Acute Deterioration Of Renal Function Research Articles

Play it safe: renal function after bilateral flexible ureteroscopy for kidney stones.

We searched for perioperative renal function deterioration risk factors in patients that underwent bilateral flexible ureteroscopy (fURS) for kidney stones. From August 2016 to February 2020, symptomatic patients > 18years old with bilateral kidney stones up to 20mm in each side were prospectively studied. Serum creatinine samples were collected on admission to surgery, immediate postoperative (IPO), on POD 3, 10, and 30. Estimated glomerular filtration rate (eGFR) was calculated using Chronic Kidney Disease Epidemiology Collaboration equation (CKD-EPI) without a race coefficient. Thirty patients underwent bilateral fURS. Comparing to preoperative eGFR, median IPO and POD3 eGFR (p < 0.001) were significantly lower, and POD10 (p = 0.092) and POD30 (p = 0.648) were similar to preoperative eGFR. During follow-up, 22/30 (73.3%), 14/30 (46.7%), and 7/30 (23.3%) of the patients presented a decrease > 10% eGFR, > 20% eGFR, and > 30% eGFR, respectively. Multivariate analysis demonstrated that lower preoperative eGFR is a risk factor for eGFR < 60mL/min/1.73m2, p = 0.019 [1.021-1.263; 1.136]; ASA > 1 is a risk factor for decrease of eGFR > 10%, p = 0.028 [1.25-51.13; 8.00]; longer operative time is a risk factor for decrease of eGFR > 20%, p = 0.042 [1.00-1.05; 1.028]; and operative time ≥ 120min is a risk factor for decrease of eGFR > 30%, p = 0.026 [0.016-0.773; 0.113]. Renal function suffers a reversible decrease after bilateral fURS. Our study suggests that adequate selection of patients and maintaining operative time < 120min are relevant factors in preventing acute renal function deterioration following bilateral fURS.

A Systematic Review and an Updated Meta-Analysis of Fenestrated/Branched Endovascular Aortic Repair of Chronic Post-Dissection Thoracoabdominal Aortic Aneurysms.

The objective of this study is to present the current outcomes of fenestrated/branched endovascular repair (F/BEVAR) for post-dissection thoracoabdominal aortic aneurysms (PDTAAAs). A systematic review of the literature according to PRISMA guidelines up to October 2023 was conducted (protocol CRD42023473403). Studies were included if ≥10 patients were reported and at least one of the major outcomes was stated. A total of 10 studies with 585 patients overall were included. The pooled estimate for technical success was 94.3% (95% CI 91.4% to 96.2%). Permanent paraplegia developed with a pooled rate of 2.5% (95% CI 1.5% to 4.3%), whereas a cerebrovascular event developed with a pooled rate of 1.6% (95% CI 0.8% to 3.0%). An acute renal function impairment requiring new-onset dialysis occurred with a pooled rate of 2.0% (95% CI 1.0% to 3.8%). Postoperative respiratory failure was observed with a pooled estimate of 5.5% (95% CI 3.8% to 8.1%). The pooled estimate for 12-month overall survival was 90% (95% CI 85% to 93.5%), and the pooled estimates for 24-month and 36-month survival were 87.8% (95% CI 80.9% to 92.5%) and 85.5% (95% CI 76.5% to 91.5%), respectively. Freedom from reintervention was estimated at 83.9% (95% CI 75.9% to 89.6%) for 12 months, 82.8% (95% CI 68.7% to 91.4%) for 24 months and 76.1% (95% CI 60.6% to 86.8%) for 36 months. According to the present findings, F/BEVAR can be performed in PD-TAAAs with high rates of technical success and good mid-term results.

Complicaciones agudas del paciente cirrótico. Ascitis, encefalopatía hepática y síndrome hepatorrenal

Hepatic cirrhosis is a disease that is initially silent (compensated cirrhosis) until advanced stages, when the patient presents with a symptomatic event known as decompensation, which is the consequence of progressive deterioration of liver function and an increase in portal pressure. Ascites, hepatic encephalopathy, and gastrointestinal bleeding due to varices are the classic decompensations of cirrhosis and their onset entails a marked worsening of the prognosis. The treatment of hepatic encephalopathy and ascites based on hygienic and dietary measures and a large treatment arsenal allows for a substantial improvement in quality of life. However, these patients must be evaluated for liver transplant, which is the only curative treatment of decompensated cirrhosis. Likewise, usually in the context of an infection or other triggering event, patients with cirrhosis and portal hypertension may present with acute deterioration of renal function known as hepatorenal syndrome (HRS), which emerges as a consequence of the local compensatory vasoconstriction due to loss of effective volume. The treatment of HRS is based on avoiding nephrotoxins, albumin infusion, and starting splanchnic vasoconstrictors, though again, liver transplant is the only curative treatment.

Recent Progress in Biomarker Detection in Cardiovascular and Renal Diseases

Cardiorenal syndrome is a clinical condition in which there is a correlation between heart and kidney diseases. In recent times, many biomarkers have been studied in patients with cardiovascular diseases for developing proper knowledge of renal function and identifying patients who are more susceptible to chronic or acute deterioration of renal function. Because diagnostic and prognostic usefulness of a single time point biomarker is limited, biomarkers should be combined and monitored at multiple times for optimal clinical impact. This review mainly lays emphasis on the potential clinical uses of the biomarkers in cardiorenal syndrome, recent advancements of biomarkers in developing therapeutic agents for Alzheimer’s disease, and classification of different types of biomarkers as well as highlights classic heart failure biomarkers with critical values adjusted to glomerular filtration rate and summarizes research progress of new heart failure biomarkers and future research directions.

Anticoagulant-related nephropathy induced by direct-acting oral anticoagulants: Clinical characteristics, treatments and outcomes

IntroductionThere is a scarcity of data on anticoagulation-related nephropathy (ARN) caused by direct-acting oral anticoagulants (DOACs) in recent years. Materials and methodsWe collected literatures on DOACs-induced ARN to October 1, 2022, without language restrictions for retrospective analysis. ResultsTwenty events were included with a median onset time of 28 days among which fourteen were caused by dabigatran. Patients accompanied by chronic kidney disease (85 %) seemed more easily to have an ARN. Clinical symptoms associated with ARN were mostly presented as hematuria and acute decline of renal function (100 %), then abnormal coagulation function (75 %) but only one with an INR over 3. Renal biopsies were performed in 14 patients, with thirteen showing occlusive intratubular red blood cell casts and ten showing acute tubular injury of varying intensity or even tubular necrosis. Extensive changes in interstitial compartment like hemorrhage, fibrosis or inflammation were also presented in eight biopsies. IgA nephropathy as a latent or undiagnosed disease was demonstrated in eight biopsies. Treatments of ARN were mainly supportive with all patients discontinuing DOACs and 35 % initiating dialysis for acute deterioration of renal function. Steroids were used in 9 patients with a severe ARN verified by biopsy. 60 % of patients did not recover baseline renal function and some even deteriorated. ConclusionsIn conclusion, DOACs-induced ARN is a rare but serious adverse reaction. A prompt diagnosis of ARN and supportive treatments are necessary for patients receiving DOACs concurrent with an acute renal injury.

Benefits of Robotic Assisted vs. Traditional Laparoscopic Partial Nephrectomy: A Single Surgeon Comparative Study

The current study aims to compare peri-operative and post-operative outcomes between robotic assisted vs. laparoscopic partial nephrectomy. Multiple reviews of the current literature have detailed the lack of single surgeon studies in this domain. To limit inter-operator bias, we utilise a single surgeon experienced in both approaches to reduce this bias seen in other multi-centre studies. We retrospectively compared patient demographics, tumour characteristics, peri-operative and post-operative outcomes of all partial nephrectomies undertaken by a single surgeon between 2014 and 2021 with experience in both laparoscopic and robotic surgery. The Da Vinci surgical system was utilized. Statistical analysis was carried out using GraphPad prism software version 7.03, San Diego, CA, USA. Warm ischemia time was reduced by 2.6 min, length of stay reduced by 1.3 days and acute renal function deterioration was reduced by 55% with all these results being significant with robotic assisted partial nephrectomy compared to laparoscopic partial nephrectomy. This study highlights the benefits of robotic assisted in comparison to laparoscopic partial nephrectomy. Further large-scale prospective studies and cost-benefit analysis of robotic assisted partial nephrectomy would be valuable in confirming these findings and justifying the usage against their financial cost.

Systematic review and meta-analysis of prophylaxis use with intravenous contrast exposure to prevent contrast-induced nephropathy

PurposeIodinated radiographic contrast media has been associated with an acute deterioration in renal function, termed contrast induced nephropathy (CIN). This review aims to establish the efficacy of prophylaxis interventions used in adult patients prior to intravenous exposure to iodinated contrast to reduce the risk of CIN. MethodsAn electronic search for published peer-reviewed articles was performed, supplemented with manual review of references from previous systematic reviews and the National Institute for Health and Care Excellence guidelines. Risk of bias was assessed using the Cochrane Collaboration’s tool for assessing risk of bias. Random-effect meta-analyses were used to assess CIN incidence, need for kidney replacement therapy (KRT), mortality, fluid overload and persistent kidney dysfunction. Results22 studies assessing a range of interventions were included in the qualitative analysis. The incidence of CIN was reduced by the use of N-acetylcysteine compared to a control group of saline (risk difference = -0.07, 95% CI −0.13 to −0.01) but not by sodium bicarbonate compared to control group of saline (risk difference = -0.02, 95% CI −0.04 to 0.01). Published studies give no indication that prophylactic interventions have significant impact on the need for KRT, mortality or persistent renal impairment. ConclusionEvidence for prophylaxis against CIN in patients receiving intravenous iodinated contrast is limited. There was an association with the use of NAC with reduced incidence of CIN following intravenous contrast but there was no impact on other clinical outcomes assessed. The clinical significance of these findings remains unclear and further research focusing on these clinical outcomes is required.

Treatment of Severe Renal Artery Stenosis with Acute Kidney Injury Requiring Hemodialysis by Percutaneous Transluminal Renal Angioplasty and Stent Implantation

PurposeTo evaluate the outcomes of percutaneous transluminal renal angioplasty with stent implantation (PTRAS) among patients with renal artery stenosis (RAS) who become dialysis-dependent due to acute deterioration of renal function. Materials and MethodsThis was a single-center retrospective cohort study of all PTRAS procedures performed from 2003 to 2019 in a referral hospital. A total of 109 procedures were performed in 92 patients. Eleven patients (12%) presented with anuric acute kidney injury (AKI) secondary to high-grade RAS (defined as intraluminal stenosis above 70% per angiography) and underwent PTRAS after starting hemodialysis. Data collected included demographic parameters, medical background, creatinine, blood pressure, indication for intervention, procedure characteristics, adverse events, and long-term data including dialysis treatment and mortality. Among the dialysis-dependent AKI group, outcome measures were defined based on the postprocedural improvement in kidney function and discontinuation of dialysis. ResultsFollowing PTRAS, 8 of 11 patients (73%) demonstrated improved kidney function and were able to discontinue dialysis. The median time on dialysis was 18 days (range, 2–35 days) before PTRAS and 4.5 days (range, 1–24 days) to recovery of kidney function after the time of intervention. ConclusionsPatients with atherosclerotic RAS who develop RAS-related AKI may benefit from PTRAS even after several weeks of anuria and dialysis dependence.

Acute-phase proteins in cats with obstructive feline lower urinary tract disease.

Feline obstructive disease of the lower urinary tract (FLUTD) is a common pathologic condition of cats. It can be related to sterile inflammation, which leads to acute impairment of renal function and the accumulation of electrolytes and acid-base imbalance. Acute-phase proteins (APPs) are biomarkers of tissue damage from inflammation that assist in monitoring treatment and prognosis. Monitoring the inflammatory processes of obstructive feline lower urinary tract disease through the determination of plasma fibrinogen concentrations and serum concentrations of the acute-phase proteins, serum amyloid A (SAA), alpha-1-acid glycoprotein (AGP), and albumin. Twenty-five male cats were included in this study. They were divided into two experimental groups: a control group (CG) and an obstruction group (OG). There were 8 healthy cats in the CG group and 17 cats with obstructive FLUTD in the OG group. APP measurements were conducted using ELISA kits. Samples were collected for APP analyses, serum biochemical assays, urinalyses, and urine protein: creatinine ratio calculations at diagnosis, before urethral clearance (H0), and 12 (H12), 24 (H24), and 48 (H48) hours after urethral clearance from cats in the OG group. Samples were collected once from cats in the CG group cats. At H0, we found positive correlations of SAA, AGP, and fibrinogen with urea and creatinine, and negative correlations of albumin with hematuria, SAA, and potassium. At H48, we found positive correlations between SAA and AGP, AGP and urea, fibrinogen and urea, fibrinogen and creatinine, fibrinogen and AGP, and fibrinogen and SAA. In addition, a negative correlation of albumin with urea and creatinine was observed. Serum amyloid A, AGP, fibrinogen, and albumin could be used as biomarkers of inflammatory processes in cats with obstructive FLUTD.

Renal biopsy in diabetic patients: Histopathological and clinical correlations

Introduction: Diabetes is the leading cause of chronic kidney disease and end-stage kidney disease worldwide. A kidney biopsy in a diabetic patient must be considered when non-diabetic renal disease is suspected, such as in the presence of a rapid decline in renal function or severe unexplained proteinuria. However, the timing and criteria of a biopsy remain controversial in these patients. We aimed to identify clinical and histological markers that could help differentiate diabetic and non-diabetic renal disease and decide if this invasive approach is needed or not. Subjects and Methods: We reviewed 30 years of biopsies from diabetic patients performed at a tertiary hospital. We collected patient demographic data, biopsy indications, histological findings, and clinical and analytical data both at the moment of the biopsy and extensive followup. Based on kidney biopsy findings, patients were categorized as isolated diabetic nephropathy, non-diabetic kidney disease, or non-diabetic kidney disease superimposed on diabetic nephropathy (diabetic kidney disease). Results and Discussion: We enrolled 92 patients, mostly with type 2 diabetes, with a mean age of 62.9 ± 13.2 years. Nearly half of them had isolated diabetic nephropathy (53.3%), and 15.2% had diabetic nephropathy superimposed on non-diabetic kidney disease, comprising a total of 63 patients (68.5%) with diabetic kidney disease. Twenty-nine patients (31.5%) were considered to have non-diabetic kidney disease. These last patients were significantly less likely to need insulin therapy (p=0.002), had more frequently an acute deterioration of renal function (p=0.01), lower albumin levels (p=0.03), and a higher prevalence of microhematuria (p=0.001). We found the latter to be an independent predictor of non-diabetic kidney disease. Further, patients with the primary diagnosis of diabetic nephropathy had higher survival than those who had nondiabetic kidney disease, contradicting published data. Conclusions: The criteria for performing a biopsy in diabetic patients still lack consensus, although the priority to identify non-diabetic kidney disease prevails. We believe the non-diabetic kidney disease predictors we describe may prove helpful for determining the need for a histological assessment in diabetic patients.

Contrast-Induced Nephropathy Following Peripheral Endovascular Intervention and Its Long-Term Morbidity

Background and Objectives: Contrast-induced nephropathy (CIN) is an acute deterioration of renal function seen following the administration of iodinated contrast media for various diagnostic procedures. Although extensive study has been done in various fields, the data on CIN are lacking in peripheral endovascular procedures. This study was conducted to analyze the incidence, risk factors, and long-term renal morbidity of CIN after endovascular procedure for critical limb ischemia (CLI) of lower limbs. Methods: This was a prospective, observational study and the patients undergoing peripheral endovascular procedure for CLI in a referral center were included. The patients were followed up for the development of CIN with serum creatinine levels on the 5th day postprocedure and till 6 months. Results: A total of 211 patients with various comorbidities were included. The incidence of CIN was found to be 7.5%. The risk factors and multiple comorbidities were compared between CIN and non CIN patients. The higher preprocedure creatinine (mean 1.03 mg/dl vs. 0.92 mg/dl, P &lt; 0.045), higher contrast volume (mean 73.8 ml vs. 52.1 ml, P &lt; 0.001), and lower hemoglobin (mean 10.5 g/dl vs. 11.8 g/dl, P &lt; 0.008) were significantly associated with CIN. The follow-up at 6 months showed CIN patients had increased serum creatinine and reduced estimated glomerular filtration rate as compared to non-CIN patients. Conclusion: CIN is a substantial problem in peripheral endovascular procedures with long-term renal morbidity. The strategies to prevent CIN should be included in all patients undergoing endovascular procedures irrespective of risk profile and long-term renal function monitoring of CIN patients is warranted.

Relation between pre-procedural increase in urinary albumin excretion and changes in estimated glomerular filtration rate after coronary angiography in diabetic patients

Abstract Background Contrast-induced nephropathy (CIN), is an acute impairment in renal function, and typically occurs within 3 days following the exposure to a contrast medium (CM). It is associated with increased hospital stay and increased morbidity and mortality, Adult patients with diabetes have a higher risk than the general population for developing contrast induced nephropathy. Methods The current study includes 40 patients with diabetes mellitus, scheduled for coronary angiography with estimated GFR &amp;gt;60 ml/min .the patients were divided according to their pre-procedural urinary albumin creatinine ratio (ACR) results into 3 groups: Group 1 included patients with pre-procedure urinary albumin creatinine ratio &amp;lt; 30mg/g, Group 2 included patients with pre- procedure albumin creatinine ratio 30- 300 mg/g and Group 3 included patients with pre-procedure albumin creatinine ratio &amp;gt;300 mg/g . Estimated GFR (glomerular filtration rate) calculated using MDRD and serum creatinine were measured at day 2 and 3 (Day +2 +3) after coronary angiography. Results There was no statistically significant difference in the age and gender distribution, the use of ACEIs (angiotension converting enzyme inhibitors) or diuretics between the cases who developed and who didn’t develop CIN. The mean ACR in the group with no contrast induced nephropathy was 225.38 ± 209.53 which was statistically significantly lower when compared with the cases with contrast induced nephropathy (420.43± 348.52) (p = 0.033). The mean HbA1c in no contrast induced nephropathy group was 7.11 ± 0.64 and in contrast induced nephropathy group it was 9.09 ± 0.66 which is significantly higher (P &amp;gt; 0.001).With univariate regression analysis, ACR, HbA1c and number of vessels affected were shown to be risk factors for occurrence of CIN after use of contrast, but with multivariate analysis, both ACR and HbA1c were shown to be risk factors for CIN. Conclusion An increase in albumin creatinine ratio in itself can be a risk factor for development of contrast induced nephropathy in diabetic patients.

Impaired kidney function at ED admission: a comparison of bleeding complications of patients with different oral anticoagulants

BackgroundUp to a fourth of patients at emergency department (ED) presentation suffer from acute deterioration of renal function, which is an important risk factor for bleeding events in patients on oral anticoagulation therapy. We hypothesized that outcomes of patients, bleeding characteristics, therapy, and outcome differ between direct oral anticoagulants (DOACs) and vitamin-K antagonists (VKAs).MethodsAll anticoagulated patients older than 17 years with an impaired kidney function treated for an acute haemorrhage in a large Swiss university ED from 01.06.2012 to 01.07.2017 were included in this retrospective cohort study. Patient, treatment, and bleeding characteristics as well as outcomes (length of stay ED, intensive care unit and in-hospital admission, ED resource consumption, in-hospital mortality) were compared between patients on DOAC or VKA anticoagulant.ResultsIn total, 158 patients on DOAC and 419 patients on VKA with acute bleeding and impaired renal function were included. The renal function in patients on VKA was significantly worse compared to patients on DOAC (VKA: median 141 μmol/L vs. DOAC 132 μmol/L, p = 0.002). Patients on DOAC presented with a smaller number of intracranial bleeding compared to VKA (14.6% DOAC vs. 22.4% VKA, p = 0.036). DOAC patients needed more emergency endoscopies (15.8% DOAC vs, 9.1% VKA, p = 0.020) but less interventional emergency therapies to stop the bleeding (13.9% DOAC vs. 22.2% VKA, p = 0.027). Investigated outcomes did not differ significantly between the two groups.ConclusionsDOAC patients were found to have a smaller proportional incidence of intracranial bleedings, needed more emergency endoscopies but less often interventional therapy compared to patients on VKA. Adapted treatment algorithms are a potential target to improve care in patients with DOAC.

Incidence of contrast-induced nephropathy after a computed tomography scan

Background and aimsThe term contrast-induced nephropathy is used to describe acute deterioration of renal function after the intravenous administration of iodinated contrast material. We aimed to estimate the incidence of contrast-induced nephropathy and to analyze the evolution of different biomarkers of renal function in patients who underwent computed tomography with intravenous contrast administration after premedication with oral hydration and N-acetylcysteine. Material and methodsThis prospective observational study included 112 patients with chronic renal failure (glomerular filtration rate (GFR) 30ml–60ml/min/1.73m2) scheduled for computed tomography with intravenous iodinated contrast material. We recorded demographic variables, dose of contrast material, diabetes mellitus, hypertension, and serum hemoglobin. We measured serum creatinine and GFR after premedication and after the CT examination. We summarized variables as means, standard deviations, and percentages. We used the Wilcoxon and Mann–Whitney tests to compare pre- and post-CT values and Pearson's r to analyze correlations. ResultsIncidence acute kidney injury: 0.9%; 95%CI: 0.36–1.4. Mean difference between pre- and post-CT creatinine: 0.04; 95%CI: 0.002–0.09, p<0.004. Mean difference between pre- and post-CT GFR: −3.06; 95%CI: −4.66 to −1.47), p<0.001. ConclusionsThe incidence of contrast-induced nephropathy in patients with chronic renal failure and GFR 30ml–60ml/min/1.73m2 is low. The biomarkers of renal function analyzed improve in patients who receive premedication and the minimum dose of contrast material.

FC 041TUBULAR EPITHELIAL CELL POLYPLOIDY IS ESSENTIAL TO SURVIVE AKI BUT IT CONTRIBUTES TO CKD PROGRESSION

Abstract Background and Aims Acute Kidney Injury (AKI) is a syndrome characterized by an acute deterioration of renal function. Due to its high prevalence and poor short-term outcomes, AKI represents a global healthcare issue. Many epidemiologic studies have indicated that the development of Chronic Kidney Disease (CKD) features prominently among the numerous long-term complications of AKI. The pathophysiological basis for this phenomenon has remained unclear so far. Recently, we found that tubular epithelial cells (TEC) undergo endoreplication-mediated hypertrophy after AKI. Endoreplications are incomplete cell cycles that lead to the formation of polyploid cells. Physiologically, polyploidy offers several advantages such as rapid adaptation to stress, compensation for cell loss and enhanced cell function. However, as renal epithelial cells are massively lost after AKI, TEC polyploidy may constitute an effective strategy to sustain a temporary functional recovery of the kidney without restoring tissue integrity potentially leading to CKD. Therefore, we hypothesized that: 1) polyploid TEC are an adaptive stress response required to maintain kidney function after AKI; 2) polyploid TEC are involved in the AKI to CKD progression. Method To address these hypotheses, we employed a series of in vitro and in vivo transgenic models based on the Fluorescence Ubiquitin Cell Cycle Indicator (FUCCI) technology to monitor cell cycle phasing in combination with YAP1 overexpression or downregulation. In the in vivo models, YAP1 overexpressing mice and YAP1 knock-out mice were subjected to unilateral ischemia reperfusion injury (IRI) or glycerol-induced rhabdomyolysis to induce AKI. Polyploid cells have been then characterized by single cell-RNA sequencing analysis, cell sorting, super-resolution STED microscopy and transmission electron microscopy in both mouse and human. Results In vitro, human renal tubular cells undergo polyploidization. The fraction of polyploid cells significantly decreases when YAP1 nuclear translocation is blocked, indicating a possible involvement of YAP1 in regulating TEC polyploidy. After AKI in mice, YAP1 expression and nuclear translocation are significantly enhanced. The inhibition of YAP1 following AKI, reduces the number of polyploid cells impairing kidney function and causing a dramatic reduction of mouse survival. In contrast, YAP1 overexpression leads to an increase in the number of polyploid cells even in the absence of kidney damage (healthy mice). Strikingly, these healthy mice, despite having an increased percentage of polyploid cells, present an unexpected decline of renal function suggesting an association between increased polyploidy and CKD development. Indeed, they develop tubulointerstitial fibrosis acquiring a marked senescent phenotype triggering CKD. Isolation of polyploid cells proved that these cells actively transcribe and secrete pro-fibrotic factors thus confirming their role in CKD progression. Conclusion Collectively, these data suggest that: 1) polyploidization after AKI is required to maintain kidney function allowing survival; 2) polyploid cells are pro-fibrotic leading in the long run to CKD progression.

MO415DOES LOW CONTRAST VOLUMES REDUCE RATES OF CONTRAST-INDUCED NEPHROPATHY IN PATIENTS UNDERGOING CORONARY ANGIOGRAPHY?

Abstract Background and Aims Coronary angiography (CAG) necessitates administration of iodinated contrast, which may precipitate an acute deterioration in renal function (contrast-induced nephropathy). Previous work on contrast-induced nephropathy (CIN) has identified contrast volume as a risk factor and suggested that there is a toxic contrast dose above which the risk of CIN is markedly increased. The focus of this study is to provide a critical appraisal of this modifiable risk factor. Method We prospectively enrolled 158 patients who CAG with or without percutaneous coronary intervention from December 2017 to February 2018 at a cardiology department . CIN was defined as an increase in serum creatinine level &amp;gt;25% or 0.5 mg/dL after 48 hours postcardiac catheterization. Toxic contrast dose was defined as a ratio volume of contrast media to estimated glomerular filtration rate (V/eGFR) &amp;gt; 2 . Multivariable regression was conducted to evaluate the effect of exceeding the toxic contrast dose on CIN. Results Of 158 patients (females = 36.1%, mean age 60.0 ± 11 years) who underwent CAG , 15 (9,5%) developed CIN . The volume administered of contrast was not related to the existence of postprocedure CIN (96,6±35,9 ml vs 102,5±33,7ml , p=0,16). However , it was associated with a higher incidence of CIN in patients with chronic renal failure (90±19,1 ml vs 116,6±73,7ml , p=0,008) . The mean V/eGFR value was 1,2±0,7.Nine percent of patients exceeded the toxic contrast dose. After adjusting for other known predictors of CIN, a V/eGFR ratio &amp;gt; 2 remained significantly associated with CIN (odds ratio 4.7, 95% confidence interval 1.28-17.7, P=0,02). Conclusion Low incidences of CIN suggest that a reduced dose of contrast agent is safe in high-risk patients with impaired renal function. A ratio volume of contrast media to estimated glomerular filtration rate &amp;gt; 2 is a significant and independent predictor of CIN after CAG.

The Relation between Pre-Procedural Increase in Urinary Albumin Excretion and Changes in Estimated Glomerular Filtration Rate after Coronary Angiography in Diabetic Patients

Background: Contrast-induced nephropathy (CIN), is an acute impairment in renal function, and typically occurs within 3 days following the exposure to a iodinated contrast medium (CM). It is associated with increased hospital stay and increased morbidity and mortality. Adult patients with diabetes have a higher risk than the general population for developing contrast-induced nephropathy. Objective: To assess the significance of preprocedural microalbuminuria on renal function changes post coronary angiography. Patients and methods: The current study included 40 patients all over the age of 18 years, with diabetes mellitus type 1 or type 2, scheduled for coronary angiography with estimated GFR > 60 ml/min. Results: incidence of contrast-induced nephropathy in this study was 40 % (n=16) of patients while 60% (n = 24) did not fit the definition of CIN. There was no statistically significant difference in the age, gender distribution and use of angiotension converting enzyme inhibitors (ACEIs) or diuretics between the cases who developed and who did not develop CIN. The mean albumin creatinine ratio (ACR) in the group with no contrast induced nephropathy was 225.38 ± 209.53 which was statistically significantly lower when compared to the cases with contrast-induced nephropathy (420.43 ± 348.52) (p = 0.033). The mean HbA1c in no contrast-induced nephropathy group was 7.11 ± 0.64 and in contrast induced nephropathy group it was 9.09 ± 0.66, which was significantly higher (P > 0.001). With univariate regression analysis, ACR, HbA1c and number of vessels affected were shown to be risk factors for occurrence of CIN after use of contrast, but with multivariate analysis, both ACR and HbA1c were shown to be risk factors for CIN. Conclusion: An increase in urinary albumin creatinine ratio in itself maybe be a risk factor for development of contrast-induced nephropathy in diabetic patients.

Acute and long-term kidney function after parathyroidectomy for primary hyperparathyroidism.

In kidney transplant patients, parathyroidectomy is associated with an acute decrease in renal function. Acute and chronic effects of parathyroidectomy on renal function have not been extensively studied in primary hyperparathyroidism (PHPT). This retrospective cohort study included 494 patients undergoing parathyroidectomy for PHPT. Acute renal changes were evaluated daily until day 4 post-parathyroidectomy and were stratified according to acute kidney injury (AKI) criteria. Biochemical assessment included serum creatinine, total and ionized calcium, parathyroid hormone (PTH), and 25-hydroxyvitamin D (25OHD). The estimated glomerular filtration rate (eGFR) was calculated using the CKD-EPI equation. We compared preoperative and postoperative renal function up to 5 years of follow-up. A total of 391 (79.1%) patients were female, and 422 (85.4%) were non-African American. The median age was 58 years old. The median (first and third quartiles) preoperative serum creatinine, PTH and total calcium levels were 0.81 mg/dL (0.68-1.01), 154.5 pg/mL (106-238.5), and 10.9 mg/dL (10.3-11.5), respectively. The median (first and third quartiles) preoperative eGFR was 86 mL/min/1.73 m2 (65-101.3). After surgery, the median acute decrease in the eGFR was 21 mL/min/1.73 m2 (p<0.0001). Acutely, 41.1% of patients developed stage 1 AKI, 5.9% developed stage 2 AKI, and 1.8% developed stage 3 AKI. The acute eGFR decrease (%) was correlated with age and PTH, calcium and preoperative creatinine levels in univariate analysis. Multivariate analysis showed that the acute change was related to age and preoperative values of ionized calcium, phosphorus and creatinine. The change at 12 months was related to sex, preoperative creatinine and 25OHD. Permanent reduction in the eGFR occurred in 60.7% of patients after an acute episode. There was significant acute impairment in renal function after parathyroidectomy for PHPT, and almost half of the patients met the criteria for AKI. Significant eGFR recovery was observed during the first month after surgery, but a small permanent reduction may occur. Patients treated for PHPT seemed to present with prominent renal dysfunction compared to patients who underwent thyroidectomy.

Screening for chronic kidney disease over hospital integration.

Hospital integration among rural districts to concentrate medical resources is one of the main projects of the Japanese government. In advance of this, we experienced hospital integration and screening for chronic kidney disease as definitive risk for end-stage kidney disease and cardiovascular mortality. After that, high-risk patients have been appropriately referred from generalists to nephrologists and/or cardiologists without acute deterioration of renal function or cardiac sudden death.

Kidney injury molecule-1/creatinine as a urinary biomarker of acute kidney injury in critically ill neonates

Acute kidney injury (AKI) is a complex disorder, means acute deterioration of renal function generally occurring over hours to days. Serum creatinine (SCr) is a suboptimal biomarker in neonates as the creatinine concentration reflects the maternal level for up to 72h after birth, to improve the ability for early prediction of AKI and improve clinical outcomes, there has been a significant amount of research to identify novel biomarkers of damage to allow for the earlier identification of neonates with AKI. This study aimed to study the effectiveness of urinary kidney injury molecule-1/creatinine (uKIM-1/cr) in the diagnosis of AKI in critically ill neonates. The patients' group included 50 critically ill full-term septic neonates (39 of them developed AKI according to guidelines of AKI diagnosis), and control group including 50 healthy neonates. Full history taking, clinical assessment and laboratory testing of the renal functions (urea & creatinine), eGFR, uKIM-1 by ELISA technique and uKIM-1/cr ratio on admission, and on day 3 of admission. Urea, serum creatinine increased, whereas, eGFR decreased significantly in the second sample when compared to the first sample of the AKI group. uKIM-1 and uKIM-1/cr were high in the first sample, uKIM-1 concentration and uKIM-1/creatinine were higher in second sample (2.2±0.6ng/ml & 7.1±2.1ng/mg) when compared to first sample (0.6±0.1ng/ml & 2.6±0.9ng/mg) in critically ill neonates with AKI. Serum creatinine, uKIM-1 and uKIM-1/cr ratio were significantly associated with higher KDIGO stages. Applying the ROC curve at the first sample for discrimination between critically ill neonatal patients with and without AKI, uKIM-1/cr AUC was significantly higher when compared to AUCs of creatinine, eGFR, uKIM-1. Regression analysis revealed that high uKIM-1 & uKIM-1/cr are independent predictors for AKI within critically ill neonates. So, uKIM-1 & uKIM-1/cr are early biomarkers as their level increased before creatinine increases. uKIM-1 and uKIM-1/cr are good early indicators for AKI in neonates suffering from a critical illness.