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1.
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
2.
Medicine (Baltimore) ; 98(33): e16867, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31415421

RESUMO

Acute kidney injury (AKI) is a complex syndrome with a variety of possible etiologies and symptoms. It is characterized by high mortality and poor recovery of renal function. The incidence and mortality rates of patients with AKI in intensive care units are extremely high. It is generally accepted that early identification and prompt treatment of AKI are essential to improve outcomes. This study aimed to develop a model based on risk stratification to identify and diagnose early stage AKI for improved prognosis in critically ill patients.This was a single-center, retrospective, observational study. Based on relevant literature, we selected 13 risk factors (age, sex, hypertension, diabetes, coronary heart disease, chronic kidney disease, total bilirubin, emergency surgery, mechanical ventilation, sepsis, heart failure, cancer, and hypoalbuminemia) for AKI assessment using the Kidney Disease Improving Global Outcomes (KDIGO) diagnostic criteria. Univariate and multivariate analyses were used to determine risk factors for eventual entry into the predictive model. The AKI predictive model was established using binary logistic regression, and the area under the receiver operating characteristic curve (AUROC or AUC) was used to evaluate the predictive ability of the model and to determine critical values.The AKI predictive model was established using binary logistic regression. The AUROC of the predictive model was 0.81, with a sensitivity of 69.8%, specificity of 83.4%, and positive likelihood ratio of 4.2.A predictive model for AKI in critically ill patients was established using 5 related risk factors: heart failure, chronic kidney disease, emergency surgery, sepsis, and total bilirubin; however, the predictive ability requires validation.


Assuntos
Lesão Renal Aguda/epidemiologia , Lesão Renal Aguda/etiologia , Unidades de Terapia Intensiva/estatística & dados numéricos , Modelos Estatísticos , Lesão Renal Aguda/diagnóstico , Adulto , Idoso , Bilirrubina/sangue , Comorbidade , Feminino , Insuficiência Cardíaca/epidemiologia , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Insuficiência Renal Crônica/epidemiologia , Estudos Retrospectivos , Medição de Risco , Sensibilidade e Especificidade , Sepse/epidemiologia
3.
Zhejiang Da Xue Xue Bao Yi Xue Ban ; 48(2): 224-229, 2019 Apr 25.
Artigo em Chinês | MEDLINE | ID: mdl-31309763

RESUMO

Cardiac surgery-related acute kidney injury (CSA-AKI) is a common and serious complication after cardiac surgery in adults. Currently, there is no specific examination method, and the diagnosis relying on serum creatinine and urine volume changes is of hysteresis. Biomarkers with the potential to predict CSA-AKI have become the focus in recent years. Clinical studies have shown that neutrophil gelatinase related lipid transporters and cell cycle inhibitors are of high diagnostic value; liver fatty acid binding protein can be used to assist in the diagnosis of CSA-AKI; microRNAs help to assess the poor prognosis of patients; the combined application of biomarkers may be used to predict the occurrence of CSA-AKI. CSA-AKI biomarkers provide the possibility for early clinical diagnosis and timely intervention, and are expected to become a new breakthrough in the diagnosis and treatment of CSA-AKI.


Assuntos
Lesão Renal Aguda , Biomarcadores , Procedimentos Cirúrgicos Cardíacos , Lesão Renal Aguda/sangue , Lesão Renal Aguda/diagnóstico , Lesão Renal Aguda/etiologia , Lesão Renal Aguda/urina , Adulto , Biomarcadores/análise , Biomarcadores/sangue , Procedimentos Cirúrgicos Cardíacos/efeitos adversos , Creatinina/sangue , Humanos
4.
Medicine (Baltimore) ; 98(28): e16244, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31305403

RESUMO

RATIONALE: The incidence exercise-induced rhabdomyolysis is increasing in the healthy general population. Rhabdomyolysis can lead to the life-threatening systemic complications of acute kidney injury (AKI), compartment syndrome, and disseminated intravascular coagulopathy. PATIENT CONCERNS: A 21-year-old man had bilateral lower limb pain and soreness, dark brown urine after lower exremity training. Laboratory results showed that creatinine kinase (CK) and myoglobin (Mb) increased to 140,500 IU/L and 8632 µg/L respectively, with elevated liver enzymes, Scr, and proteinuria. DIAGNOSES: Exercise-induced rhabdomyolysis with AKI. INTERVENTIONS: The patient was hospitalized and treated with vigorous hydration and sodium bicarbonate for 6 days. OUTCOMES: After 6 days of treatment, the patient had a significant decrease in the CK and Mb levels. His renal function returned to normal. His laboratory tests had completely normalized during 2-week follow-up. LESSONS: Exercise-induced rhabdomyolysis can cause serious complications such as AKI. Delayed diagnosis can be critical, so timely manner should be taken to achieve a favorable prognosis.


Assuntos
Lesão Renal Aguda/etiologia , Lesão Renal Aguda/fisiopatologia , Exercício , Extremidade Inferior , Rabdomiólise/etiologia , Rabdomiólise/fisiopatologia , Lesão Renal Aguda/diagnóstico , Lesão Renal Aguda/tratamento farmacológico , Diagnóstico Diferencial , Exercício/fisiologia , Humanos , Extremidade Inferior/fisiopatologia , Masculino , Rabdomiólise/diagnóstico , Rabdomiólise/tratamento farmacológico , Adulto Jovem
5.
Emerg Med Clin North Am ; 37(3): 459-471, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31262415

RESUMO

Acute kidney injury (AKI) is a common sequela of critical illness. Clinical manifestation of AKI varies and can include electrolyte abnormalities, anion gap, or non-anion-gap metabolic acidosis. Treatment strategies require careful identification of the cause of the AKI, relying on both clinical history and laboratory data. Once the cause has been identified, treatment can then target the underlying cause and avoid further insults. Conservative management should first be attempted for patients with AKI. If conservative management fails, renal replacement therapy or hemodialysis can be used.


Assuntos
Lesão Renal Aguda/terapia , Terapia de Substituição Renal , Desequilíbrio Hidroeletrolítico/terapia , Lesão Renal Aguda/diagnóstico , Lesão Renal Aguda/etiologia , Estado Terminal , Diuréticos/uso terapêutico , Medicina de Emergência , Serviço Hospitalar de Emergência , Hidratação , Humanos , Bicarbonato de Sódio/uso terapêutico , Vasoconstritores/uso terapêutico
6.
Braz J Cardiovasc Surg ; 34(3): 352-360, 2019 06 01.
Artigo em Inglês | MEDLINE | ID: mdl-31310475

RESUMO

Acute kidney injury (AKI) is a common and severe complication after cardiac surgery. Currently, a series of novel biomarkers have favored the assessment of AKI after cardiac surgery in addition to the conventional indicators. The biomartkers, such as urinary liver fatty acid binding protein (L-FABP), urinary neutrophil gelatinase-associated lipocalin (NGAL), serum L-FABP, heart-type FABP, kidney injury molecule 1 (KIM-1), and interleukin-18 were found to be significantly higher in patients who developed AKI after cardiac surgery than those who did not. Apart from urinary interleukin-18, the novel biomarkers have been recognized as reliable indicators for predicting the diagnosis, adverse outcome, and even mortality of AKI after cardiac surgery. The timing of the renal replacement therapy is a significant predictor relating to patients' prognoses. In patients with AKI after cardiac surgery, renal replacement therapy should be performed as early as possible in order to achieve promising outcomes. In children, AKI after cardiac surgery can be managed with peritoneal dialysis. AKI after cardiac surgery has received extensive attention as it may increase early mortality and impact long-term survival of patients as well. The purpose of this article was to analyze the changes of the pertinent biomarkers, to explore the related risk factors leading to the occurrence of AKI after cardiac surgery, and to provide a basis for the clinical prevention and reduction of AKI.


Assuntos
Lesão Renal Aguda/etiologia , Biomarcadores/análise , Procedimentos Cirúrgicos Cardíacos/efeitos adversos , Lesão Renal Aguda/terapia , Humanos , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/terapia , Medição de Risco , Fatores de Risco , Fatores de Tempo
7.
Ann Hematol ; 98(10): 2273-2281, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31256219

RESUMO

Although renal dysfunction at the time of diagnosis of paroxysmal nocturnal hemoglobinuria (PNH) is a risk factor for mortality, subsequent renal events can occur. The objective of this study was to identify clinical implication of renal dysfunction occurring during the disease course in PNH patients. One hundred one patients with a granulocyte clone size of > 10% were enrolled. Renal events were observed in 55 (54.5%) patients during a median follow-up of 94.2 months. Median time to first renal event from diagnosis of PNH was 79.3 months. Thromboembolism (TE) event and recurrent TE events were observed in 25 (24.8%) and 8 (7.9%) patients, respectively. The rate of recurrent TE was significantly higher in patients with renal events ≥ 2 compared with that in patients with renal event ≤ 1 (18.8% vs. 2.9%; P = 0.012). The rate of recurrent TE was significantly higher in patients with chronic kidney disease (CKD) + acute kidney disease (AKD) compared with the rest of the patients (27.3% vs. 5.6%; P = 0.040). CKD+AKD was the only independent risk factor for OS in multivariate analysis (hazard ratio 7.95, 95% CI 1.24-51.15, P = 0.029). Therefore, close monitoring of renal events in PNH patients during the entire clinical course is essential.


Assuntos
Lesão Renal Aguda , Hemoglobinúria Paroxística , Insuficiência Renal Crônica , Lesão Renal Aguda/epidemiologia , Lesão Renal Aguda/etiologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Feminino , Seguimentos , Hemoglobinúria Paroxística/complicações , Hemoglobinúria Paroxística/epidemiologia , Humanos , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Insuficiência Renal Crônica/epidemiologia , Insuficiência Renal Crônica/etiologia , Tromboembolia/epidemiologia , Tromboembolia/etiologia
8.
Medicine (Baltimore) ; 98(30): e16492, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31348259

RESUMO

RATIONALE: Acute kidney injury (AKI) accounts for 8% to 16% of hospital admissions and can quadruple hospital mortality, placing a serious burden on the health economy. Acute kidney injury (AKI) is mainly caused by dehydration, shock, infection, sepsis, heart disease, or as a side-effect of nephrotoxic drugs. About 10% to 60% of patients with rhabdomyolysis develop AKI, and 10% of AKI is attributable to rhabdomyolysis. However, rhabdomyolysis-induced AKI secondary to undifferentiated connective tissue disease (UCTD) has rarely been reported before. PATIENT CONCERNS: We report the case of a 50-year-old male of UCTD presented with dark brown urine, swelling and edema of the upper limbs, and decreased urine output. DIAGNOSIS: The patient was diagnosed with rhabdomyolysis-induced AKI secondary to UCTD. INTERVENTIONS: The patient was successfully treated with intravenous methylprednisolone with other supportive treatment. OUTCOMES: After 3 days of initiating treatment of medicinal charcoal tablets, sodium bicarbonate and intravenous fluids upon admission, the patient's serum creatinine changed mildly from 145.0 µmol/L to 156.0 µmol/L, but the urinary output increased from 1000 mL/24 h to 2400 mL/24 h, with his creatine kinase (CK) and myoglobin rose from 474 IU/L to 962 IU/L and from 641.5ng/mL to 1599 ng/mL, respectively. We then tried to empirically initiate UCTD therapy by giving corticosteroids. After the administration of the 40 mg of methylprednisolone daily, the serum creatinine level dropped to 97 µmol/L the second day, CK decreased to 85 IU/L within 1 week and myoglobin decreased to 65.05 ng/mL within 10 days. When maintenance dose of 4 mg daily was given, the patient showed no abnormalities in creatinine or CK levels. LESSONS: There have been few reports on the association between rhabdomyolysis-induced AKI and UCTD and its mechanism remains unclear. Clinicians should be aware of UCTD as a possible cause to rhabdomyolysis-induced AKI.


Assuntos
Lesão Renal Aguda/etiologia , Rabdomiólise/complicações , Doenças do Tecido Conjuntivo Indiferenciado/complicações , Humanos , Masculino , Pessoa de Meia-Idade
9.
Praxis (Bern 1994) ; 108(8): 519-524, 2019 Jun.
Artigo em Alemão | MEDLINE | ID: mdl-31185842

RESUMO

CME: Zoonosis in Switzerland: Leptospirosis Abstract. Leptospirosis is worldwide a common zoonosis that also occurs in Switzerland. Frequently it presents as a self-limited, mild illness. The more severe presentation with jaundice and sever acute kidney injury (Weil's disease) is, however, associated with a high morbidity and mortality. In order to make the diagnosis, it is important to recognize the typical findings and perform the appropriate diagnostic workup. In this article, we discuss the clinical signs, diagnostic workup, therapy and prevention of leptospirosis and present the case of a 54-year-old patient with severe leptospirosis.


Assuntos
Leptospirose , Doença de Weil , Lesão Renal Aguda/etiologia , Humanos , Icterícia/etiologia , Leptospirose/complicações , Leptospirose/diagnóstico , Pessoa de Meia-Idade , Suíça , Doença de Weil/etiologia
11.
Cancer Imaging ; 19(1): 38, 2019 Jun 18.
Artigo em Inglês | MEDLINE | ID: mdl-31215488

RESUMO

BACKGROUND: Contrast-induced acute kidney injury (CI-AKI) is a major adverse effect caused by intravascular administration of iodinated contrast medium. Whether there is a difference in CI-AKI incidence between iso-osmolar (IOCM) and low-osmolar contrast media (LOCM) among diabetic patients is controversial. METHODS: Randomized controlled trials comparing the nephrotoxic effects between IOCM and LOCM in diabetic patients with or without CKD (eGFR< 60 ml/min/1.73 m2) were included in the analysis. The incidence of CI-AKI was defined as an initial increase in serum creatinine (SCr) concentration of at least 0.5 mg/dl or a rise in creatinine of 25% from baseline. RESULTS: A total of 2190 patients were included, among whom 1122 patients received IOCM and 1068 received LOCM. When compared to LOCM, IOCM had no significant benefit in preventing CI-AKI (OR = 1.66, [CI: 0.97-2.84], P = 0.06, I2 = 54%). However, the difference between IOCM and LOCM was found when CI-AKI was defined as an absolute SCr increase (≥0.5 mg/dl) rather than a relative SCr increase (≥25%). Further analysis showed that LOCM resulted in more adverse events. CONCLUSIONS: Whether there is a difference of CI-AKI incidence between IOCM and LOCM in diabetic patients was related to the selected diagnostic criteria. The incidence of adverse events was significantly lower with IOCM when compared with LOCM. Therefore, we suggest that IOCM may be used in diabetic and CKD (eGFR< 60 ml/min/1.73 m2) patients.


Assuntos
Lesão Renal Aguda/etiologia , Meios de Contraste/efeitos adversos , Diabetes Mellitus/epidemiologia , Lesão Renal Aguda/epidemiologia , Meios de Contraste/química , Feminino , Humanos , Masculino , Concentração Osmolar , Ensaios Clínicos Controlados Aleatórios como Assunto
12.
J Cardiothorac Surg ; 14(1): 107, 2019 Jun 13.
Artigo em Inglês | MEDLINE | ID: mdl-31196131

RESUMO

BACKGROUND: Acute kidney injury after cardiac surgery is common and associated with increased mortality. It is unknown whether an intended higher arterial pressure during cardiopulmonary bypass reduces the incidence of acute and chronic kidney injury. METHODS: Patients were randomised either to a control group or a high pressure group (arterial pressure > 60 mmHg). The inclusion criteria were age > 70 years, combined cardiac surgery and serum creatinine < 200 µmol/L. Glomerular filtration rate using the Cr-EDTA clearance method was measured the day before surgery and 4 months postoperatively. The RIFLE criteria were used to define the presence of acute kidney injury. In addition, the ratio between urinary Neutrophil Gelatinase-Associated Lipocalin (NGAL) and creatinine was measured. RESULTS: Ninety patients were included. Mean age was 76 ± 4 years and 76% were male. Mean arterial pressure was 47 ± 5 mmHg in the control group and 61 ± 4 mmHg in the high pressure group (p < 0.0001). The change in glomerular filtration rate at follow-up was - 9 ± 12 ml/min in the control group and - 5 ± 16 ml/min in the high pressure group (p = 0.288, 95% CI - 13 to 4). According to the RIFLE criteria 38% in the control group and 46% in the high pressure group developed acute kidney injury (p = 0.447). The postoperative urinary NGAL/creatinine ratio was comparable between the groups. CONCLUSIONS: An intended increase in arterial pressure during cardiopulmonary bypass to > 60 mmHg did not decrease the incidence of acute or chronic kidney injury after cardiac surgery. TRIAL REGISTRATION: Clinicaltrials.gov, identifier: NCT01408420 . Registered 3rd of August 2011.


Assuntos
Lesão Renal Aguda/etiologia , Lesão Renal Aguda/prevenção & controle , Pressão Arterial , Ponte Cardiopulmonar/efeitos adversos , Ponte Cardiopulmonar/métodos , Idoso , Idoso de 80 Anos ou mais , Creatinina/sangue , Creatinina/urina , Feminino , Taxa de Filtração Glomerular , Humanos , Lipocalina-2/urina , Masculino , Complicações Pós-Operatórias/prevenção & controle , Valor Preditivo dos Testes
13.
Chemotherapy ; 64(1): 17-21, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31167190

RESUMO

Prolonged intermittent renal replacement therapy (PIRRT) is an increasingly adopted method of renal replacement in critically ill patients. Like continuous renal replacement therapy, PIRRT can alter the pharmacokinetics (PK) of many drugs. In this setting, dosing data for antibiotics like benzylpenicillin are lacking. In order to enable clinicians to prescribe benzylpenicillin safely and effectively, knowledge of the effects of PIRRT on the plasma PK of benzylpenicillin is required. Herein, we describe the PK of benzylpenicillin in 2 critically ill patients on PIRRT for the treatment of penicillin-susceptible Staphylococcus aureus bacteremia complicated by infective endocarditis. Blood samples were taken for each patient taken over dosing periods during PIRRT and off PIRRT. Two-compartment PK models described significant differences in the mean clearance of benzylpenicillin with and without PIRRT (6.61 vs. 3.04 L/h respectively). We would suggest a benzylpenicillin dose of 1,800 mg (3 million units) every 6-h during PIRRT therapy as sufficient to attain PK/pharmacodynamic target.


Assuntos
Antibacterianos/farmacocinética , Penicilina G/farmacocinética , Lesão Renal Aguda/etiologia , Lesão Renal Aguda/terapia , Idoso de 80 Anos ou mais , Antibacterianos/farmacologia , Antibacterianos/uso terapêutico , Bacteriemia/complicações , Bacteriemia/diagnóstico , Bacteriemia/tratamento farmacológico , Bacteriemia/microbiologia , Relação Dose-Resposta a Droga , Meia-Vida , Humanos , Masculino , Pessoa de Meia-Idade , Penicilina G/farmacologia , Penicilina G/uso terapêutico , Terapia de Substituição Renal , Sepse/complicações , Sepse/diagnóstico , Sepse/tratamento farmacológico , Sepse/microbiologia , Staphylococcus aureus/efeitos dos fármacos , Staphylococcus aureus/isolamento & purificação , Resultado do Tratamento
14.
Lancet ; 394(10197): 488-496, 2019 08 10.
Artigo em Inglês | MEDLINE | ID: mdl-31202596

RESUMO

BACKGROUND: Cardiac surgery is associated with a high risk of postoperative acute kidney injury (AKI) and subsequent loss of kidney function. We explored the clinical utility of urinary dickkopf-3 (DKK3), a renal tubular stress marker, for preoperative identification of patients at risk for AKI and subsequent kidney function loss. METHODS: This observational cohort study included patients who had cardiac surgery in a derivation cohort and those who had cardiac surgery in a validation cohort (RenalRIP trial). The study comprised consecutive patients who had elective cardiac surgery at the Saarland University Medical Centre (Homburg, Germany; derivation cohort) and those undergoing elective cardiac surgery (selected on the basis of a Cleveland Clinical Foundation score of 6 or higher) who were enrolled in the prospective RenalRIP multicentre trial (validation cohort) and who were randomly assigned to remote ischaemic preconditioning or a sham procedure. The association between the ratio of preoperative urinary concentrations of DKK3 to creatinine (DKK3:creatinine) and postoperative AKI, defined according to the Kidney Disease Improving Global Outcomes criteria, and subsequent kidney function loss, as determined by estimated glomerular filtration rate, was assessed. FINDINGS: In the 733 patient in the derivation cohort, urinary concentrations of DKK3 to creatinine that were higher than 471 pg/mg were associated with significantly increased risk for AKI (odds ratio [OR] 1·65, 95% CI 1·10-2·47, p=0·015), independent of baseline kidney function. Compared with clinical and other laboratory measurements, urinary concentrations of DKK3:creatinine significantly improved AKI prediction (net reclassification improvement 0·32, 95% CI 0·23-0·42, p<0·0001). High urinary DKK3:creatinine concentrations were independently associated with significantly lower kidney function at hospital discharge and after a median follow-up of 820 days (IQR 733-910). In the RenalRIP trial, preoperative urinary DKK3:creatinine concentrations higher than 471 pg/mg were associated with a significantly higher risk for AKI (OR 1·94, 95% CI 1·08-3·47, p=0·026), persistent renal dysfunction (OR 6·67, 1·67-26·61, p=0·0072), and dialysis dependency (OR 13·57, 1·50-122·77, p=0·020) after 90 days compared with DKK3:creatinine concentrations of 471 pg/mg or less. Urinary DKK3:creatinine concentrations higher than 471 pg/mg were associated with significantly higher risk for AKI (OR 2·79, 95% CI 1·45-5·37) and persistent renal dysfunction (OR 3·82, 1·32-11·05) only in patients having a sham procedure, but not remote ischaemic preconditioning (AKI OR 1·35, 0·76-2·39 and persistent renal dysfunction OR 1·05, 0·12-9·45). INTERPRETATION: Preoperative urinary DKK3 is an independent predictor for postoperative AKI and for subsequent loss of kidney function. Urinary DKK3 might aid in the identification of patients in whom preventive treatment strategies are effective. FUNDING: No study funding.


Assuntos
Lesão Renal Aguda/fisiopatologia , Biomarcadores/urina , Procedimentos Cirúrgicos Cardíacos/efeitos adversos , Peptídeos e Proteínas de Sinalização Intercelular/urina , Lesão Renal Aguda/etiologia , Lesão Renal Aguda/urina , Idoso , Idoso de 80 Anos ou mais , Creatinina/urina , Procedimentos Cirúrgicos Eletivos/efeitos adversos , Feminino , Taxa de Filtração Glomerular , Humanos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/fisiopatologia , Complicações Pós-Operatórias/urina , Estudos Prospectivos
15.
Medicine (Baltimore) ; 98(25): e16049, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31232940

RESUMO

OBJECTIVE: This study was performed to explore the effects of probucol on contrast-induced acute kidney injury (CIAKI) in patients with coronary heart disease undergoing percutaneous coronary intervention (PCI). METHODS: In total, 220 patients undergoing PCI were randomly assigned to either the control group (hydration from 12 hours before to 12 hours after contrast administration; n = 110) or the probucol group (hydration plus probucol 500 mg twice daily 1 day before and 3 days after the operation; n = 110). The primary endpoint was the occurrence of serum creatinine (Scr)-based CIAKI, defined as an absolute increase in Scr by 0.5 mg/dl (44.2 µmol/L) or a relative 25% increase from baseline within 48 to 72 hours after exposure to contrast medium. The secondary outcomes were composite variations in Scr, blood urea nitrogen (BUN), creatinine clearance rate (Ccr) within 48 to 72 hours, and major adverse events during hospitalization or the 7-day follow-up period after PCI. RESULTS: The overall incidence of Scr-based CIAKI was 7.3% (16/220): 5.5% (6/110) in the control group and 9.1% (10/110) in the probucol group (χ = 1.078, P = .298). There were no significant differences in the occurrence rate of major adverse events during hospitalization or the 7-day follow-up period after PCI between the groups. Multivariate logistic regression analysis showed that probucol was not an independent protective factor for CIAKI (odds ratio, 1.825; 95% confidence interval, 0.639-5.212; P = .261). However, hydration was an independent protective factor (odds ratio, 0.997; 95% confidence interval, 0.995-0.999; P = .004). CONCLUSION: Probucol cannot effectively reduce the incidence of CIAKI through its anti-inflammatory and antioxidative stress effects.


Assuntos
Lesão Renal Aguda/tratamento farmacológico , Meios de Contraste/efeitos adversos , Intervenção Coronária Percutânea/efeitos adversos , Probucol/farmacologia , Lesão Renal Aguda/etiologia , Idoso , Antioxidantes/farmacologia , Antioxidantes/uso terapêutico , China , Meios de Contraste/uso terapêutico , Angiografia Coronária/efeitos adversos , Doença das Coronárias/diagnóstico por imagem , Doença das Coronárias/cirurgia , Método Duplo-Cego , Feminino , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Intervenção Coronária Percutânea/métodos , Probucol/uso terapêutico , Estudos Prospectivos
16.
Chem Biol Interact ; 308: 269-278, 2019 Aug 01.
Artigo em Inglês | MEDLINE | ID: mdl-31153982

RESUMO

Although cisplatin is an effective anticancer drug, its clinical application is limited due to various side effects, especially nephrotoxicity. In this study, we investigated the protective effects and possible mechanisms of hesperetin on cisplatin-induced kidney damage. In vitro, hesperetin significantly attenuated oxidative stress-induced apoptosis by reducing ROS levels in cisplatin-treated HK-2 cells. Simultaneously, hesperetin activated the Nrf2 signaling pathway and regulated its downstream genes, including NQO1 and HO-1. In vivo, hesperetin could significantly attenuate cisplatin-induced nephrotoxicity, blood urea nitrogen (BUN) and serum creatinine (SCr). Furthermore, hesperetin clarifies cisplatin-induced oxidative stress by reducing MDA/MPO levels and increasing SOD/GSH levels. In addition, from the histopathological analysis of the kidney, hesperetin significantly reduced the nephrotoxicity caused by cisplatin compared with the cisplatin group. Moreover, western blotting of renal tissue revealed that hesperetin activates Nrf2 in a dose-dependent manner, attenuates the MAPK signaling pathway against inflammation, and inhibits the expression of apoptotic proteins to protect kidneys from AKI caused by cisplatin. Altogether, these findings suggest that hesperetin may be a potential protectant against cisplatin-induced nephrotoxicity.


Assuntos
Lesão Renal Aguda/patologia , Apoptose/efeitos dos fármacos , Cisplatino/farmacologia , Hesperidina/farmacologia , Estresse Oxidativo/efeitos dos fármacos , Lesão Renal Aguda/tratamento farmacológico , Lesão Renal Aguda/etiologia , Animais , Antioxidantes/metabolismo , Nitrogênio da Ureia Sanguínea , Linhagem Celular , Sobrevivência Celular/efeitos dos fármacos , Cisplatino/uso terapêutico , Creatinina/sangue , Hesperidina/uso terapêutico , Humanos , Inflamação/tratamento farmacológico , Rim/efeitos dos fármacos , Rim/patologia , Camundongos , Fator 2 Relacionado a NF-E2/metabolismo , Espécies Reativas de Oxigênio/metabolismo , Transdução de Sinais/efeitos dos fármacos
18.
Am Surg ; 85(4): 365-369, 2019 Apr 01.
Artigo em Inglês | MEDLINE | ID: mdl-31043196

RESUMO

Acute kidney injury (AKI) is a serious condition that affects critically ill patients admitted to the ICU. In this study, we report the association between right ventricle shape and AKI in a cohort of burn and trauma patients. This study is a retrospective review of trauma and burn patients who were admitted to our ICU between 2013 and 2016 who underwent hemodynamic transesophageal echocardiography. Left ventricular eccentricity index (LVEI) measurements were performed on still images obtained from transgastric short-axis view clips at end diastole. LVEI was used as a surrogate of right ventricular volume loading. There were 132 patients, the mean age was 50.8 years, and they were predominantly white and males. Using logistic regression and adjusting for age, race, gender, injury mechanism, and injury severity, higher LVEI was independently significantly associated with lower incidence of AKI (odds ratio 0.03, confidence interval 0.00-0.69). Higher LVEI is associated with a lower incidence of AKI in critically injured trauma and burn patients.


Assuntos
Lesão Renal Aguda/etiologia , Disfunção Ventricular Direita/complicações , Ferimentos e Lesões/complicações , Lesão Renal Aguda/epidemiologia , Adulto , Idoso , Queimaduras/complicações , Queimaduras/fisiopatologia , Estado Terminal , Ecocardiografia Transesofagiana , Feminino , Humanos , Incidência , Modelos Lineares , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Risco , Disfunção Ventricular Direita/diagnóstico por imagem , Ferimentos e Lesões/fisiopatologia
19.
Medicine (Baltimore) ; 98(19): e15551, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-31083215

RESUMO

RATIONALE: Acute kidney injury (AKI), rhabdomyolysis, and delayed leukoencephalopathy after carbon monoxide (CO) poisoning are very rare. We report a case presenting with AKI, rhabdomyolysis, and delayed leukoencephalopathy after CO poisoning. PATIENT CONCERNS: The patient was admitted to our emergency department due to loss of consciousness after CO exposure during a suicide attempt. DIAGNOSES: Laboratory findings revealed elevated carboxyhemoglobin, serum creatinine, and serum muscle enzyme levels. Initially, this patient was diagnosed with AKI and rhabdomyolysis due to CO poisoning. A month after the CO poisoning, she showed neuropsychiatric symptoms. Brain magnetic resonance imaging showed white-matter hyperintensity on the T2 flair image. Therefore, she was diagnosed with delayed leukoencephalopathy after CO poisoning. INTERVENTIONS: At the same time as diagnosis of AKI and rhabdomyolysis, the normobaric oxygen and hydration therapies were performed. A month later, rehabilitation was started due to delayed leukoencephalopathy. OUTCOMES: Her renal function and muscle enzyme levels were completely restored with alert mental status. She could walk with the aid of a walker at last visit. LESSONS: This case shows that we should consider about rare acute and late complications such as AKI, rhabdomyolysis, and delayed leukoencephalopathy after CO poisoning.


Assuntos
Lesão Renal Aguda/etiologia , Intoxicação por Monóxido de Carbono/complicações , Leucoencefalopatias/etiologia , Rabdomiólise/etiologia , Lesão Renal Aguda/fisiopatologia , Lesão Renal Aguda/terapia , Adulto , Encéfalo/diagnóstico por imagem , Intoxicação por Monóxido de Carbono/diagnóstico por imagem , Intoxicação por Monóxido de Carbono/fisiopatologia , Intoxicação por Monóxido de Carbono/terapia , Feminino , Humanos , Leucoencefalopatias/diagnóstico por imagem , Leucoencefalopatias/fisiopatologia , Leucoencefalopatias/terapia , Rabdomiólise/fisiopatologia , Rabdomiólise/terapia , Tentativa de Suicídio
20.
J Cardiothorac Surg ; 14(1): 90, 2019 May 07.
Artigo em Inglês | MEDLINE | ID: mdl-31064409

RESUMO

BACKGROUND: Thoracic aortic surgery and cardiopulmonary bypass are both associated with development of postoperative acute kidney injury. In this study, we undertook to investigate the relationship between cardiopulmonary bypass time and postoperative acute kidney injury in patients undergoing thoracic aortic surgery for acute DeBakey Type I aortic dissection. METHODS: All patients receiving thoracic aortic surgery for acute DeBakey Type I aortic dissection in Beijing Anzhen hospital from December 2015 to April 2017 were included. Cardiopulmonary bypass time was recorded during surgery. Acute kidney injury was defined based on the Kidney Disease Improving Global Outcomes criteria. A total of 115 consecutive patients were eventually analyzed. RESULTS: The overall incidence of acute kidney injury was 53.0% (n = 61). The average age was 47.8 ± 10.7 years; 74.8% were male. Mean cardiopulmonary bypass time was 211 ± 56 min. In-hospital mortality was 7.8%. Multivariate logistic regression revealed that cardiopulmonary bypass time was independently associated with the occurrence of postoperative acute kidney injury after adjust confounding factors (odds ratio = 1.171; 95% confidence interval: 1.002-1.368; P = 0.047). CONCLUSIONS: Cardiopulmonary bypass time is independently associated with an increased hazard of acute kidney injury after thoracic aortic surgery for acute DeBakey Type I aortic dissection. Further understanding of the mechanism of this association is crucial to the design of preventative strategies.


Assuntos
Lesão Renal Aguda/etiologia , Aneurisma Dissecante/cirurgia , Aorta Torácica/cirurgia , Aneurisma da Aorta Torácica/cirurgia , Ponte Cardiopulmonar/efeitos adversos , Procedimentos Cirúrgicos Torácicos/efeitos adversos , Lesão Renal Aguda/diagnóstico , Lesão Renal Aguda/mortalidade , Adulto , Feminino , Mortalidade Hospitalar , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Risco , Fatores de Tempo , Resultado do Tratamento
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