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Reliability of neutrophil gelatinase-associated lipocalin in detecting acute tubular necrosis in decompensated cirrhosis:Systematic review and meta-analysis

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World Journal of Hepatology 2024年第11期16卷 1331-1338页

作者： Nirav Agrawal Scarlet Louis-Jean Zoya Ladiwala Harsha Adnani Ayesha Kamal Mitchell Karpman Albert Steven Fleisher Sanmeet Singh Department of Internal Medicine Anne Arundel Medical CenterAnnapolisMD 21401United States Department of Biostatistics Anne Arundel Medical CenterAnnapolisMD 21401United States Department of Gastroenterology Anne Arundel Medical CenterAnnapolisMD 21401United States

BACKGROUND acute kidney injury(AKI)in cirrhosis is *** diagnosis of AKI in cirrhosis patients depends on clinical presentation and laboratory tests like serum ***,urine biomarkers could also be used to assess the type of AKI and the severity of the *** performed a systematic review with metaanalysis to evaluate the association with urine neutrophil gelatinase-associated lipocalin(NGAL)marker in identifying acute tubular necrosis(ATN)in patients with *** To assess the reliability of urine NGAL in the detection of ATN in patients with *** We systematically searched MEDLINE and PubMed using keywords including“urine biomarkers”,“NGAL”,“kidney dysfunction”,and“cirrhosis”to identify relevant *** was screened and *** studies assessed hospitalized cirrhosis patients with AKI using the urine NGAL *** synthesized the data using diagnostic odds ratio(DOR),comparative and descriptive analyses,and Cochran Mantel-Haenszel(CMH)statistics to evaluate *** Three thousand seven hundred and one patients with cirrhosis were analyzed from a total of 21 cohort *** DOR of 14 of those studies[pooled DOR:22.150,(95%CI:17.58-27.89),P<0.0001]demonstrated a significant association between urine NGAL levels and its identification of *** stratification by cirrhosis status,heterogeneity was analyzed and showed a significant non-zero correlation between NGAL and AKI(CMH statistic=702.19,P<0.0001).CONCLUSION In patients with cirrhosis,the use of urine NGAL is a reliable biomarker for detecting ATN and identifying the etiology of AKI.

关键词： Neutrophil gelatinase-associated lipocalin acute tubular necrosis acute kidney injury Cirrhosis Biomarker Severe liver dysfunction

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Clinical, Etiological and Progressive Aspects of acute tubular necrosis of Toxic Origin at the Brazzaville University Hospital Center

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Open Journal of Nephrology 2023年第4期13卷 464-471页

作者： Daniel Tony Eyeni Sinomono Gaël Honal Mahoungou Éric Gandzali-Ngabé Berline Ndinga Précieux Ngoma Dalia Mboungou Richard Loumingou Tarik Sqalli Houssaini Department of Nephrology Faculty of Health Sciences Marien Ngouabi University Brazzaville Republic of the Congo Department of Nephrology Hassan II University Hospital Center of Fes Fes Morocco

Background and Objectives: acute tubular necrosis (ATN) is the second cause of acute kidney injury (AKI) in an intra-hospital environment. The toxic origin is avoidable. Our objectives were to determine the toxic substances at the origin of ATN at the Brazzaville University Hospital and determine the evolving aspects and the factors associated with it. Patients and Methods: We carried out a 12-month from June 20, 2022 to June 30, 2023. It was a prospective observational study in the Nephrology Department of Brazzaville University Hospital Center. The diagnosis of ATN was done in the presence of AKI occurring in the context of taking nephrotoxic substances with negative albuminuria. Cases of ATN aggravating CKD were excluded. Data analysis was done with Epi-Info 7.2 software. Results: We identified 63 cases of AKI on toxic ATN. Their average age was 47 ± 19 years with a male predominance of 60.2%. The 3 main toxicants incriminated were: herbal medicine (49.2%), Gentamycin (17.5%) and non-steroidal anti-inflammatory drugs (14.3%). An indication for hemodialysis was made in 43 patients (68.2%), the evolution was marked by a cure in 29 patients (46.1%), 10 (15.9%) became chronic kidney failure, 19 (30.1%) died, 5 (7.9%) were lost to follow-up. The main factor for non-healing is anuria (p Conclusion: The main cause of toxic ATN at Brazzaville University Hospital is herbal medicine. The death rate is high there.

关键词： Brazzaville acute tubular necrosis Toxic

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acute Kidney Injury (AKI) in the Setting of Multi-Organ Dysfunction Syndrome (MODS) Secondary to Yellow Fever Infection (YFI) in a 19-Year-Old Woman

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Journal of Biosciences and Medicines 2020年第9期8卷 142-148页

作者： Peter K. Uduagbamen Charles J. Elikwu Adesola T. Oyelese Marion I. Ogunmola Tunde E. Thompson Tolulope E. Falana Division of Nephrology and Hypertension Department of Internal Medicine Babcock University Teaching Hospital Ilishan-Remo Nigeria Department of Medical Microbiology Babcock University Teaching Hospital Ilishan-Remo Nigeria Department of Hematology Babcock University Teaching Hospital Ilishan-Remo Nigeria

Background: Outbreak of yellow fever infection (YFI), a mosquito-borne disease, occurs sporadically worldwide especially in tropical nations. acute kidney injury (AKI) commonly results from YFI and could be associated with a poor prognosis for victims even under intensive care unit (ICU). Pathophysiologic mechanisms for AKI include hypovolemic shut down, cytotoxicity, acute tubular necrosis (ATN), hemolysis, or coagulopathy. Early diagnosis, prompt and effective treatment modalities including dialysis improve treatment outcome. Aim: We report the case management of a 19-year-old woman who had yellow fever infection complicated by acute kidney injury in the setting of multi-organ dysfunction syndrome (MODS). Case Presentation: A 19-year-old woman who presented with fever, headache and vomiting for 2 weeks. In the course of the illness, urine volume became reduced and coke colored, followed by body swelling, yellowness of the eyes bleeding from the orifices. Examination revealed an acutely ill looking woman, icteric, and with pedal edema. Her pulse was 100/min and blood pressure was 120/80 mmHg. Liver was enlarged, soft and tender. She had proteinuria 3+ and polymerase chain reaction (PCR) confirmed yellow fever infection. She had markedly deranged serum biochemical parameters for which she had a three-hour session of hemodialysis with Heparin anticoagulation. The urea reduction ratio (URR) was 46.9%. Barrier nursing was commenced. She had 7 units of whole blood and a pint of fresh frozen plasma (FFP) with antibiotics, Rabeprazole, Tranexamic acid, Vitamin K and Frusemide. She had the second dialysis session of HD and entered into the recovering phase of AKI and was subsequently discharged after 18th days on admission. Conclusion: Yellow fever infection occurs sporadically and could lead to MODS involving the kidneys, liver and hematologic system. Prompt initiation of dialysis, correction of coagulopa

关键词： acute Kidney Injury acute tubular necrosis Dialysis Yellow Fever Virus Fresh Frozen Plasma

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Nephropathy in dietary hyperoxaluria:A potentially preventable acute or chronic kidney disease

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World Journal of Nephrology 2014年第4期3卷 122-142页

作者： Robert H Glew Yijuan Sun Bruce L Horowitz Konstantin N Konstantinov Marc Barry Joanna R Fair Larry Massie Antonios H Tzamaloukas Department of Surgery University of New Mexico School of Medicine Renal Section Raymond G Murphy Veterans Affairs (VA) Medical Center and Department of MedicineUniversity of New Mexico School of Medicine Division of Nephrology Department of MedicineUniversity of New Mexico School of Medicine Rheumatology Section Raymond G Murphy VA Medical Center and Department of MedicineUniversity of New Mexico School of Medicine Department of Pathology University of New Mexico School of Medicine Radiology Service Raymond G Murphy VA Medical Center and Department of RadiologyUniversity of New Mexico School of Medicine Pathology Section Raymond G Murphy VA Medical Center and Department of PathologyUniversity of New Mexico School of Medicine

Hyperoxaluria can cause not only nephrolithiasis and nephrocalcinosis,but also renal parenchymal disease histologically characterized by deposition of calcium oxalate crystals throughout the renal parenchyma,profound tubular damage and interstitial inflammation and *** nephropathy presents clinically as acute or chronic renal failure that may progress to endstage renal disease(ESRD).This sequence of events,well recognized in the past in primary and enteric hyperoxalurias,has also been documented in a few cases of dietary *** of oxalate intake in patients with chronic dietary hyperoxaluria who developed chronic kidney disease or ESRD were comparable to the reported average oxalate content of the diets of certain populations worldwide,thus raising the question whether dietary hyperoxaluria is a primary cause of ESRD in these *** addressing this question have the potential of improving population health and should be undertaken,alongside ongoing studies which are yielding fresh insights into the mechanisms of intestinal absorption and renal excretion of oxalate,and into the mechanisms of development of oxalate-induced renal parenchymal *** preventive and therapeutic strategies for treating all types of hyperoxaluria are expected to develop from these studies.

关键词： Dietary hyperoxaluria Chronic oxalatenephropathy acute oxalate nephropathy acute tubular necrosis Interstitial nephritis Nephrocalcinosis Calcium oxalate nephrolithiasis Oxalate transporters Inflammasomes

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Approach to acute Kidney Injury: Diagnosis and Management

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Open Journal of Nephrology 2023年第3期13卷 306-316页

作者： Pranali M. Wandile Affiliated with South Carolina Clinical Research LLC Orangeburg SC USA

acute kidney injury is a critical but commonly occurring medical condition that presents with a sudden decline in kidney function. This comprehensive review article provides an in-depth examination of the risk elements, etiology, diagnosis, management, and preventive approach of AKI. The causes that contribute to the development of AKI include prerenal, intrinsic renal, and postrenal. The diagnostic approach to AKI includes clinical, laboratory, and imaging studies to evaluate the root cause analysis and to find out the severity of kidney injury. Timely and accurate diagnosis is crucial for initiating appropriate management strategies. The treatment strategies may include fluid and electrolyte management, medication adjustments, nutritional support, and renal replacement therapy. The prospect of recovery diverges as it relies on the individual factors, reasons, and gravity of the condition. This review highlights the importance of raising awareness among healthcare professionals and the public about AKI, early recognition of risk factors, and prompt management. Further research is needed to explore novel therapeutic approaches and refine existing management guidelines for this critical condition.

关键词： acute Kidney Injury Glomerulonephritis acute tubular necrosis Diabetes Hypertension Chronic Kidney Disease Hemodialysis

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Clinicopathological spectrum of snake bite-induced acute kidney injury from India

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World Journal of Nephrology 2017年第3期6卷 150-161页

作者： Sanjay Vikrant Ajay Jaryal Anupam Parashar Department of Nephrology Indira Gandhi Medical College Department of Community Medicine Indira Gandhi Medical College

AIM To study the clinico-pathological spectrum of snake bite-induced acute kidney injury(AKI).METHODS A retrospective study of patients admitted at Indira Gandhi Medical College Hospital,Shimla with snake bite-induced AKI from July 2003 to June *** records were evaluated for patient's information on demographic,clinical characteristics,complications and *** of duration of hospital stay,requirement for intensive care unit support,treatment with dialysis,survival and mortality were *** survival and non survival groups were compared to see the difference in the demographic factors,clinical characteristics,laboratory results,and *** patients subjected to kidney biopsy,the findings of histopathological examination of the kidney biopsies were also *** One hundred and twenty-one patients were diagnosed with snake bite-induced *** age was 42.2 ± 15.1 years and majority(58%) were *** details were available in 88 *** mean duration of arrival at hospital was 3.4 ± 3.7 d with a range of 1 to30 *** percent had oliguria and 55% had history of having passed red or brown colored *** defect was seen in 89% *** hematological and biochemical laboratory abnormalities were:Anemia(80.7%),leukocytosis(75%),thrombocytopenia(47.7%),hyperkalemia(25%),severe metabolic acidosis(39.8%),hepatic dysfunction(40.9%),hemolysis(85.2%) and rhabdomyolysis(68.2%).Main complications were:Gastrointestinal bleed(12.5%),seizure/encephalopathy(10.2%),hypertension,pneumonia/acute respiratory distress syndrome(ARDS) and disseminated intravascular coagulation(9.1% each),hypotension and multi organ failure(MOF)(4.5% each).Eighty-two percent patients required renal replacement *** hundred and ten(90.9%) patient survived and 11(9.1%) patients *** compared to the survival group,the white blood cell count(P = 0.023) and bilirubin levels(P = 0.006) were significant higher and albumin levels were s

关键词： acute kidney injury acute tubular necrosis acute interstitial nephritis Envenomation Hemolysis Renal cortical necrosis Rhabdomyolysis Snake bite

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Resistance index could differentiate AR and ATN in renal transplant patients really

Resistance index could differentiate AR and ATN in renal tra...

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第十五届全国泌尿外科学术会议

作者：曹小丽烟台毓璜顶医院B超室

Objective To evaluate the application of color doppler sonography in differential diagnosis between posttransplant acute rejection( AR) and acute tubular necrosis ( ATN). Methods A total of 435 cases of renal transpla... 详细信息

关键词： renal transplantation acute rejection acute tubular necrosis color Doppler ultrasonography , resistance index

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超声造影在移植肾术后肾功能恢复延迟中的应用

超声造影在移植肾术后肾功能恢复延迟中的应用

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作者：叶争渡浙江大学

学位级别：硕士

目的探讨超声造影在移植肾术后肾功能恢复延迟中的应用价值。方法对36名移植肾患者(23名功能正常,8名出现功能异常并经移植肾活检诊断为急性肾小管坏死,3名患者诊断为急性排异患者,另有2名为局部肾梗死)在移植术后2周内同时行常规超声... 详细信息

目的探讨超声造影在移植肾术后肾功能恢复延迟中的应用价值。方法对36名移植肾患者(23名功能正常,8名出现功能异常并经移植肾活检诊断为急性肾小管坏死,3名患者诊断为急性排异患者,另有2名为局部肾梗死)在移植术后2周内同时行常规超声及超声造影检查。常规超声测取移植肾体积及内部结构、彩色多普勒血流信号图像、肾动脉及其各级分支阻力指数(RI)和搏动指数(PI)。超声造影选用SonoVue作为造影剂,经静脉团注后录取造影动态图像,脱机后利用sonolive分析软件获取叶间动脉和皮质的强度-时间曲线(TIC)并计算上升时间(Rise Time RT),达峰时间(Time To Peak TTP),及两者之间的差值或比值。结果急性肾小管坏死组患者叶间动脉与肾皮质之间的上升时间差ΔRT和达峰时间差△TTP较正常组患者明显延长,以两者为标准诊断急性肾小管坏死特异性均为91.3%时,其敏感性均可达87.5%。以△RT.△TTP为标准的ROC曲线下面积为97.8%,较以RJ为标准的ROC曲线下面积86.1%明显升高。局部肾梗死患者可见移植肾局部彩色血流信号缺失,注入造影剂后可明确彩色血流信号缺失区无造影剂灌注。结论超声造影的强度-时间曲线分析结果可客观的反应移植肾急性肾小管坏死血流灌注情况,较二维超声及RI能更好的诊断急性肾小管坏死。对于移植肾局部梗死患者,超声造影能较彩色多普勒更明确地显示梗死与否及梗死范围。

关键词： kidney transplantation acute tubular necrosis Doppler ultrasonograhy contrast-enhanced sonography time-intensity curve

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