Medicine
Andrew Schofield, Paul Schofield in The Complete SAQ Study Guide, 2019
A 72-year-old man is admitted via A&E with worsening confusion and falls. His wife tells you that 2 weeks ago he had been fine, but he has been becoming progressively more confused over this period. He suffers from essential hypertension, for which he takes amlodipine, but is otherwise well. You request baseline bloods, which reveal Hb IB.5, WCC 8.96, Pits 345, Na 136, K4.8, urea 16, creatinine 224, CRP < 5. Generally, how can acute kidney injury be subclassified? (1)Give two causes of each. (3)Other than blood tests, give two other investigations you would request. (2)Name two potentially life-threatening complications of acute kidney injury. (2)Give two indications for dialysis in a patient with acute kidney injury. (2)
Polymyxins
M. Lindsay Grayson, Sara E. Cosgrove, Suzanne M. Crowe, M. Lindsay Grayson, William Hope, James S. McCarthy, John Mills, Johan W. Mouton, David L. Paterson in Kucers’ The Use of Antibiotics, 2017
The incidence of nephrotoxicity associated with intravenous polymyxin B in patients is up to 45% according to several recent studies (Dubrovskaya et al., 2015; Rigatto et al., 2015). A multicenter prospective cohort study evaluated risk factors for acute kidney injury in 410 patients treated with intravenous polymyxin B (mean daily dose 2.4 ± 0.69 mg/kg) (Rigatto et al., 2015). Acute kidney injury occurred in 46.1% (189) of the patients, including 92 as Risk, 45 as Injury, and 52 as Failure. The median time to develop acute kidney injury was 6 days since the start of the therapy. Based upon the median average daily dose (150 mg), the incidences of acute kidney injury were 32.0% (33/103), 54.0% (109/202) and 44.8% (47/105) in patients receiving < 150 mg/day, 150–199 mg/day, and ≥ 200 mg/day, respectively (p = 0.001). It is interesting to note that the incidence of acute kidney injury did not significantly differ among different categories of doses by milligrams per kilogram. With multivariate analysis, polymyxin B dose of ≥ 150 mg/day, age, and body weight were identified as independent risk factors for acute kidney injury, and higher risk of developing any degree of acute kidney injury was observed with a polymyxin B dose of ≥ 150 mg/day, irrespective of patient weight (Rigatto et al., 2015).
Renal disease in children
Brice Antao, S Irish Michael, Anthony Lander, S Rothenberg MD Steven in Succeeding in Paediatric Surgery Examinations, 2017
Scenario 1 is a neonate with moderately severe renal dysfunction with both kidneys bright antenatally and small postnatally, which is consistent with chronic kidney disease secondary to bilateral renal dysplasia. Scenario 2 has small hydronephrotic kidneys, which are consistent with bilateral renal dysplasia, and the micturating cystourethrogram shows typical features of posterior urethral valves without vesicoureteric reflux. Scenario 3 describes acute kidney injury secondary to obstruction of a solitary kidney by a renal calculus and requires urgent intervention. Scenario 4 describes acute febrile symptoms in a child with long-standing symptoms suggestive of chronic kidney disease with failure to thrive, polyuria, polydipsia and primary nocturnal enuresis. Although the acute kidney injury may be due to dehydration, obstruction or sepsis, the description of acute-on-chronic renal failure more accurately describes the whole case.
Prevalence, clinical characteristics and outcomes of hypoxic hepatitis in critically ill patients
Published in Scandinavian Journal of Gastroenterology, 2022
Sigrún Jonsdottir, Margrét B. Arnardottir, Jóhannes A. Andresson, Helgi K. Bjornsson, Sigrun H. Lund, Einar S. Bjornsson
Acute kidney injury was defined as: (a) increase in serum creatinine by ≥0.3 mg/dL (≥26.5 µmol/L) within 48 h or (b) increase in serum creatinine to ≥1.5 times baseline, which is known or presumed to have occurred within the prior seven days or (c) urine volume <0.5 mL/kg/hour for six hours [14]. Rhabdomyolysis was defined by a CK cut-off value of CK >5xULN in the appropriate clinical setting [15,16]. Acute pancreatitis (AP) was defined by abdominal pain, amylase and/or lipase value >3xULN and/or features of pancreatitis on imaging studies (abdominal ultrasound and/or CT). Two out of these three criteria were required for the diagnosis of AP [17]. Diagnosis of IP required a clinical setting of circulatory shock, arterial hypotension, hypovolemia and/or arterial hypoxemia (PaO2 of <60 mmHg (8.0 kPa or less)) prior to the diagnosis of AP without a prior history of abdominal pain to this episode. All other causes of AP, such as biliary and alcohol induced AP, were ruled out. Intestinal ischemia was defined as ischemia identified by laparotomy, laparoscopy or by autopsy.
Actual drug-related harms in residential aged care facilities: a narrative review
Published in Expert Opinion on Drug Safety, 2022
Sheraz Ali, Colin M. Curtain, Luke RE. Bereznicki, Mohammed S. Salahudeen
Acute kidney injury is an abrupt decrease in kidney function, occurring within hours and resulting in the accumulation of urea and other metabolic waste products and the dysregulation of extracellular volume and electrolytes [51]. RACF residents are at high risk for acute kidney injury owing to age-related changes in kidney structure and function [51]. Handler et al. reported that 30% (n = 38) of older residents usually experience acute kidney injury within 100 days of admission to RACFs [51]. The occurrence of a drug-related acute kidney injury is often due to the use of diuretics, angiotensin-converting enzyme inhibitors/angiotensin II receptor blockers, antibiotics, and non-steroidal anti-inflammatory drugs [51]. Clinical information systems using computerized alerts may help in the early detection of complications associated with acute kidney injury, as predicting acute kidney injury from underlying risk factors is challenging in older people [51]. Although acute kidney injury is well-studied in the acute care setting, evidence related to drug-induced acute kidney injury in RACFs is limited. Future research is needed to determine if deprescribing some renally-eliminated medications can positively impact the incidence and progression of acute kidney injury in older people living in RACFs.
Pharmacotherapeutic principles of fluid management in heart failure
Published in Expert Opinion on Pharmacotherapy, 2021
Bharat Narasimhan, R. Aravinthkumar, Ashish Correa, Wilbert S. Aronow
The RAPID-CHF trial (The Relief for Acutely Fluid-Overloaded Patients With Decompensated Congestive Heart Failure), was the first randomized study of UF versus conventional medical therapy in ADHF [132]. This study established the safety and feasibility of this approach with significant increases in weight loss. Following this, the 2006 UNLOAD trial (Ultrafiltration Versus Intravenous (IV) Diuretics for Patients Hospitalized for Acute Decompensated Heart Failure) demonstrated improved weight loss and lower readmission rates with minimal impact on renal function with UF as compared to diuretic therapy [133]. These promising results laid the foundation for the larger CARRESS-HF trial (2012), that focused largely on patients refractory to significantly higher antecedent diuretic doses than with preceding studies [134]. In this study a significant increase in acute kidney injury was observed without significant reductions in weight, symptoms, or mortality. The reason for these conflicting reports has been attributed to the inherently different study populations as mentioned above as well as longer durations of UF employed in the CARRESS trial.
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