scholarly journals Plasma exchange and hemodialysis for severe manifestations of multiple wasp stings in a child

2020 ◽  
Vol 9 (3) ◽  
pp. e27-e27
Author(s):  
Eka Laksmi Hidayati ◽  
Maulana Rosyady ◽  
Henny Adriani Puspitasari ◽  
Meilania Saraswati ◽  
Angela Grace ◽  
...  
Keyword(s):  
Plasma Exchange ◽  
Kidney Function ◽  
Kidney Injury ◽  
Complete Recovery ◽  
Acute Interstitial Nephritis ◽  
Multiple Organ ◽  
Intermittent Hemodialysis ◽  
Tubular Necrosis ◽  
Intravenous Steroid ◽  
Wasp Stings

Wasp stings occur frequently in developing countries and often lead to fatal outcomes due to the effects of wasp venom. Hemolysis and rhabdomyolysis often complicate wasp stings and result in acute kidney injury (AKI). We report a case of multiple wasp stings leading to AKI and multiple organ dysfunction syndrome (MODS) in a 9-year-old Indonesian girl. Kidney biopsy revealed acute tubular necrosis and acute interstitial nephritis. Despite delayed admission, she recovered in 33 days after 3 days of intravenous steroid administration, eight sessions of intermittent hemodialysis, and two sessions of plasma exchange (PE). Complete recovery of kidney function, indicated by normal diuresis, normal estimated glomerular filtration rate, and negative albuminuria, was reached within 12 weeks. This case showed that immediate admission following multiple wasp stings (particularly >10 stings) to initiate early dialysis is important to promptly remove toxins and preserve kidney function. The case also showed that PE can be beneficial in cases of hemolysis and rhabdomyolysis complicated by MODS.

scholarly journals Multiple Organ Dysfunction and Acute Pancreatitis Following Wasp Stings

2020 ◽  
Vol 18 (3) ◽  
pp. 566-568
Author(s):  
Olita Shilpakar ◽  
Bibek Rajbhandari ◽  
Bipin Karki ◽  
Umesh Bogati
Keyword(s):  
Acute Kidney Injury ◽  
Acute Pancreatitis ◽  
Organ Dysfunction ◽  
Kidney Injury ◽  
Complete Recovery ◽  
Multiple Organ ◽  
Multiple Organ Dysfunction ◽  
Wasp Sting ◽  
History Of ◽  
Wasp Stings

Wasp stings are common in our part of the world and may cause complications ranging from mild local reactions to fatal anaphylaxis. Severe cases may present with multisystem involvement causing acute kidney injury, hepatic dysfunction, clotting abnormalities, rhabdomyolysis or even death. However, cases with acute pancreatitis as a complication of wasp sting is not usual and have been very rarely reported. We present a case of a fifty-two-year-old lady with the history of multiple wasp stings followed by multiple organ dysfunction and acute pancreatitis with complete recovery following immediate conservative measures. Keywords: Acute kidney injury; multiple organ dysfunction; pancreatitis; wasp; sting

scholarly journals Retrospective Study on Acute Kidney Injury among Cholera Patients in an Outbreak in Whitefield, Bengaluru

2021 ◽  
Vol 2021 ◽  
pp. 1-7
Author(s):  
Girish P Vakrani ◽  
Tanuja Nambakam
Keyword(s):  
Acute Kidney Injury ◽  
Vibrio Cholerae ◽  
Kidney Function ◽  
Kidney Injury ◽  
Spontaneous Remission ◽  
Complete Recovery ◽  
Hypovolaemic Shock ◽  
Tubular Necrosis ◽  
Secretory Diarrhoea ◽  
Appropriate Therapy

Introduction. Cholera is gastroenteritis caused by Vibrio cholerae. It presents with vomiting, severe secretory diarrhoea, and dehydration. It can cause severe complications with severe electrolyte imbalances and oligoanuric acute kidney injury due to acute tubular necrosis secondary to dehydration or infection itself. However, cholera presenting with significant proteinuria and acute kidney injury has not been reported. Hence, this study was conducted. Aims and Objectives. This aim of this study was to assess clinical features, treatment, and prognosis of AKI in cholera patients; to correlate proteinuria with AKI in cholera patients; and to compare cholera patients with normal kidney function and those with AKI. Material and Methods. It was a retrospective observational study involving patients with cholera. Information regarding cholera patients with acute kidney injury, proteinuria, and prognosis were collected. Results. Most of the patients had significant vomiting, moderate-to-severe diarrhoea, dehydration, and hypovolaemic shock. Cholera caused severe complications such as severe electrolyte imbalances including hyponatraemia and hypokalaemia, acute kidney injury, and proteinuria secondary to dehydration or infection. A surprising finding noted was the lack of significant association between the onset of acute kidney injury and usual risk factors such as hypovolaemic shock and dehydration. It was found that proteinuria had influenced the onset of acute kidney injury, but it did not influence recovery. As there was complete recovery in kidney function, none of the cases required kidney biopsy. There was no mortality noted. Conclusions. This study points towards the rare occurrence of proteinuria and acute kidney injury in Vibrio cholerae infection with spontaneous remission of kidney disease with appropriate therapy.

scholarly journals A Case of Multiple Wasp Stings Causing Multi-organ Dysfunction Syndrome

2019 ◽  
Vol 12 (1) ◽  
pp. 49-52
Author(s):  
Nabin Basnet ◽  
Binod Pantha ◽  
Sanjeev Acharya ◽  
Barsha Shrestha ◽  
Rishi Kafle
Keyword(s):  
Supportive Care ◽  
Kidney Function ◽  
Kidney Injury ◽  
Health Centers ◽  
Local Health ◽  
The Third ◽  
Initial Resuscitation ◽  
Tertiary Hospitals ◽  
Specific Organ ◽  
Wasp Stings

Wasp stings occur commonly and uncomplicated cases are generally managed at local health centers. Complicated cases are referred to tertiary hospitals for multi-specialty care. We report a case of a 30-year old gentleman from a remote center in Nepal who had multiple wasp stings and developed oligo-anuric acute kidney injury, liver failure, and rhabdomyolysis. He was promptly referred to our hospital after initial resuscitation. At our hospital, he was treated with intensive conventional supportive care and specific organ-supportive care including N-Acetylcysteine infusion and hemodialysis. With the treatment given, the general condition of the patient as well as liver function improved within the first week. However, the recovery of kidney function and urine output lagged behind. The patient showed signs of improvement in kidney function at the end of the third week and completely recovered by the 40th day of treatment.

Endocrine Summary

2014 ◽  
pp. 549-566
Author(s):  
Graham T. McMahon
Keyword(s):  
Acute Kidney Injury ◽  
Filtration Rate ◽  
Hospital Admissions ◽  
Kidney Injury ◽  
Acute Interstitial Nephritis ◽  
Hospitalized Patients ◽  
Acute Glomerulonephritis ◽  
Creatinine Concentration ◽  
Tubular Necrosis ◽  
Definition Of

Acute renal failure, now referred to as acute kidney injury (AKI), complicates 5–10% of general hospital admissions and is associated with increased morbidity and mortality and prolonged hospitalizations. The definition of AKI varies, but it is usually defined as an increase in serum creatinine concentration of 25–50% above the baseline, a decline in estimated glomerular filtration rate (eGFR) of 25–50%, or the need for renal replacement therapy. It is now recognized that changes in GFR are delayed manifestations of renal injury, and the development of urinary biomarkers may help to identify AKI earlier in the course of injury. The major causes of AKI in hospitalized patients include prerenal causes (~40%), postrenal causes (~5–10%), and intrinsic diseases affecting blood vessels, glomeruli, or tubules. Of the intrinsic causes, tubular disorders (acute tubular necrosis and acute interstitial nephritis) are the most common etiologies, accounting for 40–50% of all causes of AKI. Acute glomerulonephritis and vascular disorders are rare etiologies of AKI in hospitalized patients (〈5%).

Eculizumab Modifies Outcomes in Adults with Atypical Hemolytic Uremic Syndrome with Acute Kidney Injury

2018 ◽  
Vol 48 (3) ◽  
pp. 225-233 ◽  
Author(s):  
Mercedes Cao ◽  
Bruna N. Leite ◽  
Tamara Ferreiro ◽  
María Calvo ◽  
Constantino Fernández ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Hemolytic Uremic Syndrome ◽  
Kidney Function ◽  
Case Reports ◽  
Atypical Hemolytic Uremic Syndrome ◽  
Kidney Injury ◽  
Complete Recovery ◽  
Genetic Abnormalities ◽  
Uremic Syndrome ◽  
Meta Analyses

Background: Atypical hemolytic uremic syndrome (aHUS) is a rare disease associated with congenital or acquired genetic abnormalities that result in uncontrolled complement activation, leading to thrombotic microangiopathy and kidney failure. Until recently, the only treatment was plasma exchange or plasma infusion (PE/PI), but 60% of patients died or had permanent kidney damage despite treatment. Eculizumab, a complement inhibitor, has shown promising results in aHUS. However, data are mainly extracted from case reports or studies of heterogeneous cohorts, and no direct comparison with PE/PI is available. Methods: An observational retrospective study of adult, dialysis-dependent aHUS patients with acute kidney injury (AKI) who were treated with either PE/PI alone or with second-line eculizumab in our center. We compared the effect of PE/PI and eculizumab on kidney function, hypertension, proteinuria, hematologic values, relapse, and death. Results: Thirty-one patients were included (females, 18; sporadic aHUS, 29; mean age, 46 ± 20 years). Twenty-six patients were treated with PE/PI alone, and 5 were deemed to be plasma-resistant and received eculizumab after stopping PE/PI. Among patients receiving eculizumab, 80% attained complete recovery of kidney function, 100% stopped dialysis, 20% had decreased proteinuria, and no patient relapsed (vs. 38.5, 50, 15.4, and 11.5%, respectively, of patients receiving only PE/PI). At 1-year of follow-up, no deaths had occurred in either group. Conclusion: Eculizumab shows greater efficacy than PE/PI alone for the treatment of adult aHUS patients with AKI. Prospective studies and meta-analyses are warranted to confirm our findings and set guidelines for treatment, monitoring, and maintenance.

scholarly journals P0306ACUTE KIDNEY INJURY AFTER CHECKPOINT INHIBITOR TREATMENT: FACING THE FUTURE

2020 ◽  
Vol 35 (Supplement_3) ◽  
Author(s):  
Clara Garcã­a Carro ◽  
Mónica Bolufer ◽  
Diana Oleas ◽  
María A Azancot ◽  
Irene Agraz ◽  
...  
Keyword(s):  
Kidney Biopsy ◽  
Cytotoxic T Lymphocyte ◽  
Checkpoint Inhibitors ◽  
Kidney Injury ◽  
Complete Recovery ◽  
Acute Interstitial Nephritis ◽  
University Hospital ◽  
Induction Treatment ◽  
Renal Lesion ◽  
Solid Organ

Abstract Background and Aims Checkpoint inhibitors (CPI) are used to treat solid organ metastatic malignancies. They act on by triggering a vigorous immune response against tumoral cells, preventing their proliferation. CPIs reinvigorate antitumor immune responses by interrupting co-inhibitory signaling pathways and promote immune-mediated elimination of tumor cells.This is not a selective response, deriving in immune related adverse events (irAEs). The kidney can potentially be damaged with an incidence of 13-29%. The most frequent type of toxicity is acute interstitial nephritis (AIN). Method We evaluated all the patients with solid organ metastatic malignancies treated with immunotherapy that developed acute renal injury (AKI) and underwent to kidney biopsy from March 2018 to November 2019 at Vall d’Hebron University Hospital. Results 11 patients with solid organ metastatic malignancies treated with immunotherapy developed AKI and underwent to kidney biopsy during the study period. The most frequent malignancy was lung cancer - in 6 patients-, followed by 3 patients with melanoma. 8 patients (72%) had already received previous oncological therapy, and for the remaining 3 patients (27%), CPI was the first line therapy. 8 patients (72%) were treated with anti-PD1 (programmed cell death protein 1), 4 patients (36 %) received anti PDL-1 (programmed death-ligand 1) 1 of these patients in combination with an anti CTLA-4 (cytotoxic T-lymphocyte antigen 4) and another patient received both anti PD1 and anti PDL-1. The time between the start of CPI and the onset of the AKI ranged between 2-11 months. The most frequent urine findings were subnephrotic range proteinuria with a mean protein/creatinine (mg/g creatinine) 503.6 ± 190.5 and leukocyturia in 9 of 11 patients. Mean creatinine (mg/dl) at diagnosis was 3.4 ± 1.3. 10 out of the 11 patients were diagnosed of AIN after performing a kidney biopsy. The remaining patient presented chronic changes (IFTA and glomerulosclerosis) in the biopsy, performed after receiving steroids for a month. 3 patients who presented AIN received pulses of methylprednisolone 250-500mg as induction treatment and 7 patients received prednisone 1mg/kg/day. Mean prednisone accumulated dose (mg) during the first month of treatment was 1387.5 ± 540. 9 patients experienced complete recovery of kidney function and two patients progressed to CKD. Conclusion We reported 11 patients who presented AKI associated to CPI treatment and underwent to kidney biopsy in the last 20 months at our center. 10 out of 11 presented biopsy confirmed CPI related AIN. In our experience, CPI related AIN is the most frequent renal lesion associated to the novel immunotherapy treatments. This entity seems to have good renal prognosis as long as steroid treatment is early started.

Acute interstitial nephritis: New agents for an old entity

2020 ◽  
Vol 4 (3) ◽  
pp. 100-104
Author(s):  
Filipa Cardoso ◽  
Rui Barata ◽  
David Navarro ◽  
Marco Mendes ◽  
Mário Góis ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Protein Kinase ◽  
Kidney Function ◽  
Interstitial Nephritis ◽  
Kidney Injury ◽  
Acute Interstitial Nephritis ◽  
Mitogen Activated Protein Kinase ◽  
Dermatologic Toxicity ◽  
Mitogen Activated Protein ◽  
Protein Kinase Kinase

A 73-year-old male diagnosed with metastasized malignant melanoma was started on combined therapy with dabrafenib and trametinib, but soon admitted with gastrointestinal intolerance. Blood tests revealed toxic hepatitis and acute kidney injury. Renal duplex Doppler ultrasound ruled out urinary and vascular obstruction and apart from a positive antinuclear antibody, other tests for acute kidney injury assessment were unremarkable. Urinary sediment microscopy showed dysmorphic red blood cells, in addition to yellow-pigmented casts. Kidney biopsy revealed signs of acute tubular necrosis and acute interstitial nephritis. Kidney function declined further, prompting the need for urgent hemodialysis. Treatment with dabrafenib and trametinib was stopped and corticosteroids were initiated, with a rapid beneficial effect on both the kidney function and liver toxicity. Hemodialysis was stopped after four sessions with a full recovery after 2 months of corticosteroids, with the dose being slowly tapered. Unfortunately, the patient died a few months later due to melanoma progression. Dual therapy with the combination of a B-Raf proto-oncogene inhibitor with a mitogen-activated protein kinase kinase inhibitor improves response rates and has been recently approved by the U.S. Food and Drug Administration, and while dermatologic toxicity is a common adverse effect, the association with acute renal failure has seldom been reported. To the best of our knowledge, there are only two published case reports of acute kidney injury in patients treated with combination of dabrafenib and trametinib and only one of them is biopsy proven. Further studies evaluating the incidence of acute kidney injury with the combination of B-Raf proto-oncogene and mitogen-activated protein kinase kinase inhibitors are warranted, and may provide new insights into the mechanisms underlying renal toxicity.

scholarly journals Biopsy-Proven Acute Tubular Necrosis due to Vancomycin Toxicity

2011 ◽  
Vol 2011 ◽  
pp. 1-4 ◽  
Author(s):  
Farheen Shah-Khan ◽  
Marc H. Scheetz ◽  
Cybele Ghossein
Keyword(s):  
Acute Kidney Injury ◽  
Interstitial Nephritis ◽  
Acute Tubular Necrosis ◽  
Kidney Injury ◽  
Acute Interstitial Nephritis ◽  
Etiologic Factor ◽  
Clinical Use ◽  
Tubular Necrosis

Vancomycin (VAN) has been associated with acute kidney injury (AKI) since it has been put into clinical use in the 1950's. Early reports of AKI were likely linked to the impurities of the VAN preparation. With the advent of the more purified forms of VAN, the incidence of AKI related to VAN were limited to acute interstitial nephritis (AIN) or as a potentiating agent to other nephrotoxins such as Aminoglycosides. VAN as the sole etiologic factor for nephrotoxic acute tubular necrosis (ATN) has not been described. Here, we report a case of biopsy-proven ATN resulting from VAN.

Cancer drugs and the glomerulus

2018 ◽  
Vol 2 (2-3) ◽  
pp. 78-91 ◽  
Author(s):  
Hitesh H Shah ◽  
Nupur N Uppal ◽  
Mark A Perazella
Keyword(s):  
Kinase Inhibitors ◽  
Kidney Injury ◽  
Acute Interstitial Nephritis ◽  
Renal Outcome ◽  
Cancer Drugs ◽  
Glomerular Diseases ◽  
Patients With Cancer ◽  
Tubular Necrosis ◽  
Glomerular Lesions ◽  
Endothelial Growth Factor

Several chemotherapeutics including novel immunotherapies and targeted therapies have recently been approved for the treatment of various cancers. Several nephrotoxicities secondary to treatment with chemotherapeutics have been described in patients with cancer. Acute kidney injury from acute tubular necrosis and acute interstitial nephritis is commonly reported nephrotoxicities following treatment with cancer drugs. Although less common, several glomerular lesions include minimal change disease, collapsing and non-collapsing focal segmental glomerulosclerosis secondary to chemotherapy-related podocyte injury have been reported in the literature. In addition to conventional chemotherapeutics, several novel cancer drugs including immune point check inhibitors, anti-vascular endothelial growth factor inhibitors, and tyrosine kinase inhibitors have also been associated with various glomerular lesions. While the occurrence of glomerular toxicities related to cancer drugs is less common than tubular injury, failure to recognize these associations may lead to poor renal outcome. In this article, we review several chemotherapy-related glomerular diseases including thrombotic microangiopathy.

Sign in / Sign up

Export Citation Format

Share Document