Online ISSN: 2515-8260

Keywords : Acute kidney injury


Acute kidney injury in patients hospitalised with acute decompensated heart failure

Dr.Harender Kumar, Dr.AmitJohari, Dr.Nikita Gupta, Dr. P S NAYYER

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 3, Pages 562-570

Background
Cardiorenal syndrome (CRS) is not a newly discovered syndrome. The adverse outcomes of
the renal impairment in patients with Heart failure were known since long. Our aim in this
study was to evaluate the occurrence of AKI, to determine the outcome (morbidity and
mortality) in patients suffering with AKI.
Methods
The present observational prospective study was conducted for a duration of 1 yearamong
100 patients (age 18 years or more) admitted to hospital with acute decompensated heart
failure.A written informed consent taken from each patient and were then screened for
cardiac dysfunction by a detailed history, clinical examination and
echocardiography.Univariate logistic regression was used to find out association of various
outcomes with AKI. A p value of <0.05 was considered statistically significant.
Results
The mean age of the study population was 58.98 ± 17.16 years. The mean Boston criteria for
the population was 9.87 ± 1.36. Baseline S. creatinine, eGFR and even B. Urea were strongly
associated with the occurrence of AKI. Presence of diastolic dysfunction was associated with
AKI. Mortality and readmission were significantly higher in AKI group as compared to non-
AKI group.The predictive value of AKI was maximum with the baseline S. creatinine.
Conclusion
Cardio-renal syndrome is a commonly seen in patients admitted in hospital. AKI can lead to
poor cardiac output or pre-renal failure as a result of overuse of diuretics. The mechanism
involved is complex. AKI in patients admitted with ADHF has poor prognosis with increased
mortality and longer duration of hospital stay.

Risk factors of Acute Kidney Injury and outcome of children affected with AKI

Rekha Arer ,Jitendra L Chukkanakal ,Jayaraj Patil ,Venkatesh G .

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 3, Pages 3096-3104

Background: The etiology of AKI in children varies in developed and developing countries. in the former, AKI follows major surgeries, complications associated with malignancies, and the use of nephrotoxic drugs. Objectives: to identify the risk factors of AKI and to see the outcome of children affected with AKI.
Material & Methods: This Prospective, observational study was conducted among 250 children aged between 1 month-12 years, admitted in the Pediatric Intensive Care Unit in Government General Hospital; Siddhartha Medical College; Vijayawada Results: The minimum age at enrollment was one month to 12 years of age. The comparison between the two groups based on gender was not significant (P=0.1873). None of the patients in the non-AKI group required dialysis, but in the AKI group, of the 44cases, nine case needed dialysis. The number of dialysis is highly significant, with P

Comparative evaluation of AKIN, KDIGO and pRIFLE criteria and urinary biomarkers in prediction of AKI following cardiopulmonary bypass(CPB-AKI) in children

Bhattacharjee Aniruddha, Narender Sharma, Anup Kumar Acharya, Patnaik SK,Ramamurthy HR .

European Journal of Molecular & Clinical Medicine, 2021, Volume 8, Issue 4, Pages 1790-1798

Introduction: Acute Kidney Injury (AKI) following surgery for congenital heart disease
with cardiopulmonary bypass (CPB-AKI) is fairly common. Limited studies have compared
newer definitions of AKI in relation to early non-invasive urinary biomarkers for
prediction of post CPB AKI. We sought to evaluate a) incidence using pediatric RIFLE,
AKIN and KDIGO criteria, b) utility of urinary protein creatinine ratio (UPCR), modified
urine microscopy score and NGAL as predictive early AKI biomarkers and c) risk factors
for post CPB-AKI in children with CHD.
Material & Methods: Serial blood and urine samples were collected for all children (2 mo-
18 y) undergoing congenital heart surgery with cardiopulmonary bypass between Nov
2017 to Apr 2019 at pre surgery,6,24, 48 hrs and day 7, day 30. Incidence of AKI was
calculated as per standard definitions. Urine samples were analysed for UPCR
and NGAL in the supernatant and the sediments were microscopically analysed to derive a
modified urine microscopy score. Risk factors predisposing to AKI were analysed by
multivariate analysis. ROC analysis was done for urinary biomarkers taking KDIGO as
gold standard definition of AKI.
Results: Amongst 76 children with CHD, incidence of AKI was 51% with AKIN/KDIGO
criteria and 55% with pRIFLE criteria. Urinary NGAL rose within 6 hrs of CPB. A cut-off
>84 ng/ml had 95% specificity with only 45% sensitivity (AUC-ROC 0.71). At 24 hrs, urine
PCR was significantly high (AUC-ROC 0.7686) while urine microscopy score was similar
in cases who developed AKI. Ventilation >48 hrs, exposure to multiple antibiotics and
sepsis were significantly associated with AKI.
Conclusion: Combination of pRIFLE with AKIN/KDIGO increased detection of post CPB
AKI by 4%. In our cohort urinary NGAL at 6 hours and UPCR at 24 hours had a moderate
predictive value.

Urinary Tissue Inhibitor of Metalloproteinases-2 as Early Biomarker of Acute Kidney Injury after Cardiac Surgery

Esam El–Din Mahmoud Lotfy Omar MD, Adel Abd El-Mohsen Ghorab MD, Heba S. Abdel-Aziz Assal MD, LamiaaAbd El-Wahab Mohamed, Emad A. William, Maii Mahmoud Ahmed Temraz

European Journal of Molecular & Clinical Medicine, 2021, Volume 8, Issue 3, Pages 3759-3770

Background: Tissue inhibitor of metalloproteinase-2 (TIMP-2) is a member of the
matrix metalloproteinase family, inducer of G1 cell cycle arrest, it is a marker of
cellular stress in the early phase of tubular cell injury caused by a wide variety of
insults
Aim and objectives: The aim of this work was to study if urinary TIMP-2 can be used
as one of early biomarkers of acute kidney injury after cardiac surgery.
Subjects and Methods: This was cross sectional study was conducted in collaboration
between the Internal Medicine, Cardiothorathic and Clinical pathology departments,
Faculty of Medicine, Zagazig University Hospitals. A total number of 50 patients
were included and classified into two main groups: Group I : included 25 patients
who undergone coronary artery bypass graft. Group II: included 25 patients who
undergone valve replacement surgery. The patients were reclassified after the
procedure into two groups: AKI group: defined on 24 h creatinine level elevation
either by 25% of the basal level or by 0.3 mg/dl above the basal level. No AKI group:
No rise of the serum creatinine level after 24 hours of the operation. The duration of
the study ranged from12- 18 months.

Renal Protective Effect Of Vitamin D3 In Isoproterenol-Induced Myocardial Infarction In Rats

Akmal Ahmed Hassan Diab, MD; Khaled Abdelfattah Abulfadle; MD; Nourelhuda A. Mohammed; MD and Fatma NabilHashim

European Journal of Molecular & Clinical Medicine, 2021, Volume 8, Issue 2, Pages 1341-1357

Acute kidney injury is a common complication of myocardial infarction (MI) and scarce data were available on the effect of vitamin D3 on heart and kidney functions in MI. In this study, we investigated the potential protective effect of vitamin D3 on cardiorenal functions in isoproterenol-induced MI in rats and the possible mechanisms involved. It was shown that in MI rats, there was a significant increase in serum levels of (creatine kinase myoglobin binding, lactate dehydrogenase, creatinine, malondialdehyde, interlukin-6 and tumor necrosis factor alpha) and urine levels of (total protein and albumin), with a significant decrease in urine creatinine level, creatinine clearance and serum levels of [reduced glutathione and 1, 25 dihydroxy vitamin D] in comparison with
the control rats. On treatment of rats with vitamin D3 prior to induction of MI, thesebchanges were significantly improved in comparison with the MI rats. Histopathologicalband immunohistochemical examinations of heart and kidney in MI rats reflected the deterioration in their structures with presence of marked apoptosis which were ameliorated on treatment of rats with vitamin D3 prior to induction of MI. In conclusion, vitamin D has a protective effect on heart and kidney functions in the rat model of myocardial infarction and this beneficial effect could be related to its anti-inflammatory, antioxidant and anti-apoptoticactions.

Renal Protective Effect of Vitamin D3 in Isoproterenol-Induced Myocardial Infarction in Rats.

Akmal Ahmed Hassan Diab, MD; Khaled AbdelfattahAbulfadle, MD; Nourelhuda A. Mohammed, MD; Fatma NabilHashim

European Journal of Molecular & Clinical Medicine, 2021, Volume 8, Issue 2, Pages 1928-1944

Acute kidney injury is a common complication of myocardial infarction (MI) and
scarce data were available on the effect of vitamin D3 on heart and kidney functions in MI. In
this study, we investigated the potential protective effect of vitamin D3 on cardiorenal
functions in isoproterenol-induced MI in rats and the possible mechanisms involved. It was
shown that in MI rats, there was a significant increase in serum levels of (creatine kinase
myoglobin binding, lactate dehydrogenase, creatinine, malondialdehyde, interlukin-6 and
tumor necrosis factor alpha) and urine levels of (total protein and albumin), with a significant
decrease in urine creatinine level, creatinine clearance and serum levels of [reduced
glutathione and 1, 25 dihydroxy vitamin D] in comparison with the control rats. On treatment
of rats with vitamin D3 prior to induction of MI, these changes were significantly improved in
comparison with the MI rats. Histopathological and immunohistochemical examinations of
heart and kidney in MI rats reflected the deterioration in their structures with presence of
marked apoptosis which were ameliorated on treatment of rats with vitamin D3 prior to
induction of MI. In conclusion, vitamin D3 has a protective effect on heart and kidney
functions in the rat model of myocardial infarction and this beneficial effect could be related
to its anti-inflammatory, antioxidant and anti-apoptoticactions