Prerenal Causes Research Articles

Characteristics, risk factors and outcomes of community-acquired acute kidney injury in the elderly: a prospective tertiary hospital study, Egypt

Acute Kidney Injury (AKI) is a public health problem. Elderly present a greater predisposition to the development of AKI, either due to kidney senility, or due to high prevalence of comorbidities and polypharmacy. Considering the scarcity of studies on AKI in the elderly particularly in developing countries, this study emphasizes on the pattern and outcome of AKI in the Egyptian elderly. To analyze the demographics, risk factors and outcomes of Acute Kidney Injury (AKI) in the Egyptian elderly. A total of 199 patients were included over one year and were divided into two groups; group I (79 elderly patients) and group II (120 non-elderly patients). The two groups were compared regarding demographics, risk factors and major outcomes including patient and renal survival. Elderly patients showed a higher prevalence of Diabetes Mellitus and chronic kidney disease (p=0.004 and 0.005 respectively). Pre-renal causes of AKI principally dehydration represented the major risk factor (p=0.003). Sepsis and hypertension predicted mortality in the elderly (p=0.001 and 0.035 respectively). In our locality; the elderly is highly vulnerable to AKI. Pre-renal causes principally dehydration represent the main triggers of AKI. Sepsis and hypertension contribute to mortality in this population. Preventive strategies are crucial not only in the hospital but also at home.

Epidemiology and Causes of Acute Renal Failure and Transition to Chronic Kidney Disease

Acute kidney injury (AKI) refers to an acute functional deterioration of the kidneys, which leads to retention of urinary substances, dysregulation of the electrolyte and acid-base balance, and disturbance of fluids. Although didactically helpful, the oversimplified AKI classification of prerenal/renal/postrenal is currently considered obsolete. Indeed, the boundaries blur quite quickly, particularly between prerenal and renal causes. Based on the AKI pathophysiology, it can be etiologically divided into decreased renal perfusion, postrenal obstruction and kidney specific injury or unspecific injury. AKI is a common event in hospitalized patients and associates strongly with mortality and chronic kidney disease (CKD). Today it is accepted that AKI and CKD are rather an individually variable continuum, than 2 distinct entities. If AKI has not regressed after 7 days, it is referred to as acute kidney disease (AKD). Persisting AKD for > 90days is classified as CKD. The transition from AKD to CKD is the result of an incomplete and maladaptive repair process. Although follow-up of post-AKI patients is essential, optimal concepts still need to be developed.

Etiology, Clinical Profile, and Short-Term Outcome of Children With Acute Kidney Injury.

Background: Acute kidney injury (AKI) is a common clinical syndrome in hospitalized children and it imposes heavy burden of mortality and morbidity. In resource-constraint settings, management of AKI is very challenging and associated with adverse outcomes. The aim of this study was to determine the clinico-etiological profile and outcome of AKI.Methodology: This prospective observational study was done at the department of pediatric nephrology and pediatric intensive care unit, National Institute of Child Health, Karachi, Pakistan from December 2020 to May 2021. A total of 130 children aged 1 month to 15 years, diagnosed with AKI irrespective of the underlying cause were included. Detailed medical information of each child including medical history, examination, and baseline investigations were obtained. Clinical and etiological profile of patients was noted. The patients were followed up to three months and the outcome was noted.Results: In a total of 130 children, 82 (63.1%) were male. The mean age was 5.5±4.4 years (ranging between 1 month and 15 years). There were 117 (90.0%) children who were referred from other centers for either dialysis or surgical treatment. Prerenal cause of AKI was found in 66 (50.8%) children, followed by renal 53 (40.8%) and postrenal in 11 (8.5%) cases. Fever and shortness of breath were the most common clinical presenting symptoms in 102 (78.5%) and 100 (76%) cases, respectively. There were 45 (34.6%) cases who were managed conservatively, 80 (61.5%) needed dialysis, while three children were managed with plasmapheresis and two required surgical intervention in the emergency department. At three-month follow-up period, 64 (49.2%) children recovered (including nine with partial recovery), 46 (36.1%) expired, 9 (6.9%) developed end-stage renal disease, while 11 (8.5%) had chronic kidney disease.Conclusion: Sepsis, nephrotoxic drugs, and acute glomerulonephritis were the major causes of AKI at our center. Mortality was high among children presenting with AKI. A relatively high proportion of children with younger age, septic AKI, and presentation in critical condition could be the reasons for this high mortality.

POS-048 ACUTE KIDNEY INJURY AND RENAL REPLACEMENT THERAPY IN HOSPITALIZED COVID-19 PATIENTS: A CROSS SECTIONAL STUDY FROM IRAN

Acute kidney injury is an important finding in COVID-19 patients that can even result in renal replacement therapy. AKI complicates COVID-19 management by making volume management and administering agents with renal clearance challenging tasks. Various reasons have been proposed for the development of acute kidney injury in COVID-19 patients, including multi-organ failure and pre-renal causes, drug toxicity, tubular injury, and invasion of proximal tube podocytes by SARS-CoV-2. Although the development of AKI is not uncommon in COVID-19 patients, several inconsistencies in the literature exist regarding incidence rate and risk factors of acute kidney injury among hospitalized patients.

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.

Acute kidney injury following adult lung transplantation

Background:Acute kidney injury (AKI) is a common and serious complication following lung transplantation (LTx), and it is associated with high mortality and morbidity. This study assessed the incidence of AKI after LTx and analyzed the associated perioperative factors and clinical outcomes.Methods:This retrospective study included all adult LTx recipients at the China-Japan Friendship Hospital in Beijing between March 2017 and December 2019. The outcomes were AKI incidence, risk factors, mortality, and kidney recovery. Multivariate analysis was performed to identify independent risk factors. Survival analysis was presented using the Kaplan–Meier curves.Results:AKI occurred in 137 of the 191 patients (71.7%), with transient AKI in 43 (22.5%) and persistent AKI in 94 (49.2%). AKI stage 1 occurred in 27/191 (14.1%), stage 2 in 46/191 (24.1%), and stage 3 in 64/191 (33.5%) of the AKI patients. Renal replacement therapy (RRT) was administered to 35/191 (18.3%) of the patients. Male sex, older age, mechanical ventilation (MV), severe hypotension, septic shock, multiple organ dysfunction (MODS), prolonged extracorporeal membrane oxygenation (ECMO), reintubation, and nephrotoxic agents were associated with AKI (P < 0.050). Persistent AKI was independently associated with pre-operative pulmonary hypertension, severe hypotension, post-operative MODS, and nephrotoxic agents. Severe hypotension, septic shock, MODS, reintubation, prolonged MV, and ECMO during or after LTx were related to severe AKI (stage 3) (P < 0.050). Patients with persistent and severe AKI had a significantly longer duration of MV, longer duration in the intensive care unit (ICU), worse downstream kidney function, and reduced survival (P < 0.050).Conclusions:AKI is common after LTx, but the pathogenic mechanism of AKI is complicated, and prerenal causes are important. Persistent and severe AKI were associated with poor short- and long-term kidney function and reduced survival in LTx patients.

Etiological observation of Children with Acute Kidney Injury in a Tertiary Care Hospital

Introduction: Acute Kidney Injury (AKI), formerly known as Acute Renal Failure, is characterized by a reversible increase in creatinine and nitrogenous waste product concentrations in the blood, as well as the kidney's failure to maintain proper fluid and electrolyte balance. Whether the etiology of AKI varies by area, the incidence of AKI in children appears to be increasing. The etiology of AKI in hospitalized children has shifted from primary renal disease to various causes during the last several decades, particularly in hospitalized children. As a result, further study is needed to determine the most recent trends in AKI in this region. Aim of the study: The aim of the study was to observe the etiology and its effect on outcome on children. Methods: This prospective longitudinal study was performed in the Department of Pediatrics, Dhaka Shishu Hospital, Dhaka, during the period of 12 months from January 2015 to December 2015. A total of 50 children were selected from the ones admitted into the hospital following the inclusion and exclusion criteria. A detailed history was taken, thorough physical examination and relevant laboratory investigations were done in all enrolled patients. All underwent necessary supportive care as needed until discharge or death. Result: In the present study, the mean age of the children was 2.8 ± 1.9 years, with the youngest one being 4 days and the oldest, 12.5 years. Male: female ratio was 1.8:1. Children in the age group of 1-5 years were most commonly affected. Pre-renal cause was the most common cause of acute kidney injury, present in 64% of the cases, and diarrheal complication was the most common disease in pre-renal cases. Mean serum creatinine were extremely high with Mean±SD levels of 4.03±2.81 (mg/dL). Conclusion: It was observed that, AKI was more common in early childhood (less than 5 years) than more than 5 years. Pre-renal causes etiology was the most common among the participants, and majority of the pre-renal.......

47-Year-Old Woman With Bilateral Flank Pain

47-Year-Old Woman With Bilateral Flank Pain

Hospital outcome of Children with Acute Kidney Injury in a Tertiary Care Hospital

Introduction: Acute Kidney Injury (AKI), formerly known as Acute Renal Failure, is characterized by a reversible increase in creatinine and nitrogenous waste product concentrations in the blood, as well as the kidney's failure to maintain proper fluid and electrolyte balance. Whether the etiology of AKI varies by area, the incidence of AKI in children appears to be increasing. The etiology of AKI in hospitalized children has shifted from primary renal disease to various causes during the last several decades, particularly in hospitalized children. As a result, further study is needed to determine the most recent trends in AKI in this region. Because it is still connected with significance. Aim of the study: The aim of the study was to observe the hospital outcome of hospitalized acute kidney injury children. Methods: This prospective longitudinal study was performed in the Department of Pediatrics, Dhaka Shishu Hospital, Dhaka, during the period of 12 months from January 2015 to December 2015. A total of 50 children were selected from the ones admitted into the hospital following the inclusion and exclusion criteria. A detailed history was taken, thorough physical examination and relevant laboratory investigations were done in all enrolled patients. All underwent necessary supportive care as needed until discharge or death (p&lt;0.01). Result: The mean age of the children was 2.8 ± 1.9 years, with the youngest one being 4 days and the oldest, 12.5 years. Male: female ratio was 1.8:1. Children in the age group of 1-5 years were most commonly affected. Pre-renal cause was the most common cause of acute kidney injury, present in 64% of the cases. 62% had complete recovery by hospital discharge, and 22% died. The most common cause of death was multi-organ failure and was statistically significant (p&lt;0.01). At 6-month follow up, 4 patients had chronic kidney disease and 2 patients died. Conclusion: It was observed that, AKI was more common in early childhood ..............

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.

MO406ACUTE KIDNEY INJURY AND RENAL REPLACEMENT THERAPY IN HOSPITALIZED PATIENTS: A CROSS SECTIONAL STUDY FROM IRAN

Background and AimsAcute kidney injury is an important finding in COVID-19 patients that can even result in renal replacement therapy. AKI complicates COVID-19 management by making volume management and administering agents with renal clearance challenging tasks. Various reasons have been proposed for the development of acute kidney injury in COVID-19 patients, including multi-organ failure and pre-renal causes, drug toxicity, tubular injury, and invasion of proximal tube podocytes by SARS-CoV-2. Although the development of AKI is not uncommon in COVID-19 patients, several inconsistencies in the literature exist regarding incidence rate and risk factors of acute kidney injury among hospitalized patients. This can be attributed to ethnical variations and methodological differences of studies. Herein we report AKI incidence in hospitalized COVID-19 patients in Baqiyatallah Hospital in Iran and investigate associate factors that can lead to AKI and renal replacement therapy in COVID-19 patients.MethodIn this cross-sectional study, we investigated medical records and laboratory data of hospitalized COVID-19 patients in Baqiyatallah Hospital in Tehran, Iran, from September 2020 until the end of November. COVID-19 infection was confirmed using polymerase chain reaction (PCR), and only patients with Positive PCR for COVID-19 were included. Furthermore, patients with missing data and unknown past medical history were excluded from this study, and a total of 459 patients were selected. The KDIGO criteria for acute kidney injury were used for evaluating kidney injury in COVID-19 patients. ICU admission and dialysis were according to the Ministry of Health and Medical Education on ICU admission and renal replacement therapy in COVID-19 patients.ResultsOf 459 patients with the criteria who were admitted to the hospital (244 male, 213 female, with an average age of 59.57 with SD 14.3), 75 patients (16%) developed acute kidney injury in the course of the disease. The mortality rate in patients with AKI (44%) was significantly higher than other patients (9%). The development of the AKI was significantly associated with the risk of ICU admission and the severe forms of the disease. Furthermore, it was observed that the patients who developed AKI was significantly older and male gender, diabetes (DM), Hypertension (HTN), and Previous history of Chronic kidney disease(CKD) was also significantly associated with developing AKI in COVID-19 patients. Chronic heart failure and ischemic heart disease increased the odds of developing AKI, but it was not significant enough to come up with a conclusion. It was observed that from 75 patients who developed AKI, 22 patients (29%) required renal replacement therapy. Of 22 patients who need dialysis, 14 patients did not survive (mortality rate=63%). The previous history of kidney disease increases the risk of dialysis due to AKI, while no significant association was found between age, gender, DM, HTN, and heart disease with the need for dialysis.ConclusionResults of our study indicate that acute kidney injury can be a major obstacle in managing COVID-19 patients. Patients with older age, previous history of CKD, HTN, and DM should be admitted to the hospital and monitored closely to prevent unfortunate outcomes of this disease.

MO371TIME AND THE ETIOLOGY OF ACUTE KIDNEY INJURY DEFINE PROGNOSIS IN THE COURSE OF COVID-19

Background and AimsKidneys are among the affected organs in COVID-19 and there may be different etiologies resulting in acute kidney injury (AKI) in different stages of the disease. There have been previous studies focusing on incidence and mortality of AKI in COVID-19 but none has made in depth analysis in relation to the background pathophysiology. Based on previous observations, we hypothesized that all AKIs seen in COVID-19 are not uniform and we aimed to analyze the etiologies and prognosis of AKI among hospitalized COVID-19 patients in relation to the time of AKI during different phases of the disease.MethodA total of 1056 patients were admitted to the designated COVID-19 clinics from March to July in 2020. 77 Patients who were younger than 18 years old and 7 kidney transplant patients were excluded from the study. 427 of the remaining patients were confirmed by real time polymerase chain reaction (RT-PCR) test.). As eGFR below 60 mL/min/1,73 m2 was already shown to be related to mortality, these patients (44) were also excluded. As immunologic response is generally accepted to start with the second week of COVID-19 course, patients were classified into three groups, those who had AKI on admission, those who developed AKI in the first week and those who developed AKI starting from 7th day. Initial lymphocyte counts, creatinine levels, electrolytes, acid-base status and changes in the inflammatory markers were compared between the groups. A comparison between patients who survived and who died was also performed.Results89 of the 383 included COVID-19 patients developed AKI. 24% of those who developed AKI died. Patients who developed AKI later had higher peak CRP and D-dimer levels with lower nadir lymphocyte counts (p=0,000, 0,004 and 0,003 respectively). Additionally, patients who died had higher initial inflammatory marker levels and lower lymphocyte counts than those who survived. Mortality of patients who had AKI on hospital admission (13%) was similar to the overall COVID-19 mortality for inpatients, however it was as high as 44% for those who developed AKI after 7th day. Early AKI was related to pre-renal causes and had a milder course. However, later AKIs were more related to immunologic response and had significantly higher mortality. Patients who died had significantly higher ferritin and d-dimer levels upon their hospital admissions (p=0,000). Electrolyte disturbances, metabolic acidosis and mortality were also higher in patients who developed AKI later. Hypernatremia (OR: 6,5, 95% CI: 3 – 13,9) and phosphorus disturbances (both hyperphosphatemia (OR: 3,3; 95%CI: 1,6 – 6,9) and hypophosphatemia (OR: 3,9; 95% CI: 2,0-7,9)) were related to mortality.ConclusionFindings of this study suggest that AKI in COVID-19 is not of one kind. When developed, AKI should be evaluated in conjunction with the disease stage and possible etiologies

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.

Common Risk Factors Responsible for Acute Kidney Injury among Children: Experience at Medical University in Bangladesh

Background: Acute kidney injury can occur among the younger children due to different reasons.&#x0D; Objective: The purpose of the present study was to find out the risk factors and primary disease responsible for acute kidney injury among younger children.&#x0D; Methodology: This cross-sectional study was conducted in the Department of Paediatric Nephrology with the collaboration of Paediatric Gastroenterology, Paediatric Neurology, Paediatric Neonatology and Microbiology and Immunology at Bangabandhu Sheikh Mujib University, Dhaka, Bangladesh from May 2018 to July 2019 for a period of one year. Patients with the age group of 1 month to 17 years who were at risk of AKI, and admitted in the inpatient department of Pediatrics and allied at Bangabandhu Sheikh Mujib University, Dhaka, Bangladesh in both sexes were selected as study population. To detect AKI, serum creatinine was measured at 0 h (baseline), 48 h and 5th day respectively.&#x0D; Result: A total number of 42 patients, who fulfilled the inclusion criteria were enrolled in this study. The risk factors of AKI was mainly pre renal in 60% (n=9) cases, mostly due to nephrotoxic drugs followed by hypovolemia. Renal causes were in 40% (n=6) cases. Among these 50% cases due to amikacin and 50% cases due to use of radiocontrast agent. Most patients were with renal disease which was 30(58%) cases. Among them 28(93.0%) cases were nephrotic syndrome and 2(7.0%) cases were hydronephrosis. However, 7(13%) cases were cardiac disease presented with congenital heart disease who used radiocontrast agent.&#x0D; Conclusion: In conclusion most common risk factors of acute kidney injury among younger children is pre-renal causes which are due to nephrotoxic drugs.&#x0D; Journal of National Institute of Neurosciences Bangladesh, January 2021, Vol. 7, No. 1, pp. 42-46

Ofloxacin Induced Hemolysis in G6PD-deficient Patient: A Rare Cause of Pigment Nephropathy

Thrombotic microangiopathy (TMA) commonly presents as a triad of acute kidney injury (AKI), jaundice, and hemolysis; however, tropical infections such as malaria, dengue, leptospira, and drugs like antimalarials can also have a similar presentation. They can cause AKI for many reasons including pre-renal causes but an important yet not relatively uncommon genetic cause of hemolytic anemia, that is, glucose 6-phosphate deficiency (G6PD) manifesting as jaundice, hemolysis, and AKI secondary to pigment nephropathy after receiving offending drugs needs to be worked up while evaluating such patients. Ofloxacin is not usually included in the lists of unsafe drugs in G6PD deficiency. Herein, we report a patient developing intravascular hemolysis secondary to G6PD deficiency associated with ofloxacin administration presenting as a rare cause for pigment nephropathy.

A prospective, observational study to determine the outcome of patients with acute kidney injury in pediatric intensive care unit

Background: The Spectrum and burden of AKI in developing countries may be different from that of developed countries. Objective: to determine the short-term clinical outcome in children with Acute kidney injury admitted in PICU. Setting: PICU (Pediatric Intensive Care Unit) at Basaveshwar teaching and general hospital and Sangameshwar hospital attached to Mahadevappa Rampure medical college. Result: most common condition associated with AK was sepsis, encephalitis. Pre-renal causes accounted for (54) 78.3% of AKI. In the present study, AKI Stage 1, 2, 3 was diagnosed in 11 (15.9%), 14 (20.3%) and 44(63.8%) of AKI patients. Maximum number of AKI patients were in Stage 3 (p< 0.001). 63.8%. AKI was associated with increased mortality (p

Biomarker evidence for distal tubular damage but cortical sparing in hospitalized diabetic patients with acute kidney injury (AKI) while on SGLT2 inhibitors

Background Inhibitors of sodium-glucose co-transporter-2 (SGLT2i) were found to improve renal outcome in diabetic patients in large prospective randomized trials. Yet, SGLT2i may acutely reduce kidney function through volume depletion, altered glomerular hemodynamics or intensified medullary hypoxia leading to acute tubular injury (ATI). The aim or this study was to prospectively assess the pathophysiology of acute kidney injury (AKI) in patients hospitalized while on SGLT2i, differing ATI from pre-renal causes using renal biomarkers. Methods Serum and urine Neutrophil Gelatinase-Associated Lipocalin (NGAL) and Kidney Ischemia Molecule (KIM)-1, markers of distal and proximal tubular injury, respectively, were determined in 46 diabetic patients who were on SGLT2i upon hospitalization with an acute illness. Results Serum and urine NGAL, but not KIM-1, were significantly increased in 21 of the patients who presented with AKI upon admission, as compared with 25 patients that maintained kidney function. Both serum and urinary NGAL correlated with the degree of impaired renal function, which in many cases was likely the result of additional acute renal perturbations, such as sepsis. Conclusions Increased urinary and serum NGAL indicates that ATI, principally affecting distal tubular segments, may develop in some of the patients hospitalized with an acute illness and AKI while on SGLT2i. It is suggested that intensified medullary hypoxia by SGLT2i might be detrimental in this injury. By contrast, concomitantly unaltered KIM-1 might reflect improved cortical oxygenation by SGLT2i, and may explain an overall reduced risk of AKI with SGLT1i in large series. The independent potential of SGLT2i to inflict medullary hypoxic damage should be explored further.

Overview of acute renal manifestations in cancer patients

Acute kidney injury is frequently encountered in patients with malignancy and is associated with prolonged hospitalization, significant morbidity, and increased mortality. Thorough evaluation is required to identify possible contributing factors, which may range from relatively easily reversible pre-renal causes to complex cancer-specific aetiologies. This review will serve as a practical guide for acute care physicians on the acute medical unit to the assessment and initial management of cancer patients presenting with acute kidney injury.

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.

Pattern of Renal Diseases Among Children Admitted to Assiut University Children Hospital.

Background The pattern of childhood renal diseases is different in developing countries in comparison to developed countries. Pediatric renal disease may be difficult to diagnose early as it may present only with mild symptoms.The aim of this study is to find out the pattern of renal diseases in children admitted at Assuit University Children Hospital over one year duration. Patients and methods This observational study was carried out on children and adolescents with age range from 1 day to 18 years who were admitted Assuit University Children Hospital over a period of one year from November 2016 to October 2017 data collected included symptoms, signs and investigation that aided in patients diagnosis. Results Renal diseases had constituted 1.15% of total number of patients admitted to pediatrics department in this duration. Out of 482 patients 29.7% were diagnosed as acute kidney injury (AKI) due to prerenal cause, 15.1% had glomerulonephritis (GN),14.7% had nephrotic syndrome (NS), 14.1% had congenital anomalies of the kidney and urinary tract(CAKUT), 6.6% had urolithiasis, 5.6% had hemolytic uremic syndrome(HUS), 5% had tubular disorder,4.1% urinary tract infection (UTI) not associated with renal disease, 2.7% had chronic kidney disease(CKD) due to unknown cause and finally diabetic nephropathy (DN)was seen in 2.3% from totally diagnosed patients. The common presenting features were odema , oliguria and hematuria. Conclusion The most common renal disease was acute kidney injury due to prerenal cause.