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Turkish Archives of Pediatrics Nov 2022
PubMed: 35866320
DOI: 10.5152/TurkArchPediatr.2022.22049 -
Kidney Medicine Jun 2023Continuous kidney replacement therapy (CKRT) is the predominant form of acute kidney replacement therapy used for critically ill adult patients with acute kidney injury...
RATIONALE & OBJECTIVE
Continuous kidney replacement therapy (CKRT) is the predominant form of acute kidney replacement therapy used for critically ill adult patients with acute kidney injury (AKI). Given the variability in CKRT practice, a contemporary understanding of its epidemiology is necessary to improve care delivery.
STUDY DESIGN
Multicenter, prospective living registry.
SETTING & POPULATION
1,106 critically ill adults with AKI requiring CKRT from December 2013 to January 2021 across 5 academic centers and 6 intensive care units. Patients with pre-existing kidney failure and those with coronavirus 2 infection were excluded.
EXPOSURE
CKRT for more than 24 hours.
OUTCOMES
Hospital mortality, kidney recovery, and health care resource utilization.
ANALYTICAL APPROACH
Data were collected according to preselected timepoints at intensive care unit admission and CKRT initiation and analyzed descriptively.
RESULTS
Patients' characteristics, contributors to AKI, and CKRT indications differed among centers. Mean (standard deviation) age was 59.3 (13.9) years, 39.7% of patients were women, and median [IQR] APACHE-II (acute physiologic assessment and chronic health evaluation) score was 30 [25-34]. Overall, 41.1% of patients survived to hospital discharge. Patients that died were older (mean age 61 vs. 56.8, < 0.001), had greater comorbidity (median Charlson score 3 [1-4] vs. 2 [1-3], P < 0.001), and higher acuity of illness (median APACHE-II score 30 [25-35] vs. 29 [24-33], = 0.003). The most common condition predisposing to AKI was sepsis (42.6%), and the most common CKRT indications were oliguria/anuria (56.2%) and fluid overload (53.9%). Standardized mortality ratios were similar among centers.
LIMITATIONS
The generalizability of these results to CKRT practices in nonacademic centers or low-and middle-income countries is limited.
CONCLUSIONS
In this registry, sepsis was the major contributor to AKI and fluid management was collectively the most common CKRT indication. Significant heterogeneity in patient- and CKRT-specific characteristics was found in current practice. These data highlight the need for establishing benchmarks of CKRT delivery, performance, and patient outcomes. Data from this registry could assist with the design of such studies.
PubMed: 37274539
DOI: 10.1016/j.xkme.2023.100641 -
Journal of Family Medicine and Primary... May 2020Allopurinol is a xanthine oxidase inhibitor used in management of chronic gout. It acts by reducing the amount of uric acid by inhibiting purine metabolism. A...
Allopurinol is a xanthine oxidase inhibitor used in management of chronic gout. It acts by reducing the amount of uric acid by inhibiting purine metabolism. A middle-aged hypertensive female who was on allopurinol for 7 months presented with generalized weakness and exertional dyspnea. Investigations revealed pancytopenia: normocytic normochromic anemia (Hb-3.2g/dL, TLC-3400/mm3) and severe thrombocytopenia (Platelets-1000/mm3) with mild hepatosplenomegaly and grade 2 medico renal disease with normal cardiac status. Nutritional, hemolytic and infective causes were ruled out. She was transfused with fresh whole blood, platelets, administered empirical antibiotics and started on steroids. Initially, she responded to treatment but later developed an episode of convulsions with anuria and succumbed to leukopenic sepsis secondary to hypo/aplastic anemia probably due to allopurinol. Allopurinol is used extensively in the management of chronic gout and is well tolerated due to its safety profile. But we here report a case of allopurinol induced aplastic anemia leading to the demise of a patient. Allopurinol though safe needs careful monitoring.
PubMed: 32754532
DOI: 10.4103/jfmpc.jfmpc_249_20 -
Case Reports in Nephrology and Dialysis 2022Acute kidney injury (AKI) can be a significant clue to solving a puzzling patient presentation. Postrenal AKI should be suspected if imaging shows any degree of...
Acute kidney injury (AKI) can be a significant clue to solving a puzzling patient presentation. Postrenal AKI should be suspected if imaging shows any degree of hydronephrosis and can be caused by a variety of conditions. Diagnosis of urinary obstruction without significant dilatation of the pelvic-ureteral system requires a higher degree of suspicion, and hence, its identification can become late. In patients without prior cancer screening, the etiology of obstructive uropathy must be broadened to include primary or metastatic malignancy. Clinicians should look beyond the AKI to properly evaluate the etiology of the patient's presentation and symptoms. In this report, we present the case of a middle-aged female with no known past medical history who presented with AKI secondary to malignant retroperitoneal fibrosis as the first manifestation of metastatic breast cancer. Her AKI was associated with acute onset anuria and was found to have nondilated postrenal AKI with no significant abnormalities on renal imaging. Early onset anuria in the setting of AKI, which persists despite fluid resuscitation, can suggest complete urinary tract obstruction even with reassuring results of initial renal images, and in the patient with no history of cancer screening, malignancy should be suspected as a primary cause of obstructive uropathy.
PubMed: 35433843
DOI: 10.1159/000522312 -
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 -
Nigerian Medical Journal : Journal of... 2021Ureteric injuries are not uncommon in obstetric and gynaecologic surgeries. Some specific procedures predispose to these injuries. Recognition is often delayed. This...
BACKGROUND
Ureteric injuries are not uncommon in obstetric and gynaecologic surgeries. Some specific procedures predispose to these injuries. Recognition is often delayed. This study aims to present a single-center experience on the presentation, risk factors, and management of ureteric injuries.
METHODOLOGY
We retrospectively reviewed case files of patients primarily presenting or referred to our urology division with ureteric injuries following obstetrics or gynaecologic surgeries from June 2005 to May 2015. Data extracted included the time of presentation or recognition, the specific offending surgery, the laterality, and site involved, the repair performed, and outcome.
RESULTS
Twenty-three patients had injuries (with a total of 25 ureters involved owing to 2 bilateral injuries). Caesarian-section is the commonest offending surgery in 13 (56.5%). The reasons for early recognition were sudden anuria in two and urinary leakage in the operating field in four patients constituting 26.0%, while 17 (74.0%) were recognized in the post-operative period. Urinary fistulae were the commonest presentation in 13 (76.5%) patients recognized postoperatively. Transection and ligation are the commonest mechanisms of injury. The distal third was the site involved in all patients, while ureteroneocystostomy alone was the most predominant repair in 18 (72.0%). Ureteroneocystostomy with Psoas hitch and Boari flap reconstruction was offered in six (24.0%) suggesting greater than5cm ureteral loss.
CONCLUSIONS
Ureteric injuries often occur following obstetrics and gynaecologic surgeries. Caesarian-section is the commonest predisposing surgery in our center. Prompt recognition and repair is recommended.
PubMed: 38716436
DOI: 10.60787/NMJ-62-5-52 -
Annals of Medicine and Surgery (2012) Mar 2022Obstructive Anuria (OA) constitutes a diagnostic and therapeutic emergency involving the vital prognosis of the patient requiring an emergency and multidisciplinary...
INTRODUCTION
Obstructive Anuria (OA) constitutes a diagnostic and therapeutic emergency involving the vital prognosis of the patient requiring an emergency and multidisciplinary care. The etiologies are multiple and the pelvic gynecological cancers represent one of the main causes of OA.
OBJECTIVES
Describing the epidemiological, clinical, paraclinical, etiological, therapeutic and progressive aspects of obstructive anuria of the gynecological origin, in the urology department in the University Hospital Center.
MATERIALS AND METHODS
This is a descriptive and retrospective study spread over a period of 4 years (2016-2019) including all the patients admitted for management of OA secondary to the pelvic gynecological cancers.
RESULTS
102 patients were included in the study whose the mean age was 60 years old (36-84). The main etiologies were cervical cancer (93%), followed by endometrial cancer (5%) and ovarian cancer (2%). The mean time to consultation was 4.5 days (1-8). The main circumstances of discovery were anuria (67%), oligoanuria (21.5%), low back pain (17%) and hematuria (9%). Clinical examination found an altered general condition (Performans Status> 2) in 37.5% of the patients and an advanced local state in 96% of the patients. The means of serum creatinine and blood urea were 122 mg/l and 2.4 g/l respectively. The hemodialysis (HD) was indicated in 29.5% of patients with life-threatening hyperkalemia (Kalemia> 6.4meq/l) with cardiac distress (20.5%), hydro-sodium overload (6%) and metabolic acidosis (3%). The ultrasound-guided percutaneous nephrostomy was the main method of diversion (92%) followed by the placement of the double J stent (8%). The outcome was favorable in the majority of patients with normalization of the kidney function (88%) while 7% of cases kept chronic kidney disease. The main complication was an obstruction syndrome (41%), followed by infections of the percutaneous nephrostomy tubes (13%) and venous thrombosis of the lower limbs (3%). In addition, the mortality was estimated at 5%.
CONCLUSION
The obstructive anuria constitutes a medico-surgical emergency involving the patient's vital prognosis. Our study notes the frequent association between the pelvic gynecological tumors and the obstructive anuria, which can be explained by the advanced stage of these tumors. This work underlines the fundamental interest of early diagnosis of these tumors to enable the prevention of the OA.
PubMed: 35198181
DOI: 10.1016/j.amsu.2022.103332 -
The Tohoku Journal of Experimental... Sep 2020Denys-Drash syndrome is characterized by progressive nephropathy, gonadal dysgenesis, and Wilms tumor caused by a WT1 gene mutation. Infants with Denys-Drash syndrome...
Denys-Drash syndrome is characterized by progressive nephropathy, gonadal dysgenesis, and Wilms tumor caused by a WT1 gene mutation. Infants with Denys-Drash syndrome frequently experience severe hypertension, but detailed clinical manifestations have yet to be clarified. Cases of infantile-onset Denys-Drash syndrome with severe hypertension at our hospital were retrospectively analyzed and the pathogenesis of hypertension was investigated. Six infants who received the diagnosis of Denys-Drash syndrome at the median age of 10 days (range: 2-182 days) were enrolled. Five infants had the complication of severe hypertension within a few days of diagnosis. All the patients showed rapid progression to end-stage renal disease and urgently required dialysis due to anuria/oliguria and hypervolemia with a median duration of 7.5 days (range: 0-17 days) on the day after diagnosis. Even under dialysis, all the patients continued to need antihypertensive treatment. Five patients underwent a preventive nephrectomy for Wilms tumor, and one patient underwent a nephrectomy due to progression to Wilms tumor. Two patients developed hypotension after a nephrectomy. The main causes of hypertension were hypervolemia in the predialysis stage, renin-associated hypertension in the dialysis stage, and multiple factors, including increased plasma catecholamine-associated hypertension in the postnephrectomy dialysis stage. At last the follow-up after bilateral nephrectomy, four of the five patients required antihypertensive treatment. Not all the patients showed target organ complications caused by hypertension. Severe hypertension is a common complication of infantile-onset Denys-Drash syndrome. The possibility of hypotension after nephrectomy should be considered in patients with Denys-Drash syndrome.
Topics: Age of Onset; Denys-Drash Syndrome; Humans; Hypertension; Hypotension; Infant; Infant, Newborn; Nephrectomy; Organ Specificity
PubMed: 32863338
DOI: 10.1620/tjem.252.45 -
BMC Nephrology Dec 2020Fluid overload is common in patients in the intensive care unit (ICU) and ultrafiltration (UF) is frequently required. There is lack of guidance on optimal UF practice....
BACKGROUND
Fluid overload is common in patients in the intensive care unit (ICU) and ultrafiltration (UF) is frequently required. There is lack of guidance on optimal UF practice. We aimed to explore patterns of UF practice, barriers to achieving UF targets, and concerns related to UF practice among practitioners working in Europe.
METHODS
This was a sub-study of an international open survey with focus on adult intensivists and nephrologists, advanced practice providers, and ICU and dialysis nurses working in Europe.
RESULTS
Four hundred eighty-five practitioners (75% intensivists) from 31 countries completed the survey. The most common criteria for UF initiation was persistent oliguria/anuria (45.6%), followed by pulmonary edema (16.7%). Continuous renal replacement therapy was the preferred initial modality (90.0%). The median initial and maximal rate of net ultrafiltration (UF) prescription in hemodynamically stable patients were 149 mL/hr. (IQR 100-200) and 300 mL/hr. (IQR 201-352), respectively, compared to a median UF rate of 98 mL/hr. (IQR 51-108) in hemodynamically unstable patients and varied significantly between countries. Two-thirds of nurses and 15.5% of physicians reported assessing fluid balance hourly. When hemodynamic instability occurred, 70.1% of practitioners reported decreasing the rate of fluid removal, followed by starting or increasing the dose of a vasopressor (51.3%). Most respondents (90.7%) believed in early fluid removal and expressed willingness to participate in a study comparing protocol-based fluid removal versus usual care.
CONCLUSIONS
There was a significant variation in UF practice and perception among practitioners in Europe. Future research should focus on identifying the best strategies of prescribing and managing ultrafiltration in critically ill patients.
Topics: Continuous Renal Replacement Therapy; Critical Care; Critical Care Nursing; Diuretics; Europe; Humans; Intensive Care Units; Intermittent Renal Replacement Therapy; Nephrologists; Nurse Practitioners; Nurses; Practice Patterns, Physicians'; Pulmonary Edema; Surveys and Questionnaires; Water-Electrolyte Imbalance
PubMed: 33256635
DOI: 10.1186/s12882-020-02184-y -
Inflammopharmacology Feb 2022A novel coronavirus disease (COVID-19), caused by a severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), was discovered in Wuhan, China, in December 2019, and... (Review)
Review
A novel coronavirus disease (COVID-19), caused by a severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), was discovered in Wuhan, China, in December 2019, and the world has suffered from a pandemic. As of 22nd March 2020, at least 185 countries worldwide had been affected by COVID-19. SARS-CoV-2, leading to COVID-19 pneumonia, infects cells through ACE-2 receptors. The disease has different clinical signs and symptoms, including chills, high fever, dyspnea, and cough. Other symptoms including haemoptysis, myalgia, diarrhoea, expectoration, and fatigue may also occur. The rapid rise in confirmation cases is severe in preventing and controlling COVID-19. In this review, the article will explore and evaluate the insights into how COVID influences patients with other comorbid conditions such as cardiovascular disease, diabetes, Parkinson's, and how conditions Urolithiasis, anosmia, and anuria may develop after infection. The virus mutates and the variants are now prevalent in the present scenario where the world stands in eradicating the pandemic by looking into the development of vaccines by several countries and how the vaccination can temporarily help prevent COVID spread.
Topics: Humans; Pandemics; Renin-Angiotensin System; SARS-CoV-2; Vaccination; COVID-19 Drug Treatment
PubMed: 34981320
DOI: 10.1007/s10787-021-00904-w