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Burn-Induced Acute Kidney Injury-Two-Lane Road: From Molecular to Clinical Aspects. Int J Mol Sci 2022; 23:ijms23158712. [PMID: 35955846 PMCID: PMC9368898 DOI: 10.3390/ijms23158712] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Revised: 07/19/2022] [Accepted: 08/02/2022] [Indexed: 12/29/2022] Open
Abstract
Severe burn injuries lead to acute kidney injury (AKI) development, increasing the mortality risk up to 28-100%. In addition, there is an increase in hospitalization days and complications appearance. Various factors are responsible for acute or late AKI debut, like hypovolemia, important inflammatory response, excessive load of denatured proteins, sepsis, and severe organic dysfunction. The main measure to improve the prognosis of these patients is rapidly recognizing this condition and reversing the underlying events. For this reason, different renal biomarkers have been studied over the years for early identification of burn-induced AKI, like neutrophil gelatinase-associated lipocalin (NGAL), cystatin C, kidney injury molecule-1 (KIM-1), tissue inhibitor of metalloproteinase-2 (TIMP-2), interleukin-18 (IL-18), and insulin-like growth factor-binding protein 7 (IGFBP7). The fundamental purpose of these studies is to find a way to recognize and prevent acute renal injury progression early in order to decrease the risk of mortality and chronic kidney disease (CKD) onset.
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Abstract
Volume resuscitation of patients with high-voltage electrical injuries (>1000 V) is a more complex challenge than standard burn resuscitation. High voltages penetrate deep tissues. These deep injuries are not accounted for in resuscitation formulae dependent on percentage of cutaneous burn. Myonecrosis occurring from direct electrical injury and secondary compartment syndromes can result in rhabdomyolysis, compromising renal function and urine output. Urine output is the primary end point, with a goal of 1 mL/kg/h for adult patients with high-voltage electrical injuries. As such, secondary resuscitation end points of laboratory values, such as lactate, base deficit, hemoglobin, and creatinine, as well as hemodynamic monitoring, such as mean arterial pressure and thermodilution techniques, can become crucial in guiding optimum administration of resuscitation fluids. Mannitol and bicarbonates are available but have limited support in the literature. High-voltage electrical injury patients often develop acute kidney injury requiring dialysis and have increased risks of chronic kidney disease and mortality. Continuous venovenous hemofiltration is a well-supported adjunct to clear the myoglobin load that hemodialysis cannot from circulation.
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Combining field effect scanning electron microscopy, deep UV fluorescence, Raman, classical and synchrotron radiation Fourier transform Infra-Red Spectroscopy in the study of crystal-containing kidney biopsies. CR CHIM 2016. [DOI: 10.1016/j.crci.2015.03.001] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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Abstract
Olanzapine is an atypical antipsychotic that is reported to cause myopathy and raised creatine kinase (CK) levels. The prevalence and severity of acute myopathy after deliberate olanzapine ingestion are unclear. Therefore, we reviewed casenotes from 64 consecutive patients admitted to our institution after olanzapine overdose. Overall, serum CK was higher than five times the upper limit of normal in 17% of patients. The prevalence of raised CK values was positively correlated with the stated quantity of olanzapine ingested, suggesting a dose-dependent relationship for acute muscle toxicity. There was an apparent delay of 12 hours or more between olanzapine ingestion and the occurrence of maximum CK. Despite the high prevalence of acute muscle toxicity after olanzapine ingestion, none of the patients developed renal failure.
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Affiliation(s)
- W S Waring
- Scottish Poisons Information Bureau, Royal Infirmary of Edinburgh, Edinburgh, UK.
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Preoperative dehydration increases risk of postoperative acute renal failure in colon and rectal surgery. J Gastrointest Surg 2014; 18:2178-85. [PMID: 25238816 DOI: 10.1007/s11605-014-2661-7] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2014] [Accepted: 09/08/2014] [Indexed: 01/31/2023]
Abstract
OBJECTIVES There is limited data regarding the effects of preoperative dehydration on postoperative renal function. We sought to identify associations between hydration status before operation and postoperative acute renal failure (ARF) in patients undergoing colorectal resection. METHODS The NSQIP database was used to examine the data of patients undergoing colorectal resection from 2005 to 2011. We used preoperative blood urea nitrogen (BUN)/creatinine ratio >20 as a marker of relative dehydration. Multivariate analysis using logistic regression was performed to quantify the association of BUN/Cr ratio with ARF. RESULTS We sampled 27,860 patients who underwent colorectal resection. Patients with dehydration had higher risk of ARF compared to patients with BUN/Cr <10 (AOR, 1.23; P = 0.04). Dehydration was associated with an increase in mortality of the affected patients (AOR, 2.19; P < 0.01). Postoperative complication of myocardial infarction (MI) (AOR, 1.46; P < 0.01) and cardiac arrest (AOR, 1.39; P < 0.01) was higher in dehydrated patients. Open colorectal procedures (AOR, 2.67; P = 0.01) and total colectomy procedure (AOR, 1.62; P < 0.01) had associations with ARF. CONCLUSION Dehydration before operation is a common condition in colorectal surgery (incidence of 27.7 %). Preoperative dehydration is associated with increased rates of postoperative ARF, MI, and cardiac arrest. Hydrotherapy of patients with dehydration may decrease postoperative complications in colorectal surgery.
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Ozkan S, Durukan P, Kavalci C, Duman A, Sayhan MB, Salt O, Ipekci A. Importance of neutrophil gelatinase-associated lipocalin in differential diagnosis of acute and chronic renal failure. IRANIAN RED CRESCENT MEDICAL JOURNAL 2014; 16:e14133. [PMID: 25389480 PMCID: PMC4222006 DOI: 10.5812/ircmj.14133] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/11/2013] [Revised: 01/13/2014] [Accepted: 05/22/2014] [Indexed: 11/16/2022]
Abstract
Background: Neutrophil Gelatinase-associated Lipocalin (NGAL) protein is easily detected in the blood and urine soon after acute renal injury. NGAL gains features of an early, sensitive and noninvasive biomarker for acute renal injury. Recent evidences suggest that its expression is also increased in CRF reflecting the severity of disease. Objectives: In the present study, we aimed to investigate whether blood NGAL level plays a role in the differential diagnosis of acute and chronic renal failure. Patients and Methods: This was a prospective case-control study. Fifty patients presented to emergency department with acute renal failure (ARF), 30 with chronic renal failure (CRF) and 20 healthy individuals as control group were included in this study. Blood pH, HCO3-, BUN, creatinine and potassium values were evaluated in all patients. Blood NGAL values were evaluated in all groups. BUN, serum creatinine and NGAL values were statistically compared between patients and controls. Results: Median NGAL levels in patients was 304.50 (29), and 60 (0) in control, which was statistically significant between the two groups (Z = -6.477, P < 0.001). The median NGAL values were 261.50 ± 291 in ARF group and 428.50 ± 294 in CRF group. There was a significant difference in NGAL level between ARF and CRF groups (Z = -2.52, P = 0.012). Median BUN values were 153.46 ± 82.47 in ARF group and 169.40 ± 93.94 in CRF group. There was no significant difference in BUN value between ARF and CRF groups (P > 0.05). Median creatinine values were 2.84 ± 2.95 in ARF group and 4.78 ± 4.32 in CRF group. In serum creatinine values, a significant difference was found between ARF and CRF groups (P < 0.05). Conclusions: Serum NGAL levels of ARF and CRF patients were significantly higher than healthy individuals. In addition, NGAL values of patients with CRF were significantly higher than those of ARF. Serum NGAL values can be used to detect renal injury and differentiate ARF and CRF.
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Affiliation(s)
- Seda Ozkan
- Department of Emergency Medicine, Diskapi Training and Research Hospital, Ankara, Turkey
- Corresponding Author: Seda Ozkan, Department of Emergency Medicine, Diskapi Training and Research Hospital, Ankara, Turkey. Tel: +90-3125962600, Fax: +90-3524375273, E-mail:
| | - Polat Durukan
- Department of Emergency Medicine, Faculty of Medicine, Erciyes University, Kayseri, Turkey
| | - Cemil Kavalci
- Department of Emergency Medicine, Faculty of Medicine, Baskent University, Ankara, Turkey
| | - Ali Duman
- Department of Emergency Medicine, Isparta State Hospital, Isparta, Turkey
| | - Mustafa Burak Sayhan
- Department of Emergency Medicine, Faculty of Medicine, Trakya University, Edirne, Turkey
| | - Omer Salt
- Emergency Department, Yozgat State Hospital, Yozgat, Turkey
| | - Afsin Ipekci
- Department of Emergency Medicine, Faculty of Medicine, Erciyes University, Kayseri, Turkey
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Liu D, Huang P, Li X, Ge M, Luo G, Hei Z. Using inflammatory and oxidative biomarkers in urine to predict early acute kidney injury in patients undergoing liver transplantation. Biomarkers 2014; 19:424-9. [PMID: 24888736 DOI: 10.3109/1354750x.2014.924997] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE We examined the value of inflammatory and oxidative biomarkers in predicting acute kidney injury (AKI) following orthotopic liver transplantation (OLT). METHODS Urinary excretion of tumour necrosis factor-α (TNF-α), interleukin-8 (IL-8), interleukin-10 (IL-10), superoxide dismutase (SOD), malondialdehyde (MDA), 6-keto prostaglandin F1α (6-keto-PGF1α), hydrogen peroxide (H2O2), and 8-keto prostaglandin F2α (8-iso-PGF2α), serum creatinine (SCr), blood urea nitrogen (BUN), urinary N-acetyl-beta-D-glucosaminidase (NAG), β2-microglobulin (β2-MG) and γ-glutamyl-transferase (γ-GT), were measured before surgery (baseline), at 2 h after graft reperfusion and 24 h after OLT in 28 liver transplantation patients. RESULTS The levels of TNF-α, IL-8, IL-10, SOD, MDA, 6-keto-PGF1α, H2O2 and 8-iso-PGF2α in urine were all significantly higher in patients who had AKI than in those who did not at 2 h after graft reperfusion and 24 h after OLT (p < 0.01).
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Affiliation(s)
- Dezhao Liu
- Department of Anesthesiology, The Third Affiliated Hospital of Sun Yat-Sen University , Tianhe district, Guangzhou City , China
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Tc-99m diethylenetriamine pentaacetic acid (DTPA): Is it reliable for assessment of methotrexate-induced cumulative effect on renal filtration in rheumatoid arthritis patients? EGYPTIAN RHEUMATOLOGIST 2013. [DOI: 10.1016/j.ejr.2012.10.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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A preliminary study of blood-oxygen-level-dependent MRI in patients with chronic kidney disease. Magn Reson Imaging 2012; 30:330-5. [PMID: 22244540 DOI: 10.1016/j.mri.2011.10.003] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2011] [Revised: 09/28/2011] [Accepted: 10/21/2011] [Indexed: 11/20/2022]
Abstract
BACKGROUND Blood-oxygen-level-dependent (BOLD) magnetic resonance imaging (MRI) can provide regional measurements of oxygen content using deoxyhemoglobin paramagnetic characteristics. The apparent relaxation rate or R2*(=1/T2*) can be determined from the slope of log (intensity) versus echo time and is directly proportional to the tissue content of deoxyhemoglobin. Thus, as the level of deoxyhemoglobin increases, T2* will decrease, leading to an increase in R2*. Chronic kidney disease (CKD) can affect oxygenation levels in renal parenchyma, which influences the clinical course of the disease. The goal of this study was to detect and assess renal oxygenation levels in CKD using BOLD MRI. METHODS Fifteen healthy subjects and 11 patients with CKD underwent a renal scan using multigradient-recalled-echo sequence with eight echoes. R2* (1/s) of the renal cortex and medulla was measured on BOLD images. Of the 11 patients, nine had biopsy-proven chronic glomerulonephritis, and two had a similar diagnosis based on clinical symptoms and investigations. RESULTS Mean medullary R2* (MR2*) and cortex R2* (CR2*) levels were significantly higher in patients (22 kidneys, MR2*=24.79±4.84 s(-1), CR2*=18.97±2.72 s(-1)) than in controls (30 kidneys, MR2*=19.98±1.19 s(-1), CR2*=16.03±1.23 s(-1)) (P<.01), and MR2* was increased more than CR2*. Medullary to cortical R2* ratios (MCR2*) of patients were significantly increased when compared with those of controls (P<.01). In the patient group, estimated glomerular filtration rate levels were greater than or equal to 60 ml/min/1.73 m(2) in six patients (12 kidneys), whose MR2* and CR2* were also significantly higher than those of controls (P<.01). Serum creatinine levels were normal in seven patients (14 kidneys), whose MR2*, CR2* and MCR2* were also higher than those of controls (P<.01). CONCLUSIONS BOLD MRI can be used to evaluate changes in renal oxygenation in CKD, suggesting that it has the potential to be an excellent noninvasive tool for the evaluation of renal function.
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Abstract
Urinalysis is a routine medical laboratory investigation, as examination of the urine plays a vital role in the diagnosis of kidney diseases. Sometimes the identification of urine sediment needs confirmation by expertise in clinical microscopy, and this is difficult in the far rural area in the developing countries. Here, the author evaluated a feasibility to use refrigerated urine sediment for repeated analysis. In this work, the author found that it is feasible to use refrigerated urine sediment for repeated analysis. The good correlation (> 0.9) can be seen for the epithelium, red blood cell, and cast but not for the white blood cell. The consistency of the repeat analysis results are an orderly decrease from epithelium (4 days), red blood cell (3 days), white blood cell (3 days), and cast (2 days). However, as time passes, reliability decreases.
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Affiliation(s)
- Viroj Wiwanitkit
- Department of Laboratory Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.
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Wald R, Bell CM, Nisenbaum R, Perrone S, Liangos O, Laupacis A, Jaber BL. Interobserver reliability of urine sediment interpretation. Clin J Am Soc Nephrol 2009; 4:567-71. [PMID: 19261816 DOI: 10.2215/cjn.05331008] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND AND OBJECTIVES Urine sediment interpretation is frequently used in the evaluation of patients with kidney disease. There has been no systematic evaluation of the reliability of this diagnostic maneuver. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS Digital photographs of urine sediment images were acquired from 165 consecutive patients being evaluated by the nephrology consultation service at a tertiary care hospital. Urine sediment images of 100 patients were randomly selected; 86 patients had images that were deemed to be of sufficient quality, and one image per patient was chosen for inclusion in an internet-based questionnaire. For each image, the presence or absence of 14 potential urinary structures was ascertained. Ten nephrologists (senior readers [n = 3]: >10 yr of experience; intermediate readers [n = 3]: 1 to 10 yr of experience; and junior readers [n = 4]: first year of practice) completed the questionnaire. For each urinary structure, we measured the rate of complete agreement among the readers as well as the kappa statistic as a marker of agreement beyond chance. RESULTS Unanimous agreement was highest (79.1%) regarding the presence of broad and fatty casts and poorest (31.4%) for the identification of dysmorphic red blood cells and white blood cells. Interobserver agreement was best for squamous epithelial cells (kappa = 0.54) and hyaline casts (kappa = 0.52) and worst for transitional epithelial cells (kappa = 0.14) and fatty casts (kappa = 0.06). When assessed within strata of physician experience, interobserver agreement was not associated with seniority. CONCLUSIONS Nephrologists achieved slight to moderate agreement in the identification of structures that are commonly observed in the urine sediment.
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Affiliation(s)
- Ron Wald
- Department of Medicine, Division of Nephrology, St Michael's Hospital, Toronto, ON, Canada.
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Lameire N, Hoste E. Reflections on the definition, classification, and diagnostic evaluation of acute renal failure. Curr Opin Crit Care 2005; 10:468-75. [PMID: 15616388 DOI: 10.1097/01.ccx.0000144939.24897.71] [Citation(s) in RCA: 68] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Jo DH, Lee SJ, Kim JJ, Kim MH. Severe Lower Extremity Edema during the Post-herpetic Neuralgia Management in Old Age -A case report-. Korean J Pain 2004. [DOI: 10.3344/jkps.2004.17.2.262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Affiliation(s)
- Dae Hyun Jo
- Pain Clinic, CHA General Hospital, Seongnam, Korea
| | - Se Jong Lee
- Pain Clinic, CHA General Hospital, Seongnam, Korea
| | - Jae Jung Kim
- Department of Anesthesiology, CHA General Hospital, Seongnam, Korea
| | - Myoung Hee Kim
- Department of Anesthesiology, CHA General Hospital, Seongnam, Korea
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