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1.
BMJ Case Rep ; 13(11)2020 Nov 09.
Artigo em Inglês | MEDLINE | ID: mdl-33168542

RESUMO

Renal transplant (RT) recipients are at increased risk for infectious complications. The clinical course of COVID-19 has been described in several RT recipients with varying clinical outcomes. Most present with pulmonary manifestations, however extrapulmonary presentations are not uncommon. Also, the timing and efficacy of seroconversion in transplant recipients is not well known. This report describes the duration of viral shedding and timing of seroconversion in a young adult RT recipient with COVID-19 who presented with severe diarrhoea and acute kidney injury requiring dialysis. She developed anti-SARS-CoV-2 IgG antibody after 5 weeks despite persistently shedding the virus in the nasopharynx until 6 weeks after symptom onset. Further studies are needed to determine if immunosuppressed patients have prolonged viral shedding and are still contagious despite seroconversion.


Assuntos
Injúria Renal Aguda/complicações , Infecções por Coronavirus/complicações , Infecções por Coronavirus/imunologia , Transplante de Rim , Pneumonia Viral/complicações , Pneumonia Viral/imunologia , Soroconversão , Eliminação de Partículas Virais/imunologia , Injúria Renal Aguda/imunologia , Injúria Renal Aguda/terapia , Adulto , Betacoronavirus/imunologia , Feminino , Humanos , Rim/imunologia , Rim/cirurgia , Pandemias , Diálise Renal/métodos , Transplantados , Adulto Jovem
2.
Rev Med Liege ; 75(S1): 109-114, 2020.
Artigo em Francês | MEDLINE | ID: mdl-33211431

RESUMO

The SARS-CoV-2 virus causes a respiratory distress syndrome, the main symptom of COVID-19 (for "COronaVIrus Disease 2019"). This infectious disease has been causing a major health and socio-economic pandemic since December 2019. The pulmonary alveolus is regarded as the main target of SARS-CoV-2. However, this coronavirus is capable of directly or indirectly affecting other organs, including the kidneys. Here, we summarize the presumed pathophysiology of COVID-19 renal disease. The incidence of acute kidney injury ranges from 0,5 to 22 % of all patients infected with SARS-CoV-2. The need for renal replacement therapy is reported in 5-9 % of patients in intensive care. Histological analysis of renal biopsies mainly shows acute tubular necrosis of varying severity, as well as the congestion of glomerular and peri-tubular capillaries. Endothelitis has been described in few cases. Evidence for a factual inflammation of the glomerulus remains controversial. The medium/long term consequences of COVID-19 nephropathy are unknown and will deserve a tight follow-up.


Assuntos
Injúria Renal Aguda , Betacoronavirus , Infecções por Coronavirus , Pandemias , Pneumonia Viral , Injúria Renal Aguda/complicações , Infecções por Coronavirus/complicações , Infecções por Coronavirus/epidemiologia , Humanos
3.
J Pharmacol Sci ; 144(4): 229-236, 2020 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-33070842

RESUMO

The kidneys are the major organs for erythropoietin (EPO) production in adults, and thus, kidney damage results in reduced EPO levels and anemia. Inhibitors of Hypoxia-inducible factor-prolyl hydroxylase domain-containing protein (HIF-PHD) are awaited as new therapeutic options for renal anemia. It can be predicted that most patients who receive HIF-PHD inhibitors have renal dysfunction as a cause of anemia. Therefore, in the present study, we investigated the effects of the HIF-PHD inhibitor molidustat on anemia and renal dysfunction when initiated after the onset of renal anemia. Male C57BL/6J mice received adenine orally to induce nephropathy. After the onset of nephropathy, the mice were treated with either vehicle or molidustat. After 4 weeks of administration, vehicle-treated mice displayed significant anemia, and molidustat ameliorated this anemia. Vehicle-treated mice exhibited reduced creatinine clearance and body weight, increased blood urea nitrogen levels, histopathological changes, immune cell infiltration, and dehydration. Molidustat reversed immune cell infiltration, dehydration, and renal fibrosis without improving renal functional parameters. In conclusion, molidustat treatment initiated after the onset of nephropathy and renal anemia reversed anemia in mice. Molidustat improved some parameters of renal abnormality, but it did not restore renal function.


Assuntos
Injúria Renal Aguda/induzido quimicamente , Injúria Renal Aguda/complicações , Adenina/efeitos adversos , Anemia/tratamento farmacológico , Anemia/etiologia , Fator 1 Induzível por Hipóxia/antagonistas & inibidores , Inibidores de Prolil-Hidrolase , Pirazóis/uso terapêutico , Triazóis/uso terapêutico , Injúria Renal Aguda/metabolismo , Animais , Modelos Animais de Doenças , Eritropoetina/metabolismo , Masculino , Camundongos Endogâmicos C57BL , Pirazóis/administração & dosagem , Pirazóis/farmacologia , Triazóis/administração & dosagem , Triazóis/farmacologia
4.
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 , Injúria 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
5.
Acta Biomed ; 91(3): e2020029, 2020 09 07.
Artigo em Inglês | MEDLINE | ID: mdl-32921724

RESUMO

BACKGROUND: The association between acute kidney injury (AKI) and outcome of coronavirus disease 2019 (COVID-19) has not yet been conclusively established. Therefore, we conducted a meta-analysis of recent scientific literature to assess whether AKI may be associated with worse prognosis and increased mortality in COVID-19 patients. METHODS: A systematic search of literature was conducted between 1st November 2019 and 15th May 2020 on Medline (PubMed interface) and China National Knowledge Infrastructure (CNKI) to identify potentially eligible studies. Cohort or case-control studies reporting data on AKI in patients with or without severe COVID-19 were included. Studies were divided into separate cohorts for analysis based on two endpoints (severity [severe vs non-severe] and mortality [non-survivors vs survivors]). Data were pooled into a meta-analysis to estimate pooled odds ratio (OR) with 95% confidence interval (95% CI) for either outcome. RESULTS: A total of 15 studies (n= 5,832 patients) were included in the analysis. Overall, AKI was found to be associated with significantly increased odds of COVID-19 severity (OR= 18.5; 95% CI 8.99-38.08) and mortality (OR= 23.9; 95% CI 18.84-30.31). No heterogeneity was observed for both outcomes (Cochran's Q= 6.21, p=0.52, I2=0% and Cochran's Q= 4.56, p=0.47, I2=0% respectively). -Conclusion: According to current data, AKI seems to be associated with worse prognosis in COVID-19 -patients. -Further investigation of the underlying mechanism of renal disease in COVID-19 would be needed to clarify possible therapeutic targets. AKI could be used as a clinical characteristic in severity classification and risk -stratification.


Assuntos
Injúria Renal Aguda/complicações , Betacoronavirus , Infecções por Coronavirus/complicações , Pandemias , Pneumonia Viral/complicações , Injúria Renal Aguda/epidemiologia , Infecções por Coronavirus/epidemiologia , Progressão da Doença , Saúde Global , Humanos , Pneumonia Viral/epidemiologia , Prognóstico , Taxa de Sobrevida/tendências
6.
A A Pract ; 14(9): e01287, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32909713

RESUMO

Methemoglobinemia is a rare disorder of the blood in which there is an increase in methemoglobin, which occurs when hemoglobin is present in the oxidized form. Methemoglobin impairs hemoglobin's ability to transport oxygen, produces functional anemia, and leads to tissue hypoxia. We report the successful management of a case of refractory hypoxia due to acutely acquired methemoglobinemia in a patient undergoing treatment for coronavirus disease 2019 (COVID-19) pneumonia. The cause of methemoglobinemia in this patient remains unknown. Hypoxia and methemoglobinemia did not respond to methylene blue and required administration of packed red blood cell transfusions.


Assuntos
Infecções por Coronavirus/complicações , Hipóxia/etiologia , Metemoglobinemia/complicações , Pneumonia Viral/complicações , Insuficiência Respiratória/etiologia , Injúria Renal Aguda/complicações , Injúria Renal Aguda/terapia , Idoso , Anticorpos Monoclonais Humanizados/uso terapêutico , Antioxidantes/uso terapêutico , Ácido Ascórbico/uso terapêutico , Betacoronavirus , Infecções por Coronavirus/tratamento farmacológico , Corynebacterium , Infecções por Corynebacterium/complicações , Infecções por Corynebacterium/terapia , Síndrome da Liberação de Citocina/complicações , Inibidores Enzimáticos/uso terapêutico , Transfusão de Eritrócitos , Hematínicos/uso terapêutico , Humanos , Hidroxocobalamina/uso terapêutico , Hidroxicloroquina/uso terapêutico , Hipóxia/terapia , Masculino , Metemoglobinemia/terapia , Azul de Metileno/uso terapêutico , Pandemias , Pneumonia Bacteriana/complicações , Pneumonia Bacteriana/terapia , Pneumonia Viral/tratamento farmacológico , Terapia de Substituição Renal , Insuficiência Respiratória/terapia , Choque Séptico/complicações
7.
Internist (Berl) ; 61(11): 1193-1195, 2020 Nov.
Artigo em Alemão | MEDLINE | ID: mdl-32995904

RESUMO

This article presents the case of a 95-year-old patient with acute urinary retention, postrenal acute renal failure, and subsequent delirium. Especially in older men, urinary retention is often the cause of clinically ambiguous confusional state and should always be considered in the differential diagnosis. This case report demonstrates the value of a good medical history and physical examination as fundamental elements of daily practice.


Assuntos
Injúria Renal Aguda/complicações , Delírio/etiologia , Retenção Urinária , Idoso de 80 Anos ou mais , Delírio/diagnóstico , Diagnóstico Diferencial , Humanos , Masculino
8.
Value Health ; 23(9): 1225-1234, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32940241

RESUMO

OBJECTIVES: Acute kidney injury (AKI) and acute kidney disease (AKD) are a continuum on a disease spectrum and frequently progress to chronic kidney disease. Benefits of nephrologist subspecialty care during the AKD period after AKI are uncertain. METHODS: Patients with AKI requiring dialysis who subsequently became dialysis independent and survived for at least 90 days, defined as the AKD period, were identified from the Taiwanese population's health insurance database. Cox proportional hazard models using death as the competing risk before and after propensity-score matching were applied to evaluate various endpoints. RESULTS: Among a total of 20 260 patients with AKI requiring dialysis who became dialysis independent, only 7550 (37.3%) patients were followed up with by a nephrologist (F/Unephrol group) during the AKD period. During a mean 4.04 ± 3.56 years of follow-up, the patients in the F/Unephrol group were more often administered statin, antihypertensives, angiotensin converting enzyme inhibitors (ACEI) or angiotensin receptor blockers (ARB), diuretics, antiplatelet agents, and antidiabetic agents. The patients in the F/Unephrol group had a lower mortality rate (hazard ratio [HR] = 0.87, P < .001) and were less likely to have major adverse cardiovascular events (MACE) (subdistribution HR [sHR] = 0.85, P < .001), congestive heart failure (CHF) (sHR = 0.81, P < .001), and severe sepsis (sHR = 0.88, P = .008) according to the Cox proportional model after adjusting for mortality as a competing risk. During the AKD period, an increase in the frequency of nephrology visits was associated with improved outcomes. CONCLUSIONS: In this population-based cohort, even after weaning off acute dialysis, only a minority of patients visited a nephrologist during the AKD period. We showed that nephrology follow-up is associated with a decrease in MACE, CHF exacerbations, and sepsis, as well as lower mortality; thus it may improve outcomes in patients with AKD.


Assuntos
Injúria Renal Aguda/terapia , Nefrologia/estatística & dados numéricos , Diálise Renal/estatística & dados numéricos , Injúria Renal Aguda/complicações , Injúria Renal Aguda/mortalidade , Idoso , Idoso de 80 Anos ou mais , Estudos de Casos e Controles , Progressão da Doença , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Modelos de Riscos Proporcionais , Taiwan/epidemiologia
11.
BMJ Case Rep ; 13(8)2020 Aug 11.
Artigo em Inglês | MEDLINE | ID: mdl-32784239

RESUMO

The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic has presented many diagnostic challenges and uncertainties. Little is known about common pathologies complicating pregnancy and how their behaviour is modified by the presence of SARS-CoV-2. Pregnancy itself can alter the body's response to viral infection, which can cause more severe symptoms. We report the first case of a patient affected with sudden-onset severe pre-eclampsia complicated by acute fatty liver disease of pregnancy, HELLP (haemolysis, elevated liver enzymes and low platelet) syndrome and acute kidney injury following SARS-CoV-2 infection. Although an initial diagnostic dilemma, a multidisciplinary team approach was required to ensure a favourable outcome for both the mother and the baby. Our case report highlights the need for health professionals caring for pregnant women to be aware of the complex interplay between SARS-CoV-2 infection and hypertensive disorders of pregnancy.


Assuntos
Injúria Renal Aguda/complicações , Betacoronavirus , Infecções por Coronavirus/complicações , Fígado Gorduroso/complicações , Síndrome HELLP/diagnóstico , Pneumonia Viral/complicações , Pré-Eclâmpsia/diagnóstico , Complicações Infecciosas na Gravidez/diagnóstico , Injúria Renal Aguda/sangue , Injúria Renal Aguda/diagnóstico , Adulto , Infecções por Coronavirus/sangue , Fígado Gorduroso/sangue , Fígado Gorduroso/diagnóstico , Feminino , Síndrome HELLP/sangue , Humanos , Testes de Função Renal , Pandemias , Pneumonia Viral/sangue , Pré-Eclâmpsia/sangue , Gravidez , Complicações na Gravidez/sangue , Complicações na Gravidez/diagnóstico , Complicações Infecciosas na Gravidez/sangue
13.
Clin Immunol ; 219: 108555, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32771488

RESUMO

Respiratory failure and acute kidney injury (AKI) are associated with high mortality in SARS-CoV-2-associated Coronavirus disease 2019 (COVID-19). These manifestations are linked to a hypercoaguable, pro-inflammatory state with persistent, systemic complement activation. Three critical COVID-19 patients recalcitrant to multiple interventions had skin biopsies documenting deposition of the terminal complement component C5b-9, the lectin complement pathway enzyme MASP2, and C4d in microvascular endothelium. Administration of anti-C5 monoclonal antibody eculizumab led to a marked decline in D-dimers and neutrophil counts in all three cases, and normalization of liver functions and creatinine in two. One patient with severe heart failure and AKI had a complete remission. The other two individuals had partial remissions, one with resolution of his AKI but ultimately succumbing to respiratory failure, and another with a significant decline in FiO2 requirements, but persistent renal failure. In conclusion, anti-complement therapy may be beneficial in at least some patients with critical COVID-19.


Assuntos
Injúria Renal Aguda/imunologia , Anticorpos Monoclonais Humanizados/uso terapêutico , Betacoronavirus/patogenicidade , Inativadores do Complemento/uso terapêutico , Infecções por Coronavirus/imunologia , Síndrome da Liberação de Citocina/imunologia , Pneumonia Viral/imunologia , Síndrome Respiratória Aguda Grave/imunologia , Injúria Renal Aguda/complicações , Injúria Renal Aguda/tratamento farmacológico , Injúria Renal Aguda/virologia , Adulto , Betacoronavirus/imunologia , Biomarcadores/metabolismo , Ativação do Complemento/efeitos dos fármacos , Complemento C4b/antagonistas & inibidores , Complemento C5/antagonistas & inibidores , Complexo de Ataque à Membrana do Sistema Complemento/antagonistas & inibidores , Infecções por Coronavirus/complicações , Infecções por Coronavirus/tratamento farmacológico , Infecções por Coronavirus/virologia , Síndrome da Liberação de Citocina/complicações , Síndrome da Liberação de Citocina/tratamento farmacológico , Síndrome da Liberação de Citocina/virologia , Feminino , Produtos de Degradação da Fibrina e do Fibrinogênio/metabolismo , Humanos , Imunidade Humoral/efeitos dos fármacos , Masculino , Serina Proteases Associadas a Proteína de Ligação a Manose/genética , Serina Proteases Associadas a Proteína de Ligação a Manose/imunologia , Pessoa de Meia-Idade , Neutrófilos/imunologia , Neutrófilos/patologia , Pandemias , Fragmentos de Peptídeos/antagonistas & inibidores , Pneumonia Viral/complicações , Pneumonia Viral/tratamento farmacológico , Pneumonia Viral/virologia , Síndrome Respiratória Aguda Grave/complicações , Síndrome Respiratória Aguda Grave/tratamento farmacológico , Síndrome Respiratória Aguda Grave/virologia
14.
Cell Mol Immunol ; 17(9): 992-994, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32620787
16.
Am J Physiol Renal Physiol ; 319(2): F304-F311, 2020 08 01.
Artigo em Inglês | MEDLINE | ID: mdl-32567350

RESUMO

Acute kidney injury (AKI) significantly increases the risk of development of chronic kidney disease (CKD). Recently, our laboratory generated a mouse model with the typical phenotypes of AKI to CKD transition in the unilateral kidney. However, AKI, CKD, and even the transition from AKI to CKD usually occur bilaterally rather than unilaterally in patients. Therefore, in the present study, we further modified the strategy and developed a new model of CKD transitioned from bilateral ischemia-reperfusion injury (IRI) in C57BL/6 mice. In this new model, unilateral severe IRI was performed in one kidney while the contralateral kidney was kept intact to maintain animal survival; then, following 14 days of recovery, when the renal function of the injured kidney restored above the survival threshold, the contralateral intact kidney was subjected to a similar IRI. Animals of these two-stage bilateral IRI models with pedicle clamping of 21 and 24 min at a body temperature of 37°C exhibited incomplete recovery from AKI and subsequent development of CKD with characteristics of progressive decline in glomerular filtration rate, increases in plasma creatinine, worsening of proteinuria, and deleterious histopathological changes, including interstitial fibrosis and glomerulosclerosis, in both kidneys. In conclusion, a new bilateral AKI to CKD transition animal model with a typical phenotype of CKD was generated in C57BL/6 mice.


Assuntos
Injúria Renal Aguda/complicações , Injúria Renal Aguda/patologia , Insuficiência Renal Crônica/patologia , Traumatismo por Reperfusão/patologia , Animais , Modelos Animais de Doenças , Fibrose/metabolismo , Taxa de Filtração Glomerular/fisiologia , Rim/patologia , Masculino , Camundongos Endogâmicos C57BL , Proteinúria/fisiopatologia , Traumatismo por Reperfusão/complicações
18.
J Am Soc Nephrol ; 31(8): 1688-1695, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32561682

RESUMO

BACKGROUND: Kidney involvement is a feature of COVID-19 and it can be severe in Black patients. Previous research linked increased susceptibility to collapsing glomerulopathy, including in patients with HIV-associated nephropathy, to apo L1 (APOL1) variants that are more common in those of African descent. METHODS: To investigate genetic, histopathologic, and molecular features in six Black patients with COVID-19 presenting with AKI and de novo nephrotic-range proteinuria, we obtained biopsied kidney tissue, which was examined by in situ hybridization for viral detection and by NanoString for COVID-19 and acute tubular injury-associated genes. We also collected peripheral blood for APOL1 genotyping. RESULTS: This case series included six Black patients with COVID-19 (four men, two women), mean age 55 years. At biopsy day, mean serum creatinine was 6.5 mg/dl and mean urine protein-creatinine ratio was 11.5 g. Kidney biopsy specimens showed collapsing glomerulopathy, extensive foot process effacement, and focal/diffuse acute tubular injury. Three patients had endothelial reticular aggregates. We found no evidence of viral particles or SARS-CoV-2 RNA. NanoString showed elevated chemokine gene expression and changes in expression of genes associated with acute tubular injury compared with controls. All six patients had an APOL1 high-risk genotype. Five patients needed dialysis (two of whom died); one partially recovered without dialysis. CONCLUSIONS: Collapsing glomerulopathy in Black patients with COVID-19 was associated with high-risk APOL1 variants. We found no direct viral infection in the kidneys, suggesting a possible alternative mechanism: a "two-hit" combination of genetic predisposition and cytokine-mediated host response to SARS-CoV-2 infection. Given this entity's resemblance with HIV-associated nephropathy, we propose the term COVID-19-associated nephropathy to describe it.


Assuntos
Injúria Renal Aguda/genética , Apolipoproteína L1/genética , Infecções por Coronavirus/genética , Glomérulos Renais/virologia , Pneumonia Viral/genética , Injúria Renal Aguda/complicações , Adulto , Grupo com Ancestrais do Continente Africano , Idoso , Alelos , Biópsia , Infecções por Coronavirus/complicações , Creatinina/sangue , Feminino , Genótipo , Humanos , Rim/patologia , Glomérulos Renais/fisiopatologia , Túbulos Renais/patologia , Masculino , Pessoa de Meia-Idade , Pandemias , Pneumonia Viral/complicações , Risco
19.
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
Injúria Renal Aguda , Choque Séptico , APACHE , Injúria Renal Aguda/complicações , Injúria Renal Aguda/etiologia , Pressão Venosa Central , Humanos , Prognóstico , Estudos Prospectivos , Curva ROC , Estudos Retrospectivos
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