Kidney Injury Stage Research Articles

Regulation of FGF23 Production in Osteocytes.

FGF23 is a bone-derived hormone working to reduce serum phosphate level. This review focuses on recent findings regarding regulatory mechanisms of FGF23 expression in osteocytes, FGF23 levels, and activities. Circulatory FGF23 levels reflecting FGF23 biological activities can be regulated by both FGF23 expression and posttranslational modification of FGF23 protein. O-linked glycosylation and phosphorylation of FGF23 protein as well as enzymes that can cleave FGF23 protein are involved in the posttranslational modification. However, precise mechanisms of FGF23 protein processing are not clear. Several extracellular factors have been shown to affect FGF23 levels in kidney injuries. Contribution of these factors may be different depending on the causes and stages of kidney injury. FGF23 activities are regulated by complex mechanisms involving transcriptional and posttranslational modulations. There still remain several questions regarding the regulatory mechanisms of FGF23 expression and FGF23 processing.

Comparative Analysis of Intensive Care Prognosis Scoring Systems and Acute Kidney Injury Scores (AKIN and pRIFLE) in Critically Ill Children

A total of 716 children, whose serum creatinine levels were within the normal limits at the time of admission to the PICU between January 2018 and December 2020, were included. Along with the demographic and clinical variables, AKIN and pRIFLE classifications were recorded at the most advanced stage of AKI. Along with the PIM-2, PRISM III, and PELOD-2 scores, the highest value of the pSOFA score was recorded. According to the pRIFLE and AKIN classifications, 62 (8.7%) patients developed kidney injury, which had a statistically significant effect on mortality. The occurrence of renal injury was found to be statistically strongly and significantly correlated with high PRISM III, PELOD-2, and pSOFA scores. When the stages of kidney injury according to the AKIN criteria were compared with the PRISM III, PELOD 2, and pSOFA scores, a significant difference was found between the patients who did not develop AKI and those who developed stage 1, stage 2, and stage 3 kidney injury. For the PRISM III, PELOD 2, and pSOFA scores, there were no significant differences between the stages according to the AKIN criteria. A substantial difference was discovered between the patients who did not develop AKI and those who were in the risk, injury, and failure plus loss stages according to the pRIFLE criteria. According to the PIM-2 ratio and pRIFLE criteria, there was a statistically significant difference between patients in the injury and failure plus loss stages and those who did not develop AKI. Our study is the first pediatric study to show a substantial correlation between the variables associated with the PICU scoring modalities in critically ill children with AKI. Identifying the risk factors for the development of AKI and planning antimicrobial regimens for patients with favorable prognoses at the time of PICU admission could lower mortality rates.

Clinical Investigation of Immune Checkpoint Inhibitor-Associated Kidney Injury in Patients with Urologic Cancers

We investigated the clinical characteristics of patients who developed kidney injury after starting treatment with immune checkpoint inhibitors (ICI) for urologic malignancies. The study included 118 patients who were treated with ICI at our hospital. They consisted of 65 with renal cell carcinoma, 52 with urothelial carcinomas and 1 with adrenocortical carcinoma with high-frequency microsatellite instability. Immune-related kidney injury was observed in 13 patients (11.0%), including stage 1, 2 and 3 kidney injuries in 9, 0 and 4 patients, respectively. In univariate analyses, ≥stage 4 chronic kidney disease (CKD) before ICI treatment and proton pump inhibitor use were significantly associated with all stages of kidney injury, whereas ≥stage 4 CKD and ICI combination therapy were significantly associated with kidney injury at ≥ stage 2. Of the 4 patients who developed ≥stage 2 kidney injury, histological examination was done only for 2 because renal biopsy was contraindicated in the other 2 due to prior nephrectomy. Steroid pulse therapy was performed for 3 patients but provided complete recovery only in 1. We should be aware of the risk for immune-related kidney injury in patients with baseline CKD (≥stage 4) and receiving ICI combination therapy. Precise diagnosis by histological examination can often be challenging due to a history of nephrectomy.

COVID-19 and acute kidney injury in German hospitals 2020.

IntroductionThe SARS-CoV-2 pandemic is a major challenge for patients, healthcare professionals, and populations worldwide. While initial reporting focused mainly on lung involvement, the ongoing pandemic showed that multiple organs can be involved, and prognosis is largely influenced by multi-organ involvement. Our aim was to obtain nationwide retrospective population-based data on hospitalizations with COVID-19 and AKI in Germany.Materials & methodsWe performed a query of G-DRG data for the year 2020 via the Institute for the hospital remuneration system (Institut für das Entgeltsystem im Krankenhaus GmbH, InEK) data portal and therefore included hospitalizations with a secondary diagnosis of RT-PCR proven COVID-19 infection, aged over 15 years. We included hospitalizations with acute kidney injury (AKI) stages 1 to 3. Age-specific and age-standardized hospitalization and in-hospital mortality rates (ASR) per 100.000 person years were calculated, with the German population of 2011 as the standard.ResultsIn 2020, there were 16.776.845 hospitalizations in German hospitals. We detected 154.170 hospitalizations with RT-PCR proven COVID-19 diagnosis. The age-standardized hospitalization rate for COVID-19 in Germany was 232,8 per 100.000 person years (95% CI 231,6–233,9). The highest proportion of hospitalizations associated with COVID-19 were in the age group over 80 years. AKI was diagnosed in 16.773 (10.9%) of the hospitalizations with COVID-19. The relative risk of AKI for males was 1,49 (95%CI 1,44–1,53) compared to females. Renal replacement therapy (RRT) was performed in 3.443 hospitalizations, 20.5% of the hospitalizations with AKI. For all hospitalizations with COVID-19, the in-hospital mortality amounted to 19.7% (n = 30.300). The relative risk for in-hospital mortality was 3,87 (95%CI 3,80–3,94) when AKI occurred. The age-standardized hospitalization rates for COVID-19 took a bimodal course during the observation period. The first peak occurred in April (ASR 23,95 per 100.000 person years (95%CI 23,58–24,33)), hospitalizations peaked again in November 2020 (72,82 per 100.000 person years (95%CI 72,17–73,48)). The standardized rate ratios (SRR) for AKI and AKI-related mortality with the overall ASR for COVID-19 hospitalizations in the denominator, decreased throughout the observation period and remained lower in autumn than they were in spring. In contrast to all COVID-19 hospitalizations, the SRR for overall mortality in COVID-19 hospitalizations diverged from hospitalizations with AKI in autumn 2020.DiscussionOur study for the first time provides nationwide data on COVID-19 related hospitalizations and acute kidney injury in Germany in 2020. AKI was a relevant complication and associated with high mortality. We observed a less pronounced increase in the ASR for AKI-related mortality during autumn 2020. The proportion of AKI-related mortality in comparison to the overall mortality decreased throughout the course of the pandemic.

Immunotactoid glomerulopathy \u2013 an enigmatic case in the setting of nodal marginal zone lymphoma and systemic sclerosis sine scleroderma

BackgroundImmunotactoid Glomerulopathy (ITG) is an exceedingly rare type of glomerulopathy characterised by distinctive electron microscopic features. ITG has been linked to lymphoproliferative or autoimmune disorders. The clinical manifestations are diverse including nephrotic syndrome (NS), haematuria, acute kidney injury and end stage renal failure (ESRD). We present a case with a stage 3 Nodal Marginal Zone Lymphoma (NMZL) and systemic sclerosis sine scleroderma (SSSS), where the evolution of ITG was documented in 2 renal biopsies 19 months apart. To the best of our knowledge, no cases have been reported linking ITG to NMZL. Furthermore, there is only one non-peer reviewed report linking ITG to scleroderma. We discuss the implications of our findings and highlight the satisfactory management of the case.Case presentationA 79-year-old female with history of systemic sclerosis sine scleroderma and stage 3 NMZL presented with acute kidney injury and NS on a background of chronic kidney disease. Her first kidney biopsy showed a diffuse proliferative glomerulonephritis and her serum protein electrophoresis showed no abnormalities. She was managed satisfactorily with conservative measures. She returned 19 months later with features of fluid overload, increasing proteinuria and rising serum creatinine. A repeat serum protein electrophoresis showed excess free kappa light chains and ITG was detected in the repeat kidney biopsy. Her kidney function and proteinuria showed a good and sustained response to rituximab administered after the second biopsy.ConclusionITG is a rare type of glomerulopathy, associated with underlying haematological malignancies and autoimmune disorders that may result in ESRD.Rituximab is one of the effective agents used in the management of ITG with haematological malignancies.

Matrix Metalloproteinase-10 in Kidney Injury Repair and Disease.

Matrix metalloproteinase-10 (MMP-10) is a zinc-dependent endopeptidase with the ability to degrade a broad spectrum of extracellular matrices and other protein substrates. The expression of MMP-10 is induced in acute kidney injury (AKI) and chronic kidney disease (CKD), as well as in renal cell carcinoma (RCC). During the different stages of kidney injury, MMP-10 may exert distinct functions by cleaving various bioactive substrates including heparin-binding epidermal growth factor (HB-EGF), zonula occludens-1 (ZO-1), and pro-MMP-1, -7, -8, -9, -10, -13. Functionally, MMP-10 is reno-protective in AKI by promoting HB-EGF-mediated tubular repair and regeneration, whereas it aggravates podocyte dysfunction and proteinuria by disrupting glomerular filtration integrity via degrading ZO-1. MMP-10 is also involved in cancerous invasion and emerges as a promising therapeutic target in patients with RCC. As a secreted protein, MMP-10 could be detected in the circulation and presents an inverse correlation with renal function. Due to the structural similarities between MMP-10 and the other MMPs, development of specific inhibitors targeting MMP-10 is challenging. In this review, we summarize our current understanding of the role of MMP-10 in kidney diseases and discuss the potential mechanisms of its actions.

Features of the course of new coronaviral infection (COVID-19) in patients with acute kidney injury and end stage renal failure

BACKGROUND. In the modern era, COVID-19 is the biggest problem facing doctors and scientists around the world. SARSCоV-2 is a multisystem infection that is not limited to lung damage and has the immuno-mediated effect of negative effects on organs and systems, including the kidneys. To date, there is no precise understanding of the pathogenesis of nephrological disorders in patients with COVID-19. Patients with chronic kidney disease (CKD) are a group of particularly high risk of CO-VID-19 infection and high mortality in the development of the disease.THE AIM: to evaluate the features of the course of a new coronavirus infection (COVID 19) in patients with acute kidney injury and terminal renal insufficiency.PATIENTS AND METHODS. The study of clinical, laboratory and instrumental parameters was carried out in 119 patients (67 men and 52 women) diagnosed with COVID-19. The average age of the patients was 63.1±1.7 years. All patients were divided into two groups: group 1 - patients with CKD and HD, group 2 - patients with newly diagnosed kidney damage against the background of coronavirus infection (COVID-19). Statistical data analysis was carried out using the software package "IBM SPSS Statistics 21.0" (USA) (Russified version).RESULTS. As a result of the study, it was found that in the clinical picture of COVID-19 patients suffering from CKD and undergoing hemodialysis, such a symptom as myalgia was noted 2 times more often, the percentage of saturation of arterial blood hemoglobin with oxygen (SaO2,%) was significantly lower compared to patients with newly diagnosed kidney damage on the background of infection. The duration of the temperature reaction during the disease was 5 times longer than in patients without CKD. Although the incidence of lung damage in patients of both groups was identical, mortality was significantly higher in the group of patients with CKD.CONCLUSION. In the patients examined by us, proteinuria, an increase in the level of nitrogenous metabolites, as well as D-dimers in both groups, are associated with increased mortality. Mortality in patients with CKD and HD was several times higher than in those without pathology of the urinary system. The severity of the patients' condition was primarily due to the symptoms of damage to the respiratory system, but the degree of renal dysfunction is undoubtedly an important prognostic value. Thus, monitoring the state of individual nephron structures in patients with CO-VID-19 is of great importance, and emergency nephroprotective measures may be crucial in the fight against cytokine storm.

Successful Bridging to Recovery Using the Prometheus® Liver Support in a Critical Ill COVID-19 Patient with Acute Liver Failure: A Case Report

Liver impairment is frequently reported in Severe Acute Respiratory Syndrome-Coronavirus-2 (SARS-CoV-2) infected patients and contributes to increased morbidity and mortality in critically ill Coronavirus disease-2019 (COVID-19) patients. We report of a 44-year-old male patient with hypoxic and cholestatic liver failure after an initially complicated course of COVID-19 pneumonia with moderate Acute Respiratory Distress Syndrome (ARDS), Acute Kidney Injury (AKI) stage 3 with Kidney Replacement Therapy (KRT), thromboembolic intestinal ischemia with subtotal colectomy and partial resection of the small intestine and septic shock. After considerable clinical improvement we initiated extracorporeal liver support due to progressive hyperbilirubinemia up to 25,3 mg/dl. Within 17 days we conducted 11 sessions of extracorporeal liver support by Fractionated Plasma Separation and Adsorption (FPSA; Prometheus®) until stabilization of liver function occurred. After 52 days of intensive care treatment and successful weaning from ventilation and KRT, the patient was transferred to an Intermediate Care (IMC) unit. To the best of our knowledge, this is the first report of a COVID-19 patient successfully treated with prolonged extracorporeal liver support. Extracorporeal procedures that support liver function should be considered as bridging to recovery in selected COVID-19 patients if liver failure presents a dominant organ dysfunction.

Renal Biopsy in Children-Effect on Treatment Decisions: A Single-Center Experience.

Renal biopsy is an important diagnostic tool, though invasive and carries risks involved with sedation. The authors wanted to compare suspect histopathological diagnosis with final diagnosis and find out impact of biopsy findings on treatment. They retrospectively analyzed 108 patients. Details of patients, diagnosis, treatment and complications due to kidney biopsy were documented. Statistical analysis was done using SPSS version 20.0 (IBM, NY). Indications of 108 children (69 boys, 39 girls) undergoing renal biopsy were steroid-resistant nephrotic syndrome (35.1%), steroid-dependent nephrotic syndrome requiring calcineurin inhibitors (CNI) (12%), nephrotic range proteinuria with atypical features (16.7%), lupus nephritis (13%), and acute kidney injury (AKI) stage 3 (17.6%). Suspect and histopathological diagnoses were similar in 53% cases with agreement factor of 0.462. Treatment changed in 28.7%. Renal biopsy made substantial impact in patients with nephrotic range proteinuria with atypical features (55.6%) and AKI stage 3 (52.6%). One (0.9%) had developed gross hematuria, which resolved spontaneously.

The wrong Spirochaete? Acute kidney injury in a returning traveller with syphilis \u2013 a case report

BackgroundSyphilis has seen an increased incidence in recent years and can have serious and irreversible consequences if left un-diagnosed and untreated. This case report describes a presentation of syphilis and acute kidney injury – a scenario sparsely described in existing literature.Case presentationThis 43-year old Man who has Sex with Men (MSM) presented to the emergency department with a 3-week history of vomiting and headaches, progressing to include pyrexia. These symptoms started following his return from a 2-week cruise in Central America throughout which he had been well. He had a background of well-controlled human immunodeficiency virus (HIV).On admission he had an Acute Kidney Injury (AKI) stage 3, without hydronephrosis, presumed to be pre-renal. Leptospirosis, the main differential, was negative serologically. ‘Pyrexia of unknown origin’ testing was performed, and cefuroxime commenced. Later in the admission, syphilis testing indicated an acute infection and he completed a full treatment course of benzylpenicillin. This, alongside intravenous fluids, resulted in symptom and renal resolution in 9 days and restoration of renal function.ConclusionsRenal complications in syphilis are rare, furthermore the majority of those documented occur in latent syphilis and are irreversible. There are limited numbers of other documented cases of AKI in acute syphilis, which like the gentleman in this case were reversible and did not lead to permanent kidney damage.This case adds to the knowledge base of AKI in initial presentation of syphilis. It also demonstrates not only the importance of taking a sexual history in patients with new infective symptoms but that testing for syphilis in at-risk groups regardless of history should be performed given its rising incidence. These considerations by physicians can lead to prompt diagnosis and management of syphilis and improve patient care and long-term outcomes.

Renal and Neurologic Benefit of Levosimendan vs Dobutamine in Patients With Low Cardiac Output Syndrome After Cardiac Surgery: Clinical Trial FIM-BGC-2014-01.

BackgroundLow-cardiac output syndrome (LCOS) after cardiac surgery secondary to systemic hypoperfusion is associated with a higher incidence of renal and neurological damage. A range of effective therapies are available for LCOS. The beneficial systemic effects of levosimendan persist even after cardiac output is restored, which suggests an independent cardioprotective effect.MethodsA double-blind clinical trial was conducted in patients with a confirmed diagnosis of LCOS randomized into two treatment groups (levosimendan vs. dobutamine). Monitoring of hemodynamic (cardiac index, systolic volume index, heart rate, mean arterial pressure, central venous pressure, central venous saturation); biochemical (e.g. creatinine, S100B protein, NT-proBNP, troponin I); and renal parameters was performed using acute kidney injury scale (AKI scale) and renal and brain ultrasound measurements [vascular resistance index (VRI)] at diagnosis and during the first 48 h.ResultsSignificant differences were observed between groups in terms of cardiac index, systolic volume index, NT-proBNP, and kidney injury stage at diagnosis. In the levosimendan group, there were significant variations in AKI stage after 24 and 48 h. No significant differences were observed in the other parameters studied.ConclusionLevosimendan showed a beneficial effect on renal function in LCOS patients after cardiac surgery that was independent from cardiac output and vascular tone. This effect is probably achieved by pharmacological postconditioning.Clinical Trial RegistrationEUDRA CT, identifier 2014-001461-27. https://www.clinicaltrialsregister.eu/ctr-search/search?query=2014-001461-27

Prediction Value of Serum NGAL in the Diagnosis and Prognosis of Experimental Acute and Chronic Kidney Injuries.

Sensitive and accurate serum biomarkers for monitoring acute and chronic kidney disease progression are more convenient and can better evaluate drug efficiency in pharmacological research. Neutrophil Gelatinase-associated Lipocalin (NGAL) is considered a hopeful early biomarker of acute kidney injury (AKI), but its utility in early prediction and prognosis of diabetic nephropathy (DN) and immune-mediated glomerulonephritis is still not clear. Moreover, detailed prognosis studies of NGAL in AKI are lacking, and most studies use a urine source. In the current study, through two experimental AKI and two chronic kidney injury animal models, serum NGAL (sNGAL) prediction values on diagnosis and prognosis of kidney injuries in animal disease models have been investigated thoroughly. Four experimental kidney disease models include cisplatin-induced and lipopolysaccharide (LPS)-induced AKI, streptozocin-induced diabetic nephropathy (DN), and cationized-bovine serum albumin (c-BSA)-induced membranous nephropathy (MN), respectively. The sNGAL concentration was measured at different stages of kidney injury (KI) in each experimental model, and receiver operating characteristic (ROC) analyses were performed to investigate the diagnosis efficiency of sNGAL for KI. Western blot and immunohistochemistry were used to measure the protein levels in the kidneys, and pathological analysis was used as the gold standard to confirm KI. Results suggest that sNGAL can predict early diagnosis of cisplatin-induced AKI accurately but is less powerful in later stages compared to blood urea nitrogen (BUN) and serum creatinine (Scr). sNGAL is sensitive but lacks specificity to evaluate early kidney injury for LPS-induced AKI under low-dosage LPS challenge. sNGAL is not an efficient biomarker for early diagnosis of STZ-induced DN, but sNGAL is an efficient predictor for the early diagnosis and prognosis of immune-mediated MN. In conclusion, application of sNGAL as a kidney injury biomarker to determine the diagnosis and prognosis in pharmacological studies is dependent on experimental animal models.

P1517Risk of acute kidney injury in transcatheter aortic valve implantation procedures and impact on 30-day outcome

Abstract Background Transcatheter aortic valve implantation (TAVI) is a safe and effective procedure for patients with symptomatic aortic stenosis who do not qualify for surgery. Nevertheless, post-procedure acute kidney injury (AKI) is a frequent complication and it is associated with worse outcomes. Aim To assess the impact of acute kidney injury (AKI) occurring immediately after the TAVI procedure on patients' outcome. Methods We conducted a multicenter retrospective study on patients treated with TAVI from 2010 to 2018. The assigned treatment, the selection of the device (self-expandable/balloon-expandable valve) and the type of approach used were determined by each individual Center on the basis of the patient's characteristics and the choice of the operator. All patients had an intermediate or high Society of Thoracic Surgeons (STS) score. Basal creatinine and glomerular filtrate (using the body mass index, sex and age) were evaluated for each patient. According to the KDIGO criteria, AKI is defined as an increase in serum creatinine (SCr) ≥0,3mg/dl within 48 hours or an increase in SCr ≥1.5 times baseline or urine volume <0,5ml/kg/h for 6 hours. The incidence of post procedural AKI and its correlation with the short-term mortality and outcomes was evaluated as primary end point (stroke/TIA/RIND, cardiac tamponade, bleeding, vascular complications, cardiocirculatory arrest with subsequent ROSC, definitive pacemaker implantation, postoperative atrial fibrillation, left bundle branch block de novo).Postoperative outcomes were defined according to the updated Valve Academic Research Consortium 2 definitions Results A total of 371 pts were analysed. Mean age was 82.3±5.9 and the majority of the pts had an STS score>10 (97.6%). Incidence of Acute kidney Injury (AKI) stage 3 post TAVI, according to VARC-2 criteria, was 16,2%. In patient with AKI, the hospitalization time was longer 18,7±6,1 days vs 8,4±6,1 days without AKI (p<0,01). Patients with AKI had an increased risk of in hospital mortality (OR 50,0; 95% CI 5,2–390,16; p<0,01) and 30 day mortality (OR: 5,88; 95% CI 2,08–16,60; p<0,01). Acute Kidney Injury instead was more common in patients treated with transapical access (OD 3,9-CI 95% 2,16–7,07; p<0,01) or with PAD (OR 1,87 - CI 95% 1,03–3,41; p=0,03) AKI and short term mortality Conclusion Acute kidney injury is a frequent complication after TAVI. AKI seems to be the strongest predictor for 30 day mortality and increases the hospitalization time. AKI was more common in patients treated with a transapical approach or if they presented a PAD. In contrast, pre-procedural chronic kidney disease did not seem to correlate directly with an increased risk of AKI.

TRAIL, OPG, and TWEAK in kidney disease: biomarkers or therapeutic targets?

Ligands and receptors of the tumor necrosis factor (TNF) superfamily regulate immune responses and homeostatic functions with potential diagnostic and therapeutic implications. Kidney disease represents a global public health problem, whose prevalence is rising worldwide, due to the aging of the population and the increasing prevalence of diabetes, hypertension, obesity, and immune disorders. In addition, chronic kidney disease is an independent risk factor for the development of cardiovascular disease, which further increases kidney-related morbidity and mortality. Recently, it has been shown that some TNF superfamily members are actively implicated in renal pathophysiology. These members include TNF-related apoptosis-inducing ligand (TRAIL), its decoy receptor osteoprotegerin (OPG), and TNF-like weaker inducer of apoptosis (TWEAK). All of them have shown the ability to activate crucial pathways involved in kidney disease development and progression (e.g. canonical and non-canonical pathways of the transcription factor nuclear factor-kappa B), as well as the ability to regulate cell proliferation, differentiation, apoptosis, necrosis, inflammation, angiogenesis, and fibrosis with double-edged effects depending on the type and stage of kidney injury. Here we will review the actions of TRAIL, OPG, and TWEAK on diabetic and non-diabetic kidney disease, in order to provide insights into their full clinical potential as biomarkers and/or therapeutic options against kidney disease.

Outcome of kidney function after ischaemic and zero-ischaemic laparoscopic and open nephron-sparing surgery for renal cell cancer

BackgroundNephron-sparing surgery (NSS) remains gold standard for the treatment of localised renal cell cancer (RCC), even in case of a normal contralateral kidney. Compared to radical nephrectomy, kidney failure and cardiovascular events are less frequent with NSS. However, the effects of different surgical approaches and of zero ischaemia on the postoperative reduction in renal function remain controversial.We aimed to investigate the relative short- and long-term changes in estimated glomerular filtration rate (eGFR) after ischaemic or zero-ischaemic open (ONSS) and laparoscopic NSS (LNSS) for RCC, and to analyse prognostic factors for postoperative acute kidney injury (AKI) and chronic kidney disease (CKD) stage ≥3.MethodsData of 444 patients (211 LNSS, 233 ONSS), including 57 zero-ischaemic cases, were retrospectively analysed. Multiple regression models were used to predict relative changes in renal function. Natural cubic splines were used to demonstrate the association between ischaemia time (IT) and relative changes in renal function.ResultsIT was identified as significant risk factor for short-term relative changes in eGFR (ß = − 0.27) and development of AKI (OR, 1.02), but no effect was found on long-term relative changes in eGFR. Natural cubic splines revealed that IT had a greater effect on patients with baseline eGFR categories ≥G3 concerning short-term decrease in renal function and development of AKI. Unlike LNSS, ONSS was significantly associated with short-term decrease in renal function (ß = − 13.48) and development of AKI (OR, 3.87). Tumour diameter was associated with long-term decrease in renal function (ß = − 1.76), whereas baseline eGFR was a prognostic factor for both short- (ß = − 0.20) and long-term (ß = − 0.29) relative changes in eGFR and the development of CKD stage ≥3 (OR, 0.89).ConclusionsIT is a significant risk factor for AKI. The short-term effect of IT is not always linear, and the impact also depends on baseline eGFR. Unlike LNSS, ONSS is associated with the development of AKI. Our findings are helpful for surgical planning, and suggest either the application of a clampless NSS technique or at least the shortest possible IT to reduce the risk of short-time impairment of the renal function, which might prevent AKI, particularly regarding patients with baseline eGFR category ≥G3.

Myoclonus in a Patient with Acute Kidney Injury: A Rare Presentation of Gabapentin Toxicity

Gabapentin, an anti-epileptic drug (AED) is commonly used off label for management of neuropathic pain and psychiatric disorders. Dosing of gabapentin requires taking into consideration the renal function as it is entirely cleared by the kidneys. Acute kidney injury and end stage renal disease increase the risk of developing myoclonic activity, an infrequent manifestation of gabapentin toxicity. We report a case of confusion and myoclonic activity related to gabapentin toxicity coincident with acute kidney injury that resolved with discontinuation of gabapentin and treatment with intravenous fluid hydration. As gabapentin is commonly used off label across multiple specialties, clinician recognition of the significance of renal dosing and understanding of the potential association with myoclonus and neurotoxicity is important.

The Estimation of Glomerular Filtration Rate Based on the Serum Cystatin C and Creatinine Values.

Renal insufficiency is one of the most serious renal diseases. Early diagnosis plays an essential role. Serum creatinine as a marker has had priority so far. The use of cystatin C for estimation of glomerular filtration rate has been recommended recently. There is a set of formulae which consolidates serum values of both creatinine and cystatin C. The study focuses on different formulae and their estimation for the purpose of better, faster, and more accurate diagnosis of renal insufficiency. The sample consists of 75 examinees which are divided into three groups. The first group is made of patients with the glomerular filtration rate (GFR) 90 - 120 mL/minute/1.73m². The second group consists of patients with GFR 60 - 89 mL/minute/1.73m² and the third with GFR 30 - 59 mL/minute/1.73m². The exclusion criteria are the following: children and adolescents under the age of 20, pregnant women, patients on corticosteroid therapy and blockers of the distal tubular creatinine secretion. The five equations (GFR1-5) used in this research are: a Cockcroft-Gault equation - GFR1; a MDRD equation - GFR2; CKD-EPI - an equation based on cystatin C - GFR3; CKD-EPI - an equation based on cystatin C, adjusted according to the gender and age - GFR4; and CKDEPI - a combined equation based on cystatin C and creatitine, adjusted according to the age, gender, and race - GFR5. Upon acquiring the results, it is followed up with the statistical data analysis followed by graphs and tables. After data analysis, it is established that data distribution does not show normal distribution in each case, which leads to the use of nonparametric statistics. Depending on the stage of kidney injury there are different results regarding the difference in statistics of the used formulae. The highest sensitivity is recorded with the formulae GFR4 and GFR5. Then the increase in cystatin C levels increases sensitivity with the formulae GFR3 and GFR4. As a result of this study, it is to be established that the formula of choice is the GFR3 - CKD-EPI formula based on serum cystatin C values, without adjustments. Its sensitivity, specificity, price, and feasibility are to be observed as parameters. Besides that, the increase in serum cystatin levels leads to the increase of sensitivity of the GFR3 formula, which could be an additional factor in the selection of formulae.

Abstract 13320: Effect of Cardiovascular Comorbidities on the Mortality Risk Associated with Serum Potassium

Introduction: Both hypokalemia and hyperkalemia are known to be associated with an increased mortality risk. The serum potassium (K + ) levels associated with these risks and the relationships to comorbidity, however, are not well defined. We therefore evaluated the odds of death in patients with and without comorbid conditions, stratified by K + level. Methods: De-identified medical records (2007-2012) from a large U.S. population of persons ≥ 5 years of age with at least 2 K + readings were evaluated. Patients 45-64 years of age with comorbidities defined as CKD stages 3-5, heart failure, diabetes, hypertension, and cardiovascular disease (n=231,070) were identified from demographic data, ICD-9 codes and biochemical data, excluding those with acute kidney injury or end stage renal disease, and compared with controls having none of these conditions (n=146,645). A separate analysis of patients ≥ 65 years of age was performed. Index K + value was defined as the last reported value prior to pre-determined cut-off date. Mortality was evaluated through hospital discharge records and Social Security registry information. Results: Among patients aged 45-64 with comorbid conditions, index K + levels below 4.1 mEq/L and above 4.6 mEq/L demonstrate a significant increase in mortality (Figure). This finding was similar in patients ≥ 65 years of age. The general pattern remained after adjustments for demographic characteristics (sex, race) and subgroup analyses controlling for comorbidities associated with the propensity to develop hypo- and hyperkalemia. Conclusions: These results indicate that the level of potassium and the risk of mortality in patients with hypokalemia or hyperkalemia is highly associated with underlying disease; is significantly greater in patients with comorbid conditions; and is independent of demographic characteristics. The increased mortality in patients with comorbidity occurs even at K + levels within the usual normal laboratory range.