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Journal of the Intensive Care Society Nov 2022A 76-year-old lady was found on the floor following a fall at home. She was uninjured, but unable to get up, and had been lying on the floor for roughly 18 hours before...
A 76-year-old lady was found on the floor following a fall at home. She was uninjured, but unable to get up, and had been lying on the floor for roughly 18 hours before her son arrived. She had been unwell for the past 3 days with a cough and shortness of breath. She had a past medical history of diabetes, hypertension, hypercholesterolaemia and atrial fibrillation (AF). On examination, she was alert but distressed, clinically dehydrated, febrile and tachycardic. She was treated for community acquired pneumonia with co-amoxiclav and was fluid resuscitated with Hartmann's solution. Her hyperkalaemia was treated with 50 mL of 50% glucose containing 10 units of rapid-acting insulin. Her creatinine kinase (CK) on admission was 200,000, and she had an acute kidney injury (AKI). Urine dipstick was positive for blood. However, her renal function continued to deteriorate over the succeeding 48 h, when she required renal replacement therapy (RRT) due to fluid overload and anuria.
PubMed: 36751356
DOI: 10.1177/17511437211050782 -
International Urology and Nephrology Jun 2017Pyocystis, empyema cystis, vesical empyema are all terms that describe the purulent filled bladder that may develop in patients with defunctionalized bladders such as... (Review)
Review
Pyocystis, empyema cystis, vesical empyema are all terms that describe the purulent filled bladder that may develop in patients with defunctionalized bladders such as after supravesical urinary diversion without cystectomy or in patients with end-stage renal disease with anuria. It is a severe form of lower urinary tract infection. In addition to the local symptoms of suprapubic pain and malodorous discharge, the condition can be more serious with bacterial dissemination into the blood stream and ensuing sepsis and even mortality. The current review will discuss the pathogenesis, risk factors and management of this commonly forgotten complication of urinary diversion.
Topics: Anti-Bacterial Agents; Anuria; Cystectomy; Empyema; Humans; Risk Factors; Therapeutic Irrigation; Urinary Bladder; Urinary Bladder Diseases; Urinary Diversion
PubMed: 28265966
DOI: 10.1007/s11255-017-1562-6 -
Current Opinion in Critical Care Dec 2018Sepsis-induced acute kidney injury (SI-AKI) represents the first cause of AKI in ICUs, and renal replacement therapy (RRT) is frequently applied in advanced AKI stages.... (Review)
Review
PURPOSE OF REVIEW
Sepsis-induced acute kidney injury (SI-AKI) represents the first cause of AKI in ICUs, and renal replacement therapy (RRT) is frequently applied in advanced AKI stages. The debate between 'rescue' indications for RRT start in patients with severe AKI (acidosis, hyperkalemia, uremia, oliguria/anuria, volume overload) and a proactive RRT initiation is still ongoing. In addition, current SI-AKI pathophysiologic theory has identified the toxic effects of soluble middle-molecules released during sepsis and inflammation (pathogen and damaged associated molecular patterns).The purpose of the present review is to summarize the recent literature on RRT for patients with SI-AKI. Supportive or replacement measures for severe stages of renal dysfunction and blood purification techniques for sepsis syndrome will be reviewed.
RECENT FINDINGS
Anticipated RRT for SI-AKI does not seem to improve survival or renal recovery. There is no clinical advantage by delivering continuous RRT at high doses for blood purification purposes. Similarly, specific applications with dedicated devices and membranes have yielded no clinical benefit in these patients, so far.
SUMMARY
In the present review, the recent insights and results from large randomized and nonrandomized trials in the area of RRT applied both as supportive measures for kidney failure and blood purification techniques are described.
Topics: Acute Kidney Injury; Clinical Protocols; Humans; Intensive Care Units; Randomized Controlled Trials as Topic; Renal Replacement Therapy; Sepsis; Treatment Outcome; Water-Electrolyte Balance
PubMed: 30239411
DOI: 10.1097/MCC.0000000000000544 -
Journal of Complementary & Integrative... Oct 2018Background Euphorbia granulata is herb of family Euphorbiaceae having several traditional uses. The aim of the study is to summarize reported nutritional and medicinal... (Review)
Review
Background Euphorbia granulata is herb of family Euphorbiaceae having several traditional uses. The aim of the study is to summarize reported nutritional and medicinal value along with ethnomedical records. Methods The papers on nutritional and medicinal value of E. granulata are collected from electronic search engines (Google Scholar, PubMed). Synonyms are confirmed from "The plant List." Results Pharmacological studies suggest that the extracts of E. granulata possess antioxidant, antibacterial, antifungal, diuretic, antiulcerative colitis and spasmolytic properties. Moreover, it is rich with nutritive components such as carbohydrates, lipid contents (saturated and unsaturated fatty acids), minerals and protein (amino acids). Toxicological data of E. granulata showed that it may be poisonous and toxic at higher doses. Conclusion Research studies suggest that E. granulata has sufficient pharmacological potential against several diseases including infections, gastric ulcers, anuria, oliguria and spasmodic disorders; however, more research is required to confirm its pharmacological potential. Moreover, dose fixation studies should be carried out to avoid its toxicity.
Topics: Amino Acids; Animals; Carbohydrates; Euphorbia; Humans; Lipids; Medicine, Traditional; Nutritive Value; Plant Extracts
PubMed: 30312167
DOI: 10.1515/jcim-2018-0149 -
Saudi Journal of Kidney Diseases and... May 2023Naphthalene is a widely available moth repellant in the Asian subcontinent. Toxicity can occur either accidentally or intentionally as a suicide attempt. An overdose can...
Naphthalene is a widely available moth repellant in the Asian subcontinent. Toxicity can occur either accidentally or intentionally as a suicide attempt. An overdose can lead to a variety of clinical symptoms, including intravascular hemolysis, and can sometimes lead to life-threatening clinical situations. A young male was admitted to our center with an alleged history of ingesting an unknown quantity of naphthalene balls (mothballs). He developed methemoglobinemia, intra-vascular hemolysis, anuria, and acute kidney injury (AKI), followed by cardiorespiratory arrest. He was treated successfully with intravenous methylene blue and dialysis. Naphthalene toxicity can lead to methemoglobinemia and intravascular hemolysis. This can result in AKI caused by pigment nephropathy.
Topics: Humans; Male; Hemolysis; Methemoglobinemia; Methylene Blue; Acute Kidney Injury; Naphthalenes
PubMed: 38231722
DOI: 10.4103/1319-2442.394000 -
International Journal of Nephrology 2020Acute kidney injury secondary to obstructive nephropathy is a frequent event that accounts for 5 to 10% of all acute kidney injury cases and has a great impact on the... (Review)
Review
Acute kidney injury secondary to obstructive nephropathy is a frequent event that accounts for 5 to 10% of all acute kidney injury cases and has a great impact on the morbidity and mortality in those affected. The obstruction in the urinary tract has a profound impact on kidney function due to damage produced by ischemic and inflammatory factors that have been associated with intense fibrosis. This pathology is characterized by its effects on the management of fluids, electrolytes, and the acid-base mechanisms by the renal tubule; consequently, metabolic acidosis, hyperkalemia, uremia, and anuria are seen during acute kidney injury due to obstructive nephropathy, and after drainage, polyuria may occur. Acute urine retention is the typical presentation. The diagnosis consists of a complete medical history and should include changes in urinary voiding and urgency and enuresis, history of urinary tract infections, hematuria, renal lithiasis, prior urinary interventions, and constipation. Imaging studies included tomography or ultrasound in which hydronephrosis can be seen. Management includes, in addition to drainage of the obstructed urinary tract system, providing supportive treatment, correcting all the metabolic abnormalities, and initiating renal replacement therapy when required. Although its recovery is in most cases favorable, it seems to be an undervalued event in nephrology and urology. This is because it is mistakenly believed that the resolution and recovery of kidney function is complete once the urinary tract is unobstructed. It can have serious kidney sequelae. In this review, we report the epidemiology, incidence, pathophysiological mechanisms, diagnosis, and treatment of acute kidney injury due to obstructive nephropathy.
PubMed: 33312728
DOI: 10.1155/2020/8846622 -
Turkish Archives of Pediatrics Nov 2022
PubMed: 35866320
DOI: 10.5152/TurkArchPediatr.2022.22049 -
Kidney International Sep 2023The management of volume status in dialysis patients is an important determinant of the rate of decline of residual kidney function. The implementation of clinical...
The management of volume status in dialysis patients is an important determinant of the rate of decline of residual kidney function. The implementation of clinical protocols to guide volume management in the in-center hemodialysis unit resulted in comparable rates of development of anuria and decline in residual kidney function when compared with bioimpedance spectroscopy-guided volume management. Clinical judgment and experience are important drivers of patient outcomes. The importance and applicability of bioimpedance spectroscopy in other clinical settings, such as units without clear volume management protocols or in home dialysis units, remain to be seen.
Topics: Humans; Renal Dialysis; Hemodialysis, Home; Anuria
PubMed: 37599016
DOI: 10.1016/j.kint.2023.06.033 -
Medicina Intensiva Nov 2023The use of ultrasound while caring for critically ill patients has been increasing exponentially in the last two decades and now is an essential component of intensive... (Review)
Review
The use of ultrasound while caring for critically ill patients has been increasing exponentially in the last two decades and now is an essential component of intensive care practice. Abdominal ultrasound is an established technique in other specialties, but its use in intensive care has lagged behind other ultrasound modalities. However, its potential role in the diagnosis and management of patients will make it an invaluable tool for intensivists. The main use of abdominal ultrasound at the bedside is for free fluid detection in trauma patients. But abdominal ultrasound can also help us diagnose patients with abdominal pain, hypovolemia or anuria, and it can guide us during procedures such as paracentesis or bladder catheter and gastric tube placement.
Topics: Humans; Critical Care; Ultrasonography; Abdomen; Abdominal Pain; Paracentesis; Hypovolemia; Abdominal Injuries
PubMed: 38783747
DOI: 10.1016/j.medine.2023.06.008