Prognosis Of Acute Kidney Injury Research Articles

Clinical research of serum CysC combined with APACHEII score in predicting acute kidney injury in patients with sepsis

Objective To investigate the clinical value of serum cystatin C (sCysC) and APACHEⅡ score in predicting diagosis and prognosis of acute kidney injury(AKI) in patients with sepsis. Methods In this study, we prospectively enrolled 138 adult patients with sepsis who had been admitted to the mixed ICU of Xiaolan Hospital of Southern Medical University during March 2015 to January 2016. According to the Kidney Disease Improving Global Outcomes (KDIGO) criterion, the patients were divided into non-AKI group and AKI group (including mild AKI and severe AKI). The receiver operating characteristic(ROC) curve and the area under curve(AUC) were used to evaluate these indexes’ capability of detecting septic AKI and its prognosis. Results In this study,72 patients (52.2%) developed AKI. The levels of sCysC and APACHEⅡ score were significantly higher in AKI than in non-AKI (P<0.05). In total, 33 patients (23.9%) developed severe AKI. The levels of sCysC and APACHEⅡ score were significantly higher in severe AKI than in non-AKI and mild AKI (P<0.05) . Combination of sCysC and APACHEⅡ score predicted AKI and severe AKI after ICU admission with a higher AUC value (0.880&0.930) than each biomarker alone. In this cohort, in-hospital mortality was 19.6% and renal replacement therapy rate was 9.4%,which were strikingly higher in AKI group than non AKI group (P<0.05). Conclusions sCysC is a novel indexes for predicting AKI and its prognosis in patients with sepsis. Combinating with APACHEⅡ score can further improve its predictive performance of AKI detection and short-term prognosis. Key words: Sepsis; Acute kidney injury; Cystatin C; APACHEⅡscore; Diagnosis and prognosis

The effect of cause, timing, kidney function recovery, and recurrent events on the prognosis of acute kidney injury in kidney transplant recipients.

To assess the incidence of acute kidney injury (AKI) and its common etiologies in kidney transplant recipients and the effect of AKI's characteristics on graft survival. In a retrospective longitudinal cohort study, all serum creatinine (SCr) values of patients that had kidney transplantation between 01/2002-12/2010 were retrieved. AKI was defined as a 50% increase in SCr. Etiologies, recurrence, timing, and kidney function dynamics during the event were evaluated. The primary endpoint was defined as graft loss. Time-varying Cox model was used for the analysis. Of 659 patients, 208 (31.6%) patients had 321 documented AKI events. Of these, 138 (66.4%) patients had one event, and 70 (33.6%) patients had recurrent events. The leading etiologies of the first AKI event were as follows: infection (33.4%), hypovolemia (14.3%), and unknown etiology (16.8%). Both first and recurrent AKI events were associated with an increased risk of graft loss (HR: 2.76, 95% CI: 1.95-3.89) and (HR: 4.54, 95% CI: 2.59-7.93), respectively. This deleterious association was lower within three months after transplantation, compared to later events. Patients in whom kidney function returned to baseline were less prone to graft loss. Late-onset, incomplete recovery, and recurrent AKI events are associated with increased graft loss.

Defective Treg response in acute kidney injury was caused by a reduction in TIM-3+ Treg cells

ABSTRACTBackground: Despite years of research, the treatment of acute kidney injury (AKI) remains a significant challenge. Animal studies presented causal links between elevated regulatory T cell (Treg) response and better prognosis in AKI. Previous studies in mice and humans showed that TIM-3+ Treg cells were more potent than TIM-3- Treg cells. In this study, we investigated the role of TIM-3 in Treg in AKI patients.Methods: Peripheral blood from AKI patients and healthy controls were gathered, and TIM-3+ Treg subset was examined.Results: Compared to healthy controls, the AKI patients presented a significant upregulation in the frequency of circulating CD4+CD25+ T cells; however, the majority of this increase was from the CD4+CD25+TIM-3- subset, and the frequency of CD4+CD25+TIM-3+ T cells was downregulated in AKI patients. In both healthy controls and AKI patients, the CD4+CD25+TIM-3+ T cells expressed higher levels of Foxp3, and were more potent at expressing LFA-1, LAG-3, CTLA-4, IL-10 and TGF-β. In addition, the CD4+CD25+TIM-3+ T cells from both healthy controls and AKI patients presented higher capacity to suppress CD4+CD25- T cell proliferation than the CD4+CD25+TIM-3- T cells. Interestingly, the total CD4+CD25+ T cells from AKI patients presented significantly lower inhibitory capacity than those from healthy controls, indicating that the low frequency of CD4+CD25+TIM-3+ T cells was restricting the efficacy of the Treg responses in AKI patients.Conclusions: We demonstrated that TIM-3 downregulation impaired the function of Treg cells in AKI. The therapeutic potential of CD4+CD25+TIM-3+ T cells in AKI should be investigated in future studies.

The use of cell cycle arrest biomarkers in the early detection of acute kidney injury. Is this the new renal troponin?

Acute kidney injury (AKI) has a high prevalence in critical care patients. Early detection might prevent patients from developing chronic kidney disease and requirement for renal replacement therapy. If we compare AKI with acute coronary syndrome, in which an increase in cardiac troponin may trigger early diagnosis and therapeutic intervention, we could extrapolate a similar technique in patients with early AKI without changes in urinary frequency or serum creatinine. The objective is to identify biomarker-positive, creatinine-negative patients that would allow therapeutic interventions to be initiated before finding changes in serum creatinine, preventing kidney damage. Tissue inhibitor of metalloproteinase 2 and insulin-like growth factor binding protein 7 are cell cycle arrest biomarkers that have demonstrated, in recent clinical trials, to have good sensitivity and specificity for early detection of AKI. Other recent studies have shown that the joint use of these biomarkers with serum creatinine and urine production could improve the prognosis of AKI in critical patients. The application of these biomarkers in clinical practice would enable the early identification of patients at risk of AKI, establishing interventions that would improve the survival of renal function.

Autophagy activation in circulating proangiogenic cells aggravates AKI in type I diabetes mellitus.

Acute kidney injury (AKI) occurs frequently in hospitals worldwide, but the therapeutic options are limited. Diabetes mellitus (DM) affects more and more people around the globe. The disease worsens the prognosis of AKI even further. In recent years, cell-based therapies have increasingly been applied in experimental AKI. The aim of the study was to utilize two established autophagy inducers for pharmacological preconditioning of so-called proangiogenic cells (PACs) in PAC treatment of diabetic AKI. Insulin-dependent DM was induced in male C57/Bl6N mice by intraperitoneal injections of streptozotocine. Six weeks later, animals underwent bilateral renal ischemia for 45 min, followed by intravenous injections of either native or zVAD (benzyloxycarbonyl-Val-Ala-Asp-fluoro-methylketone)- or Z-Leu-Leu-Leu-al (MG132)-pretreated syngeneic murine PACs. Mice were analyzed 48 h (short term) and 6 wk (long term) later, respectively. DM worsened postischemic AKI, and PAC preconditioning with zVAD and MG132 resulted in a further decline of excretory kidney function. Injection of native PACs reduced fibrosis in nondiabetic mice, but cell preconditioning promoted interstitial matrix accumulation significantly. Both substances aggravated endothelial-to-mesenchymal transition (EndoMT) under diabetic conditions; these effects occurred either exclusively in the short (zVAD) or in the short and long term (MG132). Preconditioned cells stimulated the autophagocytic flux in intrarenal endothelial cells, and all experimental groups displayed increased endothelial abundances of senescence-associated β-galactosidase, a marker of premature cell senescence. Pharmacological autophagy activation may not serve as an effective strategy for improving PAC competence in diabetic AKI in general. On the contrary, several outcome parameters (excretory function, fibrosis, EndoMT) may even be worsened.

Approach to the Patient with Kidney Disease

Chronic kidney disease (CKD) has diverse presentations that are frequently subclinical early in its course but symptomatic in more advanced stages. Quite commonly, kidney disease is diagnosed as an incidental finding in blood or urine tests. It is therefore crucial to understand how to assess kidney function tests and know the diverse presentations of kidney diseases in clinical practice. Assessment of kidney function mainly comprises three important steps: measuring glomerular filtration rate (GFR), estimation of urine albumin or protein excretion, and urinalysis/sediment examination. Estimating GFR based on a filtration marker (usually serum creatinine) is now widely accepted as the initial test. Several GFR prediction equations that use serum creatinine or other filtration markers along with certain patient characteristics (such as age, gender, and race) are used to estimate GFR, though several limitations must be considered when interpreting their results. Measurement of proteinuria or albuminuria provides insights into etiology (glomerular versus other parenchymal kidney diseases) and an assessment of risk of progression (ie, greater proteinuria, higher risk of progression). A complete examination of urine should be performed in all kidney patients. Urinalysis/sediment examination provides important information for both differential diagnosis of acute kidney disease (AKD) and CKD and clues for underlying etiologies of kidney disease. Several serologic tests and selected imaging studies complement the assessment of kidney diseases. Renal biopsy is occasionally required to specify the exact diagnosis and direct the treatment. All these investigations should be performed to determine the duration of kidney disease (ie, acute or chronic), designate the specific etiology, assess the risk for progression, and evaluate the presence of complications. Recently, several risk stratification scores or prediction models were developed for early diagnosis or predicting prognosis of acute kidney injury or CKD. These risk models may help to decrease the huge burden of kidney diseases on the individual as well as social level. This review contains 1 figure, 11 tables and 29 references Key Words: albumin-creatinine ratio, albuminuria, biomarkers, eGFR, chronic kidney disease, cystatin C, history, imaging, glomerular filtration rate , physical examination, renal biopsy, serum creatinine, urinalysis

The use of cell cycle arrest biomarkers in the early detection of acute kidney injury. Is this the new renal troponin?

Acute kidney injury (AKI) has a high prevalence in critical care patients. Early detection might prevent patients from developing chronic kidney disease and requirement for renal replacement therapy. If we compare AKI with acute coronary syndrome, in which an increase in cardiac troponin may trigger early diagnosis and therapeutic intervention, we could extrapolate a similar technique in patients with early AKI without changes in urinary frequency or serum creatinine. The objective is to identify biomarker-positive, creatinine-negative patients that would allow therapeutic interventions to be initiated before finding changes in serum creatinine, preventing kidney damage. Tissue inhibitor of metalloproteinase 2 and insulin-like growth factor binding protein 7 are cell cycle arrest biomarkers that have demonstrated, in recent clinical trials, to have good sensitivity and specificity for early detection of AKI. Other recent studies have shown that the joint use of these biomarkers with serum creatinine and urine production could improve the prognosis of AKI in critical patients. The application of these biomarkers in clinical practice would enable the early identification of patients at risk of AKI, establishing interventions that would improve the survival of renal function.

Assessment of Renal Damage in Patients with Multi-Drug Resistant Strains of Pneumonia Treated with Colistin

Background: Treatment of multi-drug-resistant strains of pneumonia with common antibiotics in renal patients is ineffective and physicians are compelled to use Colistin for such cases. Objectives: This study was conducted to assess the mortality, length of stay, and renal damages in the treatment of multi-drugresistant pneumonia with Colistin among multiple trauma patients admitted to the emergency department and transferred to the ICU. Methods: This retrospective cohort study was conducted between 2011 and 2016. 102 multiple trauma (MT) patients with multidrug-resistant strains of hospital-acquired pneumonia (HAP) admitted to the emergency department then transferred to the ICU were assessed. All patients received Colistin according to their weight. Renal damage was evaluated according to the RIFLE criteria. The mortality and the length of stay were assessed. In order to statistically analyze the data, SPSS version 23 software was used to conduct t-test and chi-square test. Results: Out of 102 patients, 55 (54%) died and 50 (49.1%) developed acute renal failure; 64 cases had no hypertension. Patients according to the RIFLE index were assessed: Risk (11.01%), Injury (14%), Failure (18%), Loss (6%), and End-stage renal disease. The prevalence and prognosis of acute kidney injury in multiple trauma patients treated with Colistin were significantly correlated with drug dosage, body mass index, and use of corticosteroids (when assessed using relevant scoring systems, P < 0.05). Conclusions: The use of a scoring system in the intensive care unit, determining those patients requiring Colistin, and adjusting the dosage of this drug for treatment of MT patients with multi-drug resistant strains of HAP are vital. Creatinine levels must be carefully monitored.

Preoperative dipstick albuminuria and other urine abnormalities predict acute kidney injury and patient outcomes

BackgroundIt is unclear whether pathologic findings on preoperative urinalysis are associated with the risk of postoperative acute kidney injury (AKI). Therefore, we performed a retrospective review to investigate this association. MethodsWe assessed the clinical significance of preoperative dipstick urinalysis in a 10-year surgery cohort from a tertiary hospital in Korea. Patients without available information on perioperative serum creatinine levels or kidney injury prior to surgery were excluded. Preoperative dipstick urinalysis parameters, including albuminuria, hematuria, pyuria, and others were studied. The primary outcome was postoperative acute kidney injury. Secondary outcomes were postoperative 1-year mortality and progression of poor kidney function parameters. ResultsWe enrolled 40,090 patients. The presence of dipstick albuminuria was associated with an increased risk of postoperative AKI (adjusted odds ratio 1.47 [1.29–1.66], P < .001), and the association showed a dose-response relationship. High specific gravity was significantly associated with increased risk of AKI (adjusted odds ratio 1.30 [1.04–1.63], P = .02). Furthermore, in patients with postoperative AKI, those with baseline albuminuria had a worse prognosis with regard to 1-year mortality (adjusted hazard ratio 2.81 [1.56–5.09], P < .001) and persistent renal function impairment (adjusted odds ratio 2.07 [1.21–3.46], P = .007), independent of estimated glomerular filtration rate values. Patients with baseline hematuria and pyuria also had an inferior postoperative AKI prognosis when compared to those without the urinalysis abnormalities. ConclusionBaseline dipstick urinalysis may predict postoperative AKI and may be significantly associated with prognosis after surgery. (Surgery 2017;160:XXX-XXX.)

New Molecular and Epigenetic Expressions as Novel Biomarkers in Critically Ill Polytrauma Patients with Acute Kidney Injury (AKI).

A high percentage of the critically ill polytrauma patients develop acute kidney injury (AKI) secondary to trauma and are therefore prone to high morbidity and mortality rates. One of the main objectives in these cases is the fast detection of the condition and continuous rigorous monitoring of the patients. Currently the panel of biomarkers available for monitoring and for the prognosis of AKI is limited. Numerous studies have proven the importance of microRNAs in this field. In this actualization paper we wish to summarize the most relevant microRNAs that can be used as biomarkers for patients with AKI. For this paper, we looked into the studies available in scientific databases such as PubMed and Scopus. For the analysis we used the following key words: "miRNAs biomarker", "acute kidney injury AKI", "genetic expression in AKI", and "epigenetic microRNAs biomarkers in AKI". Numerous studies have shown high specificity for certain microRNA species in the case of patients with AKI. Moreover, they have reported a series of microRNAs that present high specificity and that have a strong expression in fluids that can be sampled through non-invasive methods, such as urine and saliva. The expression of microRNAs can be successfully used in the future as a non-invasive method for the evaluation and monitoring of AKI patients.

Incidence, characteristics and prognosis of acute kidney injury in Cameroon: a prospective study at the Douala General Hospital

Objective: There are limited data on AKI in sub-Saharan Africa. We aim to determine the incidence, characteristics and prognosis of AKI in Cameroon. Patients and methods: A prospective study including all consenting acute admissions in the internal medicine and the ICU of a tertiary referral hospital in Cameroon from January 2015 to June 2016. Serum creatinine assay was done on admission, days 2 and 7 to diagnose AKI. For patients with AKI, serum creatinine was done on discharge, days 30, 60 and 90. AKI was defined according to the modified KDIGO 2012 criteria as an increase or decrease in serum creatinine of 3 mg/l or greater, or an increase of 50% or more from the reference value obtained at admission or the known baseline value. AKI severity was graded using KDIGO2012 criteria. Outcome measures were renal recovery, mortality and causes of death. Renal recovery was complete if serum creatinine between the first 90 days was less than baseline or reference, partial if less than diagnosis but not baseline or reference, no-recovery if creatinine did not decrease or if the patient remained on dialysis. Results: Of the 2402 patients included, 536 developed AKI giving a global incidence of 22.3% and annual incidence of 15 per 100 patients-years. Of the 536 patients with AKI, 43.3% were at stage 3, 54.7% were males, median age was 56 years. Pre-renal AKI (61.4%) and acute tubular necrosis (28.9%) were the most frequent forms. Main etiologies were sepsis (50.4%) and volume depletion (31.6%). Renal outcome was unknown in 34% of patients. Of the 354 patients with known renal function at 3 months, 84.2% recovered completely, 14.7% partially and 1.1% progressed to CKD. Global mortality rate was 36.9% mainly due to sepsis. Conclusions: AKI is frequent in our setting, mainly due to sepsis and hypovolemia. It carries a poor prognosis.

Risk, Predictors, and Outcomes of Acute Kidney Injury in Patients Admitted to Intensive Care Units in Egypt

Epidemiology of acute kidney injury (AKI) in developing countries is under-studied. We evaluated the risk and prognosis of AKI in patients admitted to intensive care units (ICUs) in Egypt. We recruited consecutive adults admitted to ICUs in Alexandria Teaching Hospitals over six months. We used the KDIGO criteria for AKI. We followed participants until the earliest of ICU discharge, death, day 30 from entry or study end. Of the 532 participants (median age 45 (Interquartile range [IQR]: 30–62) years, 41.7% male, 23.7% diabetics), 39.6% had AKI at ICU admission and 37.4% developed AKI after 24 hours of ICU admission. Previous need of diuretics, sepsis and low education were associated with AKI at ICU admission; APACHE II score independently predicted AKI after ICU admission. A total of 120 (22.6%) patients died during 30-day follow-up. Compared to patients who remained AKI-free, mortality was significantly higher in patients who had AKI at study entry (Hazard Ratio [HR] 2.14; 95% Confidence Interval [CI] 1.02–4.48) or developed AKI in ICU (HR 2.74; 95% CI 1.45–5.17). The risk of AKI is high in critically ill people and predicts poor outcomes. Further studies are needed to estimate the burden of AKI among patients before ICU admission.

Effect of post-nephrectomy acute kidney injury on renal outcome: a retrospective long-term study.

The effects on renal prognosis of acute kidney injury after elective unilateral nephrectomy are ill-defined. We evaluated as whether post-operative acute kidney injury modifies renal outcome over the long term. This is a retrospective study examining all consecutive adult patients referred to three Nephrology Units and that had previously undergone elective unilateral nephrectomy. We evaluated the association of post-nephrectomy acute kidney injury with the combined renal outcome of chronic dialysis requirement, ≥40% decline in glomerular filtration rate or new-onset severe proteinuria (>500mg/24h). Clinical correlates of acute kidney injury and renal outcome were also examined. 106 patients were enrolled. 52 patients had post-operative acute kidney injury with a median increment of serum creatinine of 0.67 [0.48-0.86]mg/dl; in these patients, serum creatinine and urea increased from the first day post-nephrectomy while contraction of urinary output was found in 7 patients. Older age [OR: 1.72; 95% CI 1.05-2.82; P=0.030] associated with post-operative acute kidney injury. Over a median follow-up of 8.9 [95% CI 3.1-24.2]years, the combined renal outcome occurred, respectively, in 28 (53.8%) and 14 (25.9%) patients with and without acute kidney injury (P=0.003). Logistic regression analysis showed that acute kidney injury (OR: 3.22; 95% CI 1.35-7.66; P=0.008) and male gender (OR: 2.72; 95% CI 1.08-6.85; P=0.034) were associated with poor renal outcome after adjustment for main comorbidities. In our population of referred patients, acute kidney injury after unilateral nephrectomy was common and associated with progressive chronic kidney disease, especially in older males.

Epidemiology and Management of Acute Kidney Injury in Hepatocellular Carcinoma Patients Undergoing Transcatheter Arterial Chemoembolization.

Transcatheter arterial chemoembolization (TACE) is an effective therapy for hepatocellular carcinoma (HCC). However, acute kidney injury (AKI) may occur after TACE due to the contrast agent and cytotoxic anticancer drugs used in this procedure. Post-TACE AKI is not an unusual event, and may adversely affect patient outcome. Coexisting situations including cirrhosis, renal insufficiency, diabetes and hypertension play a role in the development of HCC, and may predispose patients to AKI after TACE. Most post-TACE are transient and reversible, while prolonged AKI may predict a decreased survival. The best strategy to manage post-TACE AKI is prevention. Patients, before undergoing TACE, should be carefully assessed. In this study, we reviewed the current literature published in English about the incidence rate, risk factors, management and prognosis of AKI in patients with HCC undergoing TACE for a better understanding of this complication.

Study of causes and prognosis of acute kidney injury (AKI) in tertiary care institute

Background: Acute kidney injury (AKI) is a common clinical syndrome with a broad aetiological profile. It is associated with major morbidity and significant mortality. This study is to determine the various causes of AKI, in our hospital and to find out the incidence of AKI by using renal failure indices and to analyze outcome of AKI pertaining to the aetiology.Methods: Study is conducted on 100 AKI patients on haemodialysis admitted in various medical wards of the Mc Gann Hospital attached to Shimoga institute of medical sciences, Shimoga. From January 1st, 2017 to June 30th, 2017 detailed history was taken in all the patients and a through physical examination was done. Baseline and peak levels of serum Creatinine, urine output was documented. Data regarding laboratory investigations were collected to confirm the etiology of AKI.Results: There were 65 males and 35 females. The highest number of cases are in age group 51 to 60 year (32%). Average age is 56±5.6 years. Fever, nausea and oliguria are the most common clinical features seen 66,66 and 64 percentage respectively, followed by edema (23%) and loses tools (17%). Blood urea (&gt;100), serum Creatinine (&gt;4) in 44% and 46% respectively. Hb &lt;10 gm/dl in 54%. WBC count &gt;12000 in 65%. Sepsis and gastroenteritis are leading medical causes 25% and 12% respectively. Surgical causes are 14% and obstetrics causes are 11%.Conclusions: AKI remains a common disorder among critically ill patients Consistent with other studies from developing world; this study has also shown that infections, nephrotoxins and gastroenteritis are the primary causes of AKI at our institute. Most of these causes can be prevented with simple interventions such as health education on oral rehydration, quality prenatal and emergency obstetric care, appropriate management of infections and taking appropriate precautions when prescribing potentially nephrotoxic medications.

Epidemiology of AKI: Utilizing Large Databases to Determine the Burden of AKI.

Large observational databases linking kidney function and other routine patient health data are increasingly being used to study acute kidney injury (AKI). Routine health care data show an apparent rise in the incidence of population AKI and an increase in acute dialysis. Studies also report an excess in mortality and adverse renal outcomes after AKI, although with variation depending on AKI severity, baseline, definition of renal recovery, and the time point during follow-up. However, differences in data capture, AKI awareness, monitoring, recognition, and clinical practice make comparisons between health care settings and periods difficult. In this review, we describe the growing role of large databases in determining the incidence and prognosis of AKI and evaluating initiatives to improve the quality of care in AKI. Using examples, we illustrate this use of routinely collected health data and discuss the strengths, limitations, and implications for researchers and clinicians.

Clinical value of urine albumin/creatinine ratio in predicting diagnosis and prognosis of actue kidney injury in critically ill patients

Objective To explore the clinical value of urine albumin/creatinine ratio(UACR)in predicting diagnosis and prognosis of acute kidney injury (AKI) in adult critically ill patients. Methods A total of 527 adult critically ill patients admitted to the adult mixed ICU of three hospitals in Guangdong Province were prospectively enrolled from October 2014 to May 2015. According to the Kidney Disease Improving Global Outcomes(KDIGO)criterion, the patients were divided into non-AKI group and AKI group (including mild AKI and severe AKI). The biomarker's capability of detecting AKI and its prognosis were evaluated by using the receiver operating characteristic curve(ROC) and the area under curve(AUC). A P<0.05 was considered to indicate statistical significance. Results There were 148 AKI patients (28.1%). The level of UACR was significantly higher in AKI than that in non-AKI (P<0.05). In total, there were 54 patients(10.2%)developed into severe AKI.The level of UACR was significantly higher in severe AKI than that in non-AKI and mild AKI (P<0.05). The AUC of UACR predicted AKI and severe AKI after ICU admission were 0.706 and 0.748, respectively with moderate predictive capability. The AUC of UACR for established AKI, later-onset AKI and AKI progression were 0.702, 0.675, 0.649, respectively. AUC of UACR for required dialysis, in-ICU mortality and in-hospital mortality prediction were 0.851, 0.781, 0.748, respectively. Conclusions UACR has capability in predict diagnosis and prognosis of AKI in adult critically ill patients, and it is the biomarker for early diagnosis and prognosis evaluation of AKI. Key words: Urine albumin/creatinine ratio; Critical patients; Acute kidney injury; Diagnosis; Prognosis

Renal Support for Acute Kidney Injury in the Developing World

There is wide variation in the management of acute kidney injury (AKI) and the practice of renal replacement therapy (RRT) around the world. Clinicians in developing countries face additional challenges due to limited resources, reduced availability of trained staff and equipment, cultural and socioeconomic aspects, and administrative and governmental barriers. In this article, we report the consensus recommendations from the 18th Acute Dialysis Quality Initiative conference in Hyderabad, India. We provide the minimal requirements for provision of acute RRT in developing countries, including patient selection, choice of RRT modality and monitoring, transition, and termination of acute RRT. We also discuss areas of uncertainty and propose themes for future research. These recommendations can serve as a foundation for clinicians to implement renal support for AKI in low resource settings.

Acute kidney injury in patients with pulmonary embolism: A population-based cohort study.

Acute kidney injury (AKI) is overlooked in patients with pulmonary embolism (PE). Risk factors for and long-term outcomes of this complication remain unknown. This study evaluated the predictors and prognosis of AKI in patients with PE.This retrospective cohort study used Taiwan's National Health Insurance Research Database. We enrolled a total of 7588 patients who were admitted to a hospital for PE from January1997 to December 2011 and administered anticoagulation or thrombolytic agents. All demographic data, risk factors, and outcomes were analyzed.AKI was diagnosed in 372 (4.9%) patients. Multivariate logistic regression analysis revealed pre-existing chronic kidney disease, hypertension, diabetes mellitus, massive PE, anemia, and sepsis as independent risk factors for AKI. In the long-term follow-up, the survival rate was similar in the AKI and non-AKI groups.Careful risk factor screening and intensive intervention in patients with AKI might yield outcomes similar to those in patients without AKI.

Incidence, risk factors and clinical outcomes of acute kidney injury associated with scrub typhus: a retrospective study of 510 consecutive patients in South Korea (2001–2013)

ObjectivesRenal involvement in scrub typhus ranges from simple urinary abnormalities to acute kidney injury (AKI) leading to death. This study evaluated the incidence, predictors and prognosis of AKI associated with...