RESUMO
Background: Worldwide incidence and causes of acute kidney injury (AKI) are variable and even more in developed and developing countries. At least 80% of AKI in tropics is community acquired. Acute gastroenteritis (AGE) is a common problem in developing countries. Present study concentrates on AGE as cause of AKI during monsoon period. It presents in epidemic proportion during monsoon and is preventable with timely intervention.Methods: The study was carried out prospectively in tertiary care hospital in Mumbai during monsoon season of 2012 and 2013. AKI was staged as per AKIN criteria. Patients were treated for primary disease and AKI, initially conservatively and dialysis if indicated. Patients were followed during the hospital stay.Results: Two hundred and thirty patients had AKI due to infectious disease during monsoon. Incidence of AKI due to diarrhea was 23%, and affecting males predominantly in 4th decade. Diarrhea and vomiting were the most common presenting complaints. 32% patients required dialysis. Mortality rate was 3.8%.Conclusions: AKI secondary to AGE is common in tropics. Treatment of primary disease and hemodynamic optimization at the earliest helps to prevent AKI. Presents with less severe AKI and has better outcome. Multiorgan involvement and need for supportive lifesaving therapies were risk factors for AKI.
RESUMO
Abstract Purpose: To investigate whether hirudin exerts its antithrombin action to decrease the ratio of Human Microvascular Endothelial Cells (HMVECs) apoptosis. Methods: Human microvascular endothelial cells (HMVECs) cultured in the third and fifth generations were used. HMVECs were divided into normal group, thrombin group (T group), natrual hirudin group (H group), thrombin + natrual hirudin group (T + H group), AG490 group, thrombin + AG490 group (T + AG490 group), natrual hirudin + AG490 group (H + AG490 group), thrombin + natural hirudin + AG490 (T + H + AG490 group).Apart from the normal group, the other groups were exposed to the relevant drugs for 24 hours.HMVEC apoptosis was assessed by flow cytometric and double Immunofluorescence of phosphorylation of JAK (P-JAK2) and TUNEL assay. Results: Compared with the normal group, in thrombin group the HMVECs apoptosis rate were significantly increased (P<0.05).The results indicated that the index of apoptosis and the apoptosis rate were improved in cultures treated by natural hirudin (T + H group), relative to cultures with thrombin only (T group). We found that the index of apoptosis and the apoptosis rate in the AG490 + thrombin group were higher than that in the hirudin + thrombin group (P<0.05). Double Immunofluorescence of p-JAK2 and TUNEL assays showed that cells were double positive for P-JAK2 uptake and TUNEL detection liquid binding. Conclusion: The natural hirudin and JAK2/STATs signal inhibitor AG490 could block the effects of thrombin. Natural hirudin could attenuate HMVECs apoptosis via antagonizing thrombin and it is suggested that this effect may occur by blocking the JAK2/STATs signaling pathway and this signaling pathways appears to be not the only pathway.