Introduction: The incidence of acute renal failure (ARF) increases with age. In Senegal, few studies have described the epidemiology of ARF in the elderly. The aim of our study is to establish the epidemiological prof...Introduction: The incidence of acute renal failure (ARF) increases with age. In Senegal, few studies have described the epidemiology of ARF in the elderly. The aim of our study is to establish the epidemiological profile of elderly patients with ARF, identify the causes of ARF in the elderly and assess treatment and prognosis. Methods: We conducted a descriptive and retrospective study over a five-year period from 2011 to 2015 involving patients aged 60 and over, treated for ARI during the study period. Data entry and analysis were done on Epi info 7.3. Results: We included a total of 45 patients. The prevalence of ARF was 3.34%. The mean age was 70.31 years (60 - 83) and the sex ratio was 3.5. Phytotherapy was found in 68.9%, hypertension was found in 68.9%, and diabetes was found in 31.1%. Prostate hypertrophy was found in 53.4% of patients. Pre-renal ARF was the most common (46.6%). Most of the cases, 66.67%, were at Stage 3 of KDIGO. The most common etiologies were respectively tumor (35.5%) and infection (20%). The most common complications were respectively hyperkalemia (33.3%) and hyponatremia (33.3%). Recovery was complete in 62.6% of cases, partial in 37.8% of patients and 13.3% of patients ended up on chronic hemodialysis. Mortality was 4.4%. Conclusion: Herbal medicine, hypertension and diabetes are frequently associated with ARF in the elderly. This justifies increased monitoring of the elderly subject with these conditions in order to subject him to early and appropriate care.展开更多
Introduction: SARS-CoV-2 (Severe Acute Respiratory Syndrome Corona-virus 2) causes an acute respiratory disease with interstitial and alveolar pneumonia, which can affect several organs including the kidneys [1] [2] [...Introduction: SARS-CoV-2 (Severe Acute Respiratory Syndrome Corona-virus 2) causes an acute respiratory disease with interstitial and alveolar pneumonia, which can affect several organs including the kidneys [1] [2] [3]. As Mali is no stranger to this pandemic, we report our experience of the management of cases of kidney failure observed in the COVID-19 intensive care unit at the Point G University Hospital Centre (CHU). The aim of this work was to characterise acute renal failure in COVID-19 patients in intensive care, describing the management methods used and determining the vital prognosis. Materials and Methods: This was a retrospective descriptive study, covering an 18-month period from April 2020 to September 2021. We included all patients admitted to the COVID-19 intensive care unit on the basis of a positive RT-PCR and/or the presence of ground-glass images on thoracic computed tomography. Results: We selected 232 patients admitted for COVID-19. Acute Renal Failure (ARF) developed in 71 patients (30.6%). The stages of AKI according to KDIGO were Stage 1 in 28.2%, Stage 2 in 18.3% and Stage 3 in 53.5%. The mean age was 63.96 years, with a standard deviation of 16.6, and males accounted for the majority (71.8%). Organic ARF was found in 80.3% of cases. Risk factors and comorbidities for ARF included advanced age (60.6%), male sex (71.8%), hypertension (52.1%), diabetes (21.1%), invasive mechanical ventilation (71.8%) and septic shock (56.3%). Extra renal purification (haemodialysis) was used in 29.6% of patients. Admission to intensive care ranged from 7 days to 14 days in 43.7% of cases. More than half the patients (52.1%) were in critical condition on admission. Death occurred in 76.1% of patients. Conclusion: ARF appears to occur more frequently in patients with severe COVID-19. It is associated with a poor prognosis.展开更多
BACKGROUND Vancomycin is the most commonly used drug for methicillin-resistant Staphylococcus aureus.The empirical clinical doses of vancomycin based on non-obese patients may not be optimal for obese ones.CASE SUMMAR...BACKGROUND Vancomycin is the most commonly used drug for methicillin-resistant Staphylococcus aureus.The empirical clinical doses of vancomycin based on non-obese patients may not be optimal for obese ones.CASE SUMMARY This study reports a case of vancomycin dosing adjustment in an obese patient(body mass index 78.4 kg/m2)with necrotizing fasciitis of the scrotum and left lower extremity accompanied with acute renal failure.Dosing adjustment was performed based on literature review and factors that influence pharmacokinetic parameters are analyzed.The results of the blood drug concentration monitoring confirmed the successful application of our dosing adjustment strategy in this obese patient.Total body weight is an important consideration for vancomycin administration in obese patients,which affects the volume of distribution and clearance of vancomycin.The alterations of pharmacokinetic parameters dictate that vancomycin should be dose-adjusted when applied to obese patients.At the same time,the pathophysiological status of patients,such as renal function,which also affects the dose adjustment of the patient,should be considered.CONCLUSION Monitoring vancomycin blood levels in obese patients is critical to help adjust the dosing regimen to ensure that vancomycin concentrations are within the effective therapeutic range and to reduce the incidence of renal injury.展开更多
Background: Rhabdomyolysis (RM) is striate muscle-cell damage with the release of intracellular substances to the circulation—myoglobin, muscular enzymes, potassium, etc., with or without the development of acute ren...Background: Rhabdomyolysis (RM) is striate muscle-cell damage with the release of intracellular substances to the circulation—myoglobin, muscular enzymes, potassium, etc., with or without the development of acute renal injury. RM due to the intake of illicit and controlled substances, including cocaine, amphetamine and its derivates, cannabis, and alcohol abuse is a common cause of acute renal failure in adolescents and adults. Aim: to alert clinicians to the need of early diagnosis and treatment of RM due to the intake of controlled substances and energy drinks. Case Presentation: We describe a 20-year-old male patient with acute renal failure due to rhabdomyolysis after the intake of controlled substances, energy drinks, physical efforts and dehydration. The renal biopsy revealed acute tubular injury. After rehydration, alkalization, temporary dialysis treatment, intravenous corticosteroids and symptomatic treatment the patient restored renal function. Conclusion: RM can be a severe life-threatening complication of the intake of controlled substances combined with strenuous physical activity, energy drinks and dehydration. The described case represents a typical scenario of RM developing secondary to controlled substance abuse in combination with alcohol and strenuous physical activity. The prompt diagnosis and the timely initiation of supportive (rehydration and alkalization) and corticosteroid therapy and the early dialysis lead to fast resolution of renal failure. The clinicians should keep in mind illicit drugs, alcohol and energy drinks and physical efforts as possible triggers of RM and acute kidney injury, especially in young people.展开更多
Renal damage secondary to paracetamol intoxication is rare, estimated between 1% and 2% of intoxication cases. Its pathophysiology is still debated, the clinical involvement consisting in an acute tubular necrosis wit...Renal damage secondary to paracetamol intoxication is rare, estimated between 1% and 2% of intoxication cases. Its pathophysiology is still debated, the clinical involvement consisting in an acute tubular necrosis with a good prognosis if it is rapidly treated. Renal damage can sometimes occur without prior hepatic damage, and the onset of renal manifestations is generally between the 2nd and 7th day after taking paracetamol. If its management remains exclusively symptomatic, its late onset can sometimes lead to serious metabolic complications. It is therefore important to systematically monitor renal function following paracetamol drug intoxication. We report the case of a 60-year-old male subject hospitalized for the management of voluntary drug intoxication (VDI) with paracetamol complicated by acute hepatocellular failure and acute renal failure. His management required extrarenal purification (hemodialysis) and the evolution was favorable with recovery ad integrumof renal function. Conclusion: Although less known and of unelucidated physiopathology, nephrotoxicity secondary to voluntary drug intoxication with paracetamol is a reality and can lead in extreme cases to the use of extrarenal purification technique (hemodialysis).展开更多
BACKGROUND: Acute renal failure(ARF) due to obstructive uropathy is a urological emergency. The standard radiological investigations in the emergency setting include X-ray, ultrasonography and computed tomography. But...BACKGROUND: Acute renal failure(ARF) due to obstructive uropathy is a urological emergency. The standard radiological investigations in the emergency setting include X-ray, ultrasonography and computed tomography. But occasionally the cause of obstruction may be elusive.METHODS: We present a case of obstructive uropathy due to bilateral stones presenting as acute renal failure. The patient underwent successful shock wave lithotripsy(SWL) for dissolution of calculi.RESULTS: The patient was successfully treated, and reported asymptomatic in a follow-up.CONCLUSION: Close collaboration between nephrological, urological, and radiological services is required.展开更多
We report a case of IgG4-related disease presenting both tubulointerstitial nephritis and retroperitoneal fibrosis causing acute renal failure in a 63-year-old male. He was admitted to our hospital because of acute re...We report a case of IgG4-related disease presenting both tubulointerstitial nephritis and retroperitoneal fibrosis causing acute renal failure in a 63-year-old male. He was admitted to our hospital because of acute renal failure requiring emergent hemodialysis. Computed tomography showed a soft-tissue density mass with an irregular border in the retroperitoneum. The mass involved bilateral ureters and had caused acute renal failure by bilateral hydronephrosis. Because of a history of uveitis and high IgG4 levels, we considered a diagnosis of retroperitoneal fibrosis, IgG4-related disease. Kidney biopsy revealed IgG4-related kidney disease with interstitial nephritis. After relief of urinary obstruction by inserting ureteral catheters into the bilateral ureters, renal function recovered.展开更多
Objective To evaluate risk factors for postoperative acute renal failure requiring dialysis (ARF-D) after hear valve surgery. Methods Adult patients (age≤18 years) underwent valve surgery with preoperative serum crea...Objective To evaluate risk factors for postoperative acute renal failure requiring dialysis (ARF-D) after hear valve surgery. Methods Adult patients (age≤18 years) underwent valve surgery with preoperative serum creati nine 【 300 μmol / L were included between January 2005 and December 2008. Fifty patients developed ARF-D展开更多
The surgical emergency treatments and cura-tive effects of postrenal acute renal failure following obstruction due to upper urinary calculi in infants were evaluated.Of the 13 infants with postrenal acute renal failur...The surgical emergency treatments and cura-tive effects of postrenal acute renal failure following obstruction due to upper urinary calculi in infants were evaluated.Of the 13 infants with postrenal acute renal failure following obstruction due to upper urinary calculi,11 received retrograded catheterizations of the ureter with semi-rigid ureteroscopy(F 6.8),and two received open ureterolithotomy.The results showed that only one infant had anuresis and continuous reduction of hemoglobin 5 h after the open ureterolithotomy and received exploration via excision and peritoneal dialysis,and the remaining 12 patients well recovered in this group.The renal function of all the patients was restored without postoperative complications.It is concluded that the retrograded catheterization of the ureter with ureteroscopy is a minimally invasive,safe and effective therapy for postrenal acute renal failure following obstruction due to upper urinary calculi in infants.For those infants whose urethras are thin and small,the open ureterolithotomy is a suitable method.But patients with bleeding tendency need to be corrected prior to the open ureterotomy to remove obstructions.展开更多
An independent association between acute renal failure(ARF)and intra-abdominal hypertension(IAH)after liver transplantation has not been established previously.The aim of this retrospective study was to understand the...An independent association between acute renal failure(ARF)and intra-abdominal hypertension(IAH)after liver transplantation has not been established previously.The aim of this retrospective study was to understand the role of IAH as an independent risk factor for ARF in the early postoperative period.This study involved 62 subjects who underwent liver transplantation.Intra-abdominal pressure(IAP)was measured in the first three days after surgery by using the urinary bladder technique.An IAP of at least 20 mmHg per day was defined as IAH.Clinical parameters between group IAH and group NO-IAH were compared in terms of the incidence of ARF,blood creatinine levels,blood urea nitrogen(BUN)levels,urine volume per hour and glomerular filtration gradient(GFG).Hemodynamic variations were recorded in the first three postoperative days between group ARF and group NO-ARF.The perioperative suspected risk factors of ARF were determined for statistical evaluation using correlation coefficients and logistic regression analysis.In group IAH,45.8%patients developed ARF as against 7.9%in group NO-IAH;GFG was significantly lower at 0–72 h after surgery;and blood creatinine levels,BUN levels,urine volume per hour were significantly different at 24–72 h after surgery compared with group NO-IAH.The patients with ARF were not significantly different from those without ARF in terms of central venous pressure,pulmonary artery pressure and mean arterial pressure(MAP)in the first three postoperative days despite a significant increase in heart rate at 24–72h after operation.Postoperative IAH,intraoperative MAP and intraoperative blood transfusion volume of more than 15 U were found to be independent risk factors for ARF.IAH impaired renal function and was an independent risk factor for ARF after liver transplantation.Routine measurement should be taken to monitor IAP every eight hours postoperatively.展开更多
BACKGROUND Fish gallbladder has long been used as a folk remedy in Asian countries.Multiple organ damage after ingestion of fish gallbladder resulting in near mortality has been known to us.Here,we describe a case of ...BACKGROUND Fish gallbladder has long been used as a folk remedy in Asian countries.Multiple organ damage after ingestion of fish gallbladder resulting in near mortality has been known to us.Here,we describe a case of acute renal failure(ARF)and hepatitis due to grass carp gallbladder poisoning and review the literature.CASE SUMMARY A previously healthy,50-year-old woman was admitted to our hospital with a 2-d history of generalized abdominal pain and repeated vomiting following ingestion of two raw grass carp gallbladders in an attempt to alleviate her cough.She developed anuria on day 4 with markedly elevated serum creatinine,urea,bilirubin,alanine aminotransferase,and aspartate aminotransferase.Based on thorough evaluation of her history and prompt biochemical investigations,we diagnosed her with ARF and hepatitis secondary to fish gallbladder poisoning.Her renal biopsy revealed acute tubular necrosis,following which she underwent six sessions of conventional hemodialysis due to renal failure.Supportive treatment with gastric mucosal protectant and liver protectant was administered for targeted organ protection.The patient’s liver function gradually recovered,and serum creatinine was 164 mmol/L at discharge on day 24.Over a follow-up period of 2 wk,her renal function completely recovered.CONCLUSION Physicians should be mindful of toxic complications of raw grass carp gallbladder ingestion and we should promote awareness to reduce incidences of food poisoning.展开更多
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 remedy.CASE SUMMARY A 78-yea...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 remedy.CASE 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 weakness.In the preceding 1 wk,he had consumed 3 bottles of concentrated juice self-prepared from 1 kg of small sour starfruits.His serum creatinine was noted to be 1101μmol/L from baseline normal prior to his ED visit.He was diagnosed with AKI secondary to excessive starfruit consumption.CONCLUSION Consumption of starfruit can cause acute renal failure,with a good outcome when promptly identified and treated.展开更多
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 sarc...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.展开更多
BACKGROUND Rhabdomyolysis is a life-threatening condition,often leading to progressive renal failure and death.It is caused by destruction of skeletal muscle and the release of myoglobin and other intracellular conten...BACKGROUND Rhabdomyolysis is a life-threatening condition,often leading to progressive renal failure and death.It is caused by destruction of skeletal muscle and the release of myoglobin and other intracellular contents into the circulation.The most frequent cause of this condition is“crush syndrome”,although several others have been described and paraneoplastic inflammatory myopathies associated with various types of cancer are repeatedly reported.CASE SUMMARY We describe a rare case of a patient with pancreatic cancer who developed rhabdomyolysis early on,possibly due to paraneoplastic myositis leading to acute renal failure and eventually to rapid death.A 78-year-old Caucasian woman was referred to our hospital for obstructive jaundice and weight loss due to a lesion in the pancreatic head.She presented increasingly severe renal insufficiency with anuria,a dramatic increase in creatine phosphokinase(36000 U/L,n.v.20-180 U/L)and myoglobin(>120000μg/L,n.v.12-70μg/L).On clinical examination,the patient showed increasing pain in the lower limbs associated with muscle weakness which was severe enough to immobilize her.Paraneoplastic myopathy linked to the malignant lesion of the pancreatic head was suspected.The patient was treated with hemodialysis and intravenous methylprednisolone.Despite all the efforts to prepare the patient for surgery,her general condition rapidly deteriorated and she eventually died 30 d after hospital admission.CONCLUSION The possible causes of rhabdomyolysis in this patient with pancreatic cancer are discussed,the development of paraneoplastic myopathy being the most likely.Clinicians should bear in mind that these syndromes may become clinically manifest at any stage of the cancer course and their early diagnosis and treatment could improve the patient’s prognosis.展开更多
Objective To investigate the risk factors of acute renal injury(acute kidney injury)in patients with acute left heart failure.Methods Clinical data of 188 patients with acute left heart failure who were admitted to ou...Objective To investigate the risk factors of acute renal injury(acute kidney injury)in patients with acute left heart failure.Methods Clinical data of 188 patients with acute left heart failure who were admitted to our hospital were retrospectively analyzed.Logistic regression analysis was used to assess the risk factors for AKI.展开更多
APRT) deficiency is an uncommon genetic cause ofchronic kidney disease due to crystalline nephropathy.Methods: A case of a Chinese boy with APRT defi ciencypresenting with severe acute kidney injury secondaryto obstru...APRT) deficiency is an uncommon genetic cause ofchronic kidney disease due to crystalline nephropathy.Methods: A case of a Chinese boy with APRT defi ciencypresenting with severe acute kidney injury secondaryto obstructive uropathy from multiple renal calculi wasreviewed.Results: The patient underwent staged removal of thecalculi. Infrared spectrometry of the renal calculi showed2,8-dihydroxyadenine. APRT deficiency was confirmedwith abolished APRT enzyme activity in red blood cells.He was started on allopurinol and low purine diet withcomplete resolution of the residual calculi.Conclusion: APRT defi ciency should be considered inpatients with multiple radiolucent renal calculi.展开更多
Background:Albumin is a critical component in the standard therapeutic approach to acute renal failure(ARF)and spontaneous bacterial peritonitis(SBP)in the setting of ascites.However,data regarding the safety and mini...Background:Albumin is a critical component in the standard therapeutic approach to acute renal failure(ARF)and spontaneous bacterial peritonitis(SBP)in the setting of ascites.However,data regarding the safety and minimumeffective dose are limited.Methods:We conducted a retrospective review of patients with decompensated cirrhosis who received albumin within the first 48 hours of hospitalization at Beth Israel Deaconess Medical Center between 2010 and 2013.Outcomes included 90-day risk of death or transplantation(primary)and(secondary)complications of albumin infusion(length of stay(LOS)and need for critical care),all adjusted for comorbidity and severity of illness.Results:We included 169 patients with ARF and 88 patients with SBP.The optimal doses of albumin for a survival benefit were found to be 87.5 g and 100 g in the ARF and SBP cohorts,respectively.The odds ratio(OR)for the 90-day risk of death or liver transplantation associated with the optimal loading dose was 0.36(95%CI:0.17-0.76,P=0.008)and 0.28(95%CI:0.07-0.97,P=0.04)for the ARF and SBP cohorts,respectively.This effect persisted for patients with ARF who had neither hepatorenal syndrome(HRS)nor SBP(OR:0.13,95%CI:0.007-0.79,P=0.02).LOS(beta coefficient per log albumin dose:1.69;95%CI:0.14-3.24,P=0.03)and risk of critical care(OR/g albumin:1.03;95%CI:1.01-1.05,P=0.01)were also dose dependent.Conclusion:Albumin has a dose-dependent effect on both survival and complications in patients with cirrhosis with ARF(HRS and otherwise)and/or SBP.展开更多
Acute kidney injury(AKI) is a major health threat worldwide. The literature on herbal intervention in AKI was searched from English and Chinese databases and reports were critically analyzed in terms of preventing AKI...Acute kidney injury(AKI) is a major health threat worldwide. The literature on herbal intervention in AKI was searched from English and Chinese databases and reports were critically analyzed in terms of preventing AKI, promoting repair and regeneration, enhancing extrarenal clearance of uremic toxins, and preventing progression to chronic kidney disease(CKD). Altogether, 16 herbal formulae and a few extracts derived from individual herbs were reported to prevent or mitigate AKI in animal models induced by renal ischemia/reperfusion, cisplastin,gentamicin, glycerol, adenine, sepsis or physical exhaustion. Four formulae and six individual herbs were reported to accelerate recovery and/or to prevent CKD in established AKI animal models. Intrarectal herbal medicines, with or without simultaneous oral administration, were reported in six clinical trials and in an animal model to increase extrarenal clearance of uremic toxins. Additional 13 clinical trials reported oral or intravenous herbal interventions in AKI of different etiologies. Despite recurring problems, notably poor compliance with good practice guidelines for clinical trials and for authentication, naming and quality control of herbal materials, accumulating experimental data on the preventive effects of herbal medicines in AKI look encouraging and urge for better, definitive trials to guide clinical practice. Herbal enemas promoting extrarenal clearance of uremic toxins seem cost-effective, but better clinical evidence is certainly needed before any affirmative recommendation be made for AKI patients without access to dialysis. New frontiers, however, lie in those herbal remedies that promote repair/regeneration and prevent chronicity after AKI. Recent experimental data suggest that this may be possible.展开更多
文摘Introduction: The incidence of acute renal failure (ARF) increases with age. In Senegal, few studies have described the epidemiology of ARF in the elderly. The aim of our study is to establish the epidemiological profile of elderly patients with ARF, identify the causes of ARF in the elderly and assess treatment and prognosis. Methods: We conducted a descriptive and retrospective study over a five-year period from 2011 to 2015 involving patients aged 60 and over, treated for ARI during the study period. Data entry and analysis were done on Epi info 7.3. Results: We included a total of 45 patients. The prevalence of ARF was 3.34%. The mean age was 70.31 years (60 - 83) and the sex ratio was 3.5. Phytotherapy was found in 68.9%, hypertension was found in 68.9%, and diabetes was found in 31.1%. Prostate hypertrophy was found in 53.4% of patients. Pre-renal ARF was the most common (46.6%). Most of the cases, 66.67%, were at Stage 3 of KDIGO. The most common etiologies were respectively tumor (35.5%) and infection (20%). The most common complications were respectively hyperkalemia (33.3%) and hyponatremia (33.3%). Recovery was complete in 62.6% of cases, partial in 37.8% of patients and 13.3% of patients ended up on chronic hemodialysis. Mortality was 4.4%. Conclusion: Herbal medicine, hypertension and diabetes are frequently associated with ARF in the elderly. This justifies increased monitoring of the elderly subject with these conditions in order to subject him to early and appropriate care.
文摘Introduction: SARS-CoV-2 (Severe Acute Respiratory Syndrome Corona-virus 2) causes an acute respiratory disease with interstitial and alveolar pneumonia, which can affect several organs including the kidneys [1] [2] [3]. As Mali is no stranger to this pandemic, we report our experience of the management of cases of kidney failure observed in the COVID-19 intensive care unit at the Point G University Hospital Centre (CHU). The aim of this work was to characterise acute renal failure in COVID-19 patients in intensive care, describing the management methods used and determining the vital prognosis. Materials and Methods: This was a retrospective descriptive study, covering an 18-month period from April 2020 to September 2021. We included all patients admitted to the COVID-19 intensive care unit on the basis of a positive RT-PCR and/or the presence of ground-glass images on thoracic computed tomography. Results: We selected 232 patients admitted for COVID-19. Acute Renal Failure (ARF) developed in 71 patients (30.6%). The stages of AKI according to KDIGO were Stage 1 in 28.2%, Stage 2 in 18.3% and Stage 3 in 53.5%. The mean age was 63.96 years, with a standard deviation of 16.6, and males accounted for the majority (71.8%). Organic ARF was found in 80.3% of cases. Risk factors and comorbidities for ARF included advanced age (60.6%), male sex (71.8%), hypertension (52.1%), diabetes (21.1%), invasive mechanical ventilation (71.8%) and septic shock (56.3%). Extra renal purification (haemodialysis) was used in 29.6% of patients. Admission to intensive care ranged from 7 days to 14 days in 43.7% of cases. More than half the patients (52.1%) were in critical condition on admission. Death occurred in 76.1% of patients. Conclusion: ARF appears to occur more frequently in patients with severe COVID-19. It is associated with a poor prognosis.
基金Supported by the Hebei Natural Science Foundation of China,No.H2019206614。
文摘BACKGROUND Vancomycin is the most commonly used drug for methicillin-resistant Staphylococcus aureus.The empirical clinical doses of vancomycin based on non-obese patients may not be optimal for obese ones.CASE SUMMARY This study reports a case of vancomycin dosing adjustment in an obese patient(body mass index 78.4 kg/m2)with necrotizing fasciitis of the scrotum and left lower extremity accompanied with acute renal failure.Dosing adjustment was performed based on literature review and factors that influence pharmacokinetic parameters are analyzed.The results of the blood drug concentration monitoring confirmed the successful application of our dosing adjustment strategy in this obese patient.Total body weight is an important consideration for vancomycin administration in obese patients,which affects the volume of distribution and clearance of vancomycin.The alterations of pharmacokinetic parameters dictate that vancomycin should be dose-adjusted when applied to obese patients.At the same time,the pathophysiological status of patients,such as renal function,which also affects the dose adjustment of the patient,should be considered.CONCLUSION Monitoring vancomycin blood levels in obese patients is critical to help adjust the dosing regimen to ensure that vancomycin concentrations are within the effective therapeutic range and to reduce the incidence of renal injury.
文摘Background: Rhabdomyolysis (RM) is striate muscle-cell damage with the release of intracellular substances to the circulation—myoglobin, muscular enzymes, potassium, etc., with or without the development of acute renal injury. RM due to the intake of illicit and controlled substances, including cocaine, amphetamine and its derivates, cannabis, and alcohol abuse is a common cause of acute renal failure in adolescents and adults. Aim: to alert clinicians to the need of early diagnosis and treatment of RM due to the intake of controlled substances and energy drinks. Case Presentation: We describe a 20-year-old male patient with acute renal failure due to rhabdomyolysis after the intake of controlled substances, energy drinks, physical efforts and dehydration. The renal biopsy revealed acute tubular injury. After rehydration, alkalization, temporary dialysis treatment, intravenous corticosteroids and symptomatic treatment the patient restored renal function. Conclusion: RM can be a severe life-threatening complication of the intake of controlled substances combined with strenuous physical activity, energy drinks and dehydration. The described case represents a typical scenario of RM developing secondary to controlled substance abuse in combination with alcohol and strenuous physical activity. The prompt diagnosis and the timely initiation of supportive (rehydration and alkalization) and corticosteroid therapy and the early dialysis lead to fast resolution of renal failure. The clinicians should keep in mind illicit drugs, alcohol and energy drinks and physical efforts as possible triggers of RM and acute kidney injury, especially in young people.
文摘Renal damage secondary to paracetamol intoxication is rare, estimated between 1% and 2% of intoxication cases. Its pathophysiology is still debated, the clinical involvement consisting in an acute tubular necrosis with a good prognosis if it is rapidly treated. Renal damage can sometimes occur without prior hepatic damage, and the onset of renal manifestations is generally between the 2nd and 7th day after taking paracetamol. If its management remains exclusively symptomatic, its late onset can sometimes lead to serious metabolic complications. It is therefore important to systematically monitor renal function following paracetamol drug intoxication. We report the case of a 60-year-old male subject hospitalized for the management of voluntary drug intoxication (VDI) with paracetamol complicated by acute hepatocellular failure and acute renal failure. His management required extrarenal purification (hemodialysis) and the evolution was favorable with recovery ad integrumof renal function. Conclusion: Although less known and of unelucidated physiopathology, nephrotoxicity secondary to voluntary drug intoxication with paracetamol is a reality and can lead in extreme cases to the use of extrarenal purification technique (hemodialysis).
文摘BACKGROUND: Acute renal failure(ARF) due to obstructive uropathy is a urological emergency. The standard radiological investigations in the emergency setting include X-ray, ultrasonography and computed tomography. But occasionally the cause of obstruction may be elusive.METHODS: We present a case of obstructive uropathy due to bilateral stones presenting as acute renal failure. The patient underwent successful shock wave lithotripsy(SWL) for dissolution of calculi.RESULTS: The patient was successfully treated, and reported asymptomatic in a follow-up.CONCLUSION: Close collaboration between nephrological, urological, and radiological services is required.
文摘We report a case of IgG4-related disease presenting both tubulointerstitial nephritis and retroperitoneal fibrosis causing acute renal failure in a 63-year-old male. He was admitted to our hospital because of acute renal failure requiring emergent hemodialysis. Computed tomography showed a soft-tissue density mass with an irregular border in the retroperitoneum. The mass involved bilateral ureters and had caused acute renal failure by bilateral hydronephrosis. Because of a history of uveitis and high IgG4 levels, we considered a diagnosis of retroperitoneal fibrosis, IgG4-related disease. Kidney biopsy revealed IgG4-related kidney disease with interstitial nephritis. After relief of urinary obstruction by inserting ureteral catheters into the bilateral ureters, renal function recovered.
文摘Objective To evaluate risk factors for postoperative acute renal failure requiring dialysis (ARF-D) after hear valve surgery. Methods Adult patients (age≤18 years) underwent valve surgery with preoperative serum creati nine 【 300 μmol / L were included between January 2005 and December 2008. Fifty patients developed ARF-D
基金supported by grants from Hubei Key Projects of Science and Technology(No.2007AA301B45)Young Researcher Grant of Hubei Health Bureau(No.QJX2008-44)Scientific Research Programs on Clinic Medicine of Wuhan Health Bureau(No.WX08B06).
文摘The surgical emergency treatments and cura-tive effects of postrenal acute renal failure following obstruction due to upper urinary calculi in infants were evaluated.Of the 13 infants with postrenal acute renal failure following obstruction due to upper urinary calculi,11 received retrograded catheterizations of the ureter with semi-rigid ureteroscopy(F 6.8),and two received open ureterolithotomy.The results showed that only one infant had anuresis and continuous reduction of hemoglobin 5 h after the open ureterolithotomy and received exploration via excision and peritoneal dialysis,and the remaining 12 patients well recovered in this group.The renal function of all the patients was restored without postoperative complications.It is concluded that the retrograded catheterization of the ureter with ureteroscopy is a minimally invasive,safe and effective therapy for postrenal acute renal failure following obstruction due to upper urinary calculi in infants.For those infants whose urethras are thin and small,the open ureterolithotomy is a suitable method.But patients with bleeding tendency need to be corrected prior to the open ureterotomy to remove obstructions.
文摘An independent association between acute renal failure(ARF)and intra-abdominal hypertension(IAH)after liver transplantation has not been established previously.The aim of this retrospective study was to understand the role of IAH as an independent risk factor for ARF in the early postoperative period.This study involved 62 subjects who underwent liver transplantation.Intra-abdominal pressure(IAP)was measured in the first three days after surgery by using the urinary bladder technique.An IAP of at least 20 mmHg per day was defined as IAH.Clinical parameters between group IAH and group NO-IAH were compared in terms of the incidence of ARF,blood creatinine levels,blood urea nitrogen(BUN)levels,urine volume per hour and glomerular filtration gradient(GFG).Hemodynamic variations were recorded in the first three postoperative days between group ARF and group NO-ARF.The perioperative suspected risk factors of ARF were determined for statistical evaluation using correlation coefficients and logistic regression analysis.In group IAH,45.8%patients developed ARF as against 7.9%in group NO-IAH;GFG was significantly lower at 0–72 h after surgery;and blood creatinine levels,BUN levels,urine volume per hour were significantly different at 24–72 h after surgery compared with group NO-IAH.The patients with ARF were not significantly different from those without ARF in terms of central venous pressure,pulmonary artery pressure and mean arterial pressure(MAP)in the first three postoperative days despite a significant increase in heart rate at 24–72h after operation.Postoperative IAH,intraoperative MAP and intraoperative blood transfusion volume of more than 15 U were found to be independent risk factors for ARF.IAH impaired renal function and was an independent risk factor for ARF after liver transplantation.Routine measurement should be taken to monitor IAP every eight hours postoperatively.
文摘BACKGROUND Fish gallbladder has long been used as a folk remedy in Asian countries.Multiple organ damage after ingestion of fish gallbladder resulting in near mortality has been known to us.Here,we describe a case of acute renal failure(ARF)and hepatitis due to grass carp gallbladder poisoning and review the literature.CASE SUMMARY A previously healthy,50-year-old woman was admitted to our hospital with a 2-d history of generalized abdominal pain and repeated vomiting following ingestion of two raw grass carp gallbladders in an attempt to alleviate her cough.She developed anuria on day 4 with markedly elevated serum creatinine,urea,bilirubin,alanine aminotransferase,and aspartate aminotransferase.Based on thorough evaluation of her history and prompt biochemical investigations,we diagnosed her with ARF and hepatitis secondary to fish gallbladder poisoning.Her renal biopsy revealed acute tubular necrosis,following which she underwent six sessions of conventional hemodialysis due to renal failure.Supportive treatment with gastric mucosal protectant and liver protectant was administered for targeted organ protection.The patient’s liver function gradually recovered,and serum creatinine was 164 mmol/L at discharge on day 24.Over a follow-up period of 2 wk,her renal function completely recovered.CONCLUSION Physicians should be mindful of toxic complications of raw grass carp gallbladder ingestion and we should promote awareness to reduce incidences of food poisoning.
文摘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 remedy.CASE 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 weakness.In the preceding 1 wk,he had consumed 3 bottles of concentrated juice self-prepared from 1 kg of small sour starfruits.His serum creatinine was noted to be 1101μmol/L from baseline normal prior to his ED visit.He was diagnosed with AKI secondary to excessive starfruit consumption.CONCLUSION Consumption of starfruit can cause acute renal failure,with a good outcome when promptly identified and treated.
文摘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.
文摘BACKGROUND Rhabdomyolysis is a life-threatening condition,often leading to progressive renal failure and death.It is caused by destruction of skeletal muscle and the release of myoglobin and other intracellular contents into the circulation.The most frequent cause of this condition is“crush syndrome”,although several others have been described and paraneoplastic inflammatory myopathies associated with various types of cancer are repeatedly reported.CASE SUMMARY We describe a rare case of a patient with pancreatic cancer who developed rhabdomyolysis early on,possibly due to paraneoplastic myositis leading to acute renal failure and eventually to rapid death.A 78-year-old Caucasian woman was referred to our hospital for obstructive jaundice and weight loss due to a lesion in the pancreatic head.She presented increasingly severe renal insufficiency with anuria,a dramatic increase in creatine phosphokinase(36000 U/L,n.v.20-180 U/L)and myoglobin(>120000μg/L,n.v.12-70μg/L).On clinical examination,the patient showed increasing pain in the lower limbs associated with muscle weakness which was severe enough to immobilize her.Paraneoplastic myopathy linked to the malignant lesion of the pancreatic head was suspected.The patient was treated with hemodialysis and intravenous methylprednisolone.Despite all the efforts to prepare the patient for surgery,her general condition rapidly deteriorated and she eventually died 30 d after hospital admission.CONCLUSION The possible causes of rhabdomyolysis in this patient with pancreatic cancer are discussed,the development of paraneoplastic myopathy being the most likely.Clinicians should bear in mind that these syndromes may become clinically manifest at any stage of the cancer course and their early diagnosis and treatment could improve the patient’s prognosis.
文摘Objective To investigate the risk factors of acute renal injury(acute kidney injury)in patients with acute left heart failure.Methods Clinical data of 188 patients with acute left heart failure who were admitted to our hospital were retrospectively analyzed.Logistic regression analysis was used to assess the risk factors for AKI.
文摘APRT) deficiency is an uncommon genetic cause ofchronic kidney disease due to crystalline nephropathy.Methods: A case of a Chinese boy with APRT defi ciencypresenting with severe acute kidney injury secondaryto obstructive uropathy from multiple renal calculi wasreviewed.Results: The patient underwent staged removal of thecalculi. Infrared spectrometry of the renal calculi showed2,8-dihydroxyadenine. APRT deficiency was confirmedwith abolished APRT enzyme activity in red blood cells.He was started on allopurinol and low purine diet withcomplete resolution of the residual calculi.Conclusion: APRT defi ciency should be considered inpatients with multiple radiolucent renal calculi.
基金supported by a grant from the Scholars in Medicine office,Harvard Medical School.Dr.Tapper was supported by a grant from the Carl J.Shapiro Institute for Education and Research.The content is solely the responsibility of the authors and does not necessarily represent their funding institutions.
文摘Background:Albumin is a critical component in the standard therapeutic approach to acute renal failure(ARF)and spontaneous bacterial peritonitis(SBP)in the setting of ascites.However,data regarding the safety and minimumeffective dose are limited.Methods:We conducted a retrospective review of patients with decompensated cirrhosis who received albumin within the first 48 hours of hospitalization at Beth Israel Deaconess Medical Center between 2010 and 2013.Outcomes included 90-day risk of death or transplantation(primary)and(secondary)complications of albumin infusion(length of stay(LOS)and need for critical care),all adjusted for comorbidity and severity of illness.Results:We included 169 patients with ARF and 88 patients with SBP.The optimal doses of albumin for a survival benefit were found to be 87.5 g and 100 g in the ARF and SBP cohorts,respectively.The odds ratio(OR)for the 90-day risk of death or liver transplantation associated with the optimal loading dose was 0.36(95%CI:0.17-0.76,P=0.008)and 0.28(95%CI:0.07-0.97,P=0.04)for the ARF and SBP cohorts,respectively.This effect persisted for patients with ARF who had neither hepatorenal syndrome(HRS)nor SBP(OR:0.13,95%CI:0.007-0.79,P=0.02).LOS(beta coefficient per log albumin dose:1.69;95%CI:0.14-3.24,P=0.03)and risk of critical care(OR/g albumin:1.03;95%CI:1.01-1.05,P=0.01)were also dose dependent.Conclusion:Albumin has a dose-dependent effect on both survival and complications in patients with cirrhosis with ARF(HRS and otherwise)and/or SBP.
基金Kidney Research UK and the European Union for fundingChina Scholarship Council for funding
文摘Acute kidney injury(AKI) is a major health threat worldwide. The literature on herbal intervention in AKI was searched from English and Chinese databases and reports were critically analyzed in terms of preventing AKI, promoting repair and regeneration, enhancing extrarenal clearance of uremic toxins, and preventing progression to chronic kidney disease(CKD). Altogether, 16 herbal formulae and a few extracts derived from individual herbs were reported to prevent or mitigate AKI in animal models induced by renal ischemia/reperfusion, cisplastin,gentamicin, glycerol, adenine, sepsis or physical exhaustion. Four formulae and six individual herbs were reported to accelerate recovery and/or to prevent CKD in established AKI animal models. Intrarectal herbal medicines, with or without simultaneous oral administration, were reported in six clinical trials and in an animal model to increase extrarenal clearance of uremic toxins. Additional 13 clinical trials reported oral or intravenous herbal interventions in AKI of different etiologies. Despite recurring problems, notably poor compliance with good practice guidelines for clinical trials and for authentication, naming and quality control of herbal materials, accumulating experimental data on the preventive effects of herbal medicines in AKI look encouraging and urge for better, definitive trials to guide clinical practice. Herbal enemas promoting extrarenal clearance of uremic toxins seem cost-effective, but better clinical evidence is certainly needed before any affirmative recommendation be made for AKI patients without access to dialysis. New frontiers, however, lie in those herbal remedies that promote repair/regeneration and prevent chronicity after AKI. Recent experimental data suggest that this may be possible.
