygo-num cuspidatum,Kansui radix,Platycladi cacumen,Aucklandiae radix high and low dose groups. Mice were treated twice a day for 5 d,ig. After 1 h of the last dosing,they were iv given PAH in tail(30 mg/kg). The PAH pharmacokinetic parameters of the kidney homogenate were determined and the PAH intake in kidney tissue at the time point of 1,5,10,15 and 20 min was detect-ed. The PAH in blood was analyzed by DAS 2.0 software. The grouping and dosing were the same as before,after 1 h of the last dosing,kidney slices were made and put into PAH-buffer. The PAH intake of kidney slices was determined. RESULTS:Compared with normal control group,the t1/2β in C. rhizoma high dose group,A. kusnezoffii high and low dose groups,A. pubescentis high dose group,P. cuspidatum high and low dose groups and P. cacumen group were increased;Vd were all decreased in 10 kinds of TCM high and low dose groups;except for A. pubescentis low dose group,G. spian low dose group and K. radix low dose group, the CL was decreased and AUC0-20 min was increased in all other groups,with significant difference (P<0.01 or P<0.05). Com-pared with normal control group,the content of PAH in kidney tissue in P. radix high dose group,C. rhizoma high dose group,A. kusnezoffii high dose group,A. radix high and low dose groups,A. pubescentis high and low dose groups,G. spina high and low dose groups,P. cuspidatum high and low dose groups,K. radix high and low dose groups,P. cacumen high and low dose groups and A. radix high and low dose groups were increased,with significant difference (P<0.01 or P<0.05). Compared with normal control group,the intake of PAH in kidney slices in C. rhizoma high dose group,A. kusnezoffii high and low dose groups,G. spi-na high and low dose groups,K. radix high dose group,P. ca-cumen high and low dose groups and A. radix high dose group were decreased,with significant difference (P<0.01 or P<0.05). CONCLUSIONS:The 10 kinds of nephrotoxic TCM probably induced kidney injury through inhibiting the Oat1,Oat2 and Oat3 of Oats.

Intoxicação espontânea por Amaranthus hybridus (Amaranthaceae) em bovinos no sul do Rio Grande do Sul / Spontaneous poisoning by Amaranthus hybridus in cattle in southern Rio Grande do Sul

Descreve-se um surto de intoxicação por Amaranthus hybridus ocorrido em bovinos em fevereiro/março de 2013 na região sul do Rio Grande do Sul. A morbidade foi de 48,33%, a mortalidade de 41,66% e a letalidade 86,20%. O diagnóstico da intoxicação por A. hybridus foi baseado nos dados epidemiológicos, sinais clínicos, achados de necropsia e lesões histológicas características da intoxicação por plantas nefrotóxicas e pela presença da planta em grande quantidade na área onde estavam os bovinos. A invasão da pastagem de Brachiaria sp. pela planta alerta para a possibilidade da ocorrência da intoxicação não somente em áreas de resteva com carência de forragem, uma vez que no surto relatado neste trabalho havia abundante disponibilidade de forragem nas áreas onde os bovinos se intoxicaram. No presente caso provavelmente as boas condições climáticas e o solo fertilizado para a plantação da pastagem favoreceram o crescimento da invasora.

An outbreak of Amaranthus hybridus poisoning in cattle was observed in February/March 2013 in southern Rio Grande do Sul, Brazil. The morbidity rate observed was 48.33%, the mortality rate was 41.66% and lethality rate was 86.20%. The diagnosis of A. hybridus poisoning was made based on the epidemiological data, clinical signs, macroscopic and histological lesions characteristic of intoxication by nephrotoxic plants and by the presence of large amounts of the plant in the area where cattle were placed. Invasion of Brachiaria sp. pasture by A. hybridus alerts for the possibility of the occurrence of poisoning not only in stubble areas with lack of forage. In the case reported here there was abundant forage availability in the area where the outbreak occurred. Favorable climatic conditions and fertile soil for planting pasture, probably favored the growth of this invasive species.

Glomerulonefritis Membranosa asociada al uso de analgésicos antiinflamatorios no esteroideos: Reporte de caso / Membranous Glomerulonephritis associated with the use of non-steroidal anti-inflamatory drugs: Case report

Las alteraciones renales producidas por el uso crónico de analgésicos antiinflamatorios no esteroideos (AINE) son diversas, la principal corresponde a nefropatía tubulointersticial que resulta en la necrosis papilar renal. También se han reportado casos de síndrome nefrótico con biopsias que revelan enfermedad de cambios mínimos y muy excepcionalmente una glomerulonefritis membranosa, la cual desaparece al suspender el medicamento. Se presenta el caso de una paciente remitida al Servicio de Nefrología del Hospital Militar Central (HMC) de Bogotá por presentar elevación de los azoados durante una valoración prequirúrgica. Sin evidencia de causa secundaria y después de ser estudiada fue llevada a biopsia renal, encontrando una nefropatía membranosa y como único antecedente el uso crónico de AINE.

The renal effects caused by chronic use of non-steroidal anti-inflammatory drugs (NSAIDs) are diverse; the main corresponds to tubulointerstitial nephropathy resulting in renal papillary necrosis. There have also been reported cases of nephrotic syndrome with biopsy that revealed minimal change disease and exceptionally membranous glomerulonephritis, which resolves after discontinuation of medication. There is a report of a case in Bogota in which a patient was referred to the Nephrology Service of the Central Military Hospital due to elevation of nitrogen compounds during preoperative assessment. No evidence of secondary cause was present and after being studied, a renal biopsy was carried out, membranous nephropathy located; the only positive finding in the past medical history is the chronic use of NSAIDs.

Insuficiência renal aguda nefrotóxica: prevalência, evolução clínica e desfecho / Nephrotoxic acute renal failure: prevalence, clinical course and outcome

Introdução: A insuficiência renal aguda (IRA) nefrotóxica é frequente e importante causa de morbimortalidade. objetivo: Avaliar a prevalência, o curso clínico e o desfecho da IRA nefrotóxica. pacientes e Métodos: Coorte histórica realizada em um hospital de ensino terciário, no período de fevereiro a novembro de 1997. Foram incluídos pacientes acima de 12 anos, com diagnóstico de IRA, acompanhados pela equipe de Interconsulta de Nefrologia. Foram excluídos transplantados renais, portadores de insuficiência renal crônica, dialisados por intoxicação exógena e aqueles transferidos de hospital durante o tratamento. Resultados: Dos 234 pacientes acompanhados, 12% apresentaram IRA nefrotóxica e 24%, IRA multifatorial associada ao uso de drogas nefrotóxicas. Entre as comorbidades mais prevalentes, estão hipertensão arterial, hepatopatias, neoplasias, insuficiência cardíaca congestiva e diabetes mellitus. Quinze por cento necessitaram de diálise, e o tipo mais frequentemente usado foi hemodiálise venovenosa contínua; 42% eram oligúricos, 44,7% evoluíram para óbito e 33% recuperaram a função renal. Antibióticos, AINH e contraste radiológico foram as drogas nefrotóxicas mais prevalentes. Os medicamentos nefrotóxicos implicados foram, em ordem de frequência, vancomicina, aminoglicosídeos, aciclovir, quimioterápicos e contraste radiológico. Hepatopatia foi a única variável com significância estatística (p=0,03, IC= 1,08 a 6,49) em análise multivariada. Na comparação entre IRA nefrotóxica, houve aumento da mortalidade proporcionalmente aos dias de internação. Conclusão: IRA nefrotóxica é frequente, grave e deve ser continuamente monitorada, tanto ambulatorialmente quanto no ambiente intra-hospitalar.

Background: Acute renal failure (ARF) is frequent and important cause of morbidity and mortality. Objective: To evaluate the prevalence, clinical course and outcome of nephrotoxic ARF. Patients and Methods: This historical cohort study conducted in a tertiary hospital in the period from February to November 1997. We included patients over 12 years, diagnosed with ARF, accompanied by a team of nephrologists. Were excluded from renal transplant patients, patients with chronic renal failure, dialysis with exogenous poisoning and those transferred to hospital during treatment. Results: Of 234 patients enrolled, 12% had nephrotoxic ARF, and 24% multifactorial ARF associated with the use of nephrotoxic drugs. Among the most prevalent comorbidities are arterial hypertension, liver diseases, cancer, congestive heart failure and diabetes mellitus. Fifteen percent required dialysis, and the type most often used was continuous venovenous hemodialysis, 42% were oliguric, 44.7% died and 33% recovered renal function. Antibiotics, NSAIDs and contrast radiological nephrotoxic drugs were more prevalent. The nephrotoxic drugs were, in order of frequency, vancomycin, aminoglycosides, acyclovir, chemotherapy and radiological contrast. Liver was the only variable with statistical significance (p = 0.03, CI = 1.08 to 6.49) in multivariate analysis. In comparison nephrotoxic ARF, there was increased mortality proportional to the length of hospitalization. Conclusion: Nephrotoxic ARF is common, serious and must be continuously monitored, both outpatient and in-hospital setting.

Correlation between serum creatinine levels and underlying risk factors for renal disorders in a group of patient undergoing computed tomography using intravenous iodinated radiographic contrast medium.

Intravenous administration of iodinated radiographic contrast media has been known to have nephrotoxic side effects especially patients with renal disorders. Ideally, each patient should have serum creatinine measured before administering the contrast media. This is costly in termed of time and finance and is not practical in our situation here at Siriraj Hospital. The aim of this study is to determine whether serum creatinine levels correlate with the patient's underlying risk factors. The data were collected from 81 patients who were sent for computed tomographic examination. 63 patients (77.78%) were found to have underlying risk factors. These included hypertension 21 cases (33.33%), diabetes mellitus 18 cases (28.57%), administration of chemotoxic drugs 13 cases (20.64%), renal disease 4 cases (6.35%), high serum uric acid 4 cases (6.35%), AIDS 2 cases (3.17%), and ACEI 1 case (1.59%). Of these, only 5 cases (6.17%) were found to have abnormally high serum creatinine levels (over 2 mg/dl), all had underlying risk factors and were over 60 years old.

Study on preventing nephrotoxic injury of amikacin / 实用儿科临床杂志

Objective To search for the methods preventing nephrotoxic injury of amikacin,Methods Case-control research was used in this study. There were 50 normal children in control group The urine routine, the ?2-microglobulin (?2 -M), mosmol and THP in urine and blood, the AIb, rGT and NAG in urine, the renal function and serum concentration of amikacin were determined respectively.The 43 patients with serious illness childten in study group, were divided into 2 groups (Group 1 and group 2 ). Group 1 (23 cases) was treated only with amikacin for 7 days, and group 2 (20 cases) was treated with vitaminC, vitamin E and amikacin for 7 days. Before treatment, the 3rd and 7th day during the treatment, all the items mentioncd above were examined in gtoup 1 and 2.Results The incidences of nephrotoxic injury of amikacin are 87 per cent (20/23)and 55 per cent (11/20) respectively in group 1 and 2. There is significant difference (P

EFFECTS OF TR1TERYGIUM WILFORDII ON THE PRODUCTION OF INTERLEUKIN 2 IN SPLEEN CELL FROM MIC WITH NEPHROTOXIC SERUM NEPHRITIS / 解放军医学杂志

Interleukin 2 (IL-2) activity in spleen lymphocyte and anti-Rabbit IgG antibody from mice with nephrotoxic serum nephritis were examined to investigate immunosuppressive effect of Triterygium Wilfordii (TW), IL-2 bioactivity and serum anti-Rabbit IgG antibody were significantly higher in the group of nephrotoxic serum nephritis. The administration of TW prevented the overproduction of IL-2 and serum anti-Rabbit IgG antibody, and reduced excretion of urinary protein and renal histologic changes.