The Artificial Neural Network as a Diagnostic Tool of the Risk of Clostridioides difficile Infection among Patients with Chronic Kidney Disease.

The majority of recently published studies indicate a greater incidence and mortality due to Clostridioides difficile infection (CDI) in patients with chronic kidney disease (CKD). Hospitalization, older age, the use of antibiotics, immunosuppression, proton pump inhibitors (PPI), and chronic diseases such as CKD are responsible for the increased prevalence of infections. The aim of the study is to identify clinical indicators allowing, in combination with artificial intelligence (AI) techniques, the most accurate assessment of the patients being at elevated risk of CDI.

Clinical Determinants Predicting Clostridioides difficile Infection among Patients with Chronic Kidney Disease.

The majority of recently published studies indicate a greater incidence rate and mortality due to Clostridioides difficile infection (CDI) in patients with chronic kidney disease (CKD). The aim of this study was to assess the clinical determinants predicting CDI among hospitalized patients with CKD and refine methods of prevention. We evaluated the medical records of 279 patients treated at a nephrological department with symptoms suggesting CDI, of whom 93 tested positive for CDI. The survey showed that age, poor kidney function, high Padua prediction score (PPS) and patients' classification of care at admission, treatment with antibiotics, and time of its duration were significantly higher or more frequent among patients who suffered CDI. Whereas BMI, Norton scale (ANSS) and serum albumin concentration were significantly lowered among CDI patients. In a multivariate analysis we proved the stage of CKD and length of antibiotics use increased the risk of CDI, whereas higher serum albumin concentration and ANSS have a protective impact.

Risk factors of the Clostridium difficile infection in patients with chronic kidney disease.

BACKGROUND: Clostridium difficile (C. difficile) is a Gram-positive bacillus responsible for diarrhea and colitis, mainly among hospitalized patients. It is a leading cause of nosocomial infections. OBJECTIVES: The main goal of the study was to assess the risk factors of the C. difficile infection in patients with chronic kidney disease (CKD). MATERIAL AND METHODS: We evaluated the medical records of all patients treated at the Department of Nephrology and Renal Transplantation of the Research and Development Center in the Provincial Specialist Hospital in Wroclaw, Poland, between February 2009 and May 2012, who developed diarrhea, abdominal pain and/or fever within 72 h after admission. In patients with these symptoms, an enzyme cassette immunoassay was performed to detect antigens of C. difficile toxins A and B in stool. RESULTS: There were 207 patients enrolled in the study, presented with the symptoms of the C. difficile infection. Out of these patients, 69 (33%) persons were positive for C. difficile toxins. Longer hospitalization time and lower initial serum albumin concentration significantly increased the risk of infection (p < 0.05). Apart from the C. difficile infection, age, the number of used antibiotics, longer hospitalization time, and lower initial serum albumin concentration significantly augmented the risk of death (p < 0.05). CONCLUSIONS: In patients with CKD, longer hospitalization time and lower serum albumin concentration significantly increased the risk of the C. difficile infection. The C. difficile infection, age, the number of used antibiotics, longer hospitalization time, and lower initial serum albumin concentration notably augmented the risk of death. Although the incidence of the C. difficile infection did not correlate with the estimated glomerular filtration rate (eGFR), 67% of patients who tested positive were class 5 of CKD, whereas only 5.7% were class 1.

[Rapid progressive glomerulonephritis (RPGN) and skin involvement as a clinical manifestation of vasculitis: a case report]. / Gwaltownie postepujace klebuszkowe zapalenie nerek oraz zajecie skóry w przebiegu ukladowego zapalenia naczyn: prezentacja przypadku.

Systemic vasculitis is a heterogeneous group of diseases characterized by infiltrates consisting of neutrophils infiltrated the walls of blood vessels of various caliber. The most common clinical manifestation is renal involvement, nervous system, lungs and skin. These disorders may be manifested by changes in the image of urine in the form of a nephritic syndrome, deterioration of renal function, haemoptysis and ulceration of the skin. Characteristic for systemic vasculitis is the presence of neutrophil cytoplasmic antibodies (ANCA), which binds to the specific antigens generate immune complexes, which then activates a cascade of inflammatory reactions and lead to damage of vascular walls. The treatment includes steroids and cyclophosphamide and therapeutic plasma exchange treatments, and after reaching remission therapy is continued by low-dose steroids and azathioprine. A case of a man with systemic vasculitis is presented, in whom symptoms were present in the form of nephritic syndrome and RPGN, and has developed sores on the skin of abdomen and lower limbs. After the use of prednisone at a dose of 1 mg/kg and pulses of cyclophosphamide, remission has been achieved, patient restored normal kidney function, and the massive skin lesions have healed.