Acute renal failure in people with cystic fibrosis

Renal Function in Patients with Cystic Fibrosis: A Single-Center Study

Cystic fibrosis (CF) is the most common incurable autosomal recessive disease affecting the Caucasian population. As the prognosis for life extension of CF patients improves, co-morbidities, including kidney disease, become more common. Identifying those at the highest risk of kidney injury is therefore extremely important. The aim of this study was to evaluate the biomarkers of renal function in 50 CF patients using the estimated glomerular filtration rate (eGFR) based on creatinine and cystatin C equation as well as serum creatinine (sCr), serum cystatin C (CysC), serum urea and urinary neutrophil gelatinase-associated lipocalin (uNGAL) concentrations. sCr, CysC, urea and uNGAL were estimated. eGFR was calculated according to the CKD-EPI formula. CysC was significantly increased, while eGFR was significantly lower in the CF group than in the controls (p < 0.001 and p < 0.01, respectively). There was no significant difference in the sCr, urea and uNGAL concentrations between patients with CF and healthy subjects. For the purpose of our analysis, in order to assess renal function in patients with CF in clinical practice, the concentration of serum CysC and eGFRCKD-EPI should be determined. Patients with CF presented with renal function impairment pictured by increased serum CysC and decreased eGFR values compared to controls. Unchanged uNGAL concentrations suggested preserved tubular function despite aminoglycoside treatment. Further prospective studies are needed to clarify whether kidney impairment observed in the course of CF progresses.

Evaluation of the Risk for Acute Kidney Injury in Adult Cystic Fibrosis Patients Receiving Concomitant Vancomycin and Tobramycin

Background

The risk for acute kidney injury (AKI) has been associated with both tobramycin and vancomycin.

Objective

To determine whether the rate of drug therapy-related nephrotoxicity is greater in Cystic Fibrosis (CF) patients receiving concomitant vancomycin and tobramycin than patients receiving either agent alone.

Methods

Adult CF patients admitted for acute pulmonary exacerbation (APE) over a seven-year period (2008-2014), who received at least 72 hours of intravenous vancomycin, tobramycin or a combination of the two agents were evaluated for AKI. AKI was defined as a 1.5-fold increase in serum creatinine per RIFLE criteria. One hundred seventy-four hospital encounters from 72 unique patients were assessed in this single-center, cross-sectional study.

Results

AKI outcomes were not statistically different. AKI rates were 19% for vancomycin, 8.7% for tobramycin, and 19.7% for combination cohorts (p = 0.16).

Conclusion

Our data suggest there is no significant difference in AKI risk when vancomycin and tobramycin combination therapy is used.

Do cystic fibrosis centres with the lowest FEV1 still use the least amount of intravenous antibiotics? A registry-based comparison of intravenous antibiotic use among adult CF centres in the UK

BACKGROUND

The Epidemiologic Study of Cystic Fibrosis using 1995-1996 and 2003-2005 data found that CF centres with lowest FEV₁ tended to use fewer intravenous antibiotics. We repeated the analyses using 2013-2014 UK CF registry data to determine if this was still the case.

METHODS

Analysing data for 2013 and 2014 separately, 28 adult CF centres were ranked according to median % age-adjusted FEV₁. The top 7 centres were placed in the 'upper quarter' (best FEV₁), the bottom 7 centres in 'lower quarter' (lowest FEV₁), and the rest in 'middle half'. IV use was stratified according to %FEV₁, then compared between the three groups.

RESULTS

Centres in the 'upper quarter' and 'middle half' used significantly more IV antibiotics compared to centres in the 'lower quarter' (van Elteren test P-value<0.001). Regression analyses showed that people with CF attending centres in the 'upper quarter' or 'middle half' are 30-50% more likely to receive at least one IV course per year compared to people attending centres in the 'lower quarter'.

CONCLUSIONS

CF centres with lowest FEV₁ are still distinguished by lower use of intravenous antibiotics.

[Renal diseases in cystic fibrosis]

Patients with cystic fibrosis (CF) show a continuing improvement in their life expectancy thanks to advances in knowledge of this disorder, allowing better multidisciplinary routine monitoring and earlier therapeutic interventions. Likewise, more than of 40% of these patients are adults and CF is no more only a pediatric disease. Due to their higher life expectancy, CF patients present new and unusual complications that were not recorded before. Among them, some renal disorders have to be added to the CF-related renal diseases. They are due to frequent and prolonged exposure to various potentially nephrotoxic factors that need to be taken into account early enough in order to avoid renal failure : essentially risk factors for kidney stones formation, bacterial infections with their associated immune complexes diseases, nephrotoxic effects of antibiotics, diabetes mellitus. Because we observed a case of IgA glomerulonephritis in a 35-year-old patient with cystic fibrosis, we have searched about all these renal consequences due to this affection and here report them.