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1.
Article in Portuguese | LILACS | ID: biblio-1353115

ABSTRACT

A intoxicação por vitamina D era pouco frequente no Brasil até seu crescente uso na última década. Neste artigo relatamos um caso de intoxicação por vitamina D em que houve a prescrição intencional de dose muito superior ao recomendado pela literatura, com a finalidade de prevenir doenças via "modulação hormonal". A paciente em questão, idosa, previamente hígida, foi submetida a um tratamento não regulamentado e sem respaldo científico, que culminou em sintomas como náuseas e vômitos, além de perda de peso, inapetência, poliúria e astenia ao longo dos meses. Através da história e exames laboratoriais foi diagnosticada intoxicação por vitamina D e lesão renal aguda. Após o tratamento houve remissão completa dos sintomas. A "modulação hormonal" é uma prática condenada pelos Conselhos Federais de Medicina e Odontologia e pela Sociedade Brasileira de Endocrinologia e Metabologia. O ato de prescrever é de grande responsabilidade ética e técnica e deve ser embasado em evidências científicas, oferecendo o melhor tratamento possível aos pacientes, seja ele preventivo ou curativo, minimizando riscos e danos, respeitando as recomendações das autoridades competentes. (AU)


Vitamin D poisoning was not frequent in Brazil until its increasing use in the last decade. In this article, we report a case of intoxication by intentional prescription of vitamin D in a much higher dose than the literature recommends, in order to prevent diseases via "hormonal modulation". The case described in this report was an elderly woman, previously healthy patient that was submitted to an unregulated treatment without scientific support, leading to symptoms such as nausea and vomiting, in addition to weight loss, lack of appetite, polyuria and asthenia over the months. Through the history and laboratory testing, vitamin D intoxication and acute kidney injury were diagnosed. After treatment, there was a complete remission of the symptoms. "Hormonal modulation" is a practice condemned by the Federal Councils of Medicine and Dentistry and by the Brazilian Society of Endocrinology and Metabology. The act of prescribing is of great ethical and technical responsibility and it must be based on scientific evidence. Thus, the patient can receive the best possible treatment, for either preventive or curative nature, by respecting the recommendations of the competent authorities and, therefore, minimizing risks and damages to patients. (AU)


Subject(s)
Humans , Female , Aged , Polyuria , Asthenia , Vitamin D/toxicity , Weight Loss , Anorexia , Ethics, Professional , Acute Kidney Injury
2.
Arch. argent. pediatr ; 119(6): 414-418, dic. 2021. tab, ilus
Article in English, Spanish | LILACS, BINACIS | ID: biblio-1342853

ABSTRACT

El compromiso renal en los pacientes pediátricos con enfermedad por el coronavirus 2019 (COVID-19, por su sigla en inglés) varía entre el 10 % y el 80 %. Dado que existe limitada información sobre su pronóstico, se realizó este estudio con el objetivo de describir la evolución en el corto plazo de pacientes a quienes se les detectó compromiso renal durante la internación por COVID-19. Estudio observacional y transversal que incluyó pacientes entre 1 mes y 18 años con COVID-19 con compromiso renal. Se excluyeron aquellos con patología renal conocida. Se identificaron 27 pacientes con afectación renal, en 14 de ellos se pudo realizar seguimiento para estudiar la evolución renal luego de 3 meses del diagnóstico. Todos habían normalizado los niveles de creatinina plasmática durante la internación y al momento del control ambulatorio, realizado a los 145 días (92-193), todos se encontraban normotensos y con hallazgos urinarios normales, excepto uno que persistía con microhematuria. La evolución fue favorable; la mayoría de los pacientes presentaron remisión completa del compromiso renal.


Renal involvement among pediatric patients with coronavirus disease 2019 (COVID-19) ranges between 10 % and 80 %.Given the limited information about its prognosis, the objective of this study was to describe the short-term course of patients in whom renal involvement was detected during hospitalization due to COVID-19. This was an observational, cross-sectional study in patients aged 1 month to 18 years who had COVID-19 and renal involvement. Those with a known kidney disease were excluded. A total of 27 patients with renal involvement were identified; 14 of them were followed-up to study their disease course for 3 months after diagnosis. All of the patients had achieved normal plasma creatinine levels during hospitalization and, at the time of outpatient follow-up, which took place 145 days (92-193) later, all had normal blood pressure and urinary values, except for 1 patient who continued with microscopic hematuria. Course was favorable; in most patients, renal involvement had fully resolved.


Subject(s)
Humans , Male , Female , Infant , Child, Preschool , Child , Adolescent , Acute Kidney Injury , COVID-19 , Prognosis , Cross-Sectional Studies , SARS-CoV-2 , Hematuria
3.
Int. j. med. surg. sci. (Print) ; 8(3): 1-11, sept. 2021. tab
Article in Spanish | LILACS | ID: biblio-1292472

ABSTRACT

El intervencionismo coronario se asocia a la aparición de nefropatía inducida por contraste. El propósito del estudio fue evaluar el riesgo de desarrollar nefropatía inducida por contraste (NIC) en pacientes con obstrucción coronaria significativa y su relación con factores de riesgo conocidos para esta nefropatía. Se diseñó un estudio de cohorte prospectiva con 160 pacientes atendidos en el cardiocentro del hospital "Hermanos Ameijeiras", Cuba, a los cuales se les realizó una coronariografía invasiva, entre enero 2016 y julio 2017. La edad promedio fue de 61,6 ± 9,2 años; el 70,6% eran hombres. Predominaron los antecedentes patológicos personales de cardiopatía isquémica (85,6%), y de hipertensión arterial (75,6%). El 75% de los casos presentó una oclusión coronaria significativa. La frecuencia de nefropatía por contraste fue de 42,5%. Los factores que guardaron importante relación estadística con la presencia de oclusión arterial significativa fueron la cardiopatía isquémica conocida (p<0,001), el intervencionismo coronario percutáneo previo (p=0,007), la creatinina después (p=0,043) y la NIC (p=0,016) así como el volumen de contraste administrado (p=0,006). En el subgrupo de pacientes con oclusión significativa el hematocrito bajo (p=0,025) y el intervencionismo coronario percutáneo de urgencia (p=0,007) fueron los factores más influyentes. Se concluye que los pacientes con oclusión coronaria significativa tienen un riesgo aumentado para el desarrollo de la nefropatía por contraste. La corrección de aquellos factores de riesgo que sean modificables (como el hematocrito bajo) y la correcta aplicación del protocolo de hidratación son esenciales para prevenir esta complicación.


Coronary intervention is associated with the appearance of contrast-induced nephropathy. The purpose of the study was to assess the risk of developing contrast-induced nephropathy in patients with significant coronary obstruction and its relationship with known risk factors for this nephropathy. A prospective cohort study was designed with 160 patients treated at the cardiocenter of the "Hermanos Ameijeiras" hospital, Cuba, who underwent invasive coronary angiography, between January 2016 and July 2017. The average age was 61.6 ± 9 ,2 years; 70.6% were men. The personal pathological history of ischemic heart disease (85.6%) and arterial hypertension (75.6%) predominated. 75% of the cases presented a significant coronary occlusion. The frequency of contrast nephropathy was 42.5%. The factors that had an important statistical relationship with the presence of significant arterial occlusion were known ischemic heart disease (p <0.001), previous percutaneous coronary intervention (p = 0.007), creatinine after the procedure (p = 0.043) and CIN (p = 0.016) as well as the volume of contrast administered (p = 0.006). In the subgroup of patients with significant occlusion, low hematocrit (p = 0.025) and emergency percutaneous coronary intervention (p = 0.007) were the most influential factors. It is concluded that patients with significant coronary occlusion have an increased risk for the development of contrast nephropathy. The correction of those risk factors that are modifiable (such as low hematocrit) and the correct application of the hydration protocol are essential to prevent this complication


Subject(s)
Humans , Male , Female , Contrast Media/adverse effects , Coronary Occlusion , Acute Kidney Injury , Prospective Studies , Risk Factors
4.
Mali méd. (En ligne) ; 36(2): 45-50, 20210812. Tableaux
Article in English | AIM | ID: biblio-1283919

ABSTRACT

Le rein est une des cibles de Covid-19.L'atteinte peut se présenter sous forme d'une insuffisance rénale aigue (5-35% des patients), d'une hématurie (30-40%) et/ou d'une protéinurie (40-65%). Nous rapportons deux cas d'insuffisance rénale aigue due au Covid-19 au Mali. Il s'agit d'une femme de 63 ans et d'un homme de 60 ans, de race noire et tous deux diabétiques. Les circonstances de découverte de l'insuffisance rénale ont été l'oligurie dans les deux cas et l'hématurie macroscopique totale dans le deuxième cas. Conclusion : Les atteintes rénales deviennent de plus de plus fréquentes au cours de l'infection à Covid-19. Nous suggérons de les rechercher systématiquement dès que le diagnostic de cette infection est posé.


Subject(s)
Humans , Proteinuria , Acute Kidney Injury , COVID-19 , Hematuria , Mali
5.
Rev. cuba. anestesiol. reanim ; 20(2): e721, 2021. tab, graf
Article in Spanish | LILACS, CUMED | ID: biblio-1289351

ABSTRACT

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


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


Subject(s)
Humans , Acute Kidney Injury/complications , Acute Kidney Injury/prevention & control , Postoperative Period , Case Reports , Risk Factors
6.
Arch. argent. pediatr ; 119(4): 238-244, agosto 2021. tab, ilus
Article in English, Spanish | LILACS, BINACIS | ID: biblio-1280902

ABSTRACT

Introducción. La definición habitual de síndrome urémico hemolítico causado por Escherichia coli productora de toxina Shiga (STEC-SUH) se basa en la presencia de anemia, plaquetopenia y elevación de los niveles séricos de creatinina, acompañadas o no de proteinuria y/o hematuria. La definición estricta solo acepta como criterio renal el aumento de la creatinina sérica. La definición amplia mantiene criterios renales flexibles, aunque reemplaza la anemia por hemólisis y acepta la caída brusca del recuento plaquetario como indicador de consumo plaquetario. El objetivo de este estudio fue estimar y comparar la sensibilidad diagnóstica de dichas definiciones en pacientes con STEC-SUH como diagnóstico de egreso hospitalario. Población y métodos. Revisión retrospectiva de las historias clínicas de pacientes con SUH. Se calculó la sensibilidad y el valor predictivo positivo con sus intervalos de confianza 95 % (IC95 %) de las tres definiciones en función del diagnóstico de egreso de STEC-SUH (diagnóstico de referencia). Se utilizó la prueba de McNemar. Resultados. De 208 pacientes, 107 (51,4 %) fueron identificados con la definición estricta, 133 (63,9 %) con la habitual; y 199, con la amplia (95,6 %). La sensibilidad resultó menor para la definición estricta (51,4 %; IC 95 %: 44,8-58,3), intermedia para la habitual (63,9 %; IC 95 %: 56,9-70,4) y mayor para la amplia (95,6 %; IC 95 %: 91,6-97,8); (p < 0,001). Conclusión. Las distintas definiciones de STEC-SUH presentaron diferencias significativas en la sensibilidad diagnóstica. Dado que la definición amplia alcanzó una sensibilidad superior al 95 %, su uso generalizado podría disminuir la demora diagnóstica


Introduction. The usual definition of Shiga toxin-producing Escherichia coli hemolytic uremic syndrome (STEC-HUS) is based on the presence of anemia, thrombocytopenia, and elevated serum creatinine levels, with or without proteinuria and/or hematuria. The strict definition only considers elevated serum creatinine levels as a renal criterion. The extended definition maintains flexible renal criteria, although it replaces anemia with hemolysis and considers a sharp drop in platelet count as an indicator of platelet consumption. The objective of this study was to estimate and compare the diagnostic sensitivity of these definitions in patients with STEC-HUS as hospital discharge diagnosis. Population and methods. Retrospective review of medical records of HUS patients. Sensitivity and positive predictive value, with their corresponding 95 % confidence intervals (CIs), were estimated for the 3 definitions based on a discharge diagnosis of STEC-HUS (reference diagnosis). The McNemar test was used. Results. Out of 208 patients, 107 (51.4 %), 133 (63.9 %), and 199 (95.6 %) were identified with the strict, usual, and extended definition, respectively. Sensitivity was lower for the strict definition (51.4 %; 95 % CI: 44.8-58.3), intermediate for the usual definition (63.9 %; 95 % CI: 56.9-70.4), and higher for the extended one (95.6 %; 95 % CI: 91.6-97.8); (p < 0.001). Conclusion. The different STEC-HUS definitions showed significant differences in diagnostic sensitivity. The extended definition reached a sensitivity above 95 %, so its generalized use may help to reduce diagnostic delays


Subject(s)
Humans , Male , Female , Infant, Newborn , Infant , Child, Preschool , Child , Adolescent , Shiga-Toxigenic Escherichia coli , Hemolytic-Uremic Syndrome/diagnosis , Thrombocytopenia , Cross-Sectional Studies , Retrospective Studies , Sensitivity and Specificity , Acute Kidney Injury
8.
Rev. colomb. anestesiol ; 49(2): e300, Apr.-June 2021. tab, graf
Article in English | LILACS, COLNAL | ID: biblio-1251499

ABSTRACT

Abstract Introduction Although the use of matching techniques in observational studies has been increasing, it is not always adequate. Clinical trials are not always feasible in critically ill patients with renal outcomes, and observational studies are an important alternative. Objective Through a scoping review, determine the available evidence on the use of matching methods in studies involving critically ill patients and renal outcome assessments. Methods Medline, Embase, and Cochrane databases were used to identify articles published between 1992 and week 10 of 2020. Studies had to assess different exposures in critically ill patients with renal outcomes using propensity score matching. Results Most publications are cohort studies 94 (94.9%), with five (5.1%) reporting cross-sectional studies. The main pharmacological intervention was the use of antibiotics in seven studies (7.1%) and the main risk factor studied was renal injury prior to ICU admission in 10 studies (10.1%). The use of standardized means to assess balance of baseline characteristics was found in only 28 studies (28.2%). Most studies 95 (96%) used logistic regression to calculate the propensity score. Conclusion Major inconsistencies were observed regarding the use of methods and reporting of findings. Considerations related to the use of propensity score matching methods and reporting of findings are summarized.


Resumen Introducción El uso de técnicas de emparejamiento en estudios observacionales ha ido en aumento y no siempre se usa adecuadamente. Los experimentos clínicos no siempre son factibles en los pacientes críticos con desenlaces renales, por lo que los estudios observacionales son una alternativa importante. Objetivo Mediante una revisión de alcance, determinar la evidencia disponible sobre la utilización de los métodos de emparejamiento en los estudios que incluyen pacientes críticamente enfermos y que evalúan desenlaces renales. Métodos Se utilizaron las bases de datos de Medline, Embase, y Cochrane para identificar artículos publicados entre 1992 y 2020 hasta la semana 10, que estudiaran diferentes exposiciones en el paciente crítico con desenlaces renales y utilizaran métodos de emparejamiento por propensión. Resultados La mayoría de las publicaciones (94) son estudios de Cohorte (94,9 %), cinco estudios (5,1 %) correspondieron a cross-secctional. La principal intervención farmacológica fue el uso de antibióticos en siete estudios (7,1 %) y el principal factor de riesgo estudiado fue la lesión renal previa al ingreso a UCI en diez estudios (10,1 %). El balance entre las características de base evaluado mediante medias estandarizadas se encontró solo en 28 estudios (28,2 %). La mayoría de los estudios 95 (96 %) utilizaron regresión logística para calcular el índice de propensión. Conclusiones Se observaron grandes inconsistencias en la utilización de los métodos y en el informe de los hallazgos. Se hace un resumen de los aspectos por considerar en la utilización de los métodos y reporte de los hallazgos con el emparejamiento por índice de propensión.


Subject(s)
Humans , Critical Illness , Renal Replacement Therapy , Critical Care , Libraries, Digital , Propensity Score , Acute Kidney Injury , Kidney Diseases
9.
Rev. cuba. pediatr ; 93(1): e1205, ene.-mar. 2021. tab
Article in Spanish | LILACS, CUMED | ID: biblio-1251747

ABSTRACT

Introducción: El ensayo de muestras matutinas de orina pudiera mejorar el estudio de la función tubular en niños y adolescentes. Objetivo: Describir las tubulopatías diagnosticadas en niños y adolescentes después del ensayo de muestras matutinas de orina. Métodos: Se completó un estudio retrospectivo y analítico en el Laboratorio de Estudio de la Función Renal, Servicio de Laboratorio Clínico, Hospital Pediátrico Docente "Juan Manuel Márquez", con 70 informes de la función tubular hechos en muestras matutinas de orina de 56 probandos (varones: 50,0 por ciento; edad promedio: 4,3 ± 5,5 años; edades < 12 meses: 41,1 por ciento) atendidos entre 2015-2019 (ambos inclusive) que contenían los valores del filtrado glomerular, la excreción urinaria absoluta y fraccional de las sustancias de interés, la brecha aniónica, la presión parcial de los gases, y la acidez titulable, el pH, la densidad y la osmolaridad de los fluidos pertinentes. Los resultados obtenidos se integraron dentro de las construcciones de caso de varias tubulopatías. Resultados: La función tubular estaba conservada en el 41,1 por ciento de los probandos. La inmadurez tubular explicó los hallazgos en otros dos niños. La hipercalciuria idiopática (16,0 por ciento), la diabetes insípida de causa nefrogénica (8,9 por ciento) y la insuficiencia renal aguda (5,3 por ciento) fueron los hallazgos más frecuentes. En 14 de los probandos se diagnosticaron 10 tubulopatías que recorrieron el raquitismo carencial, la hipofosfatasia, la enfermedad de Leigh, el síndrome de Bartter, la enfermedad de Dent y la acidosis tubular I, II y IV. Conclusiones: El estudio tubular en muestras matutinas de orina permite el diagnóstico de importantes tubulopatías en las edades pediátricas(AU)


Introduction: The morning urine sample assay may improve the study of tubular function in children and adolescents. Objective: Describe the tubulopathies diagnosed in children and adolescents after the trial of morning urine samples. Methods: A retrospective and analytical study was completed at the Renal Function´s Study Laboratory, in the Clinical Laboratory Service at "Juan Manuel Marquez" Teaching Pediatric Hospital, with 70 reports of tubular function made in morning urine samples of 56 testees (males: 50.0 percent; average age: 4.3 ± to 5.5 years; ages< 12 months: 41.1 percent) attended from 2015 to 2019 (both inclusive) containing glomerular filtration values, absolute and fractional urinary excretion of substances of interest, anionic gap, partial gas pressure, and titrable acidity, pH, density and osmolarity of relevant fluids. The results obtained were integrated into the case constructions of various tubulopathies. Results: Tubular function was preserved in 41.1 percent of the testees. Tubular immaturity explained the findings in two other children. Idiopathic hypercalciuria (16.0 percent), nephrogenic diabetes insipidus (8.9 percent) and acute renal failure (5.3 percent) were the most frequent findings. In 14 of the testees, 10 tubulopathies were diagnosed were through deficiency rickets, hypophosphatasia, Leigh's disease, Bartter syndrome, Dent disease and tubular acidosis I, II and IV.. Conclusions: The tubular study with morning urine samples allows the diagnosis of important tubulopathies in the pediatric ages(AU)


Subject(s)
Humans , Male , Female , Infant , Child, Preschool , Osmolar Concentration , Diabetes Insipidus, Nephrogenic , Acute Kidney Injury , Clinical Laboratory Services , Hydrogen-Ion Concentration
10.
Rev. bras. cir. cardiovasc ; 36(1): 1-9, Jan.-Feb. 2021. tab, graf
Article in English | LILACS | ID: biblio-1155799

ABSTRACT

Abstract Introduction: Postoperative acute kidney injury contributes to longer hospital stays and increased costs related to cardiac surgery in the elderly. We analyse the influence of the patient's age on risk factors for acute kidney injury after cardiac valve surgery. Methods: We evaluated the prevalence and risk factors for acute kidney injury in 939 consecutive patients undergoing valve surgery, between 2013 and 2018. Results: The prevalence of acute kidney injury was 19.5%. Hypertension (P=0.017); RR (95% CI): 1.74 (1.10-3.48), age ≥70 years (P=0.006); RR (95% CI): 1.79 (1.17-2.72), preoperative haematocrit <33% (P=0.009); RR (95% CI): 2.04 (1.19-3.48), glomerular filtration rate <60 ml/min/1.73 m2 (P<0.0001); RR (95%) CI: 2.36 (1.54-3.62) and cardiac catheterization <8 days before surgery (P=0.021); RR (95% CI): 2.15 (1.12-4.11) were identified as independent risk factors. In patients older than 70 years, with no kidney disease diagnosed preoperatively, glomerular filtration rate <70 ml/min/1.73 m2, male gender, cardiopulmonary bypass time, preoperative haematocrit <36% and preoperative therapy with angiotensin-converting enzyme inhibitors were risk factors for acute kidney injury after valve surgery. Conclusions: In elderly patients, postoperative acute kidney injury develops with higher values of preoperative glomerular filtration rate than those observed in a younger population. Preoperative correction of anaemia, discontinuation of angiotensin-converting enzyme inhibitors and surgical techniques reducing cardiopulmonary bypass time would be considered to reduce the prevalence of renal failure.


Subject(s)
Humans , Male , Female , Aged , Acute Kidney Injury/etiology , Acute Kidney Injury/epidemiology , Cardiac Surgical Procedures/adverse effects , Postoperative Complications/etiology , Retrospective Studies , Risk Factors , Glomerular Filtration Rate , Heart Valves
11.
Arq. bras. med. vet. zootec. (Online) ; 73(1): 99-107, Jan.-Feb. 2021. tab
Article in English | ID: biblio-1153067

ABSTRACT

This study evaluated the most common toxic agents affecting domestic cats, the clinical signs of toxicity, and the therapeutic approaches for recovery. A survey on poisoning in cats was conducted among small animal veterinary practitioners from 2017 to 2018. Of the 748 completed questionnaires, 543 (72.6%) were evaluated. Pesticides and household cleaning supplies were the most common causes of poisoning in cats. The toxicant groups included pesticides and household cleaning supplies (organophosphates), human drugs (acetaminophen), plants/plant derivatives (lily), and veterinary drugs (tramadol). The major clinical signs for these four groups of toxicants were (1) acetaminophen poisoning, which caused oxidative erythrocyte damage; (2) muscarinic and nicotinic cholinergic syndrome, which resulted from organophosphate poisoning; (3) acute kidney injury, which resulted from intoxication of lily; and (4) serotonin syndrome, which resulted from tramadol toxicosis. Interventions for treating poisoning in cats were based on the clinical presentation of animals. In the present study, the significant toxins identified to be dangerous for cats were characterized using the obtained data in Brazil as well as the main associated clinical signs and therapy recommended by veterinarians.(AU)


Objetiva-se com este trabalho caracterizar os principais toxicantes para gatos domésticos, bem como os prevalentes sinais clínicos e a terapêutica associada. Uma pesquisa sobre envenenamento em gatos foi realizada entre médicos veterinários no período de 2017 a 2018. Dos 748 questionários preenchidos, 543 (72,6%) foram avaliados. Pesticidas e domissanitários foram os principais causadores de intoxicação em gatos. Entre os grupos tóxicos, destacaram-se, na categoria pesticidas e domissanitários (organofosforados), medicamentos humanos (acetaminofeno), plantas e derivados de planta (lírio) e medicamentos veterinários (tramadol). Os principais sinais clínicos para os quatro grupos de substâncias tóxicas foram: (1) intoxicação por acetaminofeno, que causou dano eritrocitário oxidativo; (2) síndrome colinérgica muscarínica e nicotínica, resultante do envenenamento por organofosforado; (3) lesão renal aguda, causada pela intoxicação por lírio; e (4) síndrome serotoninérgica, resultante da exposição ao tramadol. As intervenções realizadas para o tratamento dos envenenamentos foram justificáveis mediante a apresentação clínica dos animais. Por meio dos dados obtidos, puderam-se caracterizar os principais tóxicos para gatos no Brasil, bem como os principais sinais clínicos associados e a terapêutica preconizada pelos médicos veterinários.(AU)


Subject(s)
Animals , Cats , Organophosphorus Compounds/toxicity , Poisoning/etiology , Poisoning/veterinary , Tramadol/toxicity , Lilium/toxicity , Acetaminophen/toxicity , Serotonin Agents/toxicity , Oxidative Stress , Muscarinic Antagonists/toxicity , Acute Kidney Injury/chemically induced
12.
Acta Paul. Enferm. (Online) ; 34: eAPE03193, 2021. tab
Article in Portuguese | LILACS, BDENF | ID: biblio-1278068

ABSTRACT

Resumo Objetivo: Identificar a prevalência da síndrome cardiorrenal (SCR) em pacientes com insuficiência cardíaca (IC) crônica descompensada e sua associação com os dados sociodemográficos, clínicos, achados admissionais, mortalidade e tempo de hospitalização. Método: Estudo transversal, com abordagem quantitativa. A amostra foi constituída por 379 prontuários de pacientes adultos com o diagnóstico médico de IC crônica descompensada, admitidos em hospital público no estado de São Paulo, ao longo de 2015. A coleta de dados ocorreu em 2016. A disfunção renal foi considerada em pacientes com diagnóstico prévio de doença renal crônica (DRC) pela taxa de filtração glomerular (TFG) < 89 mL/min/1.73 m2. Testes com valor de p menor ou igual a 0,05 foram estatisticamente significativos. Resultados: A prevalência da SCR foi de 54,1%, sendo 24,8% do tipo 1 e 29,3% do tipo 2. Os principais fatores associados à SCR foram: maior média de idade, mulheres, IC de etiologia isquêmica, menor fração de ejeção, portadores de diabetes mellitus, doença arterial coronariana, uso de estimuladores cardíacos artificiais, hipotireoidismo e doença de Chagas, bem como o perfil hemodinâmico de descompensação da IC nos tipos C e L. Destacam-se, ainda, inapetência, sonolência, estertores na ausculta respiratória, alteração na perfusão tissular, redução do débito urinário, com aumento dos níveis séricos de potássio, ureia e creatinina na avaliação clínica inicial. Os pacientes com disfunção renal apresentaram maior mortalidade, sem diferença significativa quanto ao tempo de hospitalização. Conclusão: Houve alta prevalência da SCR em pacientes com IC crônica descompensada, associada à maior mortalidade e diversos indicadores clínicos.


Resumen Objetivo: Identificar la prevalencia del síndrome cardiorrenal (SCR) en pacientes con insuficiencia cardíaca (IC) crónica descompensada y su relación con los datos sociodemográficos, clínicos y descubiertos en la admisión, la mortalidad y el tiempo de hospitalización. Métodos: Estudio transversal, con enfoque cuantitativo. La muestra estuvo compuesta por 379 historias clínicas de pacientes adultos con diagnóstico médico de IC crónica descompensada, ingresados en hospital público en el estado de São Paulo, durante 2015. La recolección de datos se realizó en 2016. La disfunción renal fue considerada en pacientes con diagnóstico previo de enfermedad renal crónica (ERC) por el índice de filtración glomerular (IFG) < 89 mL/min/1.73 m2. Pruebas con un valor de p menor o igual a 0,05 fueron estadísticamente significativos. Resultados: La prevalencia del SCR fue del 54,1 %, del cual el 24,8 % fue de tipo 1 y el 29,3 % de tipo 2. Los principales factores asociados al SCR fueron: mayor promedio de edad, mujeres, IC de etiología isquémica, menor fracción de eyección, portadores de diabetes mellitus, enfermedad arterial coronaria, uso de estimuladores cardíacos artificiales, hipotiroidismo y enfermedad de Chagas, así como también el perfil hemodinámico de descompensación de la IC en el tipo C y L. Además, se destacan la inapetencia, somnolencia, estertores en la auscultación pulmonar, alteración en la perfusión tisular, reducción del flujo urinario, con aumento del nivel en sangre de potasio, urea y creatinina en la evaluación clínica inicial. Los pacientes con disfunción renal presentaron mayor mortalidad, sin diferencia significativa con relación al tiempo de hospitalización. Conclusión: Se observó una alta prevalencia del SCR en pacientes con IC crónica descompensada, relacionada con una mayor mortalidad y diversos indicadores clínicos.


Abstract Objective: to identify cardiorenal syndrome (CRS) prevalence in patients with decompensated chronic heart failure (HF) and its association with sociodemographic and clinical data, admission findings, mortality and length of hospital stay. Methods: a cross-sectional study with a quantitative approach. The sample consisted of 379 medical records of adult patients with a medical diagnosis of decompensated chronic HF admitted to a public hospital in the state of São Paulo, throughout 2015. Data collection occurred in 2016. Kidney failure was considered in patients with a previous diagnosis of chronic kidney disease (CKD) by glomerular filtration rate (GFR) <89 mL/min/1.73 m2. Tests with a p value less than or equal to 0.05 were statistically significant. Results: CRS prevalence was 54.1%, with 24.8% being type 1 and 29.3% being type 2. The main factors associated with CRS were: higher mean age; women; HF of ischemic etiology; lower ejection fraction; people with diabetes mellitus; coronary artery disease; artificial cardiac stimulator use; hypothyroidism and Chagas disease; hemodynamic profile of HF decompensation in types C and L. Also noteworthy are inappetence, drowsiness, rales on respiratory auscultation, alteration in tissue perfusion, decreased urine output, with increased serum levels of potassium, urea and creatinine in the initial clinical assessment. Patients with kidney failure had higher mortality, with no significant difference in length of hospital stay. Conclusion: There was a high prevalence of CRS in patients with decompensated chronic HF, associated with higher mortality and several clinical indicators.


Subject(s)
Humans , Male , Female , Middle Aged , Aged , Medical Records , Renal Insufficiency, Chronic/complications , Acute Kidney Injury/complications , Cardio-Renal Syndrome , Heart Failure/etiology , Chronic Disease , Cross-Sectional Studies , Evaluation Studies as Topic , Nursing Care
13.
Braz. j. med. biol. res ; 54(11): e9941, 2021. tab, graf
Article in English | LILACS | ID: biblio-1339454

ABSTRACT

Acute kidney injury (AKI) is a common complication in seriously ill patients, while renal ischemia-reperfusion (I/R) injury is the most frequent event in this oxidative renal injury. N-acetylcysteine (NAC) is a small molecule containing a thiol group that has antioxidant properties, promoting detoxification and acting directly as a free radical scavenger. In this study, the protective effect of NAC was investigated in short-term (30 min) and long-term (45 min) ischemic AKI. This was achieved via clamping of the renal artery for 30 or 45 min in Wistar rats to induce I/R injury. AKI worsened with a longer period of ischemia (45 compared to 30 min) due to probable irreversible damage. Preconditioning with NAC in short-term ischemia improved renal blood flow and increased creatinine clearance by reducing oxidative metabolites and increasing antioxidant capacity. Otherwise, NAC did not change these parameters in the long-term ischemia. Therefore, this study demonstrated that the period of ischemia determines the severity of the AKI, and NAC presented antioxidant effects in short-term ischemia but not in long-term ischemia, confirming that there is a possible therapeutic window for its renoprotective effect.


Subject(s)
Humans , Animals , Rats , Reperfusion Injury/prevention & control , Acute Kidney Injury/prevention & control , Acetylcysteine/therapeutic use , Rats, Wistar , Oxidative Stress , Kidney
14.
Repert. med. cir ; 30(1): 43-47, 2021. tab.
Article in English, Spanish | LILACS, COLNAL | ID: biblio-1284478

ABSTRACT

Introducción: los cristaloides son medicamentos usados en pacientes críticamente enfermos, con resultados ambiguos cuando se utilizan soluciones balanceadas versus solución salina normal. Objetivo: conocer si existen diferencias al usar solución salina 0.9% vs. lactato de Ringer en pacientes críticamente enfermos con sepsis y choque séptico o hipovolémico, en cuanto a mortalidad, lesión renal aguda y tiempo de estancia hospitalaria. Métodos: estudio observacional de tipo cohorte retrospectiva en mayores de 18 años con diagnóstico de sepsis, choque séptico o hipovolémico. Se excluyeron aquellos con enfermedad renal crónica en diálisis, las hospitalizadas por ginecología/obstetricia y aquellos con diagnóstico de muerte encefálica o donantes de órganos. Se evaluaron los desenlaces primarios de mortalidad, lesión renal aguda y estancia hospitalaria. Resultados y discusión: se incluyeron 314 pacientes, 158 en el grupo expuesto a solución salina al 0.9% y 156 con lactato de Ringer. Se presentó lesión renal aguda en 22.7% con solución salina y 25.8% con lactato de Ringer (OR 1.18 IC 95%:0.7-2). La mortalidad con solución salina fue de 49%, y en lactato 49% (OR 1.01 IC 95%:0.63-1.63). Los factores de riesgo identificados para mortalidad fueron uso de soporte vasopresor (OR 35 IC 95% 12-83) y lesión renal aguda (1.3 IC 95% 1.01-1.69). Conclusiones: en el paciente críticamente enfermo con sepsis, choque séptico o hipovolémico el uso desolución salina 0.9% no representa diferencias al compararlo con lactato de Ringer en cuanto a mortalidad, lesión renal aguda o estancia hospitalaria. La elección de un cristaloide debe ser individualizada, teniendo en cuenta las comorbilidades, la presencia de hipercloremia o hiperpotasemia.


Objective: crystalloids are drugs used in critically ill patients, with ambiguous results when balanced solutions versus normal saline solution (NS) are used. The objective of this study is to determine if there are differences when NS (0.9%) vs. lactated Ringer ́s (LR) solution are given to critically ill patients in sepsis or septic or hypovolemic shock, in terms of mortality, acute renal injury and length of hospital stay. Methods: a retrospective observational cohort study in patients over 18 years old with sepsis or septic or hypovolemic shock. Patients with chronic renal disease on dialysis, those hospitalized by gynecology/obstetrics and those diagnosed with brain death or organ donors were excluded. The primary mortality outcomes, acute renal injury and hospital stay were evaluated. Results: 314 patients were included, 158 in the NS group and 156 in the LR group. Acute renal injury occurred in 22.7% in the NS group and 25.8% in the LR group (OR 1.18 IC 95%:0.7-2). Mortality rate was 49% in the NS group and 49% in the LR group (OR 1.01 95%: CI 0.63-1.63). Mortality risk factors included the use of vasopressor support (OR 35 95% CI 12-83) and acute renal injury (1.3 95% CI 1.01-1.69). Conclusions: no difference was found with the use of NS in critically ill patients with sepsis or septic or hypovolemic shock when compared with LR in terms of mortality, acute renal injury or hospital stay. The choice of which crystalloid to administer should be individualized, based on the comorbidities and the presence of hyperchloremia or hyperkalemia.


Subject(s)
Humans , Male , Female , Adult , Middle Aged , Aged , Aged, 80 and over , Shock/therapy , Sepsis/therapy , Ringer's Lactate/therapeutic use , Saline Solution/therapeutic use , Shock/mortality , Shock, Septic/mortality , Shock, Septic/therapy , Multivariate Analysis , Retrospective Studies , Treatment Outcome , Sepsis/mortality , Acute Kidney Injury/chemically induced , Ringer's Lactate/adverse effects , Saline Solution/adverse effects , Length of Stay
15.
Rev. Pesqui. (Univ. Fed. Estado Rio J., Online) ; 13: 678-684, jan.-dez. 2021. tab
Article in English, Portuguese | LILACS, BDENF | ID: biblio-1178212

ABSTRACT

Objetivo: Analisar a ocorrência de óbitos pós-cirúrgicos em recém-nascidos com malformação do aparelho digestivo ou osteomuscular em uma maternidade de referência. Método: Estudo exploratório, retrospectivo, de abordagem quantitativa, realizado em uma maternidade de referência localizada em Teresina ­ PI. Os dados foram coletados do Tabwin e de fichas de investigação de óbito infantil de neonatos nascidos em 2016 e 2017 e analisados no software Statistical Package for the Social Sciences. Resultados: O tipo de malformação mais prevalente do aparelho digestivo e osteomuscular entre os neonatos que foram a óbito após cirurgia foi o ânus imperfurado (41%) e a gastrosquise (64,2%), respectivamente. O choque séptico, seguido da insuficiência renal aguda foram os fatores determinantes dos óbitos analisados. Conclusão: O diagnóstico precoce é o fator primordial para redução da morbimortalidade de neonatos acometidos por malformações congênitas, uma vez que contribui para o direcionamento e planejamento dos cuidados imprescindíveis a esses pacientes


Objective: To analyze the occurrence of post-surgical deaths in newborns with malformation in the digestive or musculoskeletal systems in a reference maternity hospital. Method: This is an exploratory and retrospective study, with a quantitative approach, conducted in a reference maternity located in Teresina ­ PI. Data were collected from Tabwin and infant death investigation forms of neonates born in 2016 and 2017 and analyzed through the Statistical Package for the Social Sciences software. Results: The most prevalent type of malformation of the digestive and musculoskeletal systems among neonates who died after surgery was the imperforate anus (41%) and gastroschisis (64.2%), respectively. Septic shock, followed by acute kidney failure, constituted the determining factors of the analyzed deaths. Conclusion: Early diagnosis is the key factor for reducing morbidity and mortality in neonates affected by congenital malformations, as it contributes to the targeting and planning of care actions essential for these patients


Objetivo: Analizar la ocurrencia de muertes post-quirúrgicas en recién nacidos con malformación digestiva o musculoesquelética en una maternidad de referencia. Método: Estudio exploratorio, retrospectivo, con enfoque cuantitativo, realizado en una maternidad de referencia ubicada en Teresina - PI. Los datos se recopilaron de Tabwin y de registros de investigación de muerte infantil de neonatos en 2016 y 2017 y se analizaron utilizando el programa Statistical Package for the Social Sciences. Resultados: El tipo de malformación digestiva y musculoesquelética más frecuente entre los neonatos que murieron después de la cirugía fue el ano imperforado (41%) y la gastrosquisis (64,2%), respectivamente. El shock séptico, seguido de insuficiencia renal aguda, constituyeron los factores determinantes de las muertes analizadas. Conclusión: El diagnóstico temprano es el factor principal para reducir la morbimortalidad en los neonatos afectados por malformaciones congénitas, ya que contribuye a la dirección y planificación de la atención esencial para estos pacientes


Subject(s)
Humans , Male , Female , Infant, Newborn , Anus, Imperforate/complications , Congenital Abnormalities/surgery , Gastroschisis/complications , Perinatal Death , Infant Death , Postoperative Care/adverse effects , Shock, Septic , Infant Mortality , Indicators of Morbidity and Mortality , Retrospective Studies , Early Diagnosis , Digestive System/pathology , Renal Insufficiency , Acute Kidney Injury , Musculoskeletal System/pathology
16.
Texto & contexto enferm ; 30: e20200501, 2021. tab
Article in English | LILACS, BDENF | ID: biblio-1341732

ABSTRACT

ABSTRACT Objective: to analyze the incidence, risk factors and survival of critically-ill patients with acute kidney injury. Method: a concurrent cohort study, conducted with 126 participants between May and September 2019 in a public Intensive Care Unit of the state of Acre. The Kaplan-Meier method was used to estimate the probability of death (log-rank 95% test) and the Cox regression model was employed to determine the prognostic factors of death. Results: the incidence of acute kidney injury was 37.3 per 1,000 individuals admitted to the intensive Care Unit. Disease recovery was the outcome in 36.7% of the patients, and 42.9% evolved to death. The conditional probability of death was higher in the female gender and in those who did not use mechanical ventilation, with glomerular filtration rate at admission < 60 ml/min/1.73 m2 and sepsis diagnosis. Regardless of the acute kidney injury diagnosis, the risk factors associated with death in the population of critically-ill patients were serum creatinine above 1.2 mg/dl at admission and glomerular filtration rate < 60 ml/min/1.73 m2 at admission. Conclusion: in this population, survival is aggravated by gender dimorphism and by the reduction of the glomerular filtration rate.


RESUMEN Objetivo: evaluar la incidencia, los factores de riesgo y la sobrevida de pacientes en estado crítico con insuficiencia renal aguda. Método: estudio de cohorte concurrente, realizado con 126 pacientes entre mayo y septiembre de 2019 en una Unidad de Cuidados Intensivos pública del estado de Acre. Se utilizó el método Kaplan-Meier para estimar la probabilidad de fallecimiento (prueba de log-rank 95%) y se empleó el modelo de regresión de Cox para determinar los factores que pronostican el fallecimiento. Resultados: la incidencia de insuficiencia renal aguda fue de 37,3 cada 1000 individuos ingresados en la unidad de cuidados intensivos. El 36,7% de los pacientes se recuperó de la enfermedad y el 42,9% falleció. La probabilidad condicional de fallecimiento fue mayor en el sexo femenino y en las personas que no se encontraban en ventilación mecánica, con tasas de filtración glomerular al momento de la admisión < 60 ml/min/1,73 m2 y diagnóstico de sepsis. Los factores de riesgo asociados al fallecimiento en la población de pacientes en estado crítico, independientemente del diagnóstico de insuficiencia renal aguda, fueron los siguientes: creatinina sérica superior a 1,2 mg/dl y tasa de filtración glomerular < 60 ml/min/1,73 m2, ambos al momento de la admisión. Conclusión: la sobrevida en esta población se ve agravada por el dimorfismo de género y por la disminución en la tasa de filtración glomerular.


RESUMO Objetivo: avaliar a incidência, os fatores de risco e a sobrevida de pacientes críticos com lesão renal aguda. Método: coorte concorrente, realizada entre maio e setembro de 2019 em uma Unidade de Terapia Intensiva pública do estado do Acre, com 126 pacientes. Utilizaram-se o método Kaplan Meier, para estimar a probabilidade do óbito (teste de log-rank95%) e o modelo de regressão de Cox, para determinar os fatores prognósticos do óbito. Resultados: a incidência de lesão renal aguda foi de 37,3 a cada 1.000 indivíduos admitidos na unidade de terapia intensiva. A recuperação da doença ocorreu em 36,7% deles, e 42,9% evoluíram ao óbito. A probabilidade condicional de óbito foi maior no sexo feminino e naqueles que não utilizaram ventilação mecânica, taxa de filtração glomerular admissional <60 ml/min/1,73 m² e diagnóstico de sepse. Os fatores de risco associados ao óbito na população de pacientes críticos, independentemente do diagnóstico de lesão renal aguda, foram creatinina sérica maior que 1,2 mg/dl na admissão e taxa de filtração glomerular <60 ml/min/1,73 m² na admissão. Conclusão: a sobrevida nessa população é agravada pelo dimorfismo de gênero e pela redução da taxa de filtração glomerular.


Subject(s)
Humans , Prognosis , Survival , Incidence , Longitudinal Studies , Acute Kidney Injury , Intensive Care Units
17.
Med. lab ; 25(2): 535-546, 2021. tabs, graf
Article in Spanish | LILACS | ID: biblio-1342897

ABSTRACT

El síndrome hemolítico urémico (SHU) típico en adultos es una patología infrecuente. En la literatura se encuentran pocos reportes, y se ha documentado principalmente en la población pediátrica. Esta entidad se caracteriza por ser una microangiopatía trombótica (MAT) que compromete de manera característica los riñones. Es causada usualmente por la infección por Escherichia coli productora de toxina Shiga (STEC), específicamente el serotipo O157:H7. En Colombia no existen casos reportados sobre esta condición en adultos, lo cual llama la atención, pero puede deberse en parte a las dificultades en su diagnóstico, al no tenerse fácil acceso a algunas de las pruebas que orientan hacia esta enfermedad y confirman el diagnóstico. Se reporta el caso de una mujer adulta mayor colombiana, quien consultó por deposiciones diarreicas y hematoquecia, con el posterior desarrollo de trombocitopenia severa, lesión renal aguda, y evidencia de equinocitos y esquistocitos en extendido de sangre periférica, lo que llevó a sospechar una MAT. Se le solicitó FilmArray® gastrointestinal, el cual fue positivo para STEC, confirmando así el diagnóstico de un SHU típico. Se presenta también una breve revisión del tema de una entidad que requiere un diagnóstico temprano y certero que permita brindar un tratamiento eficaz y oportuno


The classic or typical hemolytic uremic syndrome (HUS) in adults is a rare disease. Few reports are found in the literature, and it has mainly been documented in the pediatric population. This condition is a form of thrombotic microangiopathy (TMA), which characteristically compromises the kidneys. It is mainly caused by infection with Shiga toxin-producing Escherichia coli (STEC), specifically the O157:H7 serotype. In Colombia there are no reports on this condition in adults, and may be due in part to difficulties in its diagnosis, as there is not easy access to some of the tests that guide towards this condition and confirm the diagnosis. The case of an elderly Colombian woman is reported, who presented diarrhea and hematochezia, and subsequently developed severe thrombocytopenia and acute kidney injury, with evidence of echinocytes and schistocytes in peripheral blood smears, which led to suspect TMA. A gastrointestinal FilmArray™ was ordered, which was positive for STEC, thus confirming the diagnosis of a typical HUS. A brief literature review is also presented, which covers general concepts of a condition that requires an early and accurate diagnosis in order to provide an effective and timely treatment


Subject(s)
Thrombotic Microangiopathies , Thrombocytopenia , Shiga Toxin , Diarrhea , Escherichia coli , Acute Kidney Injury , Hemolytic-Uremic Syndrome , Anemia, Hemolytic
18.
REVISA (Online) ; 10(1): 77-93, 2021.
Article in Portuguese | LILACS | ID: biblio-1177135

ABSTRACT

Objetivo: analisar a produção científica sobre a lesão renal aguda causada pela síndrome da Lise tumoral no paciente internado em unidade de terapia intensiva, bem como o conhecimento do enfermeiro sobre tal patologia. Método: Trata-se de um artigo de revisão integrativa realizado através da leitura de 30 artigos científicos retirados da Biblioteca Virtual de Saúde. Resultados: Identificouse a ocorrência da lesão renal aguda e síndrome de lise tumoral através das alterações metabólicas e hemodinâmicas nos pacientes internados na unidade de terapia intensiva e observou-se que não há publicações com relatos do enfermeiro sobre o conhecimento desta patologia. Conclusão: Apesar dos estudos atuais e a busca constante pelo conhecimento, sabe-se que a lesão renal aguda e Síndrome de Lise Tumoral é uma emergência oncológica com alta taxa de morbidade, onde a principal estratégia para melhorar a evolução de pacientes é estabelecer medidas profiláticas e o tratamento adequado com urgência. Deve existir uma análise contínua do enfermeiro, bem como de toda equipe, estratificação dos riscos e elaboração de protocolos de controles hidroeletrolíticos e laboratoriais para estabilização hemodinâmica do paciente oncológico na unidade de terapia intensiva.


Objective: to analyze the scientific production on acute kidney injury caused by tumor lysis syndrome in patients admitted to the intensive care unit, as well as the nurses' knowledge about such pathology. Method: This is an integrative review article carried out by reading 30 scientific articles taken from the Virtual Health Library. Results: The occurrence of acute kidney injury and tumor lysis syndrome was identified through metabolic and hemodynamic changes in patients admitted to the intensive care unit and it was observed that there are no publications with nurses' reports on the knowledge of this pathology. Conclusion: Despite current studies and the constant search for knowledge, it is known that acute kidney injury and Tumor Lysis Syndrome is an oncological emergency with a high morbidity rate, where the main strategy to improve the evolution of patients is to establish prophylactic measures and appropriate urgent treatment. There must be a continuous analysis of the nurse, as well as the entire team, risk stratification and elaboration of hydroelectrolytic and laboratory control protocols for hemodynamic stabilization of the cancer patient in the intensive care unit.


Objetivo: analizar la producción científica sobre la lesión renal aguda por síndrome de lisis tumoral en pacientes ingresados en la unidad de cuidados intensivos, así como el conocimiento de los enfermeros sobre dicha patología. Método: Se trata de un artículo de revisión integradora realizada mediante la lectura de 30 artículos científicos extraídos de la Biblioteca Virtual en Salud. Resultados: Se identificó la ocurrencia de daño renal agudo y síndrome de lisis tumoral a través de cambios metabólicos y hemodinámicos en pacientes ingresó en la unidad de cuidados intensivos y se observó que no existen publicaciones con informes de enfermeras sobre el conocimiento de esta patología. Conclusión: a pesar de los estudios actuales y la búsqueda constante de conocimiento, se sabe que la lesión renal aguda y el síndrome de lisis tumoral es una emergencia oncológica con una alta morbilidad, donde la principal estrategia para mejorar la evolución de los pacientes es establecer medidas profilácticas. y tratamiento urgente apropiado. Se debe realizar un análisis continuo de la enfermera, así como de todo el equipo, estratificación de riesgo y elaboración de protocolos de control hidroelectrolítico y de laboratorio para la estabilización hemodinámica del paciente oncológico en la unidad de cuidados intensivos.


Subject(s)
Humans , Tumor Lysis Syndrome/complications , Health Knowledge, Attitudes, Practice , Acute Kidney Injury/etiology , Intensive Care Units , Nurse Practitioners , Tumor Lysis Syndrome/etiology
19.
Clinics ; 76: e1924, 2021. tab, graf
Article in English | LILACS | ID: biblio-1153960

ABSTRACT

OBJECTIVES: Positive fluid balance is frequent in critically ill patients and has been considered a potential biomarker for acute kidney injury (AKI). This study aimed to evaluate positive fluid balance as a biomarker for the early detection of AKI in critically ill patients. METHODS: This was a prospective cohort study. The sample was composed of patients ≥18 years old who stayed ≥3 days in an intensive care unit. Fluid balance, urinary output and serum creatinine were assessed daily. AKI was diagnosed by the Kidney Disease Improving Global Outcome criteria. RESULTS: The final cohort was composed of 233 patients. AKI occurred in 92 patients (40%) after a median of 3 (2-6) days following ICU admission. When fluid balance was assessed as a continuous variable, a 100-ml increase in fluid balance was independently associated with a 4% increase in the odds of AKI (OR 1.04; 95% CI 1.01-1.08). Positive fluid balance categorized using different thresholds was always significantly associated with subsequent detection of AKI. The mixed effects model showed that increased fluid balance preceded AKI by 4 to 6 days. CONCLUSION: These results suggest that a positive fluid balance might be an early biomarker for AKI development in critically ill patients.


Subject(s)
Humans , Adult , Critical Illness , Acute Kidney Injury/diagnosis , Water-Electrolyte Balance , Biomarkers , Prospective Studies , Intensive Care Units
20.
Article in Chinese | WPRIM | ID: wpr-880844

ABSTRACT

OBJECTIVE@#To assess the predictors and outcomes of acute kidney injury (AKI) among patients with coronavirus disease 2019 (COVID-19).@*OBJECTIVE@#This retrospective observational study was conducted among patients with a confirmed diagnosis of COVID-19 admitted to Hankou Hospital between January, 5 and March 8, 2020. We evaluated the association of AKI with the demographic and biochemical parameters and clinical outcomes of the patients using univariate regression analysis.@*OBJECTIVE@#Atotal of 287 COVID-19 patients, including 55 with AKI and 232 without AKI, were included in the analysis. Compared with the patients without AKI, the patients with AKI were older, predominantly male, and were more likely to have hypoxia and pre-existing hypertension and cerebrovascular diseases. The patients with AKI also had higher levels of white blood cells, D-dimer, aspartate aminotransferase, total bilirubin, creatine kinase, lactate dehydrogenase, procalcitonin, C-reactive protein, a higher prevalence of hyperkalemia, lower lymphocyte counts, and higher chest computed tomographic scores. The incidence of stage 1 AKI was 14.3% and that of stage 2 or 3 AKI was 4.9%. The patients with AKI had much higher mortality rate than those without AKI.@*OBJECTIVE@#AKI is an important complication of COVID-19. An older age, a male gender, multiple pre- existing comorbidities, lymphopenia, increased infection indicators, elevated D-dimer, and impaired heart and liver functions are all potential risk factors ofAKI. COVID- 19 patients with AKI that progresses into stages 2 or 3 AKI have a high mortality rate. Prevention of AKI and monitoring kidney function is critical in the care of COVID-19 patients.


Subject(s)
Acute Kidney Injury/epidemiology , Aged , COVID-19 , China/epidemiology , Humans , Male , Retrospective Studies , SARS-CoV-2
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