Occurrence Of Acute Renal Failure Research Articles

Acute renal failure during cisplatin-based chemotherapy: A prospective monocentric study.

Cisplatin is a widely used antineoplastic in the treatment of various types of solid cancers. The objectives of our study were to evaluate the prevalence of acute renal failure (ARF) during cisplatin-based chemotherapy and to determine the factors correlated with renal toxicity. This is a prospective study that was conducted over a period of 6 months. We included patients followed for histologically confirmed solid cancer and treated with cisplatin-based chemotherapy. Assessment of renal function was made by calculating renal creatinine clearance before starting cisplatin, before every cycle, at 3 months and at 6 months. Forty patients were included. The median age was 54 years (31-71 years). The mean cumulative dose received was 286 mg/m² (100-560 mg/m²). Twelve patients (30%) developed ARF which was grade 1 in 83% of cases. Cisplatin ARF was observed after a mean cumulative dose of 208 mg/m². Digestive toxicity (67%) and obstruction of the excretory tracts of tumoral origin (8%) were aggravating factors. Cisplatin cycle number >3 (p = 0.04) and dose ≥330 mg/m2 (p = 0.04) were the factors associated with cisplatin renal toxicity. This study concluded that ARF is dose-dependent with the predominance of grade 1 toxicity. A cumulative dose exceeding 330 mg/m2 was correlated with an increased risk of occurrence of ARF.

ACUTE KIDNEY INJURY IN HOSPITALIZED PATIENTS WITH CORONAVIRUS DISEASE 2019 (COVID-19) AND LITERATURE REVIEW

The coronavirus disease 2019 (COVID-19) outbreak has quickly become a global pandemic. Most patients with COVID-19 have mild symptoms, but develop severe symptoms as well, which can include acute respiratory distress syndrome, septic shock, and multiple organ failure. Renal involvement is common, with a clinical presentation ranging from mild proteinuria to progressive acute renal failure requiring renal replacement therapy (RRT). An understanding of the pathophysiology and mechanisms of kidney injury and ARI in the context of critical illness and COVID-19 We conducted a literature review to identify the impact of COVID 19 infection on the occurrence of acute renal failure. We specifically analyzed kidney functions in COVID-19 patients and their relationship to mortality. Only acute renal failure (ARI) directly linked to SARS-CoV 2 infection is considered other causes of renal failure of hemodynamic, iatrogenic or other origin are excluded.

Both hypophosphatemia and hyperphosphatemia are associated with increased mortality in septic patients.

This study was intended to explore the relationship between level of serum phosphate and prognosis in septic patients. Data were obtained from the public database, which were divided into 2 subgroups according to whether they were complicated with chronic kidney disease. Initial values of serum phosphate were extracted from patients on admission to hospital. Propensity score-matched analysis was performed. The relationship between hypophosphatemia, hyperphosphatemia and the severity of the disease in septic patients was explored separately. The lowess smoothing technique and the Kaplan-Meier method were utilized for a preliminary analysis of serum phosphate levels in relation to in-hospital mortality and 28-day survival. The initial values of serum phosphate were graded as level 1 (<1.5 mg/dL), level 2 (1.5-2.7 mg/dL), level 3 (2.7-4.5 mg/dL), level 4 (4.5-5.5 mg/dL), level 5 (5.5-6.5 mg/dL), level 6 (6.5-7.5 mg/dL) and level 7 (> 7.5 mg/dL). Multivariate logistic regression and cox regression was used to analyse the relationship between serum phosphate levels and mortality. There were 4059 cases (17.4%) combined with chronic kidney disease, including 419 cases (10.3%) with hypophosphatemia and 1091 cases (26.8%) with hyperphosphatemia. There were 19224 cases (82.6%) not combined with chronic kidney disease, including 3769 cases (19.6%) hypophosphatemia and 2158 cases (11.2%) hyperphosphatemia. After propensity score-matched, in-hospital mortality, 28-day mortality, risk of septic shock was significantly higher in the 2 subgroups of hypophosphatemia patients than in normophosphatemia patients. In-hospital mortality, 28-day mortality, risk of septic shock, occurrence of renal replacement therapy, occurrence of acute renal failure, and maximum clinical score were all significantly higher in the 2 subgroups of patients with hyperphosphatemia than in patients with normophosphatemia. Multivariate logistic regression was consistent with cox regression results. In septic patients without chronic kidney disease, hypophosphatemia was an independent risk factor for death. When serum phosphate was lower, the risk of death was higher. In all septic patients, hyperphosphatemia was an independent risk factor for death. When serum phosphate was higher, the risk of death was greater. Both hypophosphatemia and hyperphosphatemia are associated with increased mortality in septic patients and are independent risk factors for death.

Endothelial Activation and Stress Index (EASIX) as an Early Predictor for Mortality and Overall Survival in Hematological and Non-Hematological Patients with COVID-19: Multicenter Cohort Study.

COVID-19, as a disease involving the endothelium of multiple organs, is characterized by high mortality rates among hospitalized patients. Patients with hematological malignancies are particularly at risk of an unfavorable course of COVID-19. The endothelial activation and stress index (EASIX) score has been used as a simple predictor of overall survival (OS) in specific groups of hematological cancer patients. EASIX, as a biomarker of endothelial dysfunction, might play a prognostic role in patients with COVID-19. Here, we performed a comprehensive retrospective analysis of the EASIX score in 523 hospitalized COVID-19 patients with or without coexisting hematological cancer. Hematological cancer COVID-19 patients had higher EASIX scores compared to the overall population with COVID-19. In hematological patients, EASIX was a strong predictor of the occurrence of sepsis during COVID-19. Our findings demonstrated EASIX as a strong predictor of intensive care unit admission, in-hospital mortality, the occurrence of acute renal failure and the need for hemodialysis, both in hematological and non-hematological COVID-19 patients. Patients with a high EASIX score on COVID-19 diagnosis had significantly inferior OS compared to patients with low EASIX. We showed for the first time that EASIX might serve as a simple, universal prognostic tool of OS in both hematological and non-hematological COVID-19 patients.

Neuroleptic Malignant Syndrome Associated with Rhabdomyolysis Induced by Antipsychotic Agents: A Rare Occurrence

Neuroleptic Malignant Syndrome (NMS) is a medical emergency of infrequent presentation in Emergency department, which is associated with the use of psychotropic agents, classical and atypical antipsychotics. We report a case involving a 56-year-old male patient diagnosed with schizophrenia and depression for 30 years, who had been receiving Amisulpride, Trifluoperazine, Clozapine, and Amitryptiline as part of his treatment. This patient presented with symptoms of NMS with fever, muscle rigidity, altered mental state, elevated CPK, Urea, and S. Creatinine levels. NMS may be responsible for serious rhabdomyolysis, acute respiratory distress syndrome, and disseminated intravascular coagulation. We hypothesize the occurrence of acute renal failure precipitated by NMS. His treatment included the withdrawal of all psychotropic agents, Bromocriptine, and other supportive measures.

MO344INCIDENCE AND RISK FACTORS FOR ACUTE POSTOPERATIVE RENAL FAILURE

Abstract Background and Aims Postoperative acute renal failure (AKI) is a particular form of acute failure with several triggers. Decreased renal blood flow and the resulting ischemia seem to be the most common cause of kidney damage. The objective was to study the incidence and risk factors associated with post-operative AKI. Method It was a retrospective, descriptive study spanning a 3-year period from January 1, 2017 to December 31, 2019. The patients in this series were admitted to the various surgical departments. Results Our study included 618 cases of AKI. The incidence of postoperative AKI was 8.73%. The average age of our patients was 40.4 +/- 12.3 years, a male predominance with a sex ratio of 1.2. The main history was diabetes found in 39%, hypertension in 27.5% and an injection of contrast product a few days before the intervention in 14.5%. General surgery topped the list in 49.5% of our patients, followed by trauma in 25%, gyneco-obstetrics in 14.5%, and 11% for the rest of the surgeries. The associated risk factors were: hypovolemic shock, diabetes, severe sepsis. Conclusion The occurrence of acute renal failure in the postoperative period results from factors related to the field and surgery. Hence the need for early identification of risk situations, in order to reduce the incidence of renal damage during the perioperative period.

Daily parenteral selenium therapy in critically ill patients: An updated systematic review and meta-analysis of randomized controlled trials.

Patients hospitalized at the intensive care unit (ICU) are more prone to oxidative stress. Antioxidants such as selenium (Se) may have beneficial effects on outcomes in these patients. Studies and systematic reviews in this field have inconclusive results. An updated systematic search was done to find clinical trials published in PubMed, Cochrane's library, ISI web of Science, Scopus, and Ovid databases from January 1980 up to April 2020, to assess the effects of daily Se supplementation on patient's survival, hospital and ICU stay, duration of mechanical ventilation, infection, acute renal failure (ARF) occurrence and serum creatinine levels. From 1394 papers found in the first step of the search, after deleting duplicate findings, 24 studies were included in this meta-analysis. Results of the pooled random-effect size analysis of 24 trials showed no remarkable effect of daily parenteral Se administration on patient's hospital and ICU stay, duration of mechanical ventilation, infectious complications, ARF, survival and serum creatinine levels (p>0.05). The subgroup analysis showed that daily parenteral Se administration (in doses higher than 1000μg/d) increased the length of ICU stay by 4.48-folds (95%CI:-0.5, 9.46, p=0.07). Parenteral Se supplementation at the first and following dose of ≤1000μg reduced the number of ARF at the hospitalized patients by 76% and 45%, respectively (p=0.02, and p=0.05). High doses of Se increases days of ICU stay, but low doses decreases the number of ARF occurrence in ICU patients. More trials are needed to assess its effect on ARF occurrence.

Acute decrease in kidney function after acute coronary syndromes predicts future bleeding and death

Abstract Background Coronary artery disease and kidney failure are conditions of substantial clinical impact. Current data shows evidence for adverse cardiovascular outcomes after percutaneous coronary intervention (PCI) with occurrence of acute renal failure. Purpose In the present study, we aimed to evaluate the impact of acute kidney failure on cardiovascular outcomes in patients presenting with acute coronary syndromes (ACS). Methods We analysed data of 787 patients who presented with ACS and underwent coronary angiography at the University Hospital Zurich between 01.01.2009 and 15.10.2012. Blood samples were obtained each prior to PCI (T1) and after 12–24h (T2). A first follow-up was performed at 30 days via phone interview. After 1 year, patients presented for a clinical visit. Renal function was assessed by measurement of creatinine levels at T1 and T2. Subsequently, renal function was classified into 6 groups by glomerular filtration rate (GFR) estimations according to the Kidney Disease: Improving Global Outcomes (KDIGO) classification of chronic kidney injury. As an incremental value, we analysed the absolute change in creatinine levels by referring to a cut-off of ≥0.3 mg/dl. Primary endpoints were defined as the occurrence of major adverse cardiac and cerebrovascular events (MACCE), bleeding events, as well as the combination of both (defined as Net Adverse Clinical Events (NACE)) at 30 days and 1 year. Bleeding events were assessed according to the Bleeding Academic Research Consortium (BARC), Global Utilization of Streptokinase and tPA for Occludes Coronary Arteries (GUSTO) an Thrombolysis In Myocardial Infarction (TIMI) classifications. Results 179 patients (24.7%) showed an acute decline in kidney function between T1 and T2 if assessed by decrease in GFR class. If acute kidney failure was defined as a change in creatinine levels ≥0.3 mg/dl, the number of patients with kidney failure was even larger (n=325, 44.9%). MACCE occurred in 31 of all patients (4.3%) after 30 days and in 65 patients (9%) after 1 year. If MACCE was compared between patients with stable and decreasing GFR class, a significant difference to the disadvantage of those with declining kidney function was shown: after 30 days, MACCE occurred in 3.1% vs. 7.8% (p&amp;lt;0.05) and after 1 year in 7.5% vs. 13.4% (p&amp;lt;0.05), respectively. Similarly, bleeding events occurred significantly more often in patients with kidney failure both at 30 days and 1 year. At 1 year, NACE events happened significantly more frequently in patients with renal impairment (27.4%) compared to those with stable kidney function (13.6%, p&amp;lt;0.05). Conclusion In patients presenting with ACS, a decline in kidney function within 24 hours is associated with significantly higher rates of cardiovascular and bleeding events at 30 days and 1 year. Funding Acknowledgement Type of funding source: Foundation. Main funding source(s): Swiss National Science Foundation, Swiss Heart Foundation

STUDY OF ACUTE RENAL FAILURE DUE TO GASTROENTERITIS IN A TERTIARY HEALTH CARE CENTRE

Acute renal failure (ARF) also known as acute kidney injury (AKI) due the gastroenteritis is a very common and dramatic syndrome encountered in clinical practice.ARF complicates 5 % of emergency clinic affirmations and 30 % of ICU confirmations. Primary goals are to consider the clinical profile of renal inclusion in gastroenteritis patients by point by point history, clinical assessment and research facility contemplates, to decide poor prognostic variables, to concentrate in-emergency clinic result of intense kidney injury in gastroenteritis patients. Methods: This study was undertaken in a tertiary care centre, Maharashtra. A total of 87 patients fulfilling the inclusion and exclusion criteria were selected for the study who were admitted to the medical wards with acute renal failure following gastroenteritis. Results: The mean age of study participants was 53.71 ± 17.34 years, with maximum age 85 and minimum 16 years. A total of 48.3% patients were from 51-70 years of age, 58.6% patients were male and rest 41.4% was female. Among the 87 patients included in the study, 92% patients were managed conservatively, while 8% patients received Haemodialysis. 93.1% patients improved after treatment, while 4.6% patients did not show any change in their clinical condition. 2 patients died during hospital stay. Conclusion: The occurrence of acute renal failure in cases of acute gastroenteritis is very common and conservative treatment remains the main stay of the treatment. Renal replacement therapy is required is some cases and mortality rate is less if prompt diagnosis and treatment is provided to the patients.

Preoperatif hiponatreminin sol ventrikül ejeksiyon fraksiyonu üzerine etkileri ve klinik sonuçlarla ilişkisi

Aim: In this study, we aim to investigate the relation between preoperative serum sodium levels and postoperative clinical follow-up; moreover, to compare the left ventricular ejection fraction increment in hyponatremic and normonatremic cases. Herein, we present one-year results of our clinic in open cardiac surgery performed patients.Materials and Methods: This is a retrospective study of cases who underwent open cardiac surgery between February 2014-2015 in our clinic. Transplantation assist device implanted cases and hemodialysis receiving patients by reason of chronic renal failure were excluded.Patients were divided into two groups according to blood serum sodium levels on admission day as normonatremic (135–145 mEq/L) or hyponatremic &amp;lt;135 mEq/L. The demographic characteristics of the patients, duration of intubation and length of intensive care unit (ICU) stay, need for inotropic support, mediastinal drainage amount, alteration in left ventricular ejection fraction (LVEF), intraaortic balloon pump (IABP) usage ratio, occurrence of acute renal failure, cardiopulmonary bypass time, cross clamping time and differences in clinical outcomes were examined.Results: Hyponatremia was observed in 31,3% of patients and those had higher NYHA classification score. There was no statistical difference between groups in LVEF alteration was determined (p=0.756). Postoperative duration of intubation (p=0.003), need of blood products transfusion(p=0.033), vasoactive inotropic support (p=0.021) and postoperative amount of drainage was statistically higher in hyponatremic cases surplus(p=0.018). Peroperatively, both aortic cross clamping time (p=0.018) and cardiopulmonary bypass durations (p=0.026) were higher in hyponatremic group. Furthermore, postoperative mortality was also significantly higher (p=0.001). Conclusion: We suggest that being hyponatremic has a prognostic importance in patients who undergo open cardiac surgery.

The Effectiveness of Heart Valve Replacement Surgery in a Non-Referral Regional Hospital: The Analysis of Outcomes after Isolated and Complex Valve Replacement.

To comprehensively investigate early and late outcomes for all valve replacement surgery patients in a non-referral regional hospital database and to compare these results with the literature. This was a retrospective study and made up of patients undergoing heart valve replacement in the cardiovascular department of a non-referral regional hospital between May 2008 and February 2018. Inclusion criteria were aortic, mitral and double valve replacement with or without CABG. 212 patients were included in the study. Of the 212 patients, 65 were aortic valve replacement, 119 were mitral valve replacement, 28 were double valve replacement patients. Mean follow-up of all patients was 3.4 ± 2.9 years. There was no significant difference among the groups regarding hospital mortality. The occurrence of acute renal failure and neurological event was the main factors of morbidity-associated mortality. Concomitant CABG procedure was found to be an independent predictor of early mortality after MVR. In the AVR group, there was no significant difference between AVR with CABG and without CABG regarding the 5-year survival rates; whereas in MVR and DVR group, there was a statistically significant difference between the groups. According to Cox proportional hazards model for determining factors related to late mortality, preoperative chronic renal failure and concomitant CABG were factors independently related to late mortality after MVR. We believe that our study will contribute to the development of the outcomes of heart valve replacement surgery in these centers by supporting other non-heart center clinics in working toward acceptable morality rates for complex valve surgeries.

READY: relative efficacy of loop diuretics in patients with chronic systolic heart failure-a systematic review and network meta-analysis of randomised trials.

The majority of patients with chronic heart failure (HF) receive long-term treatment with loop diuretics. The comparative effectiveness of different loop diuretics is unknown. We searched PubMed, clinicaltrials.gov , the Cochrane Central Register of Controlled Trials and the European Union Clinical Trials Register for randomised clinical trials exploring the efficacy of the loop diuretics azosemide, bumetanide, furosemide or torasemide in patients with HF. Comparators included placebo, standard medical care or any other active treatment. The primary endpoint was all-cause mortality. Secondary endpoints included cardiovascular mortality, HF-related hospitalisation and any combined endpoint thereof. Hypokalaemia and acute renal failure were defined as additional safety endpoints. Evidence was synthesised using network meta-analysis (NMA). Thirty-four trials reporting on 2647 patients were included. The overall quality of evidence was rated as moderate. NMA demonstrated no significant differences between loop diuretics with respect to all-cause mortality, cardiovascular mortality or hypokalaemia. In contrast, torasemide ranked best in terms of HF hospitalisation, and there was a trend towards benefits with torasemide with regard to occurrence of acute renal failure. Sensitivity analyses excluding trials with a follow-up < 6months, trials with a cross-over design and those including < 25 patients confirmed the main results. We found no significant superiority of either loop diuretic with respect to mortality and safety endpoints. However, clinicians may prefer torasemide, as it was associated with fewer HF-related hospitalisations.

Acute Renal Failure in Hospitals in Togo: Comparative Analysis of HIV Positive Patients and HIV Negative Patients

Introduction: Human Immunodeficiency (HIV) is a risk factor often associated with the occurrence of Acute Renal Failure (ARF). Objectives: To describe the profile of Acute Renal Failure (ARF) in HIV-infected patients and compare them to non-infected patients. Patients and Methods: It was a prospective study from January 2018 to February 2019 that took place in the nephrology, infectious diseases and internal medicine departments of the Sylvanus Olympio University Hospital Center in Lome (Togo). Results: The prevalence of ARF in HIV-infected patients was 48.07%. HIV-infected patients had an average age of 46.9 ± 11.6 years (p = 0.36) compared to 44.0 ± 20.4 years for non-HIV infected patients. Female sex was predominant in the HIV-infected population with a sex ratio H/F of 0.6 (p < 0.0001) versus 2.9 for the non-infected. The reasons for admission were such as fever (28%), digestive disorders (56%) were more common in HIV-infected patients than non-infected patients (11.1%, 37%). Infected patients had more diarrhea than non-infected patients (24% versus 7.4%) with p = 0.01. They showed more signs of infections than uninfected patients (40% versus 18.5%) with P = 0.02. HIV infection was known before admission in 96% of cases. Patients whose HIV was known before admission had hypertension (16.7%), diabetes (12.5%) and CD4 count < 200 (/mm3) in 50% of cases. HIV infected patients had more anemia (52.0% versus 22.2%) with p = 0.002. Conclusion: No deaths were recorded in the HIV-infected group.

Prognosis of Acute Renal Failure of the Child during Severe Malaria in Niamey-Niger

Introduction: In malaria-endemic areas, acute renal failure (ARF) is one of the most serious complications, it occurs in 40% of severe forms of malaria in adults and is linked to 75% of deaths, especially when extra-renal cleaning is not available. In children, studies of ARF during malaria are limited. We have no published studies on this topic in Niger. The main objective of our study is to evaluate the prognosis of ARF during severe malaria in children. Patients and Method: This is a one-year prospective study (January 1, 2016 to December 31, 2016) conducted in the resuscitation unit of the pediatric department of the National Lamorde Hospital of Niamey (Niger). We included in the study children aged 0 to 15 years hospitalized for severe malaria with impaired renal function. Patients who had chronic renal failure or who had acute renal failure with a thick negative drop were excluded from the study. Acute renal failure is defined according to Kidney Disease Improving Global Outcomes (KDIGO) criteria basing on creatinine clearance. Results: The incidence of ARF was 12.60%. The mean age of the patients was 4.25 ± 1.3 years [8 months - 15 years]. The mean hemoglobin level was 8.2 ± 2.7 g/dl. In 54.02% of cases, the hemoglobin level is ≤5 g/dl. Mean serum creatinine was 543.7 ± 69.5 μmol/l [107 - 2500 μmol/l] and mean azotemia was 27.5 ± 3.5 mmol/l. Severe anemia (54.02%) were more related to the occurrence of ARF(with p = 0.014). According to the RIFLE classification, 55 patients (63.22%) were in the Risk stage, 18 patients (20.69%) were in the injury stage and 14 patients (16.09%) in the failure stage. All patients were placed on injectable Artesunate. The average length of hospital stay was 8.6 ± 4.5 days [5 to 22 days]. Dialysis was reported in 15/87 (17.24%). For technical and financial reasons only 8 patients were hemodialysed. Indications for dialysis were severe uremic syndrome 7 cases (8.04%), fluid overload 5 cases (5.75%) and severe hyperkalemia 3 cases (3.45%). Conclusion: The etiological factors of ARI in malaria were massive hemoglobinuria, severe anemia and shock. Adequate management of simple cases of malaria and the early transfer of severe cases to resuscitation services can prevent certain complications such as acute renal failure.

Myoglobin: still a useful biomarker in 2017?

The clinical biologist plays a role as a consultant for the relevant use of biological examination. Advisory activities of the medical laboratory may help physician in diagnosis or therapeutic algorithm, avoiding redundant ordering or useless tests. In this context, we performed a review of literature about the clinically interest of myoglobin assays. The indications of myoglobin's assays appear fairly limited. It is no longer mentioned in the European guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation. In patients with rhabdomyolysis myoglobin is neither a diagnostic nor a prognostic criterion. Its interest in predicting the occurrence of acute renal failure is also discussed. The most recent clinico-biological score (such as the McMahon score) do not integrate it. In this context, we decided to stop performing myoglobin assay.

Study of renal profile in septicemic neonates

Background: Neonatal sepsis can cause multiorgan involvement causing neonatal morbidity and mortality. The kidneys are an important organ affected in septicemic newborns. In this study we evaluated the renal functions and its association with various risk factors along with outcome in septicemic neonates.Methods: This study was a prospective observational study conducted in a tertiary care teaching hospital. The sample size was 276 cases of septicemic new-borns and study duration was 2 years. The profile of acute renal failure (ARF) and various risk factors were studied in a sample of 276 septicemic neonates. Detailed clinical examination and investigations were done to confirm the diagnosis of neonatal sepsis and the occurrence of ARF was studied among these septicemic newborns. Risk factors like birth weight, gestational age, shock, etiological agents, DIC were studied for the occurrence of ARF and mortality in ARF patients among septicemic neonates.Results: 30.07% of septicemic neonates developed ARF. DIC (p value=0.014), shock (p value=&lt;0.0001), gestational age (p value=0.005), birth weight (p value=0.003), were found to be analytically significant for the occurrence of ARF. Birth weight (p value=0.006), age of onset of sepsis (p value=0.019), shock (p value =&lt;0.0001), oliguria (p value =&lt;0.0001), and DIC (p value=0.015) were significant predictors of mortality in ARF among septicemic neonates.Conclusions: Awareness and early identification of various risk factors and ARF in septicemic neonates can prevent morbidity and mortality among neonates.

Occurrence of acute renal failure on the same day as immune globulin product administrations during 2008 to 2014.

Acute renal failure (ARF) is a rare serious adverse event after immune globulin (IG) use. Our large claims-based study evaluated occurrence of same-day ARF after administration of different IGs and ascertained potential risk factors, during the 2008 to 2014 study period. A retrospective cohort study was conducted using a large commercial administrative database. The cohort included individuals exposed to IG products as identified by procedure codes. ARF was ascertained using ICD-9-CM diagnoses. Unadjusted same-day ARF rates (per 1000 persons exposed) were estimated overall and by age, sex, and IG products. Regression analyses were conducted to control for confounding and assess potential risk factors. Of 20,440 persons exposed, 163 (7.97 per 1000) had a recorded same-day ARF. The unadjusted nonzero same-day ARF rates (per 1000) ranged from 1.92 (95% confidence interval [CI], 0.05-10.69) for Hizentra to 16.97 (95% CI, 11.36-24.37) for Privigen and differed by sex. In multivariate analyses, compared to Gammagard Liquid, no significantly elevated ARF risks were identified with any IGs. A significantly lower odds ratio was identified with Gamunex, 0.53 (95% CI, 0.30-0.93). Age 45 and over, prior renal impairment, hypertension, and other factors were associated with increased risk of same-day ARF. The study showed variation in the risk of IG-related ARF by age, sex, and IG products. The study results suggest the importance of recipient factors, such as older age and underlying health conditions. Variations in ARF occurrence may also be explained by product dosage, administration route and rate, and manufacturing processes, which warrant further evaluation.

Dabigatran: A Novel and Rare Cause of Diffuse Alveolar Hemorrhage (DAH)

SESSION TITLE: Diffuse Lung Disease SESSION TYPE: Affiliate Case Report Slide PRESENTED ON: Sunday, October 29, 2017 at 10:45 AM - 12:00 PM INTRODUCTION: DAH is a rare, life-threatening pathology characterized by intra-alveolar hemorrhage with a spectrum of clinical presentations. This syndrome includes hemoptysis, anemia, pulmonary infiltrates and hypoxemic respiratory failure. This case is a rare presentation of DAH secondary to a Novel Oral Anticoagulant (NOAC) in the absence of systemic vasculitis. CASE PRESENTATION: An 86 year old male with past medical history of atrial fibrillation on dabigatran and congestive heart failure, was found at home, hypoxemic and bradycardic to the emergency room. The patient was also noted to be anemic, requiring 2 units of PRBC and in acute renal failure. The patient met criteria for ARDS, including a chest X-ray suggestive of bilateral diffuse pulmonary infiltrates. He was maintained on low tidal volume, high PEEP ventilator support. Bronchoscopic lavage demonstrated progressively more hemorrhagic effluent, pathognomic for DAH. Investigations for vasculitis were negative. The thrombin time was noted to be elevated and hence Idaricizumab was started and hemodialysis initiated. The patient was successfully extubated in 7 days duration. DISCUSSION: GI bleeds and intracranial hemorrhages are known complications with dabigatran, however DAH is rare with only four other cases reported in our literature review1,2. Most of these cases were prior to the advent of Idarucizumab. Dabigatran toxicity may have occurred in this patient due to the occurrence of acute renal failure. Reversal agent may have a role in treating pulmonary hemorrhage and subsequent respiratory failure secondary to the use of NOACs. Interestingly, this patient also had no prior history of vasculitides or lung disease that would predispose the patient to DAH. CONCLUSIONS: To our knowledge this is the only case where resolution of ARDS secondary to DAH by Dabigatran use was achieved with the use of Idarucizumab, hemodialysis and lung protective ventilator strategy. This highlights the importance of considering DAH as a cause of ARDS especially in the setting of anticoagulation. Increasing use of NOACs requires physicians to be aware of the adverse effects and indications for using reversal agents, when available. Reference #1: Yokoi K, Isoda K, Kimura T, Adachi T. Diffuse Alveolar Hemorrhage Associated with Dabigatran. Intern Med. 2012;51(18):2667-2668 Reference #2: Kudo, K, Tanimoto, Y, Hisamoto, A, Ichihara, E, Tanimoto, M, Kiura, K. Dabigatran etexilate-induced alveolar hemorrhage. AJRS, 1(3): 247-250, 2012. DISCLOSURE: The following authors have nothing to disclose: Shyam Shankar, Prarthna Chandar, Hatem Desoky, Ishan Malhotra, Anand Kumar Rai, Mangalore Amith Shenoy, Benhoor Shamian, Pavel Gozenput, Roman Bernstein, Pavan Irukulla, Yizhak Kupfer No Product/Research Disclosure Information

An 8-Year Retrospective Study of Human Visceral Leishmaniasis

Visceral leishmaniasis (VL) is a zooanthroponosis affecting both rural and periurban areas, and can also spread into urban areas. VL has emerged in many countries in the world, presenting new cases in new countries of occurrence. Thus, studies concerning epidemiological aspects in different world regions are very meaningful. With this purpose, this study analyzed 89 cases of VL, treated between June 2006 and June 2014 at Eduardo de Menezes Hospital (HEM), a Reference Center of Infectious Diseases situated in Belo Horizonte, in Minas Gerais state, Brazil. According to the results, it was observed that males are mostly infected (84%/n=75) and the most affected age range was 20-49 years old (83%/n=74). The treatment liposomal amphotericin B (33%/n=29) was mostly used. Recurrences were more frequent in patients treated with Glucantime® (17%/n=9). No side effects were reported among the 29 patients treated with liposomal amphotericin B. On the other hand, there were 23 cases related to the occurrence of acute renal failure (ARF) and the use of conventional amphotericin B, both when it was administered alone or in combination with other drugs. Additionally, we observed a close relationship between the VL and HIV infection, observing a coinfection rate of 28.1% (n=25). From the survey data, it was possible to conclude that the majority of VL patient treated at HEM is male, classified as brown racial group, economically active, and may be drug addicts, chronic alcoholics and/or smokers. They may present some Non-communicable diseases (NCD), such as hypertension, diabetes mellitus, dyslipidemia and/or obesity and, predominantly present a great chance of being a carrier of the Human Immunodeficiency Virus, associated or not with tuberculosis. As symptoms, these patients possibly will present hepatosplenomegaly, fever and pronounced weight loss.

Benefits of pomegranate (Punica granatum Linn) fruit extracts to weight changes, total protein, and uric acid in white rats (Rattus norvegicus) as an animal model of acute renal failure.

Aim:The occurrence of acute renal failure (ARF) cases continues to increase every year. Some of the cases are due to nephrotoxic effect caused by overdose of antibiotic consumption or abuse of the drug, gentamicin. An antibiotic therapy that can be used to overcome in such a case is the pomegranate extracts. However, until now, studies using pomegranate for cases of ARF have not been done. This study aims to determine changes in body weight, the levels of total protein (TP), and the levels of serum uric acid (UA) as a result of the pomegranate extract consumption.Materials and Methods:A total number of 32 rats (Rattus norvegicus) were divided into four groups randomly. One group was assigned as the control group (P0) and given intraperitoneal (i.p.) saline and 0.3% carboxy methyl cellulose sodium (CMC) Na; P1 was provided with 80 mg/kg bw/i.p. gentamicin and 0.3% CMC Na orally, P2 was supplied with 80 mg/kg bw/i.p. gentamicin and ellagic acid in 0.3% CMC Na, and P3 was given 80 mg/kg bw/i.p. gentamicin and 150 mg/kg bw pomegranate extract in 0.3% CMC Na. The provision of treatment was carried out in 8 days and followed by making the overthrow of body weight and blood sampling for the examination of study variables.Results:The results taken by doing the analysis of variance method for the four treatment groups show that the control group (P0) has significant differences from P1, P2, and P3 (p<0.05), but there are no significant differences among the other three treatment groups. Meanwhile, the average values of serum UA levels among P1, P2, and P3 indicate significant differences.Conclusion:In conclusion, the administration of pomegranate extracts in the treatment of nephrotoxicity toward rats is effective to maintain normal body weight, normal TP levels, and the UA blood serum of the rats. As this study is a preventive therapy, it needs further researches about the effective dose as a curative therapy, its level of effectiveness and its long-term side effects.