جستجوی مقالات مرتبط با کلیدواژه « Acute Renal Injury » در نشریات گروه « پزشکی »

Rhabdomyolysis, a potentially life-threatening condition, occurs when myoglobin is released from damaged muscle cells, leading to acute kidney injury (AKI). Alpha lipoic acid (ALA), an organosulfur compound known for its anti-oxidant and anti-inflammatory properties, was examined in this study for its potential impact on rhabdomyolysis-induced AKI in rats. 

Six groups of rats were included in the study, with each group consisting of six rats (n=6): Control, rhabdomyolysis, rhabdomyolysis treated with different doses of ALA (5, 10, and 20 mg/kg), and ALA alone (20 mg/kg) groups. Rhabdomyolysis was induced by intramuscular injection of glycerol on the first day of the experiment, while ALA was administered intraperitoneally for four consecutive days. Renal function parameters, oxidative stress markers, and histological changes in the kidneys were evaluated. Western blot analysis was performed to measure the levels of neutrophil gelatinase-associated lipocalin (NGAL) and tumor necrosis factor-alpha (TNF-α) proteins.

A significant increase in serum urea, creatinine, renal malondialdehyde, NGAl, and TNF-α protein levels was observed in glycerol-injected rats. In addition, a significant decrease in glutathione was recorded. Compared to the rhabdomyolysis group, treatment with ALA recovered kidney histological and biochemical abnormalities. 

Results suggest that rhabdomyolysis-induced AKI is associated with increased oxidative stress and inflammation. Treatment with ALA improved kidney histological abnormalities and reduced oxidative stress markers in rats. Therefore, ALA may have a potential protective effect against rhabdomyolysis-induced AKI.

Ureteral injuries complicate 0.5-1% of pelvic surgeries in both genders. Diagnosis is usually delayed due to subtle presentation, causing accumulation of urea in the blood and acute renal injury. This prevents physicians from using contrast-based imaging modalities to locate the site of ureteral defect. We aim to reinforce the importance of renal scintigraphy in patients with ureter injury and coexisting renal functional compromise. Two cases of iatrogenic ureter injury and one case of a urinary leak following renal transplantation are presented. All three cases presented with increased creatinine level (due to delayed diagnosis) which made a CT scan, or intravenous pyelogram contraindicated. We used a Technetium-99m-L,L-ethylenedicysteine ([99mTc]Tc-EC) renal scan to locate the site of the ureteral defect without adversely affecting the renal function. In conclusion, [99mTc]Tc-EC is mainly excreted from nephron tubules and can be used in patients with decreased glomerular filtration rate with no additional harm to the kidney including in patients with delayed diagnosis of iatrogenic ureteral defect leading to acute kidney injury (AKI). While the CT scan or IVP was contraindicated, the [99mTc]Tc-EC renal scan located the ureteral defect without compromising kidney function, as [99mTc]Tc-EC is mainly excreted from nephron tubules and can be safely used in patients with AKI.

Sepsis is an important risk factor for the development of acute renal injury (ARI) among patients admitted to the intensive care unit (ICU). There are limited studies showing that increased uric acid level is an important risk factor for the development of ARI. The present study was carried out to find out whether increased basal uric acid levels play an important role in predicting the development of ARI and whether it could be used as a biomarker for this.

This retrospective study included patients aged ≥ 18 years who were admitted to the ICU of Yüzüncü Yıl University Medical Faculty Hospital from September 2018 to December 2020. Group 1 comprised 100 patients developing ARI and group 2 comprised 110 patients who did not develop ARI. Laboratory test values and Simplified Acute Physiologic Score II (SAPS II) data on the first day of ICU admission were obtained from archive records.

During the 10-day follow-up of patients included in the study, the ARI development rate was 57.3%. Basal serum uric acid levels were higher in group 1 compared to group 2 (P = 0.001). Based on the results of the multivariate logistic regression analysis, basal serum uric acid values and albumin and SAPS II values had independent correlations with ARI (P < 0.001).

We believe that increased basal uric acid levels examined in patients admitted to the ICU with sepsis diagnosis may be an important biomarker for the prediction of ARI.

The study was aimed to investigate the effects and potential mechanisms of Dexmedetomidine (Dex) on hypoxia/reoxygenation (H/R) injury in human renal tubular epithelial HK-2 cells.

In this experimental study, HK-2 cells were divided into four groups: control group, Dex group, H/R group, and Dex+H/R group. The cells in control group received no treatment, and cells in Dex group were only treated with 0.1 nmol/L Dex. The cells in H/R group and Dex+H/R group were all treated with H/R (hypoxia for 24 hours and normoxia for 4 hours), and only the cells in Dex+H/R group were pre-administrated with 0.1 nmol/L Dex. Following treatments at 37˚C for 28 hours, cell viability and apoptosis were measured by MTT assay and flow cytometry, respectively. Also, the expressions of hypoxia-inducible factor 1 (HIF-1α), glucose-regulated protein 78 (GRP78), C/EBP homologous protein (CHOP), caspase-12 and cleaved caspase-3 were determined by western blot.

The cell viability was significant decreased in H/R group compared with control group (P<0.05), while was significantly increased in Dex+H/R group compared with that in H/R group (P<0.05). However, the change tendency of the cell apoptosis was opposite to that of cell viability. Compared with H/R group, the expression of HIF-1α was evidently up-regulated, while GRP78, CHOP, capase-12 and cleaved caspase-3 expressions were all obviously down- regulated in Dex+H/R group (P<0.05). In addition, the concentrations of malondialdehyde (MDA) in H/R group and Dex+H/R group were 1.68 ± 0.22 nmol/mgprot and 0.85 ± 0.16 nmol/mgprot, respectively. The superoxide dismutase (SOD) activity was higher in Dex+H/R group (121 ± 11 U/L), which which was more than twice larger than that in H/R group (57 ± 10 U/L).

Dex could promote cell viability and inhibit apoptosis through up-regulating HIF-1α, reducing endoplasmic reticulum (ER) stress and mediating oxidative stress, thus ameliorating the H/R injury.

 Contrast-induced nephropathy (CIN) is the most common cause of iatrogenic acute kidney injury, happens more commonly in patients with underlying kidney diseases. It has been shown that oxidative stress is the main mechanism of contrast nephropathy. Curcumin is suggested as an herbal antioxidant agent, thus we decided to assess the effect of curcumin in preventing this complication in patients with underlying chronic kidney disease who need coronary angiography.

 We conducted double blind, placebo-controlled clinical trial in 60 moderate to severe CKD patients who underwent coronary angiography or angioplasty. Adjusted dose of Iodixanol was used as contrast agent in all of them. Curcumin or placebo administered orally, 1.5 g daily from 2 days before procedure to 3 days after it. CIN was defined by an increased serum creatinine ≥ 0.3 mg/dL or an increase to ≥ 1.5 times of the baseline within 48 hours after procedure.

CIN occurred in 12 (20%) of patients, 5 (16.7%) in Curcumin group and 7 (23.3%) in placebo group (OR = 0.56, 95% CI = 0.18 to 2.36; P > .05). Serum Creatinine was increased after 72 hours of intervention from 1.65 ± 0.26 mg/dL to 1.79 ± 0.33 mg/dL in Curcumin group and from 1.61 ± 0.23 mg/dL to 1.86 ± 0.35 in placebo group. No significant difference was seen between the mean increase of serum creatinine in two groups (difference of 0.006 mg/dL, 95% CI = - 0.06 to 0.08; P > .05). Conclusion. Prophylactic oral Curcumin could not show protective effects on CIN in high-risk patients who have undergone coronary procedures

Treatment of multi-drug-resistant strains of pneumonia with common antibiotics in renal patients is ineffective and physicians are compelled to use Colistin for such cases.

This study was conducted to assess the mortality, length of stay, and renal damages in the treatment of multi-drugresistant pneumonia with Colistin among multiple trauma patients admitted to the emergency department and transferred to the ICU.

This retrospective cohort study was conducted between 2011 and 2016. 102 multiple trauma (MT) patients with multidrug-resistant strains of hospital-acquired pneumonia (HAP) admitted to the emergency department then transferred to the ICU were assessed. All patients received Colistin according to their weight. Renal damage was evaluated according to the RIFLE criteria. The mortality and the length of stay were assessed. In order to statistically analyze the data, SPSS version 23 software was used to conduct t-test and chi-square test.

Out of 102 patients, 55 (54%) died and 50 (49.1%) developed acute renal failure; 64 cases had no hypertension. Patients according to the RIFLE index were assessed: Risk (11.01%), Injury (14%), Failure (18%), Loss (6%), and End-stage renal disease. The prevalence and prognosis of acute kidney injury in multiple trauma patients treated with Colistin were significantly correlated with drug dosage, body mass index, and use of corticosteroids (when assessed using relevant scoring systems, P < 0.05).

The use of a scoring system in the intensive care unit, determining those patients requiring Colistin, and adjusting the dosage of this drug for treatment of MT patients with multi-drug resistant strains of HAP are vital. Creatinine levels must be carefully monitored.

Postoperative pain-management with non-steroid anti-inflammatory drugs has been controversial, due to related side-effects. We investigated whether there was a significant difference between an oxycodone-based pain-management regimen versus a slow-release ibuprofen based regimen, in a short term post-cardiac surgery setting. Particular attention was given to the rate of myocardial infarction, sternal healing, gastro-intestinal complications, renal failure and all-cause mortality. This was a single-centre, open label parallel design randomised controlled study. Patients, who were undergoing cardiac surgery for the first time, were randomly allocated either to a regimen of slow-release oxycodone (10 mg twice daily) or slow-release ibuprofen (800 mg twice daily) combined with lansoprazole. Data relating to blood-tests, angiographies, surgical details and administered medicine were obtained from patient records. The follow-up period was 1 to 37 months (median 25 months). One hundred eighty-two patients were included in the trial and available for intention to treat analysis. There were no significant difference between the groups (P>0.05) in the rates of sternal healing, postoperative myocardial infarction or gastrointestinal bleeding. The preoperative levels of creatinine were found to increase by 100% in nine patients (9.6%) in the ibuprofen group, resulting in an acute renal injury (in accordance with the RIFLE-criteria). Eight of these patients returned to normal renal function within 14 days. The levels of creatinine in patients in the oxycodone group were not found to increase to the same magnitude. The results of this study suggest that patients treated postoperatively, following cardiac surgery, are at no greater risk of harm if short term slow release ibuprofen combined with lansoprazole treatment is used when compared to an oxycodone based regimen. Renal function should, however, be closely monitored and in the event of any decrease in renal function ibuprofen must be discontinued.

Acute renal damage mainly develops following toxic or ischemic insults and is defined as acute. These damages have largely been attributed to oxidative stress. Recently much attention has been directed toward decreased renal tubular cell regeneration during tubular cell injury. Antioxidants have recently been the focus of researchers and scientists for prevention and treatment of various oxidative stress-related conditions, including renal toxicities. Although free radicals are known to contribute in kidney injury and abundant researches, particularly laboratory trials, have shown the beneficial effects of antioxidants against these complications, long term clinical trials do not uniformly confirm this matter, especially for single antioxidant consumption such as vitamin C. The aim of this paper is to discuss the possible explanation of this matter.