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Sound waves and solutions:Point-of-care ultrasonography for acute kidney injury in cirrhosis

World Journal of Critical Care Medicine 2024年第2期13卷 83-92页

作者： David Aguirre-Villarreal Mario Andrés de Jesús Leal-Villarreal Ignacio García-Juárez Eduardo R Argaiz Abhilash Koratala Departamento de Gastroenterología Instituto Nacional de Ciencias Médicas y Nutrición Salvador ZubiránMexico City 14080Mexico Cardiología Instituto Nacional de Cardiología Ignacio ChávezMexico City 14080Mexico Unidad de Hepatología y Trasplante Departamento de GastroenterologíaInstituto Nacional de Ciencias Medicas y Nutricion Salvador ZubiranMexico City 14080Mexico Departamento de Nefrología y Metabolismo Mineral Instituto Nacional de Ciencias Médicas y Nutrición Salvador ZubiránMexico City 14080Mexico Tecnológico de Monterrey Escuela de Medicina y Ciencias de la SaludMexico City 64710Mexico Department of Nephrology Medical College of WisconsinMilwaukeeWI 53226United States

This article delves into the intricate challenges of acute kidney injury(AKI)in cirrhosis,a condition fraught with high morbidity and *** complexities arise from distinguishing between various causes of AKI,particularly hemodynamic AKI,in cirrhotic patients,who experience hemodynamic changes due to portal *** term"hepatocardiorenal syndrome"is introduced to encapsulate the intricate interplay among the liver,heart,and *** narrative emphasizes the often-overlooked aspect of cardiac function in AKI assessments in cirrhosis,unveiling the prevalence of cirrhotic cardiomyopathy marked by impaired diastolic *** conventional empiric approach involving volume expansion and vasopressors for hepatorenal syndrome is critically analyzed,highlighting potential risks and variable patient *** advocate for a nuanced algorithm for AKI evaluation in cirrhosis,prominently featuring point-of-care ultrasonography(POCUS).POCUS applications encompass assessing fluid tolerance,detecting venous congestion,and evaluating cardiac function.

关键词： Point-of-care ultrasonography Bedside ultrasound Cirrhosis Congestion acute kidney injury Congestive nephropathy

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Revaccination after acute kidney injury Associated with Prior COVID-19 Vaccination: Case Report

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Advances in Infectious Diseases 2024年第1期14卷 196-205页

作者： Senyo Tagboto Laurette Geldenhuys Department of Internal Medicine Yarmouth Regional Hospital Yarmouth Canada Department of Medicine Dalhousie University Halifax Canada Department of Internal Medicine University of Health and Allied Sciences Ho Ghana Department of Pathology Dalhousie University Halifax Canada Department of Pathology and Laboratory Medicine Central Zone Nova Scotia Health Halifax Canada

Background: acute kidney injury associated with proteinuria has been reported following vaccination against SARS-CoV-2 several times since 2021. Decisions about subsequent revaccination in these patients have been difficult because of the uncertainty of the consequences of doing so, and the absence of publications to help determine whether revaccination may be considered safe or not. Purpose: We present a case report of a 59-year-old Canadian man who developed severe acute kidney injury associated with moderate proteinuria following his first COVID-19 vaccine with the Moderna vaccine (an mRNA vaccine). He required haemodialysis for 2 weeks, which was initiated when his creatinine reached 1002 μmol/l. A kidney biopsy showed changes consistent with acute tubular necrosis. The patient was cautioned that repeat vaccination might result in further kidney injury which might be irreversible. However, he badly wanted to attempt a second COVID-19 vaccination, to facilitate a family vacation across several countries in Europe, at a time when travel restrictions were in place in many countries for persons who had not completed a course of vaccines. Method: Following deliberations, the patient chose to try a different type of Covid-19 vaccine. On this occasion, he was vaccinated with the Novavax vaccine (a subunit COVID-19 vaccine). Following this, close monitoring of his urine to detect proteinuria and blood testing for acute kidney injury were carried out on days 1, 3, 7, and 60 after vaccination. Furthermore, a year after his repeat vaccination, his kidney function and urinalysis were again assessed. Result and Conclusions: The patient did not develop acute kidney injury or worsening proteinuria following repeat vaccination. It remains unclear if acute kidney injury with proteinuria is caused by Covid-19 vaccination, or simply an incidental association. This case report suggests that it is may be reasonable for patients with acute kidney injury after COVID-19 vaccination to

关键词： Covid-19 Vaccination acute kidney injury Proteinuria Haemodialysis Revaccination

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Exertional Rhabdomyolysis Induced acute kidney injury: A Case Report and Literature Review

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Case Reports in Clinical Medicine 2024年第3期13卷 53-62页

作者： Yu Zhang Department of Geriatric The Second Hospital of Tianjin Medical University Tianjin China

Background: The exRML (exertional rhabdomyolysis) is a pathophysiologic condition of skeletal muscle cell damage and breakdown associated with high intensity or prolonged exercise, normal exercise under extreme circumstances, or sudden and excessive skeletal muscle contraction. It may manifest from the increase in CK (creatine kinase) or MYO (myoglobin), a protein that can cause life-threatening injury to the kidney (AKI, acute kidney injury), and may or may not be associated with myoglobinuria. Here, we presented a case of exRML with AKI, and then reviewed the related reports. Vigorous hydration, sodium bicarbonate and furosemide are key treatments. Aim: To examine an elderly patient with exRML induced AKI and the key treatment process. Case summary: A 61-year-old man left our hospital without permission after his admission and has been walking for almost 30 kms with no water and food intake, then was diagnosed exRML and exRML induced AKI with an obvious elevation of CK, MYO and decrease of eGFR (estimated glomerular filtration rate) after coming back, and was treated with vigorous hydration, loop diuresis, sodium bicarbonate, prostaglandin and Shenkang injection. After vigorous resuscitation, the patient’s renal function, CK and MYO returned normal. Conclusions: The exRML can cause serious complications such as AKI and death. Delayed diagnosis can be critical;therefore, manner of time should be taken to achieve a favorable prognosis.

关键词： Exertional Rhabdomyolysis Serum Creatine Kinase Myoglobin acute kidney injury

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A Case of Waldenström Macroglobulinemia with acute kidney injury as the First Manifestation and Literature Review

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Proceedings of Anticancer Research 2024年第3期8卷 127-132页

作者： Yang Xu Shanshan Guo Yanli Gou Xijie Zheng Department of Nephrology Affiliated Hospital of Hebei UniversityBaoding 071000Hebei ProvinceChina

Waldenström macroglobulinemia is a rare lymphoid tumor accounting for 2% of all hematological malignancies. Renal complications are less common compared to multiple myeloma, with the most frequent renal manifestations being microproteinuria and microhematuria. This paper presents a case of Waldenström macroglobulinemia with acute kidney injury as the initial manifestation. A 75-year-old male was admitted to the Affiliated Hospital of Hebei University after elevated blood creatinine levels were detected for one day. Upon admission, his blood creatinine was 255 μmol/L, urine protein was 1+, urine erythrocytes were negative, electrophoresis showed IgM positivity in the κ-region, and a bone marrow biopsy indicated a tendency towards lymphoplasmacytic lymphoma. The patient was discharged after receiving a treatment regimen of prednisone acetate, thalidomide, and cyclophosphamide, and continued oral medication outside the hospital. The patient returned two weeks later due to diarrhea and was found to have a blood creatinine level of 985 μmol/L, along with severe acidosis and hyperkalemia. The patient refused renal replacement therapy and was not followed up, resulting in a poor prognosis. Additionally, a review of the literature is provided to contextualize this case within the broader scope of existing research.

关键词： Waldenström macroglobulinemia acute kidney injury Prognosis Literature review

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Obstructive uropathy: Overview of the pathogenesis, etiology and management of a prevalent cause of acute kidney injury

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World Journal of Nephrology 2024年第2期13卷 5-15页

作者： Xabier Pérez-Aizpurua Ramiro Cabello Benavente Gonzalo Bueno Serrano JoséMaría Alcázar Peral Blanca Gómez-Jordana Mañas Jaime Tufet i Jaumot Joaquín Ruiz de Castroviejo Blanco Felipe Osorio Ospina Carmen Gonzalez-Enguita Department of Urology Hospital Universitario Fundación Jiménez DíazMadrid 28015MadridSpain

Obstructive uropathy is defined as the structural or functional interruption of urinary outflow at any level in the urinary *** is regarded as one of the most prevalent causes of acute kidney injury(AKI),accounting for 5%–10%of *** severe obstruction of the urinary tract is a potentially threatening situation for the kidneys and therefore requires prompt identification and management to relieve *** aim of the present article is to review and synthesize available evidence on obstructive uropathy,providing a clinical guideline for clinicians.A literature review on obstructive uropathy in the context of AKI was performed,focusing on the least clarified aspects regarding diagnosis and *** literature searching was conducted in English and top-level evidence articles including systematic reviews,metanalyses and large series were *** obstruction of the urinary tract is a diagnostic and therapeutical challenge that may lead to important clinical complications together with direct structural and hemodynamic damage to the *** recognition of the leading cause and its exact location is essential to ensure prompt urinary drainage together with the most suitable drainage technique selection.A multidisciplinary approach,including urologists,nephrologists,and other medical specialties,is best suited to correctly manage concomitant hemodynamic changes,fluid and electrolyte imbalances,and other related *** uropathy is one of the leading causes of *** of patients suitable for early diversion and feasibility or adequate selection of the indicated technique is sometimes challeng-ing.A thorough understanding of the physiopathology behind the development of urinary obstruction is vital for correct diagnosis and management.

关键词： Obstructive uropathy Urinary tract obstruction Obstruction of the urinary tract acute kidney injury Urinary diversion Renal recovery

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Predictors of Fatal Outcome in Hospitalised Adult Patients with acute kidney injury at Two Tertiary Hospitals in Sub-Saharan Africa

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Open Journal of Nephrology 2024年第1期14卷 86-103页

作者： Denis Georges Teuwafeu Fombo Enjeh Jabbossung Maimouna Mahamat Eric Aristide Nono Tomta Mbapah Leslie Tasha Francois Kaze Folefack Gloria Ashuntantang Faculty of Health Sciences University of Buea Buea Cameroon Triad Research Fundation Buea Cameroon Faculty of Medicine and Biomedical Sciences University of Yaounde I Yaounde Cameroon Department of nephrology Yaounde General Hospital Yaounde Cameroon Departement of Nephrology Yauonde Teaching Hospital Yaounde Cameroon

Introduction: Data on mortality in acute kidney injury (AKI) derives from high-income countries where AKI is hospital-acquired and occurs in elderly patients with a high burden of cardiovascular disease. In sub-Saharan Africa (SSA), AKI is community-acquired occurring in healthy young adults. We aimed to identify predictors of fatal outcomes in patients with AKI in two tertiary hospitals in Cameroon. Methods: Medical records of adults with confirmed AKI, from January 2018 to March 2020 were retrieved. The outcomes of interest were in-hospital deaths and presumed causes of death. We used multiple logistic regressions modeling to identify predictors of death. The study was approved by the ethics boards of both hospitals. Values were considered significant for a p-value of 0.05. Results: We included 285 patient records (37.2% females). The mean (SD) age was 50.1 (19.0) years. Hypertension (n = 97, 34.0%), organ failure (n = 88, 30.9%), and diabetes (n = 60, 21.1%) were the main comorbidities. The majority of patients had community-acquired AKI (78.6%, n = 224), were KDIGO stage 3 (88.8%, n = 253), and needed dialysis (52.6%, n = 150). Up to 16.7% (n = 25) did not receive what was needed. The in-hospital mortality rate was 29.1% (n = 83). Lack of access to dialysis (OR = 27.8;CI: 5.2 - 149.3, p = 0.001), hypotension (OR = 11.8;CI: 1.3 - 24.8;p = 0.001) and ICU admission (OR = 5.7;CI: 1.3 - 24.8, p = 0.001) were predictors of mortality. The presence of co-morbidities or underlying diseases (n = 46, 55%) were the main causes of death. Conclusions: In-hospital AKI mortality is high, as in other low- and middle-income economies. Lack of access to dialysis and the severity of the underlying illness are major predictors of death.

关键词： Predictors Fatal Outcome acute kidney injury Tertiary Hospital

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acute kidney injury following adult lung transplantation

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Chinese Medical Journal 2022年第2期135卷 172-180页

作者： Lei Jing Wenhui Chen Li Zhao Lijuan Guo Chaoyang Liang Jingyu Chen Chen Wang Chinese Academy of Medical Sciences and Peking Union Medical College Beijing 100730China Department of Lung Transplantation Centre of Lung TransplantationCentre of Respiratory DiseasesChina-Japan Friendship HospitalBeijing 100029China National Center for Respiratory Medicine Beijing 100029China Institute of Respiratory Medicine Chinese Academy of Medical SciencesBeijing 100029China National Clinical Research Center for Respiratory Diseases Beijing 100029China Wuxi Lung Transplant Center Wuxi People's Hospital affiliated to Nanjing Medical UniversityWuxiJiangsu 214023China

Background:acute kidney injury(AKI)is a common and serious complication following lung transplantation(LTx),and it is associated with high mortality and *** study assessed the incidence of AKI after LTx and analyzed the associated perioperative factors and clinical ***:This retrospective study included all adult LTx recipients at the China-Japan Friendship Hospital in Beijing between March 2017 and December *** outcomes were AKI incidence,risk factors,mortality,and kidney *** analysis was performed to identify independent risk *** analysis was presented using the Kaplan-Meier ***: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 *** replacement therapy(RRT)was administered to 35/191(18.3%)of the *** 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(Pkidney function,and reduced survival(Pkidney function and reduced survival in LTx patients.

关键词： acute kidney injury Adult lung transplantation Incidence Outcomes Risk factors

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acute kidney injury due to intravenous detergent poisoning:A case report

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World Journal of Clinical Cases 2022年第6期10卷 2036-2044页

作者： Sungbin Park Hyun-Sik Ryu Jae-Kwang Lee Sung-Soo Park Sun-Jung Kwon Won-Min Hwang Sung-Ro Yun Moon-Hyang Park Yohan Park Department of Internal Medicine Division of NephrologyKonyang University HospitalCollege of MedicineDaejeon 35365South Korea Department of Emergency Medicine Konyang University HospitalCollege of MedicineDaejeon 35365South Korea Department of Internal Medicine Division of Respiratory and Critical Care MedicineKonyang University HospitalCollege of MedicineDaejeon 35365South Korea Department of Pathology Konyang University HospitalCollege of MedicineDaejeon 35365South Korea

BACKGROUND Detergent poisoning mostly occurs through oral ingestion(>85%),ocular exposure(<15%),or dermal exposure(<8%).Reports of detergent poisoning through an intravenous injection are extremely *** addition,there ... 详细信息

BACKGROUND Detergent poisoning mostly occurs through oral ingestion(>85%),ocular exposure(acute kidney injury caused by detergent poisoning through an accidental intravenous *** SUMMARY A 61-year-old man was intravenously injected with 20 mL of detergent by another patient in the same room of a local *** surfactant and calcium carbonate accounted for the largest proportion of the *** patient complained of vascular pain,chest discomfort,and nausea,and was transferred to our *** hospitalization,the patient’s serum creatinine level increased to 5.42 mg/dL,and his daily urine output decreased to approximately 300 *** biopsy findings noted that the glomeruli were relatively intact;however,diffuse acute tubular injury was *** edema was also noted,and the patient underwent a total of four hemodiafiltration ***,the patient’s urine output gradually increased whereas the serum creatinine level *** patient was discharged in a stable status without any *** Detergents appear to directly cause renal tubular injury by systemic *** treating a patient with detergent poisoning,physicians should be aware that the renal function may also *** addition,timely renal replacement therapy may help improve the patient’s prognosis.

关键词： Detergents Poisoning Intravenous injection acute kidney injury acute tubular injury Case report

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acute kidney injury in traumatic brain injury intensive care unit patients

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World Journal of Clinical Cases 2022年第9期10卷 2751-2763页

作者： Zheng-Yang Huang Yong Liu Hao-Fan Huang Shu-Hua Huang Jing-Xin Wang Jin-Fei Tian Wen-XianZeng Rong-Gui Lv Song Jiang Jun-Ling Gao Yi Gao Xia-Xia Yu School of Biomedical Engineering Health Science CenterShenzhen UniversityShenzhen 518037Guangdong ProvinceChina Intensive Care Unit Shenzhen HospitalSouthern Medical UniversityShenzhen 518101Guangdong ProvinceChina Department of Medicine LKS Medical FacultyThe University of Hong KongHongkong 999077China

BACKGROUND The exact definition of acute kidney injury(AKI)for patients with traumatic brain injury(TBI)is *** To compare the power of the“Risk,injury,Failure,Loss of kidney function,and End-stage kidney disease”(RIFLE),acute kidney injury Network(AKIN),Creatinine kinetics(CK),and kidney Disease Improving Global Outcomes(KDIGO)to determine AKI incidence/stage and their association with the inhospital mortality rate of patients with *** This retrospective study collected the data of patients admitted to the intensive care unit for neurotrauma from 2001 to 2012,and 1648 patients were *** subjects in this study were assessed for the presence and stage of AKI using RIFLE,AKIN,CK,and *** addition,the propensity score matching method was *** Among the 1648 patients,291(17.7%)had AKI,according to *** highest incidence of AKI was found by KDIGO(17.7%),followed by AKIN(17.1%),RIFLE(12.7%),and CK(11.5%)(P=0.97).Concordance between KDIGO and RIFLE/AKIN/CK was 99.3%/99.1%/99.3%for stage 0,36.0%/91.5%/44.5%for stage 1,35.9%/90.6%/11.3%for stage 2,and 47.4%/89.5%/36.8%for stage *** in-hospital mortality rates increased with the AKI stage in all four *** severity of AKI by all definitions and stages was not associated with inhospital mortality in the multivariable analyses(all P>0.05).CONCLUSION Differences are seen in AKI diagnosis and in-hospital mortality among the four AKI definitions or *** study revealed that KDIGO is the best method to define AKI in patients with TBI.

关键词： kidney Disease Improving Global Outcomes acute kidney injury Traumatic brain injury Evaluation In-hospital mortality

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acute kidney injury and the compensation of kidney function after nephrectomy in living donation

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World Journal of Transplantation 2022年第8期12卷 223-230页

作者： Kenji Okumura Holly Grace Hiroshi Sogawa Shigeyoshi Yamanaga Department of Surgery Westchester Medical Center/New York Medical CollegeValhallaNY 10595United States Department of Surgery New York Medical CollegeValhallaNY 10595United States Department of Surgery Japanese Red Cross Kumamoto HospitalKumamoto 861-8520Japan

acute kidney injury(AKI)incidence is growing rapidly,and AKI is one of the predictors of inpatient *** nephrectomy,all the patients have decreased kidney function with AKI and recover from ***,the characteristic and behavior of AKI is different from usual AKI and compensatory kidney function has been well known in the postoperative setting,especially in living *** this review,we have focused on the compensation of kidney function after nephrectomy in living *** discuss factors that have been identified as being associated with kidney recovery in donors including age,sex,body mass index,remnant kidney volume,estimated glomerular filtration rate,and various comorbidities.

关键词： acute kidney injury kidney transplant donor Compensation kidney function

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