Postrenal Causes Research Articles

CYSTOCENTESIS AND URINALYSIS IN ZOOMEDICINE: AN UNDERESTIMATED TOOL FOR LARGE FELID STANDARD HEALTH CHECKS.

Chronic kidney disease (CKD) is a prevalent disease among felids; yet its origin is still poorly understood, and the disease often remains asymptomatic for years, underscoring the need for early diagnosis. This study aimed to investigate the diagnostic value of urinalysis in accurately staging CKD, particularly as routine health checks in large felids often overlook its significance. In this research, ultrasound-guided cystocentesis (UGC) was performed on 50 captive nondomestic felids during routine veterinary health checks under general anesthesia. Urinalysis included microscopic examination of the sediment, measurement of urine specific gravity (USG) and protein to creatinine ratio (UPC). Additional serum kidney markers, such as creatinine and symmetric dimethylarginine, were compared with USG and UPC to assess their diagnostic value as urinary biomarkers. The results demonstrated proteinuria (UPC > 0.4) or borderline proteinuria (UPC 0.2-0.4) in 49% of the animals. Among these cases, 62% were of renal origin, and 38% were postrenal causes. USG was significantly higher in felids with borderline proteinuria compared to those with proteinuria. A moderate, but significant negative correlation between serum parameters and USG was observed, emphasizing the importance of assessing both diagnostic parameters during kidney evaluations. Additionally, felids with CKD have an increased risk of urinary tract infections, necessitating microscopic urinalysis and bacterial culture analysis. Abnormalities, including hematuria, pyuria, crystalluria, and bacteriuria, were found in approximately 38% of cases through microscopical examination of urine. No complications associated with UGC were observed and abnormal findings were detected in 60% of the cases. Based on these results, the authors recommend the inclusion of UGC and urinalysis as standard diagnostic tools in general health checks for nondomestic felids. This approach provides valuable insights into the early detection and staging of CKD, supporting early intervention and supportive medical care to prolong renal health in these animals.

Role of point-of-care ultrasound (POCUS) in clinical hepatology.

Hospitalized patients with cirrhosis frequently require critical care management for sepsis, HE, respiratory failure, acute variceal bleeding, acute kidney injury (AKI), shock, and optimization for liver transplantation, while outpatients have unique care considerations. Point-of-care ultrasonography (POCUS) enhances bedside examination of the hepatobiliary system and relevant extrahepatic sites. POCUS includes cardiac US and is used to assess volume status and hemodynamic parameters like cardiac output, systemic vascular resistance, cardiac contractility, and pulmonary artery pressure, which aid in the early and accurate diagnosis of heart failure, cirrhotic cardiomyopathy, porto-pulmonary hypertension, hepatopulmonary syndrome, arrhythmia, and pulmonary embolism. This also helps in fluid management and vasopressor use in the resuscitation of patients with cirrhosis. Lung ultrasound (LUS) can help in differentiating pneumonia, effusion, and edema. Further, US guides interventions such as line placement, drainage of abdominal collections/abscesses, relief of tension pneumothorax, drainage of pleural and pericardial effusions, and biliary drainage in cholangitis. Additionally, its role is essential to assess liver masses foci of sepsis, for appropriate sites for paracentesis, and to assess for vascular disorders such as portal vein or hepatic vein thrombosis. Renal US can identify renal and postrenal causes of AKI and aid in diagnosis of prerenal AKI through volume assessment. In this review, we address the principles and methods of POCUS in hospitalized patients and in outpatients with cirrhosis and discuss the application of this diverse modality in clinical hepatology.

#1799 Liver affliction among women with pregnancy-related acute kidney injury and its impact on fetal and maternal outcome

Abstract Background and Aims Pregnancy-related acute kidney injury (PR-AKI) is a worldwide health challenge that is accompanied by an increased risk of morbidity and mortality in both the mother and the fetus. PR-AKI occurs due to several causes including prerenal (hemorrhage, sepsis, hypovolemia, etc), postrenal and intrinsic renal causes (renal cortical necrosis, acute tubular necrosis, thrombotic microangiopathy [TMA], hemolysis elevated liver enzymes, low platelet count (HELLP) syndrome, preeclampsia/eclampsia, acute fatty liver of pregnancy (AFLP), glomerulonephritis [GN], etc). Hepatic affection in the context of PR-AKI may further compromise the detrimental maternal and fetal outcomes, however this seldom has been studied. Thus, this study aimed to explore the incidence of liver affliction in women with PR-AKI and to investigate its effect on the maternal and fetal outcome. Method This three-year retrospective study included women who presented to Mansoura Nephrology and Dialysis Unit with severe PR-AKI. Patients with stage I, II AKI admitted to obstetric departments were not included in the study. Patients with incomplete data were excluded from the study. The routine laboratory data and fetal and maternal outcomes were obtained from the medical records. Results The study included 77 women with PR-AKI, the mean maternal age was 28 with a minimum of 19 and maximum of 43 years. Twelve patients had hypertension while none of them had diabetes. The causes of PR-AKI are displayed in Fig. 1. Thirty-one patients (40.3%) had liver affliction. Six of them were due to HELLP, three due to underlying liver cirrhosis, one due to AFLP, the remaining cases showed abnormally elevated liver enzymes. White blood cells and INR were significantly higher among women with liver affliction than those without (P = 0.023, 0.003, respectively), while platelets were significantly lower in women with liver affliction (P = 0.002). Patients with liver affliction showed significantly higher median alanine transaminase (99 vs 27) and aspartate transaminase (103 vs 23) than those without (P < 0.001 for both). On the other hand, there were no statistically significant differences between patients with and without liver affliction as regard blood hemoglobin, serum creatinine, quantitative proteinuria, bicarbonate, and gestational age at termination of pregnancy. The studied women with liver affliction experienced lower percentage of renal recovery compared to those without but with no statistical significance (54.8%vs72.5%, P = 0.122). Maternal mortality was significantly more among patients with liver affliction compared to those without (32.3% vs 9.8%, P = 0.017). On the other hand, there was no significant difference between patients with and without liver affection regarding fetal outcome (live birth 55.2% vs 55.6%, P = 0.975) (Table 1). Conclusion Liver affliction is not uncommon problem among women with PR-AKI and it is associated with higher maternal mortality and lower rates of renal recovery.

Bilateral Ureteral Obstruction Caused by a Fecaloma: An Uncommon Presentation of Acute Kidney Injury

An 84 year-old woman with a history of hypertension, dyslipidemia, type 2 diabetes, atrial fibrillation, and diabetic kidney disease, presented with anorexia, oligoanuria, and constipation despite laxatives. The physical exam revealed a distended abdomen, and lab tests showed high creatinine levels only. The pre-renal etiology of the acute kidney injury was considered due to anorexia and probable dehydration. However, given the constipation mentioned in the clinical history, it was important to rule out a post-renal cause for the acute kidney injury, so an abdominal and pelvic CT scan was requested. The CT scan revealed small kidneys with ureters compressed by an 8 cm fecaloma, leading to acute renal failure due to post-renal obstruction (Figures 1 and 2). Laxative therapy was initiated, which resolved the fecaloma, and the patient was catheterized, resulting in the immediate release of 1 liter of urine. The resolution of the fecaloma and subsequent post-renal decompression led to a rapid recovery of kidney function.

The Effect of Oral N-Acetyl Cysteine Administration on Acute Kidney Injury Patients at Dr. Mohammad Hoesin General Hospital, Palembang, Indonesia

Background: Acute kidney injury (AKI) is a clinical condition characterized by a rapid decline in kidney function that includes structural damage (injury) or malfunction (impairment). AKI is a common complication that occurs in 5-10% of patients due to various underlying etiologies. One of the underlying pathophysiology of AKI is the role of discharge reactive oxygen species (ROS), which causes injury to kidney cells. From various studies, it has been reported that N-acetylcysteine (NAC) has anti-inflammatory and antioxidant effects and has an effect on reducing serum creatinine values.
 Methods: This research is an open randomized clinical trial without control involving 30 patients at Dr. Mohammad Hoesin General Hospital, Palembang, who were all given intervention in the form of NAC 1200 mg/day, starting in September – October 2023. This study aimed to determine the role of NAC in reducing serum creatinine values in patients with acute kidney injury at Dr. Mohammad Hoesin General Hospital, Palembang, Indonesia. Data analysis was carried out using SPSS 21 univariate and bivariate.
 Results: From the research results, it was found that the average age of patients was 53.9 years, involving 21 males (70%, N=30) and 9 females (30%, N=30). The most common causes were prerenal and then renal (53.3% and 46.7%). The initial serum creatinine level was found to be 2.12± 0.79 mg/dL (n = 30 samples), and after administration of the intervention, the mean serum creatinine level was 1.28± 0.63 mg/dL (n = 30 samples). By using a paired t-test, there was a decrease in serum creatinine levels significant (p=0,012).
 Conclusion: NAC administration to patients with acute kidney injury of pre-renal or post-renal causes has a statistical effect on reducing serum creatinine values in patients with acute kidney injury at Dr. Mohammad Hoesin General Hospital, Palembang, Indonesia.

Care of the acute kidney injury patient

Acute kidney injury, previously called acute renal failure, indicates a sudden and often reversible reduction in kidney function as measured by glomerular filtration rate, increased serum and plasma creatinine concentration and changes in urine output. This article reviews the pathophysiology and common causes of acute kidney injuries, including pre-renal causes from hypovolaemia, intrinsic renal causes such as glomerular diseases and post-renal obstructive causes. Veterinary nurses should be aware of the common diagnostic tests used and how to deliver support to the hospitalised patient. While an acute kidney injury can be a serious condition for some patients, it is possible for others to recover and maintain a good quality of life with effective nursing care to help maximise the prognosis of these patients.

Acute kidney injury in children: incidence, awareness and outcome—a retrospective cohort study

The primary objective was to determine the epidemiologic influence of AKI awareness among physicians in a mixt paediatric population, including neonates. This single-centre, multiyear, observational retrospective study included all admitted patients between first of July 2014 and 31 December 2021. AKI was identified in 2194 patients out of the 128,036 hospital admissions with 129,936 serum creatinine measurements. Matching comparisons were used between AKI aware and AKI non-aware patients. The overall incidence of AKI was 1.65%. Stage 1 was identified in 24.24% of the AKI cases, stage 2 in 31.03% and stage 3 in 44.71%. The most prevalent cause of AKI was represented by prerenal AKI in 85.64% of the cases, followed by 12.16% renal causes respectively 2.18% postrenal causes. Exposure to sepsis, critical illness, hypovolemic shock and mechanical ventilation increased mortality by 2.09, 4.69, 4.64- and 4.93-times (p = 0.001). Cancer and heart failure increased mortality by 4.22 (p < 0.001) respectively 2.17 times (p = 0.001). The presence of AKI increased mortality by 79.11 times while only half of the AKI associated deaths were recognized by physicians. AKI increased hospitalization more than 4 times the average stay. AKI awareness was dependent of lower age and severity. Also, awareness increased mortality and prolonged hospitalization. 1 in 3 neonates and 1 in 4 children were AKI aware. The physician’s awareness of AKI diagnosis is in general low due to lack of appliance of current guidelines in exploring exposures and susceptibilities for AKI screening.

The utility of clinicopathological findings and point-of-care ultrasound in increasing the index of suspicion of ureteral obstruction in azotaemic cats presenting to the emergency room.

Ureteral obstruction is a common post-renal cause of azotaemia in cats. The objective of this study was to describe clinicopathological and point-of-care ultrasound findings in azotaemic cats that may increase the index of suspicion of ureteral obstruction. A retrospective case-control study was conducted of azotaemic cats presenting to the emergency room of a referral teaching hospital. Cats were included if they were azotaemic and had point-of-care ultrasound and formal ultrasound performed. Cats were grouped into obstructed and non-obstructed groups based on formal specialist ultrasound and pyelography. Point-of-care ultrasound findings were described, including renal size and symmetry, renal pelvis dilation, perinephric fluid, and visualisation of the proximal ureter or calculi. Univariate analysis was performed to identify historical, biochemical and point-of-care ultrasound findings associated with ureteral obstruction before multivariate analysis. One hundred twenty-two azotaemic cats met the inclusion criteria. Seventy-four cats were included in the obstructed azotaemic group and 48 cats in the non-obstructed azotaemic groups. Point-of-care ultrasound abnormalities were detected in 60 of 74 (81.1%) obstructed cats and 18 of 48 (37.5%) non-obstructed cats. Renal pelvis dilation (odds ratio 38.8; 95% confidence interval 2.9 to 515), hyporexia (odds ratio 5.9; 95% confidence interval 1.15 to 30.13), hypercalcaemia (odds ratio 16.6; 95% confidence interval 1.2 to 223.0) and hypokalaemia (odds ratio 21.7; 1.33 to 354.62) were more likely to be associated with ureteral obstruction than non-obstructive disease. Point-of-care ultrasound abnormalities are documented frequently in azotaemic cats with ureteral obstruction. Cats with renal pelvis dilation were 39 times more likely to have ureteral obstruction than non-obstructive acute kidney injury.

#6039 EPIDEMIOLOGY AND OUTCOMES OF ACUTE KIDNEY INJURY: DON'T FORGET THE CHILDREN

Abstract Background and Aims Acute kidney disease (AKI) has evolved from a primary single renal disease to a syndrome secondary to other systemic illness. The aim of this study is to asses AKI epidemiology in a large East European country database comprising a mixt paediatric population (critically ill and non-critically ill) and the impact on mortality and hospitalization length. Method We conducted a retrospective observational study on all the admitted paediatric patients from 1 day to 18 years old between first of January 2014 until 31 December 2021. Out of 137760 admissions, 2194 patients were included in the study. We classified the different age groups as: premature (all the babies born before 37 weeks of gestation), full-term new-borns, infants (between 28 days and 12 months of life), toddlers (over 12 months up to 3 years), pre-schoolers (between 3 and 5 years), scholars (6 years to 11 years) and adolescents (12 to 18 years). Results The overall incidence of AKI was 15.92/1000 hospital admissions with a 4.77 times fold increased incidence over the 8 year period, from 6.72 in 2014 to 32.12/1000 admissions in 2021. The most prevalent age group, accounting for almost half the AKI cohort (49.49%), was represented by the neonatal setting with 527 (24.02%) preterm and 559 (25.47%) full-term neonates. The paediatric age groups were represented by 10.84% infants, 8.29% toddlers, 6.65% pre-schoolers, 10.57% school aged children and 14.17% adolescents. Staging AKI according to AKIN, stage 1 was identified by us in 24.24% of the AKI cases, stage 2 in 31.03% and stage 3 in 44.71%. Only 25 patients (1.1%) required RRT. Dividing the cases by AKI causes, the most common was represented by prerenal AKI in 85.64% of the cases, followed by 12.16% renal causes respectively 2.18% postrenal causes. Over the 8-years period, from the 137 760 admitted children, 0.32% (449 patients) died of whom 255 (56.79%) presented AKI diagnosis. The risk of death in the presence of AKI was 109 times higher than in the no-AKI group (p&amp;lt;0.0001, 95% CI: 90-132), mortality in the AKI group being 11.62%. Stage 3 AKI group had a higher risk of death than stage 1 with an OR of 3.31 (CI = 2.516-4.355, p&amp;lt;0.001). The average hospitalization period for all admitted patients (137 760) was 5.76 days. In the presence of AKI the average hospitalization period increased to 20.9 days ± 19.3 days. Conclusion The neonatal setting portends poor outcomes with the highest incidence of AKI. We can state that in the 21st century patients do no die of AKI but with AKI. Hospitalization increased significantly in the presence of AKI.

Paracetamol-induced acute kidney injury in the absence of acute liver injury: a retrospective cohort study

Paracetamol-induced nephrotoxicity in the absence of hepatotoxicity is only described in a few studies. The aim of this retrospective cohort study with data from the Capital Region of Denmark 2010-2017, was to examine the incidence of possible paracetamol-induced nephrotoxicity in absence of hepatotoxicity. Only one out of 5,827 admissions (0.02%) included in the study developed clinically relevant acute kidney injury (AKI) that could be attributed to paracetamol in absence of acute liver injury. This study demonstrates that clinically relevant AKI due to paracetamol overdose rarely occurs without concomitant hepatic injury when excluding other prerenal, renal, and postrenal causes of renal dysfunction, NAC interference and chronic kidney injury.

POS-127 SPECTRUM OF RENAL DISEASE IN PATIENTS WITH RETROVIRAL DISEASE AT TERITIARY CARE CENTER

Patterns of HIV associated renal disease varies from acute kidney injury (AKI), HIV associated nephropathy (HIVAN), immune complex mediated, chronic kidney disease (CKD), and electrolyte and acid base disorders. Prerenal causes like dehydration, gastroenteritis, pancreatitis, and intrinsic causes like infections, septic shock, and antiretroviral agents, analgesics, toxins, and metabolic syndrome associated with antiretroviral therapy use, CKD with incidental HIV infection. Intrinsic renal disease like ischemic renal injury due to sepsis is most common cause of AKI, rare causes like post renal cause of AKI in HIV like medication induced crystalluria, hyperuricosuria, pelvic lymphadenopathy, retoperitoneal fibrosis.

A patient with dialysis-dependent acute kidney injury due to hantavirus complicated with SARS-CoV-2 infection.

In this case, we report a 64-year-old man presenting with anorexia, nausea and vomiting, mild abdominal pain, and oligoanuria for a few hours. His previous medical history included diabetes, hypertension, and chronic kidney disease (CKD) stage 3. Upon arrival, laboratory results revealed stage III acute kidney injury (AKI) with hyperkalemia requiring dialysis treatment. During hospitalization, both pre-renal and post-renal causes of AKI were excluded, and a careful diagnostic evaluation, including kidney biopsy and serology testing, revealed acute interstitial nephritis and positive IgM for hantavirus. The patient was started on steroid treatment, which led to complete recovery of kidney function over 3 months. Moreover, during his hospitalization, the patient was also diagnosed with SARS-CoV-2 infection, possibly due to intra-hospital transmission and was hospitalized at the COVID-19 Department for 14 days, eventually with no further complications. Hantavirus nephropathy should be at the differential diagnosis of AKI, even in the absence of typical symptoms. Steroid treatment may be helpful in reversal of kidney injury.

Performing an Ultrasound-Guided Percutaneous Needle Kidney Biopsy: An Up-To-Date Procedural Review.

Ultrasound-guided percutaneous renal biopsy (PRB) has revolutionized the clinical practice of nephrology in the last decades. PRB remains an essential tool for the diagnosis, prognosis, and therapeutic management of several renal diseases and for the assessment of renal involvement in systemic diseases. In this study, we examine the different applications and provide a review of the current evidence on the periprocedural management of patients. PRB is recommended in patients with significant proteinuria, hematuria, acute kidney injury, unexpected worsening of renal function, and allograft dysfunction after excluding pre- and post-renal causes. A preliminary ultrasound examination is needed to assess the presence of anatomic anomalies of the kidney and to identify vessels that might be damaged by the needle during the procedure. Kidney biopsy is usually performed in the prone position on the lower pole of the left kidney, whereas in patients with obesity, the supine antero-lateral position is preferred. After preparing a sterile field and the injection of local anesthetics, an automatic spring-loaded biopsy gun is used under ultrasound guidance to obtain samples of renal parenchyma for histopathology. After the procedure, an ultrasound scan must be performed for the prompt identification of potential early bleeding complications. As 33% of complications occur after 8 h and 91% occur within 24 h, the ideal post-procedural observation time is 24 h. PRB is a safe procedure and should be considered a routine part of the clinical practice of nephrology.

Nephrotoxicity in Neonates

Acute kidney injury (AKI) is classified based on prerenal, intrinsic, and postrenal causes. In the newborn, AKI can occur after an insult during the prenatal, perinatal, or postnatal period. AKI is usually an underrecognized condition and its true incidence is unknown. AKI may result from the administration of a number of different nephrotoxic medications, which are often used concurrently in critically ill neonates, exponentially increasing the risk of renal injury. Drug toxicity may also compromise the formation and development of nephrons, and this is particularly important in preterm infants, who have incomplete nephrogenesis. Little is known about the pharmacokinetics and pharmacodynamics of different medications used in neonates, especially for the most immature infant, and the use of most medications in this population is off label. Strategies to prevent AKI include the avoidance of hypotension, hypovolemia, fluid imbalances, hypoxia, and sepsis as well as judicious use of nephrotoxic medications. Treatment strategies aim to maintain fluids and electrolytic and acid-base homeostasis, along with an adequate nutritional status. Neonates are especially prone to long-term sequelae of AKI and benefit from long-term follow-up. This review summarizes the most relevant aspects of nephrotoxicity in neonates and describes the prevention, treatment, and follow-up of AKI in neonates.

Renal Dysfunction in Cirrhosis: Critical Care Management.

Cirrhotic patients with manifestations of the end-stage liver disease have a high risk for developing renal dysfunction even with minor insults. The development of renal dysfunction increases the morbidity and mortality of these patients. Causes of renal dysfunction in cirrhotics can be due to hepatorenal syndrome (HRS) or acute kidney injury (AKI) resulting from prerenal, renal, and postrenal causes. Development of pretransplant renal dysfunction has been shown to affect post-liver transplantation outcomes. Early detection and aggressive strategies for the prevention of further progression of renal dysfunction seem to decrease the morbidity and improve survival in this group of patients. This article aims to outline the pathogenesis of renal dysfunction in cirrhosis, etiological factors, and evaluation of renal dysfunction, strategies for aggressive therapy for renal dysfunction, the indications of renal replacement therapy (RRT) in this group of patients, and the various modalities of RRT with their merits and demerits. A thorough understanding of the pathogenesis, early detection, and aggressive corrective measures for AKI can prevent further progression. In conclusion, a good knowledge of treatment modalities available for renal dysfunction in cirrhosis and institution of timely interventions can significantly improve survival in this group of patients.Key messagesDevelopment of renal dysfunction in cirrhotics increases the morbidity and mortality of these patients and results in poor outcomes after liver transplantation. Early detection and aggressive strategies for the prevention of further progression of renal dysfunction seem to decrease the morbidity and improve survival in this group of patients.How to cite this articleRajakumar A, Appuswamy E, Kaliamoorthy I, Rela M. Renal Dysfunction in Cirrhosis: Critical Care Management. Indian J Crit Care Med 2021;25(2):207–214.

Acute Kidney Injury in Obstetric Patients.

Obstetric-related acute kidney injury (obstetric AKI) is an important and complex public health problem; its early recognition and proper treatment are key in preventing maternal and fetal adverse outcomes. While the incidence of obstetric AKI has drastically declined in some developing countries due to reduction of sepsis-related causes, the opposite has been observed in other developed nations in the last decade due to advanced maternal age and the presence of comorbidities. The diagnosis of obstetric AKI has been made difficult by the physiologic decrease in serum creatinine of pregnancy as well as the absence of a uniform definition for AKI in this population. The most common causes of obstetric AKI include pre-renal etiologies such as hyperemesis gravidarum and post-abortal sepsis, intra-renal causes which comprise the thrombotic microangiopathies (preeclampsia/HELLP, thrombotic thrombocytopenic purpura, pregnancy associated-hemolytic uremic syndrome, lupus nephritis), and post-renal causes due to obstruction from kidney stones or iatrogenic injuries during delivery. A kidney biopsy is rarely required and should be reserved for cases where the diagnosis will change management, preferably before the third trimester. A multidisciplinary approach with the maternal-fetal-medicine specialist and nephrologist, along with the intensivist and hematologist may be needed. In this review, we will present the latest updates on the global epidemiology, focus on the most challenging thrombotic microangiopathy diagnoses, summarize treatment recommendations, and delineate the ongoing challenges as well as novel strategies to tackle this public health burden which does not seem to be disappearing.

Characteristics associated with bacterial growth in urine in 451 proteinuric dogs (2008-2018).

BackgroundUrine cultures are frequently recommended to rule out infection as a postrenal cause of proteinuria.ObjectiveIdentify characteristics associated with bacterial growth in urine in proteinuric dogs.AnimalsFour hundred and fifty‐one dogs admitted to a teaching hospital between January 2008 and January 2018 with urine protein‐to‐creatinine ratios (UPCs) >0.5.MethodsRetrospective study included dogs with a UPC, urinalysis, and quantitative urine culture (QUC) performed within a 72‐hour period by searching electronic records. Dogs with recent antimicrobial therapy, urine collected by methods other than cystocentesis, or UPC ≤0.5 were excluded. Signalment, comorbidities, serum BUN and creatinine concentrations, urinalysis findings, and QUC results were recorded. The association between these characteristics and presence of bacterial growth in urine was assessed by univariable and multivariable analysis.ResultsThirty of four hundred fifty‐one dogs (6.7%) had bacterial growth in urine. Of these, 18 (60.0%) had active urine sediment. Bacterial growth in urine was associated with pyuria (odd ratio [OR] 25.1, 95% confidence interval [CI] 7.9‐79.6, P < .001), bacteriuria (OR 11.1, 95% CI 3.2‐39.1, P < .001), and lower urinary tract disease (OR 6.7, 95% CI 1.9‐23.0; P = .0028). If QUC was prompted based on these criteria, 8/451 (1.8%) of proteinuric dogs would have had undetected bacterial growth.Conclusions and Clinical ImportanceThe proportion of proteinuric dogs with both inactive urine sediment and bacterial growth in urine was low, suggesting that QUC might not be necessary in the evaluation of all proteinuric dogs. An active urine sediment or lower urinary tract disease should prompt QUC for proteinuric dogs.

Acute Kidney Injury Caused by Darunavir in a Patient with COVID-19: A Case Report

Background: A highly contagious virus known as severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has been a pandemic globally. HIV medications were one of the suggested treatments for Coronavirus disease 2019 (COVID-19). Here, we report an unusual adverse drug reaction with darunavir in a SARS-CoV-2-infected patient. Case Presentation: This is a case presentation of a 53-year-old male with no past medical history who was diagnosed with COVID-19. One week after initiating treatment, the patient developed acute kidney injury, and his serum creatinine increased significantly. Conclusion: As there was no clear justification for renal impairment such as a prerenal or postrenal cause, acute kidney injury, possibly crystal-induced nephropathy, was considered an adverse drug reaction from darunavir.

SAT-337 ACUTE KIDNEY INJURY IN PATIENTS WITH SOLID ORGAN AND HAEMATOLOGICAL MALIGNANCIES: A SINGLE CENTRE EXPERIENCE

Acute kidney injury(AKI) is common in patients with malignancies, both solid organ and haematological malignancies. The aim of this study was to look at the incidence of acute kidney injury and its clinical correlates in patients with haematological and solid organ malignancies receiving chemotherapy. Population: All patients, more than 18 years of age receiving outpatient chemotherapy for solid organ and haematological malignancies at our hospital from Jan 2016 to Dec 2016. Data collected using MOSAIQ( Local Oncology Database) and Hospital Database. Patients were retrospectively followed up during the course of the year for acute kidney injury, which was identified using Creatinine measurements recorded in the lab database. Incidence of acute kidney injury was computed and its causes and clinical correlates were analysed using univariate analysis and multivariate analysis. AKI was defined using rifle criteria, serum Creatinine part of the definition. Injury was defined as Creatinine rise upto 50% above baseline. Results: 592 patients were included in the study. Most common malignancies were bowel cancer followed by breast. Acute kidney injury during the one year course of chemotherapy was seen in 158 patients (27.24%). Pre-renal acute kidney injury was seen in 82 patients (51.8%) and intrinsic renal in 20 patients (12.65%) and post renal cause in 35 patients (22.15%). In 21 patients (13.31%) of study population, cause of acute kidney injury was not identified. When we subclassified each of the causes, sepsis was the most common cause of acute kidney injury seen in 31 patients (19.6%), followed by hypovolumia in 24 patients (15.1%). Bilateral hydronephrosis occurred in 23 patients (14.5%). Interestingly there were 13 patients where the acute kidney injury was attributed to drugs. 5 patients had NSAIDS exposure and 8 patients had chemotherapeutic drug causing AKI. The chemotherapy drugs were Lenalidomide, Methotrexate, Ibrutinib, Pamidronate, Gemcitabine, Vemurafinib and Crizotinib. Patients with acute kidney injury attributed to above drugs had either a dose reduction or change in chemotherapy regimen. None of the patients had a renal biopsy to confirm drug induced pathology. However all of the patients had resolution of acute kidney after stopping the drug or changing the regimen. Also of note, only one patient with pamidronate induced acute kidney injury was referred to nephrology service. Looking at individual cancer types, 5 out of 10 patients (50%) with RCC developed acute kidney injury followed by lymphoma ( n=22, 43%) prostate (n=17, 41%) and myeloma(n=15, 39%). Although bowel and breast cancer were the two most common cancers, proportion of AKI in this group was (n=41,29%) and( n=6, 7%) respectively. Factors associated with acute kidney injury, higher ECOG score, diabetes and hypertension were associated with higher risk of developing acute kidney injury. Contrast to other published papers, having metastatic disease was not associated with higher risk of acute kidney injury. Acute kidney injury is associated with increased mortality. We observed the same trend in our study. Without adjusting for confounding factors, mortality in the acute kidney group at 6, 12 and 18 months was 15%, 31% and 46% compared to Non AKI group which was 5%, 26% and 43%. AKI is common in patients with malignancies and its associated with mortality.

Stevens-Johnson Syndrome complicated by obstructive uropathy, pneumothorax, and pneumomediastinum: a case report and literature review

BackgroundStevens-Johnson Syndrome (SJS) is an acute mucocutaneous eruption with blisters of the skin and haemorrhagic erosions of mucous membranes. This report describes air-leak syndrome and obstructive uropathy occurring simultaneously in a teenage patient affected by SJS.Case presentationA 17-year-old Malay female with SJS suffered from bilateral pneumothoraces, pneumomediastinum, and obstructive uropathy as early complications of her disease. She required intubation, chest tube insertion, and bilateral ureteric stenting as part of her intensive care management. These extra-cutaneous complications of renal and pulmonary systems were likely secondary to widespread epithelial detachment.ConclusionDespite paucity of cases in adult literature, post-renal causes for acute kidney injury must be considered in SJS, especially in the setting of gross haematuria. Bedside point-of-care ultrasonography may be a useful tool for excluding obstructive uropathy. Pneumothorax is a rare but documented complication of SJS in paediatric cases and, to a lesser extent, adult patients. Extra care should be exercised when caring for mechanically ventilated patients suffering from SJS.