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Methods and Findings in Experimental... 2005Rhabdomyolysis is a condition caused by skeletal muscle injury and release of muscle cell contents into the circulation. It may result in myoglobinuria, the filtration... (Review)
Review
Rhabdomyolysis is a condition caused by skeletal muscle injury and release of muscle cell contents into the circulation. It may result in myoglobinuria, the filtration of myoglobin into the urine, and is often associated with acute renal failure (ARF). Rhabdomyolysis may complicate many disease states. In some, such as crush injury, muscle injury is obvious; in others, such as drug overdose, it may never be apparent. It may occur in the setting of an altered mental status, and even in the conscious patient, it may occur with minimal symptoms or physical findings. Therefore, diagnosis requires a high level of suspicion and appropriate sensitivity to abnormal laboratory values. Many insults can precipitate rhabdomyolysis and myoglobinuria. Disruption of the muscle cell membrane may result from a direct mechanical or toxic insult to the membrane or an inability to maintain ionic gradients across the membrane (as in ischemia or extreme exertion). This article reviews the etiology, pathogenesis, clinical features, complications, and management of rhabdomyolysis, particularly crush injuries in the setting of a major disaster.
Topics: Acute Kidney Injury; Humans; Rhabdomyolysis
PubMed: 15834458
DOI: 10.1358/mf.2005.27.1.875435 -
Cardiorenal Medicine 2024The growing complexity of patient data and the intricate relationship between heart failure (HF) and acute kidney injury (AKI) underscore the potential benefits of... (Review)
Review
BACKGROUND
The growing complexity of patient data and the intricate relationship between heart failure (HF) and acute kidney injury (AKI) underscore the potential benefits of integrating artificial intelligence (AI) and machine learning into healthcare. These advanced analytical tools aim to improve the understanding of the pathophysiological relationship between kidney and heart, provide optimized, individualized, and timely care, and improve outcomes of HF with AKI patients.
SUMMARY
This comprehensive review article examines the transformative potential of AI and machine-learning solutions in addressing the challenges within this domain. The article explores a range of methodologies, including supervised and unsupervised learning, reinforcement learning, and AI-driven tools like chatbots and large language models. We highlight how these technologies can be tailored to tackle the complex issues prevalent among HF patients with AKI. The potential applications identified span predictive modeling, personalized interventions, real-time monitoring, and collaborative treatment planning. Additionally, we emphasize the necessity of thorough validation, the importance of collaborative efforts between cardiologists and nephrologists, and the consideration of ethical aspects. These factors are critical for the effective application of AI in this area.
KEY MESSAGES
As the healthcare field evolves, the synergy of advanced analytical tools and clinical expertise holds significant promise to enhance the care and outcomes of individuals who deal with the combined challenges of HF and AKI.
Topics: Humans; Acute Kidney Injury; Heart Failure; Artificial Intelligence; Machine Learning
PubMed: 38350433
DOI: 10.1159/000537751 -
Medicine Nov 2023Acute kidney injury (AKI) is a common complication of acute liver failure (ALF); but its pathogenesis is unknown. ALF was divided into 2 subgroups; ALF with hepatic...
Acute kidney injury (AKI) is a common complication of acute liver failure (ALF); but its pathogenesis is unknown. ALF was divided into 2 subgroups; ALF with hepatic coma, which corresponds to ALF in the US and Europe, and ALF without hepatic coma. AKI has been shown to worsen the prognosis of ALF patients with hepatic coma; however, its prognostic significance in ALF without hepatic coma remains unknown. A single-center retrospective study of 174 patients with ALF was performed. AKI was defined according to KDIGO criteria. AKI developed in 29 (66.0%) of 44 ALF patients with hepatic coma and 27 (38.5%) of 130 ALF patients without hepatic coma. Systemic inflammatory response syndrome (SIRS) was found to be significantly associated with AKI incidence in ALF patients (P < .001). Tumor necrosis factor-alpha (TNF-α) was found to be significantly associated with the presence and severity of AKI (P = .0039 and P = .0140, respectively). On multivariate analysis, TNF-α was an independent risk factor linked with AKI (P = .0103). Even in the absence of hepatic coma, the transplant-free survival rate of ALF was significantly associated with the presence and severity of AKI. Even when hepatic coma is absent, AKI complicated in ALF is strongly associated with TNF-α and worsens the transplant-free survival rate. Before the onset of hepatic coma, plasma exchange, or extracorporeal blood purification to remove inflammatory cytokines should be considered in ALF patients.
Topics: Humans; Acute Kidney Injury; Hepatic Encephalopathy; Liver Failure, Acute; Prognosis; Retrospective Studies; Systemic Inflammatory Response Syndrome; Tumor Necrosis Factor-alpha
PubMed: 37960809
DOI: 10.1097/MD.0000000000035931 -
Nephron 2019Delayed allograft function (DGF) is defined as dialysis treatment in the kidney transplant recipient in the first week following transplantation. With the demand for... (Review)
Review
Delayed allograft function (DGF) is defined as dialysis treatment in the kidney transplant recipient in the first week following transplantation. With the demand for kidney transplants growing and the supply limited, as well as implementation of a national allocation scheme for deceased donor kidneys, rates of DGF remain high, on average, 30% for recipients of deceased donor kidneys. DGF is associated with inferior allograft outcomes, and there are no FDA-approved therapies to mitigate this disorder. There is renewed interest in this therapeutic arena, and there are several recent clinical trials that have considered interventions within the recipient to reduce injury. A critical issue is that of trial design and end points as well as translating from acute kidney injury (AKI) trials in cardiac bypass to the more complicated kidney transplant scenario. DGF is a significant clinical outcome after kidney transplantation without known approved therapy beyond clinical support. This mini-review highlights our presentation at the 24th International Conference on Advances in Critical Care Nephrology and UAB/UCSD O'Brien Center AKI Pre-Meeting.
Topics: Acute Kidney Injury; Animals; Delayed Graft Function; Graft Rejection; Humans; Kidney Transplantation; Postoperative Complications
PubMed: 31096218
DOI: 10.1159/000500550 -
Nephron 2017Adjudication, which comes from the Latin term "adjudicare" (to act as a judge), uses expert opinion to define and classify disease entities. The use of clinical... (Review)
Review
Adjudication, which comes from the Latin term "adjudicare" (to act as a judge), uses expert opinion to define and classify disease entities. The use of clinical adjudication may help to define more homogeneous disease subsets but comes at the expense of effort needed and generalizability. Here, we will describe the pros and cons of acute kidney injury (AKI) adjudication under varied circumstances. We will use heart failure as a paradigm and provide comparable examples from the current AKI literature.
Topics: Acute Kidney Injury; Biomarkers; Heart Failure; Humans
PubMed: 28614829
DOI: 10.1159/000477831 -
Medizinische Klinik, Intensivmedizin... Apr 2024Digitalization is increasingly finding its way into intensive care units and with it artificial intelligence (AI) for critically ill patients. One promising area for the... (Review)
Review
Digitalization is increasingly finding its way into intensive care units and with it artificial intelligence (AI) for critically ill patients. One promising area for the use of AI is in the field of acute kidney injury (AKI). The use of AI is primarily focused on the prediction of AKI, but further approaches are also being used to classify existing AKI into different phenotypes. Different AI models are used for prediction. The area under the receiver operating characteristic curve values (AUROC) achieved with these models vary and are influenced by several factors, such as the prediction time and the definition of AKI. Most models have an AUROC between 0.650 and 0.900, with lower values for predictions further into the future and when applying Acute Kidney Injury Network (AKIN) instead of KDIGO criteria. Classification into phenotypes already makes it possible to categorize patients into groups with different risks of mortality or requirement of renal replacement therapy (RRT), but the etiologies or therapeutic consequences derived from this are still lacking. However, all the models suffer from AI-specific shortcomings. The use of large databases does not make it possible to promptly include recent changes in therapy and the implementation of new biomarkers in a relevant proportion. For this reason, serum creatinine and urinary output, with their known limitations, dominate current AI models for prediction impairing the performance of the current models. On the other hand, the increasingly complex models no longer allow physicians to understand the basis on which the warning of a threatening AKI is calculated and subsequent initiation of therapy should take place. The successful use of AIs in routine clinical practice will be highly determined by the trust of the physicians in the systems and overcoming the aforementioned weaknesses. However, the clinician will remain irreplaceable as the decisive authority for critically ill patients by combining measurable and nonmeasurable parameters.
Topics: Humans; Artificial Intelligence; Critical Illness; Prospective Studies; Acute Kidney Injury; Biomarkers
PubMed: 38396124
DOI: 10.1007/s00063-024-01111-5 -
British Medical Journal May 1979
Topics: Acute Kidney Injury; Antineoplastic Agents; Humans; Myoglobinuria; Renal Dialysis; Uric Acid
PubMed: 455009
DOI: 10.1136/bmj.1.6173.1233-a -
Pharmacology & Therapeutics Aug 2019Acute kidney injury (AKI) is defined as a decrease in kidney function within hours, which encompasses both injury and impairment of renal function. AKI is not considered... (Review)
Review
Acute kidney injury (AKI) is defined as a decrease in kidney function within hours, which encompasses both injury and impairment of renal function. AKI is not considered a pathological condition of single organ failure, but a syndrome in which the kidney plays an active role in the progression of multi-organ dysfunction. The incidence rate of AKI is increasing and becoming a common (8-16% of hospital admissions) and serious disease (four-fold increased hospital mortality) affecting public health costs worldwide. AKI also affects the young and previously healthy individuals affected by infectious diseases in Latin America. Because of the multifactorial pathophysiological mechanisms, there is no effective pharmacological therapy that prevents the evolution or reverses the injury once established; therefore, renal replacement therapy is the only current alternative available for renal patients. The awareness of an accurate and prompt recognition of AKI underlying the various clinical phenotypes is an urgent need for more effective therapeutic interventions to diminish mortality and socio-economic impacts of AKI. The use of biomarkers as an indicator of the initial stage of the disease is critical and the cornerstone to fulfill the gaps in the field. This review discusses emerging strategies from basic science toward the anticipation of features, treatment of AKI, and new treatments using pharmacological and stem cell therapies. We will also highlight bioartificial kidney studies, addressing the limitations of the development of this innovative technology.
Topics: Acute Kidney Injury; Animals; Bioartificial Organs; Biomarkers; Humans; Kidneys, Artificial
PubMed: 30959059
DOI: 10.1016/j.pharmthera.2019.04.001 -
Nephron 2017Acute kidney injury (AKI) continues to be a major therapeutic challenge. Despite significant advances made in cellular and molecular pathophysiology of AKI, major gaps... (Review)
Review
Acute kidney injury (AKI) continues to be a major therapeutic challenge. Despite significant advances made in cellular and molecular pathophysiology of AKI, major gaps in knowledge exist regarding the changes in renal hemodynamics and oxygenation in the early stages and through the continuum of AKI. Particular features of renal hemodynamics and oxygenation increase the susceptibility of the kidney to sustain injury due to oxygen demand-supply mismatch and also play an important role in the recovery and repair from AKI as well as the transition of AKI to chronic kidney disease. However, lack of well-established physiological biomarkers and noninvasive imaging techniques limit our understanding of the interactions between renal macro and microcirculation and tissue oxygenation in AKI. Advances in our ability to assess these parameters in preclinical and clinical AKI will enable the development of targeted therapeutics to improve clinical outcomes.
Topics: Acute Kidney Injury; Hemodynamics; Humans; Kidney; Oxygen Consumption; Renal Circulation
PubMed: 28614837
DOI: 10.1159/000477830 -
International Journal of Molecular... Jan 2017Evidence suggests a link between opioid use and kidney disease. This review summarizes the known renal manifestations of opioid use including its role in acute and... (Review)
Review
Evidence suggests a link between opioid use and kidney disease. This review summarizes the known renal manifestations of opioid use including its role in acute and chronic kidney injury. Both the direct and indirect effects of the drug, and the context which leads to the development of renal failure, are explored. While commonly used safely for pain control and anesthesia in those with kidney disease, the concerns with respect to side effects and toxicity of opioids are addressed. This is especially relevant with the worldwide increase in the use of opioids for medical and recreational use.
Topics: Acute Kidney Injury; Analgesics, Opioid; Humans; Incidence; Kidney; Renal Insufficiency
PubMed: 28117754
DOI: 10.3390/ijms18010223