Incidence Of Kidney Injury Research Articles

Kidney Injury Incidence in COVID-19 Patients and Evaluation of Several Function Variables

Kidney Injury Incidence in COVID-19 Patients and Evaluation of Several Function Variables

Analysis of microRNA expression in rat kidneys after VEGF inhibitor treatment under different degrees of hypoxia.

Previously, we found that the incidence of kidney injury in patients with chronic hypoxia was related to the partial pressure of arterial oxygen. However, at oxygen concentrations that contribute to kidney injury, the changes in the relationship between microRNAs (miRNAs) and the hypoxia-inducible factor-1α (HIF-1α)-vascular endothelial growth factor (VEGF) axis and the key miRNAs involved in this process have not been elucidated. Therefore, we elucidated the relationship between VEGF and kidney injury at different oxygen concentrations and the mechanisms mediated by miRNAs. Sprague-Dawley rats were exposed to normobaric hypoxia and categorized into six groups based on the concentration of the oxygen inhaled and injection of the angiogenesis inhibitor bevacizumab, a humanized anti-VEGF monoclonal antibody. Renal tissue samples were processed to determine pathological and morphological changes and HIF-1α, VEGF, and miRNA expression. We performed a clustering analysis of high-risk pathways and key hub genes. The results were validated using two Gene Expression Omnibus datasets (GSE94717 and GSE30718). As inhaled oxygen concentration decreased, destructive changes in the kidney tissues became more severe. Although the kidney possesses a self-protective mechanism under an intermediate degree of hypoxia (10% O2), bevacizumab injections disrupted this mechanism, and VEGF expression was associated with the ability of the kidney to repair itself. rno-miR-124-3p was identified as a crucial miRNA; a key gene target, Mapk14, was identified during this process. VEGF plays an important role in kidney protection from injury under different hypoxia levels. Specific miRNAs and their target genes may serve as biomarkers that provide new insights into kidney injury treatment.NEW & NOTEWORTHY Renal tolerance to hypoxic environments is limited, and the degree of hypoxia does not show a linear relationship with angiogenesis. VEGF plays an important role in the kidney's self-protective mechanism under different levels of hypoxia. miR-124-3p may be particularly important in kidney repair, and it may modulate VEGF expression through the miR-124-3p/Mapk14 signaling pathway. These microRNAs may serve as biomarkers that provide new insights into kidney injury treatment.

Thoraflex Hybrid vs. AMDS: To replace the arch or to stent it in type A aortic dissection?

Acute type A aortic dissection (ATAAD) is a life-threatening medical emergency that requires urgent surgical intervention. The mainstay surgical approach to treating ATAAD with aortic arch involvement is total arch replacement (TAR). The frozen elephant trunk (FET) procedure involves TAR with hybrid endovascular stenting of the DTA in a single step using a hybrid prosthesis (HP). The prime example of a FET HP is Thoraflex Hybrid Prosthesis (THP). Another treatment option is the novel Ascyrus Medical Dissection Stent (AMDS) that is deployed as a non-covered stent along with the aortic arch as an adjunct to prior hemi-arch replacement. This comparative review highlights the clinical applications and outcomes of THP and AMDS in the treatment of ATAAD and discusses the main differences between both approaches. A comprehensive literature search was conducted using multiple electronic databases including PubMed, Google Scholar, Ovid, Scopus and Embase. TAR with FET can be considered the superior approach to managing ATAAD with arch involvement relative to AMDS with hemi-arch replacement due to more optimal clinical outcomes. Upon comprehensively searching the literature, early mortality was substantially lower with FET ranging from 0-11% compared to 12.5-18.7% using AMDS, with more favourable long-term survival. The incidence of kidney injury and new stroke post-FET ranged from 3-20% and 5-16%, and 11-37.5% and 0-18.8% following AMDS implantation. However, evidence supporting the use of AMDS is extremely limited. Meanwhile, TAR with FET is a well-established and well-described procedure for ATAAD repair. Despite the novel nature of AMDS, its clinical safety and effectiveness are yet to be proven. In conclusion, THP remains the best evidenced-based approach to treat ATAAD in this era.

Where do you live and what do you do? Two questions that might impact your kidney health.

In many cases the social determinants of health need to be assessed through their interaction with environmental factors. This review looks at the impact of physical location and occupation of individuals on their kidney health. It examines the effect of living at high altitude on kidney function and the relationship between extreme cold or hot temperatures and the incidence of kidney injury. It reviews as well the many occupations that have been linked to kidney disease in high-income and low-and-middle-income countries. As a conclusion, this overview proposes preventive recommendations that could be individualized based on weather, altitude, socio-economic level of the country and occupation of the individual.

The relationship between chikungunya virus and the kidneys: A scoping review.

Several atypical forms of chikungunya fever (CHIK) have been described, including neurological, cardiac and renal involvement. These forms may be related to high morbidity and mortality rates. This scoping review based on the PubMed, Scopus, and WOS databases aims to identify and summarise all the available evidence regarding the clinical and histopathological presentations and risk factors associated with kidney injury related to CHIK, as well as the clinical impact. Thus, a total of 54 papers were selected from 1606 initial references after applying the defined inclusion criteria. Data on the association between kidney injury and CHIK are scarce, with studies only conducted in the acute phase of the disease, lacking further characterisation. Kidney injury incidence in hospitalised patients using the Kidney Disease Improving Global Outcomes criteria varies from 21% to 45%, being higher among patients with atypical and severe manifestations. Although acute kidney injury does not seem to be related to viraemia, it may be related to higher mortality. Few studies have described the renal histopathological changes in the acute phase of CHIK, with prevalent findings of acute interstitial nephritis with mononuclear infiltrate, glomerular congestion and nephrosclerosis. Only one study assessed the kidney function of patients in the subacute and chronic phases of CHIK. Additionally, individuals with comorbidities, including chronic kidney disease, may be among those with a greater risk of presenting worse outcomes when affected by CHIK. The results described herein may contribute to better understand the relationship between the kidneys and chikungunya virus.

Abstract 10280: The Association of Obesity Level and In-Hospital Survival of Patients with Covid-19 Who Received Corticosteroids

Introduction: Obesity is one of the most frequent comorbidities among COVID-19 patients. Although previous studies have shown higher body mass index (BMI) is associated with higher mortality, steroids as the current standard treatment for moderate to severe COVID-19 infection were not applied in most patients in these studies. Hypothesis: We hypothesized that patients with higher BMI still have higher mortality even on steroids. Methods: We conducted a retrospective study of 4,587 hospitalized patients with COVID-19 who received corticosteroids between March 1 st , 2020, and March 30 th , 2021. We divided patients into 6 groups by BMI[MOU1] (less 18.5, 18.5-25, 25-30, 30-35, 35-40, 40 or greater, kg/m 2 ) and investigated in-hospital mortality as the primary outcome, in-hospital mortality among severe COVID-19 patients which was defined as requiring intensive care unit or endotracheal intubation as a subgroup analysis, and acute kidney injury (AKI) incidence rate as the secondary outcome. Results: Patients with higher BMI were younger and more likely to have a history of asthma, obstructive sleep apnea, diabetes, and less likely to have malignancies. The smooth spline curve showed J curve association of BMI with risk adjusted in-hospital mortality with flexion point at BMI between 25 and 30 kg/m 2 (Figure 1). Compared to overweight (25≤BMI<30 kg/m 2 ) patients, class III obesity (BMI>40 kg/m 2 ) was associated with higher risk adjusted in-hospital mortality overall (Table 1) as well as among patients with severe COVID-19 (OR [95% CI]: 3.21 [1.86-5.66], P<0.001). Class III obesity was also associated with a higher risk adjusted incidence of AKI (OR [95% CI]: 1.52 [1.06-2.18], P=0.024) compared to overweight patients. Conclusions: Class III obesity was associated with higher in-hospital mortality and AKI incidence rate in COVID-19 patients with steroids treatment.

Effect of animal protein diet on the prognosis of children with Henoch-Schönlein purpura.

To study the association of animal protein diet with the recurrence of Henoch-Schönlein purpura (HSP)/skin rash and the risk factors for recurrence of HSP. A prospective analysis was performed for 121 children with HSP who were admitted to the Beijing Children's Hospital from October to December 2020. The children were given the doctor's advice of the same diet (animal protein diet could be added after 1 week without new-onset skin rash). Follow-up was performed at the outpatient service for half a year. According to the presence or absence of animal protein intake, the children were divided into an observation group with 65 children and a control group with 56 children. The times of skin rash recurrence, the incidence of HSP recurrence, and the incidence of kidney injury were compared between the two groups. According to the presence or absence of recurrence, the children were divided into a recurrence group with 32 children and a non-recurrence group with 89 children. A questionnaire on food frequency was used to record the daily intake of animal protein in the two groups. A multivariate logistic regression analysis was used to identify the risk factors for recurrence of HSP in children. There was no significant difference between the observation and control groups in the times of skin rash recurrence, the incidence rate of HSP recurrence, and the incidence rate of kidney injury (P>0.05). There was no significant difference in the daily intake of animal protein between the recurrence and non-recurrence groups (P>0.05). The multivariate logistic regression analysis showed that presence of kidney injury at initial onset, respiratory infection after cure for the first time, and lack of exercise control after cure for the first time were independent risk factors for the recurrence of HSP in children (P<0.05). There is no significant association between animal protein diet and the recurrence of HSP or skin rash. Timely treatment of kidney injury, avoidance of infection after cure, and limitation of strenuous exercise may help to reduce the recurrence rate of HSP in children. Citation.

Effects of targeted hydration on risk of major adverse renal and cardiac events: a systematic review and meta-analysis of randomized controlled trials

Abstract Background Inconsistent results have been published that have evaluated the preventive effect of targeted hydration in major adverse renal and cardiac events among patients exposed to contrast agents. Methods Online databases were searched up to October, 2019, for randomized controlled trials (RCTs). The primary outcome was the incidence of contrast-induced acute kidney injury (CI-AKI), and the secondary outcomes were all-cause in-hospital mortality, all-cause long-term mortality, requirement for dialysis, acute pulmonary edema and stroke/transient ischemic attack (TIA). Results 9 high quality trials were identified including 2424 patients. Overall, compared with general hydration, targeted hydration significantly reduced the incidence of CI-AKI by 58% (RR 0.42; 95% CI: 0.33–0.54, p&amp;lt;0.01), the requirement for dialysis by 68% (RR 0.32, 95% CI: 0.17–0.62, p&amp;lt;0.01) and the all-cause long-term mortality by 55% (RR 0.45; 95% CI: 0.26–0.76, p&amp;lt;0.01). The effect on all-cause in-hospital mortality was not statistically significant. The effect on acute pulmonary edema and stroke/TIA also showed no difference between two groups (RR: 0.54, 95% CI: 0.28–1.03, p=0.18; RR: 0.61, 95% CI: 0.14–2.61, p=0.49, respectively). Trial sequential analysis confirmed that an additional 3900 study participants would need to be recruited to demonstrate a statistically significant improvement for all-cause in-hospital mortality. Conclusions Targeted hydration likely reduces the incidence of CI-AKI, dialysis and all-cause long-term mortality in patients exposed to contrast agents. However, further independent high-quality RCTs should elucidate the effectiveness and safety of this prophylactic strategy in interventional cardiology. Funding Acknowledgement Type of funding source: None

Incidence and Impact of Acute Kidney Injury in Patients with Hypoplastic Left Heart Syndrome following the Hybrid Palliation

Purpose: There is a well-established link between acute kidney injury (AKI) and pediatric cardiac surgery, but few studies evaluating AKI after the Hybrid palliation for hypoplastic left heart syndrome (HLHS). One small study reported an AKI incidence of 29% in the hybrid population, but a majority of centers utilize the Hybrid palliation predominantly for high risk patients. Few centers utilize the Hybrid palliation as a primary palliative strategy, and thus we hypothesized that our population of HLHS patients, who underwent the hybrid procedure as a primary option, would …

P0568INCIDENCE AND RISK FACTORS OF ACUTE KIDNEY INJURY AND TUMOR LYSIS SYNDROME IN PATIENTS WITH MULTIPLE MYELOMA TREATED WITH BORTEZOMIB

Abstract Background and Aims Nephrotoxicity of bortezomib, a proteasome inhibitor, has not yet been described frequently, while tumor lysis syndrome (TLS) associated with multiple myeloma (MM) has been increased after introduction of the drug. This study compared the incidence and risk factors of acute kidney injury (AKI) and TLS in patients with MM after bortezomib-based chemotherapy to investigate the drug-related nephrotoxicity. Method From 2006 to 2017, 276 patients who underwent first cycle of bortezomib-based chemotherapy for MM were identified in single tertiary hospital. Laboratory TLS was defined according to the Cairo-Bishop definition. Development of AKI was assessed by AKI Network (AKIN) criteria within 7 days after first chemotherapy. Results The age was 65 [56-72] years old, and 47% (n=131) of participants were female and baseline estimated glomerular filtration rate (eGFR) was 61.3 [34.1-89.1] mL/min/1.73m2. The incidences of AKI and laboratory TLS were 17% (n=47) and 13% (n=36), respectively. Ten (3.6%) subjects corresponded to the both AKI and TLS criteria. Multivariate analyses showed that lower eGFR category (30∼59, odds ratio [OR]=3.063 [1.278-7.339]; 15∼29, OR=3.417 [1.088-10.726]; &amp;lt;15, OR=10.080 [2.677-37.951] vs ≥ 60), lower serum albumin level (OR=0.491 [0.278-0.868], P=0.0144) and renal amyloidosis (OR=11.174 [3.974-31.420], P&amp;lt;0.0001) were predictors of development of AKI. MM stages and β2-microglobulin were not associated with AKI occurrence. Regarding laboratory TLS, MM stage and β2-microglobulin were higher in those with TLS. In multivariate analyses, β2-microglobulin levels (OR=1.194 [1.066-1.337], P=0.0021) and any chromosomes abnormalities at high risk (OR=0.115 [0.026-0.503], P=0.0041) were associated with higher risk of TLS. Conclusion Development of AKI was often observed without being accompanied by TLS in patients with MM after treatment of bortezomib. In addition, risk factors of AKI and TLS were widely different. These findings implicated the potential nephrotoxicity of bortezomib besides TLS in patients with decreased kidney function. The efforts to prevent bortezomib associated AKI are needed in patients at high risk.

Risk of Kidney Injury among Construction Workers Exposed to Heat Stress: A Longitudinal Study from Saudi Arabia.

Saudi Arabia (SA) is one of the hottest countries in the world. This study was conducted to assess the impact of summer heat stress in Southeastern SA on short-term kidney injury (KI) among building construction workers and to identify relevant risk factors. Measurements of urinary albumin-creatinine ratio (ACR), height, weight, hydration, symptoms, daily work and behavioral factors were collected in June and September of 2016 from a cohort of construction workers (n = 65) in Al-Ahsa Province, SA. KI was defined as ACR ≥ 30 mg/g. Multivariate linear regression analysis was used to assess factors related to cross-summer changes in ACR. A significant increase in ACR occurred among most workers over the study period; incidence of KI was 18%. Risk factors associated with an increased ACR included dehydration, short sleep, and obesity. The findings suggest that exposure to summer heat may lead to the development of KI among construction workers in this region. Adequate hydration and promotion of healthy habits among workers may help reduce the risk of KI. A reduction in work hours may be the most effective intervention because this action can reduce heat exposure and improve sleep quality.

196 Incidence and Mortality of Acute Kidney Injury in Patients Undergoing Hematopoietic stem cell transplant: A Systematic Review and Meta-analysis

196 Incidence and Mortality of Acute Kidney Injury in Patients Undergoing Hematopoietic stem cell transplant: A Systematic Review and Meta-analysis

Acute kidney injury after nephron sparing surgery and microwave ablation: focus on incidence, survival impact and prediction

Purpose To compare acute kidney injury (AKI) incidence between nephron sparing surgery (NSS) and microwave ablation (MWA) for T1a RCC patients, reveal the effect of AKI on survival prognosis, construct AKI nomogram and use Law of Total Probability for survival probability (SP) prediction. Materials and methods Patients were studied retrospectively after NSS (n = 1267) or MWA (n = 210) from January 1, 2011 to June 30, 2017. Using one to one Propensity Score Matching (PSM), 158 pairs of patients were identified for the cohort study. AKI incidence, risk factors and impact on survival outcomes were analyzed using Chi-square test, logistic and cox regression analysis. AKI risk and SP were predicted by nomogram and Law of Total Probability. The performance of the nomogram was assessed with respect to its discrimination, calibration, and clinical usefulness. Results AKI occurred more commonly in NSS (27.85%) cohort, when compared to MWA (17.72%) cohort (p = 0.032), but treatment modality was not independently predictive of AKI occurrence (odds ratio [OR]: 0.598; 95% confidence interval [CI]: 0.282–1.265; p = 0.178). The 5-yr overall survival (OS) was lower in AKI patients (73.5%) compared with non-AKI patients (94.8%; p < 0.001). AKI was an independent risk factor for all-cause mortality in RCC patients (hazard ratio [HR]: 2.820; 95% confidence interval [CI]: 1.110–7.165; p = 0.029). Predictors for both NSS- and MWA-related AKI included tumor diameter, baseline eGFR and CCI score. RENAL score and tumor blood supply can predict AKI after NSS and MWA, respectively. The AKI normograms demonstrated good discrimination, with AUCs >0.86, excellent calibration and net benefits at the decision curve analysis with probabilities ≥5%. SP predicted by Law of Total Probability was comparable to actual OS. Conclusion AKI was an early indicator for poor overall survival in RCC patients. It can be predicted by several oncological parameters. Nomogram and Law of Total Probability can accurately predict AKI risk and SP.

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Tumor necrosis factor-α 308G/A and cardiac valves replacement surgery with cardiopulmonary bypass associated acute kidney injury in Chinese Han population

Objective To investigate the effect of polymorphism of tumor necrosis factor-α (TNF-α) 308G/A on the risk of cardiac valves replacement surgery with cardiopulmonary bypass associated acute kidney injury in Chinese Han. Methods A total of 223 consecutive patients who underwent cardiac valves replacement surgery with cardiopulmonary bypass at our institution were prospectively enrolled. Patients were genotyped for TNF-α308G/A (rs1800629). According to the A allele, they were divided into two groups: TNF1 (GG) and TNF2 (GA+ AA), and compared the incidence of postoperative acute kidney injury. Results Genotyping revealed for TNF-α308G/A, 14 patients were carriers of the AA allele (6%), 93 patients GG (42%), and 116 patients GA (52%). The genotype frequency conformed to the hardy-weinberg equilibrium. Demographic characteristics and procedural data revealed no significant differences between genotypes. The incidence of postoperative kidney injury was 33%in TNF1 and 28% in TNF2 respectively. No association between TNF-α308G/A genotypes and the KDIGO criteria could be detected. Conclusion TNF-α308G/A polymorphism is not associated with acute renal injury after cardiac valves replacement surgery with cardiopulmonary bypass. Key words: Tumor necrosis factor-α308G/A polymorphism; Cardiopulmonary bypass; Cardiac valves replacement; Acute kidney injury

Plasma triglyceride levels and central obesity predict the development of kidney injury in Chinese community older adults

Objective: Despite the achievement of blood glucose, blood pressure targets, the risk for kidney injury remains high among older adults. This observational retrospective study investigated whether high TG or high WC contribute to this high residual risk for kidney injury.Methods: A total of 843 elderly from Dongli Community, Tianjin, China, we selected 666 individuals with a baseline estimated glomerular filtration rate (eGFR) ≥60 mL/min/1.73 m2 and negative microalbuminuria completing a 3-year follow-up. At baseline, subjects were grouped according to the levels of TG and WC. The primary outcome was the incidence of kidney injury, defined as low eGFR (eGFR <60 mL/min/1.73 m2) or reduced eGFR (eGFR reduced >25%) or UACR ≥30 mg/g.Results: Overall, 6.01% developed low eGFR, 11.11% reduced eGFR, 25.98% UACR ≥30 mg/g, and 3.45% low eGFR and UACR ≥30mg/g after 3-year follow-up. TG ≥1.7 mmol/L increased the risk of eGFR <60 mL/min/1.73 m2 by 1.44-fold, of UACR ≥30 mg/g by 32%, and of developing both abnormality by 1.41-fold in model 1; further adjustment for potential confounders factors, the association is slightly weakened in model 2 and 3; WC (≥90 cm in men and ≥85 cm in women) were associated with a 1.68-fold higher risk of eGFR <60 mL/min/1.73 m2 and a 1.43-fold risk of UACR ≥30 mg/g and a 1.89-fold risk of developing both abnormality in model 1. Further adjustment for potential confounders factors, the association is slightly weakened in model 2 and 3.Conclusions: In a population of Chinese community-dwelling older adults, high TG and central obesity were risk factors for the development of kidney injury over 3 years.

Evaluating the diagnostic and prognostic value of lone anti-Sm for autoimmune diseases using Euroimmun line immunoassays.

To investigate the value of lone anti-Smith antibody (anti-Sm) using Euroimmun line immunoassay (LIA) in a Chinese population. One thousand two hundred eight of 39,766 patients who were analyzed for anti-Sm had positive anti-Sm, and were divided into true group (having both positive Sm and nRNP/Sm bands) and lone group (only having Sm band without nRNP/Sm band). The proportions of clinical diagnosis of autoimmune diseases (AIDs), non-autoimmune diseases (NAIDs), concentration of C3, C4, and rheumatoid factor (RF), positive rate of autoantibodies of antinuclear antibody (ANA) profile, and titer of anti-Sm and ANA in systemic lupus erythematosus (SLE) patients were analyzed. Lone anti-Sm was evident in 271/1208 (22.42%) of all positive cases. One hundred seventy-five of them had definitive diagnoses with AIDs being the most prominent (69.71%, 122/175). Compared to the true group, SLE patients in the lone group showed significantly lower ANA and anti-Sm titers (both P < 0.001). There was no difference in frequency of other autoantibodies or C3, C4, and RF levels of SLE patients between the two groups. In NAIDs patients, lone anti-Sm indicates less incidence of kidney injury than true anti-Sm (P = 0.05). Lone anti-Sm has great diagnostic value in AIDs, especially SLE. Lone anti-Sm has relationship with mild kidney impairment. Positive anti-Sm patients with no clinical findings or SLE diagnosis should be submitted to new testing to identify changes in anti-Sm, because turning of lone anti-Sm to true anti-Sm indicates evolving kidney injury.

Analysis of risk factors for acute kidney injury following hepatic arterial chemoembolization inpatients with hepatocellular carcinoma of Child class A

Objective To explore the incidence and risk factors of acute kidney injury (AKI) following hepatic arterial chemoembolization inpatients with hepatocellular carcinoma (HCC) , Child class A. Methods Retrospective analysis was performed on patients with HCC, Child Class A who were admitted from January 2008 to October 2016.The inclusion criteria: (1) patients were diagnosed with pathologically confirmed hepatocellular carcinoma based on the standards of primary liver cancer diagnosis and treatment (2011 edition);(2) patients have complete laboratory parameters and imaging data within the 7 days before the TACE treatment;(3) the Child-pugh score was 5 to 6;(4) patients have no acute or chronic renalfailure before the treatment of TACE.The morbidity of AKI after TACE was investigated.Twenty-six factors such as age,sexy,contrast dose,hemoglobin were included as independent variable, so as to investigate the risk factors for postoperative AKI. Results A total of 818 patients were included in the study, including 38 experiencing postoperative AKI(4.64%). Multivariate logistic regression analysis identified elevated preoperative uric acid as the independent risk factor for postoperative AKI(OR=1.005, 95% CI 1.000 to 1.009,P=0.037), and elevated preoperative hemoglobin as the protective factor for postoperative AKI(OR=0.974, 95% CI 0.952 to 0.997,P=0.028). Conclusions AKI is not uncommon following hepatic arterial chemoembolization inpatients with HCC, Child Class A, and is correlated with elevated uric acid and anemia. Preoperative risk assessment and anemia correction might be effective for reducing the incidence of AKI following hepatic arterial chemoembolization. Key words: Carcinoma, hepatocellular; Chemoembolization, therapeutic; Acute kidney injury

The analysis of acute kidney injury in hepatitis B virus related acute-on-chronic liver failure

Objective To investigate the incidence and risk factors of acute kidney injury (AKI) in hepatitis B virus (HBV) related acute-on-chronic liver failure (ACLF) patients, and to explore the impact of AKI on the prognosis of ACLF. Methods The medical records of 227 patients who were diagnosed with HBV-related ACLF at the Department of Infectious Diseases in the First Affiliated Hospital of Nanchang University from January 2015 to August 2016 were retrospectively reviewed. Patients were divided into AKI group and non-AKI group based on the AKI criteria published by International Club of Ascites in 2015. Demographic and clinical data were compared between groups. The AKI incidence and its impact on patients’ prognosis were analyzed. The comparison of continuous variables was done by t test or rank-sum test. The comparison of categorical variables was done by χ2 test or Fisher exact test. AKI risk factors were analyzed by using logistic regression. Results There were 66 (29.1%) cases were diagnosed with AKI among 227 ACLF patients, among which, 45 patients (68.2%) were stage Ⅰ, 14 (21.2%) were stage Ⅱ and 7 (10.6%) were stage Ⅲ. Age, cirrhosis, concentrations of total bilirubin and albumin, international normalized ratio (INR), percentage of neutrophils, MELD scores and spontaneous peritonitis rate (SBP) were all statistically different between AKI group and non-AKI group (all P<0.05). The binary logistic regression analysis revealed that only INR (OR=3.132, P=0.001) and SBP(OR=4.204, P=0.001) were the independent risk factors of AKI. The optimal cut-off value for INR was 2.025 with AUROC of 0.609 (P=0.01), sensitivity of 59.1% and specificity of 62.1%.The 30-day mortality of AKI group was significantly higher than non-AKI group (χ2=18.324, P<0.01). Conclusions AKI is relatively common in patients with ACLF. The risk factors of AKI are INR and SBP. AKI has significant impact on the short-term survival rate of ACLF. Therefore, physicians should pay attention to patients with INR of ACLF at admissions and SBP during the management so as to prevent the occurrence of AKI and to reduce the fatality of ACLF. Key words: Hepatitis B; Acute on chronic liver failure; Acute kidney injury; Risk factors

Acute kidney injury in pregnancy

Abstract Pregnancy-related acute kidney injury (P-AKI) incidence has reduced over the recent years with better accessibility and advances in health care. It is still a concern in developing countries where septic abortions and puerperal sepsis persist due to lack of health facilities. Recent advances have helped in a better understanding of pathogenesis of disorders like pre-eclampsia, acute fatty liver of pregnancy, and thrombotic microangiopathy which has helped the physicians to solve the enigma in both diagnosis and management of these conditions. Diagnosis of P-AKI is challenging due to normal maternal physiological changes. Usual definitions of AKI are not very accurate in pregnancy and newer markers for diagnosis of AKI are not well studied in pregnancy. Early identification of the cause of P-AKI and its prompt treatment holds the key in the management of P-AKI. It is of utmost importance to maintain the hemodynamics and acid base balance for ensuring proper utero-placental blood flow and fetal well being in P-AKI. There is neither particular modality of RRT which is better than other nor a preset dialysis prescription for P-AKI, and renal replacement therapy should be individualized to provide optimal care.