Case Of Acute Renal Failure Research Articles

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.

Giant bladder stone: A case report

Giant bladder stones are rare in younger patients. Herein, we report a case of acute renal failure in a 31-year-old male with a giant bladder stone. The patient presented with lower urinary tract symptoms and urinary retention with milky-white urine. An emergency suprapubic cystotomy was performed and an 11-cm oval, solid stone was removed. Post-operative creatinine levels progressively decreased to normal and the patient exhibited smooth urination and good recovery at follow-up. A comprehensive physical examination and thorough investigation of the patient's medical history are required during clinical evaluation, diagnosis and treatment, thus preventing misdiagnoses and ensuring prompt treatment.

Obstructive uropathy associated with a Retzius space hematoma following postpartum pulmonary embolism

Background: To report on a case of acute renal failure associated with a Retzius space hematoma that had been extended to retroperitoneal space, following pulmonary embolism treatment in the postpartum period. Case report: A 30-year-old woman was transferred to the hospital for syncope on the first postoperative day following cesarean section. There were no active vaginal bleeding or intra-abdominal bleeding. On diagnosis of pulmonary embolism, she was treated with extracorporeal membrane oxygenation with heparinization. On day 4, ultrasonography showed newly developed hematoma at the anterior side of the uterus, and transarterial embolization was performed. On day 5, she developed acute kidney injury but there were no increase in size of the hematoma on ultrasonography. She recovered after 3 days of renal replacement therapy. However, on day 10, she showed tachycardia and increased serum creatinine. Computed tomography revealed not only a 15-cm hematoma anterior to the uterus, but also another 17-cm hematoma in the retroperitoneal space under the left kidney. Exploratory laparotomy was performed for obstructive uropathy and hematomas were evacuated. The patient’s vital sign stabilized one day following surgery. Conclusion: When treating postpartum patients with pulmonary embolism, physicians should be aware of the possibility of a concealed hemorrhage in the Retzius space and of subsequent kidney injury.

Outcome of Acute Renal Failure in Neonates and Its Associating Factors

Objective:To identify various predisposing causes and immediate consequences in new-borns presenting with acute renal failure. Study design: The study design was case series. Place &amp; duration:In the Pediatric department of Shifa International Hospital, Islamabad for one-year duration from September 2020 to August 2021. Material and Methods:A total of 1300 cases were assessed for acute renal failure (ARF)and 98 established cases of ARF being included in the research. The neonates (0-28 days old) who met the criteria for ARF, i.e., anuria/oliguria plus a serum creatinine level more than 1.5 mg/dl, were included in this research. The patient's relevant medical history, physical examination, and laboratory tests were recorded on a separate proforma after given informed permission for the procedure. Each patient's outcome was precisely documented. The statistical software for social sciences was used to examine the data (SPSS20.0). A p-value of less than &lt; 0.05 was considered significant. Results:A total of 98 cases (7.5 percent) were studied, with 68 (69.4 percent) males and 30 (30.6 percent) females. The ratio of males to females was 1.6:1. According to the study results, the mean age was 9.85± 7.20 days and the mean weight was 2.54± 0.65 kg. The majority of the infants were delivered at a hospital (73.5 percent). The most prevalent ARF symptoms in our neonates were birth asphyxia (30.6%), sepsis (24.5%), respiratory distress syndrome (RDS) (11.2%), and dehydration (9.2%), bleeding in (4.1 percent) and meconium aspiration in 3(3.1 percent). CCF and neurogenic bladder were both present in two patients. In 4 individuals, obstructive uropathy was found, including 2 cases of urethral valve (PUV) blockage and 2 cases of pelvic ureteric junction obstruction (PUJO). Neonates with ARF had a 28.5 percent overall death rate (28 cases). Conclusion:When it comes to neonates in critical care, acute renal failure is a frequent concern to observe. More than one predisposing factor for acute renal failure was present in the majority of the patients. Preventing acute renal failure in infants may be accomplished by early identification of risk factors and prompt treatment of underlying diseases. Keywords:Renal failure, Sepsis, Birth asphyxia, Neonates

Thrombotic thrombocytopenic purpura in pregnancy. Giving birth or not giving birth, that is the question

Introduction. Pregnancy is one of the most frequent triggers of congenital and acquired forms of thrombotic thrombocytopenic purpura (TTP).Aim — to develop tactics for the treatment of pregnant women with TTP.Results. TTP was associated with pregnancy in 55.5 % of all cases of TTP in women. In 5 pregnancies in which the diagnosis of TTP was known before pregnancy, or established in the early stages, TTP was treated throughout the pregnancy. In the congenital form, plasma transfusions were performed once every two weeks until the  20th  week of pregnancy, or  weekly, if thrombocytopenia &lt; 150 × 109 /L persisted. Plasma transfusions were performed weekly after the 20th week with the goal of achieving clinical remission. With acquired TTP, glucocorticosteroids and plasma exchanges were used as  treatment, in 1 case — rituximab, with the aim of achieving a clinical remission and an ADAMTS13 activity &gt; 20 %. In this group of pregnant women, 1 caesarean section was performed and there were 4 cases of vaginal deliveries, with a total of 5 children being born with an average Apgar score of 7.5. In 7 pregnancies in which TTP fi rst manifested late, leading to a delayed diagnosis, preventive and curative measures were not carried out before delivery. In this group there were 2 abortions of pregnancy, 5 surgical deliveries, 3 cases of preeclampsia, 3 acute cerebral circulatory disorders, 1 intraabdominal bleeding, 1 case of acute renal failure, with two women undergoing mechanical ventilation. There was 1 case of antenatal fetal death, with a total of 4 children being born, who were assessed on the Apgar scale with an average of 5 points.Conclusion. Timely diagnosis as well as ongoing therapeutic and preventive measures help to avoid complications during childbirth in pregnant women with TTP.

[Clinical analysis of 34 cases of acute fatty liver of pregnancy].

Objective: To analyze the characteristics, diagnosis and prognosis of acute fatty liver of pregnancy (AFLP), and to guide the management of AFLP patients. Methods: The clinical data of 34 AFLP patients admitted to Beijing Obstetrics and Gynecology Hospital, Capital Medical University from January 2009 to December 2019 were retrospectively analyzed. The general situation, diagnostic characteristics, treatment and maternal and neonatal prognosis of the AFLP patients were collected and analyzed. Results: The incidence of AFLP in our hospital was 0.022% (34/152 383). The age of onset was (30.6±4.9) years old, and the gestational age was (35.3±2.4) weeks. Most of the first symptom was gastrointestinal symptoms of unknown cause in the third trimester of pregnancy (53%, 18/34), accompanied by different degrees of elevated liver enzymes. Cesarean section was performed in 97% (33/34) of patients for termination of pregnancy. Only one pregnant woman was diagnosed prenatal and delivered vaginally, and the prognosis of both mother and infant was good. Five cases were transferred to intensive care unit, including 2 cases of acute renal failure, 1 case of gastrointestinal bleeding and 2 cases of disseminated intravascular coagulation. There was no maternal death. Severe asphyxia occurred in 2 neonates. Conclusions: Attention should be paid to the digestive tract symptoms during the third trimester of pregnancy and the diversity of clinical manifestations of AFLP for early detection. Once AFLP is diagnosed, pregnancy should be terminated as soon as possible to improve maternal and infant outcomes.