Nonoliguric Acute Renal Failure Research Articles

Renal Limited Anti-Neutrophil Cytoplasmic Antibody Associated Vasculitis: A Case Report

Background: Renal Limited Vasculitis (RLV) is a localized autoimmune vascular inflammatory disorder that is part of the Pauci Immune Glomerulonephritis (PIGN) spectrum. Over 90% of PIGN patients have circulating Anti-Neutrophil Cytoplasmic Antibodies (ANCA Ab). Anti-Neutrophil Cytoplasmic Antibody (ANCA) associated vasculitides are a heterogeneous group of multisystemic autoimmune disorders with distinct pathological findings. They are characterized by widespread inflammation of vessels according to their size, their location, and their serotypes based on the presence or absence of ANCA antibodies, namely Myeloperoxidase (MPO-ANCA), Proteinase-3 (PR3-ANCA) or simply ANCA negative, if no antibodies are found. RLV is characterized by antibody positivity to myeloperoxidase in the majority of cases. Case Report: A 77-year-old Caucasian female was admitted with altered mental status and laboratory evidence of renal function compromise consistent with non-oliguric acute renal failure. Imaging and renal biopsy resulted in a diagnosis of pauci-immune glomerulonephritis consistent with MPO-ANCA vasculitis with a subtype that was associated with necrotizing arteritis, a severe form of the disease. She was placed on hemodialysis, intravenous cyclophosphamide, and oral prednisone, and entered remission. Conclusion: A high level of suspicion and familiarity with clinical signs and symptoms are critical in distinguishing primary RPGN subtypes from other types of ANCA-associated small vessel vasculitis. If left untreated, renal limited vasculitis can progress to widespread systemic involvement and become fatal.

Severe Leptospirosis With non-Oliguric Renal Failure With ‘Myocarditis’ Mimicking Acute Coronary Syndrome: A Rare Presentation From Northern India

Leptospirosis is a globally distributed zoonosis with a broad clinical spectrum. Thisthe disease mostly affectsliver and kidney tissues. Other organs can be affected by leptospirosis-induced vasculitis. In addition, cardiacmanifestations are common, and the presence of transient ECG abnormalities can be found in 50-60 % of thepatients(1). Early diagnosis and adequate supportive therapy are crucial for the appropriate management ofsymptoms. In this article, we present a case of leptospirosis with myocarditis with hypokalemia and non-oliguricacute renal failure. All clinical findings gradually regressed after treatment.

Colchicine Intoxication Subsequent to an Autolytic Attempt with Positive Evolution

Background and objectives: Colchicine is a drug that has been used to treat gout for several centuries, it is also indicated in certain autoimmune diseases and has been tested as a chemotherapeutic. Only a few cases of intoxication by this drug have been described, but it is known that it has a narrow therapeutic margin (0.5 to 0.8 mg/kg), almost always resulting in fatal results above these limits. Regarding therapeutic management, the initiation of supportive measures is essential. Initial strategies are gastric lavage, administration of activated charcoal and fluid resuscitation aimed at preventing renal failure. Case report: A 63-year-old man with a history of spondylodiscitis and gouty arthropathy, receiving colchicine treatment. He reported abdominal symptoms with nausea, vomiting, watery stools, and diffuse pain after taking 36 tablets of 1 mg of colchicine due to exacerbation of arthralgias (the patient later recognized the autolytic ideation). He was hospitalized in the ICU due to hemodynamic instability, severe pancytopenia, respiratory failure requiring mechanical ventilation and non-oliguric acute renal failure. The patient improved and was discharged from the ICU after 14 days. Conclusions: Colchicine poisoning is rare and has high mortality despite the favorable evolution of our patient. There is no specific treatment at the moment and management should emphasize early admission to the ICU, close monitoring and organ support measures.

Nephrotic syndrome in a 60-year-old man

A man in his 60s presented with increased oedema in the lower limbs and dyspnoea. Chest X-ray showed right pleural effusion and a body CT scan revealed a severe right...

Incidence of acute renal failure in birth asphyxia and its correlation with hypoxic-ischemic encephalopathy staging

Introduction: Acute renal failure (ARF) is a recognized complication of birth asphyxia and it carries a poor prognosis. Early recognition of ARF is particularly important in asphyxiated neonates with hypoxic-ischemic encephalopathy (HIE). Objectives: To determine the incidence of ARF in term asphyxiated neonates and to correlate it with HIE staging. Methods: A total of 50 term (37-42 weeks) neonates born with Apgar score of <7 at 5 min after birth were selected as cases and 50 normal term (37-42 weeks) neonates as controls. All asphyxiated neonates with clinical features of HIE are staged by Sarnat and Sarnat staging. Gestational age, birth weight, relevant perinatal history, and examination findings are recorded in predesigned pro forma. After 72 h and before 96 h of life, blood was collected and sent for relevant investigations, and clinical condition of the neonate and urine output were monitored and neonates were managed according to the standard protocol. Results: Incidence of ARF is significantly more in cases (76.0% vs. 4.0%) than the controls. Among 38 cases with ARF, 32 (84.2%) had pre-renal ARF and 6 (15.8%) had intrinsic ARF. On the basis of urine output, 12 (24.0%) had oliguric ARF and 38 cases (76.0%) had non-oliguric ARF while out of 50 controls, 2 (4%) neonates had pre-renal and non-oliguric type of ARF. Incidence of ARF correlated well with HIE staging. Among the 50 cases, 32 (84.3%) improved clinically after fluid therapy, while 6 (15.7%) did not improve. Conclusion: Perinatal asphyxia is an important cause of neonatal renal failure. ARF in birth asphyxia is predominantly pre-renal and non-oliguric type and it responds to fluid challenge. ARF in birth asphyxia correlates well with HIE staging.

Akutna bubrežna insuficijencija kod novorođenčadi kao posledica perinatalne asfiksije

Introduction: Perinatal asphyxia (PA) results in hypoxic damage to almost all organs, kidneys being most frequently (40%) affected. Objectives: was to determine the incidence of acute renal failure (ARF) in term neonates with PA and to correlate it with severity of hypoxic ischemic encephalopathy (HIE). Materials and methods: This prospective study of 54 term neonates with PA was performed in tertiary level neonatal intensive care unit at Pediatric Clinic Sarajevo from June 2014 to June 2016. The severe PA was defined as 5. minute Apgar score < 3 and moderate PA as 5. minute Apgar score 4-6. Criteria adopted for ARF were serum creatinine > 1.5 mg/dl (> 133 micromol/L) on 3rd day of life or urine output < 0.5 ml/kg/hr for > 6 hrs beyond 24 hrs of life. Results. Out of 54 neonates with PA, 22 (40.74%) had ARF. Most of them (63.6%) had non-oliguric ARF with mean renal output of 2.2 ± 0.5 ml/kg/h. Eight neonates (36.4%) had oliguric ARF with mean renal output of 0.35 ± 0.6 ml/kg/h. Most of the neonates with oliguric ARF (63.4%) had severe PA while in those with non-oliguric ARF moderate PA was predominant. ARF was highest in the neonates with HIE III (85.71 %) (Figure 1). This showed that as HIE stage progressed, more renal dysfunction was seen in asphyxiated babies and this difference in incidence was found statistically significant (p < 0.05). Conclusions. Neonates with severe PA had more frequent ARF and the predominant type of renal involvement was non oliguric. Neonates with HIE stage II and III had significantly higher incidence of ARF.

A case of acute interstitial nephritis and granulomatous hepatitis induced by ingesting quinine.

Quinine is used for the treatment of malarial infection, though not in common use. It is especially valuable for the parenteral treatment of severe illness owing to drug-resistant strains of Plasmodium falciparum. Quinine is also known to occasionally cause acute renal failure (ARF). Although quinine is listed in some reviews as a cause of acute interstitial nephritis, most cases of quinine-associated acute renal failure have been attributed to the hemolytic-uremic syndrome (HUS). Only two cases of acute renal failure due to acute interstitial nephritis associated with quinine have been reported [1, 2]. To our knowledge, there have been 6 reported cases of quinine-induced hepatic granuloma [3-8]. We report a case of quinine-induced acute interstitial nephritis (AIN) along with granulomatous hepatitis, both of which were confirmed on biopsy. A 50-year-old Nigerian man was admitted to the hospital with complaints of fever and general fatigue. He had been prescribed quinine as an antimalarial drug in a Nigerian hospital. The patient was febrile and showed nonoliguric ARF and liver dysfunction. In this case, liver injury showed gradual and spontaneous resolution after discontinuing quinine, and ARF resolved after treatment with oral prednisolone.

Association of Acute Interstitial Nephritis with Carnivora, a Venus Flytrap Extract, in a 30-Year-Old Man with Hodgkin's Lymphoma.

Acute interstitial nephritis (AIN) is a common cause of acute kidney injury and has been associated with a variety of medications. This is the case of 30-year-old man with Hodgkin's lymphoma who on routine labs before chemotherapy was found to have acute nonoliguric renal failure. A kidney biopsy was performed and confirmed the diagnosis of acute interstitial nephritis. The patient had taken several medications including a higher dose of Carnivora, a Venus flytrap extract, composed of numerous amino acids. The medication was discontinued and kidney function improved towards the patient's baseline indicating that this may be the possible cause of his AIN. Proximal tubular cell uptake of amino acids increasing transcription of nuclear factor-kappaB is a proposed mechanism of AIN from this compound.

A Rare Case of Acute Non-Oliguric Renal Failure and Cholestatic Jaundice, Transaminitis in Patient with History of Oral Anabolic Steroid Use

A Rare Case of Acute Non-Oliguric Renal Failure and Cholestatic Jaundice, Transaminitis in Patient with History of Oral Anabolic Steroid Use

Salt Wasting Nephropathy and Hypokalemia: Clinical Utility for Diagnosing Leptospirosis-Induced Non-Oliguric Acute Renal Failure

Salt Wasting Nephropathy and Hypokalemia: Clinical Utility for Diagnosing Leptospirosis-Induced Non-Oliguric Acute Renal Failure

Oliguric and non-oliguric acute renal failure in malaria in west zone of rajasthan, India-A comparative study

ObjectiveTo report a comparative clinical and histopathological study on oliguric and non-oliguric acute renal failure (ARF) in malaria. Method311 consecutive cases of malaria out of which 74 (23.79%) had ARF as per WHO criteria were conducted. Mean age was 32.58 (range 15–60 years) and male: female was 2:1. ResultMost of the cases developed ARF within 10 d of onset. 18 cases (11 falciparum, 2 mixed, 5 vivax) presented with oliguric and 56 (41 falciparum, 6 mixed, 9 vivax) with non-oliguric renal failure. Associated major manifestations were jaundice (75.68%), cerebral malaria (41.89%), bleeding manifestations (32.43%), severe anemia (27.03%), hypotension (25.68%), multi-organ failure (18.92%), severe thrombocytopenia (12.16%), and ARDS (8.11%). Kidney biopsy (n=20) showed acute tubular necrosis (n=7), Mesangioproliferative glomerulonephritis (n=4) or both (n=9). Hemodialysis was done in 8 cases of oliguric renal failure out of which 4 survived (average no. of session 2.9). ConclusionMost of the cases recovered within 3 weeks. Total mortality was 28.38% (n=21) and mortality was more in oliguric renal failure (72.22%) as compare to non-oliguric renal failure (14.29%).

Hypodipsic hypernatremia leading to reversible renal failure following surgery for craniopharyngioma

Thirst is stimulated by increases in effective plasma osmolality that are detected by cerebral osmoreceptors located in the vascular organ of the lamina terminalis. However, surgical destruction or organic lesions of the lamina terminalis decrease the sensation of thirst in response to increased plasma osmolality. A 17-year-old boy who was diagnosed with craniopharyngioma at the age of 10 years and underwent tumor resection and gamma knife surgery was admitted for non-symptomatic severe hypernatremia. Although the sodium level was 173 mmol/L and serum osmolality was also high (371 mOsm/kg), the patient did not report increased thirst. Laboratory analysis revealed hypertonic dehydration and acute non-oliguric renal failure due to dehydration. Treatment was based on correction of hypernatremia with hydration and education about regular, periodic water ingestion. The patient's hypernatremia and acute non-oliguric renal failure resolved with controlled daily fluid intake. To our knowledge, this is the first report of decreased thirst sensation secondary to craniopharyngioma and tumor resection leading to severe hypernatremia and non-oliguric renal failure in an adolescent.

Dioscorea Quinqueloba Induces Acute Kidney Injury: Two Case Reports

Context: We report two cases of acute kidney injury that developed after taking Dioscorea Quinqueloba for healthy diet. Dioscorea Quinqueloba is a medicinal herb that is widely used to treat cardiovascular disease and various medical conditions. Acute kidney injury associated with the use of herbal medicine is common throughout the world, but acute kidney injury cause by Dioscorea Quinqueloba has not been reported so far. Case details: 68-year-old man and his brother, who is 58-years-old, ingested the extract of Dioscorea Quinqueloba as traditional remedy. The following day, they complained symptoms of nausea, vomiting and diarrhea. Eventually, they were diagnosed with oliguric or non-oliguric acute renal failure, but improved without complications. Discussion: Dioscorea Quinqueloba should be correctly prepared for traditional medicine; otherwise it may cause a life-threatening acute kidney injury.

Acute Nonoliguric Renal Failure Associated With Naproxen Sodium In A Child

Acute Nonoliguric Renal Failure Associated With Naproxen Sodium In A Child

Clinical significance of hypoalbuminemia in outcome of patients with scrub typhus

BackgroundThis study was designed to investigate the clinical significance of hypoalbuminemia as a marker of severity and mortality in patients with Scrub typhus.MethodsThe patients with scrub typhus were divided into two groups based on the serum albumin levels; Group I (serum albumin <3.0 g/dL) and Group II (serum albumin ≥3.0 g/dL). The outcome of patients with hypoalbuminemia was compared with that of normoalbuminemia.ResultsOf the total 246 patients who underwent the study, 84 patients (34.1%) were categorized as Group I and 162 patients were (65.9%) as Group II. Group I showed significantly higher incidence of confusion (24.6% vs. 5.3%, p < 0.001), pulmonary edema (15.8% vs. 3.2%, p = 0.002), pleural effusion (22.8% vs. 11.1%, p = 0.03), arrhythmia (12.3% vs. 2.6%, p = 0.008) and non-oliguric acute renal failure (40.4% vs. 11.1%, p < 0.001) compared to group II. Hypoalbuminemic group had a higher APACHE II score (11.37 ± 5.0 vs. 6.94 ± 4.2, p < 0.001), longer hospital stay (19.9 ± 42.1 days vs 7.5 ± 13.8 days, p = 0.012), and higher hospital cost compared to Group II.ConclusionsThis study showed hypoalbuminemia in scrub typhus was closely related to the frequency of various complication, longer hospital stay, consequently the higher medical cost, necessitating more efficient management of patients, including medical resources.

Acute renal failure with acyclovir treatment in a child with leukemia

Acyclovir is an effective, frequently used antiviral agent. Adverse effects of this drug are well known and are especially seen with high doses and/or dehydration. In this article, we report a 6-year-old boy with leukemia with nonoliguric acute renal failure in normal hydration status after using acyclovir treatment. He had no preexisting renal impairment, and there were no additional symptoms. Dimercaptosuccinic acid radionucleid scyntigraphy and other laboratory findings revealed impairment of proximal tubule function, in addition to distal tubule. We emphasize that renal functions should be monitored carefully during treatment with acyclovir, and asymptomatic nephrotoxicity must be kept in mind.

Evaluation of kidney oxygen bioavailability in acute renal failure by blood oxygen level dependent magnetic resonance imaging

To assess the kidney oxygen bioavailability in acute renal failure using blood oxygen level dependent (BOLD) magnetic resonance (MR) imaging. Twenty-one patients with acute renal failure, including 18 patients with oliguric renal failure, 1 nonoliguric acute renal failure and 2 functional renal failure were enrolled in the study; 20 healthy subjects served as controls. All subjects received renal functional MR examination. BOLD MR imaging with 16 gradient-recalled-echoes on a 1.5-T scanner were performed. R2(*)(1/sec) values of the cortex and medulla and R2(*) ratio of the medulla to cortex (R2(*) ratio of M/C) of the renal were recorded respectively. The R2(*) values of the medulla was higher than those of the cortex in controls (17.64 +/-1.86/sec vs 13.73 +/-0.49/sec, P<0.00). The R2(*) ratio of M/C in controls was 1.28 +/-0.06. The R2(*) values of the medulla (13.31 +/-4.28/sec) and cortex (12.25 +/-2.41/sec) and the R2(* ) ratio of M/C (1.01 +/-0.25) in oliguric renal failure were lower than those in controls (P <0.05). Patients with functional renal failure and nonoliguric acute renal failure had higher R2(*) values in cortex and medulla and higher R2(*) ratio of M/C than those of controls. BOLD MRI demonstrates that decreased R2(*) values of cortex and medulla suggest lower oxygen bioavailability in acute renal failure and decreased R2(*)ratio of M/C suggests the disappearance of a steep cortico-medullary gradient of oxygen.

Renal dysfunction due to leukemic infiltration of kidneys in a case of chronic lymphocytic leukemia

Renal failure due to leukemic infiltration of kidney in chronic lymphocytic leukemia is an extremely rare condition. The authors report a case of a 59-year-old white female, with a past medical history of chronic lymphocytic leukemia (CLL) with 2 years of evolution without medical therapy, admitted with nonoliguric acute renal failure needing dialysis. Renal biopsy showed extensive small lymphocytes' infiltration in the cortical interstitium by CLL cells. Cyclophosphamide and prednisolone were started and 1 month later changed to fludarabine plus cyclophosphamide with improvement of renal function. Although renal failure due to leukemic infiltration has been described in many cases of acute leukemia, only 11 cases of renal failure due to CLL cells' infiltration have been described in the literature. Renal histology is an extremely important tool to confirm diagnosis.

Acute, Reversible Nonoliguric Renal Failure in Two Children Associated With Analgesic-Antipyretic Drugs

Analgesic-antipyretic agents and nonsteroidal anti-inflammatory drugs are the most commonly used medications worldwide for the treatment of pain and fever in children. Acute renal failure is commonly seen in adults after treatment with analgesic agents. This complication has rarely been reported in children. Here, we describe 2 patients admitted to our hospital with acute nonoliguric renal failure temporally associated with ingestion of analgesic-antipyretic drugs at therapeutic doses. The first case was a 16-year-old adolescent boy, who had taken acetaminophen (APAP) and mefenamic acid for the indication of upper respiratory tract infection with daily doses of 1500 and 500 mg, respectively. His serum urea nitrogen and creatinine values were 16 and 1.6 mg/dL. The second case was a 12-year-old boy, who had taken APAP with a daily dose of 500 mg for abdominal pain. His serum urea nitrogen and creatinine values were 21 and 2.29 mg/dL. Both of them recovered with appropriate hydration within a week. Over-the-counter analgesic-antipyretic agents seem innocent but carry the risk of acute renal failure even at therapeutic doses. We believe that increased caution and awareness of the toxic effects of APAP and nonsteroidal anti-inflammatory drugs are needed. We suggest that clinicians should be careful while using analgesic-antipyretic-anti-inflammatory drugs especially in children with subclinical dehydration.

Severe, Symptomatic Hypomagnesemia in Acute Leptospirosis

We report a case of severe hypomagnesemia in non-oliguric acute renal failure caused by leptospirosis that required large doses of magnesium replacement during the acute phase of disease. Biochemical studies confirmed kidney-related magnesium wasting and the mechanisms of this defect are discussed. Magnesium imbalance with its attendant clinical complications occurs in leptospirosis and should be monitored and treated aggressively in cases of leptospirosis-induced non-oliguric acute kidney injury.