Etiology Of Acute Kidney Injury Research Articles

Herbal medicine in the management of renal disease: A comprehensive review of its potential for acute kidney injury, chronic kidney disease, diabetic nephropathy, and hypertension

Each year, a considerable number of individuals are diagnosed with potentially life-threatening renal failure, encompassing acute kidney injury (AKI) and chronic kidney disease (CKD). New natural herbal compounds, whether used in isolation or combined with medical treatments and an appropriate regime, have been suggested for the management of renal failure. The etiology of AKI remains uncertain; nevertheless, several factors have been proposed as potential causative agents that can lead to renal failure, including renal ischemia-reperfusion injury (IRI), nephrotoxicity, sepsis, administration of radiocontrast agents, and exposure to heavy metal ions. Several commonly utilized herbs with anti-diabetic and antihypertensive properties, known for their antioxidant, anti-inflammatory, and vasorelaxant effects, have been recognized as efficacious therapeutic agents in the management of CKD. The management of renal failure typically involves treating the underlying diseases, such as IRI, sepsis, and diabetes. However, if addressing the root cause is not possible, the focus shifts to managing complications like hypertension and proteinuria.

The effectiveness of locally-prepared peritoneal dialysate in the management of children with acute kidney injury in a south-east Nigerian tertiary hospital.

Peritoneal dialysis (PD) is the preferred mode of renal replacement therapy (RRT) in children with acute kidney injury (AKI). The gold standard remains the use of commercially-prepared PD fluid. In resource-poor nations, its availability and affordability remain a challenge. This study aims to report the effectiveness of locally-prepared PD fluid in the management of AKI in a south-east Nigerian tertiary hospital. This was a retrospective study conducted at the paediatric ward of the University of Nigeria Teaching hospital, Enugu. The case records of 36 children seen over three years, diagnosed with AKI and requiring PD were reviewed. The retrieved information comprised biodata, aetiology of AKI, indications for PD, pre-and post-dialysis estimated glomerular filtration rate (eGFR) and patient outcomes. The children (20 males and 16 females) were aged 3 to 36 months with a mean age of 9.92 ± 6.29 months. The common aetiologies of AKI were septicemia (30.6%), hemolytic uremic syndrome (19.4%), and toxic nephropathy (16.7%). The frequent indications for PD were uremic encephalopathy (58.3%) and severe metabolic acidosis (38.8%). The pre-and post-dialysis mean urine flow rate was 0.16 + 0.13 and 2.77 + 0.56 ml/kg/hour respectively. The eGFR before PD, at discontinuation, and a week later was 6.06 + 2.87, 24.44 + 15.71 and 59.07 + 22.22 mls/min/1.73m2 respectively. PD with locally-prepared dialysate is safe, effective and a life-saving alternative in the management of AKI in children.

Is the Use of Dialysis Associated With an Increased Risk of Death in COVID-19-Related Acute Kidney Injury?

Acute kidney injury (AKI) is frequently reported in the setting of severe acute respiratory syndrome coronavirus 2 (SARS‑CoV‑2) infection. The aim of our work is to evaluate the impact of acute dialysis use on mortality in patients with AKI during the coronavirus disease 2019 (COVID-19) pandemic. This is a retrospective study conducted in the Hassan II University Hospital of Fez, Morocco. From July 2020 to December 2021, we included all patients admitted to a COVID-19 unit with acute kidney injury defined according to Kidney Disease Improvement Global Outcomes 2012 (KDIGO 2012) criteria. Our patients were older than 18 years, and SARS-CoV-2 infection was confirmed by a positive RT-PCR test or thoracic CT scan imaging. Patients with end-stage renal disease (ESRD) and pregnant women were excluded from our study. The total number of patients hospitalized in the COVID-19 unit during the study period was 2560, including 206 in an intensive care setting. We included 61 patients with AKI, with an incidence in the intensive care unit (ICU) setting of 15.5%. Eighty percent of patients had respiratory distress on admission, which was the main reason for consultation. Stage 1 AKI was found in 1.6% of patients, 25.8% had stage II AKI, and 72.6% had KDIGO stage 3 AKI. The main etiology of AKI was acute tubular necrosis. Lung involvement secondary to infection was severe in 18 patients; 21 had moderate involvement. In our study, twenty-one of our patients (34.4%) were hospitalized in an ICU. Thirteen of our patients were intubated (21.1%). Twenty-one (34.4%) patients were hemodynamically unstable and were put on vasoactive drugs. Twenty-three (37.7%) of our patients received at least one session of conventional acute hemodialysis with an average duration of 2.1 hours ± 0.9 (1-3.5). The indication was overload (27%), severe metabolic acidosis (1.6%), threatening hyperkalemia (1.6%), and symptomatic hyperuremia (62%). The evolution was marked by a return to baseline renal function in two patients, partial improvement in 35 of them at discharge, and no improvement in 24 patients. We recorded a death rate of 34.4% (n=21). In a univariate analysis, we compared the demographic, clinical, paraclinical, and dialytic characteristics of the dialysis and non-dialysis groups. There was a significant difference between unstable, intubated patients and those hospitalized in the ICU in the dialysis group, with respective p-values of p=0.0001, p=0.0001, and p=0.01. We noticed there were more deaths in the dialysis group than in the non-dialysis group; this difference was statistically significant with a p-value of 0.005. In multivariate analysis, a logistic regression model was performed to test the relationship between dialysis and COVID-19 mortality while adjusting for other co-factors. The final model did not show a significant association between dialysis and mortality (p = 0.150, OR: 2.578 [0.710-9.364]). The only factor that remained independently significant was admission to the intensive care unit (p = 0.004, OR: 6.732 [1.847-24.540]). AKI is a frequently encountered complication in patients with COVID-19, especially those hospitalized in the ICU. In the context of the SARS-CoV-2 infection, the use of at least one dialysis session seems to represent an excess risk of mortality related to AKI.

Tertiary lymphoid structure signatures are associated with immune checkpoint inhibitor related acute interstitial nephritis.

Tertiary lymphoid structures (TLSs) are associated with anti-tumor response following immune checkpoint inhibitor (ICI) therapy, but a commensurate observation of TLS is absent for immune related adverse events (irAEs) i.e. acute interstitial nephritis (AIN). We hypothesized that TLS-associated inflammatory gene signatures are present in AIN and performed NanoString-based gene expression and multiplex 12-chemokine profiling on paired kidney tissue, urine and plasma specimens of 36 participants who developed acute kidney injury (AKI) on ICI therapy: AIN (18), acute tubular necrosis (9), or HTN nephrosclerosis (9). Increased T and B cell scores, a Th1-CD8+ T cell axis accompanied by interferon-g and TNF superfamily signatures were detected in the ICI-AIN group. TLS signatures were significantly increased in AIN cases and supported by histopathological identification. Furthermore, urinary TLS signature scores correlated with ICI-AIN diagnosis but not paired plasma. Urinary CXCL9 correlated best to tissue CXCL9 expression (rho 0.75, p < 0.001) and the ability to discriminate AIN vs. non-AIN (AUC 0.781, p-value 0.003). For the first time, we report the presence of TLS signatures in irAEs, define distinctive immune signatures, identify chemokine markers distinguishing ICI-AIN from common AKI etiologies and demonstrate that urine chemokine markers may be used as a surrogate for ICI-AIN diagnoses.

Biochemical Predictors of Acute Kidney Injury in Critically Ill COVID-19 Patients.

It is estimated that 50% of patients with coronavirus disease 2019 (COVID-19) have varying degrees of renal involvement. In this clinical biomarker development research, we examined in a retrospective study design the temporal changes in biochemical laboratory parameters in relation to the development of acute kidney injury (AKI). In a sample of 399 patients admitted from May 2020 to May 2021 to a tertiary health care intensive care unit (ICU), the incidence of AKI was 27.3%, and the median time to AKI was on 7th day of ICU admission. Most common etiology of AKI was kidney hypoperfusion. Within 72 h of developmental of low blood pressure, 63.76% developed AKI. The likelihood of AKI was higher in those with elevated serum ferritin, aspartate transaminase, and thrombocytopenia (low platelet count). A cutoff value of 750.3 ng/mL [area under the ROC curve (AUC) = 0.777] for serum ferritin, and 40.05 U/L for alanine aminotransferase (AUC = 0.677) 1 day before development of AKI displayed, respectively, a sensitivity of 76.2% and 64.3%, whereas the specificity was 69.5% and 64.1%, respectively, for these two biochemical predictors. A cutoff value of platelets (152.50 × 109/L [AUC = 0.75]) measured 4 days before development of AKI, displayed 83.3% sensitivity and 16.4% specificity. Taken together, our study thoroughly examined the temporal association of various clinical and laboratory parameters with AKI and prediction models were developed as per results of the time series data. These observations in a tertiary health care setting contribute to ongoing efforts for biomarker discovery and development using routine biochemical tests so as to forecast AKI in patients with COVID-19.

Acute Kidney Injury and Hypothyroidism in a Patient with CKD

Acute kidney injury (AKI) in the setting of hypothyroidism has been documented in the literature. However, hypothyroidism is not generally considered a cause during investigation of an acute kidney injury. Most of the cases described have been reported in setting of rhabdomyolysis, while fewer cases describe AKI occurring in the absence of rhabdomyolysis. Only rarely have case reports been supplemented by renal biopsy findings to ensure other etiologies of acute kidney injury were ruled out, and none of these reports have documented changes in the kidney that could be associated with the hypothyroid state. We report a case of AKI in chronic kidney disease in the absence of rhabdomyolysis, occurring during severe hypothyroidism, that resolved completely after achievement of a euthyroid state. In addition, we provide renal biopsy findings likely associated with the hypothyroid state. We propose that evaluation of the thyroid function should be considered in any patient during evaluation of an acute kidney injury.

Extracellular DNA concentrations in various aetiologies of acute kidney injury

Extracellular DNA (ecDNA) in plasma is a non-specific biomarker of tissue damage. Urinary ecDNA, especially of mitochondrial origin, is a potential non-invasive biomarker of kidney damage. Despite prominent tissue damage, ecDNA has not yet been comprehensively analysed in acute kidney injury (AKI). We analysed different fractions of ecDNA, i.e. total, nuclear and mitochondrial, in plasma and urine of children, and different animal models of AKI. We also analysed the activity of the deoxyribonuclease (DNase), which is contributes to the degradation of ecDNA. Patients with AKI had higher total and nuclear ecDNA in both, plasma and urine (sixfold and 12-fold in plasma, and 800-fold in urine, respectively), with no difference in mitochondrial ecDNA. This was mainly found for patients with AKI due to tubulointerstitial nephritis and atypical haemolytic uremic syndrome. Increased plasma ecDNA was also found in animal models of AKI, including adenine nephropathy (fivefold), haemolytic uremic syndrome (fourfold), and ischemia–reperfusion injury (1.5-fold). Total urinary ecDNA was higher in adenine nephropathy and ischemia–reperfusion injury (1300-fold and twofold, respectively). DNase activity in urine was significantly lower in all animal models of AKI in comparison to controls. In conclusion, plasma total and nuclear ecDNA and urinary total ecDNA is increased in patients and animals with particular entities of AKI, suggesting a mechanism-dependent release of ecDNA during AKI. Further studies should focus on the dynamics of ecDNA and its potential role in the pathogenesis of AKI.

Renal Involvement in Hospitalized COVID-19 Patients: Epidemiology, Risk Factors, and Correlation with Outcomes

Background: While respiratory tract symptoms are the most frequent reasons for hospital admission in COVID-19 patients, renal involvement is common and is associated with worse outcomes. The aim of this study was to determine the incidence, risk factors and outcome of Acute Kidney Injury (AKI) in hospitalized COVID-19 patients in a referral center.&#x0D; Methods: In a retrospective review, patients hospitalized for COVID-&#x0D; 19 from February 2020 through April 2020 in a referral COVID center were studied. Demographic data, pre-existing comorbidities and drug history, along with laboratory data at presentation and during admission were recorded. AKI was diagnosed based on Kidney Disease Improving Global Outcomes (KDIGO) criteria. Data were analyzed to determine the incidence, risk factors and mortality of AKI.&#x0D; Results: Finally, 200 patients were included, with a mean age of 60.5 years. Of these, 126 (63%) developed AKI and this number was 73.5% among the ICU-admitted patients. Patients who developed AKI were 4.29 times more likely to die. Pre-existing CKD, treatment with immunosuppressant, ICU admission, and the need for hemodialysis, were significantly associated with mortality. Among the eleven renal transplant recipients in this study, we found that a prior renal transplant was not associated with a higher rate of AKI but was significantly associated with increased mortality after correcting for age and gender.&#x0D; Conclusion: Our findings showed a high incidence of AKI in patients admitted due to COVID-19, with a higher risk in ICU patients and it was a significant predictor of mortality. Further research is encouraged to understand the etiology of AKI, along with the long-term outcomes in the patients.

Advances in Pediatric Acute Kidney Injury Prevention and Early Diagnosis

Acute kidney injury (AKI) is frequent in critically ill neonates, children, and adolescents, but it is still underdiagnosed and referral to followup at the Pediatric Nephrology Clinic is scant. Nowadays, most pediatric studies use Kidney Disease Improving Global Outcomes (KDIGO) criteria for AKI diagnosis. These criteria are based on the elevation of serum creatinine levels and on the decrease in urine output and they correlate with a higher need for kidney replacement therapy and a higher risk of death. Nonetheless, the KDIGO definition of AKI has several limitations, which may be overcome by the simultaneous use of novel biomarkers, particularly urinary neutrophil gelatinase-associated lipocalin (NGAL). The latter is already available in clinical practice and it is a useful tool to identify AKI earlier and to establish the prognosis. The most common AKI etiologies in the pediatric population are the prerenal causes, namely kidney hypoperfusion due to hypovolemia and peripheral vasodilation in the context of sepsis. Exposure to nephrotoxic drugs has been rising as a primary cause of AKI. Decreasing the use of nephrotoxic drugs whenever clinically possible, monitoring the serum levels of these medications, and adjusting its doses can significantly reduce AKI incidence. Finally, it is important to recognize that AKI is not a completely reversible phenomenon and long-term sequelae are seen in up to 70% of affected children. These sequelae include progression to chronic kidney disease, which accentuates the need for follow-up after an AKI episode. In conclusion, it is essential to improve awareness in the Pediatric community for AKI in order to prevent it, rapidly identify it and establish reno-protective measures, which will improve its long-term prognosis. This review will focus on current definitions, epidemiology and most common etiologies, and it will also discuss strategies to improve pediatric AKI prevention, early diagnosis and follow-up.

Choline supplementation attenuates experimental sepsis-associated acute kidney injury.

Acute kidney injury (AKI) is common in critically ill patients, and sepsis is its leading cause. Sepsis-associated AKI (SA-AKI) causes greater morbidity and mortality than other AKI etiologies, yet the underlying mechanisms are incompletely understood. Metabolomic technologies can characterize cellular energy derangements, but few discovery analyses have evaluated the metabolomic profile of SA-AKI. To identify metabolic derangements amenable to therapeutic intervention, we assessed plasma and urine metabolites in septic mice and critically ill children and compared them by AKI status. Metabolites related to choline and central carbon metabolism were differentially abundant in SA-AKI in both mice and humans. Gene expression of enzymes related to choline metabolism was altered in the kidneys and liver of mice with SA-AKI. Treatment with intraperitoneal choline improved renal function in septic mice. Because pediatric patients with sepsis displayed similar metabolomic profiles to septic mice, choline supplementation may attenuate pediatric septic AKI.NEW & NOTEWORTHY Altered choline metabolism plays a role in both human and murine sepsis-associated acute kidney injury (SA-AKI), and choline administration in experimental SA-AKI improved renal function. These findings indicate that 1) mouse models can help interrogate clinically relevant mechanisms and 2) choline supplementation may ameliorate human SA-AKI. Future research will investigate clinically the impact of choline supplementation on human renal function in sepsis and, using model systems, how choline mediates its effects.

69-Year-Old Man With Dysuria and Right Lower Abdominal Pain

69-Year-Old Man With Dysuria and Right Lower Abdominal Pain

Multidisciplinary basic and clinical research of acute kidney injury with COVID-19: Pathophysiology, mechanisms, incidence, management and kidney transplantation.

Acute kidney injury (AKI) linked to coronavirus disease 2019 (COVID-19) has been identified in the course of the disease. AKI can be mild or severe and that is dependent on the presence of comorbidities and the severity of COVID-19. Among patients who had been hospitalized with COVID-19, some were admitted to intensive care unit. The etiology of AKI associated with COVID-19 is multifactorial. Prevention of severe AKI is the prime task in patients with COVID-19 that necessitates a battery of measurements and precautions in management. Patients with AKI who have needed dialysis are in an increased risk to develop chronic kidney disease (CKD) or a progression of their existing CKD. Kidney transplantation patients with COVID-19 are in need of special management to adjust the doses of immunosuppression drugs and corticosteroids to guard against graft rejection but not to suppress the immune system to place the patient at risk of developing a COVID-19 infection. Immunosuppression drugs and corticosteroids for patients who have had a kidney transplant has to be adjusted based on laboratory results and is individualized aiming at the protection of the transplanted from rejection.

Specificity of severe AKI aetiology and care in the elderly. The IRACIBLE prospective cohort study.

Acute Kidney Injury (AKI) is increasingly common in people over 65years of age, but its causes and management are poorly described. The purpose of this study was to describe the causes, management and prognosis of patients over 65 hospitalised for severe acute kidney injury (AKI) in all departments of a tertiary centre. The prospective IRACIBLE(IRA: AKI in French; CIBLE: target in French)cohort included 480 patients hospitalised at a university hospital over 18months for severe AKI or subgroup of AKIN3 (Acute Kidney Injury Network classification) defined by an acute creatinine increase > 354μmol/L or managed with acute renal replacement therapy (RRT). The history, aetiology of AKI, management, and prognosis were compared in three age groups: < 65, 65-75, and > 75years. The study population included 480 subjects (73% men) with a median body mass index (BMI) of 26.6kg/m2 [23.3, 30.9], 176 (37%) diabetic patients, 124 (26%) patients < 65years, 150 (31%) 65-75years and 206 (43%) > 75years. Increasing age class was associated with more comorbidities, a significantly lower median estimated glomerular filtration rate (eGFR) 6months before inclusion (82;62;46ml/min/1.73 m2, p < 0.05) and aetiology of AKI, which was more often obstructive (12%;15%;23%, p = 0.03) or part of a cardio-renal syndrome (6%;9%;/15%, p = 0.04). Older patients were less often managed in the intensive care unit (54%;47%;24%, p < 0.0001), wereless frequently treated byRRT (52%;43%;31%, p < 0.001) and receivedfewer invasive treatments (6%;9%;22%, p < 0.0001). Older survivors returned home less often (80%;73%;62%, p = 0.05) in favour of transfers to rehabilitation services (10%;13%;22%) with higher mortality at 3months (35%;32%;50%, p < 0.0001). Older patients hospitalised for severe AKI have a specific profile with more comorbidities, lower baseline renal function, an aetiology of AKI of mainly extra-parenchymal causes and a complex pathway ofcare with an overall poor prognosis.

MO344: Effect of Cancer Stage on Adverse Kidney Outcomes in Patients With Advanced Melanoma Treated With Immune Checkpoint Inhibitors

Abstract BACKGROUND AND AIMS Immune checkpoint inhibitor (ICI) therapy has improved the outcome of advanced melanoma but can also lead to kidney injury. Anti-programmed cell death protein 1 (anti-PD-1) therapy is now used in adjuvant setting for stage 3 melanoma after curative intent surgery, and anti-PD-1 or a combination of anti-cytotoxic T-lymphocyte-associated protein 4 (anti-CTLA-4)/PD-1 therapy is used in stage 4 melanoma. We aimed to compare the incidence and predictors of adverse kidney outcomes in patients with stage 3 and stage 4 melanoma treated with ICIs. METHOD We conducted a retrospective cohort study including all patients diagnosed with advanced melanoma who initiated ICIs between January 2016 and December 2019 at Mass General Brigham. Acute kidney injury (AKI) was defined as a 1.5-fold rise in creatinine within 1 year of ICI initiation. Sustained AKI was defined as AKI that lasted for &amp;gt; 48 h, and acute interstitial nephritis (AIN) cases (diagnosed by biopsy or clinical criteria) were determined by chart review of all episodes of sustained AKI by two nephrologists. A composite outcome of chronic kidney disease (CKD) was defined by new onset estimated glomerular filtration rate (eGFR) &amp;lt; 60 mL/min/1.73 m2 or 30% eGFR decline sustained for 90 days. Non-kidney irAEs were defined by diagnosis codes. Competing risk analysis was used to identify risk factors for adverse kidney outcomes. RESULTS A total of 855 patients with advanced melanoma were treated with ICIs between 2016 and 2019. The risk of all-cause AKI was 16.6%. Patients with stage 4 melanoma receiving anti-CTLA-4/PD-1 combination therapy had the highest rates of all-cause AKI (27.2%) and AIN (5.7%). Patients with surgically resected stage 3 melanoma treated with adjuvant anti-PD-1 therapy has the lowest absolute risk of all-cause AKI (7.5%); but the aetiology of AKI was enriched for AIN in stage 3 melanoma (causing 62.5% of all cases of AKI sustained &amp;gt;48 h) (Fig. 1). In the multivariable Fine-Gray model, cancer stage and ICI treatment regimen were the top predictors of AKI. Patients with stage 4 melanoma treated with anti-PD-1 monotherapy were more than two times likely to develop AKI within the first year compared with patients with stage 3 melanoma [aHR 2.18, 95% confidence interval (95% CI) 1.29–3.74; P &amp;lt; .01), while patients with stage 4 melanoma treated with anti-CTLA-4/PD-1 combination therapy were more than four times likely to develop AKI (aHR 4.36, 95% CI 2.58–7.39; P &amp;lt; .01) compared with patients with stage 3 melanoma (Fig. 2). Baseline CKD, diabetes, hypertension, cirrhosis and proton pump inhibitor use were not significantly associated with the risk of developing AKI. For AIN, only anti-CTLA-4/PD-1 combination therapy use was significantly associated with the outcome (aHR 4.17, 95% CI 1.28–13.54; P = .02). There was no increase in the risk of AIN in patients with stage 4 melanoma receiving anti-PD-1 monotherapy compared with stage 3 melanoma (Fig. 2). Among patients surviving &amp;gt; 4 years, 20% developed the composite CKD outcome. We identified a similar trend across the three cohorts for kidney and non-kidney irAEs: patients with stage 3 and stage 4 melanoma treated with anti-PD-1 monotherapy had similar rates of non-kidney irAEs (60% in stage 3 versus 52.7% in stage 4, P = .2), while patients with stage 4 melanoma treated with anti-CTLA-4/PD-1 combination therapy experienced higher rates of non-kidney irAEs (72%, P = .01). CONCLUSION Anti-CTLA-4/PD-1 combination therapy is associated with a higher risk of all-cause AKI and AIN. Incidence of AIN is similar between patients with stage 3 and stage 4 melanoma receiving anti-PD-1 monotherapy. Among patients with stage 3 melanoma, AKI aetiology is enriched for AIN. Survivors are at high risk of CKD regardless of cancer stage.

Acute intermittent hemodialysis management in childhood: A single center experience.

The objective of this study was to determine the common indications of acute intermittent hemodialysis (IHD) treatment in childhood and to assess the characteristics of the procedure, complications, and prognosis. The study included 102 patients aged between 0 and 18 years, who had been acute dialysis indication and treated with IHD. In terms of acute kidney injury (AKI) etiology, glomerular diseases were prominent in 56% of the patients, and 8.6% of surviving patients progressed to end-stage renal disease. Regarding the cause of AKI, having the glomerular disease was determined to be directly associated (p=0.01) with the risk of progression to chronic kidney disease (CKD) regardless of age, gender, onset time of renal replacement therapy. Glomerular diseases were the most common in AKI etiology and were associated with the progression to CKD, independent of age, gender and the time of IHD onset in our study.

Clinical profile of patients with acute kidney injury admitted in intensive care unit

Background: Acute kidney injury (AKI) is a frequent complication in critically sick patients admitted to the intensive care unit (ICU). The objective of this study was to assess the risk factors and clinical outcomes of AKI in patients admitted to a teaching hospital's intensive care unit.Methods: This prospective observational study was conducted in the department of internal medicine, Janaki Medical College, Janakpur, Nepal from June 2018 till May 2019. Adults (aged 18 years or more) diagnosed with AKI using RIFLE criteria and were either admitted in ICU with diagnosis of AKI or developed AKI after admission to ICU. AKI patients were classified as those who satisfied any of the RIFLE categorization criteria.Results: The most common presenting complaint was fever (77%). The most common etiology of AKI was sepsis (71%). Other causes of AKI were post-operative cases (16%) and alcoholic liver disease (13%). When classified as per RIFLE criteria, we classified 38 cases (31.9%) as ‘risk’, 53 (44.54%) as ‘injury’ and 28 (23.53%) as ‘failure’. The etiological classification of our patients to be significantly associated with RIFLE classification (p&lt;0.01). However, we found the mortality not to be significantly associated with RIFLE classification (p=0.74). Conclusions: AKI classification should be used as a risk assessment tool towards the AKI's influence on the prognosis of ICU patients. Further study should investigate determining the death rate according to the RIFLE criteria in this region of Nepal.

Approach to Acute Kidney Injury

Acute kidney injury is defined as an abrupt decline in kidney function, which manifests as an increase in serum creatinine level or a decrease in urine output within a short period of time. It is a commonly encountered entity in the clinical setting and necessitates a systematic diagnostic approach. Acute kidney injury etiologies are classified as either prerenal, intrinsic renal, or postrenal. This article presents the key elements of history taking, physical examination, and laboratory investigations when assessing a patient for acute kidney injury to properly classify its etiology. The use of imaging modalities is also discussed. Common etiologies of acute kidney injury in each category are highlighted. Lastly, this article provides a brief overview of management principles for acute kidney injury with a particular emphasis on indications for initiation of dialysis.

Diagnostic and prognostic role of urinary Neutrophil Gelatinase-associated Lipocalin in patients with cirrhosis and acute kidney injury

Background: Acute Kidney Injury (AKI) commonly occurs in patients with decompensated cirrhosis. Urinary Neutrophil Gelatinase-associated Lipocalin (uNGAL) could help in discriminating between different etiologies of AKI. The aim of this study was to investigate the use of uNGAL in: a) differential diagnosis of AKI; b) predicting the response to terlipressin and albumin in patients with Hepatorenal Syndrome (HRS-AKI); c) predicting in-hospital and 90-day mortality.

The role of cell-free hemoglobin and haptoglobin in acute kidney injury in critically ill adults with ARDS and therapy with VV ECMO

BackgroundIncreased plasma concentrations of circulating cell-free hemoglobin (CFH) are supposed to contribute to the multifactorial etiology of acute kidney injury (AKI) in critically ill patients while the CFH-scavenger haptoglobin might play a protective role. We evaluated the association of CFH and haptoglobin with AKI in patients with an acute respiratory distress syndrome (ARDS) requiring therapy with VV ECMO.MethodsPatients with CFH and haptoglobin measurements before initiation of ECMO therapy were identified from a cohort of 1044 ARDS patients and grouped into three CFH concentration groups using a risk stratification. The primary objective was to assess the association of CFH and haptoglobin with KDIGO stage 3 AKI. Further objectives included the identification of a target haptoglobin concentration to protect from CFH-associated AKI.Measurements and main resultsTwo hundred seventy-three patients fulfilled the inclusion criteria. Of those, 154 patients (56.4%) had AKI at ECMO initiation. The incidence of AKI increased stepwise with increasing concentrations of CFH reaching a plateau at 15 mg/dl. Compared to patients with low [< 5 mg/dl] CFH concentrations, patients with moderate [5–14 mg/dl] and high [≥ 15 mg/dl] CFH concentrations had a three- and five-fold increased risk for AKI (adjusted odds ratio [OR] moderate vs. low, 2.69 [95% CI, 1.25–5.95], P = 0.012; and OR high vs. low, 5.47 [2.00–15.9], P = 0.001). Among patients with increased CFH concentrations, haptoglobin plasma levels were lower in patients with AKI compared to patients without AKI. A haptoglobin concentration greater than 2.7 g/l in the moderate and 2.4 g/l in the high CFH group was identified as clinical cutoff value to protect from CFH-associated AKI (sensitivity 89.5% [95% CI, 83–96] and 90.2% [80–97], respectively).ConclusionsIn critically ill patients with ARDS requiring therapy with VV ECMO, an increased plasma concentration of CFH was identified as independent risk factor for AKI. Among patients with increased CFH concentrations, higher plasma haptoglobin concentrations might protect from CFH-associated AKI and should be subject of future research.

POS-862 PREVALENCE AND FACTORS ASSOCIATED WITH RHABDOMYOLYSIS IN COVID-19 PATIENTS: AN OBSERVATIONAL STUDY

Despite rhabdomyolysis is known as a potential etiology of Acute kidney injury in SARS-COV-2 patients, the burden of rhabdomyolysis in COVID-19 hospitalized patients is scarce. The objective of the present study was to assess the prevalence and risk factors of rhabdomyolysis in SARS-COVID-2 patients.