Factors Of Acute Kidney Injury Research Articles

Incidence, risk factors and outcome of acute kidney injury in critically ill COVID-19 patients in Tyrol, Austria: a prospective multicenter registry study

IntroductionAcute kidney injury is a frequent complication in critically ill patients with and without COVID-19. The aim of this study was to evaluate the incidence of, and risk factors for, acute kidney injury and its effect on clinical outcomes of critically ill COVID-19 patients in Tyrol, Austria.MethodsThis multicenter prospective registry study included adult patients with a SARS-CoV-2 infection confirmed by polymerase chain reaction, who were treated in one of the 12 dedicated intensive care units during the COVID-19 pandemic from February 2020 until May 2022.ResultsIn total, 1042 patients were included during the study period. The median age of the overall cohort was 66 years. Of the included patients, 267 (26%) developed acute kidney injury during their intensive care unit stay. In total, 12.3% (n = 126) required renal replacement therapy with a median duration of 9 (IQR 3–18) days. In patients with acute kidney injury the rate of invasive mechanical ventilation was significantly higher with 85% (n = 227) compared to 41% (n = 312) in the no acute kidney injury group (p < 0.001). The most important risk factors for acute kidney injury were invasive mechanical ventilation (OR = 4.19, p < 0.001), vasopressor use (OR = 3.17, p < 0.001) and chronic kidney disease (OR = 2.30, p < 0.001) in a multivariable logistic regression analysis. Hospital and intensive care unit mortality were significantly higher in patients with acute kidney injury compared to patients without acute kidney injury (Hospital mortality: 52.1% vs. 17.2%, p < 0.001, ICU-mortality: 47.2% vs. 14.7%, p < 0.001).ConclusionAs in non-COVID-19 patients, acute kidney injury is clearly associated with increased mortality in critically ill COVID-19 patients. Among known risk factors, invasive mechanical ventilation has been identified as an independent and strong predictor of acute kidney injury.Graphical abstract

Risk Factors for Acute Kidney Injury after Hematopoietic Stem Cell Transplantation: A Systematic Review and Meta-Analysis

Aims: The aim of this study was to identify risk factors associated with acute kidney injury (AKI) after hematopoietic stem cell transplantation (HSCT) by systematically reviewing the relevant literature. Methods: This meta-analysis surveyed relevant articles published in PubMed, Embase, and the Cochrane Library up to December 2022 to identify the reliable risk factors for AKI after HSCT, calculating odds ratios (ORs) and corresponding 95% confidence intervals (CIs). Results: Twenty studies with 4,378 patients were included. Umbilical cord blood transplantation (OR = 2.36; 95% CI: 1.77–3.15; p < 0.00001), calcineurin inhibitors (CNIs) (OR = 1.97; 95% CI: 1.06–3.67; p = 0.03), sinusoidal obstruction syndrome (SOS) (OR = 5.80; 95% CI: 3.96–8.51; p < 0.00001), allogeneic transplantation (OR = 4.27; 95% CI: 1.83–9.95; p = 0.0008), hypertension (OR = 2.07; 95% CI: 1.16–3.69; p = 0.01), amphotericin B (OR = 4.03; 95% CI: 2.54–6.40; p < 0.00001), vancomycin (OR = 2.19; 95% CI: 1.24–3.87; p = 0.007), and total body irradiation (TBI) (OR = 1.81; 95% CI: 1.27–2.57; p = 0.001) were risk factors for AKI. Conclusion: Umbilical cord blood transplantation, CNIs, SOS, allogeneic transplantation, hypertension, amphotericin B, vancomycin, and TBI were risk factors for AKI. It is important for clinical staff to be aware of these risk factors in their treatment planning with patients undergoing HSCT.

Acute Kidney Injury in Neonates: A Single-Center Experience

Background: Neonatal intensive care unit infants frequently experience acute kidney damage. Estimates of the prevalence of acute kidney vary depending on the definitions used. In Iraq, studies addressing the prevalence and risk factors of acute kidney injury in this age group are scarce, none of which has implicated the KDIGO diagnostic and staging criteria. Objectives: To describe the prevalence, demographics, risk factors, etiology, and staging of acute kidney injury using KDIGO criteria in the Neonatal intensive care unit and correlate these findings with patient outcomes. Methods: A retrospective study was conducted in the Neonatal Intensive Care Unit/ CWTH/ Medical City Complex/ Baghdad during the period from the 1st of August 2019 to the 15th of January 2020. All neonates diagnosed with acute kidney injury according to KDIGO –classification 2012 and admitted to the neonatal intensive care unit were included in this study. Demographics, clinical staging, and investigations were retrieved from patients' notes. Results: The prevalence of acute kidney damage was 7.2%. The mean gestational age of the patients was 36.8 ± 2.9 weeks, 58% of them were full-term, with a male-to-female ratio of 1.40:1. Stage I patients represented 35.1%, 43.2% were stage 2, and 21.6% had severe stage 3. Acute kidney injury-related mortality was 35.1%. The term female sex, high birth weight, and age younger than seven days at diagnosis predicted a bad prognosis. Vaginally delivered, stage III acute kidney injury-KDIGO, and peritoneal dialysis patients had the worst outcomes. Asphyxia was a major cause of acute kidney injury (P=0.001). High blood urea (P=0.01), low PH (P=0.009), low HCO3 (P=0.001), low WBC count (P=0.001), and low platelet count (0.001) were associated with unfavorable outcomes. Conclusions: The prevalence of acute kidney injury, according to KIDGO diagnostic and staging criteria, is 7.1%. Asphyxia, female gender, and vaginal deliveries are variables associated with poor prognosis in addition to advanced illness stage and laboratory indicators. Received: Dec. 2022 Accepted: Jun 2023 Published: Oct.2023

Dynamic volume status assessment with the VExUS score after heart valve surgery complicated by acute kidney injury: a case series

Background: Fluid overload is an independent risk factor for acute kidney injury after cardiac surgery. An objective volume status assessment remains an unsolved clinical problem.Objective: To analyze the relationship between the dynamic changes in splanchnic blood flow patterns (portal, hepatic, and interlobar renal veins), reflecting the venous congestion severity, and severity of renal dysfunction in the studied patients.Methods: From February to May 2023, 3 patients after open heart surgery developed acute kidney injury in the postoperative period: 2 of them required renal replacement therapy. In the perioperative period, all patients underwent Doppler ultrasonographic assessment of the splanchnic blood flow according to the venous excess ultrasound (VExUS) score.Results: The most distinct changes in blood flow patterns were observed in portal and interlobar renal veins. Two anuric patients requiring renal replacement therapy had a pulsatile portal venous flow with systolic flow reversal that indicated severe venous congestion and biphasic renal venous flow. After restoration of urine output in 1 patient, the blood flow pattern in the portal vein returned to the normal pattern. In another patient, the blood flow remained pulsatile, which manifested itself by persisting clinical signs of overhydration. In the third patient, the portal blood flow also was pulsatile but had no systolic flow reversal. The renal blood flow was biphasic, although it was initially continuous. After restoration of urine output and overhydration improvement, the blood flow pattern returned to the preoperative pattern.Conclusion: In the studied patients, the dynamic assessment of splanchnic blood flow using the VExUS score allowed to objectively assess the venous congestion severity and served as an additional criterion for initiating renal replacement therapy in case of acute kidney injury progression. Further research could validate this type of monitoring because its interpretation requires a comprehensive assessment due to moderate specificity. Received 21 June 2023. Revised 17 July 2023. Accepted 24 July 2023. Informed consent: The patients’ informed consent to use the records for medical purposes is obtained. Funding: The study did not have sponsorship. Conflict of interest: The authors declare no conflicts of interests. Contribution of the authors: The authors contributed equally to this article.

The Incidence and Risk Factors of Acute Kidney Injury After Left Ventricular Assist Device Implantation

The Incidence and Risk Factors of Acute Kidney Injury After Left Ventricular Assist Device Implantation

Benefit of continuous kidney replacement therapy for managing tumor lysis syndrome in children with hematologic malignancies.

Tumor lysis syndrome (TLS) is often diagnosed in children with hematological malignancies and can be life threatening due to metabolic disturbances. Continuous renal replacement therapy (CKRT) can reverse these disturbances relatively quickly when conventional medical management fails. Our objective was to investigate the benefit of CKRT in the management of TLS in children admitted to the intensive care unit with hematologic malignancies. In addition, we sought to assess risk factors for acute kidney injury (AKI) in the setting of TLS. Retrospective review of all children admitted to the intensive care unit with TLS who received CKRT from January 2012 to August 2022. Among 222 children hospitalized with TLS from January 2012 to August 2022, 20 (9%) underwent CKRT to manage TLS in the intensive care unit. The patients' median age was 13 years (range 3-17 y), and most were males (18/20). T-cell acute lymphoblastic leukemia was the most common diagnosis (n=10), followed by acute myeloid leukemia (n=4), Burkitt lymphoma (n=4), and B-cell acute lymphoblastic leukemia (n=2). Five patients required mechanical ventilation, and 2 required vasopressors. The most common indication for CKRT was hyperphosphatemia, followed by, hyperuricemia, and hyperkalemia. All metabolic abnormalities corrected within 12h of initiation of CKRT. CKRT courses were brief, with a median duration of 2 days (range 1-7 days). Having higher serum phosphorus levels 12h preceding CKRT was significantly associated with severe acute kidney injury (AKI). The median phosphorus level was 6.4 mg/dL in children with no/mild AKI and 10.5 mg/dL in children with severe AKI (p=0.0375). Serum uric acid levels before CKRT were not associated with AKI. All children survived to hospital discharge, and the one-year survival rate was 90%. CKRT is safe in children with hematologic malignancies with severe TLS and reverses metabolic derangements within 6-12h. Most patients had AKI at the initiation of CKRT but did not require long-term kidney replacement therapy. Hyperphosphatemia before initiation of CKRT is associated with higher risk of AKI.

Acute kidney injury is common in dogs with septic peritonitis and is associated with increased mortality.

To identify the frequency of and risk factors for acute kidney injury (AKI) in dogs undergoing abdominal surgery for septic peritonitis, and to evaluate outcome and kidney-related risk factors for survival to discharge in those dogs. 77 dogs that underwent abdominal surgery for septic peritonitis. Medical records of dogs that underwent surgery for septic peritonitis from 2012 through 2022 were reviewed. Data regarding signalment, clinical and biochemical findings at presentation, blood creatinine concentration throughout hospitalization, surgery characteristics, postoperative monitoring, and outcome were collected. Dogs were classified based on occurrence of AKI and whether they presented with or developed AKI in-hospital. Perioperative risk factors were evaluated, and outcomes were compared with univariable logistic regression. 31 dogs (40.3%) had AKI diagnosed; 18/77 (23.4%) dogs presented with AKI, 11 (61.1%) of which had it postoperatively, and 13/77 (16.9%) dogs developed AKI postoperatively. Significant factors for presenting with AKI included increasing baseline respiratory rate (OR 2.5 for every 10 beats per minute higher), decreasing systolic blood pressure (OR 0.8 for every 10 mm Hg higher), and increasing body condition score (OR 2.2 for every score greater). No significant factors for developing AKI postoperatively were identified after multiple comparisons adjustment. Sixteen dogs (20.8%) did not survive to discharge; 12 (75.0%) had AKI and 4 (25.0%) did not. Dogs with AKI had decreased odds of survival to discharge (OR 0.2). AKI was common in dogs with septic peritonitis and was a significant risk factor for survival to discharge. Clinical surveillance of AKI is critical in this population.

Risk factors and outcome of acute kidney injury in children with snake envenomation.

Our study evaluates the risk factors of acute kidney injury (AKI) in children with snake envenomation. Out of 145 cases, 54 (37%) developed AKI. Unsurprisingly, the mortality increased with oliguria and higher levels of creatinine. Bleeding manifestations were also more common among the AKI group.

Vancomycin Hydrochloride as a Risk Factor for Acute Kidney Injury: A Retrospective Study

Introduction: The incidence of acute kidney injury (AKI) caused by vancomycin hydrochloride (VCM) was reported to be 5–43%. VCM-induced AKI was reported to be more likely to occur 4–17 days after initiating VCM treatment; however, it may occur earlier. The aim of this study was therefore to investigate risk factors for the development of AKI within two (AKI_2days) and seven (AKI_7days) days of VCM administration. Methods: This was a single-center, retrospective study including patients who underwent VCM therapy between April 1, 2013, and December 31, 2019. AKI was evaluated based on the Kidney Disease: Improving Global Outcomes criteria. Results: In total, 287 patients were enrolled. The incidence of VCM-induced AKI within 7 days was 10.8% (31/286 cases), and the incidence of AKI within 2 days was 5.9% (15/252 cases). Serum VCM trough concentrations and tazobactam-piperacillin (TZP) were shown to be a risk factor for VCM-induced AKI. The serum VCM trough concentration was 12.67 μg/mL within the 48 h threshold (AKI_2days) and 19.03 μg/mL within the 7-day threshold (AKI_7days). Conclusion: Our study demonstrated that high serum VCM trough concentrations and the combination of VCM and TZP were independent risk factors for VCM-induced AKI. Avoiding the concomitant use of TZP, or thorough monitoring of renal function with the concomitant use of TZP, may be helpful in reducing the occurrence of AKI. Furthermore, monitoring serum VCM trough concentrations within 2 days may effectively reduce the incidence of AKI.

Analysis of Risk Factors and Intervention Strategies for Acute Kidney Injury After Cardiac Valve Replacement.

To investigate the risk factors and intervention strategies for the development of acute kidney injury (AKI) after cardiac valve replacement with extracorporeal circulation. Retrospective analysis of the clinical data of a total of 106 patients diagnosed with heart valve disease and undergoing extracorporeal circulation heart valve replacement surgery from January 2021 to December 2021 in the Department of Cardiac and Major Vascular Surgery of our hospital. The two groups were divided into AKI and non-AKI groups according to whether acute kidney injury occurred after surgery, and the preoperative, intraoperative and postoperative clinical data were compared. Single-factor analysis and multi-factor logistic regression analysis were used to explore the risk factors for acute kidney injury after extracorporeal heart valve replacement, and to improve the prognosis by giving kidney function protection strategies as early as possible. Univariate analysis showed that age, preoperative blood creatinine >130umol/L, LVEF <45%, presence of subacute infective endocarditis (SIE), concurrent coronary artery bypass grafting (CABG), time to extracorporeal circulation, time to surgery, MAP <70mmHg, urine output <0.5mL/(kg-h), pulmonary infection, low cardiac output, and bacteraemia were risk factors for postoperative AKI. Multi-factor regression analysis showed that preoperative blood creatinine >130umol/l, LVEF <45%, combined infective endocarditis, extracorporeal circulation time >2h, intraoperative and postoperative hypotension, low cardiac output, and postoperative bacteremia were independent risk factors for postoperative AKI. Active intervention strategies in the perioperative period can reduce the occurrence of postoperative AKI and improve patient prognosis.

The Prevalence and Risk Factors of Acute Kidney Injury during Colistin Therapy: A Retrospective Cohort Study from Lebanon.

The current study aimed to determine the prevalence, risk factors, and stages of severity of acute kidney injury (AKI) caused by colistimethate sodium (CMS) treatment in patients diagnosed with systemic antibiotic-resistant Gram-negative bacterial infections. The predictors of all-cause mortality in this patient population were also examined. This retrospective cohort study included patients who were admitted to a university-affiliated hospital and acute tertiary care referral center in Beirut, Lebanon between January 2015 and December 2018 and underwent CMS treatment for a period of 48 h or more. The study sample included 298 adult patients, of which 46.3% (n = 138/298) developed AKI (assessed using the Kidney Disease Improving Global Outcomes (KDIGO) criteria). Of these, 37.7% (n = 51/138) were diagnosed with stage 1 AKI, 23.9% with stage 2 (n = 33/138), and 38.4% with stage 3 (n = 53/138). Nephrotoxicity was reversed in 87.5% of AKI patients who survived until hospital discharge. Independent risk factors for AKI included patient age ≥ 75 years (aOR = 1.854; 95% CI: 1.060-3.241; p-value = 0.03); underlying chronic kidney disease (aOR = 4.849; 95% CI: 2.618-9.264; p-value < 0.0001); and concomitant use of vasopressors (aOR = 4.305; 95% CI: 2.517-7.456; p-value < 0.0001). Multivariate analysis showed that the predictors of severe AKI (stage 2 or 3) included baseline hypoalbuminemia (aOR = 2.542; 95% CI: 1.000-6.564; p-value = 0.05); concomitant use of vasopressors (aOR = 6.396; 95% CI: 2.741-15.87; p-value < 0.0001); and CMS days of therapy (DOT) prior to development of AKI ≥ 7 days (aOR = 4.728; 95% CI: 2.069-11.60; p-value < 0.0001). All-cause mortality was recorded in 51.3% of patients (n = 153/298), and this was significantly higher in patients with AKI (76.8%; n = 106/138) compared to those without (29.4%; n = 47/160; OR = 7.964; 95% CI: 4.727-13.417; p-value < 0.0001). Independent predictors of all-cause mortality included a baseline Charlson comorbidity index score ≥5 (aOR = 4.514; 95% CI: 2.443-8.530; p-value < 0.0001); concomitant use of vasopressors (aOR = 7.76; 95% CI: 4.238-14.56; p-value < 0.0001); and CMS-induced AKI (aOR = 4.117; 95% CI: 2.231-7.695; p-value < 0.0001). The findings of this study suggest that old age, history of chronic kidney disease, and concomitant vasopressor treatment are all independent predictors of CMS-induced AKI. The risk of developing severe AKI significantly increases with CMS DOT. Understanding the risk factors of nephrotoxicity is essential for improving prognosis and treatment outcomes.

Preoperative Anemia Is Associated With Postoperative Renal Failure After Elective Open Aortic Repair

IntroductionPreoperative anemia has been consistently shown to be a risk factor for acute kidney injury (AKI) after cardiac surgery. However, this association has not been examined in the open abdominal aortic aneurysm repair (OAR) population and is the subject of this analysis. MethodsTargeted Vascular Module from the American College of Surgeons National Surgical Quality Improvement Program was queried for patients undergoing OAR from 2013 to 2019. Anemia was defined according to World Health Organization Guidelines: Hematocrit<36% for women or <39% for men. Primary endpoint was 30-day AKI. Anemia's effect on AKI was determined using inverse probability weighted logistic regression. ResultsThere were 2275 OAR; mean age was 70.9 ± 8.2 y; 24.0% were women. Anemia was present in 498 (26.3%) patients; 165 (7.6%) had a hematocrit<33% and 8 (0.35%) had a hematocrit<24%. Differences in patient factor were nonsignificant after weighting. Any degree of postoperative AKI was more common in the anemia group (11.2% vs 5.1%; unweighted P < 0.001), as was AKI requiring hemodialysis (7.7% vs 3.2%; unweighted P < 0.001). In the weighted multivariable analysis, anemia was independently associated with postoperative AKI (odds ratio 1.51; 95% confidence interval: 1.01-2.26; P = 0.042) while controlling for age and operative factors. Patients with postoperative AKI were significantly more likely to die postoperatively than those without (26.1% vs 1.9%; <0.001). ConclusionsPreoperative anemia was independently associated with post-OAR AKI after propensity weighting and controlling for operative factors. AKI is a major source of morbidity and mortality in these patients, and, if time permits, preoperative correction of anemia or its underlying cause should be considered in high-risk patients.

Postoperative Acute Kidney Injury and Long-Term Outcomes After Lung Transplantation

BackgroundThis study sought to characterize perioperative risk factors of acute kidney injury (AKI) and report outcomes associated with its development in the immediate postoperative setting after lung transplantation. MethodsStudy investigator performed a retrospective analysis of all adult patients undergoing primary lung transplantation at a single institution from January 1, 2011 to December 31, 2021 AKI was defined using Kidney Disease: Improving Global Outcomes (KDIGO) criteria after lung transplantation and was stratified on the basis of whether patients required renal replacement therapy (RRT; AKI–no RRT vs AKI-RRT). ResultsOf the 754 patients included, 369 (48.9%) any AKI developed in the postoperative period (252 AKI–no RRT vs 117 AKI-RRT). Risk factors for postoperative AKI included higher preoperative creatinine levels (odds ratio [OR], 5.15; P < .001), lower preoperative estimated glomerular filtration rate (OR, 0.99; P < 0.018), delayed chest closure (OR, 2.72; P < .001), and higher volumes of postoperative blood products (OR, 1.09; P < .001) in the multivariable analysis. On univariate analysis, both AKI groups were also associated with higher rates of pneumonia (P < .001), reintubation (P < .001), mortality on index admission (P < 0.001), longer ventilator duration (P < .001), longer intensive care unit length of stay (P < .001), and longer hospital length of stay (P < .001), with the highest rates in the AKI-RRT group. In a multivariable survival analysis, postoperative AKI–no RRT (hazard ratio [HR], 1.50; P = .006) and AKI-RRT (HR, 2.70; P < .001) were associated with significantly worse survival independent of severe grade 3 primary graft dysfunction at 72 hours (HR, 1.45; P = .038). ConclusionsThe development of postoperative AKI was associated with numerous preoperative and intraoperative factors. Postoperative AKI remained significantly associated with poorer posttransplantation survival. Severe cases of AKI necessitating RRT portended the worst survival after lung transplantation.

Prevalence and predicting factors of acute kidney injury due to methanol intoxication; a systematic review

Introduction: Methanol intoxication and subsequence acute kidney injury (AKI) can be dangerous and deadly in case of a missed or delayed diagnosis; therefore, identifying its prevalence and predictor factors is necessary. Objectives: This study was conducted to identify the prevalence and predictor factors of AKI in methyl alcohol-intoxicated patients. Methods and Materials: The search strategy was conducted with the standard keyword in the international database, including Web of Science, Scopus, PubMed /Medline, Embase, Cochrane, WorldCat, Dimension, OpenGrey, EBSCO, DOAJ, CINAHL, and Google scholar search engines. Studies that reported the prevalence of AKI due to methanol poisoning were included in this review study. Results: Results demonstrated that six studies from five countries, with a sample size of 816 methanol intoxication patients, were included in this study. Mean AKI prevalence in all reviewed studies was 28.18%; Gender male, hypertension, older age, anemia, alcohol addiction, metabolic acidosis, high blood osmolality, high Formate concentration, alcohol overdose, sepsis, rhabdomyolysis, acute pancreatitis, and volume depletion were the reported AKI predictors in the reviewed studies. Conclusion: Identifying the AKI prevalence and its predictor factors in patients with methanol intoxication can help in their quick diagnosis, timely treatment, and reduce the subsequent complications.

The Prediction Score of Acute Kidney Injury in Patients with Severe COVID-19 Infection

Background: The incidence and risk factors for acute kidney injury in COVID-19 patients vary across studies, and predicting models for AKI are limited. This study aimed to identify the risk factors for AKI in severe COVID-19 infection and develop a predictive model for AKI. Method: Data were collected from patients admitted to the ICU at Thammasat University Hospital in Thailand with PCR-confirmed COVID-19 between 1 January 2021, and 30 June 2022. Results: Among the 215 severe-COVID-19-infected patients, 102 (47.4%) experienced AKI. Of these, 45 (44.1%), 29 (28.4%), and 28 (27.4%) patients were classified as AKI stage 1, 2, and 3, respectively. AKI was associated with 30-day mortality. Multivariate logistic regression analysis revealed that prior diuretic use (odds ratio [OR] 7.87, 95% confidence interval [CI] 1.98–31.3; p = 0.003), use of a mechanical ventilator (MV) (OR 5.34, 95%CI 1.76–16.18; p = 0.003), and an APACHE II score ≥ 12 (OR 1.14, 95%CI 1.05–1.24; p = 0.002) were independent risk factors for AKI. A predictive model for AKI demonstrated good performance (AUROC 0.814, 95%CI 0.757–0.870). Conclusions: Our study identified risk factors for AKI in severe COVID-19 infection, including prior diuretic use, an APACHE II score ≥ 12, and the use of a MV. The predictive tool exhibited good performance for predicting AKI.

Magnitude and associated factors of acute kidney injury among preterm neonates admitted to public hospitals in Bahir Dar city, Ethiopia 2022: cross-sectional study

BackgroundAcute kidney injury is an independent risk factor for morbidity and mortality in critically ill neonates. Although the magnitude of preterm neonates is high and a major risk for acute kidney injury, there is a paucity of information regarding the magnitude and associated factors of acute kidney injury among preterm neonates in the study area. Therefore, the aim of this study was to assess magnitude and associated factors of acute kidney injury among preterm neonates admitted to public hospitals in Bahir Dar city, Ethiopia, 2022.MethodsAn institutional-based cross-sectional study was conducted among 423 preterm neonates admitted to public hospitals in Bahir Dar city from May 27 to June 27, 2022. Data were entered into Epi Data Version 4.6.0.2 transferred to Statistical Package and Service Solution version 26 for analysis. Descriptive and inferential statistics were employed. A binary logistic regression analysis was done to identify factors associated with acute kidney injury. Model fitness was checked through Hosmer-Lemeshow goodness of fit test. Variables with a p-value < 0.05 were considered as statistically significant in the multiple binary logistic regression analysis.ResultOut of 423 eligible, 416 neonatal charts were reviewed with a response rate of 98.3%.This study revealed that the magnitude of acute kidney injury was 18.27% (95% CI = 15–22). Very low birth weight (AOR = 3.26; 95% CI = 1.18–9.05), perinatal asphyxia (AOR = 2.84; 95%CI = 1.55–5.19), dehydration (AOR = 2.30; 95%CI = 1.29–4.09), chest compression (AOR = 3.79; 95%CI = 1.97–7.13), and pregnancy-induced hypertension (AOR = 2.17; 95%CI = 1.20–3.93) were factors significantly associated with the development of neonatal acute kidney injury.ConclusionAlmost one in five admitted preterm neonates developed acute kidney injury. The odds of acute kidney injury were high among neonates who were very low birth weight, perinataly asphyxiated, dehydrated, recipients of chest compression, and born to pregnancy-induced hypertensive mothers. Therefore, clinicians have to be extremely cautious and actively monitor renal function in those neonatal population in order to detect and treat acute kidney injury as early as possible.

A single-center clinical study of acute kidney injury associated with acute myocardial infarction.

To investigate the risk factors of acute kidney injury (AKI) patients with acute myocardial infarction (AMI) and establish potential microRNA (miRNA) biomarkers in the peripheral blood of AMI-AKI patients. Patients hospitalized from 2016 to 2020 and diagnosed with AMI (with AKI or without AKI groups) were recruited. The data of the two groups were compared and the risk factors of AMI-AKI were analyzed by logistic regression. The receiver operator characteristics (ROC) curve was drawn and the predictive value of risk factors in AMI-AKI was evaluated. Six AMI-AKI patients were selected and six healthy subjects were enrolled as the control. The peripheral blood samples of the two groups were collected for miRNA high-throughput sequencing. A total of 300 AMI patients were collected, including 190 patients with AKI and 110 patients without AKI. Multivariate logistic regression analysis indicated that diastolic pressure (68-80mmHg), urea nitrogen, creatinine, serum uric acid (SUA), aspartate aminotransferase (AST), and left ventricular ejection fraction were the dependent risk factors of AMI-AKI patients (P < 0.05). ROC curve showed that the incidence of AMI-AKI patients was most correlated with urea nitrogen, creatinine, and SUA. In addition, 60 differentially expressed miRNAs were identified between AMI-AKI and controls. Then, hsa-miR-2278, hsa-miR-1827, and hsa-miR-149-5p were more corrected with predictors. Twelve of them targeted 71 genes involved in phagosome, oxytocin signaling pathway, and microRNAs in cancer pathways. Urea nitrogen, creatinine, and SUA were the dependent risk factors and important predictors for AMI-AKI patients. Three miRNAs may be considered as biomarkers for AMI-AKI.

Macrophages promote Fibrinogenesis during kidney injury.

Macrophages (Mø) are widely considered fundamental in the development of kidney fibrosis since Mø accumulation commonly aggravates kidney fibrosis, while Mø depletion mitigates it. Although many studies have aimed to elucidate Mø-dependent mechanisms linked to kidney fibrosis and have suggested various mechanisms, the proposed roles have been mostly passive, indirect, and non-unique to Mø. Therefore, the molecular mechanism of how Mø directly promote kidney fibrosis is not fully understood. Recent evidence suggests that Mø produce coagulation factors under diverse pathologic conditions. Notably, coagulation factors mediate fibrinogenesis and contribute to fibrosis. Thus, we hypothesized that kidney Mø express coagulation factors that contribute to the provisional matrix formation during acute kidney injury (AKI). To test our hypothesis, we probed for Mø-derived coagulation factors after kidney injury and uncovered that both infiltrating and kidney-resident Mø produce non-redundant coagulation factors in AKI and chronic kidney disease (CKD). We also identified F13a1, which catalyzes the final step of the coagulation cascade, as the most strongly upregulated coagulation factor in murine and human kidney Mø during AKI and CKD. Our in vitro experiments revealed that the upregulation of coagulation factors in Mø occurs in a Ca2 + -dependent manner. Taken together, our study demonstrates that kidney Mø populations express key coagulation factors following local injury, suggesting a novel effector mechanism of Mø contributing to kidney fibrosis.

Preoperative and intraoperative risk factors for acute kidney injury after hip fracture surgery: a cohort retrospective study

Introduction Hip fractures have several adverse effects on patients’ morbidity and mortality. Postoperative Acute kidney injury (AKI) is one of the complications that have a significant impact on the patient’s overall prognosis. We aimed to identify AKI risk after hip fracture surgery and the preoperative and intraoperative risk factors. Methodology We conducted a retrospective cohort study in a tertiary care hospital on adult patients who underwent surgery for hip fractures between January 2015 and August 2021. All clinical data were reviewed. Result A total of 611 patients were included (age = 76.44 ± 9.69 years). 126 (20.6%) of them developed AKI postoperatively. In multilinear logistic regression analysis, factors associated with postoperative AKI included eGFR [odds ratio (OR): 0.98; 95% confidence interval (CI): 0.97–0.99 with a p value .01], spinal anesthesia [OR: 1.78; 95% CI: 1.1–2.9 with a p value .01], and partial hip replacement (PHR) type of surgery [OR: 0.56; 95% CI: 0.32–0.96 with a p value .036]. The development of postoperative AKI was the strongest factor that increase mortality of the patients as the (HR = 2.42, CI 95% [1.57–3.74]; p value <.001). Conclusion In this study, we highlight that lower eGFR, and spinal anesthesia were associated with a higher risk of AKI, and PHR surgery has lower odds to develop AKI. Postoperative AKI is associated with a higher mortality rate after hip fracture surgery.

Risk Factors and Clinical Course of Patients with Acute Kidney Injury: A Systematic Literature Review

Acute kidney injury (AKI) is a serious health problem and can be life-threatening if not treated quickly and appropriately. There are several risk factors that can increase a person's chances of experiencing AKI. This study aimed to carry out a systematic review to explore the risk factors for acute kidney injury and the clinical course of acute kidney injury. The literature search process was carried out on various databases (PubMed, Web of Sciences, EMBASE, Cochrane Libraries, and Google Scholar) regarding risk factors and clinical overview of acute kidney injury. The search was performed using the terms: (1) " risk factors " OR " Clinical" OR" symptoms " OR" sign " AND (2) " acute kidney injury". There are several risk factors that can increase a person's chances of experiencing acute kidney injury (AKI). These factors can be intrinsic (inside the patient's body) or extrinsic (outside the patient's body). Patients with heart disease or other blood vessel diseases have a higher risk of developing AKI. Cardiovascular risk factors such as high blood pressure, coronary artery disease, heart failure, or chronic kidney disease can contribute to the development of AKI. In conclusion, acute kidney injury is caused by intrinsic and extrinsic risk factors. While the clinical course of patients with acute kidney injury begins with the prerenal, intrinsic, oliguric, diuretic, and recovery phases.