Your browser doesn't support javascript.
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 5.865
Filtrar
2.
Med Klin Intensivmed Notfmed ; 115(1): 37-42, 2020 Feb.
Artigo em Alemão | MEDLINE | ID: mdl-29327197

RESUMO

Acute kidney injury (AKI) occurs in 30-50% of all intensive care patients. Renal replacement therapy (RRT) has to be initiated in 10-15%. The early in-hospital mortality is about 50%. Up to 20% of all survivors develop chronic kidney disease after intensive care discharge and progress to end-stage kidney disease within the next 10 years. For timely initiation of prophylactic or therapeutic interventions, it is crucial to exactly determine the actual kidney function, i. e., glomerular filtration rate (GFR), and to gain insight into the further development of kidney function. Traditionally, renal function has been estimated using serum levels of creatinine or urea. Unfortunately, both are notoriously unreliable and insensitive in intensive care patients. Cystatin C has fewer non-GFR determinants when compared to creatinine and is more sensitive and accurate to detect early decreases of GFR. At present, new functional tests are discussed, namely the furosemide stress test (FST) and renal functional reserve (RFR). The FST consists of an intravenous infusion of 1.0-1.5 mg/kgBW furosemide to critically ill patients with AKI. An increase in urine output to >100 ml/h is indicative of a GFR >20 ml/min and almost certainly excludes progression to AKI stage III and need for RRT. Estimation of RFR can be made by short-term oral or intravenous administration of a high protein load. A subsequent increase in GFR defines the presence and the magnitude of functional reserve which can be activated. Loss of RFR is an indicator of loss of functioning nephron mass and incomplete recovery following AKI. Both FST and RFR can help to improve diagnosis and care of high-risk patients with acute and chronic kidney disease.


Assuntos
Lesão Renal Aguda , Diuréticos , Furosemida , Testes de Função Renal , Lesão Renal Aguda/diagnóstico , Creatinina , Diuréticos/administração & dosagem , Furosemida/administração & dosagem , Humanos , Rim/fisiopatologia , Terapia de Substituição Renal
3.
Ann Lab Med ; 40(2): 131-141, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31650729

RESUMO

BACKGROUND: The ability of urinary biomarkers to complement established clinical risk prediction models for postoperative adverse kidney events is unclear. We assessed the effect of urinary biomarkers linked to suspected pathogenesis of cardiac surgery-induced acute kidney injury (AKI) on the performance of the Cleveland Score, a risk assessment model for postoperative adverse kidney events. METHODS: This pilot study included 100 patients who underwent open-heart surgery. We determined improvements to the Cleveland Score when adding urinary biomarkers measured using clinical laboratory platforms (neutrophil gelatinase-associated lipocalin [NGAL], interleukin-6) and those in the preclinical stage (hepcidin-25, midkine, alpha-1 microglobulin), all sampled immediately post-surgery. The primary endpoint was major adverse kidney events (MAKE), and the secondary endpoint was AKI. We performed ROC curve analysis, assessed baseline model performance (odds ratios [OR], 95% CI), and carried out statistical reclassification analyses to assess model improvement. RESULTS: NGAL (OR [95% CI] per 20 concentration-units wherever applicable): (1.07 [1.01-1.14]), Interleukin-6 (1.51 [1.01-2.26]), midkine (1.01 [1.00-1.02]), 1-hepcidin-25 (1.08 [1.00-1.17]), and NGAL/hepcidin-ratio (2.91 [1.30-6.49]) were independent predictors of MAKE and AKI (1.38 [1.03-1.85], 1.08 [1.01-1.15], 1.01 [1.00-1.02], 1.09 [1.01-1.18], and 3.45 [1.54-7.72]). Category-free net reclassification improvement identified interleukin-6 as a model-improving biomarker for MAKE and NGAL for AKI. However, only NGAL/hepcidin-25 improved model performance for event- and event-free patients for MAKE and AKI. CONCLUSIONS: NGAL and interleukin-6 measured immediately post cardiac surgery may complement the Cleveland Score. The combination of biomarkers with hepcidin-25 may further improve diagnostic discrimination.


Assuntos
Lesão Renal Aguda/diagnóstico , Biomarcadores/urina , Procedimentos Cirúrgicos Cardíacos/efeitos adversos , Lipocalina-2/urina , Lesão Renal Aguda/etiologia , Idoso , Área Sob a Curva , Feminino , Humanos , Interleucina-6/urina , Masculino , Pessoa de Meia-Idade , Razão de Chances , Projetos Piloto , Curva ROC , Fatores de Risco , Índice de Gravidade de Doença
4.
Toxicol Lett ; 318: 65-73, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31654803

RESUMO

OBJECTIVE: The optimal measuring timing of serum/plasma Cystatin C (CysC) for early detection of contrast-induced acute kidney injury (CIAKI) remains un-studied. We elucidated further on this issue. METHODS: We searched PubMed, MEDLINE, and Embase from inception until March 2018 for studies evaluating diagnostic accuracy of CysC for detecting CIAKI in patients exposed to contrast agents during diagnostic examinations or cardiac/peripheral catheterizations. RESULTS: A total of 10 relevant studies, comprising 2554 patients, were included and divided into the <24 -h and 24 -h groups based on CysC measuring timing (i.e., hours after contrast agent exposure). Compared with creatinine, pooled diagnostic odds ratio of CysC for detecting CIAKI of the <24 -h and 24 -h groups was 7.59 (95 % confidence interval [CI]: 1.31-44.08) and 53.81 (95 % CI: 13.57-213.26). Pooled sensitivity of the <24 -h and 24 -h groups was 0.81 and 0.88. Pooled specificity of the <24 -h and 24 -h groups was 0.64 and 0.88, respectively. Area under the hierarchical summary receiver operating characteristic curve of the <24 -h and 24 -h groups was 0.75 and 0.93. CONCLUSIONS: Measuring CysC at 24 h after contrast agent exposure shows higher diagnostic accuracy for early detection of CIAKI than measuring CysC at <24 h after contrast agent exposure.


Assuntos
Lesão Renal Aguda/diagnóstico , Meios de Contraste/efeitos adversos , Cistatina C/sangue , Lesão Renal Aguda/sangue , Lesão Renal Aguda/induzido quimicamente , Idoso , Biomarcadores/sangue , Diagnóstico Precoce , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Reprodutibilidade dos Testes , Fatores de Tempo
5.
J Assoc Physicians India ; 67(11): 14-18, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31793262

RESUMO

Aim: To determine the proportion of patients who have Acute Kidney Injury (AKI), identify severity of AKI using RIFLE criteria and to identify associated factors with AKI. Methods: One thousand consecutive medical in-patients were screened for AKI and severity assessed using RIFLE criteria in tertiary care hospital in Northern India. Patients with medical renal disease and obstructive uropathy were excluded. Serum creatinine of all patients were done on days 0, 3, 7 and 14. CKD cases were also excluded. AKI patients were followed at 4 weeks and 3 months. Results: Amongst 1000 patients screened, 65 had AKI. 27(41.5%), 15(23.0%) and 23(35.38%) patients belonged to risk, injury and failure classes of AKI respectively as per RIFLE criteria, and there was incremental risk of mortality (25.92%, 46.33% and 86.95%, p<0.001). In-patients with pneumonia, chronic liver disease and acute gastroenteritis have greater odds of developing AKI, with chronic liver disease having a high mortality (90%). Hypotension (OR- 5.5:1, p=0.002) or leucocytosis at presentation (OR-2.8:1, p<0.001), smokers (OR-2.2:1, p=0.03) and alcoholics (OR-2.5:1, p=0.047) had greater odds of developing AKI. 33(50.7%) patients with AKI died and 27(41.5%) recovered before day 28. Five (7.7%) were seen in class L who had persistently elevated creatinine at day 90 i.e. progressed to ESRD, class E. Conclusion: The incidence of AKI among medical in-patients was 6.5%, with an incremental risk of mortality in risk, injury and failure classes. Pneumonia and acute gastroenteritis among infections and chronic liver disease have greater odds of developing AKI. Hypotension, leucocytosis, smoking, alcohol and aetiology are independent risk factors for AKI.


Assuntos
Lesão Renal Aguda , Lesão Renal Aguda/diagnóstico , Creatinina , Humanos , Incidência , Índia , Estudos Prospectivos , Estudos Retrospectivos , Fatores de Risco
6.
Adv Clin Exp Med ; 28(12): 1657-1666, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31851790

RESUMO

BACKGROUND: Diagnosing acute kidney injury (AKI) in preterm newborns, who are particularly susceptible to renal damage, is a serious challenge as there is no definite consensus about the diagnostic criteria. OBJECTIVES: The objective of this study was to measure the values for selected urinary biomarkers and estimated glomerular filtration rate (eGFR) among a population of preterm infants with uncomplicated clinical course as well as to determine whether these markers depend on birth weight (BW), gestational age (GA), postnatal age (PNA), or gender. MATERIAL AND METHODS: The prospective study was carried out in neonatal intensive care unit (NICU). The evaluation included 57 children that were divided into 3 categories according to BW: low birth weight (LBW) - 1501-2500 g (22 infants); very low birth weight (VLBW) - 1000-1500 g (25 infants); and extremely low birth weight (ELBW) - 750-999 g (10 infants). Urine samples were collected daily between the 4th and 28th day of life for measurements of creatinine (Cr), neutrophil gelatinase-associated lipocalin (NGAL), osteopontin (OPN), and human kidney injury molecule 1 (hKIM1). RESULTS: The values of the 3 urine tubular biomarkers, serum creatinine and eGFR were taken in substantially healthy preterm infants with normal kidney function at 4 time intervals during the neonatal period. Their correlations were determined and a multivariable regression analysis was carried out with respect to BW, GA, PNA, and gender. Trends of the studied markers in terms of PNA and BW were also assessed with the Jonckheere-Terpstra test. CONCLUSIONS: Glomerular and tubular function in preterm neonates during the 1st month of life is significantly influenced by BW, GA, PNA, and gender.


Assuntos
Lesão Renal Aguda , Taxa de Filtração Glomerular , Recém-Nascido Prematuro , Lesão Renal Aguda/diagnóstico , Biomarcadores/sangue , Biomarcadores/urina , Creatinina/sangue , Feminino , Taxa de Filtração Glomerular/fisiologia , Humanos , Recém-Nascido de Peso Extremamente Baixo ao Nascer , Recém-Nascido de Baixo Peso , Recém-Nascido , Masculino , Estudos Prospectivos
7.
Arch. argent. pediatr ; 117(6): 557-567, dic. 2019. tab, graf
Artigo em Inglês, Espanhol | LILACS, BINACIS | ID: biblio-1046289

RESUMO

Introducción. La lesión renal aguda (LRA) ha sido descrita como una complicación frecuente de las cirugías cardíacas en pacientes pediátricos, con impacto documentado en la morbimortalidad. Se estima una incidencia de alrededor del 40 % en este grupo de pacientes. El objetivo del trabajo fue calcular la incidencia de LRA en pacientes que tuvieron cirugía cardiovascular, definir los factores de riesgo asociados y el impacto de la LRA en los parámetros de evolución posquirúrgica.Población y métodos:Se realizó un estudio retrospectivo observacional sobre pacientes pediátricos con cirugías cardiovasculares, operados entre enero de 2015 y diciembre de 2017 en el Hospital Británico de Buenos Aires. Se definió la incidencia de LRA según los criterios de Kidney Disease: Improving Global Outcomes, considerando los valores de creatininemia y ritmo diurético pre- y posquirúrgicos.Resultados.Se incluyeron un total de 125 pacientes. Un 35 % desarrolló LRA. Al analizar los factores de riesgo, se observó una diferencia estadísticamente significativa para administración de vancomicina, diuréticos tiazídicos, requerimiento transfusional de glóbulos rojos, tiempo de bomba de circulación extracorpórea, de clampeo, lactato máximo intraquirúrgico, temperatura mínima y cierre diferido del tórax. Entre los parámetros de evolución posquirúrgica, se observó un incremento en la duración de la internación, requerimiento de inotrópicos, días de asistencia respiratoria mecánica, sangrado y complicaciones neurológicas.Conclusión. La incidencia de LRA en este estudio fue del 35 %. Se pudieron definir factores de riesgo modificables y no modificables asociados, y se detectó una mayor incidencia de complicaciones en aquellos pacientes que desarrollaron LRA


Introduction. Acute kidney injury (AKI) has been described as a common complication of cardiac surgery in pediatric patients, whose impact on morbidity and mortality has been documented. Its incidence has been estimated to be approximately 40 % in this patient group. The objective of this study was to estimate the incidence of AKI in patients who underwent cardiovascular surgery and to define associated risk factors and the impact of AKI on the parameters of the post-operative course.Population and methods. This was a retrospective, observational study of pediatric patients who underwent cardiovascular surgery between January 2015 and December 2017 at Hospital Británico de Buenos Aires. The incidence of AKI was defined as per the Kidney Disease: Improving Global Outcomes criteria, based on pre- and post-operative blood creatinine levels and urine output.Results. A total of 125 patients were included. Of them, 35 % developed AKI. The analysis of risk factors showed a statistically significant difference for the administration of vancomycin and thiazide diuretics, red blood cell transfusion requirement, extracorporeal circulation pump time, clamp time, maximal intraoperative lactate level, minimum temperature, and delayed chest closure. In relation to the parameters of the post-operative course, we observed a longer hospital stay, higher inotropic requirement, more days of mechanical ventilation, bleeding, and neurological complications.Conclusion. In this study, the incidence of AKI was 35 %. Modifiable and non-modifiable associated risk factors were defined and a greater rate of complications was observed in patients who developed AKI.


Assuntos
Humanos , Masculino , Feminino , Lactente , Pré-Escolar , Criança , Adolescente , Procedimentos Cirúrgicos Cardiovasculares/efeitos adversos , Fatores de Risco , Lesão Renal Aguda/epidemiologia , Pediatria , Estudos Retrospectivos , Lesão Renal Aguda/diagnóstico
8.
Zhonghua Wei Zhong Bing Ji Jiu Yi Xue ; 31(10): 1258-1263, 2019 Oct.
Artigo em Chinês | MEDLINE | ID: mdl-31771725

RESUMO

OBJECTIVE: To explore the predicting performance of renal resistive index (RRI), semi quantitative power Doppler ultrasound (PDU) score and serum cystatin C (Cys C) for acute kidney injury (AKI) in patients with cardiac failure or sepsis. METHODS: A prospective, observational study was conducted. Critically ill patients with acute cardiac failure or sepsis admitted to the emergency intensive care unit (ICU) of Cangzhou Central Hospital from January 1st to December 31st in 2018 were enrolled. In addition to the demographic data, serum Cys C, RRI, and PDU score were measured within 6 hours after admission to ICU. Renal function was assessed on day 5 according to Kidney Disease: Improving Global Outcomes (KDIGO) criteria. Patients who proceeded to AKI stage 2 or 3 within 5 days from admission were defined as the AKI 2-3 group; other patients were classified into the AKI 0-1 group. The differences of each index were compared in all patients, cardiac failure patients and sepsis patients between the two groups. Multivariate binary Logistic regression was carried out to identify the independent risk predictors of AKI 2-3. Receiver operator characteristic (ROC) curves were plotted to examine the values of Cys C, RRI, PDU score, and RRI+PDU in predicting AKI 2-3. RESULTS: Thirty-seven patients with cardiac failure (11 with no AKI, 10 with AKI stage 1, 3 with AKI stage 2, and 13 with AKI stage 3) and 26 patients with sepsis (8 with no AKI, 2 with AKI stage 1, 7 with AKI stage 2, and 9 with AKI stage 3) were recruited. In all patients as well as the subgroup of cardiac failure, compared with the AKI 0-1 group, acute physiology and chronic health evaluation II (APACHE II) score, sequential organ failure assessment (SOFA) score, rate of continuous renal replacement therapy (CRRT), 28-day mortality, serum creatinine (SCr), Cys C and RRI were higher in AKI 2-3 group, and urine output, PDU score were lower; in the subgroup of sepsis, rate of CRRT, SCr, and Cys C were higher in AKI 2-3 group, and urine output was lower. Multivariate Logistic regression analysis found that Cys C and PDU score were independent risk factors for AKI 2-3 in all patients [Cys C: odds ratio (OR) = 11.294, 95% confidence interval (95%CI) was 2.801-45.541, P = 0.001; PDU score: OR = 0.187, 95%CI was 0.056-0.627, P = 0.007]; RRI and PDU score were independent risk factors for AKI 2-3 in patients with cardiac failure [RRI (×10): OR = 6.172, 95%CI was 0.883-43.153, P = 0.067; PDU score: OR = 0.063, 95%CI was 0.007-0.584, P = 0.015]; Cys C was the independent risk factor for AKI 2-3 in patients with sepsis (OR = 22.830, 95%CI was 1.345-387.623, P = 0.030). It was shown by ROC curve analysis that: in the subgroup of cardiac failure, the predictive values of RRI, PDU score and Cys C were well [area under the curve (AUC) and 95%CI was 0.839 (0.673-0.942), 0.894 (0.749-0.971), 0.777 (0.610-0.897), all P < 0.01]. RRI+PDU performed best in predicting AKI (AUC = 0.956, 95%CI was 0.825-0.997, P < 0.01), and the predictive value was higher than Cys C [AUC (95%CI): 0.956 (0.825-0.997) vs. 0.777 (0.610-0.897), P = 0.034]. In the subgroup of sepsis, the predictive value of Cys C was well (AUC = 0.913, 95%CI was 0.735-0.987, P < 0.01), however, the predictive value of RRI, PDU, RRI+PDU were poor. CONCLUSIONS: RRI and PDU score effectively predict AKI stage 2 or 3 in cardiac failure patients, but not in patients with sepsis. The predictive values of Cys C for AKI are similar in patients with cardiac failure or sepsis.


Assuntos
Lesão Renal Aguda/diagnóstico , Cistatina C/metabolismo , Insuficiência Cardíaca , Sepse , Humanos , Unidades de Terapia Intensiva , Prognóstico , Estudos Prospectivos , Curva ROC , Ultrassonografia
9.
Lancet ; 394(10212): 1949-1964, 2019 11 23.
Artigo em Inglês | MEDLINE | ID: mdl-31777389

RESUMO

Acute kidney injury (AKI) is defined by a rapid increase in serum creatinine, decrease in urine output, or both. AKI occurs in approximately 10-15% of patients admitted to hospital, while its incidence in intensive care has been reported in more than 50% of patients. Kidney dysfunction or damage can occur over a longer period or follow AKI in a continuum with acute and chronic kidney disease. Biomarkers of kidney injury or stress are new tools for risk assessment and could possibly guide therapy. AKI is not a single disease but rather a loose collection of syndromes as diverse as sepsis, cardiorenal syndrome, and urinary tract obstruction. The approach to a patient with AKI depends on the clinical context and can also vary by resource availability. Although the effectiveness of several widely applied treatments is still controversial, evidence for several interventions, especially when used together, has increased over the past decade.


Assuntos
Lesão Renal Aguda , Lesão Renal Aguda/diagnóstico , Lesão Renal Aguda/epidemiologia , Lesão Renal Aguda/fisiopatologia , Lesão Renal Aguda/terapia , Biomarcadores/sangue , Creatinina/sangue , Humanos , Incidência , Medição de Risco , Sepse/complicações
10.
J Cardiothorac Surg ; 14(1): 191, 2019 Nov 07.
Artigo em Inglês | MEDLINE | ID: mdl-31699143

RESUMO

BACKGROUND: Mild preoperative renal dysfunction (RD) is not rare in patients receiving isolated cardiopulmonary coronary artery bypass grafting (CCABG). However, there are not too many studies about the impact of mild preoperative RD on in-hospital and follow-up outcomes after isolated CCABG. This single-centre, retrospective propensity score matching study designed to study the impact of mild preoperative RD on in-hospital and long-term outcomes after first isolated CCABG. METHODS: After propensity score matching, 1144 patients with preoperative estimated glomerular filtration rate (eGFR) of more than 60 ml/min/1.73 m2 receiving first isolated CCABG surgery from January 2012 to December 2015 entered the study, who were divided into 2 groups: A group (eGFR ≥90 ml/min/1.73 m2, n = 572) and B group (eGFR of 60-89 ml/min/1.73 m2, n = 572). The in-hospital and long-term outcomes were recorded and analyzed. The mean follow-up time was 54.4 ± 10.7 months. Acute kidney injury (AKI) was defined and classified according to the Acute Kidney Injury Network (AKIN) criteria. RESULTS: The 2 propensity score-matched groups had similar baseline and procedure except the baseline eGFR. There were 8 patients died in A group (mortality is 1.4%) and 14 died in B group (mortality is 2.5%) during the in hospital and 30-day postoperatively(χ2 = 1.159, p = 0.282). There were totally 38 patients lost to follow-up, 18 in group A and 20 in group B. 21 patients died in group A and 37 died in group B during the follow-up, and long-term survival in group A was higher than in group B (96.2% vs 93.1%, χ2 = 4.336, p = 0.037). Comparing with group A, group B was associated with an increased rates and severity of AKI postoperatively (total AKI: 62 vs 144. AKIN stageI: 54 vs 113; AKIN stageII: 6 vs 22; AKIN stageIII: 2 vs 9, p<0.0001). During follow-up, group B also had a higher rate of new onset of dialysis (0 vs 6, χ2 = 4.432, p = 0.039). Multivariable logistic regression showed that comparing with A group, the HR for long-term mortality and new onset of dialysis in B group was 1.67 and 1.52 respectively (95%CI 1.09-2.90, p = 0.035; 95%CI 1.14-2.49, p = 0.027). CONCLUSIONS: Comparing with normal preoperative renal function, patients with mild preoperative RD had a similar in-hosptial mortality, but with an increased in-hosptial rates and severity of AKI, and with a decreased long-term survival and increased long-term new onset of dialysis.


Assuntos
Ponte de Artéria Coronária , Complicações Pós-Operatórias/etiologia , Insuficiência Renal/complicações , Lesão Renal Aguda/diagnóstico , Lesão Renal Aguda/etiologia , Lesão Renal Aguda/mortalidade , Lesão Renal Aguda/terapia , Idoso , Feminino , Seguimentos , Taxa de Filtração Glomerular , Mortalidade Hospitalar , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/mortalidade , Complicações Pós-Operatórias/terapia , Período Pré-Operatório , Pontuação de Propensão , Diálise Renal , Insuficiência Renal/diagnóstico , Insuficiência Renal/mortalidade , Insuficiência Renal/terapia , Estudos Retrospectivos , Fatores de Risco , Análise de Sobrevida , Resultado do Tratamento
11.
Pan Afr Med J ; 33: 236, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31692655

RESUMO

Introduction: Acute kidney injury (AKI) is a challenging problem in developing countries due to late presentation of its victims to health care facilities. Data on the pattern of AKI, its outcome and factors associated with its recovery is scanty in developing countries therefore impeding AKI management. Aim: to study AKI recovery rate and its associated factors. Methods: An observational study conducted from September 2013 to June 2014 at Korle-Bu Teaching Hospital (KBTH). Participants were adults, admitted with AKI at KBTH. Kidney Disease: Improving Global Outcomes (KDIGO) criteria was used to diagnose and stage AKI. Results: Mean age (SD) of the participants was 41.9 (± 19.2) years. About a third of the patients (34.6%) were less than 29 years with 30-39 years and 40-60 years constituting 23.0% and 23.6% respectively. Females were in the majority (56.0%). AKI stages I, II and III accounted for 11.0%, 6.8% and 70.7% respectively. Majority, 82.2% of the patients recovered their kidney function. Stage III AKI was significantly associated with decreasing odds of recovery [OR = 0.4, 95%CI = 0.4-2.6, p = 0.002]. In addition, normal blood sodium was associated with recovery from AKI [OR, 95%CI = 2.3, (1.1-5.3), p = 0.043]. Almost half (45.5%) presented with fever whereas 32.5% and 22.5% presented with peripheral oedema and pulmonary oedema respectively. Conclusion: The study demonstrated high kidney function recovery following AKI. Dominant clinical features were fever, peripheral and pulmonary oedema. Advanced stage was associated with poor recovery whereas normal serum sodium level improves kidney function recovery.


Assuntos
Lesão Renal Aguda/fisiopatologia , Edema/epidemiologia , Febre/epidemiologia , Edema Pulmonar/epidemiologia , Lesão Renal Aguda/diagnóstico , Adulto , Edema/etiologia , Feminino , Febre/etiologia , Gana , Humanos , Testes de Função Renal , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Edema Pulmonar/etiologia , Recuperação de Função Fisiológica , Sódio/sangue , Centros de Atenção Terciária , Adulto Jovem
12.
Medicine (Baltimore) ; 98(38): e17034, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31567940

RESUMO

BACKGROUND: Pericardial infection caused by Acinetobacter baumannii is rare, particularly that of carbapenem-resistant A baumannii (CRAB). CASE PRESENTATION: We describe a rare case of purulent pericarditis due to CRAB in a 76-year-old man with acute myocardial infarction and acute kidney injury. The man was admitted to the intensive care unit for a catheter-related bloodstream infection. Pericardial effusion was detected via the bedside X-ray and ultrasound, and pericardiocentesis was performed. Cultures of the pericardial fluid, catheter tip, and blood independently revealed the presence of CRAB. These findings confirmed a diagnosis of purulent pericarditis. CONCLUSIONS: Clinicians should be reminded that CRAB infection can lead to purulent pericarditis, particularly in patients with congestive heart failure or renal insufficiency.


Assuntos
Infecções por Acinetobacter/diagnóstico , Acinetobacter baumannii/isolamento & purificação , Lesão Renal Aguda/diagnóstico , Infarto do Miocárdio sem Supradesnível do Segmento ST/diagnóstico , Pericardite/diagnóstico , Infecções por Acinetobacter/complicações , Acinetobacter baumannii/efeitos dos fármacos , Lesão Renal Aguda/complicações , Idoso , Carbapenêmicos/farmacologia , Diagnóstico Diferencial , Farmacorresistência Bacteriana , Evolução Fatal , Humanos , Masculino , Infarto do Miocárdio sem Supradesnível do Segmento ST/complicações , Pericardiocentese , Pericardite/complicações , Pericardite/diagnóstico por imagem , Tomografia Computadorizada por Raios X
13.
F1000Res ; 82019.
Artigo em Inglês | MEDLINE | ID: mdl-31598213

RESUMO

The thrombotic microangiopathies (TMAs) are a group of diseases characterised by microangiopathic haemolysis, thrombocytopenia, and thrombus formation leading to tissue injury. Traditionally, TMAs have been classified as either thrombotic thrombocytopenic purpura (TTP) or haemolytic uremic syndrome (HUS) based on the clinical presentation, with neurological involvement predominating in the former and acute kidney injury in the latter. However, as our understanding of the pathogenesis of these conditions has increased, it has become clear that this is an over-simplification; there is significant overlap in the clinical presentation of TTP and HUS, there are different forms of HUS, and TMAs can occur in other, diverse clinical scenarios. This review will discuss recent developments in the diagnosis of HUS, focusing on the different forms of HUS and how to diagnose and manage these potentially life-threatening diseases.


Assuntos
Lesão Renal Aguda , Síndrome Hemolítico-Urêmica , Púrpura Trombocitopênica Trombótica , Microangiopatias Trombóticas , Lesão Renal Aguda/diagnóstico , Lesão Renal Aguda/terapia , Hemólise , Síndrome Hemolítico-Urêmica/diagnóstico , Síndrome Hemolítico-Urêmica/terapia , Humanos , Púrpura Trombocitopênica Trombótica/diagnóstico , Púrpura Trombocitopênica Trombótica/terapia , Microangiopatias Trombóticas/diagnóstico , Microangiopatias Trombóticas/terapia
14.
Hypertension ; 74(5): 1144-1151, 2019 11.
Artigo em Inglês | MEDLINE | ID: mdl-31564161

RESUMO

Preeclampsia is a common cause of acute kidney injury (AKI) in low- and middle-income countries, but AKI incidence in preeclampsia, its risk factors, and renal outcomes are unknown. A prospective observational multicenter study of women admitted with preeclampsia in South Africa was conducted. Creatinine concentrations were extracted from national laboratory databases for women with maximum creatinine of ≥90 µmol/L (≥1.02 mg/dL). Renal injury and recovery were defined by Kidney Disease Improving Global Outcomes creatinine criteria. Predefined risk factors, maternal outcomes, and neonatal outcomes were compared between AKI stages. Of 1547 women admitted with preeclampsia 237 (15.3%) met AKI criteria: 6.9% (n=107) stage 1, 4.3% (n=67) stage 2, and 4.1% (n=63) stage 3. There was a higher risk of maternal death (n=7; relative risk, 4.3; 95% CI, 1.6-11.4) and stillbirth (n=80; relative risk, 2.2; 95% CI, 1.8-2.8) in women with AKI compared with those without. Perinatal mortality was also increased (89 of 240; 37.1%). Hypertension in a previous pregnancy was the strongest predictor of AKI stage 2 or 3 (odds ratio, 2.24; 95% CI, 1.21-4.17). Renal recovery rate reduced with increasing AKI stage. A third of surviving women (76 of 230 [33.0%]) had not recovered baseline renal function by discharge. Approximately half (39 of 76; 51.3%) of these women had no further creatinine testing post-discharge. In summary, AKI was common in women with preeclampsia and had high rates of associated maternal and perinatal mortality. Only two-thirds of women had confirmed renal recovery. History of a previous hypertensive pregnancy was an important risk factor.


Assuntos
Lesão Renal Aguda/epidemiologia , Morte Materna/tendências , Morte Perinatal , Pré-Eclâmpsia/epidemiologia , Natimorto/epidemiologia , Lesão Renal Aguda/diagnóstico , Lesão Renal Aguda/terapia , Adolescente , Adulto , Comorbidade , Intervalos de Confiança , Creatinina/sangue , Países em Desenvolvimento , Feminino , Seguimentos , Hospitalização/estatística & dados numéricos , Humanos , Recém-Nascido , Testes de Função Renal , Razão de Chances , Pobreza , Pré-Eclâmpsia/diagnóstico , Pré-Eclâmpsia/terapia , Gravidez , Prevalência , Estudos Prospectivos , Medição de Risco , Índice de Gravidade de Doença , África do Sul , Análise de Sobrevida
15.
Emerg Med Clin North Am ; 37(4): 661-677, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31563201

RESUMO

This article is an evidence-based overview of acute kidney injuries in patients seen in the emergency department setting. The article outlines the current definition of acute kidney injuries and most common causes of injuries. Furthermore, it details clinical evaluations important to appreciate and intervene on, such as volume overload, hypertension, life-threatening electrolyte derangements, and threshold for urgent dialysis. Finally, the article describes special populations that are at higher risk for acute kidney injuries and acute conditions, such as rhabdomyolysis, and the controversy of contrast-induced acute kidney injuries in patients seen in the emergency department.


Assuntos
Lesão Renal Aguda/diagnóstico , Serviço Hospitalar de Emergência , Lesão Renal Aguda/etiologia , Lesão Renal Aguda/terapia , Humanos , Fatores de Risco
16.
Acute Med ; 18(3): 138-140, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31536049

RESUMO

Reduced kidney function, whether acute or chronic, is a highly significant biomarker of in most clinical settings. This is particularly true on the acute medical take where altered renal function is associated with a worse prognosis, and may also impact on immediate management strategies such as drug choice, dosing and suspension, and the use of contrast agents for imaging. In this edition of the Acute Medical Journal, Yang et al present the results of their study describing the renal function and associated characteristics in 2,070 consecutive patients presenting on the unselected medical take at their hospital over a 40 day period. In this study, the authors provide a wealth of information on the general characteristics of acute medical patients admitted with altered kidney function, be it CKD or AKI. Importantly, both chronic kidney disease (CKD) and acute kidney injury (AKI) are very highly prevalent. Indeed, in this study more than 5% of all medical admissions actually demonstrated evidence of both.


Assuntos
Lesão Renal Aguda , Insuficiência Renal Crônica , Lesão Renal Aguda/diagnóstico , Biomarcadores , Hospitalização , Humanos , Prognóstico , Insuficiência Renal Crônica/diagnóstico , Estudos Retrospectivos , Fatores de Risco
17.
Acute Med ; 18(3): 158-164, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31536053

RESUMO

We sought to assess the impact of renal impairment on acute medical admissions and to identify potential contributory factors to admissions involving renal impairment at presentation. In a prospective cohort study, 29.5% of all acute medical emergency admissions had an eGFR <60ml/min/1.73m2 at presentation. Of these, 19.9% had definite chronic kidney disease and 8.4% had definite acute kidney injury. Detailed analysis of a random subset of patients with an eGFR <60ml/min/1.73m2 at presentation demonstrated that the major reasons for admission included falls, dehydration and fluid overload. 46% were on diuretics and 53% were on an ACEI or ARB or both. Gastrointestinal disturbance and recent medication changes were common and diuretic use persisted even with diarrhoea or vomiting.


Assuntos
Lesão Renal Aguda , Inibidores da Enzima Conversora de Angiotensina , Estado Terminal , Lesão Renal Aguda/diagnóstico , Lesão Renal Aguda/epidemiologia , Serviço Hospitalar de Emergência , Hospitalização , Humanos , Incidência , Estudos Prospectivos
18.
Zhonghua Wei Zhong Bing Ji Jiu Yi Xue ; 31(8): 1004-1007, 2019 Aug.
Artigo em Chinês | MEDLINE | ID: mdl-31537228

RESUMO

OBJECTIVE: To investigate the risk factors and prognosis of acute kidney injury (AKI) in children with sepsis in pediatric intensive care unit (PICU). METHODS: A retrospective analysis of clinical data of PICU sepsis children in Anhui Children's Hospital from May 2015 to May 2018 was performed. The children were divided into AKI group and non-AKI group according to whether AKI occurred within 48 hours of PICU [referring to the diagnostic criteria for Kidney Disease: Improving Global Outcomes (KDIGO)]. The general data, physiological data and clinical outcomes of the two groups were compared; Logistic regression analysis was used to analyze the risk factors of AKI in children with sepsis and the prognostic factors. RESULTS: AKI occurred in 55 of 127 children with sepsis, the incidence of AKI was 43.3%, and the overall mortality was 28.3% (36/127), with 41.8% (23/55) in AKI group and 18.1% (13/72) in non-AKI group. (1) Compared with non-AKI group, oxygenation index, albumin, the pediatric critical illness case score (PCIS) and urine volume in AKI group were significantly decreased, while cystatin C, procalcitonin (PCT), prothrombin time (PT), activated partial thromboplastin time (APTT), pediatric multiple organ dysfunction score (P-MODS), the proportions of mechanical ventilation, vasoactive drug use, shock, septic shock and mortality were significantly increased, while there was no difference in age, gender, mean arterial pressure (MAP), white blood cell count (WBC) and C-reactive protein (CRP) between the two groups. Multivariate Logistic regression analysis showed that low serum albumin [odds ratio (OR) = 0.627, 95% confidence interval (95%CI) = 0.495-0.794, P = 0.000] and homocystatin C (OR = 2.641, 95%CI = 1.157-6.032, P = 0.021) were risk factors for AKI in children with sepsis. (2) Compared with the survival group of children with sepsis AKI, the proportion of mechanical ventilation, septic shock, vasoactive drug use, positive balance ratio of liquid for 72 hours, 6-hour lactate clearance rate < 10%, and AKI 3-stage patients in the death group of children with sepsis AKI were significantly increased. Multivariate Logistic regression analysis showed that 72-hour positive liquid balance (OR = 8.542, 95%CI = 1.956-37.307, P = 0.004) and 6-hour lactate clearance rate < 10% (OR = 5.980, 95%CI = 1.393-25.676, P = 0.016) were risk factors for the death of children with sepsis AKI. CONCLUSIONS: Serum albumin and cystatin C should be closely monitored in children with sepsis. Early detection and intervention of positive fluid balance and low lactate clearance rate can reduce the mortality of AKI in children with sepsis.


Assuntos
Lesão Renal Aguda/diagnóstico , Sepse/diagnóstico , Lesão Renal Aguda/epidemiologia , Criança , Humanos , Unidades de Terapia Intensiva Pediátrica , Prognóstico , Estudos Retrospectivos , Fatores de Risco , Sepse/epidemiologia
19.
World J Gastroenterol ; 25(28): 3684-3703, 2019 Jul 28.
Artigo em Inglês | MEDLINE | ID: mdl-31391766

RESUMO

Acute kidney injury (AKI) is a common complication of liver cirrhosis and is of the utmost clinical and prognostic relevance. Patients with cirrhosis, especially decompensated cirrhosis, are more prone to develop AKI than those without cirrhosis. The hepatorenal syndrome type of AKI (HRS-AKI), a spectrum of disorders in prerenal chronic liver disease, and acute tubular necrosis (ATN) are the two most common causes of AKI in patients with chronic liver disease and cirrhosis. Differentiating these conditions is essential due to the differences in treatment. Prerenal AKI, a more benign disorder, responds well to plasma volume expansion, while ATN requires more specific renal support and is associated with substantial mortality. HRS-AKI is a facet of these two conditions, which are characterized by a dysregulation of the immune response. Recently, there has been progress in better defining this clinical entity, and studies have begun to address optimal care. The present review synopsizes the current diagnostic criteria, pathophysiology, and treatment modalities of HRS-AKI and as well as AKI in other chronic liver diseases (non-HRS-AKI) so that early recognition of HRS-AKI and the appropriate management can be established.


Assuntos
Lesão Renal Aguda/diagnóstico , Insuficiência Hepática Crônica Agudizada/complicações , Síndrome Hepatorrenal/diagnóstico , Cirrose Hepática/complicações , Lesão Renal Aguda/etiologia , Lesão Renal Aguda/terapia , Insuficiência Hepática Crônica Agudizada/imunologia , Insuficiência Hepática Crônica Agudizada/patologia , Creatinina/sangue , Circulação Extracorpórea/instrumentação , Circulação Extracorpórea/métodos , Fator Estimulador de Colônias de Granulócitos/uso terapêutico , Síndrome Hepatorrenal/etiologia , Síndrome Hepatorrenal/terapia , Humanos , Rim/irrigação sanguínea , Rim/imunologia , Rim/patologia , Fígado/imunologia , Fígado/patologia , Cirrose Hepática/imunologia , Cirrose Hepática/patologia , Transplante de Fígado , Fígado Artificial , Prognóstico , Índice de Gravidade de Doença , Resultado do Tratamento , Vasoconstritores/uso terapêutico
20.
BMC Res Notes ; 12(1): 484, 2019 Aug 05.
Artigo em Inglês | MEDLINE | ID: mdl-31383003

RESUMO

OBJECTIVE: This study aimed to determine if contrast medium volume (CMV) is a risk factor for acute kidney injury (AKI) during transcatheter aortic valve implantation (TAVI) via a transfemoral approach performed without major complications. All TAVI procedures performed at our institution between March 2014 and March 2018 were retrospectively reviewed. AKI was diagnosed using the Acute Kidney Injury Network classification based on the Valve Academic Research Consortium-2 definition. Procedures performed via a transapical approach and those in which circulatory dynamics failed intraoperatively were excluded. RESULTS: Eighty-one (96.4%) of 100 patients scheduled for TAVI were enrolled; seven (8.6%) developed AKI and 74 (91.4%) did not. The serum creatinine (SCr) level was significantly higher (p < 0.05) and the estimated glomerular filtration rate was significantly lower in the AKI group (p < 0.05). The CMV was significantly higher in the AKI group (103 ml vs 84 ml, p < 0.05), as was the CMV × SCr/BW value (3.34 vs 1.49, p < 0.01). The area under the curve for CMV × SCr/BW was 0.9228 and the cut-off value was 2.99. The CMV, SCr, and estimated glomerular filtration rate affect the likelihood of AKI after transfemoral TAVI and a CMV × SCr/BW value > 2.99 accurately predicts AKI.


Assuntos
Lesão Renal Aguda/diagnóstico , Meios de Contraste/metabolismo , Creatinina/sangue , Implante de Prótese de Valva Cardíaca/métodos , Substituição da Valva Aórtica Transcateter/métodos , Lesão Renal Aguda/sangue , Lesão Renal Aguda/fisiopatologia , Idoso de 80 Anos ou mais , Feminino , Taxa de Filtração Glomerular , Implante de Prótese de Valva Cardíaca/estatística & dados numéricos , Humanos , Período Intraoperatório , Modelos Logísticos , Masculino , Período Pré-Operatório , Estudos Retrospectivos , Fatores de Risco , Substituição da Valva Aórtica Transcateter/estatística & dados numéricos
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA