상단 PDF Acute Kidney Injury in In-patient undergoing Enhanced CT

Acute Kidney Injury in In-patient undergoing Enhanced CT

Acute Kidney Injury in In-patient undergoing Enhanced CT

Ascorbic acid prevents contrast- mediated nephropathy in patients with renal dysfunction undergoing coronary angiography or intervention.. Tepel M, van der Giet M, Schwarzfel[r]

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Target value of mean arterial pressure in patients undergoing continuous renal replacement therapy due to acute kidney injury

Target value of mean arterial pressure in patients undergoing continuous renal replacement therapy due to acute kidney injury

Although the present study had strengths, such as a large number of CRRT patients from multi-centers, there were certain limitations to be discussed. The study could not determine causality between MAP and mortal- ity because of the nature of its retrospective design. The important confounders, such as heart function, cause of AKI, severity of AKI at the time of CRRT initiation, and the detailed information of CRRT prescription, were not considered in the analyses. These unidentified factors may have interacted with the preset relationships. The study results were not validated in an independent co- hort. The cause of death could not be obtained in the present dataset.
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Phosphate is a potential biomarker of disease severity and predicts adverse outcomes in acute kidney injury patients undergoing continuous renal replacement therapy

Phosphate is a potential biomarker of disease severity and predicts adverse outcomes in acute kidney injury patients undergoing continuous renal replacement therapy

Disturbances in electrolyte and mineral homeostasis commonly occur in patients in the ICU. These are also frequently found even in patients receiving RRT.[10] However, whether abnormalities of electrolytes and minerals are associated with disease severity is not known. We clearly showed that phosphate level significantly correlates with various clinical parameters related to disease severity. Interestingly, besides SOFA and APACHE II scores, high serum phosphate also highly associates with low blood pressure, decreased kidney function, low UO, and high acidosis level. All these parameters represent the degree of illness in the critically ill condition. In contrast, this association was not observed or weak for other electrolytes and minerals such as sodium, potassium, and calcium. Although phosphate is well cleared by dialy- sis therapy, we found that residual hyperphosphatemia remained in a substantial portion of patients at 24 h after CRRT. We further demonstrated that this residual hyperphosphatemia also associates with the SOFA and APACHE II scores when the phosphate level at 24 h was used in the analysis. Taken together, these findings suggest that phosphate deserves attention and can be used as a potential marker of disease severity.
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Amlodipine intoxication complicated by acute kidney injury and rhabdomyolysis

Amlodipine intoxication complicated by acute kidney injury and rhabdomyolysis

Her laboratory tests showed a serum creatinine level of 2.5 mg/dL, with elevated serum creatine phosphoki- nase and myoglobin. The patient was initially treated with fluids, alkali, calcium gluconate, glucagon, and vasopressors without a hemodynamic effect. High-dose insulin therapy was also started with a bolus injection of regular insulin (RI), followed by continuous infusion of RI and 50% dextrose with water. Despite intensive treatment including insulin therapy, inotropics, mechanical ventilation, and continuous venovenous hemodia- filtration, the patient died of refractory shock and cardiac arrest with no signs of renal recovery 116 hours after her hospital admission.
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Severe acute kidney injury in COVID-19 patients is associated with in-hospital mortality

Severe acute kidney injury in COVID-19 patients is associated with in-hospital mortality

relatively large number of patients with moderate to critical symptoms in the present study, this was a retrospective cohort study performed in two centers in Korea. Thus, we could not generalize our findings to all COVID-19 patients. In conclusion, the present study demonstrated that the incidence of AKI in patients with COVID-19 was 4.0%. Kidney involvement was associated with poor prognosis, including admission to ICU, administration of MV, and in-hospital mortality. Additionally, severe AKI was an independent risk factor for in-hospital mortality. In the management of patients with COVID-19, regular monitoring of kidney function should be emphasized, and clinicians must pay attention to AKI. Early detection of AKI and prompt intervention may improve patient outcomes in COVID-19.
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Autoimmune thyroiditis with minimal change disease presenting acute kidney injury

Autoimmune thyroiditis with minimal change disease presenting acute kidney injury

The case of minimal-change disease associated with thyroiditis presenting acute kidney injury is a rare dis- ease that has not been reported in South Korea. Reported herein is the case of a 16-year-old man diagnosed with Hashimoto’s thyroiditis, with minimal-change disease presenting acute kidney injury. He revealed hypo- thyroidism, proteinuria, and impaired renal function. Renal biopsy showed minimal-change disease and mini- mal tubular atrophy. The patient was treated with thyroid hormone, and his renal function and proteinuria improved. Therefore, for patients with autoimmune thyroiditis presenting unexplained proteinuria, glomer- ulonephropathy should be ruled out. Conversely, for patients with glomerulonephropathy and persistent protei- nuria despite proper treatment, thyroid function and antibody tests should be performed.
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Recent changes and clinical characteristics of acute hepatitis A complicated by acute kidney injury

Recent changes and clinical characteristics of acute hepatitis A complicated by acute kidney injury

5 II. MATERIALS AND METHODS 1. Patient selection Patients diagnosed with AHA at Severance Hospital and Gangnam Severance Hospital from January 2006 to December 2009 were enrolled. The diagnosis was based on the clinical symptoms and signs and confirmed by the presence of anti-HAV-IgM antibodies. Demographic and serologic data, urinalysis, history including alcohol consumption, and days in hospital were analyzed retrospectively. Exclusion criteria were chronic renal failure, liver cirrhosis, and other renal disease. AKI was defined as an increase in the serum creatinine concentration of >0.5 mg/dl or 50% compared with the baseline value 9 . In AKI group, hepatorenal syndrome was ruled out through urine test (Hepatorenal syndrome shows urine red cell excretion of less than 50 cells per high power field and protein excretion less than 500mg/day). The definition of a heavy alcoholic was an alcohol consumption >45 g/day. Smoking was defined as current smokers who smoke at least 10 cigarettes a day.
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The impact of disease severity on paradoxical association between body mass index and mortality in patients with acute kidney injury undergoing continuous renal replacement therapy

The impact of disease severity on paradoxical association between body mass index and mortality in patients with acute kidney injury undergoing continuous renal replacement therapy

cut-off point for obesity in this study is lower than that in other Western countries and thus our findings may not be extrapolated to such extremely obese patients. Further studies with large number of obese patients should focus on this issue. Fourth, our database did not have much in- formation on nutritional indices, thus nutritional status could not be thoroughly evaluated. However, all nutri- tional supports including whether or not to start enteral or parenteral nutrition were precisely decided by dietitians and intensivists upon ICU admission in our centers. Fi- nally, CRRT prescription was different across BMI and disease severity groups. Patients with high BMI tended to have less amount of dialysis, and this tendency was per- sistent in both disease severity groups (data not shown).
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The impact of disease severity on paradoxical association between body mass index and mortality in patients with acute kidney injury undergoing continuous renal replacement therapy

The impact of disease severity on paradoxical association between body mass index and mortality in patients with acute kidney injury undergoing continuous renal replacement therapy

cut-off point for obesity in this study is lower than that in other Western countries and thus our findings may not be extrapolated to such extremely obese patients. Further studies with large number of obese patients should focus on this issue. Fourth, our database did not have much in- formation on nutritional indices, thus nutritional status could not be thoroughly evaluated. However, all nutri- tional supports including whether or not to start enteral or parenteral nutrition were precisely decided by dietitians and intensivists upon ICU admission in our centers. Fi- nally, CRRT prescription was different across BMI and disease severity groups. Patients with high BMI tended to have less amount of dialysis, and this tendency was per- sistent in both disease severity groups (data not shown).
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The effect of specialized continuous renal replacement therapy team in acute kidney injury patients treatment

The effect of specialized continuous renal replacement therapy team in acute kidney injury patients treatment

However, the gap of the periods was less than 6 month, the same ICU policy was applied to patients at a single center, and the patients in this study experienced no differences in decision-making process because of same nephrologist and ICU specialists. Moreover, there were no remarkable differ- ences in indications for CRRT, filter types, anticoagulation types and management between the two groups. Further- more, as shown in Table 3, there were no significant differ- ences in the baseline characteristics between the two groups, except for estimated glomerular filtration rate level. There- fore, the bias caused by the different time may be negligi- ble. However, in regard with ICU clinical care practices, there would be differences between two groups, because of adding CRRT nurses and separating general care from CRRT related tasks. This was important change in SCT management which could have influences on clinical out- comes. Third, because there are diversities in physician fac- tors, critical care programs, patient to nurse ratios and ICU systems, depending on centers, we are not certain whether identical result would be found in all other centers. Never- theless, a major strength of this study is that it is based on a relatively large number of patients requiring CRRT.
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The prognostic value of volume status assessment by bioelectrical impedance analysis and lung ultrasound on mortality in septic acute kidney injury patients undergoing continuous renal replacement therapy

The prognostic value of volume status assessment by bioelectrical impedance analysis and lung ultrasound on mortality in septic acute kidney injury patients undergoing continuous renal replacement therapy

As for the number of B-lines in lung US, it did not predict 28-day mortality with statistical significance in present study group. Since lung US was introduced, there have been many efforts to assess volume status in various patient groups. Though a few studies were performed on lung US for volume assessment, they dealt mainly with patients with chronic kidney disease undergoing intermittent hemodialysis. However, those studies verified usefulness of lung US only for prediction of pulmonary congestion and fail to verify predictive power of hemodynamic congestions such as pulmonary artery occlusion pressure. 19 Potential use of lung US in the management of acute circulatory failure such as septic AKI seems yet to be examined. 20 This study did not verify that the number of B-lines affect 28-day mortality. Meanwhile, other recent study also concluded the impact of integrated cardiopulmonary sonography including lung US on prognoses requires further study. 21 That is, the role of lung US in critically ill patients such as patients with septic AKI is not clearly identified.
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Kidney transplantation using expanded criteria deceased donors with terminal acute kidney injury: a single center experience in Korea

Kidney transplantation using expanded criteria deceased donors with terminal acute kidney injury: a single center experience in Korea

We investigated the clinical outcomes of KT from deceased donors with AKI. AKI was defined using the AKIN criteria and ECD classification. The incidence of DGF was higher in the AKI groups than it was in the non-AKI groups. The graft function (MDRD GFR levels) among the 4 groups was significantly different for up to 2 years posttransplantation. After 3 years (and persisting until at least 5 years after KT), the MDRD GFR levels did not differ significantly among the groups. In group IV, the graft function may be affected by both AKI and ECD. It seems that after completion of the repair process, preexisting AKI did not affect the long-term outcome of the allograft kidney [11]. In this study, we found that there was no significant difference in graft survival or patient survival among the 4 groups. According to our past report, ECD may have less of an effect on graft survival and patient survival than previously thought in spite of the incidence of DGF was higher than SCD. There are 2 possible reasons for this result. One is the short cold ischemic time (mean, 4.05 ± 2.18 hours), and the other is the ethnic homogeneity of Koreans [27]. However, the long-term allograft survival rate was significantly lower in group IV compared than it was in the other groups. We can assumed that this subgroup analysis showed a statistically significance because of the negative synergic effect from ECD and AKI groups. Therefore, KT from ECD kidneys with terminal AKI must be carefully considered.
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Impact of acute kidney injury in expanded criteria deceased donors on post-transplant clinical outcomes: multicenter cohort study

Impact of acute kidney injury in expanded criteria deceased donors on post-transplant clinical outcomes: multicenter cohort study

Statistical analysis Student’s t-test was used for the analysis of continuous var- iables with a normal distribution, and those were expressed as the mean ± standard deviation. On the con- trary, the Mann-Whitney test was used for the analysis of those with a non-normal distribution. The Chi-square test or Fisher’s exact test was used to analyze categorical vari- ables, and those were expressed as the number and per- centage. Kaplan-Meier curves and log-rank tests were used for the description of the death-censored graft sur- vival and patient survival. Logistic regression analysis was used to investigate whether AKI in DDs or ECD is an in- dependent risk factor for the development of DGF and re- cipient age, transplant year (1996~2005 vs. 2006~2010 vs.
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Acute decompensated heart failure and acute kidney injury due to bilateral renal artery stenosis

Acute decompensated heart failure and acute kidney injury due to bilateral renal artery stenosis

Department of Internal Medicine, Daegu Fatima Hospital, Daegu, Korea Atherosclerotic renal artery stenosis (RAS) may result in hypertension, azotemia, and acute pulmonary edema. We report on a renal angioplasty with stent placement for bilateral RAS in a patient with acute decom- pensated heart failure and acute kidney injury. A 67-year-old female patient was admitted to our hospital with acute shortness of breath and generalized edema. Echocardiography showed left ventricular wall motion abnormality and the follow up electrocardiography showed T wave inversion in the precordial leads. We performed a coronary angiography to differentiate ischemic heart disease from non-cardiac origin for the cause of the heart failure. The coronary angiography showed no significant luminal narrowing, but bilateral RAS was confirmed on the renal artery angiography, therefore, we performed renal artery revascularization.
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Impact of acute kidney injury in elderly versus young deceased donors on post-transplant outcomes: A multicenter cohort study

Impact of acute kidney injury in elderly versus young deceased donors on post-transplant outcomes: A multicenter cohort study

The primary outcome of this study was to investigate death-censored allograft survival rate of KTRs by young-DDs or elderly-DDs with AKI. Death-censored allograft survival was compared between the non-AKI-DDKT and AKI-DDKT groups with KT from young DDs or elderly DDs, respectively. The inter- action between donor age and AKI was also analyzed. Secondary outcomes were to investigate the incidence of DGF, BPAR, the change of allograft function during the first year after KT, patient survival rate between young-DDKT and elderly-DDKT, and patient survival rate between non-AKI-DDKT and AKI-DDKT subgroups in young-DDKT and elderly-DDKT groups. Clinical outcomes were also analyzed according to AKI severity in each group analysis. The cause of allograft failure included biopsy-proven acute rejection (both T-cell mediated rejection and antibody-mediated rejection (AMR)), biopsy-proven chronic AMR (cAMR), chronic allograft dys- function, biopsy-proven BK virus-associated nephropathy (BKVN), and biopsy-proven recurrent primary glo- merulonephritis. Chronic allograft dysfunction was defined when allograft findings showed non-specific chronic tissue injury without evidence of rejection or when allograft biopsy was not done within one year of allograft failure and the allograft function showed a gradual deterioration several years before the allograft failure.
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Usefulness of neutrophil gelatinase-associated lipocalin(NGAL) to confirm subclinical acute kidney injury and renal prognosis in patients following surgery

Usefulness of neutrophil gelatinase-associated lipocalin(NGAL) to confirm subclinical acute kidney injury and renal prognosis in patients following surgery

3. Subclinical AKI and prognosis The criteria for AKI based on NGAL typically use a cutoff value of 435 ng/mL, although many studies have used different values. 19 NGAL values of 100-270 ng/mL have been predicted to have the highest sensitivity and specificity for AKI. 20 However, this range is too wide to be applied to diagnosis AKI. Urine NGAL can be tested when the patient urinates after surgery; therefore, serum NGAL is easier for a clinician to use to confirm AKI compared to urine NGAL. In our study, the range of the pre-operative serum NGAL values was 268.48 ± 225.88 ng/mL and the 4-hr post-operative serum NGAL range was 252.41 ± 212.53 ng/mL.
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Analysis of the risk factors of acute kidney injury after total hip or knee replacement surgery

Analysis of the risk factors of acute kidney injury after total hip or knee replacement surgery

In another study, for patients with severe sepsis in the surgical in- tensive care unit, a lower AKI incidence rate was recorded for a crys- talloid group than for a hydroxyethyl starch group [15]. Adequate fluid management with consideration of fluid type is important to maintain hemodynamic stability in patients undergoing surgery. In- sufficient fluid administration results in renal hypoperfusion but may cause pulmonary congestion when performed excessively. In the present study, however, we found no statistically significant differenc- es related to the type and amount of fluid administered.
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Delta neutrophil index is an independent predictor of mortality in septic acute kidney injury patients treated with continuous renal replacement therapy

Delta neutrophil index is an independent predictor of mortality in septic acute kidney injury patients treated with continuous renal replacement therapy

categorized using DNI values. In addition, WBC counts alone did not predict patient outcomes. However, there were significant relationships between DNI and DIC- related parameters, including platelet count, PT, and aPTT. These findings added to the evidence that base- line DNI is a significant determinant of mortality in AKI patients requiring CRRT. In addition, DNI is routinely performed and automatically calculated without add- itional costs. DNI values can be rapidly recognized in the CBC report. Taken together, we surmised that DNI could be an early and potent prognostic indicator in pa- tients with S-AKI.
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The interactive effects of input and output on managing fluid balance in patients with acute kidney injury requiring continuous renal replacement therapy

The interactive effects of input and output on managing fluid balance in patients with acute kidney injury requiring continuous renal replacement therapy

Moreover, we also investigated the characteristics of the three patient groups stratified by their cumulative in- put and output at 24-h and 72-h after CRRT initiation (Additional file 1: Table S3). Especially, there were no significant differences in MAP, CCI, and SOFA scores among the three groups stratified by output amount, suggesting that fluid removal might be done irrespective of illness severity. Therefore, we do not think a higher rate of fluid removal is simply a marker of lower illness severity. Instead, more fluid removal could provide an indirect benefit against the oxygen-mismatched diffusion and distorted tissue architecture that originate from fluid overload and tissue edema. Taken together, we suggest that physicians need to pay closer attention to decreas- ing CFB, especially by increasing fluid removal, to im- prove the clinical outcomes of their AKI patients receiving CRRT.
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Impact of acute kidney injury in deceased donors with high Kidney Donor Profile Index on posttransplant clinical outcomes: a multicenter cohort study

Impact of acute kidney injury in deceased donors with high Kidney Donor Profile Index on posttransplant clinical outcomes: a multicenter cohort study

The death-censored graft survival and patient survival rates were analyzed using the Kaplan-Meier curves and log-rank tests. All missing data were excluded. The Cox proportional hazards regression analysis was performed to investigate the relationship of the KDPI score and AKI for the clinical outcomes in DDKT, considering the confounding factors such as recipient age, transplant year (1996–2005 vs. 2006–2010 vs. 2011–2017), transplant center, recipient HTN, and acute rejection. Interaction effects between AKI and high KDPI score were explored by adding interaction terms to the Cox proportional hazards model with backward elimination of variables. In other words, AKI
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