Case Of Acute Renal Failure Research Articles

6411 Ozempic - Oh no! Acute Renal Failure Associated with Initiation of Semaglutide

Abstract Disclosure: K. Barney: None. D. Tahir: None. A. Pannu: None. R. Saeed: None. Background: Semaglutide is a glucagon-like peptide-1 (GLP-1) receptor agonist which has been proven to reduce weight in those with obesity and improve glycemic control in patients with type II diabetes mellitus. The effect of semaglutide on kidney function has not been well established. The phase 3b SUSTAIN trials revealed that when compared with other GLP-1 agonists, semaglutide exhibited more frequent acute kidney injuries [1-3]. The SUSTAIN 6 trial reported two instances of acute renal failure (ARF) in patients with chronic kidney disease, and one case of ARF in a patient with normal kidney function who was treated with semaglutide [3]. Despite these reports, the SUSTAIN 1-9 trials report no significant decline in kidney function associated with semaglutide [3-6]. Case: We present the case of a 58-year-old male with a past medical history of human immunodeficiency virus (HIV), type II diabetes mellitus, and hypertension who presented to the hospital with ARF after initiation of Ozempic (semaglutide) two months prior to presentation. On admission, vitals were stable and physical examination was benign. His pertinent labs were blood urea nitrogen (BUN) 55 mg/dL, creatinine 5.94 mg/dL (baseline 1.2 mg/dL), and urinalysis with 2+ protein. To determine the cause of his renal failure, urine sodium and creatinine were obtained to calculate his fractional excretion of sodium, which was found to be consistent with intrinsic renal disease. Further workup, including renal ultrasound, urine protein, urine eosinophils, complement and free light chain levels, and creatinine kinase, were unrevealing for cause of intrinsic renal injury. He was managed with intravenous fluids and his creatinine improved to 2.03 mg/dL. Given the acute onset of the patient’s renal failure and recent initiation of Ozempic, it was determined that this medication was the cause of his renal failure, and it was discontinued on discharge. He has since followed up with nephrology and endocrinology. He remains off Ozempic and is doing well. Conclusions: Our case highlights a rare but significant adverse effect of semaglutide on renal function. As the use of semaglutide has increased due to its rising popularity for weight loss and glycemic control in type II diabetes mellitus, the potential for renal injury should be considered and discussed with patients. Furthermore, it is imperative that semaglutide associated renal injury be considered as a cause for ARF in patients taking this medication. This case demonstrates that instances of ARF associated with semaglutide treatment are a cause for concern and further exploration. Presentation: 6/1/2024

6695 When Pheochromocytoma Presents As Acute Renal Failure, With Complete Resolution, A Case Report

Abstract Disclosure: U.A. Siddiqui: None. D. Deyar: None. D. Bondarenko: None. M. Ahmad: None. K.K. Lessard: None. Pheochromocytomas and paragangliomas (PPGL), are rare neuroendocrine tumors (0.66/ 100,000 cases), often characterized by paroxysmal hypertension and associated symptoms. While cardiac complications have been well-documented in the literature, there is limited information regarding acute renal failure. We explore a unique case of pheochromocytoma presenting initially with hypertensive crisis, but also with an unexpected journey into acute renal failure and subsequent recovery. 62-year-old hispanic male without known past medical history presents to the emergency department with chest pain, epigastric pain, dyspnea, and emesis. He was tachypneic, febrile (101°F), hypoxic (83% on room air), and profoundly hypertensive (188/112 mmHg). CT scan showed pneumonia as well as a 7cm complex mass within the left adrenal gland. Admitting labs showed metabolic acidosis, acute kidney injury (Cr 2.52mg/dL) and elevated troponins. Echocardiogram showed a reduced ejection fraction 45-50% and coronary angiography showed mild nonocclusive coronary artery disease. MRI visualized a solid left adrenal mass measuring 6.8cm with enhanced, mixed T1/T2 signaling and drop out inconsistent with adenoma. Adrenal labs revealed ACTH 125 pg/mL (9-46 pg/mL) and cortisol 27mcg/dL free metanephrine (MN) 1,422 pg/mL (<57 pg/mL), and free normetanephrine (NMN) >20,000 pg/mL (<148 pg/mL), total free MN + NMN >40,000 pg/mL (<205 pg/mL). Preoperative MIBG scan showed increased tracer activity of the left adrenal consistent with pheochromocytoma. Alpha blockade was performed using doxazosin and carvedilol was continued. Unfortunately, he developed oliguria and rising creatinine ( 7.4mg/DL). Kidney biopsy showed findings of acute tubular necrosis and mild fibrosis. Hemodialysis was initiated, receiving 12 sessions prior to undergoing open left adrenalectomy with mass resection on day 22 of admission. Post-operative blood pressure was managed with volume re-expansion and tapering of alpha blocker. Within 72 hours, renal function fully recovered and dialysis was discontinued. Follow up metanephrines are within normal limits and genetic testing results remain pending. Cases of acute renal failure and PPGL are scarce, and this case report contributes to the topic. Mortality in p is usually due to cardiovascular complications such as stroke, cardiomyopathy, and dysrhythmia [2]. Renal complications result from hypertensive nephrosclerosis or nephrotic syndrome. To date, only one case report from 1961 exists on acute tubular necrosis and PPGL [3]. We present an interesting case of pheochromocytoma complicated by hypertensive crisis and acute renal failure requiring dialysis. Resection of the pheochromocytoma normalized renal function. This demonstrates the importance of timely resection of the tumor and meticulous blood pressure management to ensure optimal outcomes. Presentation: 6/2/2024

The New Spectrum of Plasmodium Vivax Malaria Severity: A Single-Center Experience

Plasmodium vivax malaria, once considered a benign and self-limiting disease, has emerged as a significant public health concern, with increasing reports of severe and even fatal cases. Objective: To evaluate the clinical severity and complications associated with Plasmodium vivax malaria in patients in Peshawar. Methods: A descriptive cross-sectional study was conducted at Lady Reading Hospital, Peshawar, for about two months. A total of 160 patients diagnosed with Plasmodium vivax malaria were enrolled. Participants were divided into two groups based on platelet count. Laboratory tests, including complete blood count, liver function tests, and Renal Function Tests were performed. Data were analyzed using SPSS version 20.0 , An Independent sample t-test was used to assess the significant difference between the two groups with statistical significance set at p<0.05. Results: A total of 165 patients were included in the study. In the severe thrombocytopenia group (<100,000/µL), there were 23 cases of anemia, jaundice (n=25), acute renal failure (n=7), cerebral malaria (n=2), seizures (n=1) and hypoglycemia (n=1). In the less severe thrombocytopenia group (>100,000/µL), there were 14 cases of anemia, jaundice (n=17), and acute renal failure (n=2). The blood glucose level (p=0.37), systolic blood pressure (p=0.18) and pulse rate (p=0.21) revealed no significant differences between the two groups. Conclusions: It was concluded that severe thrombocytopenia in P. vivax malaria was associated with more severe clinical manifestations, with a few cases requiring transfusions. Patients with less severe thrombocytopenia had fewer complications

Endocytic pathways and metabolic fate of colloidal bismuth subcitrate in human renal cells

Bismuth compounds, particularly colloidal bismuth subcitrate (CBS), have been widely used in the treatment of gastrointestinal diseases. However, overdose of CBS has been linked to cases of acute renal failure, primarily due to the intracellular accumulation of bismuth in the kidney. To date, the detailed mechanisms of CBS internalization and its metabolic fate remain unclear. In this study, CBS was characterized as a type of nano-object using transmission electron microscopy and dynamic light scattering. Renal cells internalized CBS primarily via clathrin-mediated endocytosis in an active transport manner. Gene knockdown techniques revealed that CBS binds to the transferrin receptor likely through complexing with transferrin before cellular uptake. Once internalized, CBS was sorted into early endosomes, late endosomes, and lysosomes, mediated by microtubules and the Golgi apparatus. Additionally, differentially expressed genes analysis revealed that CBS endocytosis stimulated oxidative stress, significantly affecting the metabolism of glutathione and cysteine within cells. This led to the formation of black bismuth sulfide particles as a result of CBS conjugating with intracellular glutathione. These findings provide crucial insights into the cellular mechanisms underlying excessive CBS exposure, which is essential for understanding and potentially mitigating the risks associated with the use of bismuth compounds in medical treatments.

Acute renal failure caused by Sjögren's syndrome and rheumatoid arthritis overlap syndrome.

Sjögren's syndrome (SS) and rheumatoid arthritis (RA) are two chronic autoimmune diseases. To date, there have been few reports on the overlap between SS and RA in China, especially regarding correlated acute renal failure cases. To provide a reference for our clinical peers, this article presents the case report of an elderly female patient who was diagnosed with acute renal failure caused by SS and RA overlap syndrome. We also provide a relevant analysis of SS and RA overlap syndrome treatment. We also provide a relevant analysis of SS and RA overlap syndrome treatment.

Granulomatous Acute Interstitial Nephritis Revealing Multisystem Sarcoidosis Associated with Thyroiditis and Cushingoid Syndrome: Report of a Case and Review of the Literature

Introduction: Sarcoidosis can present with acute renal failure (ARF) due to granulomatous interstitial nephritis (GIN). We report the case of granulomatous acute renal failure (ARF) revealing multisystemic sarcoidosis in the nephrology department of the Aristide Le Dantec hospital in Dakar. Observation: Mrs. kD aged 54 with a past history of high blood pressure for 22 years, a multi nodular euthyroid goiter, referred to the nephrology department for impaired renal function. The clinical examination revealed at entry, deterioration in the general condition with weight loss and non-selective anorexia. Clinical anemia was also noted. The clinical examination also revealed Cushingoid syndrome and dry mouth syndrome. On biology, the blood count showed bicytopenia with anemia at 10.9 g/dl and leukopenia at 2620/mm3. There was an impairment of renal function with creatinine at 139.2 mg/l and blood urea at 1.76 g/l. The renal ultrasound became normal. Cervical ultrasound showed an aspect of abscessed thyroiditis of the right lobe. Chest computed tomography (CT) showed bilateral hilar adenomegaly and a band of bilateral basal linear atelectasis. The renal biopsy showed glomeruli of subnormal structure, the interstitium is riddled with tuberculoid follicles formed of epithelioid and multinucleated histiocytes of the Langhans type. The diagnosis of granulomatous acute interstitial nephritis revealing multisystemic sarcoidosis was kept. The evolution was favorable after 1 month of treatment with corticosteroid therapy with a clear improvement in renal function. Conclusion: Renal manifestations during sarcoidosis are rare. They can be indicative of the disease as in our patient. Renal biopsy is essential in any patient presenting with impaired renal function with extra-renal signs.

Causes and Prognosis of Cases of Acute Obstructive Renal Failure Managed at the Donka National Hemodialysis Center

Causes and Prognosis of Cases of Acute Obstructive Renal Failure Managed at the Donka National Hemodialysis Center

Vitamin D Abuse inPursuit of"Gains" Resulting inAcute Kidney Injury.

Vitamin toxicity represents an increasingly frequent clinical diagnosis and can be difficult to initially recognize given the plethora of over-the-counter supplements available. The young, active, and heavily male population of the military is especially susceptible to such supplementation pitfalls. Here we present the case of acute renal failure with hypercalcemia that was found to be secondary to unrecognized high-dose over-the-counter vitamin supplementation and subsequent vitamin D hypervitaminosis initiated by the patient in the hope of boosting testosterone production. This clinical scenario demonstrates the dangers of easily accessible, often seemingly benign supplements and the need for greater education and awareness of supplementation use.

Ant bite causing acute oliguric renal failure – A case report

Ant bites usually cause mild local reactions without significant complications. Extensive bites may lead to subclinical myonecrosis or secondary bacterial infection. Here, we present a case of acute renal failure as a rare complication of extensive bites by carpenter ants. The patient improved on supportive management and hemodialysis.

Acute Ocular Complications after Recently Diagnosed Goodpasture's Syndrome - An Unusual Case of Hypertensive Retinopathy.

Ernest Goodpasture first identified Goodpastureʼs syndrome (GS) in 1919. It is a rare disease with an estimated incidence of about 0.5 – 1 case per million per year. GS most frequently occurs in two age ranges, 20 – 30 years and 60 – 70 years, and typically includes the following triad: acute renal failure, pulmonary hemorrhage, and presence of anti-glomerular basement membrane (anti-GBM) antibodies. Although the overall incidence is relatively low, GS is the cause of approximately one-fifth of all cases of acute renal failure with rapidly progressive glomerulonephritis. If accompanied by pulmonary hemorrhage or secondary malignant hypertension, the disease may be life-threatening [1].

Severe Metabolic Acidosis, Acute Renal Failure, and Delayed Paralysis Leading to Respiratory Depression due to Manganese ethylene-bis-dithiocarbamate.

Maneb is a widely used agricultural fungicide, which can lead to parkinsonism due to its neurotoxic effects on the dopaminergic system after chronic low-dose exposure. Previous acute human maneb poisoning cases occurred with low-dose maneb exposure through the dermal route causing renal failure. This report presents a case of acute renal failure and delayed paralysis due to ingestion of a large dose of maneb for a suicide attempt. A 16-year-old female patient was admitted to the emergency room because of drinking almost a whole bottle of maneb (400 mL [2 g L-1]) about 2 hours before. The patient was transferred to the intensive care unit with severe metabolic acidosis and renal failure. On the 4th day in intensive care unit, although the severe acidosis was resolved with haemodialysis, the patient was intubated because of ascending muscle weakness and dyspnoea. After staying in the intensive care unit for 9 days and in the nephrology ward for 2 weeks, the patient was discharged well from the hospital with no further need for haemodialysis but a persistent bilateral drop foot. One year after the event, renal functions were normal, and motor function in the lower extremities improved entirely.

Risk Factors Associated with Acute Renal Failure in Neonates of a neonatal Intensive Care Unit

Objetive: Determining the risk factors associated with acute renal failure in neonates.
 Materials and Methods: A case-control study was carried out, in 65 cases of acute renal failure and 65 without acute renal failure in the Intensive Care Unit Neonatals (NICU) of a hospital in Pachuca Hidalgo, Mexico. The variables studied; prematurity, low weight, type I respiratory distress syndrome, perinatal asphyxia, sepsis, necrotizing enterocolitis, administration of vancomycin, amikacin, amphotericin, cefotaxime and water restriction. The information was collected from the data of the clinical records and the analysis was carried out in the Epi-info software. The statistical analysis, it was performed using non-parametric tests such as Chi2 and Fisher's Exact Test.
 Results: Denote underweight with an OR 2, 95% CI. from 1.1 to 3.3 and <P 0.05 by Chi2 and Fisher's exact test. For; perinatal asphyxia with OR 2.1, 95% CI. from 1.3 to 3.4 and <P 0.05 through Chi2 and Fisher's exact test. For vancomycin administration OR 4.7, 95% CI. From 2.3 to 9.3 and <P 0.05 by Chi2 and Fisher's exact test. For water restriction OR 2, 95% CI. From 1.2 to 3.3 and <P 0.05 by Chi2 and Fisher's exact test.
 Conclusion: A significant association was found between acute renal failure with low weight, perinatal asphyxia, administration of vancomycin and water restriction.

Management of a rare case of acute renal failure in a pregnant woman during the last trimester of pregnancy: A case report

This case report is about the successful treatment of a patient with acute kidney injury during pregnancy. Primigravida at 37 weeks gestational age presented at the emergency department of our hospital with tonic – clonic muscle spasms. After performing immediate clinical examination and the appropriate lab investigation we reached to the diagnosis of HELLP syndrome and performed an emergency cesarean section, due to eclampsia during HELLP syndrome. Right after surgery, kidney dysfunction and rising creatinine levels led nephrologists to start dialysis sessions, because of the acute kidney injury. Postoperative period was without complications. On the sixth postoperative day the patient’s clinical status was significantly improved, thus she got discharged from the clinic. It was considered necessary by the nephrologists to continue the dialysis sessions until full rehabilitation of the renal function is succeeded. In this paper, apart from the presentation of the case, a literature review is attempted of the acute kidney injury during pregnancy, in relation to current available therapeutic options, which performed in – time contributes to the best possible prognostic outcome.

274 - Ehrlichiosis: a rare case of acute hepatic and renal failure

274 - Ehrlichiosis: a rare case of acute hepatic and renal failure

A Unique Case of Acute Renal Failure and Hepatocellular Injury Occurring in the Course of a Mild SARS-CoV-2 Infection

A Unique Case of Acute Renal Failure and Hepatocellular Injury Occurring in the Course of a Mild SARS-CoV-2 Infection

In Response to "Acute Renal Failure after Amanita ovoidea Eating".

Dear Editor, In issue 29(1) of Indian J. Nephrol., a report entitled “Acute Renal Failure after Amanita ovoidea Eating” was published by Li Cavoli et al., in which a case of severe acute renal failure in an individual was attributed to consumption of the basidiomycete Amanita ovoidea.[1] The latter is morphologically similar to A. proxima, a nephrotoxic species containing the amino acid allenic norleucine, implicated in several poisonings.[2-5] Li Cavoli et al. (2019)[1] based their conclusions on the opinion of a single mycologist (the identity of whom is not disclosed, nor is the exact method of determination), who reportedly examined “remaining parts” of the collected basidiomes and identified the species as “A. ovoidea.” The authors also provide two ex situ photographs of at least five collected basidiomes, none of them in pristine condition. We remain skeptical as to whether all depicted basidiomes represent A. ovoidea. The distinction of A. ovoidea from A. proxima is not always straightforward and, although some of the depicted basidiomes appear to be A. ovoidea, at least one of them displays a long slender stipe and an ochraceous-orange volva—features more consistent with A. proxima. Microscopic features do not separate the two species of concern. Furthermore, A. ovoidea and A. proxima grow in the same habitats, often fruiting side by side.[6,7] Therefore, a mixed collection containing basidiomes of both species cannot be excluded, which could potentially explain why the remaining four consumers remained asymptomatic. Given the above, the available samples should, in our opinion, have been subjected to DNA sequencing of the ribosomal internal transcribed spacer (ITS) region, a relatively inexpensive and reliable method of analysis, to confirm identification and exclude the possibility of a mixed collection. We call attention to the findings of Biagi et al. (2014),[8] who detected only minimal presence of amino acids (including allenic norleucine) in A. ovoidea, although they hypothesized that the fungus may potentially become toxic under certain conditions. Nevertheless, A. ovoidea is frequently consumed in parts of the Mediterranean region, and such potent nephrotoxicity has never previously been reported.[6,7,9] We feel that the evidence presented in support of toxicity of A. ovoidea is insufficient and the question warrants a more thorough investigation. Due to the possibility of mixed collections and obvious difficulties in reliably identifying poorly preserved specimens or fragments of basidiomes by standard morphological techniques, we urge clinicians to pursue DNA sequencing of all available samples as soon as possible after emergency intervention, before designating the culprit in a poisoning incident. Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.

Wild type through Omicron: Maternal outcomes across COVID-19 waves

SARS-CoV-2 has been associated with poor maternal complications. Few studies exist that specifically compare maternal outcomes across the waves and variants of the pandemic. We sought to determine if maternal complication of COVID differ across COVID-19 waves. Retrospective study of pregnant patients diagnosed with SARS-CoV-2 between 3/6/20 and 2/28/22 at a single academic center. Three distinct waves of the pandemic were identified that correlated to the following variants: Wild type (3/6/20-12/31/20), Alpha/Delta (1/1/21-12/14/21), and Omicron (12/15/21-2/28/22). Baseline demographics and clinical outcomes were collected. The primary outcome was development of maternal COVID-19 complications (venous thromboembolism, pneumonia, acute respiratory failure, stroke, myocardial infarction, acute renal or hepatic failure, and transaminitis). Statistical analysis was performed using Chi square tests, student T-tests, and logistic regression modeling, with significance defined as p< 0.05. There were 654 patients included in the analysis with 190 (29%) in the wild type wave, 207 (31%) in the Alpha/Delta wave, and 257 (39%) in the Omicron wave. Women diagnosed during the wild type wave (OR 22.9 (95% CI 2.9-177.4)) or the Alpha/Delta wave (OR 10.6 (95% CI 1.3-85.1)) had significantly higher odds of maternal complications compared to those diagnosed during the Omicron wave. Pneumonia was the most common complication, and the incidence differed across waves: 7.4% during the wild type, 4.3% during the Alpha/Delta, and 0.4% during the Omicron wave (p< 0.001). Rates of other maternal complications across waves are shown in Figure 1. There were no cases of stroke, MI, acute renal or hepatic failure. Women diagnosed during Omicron were more likely to be AMA and have co-morbidities, whereas parity, Hispanic ethnicity, GA at diagnosis and government insurance were greater during the wild type wave (p< 0.05) [Table 1]. Maternal complications of COVID were higher during the Wild type and Alpha/Delta waves compared to the Omicron wave.View Large Image Figure ViewerDownload Hi-res image Download (PPT)

Acute Kidney Failure and Mycelian Sepsis: About A Case at Hospital Du Point “G”

Mycelial sepsis or fungal sepsis is a rare cause of acute renal failure. Candida albicans is the most frequently incriminated fungus. We report a case of acute renal failure and mycelial sepsis diagnosed in the nephrology department of the Point ''G'' university hospital center in Bamako, Mali, the purpose of this work of which is to describe the severity and the urgency of taking responsible for this rare pathology. It was a 30-year-old patient who was hospitalized for recently discovered kidney failure in a pregnancy of around seven months. The appearance of fever, headache and abdominal pain and the HELLP syndrome to motivate a caesarean section with a stillborn child. Faced with the persistence of fever, a blood culture was performed with evidence of candida parapsilosis, the germ responsible for mycelia sepsis. An antifungal treatment was initiated with a good clinical and biological evolution.

A Description of Acute Renal Failure and Nephrolithiasis Associated With Sodium-Glucose Co-Transporter 2 Inhibitor Use: A VigiBase Study.

Background: The Food and Drug Administration issued a warning on the risk of acute kidney injury and a signal of nephrolithiasis for patients using sodium–glucose co-transporter 2 inhibitors (SGLT2i). We performed a descriptive analysis on acute renal failure (ARF) and nephrolithiasis cases reported to SGLT2i in the VigiBase®, in the scope of characterizing the patients and reactions and to report on the disproportionality analysis. Methods: We analyzed all ARF and nephrolithiasis reports for SGLT2i in VigiBase from inception to September 2021. ARF cases were defined as reports containing at least one of the preferred terms (PTs) included in the ARF narrow Medical Dictionary for Regulatory Activities Standardised Queries (MedDRA SMQ). SGLT2i exposure was considered for reports with at least one gliflozin as a suspected/interacting drug. We characterized the patients, reporters, and reactions, and we present the proportional reporting ratio (PRR). Results: Of 27,370,413 total reports in VigiBase, we found 3,972 ARF reactions to gliflozins as suspected/interacting drugs in 3,751 patients and 231 nephrolithiasis reactions in 227 patients. Most cases were reported from American regions (3057; 81.49%), for patients of age group 45–64 years (1590; 59%). About 30% (1156) of the ARF reports were registered in 2018, most from spontaneous reporting, and from consumers followed by healthcare professionals (2,235; 61% and 1440; 38%, respectively). Canagliflozin was the most involved gliflozin in the ARF and nephrolithiasis cases (2,640; 67% and 109; 47%, respectively). The great majority of ARF and nephrolithiasis reports were serious (3,761; 95% and 182; 79%, respectively). Of the total ARF cases reported, 51 had fatal outcome, while 152 had not recovered/not resolved outcome. No fatal outcome was reported for nephrolithiasis. Disproportionality analysis in full database showed a PRR of 4.68 (95% CI 4.53–4.83) for all gliflozins–ARF and a PRR of 3.44 (95% CI 3.00–3.95) for all gliflozins–nephrolithiasis. Conclusion: Most of ARF reports associated with gliflozins were serious, with an important number of cases with fatal outcome. A drug safety signal was found between ARF narrow SMQ and gliflozins. Also, gliflozins were associated with an increase in the proportion of nephrolithiasis reports compared to other medications.

A case of acute renal failure with COVID-19 under Molnupiravir treatment

Objective: Diarrhea, nausea, and vomiting are the most commonly reported mild side effects of Molnupiravir. However, this case shows that it may indirectly cause acute renal failure. Case: 67-Year-old male patient diagnosed with hypertension and chronic obstructive pulmonary disease developed severe nausea, vomiting, and diarrhea with the use of drugs. In the patient's examinations, severe deterioration in kidney functions occurred. The patient who developed acute tubular necrosis was taken to hemodialysis twice. Intravenous hydration and supportive treatments were started. In the follow-up, clinical and renal functions improved. In patients over 65 years of age and with comorbidities, the adverse effects of Molnupiravir should be considered and followed closely.