Nephrotoxic Medications Research Articles

Prevalence and associated factors of acute kidney injury in Ethiopia, systematic review and meta-analysis.

Acute kidney injury, characterized by a sudden decline in glomerular filtration rate, presents a significant global health challenge, with its high prevalence exacerbated by hypertension and limited healthcare access. This systematic review and meta-analysis examined 19 studies encompassing 11,955 participants to assess acute kidney injury prevalence and associated factors in hospitalized patients inEthiopia. The overall pooled prevalence of acute kidney injury was found to be 3.20% (95% CI 2.91-3.48), with considerable heterogeneity (I2 = 99.3%; p < 0.001). Subgroup analyses identified elevated rates ofacute kidney injury in studies conducted post-2020 (31.656%, 95% CI 24.465-38.848), particularly in the Oromia region (41.622%, 95% CI 11.873-71.372), and smaller study sample (< 400) (44.524%, 95% CI 30.117-58.932). Hypertension, congestive heart failure, sepsis, chronic kidney diseases, and nephrotoxicity emerged as significant risk factors. Regular monitoring of renal function through blood and urine analyses is crucial for early detection and management of acute kidney injury, particularly in high-risk groups. Addressing healthcare disparities and reducing nephrotoxic medication use are essential strategies to mitigate acute kidney injury incidence and improve kidney health outcomes worldwide.

Drug-induced acute kidney injury: a cohort study on incidence, identification of pathophysiological mechanisms, and prognostic factors.

Acute Kidney Injury (AKI) is a common clinical syndrome characterized by an abrupt decline in the glomerular filtration rate (GFR), which can cause severe alterations in blood volume and acid-base balance. Drug-Induced Acute Kidney Injury (DI-AKI) is associated with exposure to nephrotoxic medications, particularly among hospitalized patients. Adverse drug reactions comprises type A and type B reactions. Type A reactions are predictable based on the pharmacology of the substance, dose-dependent, and manifest as Acute Tubular Necrosis (ATN). Type B reactions are unpredictable, idiosyncratic, not dose-dependent, and manifest as Acute Interstitial Nephritis (AIN), Crystal-Induced Nephropathy, among others. To evaluate DI-AKI incidence, identify the main associated drugs and the pathophysiological mechanism of the observed injury, analyze prognostic factors associated with unfavorable outcomes, and compare the outcomes of death and the need for Acute Kidney Support Therapy (AKST) between patients with DI-AKI vs. AKI due to other etiologies. A retrospective cohort study conducted at the Hospital das Clínicas of the Faculty of Medicine of Botucatu - UNESP (HC-FMB), using data from patients hospitalized between January 2016 and April 2022 and followed, via consultation, by the AKI-Nephrology team. Inclusion criteria: diagnosis of AKI and Chronic Kidney Disease (CKD) with superimposed AKI. Exclusion criteria: patients under 18 years old or on chronic Renal Replacement Therapy. AKI was diagnosed based on creatinine increase as established by KDIGO 2012. Data were presented as mean and standard deviation or median with interquartile range and frequency. Statistical significance was set at 5% (p < 0.05). Comparative analyses were performed using the Chi-Square test for categorical variables and the T-test for continuous variables. Subsequently, logistic regression was performed to identify factors associated with the need for AKST and death. A total of 1,398 patients were analyzed, most of them males (61.4%), with a mean age of 64 years ±14.4 years. The most prevalent etiology of AKI was Mixed Ischemic + Septic AKI (28%). DI-AKI was a significant cause of AKI (19.3%). Of these, 25.2% were isolated DI-AKI and 74.8% were Mixed DI-AKI + Ischemia and/or Sepsis. Among patients with DI-AKI, the mean age was 61.15 ± 15.26, males were the most frequent, the majority were not subjected to AKST and survived. Most of these patients were hospitalized in the ward, did not need vasoactive drugs, nor did they use mechanical ventilation. DI-AKI showed lower severity and mortality compared to other AKI etiologies but had a similar need for AKST (26.3% vs. 35.4%, p < 0.05 and 31.8% vs. 36.8%, p > 0.05). Most nephrotoxic drugs caused type A reactions, with Vancomycin being the primary nephrotoxin. Among drugs associated with DI-AKI, Vancomycin was associated with a higher need for AKST and death, while Amphotericin B was associated with a lower risk of AKST and death. Although the mortality rate is lower among DI-AKIs compared to other AKI etiologies, the need for AKST was similar. Therefore, it is recommended that DI-AKI be recognized early to enable dose reduction or even drug suspension, depending on the type of reaction, to reduce healthcare costs and improve clinical outcomes for patients.

10 TIPS on how to use dynamic risk assessment and alerts for AKI

Abstract Acute kidney injury (AKI) is a common syndrome in hospitalized patients and is associated with increased morbidity and mortality. The focus of AKI care requires a shift away from strictly supportive management of established injury to the early identification and timely prevention of worsening renal injury. Identifying patients at risk for developing or progression of severe AKI is crucial for improving patient outcomes, reducing length of hospitalization and minimizing resource utilization. Implementation of dynamic risk scores and incorporation of novel biomarkers show promise for early detection and minimizing progression of AKI. Like any risk assessment tools, these require further external validation in a variety of clinical settings prior to widespread implementation. Additionally, alerts which may minimize exposure to a variety of nephrotoxic medications or prompt early nephrology consultation are shown to reduce the incidence and progression of AKI severity and enhance renal recovery. While dynamic risk scores and alerts are valuable, implementation requires thoughtfulness and should be used in conjunction with the overall clinical picture in certain situations, particularly when considering the initiation of fluid and diuretic administration or renal replacement therapy. Despite the contemporary challenges encountered with alert fatigue, implementing an alert-based bundle to improve AKI care is associated with improved outcomes, even when implementation is incomplete. Lastly, all alert-based interventions should be validated at an institutional level and assessed for their ability to improve institutionally relevant, clinical meaningful outcomes, reduce resource utilization and provide cost effective interventions.

Treatment of kidney disease: an analytical decision model at a Swiss university hospital

Abstract Background An observational hospital-based cohort study, where the kidney disease staging is identified as a digital marker, and the association between the standardised staging of Kidney Disease (KD) and the outcomes is assessed along the treatment process. Methods The clinical and administrative data for all patients are stored in the Clinical Data Warehouse. A specific digital marker for an exact KD staging is applied. Three retrospective patient cohorts for exact and imprecise staging and missing diagnosis are defined and compared regarding the in-hospital mortality, all-cause mortality and disease progression. Results In total, 83146 hospitalisations of 40421 patients with KD, treated in 2014-2023 (2016-2023 will be updated) were identified; the number of the first hospitalisations with exact staging was 847 (2%), unprecise 29934 (72%) and missing diagnosis (26%). The demographic and baseline factors distribution between groups was tested with no association (chi-squared test statistic). The median survival time with a 95% CI was 7.94 (7.66, 8.81) years for the exact and 7.47 (7.42, 7.53) for the imprecise staging group. A log-rank and loglikelihood tests indicated a significant difference in survival between the groups, p &amp;lt; 0.0001. The Cox regression model shows a statistically significant difference in Hazard Ratio; KD staging, age, Elixhauser van Walraven index, treatment, nephrotoxic medication, contrast agent application, and AKI were identified as the significant covariates, C-statistic 0.730, Likelihood ratio test, Wald test, log-rank score on 42 df, p &amp;lt; 2e-16. ANOVA analysis confirmed a significant difference in cost distribution between the groups. An economic decision model proposal integrates the findings, combining a profile-level Markov cohort with a Discreet Time-To-Event Simulation DICE. Conclusions The study demonstrates a better outcome regarding all-cause mortality, in-hospital mortality, and costs if a standardised KD staging was applied. Key messages • Intuition (clinical judgement) and standardised kidney disease staging perform differently regarding clinical outcomes and costs. • The study demonstrates a better outcome regarding all-cause mortality, in-hospital mortality, and costs if a standardised KD staging was applied.

The frequency, risk factors, onset time, and outcome of acute kidney injury induced by vancomycin, colistin, and liposomal amphotericin B in hospitalized patients

Introduction: Medications are among the major causes of acute kidney injury (AKI) in hospitalized patients. Objectives: This study aimed to explore the frequency, characteristics, risk factors, and clinical outcomes of AKI induced by vancomycin, colistin, and liposomal amphotericin B (L-AmB) in hospitalized patients across various wards of two educational hospitals in Shiraz, Iran. Patients and Methods: From October 2022 to May 2023, an observational cross-sectional study was conducted in both intensive care unit (ICU) and non-ICU wards of Namazi and Shahid Faghihi hospitals, Shiraz, Iran. Patients aged 18 and older, without a documented history of AKI or chronic kidney disease, scheduled to receive treatment with vancomycin, colistin, or L-AmB for at least one week, were considered eligible. Relevant data, including demographic, clinical, and laboratory findings, were collected. Results: AKI was observed in 36 (34.3%) out of 105 patients during treatment. The incidence rates of AKI were 29%, 55%, and 31.1% in vancomycin, colistin, and L-AmB recipients, respectively. The mean ± SD time to AKI onset was 5.44 ± 2.04 days (range; 3 to 13 days). Dehydration at admission significantly increased the risk of antibiotic-induced AKI (odds ratio [OR] = 3.686, 95% confidence interval [CI] = 1.226–11.081, P = 0.020). Co-administration of aminoglycosides (OR = 8.422, 95% CI = 1.846 – 38.426, P = 0.006), diuretics (OR = 3.763, 95% CI = 1.092–12.965, P = 0.036), and angiotensin-converting enzyme inhibitors/angiotensin receptor blockers (OR = 7.149, 95% CI = 1.534–33.308, P = 0.012) were also identified as independent risk factors. The in-hospital mortality rate was significantly higher in patients with AKI than in those without AKI (8.6% vs. 6.7%; P &lt; 0.044). Conclusion: AKI induced by vancomycin, colistin, and L-AmB occurred in about one-third of our study population, primarily within five days of initiating treatment. Dehydration and co-administration of nephrotoxic medications were significantly associated with AKI. Clinicians should explicitly address these factors in preventive strategies to reduce antibiotic-induced AKI in hospitalized patients.

Chronic kidney disease associated with extremely premature birth and extremely low birth weight may progress through the burden of growth.

Chronic kidney disease associated with low birth weight and/or premature birth (L/P-CKD) in infants may result from a decreased number of nephrons at birth. These infants may develop acute kidney injury due to exposure to nephrotoxic substances or other events during nephrogenesis in early infancy. Nonetheless, L/P-CKD progression remains unclear. We present three cases of L/P-CKD diagnosed after neonatal intensive care unit (NICU) discharge. Three patients were born extremely prematurely (gestational age, 24-26weeks) with extremely low birth weight (606-906g). They were admitted to the NICU (117-311days) anad received several nephrotoxic medications during the early postnatal period. They showed elevated serum creatinine levels at 4weeks after birth, which decreased to normal levels at NICU discharge. Proteinuria was first detected during adolescence (10-15years) on annual school urine screening, with a remarkable increase in their height (18 - 50.8cm), without known episodes of urinary tract infection, dehydration, lifestyle-related issues, such as excessive salt/protein intake, and extreme lack of exercise that might have caused kidney damage. Their kidneys were smaller than normal on renal ultrasonography. Open renal biopsy findings indicated glomerulomegaly and perihilar glomerulosclerosis in two of the three patients, suggesting glomerular hypertension. The remarkable differences between the body height before CKD and the timing of diagnosis of CKD could contribute to the progress of CKD. Long-term follow-up of low birth weight and extremely premature infants, from NICU discharge until adulthood, should be established.

Using Doppler duplex ultrasound to determine hemodynamic alterations in renal vasculature: Crucial pathophysiological event preceding renal dysfunction in decompensated cirrhosis

BackgroundRenal dysfunction is a watershed event in cirrhosis, often preceded by renal vasoconstriction. However, our reliability on elevated serum creatinine often delays interventions. Measurement of Renal Resistive Index (RI) and Renal Venous Stasis Index (RVSI) by Doppler ultrasound offers insight into renal vasoconstriction. MethodsFifty participants with decompensated cirrhosis with ascites and normal serum creatinine underwent renal Doppler ultrasound for the measurement of RI and RVSI. All patients were compliant with a salt-restricted diet. Individuals aged <18 years, hepatocellular carcinoma, non-cirrhosis-related ascites, pre-existing renal disease, obstructive uropathy, or history of nephrotoxic medication use were excluded. Statistical analyses, including Pearson correlation, regression analysis, and Chi-square/Fisher’s exact tests, were performed to assess the statistical significance between RI, RVSI, and renal parameters. Additionally, the association of RI with the model for end-stage liver disease sodium (MELD-Na) and Child-Turcotte-Pugh (CTP) scores was also assessed. ResultsMajority were males (88%), average CTP score was 11.7, mean MELD-Na score was 20.92, and mean serum creatinine was 1.05 mg/dL. Renal parameters had varying RI values among renal arteries, with the main right and left arteries at 0.615 [standard deviation (SD): 0.089] and 0.638 (SD: 0.083), respectively. RI and RVSI are significantly correlated with serum creatinine. Further, significant correlation between, RI, RVSI values noted with MELD-Na score even when serum creatinine values are normal. ConclusionStrong correlations between serum creatinine, RI, and MELD-Na scores hints at predictive clinical potential. Future research with larger cohorts and extended follow-up is required to gauge clinical utility and its impact on outcomes.

Insights into renal and urological complications of inflammatory bowel disease.

Inflammatory bowel disease (IBD) is a chronic condition characterized by immune-mediated inflammation in the gastrointestinal tract, which follows a relapsing and remitting course. Apart from affecting the gastrointestinal tract, IBD also has extra-intestinal manifestations (EIMs). While the etiology of extraintestinal manifestation remains unclear, it is theorized to be based on immunological responses influenced by genetic factors. Renal involvement is one of the EIMs observed in ulcerative colitis and Crohn's disease. The renal manifestations in IBD patients encompass a range of conditions including nephrolithiasis, amyloidosis, tubulointerstitial nephritis, glomerulonephritis (GN), obstructive pathologies, and chronic kidney disease (CKD). The incidence of CKD in IBD patients varies from 5%-15%. The decline in renal function can stem from various factors such as direct inflammatory damage to the kidneys leading to glomerular or tubular injury, or from complications like recurrent stones, amyloidosis, or GN. Additionally, nephrotoxic medications used in treating IBD, such as TNF-α inhibitors, calcineurin inhibitors, and aminosalicylates, can exacerbate the decline in renal function. Currently, there is a lack of consensus regarding these patients' screening and renal function monitoring. This review aims to assess the existing literature on the different renal complications among individuals with IBD, shedding light on their pathophysiology and management.

Acute Kidney Injury in Relation to Nephrotoxic Medication Use Among Critically Ill Children in the Paediatric Intensive Care Unit.

Background: Critically ill children are vulnerable to acute kidney injury (AKI) and are often exposed to nephrotoxic medications. Objectives: We aimed to investigate the association between nephrotoxic medications and the risk of AKI in critically ill children admitted to our paediatric intensive care unit (PICU). Methods: Patients aged > 1 month to ≤18 years old were prospectively recruited from 6/2020 to 6/2021. The medication records from 14 days prior to PICU admission to PICU discharge were reviewed. Medication-exposure intensity was defined as the number of concomitant nephrotoxic medications. The relative risk (RR) of nephrotoxic medication exposure indices and other potential predictors for AKI development were determined. Results: Altogether 253 episodes of admissions (median [IQR] age of 4.9 [9.6] years) were enrolled. The AKI incidence was 41.9% and 69.2% of the patients were exposed to ≥1 of the 47 nephrotoxic medications. The total nephrotoxic medication dose (RR: 1.01 [1.00, 1.02]) and medication-exposure intensity (RR: 1.381 [1.101, 1.732]) were significantly associated with AKI development. The risk of AKI increased when the medication-exposure intensity was ≥4 (RR: 3.687 (1.320, 10.301)). During their PICU stay, children with AKI received a higher number (P < .01), total dose (P < .01) and medication exposure intensity (P < .01) of nephrotoxic medications. Children with AKI who received nephrotoxic medications were more likely to have a persistently higher peak-to-baseline ratio (P = .046). Conclusion: Nephrotoxic medication exposure significantly increased the risk of AKI development among critically ill children. The use of nephrotoxic medications among critically ill children at risk for AKI should be monitored frequently.

Particulars of breastfeeding age in preterm child (case report)

Background. General physicians often encounter preterm infants and adverse sequelae of prematurity-related morbidities. Interruption of intrauterine development leads to considerable deficits in the internal organs structure and function. It can lead to endothelial dysfunction, hypertension, proteinuria and metabolic abnormalities that persist throughout life. Children born early or low birth weight (LBW) infants also have relatively increased risk for the deve­lopment of kidney injury later in life. Often these infants have history of treatment at the intensive care unit due to hypoxic damage or inflammatory response that also affects kidneys necessitating the use of nephrotoxic medications. The treatment and diagnosis outcomes were applied to make a conclusion about clinical features of the preterm 7-month-old girl. The data were analyzed using PubMed/MEDLINE and Google Scholar databases. The aim is to summarize particulars of breastfeeding period in a LBW baby, providing a physician with practical information regar­ding organization of a follow-up. Material and methods. The baby was moderately preterm (32–33 weeks of gestation) with LBW (2100 g). Her mother was consulted regarding hypertension and threat of miscarriage during pregnancy. The child had renal borderline states in the newborn period. Apgar score was low, neonatal resuscitation and respiratory support by the continuous positive airway pressure were used. The newborn had poor regulation of body temperature, depended on environmental factors and prone to rapid heat loss, so she was nursed in incubator. A feeding tube was used despite poor sucking at the first days after delivery and breastfeeding was continued as soon as possible. Eventually, formula feeding was started. Results. Fever, vomiting, dehydration, loss of body weight and oliguria appeared in the 7-month-old baby after the upper respiratory tract infection. Examination showed the stigmas, neurodevelopmental delay, physical growth gap. Blood tests revealed anemia of the first stage and a rapid increase in the level of white blood cells with a left shift and electrolyte imbalance. The laboratory tests of primary and secondary hemostasis were normal. Physical, chemical and microscopic urine properties were changed according to results of urine test. The sonography revealed changes in renal tissue and thymic hyperplasia. The child was diagnosed with acute pyelonephritis and treated. Conclusions. Physicians should focus attention on the stigmas, neurodevelopmental delay, physical growth gap, life history, clinical signs and results of examination to make timely conclusion about child’s general state. Kidney injury could be diagnosed in preterm LBW infants.

Contrast-induced nephropathy: nursing interventions - a scoping review

Abstract Introduction Contrast-induced nephropathy (CIN) refers to a reduction in renal function following contrast administration, excluding other causes. It is characterized by na increase in creatinine levels of 0.5mg/dl or greater, or a 25% increase over baseline creatinine, occurring 48 to 72 hours post-contrast administration and lasting for 2 to 5 days (Santos et al., 2011). Antunes et al. (2013) refers that the CIN is the 3rd cause of acute renal insufficiency (ARI) and that CIN may develop in up to 55% of patients who receive contrast exposure during coronary angiography and of these may result in 12,6% requiring dialysis among high-risk groups following percutaneous coronary intervention (PCI) (Wu et al., 2022). Objective This review aims to map the available evidence regarding nursing interventions to prevent contrast-induced nephropathy in patients undergoing PCI. Methods The review follows the methodology proposed by the Joanna Briggs Institute guided by the PCC (Population, Concept, Context) strategy. Were identified 44 articles by MEDLINE Complete (via PubMed), CINAHL Complete (via EBSCO) e SciELO, and analyzed/ selected through PRISMA Scr flowchart. Four articles were included. Results These articles revealed that the incidence of CIN varies based on risk factors such as age, hypertension, and pre-existing chronic kidney disease. As there is no specific treatment for contrast-induced nephropathy, prevention strategies are essential. Nursing professionals have a significant and privileged role in the pre-, intra-, and post-procedural phases, and thus, are best positioned to implement prevention strategies for CIN. In general, hospitals that implemented improvement interventions reduced CIN by 21% compared to the pre-intervention phase. Compared to patients with pre-existing CKD, the reduction was 28% (Lambert et al., 2017). Teams also report important successes in implementing improvements, such as changing behavior with greater awareness of CIN prevention strategies, implementing the hydration protocol, standardizing medical prescriptions and minimizing the volume of contrast administered. Conclusions Nursing plays a crucial and privileged role in preventing CIN. Key interventions involve conducting a thorough initial assessment to identify individuals at risk for CIN (considering factors such as age, comorbidities, nephrotoxic medication, and dehydration). Pioli et al. (2023) found that oral hydration can be effective in the process of preventing CIN, before and after elective percutaneous procedures. It concluded that the oral hydration protocol carried out by nurses proved to be as effective as the hospital intravenous hydration protocol in protecting the kidneys of individuals at risk of developing CIN associated with elective coronary interventions (Picture 1). By implementing these strategies, nursing professionals can effectively contribute to reducing the incidence of contrast-induced nephropathy in patients undergoing PCI.

Acute Kidney Injury in Neonates: A Meta-Analysis.

There is a paucity of pooled synthesized data on the epidemiology of neonatal acute kidney injury (AKI). Our objective with this study is to systematically assess the worldwide incidence of AKI in neonates. We searched 3 electronic databases (Embase, PubMed, Web of Sciences) from January 2004 to December 2022 without language restrictions. We included cohort and cross-sectional studies that reported the incidence of AKI or associated mortality in neonates. Eligible studies had at least 10 participants and used standard criteria (Acute Kidney Injury Network/Pediatric Risk, Injury, Failure, Loss, End Stage Renal Disease (pRIFLE)/ Kidney Disease Improving Global Outcomes) to define AKI. Two authors independently retrieved data on demographic characteristics, clinical setting, and outcomes (incidence and AKI-associated mortality) using a semi-structured proforma and assessed the risk of bias. We used a random-effects meta-analysis to calculate pooled estimates with 95% confidence intervals. We included 201 studies (98 228 participants) from 45 countries. The incidence of any stage AKI was 30% (95% confidence interval 28-32), and that of severe AKI was 15% (14-16). Overall, AKI-associated mortality was 30% (27-33). The odds of mortality were higher (odds ratio 3.4; 2.9-4.0) in neonates with AKI compared with those without AKI. We found that perinatal asphyxia, sepsis, patent ductus arteriosus, necrotizing enterocolitis, and nephrotoxic medications were significant risk factors for AKI. Significant heterogeneity in the pooled estimates was a limitation of this study. AKI was observed in one-third of the neonates and was associated with increased risk of mortality. The incidence of AKI was almost similar in neonates with perinatal asphyxia and sepsis, but mortality was higher in the former group.

Acute Kidney Injury in Neonatal Intensive Care Unit: Epidemiology, Diagnosis and Risk Factors.

Acute kidney injury (AKI) is associated with long-term consequences and poor outcomes in the neonatal intensive care unit. Its precocious diagnosis represents one of the hardest challenges in clinical practice due to the lack of sensitive and specific biomarkers. Currently, neonatal AKI is defined with urinary markers and serum creatinine (sCr), with limitations in early detection and individual treatment. Biomarkers and risk factor scores were studied to predict neonatal AKI, to early identify the stage of injury and not the damage and to anticipate late increases in sCr levels, which occurred when the renal function already began to decline. Sepsis is the leading cause of AKI, and sepsis-related AKI is one of the main causes of high mortality. Moreover, preterm neonates, as well as patients with post-neonatal asphyxia or after cardiac surgery, are at a high risk for AKI. Critical patients are frequently exposed to nephrotoxic medications, representing a potentially preventable cause of AKI. This review highlights the definition of neonatal AKI, its diagnosis and new biomarkers available in clinical practice and in the near future. We analyze the risk factors involving patients with AKI, their outcomes and the risk for the transition from acute damage to chronic kidney disease.

#1141 Chronic kidney disease in inflammatory bowel disease: systematic review and meta-analysis

Abstract Background and Aims Chronic kidney disease (CKD) is defined by a reduction in kidney function (estimated glomerular filtration rate &amp;lt; 60 mL/min/1.73 m2) and/or damage markers that are present for at least three months, regardless of the underlying aetiology. Case reports and cohort studies suggest that inflammatory bowel disease (IBD is associated with CKD. The extent and magnitude of a potential association between IBD and CKD is currently unknown. Method A comprehensive search was conducted in EMBASE, MEDLINE, Web of Science, the Cochrane database, and SCOPUS. Two separate reviewers were involved in the process of article selection and evaluation. In studies where a comparison between an IBD population and a non-IBD control population was available, odds ratios were calculated to quantify the association. To derive an overall estimate of the effect, the Mantel–Haenszel test was employed, utilising a random effect model. This systematic was registered with Prospero. Results Fifty-four articles were included in the review (Table 1). Eight articles compared an IBD population with a healthy control population and were included in the meta-analysis, although with high heterogeneity (I2 88%). An increased risk of CKD in the IBD population was observed, with an overall odds ratio of 1.59 (95% CI 1.31-1.93) (Fig. 1). Importantly, this effect was independent of 5-aminosalicylic acid use. Data on other therapies was sparse, except for known nephrotoxic medication like tacrolimus and cyclosporine. Interestingly, several studies reported a decreasing relative risk with increasing age, potentially reflecting an increased baseline risk in this ageing population. Conclusion The existing evidence on CKD in IBD was systematically reviewed, including all human epidemiological studies. An increased CKD prevalence in IBD was found; independent of medication. Hence, we suggest regular measurements of kidney function for all patients with IBD, irrespective of the therapeutic regimen. Measurements should include determination of the baseline creatinine, albumin/creatinine ratio and urinary sediment. For patients having a normal baseline function, we would recommend annual follow-up. A more systematic research approach regarding CKD and IBD is warranted

Study of acute kidney injury in children with nephrotic syndrome in a rural tertiary care hospital

Background: Acute kidney injury (AKI) is a common comorbidity in critically ill children and is associated with an increased risk of morbidity and mortality in children with nephrotic syndrome. The etiology of AKI in nephrotic syndrome is complex and multifactorial. Aims and Objectives: To determine the proportion, risk factors, and outcomes of patients with AKI in children hospitalized with nephrotic syndrome. Materials and Methods: This cross-sectional study was done on children between 1 month and 14 years of age attending the pediatric department for 1 year from October 2020 to June 15, 2022. Detailed history, physical examination, and investigations were done in children with nephrotic syndrome as per pro forma. Information was collected on demographic variables, vital signs, anthropometry, diagnosis, comorbidities, therapies, presence of hypovolemia, sepsis or shock, use of diuretics or nephrotoxic medications, need for oxygen, mechanical ventilation, vasopressors or renal replacement therapy, length of hospital stay, and outcome at discharge. For those children having AKI, clinical outcomes were measured in terms of duration of hospital stay, recovery of S.creatinine, and urine output. Results: A total of 64 patients with nephrotic syndrome were enrolled in this study. Fifteen patients had AKI (23.4%) among children with nephrotic syndrome. The most common etiology being sepsis accounting for 4 out of 15 (26.7%) of total cases followed by acute respiratory distress syndrome (13.3%), nephrotoxic medications (13.3%), renal parenchymal disease (13.3%), Post-streptococcal glomerulonephritis (13.3% each) and Sickle cell disease with nephritis and acute fulminant hepatitis (6.7%). There was significantly more mortality among subjects with stage 2 (14.3%) and 3 (14.3%) kidney disease. Conclusion: AKI is common in our children with nephrotic syndrome and the main risk factors of AKI include sepsis, gross hematuria, urinary tract infections, peritonitis, and exposure to potentially nephrotoxic medications. There is a need to identify the patients with nephrotic syndrome at risk of AKI and apply strategies to prevent AKI in focused at-risk groups.

Kidney Transplantation as a Treatment Option of Chronic Renal Failure Among Lung Transplant Recipients: A Single-Center Experience

Chronic renal failure is one of the most common complications after solid organ transplantation. It is associated with multiple pre-, peri-, and post-transplant factors. In some patients, the available methods of conservative treatment are insufficient and kidney transplantation (KTx) is necessary. The aim of this study was to present our experience in the treatment of renal failure by KTx after lung transplantation (LTx). Our study is a single-center retrospective review of clinical data of all 7 LTx recipients who underwent a KTx between the years 2013 and 2021. Patients' clinical condition, pulmonary function, renal function, and survival were examined. There were a total of 7 patients with medium age 36 years (±15). In 3 patients, the period of time from LTx to KTx was less than 3 years, and in 4 of them less than 13 years. Dialysis therapy was required in 4 patients. One patient had pre-LTx renal disease, while 6 patients had renal dysfunction related to post-transplant factors, including the use of calcineurin inhibitors. Renal protection is a very important aspect among LTx recipients; therefore, physicians must show a holistic and individual approach to patients and minimize exposure to nephrotoxic medication. Patients at high risk of developing chronic renal failure should be identified and, if required, renal replacement therapy should be initiated, including KTx.

Use of urine neutrophil gelatinase-associated lipocalin for nephrotoxic medication acute kidney injury screening in neonates.

Daily serum creatinine monitoring protocols for acute kidney injury (AKI) are invasive and may lead to surveillance resistance. We aimed to understand if use of urine neutrophil gelatinase-associated lipocalin (uNGAL) could increase high-risk nephrotoxic medication (NTMx) associated AKI screening adherence in neonates. Statistical process control methods prior to and post implementation were trended. The primary outcome, screening adherence, was defined as either daily serum creatinine or uNGAL assessment through 2 days post high-risk NTMx exposure. 1291 monitoring days from the pre-implementation era (4/2020-6/2021) were compared to1377 monitoring days from the post-era (6/2021-10/2022). AKI screening adherence increased (81 to 92%) following implementation of optional uNGAL screening. Urine NGAL accounted for 35% of screening obtained. Use of uNGAL resulted in a 40% reduction in blood sampling for serum creatinine. Incorporation of uNGAL as a complementary screening tool to serum creatinine demonstrated sustained increased AKI surveillance in our Baby NINJA monitoring program.

Epidemiology, Risk Factors, and Clinical Outcomes of AKI in Pediatric Hematopoietic Stem Cell Transplant Patients.

Key Points The cumulative incidence of AKI diagnosis post–hematopoietic stem cell transplantation was 12.9%. Calcineurin inhibitor use was associated with the highest cumulative incidence, 21.6%, after hematopoietic stem cell transplantation.Patients with AKI with hypertension/hypertensive disease had a 30-day survival probability of 63.9% (hazard ratio, 4.86, 95% confidence interval, 3.58 to 6.60).Patients with AKI were 2.5 times more likely to experience composite hospitalization and/or mortality at 30 days. Of patients who developed AKI, dialysis dependence has nearly tripled since 2014. Background AKI is a common complication in pediatric patients undergoing hematopoietic stem cell transplantation (HSCT), with a reported prevalence ranging from 68% to 84%. Few multicenter pediatric studies comprehensively assess the epidemiologic associations and clinical outcomes associated with AKI development. Methods An observational, retrospective analysis was conducted using an aggregated electronic health record data platform. The study population consisted of pediatric patients (age &lt;18 years) who underwent HSCT over a 20-year period. The study groups consisted of patients with an encounter diagnosis of AKI (n=713) and those without AKI (n=4455). Both groups were propensity matched for age, sex, race, prior cancer diagnosis, and other comorbidities. End points were incidence, mortality risk, clinical outcomes, and prevalence of dialysis dependence. Competing risks analysis, Cox proportional hazard analyses, Kaplan–Meier survival curves, and incidence/prevalence rates were calculated. Results After matching, 688 patients were identified. Cumulative incidence of AKI diagnosis post-HSCT was 13.7%. Hypertensive disease, calcineurin inhibitors, and vancomycin were the most prevalent risk factors for AKI, with calcineurin inhibitors showing the highest cumulative incidence (21.6%). Patients with AKI with hypertensive disease had a survival probability of 63.9% at 30 days, followed by calcineurin inhibitors (64.4%) and vancomycin (65.9%). Patients with AKI were 1.7 times more likely to experience composite hospitalization and/or mortality at 30 days. At 365 days post-HSCT, patients with AKI had higher rates of all-cause emergency department visits, intensive care unit admissions, and mechanical ventilation compared with non-AKI. Of patients who developed AKI, the prevalence of dialysis dependence has nearly tripled since 2014. Conclusions The findings highlight a strong association between specific risk factors, such as hypertension, calcineurin inhibitor use, and vancomycin use, with increased mortality and adverse clinical outcomes in patients with AKI after HSCT. These results emphasize the need for preventative actions such as 24-hour BP monitoring and discontinuation of potential nephrotoxic medications.

Renal deficit and associated factors in children born with low birth weight.

Kidney problems may be due to low birth weight alone or may occur in association with other conditions. The objective this study was to evaluate the association between maternal and birth characteristics, anthropometric measurements, and kidney function deficit in low birth weight infants. Cross-sectional study with children who were born weighing < 2500 grams and were under outpatient follow-up. Maternal factors investigated were prenatal care and presence of hypertension, diabetes, and infection during pregnancy. The children's variables were sex, gestational age, birth weight, Apgar score, use of nephrotoxic medications, age, body weight at the time of evaluation, height, and serum creatinine and cystatin C dosages. The glomerular filtration rate (GFR) was estimated with the combined Zapittelli equation. Multivariate logistic regression model was used for identification of associated factors, with renal function deficit (GFR < 60 mL/min/1.73 m2) as the dependent variable. Of the 154 children evaluated, 34.42% had kidney function deficit. Most of them had a gestational age > 32 weeks (56.6%), a mean birth weight of 1439.7 grams, and mean estimated GFR of 46.9 ± 9.3 mL/min/1.73 m2. There was a significant association of GFR < 60 mL/min/1.73 m2 with children's current weight and use of nephrotoxic drugs. Children born with low birth weight had a high prevalence of kidney function deficit and current normal weight was a protective factor while the use of nephrotoxic drugs during perinatal period increased the chance of kidney deficit. These findings reinforce the need to evaluate the kidney function in these children, especially those who use nephrotoxic drugs.

Intravenous gentamicin therapy induces functional type VII collagen in patients with recessive dystrophic epidermolysis bullosa: an open-label clinical trial.

Recessive dystrophic epidermolysis bullosa (RDEB) is an incurable widespread blistering skin disorder caused by mutations in the gene encoding for type VII collagen (C7), the major component of anchoring fibrils. To evaluate the efficacy and safety of intravenous (IV) gentamicin readthrough therapy in patients with RDEB harbouring nonsense mutations. The primary outcomes were increased expression of C7 in patients' skin and safety assessments (ototoxicity, nephrotoxicity, autoimmune response); secondary outcomes included measuring wound healing in target wounds and assessment by a validated Epidermolysis Bullosa Disease Activity and Scarring Index (EBDASI) scoring system. An open-label pilot trial to assess two different IV gentamicin regimens between August 2018 and March 2020 with follow-up through to 180 days post-treatment was carried out. Three patients with RDEB with confirmed nonsense mutations in COL7A1 in either one or two alleles and decreased baseline expression of C7 at the dermal-epidermal junction (DEJ) of their skin participated in the study. Three patients received gentamicin 7.5 mg kg-1 daily for 14 days and two of the three patients further received 7.5 mg kg-1 IV gentamicin twice weekly for 12 weeks. Patients who had pre-existing auditory or renal impairment, were currently using ototoxic or nephrotoxic medications, or had allergies to aminoglycosides or sulfate compounds were excluded. After gentamicin treatment, skin biopsies from all three patients (age range 18-28 years) exhibited increased C7 in their DEJ. With both regimens, the new C7 persisted for at least 6 months post-treatment. At 1 and 3 months post-treatment, 100% of the monitored wounds exhibited > 85% closure. Both IV gentamicin infusion regimens decreased EBDASI total activity scores. Of the patients assessed with the EBDASI, all exhibited decreased total activity scores 3 months post-treatment. All three patients completed the study; no adverse effects or anti-C7 antibodies were detected. IV gentamicin induced the readthrough of nonsense mutations in patients with RDEB and restored functional C7 in their skin, enhanced wound healing and improved clinical parameters. IV gentamicin may be a safe, efficacious, low-cost and readily available treatment for this population of patients with RDEB.