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Ergin B, Kapucu A, Chawla L, Ince C. Synthetic Angiotensin II ameliorates alterations of systemic hemodynamics, microcirculatory deterioration, and renal damage in septic rats. Microvasc Res 2024; 155:104709. [PMID: 38936768 DOI: 10.1016/j.mvr.2024.104709] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2024] [Revised: 05/29/2024] [Accepted: 06/11/2024] [Indexed: 06/29/2024]
Affiliation(s)
- Bulent Ergin
- Department of Intensive Care, Laboratory of Translational Intensive Care, Erasmus Medical Center, Rotterdam, the Netherlands.
| | - Aysegul Kapucu
- Department of Zoology, Faculty of Science, University of Istanbul, Istanbul, Turkey
| | - Lakhmir Chawla
- UC San Diego Health, University of California, San Diego, United States of America
| | - Can Ince
- Department of Intensive Care, Laboratory of Translational Intensive Care, Erasmus Medical Center, Rotterdam, the Netherlands
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2
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Tamargo C, Hanouneh M, Cervantes CE. Treatment of Acute Kidney Injury: A Review of Current Approaches and Emerging Innovations. J Clin Med 2024; 13:2455. [PMID: 38730983 PMCID: PMC11084889 DOI: 10.3390/jcm13092455] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2024] [Revised: 04/12/2024] [Accepted: 04/18/2024] [Indexed: 05/13/2024] Open
Abstract
Acute kidney injury (AKI) is a complex and life-threatening condition with multifactorial etiologies, ranging from ischemic injury to nephrotoxic exposures. Management is founded on treating the underlying cause of AKI, but supportive care-via fluid management, vasopressor therapy, kidney replacement therapy (KRT), and more-is also crucial. Blood pressure targets are often higher in AKI, and these can be achieved with fluids and vasopressors, some of which may be more kidney-protective than others. Initiation of KRT is controversial, and studies have not consistently demonstrated any benefit to early start dialysis. There are no targeted pharmacotherapies for AKI itself, but some do exist for complications of AKI; additionally, medications become a key aspect of AKI management because changes in renal function and dialysis support can lead to issues with both toxicities and underdosing. This review will cover existing literature on these and other aspects of AKI treatment. Additionally, this review aims to identify gaps and challenges and to offer recommendations for future research and clinical practice.
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Affiliation(s)
- Christina Tamargo
- Department of Medicine, Division of Nephrology, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA
| | - Mohamad Hanouneh
- Department of Medicine, Division of Nephrology, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA
- Nephrology Center of Maryland, Baltimore, MD 21239, USA
| | - C. Elena Cervantes
- Department of Medicine, Division of Nephrology, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA
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3
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Vasylaki A, Ghosh P, Jaimes EA, Williams RM. Targeting the Kidneys at the Nanoscale: Nanotechnology in Nephrology. KIDNEY360 2024; 5:618-630. [PMID: 38414130 PMCID: PMC11093552 DOI: 10.34067/kid.0000000000000400] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Accepted: 02/16/2024] [Indexed: 02/29/2024]
Abstract
Kidney diseases, both acute and chronic, are a substantial burden on individual and public health, and they continue to increase in frequency. Despite this and an intense focus on the study of disease mechanisms, few new therapeutic approaches have extended to the clinic. This is in part due to poor pharmacology of many, if not most, therapeutics with respect to the sites of kidney disease within the glomerulus or nephron. Considering this, within the past decade, and more pointedly over the past 2 years, there have been substantial developments in nanoparticle systems to deliver therapeutics to the sites of kidney disease. Here, we provide a broad overview of the various classes of nanomaterials that have been developed to improve therapeutic development for kidney diseases, the strategy used to provide kidney accumulation, and briefly the disease models they focused on, if any. We then focus on one specific system, polymeric mesoscale nanoparticles, which has broadly been used over 13 publications, demonstrating targeting of the tubular epithelium with 26-fold specificity compared with other organs. While there have been several nanomedicines that have advanced to the clinic in the past several decades, including mRNA-based coronavirus disease vaccines and others, none have focused on kidney diseases specifically. In total, we are confident that the rapid advancement of nanoscale-based kidney targeting and a concerted focus by clinicians, scientists, engineers, and other stakeholders will push one or more of these technologies into clinical trials over the next decade.
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Affiliation(s)
- Anastasiia Vasylaki
- Department of Biomedical Engineering, The City College of New York, New York, New York
| | - Pratyusha Ghosh
- Department of Biomedical Engineering, The City College of New York, New York, New York
| | - Edgar A. Jaimes
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
- Department of Medicine, Weill Cornell Medicine, New York, New York
| | - Ryan M. Williams
- Department of Biomedical Engineering, The City College of New York, New York, New York
- PhD Program in Chemistry, The Graduate Center of CUNY, New York, New York
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4
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Aggarwal S, Wang Z, Rincon Fernandez Pacheco D, Rinaldi A, Rajewski A, Callemeyn J, Van Loon E, Lamarthée B, Covarrubias AE, Hou J, Yamashita M, Akiyama H, Karumanchi SA, Svendsen CN, Noble PW, Jordan SC, Breunig JJ, Naesens M, Cippà PE, Kumar S. SOX9 switch links regeneration to fibrosis at the single-cell level in mammalian kidneys. Science 2024; 383:eadd6371. [PMID: 38386758 DOI: 10.1126/science.add6371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Accepted: 01/11/2024] [Indexed: 02/24/2024]
Abstract
The steps governing healing with or without fibrosis within the same microenvironment are unclear. After acute kidney injury (AKI), injured proximal tubular epithelial cells activate SOX9 for self-restoration. Using a multimodal approach for a head-to-head comparison of injury-induced SOX9 lineages, we identified a dynamic SOX9 switch in repairing epithelia. Lineages that regenerated epithelia silenced SOX9 and healed without fibrosis (SOX9on-off). By contrast, lineages with unrestored apicobasal polarity maintained SOX9 activity in sustained efforts to regenerate, which were identified as a SOX9on-on Cadherin6pos cell state. These reprogrammed cells generated substantial single-cell WNT activity to provoke a fibroproliferative response in adjacent fibroblasts, driving AKI to chronic kidney disease. Transplanted human kidneys displayed similar SOX9/CDH6/WNT2B responses. Thus, we have uncovered a sensor of epithelial repair status, the activity of which determines regeneration with or without fibrosis.
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Affiliation(s)
- Shikhar Aggarwal
- Board of Governors Regenerative Medicine Institute, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA
- Department of Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA
| | - Zhanxiang Wang
- Board of Governors Regenerative Medicine Institute, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA
- Department of Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA
| | - David Rincon Fernandez Pacheco
- Board of Governors Regenerative Medicine Institute, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA
- Department of Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA
| | - Anna Rinaldi
- Division of Nephrology, Ente Ospedaliero Cantonale, CH-6900 Lugano, Switzerland
| | - Alex Rajewski
- Applied Genomics, Computation, and Translational Core, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA
| | - Jasper Callemeyn
- Department of Microbiology, Immunology and Transplantation, KU Leuven, BE-3000 Leuven, Belgium
| | - Elisabet Van Loon
- Department of Microbiology, Immunology and Transplantation, KU Leuven, BE-3000 Leuven, Belgium
| | - Baptiste Lamarthée
- Department of Microbiology, Immunology and Transplantation, KU Leuven, BE-3000 Leuven, Belgium
| | - Ambart Ester Covarrubias
- Division of Nephrology, Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA
| | - Jean Hou
- Department of Pathology and Laboratory Medicine, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA
| | - Michifumi Yamashita
- Department of Pathology and Laboratory Medicine, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA
| | - Haruhiko Akiyama
- Department of Orthopaedic Surgery, Gifu University Graduate School of Medicine, Gifu 501-1194, Japan
| | - S Ananth Karumanchi
- Department of Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA
- Division of Nephrology, Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA
| | - Clive N Svendsen
- Board of Governors Regenerative Medicine Institute, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA
- Department of Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA
| | - Paul W Noble
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Women's Guild Lung Institute, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA
| | - Stanley C Jordan
- Division of Nephrology, Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA
| | - Joshua J Breunig
- Board of Governors Regenerative Medicine Institute, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA
- Department of Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA
| | - Maarten Naesens
- Department of Microbiology, Immunology and Transplantation, KU Leuven, BE-3000 Leuven, Belgium
| | - Pietro E Cippà
- Division of Nephrology, Ente Ospedaliero Cantonale, CH-6900 Lugano, Switzerland
- Faculty of Biomedical Sciences, Università della Svizzera Italiana, CH-6900 Lugano, Switzerland
| | - Sanjeev Kumar
- Board of Governors Regenerative Medicine Institute, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA
- Department of Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA
- Division of Nephrology, Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA
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Romero-González G, Rodríguez-Chitiva N, Cañameras C, Paúl-Martínez J, Urrutia-Jou M, Troya M, Soler-Majoral J, Graterol Torres F, Sánchez-Bayá M, Calabia J, Bover J. Albuminuria, Forgotten No More: Underlining the Emerging Role in CardioRenal Crosstalk. J Clin Med 2024; 13:777. [PMID: 38337471 PMCID: PMC10856688 DOI: 10.3390/jcm13030777] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2023] [Revised: 01/21/2024] [Accepted: 01/23/2024] [Indexed: 02/12/2024] Open
Abstract
Kidneys have an amazing ability to adapt to adverse situations, both acute and chronic. In the presence of injury, the kidney is able to activate mechanisms such as autoregulation or glomerular hyperfiltration to maintain the glomerular filtration rate (GFR). While these adaptive mechanisms can occur in physiological situations such as pregnancy or high protein intake, they can also occur as an early manifestation of diseases such as diabetes mellitus or as an adaptive response to nephron loss. Although over-activation of these mechanisms can lead to intraglomerular hypertension and albuminuria, other associated mechanisms related to the activation of inflammasome pathways, including endothelial and tubular damage, and the hemodynamic effects of increased activity of the renin-angiotensin-aldosterone system, among others, are recognized pathways for the development of albuminuria. While the role of albuminuria in the progression of chronic kidney disease (CKD) is well known, there is increasing evidence of its negative association with cardiovascular events. For example, the presence of albuminuria is associated with an increased likelihood of developing heart failure (HF), even in patients with normal GFR, and the role of albuminuria in atherosclerosis has recently been described. Albuminuria is associated with adverse outcomes such as mortality and HF hospitalization. On the other hand, it is increasingly known that the systemic effects of congestion are mainly preceded by increased central venous pressure and transmitted retrogradely to organs such as the liver or kidney. With regard to the latter, a new entity called congestive nephropathy is emerging, in which increased renal venous pressure can lead to albuminuria. Fortunately, the presence of albuminuria is modifiable and new treatments are now available to reverse this common risk factor in the cardiorenal interaction.
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Affiliation(s)
- Gregorio Romero-González
- Nephrology Department, Germans Trias i Pujol University Hospital, 08916 Badalona, Spain; (G.R.-G.); (N.R.-C.); (C.C.); (J.P.-M.); (M.T.); (J.S.-M.); (F.G.T.); (M.S.-B.)
- REMAR-IGTP Group (Kidney-Affecting Diseases Research Group), Germans Trias i Pujol Research Institute (IGTP), 08916 Badalona, Spain
- International Renal Research Institute of Vicenza, 36100 Vicenza, Italy
| | - Néstor Rodríguez-Chitiva
- Nephrology Department, Germans Trias i Pujol University Hospital, 08916 Badalona, Spain; (G.R.-G.); (N.R.-C.); (C.C.); (J.P.-M.); (M.T.); (J.S.-M.); (F.G.T.); (M.S.-B.)
- REMAR-IGTP Group (Kidney-Affecting Diseases Research Group), Germans Trias i Pujol Research Institute (IGTP), 08916 Badalona, Spain
| | - Carles Cañameras
- Nephrology Department, Germans Trias i Pujol University Hospital, 08916 Badalona, Spain; (G.R.-G.); (N.R.-C.); (C.C.); (J.P.-M.); (M.T.); (J.S.-M.); (F.G.T.); (M.S.-B.)
| | - Javier Paúl-Martínez
- Nephrology Department, Germans Trias i Pujol University Hospital, 08916 Badalona, Spain; (G.R.-G.); (N.R.-C.); (C.C.); (J.P.-M.); (M.T.); (J.S.-M.); (F.G.T.); (M.S.-B.)
- REMAR-IGTP Group (Kidney-Affecting Diseases Research Group), Germans Trias i Pujol Research Institute (IGTP), 08916 Badalona, Spain
| | - Marina Urrutia-Jou
- Nephrology Department, University Hospital Joan XXIII, 43005 Tarragona, Spain;
| | - Maribel Troya
- Nephrology Department, Germans Trias i Pujol University Hospital, 08916 Badalona, Spain; (G.R.-G.); (N.R.-C.); (C.C.); (J.P.-M.); (M.T.); (J.S.-M.); (F.G.T.); (M.S.-B.)
- REMAR-IGTP Group (Kidney-Affecting Diseases Research Group), Germans Trias i Pujol Research Institute (IGTP), 08916 Badalona, Spain
| | - Jordi Soler-Majoral
- Nephrology Department, Germans Trias i Pujol University Hospital, 08916 Badalona, Spain; (G.R.-G.); (N.R.-C.); (C.C.); (J.P.-M.); (M.T.); (J.S.-M.); (F.G.T.); (M.S.-B.)
- REMAR-IGTP Group (Kidney-Affecting Diseases Research Group), Germans Trias i Pujol Research Institute (IGTP), 08916 Badalona, Spain
| | - Fredzzia Graterol Torres
- Nephrology Department, Germans Trias i Pujol University Hospital, 08916 Badalona, Spain; (G.R.-G.); (N.R.-C.); (C.C.); (J.P.-M.); (M.T.); (J.S.-M.); (F.G.T.); (M.S.-B.)
- REMAR-IGTP Group (Kidney-Affecting Diseases Research Group), Germans Trias i Pujol Research Institute (IGTP), 08916 Badalona, Spain
| | - Maya Sánchez-Bayá
- Nephrology Department, Germans Trias i Pujol University Hospital, 08916 Badalona, Spain; (G.R.-G.); (N.R.-C.); (C.C.); (J.P.-M.); (M.T.); (J.S.-M.); (F.G.T.); (M.S.-B.)
- REMAR-IGTP Group (Kidney-Affecting Diseases Research Group), Germans Trias i Pujol Research Institute (IGTP), 08916 Badalona, Spain
| | - Jordi Calabia
- Nephrology Department, University Hospital Josep Trueta, IdIBGi Research Institute, Universitat de Girona, 17007 Girona, Spain;
| | - Jordi Bover
- Nephrology Department, Germans Trias i Pujol University Hospital, 08916 Badalona, Spain; (G.R.-G.); (N.R.-C.); (C.C.); (J.P.-M.); (M.T.); (J.S.-M.); (F.G.T.); (M.S.-B.)
- REMAR-IGTP Group (Kidney-Affecting Diseases Research Group), Germans Trias i Pujol Research Institute (IGTP), 08916 Badalona, Spain
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6
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Tounsa A, Hussain A, Hussain I, Tariq R, Saqlain M, Shaikh SA, Mumtaz H. Acute kidney injury in birth asphyxiated patients: A cross sectional study at Bahawal Victoria Hospital. Lung India 2024; 41:30-34. [PMID: 38160456 PMCID: PMC10883448 DOI: 10.4103/lungindia.lungindia_225_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Revised: 10/14/2023] [Accepted: 11/15/2023] [Indexed: 01/03/2024] Open
Abstract
BACKGROUND The presence of perinatal asphyxia and its severity appear to correlate with increasing incidence of Acute kidney injury (AKI). The objective of this study is to determine the frequency of AKI and its outcome in birth asphyxia. METHODS This cross-sectional study was carried out in the Department of Pediatric Medicine from March 2019 to September 2019. A total of 111 newborns with birth asphyxia of gestational age 37-41 weeks were included. Neonates born to mothers having hypertension and diabetes mellitus, patients with congenital kidney anomalies like polycystic kidney disease and renal agenesis, and mothers taking nephrotoxic drugs or any other known cause of AKI like hypovolemic shock were excluded. Urine output (UOP) and final outcome of the patient were also noted. AKI was noted. RESULTS The mean gestational age was 38.29 ± 1.07 weeks. The mean weight of neonates was 3.08 ± 0.31 kg. The frequency of AKI in birth asphyxia was 20 (18.02%) neonates. Complete recovery in AKI patients was seen in 07 (35.0%) and death in 13 (65.0%) patients. CONCLUSION This study has shown that the frequency of AKI in birth asphyxia was found in 18.02% neonates with complete recovery seen in 35.0% and death in 65.0% patients.
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Affiliation(s)
- Akhtar Tounsa
- Consultant Emergency Child Life Foundation, Mayo Hospital Lahore, Pakistan
| | - Arif Hussain
- Pediatrics Department, Akhtar Saeed Medical College Islamabad, Pakistan
| | | | - Rabia Tariq
- Pediatric Oncology, PIMS Islamabad, Pakistan
| | | | - Saba A. Shaikh
- Pediatrics Departments, Akhtar Saeed Medical College, Islamabad, Pakistan
| | - Hassan Mumtaz
- Clinical Research Associate, Maroof International Hospital, Islamabad, Pakistan
- Public Health Scholar, Health Services Academy, Islamabad, Pakistan
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7
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Mogi M, Tanaka A, Node K, Tomitani N, Hoshide S, Narita K, Nozato Y, Katsurada K, Maruhashi T, Higashi Y, Matsumoto C, Bokuda K, Yoshida Y, Shibata H, Toba A, Masuda T, Nagata D, Nagai M, Shinohara K, Kitada K, Kuwabara M, Kodama T, Kario K. 2023 update and perspectives. Hypertens Res 2024; 47:6-32. [PMID: 37710033 DOI: 10.1038/s41440-023-01398-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Accepted: 07/30/2023] [Indexed: 09/16/2023]
Abstract
Total 276 manuscripts were published in Hypertension Research in 2022. Here our editorial members picked up the excellent papers, summarized the current topics from the published papers and discussed future perspectives in the sixteen fields. We hope you enjoy our special feature, 2023 update and perspectives in Hypertension Research.
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Affiliation(s)
- Masaki Mogi
- Deparment of Pharmacology, Ehime University Graduate School of Medicine, 454 Shitsukawa Tohon, Ehime, 791-0295, Japan.
| | - Atsushi Tanaka
- Department of Cardiovascular Medicine, Saga University, 5-1-1, Nabeshima, Saga, Saga, 849-8501, Japan
| | - Koichi Node
- Department of Cardiovascular Medicine, Saga University, 5-1-1, Nabeshima, Saga, Saga, 849-8501, Japan
| | - Naoko Tomitani
- Division of Cardiovascular Medicine, Department of Medicine, Jichi Medical University School of Medicine, 3311-1, Yakushiji, Shimotsuke, Tochigi, 329-0498, Japan
| | - Satoshi Hoshide
- Division of Cardiovascular Medicine, Department of Medicine, Jichi Medical University School of Medicine, 3311-1, Yakushiji, Shimotsuke, Tochigi, 329-0498, Japan
| | - Keisuke Narita
- Division of Cardiovascular Medicine, Department of Medicine, Jichi Medical University School of Medicine, 3311-1, Yakushiji, Shimotsuke, Tochigi, 329-0498, Japan
| | - Yoichi Nozato
- Department of Geriatric and General Medicine, Osaka University Graduate School of Medicine, 2-2, Yamada-oka, Suita, Osaka, 565-0871, Japan
| | - Kenichi Katsurada
- Division of Cardiovascular Medicine, Department of Medicine, Jichi Medical University School of Medicine, 3311-1, Yakushiji, Shimotsuke, Tochigi, 329-0498, Japan
- Division of Clinical Pharmacology, Department of Pharmacology, Jichi Medical University School of Medicine, 3311-1, Shimotsuke, Tochigi, 329-0498, Japan
| | - Tatsuya Maruhashi
- Department of Regenerative Medicine, Research Institute for Radiation Biology and Medicine, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8553, Japan
| | - Yukihito Higashi
- Department of Regenerative Medicine, Research Institute for Radiation Biology and Medicine, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8553, Japan
- Divivsion of Regeneration and Medicine, Medical Center for Translational and Clinical Research, Hiroshima University Hospital, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan
| | - Chisa Matsumoto
- Center for Health Surveillance & Preventive Medicine, Tokyo Medical University Hospital, 6-7-1 Nishishinjuku, Shinjuku-ku, Tokyo, 160-0023, Japan
- Department of Cardiology, Tokyo Medical University, 6-1-1 Shinjuku, Shinjuku-ku, Tokyo, 160-8402, Japan
| | - Kanako Bokuda
- Department of Endocrinology and Hypertension, Tokyo Women's Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo, 162-8666, Japan
| | - Yuichi Yoshida
- Department of Endocrinology, Metabolism, Rheumatology and Nephrology, Faculty of Medicine, Oita University, 1-1 Idaigaoka, Hasama-machi, Yufu city, Oita, 879-5593, Japan
| | - Hirotaka Shibata
- Department of Endocrinology, Metabolism, Rheumatology and Nephrology, Faculty of Medicine, Oita University, 1-1 Idaigaoka, Hasama-machi, Yufu city, Oita, 879-5593, Japan
| | - Ayumi Toba
- Tokyo Metropolitan Institute for Geriatrics and Gerontology, Sakaecho, Itabashi-ku, Tokyo, 173-0015, Japan
| | - Takahiro Masuda
- Division of Nephrology, Department of Medicine, Jichi Medical University School of Medicine, 3311-1, Yakushiji, Shimotsuke, Tochigi, 329-0498, Japan
| | - Daisuke Nagata
- Division of Nephrology, Department of Medicine, Jichi Medical University School of Medicine, 3311-1, Yakushiji, Shimotsuke, Tochigi, 329-0498, Japan
| | - Michiaki Nagai
- Cardiovascular Section, Department of Internal Medicine, Heart Rhythm Institute, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, 800 SL Young Blvd, COM 5400, Oklahoma City, OK, 73104, USA
- Department of Cardiology, Hiroshima City Asa Hospital, 1-2-1 Kameyamaminami Asakita-ku, Hiroshima, 731-0293, Japan
| | - Keisuke Shinohara
- Department of Cardiovascular Medicine, Faculty of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
| | - Kento Kitada
- Department of Pharmacology, Faculty of Medicine, Kagawa University, 1750-1 Miki, Kita, Kagawa, 761-0793, Japan
| | - Masanari Kuwabara
- Department of Cardiology, Toranomon Hospital, 2-2-2, Toranomon, Minato-ku, Tokyo, 105-8470, Japan
| | - Takahide Kodama
- Department of Cardiology, Toranomon Hospital, 2-2-2, Toranomon, Minato-ku, Tokyo, 105-8470, Japan
| | - Kazuomi Kario
- Division of Cardiovascular Medicine, Department of Medicine, Jichi Medical University School of Medicine, 3311-1, Yakushiji, Shimotsuke, Tochigi, 329-0498, Japan
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8
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Morinaga Y, Tanaka R, Tatsuta R, Takano K, Hashimoto T, Ogata M, Hiramatsu K, Itoh H. Risk Factors for Teicoplanin-Associated Acute Kidney Injury in Patients with Hematological Malignancies: Focusing on Concomitant Use of Tazobactam/Piperacillin. Biol Pharm Bull 2024; 47:988-996. [PMID: 38763761 DOI: 10.1248/bpb.b23-00848] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/21/2024]
Abstract
Patients with hematological malignancies (HM) often receive tazobactam/piperacillin (TAZ/PIPC) and glycopeptide antibiotics for febrile neutropenia. The effect of concomitant use of TAZ/PIPC on risk of teicoplanin (TEIC)-associated acute kidney injury (AKI) remains unclear. We investigated the impact of concomitant TAZ/PIPC use on TEIC-associated AKI in HM patients and identified the risk factors. In this retrospective, single-center, observational cohort study, 203 patients received TEIC, 176 of whom satisfied the selection criteria and were divided into TEIC cohort (no TAZ/PIPC; n = 118) and TEIC + TAZ/PIPC cohort (n = 58). AKI was defined as serum creatinine increase ≥0.3 mg/dL within 48 h or ≥50% from baseline. Incidence of AKI in TEIC cohort before and after propensity score matching was 9.3 and 5.9%, respectively, and that in TEIC + TAZ/PIPC cohort was 10.3 and 11.8%. AKI incidence and risk were not significantly different between two cohorts before (p = 0.829; odds ratio (OR) 1.122, 95% confidence interval (CI) 0.393-3.202) and after matching (p = 0.244; OR 2.133, 95% CI 0.503-9.043). Logistic regression analysis with factors clinically or mechanistically potentially related to TEIC-associated AKI, including concomitant TAZ/PIPC use, as independent variables identified baseline hemoglobin level as the only significant risk factor for TEIC-associated AKI (p = 0.011; OR 0.484, 95% CI 0.276-0.848). In HM patients treated with TEIC, concomitant TAZ/PIPC use did not increase AKI risk whereas lower hemoglobin levels had higher risk for TEIC-associated AKI development, suggesting the necessity to monitor serum creatinine when using TEIC in patients with anemia.
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Affiliation(s)
- Yuko Morinaga
- Department of Clinical Pharmacy, Oita University Hospital
| | - Ryota Tanaka
- Department of Clinical Pharmacy, Oita University Hospital
| | | | | | | | - Masao Ogata
- Department of Hematology, Oita University Hospital
| | | | - Hiroki Itoh
- Department of Clinical Pharmacy, Oita University Hospital
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Zhou Y, Zhu L, Liu B, Xu W, Yang X, Liu Y, Ruan B, Yi S, Liang B, Dong G, Huang J. Tailored Zwitterionic Hemicyanine Reporters for Early Diagnosis and Prognostic Assessment of Acute Renal Failure. Angew Chem Int Ed Engl 2023; 62:e202315457. [PMID: 37949837 DOI: 10.1002/anie.202315457] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Revised: 11/09/2023] [Accepted: 11/10/2023] [Indexed: 11/12/2023]
Abstract
Drug-induced renal failure (DIRF) poses a serious medical complication with high mortality risk. However, early diagnosis or prognosis of DIRF remain challenging, as current methods rely on detecting late-stage biomarkers. Herein we present a library of zwitterionic unimolecular hemicyanines (ZCs) available for constructing activatable reporters to detect DIRF since its initial stage. Zwitterionic properties of these probes are achieved through interspersedly integrating alkyl sulfonates and quaternary ammonium cations onto hemicyanine skeleton, which result in record low plasma protein binding (<5 %) and remarkable renal clearance efficiencies (≈96 %). An activatable reporter ZCRR is further developed by masking the optimal candidate ZC6 with a tetrapeptide specifically cleavable by caspase-8, an initiating indicator of apoptosis. In living mice with cisplatin-induced DIRF, systematically administered ZCRR efficiently accumulates in kidneys and responds to elevated caspase-8 for near-infrared fluorescence signals 'turn-on', enabling sensitive detection of intrarenal apoptosis 60 h earlier than clinical methods, and precise evaluation of apoptosis remediation effects by different medications on DIRF mice. As it's urinary excretable, ZCRR also allows for remote detection of DIRF and predicting renoprotective efficacy through in vitro optical urinalysis. This study thus presents unimolecular renal clearable scaffolds that are applicable to developing versatile activatable reporters for renal diseases management.
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Affiliation(s)
- Ya Zhou
- Department School of Pharmaceutical Sciences, Sun Yat-sen University, Guangzhou, 510006, China
- National-Local Joint Engineering Laboratory of Druggability and New Drugs Evaluation, Guangdong Provincial Key Laboratory of New Drug Design and Evaluation, Sun Yat-sen University, Guangzhou, 510006, China
| | - Lijuan Zhu
- Department School of Pharmaceutical Sciences, Sun Yat-sen University, Guangzhou, 510006, China
- National-Local Joint Engineering Laboratory of Druggability and New Drugs Evaluation, Guangdong Provincial Key Laboratory of New Drug Design and Evaluation, Sun Yat-sen University, Guangzhou, 510006, China
| | - Biaoxiang Liu
- Department School of Pharmaceutical Sciences, Sun Yat-sen University, Guangzhou, 510006, China
- National-Local Joint Engineering Laboratory of Druggability and New Drugs Evaluation, Guangdong Provincial Key Laboratory of New Drug Design and Evaluation, Sun Yat-sen University, Guangzhou, 510006, China
| | - Weiping Xu
- Department School of Pharmaceutical Sciences, Sun Yat-sen University, Guangzhou, 510006, China
- National-Local Joint Engineering Laboratory of Druggability and New Drugs Evaluation, Guangdong Provincial Key Laboratory of New Drug Design and Evaluation, Sun Yat-sen University, Guangzhou, 510006, China
| | - Xingyue Yang
- Department School of Pharmaceutical Sciences, Sun Yat-sen University, Guangzhou, 510006, China
- National-Local Joint Engineering Laboratory of Druggability and New Drugs Evaluation, Guangdong Provincial Key Laboratory of New Drug Design and Evaluation, Sun Yat-sen University, Guangzhou, 510006, China
| | - Yi Liu
- Department School of Pharmaceutical Sciences, Sun Yat-sen University, Guangzhou, 510006, China
- National-Local Joint Engineering Laboratory of Druggability and New Drugs Evaluation, Guangdong Provincial Key Laboratory of New Drug Design and Evaluation, Sun Yat-sen University, Guangzhou, 510006, China
| | - Bankang Ruan
- Department School of Pharmaceutical Sciences, Sun Yat-sen University, Guangzhou, 510006, China
- National-Local Joint Engineering Laboratory of Druggability and New Drugs Evaluation, Guangdong Provincial Key Laboratory of New Drug Design and Evaluation, Sun Yat-sen University, Guangzhou, 510006, China
| | - Shujuan Yi
- Department School of Pharmaceutical Sciences, Sun Yat-sen University, Guangzhou, 510006, China
- National-Local Joint Engineering Laboratory of Druggability and New Drugs Evaluation, Guangdong Provincial Key Laboratory of New Drug Design and Evaluation, Sun Yat-sen University, Guangzhou, 510006, China
| | - Baoshuai Liang
- Department School of Pharmaceutical Sciences, Sun Yat-sen University, Guangzhou, 510006, China
- National-Local Joint Engineering Laboratory of Druggability and New Drugs Evaluation, Guangdong Provincial Key Laboratory of New Drug Design and Evaluation, Sun Yat-sen University, Guangzhou, 510006, China
| | - Guoqi Dong
- Department School of Pharmaceutical Sciences, Sun Yat-sen University, Guangzhou, 510006, China
- National-Local Joint Engineering Laboratory of Druggability and New Drugs Evaluation, Guangdong Provincial Key Laboratory of New Drug Design and Evaluation, Sun Yat-sen University, Guangzhou, 510006, China
| | - Jiaguo Huang
- Department School of Pharmaceutical Sciences, Sun Yat-sen University, Guangzhou, 510006, China
- National-Local Joint Engineering Laboratory of Druggability and New Drugs Evaluation, Guangdong Provincial Key Laboratory of New Drug Design and Evaluation, Sun Yat-sen University, Guangzhou, 510006, China
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Barns ME, Dinh Chau MVH, Teloken PE, Hodder R. The Use of Prophylactic Ureteric Stents in Major Abdomino-Pelvic Sarcoma Surgery: Risks, Benefits, and Potential Complications. Res Rep Urol 2023; 15:577-585. [PMID: 38145156 PMCID: PMC10748668 DOI: 10.2147/rru.s435959] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Accepted: 12/14/2023] [Indexed: 12/26/2023] Open
Abstract
Here we present two cases of post-operative obstructive renal failure following major abdomino-pelvic sarcoma surgery. In both cases, prophylactic ureteric stents were inserted to aid the identification and protection of the ureters during resection of these complex retroperitoneal masses. In case one, obstructive renal failure occurred following ureteric stent removal on day 0 post-operatively. In case two, obstructive renal failure developed on day 1 post-operatively despite having a ureteric stent in situ. Here we propose that a combination of reflex anuria/ureteric edema and papillary sloughing led to the obstructive renal failure in both cases. Re-insertion of bilateral ureteric stents in case one, and replacement of a right ureteric stent in case two saw prompt excretion of urine and sloughy debris with rapid improvement of renal function. This article presents these cases in detail and further reviews the use of prophylactic ureteric stents in major abdomino-pelvic surgery along with the current guidelines for their usage.
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Affiliation(s)
| | | | | | - Rupert Hodder
- Sir Charles Gardiner Hospital, Department of General Surgery, Perth, WA, Australia
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11
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Kurasawa S, Yasuda Y, Kato S, Maruyama S, Okada H, Kashihara N, Narita I, Wada T, Yamagata K. Relationship between the lower limit of systolic blood pressure target and kidney function decline in advanced chronic kidney disease: an instrumental variable analysis from the REACH-J CKD cohort study. Hypertens Res 2023; 46:2478-2487. [PMID: 37460823 DOI: 10.1038/s41440-023-01358-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2023] [Revised: 06/09/2023] [Accepted: 06/15/2023] [Indexed: 10/04/2023]
Abstract
Intensive antihypertensive treatment decreases cardiovascular disease and mortality risks in chronic kidney disease (CKD), whereas extremely low systolic blood pressure (SBP) is associated with worsening kidney function and poor prognosis. Although the SBP variation is particularly large in patients with CKD, the optimal lower limit of SBP target is unclear. In a nationwide, multicenter cohort study of patients with an estimated glomerular filtration rate (eGFR) < 45 mL/min/1.73 m2, we evaluated the association between the eGFR slopes and the lower limit of SBP target at ≥110 mmHg using a linear mixed-effects model and an instrumental variable method. The instrumental variable was calculated as the facility-level percentage of nephrologists who answered in the survey that their lower limit of SBP target was 110 mmHg or higher. A total of 1320 patients (mean age 70 years; 66% men) were included. The mean eGFR slope ± standard deviation over the four years to baseline was -2.48 ± 2.15 mL/min/1.73 m2/year. The instrumental variable for the lower limit of SBP target at ≥110 mmHg (vs. ≤100 mmHg) was associated with less eGFR decline (coefficient: +1.05 mL/min/1.73 m2/year; 95% confidence interval: 0.33-1.77), while unassociated with a history of cardiovascular disease. The renoprotective effect was particularly larger in the subgroups of the elderly and those with a history of cardiovascular disease. In conclusion, the lower limit of SBP target at 110 mmHg or higher was associated with improved eGFR slope, suggesting the importance of aiming at avoiding excessively low SBP in patients with advanced CKD.
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Affiliation(s)
- Shimon Kurasawa
- Department of Nephrology, Nagoya University Graduate School of Medicine, Nagoya, Japan.
- Department of Clinical Research Education, Nagoya University Graduate School of Medicine, Nagoya, Japan.
| | - Yoshinari Yasuda
- Department of Nephrology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Sawako Kato
- Department of Nephrology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Shoichi Maruyama
- Department of Nephrology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Hirokazu Okada
- Department of Nephrology, Saitama Medical University, Saitama, Japan
| | - Naoki Kashihara
- Department of Nephrology and Hypertension, Kawasaki Medical School, Okayama, Japan
| | - Ichiei Narita
- Division of Clinical Nephrology and Rheumatology, Niigata University Graduate School of Medical and Dental Science, Niigata, Japan
| | - Takashi Wada
- Department of Nephrology and Laboratory Medicine, Kanazawa University, Ishikawa, Japan
| | - Kunihiro Yamagata
- Department of Nephrology, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
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12
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DeCarlo C, Mohebali J, Dua A, Conrad MF, Mohapatra A. Preoperative Anemia Is Associated With Postoperative Renal Failure After Elective Open Aortic Repair. J Surg Res 2023; 291:187-194. [PMID: 37442045 DOI: 10.1016/j.jss.2023.05.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Revised: 03/23/2023] [Accepted: 05/15/2023] [Indexed: 07/15/2023]
Abstract
INTRODUCTION Preoperative anemia has been consistently shown to be a risk factor for acute kidney injury (AKI) after cardiac surgery. However, this association has not been examined in the open abdominal aortic aneurysm repair (OAR) population and is the subject of this analysis. METHODS Targeted Vascular Module from the American College of Surgeons National Surgical Quality Improvement Program was queried for patients undergoing OAR from 2013 to 2019. Anemia was defined according to World Health Organization Guidelines: Hematocrit<36% for women or <39% for men. Primary endpoint was 30-day AKI. Anemia's effect on AKI was determined using inverse probability weighted logistic regression. RESULTS There were 2275 OAR; mean age was 70.9 ± 8.2 y; 24.0% were women. Anemia was present in 498 (26.3%) patients; 165 (7.6%) had a hematocrit<33% and 8 (0.35%) had a hematocrit<24%. Differences in patient factor were nonsignificant after weighting. Any degree of postoperative AKI was more common in the anemia group (11.2% vs 5.1%; unweighted P < 0.001), as was AKI requiring hemodialysis (7.7% vs 3.2%; unweighted P < 0.001). In the weighted multivariable analysis, anemia was independently associated with postoperative AKI (odds ratio 1.51; 95% confidence interval: 1.01-2.26; P = 0.042) while controlling for age and operative factors. Patients with postoperative AKI were significantly more likely to die postoperatively than those without (26.1% vs 1.9%; <0.001). CONCLUSIONS Preoperative anemia was independently associated with post-OAR AKI after propensity weighting and controlling for operative factors. AKI is a major source of morbidity and mortality in these patients, and, if time permits, preoperative correction of anemia or its underlying cause should be considered in high-risk patients.
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Affiliation(s)
- Charles DeCarlo
- Division of Vascular and Endovascular Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts.
| | - Jahan Mohebali
- Division of Vascular and Endovascular Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Anahita Dua
- Division of Vascular and Endovascular Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Mark F Conrad
- Division of Vascular Surgery, St Elizabeth's Hospital, Brighton, Massachusetts
| | - Abhisekh Mohapatra
- Division of Vascular and Endovascular Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
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Maia J, Rodrigues AF, Dias AL, Azevedo B, Leite-Moreira A, Lourenço A, Almeida C. Kidney Injury after Cardiac Surgery: Prevention-Associated Cost Reduction. ACTA MEDICA PORT 2023; 36:567-587. [PMID: 36889336 DOI: 10.20344/amp.18755] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Accepted: 12/06/2022] [Indexed: 03/10/2023]
Abstract
INTRODUCTION Cardiac surgery may induce acute kidney injury and the need for renal replacement therapy. It is also associated with higher hospital costs, morbidity and mortality. The aims of this study were to investigate predictors of cardiac surgery associated acute kidney injury in our population and to determine the burden of acute kidney injury in elective cardiac surgery, evaluating the potential cost effectiveness of preventing it through the application of the Kidney Disease: Improving Global Outcomes bundle of care to high-risk patient groups identified by the [TIMP-2]x[IGFBP7] used as a screening test. MATERIAL AND METHODS In a University Hospital single-center retrospective cohort study we analyzed a consecutive sample of adults who underwent elective cardiac surgery between January and March 2015. A total of 276 patients were admitted during the study period. Data from all patients was analyzed until hospital discharge or the patient's death. The economic analysis was performed from the hospital costs' perspective. RESULTS Cardiac surgery associated acute kidney injury occurred in 86 patients (31%). After adjustment, higher preoperative serum creatinine (mg/L, ORadj = 1.09; 95% CI: 1.01 - 1.17), lower preoperative hemoglobin (g/dL, ORadj = 0.79; 95% CI: 0.67 - 0.94), chronic systemic hypertension (ORadj = 5.00; 95% CI: 1.67 - 15.02), an increase in cardiopulmonary bypass time (min, ORadj = 1.01; 95% CI: 1.00 - 1.01) and perioperative use of sodium nitroprusside (ORadj = 6.33; 95% CI: 1.80 - 22.28) remained significantly associated with cardiac surgery related acute kidney injury. The expected cumulative surplus cost for the hospital linked with cardiac surgery associated acute kidney injury (86 patients) was €120 695.84. Based on a median absolute risk reduction of 16.6%, by dosing kidney damage biomarkers in every patient and using preventive measures in high-risk patients, we would expect a break-even point upon screening 78 patients, which would translate, in our patient cohort, into an overall cost benefit of €7145. CONCLUSION Preoperative hemoglobin, serum creatinine, systemic hypertension, cardiopulmonary bypass time and perioperative use of sodium nitroprusside were independent predictors of cardiac surgery associated acute kidney injury. Our cost-effectiveness modelling suggests that the use of kidney structural damage biomarkers combined with an early prevention strategy could be associated with potential cost savings.
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Affiliation(s)
- João Maia
- Departamento de Anestesiologia. Centro Hospitalar e Universitário de São João. Porto. Portugal
| | | | - Ana Lídia Dias
- Departamento de Anestesiologia. Centro Hospitalar e Universitário de São João. Porto; Faculdade de Medicina. Universidade do Porto. Porto. Portugal
| | - Bárbara Azevedo
- Departamento de Anestesiologia. Centro Hospitalar e Universitário de São João. Porto. Portugal
| | - André Leite-Moreira
- Departamento de Anestesiologia. Centro Hospitalar e Universitário de São João. Porto; Faculdade de Medicina. Universidade do Porto. Porto. Portugal
| | - André Lourenço
- Departamento de Anestesiologia. Centro Hospitalar e Universitário de São João. Porto; Faculdade de Medicina. Universidade do Porto. Porto. Portugal
| | - Cláudia Almeida
- Departamento de Anestesiologia. Centro Hospitalar e Universitário de São João. Porto. Portugal
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14
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Kim J, Lee KW, Kim K, Kang H, Yang J, Park JB, Kim G. Factors to consider during anesthesia in patients undergoing preemptive kidney transplantation: a propensity-score matched analysis. BMC Anesthesiol 2023; 23:263. [PMID: 37543574 PMCID: PMC10403880 DOI: 10.1186/s12871-023-02208-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Accepted: 07/15/2023] [Indexed: 08/07/2023] Open
Abstract
BACKGROUND International guidelines have recommended preemptive kidney transplantation (KT) as the preferred approach, advocating for transplantation before the initiation of dialysis. This approach is advantageous for graft and patient survival by avoiding dialysis-related complications. However, recipients of preemptive KT may undergo anesthesia without the opportunity to optimize volume status or correct metabolic disturbances associated with end-stage renal disease. In these regard, we aimed to investigate the anesthetic events that occur more frequently during preemptive KT compared to nonpreemptive KT. METHODS This is a single-center retrospective study. Of the 672 patients who underwent Living donor KT (LDKT), 388 of 519 who underwent nonpreemptive KT were matched with 153 of 153 who underwent preemptive KT using propensity score based on preoperative covariates. The primary outcome was intraoperative hypotension defined as area under the threshold (AUT), with a threshold set at a mean arterial blood pressure below 70 mmHg. The secondary outcomes were intraoperative metabolic acidosis estimated by base excess and serum bicarbonate, electrolyte imbalance, the use of inotropes or vasopressors, intraoperative transfusion, immediate graft function evaluated by the nadir creatinine, and re-operation due to bleeding. RESULTS After propensity score matching, we analyzed 388 and 153 patients in non-preemptive and preemptive groups. The multivariable analysis revealed the AUT of the preemptive group to be significantly greater than that of the nonpreemptive group (mean ± standard deviation, 29.7 ± 61.5 and 14.5 ± 37.7, respectively, P = 0.007). Metabolic acidosis was more severe in the preemptive group compared to the nonpreemptive group. The differences in the nadir creatinine value and times to nadir creatinine were statistically significant, but clinically insignificant. CONCLUSION Intraoperative hypotension and metabolic acidosis occurred more frequently in the preemptive group during LDKT. These findings highlight the need for anesthesiologists to be prepared and vigilant in managing these events during surgery.
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Affiliation(s)
- Jeayoun Kim
- Department of Anesthesiology and Pain Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-Ro, Gangnam-Gu, Seoul, 06351, Korea
| | - Kyo Won Lee
- Department of Transplantation Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Keoungah Kim
- Department of Anesthesiology and Pain Medicine, School of Dentistry, Dankook University, Cheonan, Korea
| | - Hyeryung Kang
- Department of Anesthesiology and Pain Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-Ro, Gangnam-Gu, Seoul, 06351, Korea
| | - Jaehun Yang
- Department of Surgery, Gil Medical Center, Gachon University College of Medicine, Incheon, Korea
| | - Jae Berm Park
- Department of Transplantation Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Gaabsoo Kim
- Department of Anesthesiology and Pain Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-Ro, Gangnam-Gu, Seoul, 06351, Korea.
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15
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ENER K, CANDA AE, BİNBAY M, BALBAY MD, ATMACA AF. Zero ischemia robotic partial nephrectomy: Oncological and functional outcomes of a multicenter study. Turk J Med Sci 2023; 53:941-948. [PMID: 38031944 PMCID: PMC10760587 DOI: 10.55730/1300-0144.5658] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Revised: 08/18/2023] [Accepted: 02/28/2023] [Indexed: 12/01/2023] Open
Abstract
BACKGROUND The functional and oncological outcomes of zero ischemia robotic partial nephrectomy (RPN) procedures were evaluated. METHODS A total of 56 patients underwent zero ischemia RPN transperitoneally, and their data were collected prospectively. Radius, exo/endophytic, nearness, anterior/posterior, location (R.E.N.A.L.) nephrometry, and PADUA scores were calculated. Patient and tumor characteristics were evaluated. Intra- and perioperative (0-30 days) complications were evaluated by Clavien classification. The change in serum creatinine, and estimated glomerular filtration rates (eGFR) were evaluated during preoperative, immediate postoperative periods, and at postoperative 6th months. RESULTS The mean age of the patients was 52.2 ± 8.1 (27-75) years. R.E.N.A.L. nephrometry and PADUA scores were 6.1 ± 1.3 and 7.3 ± 1.0, respectively. The duration of surgery was 108.4 ± 18.2 min and estimated blood loss was 166.2 ± 124.7 mL. There were no intraoperative complications in any of the patients. Clavien Grade 1 and 3 complications were seen in 2 patients in the perioperative period. In the perioperative period (1-30 days), one patient required blood transfusion and angiographic intervention due to postoperative bleeding (Clavien Grade 3), and one patient required hospitalisation due to prolonged subileus (Clavien Grade 1) that resolved conservatively. The radiological and pathological tumor sizes were 3.1 ± 1.1 cm and 2.8 ± 1.4 cm, respectively. The surgical margins were positive in two patients with tumour sizes of 1.5 and 4 cm. Neither local recurrence nor distant metastasis was detected, during 33.6 ± 12.3 (3-76) months. There were no statistically significant differences between preoperative eGFR and serum creatinine levels, compared with those of immediate postoperative and postoperative 6th month periods. DISCUSSION Zero ischemia RPN is a safe and applicable method with acceptable oncological and functional outcomes in small renal tumors and even in selected larger renal tumors.
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Affiliation(s)
- Kemal ENER
- Department of Urology, Ümraniye Training and Research Hospital, University of Health Sciences, İstanbul,
Turkiye
| | | | - Murat BİNBAY
- Department of Urology, School of Medicine, Altınbaş University, İstanbul,
Turkiye
| | - Mevlana Derya BALBAY
- Department of Urology, Ümraniye Training and Research Hospital, University of Health Sciences, İstanbul,
Turkiye
| | - Ali Fuat ATMACA
- Department of Urology, School of Medicine, Ankara Yıldırım Beyazıt University, Ankara,
Turkiye
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Abe M, Hemmi S, Kobayashi H. How should we treat acute kidney injury caused by renal congestion? Kidney Res Clin Pract 2023; 42:415-430. [PMID: 37098670 PMCID: PMC10407633 DOI: 10.23876/j.krcp.22.224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Revised: 10/28/2022] [Accepted: 10/29/2022] [Indexed: 04/27/2023] Open
Abstract
Decreased kidney function is associated with increased risk of cardiovascular events and mortality, and heart failure (HF) is a wellknown risk factor for renal dysfunction. Acute kidney injury (AKI) in patients with HF often is attributed to prerenal factors, such as renal hypoperfusion and ischemia as a result of decreased cardiac output. Another such factor is reduction of absolute or relative circulating blood volume, with the decrease in renal blood flow leading to renal hypoxia followed by a decrease in the glomerular filtration rate. However, renal congestion is increasingly being recognized as a potential cause of AKI in patients with HF. Increased central venous pressure and renal venous pressure lead to increased renal interstitial hydrostatic pressure and a reduction of the glomerular filtration rate. Both decreased kidney function and renal congestion have been shown to be important prognostic factors of HF, and adequate control of congestion is important for improving kidney function. Loop and thiazide diuretics are recommended as standard therapies to reduce volume overload. However, these agents are associated with worsening renal function even though they are effective for improving congestive symptoms. There is growing interest in tolvaptan, which can improve renal congestion by increasing excretion of free water and decreasing the required dose of loop diuretic, thereby improving kidney function. This review summarizes renal hemodynamics, the pathogenesis of AKI due to renal ischemia and renal congestion, and diagnosis and treatment options for renal congestion.
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Affiliation(s)
- Masanori Abe
- Division of Nephrology, Hypertension and Endocrinology, Department of Medicine, Nihon University School of Medicine, Tokyo, Japan
| | - Seiichiro Hemmi
- Division of Nephrology, Hypertension and Endocrinology, Department of Medicine, Nihon University School of Medicine, Tokyo, Japan
| | - Hiroki Kobayashi
- Division of Nephrology, Hypertension and Endocrinology, Department of Medicine, Nihon University School of Medicine, Tokyo, Japan
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Stottlemyer BA, Abebe KZ, Palevsky PM, Fried L, Schulman IH, Parikh CR, Poggio E, Siew ED, Gutierrez OM, Horwitz E, Weir MR, Wilson FP, Kane-Gill SL. Expert Consensus on the Nephrotoxic Potential of 195 Medications in the Non-intensive Care Setting: A Modified Delphi Method. Drug Saf 2023; 46:677-687. [PMID: 37223847 PMCID: PMC10208182 DOI: 10.1007/s40264-023-01312-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/18/2023] [Indexed: 05/25/2023]
Abstract
INTRODUCTION Nephrotoxin exposure is significantly associated with acute kidney injury (AKI) development. A standardized list of nephrotoxic medications to surveil and their perceived nephrotoxic potential (NxP) does not exist for non-critically ill patients. OBJECTIVE This study generated consensus on the nephrotoxic effect of 195 medications used in the non-intensive care setting. METHODS Potentially nephrotoxic medications were identified through a comprehensive literature search, and 29 participants with nephrology or pharmacist expertise were identified. The primary outcome was NxP by consensus. Participants rated each drug on a scale of 0-3 (not nephrotoxic to definite nephrotoxicity). Group consensus was met if ≥ 75% of responses were one single rating or a combination of two consecutive ratings. If ≥ 50% of responses indicated "unknown" or not used in the non-intensive care setting, the medication was removed for consideration. Medications not meeting consensus for a given round were included in the subsequent round(s). RESULTS A total of 191 medications were identified in the literature, with 4 medications added after the first round from participants' recommendations. NxP index rating consensus after three rounds was: 14 (7.2%) no NxP in almost all situations (rating 0); 62 (31.8%) unlikely/possibly nephrotoxic (rating 0.5); 21 (10.8%) possibly nephrotoxic (rating 1); 49 (25.1%) possibly/probably nephrotoxic (rating 1.5); 2 (1.0%) probably nephrotoxic (rating 2); 8 (4.1%) probably/definite nephrotoxic (rating 2.5); 0 (0.0%) definitely nephrotoxic (rating 3); and 39 (20.0%) medications were removed from consideration. CONCLUSIONS NxP index rating provides clinical consensus on perceived nephrotoxic medications in the non-intensive care setting and homogeneity for future clinical evaluations and research.
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Affiliation(s)
| | - Kaleab Z Abebe
- Division of General Internal Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Paul M Palevsky
- Renal-Electrolyte Division, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
- Kidney Medicine Section, VA Pittsburgh Healthcare System, Pittsburgh, PA, USA
| | - Linda Fried
- Renal-Electrolyte Division, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
- Kidney Medicine Section, VA Pittsburgh Healthcare System, Pittsburgh, PA, USA
| | - Ivonne H Schulman
- Division of Kidney, Urologic and Hematologic Diseases, National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), National Institutes of Health (NIH), Bethesda, MD, USA
| | - Chirag R Parikh
- Division of Nephrology, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Emilio Poggio
- Department of Nephrology and Hypertension, Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Edward D Siew
- Division of Nephrology and Hypertension, Vanderbilt University Medical Center, Tennessee Valley Health Systems (TVHS) Nashville Veterans Affairs Hospital, Nashville, TN, USA
| | - Orlando M Gutierrez
- Department of Medicine, Department of Epidemiology, University of Alabama at Birmingham, Birmingham, AL, USA
| | | | - Matthew R Weir
- Division of Nephrology, Department of Medicine, University of Maryland School of Medicine, Baltimore, MD, USA
| | - F Perry Wilson
- Clinical and Translational Research Accelerator, Department of Medicine, Yale School of Medicine, New Haven, CT, USA
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Girard M, Deschamps J, Razzaq S, Lavoie N, Denault A, Beaubien-Souligny W. Emerging Applications of Extracardiac Ultrasound in Critically Ill Cardiac Patients. Can J Cardiol 2023; 39:444-457. [PMID: 36509177 DOI: 10.1016/j.cjca.2022.11.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Revised: 11/21/2022] [Accepted: 11/30/2022] [Indexed: 12/13/2022] Open
Abstract
Point-of-care ultrasound has evolved as an invaluable diagnostic modality and procedural guidance tool in the care of critically ill cardiac patients. Beyond focused cardiac ultrasound, additional extracardiac ultrasound modalities may provide important information at the bedside. In addition to new uses of existing modalities, such as pulsed-wave Doppler ultrasound, the development of new applications is fostered by the implementation of additional features in mid-range ultrasound machines commonly acquired for intensive care units, such as tissue elastography, speckle tracking, and contrast-enhanced ultrasound quantification software. This review explores several areas in which ultrasound imaging technology may transform care in the future. First, we review how lung ultrasound in mechanically ventilated patients can enable the personalization of ventilator parameters and help to liberate them from mechanical ventilation. Second, we review the role of venous Doppler in the assessment of organ congestion and how tissue elastography may complement this application. Finally, we explore how contrast-enhanced ultrasound could be used to assess changes in organ perfusion.
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Affiliation(s)
- Martin Girard
- Centre de Recherche du Centre Hospitalier de l'Université de Montréal, Montréal, Québec, Canada; Department of Anaesthesiology, Centre Hospitalier de l'Université de Montréal, Montréal, Québec, Canada
| | - Jean Deschamps
- Department of Intensive Care and Resuscitation, Anesthesiology Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | | | | | - André Denault
- Department of Anaesthesiology, Montréal Heart Institute, Montréal, Québec, Canada
| | - William Beaubien-Souligny
- Centre de Recherche du Centre Hospitalier de l'Université de Montréal, Montréal, Québec, Canada; Division of Nephrology, Centre Hospitalier de l'Université de Montréal, Montréal, Québec, Canada.
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19
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Domínguez M, Meyer K, Sancenón F, Blandez JF, Serrano M, Martínez-Máñez R. A NIR fluorescent probe for the detection of renal damage based on overrepresentation of alanine aminopeptidase enzyme. Chem Commun (Camb) 2023; 59:2481-2484. [PMID: 36752222 DOI: 10.1039/d2cc05408f] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Kidney damage generates changes at the phenotypic and genotypic levels that allow its monitoring using different biomarkers in blood, urine or serum. Among these biomarkers, kidney failure causes the urine overrepresentation of the alanine aminopeptidase (APN) enzyme. Here, we describe the design of a molecular probe (NB-ALA) based on the Nile Blue fluorophore (NB), which can detect the APN enzyme in urine by simple fluorometric measurements.
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Affiliation(s)
- Marcia Domínguez
- Instituto Interuniversitario de Investigación de Reconocimiento Molecular y Desarrollo Tecnológico (IDM), Universitat Politècnica de València, Universitat de València, Spain.,CIBER de Bioingeniería, Biomateriales y Nanomedicina, Instituto de Salud Carlos III, Spain
| | - Kathleen Meyer
- Institute for Research in Biomedicine (IRB Barcelona), Barcelona Institute of Science and Technology (BIST), Barcelona, 08028, Spain.
| | - Félix Sancenón
- Instituto Interuniversitario de Investigación de Reconocimiento Molecular y Desarrollo Tecnológico (IDM), Universitat Politècnica de València, Universitat de València, Spain.,CIBER de Bioingeniería, Biomateriales y Nanomedicina, Instituto de Salud Carlos III, Spain.,Unidad Mixta de Investigación en Nanomedicina y Sensores, Universitat Politècnica de València, Instituto de Investigación Sanitaria La Fe, Spain. .,Unidad Mixta UPV-CIPF de Investigación en Mecanismos de Enfermedades y Nanomedicina, Universitat Politècnica de València, Centro de Investigación Príncipe Felipe, Spain
| | - Juan F Blandez
- Instituto Interuniversitario de Investigación de Reconocimiento Molecular y Desarrollo Tecnológico (IDM), Universitat Politècnica de València, Universitat de València, Spain.,CIBER de Bioingeniería, Biomateriales y Nanomedicina, Instituto de Salud Carlos III, Spain.,Unidad Mixta de Investigación en Nanomedicina y Sensores, Universitat Politècnica de València, Instituto de Investigación Sanitaria La Fe, Spain.
| | - Manuel Serrano
- Institute for Research in Biomedicine (IRB Barcelona), Barcelona Institute of Science and Technology (BIST), Barcelona, 08028, Spain. .,Catalan Institution for Research and Advanced Studies (ICREA), Barcelona, 08010, Spain
| | - Ramón Martínez-Máñez
- Instituto Interuniversitario de Investigación de Reconocimiento Molecular y Desarrollo Tecnológico (IDM), Universitat Politècnica de València, Universitat de València, Spain.,CIBER de Bioingeniería, Biomateriales y Nanomedicina, Instituto de Salud Carlos III, Spain.,Unidad Mixta de Investigación en Nanomedicina y Sensores, Universitat Politècnica de València, Instituto de Investigación Sanitaria La Fe, Spain. .,Unidad Mixta UPV-CIPF de Investigación en Mecanismos de Enfermedades y Nanomedicina, Universitat Politècnica de València, Centro de Investigación Príncipe Felipe, Spain
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20
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Kwiatkowska E, Kwiatkowski S, Dziedziejko V, Tomasiewicz I, Domański L. Renal Microcirculation Injury as the Main Cause of Ischemic Acute Kidney Injury Development. BIOLOGY 2023; 12:biology12020327. [PMID: 36829602 PMCID: PMC9953191 DOI: 10.3390/biology12020327] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/04/2022] [Revised: 02/04/2023] [Accepted: 02/09/2023] [Indexed: 02/22/2023]
Abstract
Acute kidney injury (AKI) can result from multiple factors. The main cause is reduced renal perfusion. Kidneys are susceptible to ischemia due to the anatomy of microcirculation that wraps around the renal tubules-peritubular capillary (PTC) network. Cortical and medullary superficial tubules have a large share in transport and require the supply of oxygen for ATP production, while it is the cortex that receives almost 100% of the blood flowing through the kidneys and the medulla only accounts for 5-10% of it. This difference makes the tubules present in the superficial layer of the medulla very susceptible to ischemia. Impaired blood flow causes damage to the endothelium, with an increase in its prothrombotic and pro-adhesive properties. This causes congestion in the microcirculation of the renal medulla. The next stage is the migration of pericytes with the disintegration of these vessels. The phenomenon of destruction of small vessels is called peritubular rarefaction, attributed as the main cause of further irreversible changes in the damaged kidney leading to the development of chronic kidney disease. In this article, we will present the characteristic structure of renal microcirculation, its regulation, and the mechanism of damage in acute ischemia, and we will try to find methods of prevention with particular emphasis on the inhibition of the renin-angiotensin-aldosterone system.
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Affiliation(s)
- Ewa Kwiatkowska
- Department of Nephrology, Transplantology and Internal Medicine, Pomeranian Medical University in Szczecin, Powstańców Wlkp, 72, 70-204 Szczecin, Poland
- Correspondence:
| | - Sebastian Kwiatkowski
- Department of Obstetrician and Gynecology, Pomeranian Medical University in Szczecin, Powstańców Wlkp, 72, 70-204 Szczecin, Poland
| | - Violetta Dziedziejko
- Department of Biochemistry and Medical Chemistry, Pomeranian Medical University in Szczecin, Powstańców Wlkp, 72, 70-204 Szczecin, Poland
| | - Izabela Tomasiewicz
- Department of Nephrology, Transplantology and Internal Medicine, Pomeranian Medical University in Szczecin, Powstańców Wlkp, 72, 70-204 Szczecin, Poland
| | - Leszek Domański
- Department of Nephrology, Transplantology and Internal Medicine, Pomeranian Medical University in Szczecin, Powstańców Wlkp, 72, 70-204 Szczecin, Poland
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Abstract
An increased intraabdominal pressure, particularly when occurring during periods of hemodynamic instability or fluid overload, is regarded as a major contributor to acute kidney injury (AKI) in intensive care units. During abdominal laparoscopic procedures, intraoperative insufflation pressures up to 15 mmHg are applied, to enable visualization and surgical manipulation but with the potential to compromise net renal perfusion. Despite the widely acknowledged renal arterial autoregulation, net arterial perfusion pressure is known to be narrow, and the effective renal medullary perfusion is disproportionately impacted by venous and lymphatic congestion. At present, the potential risk factors, mitigators and risk-stratification of AKI during surgical pneumoperitoneum formation received relatively limited attention among nephrologists and represent an opportunity to look beyond mere blood pressure and intake-output balances. Careful charting and reporting duration and extent of surgical pneumoperitoneum represents an opportunity for anesthesia teams to better communicate intraoperative factors affecting renal outcomes for the postoperative clinical teams. In this current article, the authors are integrating preclinical data and clinical experience to provide a better understanding to optimize renal perfusion during surgeries. Future studies should carefully consider intrabdominal insufflation pressure as a key variable when assessing outcomes and blood pressure goals in these settings.
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Cho H, Yang SW, Suh GH, Choi J. Sedative effect with the combination of butorphanol and midazolam on two-dimensional shear wave elastography of pancreas and kidney in healthy dogs. Am J Vet Res 2023; 84:ajvr.22.10.0187. [PMID: 36662605 DOI: 10.2460/ajvr.22.10.0187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
OBJECTIVE To evaluate the sedative effect of a combination of butorphanol and midazolam on 2-D shear wave elastography (SWE) of the kidneys and pancreas in dogs. ANIMALS 8 clinically healthy dogs. PROCEDURES We conducted a 2-D SWE examination of the bilateral kidneys and the pancreas before and after IV of 0.2 mg/kg butorphanol and 0.1 mg/kg midazolam in each dog. We performed 2-D SWE on the left kidney via a subcostal approach with the dog in right lateral recumbency, on the right kidney via the intercostal approach with the dog in left lateral recumbency, and on the right lobe of the pancreas via the subcostal approach. Subsequently, the pancreas and kidney shear wave velocities (SWV) pre- and postsedation were compared. RESULTS On qualitative evaluation using color mapping, the pancreas and kidneys showed a homogeneous blue-to-green color in pre- and post-sedation 2-D SWE. There was no significant difference in SWV pre- and post-sedation in the pancreas and kidneys. CLINICAL RELEVANCE Intravenous administration of a combination of 0.2 mg/kg butorphanol and 0.1 mg/kg midazolam did not change the 2-D SWE of the pancreas and kidneys significantly. The combination of butorphanol and midazolam can be used in healthy dogs for 2-D SWE evaluation of the pancreas and kidneys, especially when the patient is uncooperative during the examination.
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Affiliation(s)
- Hyun Cho
- Department of Veterinary Medical Imaging, College of Veterinary Medicine, Chonnam National University, Gwangju, South Korea.,Doctor Dog Animal Medical Center, Goyang, South Korea
| | | | - Guk Hyun Suh
- Department of Veterinary Internal Medicine, College of Veterinary Medicine, Chonnam National University, Gwangju, South Korea
| | - Jihye Choi
- Department of Veterinary Medical Imaging, College of Veterinary Medicine, Seoul National University, Seoul, South Korea
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23
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Hu J, Ananth D, Sethi SK, Taliwal N, Govindan S, Raina R. Neonatal AKI: An update. J Neonatal Perinatal Med 2023; 16:361-373. [PMID: 37718869 DOI: 10.3233/npm-230120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/19/2023]
Abstract
Neonatal acute kidney injury (AKI) is a common complication, especially in the neonatal intensive care unit, that is associated with long term consequences and poor outcomes. Early detection and treatment is critical. Currently, neonatal AKI is defined with urinary markers and serum creatinine, with limitations on early detection and individual treatment. There have been numerous biomarkers and risk factor scores that have been studied for their ability to predict neonatal AKI. To move towards personalized medicine, neonatal AKI must be categorized into phenotypes and subphenotypes that fully encapsulate the diverse causes and specific treatments. This review aims to advance our understanding of neonatal AKI detection through the use of biomarkers, subphenotypes, and phenotypes to move towards personalized treatment strategies.
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Affiliation(s)
- J Hu
- Department of Medicine, Northeast Ohio Medical University, Rootstown, OH, USA
| | - D Ananth
- Department of Medicine, Northeast Ohio Medical University, Rootstown, OH, USA
| | - S K Sethi
- Pediatric Nephrology & Pediatric Kidney Transplantation, Kidney and Urology Institute, Medanta, The Medicity Hospital, Gurgaon, India
| | - N Taliwal
- Akron Nephrology Associates/Cleveland Clinic Akron General Medical Center, Akron, OH, USA
| | - S Govindan
- Department of Pediatric Nephrology, Dr. Mehta's Hospitals, Chetpet and Vellapanchavadi, Chennai, India
| | - R Raina
- Akron Nephrology Associates/Cleveland Clinic Akron General Medical Center, Akron, OH, USA
- Department of Nephrology, Akron Children's Hospital, Akron, OH, USA
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24
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Association between intraoperative oliguria and postoperative acute kidney injury in non-cardiac surgical patients: a systematic review and meta-analysis. J Anesth 2022; 37:219-233. [PMID: 36520229 DOI: 10.1007/s00540-022-03150-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2022] [Accepted: 12/01/2022] [Indexed: 12/23/2022]
Abstract
PURPOSE This systematic review and meta-analysis aimed to evaluate the association between intraoperative oliguria and the risk of postoperative acute kidney injury (AKI) in patients undergoing non-cardiac surgery. METHODS The MEDLINE and EMBASE databases were searched up to August 2022 for studies in adult patients undergoing non-cardiac surgery, where the association between intraoperative urine output and the risk of postoperative AKI was assessed. Both randomised and non-randomised studies were eligible for inclusion. Study selection and risk of bias assessment were independently performed by two investigators. The risk of bias was evaluated using the Newcastle-Ottawa scale. We performed meta-analysis of the reported multivariate adjusted odds ratios for the association between intraoperative oliguria (defined as urine output < 0.5 mL/kg/hr) and the risk of postoperative AKI using the inverse-variance method with random effects models. We conducted sensitivity analyses using varying definitions of oliguria as well as by pooling unadjusted odds ratios to establish the robustness of the primary meta-analysis. We also conducted subgroup analyses according to surgery type and definition of AKI to explore potential sources of clinical or methodological heterogeneity. RESULTS Eleven studies (total 49,252 patients from 11 observational studies including a post hoc analysis of a randomised controlled trial) met the selection criteria. Seven of these studies contributed data from a total 17,148 patients to the primary meta-analysis. Intraoperative oliguria was associated with a significantly elevated risk of postoperative AKI (pooled adjusted odds ratio [OR] 1.74; 95% confidence interval [CI] 1.36-2.23, p < 0.0001, 8 studies). Sensitivity analyses supported the robustness of the primary meta-analysis. There was no evidence of any significant subgroup differences according to surgery type or definition of AKI. CONCLUSIONS This study demonstrated a significant association between intraoperative oliguria and the risk of postoperative AKI, regardless of the definitions of oliguria or AKI used. Further prospective and multi-centre studies using standardised definitions of intraoperative oliguria are required to define the thresholds of oliguria and establish strategies to minimise the risk of AKI.
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25
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New Approach to Hyponatremia: High Prevalence of Cerebral/Renal Salt Wasting, Identification of Natriuretic Protein That Causes Salt Wasting. J Clin Med 2022; 11:jcm11247445. [PMID: 36556061 PMCID: PMC9786136 DOI: 10.3390/jcm11247445] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Revised: 12/07/2022] [Accepted: 12/13/2022] [Indexed: 12/23/2022] Open
Abstract
Our understanding of hyponatremic conditions has undergone major alterations. There is a tendency to treat all patients with hyponatremia because of common subtle symptoms that include unsteady gait that lead to increased falls and bone fractures and can progress to mental confusion, irritability, seizures, coma and even death. We describe a new approach that is superior to the ineffectual volume approach. Determination of fractional excretion (FE) of urate has simplified the diagnosis of a reset osmostat, Addison's disease, edematous causes such as congestive heart failure, cirrhosis and nephrosis, volume depletion from extrarenal salt losses with normal renal tubular function and the difficult task of differentiating the syndrome of inappropriate secretion of antidiuretic hormone (SIADH) from cerebral/renal salt wasting (C/RSW). SIADH and C/RSW have identical clinical and laboratory parameters but have diametrically opposite therapeutic goals of water-restricting water-loaded patients with SIADH or administering salt water to dehydrated patients with C/RSW. In a study of nonedematous patients with hyponatremia, we utilized FEurate and response to isotonic saline infusions to differentiate SIADH from C/RSW. Twenty-four (38%) of 62 hyponatremic patients had C/RSW with 21 having no clinical evidence of cerebral disease to support our important proposal to change cerebral to renal salt wasting (RSW). Seventeen (27%) had SIADH and 19 (31%) had a reset osmostat. One each from hydrochlorothiazide and Addison's disease. We demonstrated natriuretic activity in the plasma of patients with neurosurgical and Alzheimer diseases (AD) in rat clearance studies and have now identified the natriuretic protein to be haptoglobin related protein without signal peptide (HPRWSP). We introduce a new syndrome of RSW in AD that needs further confirmation. Future studies intend to develop HPRWSP as a biomarker to simplify the diagnosis of RSW in hyponatremic and normonatremic patients and explore other clinical applications that can improve clinical outcomes.
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26
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Hashimoto T, Shibata K, Hasumi K, Honda K, Nobe K. Effect of SMTP-7 on Cisplatin-Induced Nephrotoxicity in Mice. Biol Pharm Bull 2022; 45:1832-1838. [DOI: 10.1248/bpb.b22-00620] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Affiliation(s)
- Terumasa Hashimoto
- Division of Pharmacology, Department of Pharmacology, Toxicology and Therapeutics, School of Pharmacy, Showa University
| | | | - Keiji Hasumi
- Department of Applied Biological Science, Tokyo University of Agriculture and Technology
| | - Kazuo Honda
- Division of Pharmacology, Department of Pharmacology, Toxicology and Therapeutics, School of Pharmacy, Showa University
| | - Koji Nobe
- Pharmacological Research Center, Showa University
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Assar DH, Asa SA, El-Abasy MA, Elbialy ZI, Shukry M, Latif AAE, BinMowyna MN, Althobaiti NA, El-Magd MA. Aspergillus awamori attenuates ochratoxin A-induced renal and cardiac injuries in rabbits by activating the Nrf2/HO-1 signaling pathway and downregulating IL1β, TNFα, and iNOS gene expressions. ENVIRONMENTAL SCIENCE AND POLLUTION RESEARCH INTERNATIONAL 2022; 29:69798-69817. [PMID: 35576029 PMCID: PMC9512883 DOI: 10.1007/s11356-022-20599-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Accepted: 04/29/2022] [Indexed: 05/10/2023]
Abstract
Ochratoxin A (OTA) is one of the most dangerous and that pollute agricultural products, inducing a variety of toxic effects in humans and animals. The current study explored the protective effect of different concentrations of Aspergillus awamori (A. awamori) against OTA (0.3 mg/kg diet) induced renal and cardiac damage by exploring its mechanism of action in 60 New Zealand white male rabbits. Dietary supplementation of A. awamori at the selected doses of 50, 100, and 150 mg/kg diet, respectively, for 2 months significantly improved the rabbit's growth performance; modulated the suppressed immune response and restored the altered hematological parameters; reduced the elevated levels of renal injury biomarkers such as urea, creatinine, and alkaline phosphatase; and increased serum total proteins concentrations. Moreover, it also declined enzymatic activities of cardiac injury biomarkers, including AST, LDH, and CK-MB. A. awamori alleviated OTA-induced degenerative and necrotic changes in the kidney and heart of rabbits. Interestingly, A. awamori upregulated Nrf2/OH-1 signaling pathway. Therefore enhanced TAC, CAT, and SOD enzyme activities and reduced OTA-induced oxidative and nitrosative stress by declining iNOS gene expression and consequently lowered MDA and NO levels. In addition to attenuating renal and cardiac inflammation via reducing IL-1β, TNF-α gene expressions in a dose-dependent response. In conclusion,this is the first report to pinpoint that dietary incorporation of A. awamori counteracted OTA-induced renal and cardiac damage by potentiating the rabbit's antioxidant defense system through its potent antioxidant, free radical scavenging, and anti-inflammatory properties in a dose-dependent response. Based on our observations, A. awamori could be utilized as a natural protective agent against ochratoxicosis in rabbits.
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Affiliation(s)
- Doaa H. Assar
- Clinical Pathology Department, Faculty of Veterinary Medicine, Kafrelsheikh University, Kafr El-Sheikh, 33516 Egypt
| | - Samah Abou Asa
- Pathology Department, Faculty of Veterinary Medicine, Kafrelsheikh University, Kafr El-Sheikh, 33516 Egypt
| | - Moshira A. El-Abasy
- Poultry and Rabbit Diseases Department, Faculty of Veterinary Medicine, Kafr El-Sheikh University, Kafr El-Sheikh, 33516 Egypt
| | - Zizy I. Elbialy
- Fish Processing and Biotechnology Department, Faculty of Aquatic and Fisheries Sciences, Kafrelsheikh University, 33516 Kafr El-Sheikh, Egypt
| | - Mustafa Shukry
- Physiology Department, Faculty of Veterinary Medicine, Kafrelsheikh University, Kafr El-Sheikh, 33516 Egypt
| | - Amera Abd El Latif
- Department of Pharmacology, Faculty of Veterinary Medicine, Kafrelsheikh University, Kafr El-Sheikh, 33516 Egypt
| | - Mona N. BinMowyna
- College of Applied Medical Sciences, Shaqra University, Shaqra, Saudi Arabia
| | - Norah A. Althobaiti
- Biology Department, College of Science and Humanities-Al Quwaiiyah, Shaqra University, Al Quwaiiyah, 19257 Saudi Arabia
| | - Mohammed A. El-Magd
- Anatomy and Embryology Department, Faculty of Veterinary Medicine, Kafrelsheikh University, Kafr El-Sheikh, 33516 Egypt
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Yoshimoto H, Fukui S, Higashio K, Endo A, Takasu A, Yamakawa K. Optimal target blood pressure in critically ill adult patients with vasodilatory shock: A systematic review and meta-analysis. Front Physiol 2022; 13:962670. [PMID: 36051909 PMCID: PMC9424848 DOI: 10.3389/fphys.2022.962670] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Accepted: 07/21/2022] [Indexed: 11/13/2022] Open
Abstract
While the Surviving Sepsis Campaign guidelines recommend an initial target value of 65 mmHg as the mean arterial pressure (MAP) in patients with septic shock, the optimal MAP target for improving outcomes remains controversial. We performed a meta-analysis to evaluate the optimal MAP for patients with vasodilatory shock, which included three randomized controlled trials that recruited 3,357 patients. Between the lower (60–70 mmHg) and higher (>70 mmHg) MAP target groups, there was no significant difference in all-cause mortality (risk ratio [RR], 1.06; 95% confidence intervals [CI], 0.98–1.16) which was similar in patients with chronic hypertension (RR, 1.10; 95% CI, 0.98–1.24) and patients aged ≥65 years (RR, 1.10; 95% CI, 0.99–1.21). No significant difference in adverse events was observed between the different MAP groups (RR, 1.04; 95% CI, 0.87–1.24); however, supraventricular arrhythmia was significantly higher in the higher MAP group (RR, 1.73; 95% CI, 1.15–2.60). Renal replacement therapy was reduced in the higher MAP group of patients with chronic hypertension (RR, 0.83; 95% CI, 0.71–0.98). Though the higher MAP control did not improve the mortality rate, it may be beneficial in reducing renal replacement therapy in patients with chronic hypertension. Systematic review registration: UMIN Clinical Trials Registry, identifier UMIN000042624
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Affiliation(s)
- Hidero Yoshimoto
- Department of Emergency and Critical Care Medicine, Osaka Medical and Pharmaceutical University, Takatsuki, Osaka, Japan
- Department of Surgery, Osaka Medical and Pharmaceutical University, Takatsuki, Osaka, Japan
| | - Satoshi Fukui
- Faculty of Medicine, Osaka Medical and Pharmaceutical University, Takatsuki, Osaka, Japan
| | - Koki Higashio
- Faculty of Medicine, Osaka Medical and Pharmaceutical University, Takatsuki, Osaka, Japan
| | - Akira Endo
- Trauma and Acute Critical Care Center, Tokyo Medical and Dental University Hospital, Bunkyo-ku, Tokyo, Japan
| | - Akira Takasu
- Department of Emergency and Critical Care Medicine, Osaka Medical and Pharmaceutical University, Takatsuki, Osaka, Japan
| | - Kazuma Yamakawa
- Department of Emergency and Critical Care Medicine, Osaka Medical and Pharmaceutical University, Takatsuki, Osaka, Japan
- *Correspondence: Kazuma Yamakawa,
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29
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Wang M, Yan P, Zhang NY, Deng YH, Luo XQ, Wang XF, Duan SB. Prediction of Mortality Risk After Ischemic Acute Kidney Injury With a Novel Prognostic Model: A Multivariable Prediction Model Development and Validation Study. Front Med (Lausanne) 2022; 9:892473. [PMID: 36045922 PMCID: PMC9420861 DOI: 10.3389/fmed.2022.892473] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Accepted: 06/03/2022] [Indexed: 11/13/2022] Open
Abstract
Background and Objectives: Acute kidney injury (AKI) that results from ischemia is a common clinical syndrome and correlates with high morbidity and mortality among hospitalized patients. However, a clinical tool to predict mortality risk of ischemic AKI is not available. In this study, we aimed to develop and validate models to predict the 30-day and 1-year mortality risk of hospitalized patients with ischemic AKI. Methods A total of 1,836 admissions with ischemic AKI were recruited from 277,898 inpatients admitted to three affiliated tertiary general hospitals of Central South University in China between January 2015 and December 2015. Patients in the final analysis were followed up for 1 year. Study patients were randomly divided in a 7:3 ratio to form the training cohort and validation cohort. Multivariable regression analyses were used for developing mortality prediction models. Results Hepatorenal syndrome, shock, central nervous system failure, Charlson comorbidity index (≥2 points), mechanical ventilation, renal function at discharge were independent risk factors for 30-day mortality after ischemic AKI, while malignancy, sepsis, heart failure, liver failure, Charlson comorbidity index (≥2 points), mechanical ventilation, and renal function at discharge were predictors for 1-year mortality. The area under the receiver operating characteristic curves (AUROCs) of 30-day prediction model were 0.878 (95% confidence interval (CI): 0.849-0.908) in the training cohort and 0.867 (95% CI: 0.820–0.913) in the validation cohort. The AUROCs of the 1-year mortality prediction in the training and validation cohort were 0.803 (95% CI: 0.772–0.834) and 0.788 (95% CI: 0.741–0.835), respectively. Conclusion Our easily applied prediction models can effectively identify individuals at high mortality risk within 30 days or 1 year in hospitalized patients with ischemic AKI. It can guide the optimal clinical management to minimize mortality after an episode of ischemic AKI.
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Affiliation(s)
- Mei Wang
- Department of Nephrology, Hunan Key Laboratory of Kidney Disease and Blood Purification, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Ping Yan
- Department of Nephrology, Hunan Key Laboratory of Kidney Disease and Blood Purification, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Ning-Ya Zhang
- Information Center, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Ying-Hao Deng
- Department of Nephrology, Hunan Key Laboratory of Kidney Disease and Blood Purification, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Xiao-Qin Luo
- Department of Nephrology, Hunan Key Laboratory of Kidney Disease and Blood Purification, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Xiu-Fen Wang
- Department of Nephrology, Hunan Key Laboratory of Kidney Disease and Blood Purification, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Shao-Bin Duan
- Department of Nephrology, Hunan Key Laboratory of Kidney Disease and Blood Purification, The Second Xiangya Hospital of Central South University, Changsha, China
- *Correspondence: Shao-Bin Duan
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Tanaka T, Kavsur R, Sugiura A, Haurand JM, Galka N, Öztürk C, Vogelhuber J, Becher MU, Weber M, Westenfeld R, Zimmer S, Kelm M, Nickenig G, Horn P, Zachoval C. Acute Kidney Injury Following Tricuspid Transcatheter Edge-to-Edge Repair. JACC Cardiovasc Interv 2022; 15:1936-1945. [PMID: 36008268 DOI: 10.1016/j.jcin.2022.07.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Revised: 07/13/2022] [Accepted: 07/13/2022] [Indexed: 10/15/2022]
Abstract
BACKGROUND Little is known about the incidence and clinical relevance of postprocedural acute kidney injury (AKI) in patients undergoing transcatheter edge-to-edge repair (TEER) for tricuspid regurgitation (TR). OBJECTIVES The aim of this study was to investigate the prognostic impact of postprocedural AKI following TEER for TR. METHODS Two hundred sixty-eight patients who underwent TEER for TR at 2 centers were retrospectively analyzed. Postprocedural AKI was defined as an increase in serum creatinine of ≥0.3 mg/dL within 48 hours or ≥50% within 7 days after the procedure compared with baseline. The association between AKI and the composite outcome, consisting of all-cause mortality and rehospitalization for heart failure within 1 year after the procedure, was determined. RESULTS The mean age of the patients was 79.0 ± 6.8 years, and 43.3% were men. Postprocedural AKI occurred in 42 patients (15.7%). Age, male sex, an estimated glomerular filtration rate of <60 mL/min/1.73 m2, and absence of procedural success were associated with the occurrence of AKI. Patients with AKI had a higher incidence of in-hospital mortality than those without AKI (9.5% vs 0.9%; P = 0.006). Moreover, AKI was associated with the incidence of the composite outcome within 1 year after TEER for TR (adjusted HR: 2.39; 95% CI: 1.45-3.94; P = 0.001). CONCLUSIONS Postprocedural AKI occurred in 15.7% of patients undergoing TEER for TR, despite the absence of iodinated contrast agents, which was associated with worse clinical outcomes. These findings highlight the clinical impact of AKI following TEER for TR and should help in identifying patients at high risk for AKI.
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Affiliation(s)
- Tetsu Tanaka
- Heart Center Bonn, Department of Internal Medicine II, University Hospital Bonn, Bonn, Germany
| | - Refik Kavsur
- Heart Center Bonn, Department of Internal Medicine II, University Hospital Bonn, Bonn, Germany
| | - Atsushi Sugiura
- Heart Center Bonn, Department of Internal Medicine II, University Hospital Bonn, Bonn, Germany
| | - Jean Marc Haurand
- Department of Cardiology, Pulmonology and Vascular Medicine, Medical Faculty of the Heinrich Heine University, Düsseldorf, Germany
| | - Natalia Galka
- Heart Center Bonn, Department of Internal Medicine II, University Hospital Bonn, Bonn, Germany
| | - Can Öztürk
- Heart Center Bonn, Department of Internal Medicine II, University Hospital Bonn, Bonn, Germany
| | - Johanna Vogelhuber
- Heart Center Bonn, Department of Internal Medicine II, University Hospital Bonn, Bonn, Germany
| | - Marc Ulrich Becher
- Heart Center Bonn, Department of Internal Medicine II, University Hospital Bonn, Bonn, Germany
| | - Marcel Weber
- Heart Center Bonn, Department of Internal Medicine II, University Hospital Bonn, Bonn, Germany
| | - Ralf Westenfeld
- Department of Cardiology, Pulmonology and Vascular Medicine, Medical Faculty of the Heinrich Heine University, Düsseldorf, Germany
| | - Sebastian Zimmer
- Heart Center Bonn, Department of Internal Medicine II, University Hospital Bonn, Bonn, Germany
| | - Malte Kelm
- Department of Cardiology, Pulmonology and Vascular Medicine, Medical Faculty of the Heinrich Heine University, Düsseldorf, Germany
| | - Georg Nickenig
- Heart Center Bonn, Department of Internal Medicine II, University Hospital Bonn, Bonn, Germany
| | - Patrick Horn
- Department of Cardiology, Pulmonology and Vascular Medicine, Medical Faculty of the Heinrich Heine University, Düsseldorf, Germany
| | - Christian Zachoval
- Heart Center Bonn, Department of Internal Medicine II, University Hospital Bonn, Bonn, Germany.
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The Role of Vitamin D in SARS-CoV-2 Infection and Acute Kidney Injury. Int J Mol Sci 2022; 23:ijms23137368. [PMID: 35806377 PMCID: PMC9266309 DOI: 10.3390/ijms23137368] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Revised: 06/30/2022] [Accepted: 06/30/2022] [Indexed: 02/04/2023] Open
Abstract
Vitamin D has been described as an essential nutrient and hormone, which can cause nuclear, non-genomic, and mitochondrial effects. Vitamin D not only controls the transcription of thousands of genes, directly or indirectly through the modulation of calcium fluxes, but it also influences the cell metabolism and maintenance specific nuclear programs. Given its broad spectrum of activity and multiple molecular targets, a deficiency of vitamin D can be involved in many pathologies. Vitamin D deficiency also influences mortality and multiple outcomes in chronic kidney disease (CKD). Active and native vitamin D serum levels are also decreased in critically ill patients and are associated with acute kidney injury (AKI) and in-hospital mortality. In addition to regulating calcium and phosphate homeostasis, vitamin D-related mechanisms regulate adaptive and innate immunity. Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infections have a role in excessive proinflammatory cell recruitment and cytokine release, which contribute to alveolar and full-body endothelial damage. AKI is one of the most common extrapulmonary manifestations of severe coronavirus disease 2019 (COVID-19). There are also some correlations between the vitamin D level and COVID-19 severity via several pathways. Proper vitamin D supplementation may be an attractive therapeutic strategy for AKI and has the benefits of low cost and low risk of toxicity and side effects.
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Hang S, Chen H, Wu W, Wang S, Fang Y, Sheng R, Tu Q, Guo R. Progress in Isoindolone Alkaloid Derivatives from Marine Microorganism: Pharmacology, Preparation, and Mechanism. Mar Drugs 2022; 20:md20060405. [PMID: 35736208 PMCID: PMC9227046 DOI: 10.3390/md20060405] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Revised: 06/11/2022] [Accepted: 06/17/2022] [Indexed: 12/15/2022] Open
Abstract
Compound 1 (SMTP-7, also FGFC1), an isoindolone alkaloid from marine fungi Starchbotrys longispora FG216 and fungi Stachybotrys microspora IFO 30018, possessed diverse bioactivities such as thrombolysis, anti-inflammatory and anti-oxidative properties, and so on. It may be widely used for the treatment of various diseases, including cerebral infarction, stroke, ischemia/reperfusion damage, acute kidney injury, etc. Especially in cerebral infarction, compound 1 could reduce hemorrhagic transformation along with thrombolytic therapy, as the traditional therapies are accompanied with bleeding risks. In the latest studies, compound 1 selectively inhibited the growth of NSCLC cells with EGFR mutation, thus demonstrating its excellent anti-cancer activity. Herein, we summarized pharmacological activities, preparation of staplabin congeners—especially compound 1—and the mechanism of compound 1, with potential therapeutic applications.
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Affiliation(s)
- Sijin Hang
- College of Food Science and Technology, Shanghai Ocean University, Shanghai 201306, China; (S.H.); (W.W.)
| | - Hui Chen
- Shanghai Engineering Center of Hadal Science and Technology, College of Marine Sciences, Shanghai Ocean University, Shanghai 201306, China;
| | - Wenhui Wu
- College of Food Science and Technology, Shanghai Ocean University, Shanghai 201306, China; (S.H.); (W.W.)
| | - Shiyi Wang
- AIEN Institute, Shanghai Ocean University, Shanghai 201306, China;
| | - Yiwen Fang
- Department of Chemistry, College of Science, Shantou University, Shantou 515063, China;
| | - Ruilong Sheng
- CQM-Centro de Química da Madeira, Campus da Penteada, Universidade da Madeira, 9000-390 Funchal, Portugal;
| | - Qidong Tu
- Jiangxi Provincial Key Laboratory of Drug Design and Evaluation, School of Pharmacy, Jiangxi Science & Technology Normal University, Nanchang 330013, China
- Correspondence: (Q.T.); (R.G.)
| | - Ruihua Guo
- College of Food Science and Technology, Shanghai Ocean University, Shanghai 201306, China; (S.H.); (W.W.)
- Shanghai Engineering Research Center of Aquatic-Product Processing & Preservation, Shanghai 201306, China
- Laboratory of Quality and Safety Risk Assessment for Aquatic Products on Storage and Preservation (Shanghai), Ministry of Agriculture, Shanghai 201306, China
- Correspondence: (Q.T.); (R.G.)
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Tang W, Panja S, Jogdeo CM, Tang S, Yu A, Oupický D. Study of Renal Accumulation of Targeted Polycations in Acute Kidney Injury. Biomacromolecules 2022; 23:2064-2074. [PMID: 35394757 PMCID: PMC9150723 DOI: 10.1021/acs.biomac.2c00079] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Acute kidney injury (AKI) is a global healthcare burden characterized by rapid loss of renal function and high morbidity and mortality. Chemokine receptor CXCR4 participates in the renal infiltration of immune cells following injury and in local inflammatory enhancement. Injured renal tubule cells overexpress CXCR4, which could be used as a target for improved drug delivery in AKI. Plerixafor is a small-molecule CXCR4 antagonist that has shown beneficial effects against AKI and has been previously developed into a polymeric analog (polymeric plerixafor, PP). With the goal of gaining a better understanding of how overall charge and hydrophilicity affect renal accumulation of PP, we have synthesized PP copolymers containing hydroxyl, carboxyl, primary amine, and alkyl moieties using Michael-type addition copolymerization. All synthesized copolymers showed excellent CXCR4-binding and inhibiting ability in vitro and improved cellular uptake in hypoxia-reoxygenation stimulated mouse tubule cells. Analysis of serum protein binding revealed that polymers with hydroxyl group modification showed the least amount of protein binding. Biodistribution of the polymers was tested in a unilateral ischemia reperfusion-induced AKI mouse model. The results showed significant differences in accumulation in the injured kidneys depending on the net charge and hydrophilicity of the polymers. The findings of this study will guide the development of polymeric drug carriers for targeted delivery to injured kidneys for better AKI therapy.
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Affiliation(s)
- Weimin Tang
- Center for Drug Delivery and Nanomedicine, Department of Pharmaceutical Sciences, University of Nebraska Medical Center, Omaha, NE 68198, USA
| | - Sudipta Panja
- Center for Drug Delivery and Nanomedicine, Department of Pharmaceutical Sciences, University of Nebraska Medical Center, Omaha, NE 68198, USA
| | - Chinmay M. Jogdeo
- Center for Drug Delivery and Nanomedicine, Department of Pharmaceutical Sciences, University of Nebraska Medical Center, Omaha, NE 68198, USA
| | - Siyuan Tang
- Center for Drug Delivery and Nanomedicine, Department of Pharmaceutical Sciences, University of Nebraska Medical Center, Omaha, NE 68198, USA
| | - Ao Yu
- Center for Drug Delivery and Nanomedicine, Department of Pharmaceutical Sciences, University of Nebraska Medical Center, Omaha, NE 68198, USA
| | - David Oupický
- Center for Drug Delivery and Nanomedicine, Department of Pharmaceutical Sciences, University of Nebraska Medical Center, Omaha, NE 68198, USA
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Liu Z, Zhang X, Lv P, Wu B, Bai S. Functional, oncological outcomes and safety of laparoscopic partial nephrectomy versus open partial nephrectomy in localized renal cell carcinoma patients with high anatomical complexity. Surg Endosc 2022; 36:7629-7637. [PMID: 35411462 DOI: 10.1007/s00464-022-09225-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Accepted: 03/26/2022] [Indexed: 12/24/2022]
Abstract
PURPOSE Partial nephrectomy (PN) is the main treatment strategy for localized renal cell carcinoma (RCC). However, for RCC with high anatomical complexity, PN remains a challenge for urologists. Therefore, this study aimed to evaluate the functional oncological outcomes and safety of laparoscopic partial nephrectomy (LPN) versus open partial nephrectomy (OPN) in localized RCC patients with highly anatomical complexity (R.E.N.A.L. score ≥ 10). PATIENTS AND METHODS We retrospectively studied 575 patients who underwent PN at our center between January 2007 and December 2017. After propensity score-matching (PSM), 137 patients treated with LPN and 54 patients treated with OPN were balanced into 97 and 44 pairs. Patient demographics, and extensive perioperative and prognostic data were recorded and compared. RESULTS In the matched group, the OPN group had significantly less eGFR loss than the LPN group (2.57 ml/min/1.73 m2 vs. 31.59 ml/min/1.73 m2, P < 0.001). The recurrence-free survival (P = 0.287), overall survival (P = 0.296), cancer-specific survival (P = 0.664), and cardiocerebrovascular disease-specific survival (P = 0.341) were equivalent between groups. The rates of minor (P = 0.621) and major (P = 0.647) complications were also similar between groups. CONCLUSIONS This PSM cohort study showed that OPN resulted in better renal function preservation than LPN in localized RCC patients with high anatomical complexity, and had comparable oncological and safety outcomes after long-term follow-up. These findings may help improve clinical decision-making for localized RCC patients with high anatomical complexity.
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Affiliation(s)
- Zeqi Liu
- Department of Urology, Shengjing Hospital of China Medical University, 36 Sanhao Street, Shenyang, Liaoning, 110004, People's Republic of China
| | - Xuanyu Zhang
- Department of Urology, Shengjing Hospital of China Medical University, 36 Sanhao Street, Shenyang, Liaoning, 110004, People's Republic of China
| | - Peng Lv
- Department of Urology, Shengjing Hospital of China Medical University, 36 Sanhao Street, Shenyang, Liaoning, 110004, People's Republic of China
| | - Bin Wu
- Department of Urology, Shengjing Hospital of China Medical University, 36 Sanhao Street, Shenyang, Liaoning, 110004, People's Republic of China
| | - Song Bai
- Department of Urology, Shengjing Hospital of China Medical University, 36 Sanhao Street, Shenyang, Liaoning, 110004, People's Republic of China.
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Ojo B, Campbell CH. Perioperative acute kidney injury: impact and recent update. Curr Opin Anaesthesiol 2022; 35:215-223. [PMID: 35102042 DOI: 10.1097/aco.0000000000001104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW Acute kidney injury (AKI) is common in hospitalized patients and is a major risk factor for increased length of stay, morbidity, and mortality in postoperative patients. There are multiple barriers to reducing perioperative AKI - the etiology is multi-factorial and the diagnosis is fraught with issues. We review the recent literature on perioperative AKI and some considerations for anesthesiologists that examine the far-reaching effects of AKI on multiple organ systems. RECENT FINDINGS This review will discuss recent literature that addresses the epidemiology, use of novel biomarkers in risk stratification, and therapeutic modalities for AKI in burn, pediatrics, sepsis, trauma, cardiac, and liver disease, contrast-induced AKI, as well as the evidence assessing goal-directed fluid therapy. SUMMARY Recent studies address the use of risk stratification models and biomarkers, more sensitive than creatinine, in the preoperative identification of patients at risk for AKI. Although exciting, these scores and models need validation. There is a need for research assessing whether early AKI detection improves outcomes. Enhanced recovery after surgery utilizing goal-directed fluid therapy has not been shown to make an appreciable difference in the incidence of AKI. Reducing perioperative AKI requires a multi-pronged and possibly disease-specific approach.
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Affiliation(s)
- Bukola Ojo
- Department of Anesthesiology & Pain Medicine, University of Washington School of Medicine, Seattle Children's Hospital, Seattle, WA
| | - Cedric H Campbell
- Department of Anesthesiology, Virginia Commonwealth University Health System, Richmond, Virginia, USA
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36
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Buzakuk B, van der Voort J. Metabolic mayhem. The advantage of keeping your nose both in the books and in the nappy! Arch Dis Child Educ Pract Ed 2022; 107:150-155. [PMID: 34131008 DOI: 10.1136/archdischild-2019-318477] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Accepted: 05/21/2021] [Indexed: 11/03/2022]
Abstract
This case presentation takes you on a journey of diagnostic hurdles, covering a common neonatal presentation: abdominal distention with failure to pass meconium, followed by a presentation in infancy with metabolic, renal and electrolyte abnormalities. The article provides a systematic approach to the different clinical problems, allowing interpretation of results, making differential diagnoses and deciding on investigations and management.
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Affiliation(s)
- Buthaina Buzakuk
- Paediatrics and Paediatric Gastroenterology, Swansea Bay University Health Board, Swansea, Neath Port Talbot, UK
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Pathophysiologic Approach to Understanding and Successfully Treating Idiopathic Edema: Unappreciated Importance of Nocturia. Am J Med Sci 2022; 364:229-236. [DOI: 10.1016/j.amjms.2021.12.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Revised: 08/30/2021] [Accepted: 12/17/2021] [Indexed: 11/21/2022]
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Tsuji T, Hosoda A, Toriyama Y, Yoshida Y, Kohno T. Renin-angiotensin system inhibitors combined with cisplatin exacerbate cisplatin-induced nephrotoxicity in mice. Transl Oncol 2022; 18:101369. [PMID: 35182957 PMCID: PMC8857575 DOI: 10.1016/j.tranon.2022.101369] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Revised: 11/26/2021] [Accepted: 02/09/2022] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION We previously reported that the concomitant use of enalapril and telmisartan exacerbates the risk of cisplatin (CDDP)-induced acute renal dysfunction compared to other antihypertensive drugs in mice. Thus, in the current study, we investigated the risk of developing chronic kidney disease following repeated concomitant use of CDDP and antihypertensive drugs. MATERIALS AND METHODS Male BALB/c mice were divided into 12 groups: (1) Control group (untreated), (2) CDDP group (7 mg/kg, CDDP), (3) AML group (5 mg/kg, amlodipine), (4) ENA group (2.5 mg/kg, enalapril), (5) TEL group (10 mg/kg, telmisartan), (6) LOS group (10 mg/kg, losartan), (7) CDDP+AML group (5 mg/mL, AML), (8) CDDP+ENA group (2.5 mg/kg, ENA), (9) CDDP+LowENA group (1.25 mg/kg, ENA), (10) CDDP+TEL group (10 mg/kg, TEL), (11) CDDP+LowTEL group (5 mg/kg, TEL), and (12) CDDP+LOS group (10 mg/kg, LOS). CDDP was administered intraperitoneally four times every 7 days, and each antihypertensive drug was administered orally from day 3 before CDDP administration until day 24 (six times a week). The degree of renal damage was assessed. The nephrotoxicity of each individual was evaluated by measuring serum creatinine and blood urea nitrogen levels. The degrees of renal fibrosis and epithelial-mesenchymal transition were also examined in kidney tissue sections. RESULTS AND DISCUSSION The results suggest that combinatorial treatment of CDDP and renin-angiotensin system inhibitors, particularly ENA and TEL, may exacerbate CDDP-induced nephrotoxicity. This study clearly demonstrates the need for large-scale clinical studies to construct treatment regimens that do not interfere with the therapeutic intensity of CDDP.
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Affiliation(s)
- Takumi Tsuji
- Department of Pathological Biochemistry, Faculty of Pharmaceutical Sciences, Setsunan University, 45-1 Nagaotoge-cho, Hirakata, Osaka 573-0101, Japan
| | - Atsuki Hosoda
- Department of Pathological Biochemistry, Faculty of Pharmaceutical Sciences, Setsunan University, 45-1 Nagaotoge-cho, Hirakata, Osaka 573-0101, Japan; Department of Pharmacy, National Hospital Organization, Nara Medical Center, 2-789 Shitijyo, Nara 360-8053, Japan
| | - Yuuki Toriyama
- Department of Pathological Biochemistry, Faculty of Pharmaceutical Sciences, Setsunan University, 45-1 Nagaotoge-cho, Hirakata, Osaka 573-0101, Japan
| | - Yuya Yoshida
- Department of Pathological Biochemistry, Faculty of Pharmaceutical Sciences, Setsunan University, 45-1 Nagaotoge-cho, Hirakata, Osaka 573-0101, Japan
| | - Takeyuki Kohno
- Department of Pathological Biochemistry, Faculty of Pharmaceutical Sciences, Setsunan University, 45-1 Nagaotoge-cho, Hirakata, Osaka 573-0101, Japan.
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Ujjawal A, Schreiber B, Verma A. Sodium-glucose cotransporter-2 inhibitors (SGLT2i) in kidney transplant recipients: what is the evidence? Ther Adv Endocrinol Metab 2022; 13:20420188221090001. [PMID: 35450095 PMCID: PMC9016587 DOI: 10.1177/20420188221090001] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Accepted: 03/04/2022] [Indexed: 12/15/2022] Open
Abstract
Several recent randomized controlled trials (RCTs) have demonstrated the wide clinical application of sodium-glucose cotransporter-2 inhibitors (SGLT2i) in improving kidney and cardiovascular outcomes in patients with native kidney disease. In April 2021, Dapagliflozin became the first SGLT2 inhibitor to be approved by the Food and Drug Administration (FDA) for the treatment of chronic kidney disease (CKD) regardless of diabetic status. However, while these agents have drawn much acclaim for their cardiovascular and nephroprotective effects among patients with native kidney disease, little is known about the safety and efficacy of SGLT2i in the kidney transplant setting. Many of the mechanisms by which SGLT2i exert their benefit stand to prove equally as efficacious or more so among kidney transplant recipients as they have in patients with CKD. However, safety concerns have excluded transplant recipients from all large RCTs, and clinicians and patients alike are left to wonder if the benefits of these amazing drugs outweigh the risks. In this review, we will discuss the known mechanisms SGLT2i exploit to provide their beneficial effects, the potential benefits, and risks of these agents in the context of kidney transplantation, and finally, we will discuss current findings of the published literature for SGLT2i use in kidney transplant recipients and propose potential directions for future research.
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Deng L, Li W, Xu G. Update on pathogenesis and diagnosis flow of normoalbuminuric diabetes with renal insufficiency. Eur J Med Res 2021; 26:144. [PMID: 34895352 PMCID: PMC8665546 DOI: 10.1186/s40001-021-00612-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Accepted: 11/16/2021] [Indexed: 12/11/2022] Open
Abstract
In recent decades, the prevalence of diabetic kidney disease has remained stable and appears to be a wide heterogeneity. Normoalbuminuric diabetes with renal insufficiency, which is characterized by a decline in the glomerular filtration rate in the absence of albuminuria, has been identified as an albuminuria-independent phenotype of diabetic kidney disease. Epidemiological data demonstrate that normoalbuminuric phenotype is prevalent. Compared to albuminuric phenotype, normoalbuminuric phenotype has distinct clinical characteristics and a wide heterogeneity of pathological features. Currently, the pathogenesis of normoalbuminuric phenotype remains unclear. Additionally, the flow of diagnosing normoalbuminuric phenotype is not perfect. In this article, we review the latest studies addressing the epidemiology, clinical characteristics, and pathology of normoalbuminuric phenotype. Based on the studies of clinical features and renal histopathologic changes, we attempt to propose an underlying pathogenesis model and a flow chart for diagnosing normoalbuminuric phenotype.
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Affiliation(s)
- Le Deng
- Department of Nephrology, The Second Affiliated Hospital of Nanchang University, No. 1, Minde Road, Donghu District, Nanchang, Jiangxi, 330006, People's Republic of China
| | - Wenjie Li
- Department of Nephrology, The Second Affiliated Hospital of Nanchang University, No. 1, Minde Road, Donghu District, Nanchang, Jiangxi, 330006, People's Republic of China
| | - Gaosi Xu
- Department of Nephrology, The Second Affiliated Hospital of Nanchang University, No. 1, Minde Road, Donghu District, Nanchang, Jiangxi, 330006, People's Republic of China.
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Xu S, Tao DS. The Effect of Acute Kidney Injury on TGF- β1 and Smad3 in Patients with Coronary Heart Disease after Off-Pump Coronary Artery Bypass Grafting. JOURNAL OF HEALTHCARE ENGINEERING 2021; 2021:1361242. [PMID: 34795878 PMCID: PMC8594977 DOI: 10.1155/2021/1361242] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Revised: 09/18/2021] [Accepted: 09/24/2021] [Indexed: 01/28/2023]
Abstract
Background Acute kidney injury (AKI) is one of the most common and serious complications for coronary disease (CAD) patients, suffering from coronary artery bypass surgery (CABG). AKI occurs in nearly 30% of cardiac surgery patients, including CABG patients, affecting renal function, prolonging hospitalization time, and increasing all-cause mortality. TGF-β1 and Smad3 are sensitive biomarkers in evaluating kidney function. Therefore, comparing the TGF-β1 and Smad3 levels between the AKI patients and non-AKI patients after CABG surgery might have an important significance for identifying the risk degree of AKI and applying effective preventive measures after CABG surgery. Objective This study aims at comparing the TGF-β1 and Smad3 levels between the AKI patients and non-AKI patients after CABG surgery to identify the risk degree of AKI and apply effective preventive measures after CABG surgery in clinics. Materials and Methods A total of 25 proper patients, diagnosed as coronary disease (CAD) and undergoing AKI after CABG, were selected as the AKI group. The 25 participants, who did not suffer from AKI after CABG, were recruited using the case-control matching method in SPSS 25.0 software as the non-AKI group. Also, corresponding surgical specimens (tissues) and samples of blood were collected from them. Histopathological analysis and immunofluorescent microscopy of lesion artery and kidney of patients, who have been treated with kidney transplants, were performed on surgical specimens to find the pathological and histological change difference between the two groups. RT-PCR and Western blot were conducted to quantify the levels of TGF-β1 and Smad3 expression in serum for the patients of AKI and non-AKI groups, respectively. Results Serious renal fibrosis was noted in patients of the AKI group. In addition, by H&E staining of the lesion artery, severe histopathological changes including smooth muscles proliferation with endothelial cell infiltration, focal degeneration and disruptions, and less collagen accumulation were found in the lesion artery of patients from the AKI group. Higher levels of TGF-β1 and Smad3 were observed in serum of patients of the AKI group. Conclusion : The increased levels of TGF-β1 and Smad3 in serum might be risk factors for triggering AKI for CAD patients undergoing CABG.
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Affiliation(s)
- Shu Xu
- Department of Cardiovascular Surgery, General Hospital of Northern Theater Command, Shenyang 110016, China
| | - Deng-shun Tao
- Department of Cardiovascular Surgery, General Hospital of Northern Theater Command, Shenyang 110016, China
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Shibata K, Hashimoto T, Hasumi K, Nobe K. Potent efficacy of Stachybotrys microspora triprenyl phenol-7, a small molecule having anti-inflammatory and antioxidant activities, in a mouse model of acute kidney injury. Eur J Pharmacol 2021; 910:174496. [PMID: 34506776 DOI: 10.1016/j.ejphar.2021.174496] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Revised: 08/11/2021] [Accepted: 09/06/2021] [Indexed: 12/15/2022]
Abstract
Acute kidney injury (AKI) increases the risk of chronic kidney disease (CKD), complicates existing CKD, and can lead to the end-stage renal disease. However, there are no approved effective therapeutics for AKI. Recent studies have suggested that inflammation and oxidative stress are the primary causes of AKI. We previously reported the potential anti-inflammatory and antioxidant activities of Stachybotrys microspora triprenyl phenol-7 (SMTP-7). The aim of the present study was to evaluate the efficacy of SMTP-7 in AKI model mice. AKI was induced in mice by ischemia of the left renal artery and vein for 45 min followed by reperfusion, 2 weeks after the removal of right kidney. The efficacy of SMTP-7 was determined by measuring the renal function using urine and serum samples and morphological assessment. For deciphering the mechanism of action of SMTP-7, inflammatory cytokines and oxidative stress in kidney were detected. SMTP-7 (0.01, 0.1, 1, 10 mg/kg) dose-dependently improved the renal function. In addition, it improved the damage to renal tubules and exhibited anti-inflammatory and antioxidant activities in the kidney of AKI mice. These results indicate the potential of SMTP-7 as a medicinal compound for the treatment of AKI.
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Affiliation(s)
- Keita Shibata
- Division of Pharmacology, Department of Pharmacology, Toxicology and Therapeutics, School of Pharmacy, Showa University, 1-5-8 Hatanodai, Shinagawa-ku, Tokyo, 142-8555, Japan; Pharmacological Research Center, Showa University, 1-5-8 Hatanodai, Shinagawa-ku, Tokyo, 142-8555, Japan.
| | - Terumasa Hashimoto
- Division of Pharmacology, Department of Pharmacology, Toxicology and Therapeutics, School of Pharmacy, Showa University, 1-5-8 Hatanodai, Shinagawa-ku, Tokyo, 142-8555, Japan; Pharmacological Research Center, Showa University, 1-5-8 Hatanodai, Shinagawa-ku, Tokyo, 142-8555, Japan
| | - Keiji Hasumi
- Department of Applied Biological Science, Tokyo University of Agriculture and Technology, 3-5-8 Saiwaicho, Fuchu, Tokyo, 183-8509, Japan
| | - Koji Nobe
- Division of Pharmacology, Department of Pharmacology, Toxicology and Therapeutics, School of Pharmacy, Showa University, 1-5-8 Hatanodai, Shinagawa-ku, Tokyo, 142-8555, Japan; Pharmacological Research Center, Showa University, 1-5-8 Hatanodai, Shinagawa-ku, Tokyo, 142-8555, Japan
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Velho TR, Pereira RM, Guerra NC, Ferreira H, Sena A, Ferreira R, Nobre Â. Low Mean Arterial Pressure During Cardiopulmonary Bypass and the Risk of Acute Kidney Injury: A Propensity Score Matched Observational Study. Semin Cardiothorac Vasc Anesth 2021; 26:179-186. [PMID: 34720005 DOI: 10.1177/10892532211045765] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
INTRODUCTION Low mean arterial pressure (MAP) periods occur frequently during cardiopulmonary bypass (CPB), and their management remains controversial. Our aim was to correlate MAP during CPB with the occurrence of post-operative acute kidney injury (AKI), considering two different parameters: consecutive and cumulative low MAP periods. METHODS Single-centre observational retrospective study including 250 patients submitted to non-emergent aortic valve replacement, with tepid to mild hypothermia (not below 32°C). The primary outcome was the occurrence of AKI. A propensity scored matching of 43 patients was used to adjust both populations (AKI and No AKI). MAP measures were automatically and continuously recorded during CPB. Low MAP periods were analysed employing two parameters: consecutive and the cumulative sum of time. RESULTS Patients who experienced at least 5 min with MAP <50 mmHg had an increased risk of post-operative AKI (OR infinity; 95% CI, 1.47 to infinity; P = .026). The risk is also significant with MAP <40 mmHg (OR 2.78; 95% CI 1.1-6.9; = .044) and <30 mmHg (OR 3.36; 95% CI 1.2-9.2; P = .029). Post-operative AKI was associated with cumulative and consecutive periods of low MAP. Patients with periods of low MAP had higher levels of post-operative creatinine and reduced glomerular filtration rate (GFR). Patients with AKI had prolonged endotracheal ventilation time, and ICU and ward lengths of stay. CONCLUSION Low MAP periods during CPB are associated with an increased occurrence of post-operative AKI, leading to 1) higher creatinine levels; 2) decreased GFR and 3) longer ICU and ward lengths of stay. Both consecutive and cumulative periods of low MAP are associated with an increased risk of AKI. MAP appears to be an important contributor to post-operative AKI and should be carefully managed during CPB. Further studies must address if MAP variations lead to definitive and long-term consequences.
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Affiliation(s)
- Tiago R Velho
- Cardiothoracic Surgery Department, 70899Hospital de Santa Maria, CHLN, Lisboa, Portugal, Lisboa, Portugal.,Innate Immunity and Inflammation Laboratory, 70899Instituto Gulbenkian de Ciência, Oeiras, Portugal
| | - Rafael M Pereira
- Cardiothoracic Surgery Department, 70899Hospital de Santa Maria, CHLN, Lisboa, Portugal, Lisboa, Portugal
| | - Nuno C Guerra
- Cardiothoracic Surgery Department, 70899Hospital de Santa Maria, CHLN, Lisboa, Portugal, Lisboa, Portugal
| | - Hugo Ferreira
- Cardiothoracic Surgery Department, 70899Hospital de Santa Maria, CHLN, Lisboa, Portugal, Lisboa, Portugal
| | - André Sena
- Cardiothoracic Surgery Department, 70899Hospital de Santa Maria, CHLN, Lisboa, Portugal, Lisboa, Portugal
| | - Ricardo Ferreira
- Cardiothoracic Surgery Department, 70899Hospital de Santa Maria, CHLN, Lisboa, Portugal, Lisboa, Portugal
| | - Ângelo Nobre
- Cardiothoracic Surgery Department, 70899Hospital de Santa Maria, CHLN, Lisboa, Portugal, Lisboa, Portugal
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Hosohata K, Jin D, Takai S. In Vivo and In Vitro Evaluation of Urinary Biomarkers in Ischemia/Reperfusion-Induced Kidney Injury. Int J Mol Sci 2021; 22:ijms222111448. [PMID: 34768879 PMCID: PMC8584014 DOI: 10.3390/ijms222111448] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Revised: 10/15/2021] [Accepted: 10/21/2021] [Indexed: 01/11/2023] Open
Abstract
Oxidative stress plays an important role in the pathophysiology of acute kidney injury (AKI). Previously, we reported that vanin-1, which is involved in oxidative stress, is associated with renal tubular injury. This study was aimed to determine whether urinary vanin-1 is a biomarker for the early diagnosis of AKI in two experimental models: in vivo and in vitro. In a rat model of AKI, ischemic AKI was induced in uninephrectomized rats by clamping the left renal artery for 45 min and then reperfusing the kidney. On Day 1 after renal ischemia/reperfusion (I/R), serum creatinine (SCr) in I/R rats was higher than in sham-operated rats, but this did not reach significance. Urinary N-acetyl-β-D-glucosaminidase (NAG) exhibited a significant increase but decreased on Day 2 in I/R rats. In contrast, urinary vanin-1 significantly increased on Day 1 and remained at a significant high level on Day 2 in I/R rats. Renal vanin-1 protein decreased on Days 1 and 3. In line with these findings, immunofluorescence staining demonstrated that vanin-1 was attenuated in the renal proximal tubules of I/R rats. Our in vitro results confirmed that the supernatant from HK-2 cells under hypoxia/reoxygenation included significantly higher levels of vanin-1 as well as KIM-1 and NGAL. In conclusion, our results suggest that urinary vanin-1 might be a potential novel biomarker of AKI induced by I/R.
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Affiliation(s)
- Keiko Hosohata
- Education and Research Center for Clinical Pharmacy, Osaka Medical and Pharmaceutical University, Osaka 569-1094, Japan
- Correspondence: ; Tel.: +81-72-690-1271
| | - Denan Jin
- Department of Innovative Medicine, Osaka Medical and Pharmaceutical University, Osaka 590-0906, Japan; (D.J.); (S.T.)
| | - Shinji Takai
- Department of Innovative Medicine, Osaka Medical and Pharmaceutical University, Osaka 590-0906, Japan; (D.J.); (S.T.)
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45
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Little MH, Howden SE, Lawlor KT, Vanslambrouck JM. Determining lineage relationships in kidney development and disease. Nat Rev Nephrol 2021; 18:8-21. [PMID: 34594045 DOI: 10.1038/s41581-021-00485-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/19/2021] [Indexed: 12/17/2022]
Abstract
The lineage relationships of cells provide information about the origins of component cell types during development and repair as well as the source of aberrant cells during disease. Genetic approaches to lineage tracing applied in the mouse have revealed much about how the mammalian kidney forms, including the identification of key progenitors for the nephrons and stromal compartments. Inducible Cre systems have also facilitated lineage tracing studies in the postnatal animal that illustrate the changes in cellular fate that can occur during kidney injury. With the advent of single-cell transcriptional profiling and trajectory analyses, predictions of cellular relationships across development are now being made in model systems, such as the mouse, as well as in human fetal kidney. Importantly, these approaches provide predictions of lineage relationships rather than definitive evidence. Although genetic approaches to the study of lineage have not previously been possible in a human setting, the application of CRISPR-Cas9 gene editing of pluripotent stem cells is beginning to teach us about human lineage relationships.
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Affiliation(s)
- Melissa H Little
- Murdoch Children's Research Institute, Parkville, VIC, Australia. .,Department of Paediatrics, The University of Melbourne, Melbourne, VIC, Australia. .,Department of Anatomy and Neuroscience, The University of Melbourne, Melbourne, VIC, Australia.
| | - Sara E Howden
- Murdoch Children's Research Institute, Parkville, VIC, Australia.,Department of Paediatrics, The University of Melbourne, Melbourne, VIC, Australia
| | - Kynan T Lawlor
- Murdoch Children's Research Institute, Parkville, VIC, Australia
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46
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Lee KF, Lo EYJ, Wong KKC, Fung AKY, Chong CCN, Wong J, Ng KKC, Lai PBS. Acute kidney injury following hepatectomy and its impact on long-term survival for patients with hepatocellular carcinoma. BJS Open 2021; 5:6380640. [PMID: 34601569 PMCID: PMC8487667 DOI: 10.1093/bjsopen/zrab077] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Accepted: 07/19/2021] [Indexed: 12/29/2022] Open
Abstract
Background Acute kidney injury (AKI) is increasingly being recognized after hepatectomy. This study aimed to identify factors predicting its occurrence and its impact on long-term outcome among patients with hepatocellular carcinoma (HCC). Methods This was a retrospective analysis of the incidence of AKI, factors predicting its occurrence, and its impact on patients undergoing hepatectomy between September 2007 and December 2018. A subgroup analysis included patients with histologically proven HCC. Results The incidence of AKI was 9.2 per cent in 930 patients. AKI was associated with increased mortality, morbidity, posthepatectomy liver failure (PHLF), and a longer hospital stay. On multivariable analysis, study period December 2013 to December 2018, diabetes mellitus, mean intraoperative BP below 72.1 mmHg, operative blood loss exceeding 377ml, high Model for End-Stage Liver Disease (MELD) score, and PHLF were predictive factors for AKI. Among 560 patients with HCC, hypertension, BP below 76.9 mmHg, blood loss greater than 378ml, MELD score, and PHLF were predictive factors. The 1-, 3-, and 5-year overall survival rates were 74.1, 59.2, and 51.6 per cent respectively for patients with AKI, and 91.8, 77.9, and 67.3 per cent for those without AKI. Corresponding 1-, 3-, and 5-year disease-free survival rates were 56.9, 42.3, and 35.4 per cent respectively in the AKI group, and 71.7, 54.5, and 46.2 per cent in the no-AKI group. AKI was an independent predictor of survival in multivariable analysis. Conclusion AKI is associated with longer hospital stay, and higher morbidity and mortality rates. It is also associated with shorter long-term survival among patients with HCC. To avoid AKI, control of blood loss and maintaining a reasonable BP (72–77 mmHg) during hepatectomy is important.
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Affiliation(s)
- K F Lee
- Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, Prince of Wales Hospital, Chinese University of Hong Kong, Hong Kong, China
| | - E Y J Lo
- Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, Prince of Wales Hospital, Chinese University of Hong Kong, Hong Kong, China
| | - K K C Wong
- Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, Prince of Wales Hospital, Chinese University of Hong Kong, Hong Kong, China
| | - A K Y Fung
- Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, Prince of Wales Hospital, Chinese University of Hong Kong, Hong Kong, China
| | - C C N Chong
- Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, Prince of Wales Hospital, Chinese University of Hong Kong, Hong Kong, China
| | - J Wong
- Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, Prince of Wales Hospital, Chinese University of Hong Kong, Hong Kong, China
| | - K K C Ng
- Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, Prince of Wales Hospital, Chinese University of Hong Kong, Hong Kong, China
| | - P B S Lai
- Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, Prince of Wales Hospital, Chinese University of Hong Kong, Hong Kong, China
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Smoor RM, van Dongen EPA, Verwijmeren L, Schreurs IAAM, Vernooij LM, van Klei WA, Noordzij PG. Critical oxygen delivery threshold during cardiopulmonary bypass in older cardiac surgery patients with increased frailty risk. Eur J Cardiothorac Surg 2021; 61:685-692. [PMID: 34448850 DOI: 10.1093/ejcts/ezab396] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Revised: 07/02/2021] [Accepted: 07/08/2021] [Indexed: 12/30/2022] Open
Abstract
OBJECTIVES Older patients have a higher cardiac surgery-associated acute kidney injury (CSA-AKI) related mortality. Low oxygen delivery (DO2) during cardiopulmonary bypass (CPB) is a risk factor for CSA-AKI, but critical DO2 thresholds for older patients are unknown. This study investigated critical DO2 thresholds for CSA-AKI in patients ≥70 years undergoing on-pump cardiac surgery. METHODS Patients were enrolled from July 2015 until August 2017. CPB data from 432 patients were collected, and DO2 values were calculated per minute. The primary outcome was CSA-AKI. The association between DO2 and CSA-AKI was analysed with multivariable regression analysis. Multiple DO2 thresholds were analysed. The association between CSA-AKI and the area below the DO2 thresholds (DO2 deficit) was evaluated, as was the association between frailty and CSA-AKI. RESULTS CSA-AKI occurred in 63 (14.6%) patients. Mean and nadir (lowest) DO2 values were lower in patients with CSA-AKI (283 vs 312 ml/min/m2; P-value <0.001 and 238 vs 270 ml/min/m2; P-value <0.001, respectively). The adjusted relative risk for CSA-AKI was 1.006 [99% confidence interval (CI) 1.001-1.012] per ml/min/m2 nadir DO2 decrease. The critical DO2 threshold was 270 ml/min/m2 [adjusted relative risk 2.06 (99% CI 1.33-2.80)]. The DO2 deficit below 270 ml/min/m2 was associated with CSA-AKI [adjusted relative risk 2.84 (99% CI 1.87-3.81)]. No association between frailty and CSA-AKI was found (P = 0.82). CONCLUSIONS Low DO2 increased the risk for CSA-AKI in older patients who had cardiac surgery. A critical DO2 threshold of 270 ml/min/m2 was applicable for frail and non-frail patients. The efficacy of a DO2 >270 ml/min/m2 to reduce CSA-AKI in older patients needs further evaluation.
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Affiliation(s)
- Rosa M Smoor
- Department of Anaesthesiology, Intensive Care, and Pain Medicine, St. Antonius Hospital, Nieuwegein, Netherlands
| | - Eric P A van Dongen
- Department of Anaesthesiology, Intensive Care, and Pain Medicine, St. Antonius Hospital, Nieuwegein, Netherlands
| | - Lisa Verwijmeren
- Department of Anaesthesiology, Intensive Care, and Pain Medicine, St. Antonius Hospital, Nieuwegein, Netherlands
| | - Inge A A M Schreurs
- Department of Extra-Corporeal Circulation, St. Antonius Hospital, Nieuwegein, Netherlands
| | - Lisette M Vernooij
- Department of Anaesthesiology, Intensive Care, and Pain Medicine, St. Antonius Hospital, Nieuwegein, Netherlands.,Department of Anaesthesiology, Intensive Care, and Pain Medicine, University Medical Centre Utrecht, Utrecht University, Utrecht, Netherlands
| | - Wilton A van Klei
- Department of Anaesthesiology, Intensive Care, and Pain Medicine, University Medical Centre Utrecht, Utrecht University, Utrecht, Netherlands
| | - Peter G Noordzij
- Department of Anaesthesiology, Intensive Care, and Pain Medicine, St. Antonius Hospital, Nieuwegein, Netherlands
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Hirai T, Hanada K, Iwamoto T, Itoh T. Involvement of the effect of renal hypoperfusion medications on vancomycin trough concentration: A secondary analysis using a retrospective observational data. Basic Clin Pharmacol Toxicol 2021; 129:376-384. [PMID: 34396691 DOI: 10.1111/bcpt.13646] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Revised: 07/09/2021] [Accepted: 08/11/2021] [Indexed: 12/14/2022]
Abstract
This study examined the association between vancomycin (VCM) trough concentration and confounding factors including renal hypoperfusion medications which include angiotensin-converting enzyme inhibitors/angiotensin receptor blockers, loop/thiazide diuretics, or non-steroidal anti-inflammatory drugs. This secondary analysis included patients aged >15 years who were administered VCM intravenously between June 2015 and August 2017 at the Tokyo Women's Medical University Medical Center East. We investigated predictors for three (initial, mean, and final) dose-normalized VCM trough concentration (dose-normalized VCMtrough ) as outcome using a multiple linear regression analysis. In total, 208 patients were analysed (use of loop/thiazide diuretics: 48 [23%]). Multiple linear regression analysis revealed that the initial dose-normalized VCMtrough was negatively correlated with estimated glomerular filtration rate (eGFR) (p = 0.028) and positively correlated with the use of loop/thiazide diuretics (p = 0.003). Meanwhile, there was a positive correlation between the mean dose-normalized VCMtrough and age (p = 0.023). The mean dose-normalized VCMtrough was negatively correlated with eGFR (p < 0.001) and serum albumin (p < 0.001). The final dose-normalized VCMtrough was positively associated with age (p = 0.034) and negatively associated with eGFR (p = 0.032) and serum albumin (p = 0.007). Clinicians should closely monitor VCM trough concentration while receiving VCM and loop/thiazide diuretics.
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Affiliation(s)
- Toshinori Hirai
- Department of Pharmacy, Mie University Hospital, Faculty of Medicine, Mie University, Tsu, Japan
| | - Kazuhiko Hanada
- Department of Pharmacometrics and Pharmacokinetics, Meiji Pharmaceutical University, Tokyo, Japan
| | - Takuya Iwamoto
- Department of Pharmacy, Mie University Hospital, Faculty of Medicine, Mie University, Tsu, Japan
| | - Toshimasa Itoh
- Department of Pharmacy, Tokyo Women's Medical University Medical Center East, Tokyo, Japan
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Bo CRD, de Paula VP, Strazzi APWB, Wolosker N, Aloia TPA, Mazzeo A, Kaufmann OG. Effect of unilateral renal ischemia on the contralateral kidney assessed by Caspase 3 expression. J Vasc Bras 2021; 20:e20210040. [PMID: 34349794 PMCID: PMC8294808 DOI: 10.1590/1677-5449.210040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Accepted: 05/14/2021] [Indexed: 11/22/2022] Open
Abstract
Background Studies have demonstrated with histological analysis and Doppler flow measurement analysis that unilateral renal ischemia, which is performed in some surgeries, interfered with the contralateral kidney, identifying the phenomenon of kidney-kidney crosstalk. Objectives To identify the effects on the ischemic and contralateral kidney of renal ischemia induced by two types of clamping technique by analyzing the volume of kidney cells positive for Caspase 3. Methods Sixteen pigs were divided into 2 groups, as follows: A (n = 8) – clamping of left renal artery only and AV (n = 8) – clamping of left renal artery and vein. Immunohistochemical analyses (anti Caspase 3) were conducted with biopsy specimens collected from the ischemic and contralateral kidney at 0, 30, 60, and 90 minutes of ischemia and morphometric analysis was performed, taking the mean to represent the volume of the Caspase 3 positive area (%). Results Morphometric analysis of specimens collected at 30, 60, and 90 minutes of ischemia showed that the mean area marked for Caspase 3 was statistically larger in the contralateral kidney than the ischemic kidney in both groups: clamped renal artery (A) and clamped renal artery and vein (AV). Comparing the ischemic and contralateral kidney, there was no statistically significant difference in the area marked for Caspase 3 between the two types of clamping. Conclusions In the experimental model of unilateral renal ischemia, the non-ischemic kidney exhibited cell damage, demonstrated by Caspase 3 expression. The type of hilum clamping does not appear to influence the area marked for Caspase 3.
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Affiliation(s)
- Carolina Rodrigues Dal Bo
- Faculdade Israelita de Ciências da Saúde Albert Einstein - FICSAE, São Paulo, SP, Brasil.,Hospital Israelita Albert Einstein - HIAE, São Paulo, SP, Brasil
| | - Vitória Penido de Paula
- Faculdade Israelita de Ciências da Saúde Albert Einstein - FICSAE, São Paulo, SP, Brasil.,Hospital Israelita Albert Einstein - HIAE, São Paulo, SP, Brasil
| | | | - Nelson Wolosker
- Faculdade Israelita de Ciências da Saúde Albert Einstein - FICSAE, São Paulo, SP, Brasil.,Hospital Israelita Albert Einstein - HIAE, São Paulo, SP, Brasil.,Faculdade de Medicina da Universidade de São Paulo - USP, São Paulo, SP, Brasil
| | - Thiago Pinheiro Arrais Aloia
- Instituto de Ensino e Pesquisa - IIEP, Hospital Albert Einstein, São Paulo, SP, Brasil.,Faculdade de Medicina da Universidade de São Paulo - USP, São Paulo, SP, Brasil
| | - Angela Mazzeo
- Instituto de Ensino e Pesquisa - IIEP, Hospital Albert Einstein, São Paulo, SP, Brasil
| | - Oskar Grau Kaufmann
- Instituto de Ensino e Pesquisa - IIEP, Hospital Albert Einstein, São Paulo, SP, Brasil.,Faculdade de Medicina da Universidade de São Paulo - USP, São Paulo, SP, Brasil
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50
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Fukuda-Doi M, Yamamoto H, Koga M, Doi Y, Qureshi AI, Yoshimura S, Miwa K, Ishigami A, Shiozawa M, Omae K, Ihara M, Toyoda K. Impact of Renal Impairment on Intensive Blood-Pressure-Lowering Therapy and Outcomes in Intracerebral Hemorrhage: Results From ATACH-2. Neurology 2021; 97:e913-e921. [PMID: 34210824 PMCID: PMC8408509 DOI: 10.1212/wnl.0000000000012442] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Accepted: 05/27/2021] [Indexed: 12/02/2022] Open
Abstract
Background and Objective The clinical effect of renal impairment on intracerebral hemorrhage (ICH) is unknown. This study sought to assess whether estimated glomerular filtration rate (eGFR) affects clinical outcomes or modifies the efficacy of intensive systolic blood pressure (BP) control (target, 110–139 mm Hg) against the standard (target, 140–179 mm Hg) among patients with ICH. Methods We conducted post hoc analyses of ATACH-2, a randomized, 2-group, open-label trial. The baseline eGFR of each eligible patient was calculated using the Chronic Kidney Disease Epidemiology Collaboration equation. The outcome of interest was death or disability at 90 days. Multivariate logistic regression models were used for analysis. Results Among the 1,000 patients randomized, 974 were analyzed. The median baseline eGFR was 88 (interquartile range, 68, 99) mL/min/1.73 m2; 451 (46.3%), 363 (37.3%), and 160 (16.4%) patients had baseline eGFR values of ≥90, 60–89, and <60 mL/min/1.73 m2, respectively. Compared with normal eGFR (≥90 mL/min/1.73 m2), higher odds of death or disability were noted among those with eGFR values of <60 mL/min/1.73 m2 (adjusted odds ratio [OR], 2.02; 95% confidence interval [CI], 1.25–3.26) but not among those with eGFR values of 60–89 mL/min/1.73 m2 (OR, 1.01; 95% CI, 0.70–1.46). The odds of death or disability were significantly higher in the intensive arm among patients with decreased eGFR; the ORs were 0.89 (95% CI, 0.55–1.44), 1.13 (0.68–1.89), and 3.60 (1.47–8.80) in patients with eGFR values of ≥90, 60–89, and <60 mL/min/1.73 m2, respectively (p for interaction = 0.02). Discussion Decreased eGFR is associated with unfavorable outcomes following ICH. The statistically significant interaction between the eGFR group and treatment assignment raised safety concerns for the intensive BP-lowering therapy among patients with renal impairment. Trial Registration Information Clinicaltrials.gov identifier: NCT01176565. Classification of Evidence This study provides Class II evidence that in spontaneous ICH, decreased eGFR identifies patients at risk of death or disability following intensive BP control.
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Affiliation(s)
- Mayumi Fukuda-Doi
- Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan.,Department of Data Science, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Haruko Yamamoto
- Department of Data Science, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Masatoshi Koga
- Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Yohei Doi
- Department of Nephrology, Osaka University Graduate School of Medicine, Suita, Japan
| | - Adnan I Qureshi
- Zeenat Qureshi Stroke Institute, St. Cloud, MN, USA.,Department of Neurology, University of Missouri, Columbia, MO, USA
| | - Sohei Yoshimura
- Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Kaori Miwa
- Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Akiko Ishigami
- Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Masayuki Shiozawa
- Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Katsuhiro Omae
- Department of Data Science, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Masafumi Ihara
- Department of Neurology, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Kazunori Toyoda
- Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan
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