Acute Kidney Injury In Patients Research Articles

HUWE1-Mediated Degradation of MUTYH Facilitates DNA Damage and Mitochondrial Dysfunction to Promote Acute Kidney Injury.

The role of MUTYH, a DNA repair glycosylase in the pathogenesis of acute kidney injury (AKI) is unclear. In this study, it is found that MUTYH protein levels are significantly decreased in the kidneys of cisplatin- or folic acid (FA)-induced mouse AKI models and patients with AKI. MUTYH deficiency aggravates renal dysfunction and tubular injury following cisplatin and FA treatment, along with the accumulation of 7, 8-dihydro-8-oxoguanine (8-oxoG) and impairs mitochondrial function. Importantly, the overexpression of type 2 MUTYH (nuclear) significantly ameliorates cisplatin-induced apoptosis, oxidative stress, mitochondrial dysfunction, and DNA damage in vivo and in vitro. In contrast, overexpression of type 1 MUTYH (mitochondrial) shows a marginal effect against cisplatin-induced injury, indicating the chief role of type 2 MUTYH in antagonizing AKI. Interestingly, the results also indicate that the upregulation of the E3 ligase HUWE1 causes the ubiquitination and degradation of MUTYH in tubular epithelial cells. HUWE1 knockout or treatment with the HUWE1 inhibitor BI8622 significantly protect against cisplatin-induced AKI. Taken together, these results suggest that the ubiquitin E3 ligase HUWE1-mediates ubiquitination and degradation of MUTYH can aggravate DNA damage in the nucleus and mitochondria and promote AKI. Targeting the HUWE1/MUTYH pathway may be a potential strategy for AKI treatment.

Associations of acute kidney injury with oral anticoagulants: a disproportionality analysis of the Food and Drug Administration Adverse Event Reporting System (FAERS) database

ABSTRACT Objective The FDA Adverse Event Reporting System (FAERS) was used to evaluate the associations between oral anticoagulants (OACs) and acute kidney injury (AKI). Methods Disproportionality analysis was applied to data in the FAERS database from January 2004 to December 2023 to detect adverse events (AEs) for various OACs. The adjusted reporting odds ratios (RORs) calculated using multiple logistic regression were used to explore the risk factors for OACs-associated AKI. Results The crude RORs for the associations of AKI with warfarin, rivaroxaban, dabigatran, apixaban, and edoxaban were 1.35, 2.14, 2.98, 1.33, and 3.56, respectively. The risk of OACs-associated AKI was affected by age and sex, being higher in those aged 65 years and males. The adjusted RORs for rivaroxaban, dabigatran, apixaban, and edoxaban were 1.26, 1.67, 0.65, and 2.06, respectively.Nearly 50% of AKI cases occurred within the first 2 months, and each OAC was of the early-failure type. Hospitalization and mortality rates for AKI patients after OACs were 45.53% and 22.98%, respectively. Conclusions The study revealed a strong association between AKI and OACs, emphasizing the need for regular renal function monitoring , especially in elderly male patients. Further in-depth research is needed to confirm these exploratory findings.

The Efficacy and Safety of Continuous Veno-Venous Hemodiafiltration With High Cutoff Membrane Versus High Flux Membrane in Septic Acute Kidney Injury: A Randomized Controlled Study.

The application of high cutoff (HCO) membranes for continuous renal replacement therapy remains unclear in septic acute kidney injury (S-AKI) patients. S-AKI patients who received continuous veno-venous hemodiafiltration (CVVHDF) were randomly assigned to the experimental group (HCO membrane) and the control group (high flux membrane, HF membrane). Interleukin-6 (IL-6) and tumor necrosis factor-α (TNF-α) in serum and waste fluid were measured at 0, 2, 12, and 24 h after CVVHDF initiation and the 28-day mortality. Eleven patients were randomized to the HCO group, and 9 patients in the HF group, with a mean age of 54.9 ± 3.2 years and 6 patients (30%) being female. After 24 h of treatment with CVVHDF, there were significant reductions in serum IL-6 and TNF-α concentrations in the HCO group (p = 0.001, 0.015) and HF group (p = 0.004, 0.031). The serum IL-6 reduction rate of the HCO group was significantly higher than that of the HF group (79.21% vs. 42.69%, p = 0.025), while serum TNF-α reduction rates were comparable between the 2 groups. There were no significant changes in serum albumin after 24 h using either HCO membrane (28.7 ± 1.7 g/L vs. 32.7 ± 1.6 g/L, p = 0.138) or HF membrane (29.6 ± 1.1 g/L vs. 32.6 ± 1.3 g/L, p = 0.055). The two groups had similar 24-h filter clotting rates and 28-day mortality. While CVVHDF with the HCO membrane and HF membrane both achieved significant reductions in serum cytokine levels, the HCO membrane was associated with a greater reduction rate in IL-6 but not in TNF-α. No difference was observed in serum albumin, mortality, or filter clotting. Registry number: ChiCTR2000039725.

Outcomes of Sepsis–Associated Acute Kidney Injury

Background Acute kidney injury (AKI) is common in tropical countries. Most common cause of AKI in India is sepsis. AKI is known to progress to acute kidney disease (AKD). Long-term follow-up of sepsis associated AKI is pivotal for identifying factors influencing progression. Materials and Methods We conducted a case record review of patients admitted between January 2022 and January 2023 to assess the outcomes of sepsis-AKI and the factors associated with the transition to chronic kidney disease (CKD). Results Of a total of 2600 renal intensive care admissions, 451 were diagnosed with sepsis-AKI. About 8.8% (40 cases) completely recovered within the first week (AKI recovered), and the remaining 91.1% cases (AKD) were followed up for 1 week to 1 year. The mortality rate between this period was about 45.7% (188 patients). On the assessment of survivors (223 patients), complete renal recovery was noted in 160 patients, and 28.3% (63 patients) transitioned to CKD. Elderly age, high SOFA score, and multiorgan failure were associated with higher progression to CKD (P < 0.05). Conclusion AKI patients need a follow-up period of at least 1 year, as delayed recovery is common. Sepsis-associated AKI progresses to CKD in about 28% of patients with risk factors being old age, presence of comorbidities, severe sepsis with multiorgan involvement, and high SOFA score.

Short-term effects of empagliflozin on preventing contrast induced acute kidney injury in patients undergoing percutaneous coronary intervention, a randomised trial

Contrast-induced acute kidney injury (CI-AKI) is a prevalent cause of hospital-acquired renal impairment in patients undergoing intervention. Limited clinical trials explore SGLT2 inhibitors’ effects on CI-AKI. This study aimed to assess the short-term effect of empagliflozin- an SGLT2 inhibitor- in reducing CI-AKI incidence in PCI patients regardless of diabetes. This research conducted a double-blind randomized clinical trial involving 121 patients undergoing PCI referred to Ghaem Hospital, Mashhad, Iran from 2022 to 2023. Participants were randomly assigned to receive empagliflozin (10 mg daily) or a placebo, starting one day before PCI and continuing for two days post-procedure. Renal function parameters such as estimated glomerular filtration rate (eGFR), creatinine, cystatin C, and urea were evaluated. After the intervention, empagliflozin users exhibited a significant reduction in mean cystatin C levels compared to the placebo users across all age groups (< 50 years, 50–60 years, and > 60 years). Patients older than 60 showed significant improvements in mean changes of eGFR with empagliflozin. Patients with eGFR > 60 and 45 < eGFR < 60 had a significant increase in eGFR in the empagliflozin group. Mean changes in cystatin C levels were significantly reduced with empagliflozin in all eGFR levels (> 60, 45–60, and < 45). There was no significant difference in urea and creatinine levels between the two groups. Empagliflozin notably decreases CI-AKI incidence in PCI patients by improving renal function parameters such as eGFR and cystatin C. These benefits were observed across various age groups, particularly in middle-aged and elderly, and those with varying renal function levels.

A comparative review of murine models of repeated low-dose cisplatin-induced chronic kidney disease.

This Review evaluates various mouse and rat models of chronic kidney disease (CKD) that result from repeated low-dose cisplatin (RLDC) treatment while also discussing ethical considerations on the topic. Cisplatin can cause nephrotoxicity, and high doses of cisplatin can cause acute kidney injury. The RLDC regimen has been used in the treatment of solid organ cancers and has shown efficacy in reducing the occurrence of acute kidney injury in patients. However, prolonged treatments may lead to CKD. Mouse and rat models that effectively replicate the pathological features of CKD are invaluable for studying the mechanisms of the disease and exploring potential therapeutic interventions. Whereas administration of a single higher dose in some RLDC models may lead to higher mortality rates, a single lower dose may not replicate the fibrotic characteristics of CKD. Here we gathered information on mouse and rat models of RLDC-induced CKD and analyzed the impact of different variables, such as animal age, cisplatin dosage and administration frequency, on success rates, mortality rate and weight loss. Among the different models, weekly intraperitoneal administration of 8 mg/kg or 9 mg/kg of cisplatin for a total of 4 weeks in 12-week-old male C57BL/6 mice showed the most similar clinical characteristics of CKD while adhering to ethical requirements. In this Review, we suggest the best timings for both drug intervention and observation based on the biological traits of the model. Furthermore, given the limited research available on RLDC-induced CKD rat models, it is urgent to focus on developing RLDC methods that can induce detailed characteristics of CKD in rats.

Short-Term Renal Replacement Therapy Outcomes of Critically Ill Patients of Acute Kidney Injury and Acute on Chronic Kidney Disease

Short-Term Renal Replacement Therapy Outcomes of Critically Ill Patients of Acute Kidney Injury and Acute on Chronic Kidney Disease

P-1887. Outpatient vancomycin therapy: Rates of acute kidney injury in patients receiving area-under-the-curve-guided dosing as an inpatient followed by transition to trough-guided dosing after discharge

Abstract Background Vancomycin is one of the most prescribed antibiotics for hospitalized patients. Targeting an area under the curve to a minimum inhibitory concentration (AUC/MIC) ratio of 400-600 mg*hour/L has been associated with a reduction in vancomycin-induced acute kidney injury (AKI) compared to trough-guided dosing. Data evaluating AUC-guided vancomycin dosing in outpatient parenteral antimicrobial therapy (OPAT) are limited, and resources required for AUC-guided dosing are often unavailable. However, trough-guided dosing has been associated with vancomycin overexposure and in the outpatient setting, rates of AKI as high as 28.5% have been reported. We aim to evaluate outcomes of patients discharged on at least one week of vancomycin on a dose established through AUC-guided dosing during hospitalization followed by trough-guided dosing in the outpatient setting. Methods In this retrospective single-center cohort study, we identified 120 patients admitted to the University of Alabama (UAB) Hospital or UAB Hospital-Highlands between October 1, 2021, and March 31, 2022, who met criteria for inclusion. Though we collected additional demographics and clinical information, our primary outcome was the development of AKI, as defined by the 2012 KDIGO guidelines, while receiving vancomycin via OPAT. Results Approximately 17% of patients developed an AKI using this hybrid model. The most treated infection was prosthetic joint or hardware-associated infections (40.8%), and the most targeted organism was MRSA (41.7%). Vancomycin monotherapy comprised almost half of the antibiotic regimens on discharge (48.3%); the second agent, if prescribed, was typically a beta-lactam other than piperacillin-tazobactam (36.7%). Conclusion Future directions include identifying predictors for the development of AKI while receiving vancomycin via OPAT and comparing outcomes of this hybrid model with a historical cohort of patients at our institution who received trough-guided dosing in both the inpatient and outpatient settings. Given the paucity of data on vancomycin dosing in the outpatient setting, investigating optimal and sustainable OPAT vancomycin dosing and monitoring is of the utmost importance to minimize adverse events and maximize patient safety. Disclosures All Authors: No reported disclosures

Improved Outcomes and Resource Use With Normothermic Machine Perfusion in Liver Transplantation

Normothermic machine perfusion (NMP) has been shown to reduce peritransplant complications. Despite increasing NMP use in liver transplant (LT), there is a scarcity of real-world clinical experience data. To compare LT outcomes between donation after brain death (DBD) and donation after circulatory death (DCD) allografts preserved with NMP or static cold storage (SCS). This single-center, retrospective observational cohort study included all consecutive adult LTs performed between January 2019 and December 2023 at the Mayo Clinic in Arizona. Data analysis was performed between February 2024 and June 2024. Outcomes of DBD-SCS, DBD-NMP, DCD-SCS, and DCD-NMP transplants were compared. DBD and DCD livers preserved on NMP or SCS. The primary outcomes were early allograft dysfunction (EAD), intraoperative transfusion, and post-LT hospital resource use, including length of stay (LOS) and readmissions. Secondary outcomes included acute kidney injury (AKI) and 1-year graft and patient survival. A total of 1086 LTs were included in the following 4 groups: DBD-SCS (n = 480), DBD-NMP (n = 63), DCD-SCS (n = 264), and DCD-NMP (n = 279). Among LT recipients, median (IQR) age was 60.0 years (52.0-66.0); 399 LT recipients (36.7%) were female. DCD-NMP had the lowest EAD rate (17.5%), followed by DCD-SCS (50.0%), DBD-NMP (36.8%), and DBD-SCS (27.3%) (P < .001). DCD-NMP had the lowest intraoperative transfusion requirement compared to all other groups. Hospital and intensive care unit (ICU) LOS were shortest in DCD-NMP (median [IQR] hospital LOS, 5.0 days [4.0-7.0]; P = .01; median [IQR] ICU LOS, 1.5 days [1.2-3.1]; P = .01). One-year cumulative readmission probability was 86% lower for DCD-NMP vs DCD-SCS (95% CI, 0.09-0.22; P < .001) and 53% lower for DBD-NMP vs DBD-SCS (95% CI, 0.26-0.87; P < .001). AKI events were lower in DCD-NMP (31.1%) vs DCD-SCS (47.4%) (P = .001). Compared to SCS, the NMP group had a 78% overall reduction in graft failure (hazard ratio [HR], 0.22; 95% CI, 0.10-0.49; P < .001). For those receiving DCD allografts, the risk reduction was even more pronounced, with an 87% decrease in graft failure (HR, 0.13; 95% CI, 0.05-0.33; P < .001). NMP was significantly protective from patient mortality vs SCS (HR, 0.31; 95% CI, 0.12-0.80; P = .02). In this observational high-volume cohort study, NMP significantly improved LT clinical outcomes and reduced hospital resource use, especially in DCD allografts. NMP may enhance access to LT by addressing the challenges historically linked with DCD liver use.

Acute Kidney Injury in Critically Ill Children: Prevalence, Progression, Recovery Mortality, and Impact of Severity

Introduction: Acute kidney injury (AKI) among the pediatric population is considered a risk factor for mortality and morbidities during pediatric intensive care unit (PICU) admission. The association between AKI and increased mortality risk and length of stay (LOS) is still inconclusive. This retrospective cohort study aimed to evaluate the impact of AKI severity upon critical management and clinical parameters with an evaluation of severity progression among AKI patients admitted to the PICU at a tertiary care hospital. Methods: AKI, defined with the Kidney Disease Improving Global Outcomes (KDIGO) classification, was determined based on serum creatinine and urine output with respect to the patient’s baseline value. The following outcomes were examined: mortality, mechanical ventilation use, use of non-invasive ventilation, recovery at discharge, and LOS in the hospital and PICU stratified by type of AKI upon admission. Medical records of the 165 included patients were reviewed for clinical data and study outcomes. Results: The median age of the patients was 7 years (IQR 1.5–10 years), and 58% were boys; 78 (47.2%) had stage 1 AKI, 49 (29.71%) had stage 2 AKI, and 38 (23%) had stage 3 AKI at admission. The mortality rate was 26%. The median LOS in the PICU was statistically significant between AKI stages, with a higher median LOS among patients with AKI stage 3 at admission. Using the maximum KDIGO stage, there was no association between AKI and mortality (adjusted OR 1.91, 95% CI 0.05), whereas for the mechanical ventilation outcome, the adjusted OR was 1.84 (95% CI 0.42–8.1). Conclusions: The severity of AKI is not associated solely with mortality and clinical outcomes as the numbers of comorbidities and organ failures contribute to mortality. However, improving awareness of AKI and understanding the disease progression course would reduce acute and long-term morbidity and mortality.

Variations of renal Doppler indices during the initial 24-hour predict acute kidney injury in patients with sepsis: a single-center observational case-control clinical study

The aim of this retrospective observational case-control study was to examine the significance of different renal Doppler marker variations within the initial 24-hour period as potential predictors of Acute Kidney Injury (AKI) in patients with sepsis. A total of 198 sepsis patients were enrolled and categorized into two groups: the AKI group (n = 136) and the non-AKI group (n = 62). Three renal Doppler indices, Renal Resistive Index (RRI), Power Doppler Ultrasound (PDU) score and Renal Venous Stasis Index (RVSI), were measured within 6h (T0) and at 24h (T1) after ICU admission. The AKI group had more hypertension patients than the non-AKI group (p = 0.047). The cases of the AKI group showed higher levels of CRP (p = 0.001), PCT (p < 0.001), lactate (p < 0.001), AST (p = 0.003), ALT (p = 0.049), total bilirubin (p = 0.034), BNP (p = 0.019) and cTnI (p = 0.012). The RRI at T1 was significantly higher in the AKI group (p = 0.037). AKI group exhibited a lower incidence of reduced RRI at T1 compared with non-AKI group (p < 0.001). After controlling for age, sex, and BMI through partial correlation analysis, the results indicated significant associations between SA-AKI and CVP (r = -0.473), SOFA score (r = 0.425), lactate (r = 0.378), and RRI reduction (r = -0.344) in sepsis patients. The multivariate logistic regression analysis showed that variables including CVP, SOFA score, CRP, lactate, VIS, and RRI not reduced following 24h of ICU treatment were predictive indicators for early detection of SA-AKI in sepsis patients. CVP, SOFA score, CRP, lactate, VIS, and RRI not reduction following 24h of ICU treatment can be utilized as predictive indicators for early detection of SA-AKI in sepsis patients.

Morphological picture of acute kidney injury in patients with severe acute decompensation heart failure and its relation to clinical, functional and biochemical parameters

THE AIM: to evaluate the morphological picture and its relationship with markers of acute kidney injury and other prognostic parameters in patients with severe fatal acute decompensation of heart failure (ADHF).PATIENTS AND METHODS: material obtained from 62 patients 47–82 years old (mean age 72.8±2.1 years) with severe acute decompensation of chronic heart failure resulting in death. The red cell distribution width, erythrocyte sedimentation rate haemoglobin, creatinine, total bilirubin, C-reactive protein content in blood at admission and shortly before death were determined. Autopsy with subsequent detailed examination of renal tissue was performed in all cases.RESULTS: The average duration of hospitalization of deceased patients with ADHF was 6,9±1,1 days. The main cause of death in 25 patients (40,3%) was pulmonary oedema due to pulmonary embolism, or against the background of heart failure, its acute decompensation developed – 37 patients (59,7%). On autopsy acute tubular injury was found in 36 patients (58.1%), with its direct strong correlation with the red cell distribution width, creatinine level, C-reactive protein; medium strength correlation with erythrocytes, total bilirubin; weak strength correlation – with transaminases was revealed.CONCLUSION: In fatal ADHF, AKI occurred with high frequency and was characterized mainly by acute tubular epithelial injury of varying severity. Acute kidney injury in fatal ADHF was strongly associated with elevated levels of CRP, RDW, and creatinine, increased heart weight, and the presence of hydrothorax. There was a correlation of medium strength with decreased red blood cell count and increased total bilirubin levels, and a weak correlation with elevated transaminase concentrations. Acute kidney injury is one of the components of thanatogenesis associated with the combined effect of inflammatory factors.

Early and high-volume administration of sodium bicarbonate in sepsis-associated acute kidney injury in patients with malignancies, during continuous renal replacement therapy

Introduction Sepsis is an uncontrolled systemic response to infection that leads to life-threatening organ dysfunction. The in-hospital mortality rate remains significantly high in septic shock patients with malignancies. This study investigates whether early and high-volume administration of sodium bicarbonate during continuous renal replacement therapy (CRRT) can reduce 28-day mortality, increase shock reversal rates, and shorten the duration of CRRT, mechanical ventilation, and intensive care unit (ICU) stays. The goal is to provide valuable clinical data for the management of cancer patients with sepsis-associated acute kidney injury (SAKI). Materials and methods A retrospective study was performed on 88 patients who were admitted to the ICU and received continuous renal replacement therapy (CRRT) for acute renal failure secondary to sepsis at the Cancer Center of Sun Yat-sen University from March 2010 to October 2021. Based on the initiation time of CRRT and the volume of sodium bicarbonate infusion, patients were divided into four groups: the early high-volume group, early low-volume group, late high-volume group, and late low-volume group. Results The results of this study showed that in the 28-day mortality model, established using the Cox proportional hazards method, early CRRT (HR 0.473; 95% CI 0.245–0.915, p = 0.026) and high-volume sodium bicarbonate infusion (HR 0.173; 95% CI 0.078–0.383, p < 0.001) were identified as two independent protective factors. The 28-day mortality rate in the early high-volume group (15.0%) was significantly lower than that of the other three groups (60.0%, 30.0%, and 75.0%, respectively; χ 2 = 23.822, p < 0.001). Additionally, the shock reversal rate in the early high-volume group (80.0%) was significantly higher compared to the other groups (35.0%, 45.0%, and 35.7%; χ 2 =13.576, p = 0.004). The duration of CRRT was shorter in the early high-volume group (35.0 ± 4.45 h) than in the other groups (70.0 ± 30.19 h, 48.0 ± 5.22 h, and 72.0 ± 19.84 h; χ 2 =11.278, p = 0.01). Furthermore, the duration of mechanical ventilation (7.0 ± 3.33 days) was lower in the early high-volume group compared to the other groups (8.0 ± 1.12 days,10.0 ± 1.11 days, and 8.0 ± 2.65 days; χ 2 =8.064, p = 0.045), as was the length of ICU stay (7.0 ± 0.89 days) compared to the other groups (13.0 ± 3.35 days, 10.0 ± 1.49 days, and10.0 ± 3.70 days; χ 2 = 9.184, p = 0.027). Conclusion Early and high-volume administration of sodium bicarbonate during CRRT may reduce 28-day mortality and improve shock reversal rates in patients with sepsis-associated acute kidney injury complicated by malignancy. Prospective randomized controlled large sample studies are needed to confirm this.

The role of a "volume sparing" strategy in kidney replacement therapy of AKI: a retrospective single-center study.

The KDIGO recommendation in acute kidney injury (AKI) patients requiring kidney replacement therapy is to deliver a Urea Kt/V of 1.3 for intermittent thrice weeklyhemodialysis, and an effluent volume of 20-25ml/kg/hour when using continuous renal replacement therapy (CRRT). Considering that prior studies have suggested equivalent outcomes when using CRRT-prolonged intermittent renal replacement therapy (PIRRT) effluent doses below 20mL/kg/h, our group investigated the possible benefits of low effluent volume CRRT-PIRRT (12.5ml/Kg/hour). Thirty-six AKI patients that had been treated in the previous 12months by CRRT-PIRRT with low effluent volume were included in the present retrospective observational study. The total effluent volume, derived from the formula [25 (or 12.5ml) × kg body weight × 24], was administered over 24h in CRRT and over 10h in daily PIRRT. The control group consisted of the last 36 AKI patients previously treated with standard effluent volume CRRT (25ml/kg/hour). Mortality within 90days, shift from low effluent volume to standard effluent volume due to dialysis inadequacy, and remission of AKI were the end points. The two groups were homogeneous for age, sex, and sequential organ failure assessment (SOFA) score.Patients with AKI caused by metformin-induced lactic acidosis were excluded because they were treated with standard effluent volume CRRT until the lactic acidosis was corrected by subsequently reducing the effluent volume to 12.5 ml/kg/hour. The two groups were homogeneous as for baseline features. The UKt/V in the low effluent volume group was 0.51 ± 0.04 in CRRT and 0.50 ± 0.07 in PIRRT per session (Table 3). The UKt/V in the standard effluent volume group was 1.00 ± 0.02 in CRRT and 0.95 ± 0.05 in PIRRT per session.No differences were observed between the 2 groups regarding death from any cause at 90days, and recovery of renal function. No patient was switched from low effluent volume to standard effluent volume due to inadequate control of uremic toxins. Serum creatinine at discharge from the hospital in patients with no KRT dependence was 2.1 ± 0.6 mg/dl in standard effluent volume and 1.9 ± 0.5 in low effluent volume (p = 0.37). All low effluent volume patients showed adequate metabolic, electrolyte, and acid-base profile control. In the low effluent volume group, the incidence of hypophosphatemia was lower than in the standard effluent volume group (5 vs 15, p = 0.003). In this single-center retrospective study, low effluent volume CRRT-PIRRT was associated with similar outcomes to standard effluent volume CRRT-PIRRT, which is consistent with the results of prior observational studies. Randomized controlled studies comparing low effluent volume with standard effluent volume are needed.

Safety of steroids in severe community-acquired pneumonia.

The systemic use of corticosteroids for patients with severe community-acquired pneumonia (sCAP) remains controversial in clinical practice, particularly in terms of the safety profile of these drugs. This narrative review aims to analyse the available literature data concerning the safety of short-term steroid use in the treatment of sCAP, while also highlighting potential future research directions. Several trials and meta-analyses have evaluated corticosteroid therapy as an adjuvant treatment for sCAP, yielding heterogeneous results regarding its efficacy and safety. Despite the wide variability in results, it is generally accepted that steroids are not associated with a significant risk of healthcare-associated infections, gastrointestinal bleeding or acute kidney injury in patients with sCAP in the short term. Nevertheless, such drugs are linked to hyperglycaemia, necessitating regular monitoring and appropriate management. The influence of steroids on long-term outcomes and their potential risks in viral sCAP still needs to be investigated.

Relevance of perioperative fluid dynamics in liver transplantation to acute kidney injury and patient outcomes: a cross-sectional survey.

Fluid administration is a critical component of perioperative management for liver transplant recipients, and excessive fluid infusion can lead to acute kidney injury (AKI) and poor patient outcomes. We conducted a cross-sectional survey on the fluid intake and output of adult liver transplant recipients over a 7-day period. The patients were divided into AKI and non-AKI groups. Multivariate logistic regression analyses were used to evaluate the association between fluid balance (FB) and AKI. A Kaplan-Meier survival analysis was performed to determine the survival of the recipient survival at 180 days. A total of 210 liver transplant recipients were included. The peak FB occurred on the second day after transplantation, which was higher than on the seventh day (0.3 [IQR, -0.2 to 0.8] L vs. -0.4 [IQR, -1.0 to 0.3] L, p < 0.001). The highest incidence of AKI was observed on the second day after transplantation and the lowest on the seventh day (52.4% vs. 15.4%, p < 0.001). Multivariate analysis showed that a cumulative FB > 1 L within the first 2 days postoperatively was an independent risk factor for AKI on the second day after liver transplantation (LT) (OR = 2.66, 95% CI, 1.31-5.41, p = 0.007). Survival analysis indicated significant differences in 180-day survival rates among patients with different grades of AKI [94.0% (grade 1) vs. 91.4% (grade 2) vs. 77.8% (grade 3), χ 2 = 12.93, p < 0.001]. There is a significant correlation between post-LT AKI and perioperative FB. Cumulative FB > 1 L in the first 2 days postoperatively is an independent risk factor for AKI on the second day after LT. AKI after LT is associated with a lower 180-day survival rate in patients.

Correlation Between the Inferior Vena Cava/Aorta (Ivc/Ao) Ratio and Serum Lactate Levels in Children With Renal Disorder.

Acute kidney injury (AKI) is common in critically ill children in the PICU, with incidence rates from 2.5% to 58%, impacting mortality and hospital duration. Early AKI detection is vital, but conventional hemodynamic monitoring often lacks specificity. This study investigates the relationship between the inferior vena cava/aortic (IVC/Ao) ratio and serum lactate levels as non-invasive indicators of renal hemodynamics and tissue perfusion in children. Understanding these parameters could improve early diagnosis, aid clinical decisions, and enhance outcomes for pediatric AKI patients, offering an accessible monitoring method for clinicians. This cross-sectional study involved 48 pediatric patients aged 5-18 years showing Pediatric Early Warning Score (PEWS) ≥3 and diagnosed with renal disorders. Patients were admitted to the emergency department, high care unit, PICU, and pediatric ward at Dr. Hasan Sadikin Hospital, Bandung, between May and August 2023. AKI was diagnosed using pRIFLE or KDIGO criteria. The IVC/Ao ratio was assessed via transabdominal USG, and serum lactate levels were measured. Spearman correlation analysis was conducted to assess their relationship. The median (IQR) IVC/Ao ratio was 0.91 (0.70-1.10), and serum lactate levels were 1.5 (1.1-2.4) mmol/L. Spearman correlation analysis revealed a negative correlation between the IVC/Ao ratio and serum lactate (rho = -0.65, p < 0.001). A decrease in the IVC/Ao ratio correlates with an increase in serum lactate levels in children with AKI.

Development and validation of a predictive model for acute kidney injury in patients with ureterolithiasis

Objectives This study aims to identify risk factors for acute kidney injury (AKI) in patients with ureterolithiasis and to develop a predictive model for early AKI detection in this population. Methods A retrospective analysis was conducted on data from 1,016 patients with ureterolithiasis who presented to our outpatient emergency department between January 2021 and December 2022. Using multifactorial logistic regression, we identified independent risk factors for AKI and constructed a nomogram to predict AKI risk. The predictive model’s efficacy was assessed through the area under the ROC curve, calibration curves, Hosmer-Lemeshow (HL) test, and decision curve analysis (DCA). Results AKI was diagnosed in 18.7% of the patients. Independent risk factors identified included age, fever, diabetes, hyperuricemia, bilateral calculi, functional solitary kidney, self-medication, and prehospital delay. The nomogram demonstrated excellent discriminatory capabilities, with AUCs of 0.818 (95% CI, 0.775–0.861) for the modeling set and 0.782 (95% CI, 0.708–0.856) for the validation set. Both calibration curve and HL test results confirmed strong concordance between the model’s predictions and actual observations. DCA highlighted the model’s significant clinical utility. Conclusions The predictive model developed in this study provides clinicians with a valuable tool for early identification and management of patients at high risk for AKI, thereby potentially enhancing patient outcomes.

Utilizing Raman spectroscopy for urinalysis to diagnose acute kidney injury stages in cardiac surgery patients

Background The successful treatment and improvement of acute kidney injury (AKI) depend on early-stage diagnosis. However, no study has differentiated between the three stages of AKI and non-AKI patients following heart surgery. This study will fill this gap in the literature and help to improve kidney disease management in the future. Methods In this study, we applied Raman spectroscopy (RS) to uncover unique urine biomarkers distinguishing heart surgery patients with and without AKI. Given the amplified risk of renal complications post-cardiac surgery, this approach is of paramount importance. Further, we employed the partial least squares-support vector machine (PLS-SVM) model to distinguish between all three stages of AKI and non-AKI patients. Results We noted significant metabolic disparities among the groups. Each AKI stage presented a distinct metabolic profile: stage 1 had elevated uric acid and reduced creatinine levels; stage 2 demonstrated increased tryptophan and nitrogenous compounds with diminished uric acid; stage 3 displayed the highest neopterin and the lowest creatinine levels. We utilized the PLS-SVM model for discriminant analysis, achieving over 90% identification rate in distinguishing AKI patients, encompassing all stages, from non-AKI subjects. Conclusions This study characterizes the incidence and risk factors for AKI after cardiac surgery. The unique spectral information garnered from this study can also pave the way for developing an in vivo RS method to detect and monitor AKI effectively.

Preoperative leptin levels were associated with postoperative acute kidney injury in patients with acute type A aortic dissection

Objective Acute kidney injury (AKI) is a common surgical complication of acute type A aortic dissection (AAAD) and strongly associated with an unfavorable prognosis. Although elevated leptin levels have been identified as a potential risk factor for chronic kidney disease in middle-aged and elderly individuals, their association with AKI following AAAD surgery remains unknown. This study investigated the association between preoperative leptin levels and postoperative AKI in patients with AAAD. Methods This study included 159 patients with AAAD at Fujian Heart Medical Center. The Kidney Disease: Improving Global Outcomes standards were used to define and classify AKI. The receiver operating characteristic (ROC) curves were used to assess the ability of leptin levels to predict AKI. Binary logistic regression analysis was used to study the association between leptin level and AKI. Results The incidence of AKI was 33.96%. Leptin levels in the AKI group and stage 1, 2, and 3 AKI groups were higher than those in the non-AKI group (p < 0.05). Multivariate analysis revealed that elevated leptin levels were an independent risk factor for AKI (p < 0.001). ROC analysis of leptin detection for AKI showed an area under the curve of 0.71. The risk of AKI in the high-level group (leptin levels ≥3.62 ng/mL) was 3.87 times to the low-level group (leptin levels < 3.62 ng/mL). Conclusion Elevated leptin levels are associated with AKI, and plasma leptin may serve as a potential early blood biomarker for AKI in patients with AAAD.