Obstructive Acute Kidney Injury Research Articles

Severe Acute Kidney Injury in Hospitalized Cancer Patients: Epidemiology and Predictive Model of Renal Replacement Therapy and In-Hospital Mortality

Background: Acute kidney injury (AKI) is a common complication among cancer patients, often leading to longer hospital stays, discontinuation of cancer treatment, and a poor prognosis. This study aims to provide insight into the incidence of severe AKI in this population and identify the risk factors associated with renal replacement therapy (RRT) and in-hospital mortality. Methods: This retrospective cohort study included 3201 patients with cancer and severe AKI admitted to a Comprehensive Cancer Center between January 1995 and July 2023. Severe AKI was defined according to the KDIGO guidelines as grade ≥ 2 AKI with nephrological in-hospital follow-up. Data were analyzed in two timelines: Period A (1995–2010) and Period B (2011–2023). Results: A total of 3201 patients (1% of all hospitalized cases) were included, with a mean age of 62.5 ± 17.2 years. Solid tumors represented 75% of all neoplasms, showing an increasing tendency, while hematological cancer decreased. Obstructive AKI declined, whereas the incidence of sepsis-associated, prerenal, and drug-induced AKI increased. Overall, 20% of patients required RRT, and 26.4% died during hospitalization. A predictive model for RRT (AUC 0.833 [95% CI 0.817–0.848]) identified sepsis and hematological cancer as risk factors and prerenal and obstructive AKI as protective factors. A similar model for overall in-hospital mortality (AUC 0.731 [95% CI 0.71–0.752]) revealed invasive mechanical ventilation (IMV), sepsis, and RRT as risk factors and obstructive AKI as a protective factor. The model for hemato-oncological patients’ mortality (AUC 0.832 [95% CI 0.803–0.861]) included IMV, sepsis, hematopoietic stem cell transplantation, and drug-induced AKI. Mortality risk point score models were derived from these analyses. Conclusions: This study addresses the demographic and clinical features of cancer patients with severe AKI. The development of predictive models for RRT and in-hospital mortality, along with risk point scores, may play a role in the management of this population.

Incidence Of Acute Kidney Injury In Mild, Moderate And Severe Cases Of Coronavirus Disease

Objective: The purpose of this research was to determine the incidence of Acute Kidney Injury (AKI) in COVID-19-affected patients Methods: This retrospective cohort study was conducted at Ziauddin Hospital Clifton Campus from June to December 2020. Adult patients with AKI or acute-on-chronic kidney disease (ACKD) were included in a retrospective study. Patients infected with SARS-CoV2 and renal involvement were directed towards the ICU/Nephrology departments which have the expertise to perform laboratory analysis, radiography and institution of treatment. Supplemental oxygen use was documented. The research also assessed information about therapy (antivirals, immunomodulators, RRT) and results (renal function recovery or death). Results: After excluding patients with obstructive AKI, a total of 180 (mean age 50.1 years) of 104 males and 76 females were included in the research. 120 patients were found to have prerenal, and 60 had intrinsic AKI with significant differences between mild, moderate, and severe cases (p=0.004). Acute kidney injury (AKI) survivors had a complete recovery rate of 70%, a partial recovery rate of 22%, and a hemodialysis dependency rate of 8%. Conclusion: Patients with severe COVID-19 infection often develop more severe AKI, and those in the severe or critical stages often exhibit proteinuria and dipstick hematuria. Long-term follow-up for COVID-19 patients should be done to evaluate its influence on renal outcome, and larger samples are required to elucidate the association between COVID-19 and renal damage. Keywords: Coronavirus Disease, Renal Replacement Therapy, proteinuria, dipstick hematuria

#4229 SECONDARY BACTERIAL AND FUNGAL INFECTIONS IN COVID-19 PATIENTS WITH ACUTE KIDNEY INJURY AND RELATION WITH CYTOKINE STORM SYNDROME

Abstract Background and Aims Both COVID-19 and acute kidney injury (AKI) are associated with impaired host immunity. Virus-induced immunosuppression, overuse of antibiotics and corticosteroids are COVID-19 related factors, while dysregulation of the inflammatory response, increased volemia, hemodialysis catheters are AKI-related factors which favor secondary infections. We aimed to search the relation between markers of cytokine storm syndrome (interleukin-6 – IL-6; ferritin; C-reactive protein – CRP) and incidence of secondary infections and to identify the microorganisms involved in secondary infections in patients admitted with acute kidney injury and COVID-19 patients. Method Patients with both COVID-19 and AKI admitted in the 2nd and 3rd waves of the COVID-19 pandemic (May-December 2021) in an COVID-only hospital were included in this retrospective analysis. Diagnosis of AKI was established according to KDIGO creatinine-based criteria. Obstructive AKI cases were excluded. AKI was classified as A-AKI when it was diagnosed at the moment of admission and HA-AKI when it developed during hospitalization. Bacterial and/or fungal infections and the sites of positive cultures were registered in all patients. Colonizations with nonpathogenic microorganisms were excluded. Median values of IL-6, ferritin and CRP (maxim levels recorded during hospitalization) were compared between infected and non-infected patients. Results A total of 247 patients with AKI+COVID-19 were included in the study: 146 had A-AKI and 101 had HA-AKI. Secondary bacterial and fungal infections were registered in 111 patients (44.93%) cumulating 161 positive urine, blood, hemodialysis catheter tip, sputum, wounds, feces and tracheal intubation tubes cultures. Secondary infections were noted significantly more frequent in HA-AKI cases than in A-AKI cases: 61.38% (62 patients) vs 33.56% (49 patients) – Fischer exact test, p<0.001. The responsible microorganisms and the sites of positive culture are presented in Table 1. Median values of IL-6, ferritin and CRP (maximum levels recorded during hospitalization) were significantly higher in infected patients than in non-infected patients (Table 2) in the entire study group. IL-6 was significantly higher in infected HA-AKI patients when compared with infected A-AKI (231.40 pg/mL vs 124 pg/mL; p = 0.015), but no significant difference was found between the two subgroups of infected AKI patients regarding median ferritin levels (2481.5 ng/mL vs 1785 ng/mL; p = 0.324) or regarding median CRP values (206.27 mg/L vs 179.59 mg/L; p = 0.546). Conclusion Incidence of secondary bacterial and/or fungal infections in patients admitted with AKI and COVID-19 was very high in our study and it was associated with more severe altered markers of cytokine storm syndrome. Secondary infections in COVID-19 patients are important drivers of hospital-acquired AKI or they can aggravate its evolution.

1094: UTILITY OF RENAL ULTRASOUND IN GUIDING MANAGEMENT OF ACUTE KIDNEY INJURY

Introduction: Although guidelines recommend renal ultrasound in patients with acute kidney injury (AKI) to assess for obstructive etiologies, several studies have suggested that the clinical utility of renal ultrasound for all patients with AKI is undetermined and should be reserved for patients with risk factors for urinary tract obstruction. We looked into the characteristics of patients with a radiology-performed renal ultrasound (radiology US) for AKI to evaluate the frequency of unnecessary exams. Methods: We conducted a retrospective chart review from 6/1/2021 to 6/1/2022 at a single urban teaching hospital of patients admitted to medicine, intensive care unit or cardiac care unit with a rardiology US performed for AKI. We collected baseline demographic data, ultrasound findings, interventions including urethral catheter placement, urologic procedures or hemodialysis (HD), and time from ultrasound order to result. Results: 108 patients were included in this study. The average age was 70.2+- 14.52 and 37% were women. Patients were of diverse race/ethnicity: 22% White, 24% Black, 20% Hispanic and 12% Asian. Nephrology was consulted in 67.6%. KDIGO criteria was met in 80.6%; others had unknown baseline creatinine or had chronic kidney disease. 14 patients (n=14/108, 12%) had a final diagnosis of obstructive AKI. Of these patients, hydronephrosis was initially diagnosed on CT for 4 cases (n=4/35, 11%) and POCUS for 3 patients (n=3/8, 0.375%), and radiology US for 7 patients. Of the 11 patients who had hydronephrosis in radiology US, 4 patients had a foley placed prior to ultrasound. Only 3 out of the 11 patients required urological intervention and 1 started HD. Time from AKI detection to ordering radiology US was median 1 day [IQR 1,3] and time from radiology US order to final report was 16.97 hours [IQR 4.89, 27.39]. Conclusions: Out of 108 patients who had a radiology US for AKI, only 8 patients resulted in a change in management, specifically placement of a foley. In addition, 7 patients had hydronephrosis diagnosed on an alternate imaging study. Our study showed that it takes approximately 2 days for radiology US to result. Prevalence of hydronephrosis was low and few had change in management. Moreover, our study suggests that alternative imaging for AKI may result earlier than radiology renal US.

La calcolosi delle vie urinarie in età pediatrica a tutto tondo

Overall, the incidence of paediatric urolithiasis is increasing; 50-90% of cases are due to metabolic alterations, 3-30% are associated with urinary tract infections and the remaining cases are idio-pathic. About 20-30% of children, especially boys who are younger than 2 years of age, present an anatomic urinary tract anomaly. The main symptom is abdominal pain; however, young children tend to have subtle manifestations. Abdominal ultrasound is the first-line imaging technique. Conservative treatment with fluid intake, pain relievers and alpha-adrenergic blockers are used during the acute episode, whereas a surgical treatment is indicated in selected cases. Since there is an increased rate of recurrence in comparison to adulthood, abundant hydration and changes in dietary habits have a central role in the prevention of paediatric urolithiasis. It is very important to perform a metabolic evaluation when the acute episode is resolved, as 50% of the cases present an underlying metabolic disorder. If a metabolic abnormality is diagnosed, specific preventive interventions should be undertaken. The paper presents the clinical case of an infant who during a Proteus mirabilis urinary tract infection has developed obstructive acute kidney injury due to a stone in the distal urethra. The incidence of urinary stones caused by urinary tract infection is decreasing, however this eventuality should be considered.

69-Year-Old Man With Dysuria and Right Lower Abdominal Pain

69-Year-Old Man With Dysuria and Right Lower Abdominal Pain

104 Hemorrhagic Fungal Cystitis and Obstructive Acute Kidney Injury Associated With Empagliflozin and Secukinumab

104 Hemorrhagic Fungal Cystitis and Obstructive Acute Kidney Injury Associated With Empagliflozin and Secukinumab

Pleural Effusion Secondary to Obstructive Uropathy: A Case of Urinothorax.

Urinothorax is a rare type of pleural effusion and usually the result of genitourinary tract disease. An accurate and early diagnosis is crucial as resolution of the underlying pathology is the mainstay of treatment. We report the case of a 69-year-old man who was admitted to the Internal Medicine ward due to obstructive acute kidney injury of unknown origin. The patient was submitted to urinary catheterization and to right percutaneous nephrostomy. Two weeks after admission he developed a large left pleural effusion; a left urinoma was also visible on computed tomography. After thoracentesis, pleural fluid analysis demonstrated a paucicellular transudate with pH <7.40 and pleural fluid/serum creatinine ratio >1.0. The diagnosis of urinothorax was made and further study allowed the diagnosis of prostate cancer as the aetiology of the obstruction. When bilateral percutaneous nephrostomy was performed, resolution of the urinothorax and normalization of renal function occurred.LEARNING POINTSUrinothorax is a rare and possibly under-recognized cause of transudative pleural effusion; over the last five decades, fewer than 60 cases have been reported in the English literature worldwide.Diagnosis of urinothorax depends upon a high index of clinical suspicion and on pleural fluid analysis, but imaging can also support the diagnosis, for example by showing the presence of a urinoma.Clinicians should recognize urinothorax early in its clinical course as favourable outcomes are often achieved after correction of the underlying genitourinary tract pathology.

P1814ATYPICAL FEATURES IN A TYPICAL DISEASE: ONE THOUSANDS FACES OF IGA NEPHROPATHY IN PAEDIATRIC PATIENTS

Abstract Background and Aims Immunoglobulin A Nephropathy (IgAN) is the most common cause of idiopathic glomerulonephritis in paediatric patients. The typical presentation is characterized by recurrent episodes of macroscopic haematuria or persistent microhaematuria with mild or overt proteinuria. Renal function is normally preserved, though a slow progression to chronic kidney disease (CKD) may occur. However, in rare cases IgAN may assume atypical features, presenting with nephrotic syndrome (NS), acute kidney injury (AKI) or assuming the characteristic of a rapidly progressive glomerulonephritis, leading to significant difficulties in management and critical impact on prognosis. Method Of total 756 renal biopsies performed in our centre from 2000 till 2019, 174 (23%) diagnosis of IgA nephropathy were made: 123 (70,6%) of 174 with a milder histological stage (I or II according to Lee’s) and 51 (29,3%) with severe stages (III-IV). Clinical onset of these 51 patients was mostly characterized by a nephritic syndrome with micro-macrohaematuria, though in 7 of them it assumed atypical features (table 1). Results Patients 1, 2, 3 and 4 showed a rapidly progressive IgAN with extensive crescentic lesions at histological evaluation. In all of the four patients the onset of the disease was characterised by a compromised renal function, thought, according to the medical history, in patients 2 and 4 clinical signs of nephropathy had started some months before the first medical evaluation. This detail, considering the poorer clinical outcome of patients 2 and 4 (table 1), strongly highlights the need of promptness in the treatment of these conditions. Patient 1 achieved a complete remission after steroid pulse therapy (Pozzi scheme), while for patients 2,3,4 an additional immunosuppressive treatment was required. The nephropathy of patient 5 was, instead, characterized by AKI with consistent macrohaematuria. Interestingly, the severity of the clinical presentation was not related to the glomerular lesion (the histology showed a minimal change disease), rather to the intra-tubular haemorrhage, causing an obstructive acute kidney injury. Patient 5 achieved a complete remission after steroid treatment. The onset of IgAN in patients 6 and 7 was characterized by a nephrotic syndrome, which is a very uncommon feature (&amp;lt;2% of all IgAN). Patient 6, who showed a massive proteinuria (till 11 grams/24 hours) was promptly treated with steroid and tacrolimus, achieving a complete remission in 6 moths. Patient 7, a sri-lankan girl, was diagnosed in 2008 in Sri-Lanka. She underwent treatment with steroid and Mycophenolate and successively, for the persistence of proteinuria, with Cyclosporine A. From 2014 she has been followed by our centre. Despite a second cycle with Cyclosporine she has shown a persistence of proteinuria and a slow progression to CKD. Conclusion This study highlights that a typical disease like IgAN may hide behind an atypical and severe presentation. Moreover, the blackboard of the atypical forms is extremely heterogeneous, stretching from NS to crescentic and progressive diseases. As a consequence, the treatment of these conditions is not codified and represents an important challenge for the clinician. This calls for multicentric studies which could provide shared recommendation for the management of these atypical forms of IgAN.

Obstetrical Acute Kidney Injury: Epidemiology and Clinical Aspects in Teaching Hospital of Ignace Deen, Conakry Guinea

Introduction: In Guinea, data on the acute kidney injury (AKI) of women in the obstetrical context is still limited. This study attempted to determine the prevalence and the clinical signs of obstetric AKI in Guinea. Patients and methods: The study population consisted of pregnant or postpartum women with AKI, whom we treated in this institute from August 2018 to January 2019. All had normal anterior renal function with serum creatinine clearance ≥ 120 μmol/L, and then suffered AKI. Patients characteristics were examined; maternal age, gestational weeks, AKI characteristics. Results: Of 2438 pregnant women admitted during the study period, 56 showed AKI. Antepartum and postpartum AKI accounted for approximately 80% and 17%, respectively. Regarding the maternal age, <25 years of age accounted for 54% (range: 17 - 40). Multiple gestations accounted for 34 (60.71%) of which functional AKI, organic AKI, and obstructive AKI accounted for 28/34, 2/34, and 4/34, respectively. Regarding the clinical manifestations, abdominal pain, tinnitus, visual disturbances, edema of the lower limb, and facial swelling accounted for 79%, 75%, 7%, 57%, and 54%, respectively. Conclusion: We here demonstrated peripartum AKI in Guinea, which findings may provide fundamental data to establish some strategy against this condition in this region.

Heterogeneity of Cause, Care, and Prognosis in Severe Acute Kidney Injury in Hospitalized Patients: A Prospective Observational Study.

Background:KDIGO (Kidney Disease: Improving Global Outcomes) defines acute kidney injury (AKI) solely by serum creatinine (SCr) and urine output variation. Severe AKI is a syndrome covering various clinical situations.Objective:To describe severe AKI heterogeneity by department of hospitalization.Design:This is a prospective observational single-center study.Setting:Adult patients hospitalized in a French tertiary hospital from August 2016 to December 2017.Patients:All adults with severe AKI, defined by dialysis for AKI or an increase in SCr above 354 μmol/L.Measurements:Patient characteristics, clinical and laboratory presentation, AKI cause, medical indication for renal replacement therapy (RRT), planned palliative care, and vital status 30 days after severe AKI.Methods:A global description of patient characteristics, care, and prognosis and comparison by department of hospitalization: intensive care unit (ICU), nephrology, and others.Results:The study included 480 patients (73% men, median age: 72 years, range: 64-83), with medical histories including cardiovascular disease, diabetes, cancer, and chronic kidney disease. Principal causes were sepsis (104; 22%), hypovolemia (98; 20%), obstructive AKI (84; 18%), acute tubular necrosis (ATN; 74; 15%), and cardiorenal syndrome (51; 11%). Severe AKI was diagnosed in the ICU for 188 (39%) patients, the nephrology department for 130 (27%), and in other wards for 162 (34%). Patient characteristics differed by department for age, comorbidity, cause, and RRT use and indications. Palliative care was planned for 72 (15%) patients, most frequently in other wards.Limitations:We studied a subgroup of stage 3 KDIGO AKI patients in a single center without cardiac surgery.Conclusion:Patients hospitalized for severe AKI have frequent and various comorbidities, different clinical presentations, care, hospitalization in various departments, and different prognosis. The heterogeneity of this severe AKI implies the need for personalized care, which requires prognostic tools that include information besides SCr and diuresis.

Urinary kidney injury molecule‑1 as an early diagnostic biomarker of obstructive acute kidney injury and development of a rapid detection method.

The aim of the present study was to investigate whether urinary kidney injury molecule-1 (KIM-1) presents a suitable early diagnostic biomarker of obstructive nephropathy-induced acute kidney injury (AKI), and to develop a rapid detection method for urinary KIM-1. Obstructive AKI was induced in an experimental rat model by a unilateral ureteral obstruction (UUO) operation. Macro- and micromorphological kidney alterations were determined by visual observation and hematoxylin and eosin (HE) staining, respectively. Kidney functions were evaluated by detecting urea nitrogen and creatinine levels in rat urine and blood. Urinary KIM-1 levels were measured using an enzyme-linked immunosorbent assay, and the protein expression levels of KIM-1, α-smooth muscle actin (α-SMA) and vimentin in kidney tissues were detected using immunohistochemical assays. In order to measure KIM-1 levels, colloidal gold immunochromatographic strips were developed based on the colloidal gold immunochromatographic assay. The results indicated that KIM-1 levels were significantly higher in the UUO group when compared with the Sham group. KIM-1 levels in the urine and kidney tissues exhibited a time-dependent increase, together with increasing obstructive AKI in the UUO group. In addition, KIM-1 levels were demonstrated to be a more sensitive biomarker of early obstructive AKI, when compared with α-SMA and vimentin. A colloidal gold-based immunochromatographic strip was developed, whereby the detection of urinary KIM-1 could be completed within 5–10 min. In conclusion, results of the present study demonstrated that urinary KIM-1 may be a valuable biomarker for the early diagnosis of obstructive AKI, and the use of a colloidal gold immunochromatographic strip may be a promising method for the rapid detection of urinary KIM-1.

A Case of Obstructive Acute Kidney Injury Due to Secondary Retroperitoneal Fibrosis Not Identified on Ultrasonography

A Case of Obstructive Acute Kidney Injury Due to Secondary Retroperitoneal Fibrosis Not Identified on Ultrasonography

The First Case of Eggerthella lenta Bacteremia in Korea

The First Case of <i>Eggerthella lenta</i> Bacteremia in Korea

Quiz Page December 2012: Bilateral Kidney Enlargement and Acute Kidney Injury in a Patient With HIV Infection

Quiz Page December 2012: Bilateral Kidney Enlargement and Acute Kidney Injury in a Patient With HIV Infection

Diagnostic performance of fractional excretion of urea in the evaluation of critically ill patients with acute kidney injury: a multicenter cohort study

IntroductionSeveral factors, including diuretic use and sepsis, interfere with the fractional excretion of sodium, which is used to distinguish transient from persistent acute kidney injury (AKI). These factors do not affect the fractional excretion of urea (FeUrea). However, there are conflicting data on the diagnostic accuracy of FeUrea.MethodsWe conducted an observational, prospective, multicenter study at three ICUs in university hospitals. Unselected patients, except those with obstructive AKI, were admitted to the participating ICUs during a six-month period. Transient AKI was defined as AKI caused by renal hypoperfusion and reversal within three days. The results are reported as medians (interquartile ranges).ResultsA total of 203 patients were included. According to our definitions, 67 had no AKI, 54 had transient AKI and 82 had persistent AKI. FeUrea was 39% (28 to 40) in the no-AKI group, 41% (29 to 54) in the transient AKI group and 32% (22 to 51) in the persistent AKI group (P = 0.12). FeUrea was of little help in distinguishing transient AKI from persistent AKI, with the area under the receiver operating characteristic curve being 0.59 (95% confidence interval, 0.49 to 0.70; P = 0.06). Sensitivity was 63% and specificity was 54% with a cutoff of 35%. In the subgroup of patients receiving diuretics, the results were similar.ConclusionsFeUrea may be of little help in distinguishing transient AKI from persistent AKI in critically ill patients, including those receiving diuretic therapy. Additional studies are needed to evaluate alternative markers or strategies to differentiate transient from persistent AKI.