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Causal relationship between hypoalbuminemia and acute kidney injury

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World Journal of Nephrology 2017年第4期6卷 176-187页

作者： Christian J Wiedermann Wolfgang Wiedermann Michael Joannidis Department of Research College of Health Professions Claudiana Department of Educational School and Counseling PsychologyUniversity of Missouri College of Education Department of Internal Medicine Division of Emergency and Intensive Care MedicineMedical University of Innsbruck

Our meta-analysis published in 2010 provided evidence that low levels of serum albumin （hypoalbuminemia） are a signifcant independent predictor of acute kidney injury （AKI） and death following AKI. Since then, a large volume of additional data from observational clinical studies has been published further evaluating the relationship between serum albumin and AKI occurrence. This is an updated review of the literature to re-evaluate the hypothesis that hypoalbuminemia is independently associated with increased AKI risk. Eligible studies published from September 2009 to December 2016 were sought in PubMed （MEDLINE） and forty-three were retained, the great majority being retrospective observational cohort studies. These included a total of about 68000 subjects across a diverse range of settings, predominantly cardiac surgery and acute coronary interventions, infectious diseases, transplant surgery, and cancer. Appraisal of this latest data set served to conclusively corroborate and confirm our earlier hypothesis that lower serum albumin is an independent predictor both of AKI and death after AKI, across a range of clinical scenarios. The body of evidence indicates that hypoalbuminemia may causally contribute to development of AKI. Furthermore, administration of human albumin solution has the po-tential to prevent AKI; a randomized, controlled study provides evidence that correcting hypoalbuminemia may be renal-protective. Therefore, measurement of serum albumin to diagnose hypoalbuminemia may help identify high-risk patients who may beneft from treatment with exogenous human albumin. Multi-center, prospective, randomized, interventional studies are warranted, along with basic research to define the mechanisms throughwhich albumin affords nephroprotection.

关键词： acute kidney injury acute renal failure Hypoalbuminemia Mortality Prevention

Prevalence and outcome of acute kidney injury,as defined by the new Kidney Disease Improving Global Outcomes guideline,in very low birth weight infants

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World Journal of Nephrology 2017年第5期6卷 229-235页

作者： Maisa Al Malla Nisha Viji Varghese Mustafa AlAbdullatif Hassib Narchi Mohammad Khassawneh Department of Paediatrics Tawam HospitalP.O.Box 15258Al AinUnited Arab Emirates Department of Paediatrics United Arab Emirates UniversityP.O.Box 15551Al AinUnited Arab Emirates Department of paediatrics Jordan University of Science and TechnologyIrbid 22110Jordan

AIMTo evaluate the prevalence, risk factors and outcome of acute kidney injury （AKI） in very low birth weight （VLBW） infants. METHODSIn this retrospective study of VLBW infants, we analyzed the prevalence of AKI, as defined by changes in serum creatinine and urine output, associated risk factors and *** total of 293 VLBW infants （mean gestational age 28.7 wk） were included, of whom 109 weighed less than 1000 g at birth. The overall prevalence of AKI was 11.6% （22% in infants with a birth weight under 1000 g and 5.4% those heavier）. A total of 19 （55%） affected infants died, with a mortality rate of 58% in infant less than 1000 g and 50% in those heavier. After adjusting for confounding variables, only necrotizing enterocolitis （NEC） remained associated with AKI, with odds ratio of 4.9 （95%CI： 1.9-18.6）. Blood pressure and glomerular filtration rate （GFR） were not different between affected infants and the others upon discharge from hospital. A normal GFR was documented in all affected infants at one year of *** Using Kidney Disease Improving Global Outcomes defnition of AKI, it occurred in over 10% of VLBW infants, more commonly in infants with lower birth weight. NEC was an independent associated risk factor. renal function, as defined by GFR, was normal in all surviving affected infants 10 to 12 mo later.

关键词： Newborn Case-control Risk factors acute renal failure Mortality Kidney Disease Improving Global Outcomes

Impact of contrast-enhanced ultrasound in patients with renal function impairment

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World Journal of Radiology 2017年第1期9卷 10-16页

作者： Rossano Girometti Tiziano Stocca Elena Serena Antonio Granata Michele Bertolotto Institute of Diagnostic Radiology Department of Medical and Biological SciencesUniversity of UdineUniversity Hospital 'S. Maria della Misericordia' S.O.C. Radiologia San Giovanni di Dio Hospital Department of Radiology University of TriesteCattinara Hospital UOC di Nefrologia-Dialisi 'San Giovanni di Dio' Hospital

AIMTo investigate the role of contrast enhanced ultrasound (CEUS) in evaluating patients with renal function impairment (RFI) showing: (1) acute renal failure (ARF) of suspicious vascular origin; or (2) suspicious renal *** retrospectively evaluated patients addressed to CEUS over an eight years period to rule-out vascular causes of ARF (first group of 50 subjects) or assess previously found suspicious renal lesions (second group of 41 subjects with acute or chronic RFI). After preliminary grey-scale and color Doppler investigation, each kidney was investigated individually with CEUS, using 1.2-2.4 mL of a sulfur hexafluoride-filled microbubble contrast agent. Image analysis was performed in consensus by two readers who reviewed digital clips of CEUS. We calculated the detection rate of vascular abnormalities in the first group and performed descriptive statistics of imaging findings for the second *** the first group, CEUS detected renal infarction or cortical ischemia in 18/50 patients (36%; 95%CI: 23.3-50.9) and 1/50 patients (2%; 95%CI: 0.1-12), respectively. The detection rate of infarction was significantly higher (P = 0.0002; McNemar test) compared to color Doppler ultrasonography (10%). No vascular causes of ARF were identified in the remaining 31/50 patients (62%). In the second group, CEUS detected 41 lesions on 39 patients, allowing differentiation between solid lesions (21/41; 51.2%) vs complex cysts (20/41; 48.8%), and properly addressing 15/39 patients to intervention when feasible based on clinical conditions (surgery and cryoablation in 13 and 2 cases, respectively). Cysts were categorized Bosniak II, IIF, III and IV in 8, 5, 4 and 3 cases, respectively. In the remaining two patients, CEUS found 1 pseudolesion and 1 subcapsular *** showed high detection rate of renal perfusion abnormalities in patients with ARF, influencing the management of patients with acute or chronic RFI and renal masses throughout t

关键词： Contrast-enhanced ultrasonography renal function impairment acute renal failure renal infarction renal lesions renal cysts Bosniak classification

acute kidney injury associated with consumption of starfruit juice: A case report

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World Journal of Critical Care Medicine 2022年第5期11卷 330-334页

作者： Thajudeen Mohammed Zuhary R Ponampalam Department of Emergency Medicine Singapore General HospitalSingapore 169608Singapore

BACKGROUND This study aims to highlight the potential serious complications of acute kidney injury(AKI)resulting from the consumption of excessive amounts of starfruit,a common traditional *** SUMMARY A 78-year-old male with a past medical history of hypertension,diabetes mellitus and hyperlipidemia without prior nephropathy presented to the emergency department(ED)with hiccups,nausea,vomiting and generalized *** the preceding 1 wk,he had consumed 3 bottles of concentrated juice self-prepared from 1 kg of small sour *** serum creatinine was noted to be 1101μmol/L from baseline normal prior to his ED *** was diagnosed with AKI secondary to excessive starfruit *** Consumption of starfruit can cause acute renal failure,with a good outcome when promptly identified and treated.

关键词： acute kidney injury acute renal failure Starfruit Hemodialysis Case report

Determination of Renin-Angiotensin-Aldosterone System in Different Stages of Hemorrhagic Fever with renal Syndrome and Its Clinical Significance

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中国人民解放军军医大学学报(英文版) 1987年第2期 173-177页

作者：杨开祺阎荣刘明陈名声 Central Lab.Fourth Military Medical College Xi’an Central Lab.Fourth Military Medical College Xi’an

Serum renin-angiotensin-aldosterone(RAA)levels were determined on169 occations in 96 cases of hemorrhagic fever with renal syndrome(HFRS).Theresults reveal that RAA system levels rise in vaviable degrees in different stages ofHFRS,the highest value being in the hypotensive and oliguric stages and thenormal value,in the polyuric and convalescent *** elevation range iscorrelated with the severity of the *** closely related to the decrease ofblood volume before the bypotensive stage and to the“tubuloglomerular feedback”mechanism after the oliguric stage,the activation of RAA system may be one ofthe contributing factors of the acute renal failure in HFRS.

关键词： hemorrhagic fever with renal syndrome plasma renin activity angiotensin Ⅱ aldosterone acute renal failure

Epidemiological, Clinical and Follow-Up Data in a Series of Thirteen renal Insufficiencies Complicating Sarcoidosis

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Open Journal of Clinical Diagnostics 2015年第2期5卷 50-53页

作者： Madiha Mahfoudhi Imen Gorsane Amel Gaieb Battikh Sami Turki Hayet Kaaroud Rym Goucha Fathi Ben Hamida Taieb Ben Abdallah Internal Medicine A Department Charles Nicolle HospitalTunisTunisia Research Unit of Kidney Diseases(LR00SP01) Charles Nicolle HospitalTunisTunisia

The sarcoidosis is a systemic granulomatosis affecting most frequently the lungs and the mediastinum. An acute renal failure reveals exceptionally this disease. It’s a retrospective study implicating 13 cases of sarcoidosis complicated of acute renal failure. The aim of this study is to determine epidemiological, clinical, biological and histological profile in these cases and the interest of considering sarcoidosis diagnosis in case of unexplained renal failure. Extra-renal complications, therapeutic modalities and the outcome were determined in all patients. Our series involved 13 women with an average age of 41 years. Biological investigations showed an abnormal normocalcemia in 8 cases, a hypercalcemia in 5 cases, a hypercalciuria in 11 cases and polyclonal hypergammaglobulinemia in 7 cases. An acute renal failure was found in all patients with a median creatinin of 540 umol/L. The renal echography was normal in all patients. The kidney biopsy performed in all patients showed tubulo-interstitial nephritis. The extra-renal signs were: pulmonary interstitial syndrome in 5 cases, a sicca syndrome in 4 cases, mediastinal lymphadenopathy in 2 cases, a lymphocytic alveolitis in 3 cases, an anterior granulomatous uveitis in 3 cases and a polyarthritis in 6 cases. Six patients benefited from hemodialysis. The treatment consisted of corticosteroid in all cases. The follow up was marked by complete resolution of clinical and biological signs. The diagnosis of renal sarcoidosis should be made rapidly in order to avoid end stage renal failure.

关键词： Sarcoidosis acute renal failure Interstitial Nephritis Granuloma