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2.
Zhonghua Wei Zhong Bing Ji Jiu Yi Xue ; 32(4): 473-477, 2020 Apr.
Artigo em Chinês | MEDLINE | ID: mdl-32527356

RESUMO

OBJECTIVE: To explore a better indicator that can predict septic shock induced acute kidney injury (AKI) by combining renal resistive index (RRI) and central venous pressure (CVP). METHODS: A prospective observational study was conducted. Patients with septic shock admitted to department of critical care medicine of Hebei General Hospital from November 2017 to October 2018 were enrolled. Baseline characteristics such as age, gender, underlying diseases, infection sites, acute physiology and chronic health evaluation II (APACHE II) in the first 24-hour, sequential organ failure assessment (SOFA) were recorded; Doppler-based RRI was obtained on the first day when hemodynamics was relatively stable, meanwhile the dose of norepinephrine and hemodynamic parameters were assessed. Urine output per hour, the total duration of mechanical ventilation, the length of intensive care unit (ICU) stay and 28-day mortality were also collected. Observational end point was death at discharge or the 28th day after ICU admission, whenever which came first. The patients were divided into AKI and non-AKI groups according to the 2012 Kidney Disease: Improving Global Organization (KDIGO) clinical practice guideline. The baseline and prognostic indicators, variables potentially associated with AKI were compared between the two groups. The variables independently associated with septic shock induced AKI were identified using multivariable Logistic regression. The predictive value of RRI and RRI combining CVP for AKI were analyzed by the receiver operating characteristic (ROC) curve. RESULTS: A total of 107 patients were enrolled, with 59 patients in AKI group and 48 patients in non-AKI group. There was significant difference in RRI, CVP, percentage of norepinephrine dosage ≥ 0.5 µg×kg-1×min-1, procalcitonin (PCT), lactate (Lac), and serum creatinine (SCr) between the two groups. Logistic regression analysis showed that high CVP, RRI, Lac and PCT were independent risk factors for septic shock induced AKI [CVP: odds ratio (OR) = 1.20, 95% confidence interval (95%CI) was 1.03-1.40, P = 0.022; RRI: OR = 3.02, 95%CI was 2.64-3.48, P = 0.006; Lac: OR = 2.43, 95%CI was 1.32-4.50, P = 0.005; PCT: OR = 1.20, 95%CI was 1.05-1.38, P = 0.009]. ROC curve analysis showed that the area under ROC curve (AUC) values of CVP ≥ 9.5 mmHg (1 mmHg = 0.133 kPa) and RRI ≥ 0.695 for predicting septic shock induced AKI were 0.656 and 0.662 respectively. The AUC value of the combination of RRI and CVP was greater compared with either RRI or CVP alone in predicting septic shock induced AKI, which AUC value was 0.712, 95%CI was 0.615-0.809, the sensitivity was 59% and the specificity was 75%. CONCLUSIONS: High CVP and RRI were independent risk factors for septic shock induced AKI. The combination of RRI and CVP performs poorly in predicting septic shock induced AKI. Further studies are needed to describe factors influencing Doppler-based assessment of RRI, which may help clinicians to prevent AKI early.


Assuntos
Lesão Renal Aguda , Choque Séptico , APACHE , Lesão Renal Aguda/complicações , Lesão Renal Aguda/etiologia , Pressão Venosa Central , Humanos , Prognóstico , Estudos Prospectivos , Curva ROC , Estudos Retrospectivos
5.
PLoS One ; 15(5): e0232370, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32437362

RESUMO

BACKGROUND: In critically ill patients, acute kidney injury (AKI) is common and associated with short- and long-term complications. Our objectives were to describe the epidemiology and impact of AKI in cancer patients admitted to the Intensive Care Unit (ICU). METHODS: We identified all patients with a haematological malignancy (HM) or solid tumour (ST) who had an emergency admission to the ICU in a tertiary care centre between January 2004 and July 2012. AKI was defined according to the KDIGO criteria. RESULTS: 429 patients were included of whom 259 (60%) had AKI. Among HM patients, 73 (78%) had AKI (70% AKI on admission to ICU; 7% during ICU stay); among ST patients, 186 (56%) had AKI (45% on admission to ICU, 11% during ICU stay). ICU and 28-day mortality rates were 33% and 48%, respectively in HM patients, and 22% and 31%, respectively in ST patients. Multivariable analysis showed that AKI was an independent risk factor for both ICU and 28-day mortality. New AKI after 24 hours in ICU was associated with higher mortality than AKI on admission. CONCLUSIONS: AKI is common in critically ill cancer patients and independently associated with ICU and 28-day mortality.


Assuntos
Lesão Renal Aguda/complicações , Estado Terminal , Neoplasias/complicações , Neoplasias/mortalidade , Idoso , Feminino , Humanos , Unidades de Terapia Intensiva/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Risco
6.
Lancet Respir Med ; 8(7): 738-742, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32416769

RESUMO

The outbreak of coronavirus disease 2019 (COVID-19) has rapidly evolved into a global pandemic. Most patients with COVID-19 have mild symptoms, but about 5% develop severe symptoms, which can include acute respiratory distress syndrome, septic shock, and multiple organ failure. Kidney involvement is frequent, with clinical presentation ranging from mild proteinuria to progressive acute kidney injury (AKI) necessitating renal replacement therapy (RRT). An understanding of the pathophysiology and mechanisms of kidney damage and AKI in the setting of critical illness and COVID-19 is emerging, although further research is needed to identify patients at risk of AKI and to guide management strategies. As no specific treatment options exist for AKI secondary to COVID-19, intensive care is largely supportive. Current approaches to prevention and management of AKI, and identification of potential indications for use of RRT and sequential extracorporeal therapies, are based mainly on clinical experience, and AKI strategies are adapted empirically to patients with COVID-19. International collaborative and cross-disciplinary research is needed to obtain adequate evidence to support current clinical approaches and to develop new approaches to management.


Assuntos
Lesão Renal Aguda/complicações , Lesão Renal Aguda/terapia , Betacoronavirus , Infecções por Coronavirus/complicações , Cuidados Críticos/métodos , Pneumonia Viral/complicações , Estado Terminal , Humanos , Pandemias
7.
Life Sci ; 254: 117791, 2020 Aug 01.
Artigo em Inglês | MEDLINE | ID: mdl-32416166

RESUMO

AIMS: Sepsis-induced acute kidney injury (SI-AKI) is the fifth most common cause of hospital-acquired acute kidney injury. Pannexin1 (Panx1) triggers inflammation and apoptosis which act as crucial factors in the pathogenesis of SI-AKI. We aimed to investigate the expression of Panx1 and its role on the inflammation and apoptosis in SI-AKI. MATERIALS AND METHODS: SI-AKI model was established by lipopolysaccharide (LPS) injection in mice and LPS-treated HK-2 cells in vitro. Panx1 was inhibited by pretreating with carbenoxolone (CBX) or small interfering RNA in vivo and vitro, respectively. The expression of Panx1 was determined by qPCR, western blot and immunohistochemistry (IHC). Kidney damage was evaluated by kidney function, histopathological examination and AKI biomarkers. Inflammatory cytokines were detected by qPCR and ELISA. Apoptosis was detected by TUNEL staining and the expression of apoptosis-related proteins. The activation of nucleotide-binding domain-like receptor protein 3 (NLRP3) inflammasome was measured by western blot. KEY FINDINGS: Panx1 increased in LPS-induced SI-AKI mice and HK-2 cells, as well as in SI-AKI patients. CBX alleviated the renal function and pathological damage, as well as decreased the mRNA of kidney injury molecule (KIM-1) and neutrophil gelatinase-associated lipocalin (NGAL). Inhibiting Panx1 decreased the production of IL-1ß, IL-6 and TNF-α, as well as tubular cell apoptosis in SI-AKI. Inhibiting Panx1 suppressed inflammatory cytokines and apoptosis via inhibiting NLRP3 inflammasome activation and regulating apoptotic protein Bax and Bcl2 expression, respectively. SIGNIFICANCE: These observations suggest that pharmacological inhibition of Panx1 might be a potential approach in the clinical therapy of SI-AKI.


Assuntos
Lesão Renal Aguda/metabolismo , Apoptose/efeitos dos fármacos , Carbenoxolona/farmacologia , Conexinas/antagonistas & inibidores , Citocinas/metabolismo , Proteína 3 que Contém Domínio de Pirina da Família NLR/metabolismo , Proteínas do Tecido Nervoso/antagonistas & inibidores , Lesão Renal Aguda/complicações , Lesão Renal Aguda/patologia , Animais , Proteínas Relacionadas à Autofagia/metabolismo , Biomarcadores/metabolismo , Conexinas/biossíntese , Humanos , Inflamassomos/metabolismo , Inflamação/complicações , Inflamação/prevenção & controle , Rim/metabolismo , Rim/patologia , Testes de Função Renal , Lipopolissacarídeos , Masculino , Camundongos , Proteínas do Tecido Nervoso/biossíntese , RNA Interferente Pequeno/farmacologia , Sepse/complicações
11.
Harefuah ; 159(4): 231-234, 2020 Apr.
Artigo em Hebraico | MEDLINE | ID: mdl-32307955

RESUMO

INTRODUCTION: COVID-19, is a new corona virus of the Beta Coronavirus genus which originated in bats. The virus first emerged in China in December 2019 and has rapidly spread since to other areas worldwide. The World Health Organization (WHO) has therefore recently declared it as the source of a pandemic. The disease caused by the virus manifests in most cases as a lower respiratory tract infection leading to fever, cough and dyspnea, while more severe cases can led to respiratory failure and/or multi organ failure. COVID-19 enters the human cell using the ACE2, an enzyme abundant in renal tubular epithelial cells. Theoretically, this may be significant in several ways: acute kidney injury (AKI) as well as proteinuria and/or microhematuria could be associated with the penetration of COVID-19 into the cells. Moreover, medications based on RAAS inhibition, such and ACE inhibitors and ARBs, upregulate the enzyme ACE2 and could therefore hypothetically explain the high prevalence of hypertension and diabetes reported as previous diagnoses in severe cases. In the setting of chronic kidney disease, the risk of infection with COVID-19 is not clear at this time. However, hemodialysis patients represent a unique group of patients, mostly elderly and immunocompromised, for whom dialysis is a life-saving treatment which cannot be stopped. Hence, the COVID-19 pandemic has presented a complex medical and logistic challenge for the medical staff in hospital and community based dialysis units.


Assuntos
Lesão Renal Aguda/etiologia , Infecções por Coronavirus/complicações , Hipertensão/complicações , Pneumonia Viral/complicações , Lesão Renal Aguda/complicações , Idoso , Betacoronavirus , China , Infecções por Coronavirus/epidemiologia , Humanos , Rim/fisiologia , Pandemias , Peptidil Dipeptidase A/metabolismo , Pneumonia Viral/epidemiologia , Populações Vulneráveis
12.
G Ital Nefrol ; 37(2)2020 Apr 09.
Artigo em Italiano | MEDLINE | ID: mdl-32281761

RESUMO

We report the case of a 37-year-old woman that developed severe hypercalcemia due to a parathyroid gland mass. After the initial medical treatment, only a minimal reduction of calcemia was observed and her clinical condition worsened; thus, she required continuous renal replacement therapy (CRRT) that resulted in the normalization of calcium serum level. She then underwent a left thyroid lobectomy with exeresis of the associated parathyroid glands; the histological diagnosis revealed a giant parathyroid adenoma (GPA). CRRT, initially recommended only in case of severe refractory hypercalcemia poorly responsive to pharmacological approaches, is now being evaluated in the first line treatment of life-threatening cases, with or without associated acute kidney injury (AKI).


Assuntos
Adenoma/diagnóstico , Hipercalcemia/diagnóstico , Neoplasias das Paratireoides/diagnóstico , Lesão Renal Aguda/complicações , Adenoma/sangue , Adenoma/etiologia , Adulto , Feminino , Humanos , Hipercalcemia/sangue , Hipercalcemia/etiologia , Hormônio Paratireóideo/sangue , Neoplasias das Paratireoides/sangue , Neoplasias das Paratireoides/complicações
13.
Kidney Int ; 97(5): 829-838, 2020 05.
Artigo em Inglês | MEDLINE | ID: mdl-32247631

RESUMO

In December 2019, a coronavirus 2019 (COVID-19) disease outbreak occurred in Wuhan, Hubei Province, China, and rapidly spread to other areas worldwide. Although diffuse alveolar damage and acute respiratory failure were the main features, the involvement of other organs needs to be explored. Since information on kidney disease in patients with COVID-19 is limited, we determined the prevalence of acute kidney injury (AKI) in patients with COVID-19. Further, we evaluated the association between markers of abnormal kidney function and death in patients with COVID-19. This was a prospective cohort study of 701 patients with COVID-19 admitted in a tertiary teaching hospital that also encompassed three affiliates following this major outbreak in Wuhan in 2020 of whom 113 (16.1%) died in hospital. Median age of the patients was 63 years (interquartile range, 50-71), including 367 men and 334 women. On admission, 43.9% of patients had proteinuria and 26.7% had hematuria. The prevalence of elevated serum creatinine, elevated blood urea nitrogen and estimated glomerular filtration under 60 ml/min/1.73m2 were 14.4, 13.1 and 13.1%, respectively. During the study period, AKI occurred in 5.1% patients. Kaplan-Meier analysis demonstrated that patients with kidney disease had a significantly higher risk for in-hospital death. Cox proportional hazard regression confirmed that elevated baseline serum creatinine (hazard ratio: 2.10, 95% confidence interval: 1.36-3.26), elevated baseline blood urea nitrogen (3.97, 2.57-6.14), AKI stage 1 (1.90, 0.76-4.76), stage 2 (3.51, 1.49-8.26), stage 3 (4.38, 2.31-8.31), proteinuria 1+ (1.80, 0.81-4.00), 2+∼3+ (4.84, 2.00-11.70), and hematuria 1+ (2.99, 1.39-6.42), 2+∼3+ (5.56,2.58- 12.01) were independent risk factors for in-hospital death after adjusting for age, sex, disease severity, comorbidity and leukocyte count. Thus, our findings show the prevalence of kidney disease on admission and the development of AKI during hospitalization in patients with COVID-19 is high and is associated with in-hospital mortality. Hence, clinicians should increase their awareness of kidney disease in patients with severe COVID-19.


Assuntos
Lesão Renal Aguda , Infecções por Coronavirus , Mortalidade Hospitalar , Pandemias , Pneumonia Viral , Lesão Renal Aguda/complicações , Lesão Renal Aguda/etiologia , Betacoronavirus , China , Comorbidade , Infecções por Coronavirus/complicações , Infecções por Coronavirus/mortalidade , Feminino , Hospitalização , Humanos , Masculino , Pessoa de Meia-Idade , Pneumonia Viral/complicações , Pneumonia Viral/mortalidade , Modelos de Riscos Proporcionais , Estudos Prospectivos , Proteinúria , Fatores de Risco
14.
Gene ; 741: 144562, 2020 May 30.
Artigo em Inglês | MEDLINE | ID: mdl-32169629

RESUMO

Renal Ischemia/Reperfusion (rI/R)-induced acute lung injury (ALI) is a major problem in rI/R. The objective of the current study was to explore the defensive roles of propofol (Pro), an intravenous anesthetic, on rI/R-induced ALI through mitogen-activated protein kinase (MAPK) signaling. Rats were divided into Sham, Pro (10 mg/kg), rI/R, rI/R + Pro (5 mg/kg), and rI/R + Pro (10 mg/kg) groups. Rats were treated with Pro at 1 h after rI/R treatment. Serum and lung tissues at 24 h after rI/R were collected to evaluate morphological changes and the expression of myeloperoxidase (MPO), inflammatory cytokines, and crucial proteins in the MAPK pathway. Pro attenuated the production of mediators, resulting in reduced levels of autophagy and apoptosis by restricting the MAPK pathway in rI/R-induced ALI model. Pro represses rI/R-induced pulmonary autophagy and apoptosis by decreasing the production of inflammatory molecules, and the effects of Pro are involved in the inhibition of the MAPK pathway.


Assuntos
Lesão Renal Aguda/tratamento farmacológico , Lesão Pulmonar Aguda/tratamento farmacológico , Propofol/farmacologia , Traumatismo por Reperfusão/tratamento farmacológico , Lesão Renal Aguda/complicações , Lesão Renal Aguda/genética , Lesão Renal Aguda/patologia , Lesão Pulmonar Aguda/etiologia , Lesão Pulmonar Aguda/genética , Animais , Apoptose/efeitos dos fármacos , Autofagia/efeitos dos fármacos , Modelos Animais de Doenças , Humanos , Sistema de Sinalização das MAP Quinases/efeitos dos fármacos , Ratos , Traumatismo por Reperfusão/complicações , Traumatismo por Reperfusão/genética , Traumatismo por Reperfusão/patologia
15.
Am Heart J ; 222: 8-14, 2020 04.
Artigo em Inglês | MEDLINE | ID: mdl-32006910

RESUMO

BACKGROUND: The prevalence of renal disease in cardiac intensive care units (CICUs) is increasing, but little is known about the utilization, concurrent therapies, and outcomes of patients requiring acute renal replacement therapy (RRT) in this specialized environment. METHODS: In the Critical Care Cardiology Trials Network, 16 centers submitted data on CICU admissions including acute RRT (defined as continuous renal replacement therapy and/or acute intermittent dialysis). RESULTS: Among 2,985 admissions, 178 (6.0%; interhospital range 1.0%-16.0%) received acute RRT. Patients receiving RRT, versus not, were more commonly admitted for cardiogenic shock (15.7% vs 4.2%, P < .01), cardiac arrest (9.6% vs 3.7%, P < .01), and acute general medical diagnoses (10.7% vs 5.8%, P < .01), whereas acute coronary syndromes (16.9% vs 32.1%, P < .01) were less frequent. Variables independently associated with acute RRT included diabetes, heart failure, liver disease, severe valvular disease, shock, cardiac arrest, hypertension, and younger age. In patients receiving acute RRT, versus not, advanced therapies including mechanical ventilation (55.6% vs 18.0%), vasoactive support (73.0% vs 35.2%), invasive hemodynamic monitoring (59.6% vs 29.2%), and mechanical circulatory support (27.5% vs 8.4%) were more common. Acute RRT was associated with higher in-hospital mortality (42.1% vs 9.3%, adjusted odds ratio 3.74, 95% CI, 2.52-5.53) and longer median length of stay (10.0 vs 5.3 days, P < .01). In conclusion, acute RRT in contemporary CICUs was associated with the provision of other advanced therapies and lower survival. CONCLUSIONS: These data underscore the risks associated with the provision of renal support in patients with primary cardiovascular problems and the need to develop standardized indications and potential futility measures in this specialized population.


Assuntos
Lesão Renal Aguda/epidemiologia , Doenças Cardiovasculares/complicações , Unidades de Cuidados Coronarianos/estatística & dados numéricos , Cuidados Críticos/métodos , Sistema de Registros , Terapia de Substituição Renal/métodos , Lesão Renal Aguda/complicações , Lesão Renal Aguda/terapia , Idoso , Canadá/epidemiologia , Doenças Cardiovasculares/epidemiologia , Estudos Transversais , Feminino , Seguimentos , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Fatores de Risco , Taxa de Sobrevida/tendências , Estados Unidos/epidemiologia
16.
Crit Care ; 24(1): 52, 2020 02 14.
Artigo em Inglês | MEDLINE | ID: mdl-32059682

RESUMO

BACKGROUND: Optimal timing for the start of vasopressors (VP) in septic shock has not been widely studied since it is assumed that fluids must be administered in advance. We sought to evaluate whether a very early start of VP, even without completing the initial fluid loading, might impact clinical outcomes in septic shock. METHODS: A total of 337 patients with sepsis requiring VP support for at least 6 h were initially selected from a prospectively collected database in a 90-bed mixed-ICU during a 24-month period. They were classified into very-early (VE-VPs) or delayed vasopressor start (D-VPs) categories according to whether norepinephrine was initiated or not within/before the next hour of the first resuscitative fluid load. Then, VE-VPs (n = 93) patients were 1:1 propensity matched to D-VPs (n = 93) based on age; source of admission (emergency room, general wards, intensive care unit); chronic and acute comorbidities; and lactate, heart rate, systolic, and diastolic pressure at vasopressor start. A risk-adjusted Cox proportional hazard model was fitted to assess the association between VE-VPs and day 28 mortality. Finally, a sensitivity analysis was performed also including those patients requiring VP support for less than 6 h. RESULTS: Patients subjected to VE-VPs received significantly less resuscitation fluids at vasopressor starting (0[0-510] vs. 1500[650-2300] mL, p < 0.001) and during the first 8 h of resuscitation (1100[500-1900] vs. 2600[1600-3800] mL, p < 0.001), with no significant increase in acute renal failure and/or renal replacement therapy requirements. VE-VPs was related with significant lower net fluid balances 8 and 24 h after VPs. VE-VPs was also associated with a significant reduction in the risk of death compared to D-VPs (HR 0.31, CI95% 0.17-0.57, p < 0.001) at day 28. Such association was maintained after including patients receiving vasopressors for < 6 h. CONCLUSION: A very early start of vasopressor support seems to be safe, might limit the amount of fluids to resuscitate septic shock, and could lead to better clinical outcomes.


Assuntos
Hidratação , Norepinefrina , Choque Séptico , Vasoconstritores , Lesão Renal Aguda/complicações , Idoso , Feminino , Humanos , Unidades de Terapia Intensiva , Masculino , Pessoa de Meia-Idade , Norepinefrina/administração & dosagem , Terapia de Substituição Renal , Choque Séptico/tratamento farmacológico , Fatores de Tempo , Vasoconstritores/administração & dosagem
17.
PLoS One ; 15(2): e0228274, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32053637

RESUMO

OBJECTIVE: Fluid overload is common among critically ill patients and is associated with worse outcomes. We aimed to assess the effect of diuretics on urine output, vasopressor dose, acute kidney injury (AKI) incidence, and need for renal replacement therapies (RRT) among patients who receive vasopressors. PATIENTS AND METHODS: This is a single-center retrospective study of all adult patients admitted to the intensive care unit between January 2006 and December 2016 and received >6 hours of vasopressor therapy and at least one concomitant dose of diuretic. We excluded patients from cardiac care units. Hourly urine output and vasopressor dose for 6 hours before and after the first dose of diuretic therapy was compared. Rates of AKI development and RRT initiation were assessed with a propensity-matched cohort of patients who received vasopressors but did not receive diuretics. RESULTS: There was an increasing trend of prescribing diuretics in patients receiving vasopressors over the course of the study. We included 939 patients with median (IQR) age of 68(57, 78) years old and 400 (43%) female. The average hourly urine output during the first six hours following time zero in comparison with average hourly urine output during the six hours prior to time zero was significantly higher in diuretic group in comparison with patients who did not receive diuretics [81 (95% CI 73-89) ml/h vs. 42 (95% CI 39-45) ml/h, respectively; p<0.001]. After propensity matching, the rate of AKI within 7 days of exposure and the need for RRT were similar between the study and matched control patients (66 (15.6%) vs. 83 (19.6%), p = 0.11, and 34 (8.0%) vs. 37 (8.7%), p = 0.69, respectively). Mortality, however, was higher in the group that received diuretics. Ninety-day mortality was 191 (45.2%) in the exposed group VS 156 (36.9%) p = .009. CONCLUSIONS: While the use of diuretic therapy in critically ill patients receiving vasopressor infusions augmented urine output, it was not associated with higher vasopressor requirements, AKI incidence, and need for renal replacement therapy.


Assuntos
Diuréticos/farmacologia , Choque/tratamento farmacológico , Vasoconstritores/farmacologia , Lesão Renal Aguda/complicações , Idoso , Estudos de Coortes , Estado Terminal , Interações Medicamentosas , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Terapia de Substituição Renal , Estudos Retrospectivos , Choque/complicações , Choque/fisiopatologia , Choque/urina , Resultado do Tratamento , Vasoconstritores/uso terapêutico
18.
Adv Exp Med Biol ; 1251: 71-80, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31919709

RESUMO

High cut-off (HCO) continuous veno-venous hemodialysis (CVVHD) is one of the renal replacement therapies which nonselectively removes inflammatory mediators. This study seeks to examine the association between the inflammatory background and the need for catecholamine treatment in hemodynamically instable patients having septic shock and acute kidney injury during HCO-CVVHD. There were 38 patients (F/M; 16/22, mean age 63 ± 16 years) included in the study. The initial content of the cytokines IL-4, IL-12, IL-17, and TNFα, C-reactive protein, and the score of the Sequential Organ Failure Assessment (SOFA) were assessed. The receiver operating characteristic (ROC) plot showed that a combination consisting of IL-17 × SOFA ≤22.3 was a reliable predictive factor of the need for catecholamine treatment during HCO-CVVHD, with 82% sensitivity and 90% specificity, with the area under curve (AUC) of 0.843; p < 0.001. On the other side, SOFA ≤14.0 predicted catecholamine treatment or its discontinuation when started, with both specificity and sensitivity 83% (AUC = 0.899; p < 0.001). In conclusion, the immune system activation, assessed from the initial level of IL-17, and the clinical SOFA evaluation are of practical help in predicting the need for catecholamine treatment or the probability of a reduction thereof in patients on veno-venous hemodialysis due to septic shock.


Assuntos
Lesão Renal Aguda/complicações , Lesão Renal Aguda/terapia , Terapia de Substituição Renal Contínua , Inflamação/sangue , Inflamação/complicações , Choque Séptico/complicações , Choque Séptico/terapia , Lesão Renal Aguda/sangue , Lesão Renal Aguda/imunologia , Idoso , Biomarcadores/sangue , Feminino , Humanos , Inflamação/imunologia , Masculino , Pessoa de Meia-Idade , Curva ROC , Choque Séptico/sangue , Choque Séptico/imunologia
19.
Transplant Proc ; 52(1): 265-270, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31889542

RESUMO

BACKGROUND: Intraoperative continuous renal replacement therapy (CRRT) may need to be indicated for liver transplant recipients who show renal dysfunction. We aimed to investigate effects of intraoperative CRRT on outcomes after liver transplant. MATERIAL AND METHODS: This study included all adult patients who underwent liver transplant between January 2005 and May 2017 and were found to have renal dysfunction, which was defined as glomerular filtration rate < 30 mL/min at transplant. The patients were divided into 3 groups for outcome analysis: elective CRRT group (renal replacement therapy was already introduced pretransplant, group 1, n = 70), urgent CRRT (intraoperative CRRT was indicated because of unexpected renal dysfunction, group 2, n = 15), and no CRRT group (no intraoperative CRRT even with renal dysfunction, group 3, n = 57). Post-transplant outcomes were analyzed to determine effects of CRRT. RESULTS: Postoperative complication rates were similar in the 3 groups (P = .056). Group 1 showed the highest rate of postoperative renal replacement therapy (86.4% in group 1 vs 66.7% and 10.7% in groups 2 and 3, P < .001). Long-term renal function (at 3, 6, and 12 months post transplant) was similar among the 3 groups (P = .50, .77, and .52, respectively). Group 1 showed a higher risk of 1-year graft loss (hazard ratio, 2.55; P = .03) and mortality (hazard ratio, 2.71; P = .03) than group 3, whereas groups 2 and 3 were similar. CONCLUSION: CRRT used in the urgent setting did not show obvious benefit. Hence, its application should be carefully considered in those who unexpectedly present with acute kidney injury at the time of transplant.


Assuntos
Terapia de Substituição Renal Contínua/métodos , Transplante de Fígado/métodos , Complicações Pós-Operatórias/epidemiologia , Lesão Renal Aguda/complicações , Lesão Renal Aguda/terapia , Adulto , Feminino , Taxa de Filtração Glomerular , Humanos , Falência Hepática/complicações , Falência Hepática/cirurgia , Masculino , Pessoa de Meia-Idade , Modelos de Riscos Proporcionais , Estudos Retrospectivos , Resultado do Tratamento
20.
PLoS One ; 15(1): e0226974, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31914135

RESUMO

Renal ischemia/reperfusion injury is a common cause of acute kidney injury (AKI) and hypertension might contribute to the increased incidence of AKI. The purpose of this study was to investigate the effects of single and combined hyperbaric oxygen (HBO) preconditioning and NADPH oxidase inhibition on oxidative stress, kidney function and structure in spontaneously hypertensive rats (SHR) after renal ischemia reperfusion injury. HBO preconditioning was performed by exposing to pure oxygen (2.026 bar) twice a day for two consecutive days for 60 minutes, and 24h before AKI induction. For AKI induction, the right kidney was removed and ischemia was performed by clamping the left renal artery for 45 minutes. NADPH oxidase inhibition was induced by apocynin (40 mg/kg b.m., intravenously) 5 minutes before reperfusion. AKI significantly increased renal vascular resistance and reduced renal blood flow, which were significantly improved after apocynin treatment. Also, HBO preconditioning, with or without apocynin treatment showed improvement on renal hemodynamics. AKI significantly increased plasma creatinine, urea, phosphate levels and lipid peroxidation in plasma. Remarkable improvement, with decrease in creatinine, urea and phosphate levels was observed in all treated groups. HBO preconditioning, solitary or with apocynin treatment decreased lipid peroxidation in plasma caused by AKI induction. Also, combined with apocynin, it increased catalase activity and solitary, glutathione reductase enzyme activity in erythrocytes. While AKI induction significantly increased plasma KIM- 1 levels, HBO preconditioning, solitary or with apocynin decreased its levels. Considering renal morphology, significant morphological alterations present after AKI induction were significantly improved in all treated groups with reduced tubular dilatation, tubular necrosis in the cortico-medullary zone and PAS positive cast formation. Our results reveal that NADPH oxidase inhibition and hyperbaric oxygen preconditioning, with or without NADPH oxidase inhibition may have beneficial effects, but their protective role should be evaluated in further studies.


Assuntos
Acetofenonas/uso terapêutico , Lesão Renal Aguda/terapia , Inibidores Enzimáticos/uso terapêutico , Oxigenação Hiperbárica/métodos , NADPH Oxidases/antagonistas & inibidores , Traumatismo por Reperfusão/terapia , Lesão Renal Aguda/complicações , Lesão Renal Aguda/metabolismo , Lesão Renal Aguda/patologia , Animais , Masculino , Estresse Oxidativo/efeitos dos fármacos , Ratos , Ratos Endogâmicos SHR , Traumatismo por Reperfusão/etiologia , Traumatismo por Reperfusão/metabolismo , Traumatismo por Reperfusão/patologia
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