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Journal of Clinical Medicine Jan 2020The aim of our study was to assess the association between the macrohemodynamic profile and sepsis induced acute kidney injury (AKI). We also investigated which...
The aim of our study was to assess the association between the macrohemodynamic profile and sepsis induced acute kidney injury (AKI). We also investigated which minimally invasive hemodynamic parameters may help identify patients at risk for sepsis-AKI. We included 71 patients with sepsis and septic shock. We performed the initial fluid resuscitation using local protocols and continued to give fluids guided by the minimally invasive hemodynamic parameters. We assessed the hemodynamic status by transpulmonary thermodilution technique. Sequential organ failure assessment (SOFA score) (AUC 0.74, 95% CI 0.61-0.83, < 0.01) and cardiovascular SOFA (AUC 0.73, 95% CI 0.61-0.83, < 0.01) were found to be predictors for sepsis-induced AKI, with cut-off values of 9 and 3 points respectively. Persistent low stroke volume index (SVI) ≤ 32 mL/m/beat (AUC 0.67, 95% CI 0.54-0.78, < 0.05) and global end-diastolic index (GEDI) < 583 mL/m (AUC 0.67, 95% CI 0.54-0.78, < 0.05) after the initial fluid resuscitation are predictive for oliguria/anuria at 24 h after study inclusion. The combination of higher vasopressor dependency index (VDI, calculated as the (dobutamine dose × 1 + dopamine dose × 1 + norepinephrine dose × 100 + vasopressin × 100 + epinephrine × 100)/MAP) and norepinephrine, lower systemic vascular resistance index (SVRI), and mean arterial blood pressure (MAP) levels, in the setting of normal preload parameters, showed a more severe vasoplegia. Severe vasoplegia in the first 24 h of sepsis is associated with a higher risk of sepsis induced AKI. The SOFA and cardiovascular SOFA scores may identify patients at risk for sepsis AKI. Persistent low SVI and GEDI values after the initial fluid resuscitation may predict renal outcome.
PubMed: 31935904
DOI: 10.3390/jcm9010151 -
The American Journal of Case Reports Sep 2023BACKGROUND Legionnaires' disease is one of the most common types of community-acquired pneumonia. It can cause acute kidney injury and also occasionally become severe...
BACKGROUND Legionnaires' disease is one of the most common types of community-acquired pneumonia. It can cause acute kidney injury and also occasionally become severe enough to require continuous renal replacement therapy (CRRT). Non-occlusive mesenteric ischemia (NOMI) is a condition characterized by ischemia and necrosis of the intestinal tract without organic obstruction of the mesenteric vessels and is known to have a high mortality rate. CASE REPORT A 72-year-old man with fatigue and dyspnea was diagnosed with Legionnaires' disease after a positive result in the Legionella urinary antigen test pneumonia confirmed by chest radiography and computed tomography. He developed acute kidney injury, with anuria, rhabdomyolysis, septic shock, respiratory failure, and metabolic acidosis. We initiated treatment with antibiotics, catecholamines, mechanical ventilation, CRRT, steroid therapy, and endotoxin absorption therapy in the Intensive Care Unit. Despite ongoing CRRT, metabolic acidosis did not improve. The patient was unresponsive to treatment and died 5 days after admission. The autopsy revealed myoglobin nephropathy, multiple organ failure, and NOMI. CONCLUSIONS We report a fatal case of Legionnaires' disease complicated by rhabdomyolysis, acute kidney injury, myoglobin cast nephropathy, and NOMI. Legionella pneumonia complicated by acute kidney injury is associated with a high mortality rate. In the present case, this may have been further exacerbated by the complication of NOMI. In our clinical practice, CRRT is a treatment option for septic shock complicated by acute kidney injury. Thus, it is crucial to suspect the presence of NOMI when persistent metabolic acidosis is observed, despite continuous CRRT treatment.
Topics: Male; Humans; Aged; Legionnaires' Disease; Mesenteric Ischemia; Myoglobin; Shock, Septic; Rhabdomyolysis; Acute Kidney Injury
PubMed: 37742066
DOI: 10.12659/AJCR.940792 -
JNMA; Journal of the Nepal Medical... Jan 2022Leptospirosis, an underreported disease, is a highly prevalent spirochaetal zoonotic disease in both tropical and temperate climates. Symptoms can range from mild...
Leptospirosis, an underreported disease, is a highly prevalent spirochaetal zoonotic disease in both tropical and temperate climates. Symptoms can range from mild illness to potentially life-threatening infection. Laboratory tests are nonspecific. Microbiological confirmation is not widely available in endemic developing countries like Nepal. We need to rely on the serologic test, which has its own pitfalls in the initial days of illness. Here, we report a case of 56 years old female from the western region of Nepal who presented with fever, jaundice and anuria. She initially tested negative for leptospirosis but was later found to be positive in the second week of illness. Unlike the usual non-oliguric renal failure in leptospirosis, she presented with anuria requiring haemodialysis and subsequently had a good recovery with treatment. We highlight the importance of clinical suspicion and logical interpretation of serologic tests based on its timing from the onset of illness.
Topics: Anuria; Female; Fever; Humans; Leptospirosis; Middle Aged; Nepal; Renal Dialysis
PubMed: 35199683
DOI: 10.31729/jnma.6240 -
Cureus Dec 2021Reflex anuria (RA) is a rare cause of abrupt reduction of urine output following trauma, irritation, or painful stimuli to the kidneys, ureters, or surrounding organs....
Reflex anuria (RA) is a rare cause of abrupt reduction of urine output following trauma, irritation, or painful stimuli to the kidneys, ureters, or surrounding organs. The mechanism of RA is a reflex spasm of both ureters and/or renal arterioles. It is a well-documented complication of colorectal surgeries and gynecological surgeries which involve placement of a ureteric stent for ureteric identification and prevention of injury. RA and post-renal obstruction can both be complications of intraperitoneal hyperthermic chemotherapy (HIPEC) in patients who are undergoing surgery for colorectal cancer and peritoneal carcinomatosis. HIPEC procedure can lead to inflammation of the entire abdomen, including the ureters. This inflammation can result in hematuria that can form clots along the urinary tract and cause post-renal obstruction. The inflammation can also result in RA. It is essential to maintain high urine output during the early postoperative period to prevent clots and the ensuing post renal obstruction. It is also important to identify RA and maintain a low threshold to treat it by placing ureteric stents even in the absence of overt bilateral hydronephrosis.
PubMed: 35018265
DOI: 10.7759/cureus.20269 -
BMC Nephrology Oct 2022Concomitant occurrence of anti-GBM disease and anti-PLA2R positive membranous nephropathy have been previously described. However, to the best of our knowledge, this is...
BACKGROUND
Concomitant occurrence of anti-GBM disease and anti-PLA2R positive membranous nephropathy have been previously described. However, to the best of our knowledge, this is the first case report that documents the co-occurrence of the diseases proven by both serologic and histologic methods.
CASE PRESENTATION
A 51-year-old woman presented to hospital with nausea, bilateral lower extremity edema, dyspnea, dark urine, and then anuria. Symptoms developed one month after an upper respiratory tract infection. Laboratory results showed acute kidney injury, and hypoalbuminemia. Immunologic examination revealed both anti-GBM and anti-PLA2R positivity. Kidney biopsy demonstrated the histological features of Goodpasture's disease and anti-PLA2R positive membranous nephropathy. Steroid, cyclophosphamide, and plasmapheresis were commenced. Despite the combined immunosuppressive, the patient remained on renal replacement therapy.
CONCLUSIONS
Microbial kidney injury can trigger multiple autoimmune diseases. The simultaneous occurrence of anti-glomerular basement (anti-GBM) disease and membranous nephropathy is extremely rare. Delayed recognition leads to delayed treatment, causing worse renal and patient outcomes, as well as increased financial costs.
Topics: Female; Humans; Middle Aged; Anti-Glomerular Basement Membrane Disease; Glomerulonephritis, Membranous; Autoantibodies; Kidney Glomerulus; Cyclophosphamide
PubMed: 36271343
DOI: 10.1186/s12882-022-02941-1 -
Tropical Medicine and Infectious Disease Jan 2022Rapid identification of patients likely to develop pulmonary complications in severe leptospirosis is crucial to prompt aggressive management and improve survival. The...
Rapid identification of patients likely to develop pulmonary complications in severe leptospirosis is crucial to prompt aggressive management and improve survival. The following article is a cohort study of leptospirosis patients admitted at the National Kidney and Transplant Institute (NKTI). Logistic regression was used to predict pulmonary complications and obtain a scoring tool. The Kaplan-Meir method was used to describe survival rates. Among 380 patients with severe leptospirosis and kidney failure, the overall mortality was 14%, with pulmonary hemorrhage as the most common cause. In total, there were 85 (22.4%) individuals who developed pulmonary complications, the majority (95.3%) were observed within three days of admission. Among the patients with pulmonary complications, 56.5% died. Patients placed on mechanical ventilation had an 82.1% mortality rate. Multivariate analyses showed that dyspnea (OR = 28.76, < 0.0001), hemoptysis (OR = 20.73, < 0.0001), diabetes (OR = 10.21, < 0.0001), renal replacement therapy (RRT) requirement (OR = 6.25, < 0.0001), thrombocytopenia (OR = 3.54, < 0.0029), and oliguria/anuria (OR = 3.15, < 0.0108) were significantly associated with pulmonary complications. A scoring index was developed termed THe-RADS score (Thrombocytopenia, Hemoptysis, RRT, Anuria, Diabetes, Shortness of breath). The odds of developing pulmonary complications were 13.90 times higher among patients with a score >2 (63% sensitivity, 88% specificity). Pulmonary complications in severe leptospirosis with kidney failure have high mortality and warrant timely and aggressive management.
PubMed: 35051123
DOI: 10.3390/tropicalmed7010007 -
Frontiers in Genetics 2022Epidermolysis bullosa (EB) is a rare and genetically heterogeneous disorder characterized by skin fragility and blister formation occurring spontaneously or after minor...
Epidermolysis bullosa (EB) is a rare and genetically heterogeneous disorder characterized by skin fragility and blister formation occurring spontaneously or after minor trauma. EB is accompanied by congenital absence of skin (EB with CAS) in some patients. Pathogenic variants of are responsible for EB with CAS in the vast majority of cases. Type and subtype diagnosis of EB with CAS generally requires specific immunohistological examinations that are not widely available plus targeted gene analysis. The present study aimed to determine the clinical features of five patients affected by EB with CAS and to identify the underlying genetic defects using whole exome sequencing (WES) followed by focused analysis of the target genes. Four patients had generalized skin involvement and one had localized defects. Two patients exhibited extremely severe skin manifestations and congenital cloudy cornea along with pyloric atresia, and one had partial esophagogastric obstruction and anuria due to vesicoureteric obstruction. In the WES analysis, the average coverage of the target exons was 99.05% (726 of 733 exons), with a range of 96.4-100% for individual genes. We identified four novel and two known pathogenic/likely pathogenic variants of five distinct genes in the examined families: :c.2536G > T (p.Glu846Ter); :c.3385C > T (p.Arg1129Ter); :c.429G > A (p.Glu477Lys); c.794dupC (p.Ala266SerfsTer5); :c.5440C > T (p.Arg1814Cys); and :c.6103delG. All alleles were inherited from the parents, except for the variant as a finding. The findings reveal extremely rare phenotypes found in EB with CAS, namely congenital cloudy cornea, esophagogastric obstruction, and anuria, and extend the genotypic spectrum of EB-related genes. The data confirm that WES provides very high coverage of coding exons/genes and support its use as a reasonable alternative method for diagnosis of EB. The present data from an underrepresented population in Southeast Asia could further broaden the knowledge and research on EB.
PubMed: 35432467
DOI: 10.3389/fgene.2022.847150 -
Journal of Infection in Developing... Nov 2020Imported parasitosis, which do not require an invertebrate vector, are extremely dangerous and can lead to the occurrence of disease in currently parasite free areas. In...
INTRODUCTION
Imported parasitosis, which do not require an invertebrate vector, are extremely dangerous and can lead to the occurrence of disease in currently parasite free areas. In the present study we report a case of multi-parasitic infection in a young immigrant from Ghana to Italy caused by filaria, Schistosoma sp. and Strongyloides sp.
CASE PRESENTATION
A 27-year-old Ghanaian man attended the Hospital of Nuoro (Sardinia), Italy, at the end of August 2015, claiming pain to the kidney and hypertensive crisis; the patient presented with dyspnea and epistaxis, chronic itchy skin of the back, shoulders, arms and legs, anuria and high creatinine, metabolic acidosis and hypereosinophilic syndrome. Serological test for parasitic infections were done, and showed a marked positivity for filaria, Schistosoma sp. and Strongyloides sp. The patient started the treatment immediately with two doses per day of Bassado Antibiotic (tetracycline) for twenty days and then with a single dose of 3 mg of ivermectin that was repeated after 3 months.
CONCLUSIONS
Immigrant patients from endemic areas who show clinical signs, such as a general itching on the back, shoulders and arms and legs, should have a thorough history in order to make early diagnosis and prevent further complications. Therefore, general practitioners and doctors in Europe and in other parasitosis non-endemic countries, should consider to test for parasites in any immigrant from endemic countries to aid in establishing the final diagnosis and prevent further complications.
Topics: Adult; Animals; Anthelmintics; Coinfection; Communicable Diseases, Imported; Emigrants and Immigrants; Filariasis; Ghana; Humans; Italy; Male; Schistosoma; Schistosomiasis; Strongyloides; Strongyloidiasis
PubMed: 33296350
DOI: 10.3855/jidc.13151 -
Acta Obstetricia Et Gynecologica... Jan 2022Ureteric injury is a rare but serious, iatrogenic complication of hysterectomy. The risk depends on indication for surgery, predisposing risk factors, and peroperative...
INTRODUCTION
Ureteric injury is a rare but serious, iatrogenic complication of hysterectomy. The risk depends on indication for surgery, predisposing risk factors, and peroperative conditions. Our aims were to evaluate and learn from compensation claims to The Norwegian System of Patient Injury Compensation (NPE) for ureteric injury occurring during hysterectomies to predict risk factors, time of identification, symptoms, and consequences, and to relate these cases to injuries registered in The Norwegian Patient Registry.
MATERIAL AND METHODS
A retrospective study of ureteric injuries occurring during hysterectomies, reported to NPE and the Norwegian Patient Registry from 2009 through 2019.
RESULTS
During the study period, 53 096 hysterectomies were registered in The Norwegian Patient Registry, of which ureteric injury was documented in 643 (1.2%). More ureteric injuries were registered in large hospital trusts than in small trusts (1.3% vs. 0.7%, p < 0.05). NPE received 69 claims due to ureteric injury occurring during hysterectomy, comprising 11% of all injuries in the study period. Compensation was approved for 15%. Women who claimed compensation were younger (48.1 ± 8.9 years vs. 55.1 ± 13.6 years, p < 0.01), more likely to have had a benign diagnosis (89.9% vs. 52.1%, p < 0.01), and more likely to have had the ureteric injury recognized after discharge (58.0% vs. 33.0%, p < 0.001) compared with non-complainants. Identification of the ureters during the hysterectomy was documented in 30% of the NPE patient files. Additional information for the NPE cases included the following. The most common symptoms of unidentified injury were pain (77%), fever (12%), urinary leakage (13%), and anuria (8%). Re-operation was necessary in 77% of the cases, and 10% of the women lost one kidney. Long-term consequences after repair, such as loss of a kidney or persistent pain, were seen in 17%. No women died because of the injury.
CONCLUSIONS
The incidence of ureteric injury occurring during hysterectomy in Norway was 1.2%; 11% involved a claim for compensation, and 15% of these had their case approved. Most ureteric injuries were not recognized during the hysterectomy. Documentation of peroperative identification of the ureters during hysterectomy was often missing. Vigilance to pain as a postoperative symptom of peroperative unrecognized ureteric injury may result in earlier diagnosis and treatment.
Topics: Adult; Compensation and Redress; Female; Humans; Hysterectomy; Iatrogenic Disease; Insurance Claim Review; Middle Aged; Norway; Postoperative Complications; Retrospective Studies; Ureter
PubMed: 34766333
DOI: 10.1111/aogs.14293 -
World Journal of Nephrology Jan 2022Unilateral small-sized kidney is a radiological term referring to both the congenital and acquired causes of reduced kidney volume. However, the hypoplastic kidney may...
BACKGROUND
Unilateral small-sized kidney is a radiological term referring to both the congenital and acquired causes of reduced kidney volume. However, the hypoplastic kidney may have peculiar clinical and radiological characterizations.
AIM
To evaluate the clinical presentations, complications, and management approaches of the radiologically diagnosed unilateral hypoplastic kidney.
METHODS
A retrospective review of the records of patients with a radiological diagnosis of unilateral hypoplastic kidney between July 2015 and June 2020 was done at Assiut Urology and Nephrology Hospital, Assiut University, Egypt.
RESULTS
A total of 33 cases were diagnosed to have unilateral hypoplastic kidney with a mean (range) age of 39.5 ± 11.2 (19-73) years. The main clinical presentation was loin pain (51.5%), stone passer (9.1%), anuria (12.1%), accidental discovery (15.2%), or manifestations of urinary tract infections (12.1%). Computed tomography was the most useful tool for radiological diagnosis. However, radioisotope scanning could be requested for verification of surgical interventions and nephrectomy decisions. Urolithiasis occurred in 23 (69.7%) cases and pyuria was detected in 22 (66.7%) cases where the infection was documented by culture and sensitivity test in 19 cases. While the non-complicated cases were managed by assurance only (12.1%), nephrectomy (15.2%) was performed for persistent complications. However, symptomatic (27.3%) and endoscopic (45.6%) approaches were used for the management of correctable complications.
CONCLUSION
Unilateral hypoplastic kidney in adults has various complications that range from urinary tract infections to death from septicemia. Diagnosis is mainly radiological and management is usually conservative or minimally invasive.
PubMed: 35117977
DOI: 10.5527/wjn.v11.i1.30