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Xavier AM, Kumar AS. Acute kidney injury in the tropics. Trop Doct 2024; 54:98-107. [PMID: 38247316 DOI: 10.1177/00494755231222956] [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: 01/23/2024]
Abstract
Acute kidney injury in the Tropics is strikingly different from that in developed countries in terms of aetiology and presentation. Moreover, there are radical differences between the developed world and the economically poorer regions within the tropics. Infections are the number one cause leading to significant mortality. This article reviews the most common causes of acute kidney injury in the Tropics and describes its management briefly.
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Affiliation(s)
- Asha Maria Xavier
- Assistant Professor, Department of Internal Medicine, Chettinad Hospital and Research Institute, Chettinad Academy of Research and Education, Kelambakkam, Tamil Nadu, India
| | - Ag Sravan Kumar
- Assistant Professor, Department of Orthopaedics, Shri Sathya Sai Medical College and Research Institute, Chengalpet, Tamil Nadu, India
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2
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Charles JC, Jayarajah U, Subasinghe D. Clinical characteristics and outcomes of patients with leptospirosis complicated with acute pancreatitis: a systematic review. J Int Med Res 2023; 51:3000605231197461. [PMID: 37776529 PMCID: PMC10542321 DOI: 10.1177/03000605231197461] [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: 03/11/2023] [Accepted: 08/08/2023] [Indexed: 10/02/2023] Open
Abstract
OBJECTIVES Acute pancreatitis (AP) is a severe complication of leptospirosis. This review focuses on the current evidence of AP in patients with leptospirosis. METHODS Data on clinical characteristics, biochemical parameters, diagnosis, complications, critical care, fluid management, operative management, and outcomes were analyzed. This study was registered in PROSPERO (CRD42022360802). RESULTS We included 35 individual case reports and 4 case series involving 79 patients. Sex was reported for 48 (60.7%) patients; 38 (48.1%) were male and 10 (12.6%) were female. The patients' mean age was 45.13 (15-83 years). Acute kidney injury, thrombocytopenia, hypotension, and liver injury were the most common complications reported. Complete recovery was reported for 36 (45.5%) patients. Biochemical and radiological recovery was reported for 10 (12.6%) and 9 (11.3%) patients, respectively. Death was reported in 18 (22.7%) patients. CONCLUSION A high degree of clinical suspicion and different modalities of investigations are essential in the diagnosis of AP in leptospirosis. AP can be easily missed in leptospirosis because both conditions share similar clinical presentations and complications. Because of the high prevalence of acute kidney injury, judicious fluid management and close monitoring are mandatory.
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Affiliation(s)
- James C Charles
- Department of Surgery, Teaching Hospital Jaffna, Jaffna, Sri Lanka
| | - Umesh Jayarajah
- Department of Surgery, Colombo South Teaching Hospital, Dehiwala, Sri Lanka
| | - Duminda Subasinghe
- Department of Surgery, Faculty of Medicine, University of Colombo, Sri Lanka
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3
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Senthilkumaran S, Miller SW, Williams HF, Savania R, Thirumalaikolundusubramanian P, Patel K, Vaiyapuri S. Development of Wunderlich syndrome following a Russell's viper bite. Toxicon 2022; 215:11-16. [PMID: 35691405 DOI: 10.1016/j.toxicon.2022.06.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Revised: 05/15/2022] [Accepted: 06/06/2022] [Indexed: 12/19/2022]
Abstract
Snakebite envenomation is a high priority neglected tropical disease that predominantly affects rural communities living in developing countries. Due to myriad of complications including coagulopathies, neurotoxicity, nephrotoxicity and local tissue destruction, treating snakebite victims is a major challenge for clinicians. Russell's viper (Daboia russelii) is one of the 'Big Four' venomous snakes in India, and it is responsible for the most snakebite-induced deaths and disabilities. Acute kidney injury occurs frequently following Russell's viper bites and it is a critical factor contributing to disabilities, deaths and excessive treatment costs. In addition to commonly observed envenomation effects, Russell's viper bites induce some rare complications such as priapism, sialolithiasis and splenic rupture. Here, we report a case of Wunderlich syndrome that developed in a 22-year-old male following a Russell's viper bite. The patient displayed severe coagulopathies, abdominal tenderness, and hypotension. Notably, a peri-nephric haematoma was identified through ultrasound and computerised tomographic imaging. The haemorrhage was successfully treated using angioembolisation, and the patient recovered without any difficulties. Although a clinical condition such as this is rare, it is important to create awareness among treating clinicians about its occurrence, diagnosis and clinical management.
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Affiliation(s)
| | - Stephen W Miller
- The Poison Control Center, Children's Hospital of Philadelphia, USA
| | | | | | | | - Ketan Patel
- School of Biological Sciences, University of Reading, Reading, UK
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4
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Howells P, Laird S, Johnston AM, Billyard T. Critical illness in the returning traveller. J Intensive Care Soc 2022; 23:87-92. [PMID: 37593535 PMCID: PMC10427841 DOI: 10.1177/1751143721991955] [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: 08/19/2023] Open
Abstract
A 70 year old man, who had recently travelled in rural Iraq, presented with fevers, rigors, and developed multiorgan failure. An extensive range of diagnostic tests was undertaken in an attempt to identify the cause. He was treated with multi-organ support and a number of antibiotics. Critical illness in the returning traveller presents a number of challenges on the ICU: obtaining adequate history, the potentially broad differential diagnosis, the requirement for numerous and sometimes specialised investigations and risks of infection transmission to staff and other patients. Travellers are more often elderly, more likely to have comorbidities and immunosuppression whilst global disease patterns are changing. Particular consideration should be given to unusual infections and venous thromboembolic disease from prolonged immobility whilst in transit, alongside more commonly encountered diseases. Antimicrobial resistance may be encountered and appropriate infection control is essential for the protection of patients, staff and others. Specialist support is available in the UK via the Imported Fever Service, especially for High Consequence Infectious Diseases. Consideration of non-infectious causes of fever and critical illness in returning travellers is also warranted. Crucially, a multidisciplinary team approach with thorough information gathering, repeated clinical review and judicious use of investigations are essential for optimal patient care.
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Affiliation(s)
- Phillip Howells
- Department of Anaesthesia and Critical Care Medicine, Harefield Hospital, London, UK
| | - Steven Laird
- Department of Microbiology, University Hospital Coventry, Coventry, UK
| | - Andrew McD Johnston
- Royal Centre for Defence Medicine, Birmingham, UK
- Department of Critical Care Medicine, University Hospital Birmingham, UK
| | - Thomas Billyard
- Department of Anaesthesia and Critical Care Medicine, University Hospitals Coventry and Warwickshire, UK
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Pucca MB, Franco MVS, Medeiros JM, Oliveira IS, Ahmadi S, Cerni FA, Zottich U, Bassoli BK, Monteiro WM, Laustsen AH. Chronic kidney failure following lancehead bite envenoming: a clinical report from the Amazon region. J Venom Anim Toxins Incl Trop Dis 2020; 26:e20200083. [PMID: 33424950 PMCID: PMC7754649 DOI: 10.1590/1678-9199-jvatitd-2020-0083] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Background: Snakebite envenoming can be a life-threatening condition, for which emergency
care is essential. The Bothrops (lancehead) genus is
responsible for most snakebite-related deaths and permanent loss of function
in human victims in Latin America. Bothrops spp. venom is a
complex mixture of different proteins that are known to cause local
necrosis, coagulopathy, and acute kidney injury. However, the long-term
effects of these viper envenomings have remained largely understudied. Case presentation: Here, we present a case report of a 46-years old female patient from Las
Claritas, Venezuela, who was envenomed by a snake from the
Bothrops genus. The patient was followed for a 10-year
period, during which she presented oliguric renal failure, culminating in
kidney failure 60 months after the envenoming. Conclusion: In Latin America, especially in Brazil, where there is a high prevalence of
Bothrops envenoming, it may be relevant to establish
long-term outpatient programs. This would reduce late adverse events, such
as chronic kidney disease, and optimize public financial resources by
avoiding hemodialysis and consequently kidney transplantation.
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Affiliation(s)
- Manuela B Pucca
- Medical School, Federal University of Roraima, Boa Vista, RR, Brazil
| | | | | | - Isadora S Oliveira
- Department of BioMolecular Sciences, School of Pharmaceutical Sciences of Ribeirão Preto, University of São Paulo (USP), Ribeirão Preto, SP, Brazil
| | - Shirin Ahmadi
- Department of Biotechnology and Biomedicine, Technical University of Denmark, Kongens Lyngby, Denmark
| | - Felipe A Cerni
- Department of BioMolecular Sciences, School of Pharmaceutical Sciences of Ribeirão Preto, University of São Paulo (USP), Ribeirão Preto, SP, Brazil
| | - Umberto Zottich
- Medical School, Federal University of Roraima, Boa Vista, RR, Brazil
| | - Bruna K Bassoli
- Medical School, Federal University of Roraima, Boa Vista, RR, Brazil
| | - Wuelton M Monteiro
- School of Health Sciences, Amazonas State University, Manaus, AM, Brazil.,Department of Teaching and Research, Dr. Heitor Vieira Dourado Tropical Medicine Foundation, Manaus, AM, Brazil
| | - Andreas H Laustsen
- Department of Biotechnology and Biomedicine, Technical University of Denmark, Kongens Lyngby, Denmark
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6
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Maria-Rios JC, Marin-Garcia GL, Rodriguez-Cintron W. Renal Replacement Therapy in a Patient Diagnosed With Pancreatitis Secondary to Severe Leptospirosis. Fed Pract 2020; 37:576-579. [PMID: 33424217 PMCID: PMC7789850 DOI: 10.12788/fp.0070] [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
In areas where the zoonotic disease leptospirosis is endemic, reduced morbidity and mortality is strongly linked to quick initiation of renal replacement therapy.
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Affiliation(s)
- Jose C Maria-Rios
- is an Emergency Medicine Resident at the University of Puerto Rico School of Medicine. is a Staff Physician in Emergency and Critical Care Medicine and is a Pulmonary and Critical Care Medicine Division Chief and Program Director, both at the VA Caribbean Healthcare System; all in San Juan, Puerto Rico
| | - Gerald L Marin-Garcia
- is an Emergency Medicine Resident at the University of Puerto Rico School of Medicine. is a Staff Physician in Emergency and Critical Care Medicine and is a Pulmonary and Critical Care Medicine Division Chief and Program Director, both at the VA Caribbean Healthcare System; all in San Juan, Puerto Rico
| | - William Rodriguez-Cintron
- is an Emergency Medicine Resident at the University of Puerto Rico School of Medicine. is a Staff Physician in Emergency and Critical Care Medicine and is a Pulmonary and Critical Care Medicine Division Chief and Program Director, both at the VA Caribbean Healthcare System; all in San Juan, Puerto Rico
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7
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Mehta K, Pajai A, Bhurke S, Shirkande A, Bhadade R, D'Souza R. Acute Kidney Injury of Infectious Etiology in Monsoon Season: A Prospective Study Using Acute Kidney Injury Network Criteria. Indian J Nephrol 2018; 28:143-152. [PMID: 29861565 PMCID: PMC5952453 DOI: 10.4103/ijn.ijn_355_16] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
The epidemiological pattern of acute kidney injury (AKI) in tropical countries during monsoon reflects infectious disease as the most important cause. AKI is a confounding factor and may be overlooked by primary health-care providers and underreported in health statistics. The present study prospectively helps estimate the burden of disease and analyze etiology, clinical profile, and outcome in a tertiary care hospital of a metropolitan city in a tropical country. The study period included monsoon season of 2012 and 2013, a total of 8 months. AKI staging was done as per the AKI Network (AKIN) criteria. Patients were treated for primary disease. Renal replacement therapy (RRT) was given as required. Patients were followed up during hospitalization till recovery/death. Out of a total of 9930 admissions during this period, 1740 (17.52%) were for infections and 230 (2.31%) had AKI secondary to infectious diseases during monsoon. The incidence of AKI (230/1740) in infectious diseases during monsoon was 13.21%. The study population (n = 230) comprised 79.5% of males and the mean age was 40.95 ± 16.55 years. Severe AKI: AKIN Stage III was seen in 48.26% of patients and AKIN Stage I in 41.74%. The most common etiology of AKI was malaria (28.3%) followed by acute gastroenteritis (23%), dengue (16.5%), leptospirosis (13%), undifferentiated fever (10.4%), more than one etiology (5.4%), and enteric fever (3.5%). RRT was required in 44.78% of patients. Requirement for RRT was maximum in patients with more than one etiology followed by leptospirosis, malaria, dengue, and least in typhoid. The overall mortality was 12.17%. In multivariate analysis, vasopressor support and assisted ventilation were risk factors for mortality.
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Affiliation(s)
- K. Mehta
- Department of Nephrology, Topiwala National Medical College and B. Y. L. Nair Charitable Hospital, Mumbai, Maharashtra, India
| | - A. Pajai
- Department of Nephrology, Topiwala National Medical College and B. Y. L. Nair Charitable Hospital, Mumbai, Maharashtra, India
| | - S. Bhurke
- Department of Nephrology, Topiwala National Medical College and B. Y. L. Nair Charitable Hospital, Mumbai, Maharashtra, India
| | - A. Shirkande
- Department of Nephrology, Topiwala National Medical College and B. Y. L. Nair Charitable Hospital, Mumbai, Maharashtra, India
| | - R. Bhadade
- Department of Medicine, Topiwala National Medical College and B. Y. L. Nair Charitable Hospital, Mumbai, Maharashtra, India
| | - R. D'Souza
- Department of Medicine, Topiwala National Medical College and B. Y. L. Nair Charitable Hospital, Mumbai, Maharashtra, India
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Farooq U, Tober A, Chinchilli V, Reeves WB, Ghahramani N. Definition, Management, and Outcomes of Acute Kidney Injury: An International Survey of Nephrologists. KIDNEY DISEASES 2017; 3:120-126. [PMID: 29344507 DOI: 10.1159/000478264] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/18/2017] [Revised: 06/07/2017] [Indexed: 12/23/2022]
Abstract
Background Acute kidney injury (AKI) is a complex disease burdened by uncertainties of definition, management strategies, and prognosis. This study explores the relationship between demographic characteristics of nephrologists and their perceptions about the definition, management, and follow-up of AKI. Methods We developed a Web-based survey, the International Survey on Acute Kidney Injury (ISAKI), consisting of 29 items in 4 categories: (1) demographic and practice characteristics, (2) definition of AKI, (3) management of renal replacement therapy (RRT) in AKI, and (4) sequelae of AKI. A multivariable stepwise logistic regression model was used to examine relationships between the dependent variables and the demographic characteristics of the respondents. Results Responses from 743 nephrologists from 90 countries were analyzed. The majority (60%) of respondents reported using RIFLE and/or AKIN criteria regularly to define AKI, although US nephrologists were less likely to do so (OR: 0.58; 95% CI: 0.42-0.85). The most common initial RRT modality was intermittent hemodialysis (63.5%), followed by continuous RRT (23.8%). Faculty affiliation was associated with a higher likelihood of using a dialysis schedule of ≥4 times a week (OR: 1.75; 95% CI: 1.20-2.55). The respondents believed that a single episode of AKI increases the likelihood of development of chronic kidney disease (CKD) (55%), subsequent AKI (36%), and rapid progression of preexisting CKD (87%). US nephrologists were less likely to recommend follow-up after resolution of AKI (OR: 0.15; 95% CI: 0.07-0.33). Conclusions Our findings highlight the need for a widely accepted consensus definition of AKI, a uniform approach to management, and improved follow-up after resolution of AKI episodes.
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Affiliation(s)
- Umar Farooq
- Pennsylvania State University College of Medicine, Hershey, Pennsylvania, USA
| | - Aaron Tober
- Pennsylvania State University College of Medicine, Hershey, Pennsylvania, USA
| | - Vernon Chinchilli
- Pennsylvania State University College of Medicine, Hershey, Pennsylvania, USA
| | - W Brian Reeves
- University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA
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Acute Kidney Injury Risk Assessment: Differences and Similarities Between Resource-Limited and Resource-Rich Countries. Kidney Int Rep 2017; 2:519-529. [PMID: 28845471 PMCID: PMC5568820 DOI: 10.1016/j.ekir.2017.03.014] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
The incidence of acute kidney injury (AKI) among acutely ill patients is reportedly very high and has vexing consequences on patient outcomes and health care systems. The risks and impact of AKI differ between developed and developing countries. Among developing countries, AKI occurs in young individuals with no or limited comorbidities, and is usually due to environmental causes, including infectious diseases. Although several risk factors have been identified for AKI in different settings, there is limited information on how risk assessment can be used at population and patient levels to improve care in patients with AKI, particularly in developing countries where significant health disparities may exist. The Acute Disease Quality Initiative consensus conference work group addressed the issue of identifying risk factors for AKI and provided recommendations for developing individualized risk stratification strategies to improve care. We proposed a 5-dimension, evidence-based categorization of AKI risk that allows clinicians and investigators to study, define, and implement individualized risk assessment tools for the region or country where they practice. These dimensions include environmental, socioeconomic and cultural factors, processes of care, exposures, and the inherent risks of AKI. We provide examples of these risks and describe approaches for risk assessments in the developing world. We anticipate that these recommendations will be useful for health care providers to plan and execute interventions to limit the impact of AKI on society and each individual patient. Using a modified Delphi process, this group reached consensus regarding several aspects of AKI risk stratification.
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Shiao CC, Wu PC, Wu VC, Lin JH, Pan HC, Yang YF, Lai TS, Huang TM, Wu CH, Yang WS, Wu CJ, Kao CC, Sun CY, Huang CT, Lee KH, Lin CY, Chen TC, Hu FC, Liou HH, Lu KC, Chien KL, Wang JJ, Kan WC, Kuo FC, Lin HYH, Chen CM, You ZH, Tsai JP, Weng CJ, Chen HY, Chang CF, Hsu WD, Wu MS, Huang CC, Wu KD. Nationwide epidemiology and prognosis of dialysis-requiring acute kidney injury (NEP-AKI-D) study: Design and methods. Nephrology (Carlton) 2017; 21:758-64. [PMID: 27546777 DOI: 10.1111/nep.12670] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2015] [Accepted: 11/03/2015] [Indexed: 11/30/2022]
Abstract
AIM Acute kidney injury (AKI) carries an increasing incidence rate worldwide and increases the risk of developing end-stage renal disease (ESRD) as well as the medical expenses during the post-AKI course. The Taiwan Consortium for Acute Kidney Injury and Renal Diseases (CAKs) has thus launched a nationwide epidemiology and prognosis of dialysis-requiring acute kidney injury (NEP-AKI-D) study, which prospectively enrols critically ill patients with AKI. Through thoroughly evaluating the risk and prognostic factors of AKI, we hope to lower the incidence of AKI and ESRD from the perspective of AKI-ESRD interaction. METHODS The CAKs includes 30 hospitals which distribute widely through the four geographical regions (north, middle, south, and east) of Taiwan, and have a 1:1 ratio of medical centres to regional hospitals in each region. The NEP-AKI-D study enrols intensive care unit-based AKI patients who receive dialysis in the four seasonal sampled months (October 2014, along with January, April, and July 2015) in the included hospitals. The collected data include demographic information, pertaining laboratory results, dialysis settings and patient outcomes. The data are uploaded in a centre website and will be audited by on-site principal investigators, computer logic gates, and the CAKs staffs. The outcomes of interest are in-hospital mortality, dialysis-dependency and readmission rate within 90 days after discharge. CONCLUSION The NEP-AKI-D study enrols a large number of representative AKI patients throughout Taiwan. The results of the current study are expected to provide more insight into the risk and prognostic factors of AKI and further attenuated further chronic kidney disease transition.
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Affiliation(s)
- Chih-Chung Shiao
- Saint Mary's Hospital Luodong and Saint Mary's Medicine, Nursing and Management College, Yilan
| | | | | | - Jui-Hsiang Lin
- Taoyuan General Hospital, Ministry of Health and Welfare, Taoyuan
| | | | | | | | - Tao-Min Huang
- National Taiwan University Hospital Yun-Lin Branch, Yunlin County
| | - Che-Hsiung Wu
- Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Taipei, Taiwan and School of Medicine, Tzu Chi University, Hualien
| | - Wei-Shun Yang
- National Taiwan University Hospital Hisn-Chu Branch, Hsin-Chu City
| | | | | | | | | | | | - Chan-Yu Lin
- Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Taoyuan
| | - Te-Chuan Chen
- Kaohsiung Chang Gung Memorial Hospital, Kaohsiung and Chang Gung University College of Medicine, Taoyuan
| | - Fu-Chang Hu
- International-Harvard Statistical Consulting Company
| | | | - Kuo-Cheng Lu
- Division of Nephrology, Department of Internal Medicine, Cardinal Tien Hospital and School of Medicine, Fu-Jen Catholic University
| | - Kuo-Liong Chien
- Graduate Institute of Epidemiology and Preventive Medicine College of Public Health, National Taiwan University
| | | | | | - Feng-Chi Kuo
- Mackay Memorial Hospital Taitung branch, Taitung
| | | | | | - Zi-Hong You
- Taichung Veterans General Hospital Chiayi Branch, Taichung
| | - Jen-Pi Tsai
- Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chiayi
| | | | | | | | - Wen-Ding Hsu
- New Taipei City Hospital Sanchong Branch, New Taipei City, Taiwan
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Gupta S, Pannu HS, Jain NP, Sandhu JS, Kumar A. Profile and outcome of acute renal failure due to tropical infections – A prospective study. INDIAN JOURNAL OF MEDICAL SPECIALITIES 2016. [DOI: 10.1016/j.injms.2016.04.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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13
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Mehta RL, Cerdá J, Burdmann EA, Tonelli M, García-García G, Jha V, Susantitaphong P, Rocco M, Vanholder R, Sever MS, Cruz D, Jaber B, Lameire NH, Lombardi R, Lewington A, Feehally J, Finkelstein F, Levin N, Pannu N, Thomas B, Aronoff-Spencer E, Remuzzi G. International Society of Nephrology's 0by25 initiative for acute kidney injury (zero preventable deaths by 2025): a human rights case for nephrology. Lancet 2015; 385:2616-43. [PMID: 25777661 DOI: 10.1016/s0140-6736(15)60126-x] [Citation(s) in RCA: 677] [Impact Index Per Article: 75.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Affiliation(s)
- Ravindra L Mehta
- Department of Medicine, University of California San Diego, San Diego, CA, USA.
| | - Jorge Cerdá
- Division of Nephrology, Department of Medicine, Albany Medical College, Albany, NY, USA
| | - Emmanuel A Burdmann
- LIM 12, Division of Nephrology, University of Sao Paulo Medical School, São Paulo, Brazil
| | | | - Guillermo García-García
- Nephrology Service, Hospital Civil de Guadalajara, University of Guadalajara Health Sciences Center, Guadalajara, Jalisco, Mexico
| | - Vivekanand Jha
- The George Institute for Global Health, University of Oxford, Oxford, UK
| | - Paweena Susantitaphong
- Division of Nephrology, Department of Medicine, King Chulalongkorn Memorial Hospital, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand; Tufts University School of Medicine, Boston, MA, USA
| | - Michael Rocco
- Department of Internal Medicine, Section of Nephrology, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Raymond Vanholder
- Nephrology Section, Department of Internal Medicine, University Hospital, Ghent, Belgium
| | - Mehmet Sukru Sever
- Department of Nephrology, Istanbul School of Medicine, Istanbul University, Mehmet, Turkey
| | - Dinna Cruz
- Department of Medicine, University of California San Diego, San Diego, CA, USA
| | - Bertrand Jaber
- Tufts University School of Medicine, Boston, MA, USA; St Elizabeth's Medical Center, Boston, MA, USA
| | - Norbert H Lameire
- Nephrology Section, Department of Internal Medicine, University Hospital, Ghent, Belgium
| | - Raúl Lombardi
- Department of Critical Care Medicine, SMI, Montevideo, Uruguay
| | | | | | | | | | | | - Bernadette Thomas
- Division of Nephrology, Department of Medicine, University of Washington, Seattle, WA, USA
| | | | - Giuseppe Remuzzi
- IRCCS-Istituto di Ricerche Farmacologiche Mario Negri, Bergamo, Italy; Department of Medicine, Unit of Nephrology, Dialysis and Transplantation, Azienda Ospedaliera Papa Giovanni XXIII, Bergamo, Italy
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Abstract
Djenkolism is an uncommon but important cause of acute kidney injury. It sporadically occurs after an ingestion of the djenkol bean (Archidendron pauciflorum), which is native to Southeast Asia. The clinical features defining djenkolism include: spasmodic suprapubic and/or flank pain; urinary obstruction; and acute kidney injury. The precise pathogenesis of acute kidney injury following djenkol ingestion remains unknown. However, it is proposed that an interaction between the characteristics of the ingested beans and the host factors causes hypersaturation of djenkolic acid crystals within the urinary system, resulting in subsequent obstructive nephropathy with sludge, stones, or possible spasms. We report a case of djenkolism from our rural clinic in Borneo, Indonesia. Our systematic literature review identified 96 reported cases of djenkolism. The majority of patients recovered with hydration, bicarbonate therapy, and pain medication. Three patients required surgical intervention; one patient required ureteral stenting for the obstructing djenkolic acid stones. Four of the 96 reported patients died from acute kidney failure. We stress the importance of awareness of djenkolism to guide medical practitioners in the treatment of this rare disease in resource-poor areas in Southeast Asia.
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Affiliation(s)
- Nur C Bunawan
- Alam Sehat Lestari Clinic, West Kalimantan, Borneo, Indonesia
| | - Asghar Rastegar
- Section of Nephrology, Department of Medicine, Yale University School of Medicine, New Haven, CT, USA
| | - Kathleen P White
- General Internal Medicine, Yale University School of Medicine, New Haven, CT, USA
| | - Nancy E Wang
- Department of Surgery and Pediatric Emergency Medicine, Stanford University School of Medicine, Stanford, CA, USA
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15
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Lemos JRD, Rodrigues WF, Miguel CB, Parreira RC, Miguel RB, de Paula Rogerio A, Oliveira CJF, Chica JEL. Influence of parasite load on renal function in mice acutely infected with Trypanosoma cruzi. PLoS One 2013; 8:e71772. [PMID: 23951243 PMCID: PMC3741127 DOI: 10.1371/journal.pone.0071772] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2012] [Accepted: 07/07/2013] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Chagas disease is a neglected tropical disease caused by Trypanosoma cruzi. Despite the vast number of studies evaluating the pathophysiological mechanisms of the disease, the influence of parasite burden on kidney lesions remains unclear. Thus, the main goal of this work was to evaluate the effect of T. cruzi infection on renal function and determine whether there was a correlation between parasite load and renal injury using an acute experimental model of the disease. METHODOLOGY/PRINCIPAL FINDINGS Low, medium and high parasite loads were generated by infecting C57BL/6 mice with 300 (low), 3,000 (medium) or 30,000 (high) numbers of "Y" strain trypomastigotes. We found that mice infected with T. cruzi trypomastigotes show increased renal injury. The infection resulted in reduced urinary excretion and creatinine clearance. We also observed a marked elevation in the ratio of urine volume to kidney and body weight, blood urea nitrogen, chloride ion, nitric oxide, pro- and anti-inflammatory cytokines and the number of leukocytes in the blood and/or renal tissues of infected mice. Additionally, we observed the presence of the parasite in the cortical/medullary and peri-renal region, an increase of inflammatory infiltrate and of vascular permeability of the kidney. Overall, most renal changes occurred mainly in animals infected with high parasitic loads. CONCLUSIONS/SIGNIFICANCE These data demonstrate that T. cruzi impairs kidney function, and this impairment is more evident in mice infected with high parasitic loads. Moreover, these data suggest that, in addition to the extensively studied cardiovascular effects, renal injury should be regarded as an important indicator for better understanding the pan-infectivity of the parasite and consequently for understanding the disease in experimental models.
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Affiliation(s)
- Juliana Regina Dias Lemos
- Postgraduate Course of Pathology, Federal University of Triângulo Mineiro, Uberaba, Minas Gerais, Brazil
| | | | - Camila Botelho Miguel
- Postgraduate Course of Pathology, Federal University of Triângulo Mineiro, Uberaba, Minas Gerais, Brazil
| | - Ricardo Cambraia Parreira
- Institute of Biological and Natural Sciences, Federal University of Triângulo Mineiro, Uberaba, Minas Gerais, Brazil
| | - Renata Botelho Miguel
- Department Nutrition and Dietetics, Portuguese Beneficent Hospital of Uberaba, Uberaba, Minas Gerais, Brazil
| | - Alexandre de Paula Rogerio
- Laboratory of Experimental Immunopharmacology, Federal University of Triângulo Mineiro, Uberaba, Minas Gerais, Brazil
- Postgraduate Course of Tropical Medicine, Federal University of Triângulo Mineiro, Uberaba, Minas Gerais, Brazil
| | - Carlo Jose Freire Oliveira
- Institute of Biological and Natural Sciences, Federal University of Triângulo Mineiro, Uberaba, Minas Gerais, Brazil
- Postgraduate Course of Tropical Medicine, Federal University of Triângulo Mineiro, Uberaba, Minas Gerais, Brazil
| | - Javier Emilio Lazo Chica
- Postgraduate Course of Pathology, Federal University of Triângulo Mineiro, Uberaba, Minas Gerais, Brazil
- Institute of Biological and Natural Sciences, Federal University of Triângulo Mineiro, Uberaba, Minas Gerais, Brazil
- * E-mail:
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Lameire NH, Bagga A, Cruz D, De Maeseneer J, Endre Z, Kellum JA, Liu KD, Mehta RL, Pannu N, Van Biesen W, Vanholder R. Acute kidney injury: an increasing global concern. Lancet 2013; 382:170-9. [PMID: 23727171 DOI: 10.1016/s0140-6736(13)60647-9] [Citation(s) in RCA: 654] [Impact Index Per Article: 59.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Despite an increasing incidence of acute kidney injury in both high-income and low-income countries and growing insight into the causes and mechanisms of disease, few preventive and therapeutic options exist. Even small acute changes in kidney function can result in short-term and long-term complications, including chronic kidney disease, end-stage renal disease, and death. Presence of more than one comorbidity results in high severity of illness scores in all medical settings. Development or progression of chronic kidney disease after one or more episode of acute kidney injury could have striking socioeconomic and public health outcomes for all countries. Concerted international action encompassing many medical disciplines is needed to aid early recognition and management of acute kidney injury.
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