Acute Kidney Injury Conditions Research Articles

Management of hepatorenal syndrome and associated outcomes: a systematic review

BackgroundHepatorenal syndrome (HRS), a multiorgan condition of acute kidney injury, is seen in advanced liver disease. This study aims to evaluate the current treatment for HRS.MethodsThe authors searched PubMed, Scopus...

The study of the prooxidant-antioxidant equilibrium in the kidney tissue and blood on the background of ceruloplasmin administration under the conditions of acute kidney injury

Acute kidney injury (AKI) remains a relevant medical problem. The promising direction of the AKI treatment is the use of the antioxidants that inhibit free radical processes and prevent the destruction of cell membranes within pathological processes. Ceruloplasmin (CP) is the main antioxidant of blood plasma, that demonstrates membrane protecting effects and antitoxic activity.The aim of the study was to establish the influence of a single-dose administration of ceruloplasmin on the processes of the peroxidation in the kidney tissue and blood under the conditions of acute kidney injury.Materials and methods. The influence of ceruloplasmin on the prooxidant-antioxidant equilibrium in the kidney tissue and blood was studied in an experiment on white non-line rats under the conditions of rhabdomyolysis-induced acute kidney injury. The acute kidney injury was modeled by intramuscular administration of 50% glycerol solution at a dose of 8 mg/kg. Ceruloplasmin was administered intraperitoneally at a dose of 7 mg/kg/day. The level of main indicators of prooxidant-antioxidant balance in blood and kidney tissue was determined in 24 h after glycerol administration for induction of acute kidney injury.Research results and their discussion. There was a deep disruption of the prooxidant-antioxidant equilibrium as a result of the acute kidney injury. AKI causes an activation of the prooxidant processes by increasing the level of the malonic dialdehyde and the oxidized proteins in the kidney tissue and blood. AKI also reduces the antioxidant protection by decreasing the activity of the antioxidant enzymes in the kidneys and blood plasma.A single-dose administration of ceruloplasmin improved antioxidant protection and reduced peroxidation of lipids and proteins. There was a decrease in levels of malondialdehyde and oxidative modification of proteins. At the same time, the antioxidant protection intensified due to an increase in the activity of glutathione peroxidase and catalase in the kidneys and blood plasma.Conclusions. A single administration of ceruloplasmin influences prooxidant-antioxidant balance, reducing the content of lipid and protein peroxidation products and increasing the activity of antioxidant enzymes.

ACTIVITY OF ANTIOXIDANT PROTECTION ENZYMES IN BLOOD AS A MARKER OF NEPHROPROTECTIVE EFFECT BY SODIUM POLY-(2,5-DIHYDROXYPHENYLEN)-4-THIOSULFATE ACID

The article presents the results of assessing the activity of catalase and superoxide dismutase enzymes in the blood as markers of the nephroprotective effect by sodium poly-(2,5-dihydroxyphenylen)-4-thiosulfate acid under conditions of ethylene glycol and glycerol acute kidney injury and gentamicin-induced nephropathy. The studies were conducted on 96 white mature, full-grown non-linear rats of both sexes weighting 180-200 grams. Models of acute kidney pathology in the rats were reproduced in accordance with the methodological recommendations of the Ministry of Health of Ukraine. Blood activity of superoxide dismutase and catalase was determined spectrophotometrically with standard methods. It has been established that oxidative stress plays a significant role in the pathogenesis of ethylene glycol and glycerol acute kidney damage and gentamicin nephropathy, as evidenced by significant changes in the antioxidant defence system, and namely by inhibition of the activity of superoxide dismutase and catalase enzymes. Under the conditions of acute kidney injury and nephropathy, the sodium poly-(2,5-dihydroxyphenylen)-4-thiosulfate acid contributed to the activation of superoxide dismutase and catalase better than reference medicines as plan-based chophytol, and mexidol as antihypoxant and thiotriazoline as antioxydant. Thus, the antioxidant enzymes as superoxide dismutase and catalase can serve as markers of the nephroprotective effect produced by the preparation of sodium poly-(2,5-dihydroxyphenylen)-4-thiosulfate acid. And therefore, we suggest sodium poly-(2,5-dihydroxyphenylen)-4-thiosulfate acid exhibiting antihypoxic, cytoprotective, antioxidant properties is a promising drug for the treatment of acute kidney diseases.

In vivo effects of allogeneic mesenchymal stem cells in a rat model of acute ischemic kidney injury.

Objective(s):Renal ischemia-reperfusion injury (IRI) as a severe condition of acute kidney injury (AKI) is the most common clinical problem with high mortality rates of 35-60% deaths in hospital. Mesenchymal stem cells (MSC) due to unique regenerative characteristics are ideal candidates for the treatment of the ischemic injuries. This work is focused on the administration of MSC to IRI-induced AKI Wistar rats and evaluating their significance in AKI treatment. Material and Methods:Animals underwent surgical procedure and AKI was induced by 40 min bilateral renal pedicle clamping. Immediately after reperfusion, 2×106 rat bone marrow derived MSCs were injected via intra-parenchymal or intra-aortic route. Results:Animals subjected to AKI after days 1 and 3 showed significant increase in the serum creatinine and blood urea nitrogen (BUN) concentration along with a declined glomerular filtration rate (GFR) when compared with non-ischemic animals. On the other hand, treated animals showed a significant enhanced regeneration as compared to ischemic animals in both administration route groups. Conclusion:According to the results concluded from the renoprotective effects of MSC in IRI/AKI, MSCs could be considered as promising therapeutic approach for AKI in clinical applications.

WITHDRAWAL OF ANGIOTENSIN ANTAGONISTS IN ELDERLY CHRONIC KIDNEY DISEASE PATIENTS

Objective: Hypertension guidelines worldwide recommend first-line treatment with Angiotensin Convertor Enzyme Inhibitors (ACEI) or Angiotensin II Receptor Blockers (ARBs) in almost all groups of patients. Nevertheless, some population as elderly or CKD patients at high risk to develop renal complications may benefit from avoidance of these commonly used drugs. Design and method: We reviewed our registry of out-hospital patients who had to suspend ACEI or ARBs treatment selecting those without kidney loss, known renal artery stenosis, active neoplasms or drug withdrawal in a condition of Acute Kidney Injury and we performed 12 months follow up. Finally, 36 resulting patients completed the one year period and data of basal, three months and 12-month visits have been compared. A case-control study examining the glomerular filtration rate (GFR), first-day urine albuminuria, blood pressure control and plasmatic potassium has been performed. Results: Baseline characteristics: 17 males and 19 females both with an average age of 78.3 (SD 7.7) years, Charlson's comorbidity index of 6.8 (SD 2), 14 treated previously with ACEI and 22 with ARBs. Comparison of average blood pressure, GFR, proteinuria and potassium levels showed: 1. There were no significant variations in blood pressure at 3 and 12 months. 2. GFR increased at 3 and 12 months from 31.9 (SD 9.4) to 39.6 (SD 14.9) and 43.1 (SD 17.3) ml/min/1.73m2 [p < 0.001] 3. Plasma potassium level decreased at 3 and 12 months from 5.1 (SD 0.6) to 4.7 (SD 0.5) and 4.6 (SD 0.5) mg/dl respectively [p < 0.001] 4. First-day urine albuminuria increased significantly at the 12-month visit in the overall group(from 127.4 (SD 301.8) to 233 (SD 557) mg/g, p < 0.05). Nevertheless, no significant change was observed in the group of 27 patients without significant previous proteinuria (from 13.9 (SD 16.8) to 21.5 (SD 24.8), p = 0.1 NS). Conclusions: Elderly patients with prolonged hypertension are at risk to develop slowly progressive kidney failure associated with the use of ACEI and ARBs, especially if renal atrophy is present. These patients without previous proteinuria would benefit from the first-line use of antihypertensive drugs without suppressive effect over the renin-angiotensin system.

A rare condition of acute kidney injury: Renal arterial thrombosis in a small cell lung cancer patient

A rare condition of acute kidney injury: Renal arterial thrombosis in a small cell lung cancer patient

ネフローゼ症候群に伴う特発性急性腎障害(NSAKI)の主要な病態は腎実質浮腫である

重症浮腫を伴うネフローゼ症候群の中で，急性腎障害を来すNSAKI 症例をしばしば経験する。当院で経験したNSAKI の4 例においては，FENa やFEUN は異常低値であり，Na/K exchange index やレニン活性の上昇を認めた。加えて，高血圧や下大静脈径，hANP/BNP の増加があった。腎実質の浮腫に伴う腎虚血からレニンアンギオテンシン系の亢進が起こった結果， “腎血管の虚血” と“体血管の溢水” とが同時に存在するアンバランスな病態が引き起こされたと考えた。腎不全状態が半年以上続いたにも関わらず回復したNSAKI 症例の検討では，FENa の異常低値の持続から「腎前性腎不全とそれに反応できる尿細管機能の残存」，腎病理からは「尿細管の血流障害により急性尿細管壊死を呈している可逆的な状態」が想定された。NSAKI の治療としては腎実質の浮腫をとることが重要であり，濃厚アルブミン投与と利尿剤併用が考慮されるべきである。

Evaluation of bioartificial renal tubule device prepared with human renal proximal tubular epithelial cells cultured in serum-free medium

Bioartificial renal tubule devices (BTD) use cell therapy to improve conditions commonly observed in recipients of artificial kidneys for treatment of kidney diseases. We previously reported significant improvement of the condition of acute kidney injury (AKI) animals after treatment with BTD prepared with lifespan-extended human renal proximal tubular cells (hRPTEC). However, a major obstacle to use of BTD for patients is their biological safety, because hRPTEC are cultured in medium containing fetal calf serum. To establish the biological safety of BTD, we prepared BTD with lifespan-extended hRPTEC cultured in a newly developed serum-free medium and compared these with BTD prepared with hRPTEC cultured in serum-containing conventional medium. Lifespan-extended hRPTEC cultured in serum-free medium (hRPTEC-SFM) can proliferate similar to hRPTEC cultured in serum-containing conventional medium (hRPTEC-CM). Comparison of leakage and of reabsorption of small molecules for BTD prepared with hRPTEC-SFM (BTD-SFM) with those for our previous BTD prepared with hRPTEC-CM (BTD-CM) showed transportation in these two types of BTD was almost identical. When AKI goats were treated with BTD-SFM for 26h, increase of survival time and reduction of cytokine expression in blood cells were almost same as for AKI goats treated with BTD-CM. Quantification of the expression of some genes of hRPTEC in BTD revealed significant changes during BTD treatment for AKI goats. In conclusion, lifespan-extended hRPTEC-SFM work as well as hRPTEC-CM, and the biological safety of BTD for patients could be elevated without loss of function by preparation from hRPTEC-SFM.