Presentation Of Acute Kidney Injury Research Articles

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.

Nephrotic Syndrome and Acute Kidney Injury Presenting in an Older Adult with Uncontrolled Diabetes Mellitus Following Recent COVID-19 Infection Case Report

Nephrotic Syndrome and Acute Kidney Injury Presenting in an Older Adult with Uncontrolled Diabetes Mellitus Following Recent COVID-19 Infection Case Report

Clinical Presentation of Acute Kidney Injury in Pediatric; Dr Salma Dialysis Center 2022

BACKGROUND: Unlike in developed countries, where AKI typically develops in older patients with systemic diseases, multiple co-morbidities, and multiorgan failure, AKI in developing countries primarily affects young individuals, particularly children and adolescents, and is often caused by a single factor. Although early detection and management can reduce complications, there is limited data available from Africa on this disease. AIM: This study aims to describe the sociodemographic characteristics and clinical profile of pediatric patients with AKI presenting to Salma Dialysis Center from 2017 to 2021. METHODS: A hospital-based descriptive cross-sectional study was conducted at Salma Dialysis Center in Khartoum, Sudan. Patients' hospital records from January 2017 to December 2021 were reviewed to gather information on clinical presentation, investigations, treatment, and patient outcomes. RESULTS: Out of the 76 patients included in the study, 60.5% were males, with a median age of 8.0 years (range 0.09-17). Approximately 39.5% of the patients were from Khartoum state. The most common presenting symptoms were fever, generalized swelling, and changes in urine colour. The mean blood urea and creatinine levels were 1.6 mg/dl (range 0.2-23.8) and 82.0 mg/dl (range 9-416), respectively. The most common causes of AKI were malaria, sepsis, and sickle cell nephropathy. The majority of patients did not require dialysis and recovered without complications (84.2%). CONCLUSION: Malaria was found to be the most common cause of AKI in pediatric patients, with a higher prevalence among male patients. The prognosis for these patients was generally favourable.

P10 Collapse, confusion and acute kidney injury presenting in the context of bullous skin disease in a young male patient

P10 Collapse, confusion and acute kidney injury presenting in the context of bullous skin disease in a young male patient

Richter Transformation in Chronic Lymphocytic Leukemia with Hypercalcemia and Acute Kidney Injury Presenting as Altered Mental Status: A Case Report

Introduction: Richter’s transformation is a deadly complication of chronic lymphocytic leukemia (CLL) associated with high mortality. This transformation involves the development of an aggressive, diffuse large B cell lymphoma in the setting of a chronic, underlying case of CLL. Although it is rare, Richter’s transformation is important to identify in patients with a history of CLL because of its significant mortality if left untreated. In the setting of CLL, there are many ways in which patients can present if they are currently undergoing a Richter’s transformation. Case Description: Patients may present with symptoms common to CLL which include but are not limited to fatigue, easy bruising, weight loss, etc., or they may present more unusually, as in the case that will be presented here: with altered mental status, fall, hypercalcemia and acute kidney injury (AKI). Discussion: With the current state of affairs due to COVID-19, it is also important to recognize the potential complications of patients with this disease state that are positive for COVID-19, leading to further complications such as disseminated intravascular coagulation (DIC). Recognizing these patients, and directing their care appropriately is important for their disease progression and outlook.

Progressive chronic kidney function decline as a clinical presentation of immune checkpoint inhibitor-associated nephrotoxicity

Background: Immune checkpoint inhibitors (ICIs) have revolutionized cancer treatment. However, ICIs can be limited by inflammatory toxicities referred to as immune related-adverse events (irAEs). Clinical presentation of acute kidney injury (AKI) with corresponding pathological features of acute interstitial nephritis (AIN) is the most common manifestation of kidney irAE. Case discussion: A 74-year-old man with invasive squamous cell carcinoma (SCC) and chronic kidney disease (CKD) developed progressive kidney function decline after initiating treatment with cemiplimab (a programmed death protein 1 inhibitor). Because of the outstanding treatment response, and the fact that the patient had no other irAEs, cemiplimab was continued with close monitoring of kidney function. Over the course of 2 years, his creatinine increased from 2.1 to 3.1 mg/dL. Two years into treatment, he presented to the clinic with nausea, vomiting and diarrhea. He was hospitalized and underwent endoscopic examination that led to the diagnosis ICI-associated enterocolitis. After initiation of high dose glucocorticoids, his serum creatinine rapidly improved to his pre-ICI baseline. Conclusion: ICI-associated nephrotoxicity should be considered as a possible cause of rapidly progressive CKD; clinicians must keep a high suspicion for irAEs even in patients who have been receiving ICIs for over 1 year.

Implementation of a Pharmacist-Driven Vancomycin and Aminoglycoside Dosing Service in a Pediatric Hospital.

Pharmacy-driven antibiotic dosing services have been shown to improve clinical outcomes in adult patients. This study evaluated the effect of a pharmacist-driven antimicrobial dosing service on the percentage of therapeutic serum concentrations achieved following initial vancomycin or aminoglycoside dosing regimens. A secondary objective was to determine the effect of the dosing service on nephrotoxicity in pediatric patients. This single-center, retrospective study used data obtained from an electronic medical record to evaluate the utility of a pharmacist-driven vancomycin or aminoglycoside dosing protocol. Assessments of target, subtherapeutic, and supratherapeutic serum concentrations were evaluated. The occurrence of changes in serum creatinine and presentation of acute kidney injury (AKI) were also determined. The incidence (n [%]) of a therapeutic initial serum concentration was not statistically significant between pre-protocol and post-protocol groups (21 [46.7%] vs 22 [48.9%], respectively; p = 0.834). The incidence of initial supratherapeutic concentrations (19 [42.2%] vs 7 [15.6%]; p = 0.005) and the average number of supratherapeutic concentrations per antibiotic course (0.76 vs 0.26; p = 0.01) were higher in the pre-protocol group compared with the post-protocol group. The incidence of AKI was significantly lower in the post-protocol group (2.2% vs 13.3%; p = 0.049). Implementation of a pharmacist-driven dosing service did not affect the likelihood of achieving an initial therapeutic concentration. However, it did reduce the likelihood of both supratherapeutic concentrations and AKI. Additional studies in pediatric patients are needed to affirm the use of pharmacist dosing services.

Acute kidney injury due to deposition disease

Acute kidney injury presenting without obvious cause is a diagnostic dilemma. One condition to be considered is monoclonal gammopathy. A case of light chain deposition disease was detected as a cause, involving kidney and extra renal site. It is a part of monoclonal immunoglobulin deposition disease, and may or may not be related to multiple myeloma. Delayed diagnosis can lead to end stage kidney disease, requiring long term dialysis, with its vascular access problems, preventing the treatment by autologous stem cell transplant. The case is presented with review of literature.

Unusual presentation of acute kidney injury with Tumour Lysis Syndrome

Tumour lysis syndrome (TLS) can cause acute kidney injury (AKI) by the breakdown of intracellular contents during treatment for malignancies with large tumour burden. We report a case with an unusual presentation of AKI needing renal replacement therapy. Investigation of the cause for AKI led to the diagnosis of an underlying malignancy (lymphoma). Treatment of a Bell’s palsy with steroids before presenting to our service has caused the AKI giving us the overarching diagnosis of TLS in this patient with lymphoma.

Acute Kidney Injury in COVID-19 Pneumonia: A Single-Center Experience in Bahrain.

BackgroundKidney disease accompanying coronavirus disease 2019 (COVID-19) is not well understood, and information about the presentation of acute kidney injury (AKI), its risk factors, and outcomes is scarce, particularly in Bahrain and the Gulf region. In this study, we aimed to determine the rate of AKI among patients hospitalized with COVID-19 pneumonia at a tertiary hospital in Bahrain and to describe the various aspects of AKI in these patients, including its relationship with respiratory failure and in-hospital mortality.MethodsThis retrospective observational cohort study of patients admitted with COVID-19 pneumonia from April 1 to May 31, 2020, excluded those aged less than 18 years, those with end-stage renal disease, and those with renal transplants. Clinical and laboratory patient data were collected. The Kidney Disease: Improving Global Outcomes (KDIGO) criteria were used to define AKI.ResultsThe mean age across the 73 included patients was approximately 54 years; about 60% were men, and nearly 58% were Bahraini nationals. Of the patients, 39.7% (29) developed AKI during hospitalization, out of which 11.0% reached stage 1, 15.1% reached stage 2, and 13.7% reached stage 3. Of all patients, seven (9.6%) required hemodialysis. Chronic kidney disease conferred an increased risk for AKI (P = 0.003) as did critical COVID-19 status (P < 0.001) and the necessity for mechanical ventilation or intensive care admission (P < 0.001 for both). Additionally, AKI was significantly associated with a lower PaO2/FiO2 (partial pressure of arterial oxygen/percentage of inspired oxygen) ratio (P < 0.001) and a greater number of medications for COVID-19 pneumonia (P = 0.003). Finally, in-hospital death tolls were remarkably higher in patients with AKI (P < 0.001). No association was found between AKI and each of the following therapies: angiotensin-converting enzyme inhibitors or angiotensin receptor blockers, tocilizumab, and convalescent plasma.ConclusionsThe rate of AKI in patients hospitalized with COVID-19 pneumonia at our institution is relatively high and is strongly associated with disease severity, respiratory failure, and in-hospital mortality. Awareness of kidney disease in COVID-19 patients is crucial and of vital importance.

P56 A rare case of Sjögren's nephropathy

Abstract Background A presentation of acute kidney injury (AKI) in a patient with a longstanding diagnosis of SLE nephritis was challenged following unexpected renal biopsy and immunology resulting in a diagnosis of primary Sjögren's Syndrome (pSS) related fibrillary glomerulonephritis (FGN). Methods A 62 year old Caucasian female presented with AKI and infected leg ulcer. Previously diagnosed with SLE (1996), anti-phospholipid syndrome and non-biopsy proven lupus nephritis (LN), CKD stage G2/3 she was on Hydroxychloroquine and lifelong anticoagulation. Examination revealed bilateral pitting oedema up to knees and a large non healing skin ulcer to left knee. Investigations showed new anaemia (Hb 75g/dl, MCV 94), lymphopaenia, urea- 25 (9.8), Creatinine- 280 (97), urine protein 6.88g/24 hr. USS KUB, ECHO, CXR, virology screen, PET CT were unremarkable. Immunology studies revealed ANA 1:160, anti-Ro, anti-La, but normal DsDNA and C3, C4. In the light of reported sicca symptoms and serology the diagnosis was revised to pSS. Renal biopsy was initially reported as diffuse lupus nephritis (Class IV) with crescents, and focal weak mesangial IgG and C3 but no glomerular deposits. Electron microscopy (EM) demonstrated abundant mesangial and intramembranous deposits with a fibrillary substructure diagnostic of FGN. Immunosuppression with pulsed intravenous (IV) methylprednisolone and IV Cyclophosphamide were given. She developed acute arterial intercostal bleeding at biopsy site and further significant lower gastrointestinal bleeding unamenable to endoscopic therapy or embolisation and the patient died. Results This case highlights the importance of ensuring that serology is interpreted correctly alongside histopathology and urinalysis in the diagnosis of CTD related renal disease. PSS related nephropathy is seen in less than 10% of patients. Tubulointerstitial nephritis (TIN) accounts for 2/3 of patients and glomerulonephritis (GN), typically membranoproliferative GN (MPGN) for most others. FGN in pSS is very rare, with only 3 reported cases to date. Like lupus nephritis, FGN can present with AKI, hypertension and nephrotic range proteinuria. However, renal biopsy proves invaluable in differentiating between the conditions. In FGN characteristically on biopsy disorganised, non-branching fibrils are seen in all glomerular compartments and are negative for congo red stain further differentiating from amyloid FGN. Immunofluorescence microscopy shows uniform staining of the fibrils for immunoglobulins (mostly subclass IgG4). FGN has a poor prognosis with patients developing severe chronic renal failure despite immunosuppression. Conclusion Considering surprising investigation results, it is crucial we rechallenge the validity of longstanding diagnoses as highlighted by our case. In proven pSS with systemic features we recommend screening all patients for renal disease annually including serum electrolytes, urine dipstick, protein creatinine ratio and pH. If abnormalities are identified, renal US and consideration of biopsy is crucial in establishing aetiology as management and prognosis differs between subtypes. Disclosures C. Amoasii None. R. Benson None. J. Harper None. D. Mewar None.

2295. Streptococcus pneumoniae-Related Hemolytic Uremic Syndrome (pHUS) and the Identification of Matched Cross Country Serotypes by Plasma Next-Generation Sequencing (NGS)

BackgroundHemolytic uremic syndrome (HUS) describes a clinical presentation of acute kidney injury, microangiopathic hemolytic anemia and thrombocytopenia. Five to 15% of HUS cases are related to Streptococcus pneumoniae infection, most often meningitis or pneumonia. Despite the introduction of PCV13 and a decrease in invasive pneumococcal disease in children, the incidence of pneumococcal-related HUS (pHUS) cases is rising for unclear reasons. Efforts to determine whether certain serotypes increase the risk of pHUS are often hampered by negative cultures in patients with suspected pneumococcal disease. Direct microbiologic detection methods, such as next-generation sequencing (NGS), may be useful in identifying pHUS cases. We describe four children with pHUS from two institutions that were identified via NGS of cell-free plasma.MethodsFour patients with HUS and negative initial cultures were identified. Blood was sent to Karius (Redwood City, CA) for pathogen detection via plasma NGS. Cell-free DNA was extracted and NGS performed. Human sequences were removed and remaining sequences were aligned to a curated pathogen database including over 1000 organisms. Organisms present above a predefined statistical threshold were reported. For serotyping by NGS, sequences were aligned to a collection of 90 serotype-associated cps alleles.ResultsAll four patients were found be positive for S. pneumoniae at extremely high levels (Table 1). Three out of four samples were identified as serotype 3 by NGS and similar to the same strain (SPN034183). The fourth sample was consistent with serotype 12A and no strain call was made.ConclusionIn this case series, we report on four patients with pHUS identified via plasma NGS. These cases demonstrate the potential of NGS for pathogen detection and quantitation in plasma to assist in identification of culture-negative infections, as well as the potential to identify clusters of disease that would likely otherwise have gone undetected.Table 1:Karius NGS DataPatientImmunizations Up to DateOrganism IDMPM (Molecules/µL)*Serotype18 Months (CNMC)Y S. pneumoniae 1,957,238311 Months (Rady)Y S. pneumoniae 9,122,698326 Months (Rady)Y S. pneumoniae 151,941,20712A42 Months (Rady)N S. pneumoniae 1,435,7483*Median MPM in non-HUS S. pneumoniae positive samples over the last 90 days was 1202 MPMDisclosures S. Venkatasubrahmanyam, Karius, Inc.: Employee, Salary. D. Hong, Karius, Inc.: Employee, Salary.

Reversible acute kidney injury (AKI) by active removal of serum light chains in an HIV positive patient with myeloma kidney

The association of HIV and myeloma has rarely been reported in the literature. This following case discusses the presentation of acute kidney injury (AKI) in a 53-year-old lady with HIV, subsequently diagnosed with myeloma. Furthermore, we describe recovery of renal function and dialysis independence using a combination of light chain removal by dialysis with a high cut-off dialyzer and chemotherapy. Physical examination, urine, blood tests, renal biopsy, bone marrow aspirate and trephine, US scan. Myeloma. Dialysis and chemotherapy.