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Kidney International Reports Nov 2023Drug-induced acute kidney injury (DI-AKI) is a frequent adverse event. The identification of DI-AKI is challenged by competing etiologies, clinical heterogeneity among...
INTRODUCTION
Drug-induced acute kidney injury (DI-AKI) is a frequent adverse event. The identification of DI-AKI is challenged by competing etiologies, clinical heterogeneity among patients, and a lack of accurate diagnostic tools. Our research aims to describe the clinical characteristics and predictive variables of DI-AKI.
METHODS
We analyzed data from the Drug-Induced Renal Injury Consortium (DIRECT) study (NCT02159209), an international, multicenter, observational cohort study of enriched clinically adjudicated DI-AKI cases. Cases met the primary inclusion criteria if the patient was exposed to at least 1 nephrotoxic drug for a minimum of 24 hours prior to AKI onset. Cases were clinically adjudicated, and inter-rater reliability (IRR) was measured using Krippendorff's alpha. Variables associated with DI-AKI were identified using L1 regularized multivariable logistic regression. Model performance was assessed using the area under the receiver operating characteristic curve (ROC AUC).
RESULTS
A total of 314 AKI cases met the eligibility criteria for this analysis, and 271 (86%) cases were adjudicated as DI-AKI. The majority of the AKI cases were recruited from the United States (68%). The most frequent causal nephrotoxic drugs were vancomycin (48.7%), nonsteroidal antiinflammatory drugs (18.2%), and piperacillin/tazobactam (17.8%). The IRR for DI-AKI adjudication was 0.309. The multivariable model identified age, vascular capacity, hyperglycemia, infections, pyuria, serum creatinine (SCr) trends, and contrast media as significant predictors of DI-AKI with good performance (ROC AUC 0.86).
CONCLUSION
The identification of DI-AKI is challenging even with comprehensive adjudication by experienced nephrologists. Our analysis identified key clinical characteristics and outcomes of DI-AKI compared to other AKI etiologies.
PubMed: 38025217
DOI: 10.1016/j.ekir.2023.07.037 -
BMC Urology Nov 2023Ectopic kidney and median arcuate ligament syndrome are both rare conditions. The clinical presentation and diagnosis of these conditions are not well studied. There are...
BACKGROUND
Ectopic kidney and median arcuate ligament syndrome are both rare conditions. The clinical presentation and diagnosis of these conditions are not well studied. There are no reports on the combination of these two rare conditions.
CASE PRESENTATION
We report a 24-year-old woman with fever, dysuria, urinary frequency and left flank pain for two days. The primary diagnoses in the clinic were left acute pyelonephritis and left hydronephrosis due to throbbing pain in the left costovertebral angle and pyuria. However, further computed tomography showed right ectopic pelvic kidney, left renal pelvis dilatation without definite ureteral lesion, good bilateral renal contrast enhancement, and compression of the celiac axis due to obstruction by the median arcuate ligament. Chronic abdominal symptoms were reported by the patient after repeat history taking. The patient's condition was fully explained and discussed with her and her family, but they refused further therapy. After the acute pyelonephritis began improving, the patient was discharged for follow-up at our outpatient clinic.
CONCLUSION
We present an extremely rare case of a combination of two rare conditions: ectopic kidney and median arcuate ligament syndrome. No study to date has reported on the relationship between the two diseases. Given the rarity of the two conditions, no evidence or even a hypothesis exists to explain the possible etiology of their combination. More reports are required to enhance the understanding of these rare conditions.
Topics: Female; Humans; Young Adult; Celiac Artery; Kidney; Kidney Diseases; Ligaments; Median Arcuate Ligament Syndrome; Pyelonephritis
PubMed: 37980517
DOI: 10.1186/s12894-023-01361-z -
Boletin Medico Del Hospital Infantil de... 2023Urinary tract infection (UTI) is infants' most common serious bacterial infection. This study aimed to investigate the reliability of urianalysis (UA) to predict UTI, to... (Review)
Review
BACKGROUND
Urinary tract infection (UTI) is infants' most common serious bacterial infection. This study aimed to investigate the reliability of urianalysis (UA) to predict UTI, to specify the colony forming units (CFU)/ml threshold for diagnosis, and to identify variables that help suspect bacteremia in infants under 3 months with UTI.
METHODS
We reviewed clinical records of children under 3 months hospitalized for a fever without source and recorded age, sex, days of fever pre-consultation, temperature and severity at admission, discharge diagnoses, laboratory tests, and treatments. According to the discharge diagnosis, we divided them into UTIs (-) and (+) with or without bacteremia.
RESULTS
A total of 467 infants were admitted: 334 with UTI and 133 without UTI. In UTIs (+), the pyuria had a sensitivity of 95.8% and bacteria (+) 88.3%; specificity was high, especially for nitrites (96.2%) and bacteria (+) (92.5%). Positive predictive value (PPV) for nitrites was 95.9%, for bacteria 96.7%, and oyuria 92.5%. Escherichia coli was present in 83.8% of urine and 87% of blood cultures. UTIs with bacteremia had inflammatory urinalysis, urine culture > 100,000 CFU/ml, and higher percentage of C reactive protein (CRP) > 50 mg (p= 0.002); 94.6% of the urine culture had > 50,000 CFU.
CONCLUSIONS
The pyuria and bacteria (+) in urine obtained by catheterization predict UTI. The cut-off point for diagnosis was ≥ 50,000 CFU/ml. No variables to suspect bacteremia were identified in this study.
Topics: Child; Infant; Humans; Pyuria; Nitrites; Reproducibility of Results; Sensitivity and Specificity; Urinary Tract Infections; Urinalysis; Fever; Bacteremia
PubMed: 37963294
DOI: 10.24875/BMHIM.23000030 -
The American Journal of Emergency... Jan 2024Infected urolithiasis is a serious condition that carries with it a high rate of morbidity and mortality. (Review)
Review
INTRODUCTION
Infected urolithiasis is a serious condition that carries with it a high rate of morbidity and mortality.
OBJECTIVE
This review highlights the pearls and pitfalls of infected urolithiasis, including presentation, diagnosis, and management in the emergency department based on current evidence.
DISCUSSION
Although urolithiasis is common and the vast majority can be treated conservatively, the presence of a concomitant urinary tract infection significantly increases the risk of morbidity, to include sepsis and mortality. Identification of infected urolithiasis can be challenging as patients may have symptoms similar to uncomplicated urolithiasis and/or pyelonephritis. However, clinicians should consider infected urolithiasis in toxic-appearing patients with fever, chills, dysuria, and costovertebral angle tenderness, especially in those with a history of recurrent urinary tract infections. Positive urine leukocyte esterase, nitrites, and pyuria in conjunction with an elevated white blood cell count may be helpful to identify infected urolithiasis. Patients should be resuscitated with fluids and broad-spectrum antibiotics. Additionally, computed tomography and early urology consultation are recommended to facilitate definitive care.
CONCLUSIONS
An understanding of infected urolithiasis can assist emergency clinicians in diagnosing and managing this potentially deadly disease.
Topics: Humans; Prevalence; Urinary Tract Infections; Pyuria; Pyelonephritis; Urolithiasis
PubMed: 37950981
DOI: 10.1016/j.ajem.2023.10.049 -
Indian Journal of Medical Microbiology 2023Identification and antibiogram of uropathogenic microorganisms from direct urine samples present a great clinical impact. Here, we present a combined procedure to...
Identification and antibiogram of Enterobacterales from direct urine samples using matrix assisted laser desorption/ionization-time of flight-mass spectrometry (MALDI-TOF-MS) technology and disk-plate diffusion technique.
Identification and antibiogram of uropathogenic microorganisms from direct urine samples present a great clinical impact. Here, we present a combined procedure to determine identification (IDd) of bacteria through MALDI-TOF-MS technology and antibiogram (ATBd) using disk-plate diffusion technique, of UTI-producing Enterobacterales against the most used antibiotics. Ninety-four urine samples with presence of pyuria and Gram-negative bacilli were selected. The IDd showed a high success rate (90%). ATBd procedure showed a high correlation for tested antibiotics. This simplified, low cost and reduced work time two-step procedure significantly reduces results turnaround time and benefit the clinical management of patients with UTI.
Topics: Humans; Spectrometry, Mass, Matrix-Assisted Laser Desorption-Ionization; Urinary Tract Infections; Microbial Sensitivity Tests; Anti-Bacterial Agents; Lasers
PubMed: 37945131
DOI: 10.1016/j.ijmmb.2023.100457 -
Urologia Feb 2024The most prevalent cancer of the urinary system and the fourth most frequent cancer in men is bladder cancer. Up to 45% of non-muscle-invasive bladder cancers (NMIBC),...
BACKGROUND
The most prevalent cancer of the urinary system and the fourth most frequent cancer in men is bladder cancer. Up to 45% of non-muscle-invasive bladder cancers (NMIBC), may develop into muscle-invasive disease within 5 years after initial diagnosis, depending on the risk profile. The neutrophil to lymphocyte ratio (NLR), which is an emerging marker of host inflammation and can be easily calculated from routine complete blood counts (CBCs) with differentials, has shown to be an independent prognostic factor for a variety of solid malignancies, including urinary tract cancer. Pyuria is a well-documented prognostic factor in urinary tract carcinomas, according to several research. The relationship between preoperative pyuria and recurrence in patients with NMIBC is unclear, even though some studies found that pyuria was a strong predictor of poor prognosis in patients with NMIBC. Our study's objective was to compare the prognostic effect of pre-treatment pyuria and NLR on the likelihood of progression and recurrence in individuals with primary NMIBC.
MATERIALS AND METHODOLOGY
Data obtained from 100 bladder cancer patients who underwent transurethral resection of bladder tumor (TURBT) from June 2021 to January 2023 were evaluated prospectively.
INCLUSION CRITERIA
Age more than 18 years, having tumor size less than 3 × 3 cm, single tumor, no H/O TURBT.
EXCLUSION CRITERIA
Age less than 18 years, size more than 3 × 3 cm, multiple tumors, H/O TURBT.
RESULTS
We demonstrated in the current study that, compared to NLR, preoperative pyuria was more substantially linked with intravesical recurrence, higher T stage and disease progression following TURBT for NMIBC.
Topics: Male; Humans; Adolescent; Prognosis; Neutrophils; Non-Muscle Invasive Bladder Neoplasms; Prospective Studies; Pyuria; Urinary Bladder Neoplasms; Lymphocytes; Neoplasm Recurrence, Local; Retrospective Studies; Neoplasm Invasiveness
PubMed: 37909427
DOI: 10.1177/03915603231203780 -
Lupus Science & Medicine Oct 2023Tissue damage in lupus nephritis (LN) is mediated by activation of the classical complement pathway. Complement-mediated upregulation of endothelial cell adhesion... (Observational Study)
Observational Study
OBJECTIVE
Tissue damage in lupus nephritis (LN) is mediated by activation of the classical complement pathway. Complement-mediated upregulation of endothelial cell adhesion molecules is seen in dermal blood vessels of non-lesional skin of patients with active lupus. In diseases with systemic complement activation, extensive microvascular C5b-9 deposition is seen in non-lesional skin. In this study, we assess the presence of systemic complement pathway activation as determined by non-lesional skin microvascular C5b-9 deposition in patients with LN.
METHODS
Eight patients with active LN and eight patients without active LN underwent non-lesional skin biopsies. Using a diaminobenzidine technique, specimens were evaluated for microvascular C5b-9 consistent with systemic complement pathway activation.
RESULTS
Five of eight patients with active LN and one of eight patients without active LN demonstrated positive C5b-9 staining in non-lesional skin (p=0.04). Positive non-lesional C5b-9 staining has greater specificity, 87.5%, for active LN than pyuria, low complements, elevated double-stranded DNA (dsDNA) and proteinuria. Urine protein creatinine ratio was significantly higher in patients with positive non-lesional C5b-9 deposition (5.18 vs 1.20; p=0.04). C5b-9 deposition was not associated with a higher NIH Activity Index, interstitial fibrosis, dsDNA or lower complements.
CONCLUSION
This is the first study to demonstrate evidence in non-lesional skin of microvascular C5b-9 indicative of systemic complement pathway activation in LN. C5b-9 deposition is statistically more common and demonstrated greater specificity than most historical biomarkers for active LN. The findings support a potential role for microvascular C5b-9 assessment in non-lesional skin as a biomarker for LN activity.
Topics: Humans; Lupus Nephritis; Complement Membrane Attack Complex; Lupus Erythematosus, Systemic; Complement System Proteins; Complement Activation; Biomarkers
PubMed: 37879755
DOI: 10.1136/lupus-2023-000996 -
Cureus Sep 2023We report a case of -associated pyelonephritis in a 74-year-old Parkinson's patient. He showed constipation, a mild fever, and altered consciousness. Blood cultures...
We report a case of -associated pyelonephritis in a 74-year-old Parkinson's patient. He showed constipation, a mild fever, and altered consciousness. Blood cultures revealed Gram-positive cocci (GPC), prompting vancomycin treatment. Urinary Gram staining confirmed pyelonephritis, underscoring its diagnostic utility in elderly patients with vague symptoms. infections can be insidious, with the potential for organ abscesses and persistent fever. Due to nuanced presentations of Gram-positive infections versus Gram-negative ones, diagnosis can be delayed, risking sepsis. Gram-staining urine is vital, especially in older patients, as untreated Gram-positive bacteremia elevates mortality. Given our aging population and their comorbidities, Gram staining's role in quick antibiotic administration is crucial. Hence, its integration into community hospitals is advocated. This case emphasizes early detection and treatment of GPC infections in the elderly and endorses Gram staining for prompt diagnosis of -associated pyelonephritis.
PubMed: 37868456
DOI: 10.7759/cureus.45582