Form Of Acute Renal Failure Research Articles

Treatment variants in hepatorenal syndrome. Systematic review

Introduction: hepatorenal syndrome (HRS) is a form of acute renal failure that occurs in patients with advanced cirrhosis and presents high mortality.Objective: to describe the therapeutic alternatives in hepatorenal syndrome. Methods: a search for information was carried out using the PubMed, TripDatabase and Cochrane databases; MeSH terms were used. Initially, 1749 articles were obtained; subsequently, 5 articles used in this systematic review were selected through the use of filters, review of titles, and elimination of duplicates. Results: 548 patients were included. 325 patients received Terlipressin and 223 patients received Placebo. A reversal of SHR was evidenced in 35,8 % in patients receiving Terlipressin vs. 12,1 % placebo. Overall survival without liver transplantation was 36,7 % for the Terlipressin group and 21,1 % placebo. Adverse events were higher in the Terlipressin group. Conclusion: Terlipressin is effective in improving renal function in patients with cirrhosis and hepatorenal syndrome type 1 (HRS-1). However, its use is associated with serious adverse events, such as respiratory failure. The combined treatment of terlipressin and albumin shows a greater improvement in renal function compared to the use of albumin alone. Further studies are needed to determine whether the improvement in renal function translates into a survival benefit for patients. Liver transplantation remains the most definitive treatment, and should be considered early in the course of the disease

Ethylene Glycol Toxicity and Its Therapy Management: A Literature Review

Background: Ethylene glycol (EG) is an antifreeze substance commonly used as an additive for syrup preparations. One of the detrimental effects caused by EG toxicity is acute renal failure (ARF) and death, assuming therapy and management are delayed. Presently, there are limited studies on toxicity of EG and therapy. Therefore, this study aimed to provide an overview of EG toxicity levels, clinical manifestations, arising reactions, and therapy management methods.Objectives: A narrative review design was employed with data collected from PubMed and Google Scholar. The strategy used keywords such as “ethylene glycol toxicity” and "acute renal" with the assistance of Boolean operators including AND and OR.Methods: The result showed that the minimum EG level for toxicity was at 22 mg/dL, followed by metabolic acidosis with an increased anion gap (>10mmol/L). Based on case reports from one experimental study, the clinical manifestations of patients experiencing EG poisoning included decreased consciousness, tachycardia, and coma, with ARF occurring after 24-72 hours.Results: Write study findings in this section.Conclusion: EG poisoning could cause kidney damage in the form of ARF and lead to death, assuming therapy was delayed. Presently, the most effective therapy for EG poisoning was fomepizole.

Streptococcal toxic shock syndrome in an adolescent

A special form of streptococcal infection is streptococcal toxic shock syndrome (STS), characterized by rapid development of symptoms and high mortality. Patient O., 14 years old, was taken to the infectious diseases department of OGAUZ DBNo. 1 by the SMP team with complaints of shortness of breath, vomiting, loose stools in a state of moderate severity due to intoxication syndrome. Diagnosis upon admission: Acute infectious gastroenteritis of moderate severity. Acute respiratory infections rhinopharyngitis, acute bronchitis, pneumonia (?), DN1. During examination in the UAC, anemia, leukocytosis, acceleration of ESR, in the biochemical blood analysis – an increase in CRP, in the coagulogram — increased INR, APTT, RFMC, decreased PTI, in urine tests – protein, erythrocytes, on the X–ray — bilateral pleural effusion, in the tank. sputum culture — Streptoccocus oralis 10/3 KOE/ml, PCR SARS-CoV-2: negative, blood test for antistreptolysin-O (ASL-O): 800 IU/ml (norm up to 200 IU/ml), blood for sterility 19.05.20: no bacterial microflora growth was detected. After receiving laboratory data, the diagnosis was made: Acute glomerulonephritis?, Аcute intestinal infection. Double-sided hydrothorax. Internal combustion engine. Anemia of the 1st degree. The final diagnosis: Acute post-streptococcal glomerulonephritis with a debut in the form of streptococcal toxic shock syndrome, a period of extensive clinical and laboratory changes, with a decrease in the debut of kidney function in the form of acute renal failure, recovery period. Against the background of the treatment (2 courses of antibiotic therapy (cefotaxime, amoxicillin), infusion therapy, pulse therapy with metipred (5 pulses), double transfusion of freshly frozen plasma, prednisone, lasix, veroshpiron, enap, curantil, heparin, and other accompanying therapy), pronounced positive clinical and laboratory dynamics was noted. She was hospitalized for 43 days, of which 9 days were in the intensive care unit (5 days on a ventilator). On the 44th day, the child was discharged in a satisfactory condition with recommendations under the supervision of a pediatrician, a pediatric nephrologist at the place of residence

Acute renal failure in scrub typhus patients

Scrub typhus, a bacterial infection caused by Orientia Tsutsugamushi (formally Rickettsia) due to bite of the mite, and is increasing every year, and becomes a important cause of acute febrile illnesses. Due to lack of specific diagnostic facilities in most rural setups and non-specific clinical presentations, it becomes a challenge for clinician to correctly diagnose it on clinical examination. Clinically it presents with non-specific febrile illnesses with constitutional symptoms such as fever, rash, myalgia and headache or with organ dysfunction involving kidneys, lungs, liver, central nervous system or with circulatory collapse with hemorrhagic features. Eschar is the characteristic lesion which is present at the bite site of mite. Later an ulcer with black necrotic centre and regional lymphadenopathy occurs. Renal involvement in the form of Acute Renal Failure is seen very occasionally in these patients. So this Case-control study is designed for a period of six months which are october-2018 to march-2019, comparing 80 ELISA(Enzyme Linked Immune Sorbent Assay) confirmed cases of scrub typhus and 50 healthy controls. Statistically significant difference in Urea, Creatinine and Uric acid levels were found between two groups, using 't'-test with the significance value of P<0.0001.

Significance of Cystatin C for Early Diagnosis of Contrast-Induced Nephropathy in Iraqi Patients Undergoing Coronary Angiography

Background: Contrast-induced nephropathy (CIN) has been traditionally defined as an increase in serum creatinine (sCr) after contrast media (CM) exposure. It is generally a transient and reversible form of acute renal failure. Objectives: The objective was to compare changes in serum creatinine and serum cystatin C (sCys C) in patients undergoing CM administration during coronary angiography (CAG) and/or intervention, and whether these changes are a reliable index for early identification of CIN. Materials and Methods: In this prospective study, 50 patients were included, 9 of them were omitted, and remaining 41 patients undergoing CAG and/or intervention. sCr, serum urea, sCys C, and estimated glomerular filtration rate (eGFR) were evaluated at baseline as well as 24 h after exposure to CM. Results: Forty one patients, six of them develop CIN (CIN group) and the remainder 35 not develop CIN (non-CIN group). Clinical parameters showed no significant association between CIN group and non-CIN group except in diabetes mellitus. As comparing patients before and after catheterization, the CIN group showed increase in sCr and serum urea, while remain nearly the same for sCys C, and obvious decrease for eGFR1 and eGFR2, in addition there is significant association for sCr, eGFR1, and eGFR2. In the non-CIN group, only the serum urea showed significant difference. Conclusion: The concentration change of sCr is significantly superior to cystatin C as an early biomarker in the CIN detection. An absolute increase of the concentration of sCr is highly sensitive and specific for the CIN in comparing to cystatin C.

Bilateral acute renal cortical necrosis after a dog bite: case report

BackgroundCapnocytophaga canimorsus is a Gram-negative capnophilic rod and part of dogs/cats’ normal oral flora. It can be transmitted by bites, scratches, or even by contact of saliva with injured skin. Asplenic patients and patients with alcohol abuse are at particular risk for fulminant C. canimorsus sepsis. However, also immunocompetent patients can have a severe or even fatal infection. This is the first case of a severe C. canimorsus infection in an immunocompromised host complicated by acute renal cortical necrosis with a “reverse rim sign” in contrast-enhanced computed tomography on hospital admission.Case presentationWe report the case of a 44-year functionally asplenic patient after an allogeneic stem cell transplantation, who presented with septic shock after a minor dog bite injury 4 days prior. Because of abdominal complaints, epigastric pain with local peritonism, and radiological gallbladder wall thickening, an abdominal focus was suspected after the initial work-up. The patient underwent emergent open cholecystectomy, but the clinical suspicion of abdominal infection was not confirmed. Septic shock was further complicated by cardiomyopathy and disseminated intravascular coagulation. As a causative pathogen, C. canimorsus could be isolated. The clinical course was complicated by permanent hemodialysis and extensive acral necrosis requiring amputation of several fingers and both thighs.ConclusionWe present a severe case of a C. canimorsus infection in a functionally asplenic patient after a minor dog bite. The clinical course was complicated by septic shock, disseminated intravascular coagulation, and the need for multiple amputations. In addition, the rare form of acute renal failure - bilateral acute renal cortical necrosis – was visible as “reverse rim sign” on computed tomography scan. This case is an example of the potential disastrous consequences when omitting pre-emptive antibiotic therapy in wounds inflicted by cats and dogs, particularly in asplenic patients.

P0640DIAGNOSTIC AND TREATMENT OF THE SEVERE FORMS OF ACUTE RENAL FAILURE DURING MALARIA UNDER LIMITED CONDITIONS

Abstract Background and Aims To explore clinical features and outcome of the most severe forms of acute renal failure (ARF) during Plasmodium falciparum malaria in United Nations personnel stationed in Central African Republic, during “MINUSCA ” mission. ARF is one of the most important negative predictive criteria for outcome of malaria.Etiology is multifactorial, but most often is consequence of prerenal dehydration and tubular damages with hemoglobinuria during severe hemolysis Method We analyzed records of 54 inpatients with complicated forms of Plasmodium falciparum malaria who were treated in the Serbian level 2 hospital during 2017. Diagnosis of ARF was estimated based on RIFLE criteria. Having in mind the occasional lack of diagnostic kits for creatinine, at the almost one third of patients we used daily diuresis monitoring (with follow up of volume status) to diagnose this complication (according with RIFLE criteria). Results Total of 19 patients (35,19%) have developed ARF. Beside parenteral treatment with Artemisin, they were treated with parenteral solutions and diuretics. Despite therapy, 8 patients (14,81%) developed progressive and dialysis depended form of ARF (one had hemolytic-uremic syndrome) and they have been urgently evacuated accompanied by AMET into a senior medical institution. Based on provided back information, average creatinine on admission was 1242+/-342 µmol/l, Hb level 10,6 g/dl, potassium 6,8mmol/l. Six out of 8 patients completely recovered renal function (they needed average 7+/- 2 HD procedures; patient with HUS performed 5 plasma exchange sessions), one developed CRF grade 3 and one developed ESRD with necessity for chronic HD treatment. There were not lethal outcomes. Conclusion Early recognition of systemic complications including parameters of acute renal failure (decreasing urine output or changing of urine color could be useful markers under limited medical conditions)is necessaryin the purpose of timely recognition and promptly evacuation into higher medical facilities for further treatment.

The Frequency and Risk Factors of Delayed Graft Function in living Donor Kidney Transplantation and Its Clinical Impact on Graft and Patient Survival in Part of Middle East.

Delayed graft function (DGF) is a form of acute renal failure which results in increased post-transplantation allograft immunogenicity and risk of acute rejection episodes in addition to decreased long-term survival. Its incidence and risk factors have been extensively studied, especially after deceased donation. Until now, only few data has beenpublished on DGF in living donor kidney transplant recipients. The present study was performed to investigate the frequency and risk factors of DGF among living- kidney transplant recipients. In this retrospective study, data had been collected from existing local hospital registries in three countries (Iran, Kingdom of Saudi Arabia (KSA) , and Kuwait ).

Rhabdomyolysis-Induced Acute Kidney Injury and Kidney Protection with Melatonin

Abstract—Rhabdomyolysis is a clinical syndrome caused by damage to skeletal muscles. Its frequent severe complication is acute kidney injury. The nephroprotective potential of melatonin (5 mg/kg) in rhabdomyolysis-induced acute kidney injury has been studied in experiments on mature outbred laboratory white rats. A single administration of 8 mL/kg glycerol induces the oliguric form of acute renal failure, which is accompanied by a reduction in glomerular filtration rate, an increase in plasma creatinine level, hyperkalemia, aciduria, notable proteinuria, and impaired nephron reabsorption function. It has been found that melatonin administration exerts a cytoprotective effect on epithelial cells of renal tubules and considerably limits the extent of the damage, preventing the development of oliguria, retention azotemia, and excessive loss of sodium ions. It reduces proteinuria and increases urine pH. The protective effect is due to the antioxidant ability of melatonin, which prevents the development of oxidative stress in kidneys. These results substantiate the prospects of further studies of the nephroprotective potential of melatonin in kidney disorders of various origins.

Od monoklonalnej gammapatii o nieokreślonym znaczeniu (MGUS) do szpiczaka plazmocytowego i amyloidozy — opis przypadku

We present a 69-year-old patient, in whom in March 2016 a monoclonal gammopathy of undetermined significance (MGUS) was diagnosed. The disease was found during the diagnostics of thrombocytopenia (from 2009 the number of platelets varied between 90–140 G/l). In serum immunofixation assay the presence of monoclonal IgG kappa protein was confirmed. In July 2017, when the patient presented with nephrotic syndrome and acute renal failure, 14.5% of plasma cells were found in the bone marrow. Moreover, a biopsy of abdominal fat revealed the presence of amyloid composed of kappa light chains. The diagnosis of IgG kappa plasma cell myeloma (PCM) complicated with amyloidosis of the kidneys, heart, liver and spleen was established. The PCM progression complicated with amyloidosis was very aggressive. Despite the treatment with bortezomib and dexamethasone the patient died early. Sudden deterioration of health (e.g. in the form of acute renal failure) in a patient with MGUS may indicate not only the progression of MGUS to PCM, but also the development of amyloidosis, which is associated with turbulent disease and poor prognosis.

Can McArdle disease be induced by infection associated with rhabdomyolysis case report?

Introduction: Rhabdomyolysis is the clinicopathologic presentation that is caused by striated muscle damage with leaking of toxic pigments into the blood. Clinical findings of rhabdomyolysis ranges from asymptomatic increase of muscle enzymes to the fatal forms of acute renal failure (ARF) and electrolyte disturbance. The causes of rhabdomyolysis can be classified under several groups: (a) direct injury from trauma, (b) overuse of muscle, (c) congenital muscle enzyme errors, and (d) uncommon pathogens like drugs and toxins, ischemia of muscle, metabolic and endocrine disorders, and finally infections. The diagnosis of rhabdomyolysis is based on myalgia and weakness, tea-colored urine (myoglobinuria), an increase in muscle enzymes that is not caused by myocardial infarction (MI) or polymyositis (PM). The most important goal of treatment is to diagnose and cure complications like electrolyte disturbances and acute tubular necrosis (ATN). Case Report: The case in the present study was a young man who was admitted with fever and chill and generalized myalgia with tea-colored urine. Finally, he died because of acute adult respiratory distress syndrome (RDS), acute renal tubular necrosis, and hyperkalemia. Among congenital muscle enzyme disorders, the most common type is the carnitine-palmitotransferase defect (CPT), and after that, the second most common is myophosphorylase deficiency. Among muscle carbohydrate metabolism defects, McArdle disease (MD), or glycogenosis type V (GSD-V), is the most prevalent, which is caused by a deficiency in glycogen-phosphorylase enzyme. In this disorder, only striated muscles are affected, which leads to rhabdomyolysis in the primary steps, and exercise intolerance, muscle cramps, and myoglobinuria, when reaches more developed levels. This predisposition to rhabdomyolysis in patients with MD prevents us from administrating certain drugs in these cases. Conclusion: Rhabdomyolysis may develop among individuals with abnormal muscles as in congenital diseases of glycogenolysis, glycolysis, purine, and lipid metabolism. Considering the rare causes of rhabdomyolysis like MD permits physicians to diagnose and treat this potentially fatal occult causes.

Ischemic Renal Injury Complicating Intragastric Balloon Insertion

A 25-year-old obese woman experienced ischemic renal injury as a complication of intragastric balloon (IGB) insertion for weight reduction. Although IGB is associated with a low risk of renal injury in the form of acute renal failure, this presentation has never been reported. The patient responded well to treatment, with complete clinical and radiologic resolution after balloon removal. She did not have an apparent cause of renal ischemia other than a significant compression of the renal vessels by the balloon as seen on imaging.

A study on incidence and severity of acute renal failure and its association with parasite density in hospitalised patients with falciparum malaria

Aims of the study: To find out the incidence of acute renal failure in falciparum malaria and to correlate between the degree of parasitism at presentation with acute renal failure and its outcome in falciparum malaria. Methodology: Each patient with a history of fever, suggestive of severe malaria was subjected to peripheral blood smear examinations, up to 3 samples were examined or till positive and/or Pf antigen positive cases. The selected patients were then grouped according to the clinical features, laboratory parameters and were followed up for the outcome. Results: Out of the 50 cases of acute renal failure due to falciparum malaria, 21 had Parasite density <5% (42%), 13 had 5-10%(26%) and 16 had >10%(32%). Out of 21 cases of mild ARF 12 patients had parasite density<5% and 9 had >5%. Out of 29 cases of severe ARF 9 patients had parasite density<5% and 20 had >5%. Dialysis was done in a total of 31 cases (62%). In the severe form of acute renal failure. hemodialysis was required in 29 cases (58%), in the milder form of renal failure; only 2 cases (4%) required hemodialysis. Rests of the cases were managed by conservative treatment. Conclusion: Parasite Density has significant impact to predict the severity of renal failure, duration of hospital stays as well as the number of dialysis required. As the study was conducted with small number of cases, further study is necessary with large number of cases to arrive at a conclusion regarding the malady of acute renal failure in falciparum malaria.

Incidence of Contrast-Induced Nephropathy in Patients with Multiple Myeloma Undergoing Contrast-Enhanced Procedures.

Multiple myeloma (MM) is a malignant disorder characterized by clonal proliferation of plasma cells. Renal impairment is a common complication. Contrast-induced nephropathy (CIN) is a form of acute renal failure that can occur in the setting of IV contrast administration. It is more commonly seen in patients with pre-existing renal impairment. Patients with MM commonly require contrast enhanced procedures. The literature regarding the safety of IV contrast in this cohort is lacking. A retrospective review was carried out in a university hospital to identify the incidence of CIN in patients with MM and to look for associated risk factors. 94 patients and 165 procedures were included in the analysis. 10% of procedures resulted in CIN. 59% (10/17) of creatinines had normalized within one month of the procedure. The only factor found to be significant for the development of CIN was the timing of the procedure (<18mths verses >18mths post diagnosis of MM; p=0.045). CIN appears to occur at an increased rate in patients with MM. However this may be an over-estimation given the common occurrence of renal impairment in this cohort and the close temporal relationship which often exists between systemic illness and contrast-enhanced procedures.

Hepatorenal syndrome in decompensated cirrhosis : A special form of acute renal failure

Renal failure is aserious complication in patients with advanced cirrhosis. It occurs in about 20 % of patients hospitalized with cirrhosis. In about 70 % it is caused by prerenal failure, and in 30 % it is due to intrarenal causes. In about 70 % of patients with rperenal failure, renal function can be restored with fluid replacement, but the remaining 30 % are unresponsive to volume expansion. Minor increase in serum creatinine have been shown to be clinically relevant and can adversely affect survival. Therefore early efforts should be made to avoid precipitation of renal failure.Hepatorenal syndrome (HRS) is a fully reversible impairment of renal function in patients with cirrhosis unresponsive to volume expansion characterized by an acute progressive decrease in kidney function (serumcreatinin >1,5mg/dl) - type 1HRS, whereas type 2HRS features adecrease in kidney function over along time, mostly in patients with refractory ascites. Therapy with vasoconstrictors like terlipressin to reverse splanchnic vasodilation, together with albumin is effective in 30-50 % of patients with HRS1 and improves survival. The only effective longterm therapy is livertransplantation. An improvement of kidney fuction before transplantation is associated with abetter outcome and posttransplant kidney function.

Study of Aplastic Anaemia with Cyclosporine in Resource Poor Setting.

Aplastic Anaemia (AA) is a syndrome characterized by peripheral pancytopenia with hypo-cellular marrow. Acquired idiopathic AA is the most common variety, probably of an autoimmune aetiology. Bone Marrow Transplantation (BMT) is the treatment of choice but cost is the limiting factor. Antithymocyte Globulin and Cyclosporine-A is an alternative to BMT. Cyclosporine alone has been tried as a single agent in resource poor setting. The study was conducted with the aim to observe the treatment response in aplastic anaemia to Cycloserine-A. Patients who were diagnosed as AA and opted for Cyclosporine with informed consent were included in the study. All the subjects were started on 5mg/kg of Cyclosporine and were followed up for three months to see the treatment response. This study had the approval from IEC. Twenty patients were enrolled in the study. Age of the patients ranged from 10 to 65 years. Maximum number (10/20) of patients was in the 2(nd) decade. Most of the patients presented with mucosal bleeds and breathlessness on exertion; the predominant sign was pallor. Eleven patients had severe AA, eight had non severe and one had very severe anaemia. Out of 20, three patients were lost to follow-up and one patient discontinued therapy due to renal dysfunction; finally sixteen patients' data was analysed. Out of 16 patients, 9 responded was and 7 did not respond. Complete response was observed in three patients, partial response in six patients. Seven patients had drug toxicity in the form of acute renal failure and gum hypertrophy. Cyclosporine seems to be a reasonable therapeutic option with good response rate and minimal side effects.

Effect of nitric oxide pathway regulation on water/sodium balance and renal function in a rodent model of acute liver and renal failure.

BackgroundThe pathomechanism of acute hepatorenal syndrome (HRS), a particular form of acute renal failure that occurs in the course of acute liver injury, is still poorly understood. The aim of our study was to estimate the influence of the activation and inhibition of the nitric oxide pathway on the water/sodium balance and development of acute renal failure in the course of HRS.Material/MethodsWe used male Sprague-Dawley rats in the acute galactosamine (Ga1N) model of HRS. The nitric oxide synthase (NOS) inhibitors L-NAME and L-arginine were administered intraperitoneally before and after liver damage.ResultsHRS developed in all tested groups. L-NAME increased osmotic clearance and urine volume more effectively before liver injury. Furthermore, administration of L-NAME increased creatinine clearance both before and after Ga1N injection. A double dose of L-NAME did not yield further improvement before Ga1N injection, but improved creatinine clearance after Ga1N intoxication. Injection of L-arginine increased sodium excretion and urine volume, but only after liver injury. Moreover, L-arginine injected after Ga1N caused significant improvement of the creatinine clearance in a dose-dependent manner.ConclusionsOur study shows that inhibition of the nitric oxide pathway improves parameters of water and sodium balance and prevents development of acute renal failure in the course of acute liver injury and liver failure. Activation of the nitric oxide system also has a favorable influence on water/sodium balance and renal failure, but only after liver injury.

PP280—Blood levels of cyclosporine a and its first line metabolites during an early fase after renal transplantation in patients with normal and delayed graft function

Acute rejection (AR) and delayed graft function (DGF) are 2 main adverse early posttransplant events that one would like to avoid. DGF conventionally defined as requirement for dialysis during the first postperative week is a form of acute renal failure that results in posttransplant oligouria, increases risk of AR, and decreases graft survival. Higher incidence of DGF in renal transplant recipients treated by CsA was described previously, but the mechanism of this effect has not been explained yet.

Hepatorenales Syndrom

Hepatorenal syndrome (HRS) is a unique form of acute renal failure occurring in patients with advanced cirrhosis or acute liver failure. In patients with ascites the incidence of HRS is 8 % and in end-stage liver disease 75 % of patients suffer from HRS. Vasodilation of splanchnic arteries with subsequent decrease of effective blood volume, arterial pressure and renal vasoconstriction is hypothesized to be the central pathophysiological mechanism leading to acute renal failure. Moreover, cardiac output might be decreased in advanced cirrhosis. There are two types of HRS: while HRS type 1 is characterized by a rapid progression to acute renal failure often triggered by a precipitating event, e. g. bacterial peritonitis, which can rapidly develop into multiorgan failure, HRS type 2 shows a more steadily or slowly progressive course to renal failure with increasing ascites. Type 1 HRS has the worst prognosis. Treatment options include pharmacological treatment with vasoconstrictors and albumin and placement of transjugular intrahepatic portosystemic shunts (TIPS) but can only partially improve the survival rate. Liver transplantation is the ultimate and only definitive treatment of patients with HRS.

Ascorbic acid reduces gentamicin-induced nephrotoxicity in rats through the control of reactive oxygen species

Oxidative stress has been implicated in the pathophysiology of many forms of acute renal failure. The aim was examine the effect of vitamin C on oxidative stress and its relationship with nitric oxide on gentamicin-induced nephrotoxicity in rats. We utilized 32 Wistar rats allocated in four groups of eight animals each: control (CTL), vitamin C (VIT C), gentamicin (GENTA), and GENTA + VIT C; all groups were treated during seven days. Serum urea and creatinine, serum and renal tissue malondialdehyde, blood superoxide anion and hydrogen peroxide in GENTA were increased vs CTL and vs VIT C, and decreased in GENTA + VIT C vs GENTA (all P < 0.05). Serum nitric oxide increased in GENTA vs CTL and vs VIT C, and reduced in GENTA + VIT C vs GENTA (P < 0.001). Urinary nitric oxide was reduced in GENTA vs CTL and vs VIT C and increased in GENTA + VIT C vs GENTA (P < 0.001). Severe degeneration of proximal tubules was present in GENTA, but only mild lesions were observed in GENTA + VIT C. This study suggests that VIT C is a valuable tool to protect against GENTA-induced nephrotoxicity, by reducing reactive oxygen species and increasing the nitric oxide.