RESUMEN
Epidemiological, experimental and clinical studies support a role for uric acid in acute kidney injury (AKI). We discuss how the conventional role of uric acid in AKI has now evolved from intratubular crystal deposition to pro-inflammatory, anti-angiogenic and immunological function. Data from recent studies are presented to support the hypothesis that uric acid may have a role in AKI via a crystal-independent process in addition to its traditionally accepted role to induce injury via crystal-dependent pathways.
Asunto(s)
Lesión Renal Aguda/epidemiología , Lesión Renal Aguda/prevención & control , Inhibidores de la Angiogénesis/sangre , Hiperuricemia/tratamiento farmacológico , Modelos Biológicos , Urato Oxidasa/farmacología , Ácido Úrico/sangre , Lesión Renal Aguda/etiología , Inhibidores de la Angiogénesis/inmunología , Animales , Cisplatino/administración & dosificación , Cisplatino/farmacología , Tasa de Filtración Glomerular/efectos de los fármacos , Humanos , Hiperuricemia/complicaciones , Riñón/irrigación sanguínea , Riñón/efectos de los fármacos , Proyectos Piloto , Ratas , Urato Oxidasa/administración & dosificación , Ácido Úrico/inmunología , Vasoconstricción/efectos de los fármacosRESUMEN
Acute kidney injury in patients undergoing cardiovascular surgery is a complex problem with associated increased risks for dialysis, short- and long-term mortality, and progression to end-stage renal disease. Interventions to prevent and treat renal complications in this cohort have seldom been uniformly satisfactory due to the differences in strategies for intervention, drug doses and duration of treatment, baseline renal functions, and population studied. Nonetheless, significant advances have been made and include recognition of the effect of preexisting organ dysfunction on renal outcomes, reassessment of existing therapeutic interventions, and exploration of the feasibility of newer agents to prevent and treat acute kidney injury in cardiovascular surgery patients. This article briefly reviews several of these issues with an emphasis on recent clinical trials in this cohort.
Asunto(s)
Lesión Renal Aguda/etiología , Lesión Renal Aguda/prevención & control , Procedimientos Quirúrgicos Cardiovasculares/efectos adversos , Lesión Renal Aguda/diagnóstico , Lesión Renal Aguda/epidemiología , Antioxidantes/uso terapéutico , Ensayos Clínicos como Asunto , Progresión de la Enfermedad , Diagnóstico Precoz , Fluidoterapia/métodos , Mortalidad Hospitalaria , Médicos Hospitalarios/métodos , Humanos , Incidencia , Natriuréticos/uso terapéutico , Atención Perioperativa/métodos , Diálisis Renal , Medición de Riesgo , Factores de Riesgo , Resultado del Tratamiento , Vasodilatadores/uso terapéuticoRESUMEN
Hepatogastric fistula secondary to amebic liver abscess is extremely rare. Only three pediatric cases have been reported in the English literature. Percutaneous drainage of abscess along with parenteral metronidazole can prevent the need for extensive surgical intervention. Timely intervention is usually followed by complete recovery.
