ABSTRACT
Objective To evaluate the predictive value of CT scan in the outcome of renal function after decompression procedures in patients with acute obstructive renal failure.Methods Retrospective analysis of clinical information of 76 patients with acute obstructive renal failure between January 2012 and August 2017 was performed.Clinical information included age,cause of obstruction,type of decompression procedures,total renal area and dominant side renal area measured by CT scan,serum creatinine(SCr) level before operation,SCr level in 3 months after decompression.Patients were divided into 2 groups according to creatinine clearance rate (CCr) in 3 months after decompression,including normal renal function group (26 cases,CCr ≥50 ml/min) and decompensated renal function group (50 cases,CCr ＜ 50 ml/min).The CCr of normal renal function group was (65.3 ± 12.8)ml/min,while the decompensated renal function group was (28.9 ± 11.9)ml/min.The average age of normal renal function group was 48.3 years old,the median value of serum creatinine before operation was 633μmol/L,while the average age of decompensated group was 63.8 years old,the median value of preoperative creatinine was 583 μmol/L.Renal area was measured in CT scan image which was performed when acute obstructive renal failure was diagnosed.Univariate analysis and logistic regression multivariate analysis was used to analyze these parameters.Receiver operating characteristic curve (ROC) was used to evaluate the performance of CT scan for renal function prediction.Results There were significant differences in the renal area between the normal renal function and decompensated renal function group,the total renal area were (3 765.5 ± 628.6) mm2 (range 2 375.3-4 853.6 mm2) and (2 493.0 ± 830.6) mm2 (range 476.9-4 225.1 mm2) respectively (P ＜ 0.001),while the dominant side renal area were (2 283.5 ± 430.2) mm2 (range 1 654.6-3 383.3 mm2) and (1 655.5 ± 496.2) mm2 (range 476.94-2 816.0 mm2) respectively (P ＜ 0.001).The integration area under the ROC curve of the total renal area to predict the outcome of renal function was 0.89.Conclusions The renal area measured in CT scan image might be useful for the early prediction of renal function outcome in patients with acute obstructive renal failure.
ABSTRACT
Objective To explore the clinical effect of acupuncture on acute renal injury of sepsis.Methods From January 2015 to May 2017,adult patients with sepsis who received ≥ 7 days of treatment were collected from the Central Hospital of Zhuzhou.The participants were randomly divided into the control group (n =35) and the treatment group (n =37),and the control group was given routine treatment according to the sepsis guidelines.On the basis of control group,the treatment group was given acupuncture treatment,acupoints Shenshu and Sanyinjiao,Taixi,Zusanli.The clinical effects of the two groups of patients were compared.Results The levels of cystatin C,blood urea nitrogen and creatinine in the treatment group were significantly lower than those in the control group (P ＜ 0.05).There was no significant difference in the number and proportion of patients with blood purification between the two groups (P ＞ 0.05),while the frequency and time of blood purification treatment in the treatment group were significantly lower than those in the control group (P ＜ 0.05).The levels of blood interleukin-6 and tumor necrosis factor-alpha in the treatment group were significantly lower than those in the control group (P ＜ 0.05).From the fourth day of treatment,the Acute Physiology and Chronic Health Evaluation Ⅱ (APACHE Ⅱ) score in the treatment group was significantly lower than that in the control group (P ＜ 0.05).There was no significant difference in mortality between the two groups at 28 days (P ＞ 0.05).Conclusions Acupuncture of Shenshu,Sanyinjiao,Taixi,Zusanli can improve sepsis patients with acute kidney injury in renal function.
ABSTRACT
Objective To summarize the treatment experiences in patients with cardiac surgery-associated acute kidney injury (CSA-AKI). Methods The clinical data of 9 patients with acute renal injury after orthotopic heart transplantation in our hospital from January 2009 to July 2016 were retrospectively analyzed. Three patients were required the high-dose diuretics (furosemide, >80 mg/d) and six patients were received continuous renal replacement therapy (CRRT). The levels of serum creatinine (Cr) and estimated glomerular filtration rate (eGFR) were compared before and after heart transplantation and after the treatment of AKI. The quality of life was observed in patients in perioperative period. Results After the treatment of diuretics or CRRT, patients showed renal function recovery with significant decreased Cr levels and increased eGFR compared with the postoperation. The patients with diuretic therapy revealed a better eGFR recovery than those with CRRT. Conclusion CSA-AKI should be based on the severity of disease, and comprehensive treatment should be taken to reduce renal damage.
ABSTRACT
Objectives To investigate the risk factors of acute renal injury (acute kidney injury) in patients with acute left heart failure.Methods Clinical data of 188 patients with acute left heart failure who were admitted to our hospital were retrospectively analyzed.Logistic regression analysis was used to assess the risk factors for AKI.Results Among 188 patients with acute left heart failure,incidence of acute kidney injury was 33.51％.Univariate and Multivariable logistic regression analyses showed that the independent predictors of acute kidney injury were lower baseline eGFR (OR=4.294,P ＜ 0.001) and anemia (OR=3.573,P=0.006).Conclusions The incidence of acute left heart failure complicated with AKI was high.Basic state of renal function and anemia were the independent risk factors for AKI.
ABSTRACT
Objective To evaluate the effect of penehyclidine hydrochloride pretreatment on rhabdomyolysis-induced acute kidney injury (AKI) in rats.Methods Forty-two pathogen-free male SpragueDawley rats,weighing 200-220 g,aged 2 months,were randomly divided into 3 groups using a random number table:control group (group C,n =6),AKI group (n =18),and penehyclidine hydrochloride group (group PH,n =18).The model of rhabdomyolysis-induced AKI was established by injecting 50％ glycerol 10 ml/kg into the lateral muscle of bilateral hindlimbs in AKI and PH groups.The equal volume of normal saline was given in group C.Penehyclidine hydrochloride 0.2 mg/kg was injected intraperitoneally at 30 min before administration of glycerol in group PH.Six rats were selected at 1 h after administration of normal saline in group C,or at 1,6 and 24 h after administration of glycerol,blood samples were collected from the inferior vena cava for determination of the serum blood urea nitrogen (BUN) and creatinine (Cr) concentrations by enzymic colorimetric method.The animals were sacrificed,and kidney specimens were obtained for pathologic examination and for determination of the expression of DJ-1 and phosphatase tensin homolog deleted on chromosome 10 (PTEN) encoding protein (by immuno-histochemistry and Western blot).The damage to the renal tubules was scored.Results Compared with group C,the serum BUN and Cr concentrations and renal tubular damage score were significantly increased,the expression of D J-1 was down-regulated,and the expression of PTEN protein was up-regulated in group AKI (P＜0.05 or 0.01).Compared with group AKI,the serum BUN and Cr concentrations and renal tubular damage score were significantly decreased,the expression of DJ-1 was up-regulated,and the expression of PTEN protein was down-regulated in group PH (P＜0.05 or 0.01).Conclusion Penehyclidine hydrochloride pretreatment can reduce rhabdomyolysis-induced AKI probably by up-regulating the expression of DJ-1 and down-regulating the expression of PTEN protein in rats.
ABSTRACT
Objective To study the role of N‐acetylcysteine (NAC) in protecting rats against con‐trast‐induced acute kidney injury .Methods Forty‐five adult Wistar rats were randomly divided into control group ,model group and NAC group (15 in each group) .Their serum levels of creati‐nine ,CRP ,TNF‐a were measured before ,and 48 and 72 h after contrast medium injection .The an‐imals were killed 72 h after contrast medum injection .Their serum levels of malondialdehyde , SOD ,NO were measured .Eexpressions of Bax and Bcl‐2 were detected .Results The serum levels of creatinine ,CRP ,TNF‐a ,malondialdehyde and the expression level of Bax were significantly higher in model group and NAC group than in control group ,and in model group than in NAC group after contrast injection (P< 0 .05) .The serum levels of SOD and NO and the expression level of Bcl‐2 were significantly lower in model group and NAC group than in control group ,and in model group than in NAC group after constrast injection (P< 0 .05) .Immunohistochemistry demonstrated that the TGFβ1 expression level was significantly higher in model group and NAC group than in control group and was significantly lower in NAC group than in model group .Con‐clusion NAC can protect rats against kidney injury and reduce contrast‐induced acute kidney in‐jury by inhibiting inflammation ,oxidation ,apoptosis and cytokines .
ABSTRACT
Objective To explore the curative effect of ulinastatin against toxic acute kidney injury(AKI) in rats and its mecha-nism .Methods Twenty-four male SD(Sprague Dawley) rats were randomly divided into 3 groups ,control group ,model group and treatment group with 8 rats in each group .Rats were subcutaneously injected gentamicin(300 mg/kg of body weight per day) for 3 days to establish models of toxic AKI .Rats in treatment group were intraperitoneally injected with a 7-day course of ulinastatin(30 000 U/kg of body weight per day) from 4th day .Dectetion of serum level of creatinine and Cystatin-C(Cys C) ,urinary concentra-tion of kidney injury molecule-1 (Kim-1 ) and neutrophil gelatinase-associated lipocalin (NGAL ) ,activity of superoxide dismutase (SOD) and glutathione peroxidase(GSH-Px) ,content of malondialdehyde ,levels of tumour necrosis factor-alpha(TNF-α) and inter-leukin-1β(IL-1β) in homogenate of renal tissues as well as observation of renal pathological changes and semiquantitative score in each group were conducted on 11th day .Results In model group ,degeneration and necrosis of renal tubular epithelial cell ,dilatation of renal tubular cavity and inflammatory cell infiltration in renal interstitial were observed .Renal pathological changes were milder in treatment group ,when compared with the model group .Renal pathological semiquantitative score ,serum level of creatinine and Cys C ,urinary concentration of Kim-1 and NGAL ,content of malondialdehyde ,levels of TNF-α and IL-1β in homogenate of renal tissues were higher in model group than in control group ,while those in treatment group were lower than in model group(P<0 .01 , respectively) .And activity of SOD and GSH-Px in homogenate of renal tissues were lower in model group than in control group ,and those in treatment group were higher than in model group and control group(P<0 .01 ,respectively) .Conclusion Ulinastatin pos-sesses a curative role in toxic AKI in rat via inhibiting oxidative stress and down-regulating levels of proinflammatory factor in renal tissues .
ABSTRACT
Objective To investigate the diagnostic value of urine neutrophil gelatinase apolipoprotein (NGAL) and kidney injury molecule 1 (KIM-1) as markers of CIN,and the effectiveness of hydration therapy in the prevention of CIN.Methods One hundred and twenty patients were randomly divided into control group and treatment group.The patients of treatment group received hydration therapy through intravenous fluid infusion.Urine samples were taken for detecting the value of albumin (mAlb),NGAL,and KIM-1 before surgery (T0),after surgery 12 h (T1),24 h (T2),48 h (T3),72 h (T4) by ELISA assay.The levels of urinary mAlb,Scr,BUN and cystatin C were detected at the same time.Results (1) The urine NGAL/Cr and KIM-1/Cr significantly increased and were more than twice the baseline value at the time of 12 h after PCI in 87 of 120 cases of the participants.There are eight cases occurred CIN (6.67％) and one case occurred in hydration treatment group (1.7％),seven cases were in control group (11.7％).The difference was statistically significant.(2) There were no significant difference in BUN,Scr,mAlb/Cr,Cys-C and GFR between two gToUps (P ＞ 0.05).(3) NGAL/Cr,KIM-1/Cr were elevated at T1 in both groups (P ＜ 0.01).In hydration treatment group,levels of NGAL/Cr and KIM-1/Cr decreased substantially to the level of T0 at T4(P ＜ 0.01),while in the control group they didn't.(4) Area under the ROC curve (AUC) of NGAL/Cr and KIM-1/Cr 12 h after PCI were 0.931 [95％ CI (0.889,0.973)] and 0.811 [95％ CI(0.736,0.886)] respectively (all P＜0.05).Conclusions NGAL and KIM-1 are sensitive and specific indicators for predicting early renal injury induced by contrast medium and can be used for early diagnosis of CIN.Hydration therapy can prevent the contrast agent-induced renal damage.
ABSTRACT
Objective To investigate the risk factors and prognosis influential factors of acute kidney injury (AKI) after cardiac surgery.Methods The clinical data of patients who were hospitalized and underwent cardiac surgery from April 2009 to May 2011 were collected prospectively.Demographic characteristics,types of surgeries,preoperative renal function,pre-and intra-operative conditions and clinical outcomes,etc were recorded.Results A total of 4007 patients underwent cardiac surgery were recruited.The overall incidence of AKI was 31.2％ (1250/4007).The incidence of AKI requiring renal replacement treatment (AKI-RRT) was 2.6％ (104/4007).The overall hospital mortality was 1.9％ (77/4007),and was significantly higher in AKI group than in non-AKI group (5.4％ vs 0.3％,P ＜0.01).The hospital mortality of AKI-RRT group was 36.5％ (38/104).Grouped by type of surgery,cardiac transplantation had the highest AKI incidence (73.0％) and highest in-hospital mortality (18.9％),followed by coronary artery bypass grafting (CABG) combined with valve surgery (AKI incidence 57.8％,in-hospital mortality 6.1％) and aneurysm surgery (AKI incidence 52.0％,in-hospital mortality 5.5％).Multivariate logistic regression analysis showed that man,age,BMI,hypertension,chronic heart failure,pre-operative serum creatinine (SCr) ＞ 106.0 μmol/L,intra-operative cardiopulmonary bypass time,intra-operative hypotension and aneurysm surgery were the risk factors of AKI after cardiac surgery.Multivariate logistic regression analysis showed that pre-operative SCr ＞ 106.0 μmol/L and intra-operative hypotension were independent risk factors of renal recovery after cardiac surgery while recovery of urine output was the favorable factor.Conclusions Cardiac surgery usually induces high AKI incidence and poor prognosis,which closely associated with many risk factors in peri-operative stage.The incidence of AKI is related to a number of perioperative risk factors.Heart transplantation,aneurysm surgery,CABG combined valve surgery are high risk surgeries.
ABSTRACT
Objective To observe the protective effect of different doses sodium hydrosulfide (NaHS) as a donor of hydrogen sulfide on renal ischemia reperfusion injury (IRI).Methods Twenty-eight healthy male Wistar rats were randomly divided into 4 groups,namely sham operation (Sham) group (n =7),renal ischemia reperfusion (IR) group (n =7),sodium hydrosulfide (NaHS) high dose group (n=7),sodium hydrosulfide low dose group (n=7).After excision of the right kidney,two dose NaHS group (300 nmol/min,1.5 μmol/min) received 15-minute continuous administration via left renal artery.Sham group and IR group received same volume of saline.Five minutes after stopping drug,the left renal pedicle in NaHS group and IR group was clipped with no damage arteriole occlusion.After 45 minutes blockade,a model of acute renal ischemia reperfusion injury was established.Sham group underwent the same procedure as model groups without clamping the left renal artery.Specimens of renal tissue and blood were harvested at 24-hour after blood flow restore in the kidney.BUN and Scr were measured.Kidney pathological damage was semi-quantitatively analyzed.Production of H2S in renal tissue was detected.Expression of cystathionine γ lyase (CSE) and cystathionine β synthase (CBS) mRNA in kidney tissue was examined by real-time PCR.Results Compared with sham group,BUN and Scr increased significantly (P＜0.01),kidney tissue H2S production decreased significantly (P＜0.01),mRNA expression of CSE and CBS down-regulated significantly (P＜0.01) in IR group.The kidney pathology of sham group was normal,while acute tubular necrosis was found in IR group.Compared with IR group,BUN and Scr decreased significantly (P＜0.01),kidney tissue H2S production increased significantly (P＜0.05),mRNA expression of CSE and CBS up-regulated significantly (P＜0.01) in NaHS groups.Pathological damage of acute tubular necrosis was significantly improved in NaHS pretreatment group.There was no significant difference between two NaHS doses groups.Conclusion Hydrogen sulfide has a protective effect on renal IRI.
ABSTRACT
Chronic kidney disease (CKD) is a general term for heterogeneous disorders affecting kidney structure and function.It can be detected by routine laboratory tests.Acute kidney injury ( AKI),previously referred to as acute renal failure(ARF), represents a persistent problem in clinical medicine.Despite significant improvements in therapeutics,the mortality and morbidity associated with AKI remain high.A major reason for this is the lack of markers for early diagnosis of AKI.In this paper,we discuss recommendations for AKI and CKD laboratory assessment and management,and future challenges.( Chin J Lab Med,2012,35:773-779)
ABSTRACT
Automated urine analysis poses the advantage of rapid turn around time and is suitable for initial screening of large number of samples.However,standardized manual microscopic examination of urine sediment remains valuable for a variety of differential diagnosis,such as screening the potential causes of hematuria,to predict proliferative and non-proliferative renal pathological injury. Urinary sediment scoring system is often used to differentiate acute tubular necrosis (ATN) from pre-renal acute kidney injury (AKI).The urinary podocytes serves as a marker of glomerular injury to determine the location of and to monitor activity of glomerular lesions,as well as to differentiate focal segmental glomerulosclerosis (FSGS) and minimal change disease (MCD).These useful analyses shows the importance of urine microscopy in the clinical practice of nephrology.( Chin J Lab Med,2012,35:780-783)
ABSTRACT
OBJETIVO: Este trabalho tem como objetivo avaliar a evolução de pacientes com lesão renal aguda (LRA) por Necrose Tubular Aguda internados no Hospital das Clínicas da Faculdade de Medicina de Botucatu - UNESP. MÉTODOS: Trata-se de estudo de coorte retrospectivo, no qual foram avaliados 477 pacientes maiores de 18 anos, no período de janeiro de 2001 a dezembro de 2008. LRA foi definida de acordo com os valores de creatinina sérica, conforme proposto pelo Acute Kidney Injury Network (AKIN). RESULTADOS: A média de idade da população estudada foi de 65,5 ± 16,2 anos, com predomínio de homens (62 por cento) e com idade > 60 anos (65,2 por cento). Diabetes mellitus ocorreu em 61,9 por cento, hipertensão arterial em 44,4 por cento e doença renal crônica em 21,9 por cento. A mortalidade foi de 66 por cento. Após análise multivariada, foram variáveis associadas ao óbito a necessidade de diálise, internação em UTI, idade > 60 anos e menor tempo de acompanhamento nefrológico. A recuperação renal entre os sobreviventes foi de 96,9 por cento. CONCLUSÃO: Este trabalho mostra que a evolução dos pacientes com LRA provenientes de enfermarias clínica e cirúrgica é semelhante à literatura. Porém, a alta mortalidade do grupo mostra a necessidade da identificação de fatores de risco para o desenvolvimento de LRA nesses pacientes e capacitação da equipe assistente para o diagnóstico precoce dessa síndrome.
OBJECTIVE: This study aims to evaluate the outcome of AKI patients caused by acute tubular necrosis admitted in clinical and surgical units of Botucatu Medical School University Hospital - UNESP. METHODS: This is a retrospective cohort study with 477 adult patients were observed from January 2001 to December 2008. AKI was defined according to serum creatinine levels as proposed by Acute Kidney Injury Network (AKIN). RESULTS: The mean age was 65.5 ± 162 years. The majority of the patients were males (62 percent) older than 60 years (65.2 percent). Diabetes mellitus was diagnosed in 61.9 percent, high blood pressure in 44.4 percent and chronic kidney disease 21.8 percent of the patients. Death occurred 66 percent of dialysis requirement, critical care unit admission, age > 60 years and lower attendance time by nephrologists were significant and independently associated with death risk. The renal recorery among survivors was of 96.9 percent. CONCLUSION: This work shows that the evolution of AKI patients from clinical and surgical wards is similar to literature. However, the high mortality of the group shows the necessity of identifying risk factors for the development of AKI in these patients and training staff assistant for the early diagnosis of this syndrome.
Subject(s)
Aged , Female , Humans , Male , Acute Kidney Injury/mortality , Acute Disease , Acute Kidney Injury/diagnosis , Brazil/epidemiology , Cohort Studies , Retrospective Studies , Risk FactorsABSTRACT
Objective To investigate the changes in severe burn patients with acute renal failure by using continuous blood purification(CBP). Methods Twelve severe bum patients underwent early CBP were included in this study. The levels of creatinine、blood urea nitrogen and interleukin-6(IL-6) in plasma were determined. The termperature and heart were also observed. Results After the treatment of CBP,the clinical symptoms were improved obviously ( P ＜ 0. 05 ). The levels of creatinine[( 376. 2 ± 24. 5 ) μ mol/L vs ( 145.2 ± 57. 1 ) μmol/L] 、sodium concentration [( 5.3 ± 1.6 ) mmol/L vs ( 4. 0 ± 0. 7 ) mmol/L] and potassium concentration [( 153. 4 ± 13.0 ) mmol/L vs( 140. 1 ±8.6)mmol/L]in plasma were all decreased evidently after the treatment of CBP. There were significant differences ( t = 2. 79,3.06,3. 01, P ＜ 0. 05 ). The levels of IL-6 and APACHE Ⅱ score were ( 264. 31 ± 122.42 ) ng/Land( 15.2 ±5.8) scores before treatment. While after treatment,their levels were(94. 18 ±63. 82) ng/L and(5.4 ±3. 6) scores. The difference was also significant ( t = 4. 17,3. 67, P ＜ 0. 05 ). In this study, 8 patients cured and 4 patients died. Conclusion CBP could eliminate inflammation factors effectively in severe burn patients with acute renal failure. It could afford a useful assist treatment to these patients.
ABSTRACT
Objective To evaluate the risk factors for the postoperative acute renal failure requiring dialysis (ARF-D)after heart valve surgery. Methods Adult patients (age≤18 years) underwent valve surgery with preoperative serum creatinine ＜300 μmol/L were included between January 2005 and December 2008. Fifty patients developed ARF-D within 30 days postoperatively (ARF-D group). While random 220 patients had the same operation without ARF-D served as the control group. Univariate analysis and multivariable logistic regression were used to identify risk factors of ARF-D after valve surgery.Results The incidence of ARF-D was 1.78%, and the early mortality rate was 65.5%. Multivariate analysis identified the following independent risk factors of ARF-D: age, previous cardiac surgery, preoperative serum creatinine, NYHA class Ⅳ,and low cardiac output syndrome. ARF-D group had a longer hospital stay and ICU stay than that of the control group ( P ＜0.001 ). Conclusion Conclusion ARF-D had a higher mortality rate and longer hospital stay following heart valve surgery.Age, previous cardiac surgery, preoperative serum creatinine, NYHA class Ⅳ, and low cardiac output syndrome were the independent risk factors of ARF-D after heart valve surgery.
ABSTRACT
OBJETIVOS: Pacientes com câncer criticamente enfermos têm maior risco de lesão renal aguda, mas estudos envolvendo estes pacientes são escassos, e todos em centros únicos e realizados em unidades de terapia intensiva especializadas. O objetivo deste estudo foi avaliar as características e desfechos em uma coorte prospectiva de pacientes de câncer internados em diversas unidades de terapia intensiva com lesão renal aguda. MÉTODOS: Estudo prospectivo multicêntrico de coorte realizado em unidades de terapia intensiva de 28 hospitais brasileiros em um período de dois meses. Foram utilizadas regressões logísticas univariada e multivariada para identificar os fatores associados a mortalidade hospitalar. RESULTADOS: Dentre todas as 717 internações a unidades de terapia intensiva, 87 (12 por cento) tiveram lesão renal aguda e 36 por cento deles receberam terapia de substituição renal. A lesão renal se desenvolveu mais frequentemente em pacientes com neoplasias hematológicas do que em pacientes com tumores sólidos (26 por cento x 11 por cento; p=0,003). Isquemia/choque (76 por cento) e sepse (67 por cento) foram os principais fatores associados à lesão renal, e esta foi multifatorial em 79 por cento dos pacientes. A letalidade hospitalar foi de 71 por cento. Os escores de gravidade gerais e específicos para pacientes com lesão renal, foram imprecisos para predizer o prognóstico nestes pacientes. Na análise multivariada, a duração da internação hospitalar antes da unidade de terapia intensiva, disfunções orgânicas agudas, necessidade de ventilação mecânica e um performance status comprometido associaram-se à maior letalidade. Mais ainda, características relacionadas ao câncer não se associaram com os desfechos. CONCLUSÕES: O presente estudo demonstra que internação na unidade de terapia intensiva e suporte avançado à vida devem ser considerados em pacientes selecionados de câncer criticamente enfermos com lesão renal.
OBJECTIVES: Critically ill cancer patients are at increased risk for acute kidney injury, but studies on these patients are scarce and were all single centered conducted in specialized intensive care units. The objective was to evaluate the characteristics and outcomes in a prospective cohort of cancer patients admitted to several intensive care units with acute kidney injury. METHODS: Prospective multicenter cohort study conducted in intensive care units from 28 hospitals in Brazil over a two-month period. Univariate and multivariate logistic regression were used to identify factors associated with hospital mortality. RESULTS: Out of all 717 intensive care unit admissions, 87 (12 percent) had acute kidney injury and 36 percent of them received renal replacement therapy. Kidney injury developed more frequently in patients with hematological malignancies than in patients with solid tumors (26 percent vs. 11 percent, P=0.003). Ischemia/shock (76 percent) and sepsis (67 percent) were the main contributing factor for and kidney injury was multifactorial in 79 percent of the patients. Hospital mortality was 71 percent. General and renal-specific severity-of-illness scores were inaccurate in predicting outcomes for these patients. In a multivariate analysis, length of hospital stay prior to intensive care unit, acute organ dysfunctions, need for mechanical ventilation and a poor performance status were associated with increased mortality. Moreover, cancer-related characteristics were not associated with outcomes. CONCLUSIONS: The present study demonstrates that intensive care units admission and advanced life-support should be considered in selected critically ill cancer patients with kidney injury.
ABSTRACT
Objective To evaluate the renal cortical blood perfusion changes in rabbits with acute renal failure (ARF) with gray scale contrast-enhanced ultrasound, and to explore the relationship between these changes and the blood creatinine (SCr), as well as the blood urea nitrogen (BUN). Methods Rabbit ARF models were established with 50% glycerin injected into the rabbits' thighs. Gray scale contrast-enhanced ultrasound was performed on the day before injection (T_0) and 1, 4, 8, 12 days (T_1, T_4, T_8, T_(12)) after injection. The renal cortex perfusion time-intensity curve (TIC) was analyzed, including parameters like arrival time (AT), time to peak intensity (TTP), amplitude of peak intensity (A) and slope rate of TIC (β) of renal cortex. Meanwhile the SCr and BUN were measured, the correlation between SCr, BUN and parameters were analyzed. Results Compared with the value of T_0, the value of TTP, A, β after injection (T_1, T_4, T_8) were statistically different, respectively (P<0.05), but the differences among T_1, T_4 and T_8 were various. No linear correlation between above parameters and SCr, BUN was found. Conclusion The renal cortical blood perfusion changes can be early observed with gray scale contrast-enhanced ultrasound, but there is no linear correlation between the changes of parameters and SCr, BUN.
ABSTRACT
AIM: To observe the changes of morphology, the activity of myeloperoxidase (MPO) and membrane pump activities of spleen tissue in acute renal failure (ARF) rabbits, and to inquire into the role of spleen on pathogenesis of immune function disorders during ARF. METHODS: 42 rabbits were divided into control group, HgCl_2 group and glycerinum group. The ARF model was established by hypodermic injection of 1% HgCl_2 at dose of 1.3 mL/kg in HgCl_2 group, intramuscularly injection of 50% glycerinum at dose of 10 mL/kg in glycerinum group, respectively, and the animals were divided into the 12 h, 24 h, 48 h secondary groups (6 rabbits each group). At different time points, the rabbits were cannulated to facilitate the collection of blood sample to examine the biochemical indexes of renal function. The spleen microscopic sections were prepared for observing the morphology. The spleen homogenate was made for determining the activities of MPO and membrane pumping. RESULTS: Pathological sections of spleen showed that the different degree of congestion was found and spleen trabecula was increased in two model groups at multiple-time points. The MPO activity of spleen homogenate in HgCl_2 group and glycerinum group at all time points were obviously higher than that in control group, and at 24 h, the MPO activitie in two model groups was significantly increased than that in the same group at 12 h and 48 h. The activities of Na~+-K~+-ATPase, Ca~(2+)-ATPase, Mg~(2+)-ATPase, Ca~(2+)-Mg~(2+)-ATPase of spleen homogenate in two model groups at multiple time points were significantly lower than those in control group. Following ARF development, the ATPase activitie in two model groups at 48 h was lower than that at 12 h except the Mg~(2+)-ATPase in glycerinum group. CONCLUSION: Spleen as an immune organ has histological damage, arrest of polymorphonuclear neutrophils and dysfunction of membrane pump during the development of ARF in rabbits, leading to immune disorders.
ABSTRACT
The common causes of rhabdomyolysis include trauma, hypoxia, drugs, toxins, infections and hyperthermia. Operative insults, including direct trauma and ischemia, have the potential to cause the development of rhabdomyolysis. Pneumatic tourniquets used during arthroscopic knee surgery to prevent blood loss have led to many complications such as nerve paralysis and vascular injuries. Rhabdomyolysis can also be caused by prolonged pneumatic tourniquet application without a midapplication release, and also from an increased application pressure, but the actual incidence of this is low. In order to prevent rhabdomyolysis, the clinicians must be aware of such risks and follow strict guidelines for the application time, the midapplication release and also the inflation pressure. Vigorous hydration and postoperative patient surveillance are helpful to prevent rhabdomyolysis. We have recently experienced a case of rhabdomyolysis after the arthroscopic knee surgery, and the rhabdomyolysis could have been associated with the use of a pneumatic tourniquet.
Subject(s)
Adult , Humans , Male , Anterior Cruciate Ligament/injuries , Arthroscopy/statistics & numerical data , Renal Insufficiency/etiology , Knee Joint/surgery , Postoperative Complications/etiology , Rhabdomyolysis/etiology , Tourniquets/adverse effectsABSTRACT
IgA nephropathy is the most common type of glomerulonephritis worldwide. Although primary IgA nephropathy receives the most attention, many other diseases are also associated with IgA nephropathy. Among these, chronic liver diseases such as alcoholic liver disease or hepatitis B or C have been reported as secondary causes of glomerular IgA deposits. Recently, as the prevalence of hepatitis A virus (HAV) infection is increasing in Korea, HAV-associated renal diseases occur frequently. Acute kidney injury (AKI) is one of the most common complications of HAV infection, mainly due to acute tubular necrosis or interstitial nephritis. However, unlike hepatitis B and C, glomerular involvement is extremely rare in acute HAV infection. Here, we report a case of biopsy-proven IgA nephropathy with serologically documented HAV infection. The patient presented moderate degree of proteinuria without evidence of AKI. Renal biopsy revealed mesangial IgA deposits but tubular or interstitial inflammation was not observed. This report suggests that HAV infection may be a secondary cause of IgA nephropathy. However, further studies are required to elucidate a causal link between hepatitis A and mesangial IgA deposits.