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1.
J Investig Med High Impact Case Rep ; 8: 2324709620963635, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33019829

RESUMO

As COVID-19 (coronavirus disease 2019) spreads across the world multiple therapeutic interventions have been tried to reduce morbidity and mortality. We describe a case of collapsing focal sclerosing glomerulosclerosis (FSGS) and acute oxalate nephropathy in a patient treated with high-dose intravenous vitamin C for severe COVID-19 infection. Collapsing FSGS has been described in patients with COVID-19 infection associated with APOL-1; however, this case had collapsing FSGS developing in low-risk heterozygous APOL-1 variant, and we postulate that the intensity of the COVID-19 cytokine storm overwhelmed the protective state of APOL-1 heterozygosity. This case illustrates the importance of assessing the risk and benefit of planned therapeutic interventions on a case-by-case basis especially when there are still so many unknowns in the management of COVID-19 infection. Strong consideration should be given for performing a renal biopsy in patients who develop multifactorial acute kidney injury.


Assuntos
Ácido Ascórbico/efeitos adversos , Betacoronavirus , Infecções por Coronavirus/tratamento farmacológico , Glomerulosclerose Segmentar e Focal/induzido quimicamente , Hiperoxalúria/induzido quimicamente , Glomérulos Renais/patologia , Oxalatos/metabolismo , Pneumonia Viral/tratamento farmacológico , Doença Aguda , Lesão Renal Aguda/diagnóstico , Lesão Renal Aguda/etiologia , Ácido Ascórbico/administração & dosagem , Biópsia , Infecções por Coronavirus/epidemiologia , Progressão da Doença , Glomerulosclerose Segmentar e Focal/diagnóstico , Humanos , Hiperoxalúria/diagnóstico , Hiperoxalúria/metabolismo , Injeções Intravenosas , Masculino , Pessoa de Meia-Idade , Pandemias , Pneumonia Viral/epidemiologia , Vitaminas/administração & dosagem , Vitaminas/efeitos adversos
2.
Cir Cir ; 88(5): 569-575, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33064694

RESUMO

Objective: To describe the clinical characteristics and management of severe COVID-19 patients. Method: Observational, descriptive, longitudinal, and retrospective study. Results: 56 patients were admitted, of whom 80.3% (n = 45) were males with a mean age of 58 years [46-67]. The main comorbidities were obesity, high blood pressure, and diabetes. Symptoms onset time at admittance to the ICU was 9 [7-14] days, of which the most frequent were dyspnea, fever, and dry cough. Laboratory data were lymphopenia; elevation of LDH, fibrinogen, D-dimer, ferritin and CRP. 100% of the patients required mechanical ventilation, the median mechanical ventilation time was 12 [6-17] days, and 66% (n= 37) required a prone position. The pharmacological treatment was mainly based on azithromycin, hydroxychloroquine, tocilizumab and steroids. The most frequent complications were acute kidney injury, venous thromboembolism and acute myocardial infarction. Mortality rate was 17.8% (n = 10). Conclusion: The characteristics of the critically ill patients in our hospital were mostly elderly and obese, with the variables of higher SOFA score and acute kidney injury associated with higher mortality.


Assuntos
Betacoronavirus , Infecções por Coronavirus/terapia , Cuidados Críticos/métodos , Unidades de Terapia Intensiva , Pandemias , Pneumonia Viral/terapia , Lesão Renal Aguda/epidemiologia , Lesão Renal Aguda/etiologia , Corticosteroides/uso terapêutico , Idoso , Anticorpos Monoclonais Humanizados/uso terapêutico , Antivirais/uso terapêutico , Azitromicina/uso terapêutico , Doenças Cardiovasculares/epidemiologia , Doenças Cardiovasculares/etiologia , Terapia Combinada , Comorbidade , Infecções por Coronavirus/sangue , Infecções por Coronavirus/complicações , Infecções por Coronavirus/tratamento farmacológico , Infecções por Coronavirus/epidemiologia , Feminino , Mortalidade Hospitalar , Hospitais Universitários/organização & administração , Humanos , Hidroxicloroquina/uso terapêutico , Masculino , México/epidemiologia , Pessoa de Meia-Idade , Escores de Disfunção Orgânica , Pneumonia Viral/sangue , Pneumonia Viral/complicações , Pneumonia Viral/epidemiologia , Respiração Artificial , Avaliação de Sintomas
3.
Perit Dial Int ; 40(5): 496-498, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32998645

RESUMO

Coronavirus Disease 2019 (COVID-19) is a pandemic disease that increased the burden on health-care system. In the Kingdom of Saudi Arabia, 74,795 cases have been reported until 26 May 2020 and the number of cases is rapidly increasing. The mortality rate of COVID-19 worldwide is 6.37%. Here we report three cases of acute kidney injury (AKI) secondary to pneumonia of severe COVID-19; they were treated with automated peritoneal dialysis (PD) with full recovery. To the best of our knowledge, few reports in the literature have discussed the use of PD in AKI secondary to COVID-19.


Assuntos
Lesão Renal Aguda/epidemiologia , Lesão Renal Aguda/terapia , Infecções por Coronavirus/epidemiologia , Pandemias/estatística & dados numéricos , Diálise Peritoneal/métodos , Pneumonia Viral/epidemiologia , Lesão Renal Aguda/diagnóstico , Idoso , Infecções por Coronavirus/diagnóstico , Feminino , Humanos , Testes de Função Renal , Masculino , Pessoa de Meia-Idade , Pandemias/prevenção & controle , Pneumonia Viral/diagnóstico , Amostragem , Arábia Saudita , Resultado do Tratamento
4.
Nephrol Dial Transplant ; 35(10): 1652-1662, 2020 10 01.
Artigo em Inglês | MEDLINE | ID: mdl-33022712

RESUMO

As of 15 August 2020, Coronavirus disease 2019 (COVID-19) has been reported in >21 million people world-wide and is responsible for more than 750,000 deaths. The occurrence of acute kidney injury (AKI) in patients hospitalized with COVID-19 has been reported to be as high as 43%. This is comparable to AKI in other forms of pneumonia requiring hospitalization, as well as in non-infectious conditions like cardiac surgery. The impact of AKI on COVID-19 outcomes is difficult to assess at present but, similar to other forms of sepsis, AKI is strongly associated with hospital mortality. Indeed, mortality is reported to be very low in COVID-19 patients without AKI. Given that AKI contributes to fluid and acid-base imbalances, compromises immune response and may impair resolution of inflammation, it seems likely that AKI contributes to mortality in these patients. The pathophysiologic mechanisms of AKI in COVID-19 are thought to be multifactorial including systemic immune and inflammatory responses induced by viral infection, systemic tissue hypoxia, reduced renal perfusion, endothelial damage and direct epithelial infection with Severe Acute Respiratory Syndrome Coronavirus 2. Mitochondria play a central role in the metabolic deregulation in the adaptive response to the systemic inflammation and are also found to be vital in response to both direct viral damage and tissue reperfusion. These stress conditions are associated with increased glycolysis and reduced fatty acid oxidation. Thus, there is a strong rationale to target AKI for therapy in COVID-19. Furthermore, many approaches that have been developed for other etiologies of AKI such as sepsis, inflammation and ischemia-reperfusion, have relevance in the treatment of COVID-19 AKI and could be rapidly pivoted to this new disease.


Assuntos
Lesão Renal Aguda/etiologia , Betacoronavirus , Infecções por Coronavirus/complicações , Taxa de Filtração Glomerular/fisiologia , Rim/fisiopatologia , Pandemias , Pneumonia Viral/complicações , Lesão Renal Aguda/fisiopatologia , Infecções por Coronavirus/epidemiologia , Humanos , Pneumonia Viral/epidemiologia
5.
Annu Int Conf IEEE Eng Med Biol Soc ; 2020: 5606-5609, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-33019248

RESUMO

Acute Kidney Injury (AKI) is a common complication after surgery. Recognition of patients at risk of AKI at an earlier stage is a priority for researchers and health care providers. The objective of this study is to develop machine learning prediction models of acute kidney injury (AKI) in patients who undergo surgery. The dataset used in this study consists of in-hospital patients' data of five different cohorts coming from different major procedure types. This data was collected from the SunRiseClinical Manager (SCM) electronic medical records system that is used in the Calgary Zone, Alberta, Canada from 2008 to 2015 where the patients are >=18 years of age. Five classifiers were experimented with: support vector machine, random forest, logistic regression, k-nearest neighbors, and adaptive boosting. The area under the receiver operating characteristics curve (AUROC) ranged between 0.62-0.84 and sensitivity and specificity ranged between 0.81-0.83 and 0.43-0.85, respectively. Predictions from these models can facilitate early intervention in AKI treatment.


Assuntos
Lesão Renal Aguda , Lesão Renal Aguda/diagnóstico , Alberta , Área Sob a Curva , Humanos , Aprendizado de Máquina , Curva ROC
7.
Zhonghua Wei Zhong Bing Ji Jiu Yi Xue ; 32(9): 1074-1079, 2020 Sep.
Artigo em Chinês | MEDLINE | ID: mdl-33081893

RESUMO

OBJECTIVE: To analyze the risk factors of acute kidney injury (AKI) in hospitalized patients with infective endocarditis (IE), construct prediction model, and discuss its predictive value. METHODS: The clinical data of 402 adult inpatients diagnosed with IE admitted to the Affiliated Hospital of Qingdao University from January 2010 to January 2020 were retrospectively analyzed. The patients were divided into the AKI group and the non-AKI group. The clinical data, such as gender, age, presence of diabetes, basic estimated glomerular filtration rate (eGFR), laboratory indexes at admission, involvement of valves, presence of sepsis, medication during hospitalization, surgery and outcome of the two groups were compared. Multivariate Logistic regression analysis was used to screen the risk factors of AKI in IE inpatients. A predictive model was constructed, and receiver operating characteristic (ROC) curve was used to analyze the predictive value of the model. RESULTS: A total of 290 patients with IE were enrolled, including 198 non-AKI patients and 92 AKI patients. The incidence of AKI was 31.7%. Among the 92 AKI patients, 46 patients were at AKI stage 1 (50.0%), while 46 patients were at AKI stage 2 and stage 3 (50.0%). Compared with the non-AKI group, patients in the AKI group were older [years old: 64 (55, 71) vs. 55 (46, 63)], and had lower basic eGFR (mL×min-1×1.73 m-2: 64.6±13.6 vs. 82.9±19.5), higher proportion of diabetic and incidence of sepsis (16.3% vs. 8.6%, 38.0% vs. 13.1%), more frequent use of angiotensin converting enzyme inhibitors/angiotensin II receptor antagonists (ACEI/ARB), diuretics and non-steroidal anti-inflammatory drugs (NSAIDs; 25.0% vs. 15.2%, 82.6% vs. 63.1%, 58.7% vs. 24.2%), more abnormal urine test results (hematuria or proteinuria, 35.9% vs. 22.7%), higher pathogen culture negative rate (73.9% vs. 51.5%), lower Gram positive (G+) cocci infection rate and surgery rate (22.8% vs. 40.4%, 60.9% vs. 81.8 %), with significant differences (all P < 0.05). There were no significant differences in the gender, number and location of involved valves, and laboratory indexes at admission between the two groups. Compared with the non-AKI group, the inpatient mortality rate of the AKI group was higher (30.4% vs. 8.6%, P < 0.01), and the inpatient mortality rate of patients with AKI stage 2 and stage 3 was significantly higher than that of patients with AKI stage 1 (43.5% vs. 17.4%, P < 0.01). In multivariate Logistic regression analysis, the lower basic eGFR [hazard ratio (HR) = 0.136, 95% confidence interval (95%CI) was 0.066-0.280], sepsis (HR = 6.100, 95%CI was 2.394-15.543), demand for NSAIDs (HR = 2.990, 95%CI was 1.184-7.546) and radiocontrast agent (HR = 3.153, 95%CI was 1.207-8.238) were independent risk factors for AKI in hospitalized patients with IE (all P < 0.05). A prediction model was constructed based on the above risk factors, and ROC curve analysis showed that the area under the ROC curve (AUC) of prediction model for AKI was 0.888 (95%CI was 0.833-0.943, P < 0.01) with sensitivity of 86.4% and specificity of 80.9%. CONCLUSIONS: In the IE-susceptible population, low basic eGFR, sepsis, the need for NSAIDs and contrast agent are independent risk factors to AKI. The predictive model constructed by the above risk factors has certain predictive value for the occurrence of AKI in the IE inpatients.


Assuntos
Lesão Renal Aguda , Endocardite , Lesão Renal Aguda/etiologia , Endocardite/complicações , Hospitalização , Humanos , Estudos Retrospectivos , Fatores de Risco , Sepse
8.
Zhonghua Wei Zhong Bing Ji Jiu Yi Xue ; 32(9): 1080-1084, 2020 Sep.
Artigo em Chinês | MEDLINE | ID: mdl-33081894

RESUMO

OBJECTIVE: To compare the therapeutic effect of fluid resuscitation strategy guided by pulse-indicated continuous cardiac output (PiCCO) monitoring and early goal-directed therapy (EGDT) on renal function of acute kidney injury (AKI) patients caused by septic shock. METHODS: Septic shock patients with AKI admitted to the intensive care unit (ICU) of Tianjin Fifth Central Hospital and Teda International Cardiovascular Hospital from March 2017 to February 2020 were enrolled. All patients were given fluid resuscitation. Patients were divided into PiCCO-guided fluid resuscitation group [PiCCO group, intrathoracic blood volume index (ITBVI) was maintained between 850-1 000 mL/m2] and EGDT-guided fluid resuscitation group [EGDT group, central venous pressure (CVP) was maintained between 8-12 mmHg (1 mmHg = 0.133 kPa) or CVP ≤ 15 mmHg when patients received mechanical ventilation (MV)] according to both the patient's condition and the informed consent of the patient's family. The changes of heart rate (HR), mean arterial pressure (MAP), CVP, blood lactic acid (Lac), fluid balance, urine volume and serum creatinine (SCr) at 6, 24, and 48 hours after fluid resuscitation in the two groups were observed, and the renal replacement therapy (RRT), duration of MV, length of ICU stay and 28-day mortality between the two group were compared. RESULTS: (1) A total of 94 patients were enrolled, including 51 in the EGDT group and 43 in the PiCCO group. There was no significant difference in gender, age, acute physiology and chronic health evaluation II (APACHE II) score, sequential organ failure assessment (SOFA) score, procalcitonin (PCT), HR, MAP, CVP, Lac or SCr at ICU admission between the two groups. (2) The parameters of hemodynamics, fluid balance, urine volume and SCr were improved with the time of resuscitation in the two groups, and there was no significant difference in HR, MAP or Lac between the two groups. Compared with the EGDT group, the CVP decreased significantly at 24 hours and 48 hours after fluid resuscitation in the PiCCO group (mmHg: 9.1±0.9 vs. 12.0±1.3 at 24 hours, 8.0±1.0 vs. 10.2±1.3 at 48 hours), the fluid balance significantly decreased (mL: 2 929.8±936.3 vs. 3 898.4±923.5 at 24 hours, 3 143.5±1 325.4 vs. 4 843.8±1 326.7 at 48 hours), and the condition of urine volume and SCr were better in the PiCCO group [urine volume (mL×kg-1×h-1): 1.02±0.21 vs. 0.79±0.14 at 24 hours, 1.28±0.18 vs. 0.94±0.22 at 48 hours; SCr (µmol/L): 145.7±37.6 vs. 164.3±46.4 at 24 hours, 128.4±33.6 vs. 143.5±37.7 at 48 hours), with significant differences (all P < 0.05). (3) Compared with the EGDT group, the rate of RRT in the PiCCO group was lower [11.6% (5/43) vs. 17.6% (9/51)], the duration of MV and the length of ICU stay were shorter [duration of MV (days): 4.64±1.31 vs. 6.50±2.19, length of ICU stay (days): 10.35±3.50 vs. 14.50±5.78), with significant differences (all P < 0.05). There was no significant difference in the 28-day mortality between the PiCCO group and EGDT group [14.0% (6/43) vs. 15.7% (8/51), P > 0.05]. CONCLUSIONS: Fluid resuscitation strategy guided by PiCCO in septic shock patients with AKI can reduce the amount of fluid load, improve renal function, shorten the MV duration and length of ICU stay, and shows clinical significance.


Assuntos
Lesão Renal Aguda , Choque Séptico , Pressão Venosa Central , Hidratação , Humanos , Estudos Prospectivos
9.
Zhonghua Wei Zhong Bing Ji Jiu Yi Xue ; 32(9): 1149-1152, 2020 Sep.
Artigo em Chinês | MEDLINE | ID: mdl-33081909

RESUMO

Acute kidney injury (AKI) is a common clinical critical illness, and ischemic kidney injury is the main type. The mortality rate of ischemic kidney injury is high, because the efficacy of treatment is limited due to symptomatic and supportive treatment. Establishing a reliable animal model of ischemic AKI is an important prerequisite for conducting research on physiological, pathological and pharmacological researches, so as to explore effective prevention methods and strategies. In recent years, the establishment methods of animal models of ischemic AKI have been continuously improved. The article summarizes the common methods and model characteristics of animal models of ischemic AKI in order to provide a reference for researchers to choose a reasonable modeling method.


Assuntos
Lesão Renal Aguda , Animais , Estado Terminal , Modelos Animais de Doenças , Isquemia , Rim
10.
Med Klin Intensivmed Notfmed ; 115(7): 566-570, 2020 Oct.
Artigo em Alemão | MEDLINE | ID: mdl-33025048

RESUMO

Renal replacement therapy is after mechanical ventilation one of the most important and frequently used organ replacement therapies in daily routine intensive care practice. In contrast to mechanical ventilation, quality standards for renal replacement therapy are less well known and defined. In this position paper of the German Interdisciplinary Association for Intensive Care and Emergency Medicine, we describe quality standards of renal replacement procedures in order to improve therapy of patients with severe acute kidney injury.


Assuntos
Lesão Renal Aguda , Estado Terminal , Lesão Renal Aguda/terapia , Cuidados Críticos , Estado Terminal/terapia , Humanos , Melhoria de Qualidade , Terapia de Substituição Renal
11.
G Ital Nefrol ; 37(5)2020 Oct 05.
Artigo em Italiano | MEDLINE | ID: mdl-33026202

RESUMO

We report the case of a 68-year-old patient who arrived at the hospital with a fever and a cough for 7 days, a history of high blood pressure and chronic kidney failure stage 2 according to CKD-EPI (GFR: 62 ml/minute with creatinine: 1.2 mg/dl). Home therapy included lercanidipine and clonidine. A chest radiograph performed in the emergency department immediately showed images suggestive of pneumonia from COVID-19, confirmed in the following days by a positive swab for coronavirus. Kidney function parameters progressively deteriorated towards a severe acute kidney failure on the 15th day, with creatinine values of 6.6 mg/dl and urea of 210 mg/dl. The situation was managed first in the intensive care unit with CRRT cycles (continuous renal replacement therapy) and then in a "yellow area" devoted to COVID patients, where the patient was dialyzed by us nephrologists through short cycles of CRRT. In our short experience we have used continuous techniques (CRRT) in positive patients hemodynamically unstable and intermittent dialysis (IRRT) in our stable chronic patients with asymptomatic COVID -19. We found CRRT to be superior in hemodynamically unstable patients hospitalized in resuscitation and in the "yellow area". Dialysis continued with high cut-off filters until the normalization of kidney function; the supportive medical therapy has also improved the course of the pathology and contributed to the favorable outcome for our patient. During the COVID-19 pandemic, our Nephrology Group at Savona's San Paul Hospital has reorganized the department to better manage both chronic dialyzed patients and acute patients affected by the new coronavirus.


Assuntos
Lesão Renal Aguda/terapia , Betacoronavirus , Infecções por Coronavirus/complicações , Pandemias , Pneumonia Viral/complicações , Lesão Renal Aguda/diagnóstico por imagem , Lesão Renal Aguda/etiologia , Lesão Renal Aguda/fisiopatologia , Idoso , Anti-Hipertensivos/uso terapêutico , Antivirais/uso terapêutico , Betacoronavirus/fisiologia , Infecções por Coronavirus/diagnóstico por imagem , Infecções por Coronavirus/fisiopatologia , Infecções por Coronavirus/terapia , Creatinina/sangue , Cuidados Críticos/métodos , Gerenciamento Clínico , Hemodinâmica , Humanos , Hipertensão/complicações , Hipertensão/tratamento farmacológico , Comunicação Interdisciplinar , Falência Renal Crônica/complicações , Masculino , Equipe de Assistência ao Paciente , Isolamento de Pacientes , Pneumonia Viral/diagnóstico por imagem , Pneumonia Viral/fisiopatologia , Pneumonia Viral/terapia , Diálise Renal/métodos , Respiração Artificial , Ureia/sangue
12.
Medicine (Baltimore) ; 99(41): e22492, 2020 Oct 09.
Artigo em Inglês | MEDLINE | ID: mdl-33031284

RESUMO

RATIONALE: Metformin-associated lactic acidosis (MALA) is a rare adverse effect that has significant morbidity and mortality. MALA is a high anion gap (AG), nonosmolar acidosis. Associated osmolar-gap (OG) is rarely reported, so finding an OG may make the diagnosis of MALA challenging. PATIENT CONCERNS: Forty-five years' old type II diabetic patient on metformin presented to emergency with a two-day history of vomiting, watery diarrhea, and mild abdominal discomfort. On examinations, he looked dehydrated. Investigation revealed acute kidney injury (AKI) with a high lactic acid (LA) level of 24 mmol/L, pH of 6.8, AG of 40, and an OG of 20 mOsm/kg DIAGNOSES:: The presence of an OG made the diagnosis challenging; the history was negative for alcohol, osmolar substance, or illicit drug ingestion or use. The toxicology screen was negative. After ruling out plausible causes of AG and OG, MALA was deemed the likely reason for his presentation likely precipitated by dehydration and AKI. INTERVENTIONS: He underwent two sessions of hemodialysis, afterward managed with fluid hydration. OUTCOMES: On day 3, he was in the polyuric phase suggestive of acute tubular necrosis. His serum creatinine improved afterward with improved acidosis; after 8 days, he was discharged in stable condition. LESSONS: MALA is a rare side effect of metformin therapy. Acute kidney injury is a known precipitant of MALA. In our review, we highlight the association of MALA and the presence of an OG. We believe that treating physicians should be aware of this relationship to avoid delaying or overlooking such an important diagnosis.


Assuntos
Acidose Láctica/sangue , Acidose Láctica/induzido quimicamente , Lesão Renal Aguda/complicações , Hipoglicemiantes/efeitos adversos , Metformina/efeitos adversos , Concentração Osmolar , Desequilíbrio Ácido-Base , Acidose Láctica/diagnóstico , Diabetes Mellitus Tipo 2/tratamento farmacológico , Humanos , Ácido Láctico/sangue , Masculino , Pessoa de Meia-Idade
13.
Praxis (Bern 1994) ; 109(13): 1070-1073, 2020.
Artigo em Alemão | MEDLINE | ID: mdl-33050809

RESUMO

Unusual Cause of Acute Kidney Failure in a Patient with Metastatic Bladder Carcinoma Undergoing Palliative Chemotherapy Abstract. Tumour lysis syndrome is a potentially life-threatening complication of cancer and its treatment. It mostly occurs in highly proliferative haematological neoplasms under cytotoxic therapy but can also be seen spontaneously and in solid neoplasms, particularly with high tumour burden and/or high chemosensitivity. The present case report describes a tumour lysis syndrome in a patient with metastatic bladder cancer with an elevated lactate dehydrogenase as only potential correlate of a high tumour burden.


Assuntos
Lesão Renal Aguda , Síndrome de Lise Tumoral , Neoplasias da Bexiga Urinária , Lesão Renal Aguda/etnologia , Antineoplásicos/uso terapêutico , Humanos , Cuidados Paliativos , Neoplasias da Bexiga Urinária/complicações , Neoplasias da Bexiga Urinária/tratamento farmacológico
14.
Ther Umsch ; 77(8): 401-405, 2020.
Artigo em Alemão | MEDLINE | ID: mdl-33054652

RESUMO

Incidental finding of a high creatinine Abstract. In up to 10 % of patient visiting their General Practitioner and having blood tests an elevated creatinine or reduced kidney function are detected incidentally by the often automatically reported estimation of glomerular filtration rate (eGFR) by a creatinine-based formula. The most important step in this situation is to evaluate whether reduced kidney function is due to chronic kidney disease or whether the patient presents with an acute kidney injury (AKI). Early detection of AKI is crucial as any delay in accurate therapy can lead to further decline of kidney function and elevated mortality. In addition, intrinsic kidney diseases, which are less common should not be missed because early access to specialised management is crucial. Clinical history including history of medication, context of consultation, clinical evaluation and additional laboratory values will help to provide a first suspicion diagnosis. Further investigations (abdominal sonography, urinary sediment, proteinuria) will help to confirm the diagnosis. In any case of absence of an obvious cause of AKI, young patient, threatening severe renal insufficiency with rapid progression of kidney failure or suspicious laboratory abnormalities, the patient should be referred without any delay to a nephrologist for further evaluation and management.


Assuntos
Lesão Renal Aguda , Insuficiência Renal Crônica , Lesão Renal Aguda/diagnóstico , Creatinina , Taxa de Filtração Glomerular , Humanos , Achados Incidentais
15.
AJNR Am J Neuroradiol ; 41(10): 1791-1796, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32912875

RESUMO

BACKGROUND AND PURPOSE: Coronavirus disease 2019 (COVID-19) is increasingly being recognized for its multiorgan involvement, including various neurological manifestations. We examined the frequency of acute intracranial abnormalities seen on CT and/or MR imaging in patients with COVID-19 and investigated possible associations between these findings and clinical parameters, including length of hospital stay, requirement for intubation, and development of acute kidney injury. MATERIALS AND METHODS: This was a retrospective study performed at a large academic hospital in the United States. A total of 641 patients presented to our institution between March 3, 2020, and May 6, 2020, for treatment of coronavirus disease 2019, of whom, 150 underwent CT and/or MR imaging of the brain. CT and/or MR imaging examinations were evaluated for the presence of hemorrhage, infarction, and leukoencephalopathy. The frequency of these findings was correlated with clinical variables, including body mass index, length of hospital stay, requirement for intubation, and development of acute kidney injury as documented in the electronic medical record. RESULTS: Of the 150 patients, 26 (17%) had abnormal CT and/or MR imaging findings, with hemorrhage in 11 of the patients (42%), infarction in 13 of the patients (50%), and leukoencephalopathy in 7 of the patients (27%). Significant associations were seen between abnormal CT/MR imaging findings and intensive care unit admission (P = .039), intubation (P = .004), and acute kidney injury (P = .030). CONCLUSIONS: A spectrum of acute neuroimaging abnormalities was seen in our cohort of patients with coronavirus disease 2019, including hemorrhage, infarction, and leukoencephalopathy. Significant associations between abnormal neuroimaging studies and markers of disease severity (intensive care unit admission, intubation, and acute kidney injury) suggest that patients with severe forms of coronavirus disease 2019 may have higher rates of neuroimaging abnormalities.


Assuntos
Betacoronavirus , Doenças do Sistema Nervoso Central/etiologia , Infecções por Coronavirus/complicações , Pneumonia Viral/complicações , Lesão Renal Aguda/epidemiologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Doenças do Sistema Nervoso Central/diagnóstico por imagem , Feminino , Humanos , Unidades de Terapia Intensiva , Tempo de Internação , Leucoencefalopatias , Masculino , Pessoa de Meia-Idade , Neuroimagem , Pandemias , Estudos Retrospectivos , Adulto Jovem
18.
Medicine (Baltimore) ; 99(37): e21386, 2020 Sep 11.
Artigo em Inglês | MEDLINE | ID: mdl-32925711

RESUMO

Serum creatinine (SCr) and estimated glomerular filtration rate (eGFR) are standard biomarkers of contrast-induced nephropathy (CIN). However, recent studies suggest that serum neutrophil gelatinase-associated lipocalin (sNGAL) and urine neutrophil gelatinase-associated lipocalin (uNGAL) may be better predictors, particularly within 24 hours of contrast medium exposure.We conducted a prospective, observational cohort study of 107 consecutive patients diagnosed with arteriosclerosis obliterans between February 2016 and October 2018. We divided the patients into 2 groups: CIN (n = 22) and non-CIN (n = 85). We assessed the correlation between sNGAL and uNGAL concentrations and standard renal markers at baseline, 6, 24, and 48 hours post-procedure. We constructed conventional receiver operating characteristic (ROC) curves and calculated the area under the curve to assess the performance of SCr, eGFR, sNGAL, and uNGAL. We derived biomarker cutoff levels from ROC analysis to maximize sensitivity and specificity.The incidence of CIN within our cohort was 20.6%. sNGAL levels correlated significantly with SCr and eGFR at baseline, 6, 24, and 48 hours post-contrast medium exposure. Similarly, uNGAL levels correlated with SCr and eGFR at baseline, 24, and 48 hours post-exposure. sNGAL and uNGAL were significantly elevated as early as 6 hours post-catheterization in the CIN group, whereas only minor changes were observed in the non-CIN group. SCr was also significantly elevated in the CIN group, but not until 24 hours post-catheterization.Both sNGAL and uNGAL may be superior to SCr and eGFR as early biomarkers of CIN in patients with peripheral vascular disease undergoing endovascular therapy.


Assuntos
Lesão Renal Aguda/diagnóstico , Meios de Contraste/efeitos adversos , Procedimentos Endovasculares/efeitos adversos , Lipocalina-2/análise , Complicações Pós-Operatórias/diagnóstico , Lesão Renal Aguda/induzido quimicamente , Idoso , Área Sob a Curva , Arteriosclerose Obliterante/cirurgia , Biomarcadores/sangue , Biomarcadores/urina , Feminino , Humanos , Masculino , Complicações Pós-Operatórias/induzido quimicamente , Estudos Prospectivos , Curva ROC , Sensibilidade e Especificidade
20.
Chem Biol Interact ; 330: 109251, 2020 Oct 01.
Artigo em Inglês | MEDLINE | ID: mdl-32888910

RESUMO

Cisplatin induces acute renal failure in humans and mice.Tubular apoptosis, necrosis and inflammation are the primary pathogenesis of cisplatin-induced acute kidney injury(AKI). We previously reported that the depletion of Numb from proximal tubules exacerbates tubular cells apoptosis in cisplatin-induced AKI, however, the role of Numb in tubular necrosis and renal inflammation in cisplatin-induced AKI remains unclear. A mouse model of AKI was produced by cisplatin intraperitoneally injection in mice from proximal tubule-specific depletion of Numb (PT-Nb-KO) and their wild-type littermates (PT-Nb-WT) respectively. Renal Numb expression was determined by Western blotting. Renal morphological damage was examined by hematoxylin and eosin staining (H&E staining). Tubular necrosis was evaluated by histological study and the protein level of renal Mixed lineage kinase domain-like protein (MLKL) which is a molecular marker of necrosis. Leukocyte infiltration and pro-inflammatory cytokines was determined by immunostaining and quantitative real-time PCR (qRT-PCR) respectively.The protein level of Numb was dramatically decreased in kidneys of PT-Nb-KO mice compared with PT-Nb-WT mice. After cisplatin injection, a significant increase of tubular injury score and the protein level of renal MLKL were detected in PT-Nb-KO mice compared with those in PT-Nb-WT. In addition, the number of F4/80-positve and CD3-positive cells, markers for macrophages and neutraphils respectively, showed significantly increased in kidneys from PT-Nb-KO mice compared with those in PT-Nb-WT mice. Consistently, the gene expression of pro-inflammatory cytokines including TNF-α and MCP-1 in the kidneys was higher in PT-Nb-KO mice than those in PT-Nb-WT mice. Numb play additional protective role in cisplatin-induced AKI through ameliorating tubular necrosis and renal inflammation besides attenuating cisplatin-induced tubular apoptosis.


Assuntos
Lesão Renal Aguda/patologia , Cisplatino/efeitos adversos , Inflamação/prevenção & controle , Proteínas de Membrana/fisiologia , Necrose/prevenção & controle , Proteínas do Tecido Nervoso/fisiologia , Animais , Contagem de Células , Citocinas/metabolismo , Modelos Animais de Doenças , Inflamação/etiologia , Túbulos Renais Proximais/patologia , Mastócitos , Proteínas de Membrana/deficiência , Camundongos , Camundongos Knockout , Necrose/etiologia , Proteínas do Tecido Nervoso/deficiência , Neutrófilos , Proteínas Quinases/metabolismo
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