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Ramírez-Guerrero G, Reis T, Marcello M, de Cal M, Ronco C. Crush syndrome-related acute kidney injury in earthquake victims, time to consider new therapeutical options? Int J Artif Organs 2024; 47:3-7. [PMID: 37589299 DOI: 10.1177/03913988231191954] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/18/2023]
Affiliation(s)
- Gonzalo Ramírez-Guerrero
- Critical Care Unit, Carlos Van Buren Hospital, Valparaíso, Valparaiso Region, Chile
- Dialysis and Renal Transplant Unit, Carlos Van Buren Hospital, Valparaíso, Valparaiso Region, Chile
- Department of Medicine, Universidad de Valparaíso, Valparaíso, Valparaiso Region, Chile
| | - Thiago Reis
- Deparment of Nephrology and Kidney Transplantation, Fenix Group, Sao Paulo, Brazil
- Laboratory of Molecular Pharmacology, University of Brasília, Brasília, Brazil
| | - Matteo Marcello
- International Renal Research Institute of Vicenza, (IRRIV Foundation), Department of Nephrology, Dialysis and Kidney Transplantation, San Bortolo Hospital, Vicenza, Italy
| | - Massimo de Cal
- International Renal Research Institute of Vicenza, (IRRIV Foundation), Department of Nephrology, Dialysis and Kidney Transplantation, San Bortolo Hospital, Vicenza, Italy
| | - Claudio Ronco
- International Renal Research Institute of Vicenza, (IRRIV Foundation), Department of Nephrology, Dialysis and Kidney Transplantation, San Bortolo Hospital, Vicenza, Italy
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2
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Ke J, Wei Y, Chen B. Application of Hemoperfusion in the Treatment of Acute Poisoning. Blood Purif 2023; 53:49-60. [PMID: 37918359 DOI: 10.1159/000532050] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2023] [Accepted: 06/29/2023] [Indexed: 11/04/2023]
Abstract
Rescue of acute poisoning is a race against time, and it is particularly important to remove toxic substances in time. Traditional methods include gastric lavage, promoting elimination, chelating agents, and other treatments. Hemoperfusion is a common blood purification technique. In the clinical practice of acute poisoning, hemoperfusion can directly remove toxic substances through its unique adsorption effect, showing its excellent efficacy. This paper reviews the experience of hemoperfusion in the treatment of various drug overdoses, pesticides, biological toxins, and industrial poisons, even drug addiction. It is hoped to provide a reference for clinicians in acute poisoning rescue.
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Affiliation(s)
- Jianting Ke
- Department of Nephrology, Fifth Affiliated Hospital, Sun Yat-sen University, Zhuhai, China
| | - Yuting Wei
- Department of Nephrology, Fifth Affiliated Hospital, Sun Yat-sen University, Zhuhai, China
| | - Binhuan Chen
- Department of Nephrology, Fifth Affiliated Hospital, Sun Yat-sen University, Zhuhai, China
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Zhang Y, Wu W, Zhang Z. The predictive value of the systemic inflammatory response index for the occurrence of multiple organ dysfunction syndrome in patients with wasp sting injury. Toxicon 2023; 234:107269. [PMID: 37678579 DOI: 10.1016/j.toxicon.2023.107269] [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: 06/04/2023] [Revised: 08/13/2023] [Accepted: 08/28/2023] [Indexed: 09/09/2023]
Abstract
Wasp sting injuries pose a significant threat to public health, especially in areas with abundant trees. Mortality rates are alarmingly high, with reports indicating that up to 70% or more of cases result in multiple organ dysfunction syndrome (MODS). It is crucial for emergency and critical care physicians to promptly identify and implement effective measures to reduce the occurrence of MODS in patients who have been stung by wasps. Therefore, finding a reliable predictive indicator is of utmost importance. We conducted a retrospective study, and clinical data of 226 hospitalized patients with wasp sting from July 2013 to April 2023 in the First College of Clinical Medicine Science, China Three Gorges University were collected. The patients were divided into MODS group and non-MODS (NMODS) group, and the general data, clinical symptoms, laboratory indexes, and prognosis were compared between the two groups. The indicators with significant differences in univariate analysis were included in the multivariate Logistic regression analysis to analyze the independent risk factors for MODS. The value of systemic inflammatory response index (SIRI) in predicting the occurrence of MODS in wasp sting was analyzed by using the receiver operating characteristic curve (ROC curve). Of the 214 patients with wasp sting, 109 cases were in the NMODS group, and 105 cases were in the MODS group. The SIRI was 1.6 (0.7, 3.6) and 12.2 (5.2, 23.3) in the NMODS group and MODS group, respectively, with a significant difference between the two groups (P < 0.001). SIRI was an independent risk factor for MODS in patients with wasp sting; the AUC of SIRI in predicting MODS in wasp sting was 0.886 (P < 0.001), and the optimal cutoff value was 6.39, with a sensitivity of 71.43% and a specificity of 94.5%, which had prediction value. Allowing for early identification and enabling doctors to intervene and provide timely treatment. SIRI was defined as follows: SIRI = neutrophil count × monocyte count/lymphocyte count.
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Affiliation(s)
- Yupei Zhang
- Department of Critical Care Medicine, The First College of Clinical Medicine Science, China Three Gorges University and Yichang Central People's Hospital, Yichang, 443000, Hubei, China
| | - Wen Wu
- Department of Critical Care Medicine, The First College of Clinical Medicine Science, China Three Gorges University and Yichang Central People's Hospital, Yichang, 443000, Hubei, China.
| | - Zhaohui Zhang
- Department of Critical Care Medicine, The First College of Clinical Medicine Science, China Three Gorges University and Yichang Central People's Hospital, Yichang, 443000, Hubei, China.
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Li H, Wen J, Zhou JL, Chen B, Wu XR. Subarachnoid hemorrhage following wasp stings: A case report. Am J Emerg Med 2023; 68:215.e3-215.e7. [PMID: 37024323 DOI: 10.1016/j.ajem.2023.03.040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Revised: 03/22/2023] [Accepted: 03/22/2023] [Indexed: 04/03/2023] Open
Abstract
Three days after being stung by wasps in a rural area, a 60-year-old man was admitted to the emergency department with headaches. The physical examination showed that the patient was conscious, had moderate pain, had four head and back stings with local edema and erythema around the wounds, and had a stiff neck. Brain computed tomography upon admission revealed no abnormalities. Following lumbar puncture, the patient was diagnosed with subarachnoid hemorrhage (SAH) induced by wasp stings. No obvious aneurysms were found by either computed tomography angiography or three-dimensional rotational angiography. He received symptomatic treatment including antiallergy medication (chlorpheniramine and intravenous hydrocortisone), nimodipine for possible vasospasm, fluid infusion, and mannitol for intracranial pressure reduction and was discharged on the 14th day. This case of wasp sting-induced SAH is being reported to improve doctors' diagnostic abilities when encountering patients with wasp stings. It is important for emergency physicians to be aware that patients stung by wasps may develop rare complications such as SAH. Hymenoptera-induced SAH is an example of such a case.
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Ruwanpathirana P, Priyankara D. Clinical manifestations of wasp stings: a case report and a review of literature. Trop Med Health 2022; 50:82. [PMID: 36307881 PMCID: PMC9615201 DOI: 10.1186/s41182-022-00475-8] [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: 08/12/2022] [Accepted: 10/23/2022] [Indexed: 11/24/2022] Open
Abstract
Background Wasp stinging, a neglected tropical entity can have a myriad of local and systemic effects. We present a case of multi-organ injury following multiple wasp stings and a review of literature on the systemic manifestations of wasp stings.
Case presentation A 48-year-old Sri Lankan male who suffered multiple wasp stings, developed an anaphylactic shock with respiratory failure, which was treated with adrenaline and mechanical ventilation. Within the next 2 days the patient developed acute fulminant hepatitis, stage III acute kidney injury, rhabdomyolysis, haemolysis and thrombocytopenia. The patient was treated in the intensive care unit with ionopressors and continuous renal replacement therapy (CRRT). Haemoadsorbant therapy was used in adjunct with CRRT. There was a gradual recovery of the organ functions over the 1st week. However, the patient succumbed to fungal sepsis on the 16th day despite treatment. We conducted a literature review to identify the various clinical manifestations of wasp stinging. Wasp venom contains enzymes, amines, peptides and other compounds. These proteins can cause type 1 hypersensitive reactions ranging from local skin irritation to anaphylactic shock. Furthermore, the toxins can cause direct organ injury or delayed hypersensitivity reactions. The commonly affected organs are the kidneys, liver, and muscles. The effect on the haematological system manifests as coagulopathy and/or cytopenia. The heart, nervous system, lungs, intestines and skin can be affected rarely. Treatment is mainly supportive. Conclusion In conclusion, wasp envenomation can result in multi-organ injury and attention should be paid in doing further research and establishing evidence-based treatment practices.
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Affiliation(s)
- Pramith Ruwanpathirana
- Medical Intensive Unit, National Hospital Sri Lanka, 435/11, Thimbirigasyaya Road, Colombo 05, Sri Lanka.
| | - Dilshan Priyankara
- Medical Intensive Unit, National Hospital Sri Lanka, 435/11, Thimbirigasyaya Road, Colombo 05, Sri Lanka
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Waziri B, Alhaji UI, Oduwale MA, Umar HI, Abdulmalik AM. A rare concurrence: bee venom associated acute tubular necrosis and acute interstitial nephritis. Oxf Med Case Reports 2022; 2022:omac026. [PMID: 35619680 PMCID: PMC9127946 DOI: 10.1093/omcr/omac026] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Revised: 01/01/2022] [Accepted: 01/11/2022] [Indexed: 11/14/2022] Open
Abstract
Acute kidney injury (AKI) is generally associated with increased morbidity and mortality and is even more devastating in patients with comorbidities. Although AKI due to multiple bee stings is well established in the literature, it is still a rare entity with complex pathophysiologic mechanisms. The most commonly reported histological findings in AKI due to bee stings is acute tubular necrosis (ATN), with a few studies attributing it to acute interstitial nephritis (AIN), whereas the concurrence of both ATN and AIN is rarely reported. We hereby present a 50-year-old known Type 2 diabetes mellitus patient with a prior normal renal function, who developed AKI following multiple stings from >1000 bees. He had a kidney biopsy on account of non-recovery of his kidney function despite being on intermittent hemodialysis that showed combined features of ATN and AIN. He subsequently had a full recovery of his renal function following appropriate management.
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Affiliation(s)
- Bala Waziri
- Department of Medicine, Ibrahim Badamasi Babangida Specialist Hospital, Minna, Nigeria
| | - Umar I Alhaji
- Department of Medicine, Ibrahim Badamasi Babangida Specialist Hospital, Minna, Nigeria
| | - Mubaraq A Oduwale
- Department of Medicine, Ibrahim Badamasi Babangida Specialist Hospital, Minna, Nigeria
| | | | - Aliyu M Abdulmalik
- Department of Radiology, Ibrahim Badamasi Babangida Specialist Hospital, Minna, Nigeria
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Wang B, Zhang M, Zhang W, Zhao S, Tian X, Fu G. Hemoperfusion in combination with hemofiltration for acute severe organophosphorus pesticide poisoning: A systematic review and meta-analysis. JOURNAL OF RESEARCH IN MEDICAL SCIENCES 2022; 27:33. [PMID: 35548179 PMCID: PMC9081518 DOI: 10.4103/jrms.jrms_822_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Revised: 10/31/2021] [Accepted: 03/08/2022] [Indexed: 11/12/2022]
Abstract
Background: Acute severe organophosphorus pesticide poisoning (ASOPP) is one of the major diseases that endanger human life and health. However, the effects of conventional therapy including gastric lavages, mechanical ventilation, muscarinic antagonist drugs, and cholinesterase reactivators were uncertain. This meta-analysis aims to investigate the safety and efficacy of hemoperfusion combined with hemofiltration besides routine therapy for ASOPP. Materials and Methods: A comprehensive search for candidate publications was performed through PubMed, Medline, Cochrane Library, WanFang, Chinese Biomedical Literature, and China National Knowledge Infrastructure from database inception to May 12, 2020. The retrieved studies were screened by the predefined inclusion and exclusion criteria. The data of important end points were extracted. The risk ratio (RR) and weighted mean difference (WMD) were pooled for categorical variables and continuous variables, respectively. Meta-analyses and publication bias were conducted by using STATA software version 15.1. Results: A total of 11 randomized controlled trials with 811 patients were included. Compared to conventional therapy group, patients in the hemoperfusion plus hemofiltration group were significantly superior with regard to mortality (RR 0.38, 95% confidence interval [CI] [0.25, 0.57], P < 0.001), total atropine dosing (WMD −147.34 mg, 95% CI [−199.49, −95.18], P < 0.001), duration of mechanical ventilation (WMD −2.34 days, 95% CI [−3.77, −0.92], P < 0.001), cholinesterase recovery time (WMD −2.49 days, 95% CI [−3.14, −1.83], P < 0.001), and length of stay (WMD −4.52 days, 95% CI [−5.31, −3.73], P < 0.001). Conclusion: Combined hemoperfusion and hemofiltration was a very safe and effective treatment protocol for ASOPP, not only resulting in significantly decreased mortality but also resulting in reduced total atropine dosing, duration of mechanical ventilation, cholinesterase recovery time, and length of stay.
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Li F, Liu L, Chen D, Zhang Y, Wang M, Zhou D, Peng L, Lin W. Efficacy of Three Renal Replacement Therapy Modalities for the Treatment of Acute Kidney Injury Caused by Wasp Sting. Blood Purif 2021; 51:365-375. [PMID: 34710874 DOI: 10.1159/000514284] [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: 09/30/2020] [Accepted: 01/08/2021] [Indexed: 11/19/2022]
Abstract
BACKGROUND/AIM This study mainly aimed to explore the therapeutic effects of 3 renal replacement therapy (RRT) modalities on acute kidney injury (AKI) caused by wasp stings. METHODS A retrospective study from September 2016 to December 2019 was conducted. Thirty-one patients with AKIs caused by wasp sting were selected and divided into 3 groups according to the initial RRT modality received, namely, (1) the intermittent hemodialysis combined with hemoperfusion (IHD + HP) group, (2) the continuous veno-venous hemodiafiltration (CVVHDF) group, and (3) the CVVHDF combined with HP (CVVHDF + HP) group. The laboratory results were measured and analyzed before treatment on the 3rd, 7th, and 14th days of treatment. The renal function outcomes and survival of the patients were investigated at 3 months follow-up. RESULTS The laboratory results of enzyme measures and inflammatory indicators in wasp sting patients increased significantly in the early stage and 3 RRT modalities were effective in reducing these indicators. In addition, continuous RRT modality (CVVHDF and CVVHDF + HP) showed better clearance of myoglobin than IHD + HP. The serum creatinine levels of patients in the 3 groups did not recover to baseline within 14 days after beginning treatment. Nevertheless, the CVVHDF + HP group was better than the CVVHDF group, and CVVHDF was better than the IHD + HP group on the 3rd day. The interleukin (IL)-6 and IL-10 levels in CVVHDF + HP and IHD + HP groups were obviously lower than those in the CVVHDF group on the 3rd day. In the follow-up study, the recovery rate of renal function in CVVHDF and CVVHDF + HP groups was significantly better than that in the IHD + HP group. CONCLUSION Early RRT was effective in the treatment of patients with A KI caused by wasp sting. CVVHDF + HP and CVVHDF modalities were better than the IHD + HP group in venom clearance and renal function recovery.
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Affiliation(s)
- Fugang Li
- Department of Nephrology, People's Hospital of Jianyang, Jianyang, China.,Central Laboratory, People's Hospital of Jianyang, Jianyang, China
| | - Li Liu
- Department of Nephrology, People's Hospital of Jianyang, Jianyang, China
| | - Dezheng Chen
- Department of Nephrology, People's Hospital of Jianyang, Jianyang, China
| | - Yong Zhang
- Department of Nephrology, People's Hospital of Jianyang, Jianyang, China
| | - Mingli Wang
- Department of Nephrology, People's Hospital of Jianyang, Jianyang, China
| | - Dongmei Zhou
- Department of Nephrology, People's Hospital of Jianyang, Jianyang, China
| | - Li Peng
- Department of Nephrology, People's Hospital of Jianyang, Jianyang, China
| | - Wujun Lin
- Department of Nephrology, People's Hospital of Jianyang, Jianyang, China
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Ou WF, Huang WH, Chiu HF, Mao YC, Wen MC, Chen CH, Hung SJ, Wu MJ, Wu CL, Chao WC. Clinical manifestation of multiple wasp stings with details of whole transcriptome analysis: Two case reports. Medicine (Baltimore) 2021; 100:e24492. [PMID: 33530269 PMCID: PMC7850695 DOI: 10.1097/md.0000000000024492] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Revised: 12/28/2020] [Accepted: 01/07/2021] [Indexed: 01/05/2023] Open
Abstract
INTRODUCTION Multiple wasp stings is an emergency result from systemic reactions to the toxin with a wide range of manifestations, and we presented 2 patients with distinct clinical and transcriptomic findings. PATIENT CONCERNS Two patients without systemic disease presented with nearly 90 painful papules after attacked by a swarm of wasps (Vespa basalis). DIAGNOSIS Patient 1 was a 44-year-old healthy male whose clinical manifestations mainly comprised hemolysis, hepatic injury, rhabdomyolysis, and acute kidney injury. Patient 2 was a 49-year-old healthy female who presented with severe acute respiratory distress syndrome (ARDS) in addition to certain clinical manifestations that were also found in patient 1. We used ribo- nucleic acid sequencing (RNA-Seq) to characterize the inflammatory responses of 2 patients with distinct clinical manifestations after multiple wasp stings. INTERVENTIONS Both 2 patients received 5 sessions of plasmapheresis, and patient-1 further received mechanical ventilation for 8 days as well as 8 sessions of hemodialysis until day 17. OUTCOMES Both patients recovered uneventfully after the aforementioned management. We used RNA-Seq to demonstrate a largely regulated neutrophil-predominated immune response in patient 1. In patient 2, we found a profound neutrophilc response on week 1 and a robust neutrophilic as well as pro-inflammatory responses on week 2. Furthermore, we found increased expression of signals that were associated with renal system process on week 2. CONCLUSION In conclusion, we report 2 patients who manifested with shared and distinct presentations after an attack by the same swarm of wasps. Both patients had hemolysis, rhabdomyolysis, hepatic injury and acute kidney injury, and 1 patient had ARDS. The whole transcriptomic analyses were consistent with the distinct clinical manifestation, and these results suggest the potential of RNA-Sequencing to disentangle complex inflammatory responses in patients with multiple wasp stings. Plasmapheresis and corticosteroid were administered to both patients and case 2 also underwent 8 sessions of hemodialysis.
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Affiliation(s)
| | | | - Hsien-Fu Chiu
- Division of Nephrology, Department of Internal Medicine
| | - Yan-Chiao Mao
- Division of Clinical Toxicology, Department of Emergency Medicine
| | - Mei-Chin Wen
- Department of Pathology and Laboratory Medicine, Taichung Veterans General Hospital
| | - Cheng-Hsu Chen
- Division of Nephrology, Department of Internal Medicine
- Department of Life Science, Tunghai University
| | - Sheng-Jou Hung
- Department of Medical Research, Taichung Veterans General Hospital
| | - Ming-Ju Wu
- Division of Nephrology, Department of Internal Medicine
- School of Medicine, Chung Shan Medical University
- Rong Hsing Research Center for Translational Medicine, Institute of Biomedical Science, College of Life Science, National Chung Hsing University
- Graduate Institute of Clinical Medical Science, School of Medicine, China Medical University
| | - Chieh-Liang Wu
- Department of Critical Care Medicine, Taichung Veterans General Hospital
- Department of Industrial Engineering and Enterprise Information
| | - Wen-Cheng Chao
- Department of Critical Care Medicine, Taichung Veterans General Hospital
- Department of Computer Science, Tunghai University, Taichung, Taiwan
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10
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Evaluation and analysis of hospital efficiency in China based on macro- and micro-level analyses. J Public Health (Oxf) 2020. [DOI: 10.1007/s10389-019-01048-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
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11
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The influence of hemodialysis on FibroTest parameters. REV ROMANA MED LAB 2019. [DOI: 10.2478/rrlm-2019-0040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Abstract
Chronic hepatitis C viral infection is an important cause of morbidity and mortality in patients with end-stage renal disease treated with hemodialysis. Liver fibrosis represents a main determinant of liver disease prognosis and clinical management, and its assessment by liver biopsy can decide treatment allocation. Although liver biopsy is the gold standard for staging liver fibrosis, it is an invasive procedure associated with complications that are more prevalent in patients with end-stage renal disease. FibroTest represents a surrogate marker of fibrosis which evaluates the levels of apolipoprotein A1, total bilirubin, haptoglobin, gamma-glutamyltransferase and α2-macroglobulin, generating a score that indicates the level of fibrosis. Discrepancies were observed in clinical practice between FibroTest score and histopathological findings. The aim of this study was to evaluate how hemodialysis influences the level of each FibroTest parameter and the final score. The systematic literature review conducted by us suggests that hemodialysis induces a reduction in apolipoprotein A1, haptoglobin and bilirubin levels, with an increase in gamma-glutamyltransferase and alpha-2-macroglobulin levels. In conclusion, hemodialysis modifies the levels of FibroTest parameters, suggesting that it may also have an impact on the accuracy of liver fibrosis assessment in hemodialysis patients.
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Sun X, Chen X, Lu J, Tao Y, Zhang L, Dong L. Extracorporeal treatment in children with acute severe poisoning. Medicine (Baltimore) 2019; 98:e18086. [PMID: 31764843 PMCID: PMC6882618 DOI: 10.1097/md.0000000000018086] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2019] [Revised: 08/06/2019] [Accepted: 10/23/2019] [Indexed: 02/01/2023] Open
Abstract
Acute poisoning in children is a clinical emergency. Prompt and effective treatment is critical for life-threatening poisoning. Extracorporeal treatment (ECTR) is a practical option for enhancing the elimination of poisons.We conducted a retrospective observational study on 338 children with severe acute poisoning who received ECTR during hospitalization from January 2010 to December 2017. The poisonous substances, utilization of ECTR, adverse reactions to ECTR, and outcomes were recorded.The top 3 poisoning categories, in order of frequency, were found to be pesticides (57.99%), biotoxins (25.15%), and pharmaceuticals (14.20%). Paraquat (35.21%), an organic heterocyclic herbicide with high toxicity to humans, was the most common toxic substance. The main modalities of ECTR use were hemoperfusion (50.59%) and therapeutic plasma exchange (42.60%), followed by continuous renal replacement therapy (4.44%) and hemodialysis (1.18%). There were also 4 patients (1.18%) with a combination of ECTR performed. Adverse events of ECTR included errhysis and hematomas around the catheter exit site, oral cavity bleeding, allergic reactions, hypothermia, hypotension, and blood coagulation. The adverse reactions were mostly mild to moderate and were manageable. During the study period, there were 295 patients (87.28%) who were cured, 9 (2.66%) who experienced some improvement, and 34 (10.06%) who died.ECTR modalities were found to be clinically effective approaches to the treatment of poisoning by pesticides, biotoxins, and pharmaceuticals, indicating they are important modalities in toxicology and treatment, and are well tolerated by children.
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Affiliation(s)
- Xiaomei Sun
- Department of Pediatrics
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Ministry of Education, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Xiuying Chen
- Department of Pediatrics
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Ministry of Education, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Jing Lu
- Department of Pediatrics
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Ministry of Education, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Yuhong Tao
- Department of Pediatrics
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Ministry of Education, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Lijuan Zhang
- Department of Pediatrics
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Ministry of Education, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Liqun Dong
- Department of Pediatrics
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Ministry of Education, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
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Gong J, Yuan H, Gao Z, Hu F. Wasp venom and acute kidney injury: The mechanisms and therapeutic role of renal replacement therapy. Toxicon 2019; 163:1-7. [PMID: 30880185 DOI: 10.1016/j.toxicon.2019.03.008] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2018] [Revised: 03/07/2019] [Accepted: 03/11/2019] [Indexed: 01/02/2023]
Abstract
Stinging accidents involving wasp venom are a notable cause of acute kidney injury (AKI) in Asia. However, very little attention has been paid to the understanding of the mechanisms involved in this type of AKI. The aims of this review are to explore the evidence for the mechanisms and the therapeutic role of renal replacement therapy of wasp venom and AKI. A systematic literature search was conducted using PubMed for the association among wasp venom and AKI. Wasp venom is a complex mixture of biologically active components, including enzymes, amines, and peptides. Wasp venom may induce local anaphylaxis reactions as well as systemic reactions such as AKI. AKI may develop as a result of direct nephrotoxic effects of the venom or secondary intravascular hemolysis and/or rhabdomyolysis. Histopathological features of renal biopsies predominantly include acute tubular necrosis and acute interstitial nephritis. Renal replacement therapy, which includes intermittent hemodialysis, hemoperfusion, plasmapheresis, continuous renal replacement therapy, and peritoneal dialysis, has been used to treat severe AKI cases induced by wasp stings. Continuous renal replacement therapy appears to provide more benefit than intermittent hemodialysis in the treatment of wasp sting-induced AKI. In this review, we summarize the existing evidence of the mechanisms and treatment for venom-induced AKI, with a particular emphasis on the role of renal replacement therapy in the management of severe AKI following massive wasp stings.
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Affiliation(s)
- Jianhua Gong
- Department of Nephrology, Xiangyang Central Hospital, Affiliated Hospital of Hubei University of Arts and Science, Xiangyang, 441000, Hubei, China
| | - Hai Yuan
- Department of Nephrology, Xiangyang Central Hospital, Affiliated Hospital of Hubei University of Arts and Science, Xiangyang, 441000, Hubei, China
| | - Zhao Gao
- Department of Nephrology, Xiangyang Central Hospital, Affiliated Hospital of Hubei University of Arts and Science, Xiangyang, 441000, Hubei, China
| | - Fengqi Hu
- Department of Nephrology, Xiangyang Central Hospital, Affiliated Hospital of Hubei University of Arts and Science, Xiangyang, 441000, Hubei, China.
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Vikrant S, Parashar A. Acute kidney injury due to multiple Hymenoptera stings-a clinicopathological study. Clin Kidney J 2017; 10:532-538. [PMID: 29340149 PMCID: PMC5761506 DOI: 10.1093/ckj/sfx010] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2016] [Accepted: 01/20/2017] [Indexed: 11/14/2022] Open
Abstract
Background Acute kidney injury (AKI) after multiple Hymenoptera stings is well known but still a rare phenomenon. Methods We conducted a retrospective study of the clinicopathological spectrum of AKI due to multiple Hymenoptera stings over 13 years (July 2003-June 2016). Results A total of 35 patients were diagnosed with AKI due to multiple Hymenoptera stings. The mean age of the patients was 44.7 ± 17.4 years and the majority (60%) were men. Haematological and biochemical laboratory abnormalities included anaemia (97.1%), leucocytosis (54.3%), hyperkalaemia (68.6%), severe metabolic acidosis (51.4%), hepatic dysfunction (74.3%), haemolysis (91.4%) and rhabdomyolysis (62.9%). The main complications included acute respiratory distress syndrome (ARDS) and encephalopathy in four (11.4%) patients each; gastrointestinal bleeding, hypertension and panniculitis in two (5.7%) patients each and one (2.9%) patient each developed intra-abdominal bleeding, stroke and polyserositis. Twenty-nine (83%) patients required dialysis. Ten (29%) patients died. A higher white blood cell count (P = 0.05) and the complications of ARDS (P = 0.004) and encephalopathy (P = 0.004) were associated with mortality. The kidney functions normalized at 5.5 ± 2.6 weeks in patients who survived. Kidney biopsy was done in 13 patients. The predominant lesion was acute tubular necrosis (ATN) with or without pigmented granular cast in 10 (77%) patients. In four (30.8%) patients, the kidney biopsy showed severe ATN and in the other six (46.2%), the kidney biopsy showed features of ATN associated with mild to moderate acute interstitial nephritis (AIN). In three (23%) patients the histopathological examination revealed only moderate AIN and these patients were treated with a short course of steroids. Conclusions AKI due to multiple Hymenoptera stings is severe and is associated with high mortality. On renal histology, ATN and AIN are common.
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Affiliation(s)
- Sanjay Vikrant
- Department of Nephrology, Indira Gandhi Medical College, Shimla, Himachal Pradesh, India
| | - Anupam Parashar
- Community Medicine, Indira Gandhi Medial College, Shimla, Himachal Pradesh, India
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