Development Of Acute Renal Failure Research Articles

Risk factors for development of acute renal failure in 5077 coronary artery bypass grafting patients in the current era.

Acute renal failure (ARF) is one of the major complications after coronary artery bypass grafting (CABG) surgery. The risk factors are changing along with the technical evolution. The aim of this study was to identify the risk factors for ARF requiring dialysis after CABG surgery in the current era. Between April 2012 and November 2019, 5077 consecutive patients who underwent CABG were analyzed retrospectively. The patients were divided into ARF group and non-ARF group according to whether ARF occurred and dialysis was required after operation. Univariate analysis was performed to find possible factors associated with ARF. Any variables that had trends to be associated with ARF were included in stepwise multiple logistic regression analysis. Of the 5077 patients who underwent CABG, 53 (1.04%) developed ARF requiring dialysis whereas 5024 (98.96%) were in non-ARF group. Cardiopulmonary bypass (CPB) time (odds ratio [OR], 1.009; 95% confidence interval [CI], 1.003-1.016; p = .006), insertion of intra-aortic balloon pump (IABP; OR, 19.294; 95% CI, 5.49-67.808; p = .000), and low ejection fraction (EF; OR, 0.943; 95% CI, 0.894-0.994; p = .030) were independent risk factors for development of ARF requiring dialysis in patients undergoing CABG surgery. Our study identified prolonged CPB time, insertion of IABP, and low EF as independent risk factors for developing ARF requiring dialysis after CABG. The results suggest that shortening of CPB time and protection of cardiac function are important factors to prevent ARF and that special care should be taken to protect the renal function when the patient need insertion of IABP.

Metamizole-Associated Risks in Decompensated Hepatic Cirrhosis.

Because of the increased risk of acute renal failure (ARF), the use of cyclooxygenase (COX) inhibitors is not recommended in patients with decompensated hepatic cirrhosis. Metamizole is not a classic COX inhibitor, but there are insufficient data to support its safe use. In this study, we investigate the effect of metamizole on the risk of ARF in these patients. Metamizole use, ARF incidence, and patient mortality were examined in a large, retrospective, exploratory cohort and validated with data from a prospective registry. 523 patients were evaluated in the exploratory cohort. Metamizole use at baseline was documented in 110 cases (21%) and was independently associated with the development of ARF, severe (grade 3) ARF, and lower survival without liver transplantation at follow-up on day 28 (HR: 2.2, p < 0.001; HR: 2.8, p < 0.001; and HR: 2.6, p < 0.001, respectively). Interestingly, the risk of ARF depended on the dose of metamizole administered (HR: 1.038, p < 0.001). Compared to patients who were treated with opioids, the rate of ARF was higher in the metamizole group (49% vs. 79%, p = 0.014). An increased risk of ARF with metamizole use was also demonstrated in the independent validation cohort (p < 0.001). Metamizole therapy, especially at high doses, should only be used with a high level of caution in patients with decompensated cirrhosis.

Electrochemically based targeted metabolomics for uric acid, xanthine, and hypoxanthine in plasma samples for early diagnosis of acute renal failure after cardiopulmonary bypass using rGO-GCE

Cardiopulmonary bypass (CPB) may cause a systemic inflammatory reaction in patients during cardiac surgery due to the interaction of blood with heart-lung machine circuits. This inflammation may lead to organ failure. One of the most severe complications of cardiac surgery is the development of acute renal failure (ARF). Early diagnosis of ARF using fast, accurate, and sensitive methods may prevent ARF development. Therefore, we developed and validated an electroanalytical method for simultaneous analysis of three biomarker candidates, uric acid (UA), hypoxanthine (HXA), and xanthine (XA), from plasma samples. Their quantification was performed using reduced graphene oxide modified glassy carbon electrode (rGO-GCE) synthesized through rapid one-step electropolymerization. The characterization studies of rGO-GCE with cyclic voltammetry (CV), electrochemical impedance spectroscopy (EIS), and scanning electron microscope (SEM) analyses showed a successful surface modification of GCE with rGO. The electrochemical oxidations of the biomarkers were examined using square wave voltammetry (SWV) with the rGO sensor in 0.1 M phosphate-borate (PB) buffer (pH 7). Various operational parameters, including pH and type of supporting electrolyte, instrumental parameters, electro polymerization cycles, and GO concentration, were optimized. Under optimum conditions, good linear responses were obtained for three metabolites (R2 > 0.99). The LOQ of the method was 0.12 μM for UA, 0.13 μM for XA, and 0.43 μM for HXA. The developed method was successfully applied to patient plasma samples of ARF (n = 9) and control (n = 17) collected at five-time points of CPB. The UA, HXA, and XA levels were significantly altered in ARF patients. The results showed the applicability of the developed method for early diagnosis of ARF developed after CPB.

The long-term impact of acute renal failure after aortic arch replacement for acute type A aortic dissection.

To determine the long-term impact of developing acute renal failure (ARF) on survival after open aortic arch reconstruction for acute type A aortic dissection (ATAAD). This was an observational study of consecutive aortic surgeries from 2007 to 2021. Patients with ATAAD were identified via a prospectively maintained institutional database and were stratified by the presence or absence of postoperative ARF (by RIFLE criteria). Kaplan-Meier survival estimation and multivariable Cox regression analysis were performed. A total of 601 patients undergoing open surgery for ATAAD were identified, of which 516 (85.9%) did not develop postoperative ARF, while 85 (14.1%) developed ARF, with a median follow-up time of 4.6 years (1.6, 7.9). Baseline characteristics were similar across each group, except for higher rates of branch vessel malperfusion and lower preoperative ejection fraction in the ARF group. Patients with ARF underwent more total arch replacement and elephant trunk procedures, with longer cardiopulmonary bypass and circulatory arrest times than patients without ARF. ARF was associated with worse short-term outcomes, including increased in-hospital mortality, prolonged mechanical ventilation, higher rates of sepsis, more blood transfusions, and longer length of hospital stay. Unadjusted Kaplan-Meier survival estimates were significantly lower in the ARF group, compared to the group without ARF (p < .001, log-rank test). After multivariable adjustment, the development of postoperative ARF was significantly associated with an increased hazard of death over the study's follow-up time-period (hazard ratio: 2.74, 95% confidence interval: 1.95, 3.86, p < .001). ARF is a highly morbid postoperative event that may adversely impact long-term survival after aortic surgery.

Colistin-induced nephrotoxicity and risk factors in intensive care unit: estimating from the routine laboratory findings

Objective: In this study we aimed to evaluate the patients treated with colistin in an intensive care unit (ICU) and risk factors emergence of acute renal failure (ARF) after colistine treatment.&#x0D; Materials and Methods: Patients treated with colistine in the ICU between June 2016 and September 2018 were reviewed in this retrospective study. The 37 patients who were received colistine more than 3 days due to detection of Acinetobacter baumannii in culture of tracheal aspirate specimen were included in this study. Sociodemographic and clinical data and also biochemical parameters, glomerular filtration rates (GFR), APACHE-II, RIFLE and AKIN scores were examined. Patients were divided into two groups as ARF-developing and non-ARF-developing. Follow - up parameters were compared between these two groups.&#x0D; Results: The patient group consisted of 26 males and 11 females. The mean age of the patients was 61.0 ± 19.33 years and %45 of the patients developed ARF. Mean APACHE-II score was 20.7±5.6. Mean age was significantly older in ARF patients. Onset day of colistine was significantly lower in patients with ARF. Significant relationships were found with the creatinine, albumin, AST, ALT and BUN parameters between ARF.&#x0D; Conclusion: Older age and early initiation of colistin treatment in the ICU should be considered to be risky for ARF development. Before colistin treatment BUN, creatinine, CRP, albumin and AST levels should be considered to be risky for ARF development. After colistin treatment ALT, BUN, creatinine, urine output, platelet, AST, arterial blood gas base excess levels, urine pH, and protein amount in urine should be followed carefully.

Estimation of Kinetic Glomerular Filtration Rate in Patients with Decompensated Heart Failure

Background: The coexistence of decompensated heart failure (DHF) and acute renal failure (ARF) is associated with longerhospital stay and greater mortality.Objectives: The aim of this study was to evaluate whether kinetic glomerular filtration rate (KeGFR) estimated with Chen´sequation can predict the development of ARF or mortality during hospitalization in patients with DHF.Methods: We conducted a retrospective study of consecutive patients with estimated kinetic glomerular filtration rate usingserum creatinine levels on admission and at 24 hours. The primary endpoint was a composite of ARF or mortality, and aROC curve was built to find the cutoff value with the best sensitivity and specificity to predict events. Acute renal failure wasdefined according to the KDIGO guideline. Patients were followed-up throughout hospitalization and those with a history ofchronic renal failure were excluded from the study.Results: Among 813 patients, 190 were excluded due to chronic renal failure and 608 patients were analyzed. Median age was81 years (IQR 25-75%: 73-87) and 48% were men; 25.5% were diabetics, 76% had hypertension, 19.4% had history of priormyocardial infarction and 46.8% presented left ventricular systolic dysfunction defined as left ventricular ejection fraction<45%. Median creatinine level on admission was 1.05 mg/dl. The incidence of the composite event was 41.1%. Age, sex andcomorbidities were similar in patients with and without the composite event, but KeGFR was significantly lower in this groupof patients (median: 50.7 ml/min vs. 57.9 ml/min, p<0.01) and resulted an independent predictor of mortality. The analysis ofthe ROC curve revealed that a cutoff point of 60 ml/kg/min for KeGFR (AUC 0.60) had the best diagnostic accuracy to predictthe composite event and was present in 58.9% of the patients. Age, female sex, hypertension and diabetes were predictors ofthe composite event.Conclusions: Kinetic glomerular filtrate rate can be used as an independent predictor of the composite event, but has no clinicalrelevance due to its low specificity.

Acute Renal Failure Adversely Affects Survival in Pediatric Dengue Infection.

Aims:Dengue is currently one of the most important mosquito-borne viral infections. Acute renal failure (ARF) is a serious complication among children suffering from dengue infection.Subjects and Methods:A retrospective cohort review of baseline characteristics, disease outcomes, and risk factors of dengue-infected patients, with and without renal failure (RF), were compared.Results:Among 97 children with dengue, 13.4% had RF (estimated glomerular filtration rate <60 ml/min/1.73 m2) at presentation. In comparison to all children (100%) of RF cohort, only 32% children of non-RF cohort (P < 0.0001) were suffering either from dengue hemorrhagic fever (DHF) or dengue shock syndrome (DSS). The 7-day survival rate was 61.5% (8/13) among RF group as compared to 96.4% (81/84) in non-RF group (P < 0.001). When a fraction of patients who needed vasopressor support were significantly higher in RF cohort (70% vs. 14% for RF and non-RF, respectively, P < 0.001), requirement of mechanical ventilation (15% vs. 11%, P = 0.67) was comparable in both cohorts.Conclusions:DHF/DSS is an independent risk factor for the development of ARF in patients with dengue infection. Mortality rate is high once RF develops in these children.

Risk factors for acute renal failure in nephrectomized patients treated in a university hospital.

BackgroundNew surgical techniques for nephrectomy mainly related to early diagnosis made possible by advances in imaging studies have been developed in recent decades. However, postoperative renal dysfunction is a constant concern because of the major problems faced by healthcare services and by the patients themselves. To assess risk factors for developing acute renal failure (ARF) in patients submitted to nephrectomy in a university hospital.MethodsSeventy-seven patients submitted to nephrectomy for benign and malignant diseases in a university hospital were evaluated in respect to preoperative and postoperative creatinine clearance. Demographic (gender, age), clinical (cancer, diabetes, high blood pressure, chronic kidney disease) and surgical (anesthesia time, open or laparoscopic surgery) variables were also analyzed.ResultsOf the 77 patients, 72 met the inclusion criteria. Of these, ten (13.8%) had a diagnosis of chronic renal failure (CRF), 30 (48%) had stage I ARF and one (16.1%) had stage II ARF. The anesthesia time, type of surgery (open or laparoscopy), total or partial nephrectomy, the side of the procedure, hypertension, diabetes, CRF, renal cancer, preoperative and postoperative creatinine concentrations were analyzed. Only the difference between preoperative and postoperative creatinine clearance was clinically significant (P<0.001).ConclusionsAn altered preoperative renal function is a risk factor for the development of ARF in nephrectomized patients.

Concurrent renal artery stent during endovascular infrarenal aortic aneurysm repair confers higher risk for 30-day acute renal failure

ObjectiveConcurrent renal artery angioplasty and stenting (RAAS) during endovascular aneurysm repair (EVAR) of infrarenal abdominal aortic aneurysm (AAA) has been practiced in an attempt to maintain renal perfusion. The aim of this study was to identify the current practice of RAAS during EVAR and its effect on perioperative renal outcome. MethodsPatients with infrarenal AAA were identified from the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP, 2011-2014) database. Baseline characteristics of patients with concurrent RAAS during EVAR were compared with those of patients who underwent EVAR only. Bivariate and multivariable logistic regression analyses controlling for patients' demographics, comorbidities, and operative factors were used to evaluate the predictors of 30-day acute renal failure (ARF). Sensitivity analysis was done to evaluate the role of RAAS in patients with prior kidney disease. ResultsOverall, 6183 patients underwent EVAR for infrarenal AAA during the study period. Of them, 281 patients had RAAS during EVAR (4.5%). The median age of the patients was 74 years; 81.7% of the cohort was male, but a higher proportion of female patients received EVAR + RAAS compared with patients who underwent EVAR only (26.3% vs 17.9%; P < .001). There was no difference between groups in terms of comorbidities, being on dialysis, or functional status, yet the EVAR + RAAS group had a higher proportion of patients with glomerular filtration rate <60 mL/min/1.73 m2 (45.2% vs 37.2%; P = .011). RAAS was associated with significantly higher odds for development of ARF (adjusted odds ratio [aOR], 4.27; 95% confidence interval [CI], 2.06-8.84; P < .001). Other highly predictive factors of 30-day ARF were glomerular filtration rate <60 (aOR, 2.92; 95% CI, 1.47-5.78; P = .002), emergency status (aOR, 2.97; 95% CI, 1.21-7.27; P = .017), and ruptured AAA as the indication for EVAR (aOR, 4.74; 95% CI, 1.80-12.50; P = .002). Patients with prior kidney disease who had EVAR + RAAS demonstrated a 12-fold higher odds for 30-day ARF (aOR, 12.37; 95% CI, 4.66-32.89; P < .001). ConclusionsConcurrent RAAS was found to be a significant determinant of adverse renal outcomes after EVAR for infrarenal AAA. This effect was present even after controlling for patients' risk factors that might contribute to postoperative ARF.

Abstract PR385

Background & Objectives: Despite recent advances in understanding the pathophysiology and treatment modalities, Acute Kidney Injury (AKI) remains a common condition among post-operative patients who are admitted to the intensive care unit1. The determinants of renal function are multi factorial and are profoundly altered in the peri-operative period. The objective of this study was to identify factors associated with the development of postoperative AKI and its clinical outcomes among non cardiac post surgical patients admitted to the surgical intensive care unit. Materials & Methods: A prospective study was carried out at the surgical intensive care unit, Teaching Hospital Anuradhapura, over a 6 month period in 2013. Demographic, clinical and physiological data of patients were recorded on admission and during the course of illness, to assess the pre-operative status, intra-operative and post-operative complications. Acute renal failure (ARF) was diagnosed according to the AKIN criteria2. Organ dysfunction was assessed using SOFA score3. Univariate analysis was done to determine significant association of variables (p< 0.05) using Chi-square test. Results: Thirty eight patients met the inclusion criteria during the study period. Fourteen (37%) patients developed ARF and among them 10 (27%) needed either intermittent haemodialysis or continuous renal replacement therapy. Age, gender and BMI were not significantly associated with development of post-operative ARF. Acute lung injury/ ARDS (p=0.048), SOFA score on admission (p=0.048) and ASA grading (p=0.038) were significantly associated with ARF. Type of surgery (emergency or elective), duration of surgery, severity of surgery and blood transfusion during surgery were not significantly associated with ARF. Development of ARF was significantly associated with increased length of ICU stay. Conclusion: In our study important risk factors for development of ARF peri-operatively were acute lung injury/ ARDS, SOFA score on admission and ASA grading.

Characteristics of snake envenomation in eastern India, a study of epidemiology, complications and interventions

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; Snake bite is an important public health problem in the tropics. The annual mortality rate in India is 15000-20000 due to snake envenomation. This study intended to analyze the characteristics of snake envenomation in detail in current time.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; Total 122 cases of snake bite with features of envenomation who were admitted in our hospital in last 2 years were evaluated with detailed analysis.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; Significant association (p&amp;lt;0.05) (p=0.0029 at the degree of freedom 1) was found between time of AVS administration and development of ARF and/or RP. Patients receiving AVS at or after 6 hours were more likely to develop acute renal failure (ARF) and respiratory paralysis (RP) compared to patients receiving AVS before 6 hours. &lt;/p&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; Timely detection and early intervention by AVS can prevent dangerous complications and mortality of snake bites.

Sa1882 Exploring Predictors of in-Hospital Mortality in Dieulafoy's Lesions of the Stomach and Intestine

Introduction: Dieulafoy's lesions (DL) are a rare and often unrecognized cause of obscure, and sometimes significant upper gastrointestinal (GI) hemorrhage. There are currently no population-based studies evaluating mortality risk associated with the locality of DL. We used a national database to assess the association between in-hospital mortality and demographic, co-morbidities and intervention variables, among patients with DL of the stomach and intestine. Methods: Using National Inpatient Sample (NIS) data between January 2004 and December 2009, simple and multiple logistic regression analyses were conducted to assess the effect of the various covariates onmortality. Demographic covariates explored in this analysis included gender, age, race/ethnicity, income, and type of insurance. Co-morbidities of interest include atrial fibrillation (AFIB), coronary heart disease (CAD), congestive heart failure (CHF), acute renal failure (ARF), chronic kidney disease (CKD), end stage renal disease (ESRD) and coagulopathies (COAG). Additionally, the Charlson-Deyo Index (CDI) was used to measure the burden of co-morbidities. Interventions include packed red cell transfusion (PCT), endoscopic control of gastric hemorrhage (EGD), small bowel endoscopy (SBE) and intensive level of care (ICU). Results: We identified 4,652 patients with a primary diagnosis of DL, out of which 88% were located in the stomach and 12% were found in the small and large intestine. The overall percentage mortality of DL is around 3%. There was no significant difference in mortality between DL of the stomach and intestine. When compared to 2004, there is a significant decrease in mortality from year to year. Multiple logistic regression, modeling mortality as the outcome variable, was statistically significant for patients with age greater than 85, odds ratio (OR) =5.30 and patients with ARF OR= 4.21. About 1,335 patients or 29% of the total population had small bowel endoscopy and was found to be associated with an OR=1.78. About 70% or 3290 patients had EGD and 60% or 2786 patients had PCT. About 6% of the patients had ICU level of care, as defined by the use of mechanical ventilation (6%), central venous catheterization (13%) and hemodialysis (3%). If patient had ICU level of care, it was associated with OR=16.8 of death. Coagulopathies were not found to be significantly associated with death. Conclusion: This is the first population-based study that explored factors associated with in-hospital mortality for DL. Among demographic variables, only age greater than 85 was associated with significantly higher mortality. Disparity in care was not a factor since gender, race/ethnicity, income and type of insurance had no bearing on mortality. Mortality however, was significantly associated with the development of ARF and if the patient was admitted to ICU level of care.

Clinical and laboratory findings in patients with oliguric and non-oliguric Hantavirus haemorrhagic fever with renal syndrome: an analysis of 128 patients

Patients with haemorrhagic fever with renal syndrome (HFRS) may present without significant oliguria. We compared different initial clinical symptoms and laboratory findings in patients who developed oliguric acute renal failure (ARF) with those in patients who did not develop oliguric ARF. Overall, 128 patients with serologically confirmed HFRS were hospitalized at the University Hospital for Infectious Disease, Zagreb, Croatia between January 1999 and December 2010. Clinical signs and laboratory findings were extracted from medical charts, and were assessed for their relationship to the development of oliguric ARF. Puumala virus infection was diagnosed in 101 (79%) patients, and Dobrava-Belgrade virus infection in 27 (21%). Oliguria or anuria developed in 30% of patients. We identified the following risk factors for the development of oliguria and anuria on multivariable analysis: conjunctival hyperaemia or bleeding (relative risk (RR) 1.84, 95% CI 1.09–3.10; p 0.023), diarrhoea (RR 1.45, 95% CI 1.07–1.97; p 0.017), serum sodium of ≤133 mM (RR 2.21, 95% CI 1.34–3.64; p 0.002), and dipstick protein value of >1.5 g/L (RR 1.59, 95% CI 1.09–2.33; p 0.016), as well as hiking in the forest (RR 1.92, 95% CI 1.13–3.26; p 0.016). Our findings may help physicians in the earlier identification of patients with a more severe form of HFRS caused by Puumala and Dobrava-Belgrade viruses. Particular attention should be given to findings such as conjunctival hyperaemia or bleeding, diarrhoea, a low serum sodium level, and proteinuria.

개심술 환자의 수술 후 급성 신부전 발생 위험요인

The purpose of this study is to identify prognostic predictors of postoperative acute renal failure(ARF) for the patient undergoing cardiac surgery. Retrospectively review the electronic hospital database at a A hospital from Jan 2008 to Dec. 2011. 483 patients were included in this study. They were divided into a occurrence of ARF group(n=59) and a non occurrence of ARF group(n=424). ARF occurred in 59 cases (12.2%). Multi-variable logistic regression analysis identified that preoperative risk factors include creatinine(OR 3.92, p=<.001), advanced age(OR 2.142, p=.015), female(OR 2.165, p=.015), hypertension(OR 2.513, p=.005), NYHA(New York Heart Association) class Ⅱ(OR 3.081, p=.003), and Ⅲ(OR 6.759, p=.004), and intraoperative risk factor includes blood transfusion(OR 3.753, p=<.001), and postoperative factors include bilirubin(OR 4.541, p=.028), creatine(OR 8.554, p=.003), and cardiac output(OR 0.214, p=.033) as a prognostic predictors. The development of postoperative ARF could be a reason for increase in rate of complication and mortality after cardiac surgery. therefore the prevention of ARF is of paramount importance and treatment strategies are urgently needed.

Renal dysfunction is common following resuscitation from out-of-hospital cardiac arrest

BackgroundCardiac arrest patients often suffer from dysfunction of multiple organ systems after return of spontaneous circulation (ROSC). The incidence of renal dysfunction in patients with out-of-hospital cardiac arrest (OHCA) is not well described. Renal dysfunction has been associated with worse outcomes in critical illness. HypothesisRenal dysfunction is common after OHCA, and renal dysfunction is independently associated with survival. MethodsWe performed a retrospective review of consecutive adult patients admitted to an intensive care unit after successful resuscitation from OHCA between 01/01/2005 and 12/31/2010. Patients were excluded for death or withdrawal of care within 24h, preexisting end-stage renal disease, or OHCA due to hyperkalemia. The RIFLE criteria were used to classify subjects with renal dysfunction into one of three categories – risk, injury, or failure – based on trending of serum creatinine concentration or glomerular filtration rate. Data were analyzed using descriptive statistics. ResultsOf 364 patients, 38 were excluded due to death or withdrawal of care within 24h, 11 due to end-stage renal disease, and 4 due to OHCA from hyperkalemia, leaving 311 patients in the final analysis. The mean age was 58 (SD 16) years; 174 (59%) were male, VF/VT was the primary rhythm in 156 (50%), and 236 (80%) were comatose at hospital arrival. Among 311 patients, 32 (10.3%) developed acute renal failure (ARF), 27 (8.7%) developed acute kidney injury (AKI), and 56 (18.0%) developed risk of renal dysfunction. Of the 32 subjects that developed ARF, renal replacement therapy (RRT) was initiated on 13 (40.6%). Development of ARF was not associated with survival (OR 0.73; 95% CI 0.26, 2.05) after adjusting for initial rhythm or illness severity. ConclusionsMore than one-third of patients resuscitated from OHCA developed evidence of renal dysfunction, and 19% of patients meeting criteria for AKI or ARF. In this study, development of renal failure was not independently associated with survival.

Increasing Creatine Phosphokinase and Myglobine Levels Predict the Development of Acute Renal Failure Immediately after Combined Heart-Lung Transplantation

Purpose Combined heart–lung transplantation (HLTx) is a therapeutic option for both adult and pediatric patients since the early 1980s. The leading indications for HLTx are congenital heart disease with Eisenmenger’s syndrome and, historically idiopathic pulmonary arterial hypertension. HLTx is plagued by frequent postoperative acute renal failure (ARF) requiring hemodialysis (up to 80%), by far not always explained by perioperative hemodynamic instability and other well-known risk factors. Here, we hypothesized that high levels of creatine phosphokinase (CPK) or myoglobine would predict acute renal failure after combined heart lung transplantation. Methods and Materials In this study, we present a cohort of 75 patients, who received combined heart and lung transplantation between 2002 and 2012 at Hanover Medical School. In this cohort we defined 2 groups according to the development of ARF requiring hemodialysis after transplant. In both groups CK, CKMB and myoglobin were measured preoperative and at the time of 6h, 12h, POD 1, POD 2, POD 3, POD 4, POD 5, POD 6 and once weekly up to 8 weeks after transplantation. We also assessed at which time after transplant the patients received the first course of hemodialysis. Results Of a total of 75 patients included into this study, 42 developed ARF after transplant und needed hemodialysis. The first course of hemodialysis was necessary on POD 2 (mean). 33 patients showed sufficient renal function. We detected a statistically significant positive correlation between CPK and myglobine levels in blood during the first 48 hours preceeding initiation of hemodialsis and the development of ARF (p Conclusions High CPK and myglobine levels in peripheral blood predict (and might even cause) the development of acute kidney injury immediately after combined heart lung transplantation.

Interleukin-6 modulates oxidative stress produced during the development of cisplatin nephrotoxicity

AimsWe reported that interleukin-6 (IL-6) plays a protective role in the development of cisplatin-induced acute renal failure (ARF) through upregulation of anti-oxidative stress factors. In this study, we examined the effects of dimethylthiourea (DMTU), a hydroxyl radical scavenger, on the development of cisplatin-induced ARF in wild-type (WT) and IL-6−/− mice to determine how IL-6 contributes to modulation of oxidative stress caused by cisplatin. Main methodsWT and IL-6−/− male mice were given either cisplatin (30mg/kg) or saline intraperitoneally. DMTU (100mg/kg) or saline was given 30min before cisplatin or saline administration. Blood and kidney samples were collected on days 1 and 3 after cisplatin administration. Key findingsIn WT mice, DMTU markedly improved cisplatin-induced renal dysfunction and survival rate. DMTU reduced the expression levels of TNF-α, Bax and c-fos and increased the expression levels of IL-6, Bcl-xL and Nrf2 in WT mice. Reduced reactive oxygen species (ROS) by DMTU resulted in increases of IL-6, anti-apoptosis and anti-oxidant gene expression levels. In IL-6−/− mice, DMTU also improved cisplatin-induced renal dysfunction and reduced expression levels of TNF-α, Bax and c-fos, but not Bcl-xL and Nrf2. Since Nrf2 induces IL-6 expression, IL-6 and Nrf2 may influence each other during anti-oxidant responses. The basal level of HO-1 in IL-6−/− mice was higher than that in WT mice. SignificanceIn IL-6−/− mice, overproduction of ROS by cisplatin results in upregulation of HO-1 expression in order to eliminate oxidative stress. IL-6 mediates the generation and elimination of ROS during cisplatin-induced ARF.

Peri-operative renal protection: The strategies revisited.

Postoperative acute renal failure (ARF) is a serious complication which can result in a prolonged hospital stay and a high mortality and morbidity. Underlying renal disease, cardiac diseases, nephrotoxin exposure and renal hypoperfusion are the possible predisposing risk factors which can create a high probability for the development of ARF. The incidence of ARF is highest after major vascular, cardiac and high-risk thoraco-abdominal surgery. Among the various renal protection strategies, adequate peri-operative volume expansion and avoidance of hypovolemia is the most accepted and practiced strategy. Numerous bio-markers of renal injury are used to estimate the presence and extent of renal insult and various new are currently under trial. Traditional pharmacological interventions like dopamine, diuretics and calcium antagonists are not currently the first line of reno-protective agents. The new non-pharmacological and pharmacological methods may improve outcome in renal transplantation, contrast-induced nephropathy and in various other settings of ARF. The current review is an attempt to refresh the knowledge and put forth the various renal protection strategies during the peri-operative period.

Acute renal failure predictors in elderly patients with chronic kidney disease.

Acute renal failure (ARF) is a very common problem in the elderly and is associated with high morbidity and mortality rates. This study analysed ARF predictors in a cohort of elderly subjects and their impact on the evolution of renal function. A group of 80 elderly individuals were recruited between January and April 2006, and 56 of these who were still alive after 36 months were retrospectively studied, examining episodes of ARF, their causes, and the need for dialysis. Twelve patients (21.4%) developed ARF: 4 (33.3%) related to heart failure, 4 (33.3%) due to infection/sepsis, 2 (16.7%) due to volume depletion, and another 2 were multifactorial (16.7%). No patients required dialysis therapy. Patients with ARF were older (P=.017), had worse renal function at baseline (P=.031), higher levels of uric acid (P=.002), and lower haematocrit (P=.003). Patients with ARF had a mean baseline serum creatinine of 1.57 ± 0.59 mg/dl and peak creatinine levels during episodes of ARF averaged 4.25 ± 4.26 mg/dl (P=.035). Mean renal function at 36 months in patients with ARF had decreased (P=.024). In a logistic regression analysis (independent variables: baseline MDRD, age, gender, Charlson index, serum creatinine, urea, and uric acid), age (RR: 1.20, 1.01-1.43, P=.039), uric acid (RR: 2.65, 1.11-6.30, P=.027), and haematocrit (RR: 0.64, 0.43-0.96, P=.031) were independently associated with the development of ARF. Baseline levels of uric acid and haematocrit are independent risk factors for the development of ARF in the elderly. Although these episodes may be functional in nature and not require dialysis, this can still cause a deterioration of renal function over time.

ACUTE RENAL FAILURE IN ACUTE POISONING: PROSPECTIVE STUDY FROM A TERTIARY CARE CENTRE OF SOUTH INDIA

Cases of people presenting with poisoning are likely to develop acute renal failure (ARF), which may be due to multiple mechanisms/aetiologies. These cases need careful observation and appropriate treatment. To find the risk of ARF among acute poisoning cases, identify the underlying causes and to analyse the outcome. In this prospective study with nested case control, 1,250 cases admitted to the Poison Control, Training and Research Centre of Government General Hospital, Madras Medical College were monitored and evaluated for development of ARF. Patients with history of diabetes/hypertension, known chronic kidney disease, chronic NSAID therapy, those on drugs that increase serum creatinine by inhibiting creatinine secretion and other co-morbid illnesses were excluded. Data were interpreted after subjecting them to bivariate logistic regression and then step wise multivariate analysis. Thirty-two cases developed ARF. Twenty-four were due to snake bite, the rest due to chemical poisons. Chances of developing ARF were greater (6.15%) among the poisoning due to bites and stings than chemical poisoning (0.9%). Five in the former and seven in the latter expired. Among cases bitten by snakes, only 22 (7%) cases bitten by Russell Viper Daboia russelii developed renal failure. Copper sulphate and rat killer poisonings were the commonest causes of chemical induced ARF, dichromate, indigenous medicines and vasmol 33 (paraphenelyne diamine) were the least causes for ARF. None of the patients with organophosphate developed ARF nor did any of the 150 admitted for overdose of medicines developed ARF. The risk of ARF among the cases of poisoning was 2.5%. The outcome of ARF among bites and stings was better than chemical poisoning, and the difference was highly significant (p= 0.005, OR = 0.04-1.0, 95% CI = 0.004-0.38). Early recognition and appropriate measures reduce the occurrence of ARF.