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Gaddameedi SR, Cherukuri PB, Khan MA, Atreya S, Bandari V, Ashok M, Shah S. Alcoholism and Immobility Induced Rhabdomyolysis Culminating in Hemodialysis. Cureus 2024; 16:e59316. [PMID: 38694661 PMCID: PMC11061816 DOI: 10.7759/cureus.59316] [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] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/29/2024] [Indexed: 05/04/2024] Open
Abstract
Rhabdomyolysis is characterised by muscle breakdown and the release of myoglobin. It is a potentially serious condition that can lead to acute kidney injury (AKI). Factors, such as ischemia, trauma, muscle compression and drug toxicity, can trigger muscle breakdown. Treatment involves aggressive fluid resuscitation to maintain urine output and prevent renal injury. Severe cases with AKI may require temporary renal replacement therapy, such as haemodialysis. It has also been proposed that dialysis can speed up recovery by removing myoglobin that is secreted into the circulation by injured muscles. We present a case of a patient with alcohol abuse and prolonged immobility leading to severe rhabdomyolysis requiring hemodialysis. Our aim is to emphasise the importance of timely identification, and appropriate management of severe rhabdomyolysis not improving on fluids may require HD as soon as possible in order to minimise complications.
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Affiliation(s)
| | | | - Mahrukh A Khan
- Internal Medicine, Rutgers Health/Monmouth Medical Center, Long Branch, USA
| | - Suryansh Atreya
- Internal Medicine, Rutgers Health/Monmouth Medical Center, Long Branch, USA
| | | | - Manjula Ashok
- Nephrology, Rutgers Health/Monmouth Medical center, Long Branch, USA
| | - Shazia Shah
- Internal Medicine, Rutgers Health/Monmouth Medical Center, Long Branch, USA
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Patel SS, Shan HY. Renal-Limited Thrombotic Microangiopathy in a Patient Who Received Gemcitabine, Ramucirumab, and Pembrolizumab: A Case Report and Literature Review. Cureus 2024; 16:e53669. [PMID: 38455838 PMCID: PMC10918209 DOI: 10.7759/cureus.53669] [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] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/05/2024] [Indexed: 03/09/2024] Open
Abstract
Cancer drug-induced thrombotic microangiopathy (DITMA) is an important and serious cause of kidney disease in cancer patients. In addition to classical chemotherapy, the increasing use of targeted therapy and immunotherapy has led to more oncotherapy-associated thrombotic microangiopathy (TMA). It is important for clinicians to recognize this potentially life-threatening adverse effect and gain knowledge of the patient's clinical course and treatment response. In this paper, we report a patient with lung cancer, who was treated with three different classes of anti-neoplastic agents, gemcitabine, ramucirumab, and pembrolizumab. This patient subsequently developed renal-limited thrombotic microangiopathy(rTMA) requiring hemodialysis. The varying features of TMA caused by these therapies were discussed. We also described the clinical course, diagnostic challenges, and management of this patient.
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Affiliation(s)
- Sumit S Patel
- Division of Nephrology and Hypertension, Department of Medicine, Keck School of Medicine, University of Southern California, Los Angeles, USA
| | - Hui Yi Shan
- Division of Nephrology and Hypertension, Department of Medicine, Keck School of Medicine, University of Southern California, Los Angeles, USA
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3
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Zhu B, He J, Ye X, Pei X, Bai Y, Gao F, Guo L, Yong H, Zhao W. Role of Cisplatin in Inducing Acute Kidney Injury and Pyroptosis in Mice via the Exosome miR-122/ELAVL1 Regulatory Axis. Physiol Res 2023; 72:753-765. [PMID: 38215062 PMCID: PMC10805259] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Accepted: 09/20/2023] [Indexed: 01/14/2024] Open
Abstract
Although cisplatin is an effective chemotherapy drug for the treatment of various cancers, its clinical use is limited due to its side effects, especially nephrotoxicity. Unfortunately, acute kidney injury (AKI) caused by cisplatin remains one of the main challenges in effective cancer treatment. Evidence increasingly suggests that renal inflammation and pyroptotic inflammatory cell death of renal tubular epithelial cells (RTECs) mainly determine the progression and outcome of cisplatin-induced AKI. However, it is not clear how cisplatin regulates the pyroptosis of RTECs cells in AKI. The current study aimed to determine the regulation mechanism of AKI induced by cisplatin. We used cisplatin to induce AKI in vivo. We performed H&E staining of mouse kidney tissue sections and evaluated serological indicators of kidney injury (including blood urea nitrogen (BUN), serum creatinine, and tumor necrosis factor-alpha (TNF-alpha)). We used immunohistochemistry and western blot to detect the important substrate protein gasdermin D (GSDMD) and key target caspase-1 of pyroptosis, respectively. Cisplatin induced mouse AKI and RTECs pyroptosis. HK2 cell-derived exosomes treated with cisplatin influenced pyroptosis of the surrounding HK2 cells. Cisplatin-treated HK2 cells exosome-derived miR-122 regulated pyroptosis in the surrounding cells. Exosome-derived miR-122 affected cisplatin-induced AKI and HK2 cells pyroptosis by regulating the expression of embryonic lethal abnormal vision (ELAVL1). These results suggest that exosome miR-122 inhibited pyroptosis and AKI by targeting ELAVL1 under cisplatin treatment, and this offers a potential target for the treatment of AKI.
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Affiliation(s)
- B Zhu
- Department of Geriatric, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
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Onuigbo MA. Renin-Angiotensin-Aldosterone System Blockade (RAASB) After Acute Kidney Injury: The Controversy Thickens on If and When to Discontinue RAASB. Cureus 2023; 15:e49571. [PMID: 38161827 PMCID: PMC10756005 DOI: 10.7759/cureus.49571] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/27/2023] [Indexed: 01/03/2024] Open
Abstract
Unquestionably, there is a common consensus regarding cardiorenal protection with renin-angiotensin-aldosterone system blockade (RAASB) in both diabetic and nondiabetic chronic kidney disease (CKD). Nevertheless, there remain conflicting retrospective reports regarding renal and cardiovascular mortality outcomes following discontinuation of RAASB in advanced CKD. We present an editorial on a recent article discussing renal and mortality outcomes among hospitalized veterans who were started back on RAASB versus those who were not started back on RAASB. The controversy surrounding this topic thickens as the analysis unfolds.
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Affiliation(s)
- Macaulay A Onuigbo
- Medicine, The Robert Larner, M.D. College of Medicine, University of Vermont, Burlington, USA
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Saleh M, Salih N, Kakakhel M, Ullah I, Siraj H, Tariq MN, Ahmad K. A Rare Presentation of Acute Kidney Injury in Diffuse Large B-Cell Lymphoma: A Case Report. Cureus 2023; 15:e45642. [PMID: 37868496 PMCID: PMC10589075 DOI: 10.7759/cureus.45642] [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] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/20/2023] [Indexed: 10/24/2023] Open
Abstract
Acute kidney injury from bilateral renal infiltration is rare in diffuse large B-cell lymphoma (DLBCL). We present the case of a 45-year-old woman with a three-month history of night sweats, weight loss, fever, and fatigue. Clinical evaluation revealed anemia, edema, cervical lymphadenopathy, and elevated blood pressure. Initial lab results indicated severe kidney injury, initially suspected to be chronic kidney disease, later ruled out. Radiological assessments confirmed mediastinal lymphadenopathy. A cervical lymph node biopsy led to a diagnosis of DLBCL. Rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone chemotherapy improved renal function and hematological parameters. Subsequent staging CT confirmed lymphadenopathy. Close monitoring revealed a complete return to normal renal function after one month. Further follow-up was missed. This case emphasizes diagnostic complexities and the value of a multidisciplinary approach in managing complex clinical presentations.
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Affiliation(s)
- Mahnosh Saleh
- Internal Medicine, Ayub Teaching Hospital, Abbottabad, PAK
| | - Noman Salih
- Internal Medicine, Hayatabad Medical Complex Peshawar, Peshawar, PAK
| | - Musa Kakakhel
- Internal Medicine, Hayatabad Medical Complex Peshawar, Peshawar, PAK
| | - Izhar Ullah
- Medicine, Hayatabad Medical Complex Peshawar, Peshawar, PAK
| | - Hamza Siraj
- Internal Medicine, Khyber Teaching Hospital Peshawar, Peshawar, PAK
| | | | - Kamran Ahmad
- Internal Medicine, Hayatabad Medical Complex Peshawar, Peshawar, PAK
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Kowalski KJ, Bhat S, Fedje M, Stahl G, Beyersdorfer N, Goade DS, Johnson K, Arnce R, Hillard R. COVID-19 and Kidney Disease (KD): A Retrospective Investigation in a Rural Southwestern Missouri Region Patient Population. Cureus 2023; 15:e41043. [PMID: 37519535 PMCID: PMC10374171 DOI: 10.7759/cureus.41043] [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] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/27/2023] [Indexed: 08/01/2023] Open
Abstract
BACKGROUND Studies have linked pre-existing kidney disease (KD) to higher rates of mortality due to coronavirus disease 2019 (COVID-19) infection. In the rural Midwest, where KD is prevalent, the impact of COVID-19 has been significant in a population that includes many patients on Medicare or Medicaid. METHODS A retrospective cohort study was performed assessing patients with acute kidney injury (AKI), chronic kidney disease (CKD) and end stage renal disease (ESRD), with and without COVID-19. International Classification of Diseases 10th Revision codes were submitted by physicians into Freeman Health System's Electronic Medical Records and gathered from April 2020 to January 2021. The data were analyzed and compared to determine whether the mortality rate in patients with varying stages of KD and COVID-19 was higher than the mortality rate in patients with KD alone, excluding variables such as sex and age. RESULTS The 95% confidence interval (CI) of the mortality rate of patients with COVID-19 and any degree of KD, encompassing both AKI and CKD, was between 30.21% and 37.63%. This metric was significantly higher than the 95% CI of COVID-19 infection (6.70%-9.96%, p<0.0001) or KD alone (10.89%-13.01%, p<0.0001). Within those with COVID-19 and KD, the highest rate of mortality was in patients with AKI (38.13% and 49.02%). There was not sufficient statistical support in our sample to assert that COVID-19 increased mortality in ESRD patients. CONCLUSIONS Based on our results, patients with KD and COVID-19 are at higher risk for mortality when compared to patients with KD alone. Further studies are warranted into individual comorbidities affecting KD patient outcomes with COVID-19.
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Affiliation(s)
| | - Shilpa Bhat
- College of Medicine, Kansas City University, Joplin, USA
| | - Mariah Fedje
- College of Medicine, Kansas City University, Joplin, USA
| | - Greg Stahl
- Quality Improvement, Freeman Health System, Joplin, USA
| | | | - Darrin S Goade
- Pharmacy, Freeman Health System, Joplin, USA
- Mathematics, Missouri Southern State University, Joplin, USA
| | - Kerry Johnson
- Mathematics, Missouri Southern State University, Joplin, USA
| | - Robert Arnce
- Primary Care, Kansas City University, Joplin, USA
- Emergency Medicine, Freeman Health System, Joplin, USA
| | - Robert Hillard
- Pathology and Anatomical Sciences, Kansas City University, Joplin, USA
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Ma J, Wang X, Gu R, Guo D, Shi C, Kollisch-Singule M, Suo L, Luo J, Meng Q, Cooney RN. PROPHYLACTIC n CMT-3 ATTENUATES SEPSIS-INDUCED ACUTE KIDNEY INJURY IN ASSOCIATION WITH NLRP3 INFLAMMASOME ACTIVATION AND APOPTOSIS. Shock 2023; 59:922-929. [PMID: 36939682 PMCID: PMC10205665 DOI: 10.1097/shk.0000000000002118] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/21/2023]
Abstract
ABSTRACT Background: The kidney is the most common extrapulmonary organ injured in sepsis. The current study examines the ability of aerosolized nanochemically modified tetracycline 3 (nCMT-3), a pleiotropic anti-inflammatory agent, to attenuate acute kidney injury (AKI) caused by intratracheal LPS. Methods: C57BL/6 mice received aerosolized intratracheal nCMT-3 (1 mg/kg) or saline, followed by intratracheal LPS (2.5 mg/kg) to induce acute lung injury-induced AKI. Tissues were harvested at 24 h. The effects of nCMT-3 and LPS on AKI were assessed by plasma/tissue levels of serum urea nitrogen, creatinine, neutrophil gelatinase-associated lipocalin, kidney injury molecule 1, and renal histology. Renal matrix metalloproteinase (MMP) level/activity, cytochrome C, Bax, Bcl-2, caspase-3, p38 mitogen-activated protein kinase activation, NLRP3, and caspase-1 were also measured. Apoptotic cells in kidney were determined by TUNEL assay. Renal levels of IL-1β and IL-6 were measured to assess inflammation. Results: Acute lung injury-induced AKI was characterized by increased plasma blood urea nitrogen, creatinine, injury biomarkers (neutrophil gelatinase-associated lipocalin, kidney injury molecule 1), and histologic evidence of renal injury. Lipopolysaccharide-treated mice demonstrated renal injury with increased levels of inflammatory cytokines (IL-1β, IL-6), active MMP-2 and MMP-9, proapoptotic proteins (cytochrome C, Bax/Bcl-2 ratio, cleaved caspase-3), apoptotic cells, inflammasome activation (NLRP3, caspase-1), and p38 signaling. Intratracheal nCMT-3 significantly attenuated all the measured markers of renal injury, inflammation, and apoptosis. Conclusions: Pretreatment with aerosolized nCMT-3 attenuates LPS-induced AKI by inhibiting renal NLRP3 inflammasome activation, renal inflammation, and apoptosis.
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Affiliation(s)
- Julia Ma
- Department of Surgery, State University of New York (SUNY), Upstate Medical University, Syracuse, New York, USA
| | - Xiaojing Wang
- Department Pharmacology, State University of New York (SUNY), Upstate Medical University, Syracuse, New York, USA
| | - Raymond Gu
- Department of Surgery, State University of New York (SUNY), Upstate Medical University, Syracuse, New York, USA
| | - Dandan Guo
- Department Pharmacology, State University of New York (SUNY), Upstate Medical University, Syracuse, New York, USA
| | - Changying Shi
- Department Pharmacology, State University of New York (SUNY), Upstate Medical University, Syracuse, New York, USA
| | - Michaela Kollisch-Singule
- Department of Surgery, State University of New York (SUNY), Upstate Medical University, Syracuse, New York, USA
- Department Sepsis Interdisciplinary Research Center (SIRC), State University of New York (SUNY), Upstate Medical University, Syracuse, New York, USA
| | - Liye Suo
- Department Pathology, State University of New York (SUNY), Upstate Medical University, Syracuse, New York, USA
| | - Juntao Luo
- Department of Surgery, State University of New York (SUNY), Upstate Medical University, Syracuse, New York, USA
- Department Pharmacology, State University of New York (SUNY), Upstate Medical University, Syracuse, New York, USA
- Department Sepsis Interdisciplinary Research Center (SIRC), State University of New York (SUNY), Upstate Medical University, Syracuse, New York, USA
| | - Qinghe Meng
- Department of Surgery, State University of New York (SUNY), Upstate Medical University, Syracuse, New York, USA
- Department Sepsis Interdisciplinary Research Center (SIRC), State University of New York (SUNY), Upstate Medical University, Syracuse, New York, USA
| | - Robert N Cooney
- Department of Surgery, State University of New York (SUNY), Upstate Medical University, Syracuse, New York, USA
- Department Sepsis Interdisciplinary Research Center (SIRC), State University of New York (SUNY), Upstate Medical University, Syracuse, New York, USA
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Guan X, Li L, Zhang H, Wang X. The preoperative plasma histamine level as a possible protective biomarker for postoperative acute kidney injury. Medicine (Baltimore) 2023; 102:e32637. [PMID: 36607872 PMCID: PMC9829265 DOI: 10.1097/md.0000000000032637] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
Acute kidney injury (AKI) is a life-threatening complication of acute type A aortic dissection (ATAAD) patients. Increasing evidence suggests that histamine ameliorates the pathology of renal injury. However, data on the association between histamine levels and postoperative AKI in ATAAD patients are limited. The purpose of our study was to explore the incidence and independent risk factors of postoperative AKI, with special emphasis on the relationship between preoperative plasma histamine levels and the severity of postoperative ATAAD-AKI. This retrospective single-center study evaluated 160 patients with ATAAD admitted to the Beijing Anzhen Hospital aortic surgery database between April 2020 and December 2021. Univariate and multivariate logistic regression analyses were performed to determine the potential risk factors for postoperative ATAAD-AKI. A subgroup analysis was performed to investigate the association between preoperative plasma histamine levels and the severity of postoperative ATAAD-AKI or continuous renal replacement therapy (CRRT). ATAAD-AKI occurred in 84 of 160 patients (52.5%), including 32 with stage 1 (38.1%), 14 with stage 2 (16.7%), 38 with stage 3 (45.2%), and 34 (21.3%) received postoperative CRRT. The in-hospital mortality rate was 19.0% (16/84) in the AKI group and 2.6% (2/76) in the non-AKI group (P = .02). Preoperative lower plasma histamine levels (odds ratio [OR], 1.31; 95% confidence interval [CI], 1.10-1.52; P = .004) were an important factor related to postoperative ATAAD-AKI in multivariate logistic regression analysis. Subgroup analysis revealed that low preoperative plasma histamine level was independently associated with postoperative ATAAD-AKI (stage 3) (OR, 1.38; 95% CI, 1.10-1.73; P = .005) and CRRT (OR, 1.44; 95% CI, 1.13-1.79; P = .008). Low preoperative plasma histamine level was an independent prognostic indicator of postoperative AKI in patients with ATAAD, especially for postoperative AKI (stage 3) and CRRT. Preoperative plasma histamine levels may serve as potential protective biomarkers of postoperative ATAAD-AKI.
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Affiliation(s)
- XinLiang Guan
- Department of Cardiac Surgery, Beijing Aortic Disease Center, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart Lung and Blood Vessel Diseases, Beijing Laboratory for Cardiovascular Precision Medicine, and Beijing Engineering Research Center of Vascular Prostheses, Beijing, China
| | - Lei Li
- Department of Cardiac Surgery, Beijing Aortic Disease Center, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart Lung and Blood Vessel Diseases, Beijing Laboratory for Cardiovascular Precision Medicine, and Beijing Engineering Research Center of Vascular Prostheses, Beijing, China
| | - HongJia Zhang
- Department of Cardiac Surgery, Beijing Aortic Disease Center, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart Lung and Blood Vessel Diseases, Beijing Laboratory for Cardiovascular Precision Medicine, and Beijing Engineering Research Center of Vascular Prostheses, Beijing, China
| | - XiaoLong Wang
- Department of Cardiac Surgery, Beijing Aortic Disease Center, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart Lung and Blood Vessel Diseases, Beijing Laboratory for Cardiovascular Precision Medicine, and Beijing Engineering Research Center of Vascular Prostheses, Beijing, China
- * Correspondence: XiaoLong Wang, Department of Cardiac Surgery, Beijing Aortic Disease Center, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart Lung and Blood Vessel Diseases, Beijing Lab for Cardiovascular Precision Medicine, and Beijing Engineering Research Center of Vascular Prostheses, No.2 Anzhen Street, Beijing 100029, China (e-mail: )
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9
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Alawad MJ, Subahi EA, Al-Ani HA, Taha NM, Kamal I. A case of crescentic glomerulonephritis in a patient with COVID-19 infection: A case report and literature review. Medicine (Baltimore) 2022; 101:e28754. [PMID: 35363164 PMCID: PMC9282030 DOI: 10.1097/md.0000000000028754] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Accepted: 01/17/2022] [Indexed: 01/04/2023] Open
Abstract
RATIONALE Kidney involvement with COVID-19 infection is a well-known complication, and the majority of kidney involvement is related to ischemic injury/acute tubular injury. However, there are some cases of glomerulonephritis, the etiology of which is not yet known, but an immune process is likely to be the trigger. PATIENT CONCERNS A 27-year-old man presented to our hospital with facial puffiness and lower-limb swelling. DIAGNOSIS Laboratory assessment revealed features of impaired kidney function with proteinuria and hematuria; COVID-19 polymerase chain reaction was positive, which was consistent with pauci-immune crescentic focal segmental glomerulonephritis. INTERVENTION After renal biopsy, the patient was started on methylprednisolone and rituximab. Due to worsening kidney parameters, he underwent intermittent hemodialysis as needed. OUTCOME Kidney function tests partially improved; he was discharged on oral steroids with follow-up in the nephrology clinic to observe for the need for further hemodialysis. LESSONS We conducted a literature review of cases of glomerulonephritis associated with COVID-19 and described numerous types of glomerulonephritis. This report highlights the importance of recognizing emerging glomerulonephritis with COVID-19, the different pathological patterns of renal biopsies, and management interventions and responses.
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Affiliation(s)
- Mouhammad J. Alawad
- Department of Medical Education, Internal Medicine Residency Program, Hamad Medical Corporation, Doha, Qatar
| | - Eihab A. Subahi
- Department of Medical Education, Internal Medicine Residency Program, Hamad Medical Corporation, Doha, Qatar
| | - Haneen A. Al-Ani
- Department of Medical Education, Internal Medicine Residency Program, Hamad Medical Corporation, Doha, Qatar
| | - Noheir M. Taha
- Department of Laboratory Medicine and Pathology, Hamad Medical Corporation, Doha, Qatar
| | - Ijaz Kamal
- Department of Internal Medicine, Hamad Medical Corporation, Doha, Qatar
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Butt K, D'Souza J, Yuan C, Jayakumaran J, Nguyen M, Butt HI, Abusaada K. Correlation of the Neutrophil-to-Lymphocyte Ratio (NLR) and Platelet-to-Lymphocyte Ratio (PLR) with Contrast-Induced Nephropathy in Patients With Acute Coronary Syndrome Undergoing Percutaneous Coronary Interventions. Cureus 2020; 12:e11879. [PMID: 33415032 PMCID: PMC7781777 DOI: 10.7759/cureus.11879] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Introduction Contrast-induced acute nephropathy (CIN) in patients undergoing percutaneous coronary intervention (PCI) in the setting of acute coronary syndromes (ACS) is associated with adverse outcomes, including longer hospitalization and short and long-term mortality. Neutrophil to lymphocyte ratio (NLR) and platelet to lymphocyte ratio (PLR) are inflammatory markers that have been validated separately in prior studies as a predictor of CIN in patients with ACS who undergo a left heart catheterization. Our study aims to further investigate the role of NLR and PLR together as markers for predicting CIN in patients with ACS. Methods A retrospective chart review was performed on a total of 1,577 patients aged 18 - 90 who presented with ACS and underwent PCI between January 2011 to December 2015 at the Florida Hospital Orlando. Cut-off values used for a high PLR and NLR were PLR > 128 and NLR > 2.6. CIN was defined as an increased serum creatinine level by ≥ 0.5 mg/dL, or ≥ 25%, over the baseline value within 72 hours after contrast agent administration. Patients with end-stage renal disease (ESRD) were excluded. Results Of the 1,577 patients included in the study, 213 (13.51%) patients had CIN. On multivariate logistic regression analysis, high NLR showed an independent association with an elevated risk of CIN (OR 2.03, 95% CI: 1.403 - 3.176, P < 0.001). High PLR did not correlate with CIN (OR 0.831, 95% CI: 0.569 - 1.214, P = 0.339). Conclusion Elevated NLR is an independent predictor of CIN in patients with acute myocardial infarction (AMI) and may be used to improve on current risk prediction models.
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Affiliation(s)
- Khurram Butt
- Internal Medicine, AdventHealth Orlando, Orlando, USA
| | - Jason D'Souza
- Cardiology, St. Luke's Health System, University of Missouri, Kansas City, USA
| | - Cai Yuan
- Oncology, University of Florida, Gainesville, USA
| | - Jayapriya Jayakumaran
- Internal Medicine, Ocala Regional Medical Center, University of Central Florida College of Medicine, Orlando, USA
| | - Michelle Nguyen
- Internal Medicine, Ocala Regional Medical Center, University of Central Florida College of Medicine, Ocala, USA
| | - Hamza I Butt
- Epidemiology and Public Health, Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, USA
| | - Khalid Abusaada
- Internal Medicine, Ocala Regional Medical Center, University of Central Florida College of Medicine, Ocala, USA
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11
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Siddiqui WJ, Sadaf MI, Zain M, Mazhar R, Abbas R, Khan MH, Ahmed F, Zuberi O, Al-Saghir YM, Goldman J, Aggarwal S. Renal Injury in All-Comers After Transcatheter Aortic Valve Replacement: A Systematic Review and Meta-Analysis. Cureus 2020; 12:e7985. [PMID: 32523841 PMCID: PMC7273432 DOI: 10.7759/cureus.7985] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
Background Acute kidney injury (AKI) following aortic valve replacement is associated with poor prognosis. Transcatheter aortic valve replacement (TAVR) is a novel strategy with a percutaneous approach and early recovery time. We conducted this meta-analysis to compare TAVR to surgical aortic valve replacement (SAVR) and their respective renal outcomes. Methods We searched for randomized controlled trials (RCTs) using MEDLINE, PUBMED, and Google Scholar databases from their inception till April 6, 2019, and included eight trials comparing TAVR to SAVR in cases that reported AKIs. Results We found a significant reduction in AKI after TAVR compared to SAVR at 30 days [n = 66 vs. n = 160, respectively; odds ratio (OR) = 0.38, 95% confidence interval (CI) = 0.28-0.51; p: <0.00001, I2 = 0%]. At one year, a trend towards reduced renal failure was noted in the TAVR arm compared to the SAVR arm (n = 74 vs. n = 129, respectively; OR = 0.57, 95% CI = 0.32-1.01; p = 0.05, I2 = 69%). Conclusion Based on our findings and analysis, we have concluded that TAVR is associated with significantly reduced renal injury at 30 days when compared to SAVR.
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Affiliation(s)
- Waqas J Siddiqui
- Cardiology/Nephrology, Drexel University College of Medicine, Philadelphia, USA.,Cardiology/Nephrology, Orange Park Medical Center, Orange Park, USA
| | - Murrium I Sadaf
- Internal Medicine, Yale School of Medicine, New Haven, USA.,Internal Medicine, Waterbury Hospital, Waterbury, USA
| | - Muhammad Zain
- Internal Medicine, Sheikh Zayed Medical College and Hospital, Rahim Yar Khan, PAK
| | - Rabia Mazhar
- Internal Medicine, Orange Park Medical Center, Orange Park, USA
| | - Ramla Abbas
- Internal Medicine, Orange Park Medical Center, Orange Park, USA
| | - Mohammad H Khan
- Internal Medicine, Orange Park Medical Center, Orange Park, USA
| | - Faiza Ahmed
- Medicine, Wynford Chelation Center, Toronto, CAN
| | - Omer Zuberi
- Cardiology, Orange Park Medical Center, Orange Park, USA
| | | | - Jesse Goldman
- Nephrology, Thomas Jefferson University, Philadelphia, USA
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12
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Findakly D, Wang J. Intricate Interplay of Entwined Metabolic and Inflammatory Life-threatening Processes in Tumor Lysis Syndrome Complicating Prostate Cancer: A Systematic Review with a Single Institution Experience. Cureus 2020; 12:e7395. [PMID: 32226700 PMCID: PMC7096067 DOI: 10.7759/cureus.7395] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Tumor lysis syndrome (TLS) occurs in rapidly proliferating tumor cells, either spontaneously or after cytotoxic therapy. It has been well-documented in hematological diseases but is extremely rare in solid neoplasms, particularly in prostate cancer (PRCA). In the presence of risk factors, it can cause metabolic disturbances and be potentially fatal. We searched PubMed, Medline, ScienceDirect, and Scopus for "tumor lysis syndrome" and "prostate cancer" and conducted a systematic review with a pooled analysis for the published literature and cases from our institution. Twenty-two TLS cases were identified (18 published in the literature and four cases from our institution). The patients' median age was 68 years (range 16-82), and most cases were prostate adenocarcinoma. The median prostate-specific antigen (PSA) was 374 (range 66.7-10,867). Ten cases (45.5%) had spontaneous TLS (STLS) while 12 cases (54.5%) were treatment-related (TTLS). All patients had elevated lactate dehydrogenase (LDH) with other biochemical variables, and all underwent aggressive supportive therapy. Eleven patients underwent hemodialysis, 12 patients received rasburicase, while three patients received allopurinol. The mortality rate was 75% among 12 cases of TTLS, and it was 30% of the 10 cases with STLS. Among patients with PRCA, both TTLS and STLS linked to very high mortality. Early identification of TLS would substantially attain improved survival outcomes. Hence, physicians should consider TLS as a differential diagnosis when evaluating AKI and electrolyte abnormalities, particularly in patients with metastatic PRCA and high disease burden, even before the initiation of cytotoxic therapy.
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Affiliation(s)
- Dawood Findakly
- Internal Medicine, Creighton University Arizona Health Education Alliance / Valleywise Health Medical Center (formerly MIHS), Phoenix, USA
| | - Jue Wang
- Genitourinary Oncology, Creighton University School of Medicine / University of Arizona Cancer Center at Dignity Health St. Joseph's, Phoenix, USA
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Jung SY, Kim H, Park S, Jhee JH, Yun HR, Kim H, Kee YK, Yoon CY, Oh HJ, Chang TI, Park JT, Yoo TH, Kang SW, Lee H, Kim DK, Han SH. Electrolyte and mineral disturbances in septic acute kidney injury patients undergoing continuous renal replacement therapy. Medicine (Baltimore) 2016; 95:e4542. [PMID: 27603344 PMCID: PMC5023866 DOI: 10.1097/md.0000000000004542] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [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] [Indexed: 12/23/2022] Open
Abstract
Electrolyte and mineral disturbances remain a major concern in patients undergoing continuous renal replacement therapy (CRRT); however, it is not clear whether those imbalances are associated with adverse outcomes in patients with septic acute kidney injury (AKI) undergoing CRRT. We conducted a post-hoc analysis of data from a prospective randomized controlled trial. A total of 210 patients with a mean age of 62.2 years (136 [64.8%] males) in 2 hospitals were enrolled. Levels of sodium, potassium, calcium, and phosphate measured before (0 hour) and 24 hours after CRRT initiation. Before starting CRRT, at least 1 deficiency and excess in electrolytes or minerals were observed in 126 (60.0%) and 188 (67.6%) patients, respectively. The excess in these parameters was greatly improved, whereas hypokalemia and hypophosphatemia became more prevalent at 24 hours after CRRT. However, 1 and 2 or more deficiencies in those parameters at the 2 time points were not associated with mortality. However, during 28 days, 89 (71.2%) deaths occurred in patients with phosphate levels at 0 hour of ≥4.5 mg/dL as compared with 49 (57.6%) in patients with phosphate levels <4.5 mg/dL. The 90-day mortality was also significantly higher in patients with hyperphosphatemia. Similarly, in 184 patients who survived at 24 hours after CRRT, hyperphosphatemia conferred a 2.2-fold and 2.6-fold increased risk of 28- and 90-day mortality, respectively. The results remained unaltered when the serum phosphate level was analyzed as a continuous variable. Electrolyte and mineral disturbances are common, and hyperphosphatemia may predict poor prognosis in septic AKI patients undergoing CRRT.
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Affiliation(s)
- Su-Young Jung
- Department of Internal Medicine, College of Medicine, Institute of Kidney Disease Research, Yonsei University, Seoul, Republic of South Korea
| | - Hyunwook Kim
- Department of Internal Medicine, College of Medicine, Institute of Kidney Disease Research, Yonsei University, Seoul, Republic of South Korea
| | - Seohyun Park
- Department of Internal Medicine, College of Medicine, Institute of Kidney Disease Research, Yonsei University, Seoul, Republic of South Korea
| | - Jong Hyun Jhee
- Department of Internal Medicine, College of Medicine, Institute of Kidney Disease Research, Yonsei University, Seoul, Republic of South Korea
| | - Hae-Ryong Yun
- Department of Internal Medicine, College of Medicine, Institute of Kidney Disease Research, Yonsei University, Seoul, Republic of South Korea
| | - Hyoungnae Kim
- Department of Internal Medicine, College of Medicine, Institute of Kidney Disease Research, Yonsei University, Seoul, Republic of South Korea
| | - Youn Kyung Kee
- Department of Internal Medicine, College of Medicine, Institute of Kidney Disease Research, Yonsei University, Seoul, Republic of South Korea
| | - Chang-Yun Yoon
- Department of Internal Medicine, College of Medicine, Institute of Kidney Disease Research, Yonsei University, Seoul, Republic of South Korea
| | - Hyung Jung Oh
- Department of Internal Medicine, College of Medicine, Institute of Kidney Disease Research, Yonsei University, Seoul, Republic of South Korea
| | - Tae Ik Chang
- Department of Internal Medicine, NHIS Medical Center, Ilsan Hospital, Goyangshi, Gyeonggi-do
| | - Jung Tak Park
- Department of Internal Medicine, College of Medicine, Institute of Kidney Disease Research, Yonsei University, Seoul, Republic of South Korea
| | - Tae-Hyun Yoo
- Department of Internal Medicine, College of Medicine, Institute of Kidney Disease Research, Yonsei University, Seoul, Republic of South Korea
| | - Shin-Wook Kang
- Department of Internal Medicine, College of Medicine, Institute of Kidney Disease Research, Yonsei University, Seoul, Republic of South Korea
| | - Hajeong Lee
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, South Korea
| | - Dong Ki Kim
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, South Korea
| | - Seung Hyeok Han
- Department of Internal Medicine, College of Medicine, Institute of Kidney Disease Research, Yonsei University, Seoul, Republic of South Korea
- Correspondence: Seung Hyeok Han, Department of Internal Medicine, College of Medicine, Institute of Kidney Disease Research, Yonsei University, Yonsei-ro, Seodaemun-gu, Seoul, Republic of South Korea (e-mail: )
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14
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Yadav N, Rao S, Bhowmik DM, Mukhopadhyay A. Bone marrow cells contribute to tubular epithelium regeneration following acute kidney injury induced by mercuric chloride. Indian J Med Res 2012; 136:211-20. [PMID: 22960887 PMCID: PMC3461732] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND & OBJECTIVES Acute tubular necrosis (ATN) caused by renal ischaemia, renal hypo-perfusion, or nephrotoxic substances is the most common form of acute kidney injury (AKI). There are a few treatment options for this life-threatening disease and the mortality rate exceeds 50 per cent. In critical cases of AKI the only option is renal transplantation. In the present study we evaluated whether bone marrow cells (BMCs) are involved in regeneration of kidney tubules following acute tubular necrosis in the mouse. METHODS Six to eight week old C57BL6/J and congenic enhanced green fluorescence protein (eGFP) mice were used. The relative contributions of eGFP-expressing BMCs were compared in two different approaches to kidney regeneration in the mercuric chloride (HgCl 2 )-induced mouse model of AKI: induced engraftment and forced engraftment. In vitro differentiation of lineage-depleted (Lin - ) BMCs into renal epithelial cells was also studied. RESULTS In the forced engraftment approach, BMCs were found to play a role in the regeneration of tubules of renal cortex and outer medulla regions. About 70 per cent of donor-derived cells expressed megalin. In vitro culture revealed that Lin - BMCs differentiated into megalin, E-cadherin and cytokeratin-19 (CK-19) expressing renal epithelial cells. INTERPRETATION & CONCLUSIONS The present results demonstrate that Lin - BMCs may contribute in the regeneration of renal tubular epithelium of HgCl 2 -induced AKI. This study may also suggest a potential role of BMCs in treating AKI.
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Affiliation(s)
- Neelam Yadav
- Stem Cell Biology Laboratory, National Institute of Immunology, New Delhi, India
| | - Someshwara Rao
- Stem Cell Biology Laboratory, National Institute of Immunology, New Delhi, India
| | - Dipankar M. Bhowmik
- Department of Nephrology, All India Institute of Medical Sciences, New Delhi, India
| | - Asok Mukhopadhyay
- Stem Cell Biology Laboratory, National Institute of Immunology, New Delhi, India,Reprint requests: Dr Asok Mukhopadhyay, Stem Cell Biology Laboratory, National Institute of Immunology, Aruna Asaf Ali Marg, New Delhi 110 067, India e-mail:
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15
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Parravicini E, Nemerofsky SL, Michelson KA, Huynh TK, Sise ME, Bateman DA, Lorenz JM, Barasch JM. Urinary neutrophil gelatinase-associated lipocalin is a promising biomarker for late onset culture-positive sepsis in very low birth weight infants. Pediatr Res 2010; 67:636-40. [PMID: 20496473 PMCID: PMC3046629 DOI: 10.1203/pdr.0b013e3181da75c1] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Need for the early identification of sepsis in very low birth weight (VLBW) infants has led to the search for reliable biomarkers. This study aims to determine whether urinary neutrophil gelatinase-associated lipocalin (uNGAL) rises in culture-positive sepsis and, if so, is elevated at the time sepsis is suspected. This is a prospective study of 91 VLBW infants whose urine was collected daily for uNGAL analysis. In 65 episodes of suspected sepsis, four groups were identified: a) culture-positive sepsis; b) single culture positive for Staphylococcus epidermidis; c) and d) negative culture with antibiotic treatment for >or=7 d and <7 d, respectively. Daily means of uNGAL of each group were estimated for comparison. Mean uNGAL in group A (179 ng/mL) was significantly elevated on the day blood culture was drawn (day 0) compared with the mean of healthy VLBW infants (6.5 ng/mL), and to the means in groups B, C, and D (p<0.05). In group A, mean uNGAL was significantly elevated on day 0 and daily for 5 days when compared with that of the day before culture (p<0.05 to <0.005). uNGAL shows promise as an early marker for culture-positive sepsis in VLBW infants.
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Affiliation(s)
- Elvira Parravicini
- Department of Pediatrics, College of Physicians and Surgeons, Columbia University, New York, NY 10032, USA.
| | - Sheri L Nemerofsky
- Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, NY 10461
| | - Kenneth A Michelson
- Department of Medicine, College of Physicians and Surgeons, Columbia University, New York, NY 10032
| | - Trang K Huynh
- Department of Pediatrics, New York Presbyterian-Weill Cornell Medical College, New York, NY 10065
| | - Meghan E Sise
- Department of Medicine, College of Physicians and Surgeons, Columbia University, New York, NY 10032
| | - David A Bateman
- Department of Pediatrics, College of Physicians and Surgeons, Columbia University, New York, NY 10032
| | - John M Lorenz
- Department of Pediatrics, College of Physicians and Surgeons, Columbia University, New York, NY 10032
| | - Jonathan M Barasch
- Department of Medicine, College of Physicians and Surgeons, Columbia University, New York, NY 10032
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16
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Walters S, Porter C, Brophy PD. Dialysis and pediatric acute kidney injury: choice of renal support modality. Pediatr Nephrol 2009; 24:37-48. [PMID: 18483748 PMCID: PMC2755787 DOI: 10.1007/s00467-008-0826-x] [Citation(s) in RCA: 81] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2007] [Revised: 03/06/2008] [Accepted: 03/07/2008] [Indexed: 02/03/2023]
Abstract
Dialytic intervention for infants and children with acute kidney injury (AKI) can take many forms. Whether patients are treated by intermittent hemodialysis, peritoneal dialysis or continuous renal replacement therapy depends on specific patient characteristics. Modality choice is also determined by a variety of factors, including provider preference, available institutional resources, dialytic goals and the specific advantages or disadvantages of each modality. Our approach to AKI has benefited from the derivation and generally accepted defining criteria put forth by the Acute Dialysis Quality Initiative (ADQI) group. These are known as the risk, injury, failure, loss, and end-stage renal disease (RIFLE) criteria. A modified pediatrics RIFLE (pRIFLE) criteria has recently been validated. Common defining criteria will allow comparative investigation into therapeutic benefits of different dialytic interventions. While this is an extremely important development in our approach to AKI, several fundamental questions remain. Of these, arguably, the most important are "When and what type of dialytic modality should be used in the treatment of pediatric AKI?" This review will provide an overview of the limited data with the aim of providing objective guidelines regarding modality choice for pediatric AKI. Comparisons in terms of cost, availability, safety and target group will be reviewed.
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Affiliation(s)
- Scott Walters
- grid.214458.e0000000086837370CS Mott Children’s Hospital, Department of Pediatrics, Division of Nephrology, University of Michigan, Ann Arbor, MI USA
| | - Craig Porter
- grid.214572.70000000419368294University of Iowa Children’s Hospital, Department of Pediatrics, Division of Nephrology, Hypertension, Dialysis & Transplantation, University of Iowa, Iowa City, IA USA
| | - Patrick D. Brophy
- grid.214572.70000000419368294University of Iowa Children’s Hospital, Department of Pediatrics, Division of Nephrology, Hypertension, Dialysis & Transplantation, University of Iowa, Iowa City, IA USA ,grid.214572.70000000419368294Pediatric Nephrology, University of Iowa, 200 Hawkins Dr., Iowa City, IA 52242 USA
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