Blood transfusion reactions and risk of acute kidney injury and major adverse kidney events.

BACKGROUND: Blood transfusion reactions may have a negative impact on organ function. It is unknown whether this association holds true for acute kidney injury (AKI). Therefore, we conducted a cohort study to assess the association between transfusion reactions and the incidence of AKI and major adverse kidney events. METHODS: In this retrospective cohort study, we included patients who received transfusion of blood products during hospitalization at the Hospital Civil of Guadalajara. We analyzed them according to the development of transfusion reactions, and the aim was to assess the association between transfusion reactions and AKI during long-term follow-up. RESULTS: From 2017 to 2021, 81,635 patients received a blood product transfusion, and 516 were included in our study. The most common transfusion was red blood cell packaging (50.4%), fresh frozen plasma (28.7%) and platelets (20.9%); of the 516 patients, 129 (25%) had transfusion reactions. Patients who had transfusion reactions were older and had more comorbidities. The most common type of transfusion reaction was allergic reaction (70.5%), followed by febrile nonhemolytic reaction (11.6%) and anaphylactoid reaction (8.5%). Most cases were considered mild. Acute kidney injury was more prevalent among those who had transfusion reactions (14.7%) than among those who did not (7.8%), p = < 0.01; those with AKI had a higher frequency of diabetes, vasopressors, and insulin use. Transfusion reactions were independently associated with the development of AKI (RR 2.1, p = < 0.02). Major adverse kidney events were more common in those with transfusion reactions. The mortality rate was similar between subgroups. CONCLUSION: In our retrospective cohort of patients who received blood product transfusions, 25% experienced transfusion reactions, and this event was associated with a twofold increase in the probability of developing AKI and some of the major adverse kidney events during long follow-up.

Acute Kidney Injury and Intestinal Dysbiosis.

Within the multiple communication pathways of the intestine-kidney axis, one of the most important pathways is the interaction between the commensals of the intestinal microbiome, through the production of short-chain fatty acids, and the segments of the nephron. These interactions maintain a perfect environmental balance. During AKI, there are negative repercussions in all organs, and the systemic interconnection is related in part to the intense inflammation and the uremic environment that this syndrome generates. For example, in the intestine, the microbiome is severely affected, with a decrease in benign bacteria that promote anti-inflammatory effects and an increase in negative, pro-inflammatory bacteria. This scenario of intestinal dysbiosis widens the inflammatory loop that favors worsening kidney function and the probability of dying. It is possible that the manipulation of the intestinal microbiome with probiotics, prebiotics and symbiotics is a reasonable therapeutic goal for AKI.

Procalcitonina como biomarcador de daño renal agudo en pacientes con sepsis y choque séptico / Procalcitonin as a biomarker for acute kidney injury in patients with sepsis and septic shock

Resumen Introducción: hasta el 60 % de los pacientes con sepsis desarrollan daño renal agudo. La procalcitonina indica la presencia de sepsis y puede predecir un daño renal agudo. Objetivos: determinar los valores de procalcitonina como biomarcador predictor de daño renal agudo y sus complicaciones en el espectro de sepsis. Métodos: estudio transversal. Se midió procalcitonina durante las 24 horas de hospitalización. Se determinó el área bajo la curva, el error estándar, la sensibilidad y especificidad de los valores de procalcitonina relacionado con daño renal agudo. Resultados: un total de 72 pacientes con edad de 51 años (rango 18 -79); 35 (48,6 %) casos eran hombres, 44 (61,1 %) presentaron sepsis, 14 (19,4 %) choque séptico, 11 (15,3 %) sepsis severa y 3 (4,2 %) hipotensión inducida por sepsis. Encontramos una elevación de procalcitonina (≥0,5 ng/mL) en 54 (75 %) pacientes; presentaron daño renal agudo 42 (58,3 %) casos; estadio KDIGO 1 en 19 (45,2 %), KDIGO 2 en 12 (28,6 %) y KDIGO 3 en 11 (26,2 %) pacientes; de ellos 37 (88,1 %) presentaron procalcitonina ≥0,5 ng/mL (OR 5,65, IC 95 % 1,73 - 18,42; p<0,01). El área debajo de la curva 0,75 (IC 95 % 0,63 - 0,86 p <0,0001); el valor de procalcitonina de 2,565 ng/mL tuvo la mayor validez prediciendo daño renal agudo, con sensibilidad de 61,9 %, especificidad de 80 %, un valor predictivo positivo de 44,52 %, valor predictivo negativo de 56,18 %, LR+ de 0.80 y un LR- de 0.77. Conclusión: en el espectro de sepsis, el nivel de procalcitonina ≥2,565 ng/mL al ingreso hospitalario predice daño renal agudo.

Abstract Introduction: Up to 60% of patients with sepsis develop acute kidney injury. Procalcitonin indicates the presence of sepsis and could predict acute kidney injury. Objectives: To determine the values of procalcitonin as a predictive biomarker of acute renal injury and its complications in the sepsis spectrum. Methods: Cross-sectional study. Procalcitonin was measured during the 24 hours of hospitalization. We determined the area under the curve, standard error, sensitivity and specificity of procalcitonin values related to acute renal injury. Results: A total of 72 patients aged 51 years (range 18-79); 35 (48.6%) were male, 44 (61.1%) presented sepsis, 14 (19.4%) had septic shock, 11 (15.3%) severe sepsis and 3 (4.2%) sepsis-induced hypotension. We found an elevation of procalcitonin (≥0.5 ng / mL) in 54 (75%) patients; presented acute renal injury 42 (58.3%) cases; KDIGO 1 in 19 (45.2%), KDIGO 2 in 12 (28.6%) and KDIGO 3 in 11 (26.2%) patients; of them 37 (88.1%) had procalcitonin ≥0.5 ng / mL (OR 5.65, 95% CI 1.73-18.42, p <0.01). The area under the curve 0.75 (95% CI 0.63 - 0.86 p <0.0001); the value of procalcitonin of 2,565 ng / mL had the highest validity predicting acute renal injury, with sensitivity of 61.9%, specificity of 80%, a positive predictive value of44.52%, negative predictive value of 56.18%, LR + of 0.80 and an LR - 0.77. Conclusion: In the sepsis spectrum, the level of procalcitonin ≥2,565 ng / mL at hospital admission predicts acute kidney injury.

Rabdomiólisis y daño renal agudo asociado a infección por Clostridium difficile, reporte de caso / Rhabdomyolysis and acute kidney injury associated with Clostridium difficile infection, case report

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[Epidemiología y desenlaces de la lesión renal aguda en Latinoamérica].

La lesión renal aguda (LRA) o injuria renal aguda, como se describe en Sudamérica, está sobreestimada por estudios epidemiológicos de países de alto nivel económico. En Latinoamérica (LA) existe un vacío de información sobre la epidemiología de la LRA. Se realizó una búsqueda de artículos publicados en LA referentes a la LRA y se hallaron 61 estudios, que representan a 10,670 pacientes latinoamericanos, en los cuales se distingue entre población adulta y pediátrica, LRA adquirida en la comunidad (LRA-AC) y adquirida en el hospital (LRA-AH), y se describen sus etiologías y desenlaces. El conocimiento de la incidencia y características de los pacientes con LRA en LA nos permitirá el desarrollo de estrategias preventivas y mejor acceso a un tratamiento de apoyo adecuado.Acute kidney injury (AKI) is over represented by epidemiological studies of high-income countries. In Latin America there is a lack of information on the epidemiology of AKI. We conducted a search of articles on AKI published in Latin America, finding 61 studies that represent 10,670 Latin American patients. Data were segmented by adult and pediatric populations, and community-acquired AKI and hospital-acquired AKI. Finally, etiology and outcomes are described. The knowledge of the incidence and characteristics of patients with AKI in Latin America will allow us to develop preventive strategies and better access to adequate support treatment.

[Principios y modalidades en terapia de reemplazo renal continua].

La terapia de reemplazo renal continuo (CRRT, por sus siglas en inglés) se utiliza en pacientes críticamente enfermos con lesión renal aguda (LRA). Este tratamiento tiene una historia cargada de tintes pasionales y ambiciosos que han revolucionado el tratamiento en las Unidades de terapia intensiva. Avances tecnológicos permiten remover toxinas y ajustar líquidos y moléculas de manera paulatina y segura, lo que que plausiblemente mejora el pronóstico clínico. Las terapias continuas requieren una estrecha colaboración del equipo multidisciplinario. Aunque los datos no demuestran ventaja entre las distintas modalidades de tratamiento de sustitución renal, creemos que avanzamos hacia una estandarización del tratamiento con base en la evidencia, que ha de promover una continua mejoría en el tratamiento de pacientes críticos con LRA. En el presente artículo se comenta la evolución tecnológica, los componentes del circuito extracorpóreo, los pasos iniciales en el uso de las máquinas, los principios en mecanismos de transporte y, finalmente, las modalidades de mayor uso en CRRT.Continuous renal replacement therapy (CRRT) is used in critically ill patients with acute kidney injury. This modality of treatment, loaded with a history full of passion and ambition, has revolutionized treatment in intensive care units. Technological advances allow the removal of toxins and management of fluids and molecules in a gradual and safe way that plausibly improves the clinical prognosis. This technique requires close collaboration of the multidisciplinary team. Although data do not demonstrate an advantage among the different modalities of renal replacement therapy, we firmly believe that we are moving towards an evidence-based standardization of treatment, which should promote a continuous improvement in the management of critically ill patients with acute renal injury. The present study accomplishes the evolution of technology, the components of the extracorporeal circuit, the initial steps while using these dedicated machines, the principles of mechanisms of solute and water transport, and finally the most frequently prescribed modalities in CRRT.