Clinical Scenarios in Acute Kidney Injury-Parenchymal Acute Kidney Injury - Vascular Diseases

2016 ◽  
pp. 48-63 ◽  
Author(s):  
Mario Meola ◽  
Sara Samoni ◽  
Ilaria Petrucci ◽  
Claudio Ronco
Keyword(s):  
Acute Kidney Injury ◽  
Kidney Injury ◽  
Vascular Diseases ◽  
Clinical Scenarios

scholarly journals When azoles cannot be used: the clinical effectiveness of intermittent liposomal amphotericin prophylaxis in haematology patients

2021 ◽  
Author(s):  
R Batchelor ◽  
C Thomas ◽  
B J Gardiner ◽  
S J Lee ◽  
S Fleming ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Acute Myeloid Leukaemia ◽  
Myeloid Leukaemia ◽  
Liposomal Amphotericin ◽  
Kidney Injury ◽  
Antifungal Prophylaxis ◽  
High Rate ◽  
Clinical Scenarios ◽  
Haematology Patients ◽  
Acute Myeloid

Abstract Background Patients unable to take azoles are a neglected group lacking a standardized approach to antifungal prophylaxis. We evaluated the effectiveness and safety of intermittent liposomal amphotericin (L-AMB) prophylaxis in a heterogenous group of haematology patients. Methods A retrospective cohort of all haematology patients who received a course of intravenous L-AMB defined as 1mg/kg thrice weekly, from 1 July 2013-30 June 2018 were identified from pharmacy records. Outcomes included breakthrough-invasive fungal disease (BIFD), reasons for premature discontinuation and acute kidney injury. Results There were 198 patients who received 273 courses of L-AMB prophylaxis. Using a conservative definition, the BIFD rate was 9.6% (n=19/198) occurring either during L-AMB prophylaxis or up to 7 days from cessation in patients who received a course. Probable/proven-BIFD occurred in 13 patients (6.6%, 13/198), including molds in 54% (n=7) and non-albicans Candidaemia in 46% (n=6). Cumulative incidence of BIFD was highest in patients with acute myeloid leukaemia (6.8%) followed by acute lymphoblastic leukaemia (2.7%) and allogeneic stem cell transplantation (2.5%). The most common indication for L-AMB was chemotherapy or anticancer drug-azole interactions (75% of courses) dominated by vincristine or acute myeloid leukaemia clinical trials, followed by gut absorption concerns (13%) and liver function abnormalities (8.8%). Acute kidney injury using a modified international definition, complicated 27% of courses but was not clinically significant accounting for only 3.3% (9/273) of discontinuations. Conclusions Our findings demonstrate a high rate of BIFD among patients receiving L-AMB prophylaxis. Pragmatic trials will help find the optimal regimen of L-AMB prophylaxis for the many clinical scenarios where azoles are unsuitable, especially as targeted anticancer drugs increase in use.

scholarly journals Impact of Obesity on Acute Kidney Injury Incidence Among Patients Treated with Piperacillin–Tazobactam and Vancomycin

2017 ◽  
Vol 4 (suppl_1) ◽  
pp. S336-S336
Author(s):  
W Cliff Rutter ◽  
Ronald Hall ◽  
David S Burgess
Keyword(s):  
Acute Kidney Injury ◽  
Demographic Data ◽  
Kidney Injury ◽  
Severity Of Illness ◽  
Final Analysis ◽  
Information Criterion ◽  
Injury Incidence ◽  
University Of Kentucky ◽  
Clinical Scenarios ◽  
End Stage

Abstract Background Obesity is associated with worse patient outcomes in a variety of clinical scenarios. It is unclear from previous research if obesity is associated with increased acute kidney injury (AKI) among patients receiving concomitant piperacillin-tazobactam (TZP) and vancomycin (VAN). Methods Clinical and demographic data were collected from the University of Kentucky Center for Clinical and Translational Science Enterprise Data Trust. Patients who received TZP+VAN for at least 48 hours in combination were included. Patients with CKD, a baseline creatinine clearance (CrCl) < 30 mL/minute, CF, or missing height and weight information were excluded from analysis. AKI was defined using the Risk, Injury, Failure, Loss, End-stage (RIFLE) criteria. A weight cutoff point of 91 kg was determined by finding the most predictive bivariable logistic regression model with weights varying from 70 kg through 120 kg via minimization of the Akaike information criterion. Basic descriptive statistics were performed and bivariable and multivariable logistic regressions were performed. Results In total, 8125 patients were included in the final analysis. A total of 2452 (30.2%) of patients weighed ≥91 kg. Patients weighing less 91kg were less likely to receive concomitant nephrotoxins and had higher baseline CrCl (97.3 [70.1–128.1] mL/minute vs. 91.8 [68.1–116.5] mL/minute, <0.00001). Baseline severity of illness was similar between groups; however, diabetes (38.9% vs. 20.8%, P < 0.00001), hypertension (63.5% vs. 46.7%, P < 0.00001), and heart failure (14.8% vs. 12.5%, P = 0.007) were more common among the 91kg+ patients. Median daily VAN doses were less in the sub-91kg patients (2000 [1250–2500] mg vs. 3000 [2000–3500] mg, P < 0.00001); however, weight-based doses were lower in the ≥91kg group (25.5 [16.3–31.5] mg/kg/day vs 27.9 [18.7–34.2] mg/kg/day, P < 0.00001). AKI was more common in the patients weighing ≥91kg (23.8% vs. 17.8%, P < 0.00001; adjusted odds ratio 1.46 [95% CI 1.28–1.66]). Conclusion Obesity appears to increase the incidence of AKI among patients treated with TZP+VAN, independent of clinically important confounders, with an important breakpoint occurring at 91 kg. Disclosures R. Hall, Genentech: Scientific Advisor, Consulting fee Merck: Grant Investigator, Grant recipient

Clinical Scenarios in Acute Kidney Injury: Pre-Renal Acute Kidney Injury

2016 ◽  
pp. 21-32 ◽  
Author(s):  
Mario Meola ◽  
Federico Nalesso ◽  
Ilaria Petrucci ◽  
Sara Samoni ◽  
Claudio Ronco
Keyword(s):  
Acute Kidney Injury ◽  
Kidney Injury ◽  
Clinical Scenarios

Neonatal Acute Kidney Injury: A Survey of Neonatologists' and Nephrologists' Perceptions and Practice Management

2017 ◽  
Vol 35 (01) ◽  
pp. 001-009 ◽  
Author(s):  
J. Charlton ◽  
R. Guillet ◽  
K. Gist ◽  
M. Hanna ◽  
A. El Samra ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Neonatal Intensive Care ◽  
Current Knowledge ◽  
Kidney Injury ◽  
The United States ◽  
Clinical Scenarios ◽  
Practice Variations ◽  
Stage 1

Background Neonatal acute kidney injury (AKI) occurs in 40 to 70% of critically ill neonatal intensive care admissions. This study explored the differences in perceptions and practice variations among neonatologists and pediatric nephrologists in diagnostic criteria, management, and follow-up of neonatal AKI. Methods A survey weblink was emailed to nephrologists and neonatologists in Australia, Canada, New Zealand, India, and the United States. Questions consisted of demographic and unit practices, three clinical scenarios assessing awareness of definitions of neonatal AKI, knowledge, management, and follow-up practices. Results Many knowledge gaps among neonatologists, and to a lesser extent, pediatric nephrologists were identified. Neonatologists were less likely to use categorical definitions of neonatal AKI (p < 0.00001) or diagnose stage 1 AKI (p < 0.00001) than pediatric nephrologists. Guidelines for creatinine monitoring for nephrotoxic medications were reported by 34% (aminoglycosides) and 62% (indomethacin) of respondents. Nephrologists were more likely to consider follow-up after AKI than neonatologists (p < 0.00001). Also, 92 and 86% of neonatologists and nephrologists, respectively, reported no standardization or infrastructure for long-term renal follow-up. Conclusion Neonatal AKI is underappreciated, particularly among neonatologists. A lack of evidence on neonatal AKI contributes to this variation in response. Therefore, dissemination of current knowledge and areas for research should be the priority.

Acute Kidney Injury in the Cancer Patient

2017 ◽  
Author(s):  
Shveta Motwani ◽  
Albert Q. Lam
Keyword(s):  
Acute Kidney Injury ◽  
Tumor Lysis Syndrome ◽  
Kidney Injury ◽  
Well Being ◽  
Chemotherapeutic Agents ◽  
Concurrent Treatment ◽  
Hematopoietic Stem ◽  
Patients With Cancer ◽  
Clinical Scenarios ◽  
Cancer Experience

Acute kidney injury (AKI) is a problem frequently encountered in patients with cancer that significantly impacts their well-being and outcomes. In addition to the usual prerenal, intrarenal, and postrenal etiologies of AKI, patients with cancer experience unique causes of AKI. Nephrologists caring for this population must be able to identify and manage these conditions, which often require distinguishing between causes resulting from the cancer itself and those related to chemotherapeutic or other concurrent treatment, to institute appropriate preventive or therapeutic strategies. In this review, we present a suggested systematic approach to the diagnosis of AKI in patients with cancer and discuss common clinical scenarios specific to this patient population, with a special emphasis on tumor infiltration of the kidney parenchyma, myeloma-related AKI, tumor lysis syndrome, thrombotic microangiopathy, AKI in the patient with hematopoietic stem cell transplantation, and renal disease in patients with renal cell carcinoma. We cover the latest evidence-based strategies for management of these disorders in this evolving field. In addition, we provide an updated table of potentially nephrotoxic chemotherapeutic agents with their associated mechanisms of kidney injury as a reference for clinicians to build on as they encounter the ever-expanding list of oncologic agents in practice. As the subspecialty of onconephrology continues to evolve, it will be increasingly important for clinicians to have the skills to effectively diagnose and treat AKI in cancer patients to minimize morbidity and mortality, decrease the incidence of subsequent chronic kidney disease, and maintain chemotherapeutic options for these patients. This review contains 5 figures, 5 tables, and 61 references. Key words: acute kidney injury, cancer, chemotherapy, onconephrology, renal failure

Acute Kidney Injury in the Cancer Patient

2017 ◽  
Author(s):  
Shveta Motwani ◽  
Albert Q. Lam
Keyword(s):  
Acute Kidney Injury ◽  
Tumor Lysis Syndrome ◽  
Kidney Injury ◽  
Well Being ◽  
Chemotherapeutic Agents ◽  
Concurrent Treatment ◽  
Hematopoietic Stem ◽  
Patients With Cancer ◽  
Clinical Scenarios ◽  
Cancer Experience

Acute kidney injury (AKI) is a problem frequently encountered in patients with cancer that significantly impacts their well-being and outcomes. In addition to the usual prerenal, intrarenal, and postrenal etiologies of AKI, patients with cancer experience unique causes of AKI. Nephrologists caring for this population must be able to identify and manage these conditions, which often require distinguishing between causes resulting from the cancer itself and those related to chemotherapeutic or other concurrent treatment, to institute appropriate preventive or therapeutic strategies. In this review, we present a suggested systematic approach to the diagnosis of AKI in patients with cancer and discuss common clinical scenarios specific to this patient population, with a special emphasis on tumor infiltration of the kidney parenchyma, myeloma-related AKI, tumor lysis syndrome, thrombotic microangiopathy, AKI in the patient with hematopoietic stem cell transplantation, and renal disease in patients with renal cell carcinoma. We cover the latest evidence-based strategies for management of these disorders in this evolving field. In addition, we provide an updated table of potentially nephrotoxic chemotherapeutic agents with their associated mechanisms of kidney injury as a reference for clinicians to build on as they encounter the ever-expanding list of oncologic agents in practice. As the subspecialty of onconephrology continues to evolve, it will be increasingly important for clinicians to have the skills to effectively diagnose and treat AKI in cancer patients to minimize morbidity and mortality, decrease the incidence of subsequent chronic kidney disease, and maintain chemotherapeutic options for these patients. This review contains 5 figures, 5 tables, and 61 references. Key words: acute kidney injury, cancer, chemotherapy, onconephrology, renal failure

The Epidemiology of Cardiac Surgery-Associated Acute Kidney Injury

2008 ◽  
Vol 31 (2) ◽  
pp. 158-165 ◽  
Author(s):  
E.A. Hoste ◽  
D.N. Cruz ◽  
A. Davenport ◽  
R.L. Mehta ◽  
P. Piccinni ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Cardiac Surgery ◽  
Clinical Practice ◽  
Research Agenda ◽  
Current Knowledge ◽  
Kidney Injury ◽  
Future Research ◽  
Modified Delphi ◽  
Clinical Scenarios ◽  
Delphi Analysis

Purpose To describe current knowledge on the epidemiology of cardiac surgery-associated acute kidney injury (CSA-AKI) and to formulate recommendations for clinical practice and a research agenda. Methods After a modified Delphi analysis by the Acute Dialysis Quality Initiative (ADQI), 4 questions on the epidemiology of CSA-AKI and recommendations for clinical practice and a research agenda were formulated and addressed. Results Existing studies on CSA-AKI use over 35 different definitions for CSA-AKI. In addition, there may be important differences in patient characteristics and procedures. This explains the significant variations in reported incidence. Most studies report on CSA-AKI as defined by the need for renal replacement therapy. However, even small decreases in kidney function are associated with a worsened outcome. The workgroup formulated the recommendation to use the AKIN consensus criteria for AKI. One should differentiate early CSA-AKI, caused by the procedure, and late CSA-AKI, associated with the procedure. There may be different clinical scenarios: acute on chronic CSA-AKI, AKI prior to CS, and AKI occurring post CS. Risk factors should be differentiated between pre-, intra-, and post-CS, and between patient-, process-, and procedure-related. Endpoints should include both short-term and long-term outcomes. Conclusions Existing data on the epidemiology of CSA-AKI are difficult to compare due to variations in definition and patient cohort. A modified Delphi analysis resulted in a series of recommendations for future research on CSA-AKI.

scholarly journals Neutrophil gelatinase-associated lipocalin (NGAL) as biomarker of acute kidney injury: a review of the laboratory characteristics and clinical evidences

2012 ◽  
Vol 50 (9) ◽  
Author(s):  
Aldo Clerico ◽  
Claudio Galli ◽  
Antonio Fortunato ◽  
Claudio Ronco
Keyword(s):  
Acute Kidney Injury ◽  
Serum Creatinine ◽  
Randomized Clinical Trials ◽  
Critical Role ◽  
Kidney Injury ◽  
Neutrophil Gelatinase Associated Lipocalin ◽  
Standard Clinical Practice ◽  
Clinical Scenarios ◽  
Increased Risk ◽  
Neutrophil Gelatinase

AbstractAcute kidney injury (AKI) is a common and serious condition, currently diagnosed by functional biomarkers, such as serum creatinine measurements. Unfortunately, creatinine increase is a delayed and unreliable indicator of AKI. The lack of early biomarkers of structural kidney injury has hampered our ability to translate promising experimental therapies to human AKI. The recent discovery, translation and validation of neutrophil gelatinase-associated lipocalin (NGAL), possibly the most promising novel AKI biomarker, is reviewed here. NGAL may be measured by several methods both in plasma and urine for the early diagnosis of AKI and for the prediction of clinical outcomes, such as dialysis requirement and mortality, in several common clinical scenarios, including in the intensive care unit, cardiac surgery and renal damage due the exposition to toxic agent and drugs, and renal transplantation. Furthermore, the predictive properties of NGAL, may play a critical role in expediting the drug development process. A systematic review of literature data indicates that further studies are necessary to establish accurate reference population values according to age, gender and ethnicity, as well as reliable and specific decisional values concerning the more common clinical settings related to AKI. Furthermore, proper randomized clinical trials on renal and systemic outcomes comparing the use of NGAL vs. standard clinical practice are still lacking and accurate cost-benefit and/or cost-utility analyses for NGAL as biomarker of AKI are also needed. However, it is important to note that NGAL, in the absence of diagnostic increases in serum creatinine, is able to detect some patients affected by subclinical AKI who have an increased risk of adverse outcomes. These results also suggest that the concept and definition of AKI might need to be reassessed.

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