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1.
J Int Med Res ; 49(9): 3000605211016208, 2021 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-34510958

RESUMO

OBJECTIVE: This retrospective multicentre observational study was performed to assess the predictors of acute kidney injury (AKI) in patients with acute decompensated heart failure (ADHF) in emergency departments in China. METHODS: In total, 1743 consecutive patients with ADHF were recruited from August 2017 to January 2018. Clinical characteristics and outcomes were compared between patients with and without AKI. Predictors of AKI occurrence and underdiagnosis were assessed in multivariate regression analyses. RESULTS: Of the 1743 patients, 593 (34.0%) had AKI. AKI was partly associated with short-term all-cause mortality and cost. Cardiovascular comorbidities such as coronary heart disease, diabetes mellitus, and hypertension remained significant predictors of AKI in the univariate analysis. AKI was significantly more likely to occur in patients with a lower arterial pH, lower albumin concentration, higher creatinine concentration, and higher N-terminal pro-brain natriuretic peptide (NT-proBNP) concentration. Patients treated with inotropic agents were significantly more likely to develop AKI during their hospital stay. CONCLUSION: This study suggests that cardiovascular comorbidities, arterial pH, the albumin concentration, the creatinine concentration, the NT-proBNP concentration, and use of inotropic agents are predictors of AKI in patients with ADHF.


Assuntos
Injúria Renal Aguda , Insuficiência Cardíaca , Doença Aguda , Injúria Renal Aguda/diagnóstico , Biomarcadores , Serviço Hospitalar de Emergência , Insuficiência Cardíaca/complicações , Insuficiência Cardíaca/diagnóstico , Insuficiência Cardíaca/epidemiologia , Humanos , Peptídeo Natriurético Encefálico , Fragmentos de Peptídeos , Prognóstico , Estudos Retrospectivos
2.
BMC Nephrol ; 22(1): 297, 2021 08 31.
Artigo em Inglês | MEDLINE | ID: mdl-34465289

RESUMO

BACKGROUND: Kidney disease and renal failure are associated with hospital deaths in patients with COVID - 19. We aimed to test if contrast enhancement affects short-term renal function in hospitalized COVID - 19 patients. METHODS: Plasma creatinine (P-creatinine) was measured on the day of computed tomography (CT) and 24 h, 48 h, and 4-10 days after CT. Contrast-enhanced (n = 142) and unenhanced (n = 24) groups were subdivided, based on estimated glomerular filtration rates (eGFR), > 60 and ≤ 60 ml/min/1.73 m2. Contrast-induced acute renal failure (CI-AKI) was defined as ≥27 µmol/L increase or a > 50% rise in P-creatinine from CT or initiation of renal replacement therapy during follow-up. Patients with renal replacement therapy were studied separately. We evaluated factors associated with a > 50% rise in P-creatinine at 48 h and at 4-10 days after contrast-enhanced CT. RESULTS: Median P-creatinine at 24-48 h and days 4-10 post-CT in patients with eGFR> 60 and eGFR≥30-60 in contrast-enhanced and unenhanced groups did not differ from basal values. CI-AKI was observed at 48 h and at 4-10 days post contrast administration in 24 and 36% (n = 5/14) of patients with eGFR≥30-60. Corresponding figures in the eGFR> 60 contrast-enhanced CT group were 5 and 5% respectively, (p < 0.037 and p < 0.001, Pearson χ2 test). In the former group, four of the five patients died within 30 days. Odds ratio analysis showed that an eGFR≥30-60 and 30-day mortality were associated with CK-AKI both at 48 h and 4-10 days after contrast-enhanced CT. CONCLUSION: Patients with COVID - 19 and eGFR≥30-60 had a high frequency of CK-AKI at 48 h and at 4-10 days after contrast administration, which was associated with increased 30-day mortality. For patients with eGFR≥30-60, we recommend strict indications are practiced for contrast-enhanced CT. Contrast-enhanced CT had a modest effect in patients with eGFR> 60.


Assuntos
Injúria Renal Aguda/induzido quimicamente , COVID-19/complicações , Meios de Contraste/efeitos adversos , Creatinina/sangue , Iodo/efeitos adversos , Rim/efeitos dos fármacos , Injúria Renal Aguda/sangue , Injúria Renal Aguda/mortalidade , Injúria Renal Aguda/terapia , Idoso , COVID-19/sangue , COVID-19/mortalidade , COVID-19/fisiopatologia , Feminino , Taxa de Filtração Glomerular , Humanos , Rim/diagnóstico por imagem , Rim/fisiopatologia , Masculino , Pessoa de Meia-Idade , Razão de Chances , Análise de Regressão , Terapia de Substituição Renal , Estudos Retrospectivos , Fatores de Tempo , Tomografia Computadorizada por Raios X
3.
Arq Bras Cardiol ; 117(2): 385-391, 2021 08.
Artigo em Inglês, Português | MEDLINE | ID: mdl-34495237

RESUMO

BACKGROUND: Type 1 cardiorenal syndrome is associated with higher mortality in heart failure patients. However, few studies have compared the diagnostic criteria of acute kidney injury (AKI) in this population. OBJECTIVE: To assess clinical and functional features and factors associated AKI in patients with heart failure. METHOD: Retrospective, cohort study on patients with decompensated heart failure or recent acute myocardial infarction, conducted in a tertiary hospital in a low-income region of Brazil. Clinical, laboratory and echocardiographic features were compared between patients with and without AKI according to the Acute Kidney Network (AKIN) and Kidney Disease: Improving Global Outcomes (KDIGO) criteria. The level of statistical significance was set at p < 0.05. RESULTS: Of 81 patients, 61.73% had AKI. Mean creatinine and urea levels were 1.79±1.0 mg/dL and 81.5±46.0 mg/dL, respectively, and higher in the group with AKI (p < 0.05). No evidence of a relationship between cardiac changes and reduced renal function. Chronic renal disease was associated with higher prevalence of AKI. Higher mortality was observed in patients with AKI than in patients without AKI (32.0% vs. 9.8%, p = 0.04, OR 8.187 ad 95% confidence interval 1.402-17.190, p = 0.020). CONCLUSION: In this population of patients with heart failure, AKI was highly prevalent and considered an independent risk factor for mortality. Cardiac changes were not associated with AKI, and the KDIGO and AKIN criteria showed similar performance.


Assuntos
Injúria Renal Aguda , Síndrome Cardiorrenal , Injúria Renal Aguda/epidemiologia , Injúria Renal Aguda/etiologia , Brasil/epidemiologia , Síndrome Cardiorrenal/epidemiologia , Estudos de Coortes , Mortalidade Hospitalar , Humanos , Incidência , Rim/fisiologia , Diálise Renal , Estudos Retrospectivos , Fatores de Risco
4.
Arch Esp Urol ; 74(7): 712-715, 2021 Sep.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-34472441

RESUMO

OBJECTIVES: Patients with viral infection areat risk for secondary infections and/or co-infections. Ourstudy aims to describe coronavirus-disease-19 (COVID-19) associated with acute renal failure (ARF) secondary to fungalbezoar in urinary tract in two patients. METHODS: A chart review of two patients with COVID-19 associated pneumonia admitted to an education and training hospital Istanbul, Turkey were evaluated. RESULTS: On the first day of hospitalization, ARF was developed in both of them. Ultrasonography and computedtomography scan revealed image of urolithiasis and hydronephrosis. However, in their cystoscopies, there were densedebris materials leading to obstruction in calyceal system. Antifungal medication was added to the COVID-19 treatment due to the macroscopic aspect during the cystoscopy. Renal functions of the children were improved following the treatment. CONCLUSIONS: Clinicians caring for patients with COVID-19 should perform a comprehensive analysis to detect co-infections.


Assuntos
Injúria Renal Aguda , Bezoares , COVID-19 , Injúria Renal Aguda/etiologia , Bezoares/complicações , COVID-19/tratamento farmacológico , Criança , Humanos , SARS-CoV-2
5.
Urologiia ; (4): 158-163, 2021 Sep.
Artigo em Russo | MEDLINE | ID: mdl-34486290

RESUMO

Modern methods for the early diagnosis of acute kidney injury using high-precision biomarkers in various pathological conditions, including patients with combined trauma, is reviewed in the article. The pathological processes of cell damage underlying the etiology and pathogenesis of acute kidney injury require a quick and early start of preventive measures. As a consequence, the problem of early diagnosis of acute kidney damage and search of ways to optimize it are still relevant. In case of a possible acute kidney injury, in addition to situations when the renal tissue is already damaged, it is very important to determine level of acute kidney injury biomarkers in biological fluids. The results of our clinical study carried out in the clinic of the Department of Faculty and Endoscopic surgery of the KBSU named after H.M. Berbekov, dedicated to the early diagnosis of acute kidney injury in patients with combined trauma using the serum biomarker cystatin , are also presented.


Assuntos
Injúria Renal Aguda , Cistatina C , Injúria Renal Aguda/diagnóstico , Injúria Renal Aguda/etiologia , Biomarcadores , Creatinina , Diagnóstico Precoce , Humanos
6.
J Assoc Physicians India ; 69(6): 11-12, 2021 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-34472780

RESUMO

BACKGROUND: Acute Kidney Injury (AKI) is a dreaded complication of Covid-19 infection with high morbidity and mortality. Limited data exists on Indian experience. In a tertiary care hospital situated in South India, we analysed the incidence, clinical profile and outcomes of patients diagnosed with AKI due to COVID-19. METHODS: Retrospective data of Adult cases admitted with COVID-19 over a 8 month period from April - November 2020 was collected. Incidence, Demographics, Clinical profile, Management and Outcomes of COVID-19 associated AKI were analysed. Primary outcome was In- hospital mortality. Secondary outcomes were Dialysis Requirement and Renal Recovery. RESULTS: 52 (7%) out of a total 718 patients with COVID-19 developed AKI. Mean Age was 58 years (IQR 51-69) with a striking male predominance of 92%.(Male:Female -9.4:1) (P< 0.001). Co morbidities seen were Diabetes in 38 (73%) and Hypertension in 31(59%) and Coronary Artery Disease in 17(32%). Fever with myalgia was seen in 29 (46%), Respiratory symptoms in 31(59%), Oliguria in 26(50%) and Diarrhea in 2 (3%) patients. At admission, Hypoxemia and Hypotension were seen in 27 (51%) and 16 (30%) patients respectively. Urinalysis revealed > 2+ dipstick Proteinuria in 24 (46%) and Microscopic hematuria in 16(34%) patients. 25 (48%) were admitted in Stage 3 AKI with a mean S.Creatinine level of 4.4 + 3.4 mg/dl. CT chest showed > 50% lung involvement in 23 patients (44%). Mechanical ventilation was required in 20(38%). Hemodialysis was required in 12 (23%). The median duration of hospitalisation was 10 + 5 days. Primary Outcome of Mortality occurred in 44% of AKI cohort in comparison to 7% in Non AKI cohort (Relative Risk[RR]6.2; 95% Confidence Interval[CI], 4.1 to 9.4) (P= 0.001). Hypoxemia [RR,3.76;95% CI,1.4-9.5], Hypotension [RR 2.54; CI,1.5-4 ], Low Serum albumin [RR1.6;CI,1.1 - 2.3] and Requirement for mechanical ventilation [RR,11.3; CI, 2.9 - 23 ] were significant risk factors for mortality. All 5 patients who required both mechanical ventilation and Dialysis died. 31 patients (59%) were treated with Remdesivir therapy without survival benefit. Significantly higher C-Reactive Protein, Interleukin -6, D-Dimer levels and lower serum albumin levels were seen in those who died. Among the 29 patients who survived, the estimated GFR (e GFR) had recovered in 12 (41%) at discharge. After further followup of 4-6 weeks, the total number of patients who recovered renal function rose to 21 (72%). CONCLUSION: Mortality in COVID associated AKI stood at 44%. Multiple factors contributed to high mortality such as Severe disease with hypotension and extensive pulmonary involvement, High Neutrophil to Lymphocyte Ratio, Absolute Monocyte Count, inflammatory markers, d-Dimer and low serum albumin. It was encouraging to note that 72% of survivors recovered renal function by 4-6 weeks after discharge from hospital which means that it is worth the struggle to treat AKI in COVID-19.


Assuntos
Injúria Renal Aguda , COVID-19 , Injúria Renal Aguda/epidemiologia , Injúria Renal Aguda/etiologia , Injúria Renal Aguda/terapia , Feminino , Mortalidade Hospitalar , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Risco , SARS-CoV-2
7.
World J Surg Oncol ; 19(1): 276, 2021 Sep 15.
Artigo em Inglês | MEDLINE | ID: mdl-34526025

RESUMO

BACKGROUND: Skin autofluorescence (SAF) reflects accumulation of advanced glycation end-products (AGEs). The aim of this study was to evaluate predictive usefulness of SAF measurement in prediction of acute kidney injury (AKI) after liver resection. METHODS: This prospective observational study included 130 patients undergoing liver resection. The primary outcome measure was AKI. SAF was measured preoperatively and expressed in arbitrary units (AU). RESULTS: AKI was observed in 32 of 130 patients (24.6%). SAF independently predicted AKI (p = 0.047), along with extent of resection (p = 0.019) and operative time (p = 0.046). Optimal cut-off for SAF in prediction of AKI was 2.7 AU (area under the curve [AUC] 0.611), with AKI rates of 38.7% and 20.2% in patients with high and low SAF, respectively (p = 0.037). Score based on 3 independent predictors (SAF, extent of resection, and operative time) well stratified the risk of AKI (AUC 0.756), with positive and negative predictive values of 59.3% and 84.0%, respectively. In particular, SAF predicted AKI in patients undergoing major and prolonged resections (p = 0.010, AUC 0.733) with positive and negative predictive values of 81.8%, and 62.5%, respectively. CONCLUSIONS: AGEs accumulation negatively affects renal function in patients undergoing liver resection. SAF measurement may be used to predict AKI after liver resection, particularly in high-risk patients.


Assuntos
Injúria Renal Aguda , Produtos Finais de Glicação Avançada , Injúria Renal Aguda/diagnóstico , Injúria Renal Aguda/etiologia , Biomarcadores , Humanos , Fígado , Prognóstico , Pele
8.
J Med Case Rep ; 15(1): 459, 2021 Sep 10.
Artigo em Inglês | MEDLINE | ID: mdl-34503554

RESUMO

BACKGROUND: AngioJet® is an increasingly used method of percutaneous mechanical thrombectomy for the treatment of patients with arterial and venous thromboses. AngioJet® has been shown to cause intravascular haemoylsis universally. We report the case of a 29 year old patient who underwent AngioJet® thrombectomy and post-procedure developed a stage 3 Acute kidney injury (AKI.) requiring renal replacement therapy (RRT), secondary to intravascular haemolysis. We aim to explore the mechanism and potential risk factors associated with developing AKI in these patients and suggest steps to optimise patient management. CASE PRESENTATION: A 29 year old Caucasian male who developed a stage 3 AKI, requiring RRT, following AngioJet® thrombectomy for an occluded femoral vein stent. Urine and laboratory investigations showed evidence of intravascular haemolysis, which was the likely cause of AKI. Following a brief period of RRT he completely recovered renal function. CONCLUSIONS: AKI is an increasingly recognised complication following AngioJet® thrombectomy, but remains underappreciated in clinical practice. AKI results from intravascular haemolysis caused by the device. Up to 13% of patients require RRT, but overall short-term prognosis is good. Pre-procedural risk factors for the development of AKI include recent major surgery. Sodium bicarbonate should be administered to those who develop renal impairment. Renal biopsy is high risk and does not add to management. Increased clinician awareness and vigilance for AKI post-procedure can allow for early recognition and referral to nephrology services for ongoing management.


Assuntos
Injúria Renal Aguda , Trombectomia , Injúria Renal Aguda/etiologia , Injúria Renal Aguda/terapia , Adulto , Humanos , Rim/cirurgia , Masculino , Fatores de Tempo , Resultado do Tratamento
10.
Rev Med Chil ; 149(4): 641-647, 2021 Apr.
Artigo em Espanhol | MEDLINE | ID: mdl-34479354

RESUMO

SARS-CoV-2 infection has a wide spectrum of clinical manifestations secondary to the impairment of different organs, including kidney. Rhabdomyolysis is produced by disintegration of striated muscle and the liberation of its contents to the extracellular fluid and bloodstream. This may produce hydro electrolytic disorders and acute kidney injury. We report a 35-year-old female with a history of SARS-CoV-2 infection who was hospitalized because of respiratory failure and developed renal failure. The etiologic study showed elevated total creatine kinase levels and a magnetic resonance imaging confirmed rhabdomyolysis. The patient required supportive treatment with vasoactive drugs, mechanic ventilation and kidney replacement therapy. She had a favorable evolution with resolution of respiratory failure and improvement of kidney function.


Assuntos
Injúria Renal Aguda , COVID-19 , Rabdomiólise , Injúria Renal Aguda/diagnóstico , Injúria Renal Aguda/virologia , Adulto , COVID-19/complicações , Feminino , Humanos , Terapia de Substituição Renal , Rabdomiólise/diagnóstico , Rabdomiólise/virologia
11.
Braz J Med Biol Res ; 54(11): e9941, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34495252

RESUMO

Acute kidney injury (AKI) is a common complication in seriously ill patients, while renal ischemia-reperfusion (I/R) injury is the most frequent event in this oxidative renal injury. N-acetylcysteine (NAC) is a small molecule containing a thiol group that has antioxidant properties, promoting detoxification and acting directly as a free radical scavenger. In this study, the protective effect of NAC was investigated in short-term (30 min) and long-term (45 min) ischemic AKI. This was achieved via clamping of the renal artery for 30 or 45 min in Wistar rats to induce I/R injury. AKI worsened with a longer period of ischemia (45 compared to 30 min) due to probable irreversible damage. Preconditioning with NAC in short-term ischemia improved renal blood flow and increased creatinine clearance by reducing oxidative metabolites and increasing antioxidant capacity. Otherwise, NAC did not change these parameters in the long-term ischemia. Therefore, this study demonstrated that the period of ischemia determines the severity of the AKI, and NAC presented antioxidant effects in short-term ischemia but not in long-term ischemia, confirming that there is a possible therapeutic window for its renoprotective effect.


Assuntos
Injúria Renal Aguda , Traumatismo por Reperfusão , Acetilcisteína/uso terapêutico , Injúria Renal Aguda/prevenção & controle , Animais , Humanos , Rim , Estresse Oxidativo , Ratos , Ratos Wistar , Traumatismo por Reperfusão/prevenção & controle
12.
Int J Mol Sci ; 22(16)2021 Aug 23.
Artigo em Inglês | MEDLINE | ID: mdl-34445781

RESUMO

The prevalence of chronic kidney disease (CKD) is increasing worldwide, and a close association between acute kidney injury (AKI) and CKD has recently been identified. Black cumin (Nigella sativa) has been shown to be effective in treating various kidney diseases. Accumulating evidence shows that black cumin and its vital compound, thymoquinone (TQ), can protect against kidney injury caused by various xenobiotics, namely chemotherapeutic agents, heavy metals, pesticides, and other environmental chemicals. Black cumin can also protect the kidneys from ischemic shock. The mechanisms underlying the kidney protective potential of black cumin and TQ include antioxidation, anti-inflammation, anti-apoptosis, and antifibrosis which are manifested in their regulatory role in the antioxidant defense system, NF-κB signaling, caspase pathways, and TGF-ß signaling. In clinical trials, black seed oil was shown to normalize blood and urine parameters and improve disease outcomes in advanced CKD patients. While black cumin and its products have shown promising kidney protective effects, information on nanoparticle-guided targeted delivery into kidney is still lacking. Moreover, the clinical evidence on this natural product is not sufficient to recommend it to CKD patients. This review provides insightful information on the pharmacological benefits of black cumin and TQ against kidney damage.


Assuntos
Injúria Renal Aguda/tratamento farmacológico , Benzoquinonas/farmacologia , Rim/efeitos dos fármacos , Nigella sativa/química , Extratos Vegetais/farmacologia , Substâncias Protetoras/farmacologia , Insuficiência Renal Crônica/tratamento farmacológico , Animais , Humanos , Transdução de Sinais/efeitos dos fármacos
13.
BMJ Open ; 11(8): e047840, 2021 08 25.
Artigo em Inglês | MEDLINE | ID: mdl-34433595

RESUMO

OBJECTIVE: The association of non-steroidal anti-inflammatory drugs with postoperative acute kidney injury (AKI) is controversial. However, there are few studies focusing on the association between parecoxib and postoperative AKI. Our study aimed at the possible correlation between the intraoperative administration of cyclooxygenase-2 inhibitors parecoxib and perioperative AKI. DESIGN: A retrospective cohort study. SETTING: Third Xiangya Hospital of Central South University in Hunan Province, China. PARTICIPANTS: The electronic medical records and laboratory results were obtained from 9246 adult patients (18-60 years) undergoing non-cardiac surgery performed between 1 January 2012 and 31 August 2017. Study groups were treated with or without parecoxib. INTERVENTIONS: Univariable analysis identified demographic, preoperative laboratory and intraoperative factors associated with AKI. Logistic stepwise regression was used to calculate the adjusted OR of parecoxib and AKI association. RESULTS: The incidence of AKI was lower in the parecoxib-administered group (4%) than that in the group without parecoxib (6.3%, p=0.005). In the multivariable regression analysis, postoperative AKI risk reduced by 39% (OR 0.61; 95% CI 0.43 to 0.87) in the parecoxib-administered group after adjusting for interference factors. Sensitivity analysis showed that postoperative AKI risk reduced in four subgroups: eGRF <90 mL/min·1.73/m2 (OR 0.49; 95% CI 0.29 to 0.82), non-smoker (OR 0.55; 95% CI 0.37 to 0.83), blood loss <1000 mL (OR 0.55; 95% CI 0.37 to 0.83) and non-hypotension (OR 0.57; 95% CI 0.38 to 0.84). CONCLUSIONS: Thus, parecoxib is associated with a modest reduction of postoperative AKI risk among adult patients undergoing non-cardiac surgery.


Assuntos
Injúria Renal Aguda , Complicações Pós-Operatórias , Injúria Renal Aguda/induzido quimicamente , Injúria Renal Aguda/epidemiologia , Adulto , Estudos de Coortes , Humanos , Isoxazóis , Complicações Pós-Operatórias/induzido quimicamente , Complicações Pós-Operatórias/epidemiologia , Estudos Retrospectivos , Fatores de Risco
14.
Medicine (Baltimore) ; 100(29): e26723, 2021 Jul 23.
Artigo em Inglês | MEDLINE | ID: mdl-34398045

RESUMO

ABSTRACT: Acute kidney injury (AKI) is common in trauma patients and associated with poor outcomes. Identifying AKI risk factors in trauma patients is important for risk stratification and provision of optimal intensive care unit (ICU) treatment. This study identified AKI risk factors in patients admitted to critical care after sustaining torso injuries.We performed a retrospective chart review involving 380 patients who sustained torso injuries from January 2016 to December 2019. Patients were included if they were aged >15 years, admitted to an ICU, survived for >48 hours, and had thoracic and/or abdominal injuries and no end-stage renal disease. AKI was defined according to the Kidney Disease Improving Global Outcomes definition and staging system. Clinical and laboratory variables were compared between the AKI and non-AKI groups (n = 72 and 308, respectively). AKI risk factors were assessed using multivariate logistic regression analysis.AKI occurred in 72 (18.9%) patients and was associated with higher mortality than non-AKI patients (26% vs 4%, P < .001). Multivariate logistic regression analysis identified bowel injury, cumulative fluid balance >2.5 L for 24 hours, lactate levels, and vasopressor use (adjusted odds ratio: 2.953, 2.058, 1.170, and 2.910; 95% confidence interval: 1.410-6.181, 1.017-4.164, 1.019-1.343, and 1.414-5.987; P = .004, .045, .026, and .004, respectively) as independent risk factors for AKI.AKI in patients admitted to the ICU with torso injury had a substantial mortality. Recognizing risk factors at an early stage could aid risk stratification and provision of optimal ICU care.


Assuntos
Injúria Renal Aguda/epidemiologia , Estado Terminal , Traumatismos Torácicos , Injúria Renal Aguda/etiologia , Feminino , Mortalidade Hospitalar , Humanos , Masculino , Registros Médicos , Pessoa de Meia-Idade , República da Coreia/epidemiologia , Estudos Retrospectivos , Fatores de Risco , Tronco/lesões
15.
Molecules ; 26(16)2021 Aug 08.
Artigo em Inglês | MEDLINE | ID: mdl-34443393

RESUMO

Zizyphus lotus L. (Desf.) (Z. lotus) is a medicinal plant largely distributed all over the Mediterranean basin and is traditionally used by Moroccan people to treat many illnesses, including kidney failure. The nephrotoxicity of gentamicin (GM) has been well documented in humans and animals, although the preventive strategies against it remain to be studied. In this investigation, we explore whether the extract of Zizyphus lotus L. (Desf.) Fruit (ZLF) exhibits a protective effect against renal damage produced by GM. Indeed, twenty-four Wistar rats were separated into four equal groups of six each (♂/♀ = 1). The control group was treated orally with distilled water (10 mL/kg); the GM treated group received distilled water (10 mL/kg) and an intraperitoneal injection of GM (80 mg/kg) 3 h after; and the treated groups received ZLF extract orally at the doses 200 or 400 mg/kg and injected intraperitoneally with the GM. All treatments were given daily for 14 days. At the end of the experiment, the biochemical parameters and the histological observation related the kidney function was explored. ZLF treatment has significantly attenuated the nephrotoxicity induced by the GM. This effect was indicated by its capacity to decrease significantly the serum creatinine, uric acid, urea, alkaline phosphatase, gamma-glutamyl-transpeptidase, albumin, calcium, sodium amounts, water intake, urinary volume, and relative kidney weight. In addition, this effect was also shown by the increase in the creatinine clearance, urinary creatinine, uric acid, and urea levels, weight gain, compared to the rats treated only with the GM. The hemostasis of oxidants/antioxidants has been significantly improved with the treatment of ZLF extract, which was shown by a significant reduction in malondialdehydes levels. Histopathological analysis of renal tissue was correlated with biochemical observation. Chemical analysis by HPLC-DAD showed that the aqueous extract of ZLF is rich in phenolic compounds such as 3-hydroxycinnamic acid, catechin, ferulic acid, gallic acid, hydroxytyrosol, naringenin, p- coumaric Acid, quercetin, rutin, and vanillic acid. In conclusion, ZLF extract improved the nephrotoxicity induced by GM, through the improvement of the biochemical and histological parameters and thus validates its ethnomedicinal use.


Assuntos
Injúria Renal Aguda/patologia , Citoproteção/efeitos dos fármacos , Frutas/química , Gentamicinas/efeitos adversos , Rim/efeitos dos fármacos , Extratos Vegetais/farmacologia , Ziziphus/química , Injúria Renal Aguda/induzido quimicamente , Injúria Renal Aguda/metabolismo , Injúria Renal Aguda/prevenção & controle , Animais , Modelos Animais de Doenças , Rim/metabolismo , Rim/patologia , Ratos , Ratos Wistar
16.
BMJ Open ; 11(8): e049250, 2021 08 17.
Artigo em Inglês | MEDLINE | ID: mdl-34404711

RESUMO

INTRODUCTION: Initiation of acute kidney replacement therapy (KRT) is common in critically ill adults admitted to the intensive care unit (ICU), and associated with increased morbidity and mortality. KRT has been linked to poor neurocognitive outcomes, leading to reduced quality of life and increased utilisation of healthcare resources. Adults on dialysis in the ICU may be particularly at risk of neurocognitive impairment, as survivors of critical illness are already predisposed to developing cerebrovascular disease and cognitive dysfunction long-term relative to healthy controls. Regional cerebral oxygen saturation may provide a critical early marker of long-term neurocognitive impairment in this population. This study aims to understand cerebral oxygenation in patients undergoing KRT (continuous or intermittent) in the ICU. These findings will be correlated with long-term cognitive and functional outcomes, and structural brain pathology. METHODS AND ANALYSIS: 108 patients scheduled to undergo treatment for acute kidney injury with KRT in the Kingston Health Sciences Centre ICU will be recruited into this prospective observational study. Enrolled patients will be assessed with intradialytic cerebral oximetry using near infrared spectroscopy. Delirium will be assessed daily with the Confusion Assessment Method-ICU (CAM-ICU) and severity quantified as cumulative CAM-ICU-7 scores. Neurocognitive impairment will be assessed at 3 and 12 months after hospital discharge using the Kinarm and Repeatable Battery for the Assessment of Neuropsychological Status. Structural brain pathology on MRI will also be measured at the same timepoints. Driving safety, adverse events and medication adherence will be assessed at 12 months to evaluate the impact of neurocognitive impairment on functional outcomes. ETHICS AND DISSEMINATION: This study is approved by the Queen's University Health Sciences/Affiliated Teaching Hospitals Research Ethics Board (DMED-2424-20). Results will be presented at critical care conferences, and a lay summary will be provided to patients in their preferred format. TRIAL REGISTRATION NUMBER: NCT04722939.


Assuntos
Injúria Renal Aguda , Estado Terminal , Injúria Renal Aguda/terapia , Adulto , Circulação Cerebrovascular , Humanos , Unidades de Terapia Intensiva , Estudos Observacionais como Assunto , Oximetria , Qualidade de Vida , Diálise Renal/efeitos adversos , Terapia de Substituição Renal
17.
Bratisl Lek Listy ; 122(9): 643-646, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34463110

RESUMO

METHODS: Forty-two COVID-19 patients who underwent emergency PCI due to the diagnosis of acute coronary syndrome were included in the study. Mean age was 63±14.76 and males accounted for 81 % (34/42). Contrast-induced acute kidney injury (CI-AKI) was defined as absolute increase in serum creatinine level by 0.3 mg/dL above baseline within 48 hours of contrast exposure. Patients were divided into two groups according to CI-AKI development following coronary angiography. RESULTS: CI-AKI developed in 33.3 % (14/42) of the patients. Pre-procedure e-GFR (p=0.028), serum albumin levels (p=0.021), and ejection fraction (p=0.039) were lower in the CI-AKI group. Whereas the platelet/lymphocyte ratio was significantly lower in the non-CI-AKI group (p=0.010). CONCLUSIONS: Our study results demonstrated that patients suffering from COVID-19 had a high risk of CI-AKI development following coronary angiography (Tab. 1, Ref. 36).


Assuntos
Injúria Renal Aguda , COVID-19 , Meios de Contraste , Intervenção Coronária Percutânea , Injúria Renal Aguda/induzido quimicamente , COVID-19/complicações , Meios de Contraste/efeitos adversos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Fatores de Risco
18.
ACS Appl Mater Interfaces ; 13(33): 39126-39134, 2021 Aug 25.
Artigo em Inglês | MEDLINE | ID: mdl-34383476

RESUMO

The usage of exogenous antioxidant materials to relieve oxidative stress offers an important strategy for the therapy of oxidative stress-induced injuries. However, the fabrication processes toward the antioxidant materials usually require the involvement of extra metal ions and organic agents, as well as sophisticated purification steps, which might cause tremendous environmental stress and induce unpredictable side effects in vivo. To address these issues, herein, we proposed a novel strategy to fabricate green nanoparticles for efficiently modulating oxidative stress, which was facilely prepared from tea polyphenol extracts (originated from green tea) via a green enzymatic polymerization-based chemistry method. The resulting nanoparticles possessed a uniform spherical morphology and good stability in water and biomedium and demonstrated excellent radical scavenging properties. These nanoparticle scavengers could effectively prevent intracellular oxidative damage, accelerate wound recovery, and protect the kidneys from reactive oxygen species damaging in the acute kidney injury model. We hope this work will inspire the further development of more types of green nanoparticles for antioxidant therapies via similar synthetic strategies using green biomass materials.


Assuntos
Injúria Renal Aguda/prevenção & controle , Antioxidantes/química , Nanopartículas/química , Estresse Oxidativo/efeitos dos fármacos , Polifenóis/química , Chá/química , Células 3T3 , Células A549 , Animais , Antioxidantes/farmacologia , Catecóis/química , Sobrevivência Celular/efeitos dos fármacos , Feminino , Sequestradores de Radicais Livres/metabolismo , Química Verde , Peroxidase do Rábano Silvestre/química , Células Endoteliais da Veia Umbilical Humana , Humanos , Peróxido de Hidrogênio/química , Camundongos , Espécies Reativas de Oxigênio/metabolismo , Nanomedicina Teranóstica , Cicatrização/efeitos dos fármacos
19.
Zhonghua Wei Zhong Bing Ji Jiu Yi Xue ; 33(7): 866-870, 2021 Jul.
Artigo em Chinês | MEDLINE | ID: mdl-34412759

RESUMO

OBJECTIVE: To observe the protective effect and mechanism of different doses of Baicalin (BAI) on acute kidney injury (AKI) in septic mice. METHODS: According to the random number table, 100 mice were divided into sham operation group (Sham group), cecal ligation and perforation (CLP) induced sepsis model group (CLP group) and BAI pretreatment groups. The mice in BAI pretreatment groups were divided into low-, medium- and high-dose groups (BAI-L+CLP, BAI-M+CLP, BAI-H+CLP groups), with 20 mice in each group. A murine sepsis associated-acute kidney injury (SA-AKI) model was reproduced using CLP. The mice in the Sham group were only opened and closed the abdomen, without ligating or perforating the cecum. The mice in the BAI pretreatment groups were given BAI 25, 50 and 100 mg/kg daily for 3 days, and CLP was performed at 6 hours after administration of BAI at the 3rd day to reproduce sepsis model. The mice in the Sham group and CLP group were given the same amount of distilled water as control. Ten mice were sacrificed at 24 hours after operation to collect orbital blood for renal function determination [serum creatinine (SCr), blood urea nitrogen (BUN), plasma neutrophil gelatinase-associated lipocalin (pNGAL) and plasma kidney injury molecule-1 (pKIM-1)] by enzyme linked immunosorbent assay (ELISA). The kidney tissue was collected to observe the kidney tissue injury under light microscope after hematoxylin-eosin (HE) staining. The TdT-mediated dUTP nick-end labeling (TUNEL) was used to detect the apoptosis of renal tubular epithelial cells. Western blotting was used to detect the expression of cell FLICE like inhibitory protein (c-FLIP) in renal tissue. The remaining 10 mice in each group were used to calculate the survival rate of 7 days after operation. RESULTS: The renal tubular epithelial cells in the CLP group were massively degenerated with necrosis, the renal tubular lumen was significantly expanded, and inflammatory cells were widely infiltrated in the renal interstitium. Furthermore, the renal function deteriorated rapidly. Compared with the CLP group, the renal function of mice pretreated with low dose of BAI was improved, but the difference was not significant. Compared with the CLP group, the renal function in the mice pretreated with medium and high doses of BAI was significantly improved, the SCr, BUN, pNGAL and pKIM-1 were significantly reduced [SCr (µmol/L): 135.16±5.18, 125.70±5.26 vs. 170.42±5.42; BUN (mmol/L): 33.59±1.77, 27.29±1.61 vs. 45.68±1.39; pNGAL (µg/L): 91.29±4.68, 73.40±3.77 vs. 131.50±6.55; pKIM-1 (µg/L): 6.34±0.30, 5.51±0.35 vs. 8.03±0.29; all P < 0.01], the pathological injury of renal tissue was significantly decreased, the apoptotic number of renal tubular epithelial cells was significantly reduced (cells/HP: 16.20±0.49, 13.10±0.66 vs. 29.60±0.49, both P < 0.01), and the expression of c-FLIP protein in renal tissue was significantly increased [c-FLIP protein (c-FLIP/GAPDH): 0.35±0.02, 0.46±0.02 vs. 0.21±0.01, both P < 0.01]. No mouse in the Sham group died within 7 days. Compared with the CLP group, the average survival time of the mice within 7 days in the BAI-L+CLP, BAI-M+CLP and BAI-H+CLP groups was significantly prolonged with a dose-dependent manner (days: 3.5±2.5, 5.4±2.2, 5.9±1.9 vs. 2.1±1.2; Log-Rank test: χ2 = 73.410, P < 0.001). CONCLUSIONS: Pretreatment with medium and high doses of BAI can significantly improve the renal function in mice with SA-AKI, decrease the pathological damage and increase the survival of mice, and its mechanism may be related to promoting the increase of c-FLIP protein expression and inhibiting cell apoptosis.


Assuntos
Injúria Renal Aguda , Sepse , Injúria Renal Aguda/tratamento farmacológico , Injúria Renal Aguda/etiologia , Injúria Renal Aguda/prevenção & controle , Animais , Flavonoides , Rim , Ligadura , Camundongos , Sepse/complicações , Sepse/tratamento farmacológico
20.
Zhonghua Wei Zhong Bing Ji Jiu Yi Xue ; 33(7): 885-888, 2021 Jul.
Artigo em Chinês | MEDLINE | ID: mdl-34412764

RESUMO

Regulated necrosis is a newly discovered new cell death pathway, including necroptosis, pyroptosis and ferroptosis. It has been reported to play a key role in acute kidney injury (AKI) induced by ischemia/reperfusion, cisplatin and other drugs, and rhabdomyolysis. Studying the role of regulated necrosis-related pathways in AKI is expected to provide a new direction for clarifying the pathogenesis and treatment of AKI, with potential therapy and application prospects. In this review, we summarize the related signaling pathways of necroptosis, pyroptosis and ferroptosis, and the related research progress in AKI, in order to provide potential targets for the prevention and treatment of AKI.


Assuntos
Injúria Renal Aguda , Apoptose , Morte Celular , Humanos , Necrose , Piroptose
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