Seizures in patients with kidney diseases: a neglected problem?

Acute kidney injury in infants with hypoxic-ischemic encephalopathy

BACKGROUND

This study aimed to investigate the prevalence of acute kidney injury (AKI) in infants with varying degrees of hypoxic-ischemic encephalopathy (HIE) and its associated outcomes, including mortality and length of stay (LOS).

METHODS

The study used the National Inpatient Sample (NIS) dataset from 2010 to 2018. Regression analysis was used to control confounding variables.

RESULTS

Of 31,220,784 infants included in the study, 30,130 (0.1%) had HIE. The prevalence of AKI was significantly higher in infants with HIE (9.0%) compared to those without (0.04%), with an adjusted odds ratio (aOR) of 77.6 (CI:70.1-85.7, p < 0.001), with the highest prevalence of AKI in infants with severe HIE (19.7%), aOR:130 (CI: 107-159), p < 0.001). Infants with AKI had a higher mortality rate compared to those without AKI in those diagnosed with any degree of HIE (28.9% vs. 8.8%), aOR 3.5 (CI: 3.2-3.9, p < 0.001), particularly among those with severe HIE, aOR:1.4 (1.2-1.6, p < 0.001).

CONCLUSIONS

HIE is associated with an increased prevalence of AKI. Infants with severe HIE had the highest prevalence of AKI and associated mortality. The study highlights the need for close monitoring and early detection of AKI in infants with HIE, particularly those with severe HIE, to ameliorate the associated adverse outcomes.

Abnormal inpatient EEG predicts seizure occurrence independently of renal function

Purpose

The study aimed to determine prospectively whether there is a significant relationship between renal function as per the estimated glomerular filtration rate (eGFR), and the occurrence of seizures in patients who have no history of epilepsy and who required an EEG while hospitalized.

Methods

Adult patients who were hospitalized at Hôtel-Dieu de France University Hospital in Beirut and who required routine EEGs were included over a period of 13 months. We excluded critical patients or those with history of epilepsy.Data was analyzed depending on the EEG result and according to the baseline eGFR estimated by the CKD-EPI formula. Patients were followed prospectively by phone interview at 6 months for occurrence of seizure or death.

Results

Sixty one patients with a mean age of 66 (age range 19 to 95) were included (52 % were females). Of the 23 patients who had normal EEGs, 43.47% had abnormal eGFR, and none of them had a seizure. Of the patients with abnormal EEGs, 71.05% had abnormal eGFR, of which 7 had seizures. A significant relationship was found between having an abnormal EEG and the risk of developing a seizure in the future independently of the baseline eGFR.Whatever the eGFR is, if the EEG is normal, there will be lower risk to develop a seizure at 6 months.

Conclusions

While eGFR and the incidence of seizures were not directly related, our study showed that patients with abnormal EEG were more likely to develop seizures regardless of their baseline eGFR.

Acute kidney injury-associated delirium: a review of clinical and pathophysiological mechanisms

Acute kidney injury is a known clinical risk factor for delirium, an acute cognitive dysfunction that is commonly encountered in the critically ill population. In this comprehensive review of clinical and basic research studies, we detail the epidemiology, clinical implications, pathogenesis, and management strategies of patients with acute kidney injury-associated delirium. Specifically addressed are the pathological roles of endogenous toxin or drug accumulation, acute kidney injury-mediated neuroinflammation, and acute kidney injury-associated volume overload as discrete potential biological mechanisms of the condition. The optimization of clinical contributors and normalization of renal function are reviewed as pragmatic management strategies in addition to potential and emerging therapeutic approaches.