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J. Health Biol. Sci. (Online) ; 10(1): 1-8, 01/jan./2022. ilus
Article in English | LILACS | ID: biblio-1411263


Objective: This study aimed to evaluate the effects of ovariectomy on glycerol-induced renal changes in rats. Methods: Twenty-four female Wistar rats were submitted to ovariectomized (OVX) or sham surgery. One week after surgery, the animals received an intramuscular injection (8ml/kg) of 50% glycerol or saline (0.15 M) solution. These animals were divided into the following groups (n=6 per group): Sham, sham-operated female rats injected with saline; OVX, ovariectomized female rats injected with saline; Sham+Gly, sham-operated female rats injected with glycerol; OVX+Gly, ovariectomized female rats injected with glycerol. All rats were euthanized 3 days after the injections and the kidneys were removed for histological and immunohistochemical studies. Blood and urine samples were also collected for renal function studies. Results: The OVX+Gly group presented higher creatinine serum levels, as well as greater fractional excretion of sodium and urinary flow than the Sham+Gly group. Histological lesions and tubulointerstitial staining for macrophages, nuclear factor-kappa B, and nitrotyrosine were more pronounced in the renal cortex of the OVX+Gly group compared to the Sham+Gly group. Conclusion: We conclude that ovariectomy aggravated changes in renal function and structure in glycerol-induced acute kidney injury by the intensification of the proinflammatory tissue response.

Objetivo: Avaliar os efeitos da ovariectomia nas alterações renais induzidas pelo glicerol em ratas. Métodos: Vinte e quatro ratas Wistar foram submetidas à ovariectomia (OVX) ou cirurgia sham (intervenção falsa). Uma semana após a cirurgia, os animais receberam injeção intramuscular (8ml/kg) de glicerol a 50% ou solução salina (0,15 M). As ratas foram divididas nos seguintes grupos (n=6 por grupo): Sham, fêmeas sham-operadas e injetadas com solução salina; OVX, fêmeas ovariectomizadas e injetadas com solução salina; Sham+Gly, fêmeas sham-operadas e injetados com glicerol; OVX+Gly, fêmeas ovariectomizadas e injetadas com glicerol. Todas as ratas foram eutanasiadas 3 dias após as injeções e os rins foram removidos para estudos histológicos e imuno-histoquímicos. Amostras de sangue e urina também foram coletadas para estudos de função renal. Resultados: O grupo OVX+Gly apresentou maiores níveis séricos de creatinina, assim como maiores fração de excreção de sódio e fluxo urinário do que o grupo Sham+Gly. As lesões histológicas e imunomarcação tubulointersticial para macrófagos, fator nuclear-kappa B e nitrotirosina foram mais pronunciadas no córtex renal do grupo OVX+Gly em comparação ao grupo Sham+Gly. Conclusão: Concluímos que a ovariectomia agravou as alterações na função e estrutura renal, na lesão renal aguda induzida por glicerol, pela intensificação da resposta tecidual pró-inflamatória.

Ovariectomy , Rhabdomyolysis , Acute Kidney Injury , Glycerol , Inflammation , Kidney
Arch. argent. pediatr ; 120(5): 310-316, oct. 2022. tab
Article in English, Spanish | LILACS, BINACIS | ID: biblio-1390872


Introducción. El compromiso renal (CR) en niñosinternados con enfermedad por coronavirus2019 (COVID-19, por su sigla en inglés) varía entre el 1,2 % y el 44 %. Dado que existe limitada información local, el objetivo primario de este estudio fue estimar la prevalencia de CR en nuestro medio. Población y métodos. Estudio transversalrealizado en 13 centros de Argentina entre marzo y diciembre de 2020. Se incluyeron pacientes internados con COVID-19, de 1 mes a 18 años y que tuvieran al menos una determinación de creatinina sérica y/o de orina completa.Se excluyeron aquellos con enfermedad renal conocida. Se consideró CR la presencia de lesión renal aguda (LRA), proteinuria, hematuria, leucocituria y/o hipertensión arterial (HTA). Resultados. De 528 historias clínicas elegibles, seincluyeron las de 423 pacientes (el 55,0 % de sexo masculino, mediana de edad 5,3 años). El cuadro clínico fue asintomático en el 31 %, leve en el 39,7 %, moderado en el 23,9 %, grave en el 1,2 %, crítico en el 0,7 %, y el 3,5 % presentó síndrome inflamatorio multisistémico pediátrico (SIMP). Dos pacientes (0,47 %) fallecieron. La prevalencia de CR fue del 10,8 % (intervalo de confianza 95% 8,2-14,2), expresada por leucocituria (16,9 %), proteinuria (16,0 %), hematuria (13,2 %), HTA (3,7 %) y LRA (2,3 %). Ninguno requirió diálisis. Presentar CR se asoció (p <0,0001) con formas graves de enfermedad. Conclusión. La prevalencia de CR en pacientes pediátricos internados con COVID-19 en 13 centros de nuestro país fue del 10,8 % y predominó en las formas clínicas graves.

Introduction. Renal involvement among pediatric patients with coronavirus disease 2019 (COVID-19) ranges between 1.2% and 44%. Given the limited information available locally, the primary objective of this study was to estimate the prevalence of renal involvement in our setting. Population and methods. Cross-sectional study conducted in 13 Argentine sites between March and December 2020. Patients aged 1 month to 18 years hospitalized due to COVID-19 and with at least one measurement of serum creatinine and/or a urinalysis were included. Those with a known kidney disease were excluded. Renal involvement was defined as the presence of acute kidney injury (AKI), proteinuria, hematuria, leukocyturia and/or arterial hypertension (HTN). Results. Among 528 eligible medical records, 423 patients were included (55.0% were males; median age: 5.3 years). The clinical presentation was asymptomatic in 31%; mild, in 39.7%; moderate, in 23.9%; severe, in 1.2%; critical, in 0.7%; and 3.5% had multisystem inflammatory syndrome in children (MIS-C). Two patients (0.47%) died. The prevalence of renal involvement was 10.8% (95% confidence interval: 8.2­14.2); it was described as leukocyturia (16.9%), proteinuria (16.0%), hematuria (13.2%), HTN (3.7%), and AKI (2.3%). No patient required dialysis. Renal involvement was associated with severe forms of disease (p < 0.0001). Conclusion. The prevalence of renal involvement among pediatric patients hospitalized due to COVID-19 in 13 Argentine sites was 10.8%; severe forms of disease prevailed.

Humans , Infant , Child, Preschool , Child , Adolescent , Acute Kidney Injury/etiology , Acute Kidney Injury/epidemiology , COVID-19/complications , COVID-19/epidemiology , Hypertension/epidemiology , Proteinuria/epidemiology , Prevalence , Cross-Sectional Studies , Retrospective Studies , Systemic Inflammatory Response Syndrome , Creatinine , SARS-CoV-2 , Hematuria/etiology , Hematuria/epidemiology
J. coloproctol. (Rio J., Impr.) ; 42(2): 187-189, Apr.-June 2022. ilus
Article in English | LILACS | ID: biblio-1394417


Introduction: McKittrick-Wheelock syndrome is a rare condition that arises from a hypersecretory state secondary to large colorectal tumors, mainly villous adenomas, leading to an electrolytic disorder associated with chronic diarrhea that usually persists for years. It is a relatively unknown disease that can lead to severe complications such as acute kidney injury, severe hyponatremia, and hypokalemia. In fact, it causes death in most untreated cases. Surgical removal of the tumor is the most successful treatment, and symptoms tend to disappear after proper management. Case Report: A 62-year-old man with a 2-year history of mucoid diarrhea preceded by abdominal pain presented with acute kidney injury, hyponatremia, and hypokalemia. A digital rectal examination and sigmoidoscopy were performed, and revealed a large laterally-spreading tumor in the rectum. Further investigation showed a rectal tubulovillous adenoma with secondary McKittrick-Wheelock syndrome. An anterior resection of the rectum with a colonic J-pouch and a diverting ileostomy were performed, and the patient improved with the resolution of the renal failure and electrolyte disturbances. The histopathological analysis revealed an invasive rectal adenocarcinoma. Discussion: McKittrick-Wheelock syndrome is a condition with a low incidence that needs early intervention and proper diagnosis. It is of extreme importance that this disease is included in the differential diagnoses for chronic diarrhea associated with an electrolytic disorder. (AU)

Humans , Male , Middle Aged , Rectal Neoplasms/complications , Water-Electrolyte Imbalance/etiology , Adenocarcinoma/complications , Diarrhea/etiology , Acute Kidney Injury/etiology , Syndrome
Int. braz. j. urol ; 48(2): 284-293, March-Apr. 2022. tab, graf
Article in English | LILACS | ID: biblio-1364965


ABSTRACT A major challenge in the management of ureteropelvic junction obstruction (UPJO) is the selection of patients who would benefit from surgical treatment. Tissue inhibitor metalloproteinase-2 (TIMP-2) and insulin-like growth factor-binding protein 7 (IGFBP7) indicate renal cell stress and are associated with cell cycle arrest. The [TIMP-2] [IGFBP7] ratio (Nephrocheck®) has been recently applied in patients in intensive care units patients to predict the development of acute kidney injury. In this study, we evaluated the performance of these biomarkers performance to distinguishing obstructive hydronephrosis (HN) from non-obstructive HN. Materials and Methods: Consecutive patients with UPJO were enrolled in this study. Urinary [TIMP-2] [IGFBP7] and clinical characteristics (hydronephrosis grade, differential renal function, and drainage half-time) were measured in the following groups: 26 children with obstructive HN at initial diagnosis (group 1A) and after six months of dismembered pyeloplasty (group 1B); 22 children with non-obstructive HN (group 2), and 26 children without any urinary tract condition, as the control group (group 3). Results: Comparing the initial samples, [TIMP-2] [IGFBP7] had higher levels in the HN groups and lower levels in the control group; however, no difference was observed between the HN groups (obstructive vs. non-obstructive). After six months of follow-up, patients who underwent dismembered pyeloplasty showed stability in the urinary concentration of [TIMP-2] [IGFBP7]. All patients with [TIMP-2] [IGFBP7] higher than 1.0 (ng/mL)2/1000 had diffuse cortical atrophy on ultrasonography. Conclusions: We showed that urinary levels of urinary [TIMP-2] [IGFBP7] are higher in children with HN than controls. Nephrocheck® is not reliable in predicting the need for surgical intervention for pediatric patients with UPJO.

Humans , Child , Tissue Inhibitor of Metalloproteinase-2/blood , Acute Kidney Injury/diagnosis , Acute Kidney Injury/etiology , Biomarkers/urine , Insulin-Like Growth Factor Binding Proteins/urine , Tissue Inhibitor of Metalloproteinase-2/urine , Matrix Metalloproteinase 2 , Kidney/physiology
Medicina UPB ; 41(1): 80-84, mar. 2022.
Article in Spanish | LILACS, COLNAL | ID: biblio-1362715


El envenenamiento debido a picadora de escorpiones es reportado en diferentes países de Suramérica, en algunos, como México, es un problema de salud pública. En Colombia el accidente por escorpiones no es de reporte obligatorio, por lo que hay subregistro de casos. Los accidentes por este tipo de animales ponzoñosos se asocian a manifestaciones locales, y en casos de gravedad moderada a severa, a problemas cardiovasculares y neurológicos. Sin embargo, es importante reconocer manifestaciones que, aunque reportadas con menos frecuencia, implican gran morbilidad, como la pancreatitis y las alteraciones renales, entre las que está la nefritis. Se reporta el caso de un varón de 46 años, que presentó un accidente por Tytus, con nefritis intersticial. Este es el primer reporte de esta complicación en Colombia. Nuestro objetivo principal es resaltar la importancia de una pronta identificación de casos y un oportuno inicio del tratamiento por parte del personal de la salud, que permitan disminuir la morbilidad y mortalidad de estos pacientes.

Scorpion poisoning is reported in different countries in South America, especially in Mexico, where it has become a public health issue. In Colombia this type of accident is not mandatory to report, therefore, there is underreporting of cases. Accidents caused by these poisonous animals are mainly associated with local manifestations and, in cases of moderate to severe severity, to cardiovascular and neurological problems. Nevertheless, it is important to recognize other manifestations which, despite being reported less frequently, are associated with high morbidity such as pancreatitis and renal alterations, among which is nephritis. The case of a 46-year-old male patient is reported, who had an accident due to Tytus and presented interstitial nephritis. This is the first report of this complication in Colombia, and based on this, the main objective is to highlight the importance of prompt identification and treatment by health personnel, in order to reduce morbidity and mortality in these patients.

O envenenamento devido a picadora de escorpiões é reportado em diferentes países da América Latina, em alguns, como México, é um problema de saúde pública. Na Colômbiao acidente por escorpiões não é de reporte obrigatório, porque há sub-registro de casos. Os acidentes por este tipo de animais peçonhentos se associam a manifestações locais, e em casos de gravidade moderada a severa, a problemas cardiovasculares e neurológicos. Entretanto, é importante reconhecer manifestações que, embora reportadas com menos frequência, implicam grande morbilidade, como a pancreatite e as alterações renais, entre as que está a nefrite. Se reporta o caso de um homem de 46 anos, que apresentou um acidente por Tytus, com nefrite intersticial. Este é o primeiro reporte desta complicação na Colômbia. Nosso objetivo principal é ressaltar a importância de uma breve identificação de casos e um oportuno início do tratamento por parte do pessoal da saúde, que permitam diminuir a morbilidade e mortalidade destes pacientes.

Humans , Animals , Scorpions , Acute Kidney Injury , Scorpion Stings , Animals, Poisonous , Nephritis
Bol. latinoam. Caribe plantas med. aromát ; 21(2): 256-267, mar. 2022. tab, ilus
Article in English | LILACS | ID: biblio-1395304


Gentamicin induced acute nephrotoxicity (GIAN) is considered as one of the important causes of acute renal failure. In recent years' great effort has been focused on the introduction of herbal medicine as a novel therapeutic agent for prevention of GIAN. Hence, the current study was designed to investigate the effect of green coffee bean extract (GCBE) on GIAN in rats. Results of the present study showed that rat groups that received oral GCBE for 7 days after induction of GIAN(by a daily intraperitoneal injection of gentamicin for 7days), reported a significant improvement in renal functions tests when compared to the GIAN model groups. Moreover, there was significant amelioration in renal oxidative stress markers (renal malondialdehyde, renal superoxide dismutase) and renal histopathological changes in the GCBE-treated groups when compared to GIAN model group. These results indicate that GCBE has a potential role in ameliorating renal damage involved in GIAN.

La nefrotoxicidad aguda inducida por gentamicina (GIAN) se considera una de las causas importantes de insuficiencia renal aguda. En los últimos años, el gran esfuerzo se ha centrado en la introducción de la medicina herbal como un nuevo agente terapéutico para la prevención de GIAN. Por lo tanto, el estudio actual fue diseñado para investigar el efecto del extracto de grano de café verde (GCBE) sobre la GIAN en ratas. Los resultados del presente estudio mostraron que los grupos de ratas que recibieron GCBE oral durante 7 días después de la inducción de GIAN (mediante una inyección intraperitoneal diaria de gentamicina durante 7 días), informaron una mejora significativa en las pruebas de función renal en comparación con los grupos del modelo GIAN. Además, hubo una mejora significativa en los marcadores de estrés oxidativo renal (malondialdehído renal, superóxido dismutasa renal) y cambios histopatológicos renales en los grupos tratados con GCBE en comparación con el grupo del modelo GIAN. Estos resultados indican que GCBE tiene un papel potencial en la mejora del daño renal involucrado en GIAN.

Animals , Male , Rats , Plant Extracts/administration & dosage , Gentamicins/toxicity , Coffea/chemistry , Acute Kidney Injury/chemically induced , Acute Kidney Injury/prevention & control , Antioxidants/administration & dosage , Superoxide Dismutase/analysis , Plant Extracts/pharmacology , Rats, Wistar , Coffee , Oxidative Stress/drug effects , Kidney/drug effects , Kidney/pathology , Kidney Function Tests , Malondialdehyde/analysis , Antioxidants/pharmacology
Chinese Journal of Cardiology ; (12): 698-704, 2022.
Article in Chinese | WPRIM | ID: wpr-940909


Objectives: To explore the efficacy and safety of emergency transcatheter aortic valve replacement (TAVR). Methods: Data of patients who underwent emergency TAVR in eight centers, namely Fuwai Hospital, Wuhan Asia Heart Hospital, Xijing Hospital, Union Hospital Affiliated to Tongji Medical College of Huazhong University of Science and Technology, Guangdong Provincial People's Hospital, Zhongshan Hospital Affiliated to Fudan University, the First Affiliated Hospital of Zhengzhou University, the Second Xiangya Hospital of Central South University, between May 2017 and December 2020 were retrospectively analyzed. The use of mechanical circulatory support system (MCS) and the results of laboratory tests (N-terminal B-type natriuretic peptide (NT-proBNP)) and echocardiography (mean aortic valve cross valve pressure difference and left ventricular ejection fraction) before and after operation were collected. The primary endpoint was all-cause death, and the secondary endpoints were stroke, major bleeding, major vascular complications, myocardial infarction, permanent pacemaker implantation, and acute renal injury. Device success was caculated, which refered to absence of procedural mortality and correct positioning of a single prosthetic heart valve into the proper anatomical location and intended performance of the prosthetic heart valve (mean aortic valve gradient<20 mmHg(1 mmHg=0.133 kPa) or peak velocity<3 m/s, with no moderate or severe prosthetic valve regurgitation). Kaplan-Meier survival curve was used to estimate the survival rate of patients during follow-up. Results: This study included 48 patients. The age was (72.5±8.1) years, and 34 patients were males (70.8%). Device success rate was 91.7% (44/48). The mean aortic valve transvalvular pressure was significantly decreased after operation ((12.3±6.4)mmHg vs. (60.2±23.8)mmHg, P<0.000 1). Left ventricular ejection fraction was significantly increased ((41.5±11.7)% vs. (31.0±11.3)%, P<0.000 1). NT-proBNP significantly decreased (3 492.0 (1 638.8, 7 165.5) ng/L vs. 12 418.5 (6 693.8, 35 000.0) ng/L, P<0.000 1). In-hospital all-cause mortality was 8.3% (4/48). During hospitalization, the rate of stroke was 2.1% (1/48), major bleeding was 6.3% (3/48), major vascular complications was 10.4% (5/48), myocardial infarction was 4.2% (2/48), permanent pacemaker implantation was 6.3% (3/48), and the rate of acute renal injury was 12.5% (6/48). MCS was used in 20 patients (41.7%). The median follow-up time was 196 days. During the follow-up, one patient died (due to systemic metastasis of pancreatic cancer), two cases suffered new myocardial infarction and one case received permanent pacemaker implantation. The survival rate of 30 days, 1 year and 2 years after the operation were 91.7% (44/48), 89.6% (43/48), 89.6% (43/48), respectively. Conclusion: Emergency TAVR may be a safe and effective treatment for patients with severe decompensated aortic valve stenosis.

Acute Kidney Injury , Aged , Aged, 80 and over , Aortic Valve/surgery , Aortic Valve Stenosis/surgery , Female , Heart Valve Prosthesis , Humans , Male , Middle Aged , Myocardial Infarction/surgery , Retrospective Studies , Risk Factors , Stroke , Stroke Volume , Transcatheter Aortic Valve Replacement/methods , Treatment Outcome , Ventricular Function, Left
Frontiers of Medicine ; (4): 389-402, 2022.
Article in English | WPRIM | ID: wpr-939873


Few studies have described the key features and prognostic roles of lung microbiota in patients with severe community-acquired pneumonia (SCAP). We prospectively enrolled consecutive SCAP patients admitted to ICU. Bronchoscopy was performed at bedside within 48 h of ICU admission, and 16S rRNA gene sequencing was applied to the collected bronchoalveolar lavage fluid. The primary outcome was clinical improvements defined as a decrease of 2 categories and above on a 7-category ordinal scale within 14 days following bronchoscopy. Sixty-seven patients were included. Multivariable permutational multivariate analysis of variance found that positive bacteria lab test results had the strongest independent association with lung microbiota (R2 = 0.033; P = 0.018), followed by acute kidney injury (AKI; R2 = 0.032; P = 0.011) and plasma MIP-1β level (R2 = 0.027; P = 0.044). Random forest identified that the families Prevotellaceae, Moraxellaceae, and Staphylococcaceae were the biomarkers related to the positive bacteria lab test results. Multivariable Cox regression showed that the increase in α-diversity and the abundance of the families Prevotellaceae and Actinomycetaceae were associated with clinical improvements. The positive bacteria lab test results, AKI, and plasma MIP-1β level were associated with patients' lung microbiota composition on ICU admission. The families Prevotellaceae and Actinomycetaceae on admission predicted clinical improvements.

Acute Kidney Injury/complications , Bacteria/classification , Chemokine CCL4/blood , Community-Acquired Infections/microbiology , Humans , Lung , Microbiota/genetics , Pneumonia, Bacterial/diagnosis , Prognosis , RNA, Ribosomal, 16S/genetics
Chinese Journal of Burns ; (6): 130-136, 2022.
Article in Chinese | WPRIM | ID: wpr-935987


Objective: To investigate the changes of high density lipoprotein cholesterol (HDL-C) in sepsis patients and its early predictive value for secondary acute kidney injury (AKI) in such patients. Methods: A retrospective case series study was conducted. From June 2019 to June 2021, 232 sepsis patients who met the inclusion criteria were admitted to the Second Hospital of Hebei Medical University, including 126 males and 106 females, aged 24 to 71 years. According to whether complicating secondary AKI, the patients were divided into non-AKI group (n=158) and AKI group (n=74). Data of patients between the two groups were compared and statistically analyzed with independent sample t test or chi-square test, including the sex, age, body mass index (BMI), body temperature, heart rate, primary infection site, combined underlying diseases, acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ) score and sepsis-related organ failure assessment (SOFA) score at admission, and the serum levels of C-reactive protein (CRP), procalcitonin, creatinine, cystatin C, and HDL-C measured at diagnosis of sepsis. The multivariate logistic regression analysis was performed on the indicators with statistically significant differences between the two groups to screen the independent risk factors for developing secondary AKI in 232 sepsis patients, and the joint prediction model was established based on the independent risk factors. The receiver operating characteristic (ROC) curve of the independent risk factors and the joint prediction model predicting secondary AKI in 232 sepsis patients were drawn, and the area under the curve (AUC), the optimal threshold, and the sensitivity and specificity under the optimal threshold were calculated. The quality of the above-mentioned AUC was compared by Delong test, and the sensitivity and specificity under the optimal threshold were compared using chi-square test. Results: The sex, age, BMI, body temperature, heart rate, primary infection site, combined underlying diseases, and CRP level of patients between the two groups were similar (P>0.05). The procalcitonin, creatinine, cystatin C, and scores of APACHE Ⅱ and SOFA of patients in AKI group were all significantly higher than those in non-AKI group (with t values of -3.21, -16.14, -12.75, -11.13, and -12.88 respectively, P<0.01), while the HDL-C level of patients in AKI group was significantly lower than that in non-AKI group (t=6.33, P<0.01). Multivariate logistic regression analysis showed that creatinine, cystatin C, and HDL-C were the independent risk factors for secondary AKI in 232 sepsis patients (with odds ratios of 2.45, 1.68, and 2.12, respectively, 95% confidence intervals of 1.38-15.35, 1.06-3.86, and 0.86-2.56, respectively, P<0.01). The AUCs of ROC curves of creatinine, cystatin C, HDL-C, and the joint prediction model for predicting secondary AKI in 232 sepsis patients were 0.69, 0.79, 0.89, and 0.93, respectively (with 95% confidence intervals of 0.61-0.76, 0.72-0.85, 0.84-0.92, and 0.89-0.96, respectively, P values all below 0.01); the optimal threshold were 389.53 μmol/L, 1.56 mg/L, 0.63 mmol/L, and 0.48, respectively; the sensitivity under the optimal threshold were 76.6%, 81.4%, 89.7%, and 95.5%, respectively; the specificity under the optimal threshold values were 78.6%, 86.7%, 88.6%, and 96.6%, respectively. The AUC quality of cystatin C was significantly better than that of creatinine (z=2.34, P<0.05), the AUC quality and sensitivity and specificity under the optimal threshold of HDL-C were all significantly better than those of cystatin C (z=3.33, with χ2 values of 6.43 and 7.87, respectively, P<0.01) and creatinine (z=5.34, with χ2 values of 6.32 and 6.41, respectively, P<0.01); the AUC quality and sensitivity and specificity under the optimal threshold of the joint prediction model were all significantly better than those of creatinine, cystatin C, and HDL-C (with z values of 6.18, 4.50, and 2.06, respectively, χ2 values of 5.31, 7.23, 3.99, 6.56, 7.34, and 4.00, respectively, P<0.05 or P<0.01). Conclusions: HDL-C level in sepsis patients with secondary AKI is significantly lower than that in patients without secondary AKI. This is an independent risk factor for secondary AKI in sepsis patients with a diagnostic value being superior to that of creatinine and cystatin C. The combination of the aforementioned three indicators would have higher predicative valuable for secondary AKI in sepsis patients.

Acute Kidney Injury/etiology , Adult , Aged , Cholesterol, HDL , Female , Humans , Male , Middle Aged , Prognosis , ROC Curve , Retrospective Studies , Sepsis/diagnosis , Young Adult
Chinese Journal of Surgery ; (12): 466-471, 2022.
Article in Chinese | WPRIM | ID: wpr-935623


Objective: To investigate the prognosis factors for death within 90 days after discharge in patients with acute kidney injury(AKI) treated requiring continuous renal replacement therapy(CRRT) undergoing surgery for acute Standford type A aortic dissection. Methods: The clinic data of 126 patients undergoing CRRT for postoperative AKI after acute type A aortic dissection surgery in the Center for Cardiac Intensive Care, Beijing Anzhen Hospital from July 2016 to February 2019 were analyzed retrospectively. There were 83 males and 43 females, aging (52.9±11.2) years(range: 25 to 70 years). The patients' demographic characteristics, disease-related information, perioperative data, laboratory indexes during CRRT, complications, and survival information within 90 days after discharge were recorded. Independent prognosis factors for death within 90 days of discharge were determined by Kaplan-Meier survival analysis, univariate and multifactorial Cox regression analysis. Results: Totally 57 of 126 patients(45.2%) died over the first 90 days after discharge. Kaplan-Meier survival analysis and univariate Cox regression analysis showed that there were significant differences between the non-survival and survival group including ≥65 years old, high lactate values 12 hours after CRRT, pulmonary infection, liver dysfunction, presence of permanent neurological complications, and postoperative ejection fraction(EF)<45%. Multifactorial Cox regression analysis revealed that ≥65 years old(HR=2.14, 95%CI: 1.09 to 4.21, P=0.03), high lactate values 12 hours after CRRT(HR=1.13, 95%CI: 1.06 to 1.20, P=0.01) and postoperative EF<45%(HR=2.21, 95%CI: 1.09 to 4.51, P=0.03) were independent prognosis factors for patients' death within 90 days after hospital discharge. Conclusions: ≥65 years old, high lactate values 12 hours after CRRT and postoperative EF<45% are independent prognosis factors for death within 90 days after discharge in patients undergoing CRRT for AKI after acute type A aortic dissection surgery. Proper identification and management of prognosis factors could be beneficial to improve patients' outcomes.

Acute Kidney Injury/therapy , Aged , Aneurysm, Dissecting/surgery , Continuous Renal Replacement Therapy , Female , Humans , Lactates , Male , Patient Discharge , Prognosis , Renal Replacement Therapy/adverse effects , Retrospective Studies , Risk Factors
Article in English | WPRIM | ID: wpr-928600


OBJECTIVES@#To evaluate the effect of fluid load on the prognosis of children with sepsis-associated acute kidney injury (AKI) undergoing continuous renal replacement therapy (CRRT).@*METHODS@#A total of 121 children who underwent CRRT for sepsis-associated AKI from August 2018 to March 2021 were enrolled in the retrospective study. According to the fluid load from admission or disease progression to CRRT, they were divided into three groups: low fluid load (fluid load: <5%; n=35), high fluid load (fluid load: 5% - <10%; n=35), and fluid overload (fluid load: ≥10%; n=51). Baseline data and clinical biochemical data before CRRT were collected for comparison and analysis. The Kaplan-Meier survival curve analysis was used for comparison of 28-day survival between groups. The multivariate logistic regression model was used to identify the influencing factors for the prognosis of the children.@*RESULTS@#The survival analysis showed that the fluid overload group had a significantly higher 28-day mortality rate than the low fluid load and high fluid load groups (P<0.05). The multivariate logistic regression analysis showed that an increase in fluid overload volume was a risk factor for increased 28-day mortality in the fluid overload group, while earlier initiation of CRRT was a protective factor (P<0.05).@*CONCLUSIONS@#Fluid overload before CRRT may increase the mortality in children with sepsis-associated AKI, and CRRT should be performed for these children as early as possible.

Acute Kidney Injury/therapy , Child , Continuous Renal Replacement Therapy , Humans , Prognosis , Retrospective Studies , Sepsis/therapy
Acta Physiologica Sinica ; (6): 73-79, 2022.
Article in Chinese | WPRIM | ID: wpr-927583


Histone acetylation is one of the epigenetic modifications. Histone acetylation, which is catalyzed by histone acetyltransferases and negatively regulated by histone deacetylases, plays an important role in a variety of cellular physiological and pathophysiological processes. Recent studies have shown that histone deacetylases are involved in a variety of pathophysiological responses to acute kidney injury, such as apoptosis, dedifferentiation, proliferation and regeneration. This article reviews the role and underlying mechanism of histone deacetylases in acute kidney injury induced by ischemia reperfusion, nephrotoxicants, sepsis and rhabdomyolysis.

Acetylation , Acute Kidney Injury , Histone Acetyltransferases/metabolism , Histone Deacetylases/metabolism , Humans , Protein Processing, Post-Translational
Acta Physiologica Sinica ; (6): 39-46, 2022.
Article in Chinese | WPRIM | ID: wpr-927579


Acute kidney injury (AKI) is a common clinical syndrome and an independent risk factor of chronic kidney disease and end-stage renal failure. At present, the treatments of AKI are still very limited and the morbidity and mortality of AKI are rising. Non-coding RNAs (ncRNAs), including microRNAs, long non-coding RNAs and circular RNAs (circRNAs), are RNAs that are transcribed from the genome, but not translated into proteins. It has been widely reported that ncRNA is involved in AKI caused by ischemia reperfusion injury (IRI), drugs and sepsis through different molecular biological mechanisms, such as apoptosis and oxidative stress response. Therefore, ncRNAs are expected to become a new target for clinical prevention and treatment of AKI and a new biomarker for early warning of the occurrence and prognosis of AKI. Here, the role and mechanism of ncRNA in AKI and the research progress of ncRNA as biomarkers are reviewed.

Acute Kidney Injury/metabolism , Humans , MicroRNAs/metabolism , RNA, Circular , RNA, Long Noncoding/genetics , RNA, Untranslated/genetics , Reperfusion Injury/genetics
Acta Physiologica Sinica ; (6): 28-38, 2022.
Article in Chinese | WPRIM | ID: wpr-927578


Acute kidney injury (AKI) is a common critical clinical disease characterized by a sharp decline of renal function. Ischemia-reperfusion (IR) is one of the main causes of AKI. The mortality of AKI remains high due to the lack of early diagnosis and cause specific treatment. IR rapidly initiates innate immune responses, activates complement and innate immune cells, releasing a large number of injury-related molecules such as high mobility group box-1 (HMGB1), inflammatory mediators such as caspase-3, and then recruits immune inflammatory cells including M1 macrophages (Mϕ) to the microenvironment of injury, causing apoptosis and necrosis of renal tubular epithelial cells (TECs). Dead cells and associated inflammation further activate the adaptive immune system, which not only aggravates tissue damage, but also initiates M2 Mϕ participated inflammatory clearance, tissue repair and regeneration. Mϕ, professional phagocytes, and TECs, semi-professional phagocytes, can phagocytose around damaged cells including apoptotic Mϕ and TECs, which are key innate immune cells to regulate the outcome of injury, repair or fibrosis. In recent years, it has been found that erythropoietin (EPO) not only binds to the homodimeric receptor (EPOR)2 to induce erythropoiesis, but also binds to the heterodimeric receptor EPOR/βcR, also known as innate repair receptor, which plays renoprotective roles. Properdin is the only positive regulator in the complement activation of alternative pathway. It also can effectively identify and bind to early apoptotic T cells and facilitate phagocytic clearing by Mϕ through a non-complement activation-dependent mechanism. Our previous studies have shown that Mϕ and TECs associated with EPO and its receptors and properdin are involved in IR injury and repair, but the underlying mechanism needs to be further explored. As an important carrier of cell-to-cell signal transmission, exosomes participate in the occurrence and development of a variety of renal diseases. The role of exosomes involved in the interaction between Mϕ and TECs in IR-induced AKI is not fully defined. Based on the available results in the role of Mϕ and TECs in renal IR-induced AKI, this review discussed the role of Mϕ polarization and interaction with TECs in renal IR injury, as well as the participation of EPO and its receptors, properdin and exosomes.

Acute Kidney Injury/metabolism , Animals , Epithelial Cells/metabolism , Humans , Ischemia/metabolism , Kidney , Macrophages/physiology , Mice , Mice, Inbred C57BL , Reperfusion , Reperfusion Injury
Acta Physiologica Sinica ; (6): 4-14, 2022.
Article in Chinese | WPRIM | ID: wpr-927576


Acute kidney injury (AKI) refers to a clinical syndrome in which renal function declines rapidly in a short period of time caused by various pathological factors. During the development of AKI, renal tubules with the functions of reabsorption and excretion are prone to cell death due to external pathological stimuli, which is an important cause of impaired renal function. In recent years, a variety of new cell death pathways have been gradually recognized. Researchers have now found that regulated cell death (RCD), such as necroptosis, pyroptosis and ferroptosis, are important regulatory mechanisms of AKI. This article will summarize the research advances of various types of RCD involved in the process of AKI, aiming to deepen the understanding of AKI and provide innovative thoughts for the clinical treatment of AKI.

Acute Kidney Injury/metabolism , Cell Death , Humans , Kidney/metabolism , Necroptosis , Necrosis/pathology , Regulated Cell Death
Chinese Medical Journal ; (24): 757-766, 2022.
Article in English | WPRIM | ID: wpr-927566


Acute kidney injury (AKI), characterized by acute renal dysfunction, is an increasingly common clinical problem and an important risk factor in the subsequent development of chronic kidney disease (CKD). Regardless of the initial insults, the progression of CKD after AKI involves multiple types of cells, including renal resident cells and immune cells such as macrophages. Recently, the involvements of macrophages in AKI-to-CKD transition have garnered significant attention. Furthermore, substantial progress has also been made in elucidating the pathophysiological functions of macrophages from the acute kidney to repair or fibrosis. In this review, we highlight current knowledge regarding the roles and mechanisms of macrophage activation and phenotypic polarization, and transdifferentiation in the development of AKI-to-CKD transition. In addition, the potential of macrophage-based therapy for preventing AKI-to-CKD transition is also discussed.

Acute Kidney Injury/drug therapy , Disease Progression , Humans , Kidney , Macrophages , Renal Insufficiency, Chronic
Acta Paul. Enferm. (Online) ; 35: eAPE0168345, 2022. tab
Article in Portuguese | LILACS, BDENF | ID: biblio-1402916


Resumo Objetivo Identificar a prevalência de complicações intradialíticas em pacientes com injúria renal aguda (IRA) na unidade de terapia intensiva (UTI) e seus fatores associados; verificar quais foram as condutas profissionais imediatas adotadas pela equipe. Métodos Estudo retrospectivo, com abordagem quantitativa, realizado na UTI de um hospital universitário e público, localizado na região sul do Brasil. Foram incluídos neste estudo todos os pacientes internados na UTI com diagnóstico médico de IRA dialítica entre janeiro de 2011 e dezembro de 2016. Realizou-se coleta de dados contidos em prontuários. Considerou-se como estatisticamente significativo p-valor < 0,05. Resultados Foram incluídos 76 pacientes, sendo a maioria com idade entre 41 e 65 anos (n= 44; 57,9%). Todos realizaram hemodiálise intermitente. Do total de pacientes, 71 (93,4%) apresentaram complicações durante a hemodiálise, sendo hipotensão intradialítica a complicação mais prevalente, acometendo 51 (71,8%) pacientes. A conduta profissional imediata mais frequente para a referida complicação foi instalação e/ou controle da infusão do medicamento vasoativo (100% dos casos). Idade, ventilação mecânica, IRA relacionada à sepse, número e tempo de duração (horas) das sessões dialíticas, bem como o momento de início da diálise foram significativamente associados à frequência das complicações intradialíticas. Conclusão Os pacientes apresentaram alta prevalência de complicações intradialíticas, sendo que as condutas profissionais imediatas mais frequentes objetivaram reverter hipotensão intradialítica e foram realizadas majoritariamente pela equipe de enfermagem. Os fatores associados às complicações estiveram relacionados à gravidade dos pacientes no início da diálise.

Resumen Objetivo Identificar la prevalencia de complicaciones intradialíticas en pacientes con insuficiencia renal aguda (IRA) en la unidad de cuidados intensivos (UCI) y sus factores asociados; verificar qué conductas profesionales inmediatas fueron adoptadas por el equipo. Métodos Estudio retrospectivo, con abordaje cuantitativo, realizado en la UCI de un hospital universitario y público, ubicado en la región sur de Brasil. Se incluyeron en este estudio todos los pacientes ingresados a la UCI con diagnóstico médico de IRA dialítica entre enero de 2011 y diciembre de 2016. Se realizó la recopilación de datos de los prontuarios. Considerados estadísticamente significante p-valor < 0,05. Resultados Se incluyeron 76 pacientes, en su mayoría con edades entre 41 y 65 años (n= 44; 57,9 %). Todos realizaron hemodiálisis intermitente. Del total de pacientes, 71 (93,4 %) presentaron complicaciones durante la hemodiálisis, con hipotensión intradialítica como la complicación más prevalente, acometiendo a 51 (71,8 %) pacientes. La conducta profesional inmediata más frecuente para la referida complicación fue la instalación o el control de la infusión del medicamento vasoactivo (100 % de los casos). Edad, ventilación mecánica, IRA relacionada a la sepsis, número y tiempo de duración (horas) de las sesiones dialíticas, así como el momento de inicio de la diálisis estuvieron significativamente asociados con la frecuencia de las complicaciones intradialíticas. Conclusión Los pacientes presentaron alta prevalencia de complicaciones intradialíticas y las conductas profesionales inmediatas más frecuentes tuvieron el objetivo de revertir la hipotensión intradialítica y se realizaron mayoritariamente por el equipo de enfermería. Los factores asociados a las complicaciones se relacionaron con la gravedad de los pacientes al inicio de la diálisis.

Abstract Objective To identify the prevalence of intradialytic complications in patients with acute kidney injury (AKI) in an Intensive Care Unit (ICU) and their associated factors and verify what were the immediate professional behaviors adopted by the team. Methods This is a quantitative retrospective study, carried out in the ICU of a university and public hospital, located in southern Brazil. All patients admitted to an ICU with a medical diagnosis of dialysis AKI between January 2011 and December 2016 were included in this study. Data were collected from medical records. A statistical difference with a p-value < 0.05 was considered significant. Results A total of 76 patients were included, the majority aged between 41 and 65 years (n=44; 57.9%). All underwent intermittent hemodialysis. Of the total number of patients, 71 (93.4%) had complications during hemodialysis, with intradialytic hypotension being the most prevalent complication, affecting 51 (71.8%) patients. The most frequent immediate professional conduct for this complication was installation and/or control of vasoactive drug infusion (100% of cases). Age, mechanical ventilation, sepsis-related AKI, number and duration (hours) of dialysis sessions, as well as the time of starting dialysis were significantly associated with the frequency of intradialytic complications. Conclusion Patients had a high prevalence of intradialytic complications, and the most frequent immediate professional procedures aimed at reversing intradialytic hypotension and were performed mainly by the nursing team. Factors associated with complications were related to the severity of patients at the beginning of dialysis.

Humans , Male , Female , Adult , Middle Aged , Aged , Renal Dialysis , Acute Kidney Injury/complications , Nephrology Nursing , Intensive Care Units , Nursing Care/methods , Medical Records , Retrospective Studies
Horiz. enferm ; 33(1): 96-108, 2022.
Article in Spanish | LILACS | ID: biblio-1367866


El daño renal está reconocido como la reducción de la función renal, el cual se ve generalmente reflejado por una caída en la diuresis. A nivel mundial, el porcentaje de personas que padece daño renal va en aumento, esto debido a múltiples aspectos. En este sentido, se reconoce que el personal de enfermería es quien idóneamente tiene un gran rol en la educación de la población, para la prevención del daño renal agudo, previniendo con ello el daño renal crónico. De esta manera, en el escrito se abordan aspectos generales más relevantes, de la hidratación, la alimentación, la actividad física, el consumo de alcohol, la automedicación y la prevención de infecciones de las vías urinarias, como parte de los aspectos modificables y en los que las personas tienen directa injerencia en sus acciones, con la debida información, con los que el personal de enfermería puede reforzar sus recursos en materia de educación a la población. De la misma manera, se muestran estudios de diseño cuasiexperimental, como una manera de resaltar que puede medirse el impacto de la educación en la población en una época en donde requerimos tener mayor evidencia de la efectividad de las intervenciones que realicemos.

Renal insufficiency it is recognized as the reduction of the renal function, reflected by the decreased urine output. Worldwide, the amount of people whom have renal insufficiency it is growing, by many reasons. Because of this, is recognized that nursing staff is the best option at the population education, in order to prevent acute renal insufficiency, preventing with this, chronical renal insufficiency. In this document, it is possible to review, the most important general aspects of hydration, feeding, physical activity, alcohol consumption, self-medication and prevention of urinary tract infections, as part of modifiable aspects that people handle as part of their personal health actions, with the proper information, with which nursing staff can strengthen their resources in health education to the population. In this way, this paper shows some quasi-experimental studies, as a way to highlight that it is possible to measure the impact of population education, in a moment that the health system requires more evidence of the effectiveness of the interventions.

Humans , Male , Female , Adult , Renal Insufficiency , Acute Kidney Injury , Nursing Care , Self Medication , Urinary Tract Infections , Alcohol Drinking , Exercise , Health Education , Renal Insufficiency/diet therapy , Organism Hydration Status/physiology
Article in English, Portuguese | LILACS, BDENF | ID: biblio-1382145


Objetivo: avaliar a função renal, a gravidade, o prognóstico na admissão e o desfecho dos pacientes com sepse internados em uma Unidade de Terapia Intensiva. Método: estudo transversal e retrospectivo no qual foram levantadas as variáveis sociodemográficas, escores de gravidade e prognóstico. A função renal foi avaliada pelo escore RIFLE e pela estimativa da taxa de filtração glomerular. Resultados: foram incluídos 96 pacientes, dos quais 42 (43,7%) apresentavam função renal normal, 13 (13,5%) risco, 19 (19,7%) lesão e 22 (22,9%) falência. Os escores de gravidade e prognóstico mostraram-se mais elevados nos pacientes com alteração da função renal, porém, sem diferença entre os pacientes com função renal normal e alterada em relação ao óbito. Conclusão: a avaliação da função renal na admissão de pacientes com sepse na unidade intensiva mostrou que 56,2% apresentavam alguma alteração, além disso, pacientes com alteração da função renal se apresentaram mais graves e com pior prognóstico

Objective: to evaluate renal function, severity, prognosis at admission and outcome of patients with sepsis admitted to an Intensive Care Unit. Method: cross-sectional and retrospective study in which sociodemographic variables, severity scores and prognosis were raised. Renal function was assessed by the RIFLE score and the estimation of glomerular filtration rate. Results: 96 patients were included, of which 42 (43.7%) had normal renal function, 13 (13.5%) risk, 19 (19.7%) injury and 22 (22.9%) failure. Severity and prognostic scores were higher in patients with impaired renal function, but with no difference between patients with normal and altered renal function in relation to death. Conclusion: the evaluation of renal function on admission of patients with sepsis in the unit care showed that 56.2% had some alteration. In addition, patients with altered renal function were more severe and had a worse prognosis

Humans , Male , Female , Adult , Middle Aged , Aged , Aged, 80 and over , Sepsis , Acute Kidney Injury , Intensive Care Units
Med. j. Zambia ; 49(2): 138-145, 2022. tables
Article in English | AIM | ID: biblio-1402633


Objective:To evaluate factors associated with Pregnancy-related KidneyInjury(PRAKI) inwomen admitted to high dependency care unit at Women and Newborn Hospital in Lusaka, ZambiaMethodology:This was an unmatched case-control study conducted in the high-dependency care unit at Women and Newborn Hospital in Lusaka. Study participantswererecruitedconsecutivelybyconveniencesampling.Participants'medicalrecords were reviewed to capture serum creatinine levels;whileastructuredquestionnairewasadministeredto eligible andconsentedstudy participants to capture data on sociodemographic, obstetric, and medical factors. Serum creatinine levels above 84µmol/l were used as criteria for classifying PRAKI. Excel was used for data cleaningandStatav13usedforanalysis.Descriptive statistics were done for all variables followed by univariate and multivariable logistic regression to determine association. 95% CI was usedand p value of<0.05 was consideredsignificant.Results:Thestudy comprised of185 study participants, split into 85 women with PRAKI (cases) and 100 women without PRAKI (controls). The median age was 29 years with 11years interquartile range. 75.3%of the study participants wereinmarriagerelationships.Pre-existinghypertension was the most prevalent medical condition in both the cases (51.8%) and the controls (38%). Sickle celldisease was much less common at 1.2% in cases and 8% in controls. Among the obstetric conditions, preeclampsia was the most common condition at 77.6% and 60% in cases and controls respectively. Eclampsia was found in 38.8% of cases and 11% of controls. Sepsis was least common at 4.7% of cases. This study found that obstetricfactorssuch as eclampsia (AOR = 5.12, 95% CI [2.14 ­ 12.23]; p≤0.0001), preeclampsia (AOR = 2.46, 95% CI [1.12 ­ 5.39]; p = 0.025), and postpartum haemorrhage were associated with the development of PRAKI. Medical conditions were not associated with PRAKI.

Humans , Acute Kidney Injury , Pre-Eclampsia , Creatinine , Eclampsia , Postpartum Hemorrhage