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Abdellatif DA. Social and humanitarian issues in nephrology and hypertension. Curr Opin Nephrol Hypertens 2024:00041552-990000000-00186. [PMID: 39258991 DOI: 10.1097/mnh.0000000000001026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/12/2024]
Abstract
PURPOSE OF REVIEW Chronic kidney disease and hypertension, two widely prevalent conditions worldwide, present an urgent and pressing need for immediate action. The review describes how social conditions and humanitarian issues can influence hypertension and kidney disease. RECENT FINDINGS Undoubtedly, social determinants of health (SDoH) are key influencers in the development of many noncommunicable diseases, including hypertension and kidney disease. Healthcare professionals, including public health workers, play a crucial role in addressing these issues. Poverty, low education level, poor nutrition, housing, exposure to environmental hazards, and stress-related disorders are all factors that can be addressed, either directly or indirectly, through improved awareness and access to proper healthcare services. Besides personal factors, national, regional, or global factors cause serious apprehension. Disasters, whether natural or man-made, can lead to significant aftermaths on the healthy person and certainly on kidney disease and hypertensive patients. A Global Overview Report, 2023 turned out to be one of the most violent years since the end of the Cold War. In 2023, 59 state-based conflicts were recorded in 34 countries, the highest number registered since 1946. The wars in Ukraine and Gaza were the primary contributors with a significant impact on the kidney population, especially people living on dialysis and transplantation patients. They also yielded many refugees or displaced persons with ongoing suffering. SUMMARY It is crucial to recognize that social and humanitarian conditions can quickly exacerbate the health of vulnerable populations, particularly those with noncommunicable diseases like hypertension and chronic kidney disease. These patients, who often require continuous follow-up, especially those on dialysis, are particularly vulnerable during difficult times. Their lives depend on uninterrupted access to dialysis or transplantation medications, making the need for special attention and care more pressing. Further research and advocacy are needed to address these issues and ensure the health and well being of these populations.
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Kumar V, Jha V. Community acquired and hospital acquired AKI - two diseases divided by a common definition. Curr Opin Nephrol Hypertens 2023; 32:386-393. [PMID: 36866804 PMCID: PMC7616046 DOI: 10.1097/mnh.0000000000000882] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/04/2023]
Abstract
PURPOSE OF REVIEW Acute kidney injury (AKI) is common across the world. AKI that is acquired in the community (community acquired AKI, CA-AKI) has different risk factors, epidemiological profile, presentation and impact as compared to hospital acquired AKI (HA-AKI). Hence, similar approaches to tackle CA-AKI and HA-AKI might not work. This review highlights the important differences between the two entities that have a bearing on the overall approach to the conditions and how CA-AKI has been overshadowed by HA-AKI in research, diagnosis and treatment recommendations and clinical practice guidelines. RECENT FINDINGS The overall burden of AKI is disproportionately more in low and low-middle income countries. The Global Snapshot study of International Society of Nephrology's (ISN) AKI 0by25 program has shown that CA-AKI is the dominant form in these settings. Its profile and outcomes vary with geographical and socio-economic characteristics of the regions where it develops. The current clinical practice guidelines for AKI align more with HA-AKI than CA-AKI, and fail to capture the complete spectrum of CA-AKI as well as its impact. The ISN AKI 0by25 studies have uncovered the circumstantial compulsions in defining and assessing AKI in these settings and shown feasibility of community-based interventions. SUMMARY Efforts are needed to better understand CA-AKI in low-resource settings and develop context specific guidance and interventions. A multidisciplinary, collaborative approach with representation from community would be required.
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Affiliation(s)
- Vivek Kumar
- Department of Nephrology, Postgraduate Institute of Medical Education and Research, Chandigarh
| | - Vivekanand Jha
- George Institute for Global Health UNSW, New Delhi
- School of Public Health, Imperial College, London, UK
- Manipal Academy of Higher Education, Manipal, India
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Huang J, Qiu F, Zhang H, Shen X, Lin X. Clinical effects of continuous veno-venous hemofiltration combined with hemoperfusion for the treatment of multiple myeloma complicated with acute kidney injury. Pak J Med Sci 2023; 39:344-348. [PMID: 36950391 PMCID: PMC10025692 DOI: 10.12669/pjms.39.2.6966] [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: 07/18/2022] [Revised: 08/08/2022] [Accepted: 12/24/2022] [Indexed: 02/05/2023] Open
Abstract
Objective To evaluate the clinical efficacy of continuous veno-venous hemofiltration (CVVH) combined with hemoperfusion for the treatment of multiple myeloma (MM) complicated with acute kidney injury (AKI). Methods Medical records of 73 patients with MM complicated with AKI admitted to the First People's Hospital of Huzhou from January 2019 to January 2021 were retrospectively analyzed. According to the treatment records, 35 patients received simple chemotherapy (control group), and 38 patients received CVVH combined with HP on the basis of chemotherapy (observation group). We compared the clinical efficacies, renal function indexes, and the serum globulin and erythrocyte sedimentation rate (ESR) values between the two groups. Results After the treatment, the total efficacy of the observation group was significantly higher (81.58%) than that in the control group (57.14%; p <0.05). Serum cystatin C (CysC), urea nitrogen (BUN), β2 macroglobulin (β2-MG) and creatinine (SCr) levels were significantly lower in the observation group than in the control group (p <0.05). Serum globulin level and ESR values in the observation group after the treatment were also significantly lower than in the control group (p <0.05). Conclusions The outcomes of patients with MM complicated with AKI treated with CVVH and hemoperfusion differ significantly from those of the patients treated only with CVVH. Combining CVVH and hemoperfusion helps to improve the efficacy of the treatment, promotes renal function recovery, and improves the levels of serum globulin and ESR.
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Affiliation(s)
- Jing Huang
- Jing Huang, Department of Hematology, The First People’s Hospital of Huzhou, Zhejiang Province, Huzhou 313000, Zhejiang Province, P.R. China
| | - Fengping Qiu
- Fengping Qiu, Department of Nephrology, The First People’s Hospital of Huzhou, Zhejiang Province, Huzhou 313000, Zhejiang Province, P.R. China
| | - Huiqi Zhang
- Huiqi Zhang, Department of Hematology, The First People’s Hospital of Huzhou, Zhejiang Province, Huzhou 313000, Zhejiang Province, P.R. China
| | - Xiangli Shen
- Xiangli Shen, Department of Hematology, The First People’s Hospital of Huzhou, Zhejiang Province, Huzhou 313000, Zhejiang Province, P.R. China
| | - Xia Lin
- Xia Lin, Department of Hematology, The First People’s Hospital of Huzhou, Zhejiang Province, Huzhou 313000, Zhejiang Province, P.R. China
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Naqvi R, Hossain N, Butt S, Bhellar Z, Fatima E, Imtiaz S, Moosa PG, Abbas K, Jafri SB, Khan S. Efficacy of multiple Biomarkers: NGAL, KIM1, Cystatin C and IL18 in predicting pregnancy related acute kidney injury. Pak J Med Sci 2023; 39:34-40. [PMID: 36694779 PMCID: PMC9842994 DOI: 10.12669/pjms.39.1.6930] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Revised: 09/30/2022] [Accepted: 10/28/2022] [Indexed: 11/21/2022] Open
Abstract
Objective Several biomarkers like NGAL, KIM-1, IL-18, and Cystatin C has been previously reported as reliable marker to predict AKI. However, their predictive accuracy varies widely. We aim to observe the efficacy of multiple markers, NGAL, KIM-1, Cystatin C and IL-18, in obstetric population who are at risk of developing AKI. Methods This prospective study was carried out between June 2021 to March 2022 at Department of Obstetrics & Gynecology Unit II, Ruth Pfau KM Civil Hospital and Sindh Institute of Urology & Transplant (SIUT), Karachi Pakistan. On women brought to OBGYN-ER with the diagnosis of hemorrhage (antepartum and postpartum), hypertension (pre-eclampsia and eclampsia) and sepsis. The urine samples and 3cc blood was collected at the time of admission, blood sample processed for biochemistry at time of admission and repeat blood samples for serum creatinine at 24 and 48 hours. Urine was stored at -80ºC and later evaluated for NGAL, KIM-1, Cystatin C and IL-18. Serum Cystatin C was also processed for the time zero sample. The biomarkers were tested using ELISA assays. Results A total of 149 women were included in the study, 83% of these women were non-booked. Twenty-six (17%) women developed AKI. Serum Cystatin C, urinary Cystatin C and urinary NGAL were found significantly raised in women who developed AKI. While KIM-1 and IL-18 were not raised to statistical significance in this population. However, urinary KIM-1 along with urinary Cystatin C were significantly raised in women with positive quick sequential organ failure assessment (qSOFA). Conclusion This study validates the use of serum and urinary Cystatin C and urinary NGAL as highly predictable biomarkers for the development of AKI and nullifies urinary IL-18 and KIM-1 in this regard.
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Affiliation(s)
- Rubina Naqvi
- Rubina Naqvi, Dept. of Nephrology, Sindh Institute of Urology and Transplantation (SIUT), Karachi. 74200. Pakistan
| | - Nazli Hossain
- Nazli Hossain, Dept. of Obstetrics and Gynecology, Unit II, Ruth Pfau KM Civil Hospital, Karachi. 74200. Pakistan
| | - Sofia Butt
- Sofia Butt, Dept. of Obstetrics and Gynecology, Unit II, Ruth Pfau KM Civil Hospital, Karachi. 74200. Pakistan
| | - Zeenat Bhellar
- Zeenat Bhellar, Dept. of Obstetrics and Gynecology, Unit II, Ruth Pfau KM Civil Hospital, Karachi. 74200. Pakistan
| | - Erum Fatima
- Erum Fatima, Dept. of Obstetrics and Gynecology, Unit II, Ruth Pfau KM Civil Hospital, Karachi. 74200. Pakistan
| | - Sanam Imtiaz
- Sanam Imtiaz, Dept. of Nephrology, Sindh Institute of Urology and Transplantation (SIUT), Karachi. 74200. Pakistan
| | - Palwasha Ghulam Moosa
- Palwasha Ghulam Moosa, Dept. of Nephrology, Sindh Institute of Urology and Transplantation (SIUT), Karachi. 74200. Pakistan
| | - Khawar Abbas
- Khawar Abbas, Dept. of Lab Sciences, Sindh Institute of Urology and Transplantation (SIUT), Karachi. 74200. Pakistan
| | - Salma Batool Jafri
- Salma Batool Jafri, Dept. of Lab Sciences, Sindh Institute of Urology and Transplantation (SIUT), Karachi. 74200. Pakistan
| | - Sadia Khan
- Sadia Khan, Dept. of Lab Sciences, Sindh Institute of Urology and Transplantation (SIUT), Karachi. 74200. Pakistan
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Jensen JLS, Hviid CVB, Hvas CL, Christensen S, Hvas AM, Larsen JB. Platelet Function in Acute Kidney Injury: A Systematic Review and a Cohort Study. Semin Thromb Hemost 2022. [PMID: 36174606 DOI: 10.1055/s-0042-1757167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
Acute kidney injury (AKI) patients have increased bleeding risk, which could be partially due to acquired platelet dysfunction. We conducted a systematic review and a cohort study to investigate platelet function and count in AKI and their association with AKI-related bleeding and mortality. Through a systematic literature search in PubMed and Embase, we identified 9 studies reporting platelet function and 56 studies reporting platelet count or platelet indices in AKI patients. Overall, platelet aggregation was reduced in AKI patients in nonintensive care unit (ICU) settings but not in ICU settings, except that reduced aggregation was associated with renal replacement therapy. Thrombocytopenia in AKI was frequent and often predictive of mortality. In our cohort study, we prospectively included 54 adult ICU patients who developed AKI within 24 hours of ICU admission and 33 non-AKI ICU controls. Platelet function was measured with light transmission aggregometry and flow cytometry. AKI patients bled more frequently than non-AKI patients (p = 0.04), and bleeding was associated with increased 30-day mortality in AKI (p = 0.02). However, platelet function was not different between AKI and non-AKI patients (aggregation: all p > 0.52; flow cytometry: all p > 0.07) and platelet function was not associated with bleeding in AKI. In conclusion, a reduced platelet count is frequent in AKI, but the literature on platelet function in AKI is sparse. In a cohort study, we demonstrated that patients with AKI within 24 hours of ICU admission exhibited increased bleeding tendency but this was not associated with reduced platelet function.
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Affiliation(s)
| | - Claus Vinter Bødker Hviid
- Department of Clinical Biochemistry, Thrombosis and Haemostasis Research Unit, Aarhus University Hospital, Aarhus, Denmark.,Department of Clinical Biochemistry, Aalborg University Hospital, Aalborg, Denmark
| | - Christine Lodberg Hvas
- Department of Anaesthesiology and Intensive Care, Aarhus University Hospital, Aarhus, Denmark.,Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Steffen Christensen
- Department of Anaesthesiology and Intensive Care, Aarhus University Hospital, Aarhus, Denmark.,Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Anne-Mette Hvas
- Department of Clinical Biochemistry, Thrombosis and Haemostasis Research Unit, Aarhus University Hospital, Aarhus, Denmark.,Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Julie Brogaard Larsen
- Department of Clinical Biochemistry, Thrombosis and Haemostasis Research Unit, Aarhus University Hospital, Aarhus, Denmark
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Sun Y, Fan Y, Wang Z, Li M, Su D, Liu Y, Liang X. S100A16 promotes acute kidney injury by activating HRD1-induced ubiquitination and degradation of GSK3β and CK1α. Cell Mol Life Sci 2022; 79:184. [PMID: 35279748 PMCID: PMC8918193 DOI: 10.1007/s00018-022-04213-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Revised: 02/15/2022] [Accepted: 02/17/2022] [Indexed: 11/29/2022]
Abstract
AbstractThe pathogenesis of acute kidney injury (AKI) is associated with the activation of multiple signaling pathways, including Wnt/β-catenin signaling. However, the mechanism of Wnt/β-catenin pathway activation in renal interstitial fibroblasts during AKI is unclear. S100 calcium-binding protein A16 (S100A16), a new member of calcium-binding protein S100 family, is a multi-functional signaling factor involved in various pathogenies, including tumors, glycolipid metabolism disorder, and chronic kidney disease (CKD). We investigated the potential participation of S100A16 in Wnt/β-catenin pathway activation during AKI by subjecting wild-type (WT) and S100A16 knockout (S100A16+/−) mice to the ischemia–reperfusion injury (IRI), and revealed S100A16 upregulation in this model, in which knockout of S100A16 impeded the Wnt/β-catenin signaling pathway activation and recovered the expression of downstream hepatocyte growth factor (HGF). We also found that S100A16 was highly expressed in Platelet-derived growth factor receptor beta (PDGFRβ) positive renal fibroblasts in vivo. Consistently, in rat renal interstitial fibroblasts (NRK-49F cells), both hypoxia/reoxygenation and S100A16 overexpression exacerbated fibroblasts apoptosis and inhibited HGF secretion; whereas S100A16 knockdown or Wnt/β-catenin pathway inhibitor ICG-001 reversed these changes. Mechanistically, we showed that S100A16 promoted Wnt/β-catenin signaling activation via the ubiquitylation and degradation of β-catenin complex members, glycogen synthase kinase 3β (GSK3β) and casein kinase 1α (CK1α), mediated by E3 ubiquitin ligase, the HMG-CoA reductase degradation protein 1 (HRD1). Our study identified the S100A16 as a key regulator in the activation of Wnt/β-catenin signaling pathway in AKI.
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Affiliation(s)
- Yifei Sun
- Department of Pathophysiology, Nanjing Medical University, Nanjing, 211166, Jiangsu, China
| | - Ya Fan
- Department of Pathology, Nanjing Medical University, Nanjing, 211166, China
| | - Zheng Wang
- Department of Pathophysiology, Nanjing Medical University, Nanjing, 211166, Jiangsu, China
| | - Min Li
- Department of Pathology, Nanjing Medical University, Nanjing, 211166, China
| | - Dongming Su
- Department of Pathology, Nanjing Medical University, Nanjing, 211166, China
| | - Yun Liu
- Department of Geratology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, 210029, China
| | - Xiubin Liang
- Department of Pathophysiology, Nanjing Medical University, Nanjing, 211166, Jiangsu, China.
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Abebe A, Kumela K, Belay M, Kebede B, Wobie Y. Mortality and predictors of acute kidney injury in adults: a hospital-based prospective observational study. Sci Rep 2021; 11:15672. [PMID: 34341369 PMCID: PMC8329200 DOI: 10.1038/s41598-021-94946-3] [Citation(s) in RCA: 36] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Accepted: 07/15/2021] [Indexed: 11/09/2022] Open
Abstract
Acute kidney injury (AKI) is a major global public health problem. It is expensive to manage and associated with a high rate of prolonged hospitalization and in-hospital mortality. Little is known about the burden of acute kidney injury in moderate to low-income countries. We aim to assess predictors of in-hospital mortality among AKI patients admitted to the medical ward. We prospectively identified patients meeting kidney disease improving global outcomes (KIDGO) AKI definitions from April to August 2019. Patients with underlying CKD and patients hospitalized for less than 48 h were excluded. The Cox regression model was fitted to identify predictors of mortality and statistical significance was considered at the p-value of less than 0.05. A total of 203 patients were enrolled over 5 months. Out of this, 121(59.6%) were males, 58(28.6%) were aged greater than 60 years, and 141(69.5%) had community-acquired acute kidney injury. The most common causes of AKI were Hypovolemia 99(48.77%), Glomerulonephritis 51(25.11%), and sepsis 32(15.79%). The overall in-hospital mortality rate was 12.8%. Stage 3 AKI (AHR = 9.61, 95% CI 1.17-28.52, p = 0.035), duration of AKI (AHR = 7.04, 95% CI 1.37-36.08, p = 0.019), length of hospital stay (AHR = 0.19, 95% CI 0.05-0.73, p = 0.012), and hyperkalemia (AHR = 3.61, 95% CI 1.12-11.71, p = 0.032) were significantly associated with in-hospital mortality. There is a high rate of acute kidney injury-related in-hospital mortality in adult patients admitted to the medical ward. The severity of AKI, hyperkalemia duration of AKI, and a short length of hospital stay were predictors of 30-days in-hospital mortality. Most of the causes of AKI are preventable and patients may benefit from early identification and treatment of these reversible causes.
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Affiliation(s)
- Abinet Abebe
- School of Pharmacy, College of Medicine and Health Science, Mizan-Tepi University, Mizan, Ethiopia.
| | - Kabaye Kumela
- School of Pharmacy, Institute of Health, Jimma University, Jimma, Ethiopia
| | | | - Bezie Kebede
- School of Pharmacy, College of Medicine and Health Science, Mizan-Tepi University, Mizan, Ethiopia
| | - Yohannes Wobie
- School of Pharmacy, College of Medicine and Health Science, Mizan-Tepi University, Mizan, Ethiopia
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