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Early markers of renal injury in predicting outcome in thermal burn patients  [cached]
Sabry Alaa,Wafa Ihab,El-din Ahmed,El-Hadidy Al Moddather
Saudi Journal of Kidney Diseases and Transplantation , 2009,
Abstract: Acute renal failure (ARF) is a well known complication of severe burn and is an important factor that can increase mortality. To determine the predictors of acute renal failure that occur in major burns, we studied 40 patients with moderate to severe thermal burn injury - second to third degree with > 20% of total body surface area. All patients were subjected to routine in-vestigations including: Serum creatinine, blood urea nitrogen, fractional excretion of sodium, uri-nary malondialdehyde and microalbuminuria on day 0, 3, 7, 14 and 21 of hospitalization. Nine patients (22.5 %) developed acute renal failure; 4 patients required supportive dialysis. The group that de-veloped ARF showed an increase of markers of glomerular damage with appearance of micro-albuminuria on day 0 that reached 3 - 4 folds above its normal level on day 14 and remained constant with elevated serum creatinine and burn size in the 3 rd week of ARF, and progressed to overt proteinuria in 3 cases. Urinary malondialdehyde increased 3 folds above normal values before de-veloping acute renal failure, and gradually increased on day 14, which coincided with the increased of microalbuminuria. Two cases (22.2%) in the ARF group who developed septicemia and required dialysis died on the 32 nd and 36 th days post-burn. Burn size and occurrence of septicemia were the only predictors of acute renal failure using multiple regression analysis (P value < 0.001 and < 0.0371, respectively). We conclude that acute renal failure complicates burn patients and is related to the size and depth of burn and occurrence of septicemia. Microalbuminuria and urinary malon-dialdehyde are useful markers for prediction of renal outcome in such group of patients.
Molecular Basis of Renal Adaptation in a Murine Model of Congenital Obstructive Nephropathy  [PDF]
Brian Becknell, Ashley R. Carpenter, Jordan L. Allen, Michael E. Wilhide, Susan E. Ingraham, David S. Hains, Kirk M. McHugh
PLOS ONE , 2013, DOI: 10.1371/journal.pone.0072762
Abstract: Congenital obstructive nephropathy is a common cause of chronic kidney disease and a leading indication for renal transplant in children. The cellular and molecular responses of the kidney to congenital obstruction are incompletely characterized. In this study, we evaluated global transcription in kidneys with graded hydronephrosis in the megabladder (mgb?/?) mouse to better understand the pathophysiology of congenital obstructive nephropathy. Three primary pathways associated with kidney remodeling/repair were induced in mgb?/? kidneys independent of the degree of hydronephrosis. These pathways included retinoid signaling, steroid hormone metabolism, and renal response to injury. Urothelial proliferation and the expression of genes with roles in the integrity and maintenance of the renal urothelium were selectively increased in mgb?/? kidneys. Ngal/Lcn2, a marker of acute kidney injury, was elevated in 36% of kidneys with higher grades of hydronephrosis. Evaluation of Ngalhigh versus Ngallow kidneys identified the expression of several novel candidate markers of renal injury. This study indicates that the development of progressive hydronephrosis in mgb?/? mice results in renal adaptation that includes significant changes in the morphology and potential functionality of the renal urothelium. These observations will permit the development of novel biomarkers and therapeutic approaches to progressive renal injury in the context of congenital obstruction.
Cardiac-surgery associated acute kidney injury requiring renal replacement therapy. A Spanish retrospective case-cohort study
Jose Perez-Valdivieso, Pablo Monedero, Marc Vives, Nuria Garcia-Fernandez, Maira Bes-Rastrollo, the GEDRCC (Grupo Espa?ol de Disfunción Renal en Cirugía Cardiaca)
BMC Nephrology , 2009, DOI: 10.1186/1471-2369-10-27
Abstract: A retrospective case-cohort study in 24 Spanish hospitals. All cases of RRT after cardiac surgery in 2007 were matched in a crude ratio of 1:4 consecutive patients based on age, sex, treated in the same year, at the same hospital and by the same group of surgeons.We analyzed the data from 864 patients enrolled in 2007. In multivariate analysis, severe acute kidney injury requiring postoperative RRT was significantly associated with the following variables: lower glomerular filtration rates, less basal haemoglobin, lower left ventricular ejection fraction, diabetes, prior diuretic treatment, urgent surgery, longer aortic cross clamp times, intraoperative administration of aprotinin, and increased number of packed red blood cells (PRBC) transfused. When we conducted a propensity analysis using best-matched of 137 available pairs of patients, prior diuretic treatment, longer aortic cross clamp times and number of PRBC transfused were significantly associated with CSA-AKI.Patients requiring RRT needed longer hospital stays, and suffered higher mortality rates.Cardiac-surgery associated acute kidney injury requiring RRT is associated with worse outcomes. For this reason, modifiable risk factors should be optimised and higher risk patients for acute kidney injury should be identified before undertaking cardiac surgery.Cardiac surgery-associated acute kidney injury (CSA-AKI) requiring renal replacement therapy (RRT) increases mortality and hospital costs [1-3]. It accounts for approximately 4% of the patients [4]. A great number of the affected patients will remain RRT dependent after hospital discharge [5]. Research over the last years has identified some of the related factors, and has allowed doctors to classify patients according to their risk profile [1,6-10]. However, some of the proposed models have underestimated the risk of acute renal failure [11]. One step to further improve the accuracy of these scores is to clarify the influence of still unaccounted factors. A
Oxidative Stress and Modification of Renal Vascular Permeability Are Associated with Acute Kidney Injury during P. berghei ANKA Infection  [PDF]
Rosa Maria Elias, Matheus Correa-Costa, Claudiene Rodrigues Barreto, Reinaldo Correia Silva, Caroline Y. Hayashida, ?ngela Castoldi, Giselle Martins Gon?alves, Tarcio Teodoro Braga, Renato Barboza, Francisco José Rios, Alexandre Castro Keller, Marcos Antonio Cenedeze, Meire Ioshie Hyane, Maria Regina D'Império-Lima, Ant?nio Martins Figueiredo-Neto, Marlene Ant?nia Reis, Cláudio Romero Farias Marinho, Alvaro Pacheco-Silva, Niels Olsen Saraiva Camara
PLOS ONE , 2012, DOI: 10.1371/journal.pone.0044004
Abstract: Malaria associated-acute kidney injury (AKI) is associated with 45% of mortality in adult patients hospitalized with severe form of the disease. However, the causes that lead to a framework of malaria-associated AKI are still poorly characterized. Some clinical studies speculate that oxidative stress products, a characteristic of Plasmodium infection, as well as proinflammatory response induced by the parasite are involved in its pathophysiology. Therefore, we aimed to investigate the development of malaria-associated AKI during infection by P. berghei ANKA, with special attention to the role played by the inflammatory response and the involvement of oxidative stress. For that, we took advantage of an experimental model of severe malaria that showed significant changes in the renal pathophysiology to investigate the role of malaria infection in the renal microvascular permeability and tissue injury. Therefore, BALB/c mice were infected with P. berghei ANKA. To assess renal function, creatinine, blood urea nitrogen, and ratio of proteinuria and creatininuria were evaluated. The products of oxidative stress, as well as cytokine profile were quantified in plasma and renal tissue. The change of renal microvascular permeability, tissue hypoxia and cellular apoptosis were also evaluated. Parasite infection resulted in renal dysfunction. Furthermore, we observed increased expression of adhesion molecule, proinflammatory cytokines and products of oxidative stress, associated with a decrease mRNA expression of HO-1 in kidney tissue of infected mice. The measurement of lipoprotein oxidizability also showed a significant increase in plasma of infected animals. Together, our findings support the idea that products of oxidative stress, as well as the immune response against the parasite are crucial to changes in kidney architecture and microvascular endothelial permeability of BALB/c mice infected with P. berghei ANKA.
Da?o renal cortical en ni?os con primera infección del tracto urinario alto
Amaya Sorto,Tulio Antonio; Durán álvarez,Sandalio; Valdés Mesa,Mario; Hernández Hernández,José Severino; Pe?a Quian,Yamilé;
Revista Cubana de Pediatr?-a , 2012,
Abstract: introduction: between the 5 and the 22 % of children suffering acute pyelonephritis will develop a renal scar. objective: to describe the clinical-epidemiological features of the cortical renal damage in children with a first infection of high urinary tract. methods: a longitudinal, prospective and observational study was conducted on the cicatricial renal damage admitted in the nephrology services of the "william soler" university children hospital from january 1, 2008 to december 31, 2009. fifty patients were diagnosed and 38 fulfilled the inclusion criteria to study. patients had a mean age of 18 months and underwent renal ultrasound during the acute phase of disease and static renal scintigraphy between 6 and 12 months after the acute picture, to specify exactly the cortical renal injury. in cases of renal scar, lack or decrease of the radioactive drug capture (99mtc-dmsa) authors carried out miction uretrocystography to specify exactly the presence of vesicoureteral reflux. results: twenty six patients (73.7 %) are females, 17 (44.7 %) aged under 6 months, 17 (44.7 %) have between 6 and 36 months and 4 (10.6 %) > 3 years old. the urinary infection was atypical in 23 (60.5 %) and as a isolated germ the escherichia coli in 33 (86.8 %). ultrasound of acute phase demonstrated a renal pelvis dilation in 3 (7.9 %) and renal asymmetry in 1 (2.6 %). in 2 patients (5.2 %) there was renal scar and in 11 (28.4 %) an decreased function of the renal cortex. the miction uretrocystography demonstrated the presence of grade iii vesicoureteral reflux in a girl, who also had a renal scar. there was not relation between the onset of symptoms, the onset of therapeutics and the cortical injury. conclusions: the risk factors to develop a post-pyelonephritis renal scar were: female sex, be aged under 3 and grade iii vesicoureteral reflux.
Acute kidney injury is common, parallels organ dysfunction or failure, and carries appreciable mortality in patients with major burns: a prospective exploratory cohort study
I Steinvall, Z Bak, F Sjoberg
Critical Care , 2008, DOI: 10.1186/cc7032
Abstract: We performed an explorative cohort study on patients with a TBSA% (percentage burned of total body surface area) of 20% or more who were admitted to a national burn centre. Acute kidney injury was classified according to the international consensus classification of RIFLE (Risk, Injury, Failure, Loss of kidney function, and End-stage kidney disease). Prospectively collected clinical and laboratory data were used for assessing organ dysfunction, systemic inflammatory response, and sepsis.The incidence of acute kidney injury among major burns was 0.11 per 100,000 people per year. Of 127 patients, 31 (24%) developed acute kidney injury (12% Risk, 8% Injury, and 5% Failure). Mean age was 40.6 years (95% confidence interval [CI] 36.7 to 44.5), TBSA% was 38.6% (95% CI 35.5% to 41.6%), and 25% were women. Mortality was 14% and increased with increasing RIFLE class (7% normal, 13% Risk, 40% Injury, and 83% Failure). Renal dysfunction occurred within 7 days in 55% of the patients and recovered among all survivors. Age, TBSA%, and extent of full thickness burns were higher among the patients who developed acute kidney injury. Pulmonary dysfunction and systemic inflammatory response syndrome were present in all of the patients with acute kidney injury and developed before the acute kidney injury. Sepsis was a possible aggravating factor in acute kidney injury in 48%. Extensive deep burns (25% or more full thickness burn) increased the risk for developing acute kidney injury early (risk ratio 2.25).Acute kidney injury is common, develops soon after the burn, and parallels other dysfunctioning organs. Although acute kidney injury recovered in all survivors, in higher acute kidney injury groups, together with cardiovascular dysfunction, it correlated with mortality.Renal failure is a feared complication of critical illness and is also often an early sign of multiple organ dysfunction, which complicates the care of critically ill patients [1-4]. In modern burn care, in which most
Tissue Kidney Injury Molecule-1 Expression in the Prediction of Renal Function for Several Years after Kidney Biopsy  [PDF]
Sanja Simic Ogrizovic,Suzana Bojic,Gordana Basta-Jovanovic,Sanja Radojevic,Jelena Pavlovic,Jelena Kotur Stevuljevic,Violeta Dopsaj,Radomir Naumovic
Disease Markers , 2013, DOI: 10.1155/2013/183246
Abstract: Objectives. Retrospective study was designed to examine the importance of tissue kidney injury molecule-1 (KIM-1) expression in predicting kidney function in sixty patients (27 males) aged 34.15 ± 12.23 years with different kidney diseases over three years after kidney biopsy. Materials and Methods. Tissue KIM-1 expression was determined immunohistochemically and KIM-1 staining was scored semiquantitatively, as well as tubulointerstitialis (TIN), inflammation, atrophy, and fibrosis. Kidney function (MDRD formula) and proteinuria/day were evaluated at the time of biopsy (GFR0) and 6, 12, 24, and 36 months later. Results. Significantly positive correlations between tissue KIM-1 expression and age ( ), TIN inflammation ( ), fibrosis ( ), and proteinuria at 6 months ( ) as well as negative correlations with GFR0 ( ), GFR6 ( ), GFR24 ( ), and GFR36 ( ) were found. Meanwhile, TIN inflammation was the best predictor of all measured kidney functions during three years, while tissue KIM-1 expression ( ) was a predictor only at 6 months after biopsy. Conclusion. Tissue KIM-1 expression significantly predicts kidney function solely at 6 months after biopsy, when the effects of immune and nonimmune treatments are the strongest. 1. Introduction Chronic kidney disease (CKD) is associated with a number of comorbidities and prognosis is poor, because many patients experience progression to end-stage renal disease [1]. Also, in the majority of patients disease progression may be altered due to more or less suitable immunosuppressive protocol treatments and therapeutic approaches. The mechanisms of injury underlying progression are blurred, but traditional opinion pointed to an association between decline in renal function with the degree of proteinuria and histological findings of glomerulosclerosis and interstitial fibrosis [2, 3]. Kidney injury molecule-1 (KIM-1) is a new specific biomarker of proximal tubule injury that can be measured both in urine and kidney tissue samples. It is an apoptotic-cell phagocytosis and scavenger receptor that is most highly upregulated in proximal tubular epithelium in acute and chronic kidney injury [4]. Also, much attention has been paid to its possible pathophysiological role in modulation of tubular damage and repair [5–7]. Besides a close relationship between tissue KIM-1 expression and urinary KIM-1 concentration, our previous six-month prospective pilot study showed that KIM-1 expression in tissue correlated better with TIN features and renal function in different chronic kidney diseases than with urinary KIM-1 concentration [8].
Mannitol increases renal blood flow and maintains filtration fraction and oxygenation in postoperative acute kidney injury: a prospective interventional study
Gudrun Bragadottir, Bengt Redfors, Sven-Erik Ricksten
Critical Care , 2012, DOI: 10.1186/cc11480
Abstract: Eleven patients with AKI were studied during propofol sedation and mechanical ventilation 2 to 6 days after complicated cardiac surgery. All patients had severe heart failure treated with one (100%) or two (73%) inotropic agents and intraaortic balloon pump (36%). Systemic hemodynamics were measured with a pulmonary artery catheter. RBF and renal filtration fraction (FF) were measured by the renal vein thermo-dilution technique and by renal extraction of chromium-51-ethylenediaminetetraacetic acid (51Cr-EDTA), respectively. GFR was calculated as the product of FF and renal plasma flow RBF × (1-hematocrit). RVO2 and RO2Ex were calculated from arterial and renal vein blood samples according to standard formulae. After control measurements, a bolus dose of mannitol, 225 mg/kg, was given, followed by an infusion at a rate of 75 mg/kg/h for two 30-minute periods.Mannitol did not affect cardiac index or cardiac filling pressures. Mannitol increased urine flow by 61% (P < 0.001). This was accompanied by a 12% increase in RBF (P < 0.05) and a 13% decrease in renal vascular resistance (P < 0.05). Mannitol increased the RBF/cardiac output (CO) relation (P = 0.040). Mannitol caused no significant changes in RO2Ext or renal FF.Mannitol treatment of postoperative AKI induces a renal vasodilation and redistributes systemic blood flow to the kidneys. Mannitol does not affect filtration fraction or renal oxygenation, suggestive of balanced increases in perfusion/filtration and oxygen demand/supply.Acute kidney injury (AKI) complicates 15% to 30% of cardiac surgeries and is associated with significant morbidity and mortality [1-4]. Even minor changes in serum creatinine are associated with increased inpatient mortality [5,6]. Impaired renal oxygen delivery, caused by intraoperative hypotension and hemodilution-induced anemia and postoperative low cardiac output, is considered to be the cause of postoperative AKI in this group of patients [4,7]. The renal medulla is at the border of
Acute Renal Injury Following Detergent Ingestion  [PDF]
Yaz?c?, Raziye.,Karag?z, Ali.,Güney, ?brahim.,Alt?ntepe, Lütfullah.
The Turkish Nephrology, Dialysis and Transplantation Journal , 2013, DOI: 10.5262/tndt.2013.1002.19
Abstract: Acute kidney injury (AKI) due to detergent ingestion has been reported infrequently in the literature and there is no report about pancytopenia developing after detergent ingestion. We report a case with AKI and pancytopenia that developed after ingestion of laundry detergent. We thought that renal toxicity due to detergent ingestion might be a result of the direct toxic effect of the detergent on the renal tubular epithelium.
Early initiation of dialysis: mortality and renal function recovery in acute kidney injury patients
Nascimento, Ginivaldo Victor Ribeiro do;Balbi, André Luis;Ponce, Daniela;Abr?o, Juliana Maria Gera;
Jornal Brasileiro de Nefrologia , 2012, DOI: 10.5935/0101-2800.20120022
Abstract: introduction: the decision of when to start dialysis in acute kidney injury (aki) patients with overt uremia is strongly established, however, when blood urea nitrogen (bun) levels is < 100 mg/dl the timing of initiation of dialysis remains uncertain. purpose: the aim of this study was to assess mortality and renal function recovery aki patients started on dialysis at different bun levels. methods: this was a retrospective study performed at medical school hospital, s?o paulo, brazil, enrolling 86 patients underwent to dialysis. results: dialysis was started when bun < 75 mg/dl in 23 patients (group i) and bun > 75 mg/dl in 63 patients (group ii). hypervolemia and mortality were higher in group i than in group ii (65.2% vs. 14.3% - p < 0.05, 39.1% vs. 68.9%- p < 0.05, respectively). among survivors, the rate of renal function recovery was higher in group i (71.4% and 36.8%, respectively - p < 0.05). multivariate analysis showed that sepsis, age > 60 years, peritoneal dialysis and bun > 75 mg/dl at dialysis initiation were independently related with mortality. conclusions: lower mortality and higher renal function recovery rates were associated with early dialysis initiated at lower bun leves in aki patients.
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