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Zhang Z, Shen J, He Q, Nie H. Spontaneous rupture of bladder diverticulum with pseudo renal failure:A case report and literature review. Am J Emerg Med 2024; 79:231.e3-231.e7. [PMID: 38508995 DOI: 10.1016/j.ajem.2024.03.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2024] [Accepted: 03/11/2024] [Indexed: 03/22/2024] Open
Abstract
BACKGROUND Spontaneous or non-traumatic bladder rupture is rare but can be life-threatening. Bladder rupture caused by a diverticulum is extremely rare, with only a few case reports in medical literature. CASE PRESENTATION We report the case of a 32-year-old woman admitted to hospital complaints of abdominal pain, oliguria and ascites with no history of trauma. Laboratory tests revealed an elevated serum urea nitrogen(UN) level of 33.5 mmol/l and an elevated creatinine levels of 528 umol/l. X-ray cystography confirmed the rupture of a bladder diverticulum. Subsequent transurethral catheterization led to a prompt increase in urinary output, and serum creatinine level returned to 40 umol/l within 48 h. The patient was successfully treated with laparoscopic diverticulectomy. CONCLUSION Clinicians should maintain a high level of suspicion for urinary bladder rupture in cases presenting with acute lower abdominal pain, urinary difficulties, and oliguria. When acute renal failure, complicated ascites, and an elevated peritoneal fluid creatinine or potassium level exceeding serum levels are observed, intraperitoneal urine leakage should be suspected without delay. This case emphasizes the importance of early diagnosis and intervention in managing this rare but serious condition.
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Affiliation(s)
- Zhuo Zhang
- Department of Emergency Medicine, West China Hospital of Sichuan University, Chengdu, Sichuan, China
| | - Jing Shen
- Department of Emergency Medicine, West China Hospital of Sichuan University, Chengdu, Sichuan, China
| | - Qian He
- Department of Emergency Medicine, West China Hospital of Sichuan University, Chengdu, Sichuan, China
| | - Hu Nie
- Department of Emergency Medicine, West China Hospital of Sichuan University, Chengdu, Sichuan, China; West China Xiamen Hospital of Sichuan University, Xiamen, Fujian, China.
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Lombardi R, Ferreiro A, Ponce D, Claure-Del Granado R, Aroca G, Venegas Y, Pereira M, Chavez-Iñiguez J, Rojas N, Villa A, Colombo M, Carlino C, Guimarâes C, Younes-Ibrahim M, Rizo LM, Guzmán G, Varela C, Rosa-Diez G, Janiques D, Ayala R, Coronel G, Roessler E, Amor S, Osorio W, Rivas N, Pereira B, de Azevedo C, Flores A, Ubillo J, Raño J, Yu L, Burdmann EA, Rodríguez L, Galagarza-Gutiérrez G, Curitomay-Cruz J. Latin American registry of renal involvement in COVID-19 disease. The relevance of assessing proteinuria throughout the clinical course. PLoS One 2022; 17:e0261764. [PMID: 35085273 PMCID: PMC8794101 DOI: 10.1371/journal.pone.0261764] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Accepted: 12/09/2021] [Indexed: 01/08/2023] Open
Abstract
The Latin American Society of Nephrology and Hypertension conducted a prospective cohort, multinational registry of Latin American patients with kidney impairment associated to COVID-19 infection with the objective to describe the characteristics of acute kidney disease under these circumstances. The study was carried out through open invitation in order to describe the characteristics of the disease in the region. Eight-hundred and seventy patients from 12 countries were included. Median age was 63 years (54-74), most of patients were male (68.4%) and with diverse comorbidities (87.2%). Acute kidney injury (AKI) was hospital-acquired in 64.7% and non-oliguric in 59.9%. Multiorgan dysfunction syndrome (MODS) due to COVID-19 and volume depletion were the main factors contributing to AKI (59.2% and 35.7% respectively). Kidney replacement therapy was started in 46.2%. Non-recovery of renal function was observed in 65.3%. 71.5% of patients were admitted to ICU and 72.2% underwent mechanical ventilation. Proteinuria at admission was present in 62.4% of patients and proteinuria during hospital-stay occurred in 37.5%. Those patients with proteinuria at admission had higher burden of comorbidities, higher baseline sCr, and MODS was severe. On the other hand, patients with de novo proteinuria had lower incidence of comorbidities and near normal sCr at admission, but showed adverse course of disease. COVID-19 MODS was the main cause of AKI in both groups. All-cause mortality of the general population was 57.4%, and it was associated to age, sepsis as cause of AKI, severity of condition at admission, oliguria, mechanical ventilation, non-recovery of renal function, in-hospital complications and hospital stay. In conclusion, our study contributes to a better knowledge of this condition and highlights the relevance of the detection of proteinuria throughout the clinical course.
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Affiliation(s)
- Raúl Lombardi
- Department of Nephrology, Universidad de la República, Montevideo, Uruguay
| | - Alejandro Ferreiro
- Department of Nephrology, Universidad de la República, Montevideo, Uruguay
| | - Daniela Ponce
- Clinical Hospital of Botucatu, School Medicine, HCFMB, University of Sao Paulo State UNESP, Brazil
| | | | | | - Yanissa Venegas
- Hospital Nacional Arzobispo Loayza, Servicio de Nefrología, Lima, Perú
| | | | | | - Nelson Rojas
- Departamento de Nefrología, Hospital General de Agudos Dr Cosme Argerich, Buenos Aires, Argentina
| | - Ana Villa
- Division of Nephrology, Hospital Civil de Guadalajara, Guadalajara, Mexico
| | | | - Cristina Carlino
- Department of Nephrology, Hospital Provincial, Rosario, Argentina
| | - Caio Guimarâes
- Nefrologia, Pontificia Universidade Catolica do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Mauricio Younes-Ibrahim
- Nefrologia, Pontificia Universidade Catolica do Rio de Janeiro, Rio de Janeiro, Brazil
- Internal Medicine, University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Lilia Maria Rizo
- Nephrology Hospital Universitario Dr José Eleuterio González, Monterrey, Mexico
| | - Gisselle Guzmán
- Centros de Diagnóstico y Medicina Avanzada, Santo Domingo, República Dominicana
| | - Carlos Varela
- Servicio de Nefrología, Hospital Italiano, Buenos Aires, Argentina
| | | | - Diego Janiques
- Nefrologia, Pontificia Universidade Catolica do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Roger Ayala
- Departamento de Medicina Interna, Salud Renal MSP, Asunción, Paraguay
| | - Galo Coronel
- Departamento de Nefrología, Hospital General de Agudos Dr Cosme Argerich, Buenos Aires, Argentina
| | - Eric Roessler
- Department of Nephrology, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Serena Amor
- Servicio de Nefrología, Hospital Español, Montevideo, Uruguay
| | - Washington Osorio
- Departamento de Nefrología, Hospital de Especialidades de las Fuerzas Armadas, Quito, Ecuador
| | - Natalia Rivas
- Servicio de Nefrología y Diálisis, Hospital Rojas, Buenos Aires, Argentina
| | | | | | - Adriana Flores
- Departamento de Nefrología, Hospital Regional General Dr Carlos Mac Gregor Sanchez Navarro, DF, Mexico
| | - José Ubillo
- Departamento de Nefrología, Hospital de Pediatría CMN Siglo XXI, DF, Mexico
| | - Julieta Raño
- Departamento de Nefrología, Hospital General de Agudos Dr Cosme Argerich, Buenos Aires, Argentina
| | - Luis Yu
- Department of Nephrology, School of Medicine, University of Sao Paulo, Sao Paulo, Brazil
| | - Emmanuel A. Burdmann
- Department of Nephrology, School of Medicine, University of Sao Paulo, Sao Paulo, Brazil
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Shim JW, Kim KR, Jung Y, Park J, Lee HM, Kim YS, Moon YE, Hong SH, Chae MS. Role of intraoperative oliguria in risk stratification for postoperative acute kidney injury in patients undergoing colorectal surgery with an enhanced recovery protocol: A propensity score matching analysis. PLoS One 2020; 15:e0231447. [PMID: 32302336 PMCID: PMC7164643 DOI: 10.1371/journal.pone.0231447] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Accepted: 03/24/2020] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND The enhanced recovery after surgery (ERAS) protocol for colorectal cancer resection recommends balanced perioperative fluid therapy. According to recent guidelines, zero-balance fluid therapy is recommended in low-risk patients, and immediate correction of low urine output during surgery is discouraged. However, several reports have indicated an association of intraoperative oliguria with postoperative acute kidney injury (AKI). We investigated the impact of intraoperative oliguria in the colorectal ERAS setting on the incidence of postoperative AKI. PATIENTS AND METHODS From January 2017 to August 2019, a total of 453 patients underwent laparoscopic colorectal cancer resection with the ERAS protocol. Among them, 125 patients met the criteria for oliguria and were propensity score (PS) matched to 328 patients without intraoperative oliguria. After PS matching had been performed, 125 patients from each group were selected and the incidences of AKI were compared between the two groups. Postoperative kidney function and surgical outcomes were also evaluated. RESULTS The incidence of AKI was significantly higher in the intraoperative oliguria group than in the non-intraoperative oliguria group (26.4% vs. 11.2%, respectively, P = 0.002). Also, the eGFR reduction on postoperative day 0 was significantly greater in the intraoperative oliguria than non-intraoperative oliguria group (-9.02 vs. -1.24 mL/min/1.73 m2 respectively, P < 0.001). In addition, the surgical complication rate was higher in the intraoperative oliguria group than in the non-intraoperative oliguria group (18.4% vs. 9.6%, respectively, P = 0.045). CONCLUSIONS Despite the proven benefits of perioperative care with the ERAS protocol, caution is required in patients with intraoperative oliguria to prevent postoperative AKI. Further studies regarding appropriate management of intraoperative oliguria in association with long-term prognosis are needed in the colorectal ERAS setting.
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Affiliation(s)
- Jung-Woo Shim
- Department of Anesthesiology and Pain Medicine, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Kyoung Rim Kim
- Department of Anesthesiology and Pain Medicine, Bucheon St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Yoonju Jung
- Department of Surgery, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Jaesik Park
- Department of Anesthesiology and Pain Medicine, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Hyung Mook Lee
- Department of Anesthesiology and Pain Medicine, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Yong-Suk Kim
- Department of Anesthesiology and Pain Medicine, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Young Eun Moon
- Department of Anesthesiology and Pain Medicine, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Sang Hyun Hong
- Department of Anesthesiology and Pain Medicine, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Min Suk Chae
- Department of Anesthesiology and Pain Medicine, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
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Lee B, Kim SJ, Park JD, Park J, Jung AH, Jung SH, Choi YH, Kang HG, Ha IS, Cheong HI. Factors affecting serum concentration of vancomycin in critically ill oliguric pediatric patients receiving continuous venovenous hemodiafiltration. PLoS One 2018; 13:e0199158. [PMID: 29927988 PMCID: PMC6013195 DOI: 10.1371/journal.pone.0199158] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2017] [Accepted: 06/02/2018] [Indexed: 12/02/2022] Open
Abstract
Vancomycin is known to be unintentionally eliminated by continuous renal replacement therapy, and the protein bound fraction of vancomycin is also known to be different in adults and children. However, there are only a few studies investigating the relationship between the dose of continuous venovenous hemodiafiltration (CVVHDF) parameters and serum concentration of vancomycin in pediatric patients. The aim of this study was to determine clinical and demographic parameters that significantly affect serum vancomycin concentrations. This retrospective cohort study was conducted at a pediatric intensive care unit in a tertiary university children’s hospital. Data from oliguric patients who underwent CVVHDF and vancomycin therapeutic drug monitoring were collected. The correlation between factors affecting serum concentration of vancomycin was analyzed using mixed effect model. A total of 177 serum samples undergoing vancomycin therapeutic drug monitoring were analyzed. The median age of study participants was 2.23 (interquartile range, 0.3–11.84) years, and 126 (71.19%) were male patients. Serum concentration of vancomycin decreased significantly as the effluent flow rate (EFR; P < 0.001), dialysate flow rate (DFR; P = 0.009), replacement fluid flow rate (RFFR; P = 0.008), the proportion of RFFR in the sum of DFR and RFFR (P = 0.025), and residual urine output increased. The adjusted R2 of the multivariate regression model was 0.874 (P < 0.001) and the equation was as follows: Vancomycin trough level (mg/L) = (0.283 × daily dose of vancomycin [mg/kg/d]) + (365.139 / EFR [mL/h/kg])–(15.842 × residual urine output [mL/h/kg]). This study demonstrated that the serum concentration of vancomycin was associated with EFR, DFR, RFFR, the proportion of RFFR, and residual urine output in oliguric pediatric patients receiving CVVHDF.
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Affiliation(s)
- Bongjin Lee
- Department of Pediatrics, Seoul National University College of Medicine, Seoul, Republic of Korea
- Department of Pediatrics, Chungnam National University Hospital, Daejeon, Republic of Korea
| | - Soo Jung Kim
- Department of Pharmacy, Seoul National University Hospital, Seoul, Republic of Korea
| | - June Dong Park
- Department of Pediatrics, Seoul National University College of Medicine, Seoul, Republic of Korea
- * E-mail:
| | - Jiun Park
- Department of Pharmacy, Seoul National University Hospital, Seoul, Republic of Korea
| | - Ae Hee Jung
- Department of Pharmacy, Seoul National University Hospital, Seoul, Republic of Korea
| | - Sun Hoi Jung
- Department of Pharmacy, Seoul National University Hospital, Seoul, Republic of Korea
| | - Yu Hyeon Choi
- Department of Pediatrics, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Hee Gyung Kang
- Department of Pediatrics, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Il Soo Ha
- Department of Pediatrics, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Hae Il Cheong
- Department of Pediatrics, Seoul National University College of Medicine, Seoul, Republic of Korea
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Hada R, Poudyal B, Sharma A, Khatri R. Lambda light chain myeloma with oliguric cast nephropathy and remission with bortezomib, doxorubicin and dexamethasone. JNMA J Nepal Med Assoc 2012; 52:192-195. [PMID: 23591252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023] Open
Abstract
Cast nephropathy is one of the major causes of renal failure in patients with multiple myeloma resulting from precipitation of free light chains inside the tubules. Timely diagnosis and treatment confers a better prognosis though around 10% of patients with cast nephropathy remain dialysis dependent in spite of treatment. We report the clinical course and outcome of a patient presenting with acute kidney injury and oliguria, preceded by acute gastroenteritis and intake of Chinese medications and dialysis dependent state for eight weeks. Kidney biopsy revealed cast nephropathy with lambda light chain restriction and severe tubular injury. Serum protein electrophoresis was normal with no "M spike" but serum free light chain ratio was altered with very high lambda and normal kappa light chain levels. Bone marrow biopsy showed >85% atypical plasma cells. Haemodialysis was continued and chemotherapy with bortezomib, doxorubicin and dexamethasone was started. Kidney function gradually improved with discontinuation of dialysis after 1 month and complete remission of acute kidney injury and myeloma in 4 months of chemotherapy.
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Affiliation(s)
- R Hada
- Department of Nephrology, National Academy of Medical Sciences, Bir Hospital and Blue Cross Hospital, Kathmandu, Nepal
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Choi JI, Cho SG, Yi JH, Han SW, Kim HJ. Unintended cannulation of the subclavian artery in a 65-year-old-female for temporary hemodialysis vascular access: management and prevention. J Korean Med Sci 2012; 27:1265-8. [PMID: 23091328 PMCID: PMC3468767 DOI: 10.3346/jkms.2012.27.10.1265] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2012] [Accepted: 06/07/2012] [Indexed: 11/20/2022] Open
Abstract
Ultrasound-guided cannulation of a large-bore catheter into the internal jugular vein was performed to provide temporary hemodialysis vascular access for uremia in a 65-yr-old woman with acute renal failure and sepsis superimposed on chronic renal failure. Despite the absence of any clinical evidence such as bleeding or hematoma during the procedure, a chest x-ray and computed tomographic angiogram of the neck showed that the catheter had inadvertently been inserted into the subclavian artery. Without immediately removing the catheter and applying manual external compression, the arterial misplacement of the hemodialysis catheter was successfully managed by open surgical repair. The present case suggests that attention needs to be paid to preventing iatrogenic arterial cannulation during central vein catheterization with a large-bore catheter and to the management of its potentially devastating complications, since central vein catheterization is frequently performed by nephrologists as a common clinical procedure to provide temporary hemodialysis vascular access.
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Affiliation(s)
- Jeong-Im Choi
- Renal Division, Department of Internal Medicine, Hanyang University Guri Hospital, Guri, Korea
| | - Sung-Gun Cho
- Renal Division, Department of Internal Medicine, Hanyang University Guri Hospital, Guri, Korea
| | - Joo-Hark Yi
- Renal Division, Department of Internal Medicine, Hanyang University Guri Hospital, Guri, Korea
| | - Sang-Woong Han
- Renal Division, Department of Internal Medicine, Hanyang University Guri Hospital, Guri, Korea
| | - Ho-Jung Kim
- Renal Division, Department of Internal Medicine, Hanyang University Guri Hospital, Guri, Korea
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Paavonen J, Tikkanen M, Stefanovic V, Nuutila M, Kaaja R. [Diuretics in pregnancy can do harm]. Duodecim 2012; 128:1501-1504. [PMID: 22937610] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
We describe a case with severe pre-eclampsia with poor obstetric outcome. This patient developed oliguria and received multiple doses of furosemide which probably contributed to the poor outcome. This case presentation reminds of the risks associated with pre-eclampsia in which both blood volume and utero-placental blood flow are already decreased. This condition was further worsened by diuretics.
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Mihara A, Mori T, Nakazato T, Ikeda Y, Okamoto S. Acute renal failure caused by intravenous acyclovir for disseminated varicella zoster virus infection. ACTA ACUST UNITED AC 2009; 39:94-5. [PMID: 17366024 DOI: 10.1080/00365540600868347] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Abstract
Cardiovascular dysfunction in patients with hemolytic-uremic syndrome (HUS) may be related to secondary issues such as volume overload, hypertension or electrolyte disturbances including hyperkalemia. Additionally, primary myocardial involvement has been increasingly recognized as a potential comorbid feature of HUS. We report a 9-month-old child with HUS who developed clinical signs of poor myocardial function with depressed myocardial function noted by echocardiography. Supportive care including mechanical ventilation and inotropic agents were necessary for approximately 10 days. Follow-up echocardiography revealed return of normal ventricular function. Previous reports of primary cardiac involvement with HUS have included thrombotic microangiopathy of the coronary vasculature resulting in myocardial ischemia, myocardial infarction or depressed myocardial function, myocarditis, congestive heart failure with dilated cardiomyopathy and pericardial effusion with tamponade. Given the potential for morbidity and mortality during the preoperative period in patients with HUS, anesthesiologists involved in the care of such patients should be aware of the potential for myocardial involvement in this disease process. Preoperatively, the routine evaluation of myocardial function may be indicated.
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Affiliation(s)
- Joseph D Tobias
- Department of Anesthesiology, University of Missouri, Columbia, MO 65212, USA.
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Vieira JM, Castro I, Curvello-Neto A, Demarzo S, Caruso P, Pastore L, Imanishe MH, Abdulkader RCRM, Deheinzelin D. Effect of acute kidney injury on weaning from mechanical ventilation in critically ill patients*. Crit Care Med 2007; 35:184-91. [PMID: 17080002 DOI: 10.1097/01.ccm.0000249828.81705.65] [Citation(s) in RCA: 133] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
OBJECTIVES Acute kidney injury (AKI) worsens outcome in various scenarios. We sought to investigate whether the occurrence of AKI has any effect on weaning from mechanical ventilation. DESIGN AND SETTING Observational, retrospective study in a 23-bed medical/surgical intensive care unit (ICU) in a cancer hospital from January to December 2003. PATIENTS The inclusion criterion was invasive mechanical ventilation for > or =48 hrs. AKI was defined as at least one measurement of serum creatinine of > or =1.5 mg/dL during the ICU stay. Patients were then separated into AKI and non-AKI patients (control group). The criterion for weaning was the combination of positive end-expiratory pressure of < or =8 cm H2O, pressure support of < or =10 cm H2O, and Fio2 of < or =0.4, with spontaneous breathing. The primary end point was duration of weaning and the secondary end points were rate of weaning failure, total length of mechanical ventilation, length of stay in the ICU, and ICU mortality. RESULTS A total of 140 patients were studied: 93 with AKI and 47 controls. The groups were similar in regard to age, sex, and type of tumor. Diagnosis of acute lung injury/acute respiratory distress syndrome as cause of respiratory failure and Simplified Acute Physiology Score II at admission did not differ between groups. During ICU stay, AKI patients had markers of more severe disease: increased occurrence of severe sepsis or septic shock, higher number of antibiotics, and longer use of vasoactive drugs. The median (interquartile range) duration of mechanical ventilation (10 [6-17] vs. 7 [2-12] days, p = .017) and duration of weaning from mechanical ventilation (41 [16-97] vs. 21 [7-33.5] hrs, p = .018) were longer in AKI patients compared with control patients. Cox regression analysis demonstrated that a > or =85% increase in baseline serum creatinine (hazard rate, 2.30; 95% confidence interval, 1.30-4.08), oliguria (hazard rate, 2.51; 95% confidence interval, 1.24-5.08), and the number of antibiotics (hazard rate, 2.64; 95% confidence interval, 1.51-4.63) predicted longer duration of weaning. The length of ICU stay and ICU mortality rate were significantly greater in the AKI patients. After adjusting for Simplified Acute Physiology Score II, oliguria (odds ratio, 30.8; 95% confidence interval, 7.7-123.0) remained as a strong risk factor for mortality. CONCLUSION This study shows that renal dysfunction has serious consequences in the duration of mechanical ventilation, weaning from mechanical ventilation, and mortality in critically ill cancer patients.
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Affiliation(s)
- José M Vieira
- Oncologic Intensive Care Unit, Hospital do Câncer de São Paulo, São Paulo, Brazil
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Schortgen F, Vinsonneau C. Early isovolemic hemofiltration in oliguric patients with septic shock. Intensive Care Med 2006; 32:1097; author reply 1098. [PMID: 16791681 DOI: 10.1007/s00134-006-0196-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/20/2006] [Indexed: 11/24/2022]
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Abstract
OBJECTIVES Describe the cause of deaths among patients with postdiarrheal hemolytic uremic syndrome (HUS) and identify predictors of death at the time of hospital admission. METHODS Case-control study of 17 deaths among patients with HUS identified from the Intermountain HUS Patient Registry (1970-2003) compared against all nonfatal cases. RESULTS Of the 17 total deaths, 15 died during the acute phase of disease. Two died because treatment was withdrawn based on their preexisting conditions, and 1 died because of iatrogenic cardiac tamponade; they were excluded from analysis. Brain involvement was the most common cause of death (8 of 12); congestive heart failure, pulmonary hemorrhage, and hyperkalemia were infrequent causes. Presence of prodromal lethargy, oligoanuria, or seizures and white blood cell count (WBC) >20 x 10(9)/L or hematocrit >23% on admission were predictive of death. In multivariate analysis, elevated WBC and elevated hematocrit were independent predictors. The combination of prodromal dehydration, oliguria, and lethargy and admission WBC values >20 x 10(9)/L and hematocrit >23% appeared in 7 of the 12 acute-phase deaths. CONCLUSIONS Diarrheal HUS patients presenting with oligoanuria, dehydration, WBC >20 x 10(9)/L, and hematocrit >23% are at substantial risk for fatal hemolytic uremic syndrome. Such individuals should be referred to pediatric tertiary care centers.
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Affiliation(s)
- Robert S Oakes
- Pediatric Nephrology, University of Utah School of Medicine, Salt Lake City, Utah, USA.
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Kobayashi S, Fujimoto S, Fukuda S, Hattori A, Iwaki T, Koyama N, Tanaka T, Kokubo M, Okanishi T, Togari H. Periventricular Leukomalacia with Late-Onset Circulatory Dysfunction of Premature Infants: Correlation with Severity of Magnetic Resonance Imaging Findings and Neurological Outcomes. TOHOKU J EXP MED 2006; 210:333-9. [PMID: 17146199 DOI: 10.1620/tjem.210.333] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
The incidence of late-onset circulatory dysfunction (LCD) of premature infants, which is characterized by sudden hypotension and oliguria, has recently increased in Japan. This condition suddenly occurs after several days of age without obvious causes in preterm infants with stable respiration and circulation. Intravenous steroids frequently improve the hypotension. The main problem with LCD is the subsequent and frequent onset of periventricular leukomalacia (PVL), and neurological development appears to be worse in PVL patients with LCD than those without LCD. The aim of this study was to determine whether the severity of magnetic resonance imaging (MRI) findings and neurological outcomes differ between infants who developed PVL after LCD and those who developed PVL without LCD. We retrospectively studied preterm infants who were delivered at less than 33 weeks of gestation between the years 2000 and 2003. During the study period, 10 and 26 infants developed PVL with and without LCD, respectively. The incidence of severe or moderate MRI findings was significantly higher in PVL patients with LCD (100%) than those without LCD (50%; p < 0.05). The incidence of severe cerebral palsy was 88% in PVL infants with LCD and 43% in PVL infants without LCD (p < 0.05). Moreover, the incidence of visual disorders was significantly higher in PVL infants with LCD (63%) than those without LCD (9%; p < 0.01). In conclusion, neurological outcomes are worse in preterm infants who develop PVL with LCD than those without LCD, which is well correlated to the severity judged by MRI findings.
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Affiliation(s)
- Satoru Kobayashi
- Department of Pediatrics, Neonatology and Congenital Disorders, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan.
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Piccinni P, Dan M, Barbacini S, Carraro R, Lieta E, Marafon S, Zamperetti N, Brendolan A, D'Intini V, Tetta C, Bellomo R, Ronco C. Early isovolaemic haemofiltration in oliguric patients with septic shock. Intensive Care Med 2005; 32:80-6. [PMID: 16328222 DOI: 10.1007/s00134-005-2815-x] [Citation(s) in RCA: 109] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2004] [Accepted: 08/29/2005] [Indexed: 10/25/2022]
Abstract
OBJECTIVE To evaluate the effects of early short-term, isovolaemic haemofiltration at 45 ml/kg/h on physiological and clinical outcomes in patients with septic shock. DESIGN Retrospective study before and after a change of unit protocol (study period 8 years). SETTING Intensive care unit of metropolitan hospital. PATIENTS Eighty patients with septic shock. INTERVENTIONS Introduction of a new septic shock protocol based on early isovolaemic haemofiltration (EIHF). In the pre-EIHF period (before), 40 patients received conventional supportive therapy. In the post-EIHF period (after), 40 patients received EIHF at 45 ml/kg/h of plasma-water exchange over 6 h followed by conventional continuous venovenous haemofiltration (CVVH). Anticoagulation policy remained unchanged. MEASUREMENTS AND MAIN RESULTS The two groups were comparable for age, gender and baseline APACHE II score. Delivered haemofiltration dose was above 85% of prescription in all patients. PaO2/FiO2 ratio increased from 117+/-59 to 240+/-50 in EIHF, while it changed from 125+/-55 to 160+/-50 in the control group (p<0.05). In EIHF patients, mean arterial pressure increased (95+/-10 vs 60+/-12 mmHg; p<0.05), and norepinephrine dose decreased (0.20+/-2 vs 0.02+/-0.2 microg/kg/min; p<0.05). Among EIHF patients, 28 (70%) were successfully weaned from the ventilator compared with 15 (37%) in the control group (p<0.01). Similarly, 28-day survival was 55% compared with 27.5% (p<0.05). Length of stay in the ICU was 9+/-5 days compared with 16+/-4 days (p<0.002). CONCLUSIONS In patients with septic shock, EIHF was associated with improved gas exchange, haemodynamics, greater likelihood of successful weaning and greater 28-day survival compared with conventional therapy.
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Affiliation(s)
- Pasquale Piccinni
- Department of Anesthesiology and Intensive Care Medicine, St. Bortolo Hospital, Viale Rodolfi, 36100 Vicenza, Italy.
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Ympa YP, Sakr Y, Reinhart K, Vincent JL. Has mortality from acute renal failure decreased? A systematic review of the literature. Am J Med 2005; 118:827-32. [PMID: 16084171 DOI: 10.1016/j.amjmed.2005.01.069] [Citation(s) in RCA: 265] [Impact Index Per Article: 13.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2004] [Revised: 12/28/2004] [Accepted: 01/04/2005] [Indexed: 11/24/2022]
Abstract
PURPOSE To determine mortality rates in patients with acute renal failure during the past decades. METHODS We performed a MEDLINE search using the keywords "acute renal failure" crossed with "outcome," "mortality," "ICU," "critically ill" or "prognosis" in the period from January 1970 to December 2004. Abstracts and full articles were eligible if mortality rates were reported. We also reviewed the bibliographies of available studies for further potentially eligible studies. The dates of the observation period for each study and not the publication dates were considered for the analysis, so the earliest data were from 1956. RESULTS Of 85 articles fulfilling the criteria, 5 were excluded because of duplicate publications using the same database, so that 80 were included in our review with a total of 15897 patients. Mortality rates in most studies exceeded 30%, and there was no consistent change over time. CONCLUSION Despite technical progress in the management of acute renal failure over the last 50 years, mortality rates seem to have remained unchanged at around 50%.
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Affiliation(s)
- Yvonne Patricia Ympa
- Department of Intensive Care, Erasme Hospital, Free University of Brussels, Belgium
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17
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Figueras-Aloy J, Gómez-Lopez L, Rodríguéz-Miguélez JM, Jordán-García Y, Salvia-Roiges MD, Jiménez W, Carbonell-Estrany X. Plasma endothelin-1 and clinical manifestations of neonatal sepsis. J Perinat Med 2005; 32:522-6. [PMID: 15576275 DOI: 10.1515/jpm.2004.126] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
AIM To determine whether plasma endothelin-1 (ET-1) relates to clinical manifestations of sepsis in the newborn, especially with systemic hypotension, acidosis, severe hypoxemia (which may represent pulmonary hypertension) and oliguria. METHODS Prospective study of 35 consecutive newborns with clinical sepsis: 22 with hemoculture-positive (HC+) sepsis and 13 hemoculture-negative (HC-). Plasma ET-1 concentrations were measured within 2 days of the diagnosis of sepsis. SNAP-II severity score was performed at the time of highest clinical severity. RESULTS Newborns with HC+ sepsis had higher plasma ET-1 concentrations and SNAP-II scores (especially PO 2 /FiO 2 ratio) than HC- septic children. Plasma ET-1 concentrations increased linearly with each item of the SNAP-II score, but only reached significant differences in lowest mean blood pressure (P=0.030), lowest pH (P=0.048), multiple seizures (P=0.010) and lowest urine output (P=0.013). Leukocyte count, immature/total neutrophil ratio and C-reactive protein value were not different. Each item of the SNAP-II score was independently related only to ET-1 level. Oliguria, acidosis and systemic hypotension were more correlated (R 2 >0.5). CONCLUSIONS Plasma ET-1 levels in neonatal sepsis are related to the severity of clinical manifestations, especially oliguria, acidosis and systemic hypotension.
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Affiliation(s)
- José Figueras-Aloy
- Neonatal Service, Institut Clínic de Ginecologia, Obstetrícia i Neonatologia, Unitat Integrada de Pediatria, Hospital Clinic, 08028 Barcelona, Spain.
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18
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Jeffries CC, Ledgerwood AM, Lucas CE. Life-threatening tertiary hyperparathyroidism in the critically ill. Am J Surg 2005; 189:369-72. [PMID: 15792772 DOI: 10.1016/j.amjsurg.2004.11.025] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2004] [Revised: 11/22/2004] [Accepted: 11/22/2004] [Indexed: 11/22/2022]
Abstract
BACKGROUND Tertiary hyperparathyroidism typically occurs in patients who have recovered from renal failure after renal transplantation. This report describes a syndrome of tertiary hyperparathyroidism after recovery from multiple organ failure (MOF) with acute oliguric renal failure (AORF). METHODS Six patients with MOF including AORF are presented. Increased parathyroid hormone (PTH) levels were documented as early as 3 weeks after injury or septic insult and remained increased in some patients for several weeks. RESULTS The resultant increase in calcium levels led to recurrent bouts of bradycardia, often leading to asystole requiring cardiopulmonary resuscitation. Hypercalcemic-induced bradycardia was refractory to hydration, loop diuresis, atropine, and external pacing. Definitive treatment requires bisphosphonate therapy, which must be repeated until organ function has returned to normal. CONCLUSIONS A new syndrome of life-threatening tertiary hyperparathyroidism is described in patients with critical illness. This syndrome probably is being overlooked frequently in critical care units. Early diagnosis and prophylactic treatment with bisphosphonate may preclude the life-threatening cardiac arrhythmias.
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Affiliation(s)
- Christopher C Jeffries
- Department of Surgery, Wayne State University, 4201 St. Antoine, Suite 2V, Detroit, MI 48201, USA
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19
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Naka T, Jones D, Baldwin I, Fealy N, Bates S, Goehl H, Morgera S, Neumayer HH, Bellomo R. Myoglobin clearance by super high-flux hemofiltration in a case of severe rhabdomyolysis: a case report. Crit Care 2005; 9:R90-5. [PMID: 15774055 PMCID: PMC1175920 DOI: 10.1186/cc3034] [Citation(s) in RCA: 86] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/04/2004] [Revised: 11/25/2004] [Accepted: 12/01/2004] [Indexed: 11/28/2022]
Abstract
Objective To test the ability of a novel super high-flux (SHF) membrane with a larger pore size to clear myoglobin from serum. Setting The intensive care unit of a university teaching hospital. Subject A patient with serotonin syndrome complicated by severe rhabodomyolysis and oliguric acute renal failure Method Initially continuous veno-venous hemofiltration was performed at 2 l/hour ultrafiltration (UF) with a standard polysulphone 1.4 m2 membrane (cutoff point, 20 kDa), followed by continuous veno-venous hemofiltration with a SHF membrane (cutoff point, 100 kDa) at 2 l/hour UF, then at 3 l/hour UF and then at 4 l/hour UF, in an attempt to clear myoglobin. Results The myoglobin concentration in the ultrafiltrate at 2 l/hour exchange was at least five times greater with the SHF membrane than with the conventional membrane (>100,000 μg/l versus 23,003 μg/l). The sieving coefficients with the SHF membrane at 3 l/hour UF and 4 l/hour UF were 72.2% and 68.8%, respectively. The amount of myoglobin removed with the conventional membrane was 1.1 g/day compared with 4.4–5.1 g/day for the SHF membrane. The SHF membrane achieved a clearance of up to 56.4 l/day, and achieved a reduction in serum myoglobin concentration from >100,000 μg/l to 16,542 μg/l in 48 hours. Conclusions SHF hemofiltration achieved a much greater clearance of myoglobin than conventional hemofiltration, and it may provide a potential modality for the treatment of myoglobinuric acute renal failure.
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Affiliation(s)
- Toshio Naka
- Research Fellow, Department of Intensive Care and Department of Medicine, Melbourne University, Austin Hospital, Melbourne, Australia
| | - Daryl Jones
- Registrar, Department of Intensive Care and Department of Medicine, Melbourne University, Austin Hospital, Melbourne, Australia
| | - Ian Baldwin
- Nurse Educator, Department of Intensive Care and Department of Medicine, Melbourne University, Austin Hospital, Melbourne, Australia and PhD Candidate, Latrobe University, Bundoora, Melbourne, Australia
| | - Nigel Fealy
- Nurse Educator, Department of Intensive Care and Department of Medicine, Melbourne University, Austin Hospital, Melbourne, Australia
| | - Samantha Bates
- Research Nurse, Department of Intensive Care and Department of Medicine, Melbourne University, Austin Hospital, Melbourne, Australia
| | - Hermann Goehl
- Chief Engineer, Gambro Dialysatoren GmbH & Co., KG, Hechingen, Germany
| | - Stanislao Morgera
- Staff Specialist, Department of Nephrology, Charitè, Humboldt, University of Berlin, Germany
| | - Hans H Neumayer
- Director, Department of Nephrology, Charitè, Humboldt, University of Berlin, Germany
| | - Rinaldo Bellomo
- Director of Research, Department of Intensive Care and Department of Medicine, Melbourne University, Austin Hospital, Melbourne, Australia
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20
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Dobiliene D, Pundziene B. [Etiology and outcomes of acute renal failure in childhood]. Medicina (Kaunas) 2005; 41 Suppl 1:21-5. [PMID: 15901971] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/02/2023]
Abstract
The aim of the research was to determine causes of acute renal failure in children, their outcome and to define risk factors associated with mortality. 75 children with acute renal failure, who were treated at the Clinic of Children's Diseases of Kaunas University of Medicine between 1998-2003 years, were included in the study. The age range of patients was 1 month to 16 years. They were divided into two groups. Acute renal failure was diagnosed in 42 (56%) patients (the first study group) and in 33 (44%) patients acute renal failure was together with multiple organ failure (the second study group). In the first study group 69% of cases of acute renal failure were found to be due to renal diseases and in the second study group 97% were because of extrarenal diseases. Sepsis was the most frequent cause of acute renal failure in the second group (p<0.02). Dialysis was made for 28% patients. Hypertension was diagnosed more often in the first patients group (p<0.05). Hypertension persisted in 9 (36%) patients after recovery. Chronic renal failure developed in two patients. 28 (37.3%) patients of the original study group died. Mortality rate for children with multiple organ failure was higher than for the children, who had renal insufficiency only (78.8% vs 4.8%; p<0.001). Mortality rate of infants in the first study group was higher than for children of the same age in the second group (p<0.001). Mortality rate for children, who had oliguria or anuria, was higher in the second group, too (p<0.001).
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Affiliation(s)
- Diana Dobiliene
- Clinic of Children's Diseases, Kaunas University of Medicine, Eiveniu 2, 50009 Kaunas, Lithuania
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21
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Vukusich A, Alvear F, Villanueva P, González C, Francisco O, Alvarado N, Zehnder C. [Epidemiology of severe acute renal failure in Metropolitan Santiago]. Rev Med Chil 2004; 132:1355-61. [PMID: 15693197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/01/2023]
Abstract
BACKGROUND There is a paucity of information about the epidemiology of acute renal failure in Chile. AIM To perform a prospective multicentric survey of severe acute renal failure in Chile. MATERIAL AND METHODS All patients admitted to ten hospitals in Metropolitan Santiago, during a period of six months with severe acute renal failure, were studied. The criteria for severity was the requirement of renal replacement therapy. All patients information was gathered in special forms and the type of renal replacement therapy and evolution was registeres. RESULTS One hundred fourteen patients were studied (65 males, age range 18 to 87 years). The calculated incidence of acute renal failure was 1.03 cases per 1000 hospital discharges. The onset was nosocomial in 79 subjects (69%) and community acquired in the rest. Renal failure was oliguric in 64 cases (56%) and in 60% of patients it had two or more causative factors. Sepsis, isolated or combined with other causes, was present in 51 of patients. Other causes included ischemia in 47%, surgery in 26%, exogenous toxicity in 25%, endocenous toxicity in 11%, acute glomerular damage in 6% and obstructive uropathy in 6%. Cardiac surgery was responsible for 47% of post operative cases of acute renal failure. Intermittent conventional hemodialysis, continuous renal replacement techniques and daily prolonged hemodialysis were used in 66%, 29% and 2% of patients, respectively. Overall mortality was 45% and it was higher in oliguric patients. Gender, age, cause or the type of therapy did not influence survival. Nine percent of surviving patients had some degree of kidney dysfunction at discharge. CONCLUSIONS There is still a great space for prevention of severe acute renal failure in Chile, considering the main etiologies found in this study.
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Affiliation(s)
- Antonio Vukusich
- Comité de Insuficiencia Renal Aguda de la Sociedad Chilena de Nefrología.
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Bridges EJ, Womble S, Wallace M, McCartney J. Hemodynamic monitoring in high-risk obstetrics patients, II. Pregnancy-induced hypertension and preeclampsia. Crit Care Nurse 2003; 23:52-7. [PMID: 14606127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/27/2023]
Affiliation(s)
- Elizabeth J Bridges
- 59th Clinical Research Squadron, 59th Medical Wing, Lackland AFB, San Antonio, Tex., USA
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Coleman M, Horn R, Goral S. An uncommon disease in a patient with a solitary kidney. Am J Kidney Dis 2001; 38:896-900. [PMID: 11576899 DOI: 10.1053/ajkd.2001.27724] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- M Coleman
- Vanderbilt University Medical Center, Nashville, TN 37232-2372, USA
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Kato A, Yonemura K, Matsushima H, Ikegaya N, Hishida A. Complication of oliguric acute renal failure in patients treated with low-molecular weight dextran. Ren Fail 2001; 23:679-84. [PMID: 11725914 DOI: 10.1081/jdi-100107364] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Acute renal failure (ARF) is a well-documented but infrequent complication in patients treated with low-molecular weight dextran (LMWD). We herein report 3 cases of oliguric ARF following the administration of dextran-40. One case developed ARF totally after 1.200 g of LMWD administration. In contrast, two cases having increased serum creatinine developed oliguria despite the acceptable therapeutic doses (totally 450 and 650 g). Contrast media was also co-administered in these patients. Plasma exchange (PE), double filtration plasmapheresis (DFPP), or continuous hemodiafiltration (CHDF) but not hemodialysis (HD) reduced circulating dextran concentrations by 35-44% during a single session. All patients completely recovered from ARF by 14-32 days after the treatment. Our cases suggested that radiocontrast could predispose to the development of LMWD-induced ARF especially in patients having pre-existing renal dysfunction. In addition, PE, DFPP and CHDF afforded a beneficial effect for removing accumulated LMWD from the circulation.
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Affiliation(s)
- A Kato
- First Department of Medicine, Hamamatsu University School of Medicine, Shizuoka, Japan.
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25
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Affiliation(s)
- R L Mehta
- Department of Medicine, Division of Nephrology, University of California, San Diego, Calif., 92103, USA.
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Abstract
Two cases of pyocystis in patients in end-stage renal disease are reported. Pyocystis is a recognized complication of urinary diversion procedures, but also occurs in anuric or oliguric hemodialysis patients. The treatment differs from ordinary cystitis, requiring catheterization, bladder irrigation, and intravesical antibiotic instillation. When undiagnosed, pyocystis may progress to sepsis and death.
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Affiliation(s)
- E E Remer
- The Cleveland Clinic Foundation, Cleveland, OH 44195, USA
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Kohli HS, Bhaskaran MC, Muthukumar T, Thennarasu K, Sud K, Jha V, Gupta KL, Sakhuja V. Treatment-related acute renal failure in the elderly: a hospital-based prospective study. Nephrol Dial Transplant 2000; 15:212-7. [PMID: 10648667 DOI: 10.1093/ndt/15.2.212] [Citation(s) in RCA: 97] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Elderly individuals need a host of diagnostic procedures and therapeutic interventions to take care of ailments. This prospective study was carried out to determine the magnitude of treatment-related acute renal failure (ARF) in the elderly in a hospital setting, to know about pathogenetic factors and to study the factors that could predict an adverse outcome. METHODS All elderly patients (>60 years) admitted over a 12-month period were screened prospectively throughout their hospital stay for the development of ARF. RESULTS Of 31860 patients admitted, 4176 (13%) were elderly. Of these 59 (1.4%) developed ARF in the hospital. Nephrotoxic drugs contributed towards development of ARF in 39 (66%), sepsis and hypoperfusion in 27 (45.7%) each, contrast medium in 10 (16.9%) and postoperative ARF occurred in 15 (25.4%) patients. These pathogenetic factors were responsible for ARF in different combinations. Amongst these combination of pathogenetic factors, radiocontrast administration (partial chi(2) 28.1, P<0.0001), surgery (partial chi(2) 14.89, P=0.001), and drugs (partial chi(2) 6. 22, P=0.0126) predicted ARF on their own. Nine patients (15.23%) needed dialytic support. Of 59 patients, 15 (25.4%) died, of those who survived, 38 (86.3%) recovered renal function completely and six (13.6%) partially. Mortality in the elderly with ARF was significantly higher than in those without ARF (25.4 vs 12.5%; chi(2) 8.3, P=0.03). Sepsis (odds ratio 43), oliguria (odds ratio 64), and hypotension (odds ratio 15) were independent predictors of poor patient outcome on logistic regression analysis. CONCLUSION Incidence of treatment-related ARF in the elderly was 1.4%, with more than one pathogenetic factor playing a role in the development of ARF in the majority. Sepsis, hypotension, and oliguria were the independent predictors of poor patient outcome.
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Affiliation(s)
- H S Kohli
- Departments of Nephrology, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
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Affiliation(s)
- P E Marik
- Department of Medicine, Washington Hospital Center, DC 20010-2975, USA
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Bolte AC, van Eyck J, Kanhai HH, Bruinse HW, van Geijn HP, Dekker GA. Ketanserin versus dihydralazine in the management of severe early-onset preeclampsia: maternal outcome. Am J Obstet Gynecol 1999; 180:371-7. [PMID: 9988803 DOI: 10.1016/s0002-9378(99)70216-4] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
OBJECTIVE An open, randomized, prospective, multicenter trial was conducted to compare the efficacy and safety of intravenous ketanserin, a selective serotonin 2 receptor blocker, with that of intravenous dihydralazine in the management of severe early-onset (<32 weeks' gestation) preeclampsia. End points of this study were blood pressure control and maternal outcome. STUDY DESIGN Patients with a diastolic blood pressure >110 mm Hg were randomly assigned to receive either ketanserin (n = 22) or dihydralazine (n = 22) as initial therapy. Plasma volume expansion preceded antihypertensive treatment, which was administered according to a fixed schedule. RESULTS The reductions in blood pressure with the 2 drugs were similar; however, adequate blood pressure control was reached significantly earlier with ketanserin (84 +/_ 63 vs 171 +/- 142 minutes, P = .017). Occurrence of maternal complications was significantly lower among patients who received ketanserin than among patients who received dihydralazine (n = 6 vs n = 18, P =.0007). A significant difference in favor of ketanserin was noted in daily fluid balance. CONCLUSION Antihypertensive efficacies of ketanserin and dihydralazine were comparable, but significantly fewer maternal complications were noted among the patients receiving ketanserin. Ketanserin is an attractive alternative in the management of severe early-onset preeclampsia.
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Affiliation(s)
- A C Bolte
- Divisions of Maternal-Fetal Medicine, Departments of Obstetrics and Gynecology, Free University Hospital, Amsterdam, The Netherlands
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Affiliation(s)
- M Villa
- Divisione di Nefrologia e Dialisi, Ospedale Maggiore, IRCCS, Milano, Italy
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van Bommel EF, Hesse CJ, Jutte NH, Zietse R, Bruining HA, Weimar W. Impact of continuous hemofiltration on cytokines and cytokine inhibitors in oliguric patients suffering from systemic inflammatory response syndrome. Ren Fail 1997; 19:443-54. [PMID: 9154661 DOI: 10.3109/08860229709047730] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
The impact of continuous hemofiltration (CHF) using a polyacrylonitrile membrane on the kinetics of tumor necrosis factor alpha (TNF alpha), interleukin-1 beta (IL-1 beta), and their inhibitors (soluble TNF receptors [sTNFrI, sTNFrII], interleukin-1 receptor antagonist [IL-1Ra]) was assessed in nine oliguric patients suffering from systemic inflammatory response syndrome. Blood and plasma flow (Qb, Qp), sieving coefficient (SC), plasma and ultrafiltrate clearances (Kp, Kuf), and plasma extraction rates (ERp) were calculated at different time points using standard formulas. No significant improvement of hemodynamics or gas exchange was noted following HF but a significant increase in serum bicarbonate occurred after 24 h (P < 0.05). TNF alpha was detected in plasma from all patients (153 +/- 2.3 pg/mL [mean +/- SEM]). None of the patients had detectable IL-1 beta levels. High levels of the TNF receptors (sTNFrI 20.338 +/- 2.431 pg/mL; sTNFrII 17.839 +/- 2.630 pg/mL) and IL-1Ra (19.775 +/- 3.943 pg/mL) were found in all patients. Upon initiation of hemofiltration (HF), the mean individual sTNFrI/TNF alpha ratio amounted to 269 +/- 84.6 and the sTNFrII/TNF alpha ratio to 249 +/- 91.8. Mean ultrafiltrate volume (Vuf) was 11.8 +/- 0.4 L/day. Appreciable sieving of IL-1Ra (SC 0.45 +/- 0.10), but not of the other cytokines, was noted (SC TNF alpha, sTNFrI, sTNFrII < 0.09). Despite minimal Kuf of TNF alpha, sTNFrI, and STNFrII (Kuf < 0.8 mL/min), appreciable Kp was noted, suggesting that membrane adsorption occurs (Kp approximately 8 mL/min). There was a nonsignificant increase of the ratios between both TNF receptors and TNF alpha across the filter (sTNFrI/TNF alpha ratio [pre] 231 +/- 37.9 versus [post] 312 +/- 75.3); sTNFrII/TNF alpha ratio [pre] 211 +/- 42.1 versus [post] 291 +/- 79.3). Appreciable Kp of IL-1Ra was noted (Kp 17.3 +/- 1.61 mL/min), which was only in part due to Kuf (4.0 +/- 0.86 mL/min). There was a significant decrease of IL-1Ra levels across the membrane, both overall ([pre] 20.223 +/- 2.282 versus [post] 16.637 +/- 2.039 pg/mL; P < 0.01) and at different time points (P < 0.01). Only for IL-1Ra was significant extraction from plasma noted (ERp 26 +/- 6.0%). Plasma levels of TNF alpha, sTNFrI, sTNFrII, and IL-1Ra were not altered by 24 h of CHF. In conclusion, both cytokines and cytokine inhibitors can be removed from the circulation, either by convective transport or by membrane adsorption. Using low-volume HF (Vuf approximately 12 L/day), no impact on cytokine plasma levels nor the patients hemodynamics or gas exchange was noted. The appreciable SC of IL-1Ra (0.45), however, suggests that HF with high(er) UF volumes (> 50 L/day) may be able to achieve reductions in plasma levels of some peptide (anti)mediators. However, whether this aspecific elimination of both mediators and antimediators may alter the clinical course in critically ill patients remains to be investigated.
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MESH Headings
- Acrylic Resins
- Acute Kidney Injury/blood
- Acute Kidney Injury/complications
- Acute Kidney Injury/therapy
- Antigens, CD/analysis
- Antigens, CD/blood
- Cytokines/analysis
- Cytokines/blood
- Female
- Hemodialysis Solutions/chemistry
- Hemofiltration/instrumentation
- Humans
- Interleukin 1 Receptor Antagonist Protein
- Interleukin-1/analysis
- Interleukin-1/blood
- Male
- Membranes, Artificial
- Middle Aged
- Oliguria/blood
- Oliguria/complications
- Oliguria/therapy
- Prospective Studies
- Receptors, Interleukin-1/antagonists & inhibitors
- Receptors, Tumor Necrosis Factor/analysis
- Receptors, Tumor Necrosis Factor/blood
- Receptors, Tumor Necrosis Factor, Type I
- Receptors, Tumor Necrosis Factor, Type II
- Sialoglycoproteins/analysis
- Sialoglycoproteins/blood
- Systemic Inflammatory Response Syndrome/blood
- Systemic Inflammatory Response Syndrome/complications
- Systemic Inflammatory Response Syndrome/therapy
- Tumor Necrosis Factor-alpha/analysis
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Affiliation(s)
- E F van Bommel
- Department of Internal Medicine I, University Hospital Rotterdam Dijkzig, The Netherlands
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Abstract
Acute renal failure (ARF) is a frequent complication in hospitalized patients and is strongly related to increase in mortality. In order to analyze the clinical outcome and the prognostic factors in hospital-acquired ARF, a prospective study was performed. Data from 200 patients with established ARF during the period of January 1987 through July 1990 were collected. The incidence of ARF was 4.9/1000 admissions. Renal ischemia (50%) and nephrotoxic drugs (21%) were the main etiologic factors. The histologic study done in 43 patients showed: acute tubular necrosis (53%), tubular hydropic degeneration (16%), glomerulopathies (16%), and other lesions (15%). Dialysis therapy was performed in 101 patients. The mortality rate was 46.5% and the most important causes of death were: sepsis (38%), respiratory failure (19%), and multiple organ failure (11%). Higher mortality was observed in oliguric patients (62.9%) than nonoliguric (34.5%) (p < 0.05) and in ischemic renal failure (56.7%) when compared to nephrotoxic renal failure (14.7%) (p < 0.05). As primary cause of death was not associated to the acute renal failure, we conclude that acute renal failure is an important marker of the gravity of the underlying disease and not the cause of death.
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Affiliation(s)
- P Barretti
- Department of Internal Medicine, Botucatu Medical School-UNESP, Brazil
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33
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Cantarovich F, Verho MT. A simple prognostic index for patients with acute renal failure requiring dialysis. French Multicentric Prospective Study on Furosemide in Acute Renal Failure Requiring Dialysis. Ren Fail 1996; 18:585-92. [PMID: 8875683 DOI: 10.3109/08860229609047681] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
The probability of death in patients with acute renal failure (ARF) remains high. A valid prognostic index available on patient admission and during follow-up could be helpful for decision making. In this study, 94 ARF patients requiring dialysis (not responding to a previous single dose of furosemide 15 mg/kg) were included. On admission, patients were classified according to a Simplified Acute Physiology Score (SAPS) of < or = 15 or > 15. The prognostic value of 11 risk factors was analyzed. Only 6 in 11 risk factors were significant by univariate analysis: age (> 55 years) (0.02), mechanical ventilation (0.008), oliguria (< 500 mL/day during the first 5 days) (0.02), sepsis (0.001), shock (0.007), and serum bilirubin (> 30 mumol) (0.001). Only oliguria and sepsis were significant risk factors by multivariate analysis. Overall mortality rate was 41%. Mortality rate was higher in patients with SAPS > 15 (65%) than in those with SAPS < or = 15 (22%) (0.001). Patients with > 3 risk factors showed a significantly higher mortality rate than patients with < 3 risk factors (all patients disregarding SAPS) (0.001). Considering the worst combination of risk factors by univariate analysis, mortality prediction was 56% if oliguria, sepsis, and high serum bilirubin were present, and reached 80% if an older age was added (four risk factors). Ventilation increased probability of death to 92% (five risk factors). If all six risk factors were present, the probability rose to 96%. The corresponding observed mortality rate was 32% for three risk factors, 70% for four, 81% for five and 100% for six risk factors. The results suggest that probability of death in ARF requiring dialysis can be correctly estimated when more than three significant risk factors are present. If confirmed, they could avoid using a more complex severity scoring system in patients with ARF requiring dialysis.
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Affiliation(s)
- F Cantarovich
- S. Transplatation et Réanimation, Hôpital Necker, Paris, France
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34
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Capulong MC, Kimura K, Sakaguchi N, Kawahara H, Matsubara K, Iikura Y. Hypoalbuminemia, oliguria and peripheral cyanosis in an infant with severe atopic dermatitis. Pediatr Allergy Immunol 1996; 7:100-2. [PMID: 8902861 DOI: 10.1111/j.1399-3038.1996.tb00114.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
A six-month old male infant with severe atopic dermatitis was admitted with hypoalbuminemia, oliguria and cyanosis of the extremities. There was marked edema and generalized eczema with foul, yellowish exudates. The patient's major clinical manifestations were attributed to the loss of albumin through the skin. Although atopic dermatitis is a common disease in children, here we want to show that systemic disturbances may arise from such condition, describe the total care given the patient, and emphasize the wholistic approach in managing cases of severe atopic dermatitis. Intensive treatment was instituted and the patient was discharged after three weeks and remained in a stable condition.
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Affiliation(s)
- M C Capulong
- Department of Allergy and Immunology, National Children's Hospital, Tokyo, Japan
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35
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Le HT, Bosse GM, Tsai Y. Ibuprofen overdose complicated by renal failure, adult respiratory distress syndrome, and metabolic acidosis. J Toxicol Clin Toxicol 1994; 32:315-20. [PMID: 8007040 DOI: 10.3109/15563659409017966] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Acute ingestion of ibuprofen commonly results in no symptoms, or minor gastrointestinal or central nervous system manifestations. While most cases of ibuprofen overdose do well, serious toxicity may occur, and is difficult to predict. A case of ibuprofen overdose is presented in which the course was complicated by metabolic acidosis, adult respiratory distress syndrome, and renal failure necessitating prolonged dialysis.
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Affiliation(s)
- H T Le
- University of Louisville School of Medicine, Department of Emergency Medicine, KY 40292
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36
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Abstract
Anemia is very frequent in patients with acute failure but the nature of the relationship between the two conditions has remained unclear. We studied all patients with well-documented acute renal failure seen in consultation by our nephrology division during 1991. Fifty-three of the 56 patients had at least mild anemia (hematocrit < 35%) at some point during their hospital stay. Forty-three of the patients had a hematocrit below 30% and 14 had a hematocrit below this level on admission. Twenty-four of the patients underwent major operations and all of these patients required blood transfusions. In this group there was a significant correlation between maximum serum urea and lowest hemoglobin (r = 0.4, p < .05) but no similar correlation between maximum creatinine and lowest hemoglobin. Oliguric patients had a mean lowest hemoglobin of 7.3 +/- 0.4 g/dL, which was significantly lower than the value for nonoliguric patients, 9.0 +/- 0.4 g/dL. This study confirms the presence of anemia in 91% of patients with acute renal failure and shows it to be related to rise in urea and presence of oliguria. Clearly, however, the anemia is multifactorial, since in one-quarter of the patients it precedes onset of renal failure.
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Affiliation(s)
- M Hales
- Department of Laboratory Medicine and Pathology, Faculty of Medicine, University of Alberta, Edmonton, Canada
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37
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Abstract
OBJECTIVE To quantify glucose balance related to continuous arteriovenous hemofiltration (CAVH) when a glucose-rich replacement fluid is used for the plasma ultrafiltrate removed. DESIGN Prospective, nonintervention study. SETTING Medical/surgical and cardiac surgical intensive care units of a university hospital. PATIENTS Critically ill patients (n = 20) with acute oliguric renal failure undergoing CAVH. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS Timed collections of CAVH effluent were analyzed and other observations were made. Serum creatinine and blood urea nitrogen concentrations decreased substantially during CAVH in each patient. The mean measured glucose concentration of the replacement fluid (Dianeal 1.5%) was 1.40 +/- 0.11 (SD) g/dL (77 +/- 6 mmol/L) and rate of infusion was 1.39 +/- 0.43 L/hr. Effluent volume was 1.51 +/- 0.49 L/hr and glucose was 0.47 +/- 0.10 g/dL (26 +/- 5 mmol/L). The glucose content of the replacement fluid infused was consistently and substantially greater than that value of the effluent removed during the same period. Thus, the average net glucose uptake in relation to the CAVH circuit was 11.9 +/- 3.1 g/hr (range 4.3 to 17.6). Serum glucose concentrations increased in each patient with initiation of CAVH (from 135 +/- 44 to 278 +/- 80 mg/dL [7.4 +/- 2.4 to 15.3 +/- 4.4 mmol/L]; p < .001). Negative fluid balance achieved during CAVH was approximately 100 mL/hr. CONCLUSIONS CAVH using predilution with replacement fluid is effective in managing uremia and fluid overload in critically ill patients. The use of a glucose-rich replacement fluid is accompanied by the net uptake of large amounts of glucose, approaching 300 g/day on average in our patients and representing a major exogenous calorie source. This finding has important implications for the metabolic management of critically ill patients during CAVH and should be taken into account in prescribing their nutritional support.
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Affiliation(s)
- R Monaghan
- Division of General Surgery, University of Ottawa, ON, Canada
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38
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Kramer HJ, Mohaupt MG, Pinoli F, Bäcker A, Meyer-Lehnert H, Schlebusch H. Effects of thromboxane A2 receptor blockade on oliguric ischemic acute renal failure in conscious rats. J Am Soc Nephrol 1993; 4:50-7. [PMID: 8400069 DOI: 10.1681/asn.v4150] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
To investigate the potential pathogenetic and therapeutic roles of thromboxane A2 (TXA2) and its receptor blockade, respectively, in the early phase of ischemic acute renal failure (ARF), renal function, TXB2 excretion, and the effects of the specific TXA2 receptor antagonist sulotroban (SU) in a model of unilateral renal artery occlusion in conscious female Sprague-Dawley rats were studied. Occlusion of the left renal artery for 1 h in untreated (i.e., vehicle-treated) rats (N = 8) resulted in oliguric ARF. In SU-treated rats (N = 8), the drug was given as an i.v. bolus of 5 mg/kg body wt, followed by a continuous infusion of 0.5 mg/min.kg body wt from 1 h before and during ischemia and for 6 h after reflow. After 1 h of ischemia, urine volume of left ischemic kidneys from untreated rats had decreased from 13.2 +/- 2.8 to 1.0 +/- 0.3 and 0.5 +/- 0.2 microL/min.100 g at 2 and 6 h of reflow, respectively, and GFR had decreased from 0.32 +/- 0.04 mL/min.100 g body wt to undetectable values. At 6 h of reflow, medullary Na-K-ATPase was slightly (P < 0.05) reduced in left ischemic kidneys, whereas medullary and papillary enzyme activities were compensatorily increased (P < 0.01) in right intact kidneys. The ADP/O ratio of cortical mitochondria was 41% (P < 0.05) and ATP synthesis was 77% (P < 0.01) lower than in right intact kidneys.(ABSTRACT TRUNCATED AT 250 WORDS)
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Affiliation(s)
- H J Kramer
- Department of Medicine, University of Bonn, Germany
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39
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Montemurro NE, Di Maggio A, Strippoli P, Coviello F, Godino F, Miloro G, Scatizzi A. Combined dialysis and plasma-exchange in acute renal failure. Biomater Artif Cells Immobilization Biotechnol 1993; 21:283-7. [PMID: 8318619 DOI: 10.3109/10731199309117364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Combined use of plasma-exchange and dialysis therapy in 3 different cases of acute renal failure is presented. The first is a case of acute renal failure due to rhabdomyolysis caused by hemlock poisoning. Plasma-exchange was effective in improving the signs of rhabdomyolysis and renal failure. The second is a case of acute renal failure in an IgG-kappa myeloma. After 9 sessions of plasma-exchange, performed simultaneously with CAPD, a significant fall in the plasma and urine light chains levels was obtained. After the recovery of normal renal function, CAPD was prosecuted to remove light chains. The last is a case of acute renal failure in a patient with a mesangiocapillary nephritis and a high level of circulating immune complexes (CIC). He underwent steroid therapy and daily sessions of hemodialysis, followed by plasma-exchange, which permitted a fall of the CIC level, until a normal renal function was achieved. In conclusion, plasma-exchange combined with dialysis, is an useful tool for the management of acute renal failure caused by toxic proteins.
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Affiliation(s)
- N E Montemurro
- Division of Nephrology, Regional Hospital, Taranto, Italy
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40
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Crowe G, Spedding R, McCance DR, Rankin SJ, Atkinson AB. Severe hypercalcaemia four months after acute oliguric renal failure--successful treatment with intravenous clodronate. Ir J Med Sci 1992; 161:414-6. [PMID: 1386845 DOI: 10.1007/bf02996206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
A 33 year old man developed acute oliguric failure lasting 66 days, eight days after admission with multiple gun shot wounds. On day 99 after admission, serum calcium was elevated mildly at 2.54 mmol/l (normal range 2.1-2.5 mmol/l). Serum parathormone was undetectable. He was discharged soon afterwards. He presented again on day 164 with nausea, vomiting and blurred vision. Fundoscopy revealed an ischaemic retinopathy and extensive keratopathy. Serum calcium was 3.48 mmol/l and serum creatinine 262 umol/l (normal range 40-110 umol/l). Repeat parathormone was undetectable and there was no evidence of myeloma, sarcoidosis or malignancy. Following treatment with intravenous saline and frusemide, serum calcium fell to a nadir of 3.05 mmol/l. On day 168 an infusion of sodium clodronate 300 mg was given. Twenty-four hours later serum calcium was 2.65 mmol/l and 48 hours later calcium was 2.26 mmol/l. Normocalcaemia was maintained for 17 days and severe hypercalcaemia never recurred. This is the first report in which biphosphonates have been successfully used to treat hypercalcaemia following acute renal failure thus obviating the need for further dialysis.
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Affiliation(s)
- G Crowe
- Sir George E. Clark Metabolic Unit, Royal Victoria Hospital, Belfast, Northern Ireland
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41
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Abstract
A disturbed water and electrolyte homeostasis is not generally held to be a primary mechanism in the pathogenesis of acute mountain sickness (AMS) and high altitude pulmonary edema (HAPE), but the association of oliguria and weight gain with AMS and HAPE has led to the hypothesis that water retention may be a facilitative mechanism, possibly caused by an effect of hypoxia to release antidiuretic hormone (ADH). To examine the problem, normal Long-Evans rats (N) and the strain with congenital diabetes insipidus (DI) were exposed to hypobaric hypoxia (0.5 atm) for 4 days, and fluid balance in the whole animals and in their lungs was studied. Both strains reduced water intake and were oliguric on acute exposure, but the N rats gained body weight and increased lung water, while the DI rats increased neither body weight nor lung water. Neither strain increased lung blood at high altitude. The oliguria in the DI rats could not have been due to a release of antidiuretic hormone, and was attributed to the diminished water intake in both strains. The protection against HAPE in the DI rats was probably due to their more severe dehydration that exists already in normoxia, and its further increase in hypoxia, compared with N rats.
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Affiliation(s)
- S M Tenney
- Department of Physiology, Dartmouth Medical School, Hanover, NH 03756
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42
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Kher V, Pandey R, Sadhwani K, Gupta A, Sharma RK. Nonoliguric acute renal failure in non-Hodgkin's lymphoma. Nephron Clin Pract 1992; 62:114-5. [PMID: 1436278 DOI: 10.1159/000187011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
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43
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Abstract
The records of 110 patients with acute renal failure (ARF) admitted to the Department of Medicine of the Philippine General Hospital during a 5-year period (1983-1988) were reviewed. The objectives were to evaluate the clinical profile of ARF patients and to determine what factors influenced mortality. Infection significantly influenced the causation and prognosis of ARF. Fifteen patients died, for an overall mortality rate of 14%. Forty-six clinical variables were analyzed in order to identify factors correlated with mortality. Four variables significantly increased the risk of death from ARF: older age, hyperkalemia, oliguria, and presence of sepsis on admission. These characteristics define a subset of patients for whom more aggressive treatment of ARF is warranted.
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Affiliation(s)
- C M Dela Cruz
- Department of Medicine, Philippine General Hospital, University of the Philippines, College of Medicine, Manila
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44
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Woolf DC, Jacobs P. Methyldopa, intravascular haemolysis and renal disease. A case report. S Afr Med J 1990; 77:213-4. [PMID: 2300859] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
A 74-year-old man, who was receiving methyldopa to control systemic hypertension, presented to hospital in biventricular cardiac failure. He was found to be severely anaemic and jaundiced as a result of acute intravascular haemolysis with prominent haemoglobinuria. The cardiac failure and anaemia were initially refractory to fluid restriction and diuretics, but responded to red cell transfusion. Renal failure supervened, probably on the basis of hypoperfusion as a consequence of diuresis and hypotension. The patient died suddenly, possibly from myocardial infarction. Acute intravascular destruction of red cells in association with methyldopa appears not to have been previously reported.
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Affiliation(s)
- D C Woolf
- University of Cape Town Leukaemia Centre
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45
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Niaudet P. Oliguria, facial oedema and severe dyspnoea. Pediatr Nephrol 1989; 3:385. [PMID: 2642106 DOI: 10.1007/bf00850211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Affiliation(s)
- P Niaudet
- Hopital Necker-Enfants Malades, Paris, France
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46
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Delemos J, Dryer G, Gerstmann D, Delemos R. Oliguria in the premature baboon with hyaline membrane disease: a manifestation of multisystem immaturity? J Perinatol 1989; 9:19-25. [PMID: 2651593] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
To assess the temporal relationship between fluid balance and cardiopulmonary function in hyaline membrane disease (HMD), serial measurements were made of pulmonary gas exchange (Pa/A O2, PaO2, PaCO2), ventilation indices (FIO2, Ppeak, Pmin, frequency), blood pressure (BP), heart rate (HR), and fluid balance ratio (FBR) in 11 premature (140-day gestation) baboons with HMD treated with positive-pressure ventilation and continuous distending airway pressure (PPV/PEEP) for 11 days. All animals had radiographic and clinical evidence of HMD. Pa/AO2 fell initially, and, in spite of increase in Paw, remained below 0.2 for the first 42 hours. In the same time frame, the animals became progressively oliguric with FBR falling from 0.48 to 0.17 and remaining at that level through hour 43. Tachycardia and hypotension were also present during this period. The onset of the recovery phase at hour 42 was associated with concurrent improvement in Pa/AO2, fall in HR and BP, and the onset of diuresis. These data suggest that, at this development age in the immature baboon, recovery from HMD is associated with improved function of multiple organ systems. The apparent similarities in the "adaptive" timetable support the hypothesis that events associated with delivery and survival of the immature fetus result in accelerated maturation.
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Affiliation(s)
- J Delemos
- Department of Physiology and Medicine, Southwest Foundation for Biomedical Research, San Antonio, Texas 78284
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47
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Affiliation(s)
- J F Hesselvik
- Department of Anesthesiology, University Hospital, Linköping, Sweden
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48
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Abstract
We studied 385 episodes of nosocomial bloodstream infections occurring over 45 months to ascertain if the etiologic organisms were independent predictors of death and morbidity. Independent predictors of death included respiratory failure, oliguria, metabolic acidosis, hypotension, increased age, antibiotic therapy in cases where susceptibility data were unknown, and infection with Pseudomonas aeruginosa. If parameters associated with septic shock were excluded, increased age, severity of disease, and infection with Candida spp. or P. aeruginosa predicted death. Infection with P. aeruginosa, Enterococcus, and Klebsiella pneumoniae predicted hypotension; severity of disease, polymicrobial infection, and infection with Candida spp., Enterococcus, Enterobacter, or Serratia marcescens predicted oliguria; infection with Candida spp. or P. aeruginosa, increased age, severity of disease, and inability to meet hospital financial obligations without assistance predicted respiratory failure. Inability to meet hospital financial obligations without assistance and severity of disease predicted hypothermia; infection with Candida spp. or P. aeruginosa and sex (male) predicted metabolic acidosis.
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49
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Chepkij LP, Lenartovich LS. Urgent hemosorption in leptospirosis. Biomater Artif Cells Artif Organs 1987; 15:249-56. [PMID: 3449141 DOI: 10.3109/10731198709118525] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Resistant oliguria with increasing serum creatine phosphokinase (CPK) level are the most important early signs of the development of acute renal failure in leptospirosis. This symptomocomplex must be considered as indication for urgent hemosorption. Diuresis and normalisation of creatine phosphokinase level are the criteria for accessing the efficiency of hemosorptions.
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50
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Tulassay T, Seri I. Acute oliguria in preterm infants with hyaline membrane disease: interaction of dopamine and furosemide. Acta Paediatr Scand 1986; 75:420-4. [PMID: 3728002 DOI: 10.1111/j.1651-2227.1986.tb10224.x] [Citation(s) in RCA: 25] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Ten premature infants with hyaline membrane disease and with acute oliguria were treated with furosemide or furosemide and dopamine. Furosemide alone did not increase diuresis. Furosemide when combined with dopamine, however, caused significant increases in urine output, sodium excretion, fractional sodium excretion and creatinine clearance. These data suggest that the increase in the sodium excretion was due not only to a reduction in the tubular sodium reabsorption but also to an increase in the glomerular filtration rate. Since in premature neonates the creatinine clearance is not a very precise index of the glomerular filtration rate, the extent of contribution of the increase in the glomerular filtration rate to the enhanced sodium excretion cannot be determined. Despite the increase in the sodium excretion, the serum sodium concentration did not fall significantly. We conclude that the combined treatment with dopamine and furosemide is useful for treating furosemide-resistant, severe functional renal failure in preterm infants with hyaline membrane disease.
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