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JPMA. the Journal of the Pakistan... Feb 2023To collect all studies on acute kidney injury, even with their limitations, done in South Asia to draw a picture about the types of acute kidney injury prevalent in the... (Meta-Analysis)
Meta-Analysis
OBJECTIVE
To collect all studies on acute kidney injury, even with their limitations, done in South Asia to draw a picture about the types of acute kidney injury prevalent in the region.
METHODS
The meta-analysis was conducted in June 2022 and comprised search on PubMed, Medline, Cochrane Library and Google Scholar databases for studies on acute kidney injury done in South Asia regardless of time limit, and published in the English language. Combinations of key words used were 'community acquired acute kidney injury' or 'acute renal failure' with using individual names of 'different countries' in South Asia. Data was extracted and analysed.
RESULTS
Of the 31(67.4%) studies subjected to detailed analysis, 17(54.83%) had been done in India, 10(32.25%) in Pakistan, 2(6.45%) in Nepal, and 1(3.22%) each in Bangladesh and Sri Lanka. Overall, there were 16,584 patients with acute kidney injury. There were 16(51.61%) studies focussing on community-acquired acute kidney injury, while 15(48.38%) also included hospital-acquired acute kidney injury. Also, 17(54.83%) studies were prospective and 14(45.16%) were retrospective. Pattern of defining and classifying acute kidney injury varied in the studies. Need for renal replacement was not mentioned universally. Complete recovery reported varied 40-80% and mortality 2.2-52% in the studies analysed.
CONCLUSIONS
The number of acute kidney injury patients was considerable. Despite variations in definitions, study designs and outcomes, the meta-analysis provides useful information about the pattern of presentation and d major causes of community-acquired acute kidney injury in South Asia. .
Topics: Humans; Asia, Southern; Prospective Studies; Retrospective Studies; Acute Kidney Injury; Bangladesh
PubMed: 36800721
DOI: 10.47391/JPMA.7554 -
Nephron 2022In 2004, the term acute kidney injury (AKI) was introduced with the intention of broadening our understanding of rapid declines in renal function and to replace the... (Review)
Review
BACKGROUND
In 2004, the term acute kidney injury (AKI) was introduced with the intention of broadening our understanding of rapid declines in renal function and to replace the historical terms of acute renal failure and acute tubular necrosis (ATN). Despite this evolution in terminology, the mechanisms of AKI have stayed largely elusive with the pathophysiological concepts of ATN remaining the mainstay in our understanding of AKI.
SUMMARY
The proximal tubule (PT), having the highest mitochondrial content in the kidney and relying heavily on oxidative phosphorylation to generate ATP, is vulnerable to ischaemic insults and mitochondrial dysfunction. Histologically, pathological changes in the PT are more consistent than changes to the glomeruli or the loop of Henle in AKI. Physiologically, activation of tubuloglomerular feedback due to PT dysfunction leads to an increase in preglomerular afferent arteriole resistance and a reduction in glomerular filtration. Pharmacologically, frusemide - a drug commonly used in the setting of oliguric AKI - is actively secreted by the PT and its diuretic effect is compromised by its failure to be secreted into the urine and thus be delivered to its site of action at the loop of Henle in AKI. Increases in the urinary, but not plasma biomarkers, of PT injury within 1 h of shock suggest that the PT as the initiation pathogenic target of AKI.
KEY MESSAGE
Therapeutic agents targeting specifically the PT epithelial cells, in particular its mitochondria - including amino acid ergothioneine and superoxide scavenger MitoTEMPO - show great promises in ameliorating AKI.
Topics: Acute Kidney Injury; Humans; Kidney; Kidney Glomerulus; Kidney Tubular Necrosis, Acute; Kidney Tubules, Proximal
PubMed: 35272287
DOI: 10.1159/000522341 -
Clinical Journal of the American... Mar 2015Approximately 18% of patients undergoing cardiac surgery experience AKI (on the basis of modern standardized definitions of AKI), and approximately 2%-6% will require... (Review)
Review
Approximately 18% of patients undergoing cardiac surgery experience AKI (on the basis of modern standardized definitions of AKI), and approximately 2%-6% will require hemodialysis. The development of AKI after cardiac surgery portends poor short- and long-term prognoses, with those developing RIFLE failure or AKI Network stage III having an almost 2-fold increase in the risk of death. AKI is caused by a variety of factors, including nephrotoxins, hypoxia, mechanical trauma, inflammation, cardiopulmonary bypass, and hemodynamic instability, and it may be affected by the clinician's choice of fluids and vasoactive agents as well as the transfusion strategy used. The risk of AKI may be ameliorated by avoidance of nephrotoxins, achievement of adequate glucose control preoperatively, and use of goal-directed therapy hemodynamic strategies. Remote ischemic preconditioning is an exciting future strategy, but more work is needed before widespread implementation. Unfortunately, there are no pharmacologic agents known to reduce the risk of AKI or treat established AKI.
Topics: Acute Kidney Injury; Cardiac Surgical Procedures; Humans; Risk Factors
PubMed: 25376763
DOI: 10.2215/CJN.07830814 -
Blood Purification 2010Acute lung injury (ALI) and acute kidney injury (AKI) are complications often encountered in the setting of critical illness. Both forms of end-organ injury commonly... (Review)
Review
Acute lung injury (ALI) and acute kidney injury (AKI) are complications often encountered in the setting of critical illness. Both forms of end-organ injury commonly occur in similar settings of systemic inflammatory response syndrome, shock, and evolving multiple organ dysfunction. Recent elucidation of the pathobiology of critical illness has led to a more basic mechanistic understanding of the complex interplay between injured organs in patients with multiple organ dysfunction syndrome; this has been aptly called 'the slippery slope of critical illness' [Kidney Int Suppl 1998;66:S25-S33]. Distant organ effects of apparently isolated injuries to the lungs, gut, and kidneys have all been discovered in recent years. In this article, we will review the harmful bidirectional interaction between ALI and AKI, which appears to be a common clinical syndrome with routine clinical implications. We will review the current understanding of lung-kidney interactions from both perspectives, including the renal effects of ALI and mechanical ventilation, and the pulmonary sequelae of AKI. In this review of the emerging evidence of deleterious bidirectional organ cross talk between lung and kidney, we will focus on the role of ventilator-induced kidney injury in the pathogenesis of AKI in patients with ALI.
Topics: Acute Kidney Injury; Acute Lung Injury; Animals; Humans; Hypercapnia; Inflammation Mediators; Kidney; Models, Animal; Multiple Organ Failure; Respiration, Artificial; Respiratory Distress Syndrome; Ventilator-Induced Lung Injury
PubMed: 19923815
DOI: 10.1159/000259585 -
Scientific Reports Jan 2021Renal cortical necrosis (RCN) is a rare cause of acute kidney failure and is usually diagnosed on the basis of characteristic enhancement patterns on cross-sectional...
Renal cortical necrosis (RCN) is a rare cause of acute kidney failure and is usually diagnosed on the basis of characteristic enhancement patterns on cross-sectional imaging. Contrast-enhanced ultrasound (CEUS) offers benefits in patients with kidney failure in the clinical setting including the use of a nonnephrotoxic intravascular contrast agent and the fact that it can be performed at the bedside in critical cases. Therefore, the aim of this study is to investigate whether CEUS can reliably identify typical imaging features of RCN. We retrospectively analyzed 12 patients with RCN examined in our department and confirmation of the diagnosis by either histopathology, other contrast-enhanced cross-sectional imaging tests, and/or CEUS follow-up. Assessed parameters in conventional US were reduced echogenicity, loss of corticomedullary differentiation, length and width of kidney, hypoechoic rim, resistance index and in CEUS delayed wash-in of contrast agent (> 20 s), reverse rim sign, maximum nonenhancing rim and additional renal infarction. Furthermore, imaging features in RCN were compared with the findings in renal vein thrombosis (RVT), among them echogenicity, corticomedullar differentiation, hypoechoic rim, RI value, delayed cortical enhancement, total loss of cortical perfusion and enhancement of renal medulla. All 12 patients showed the reverse rim sign, while a hypoechogenic subcapsular rim was only visible in four patients on B-mode ultrasound. A resistance index (RI) was available in 10 cases and was always less than 1. RI was a strong differentiator in separating RVT from RCN (RI > 1 or not measurable due to hypoperfusion as differentiator, p = 0.001). CEUS showed total loss of medullary enhancement in all cases of RVT. With its higher temporal resolution, CEUS allows dynamic assessment of renal macro- and microcirculation and identification of the typical imaging findings of RCN with use of a nonnephrotoxic contrast agent.
Topics: Acute Kidney Injury; Adult; Aged; Contrast Media; Female; Humans; Kidney Cortex Necrosis; Male; Middle Aged; Rare Diseases; Ultrasonography
PubMed: 33479443
DOI: 10.1038/s41598-021-81690-x -
European Journal of Vascular and... Feb 2023Acute kidney injury (AKI) is common in patients with aortic diseases; however, it has not been extensively studied in acute type B aortic dissection (TBAD). AKI is known...
OBJECTIVE
Acute kidney injury (AKI) is common in patients with aortic diseases; however, it has not been extensively studied in acute type B aortic dissection (TBAD). AKI is known to be associated with adverse kidney outcomes and premature death. This study investigated the incidence and impact of AKI in patients with acute TBAD.
METHODS
This was a retrospective study including data from two tertiary vascular centres in the UK. Case notes and electronic records were reviewed for consecutive patients presenting with acute symptomatic TBAD. Patients were managed according to a uniform clinical protocol; both patients who underwent surgery and those managed conservatively were included in this analysis. Serum creatinine values were used to calculate the number of patients who developed AKI, based on validated Kidney Disease Improving Global Outcomes definitions. Associations between incidence of AKI, death, and Major Adverse Kidney Events (MAKE; defined as death, dialysis and/or drop in estimated glomerular filtration rate > 25%) were explored.
RESULTS
Overall, 66 (42.6%) of 155 patients developed AKI within one week of presenting with TBAD. Of these, 23 patients (34.8%) had stage 1, 26 patients (39.4%) stage 2, and 17 patients (25.8%) stage 3 AKI. MAKE at 30 and 90 days occurred in 17 (11.0%) and 12 patients (7.7%), respectively. AKI was associated with significantly worse outcomes, with a 24.2% mortality rate in the AKI group compared with 7.8% among those with no AKI (p <.001); this association was also significant in adjusted analyses, both in patients who did and did not undergo surgery.
CONCLUSION
AKI is very common among patients presenting with acute TBAD, even in clinically uncomplicated disease. There was a significant association with mortality and MAKE, whether patients underwent surgery or not. This warrants further investigation to better understand the underlying causes of the AKI and investigate management strategies which may improve outcomes.
Topics: Humans; Retrospective Studies; Risk Factors; Acute Kidney Injury; Kidney; Aortic Dissection; Incidence
PubMed: 36273677
DOI: 10.1016/j.ejvs.2022.10.032 -
Interactive Cardiovascular and Thoracic... Nov 2021We aim to investigate the impact of cardiac fibrosis and collagens on right ventricular failure (RVF) and acute kidney injury (AKI) in patients receiving continuous flow...
OBJECTIVES
We aim to investigate the impact of cardiac fibrosis and collagens on right ventricular failure (RVF) and acute kidney injury (AKI) in patients receiving continuous flow left ventricular assist devices.
METHODS
Heart tissues from 34 patients were obtained from continuous flow left ventricular assist device insertion sites and corresponding clinical data were collected. The participants were divided into 2 groups according to the extent of the cardiac fibrosis or collagens.
RESULTS
Overall, 18 patients developed RVF with 14 receiving right ventricular assist device (RVAD), and 22 patients developed AKI with 12 needing new-onset renal replacement therapy. Higher collagen I (Col1) was significantly associated with increased incidences of RVF (76.5% vs 29.4%, P = 0.015), RVAD support (64.7% vs 17.6%, P = 0.013) and stage 3 AKI (58.8% vs 17.6%, P = 0.032), and patients with higher Col1 were more prone to renal replacement therapy (52.9% vs 17.6%, P = 0.071). Receiver operating characteristic curves showed that Col1 had good predictive effects on RVF [area under the curve (AUC) = 0.806, P = 0.002], RVAD support (AUC = 0.789, P = 0.005), stage 3 AKI (AUC = 0.740, P = 0.020) and renal replacement therapy (AUC = 0.731, P = 0.028) after continuous-flow left ventricular assist device. Moreover, patients with higher Col1 had significantly longer postoperative duration of mechanical ventilation, duration of intensive care unit stay and hospital length of stay (all P < 0.05). Cardiac fibrosis, collagen III (Col3) and Col1/Col3 shared similar results or trends with Col1.
CONCLUSIONS
Cardiac fibrosis and related collagens in the apical left ventricular tissue are associated with increased risks of RVF, RVAD use and worse renal function. Further study is warranted owing to the small sample size.
Topics: Acute Kidney Injury; Collagen; Fibrosis; Heart Failure; Heart-Assist Devices; Humans; Retrospective Studies; Ventricular Dysfunction, Right
PubMed: 34252191
DOI: 10.1093/icvts/ivab180 -
Swiss Medical Weekly 2012The term acute kidney injury (AKI) has been recently coined by a large panel of international experts in place of the former expression "acute renal failure". This... (Review)
Review
The term acute kidney injury (AKI) has been recently coined by a large panel of international experts in place of the former expression "acute renal failure". This change has been motivated by a double intention: first it served to definitely find a conventional definition for acute changes of renal function, previously lacking in the medical community. In fact, any attempt to compare scientific papers and different centres experiences on AKI was essentially impossible. The second aim was to remark that this syndrome is characterised by a spectrum of progressive damage, from mild creatinine increase to renal injury to a more severe form, failure: this important concept should increase clinicians awareness to every form of renal dysfunction, even milder ones, in order to improve epidemiologic analyses, potentially preventing eventual AKI progression and finally helping standardisation of medical and supportive therapy. This review will describe such "new era" of critical care nephrology by presenting current literature (and its many controversies) about AKI diagnosis, physiopathology and management.
Topics: Acute Kidney Injury; Critical Care; Humans
PubMed: 22923149
DOI: 10.4414/smw.2012.13662 -
Journal of the American Society of... May 2016In this article, we review the current evidence for the cellular and molecular mechanisms of AKI, focusing on epithelial cell pathobiology and related cell-cell... (Review)
Review
In this article, we review the current evidence for the cellular and molecular mechanisms of AKI, focusing on epithelial cell pathobiology and related cell-cell interactions, using ischemic AKI as a model. Highlighted are the clinical relevance of cellular and molecular targets that have been investigated in experimental models of ischemic AKI and how such models might be improved to optimize translation into successful clinical trials. In particular, development of more context-specific animal models with greater relevance to human AKI is urgently needed. Comorbidities that could alter patient susceptibility to AKI, such as underlying diabetes, aging, obesity, cancer, and CKD, should also be considered in developing these models. Finally, harmonization between academia and industry for more clinically relevant preclinical testing of potential therapeutic targets and better translational clinical trial design is also needed to achieve the goal of developing effective interventions for AKI.
Topics: Acute Kidney Injury; Animals; Disease Models, Animal; Humans; Kidney
PubMed: 26860342
DOI: 10.1681/ASN.2015070740 -
Kidney International Mar 2016Acute kidney injury (AKI) is a common complication in critically ill patients and subsequently worsens outcomes. Although many drugs to prevent and treat AKI have shown... (Review)
Review
Acute kidney injury (AKI) is a common complication in critically ill patients and subsequently worsens outcomes. Although many drugs to prevent and treat AKI have shown benefits in preclinical models, no specific agent has been shown to benefit AKI in humans. Moreover, despite remarkable advances in dialysis techniques that enable management of AKI in hemodynamically unstable patients with shock, dialysis-requiring severe AKI is still associated with an unacceptably high mortality rate. Thus, focusing only on kidney damage and loss of renal function has not been sufficient to improve outcomes of patients with AKI. Recent data from basic and clinical research have begun to elucidate complex organ interactions in AKI between kidney and distant organs, including heart, lung, spleen, brain, liver, and gut. This review serves to update the topic of organ cross talk in AKI and focuses on potential therapeutic targets to improve patient outcomes during AKI-associated multiple organ failure.
Topics: Acute Kidney Injury; Animals; Critical Illness; Hemodynamics; Humans; Kidney; Multiple Organ Failure; Prognosis; Renal Dialysis; Risk Factors
PubMed: 26880452
DOI: 10.1016/j.kint.2015.11.019