Clinical Characteristics and Outcomes of Septic Acute Kidney Injury in Critically Ill Patients / 대한신장학회지

PURPOSE: This study was to determine the clinical characteristics and outcomes of critically ill patients with septic acute kidney injury (AKI). METHODS: We retrospectively collected data of patients with AKI who were > or =18 years of age and admitted to the intensive care unit (ICU) for > or =24 hours from April 2007 to December 2009, and compared the clinical characteristics and outcomes of patients with and without sepsis. RESULTS: Of the 1,075 patients, 333 had AKI, as defined by the RIFLE criteria, and 134 of them had AKI with sepsis. Septic AKI had significantly higher SAPS II and SOFA scores, and required more mechanical ventilation and vasoactive drugs than non-septic AKI. Patients with septic AKI progressed more to the failure category of the RIFLE criteria. Patients with septic AKI had higher in-hospital mortality and required more RRT, compared to patients with non-septic AKI. Amongst survivors, patients with septic AKI were more likely to recover renal function. A higher SAPS II score and a greater requirement for vasoactive drugs and renal replacement therapy were independently associated with increased in-hospital mortality in septic AKI. CONCLUSION: Patients with septic AKI have a higher burden of illness with an increased risk of death, but renal function recovers better in survivors of septic AKI.

A Case of Postrenal Acute Kidney Injury Complicating Retroperitoneal Fibrosis Associated with Autoimmune Pancreatitis / 대한신장학회지

Autoimmune pancreatitis is a recently established clinicopathologic entity often associated with various types of other autoimmune diseases. We report a case of postrenal acute kidney injury (AKI) due to retroperitoneal fibrosis associated with autoimmune pancreatitis. The seventy one year old male patient was admitted because of oliguria and lower extremity edema. He had been diagnosed to have autoimmune pancreatitis and retroperitoneal fibrosis by increased serum IgG and IgG4 level with the presence of rim like attenuation around pancreas and the retroperitoneal fibrosing mass in abdominal CT scan 1 year ago but was lost to follow up. Magnetic resonance cholangiopancretogram and follow up abdominal CT scan showed progressed retroperitoneal fibrosis with newly developed bilateral hydronephrosis and atrophied left kidney despite partial improvement in pancreatitis. Because of progressively rising serum creatinine and oliguria, percutaneous nephrostomy in right kidney was performed. Steroid treatment was initiated with insertion of double J catheter at right ureter and renal function gradually returned. We report here a rare case of postrenal AKI developed in unilateral functioning kidney complicated by combined retroperitoneal fibrosis and autoimmune pancreatitis.

Hemophagocytic Syndrome in a Patient with Acute Tubulointerstitial Nephritis Secondary to Hepatitis A Virus Infection

Hepatitis A virus (HAV) infection is generally a self-limited disease, but the infection in adults can be serious, to be often complicated by acute kidney injury (AKI) and rarely by virus-associated hemophagocytic syndrome (VAHS). Our patient, a 48-yr-old man, was diagnosed with HAV infection complicated by dialysis-dependent AKI. His kidney biopsy showed acute tubulointerstitial nephritis with massive infiltration of activated macrophages and T cells, and he progressively demonstrated features of VAHS. With hemodialysis and steroid treatment, he was successfully recovered.

A Case of Peritonitis Induced by Small Bowel Calcification and Microperforation: Sustained Secondary Hyperparathyroidism in a Patient with Continuous Peritoneal Dialysis / 대한신장학회지

Secondary hyperparathyroidism is a common complication of chronic kidney disease and known to be associated with soft tissue calcification affecting patients' morbidity and mortality. However few cases of intestinal calcification related to secondary hyperparathyroidism have been reported. Herein we report a case of peritonitis complicating small intestinal perforation in a patient who had undergone peritoneal dialysis and had sustained hyperparathyroidism. Diffuse calcifications and perforations in small intestine were identified in abdomino-pelvic CT scan as well as in resected small intestine. Because of relapsing microperforation and resultant intra-abdominal abscess, the patient has been in fasting status depending on total parenteral nutrition for over 8 months after surgery.