WCIM 2014 SEOUL KOREA 173
Poster Session
The Korean Journal of Internal Medicine Vol. 29, No. 5 (Suppl. 1)
PS 0489 Nephrology
Increased Risk of Everolimus-Associated Acute Kidney Injury in Cancer Patients with Impaired Kidney Function
Jung-Ho SHIN1, Sung Hae HA2, Hye Ryoun JANG1, Wooseong HUH1, Ho-Yeong LIM3, Yoon-Goo KIM1, Dae Joong KIM1, Ha Young OH1, Jung Eun LEE1
Samsung Medical Center, Sungkyunkwan University School of Medicine, Korea1, Dongincheon Gil Hos- pital, Gachon University School of Medicine, Korea2, Samsung Medical Center, Sungkyunkwan University School of Medicine, Korea3
Background: Everolimus was recently introduced as a second-line treatment for renal cell carcinoma (RCC) and many other cancers. A few prospective studies have shown that serum creatinine levels are increased in a signifi cant proportion of patients re- ceiving everolimus. We report the incidence, risk factors and clinical signifi cance of AKI associated with everolimus treatment in patients with cancer in the paper.
Methods: We analyzed patients who received everolimus for more than 4 weeks as an anti-cancer therapy. AKI is defi ned as a greater than 1.5-fold increase in creatinine levels from baseline levels.
Results: AKI developed in 21 (23%) RCC patients and none of the patients (N = 17) with other cancers showed AKI. Fourteen out of 21 were considered to be an everoli- mus-associated AKI. The incidence of AKI increased progressively as baseline eGFR decreased (10% in subjects with eGFR >90 mL/min/1.73 m2, 17% in with eGFR 60 – 90 mL/min/1.73 m2, 28% in eGFR 30 – 60 mL/min/1.73m2, and 100% in eGFR 15 – 30 mL/min/1.73 m2, P = 0.029 for trend). Baseline eGFR was an independent risk factor for development of everolimus-associated AKI (Hazard ratio per 10 mL/min/1.73 m2 increases, 0.70; P = 0.047). Nine out of 14 patients with everolimus-associated AKI continued with a reduced dose or after a short-term off period. Four out of 14 discon- tinued the drug because of progression of an underlying malignancy. Only one patient stopped the drug due to AKI.
Conclusions: Our study suggests that AKI was a common adverse effect of everolimus treatment, especially in subjects with impaired renal function. However, AKI occur- rence did not require discontinuation of the drug, and the treatment decision should be made through a multidisciplinary approach including the assessment of oncological benefi ts of everolimus and other therapeutic options.
PS 0490 Nephrology
Impacts of Serial Plasma Neutrophil Gelatinase-Associ- ated Lipocalin Measurement as Biomarker for Diagnosis and Prognosis in Acute Kidney Injury Patients of Emer- gency Room
Byung-Chul SHIN1, Hyun-Lee KIM1, Jong-Hoon CHUNG1 Chosun University Hospital, Korea1
Background: Acute kidney injury (AKI) is a common and serious condition, the di- agnosis of which currently depend on functional markers such as serum creatinine measurement. Neutrophil gelatinase-associated lipocalin (NGAL) appears to be a promising novel biomarker for the early diagnosis of AKI patients and a wide range in its predictive value has been reported. The aim of this study was to evaluate the pre- dictive value of serum NGAL and serial measurement in patients with established AKI in emergency room.
Methods: Serum NGAL was measured in 1293 patient at admission and 24hr after.
Patients were divided four groups; group 1 includes patients with normal renal func- tion, group 2 includes patients with AKIN stage 1, group 3 includes patients with AKIN stage 2, group 4 includes patients with AKIN stage 3. Serum NGAL were measured by ELISA at admission. We studied possible relationship between serum NGAL, estimated glomerular fi ltration rate (eGFR), and staging in patient with AKI.
Results: Serum NGAL levels were signifi cantly higher in AKI patient than in healthy control (452.19 ± 471.57 ng/mL vs. 183.12 ± 259.46 ng/mL, p < 0.001). The serum NGAL level showed a signifi cant inversed correlation with GFR (r=0.164, p=0.018). The discriminatory ability of NGAL for AKI also increased with increasing AKIN stage. (AKIN1 56.0 (52.0-548.0), AKIN2 159.0 (77.5-425.5), AKIN3 503.5 (88.0-1300), p < 0.001).
Conclusions: From this results, we concluded that serum NGAL is a reliable marker of renal function in AKI patient. Serial NGAL measurement has impacts for diagnosis and prognosis, but monitoring protocols are needed for early detection and management of AKI patients.
PS 0491 Nephrology
Congenital Agenesis of the Inferior Vena Cava in a Pre- senting with Acute Renal Failure
Hanife USTA ATMACA1, Feray AKBAS1, Yesim KARAGOZ2, Ebru PEKGUC1, Mustafa BOZ1
Istanbul Training and Research Hospital Department of Internal Medicine, Turkey1, Istanbul Training and Research Hospital Department of Radiology, Turkey2
Introduction: Agenesis of IVC (inferior vena cava) is a rare congenital anomaly which is generally incidentally found in asymptomatic patients. In patients with congenital intra-abdominal venous malformation, extreme care must be taken during radiological or surgical interventions.
Case Report: A 35-year-old male patient was presented with nausea and vomiting following abdominal CT- performed for chronic abdominal pain-, presenting a subse- quent decrease in urine output, and elevation of blood urea and creatinine. The patient had suffered from disseminated varicosities since the age of 15. In physical examina- tion, intense subcutaneous venous collaterals on both lower extremities and abdomen and hepatosplenomegaly were observed. Grade 2 hydronephrosis in the right kidney and grade 4 hydronephrosis with decreased parenchymal thickness in the left kidney were present on renal ultrasonography. CT scan revealed discontinuity of contrast in the left portal vein compatible with portal vein thrombosis. On the left, ureteral continuity was not found. MR venography revealed an abnormally narrow IVC. The diagnosis was established as contrast induced nephropathy and the patient underwent hemodialysis. After 3 sessions, serum urea and creatinine levels, renal functions, and urine excretion returned to normal. The patient was discharged and a follow-up was planned.
Discussion: Recognition of vascular abnormalities is important to prevent related complications. Agenesis of IVC enhances the risk of acute renal failure; regarding decreased renal fi ltration due to insuffi ciency of venous return and the mass effect on ureters, Extreme caution or even total abstinence for contrast media injection is necessary. Surgeons and interventional radiologists should be warned against potential complications.
PS 0492 Nephrology
Clinical Characteristics of Acute Kidney Injury in Pa- tients with Acute Pyelonephritis-Rifl e Criteria Valida- tion
In O SUN1, Hyun Ju YOON1, Jeong Gwan KIM1, Kwang Young LEE1 Presbyterian Medical Center, Korea1
Background: The aim of this study is to investigate the incidence and clinical charac- teristics of acute kidney injury (AKI) based on the RIFLE criteria in acute pyelonephritis.
Methods: From 2007 to 2012, 706 patients were diagnosed with acute pyelonephritis.
Of these, we included 690 patients who were followed up until renal recovery or for at least three months. We evaluated the incidence, clinical characteristics, and severity of AKI based on the RIFLE classifi cation.
Results: Of the 690 patients, 164 had acute pyelonephritis-associated AKI. The inci- dence of AKI was 23.1%; of which, 10.8%, 10.0% and 2.3% were classifi ed as Risk, Injury and Failure, respectively. In comparison with patients in the non-AKI group, the patients in the AKI group were older (65 ± 15 vs 53 ± 18 year, P=0.01) and had low albumin level (3.4 ± 0.6 vs 3.8 ± 0.6 mg/dL, P=0.01). Length of hospital stay, intensive care unit admission rate and proportion of hypertension were higher in patients with AKI than in those without. In the AKI group, 151 patients had AKI prior to admission, and 9 patients experienced AKI during their hospitalization. Multivariate analysis re- vealed that age; male gender; hypertension; complicated type of APN; leukocytosis;
hypoalbuminemia were independent predictors for AKI in patients with acute pyelone- phritis.
Conclusions: The incidence of AKI in patient with acute pyelonephritis is 23.1%. We identifi ed several factors associated with AKI. Recognition of these predictive factors may help reduce the incidence of acute pyelonephritis-associated AKI.
