RESUMO
Introduction Acute kidney injury (AKI) is an abrupt reduction in kidney function that causes nitrogenous waste and other waste products to be retained. Methods This cross-sectional study was conducted from February 2015 to January 2016. The study received approval from the Independent Ethics Committee, which included patients over 60 with AKI. The study duration was 12 consecutive months to ascertain the etiology, severity, and hospital outcomes of AKI. Results The common etiologies of AKI included drug-induced (25%), age-related (21.67%), cardiac (13.33%), respiratory (20%), tropical (15%), and pancreatitis (15%) cases. Another predominant etiology observed was obstructive nephropathy (55%), with the highest (37.5%) mortality rate. The distribution of patients based on KDIGO criteria showed no significant difference in mortality percentages among classes (p=0.177). Conservative management without renal replacement therapy was the most common approach to treat AKI, with a 39% mortality rate. Conclusion Among different causes of AKI in the geriatric age group, drug-induced AKI, and obstructive nephropathy were predominantly associated with hospital mortality.
RESUMO
Introduction Acute kidney injury (AKI) develops in 20-70% of patients with COVID-19. AKI is a syndromic diagnosis with multiple causes and outcomes. This cross-sectional study explored different outcomes of AKI in patients admitted with COVID-19. Material and methods It was a cross-sectional and descriptive study carried out in a tertiary care teaching hospital in Western Maharashtra for two months (May to June 2020). We collected clinical and laboratory data of 456 inpatients admitted with COVID-19 over two consecutive months. We excluded patients already on dialysis upon arrival at the hospital. It predominantly consists of patients who developed AKI during their stay in the hospital. Result C-reactive protein (CRP) was elevated in patients with COVID-19 associated with AKI (COVAKI) (78.87) but was statistically significant (p<0.003). Ferritin was elevated significantly (1619.19) in patients with AKI (p<0.0001). Similarly, higher levels of D-dimer (426.35) and lower serum albumin (1.86) were associated with COVAKI (p<0.0001). The average ICU stay was six days for patients with AKI and 0.37 days for patients without AKI. Days on the ventilator were 3.3 days for patients with AKI and 0.11 days for non-AKI patients. Out of a total 12 deaths of COVID-19 patients over these two months, nine had AKI. This made the association statistically significant (p<0.0001). Conclusion The phenotype COVAKI was associated with higher inflammatory markers, prolonged hospital stay, days spent on a ventilator, and higher oxygen requirement translating into higher mortality compared to those without COVAKI. We found low serum albumin without a corresponding proteinuria or liver dysfunction. The development of COVAKI during the hospital stay was associated with the use of glucocorticoids, hydroxychloroquines (HCQs), and heparin.
RESUMO
Acute kidney injury can complicate rhabdomyolysis in 10-40% patients. Myoglobinuria and elevated creatine kinase (CK) form the basis of diagnosis. When associated with azotemia and/or oliguria, intermittent hemodialysis is a treatment option. 31-year-old young man came with lower limb pain after doing 800 sit ups. At the presentation, blood pressure was high, serum creatinine was 15.7mg/dl and creatine kinase(CK)>20000 IU/L. Intermittent dialysis was initiated. He developed posterior reversible encephalopathy syndrome, generalized tonic clonic convulsions and a further rise in CK. He underwent extracorporeal removal of myoglobin with medium cut-off (MCO) membrane. After 3 sessions with MCO membrane, myoglobin and CK levels reduced. He was transitioned to conventional dialysis and discharged in a stable condition with complete renal recovery. Medium cut-off membrane effectively removes circulating myoglobin without significant albumin loss and is cost effective.