Rhabdomyolysis and acute renal failure in a child with influenza A infection

A 13-year-old previously healthy girl developed rhabdomyolysis and acute renal failure during influenza A infection. The patient recovered renal function completely with supportive therapy. This complication has been described in adult patients, but progression to acute renal failure in this context has not been reported previously in children. This diagnosis should be considered in the differential diagnosis of a pediatric patient presenting with acute renal failure and viral symptomatology. Received July 16, 1996; received in revised form and accepted November 6, 1996     

C-reactive protein in acute renal failure

This paper demonstrates the utility of C-reactive protein (CRP) in the diagnosis of infection in patients with acute renal failure. C-reactive protein can be assayed using plasma as effectively as using serum, thus avoiding the problems of microclots in serum, which can occur in samples from a heparinised patient. Plasma concentrations of C-reactive protein are unaffected by the process of haemodialysis. In the complicated setting of the severely ill patient with acute renal failure, infection remains the most common cause of death and its detection is often difficult. The use of C-reactive protein assay in this setting is illustrated by data from 20 patients, and two representative cases are described in detail. It is recommended that C-reactive protein be assayed daily to aid in the detection of infection in patients with acute renal failure.     

Acute renal failure due to rhabdomyolysis after proximal humerus fracture associated with axillary artery rupture

The anatomical proximity of axillary artery to the humeral head makes it quite vulnerable to blunt trauma during shoulder injury. Axillary artery rupture and prolonged ischemia may lead to rhabdomyolysis and acute renal failure. Herein we present a case of a patient who sustained proximal humerus fracture associated with axillary artery rupture and acute renal failure due to rhabdomyolysis.     

Acute renal failure following multiple wasp stings

We report the cases of two patients who developed acute renal failure following multiple wasp stings. Both patients required dialysis and recovered within 4 weeks. The kidney biopsy from one patient showed acute tubular necrosis with interstitial nephritis. One patient had complete recovery of renal function on follow-up, while the other was lost to follow-up.     

Acute renal failure due to phenazopyridine (Pyridium®) overdose: case report and review of the literature

Phenazopyridine (Pyridium) is a commonly used urinary tract analgesic. It has been associated with yellow skin discoloration, hemolytic anemia, methemoglobinemia, and acute renal failure, especially in patients with preexisting kidney disease. We report a 17-year-old female with vertically transmitted human immunodeficiency virus (HIV) infection, presenting with acute renal failure and methemoglobinemia following a suicidal attempt with a single 1,200 mg ingestion of Pyridium. She had no prior evidence of HIV nephropathy. The patient had a progressive nonoliguric renal failure on the 3rd day following the ingestion. She was treated with N-acetylcysteine, intravenous carnitine, and alkalinization of the urine. Her kidney biopsy revealed acute tubular necrosis with no glomerular changes. After 7 days of conservative management, she was discharged home with normal kidney function. To our knowledge, this is the second smallest amount of Pyridium overdose resulting in acute renal failure with no previous history of kidney disease.     

移植肾切除术后急性心力衰竭合并呼吸衰竭的多学科综合诊疗

目的  探讨多学科综合诊疗（MDT）在移植肾切除术后急性心力衰竭（AHF）合并呼吸衰竭治疗中的作用。方法  对1例突发移植肾出血致失血性休克,行移植肾切除术后2周发生急性心肌梗死（AMI）合并AHF、急性肺淤血、肺部感染、急性呼吸衰竭患者进行MDT讨论,制定治疗方案并进行效果评价。结果  综合MDT讨论意见,给予经鼻高流量氧疗、床旁连续性静脉-静脉血液透析滤过（CVVHDF）降低心脏负荷、抗凝、扩张血管、降低心肌耗氧量、改善心肌重塑、调脂、抗感染及营养支持等综合治疗,临床结局良好,患者恢复规律血液透析治疗。结论  应用MDT模式可为移植肾切除术后AHF合并呼吸衰竭患者制定全面有效的个体化治疗方案,提高临床治疗效果,改善患者预后。     

Choice of dialysis modality for management of pediatric acute renal failure

Acute renal failure in children requiring dialysis can be managed with a variety of modalities, including peritoneal dialysis, intermittent hemodialysis, and continuous hemofiltration or hemodiafiltration. The choice of dialysis modality to be used in managing a specific patient is influenced by several factors, including the goals of dialysis, the unique advantages and disadvantages of each modality, and institutional resources. This review will examine these aspects of acute renal failure management, with the goal of providing practical guidance regarding modality selection to the physician involved in the management of pediatric acute renal failure. Received: 13 July 2001 / Revised: 25 September 2001 / Accepted: 26 September 2001     

Causes and Prognosis of Acute Renal Failure in Elderly Patients

In this retrospective study, 287 patients with acute renal failureobserved between 1980 and 1985 were divided into 2 groups, accordingto age: group 1 of 65 years or more (n = 100) and group 2 between17 and 64 years (n = 187). In both age groups the whole spectrumof causes of acute renal failure was found, but within thatspectrum a higher incidence of post-renal failure, acute renalvascular disease and of hypovolaemic acute renal failure wasnoted in group 1 versus group 2. On the other hand, pigment-inducedacute renal failure was lower in group 1 (4%) versus group 2(13%). The overall survival was 54% in the elderly versus 56% in theyounger patients (NS). A close relationship between survivaland the number of postadmission complications was found in bothgroups. Interestingly, the presence of severe hypokalaemia (<3.5mmmol/l) and metabolic alkalosis (plasma HCO₃>30 mmol/l)was associated with a very high mortality of 73% and 86% respectivelyin the elderly patients. Complete or incomplete recovery ofrenal function was the same in both age groups. It is concludedthat age alone should not be used as a discriminating factorin therapeutic decisions concerning acute renal failure in anolder patient.     

ALPORT SYNDROME: RENAL TRANSPLANTATION AND DONOR SELECTION

A 39-year-old male suffered a myocardial infarction at work and cardiopulmonary resuscitation was initiated immediately. After 15 cardioversions, ventricular fibrillation converted to sinus rhythm. Rhabdomyolysis with a 100-fold increase of serum creatine kinase level and myoglobinuria with acute renal failure ensued, requiring hemodialysis treatment. The patient died and autopsy revealed acute posterior myocardial infarction. Prolonged cardiopulmonary resuscitation involving repeated cardioversion may predispose to myoglobinuric renal failure.     

Acute renal failure in a patient with paroxysmal cold hemoglobinuria

Acute renal failure following auto-immune hemolysis is rare. We report a child with acute paroxysmal cold hemoglobinuria (PCH) complicated by renal failure. She was treated by peritoneal dialysis and red blood cell transfusion. After 2 weeks she had made a complete recovery with a normal blood count and renal profile, and the peritoneal dialysis catheter was removed. Extensive investigation, including an analysis of heme oxygenase-1 gene promoter region polymorphisms, failed to identify a cause for the renal failure in this patient.     

ACUTE RENAL FAILURE IN NEUROLEPTIC MALIGNANT SYNDROME

We report a patient with neuroleptic malignant syndrome (NMS) who developed acute renal failure and was successfully treated by hemodialysis. A 60-year-old man with a 26-year history of schizophrenia had been treated with thioridazine and sulpiride. He was admitted to our hospital for muscular rigidity and oliguria. After the diagnosis of NMS with acute renal failure was established, thioridazine and sulpiride were discontinued and hemodialysis was instituted. Renal function gradually improved and hemodialysis was discontinued after 17th treatment. We also reviewed 57 cases of NMS with acute renal failure reported in the literature. To our knowledge, 26 years is the longest latency between initiation of neuroleptic drug treatment and onset of NMS. Our review of reported NMS cases with acute renal failure identified those risks for poor prognosis as high level of BUN, age and female gender.     

Acute renal failure after prolonged pneumoperitoneum in robot-assisted prostatectomy: a rare complication report

Robot-assisted surgery has been used widely in urological surgery since 2000. In Taiwan, robotic surgery started in 2004 and progress has been ongoing since this time. Herein we report a case of acute renal failure post robot-assisted radical prostatectomy. The patient received postoperative hemodialysis and intensive care. The renal function recovered to a serum creatinine level of 2.0 mg/dl 2 months after surgical intervention. The renal function was still normal and the PSA level was nadir after one-year follow-up. The outcome is encouraging from the point of view of oncology. To our knowledge, this is the first report of postoperative acute renal failure in robotic surgery.     

Acute renal failure after exercise in a child with renal hypouricaemia

We describe a 12-year-old boy with renal hypouricaemia who presented with acute renal failure after a 6-h sports training session. Back and loin pain were noted at presentation. Although serum creatinine and blood urea nitrogen were elevated, the serum uric acid concentration was normal (2.6 mg/dl). This decreased to 0.3 mg/dl after recovery. The pyrazinamide and probenecid tests revealed that the cause of renal hypouricaemia in this patient was totally defective uric acid reabsorption. Acute renal failure after exercise is a rare but serious complication in paediatric patients with renal hypouricaemia.     

Intensive care treatment of severe mixed metabolic acidosis

We report a case of severe metabolic acidosis associated with acute renal failure and septicaemia following treatment with maximal therapeutic doses of metformin and diclofenac. On the second day of intensive care the patient deteriorated with respiratory insufficiency and abdominal pain during continuous renal replacement therapy. A laparoscopy revealed a perforated cholecystitis with abscess formation. The patient regained renal function and recovered. Intake of diclofenac 5 days before this episode could have been the main cause of renal insufficiency and metabolic acidosis in this patient and could also have delayed surgical treatment by masking early clinical signs of perforated cholecystitis. The renal failure may also have caused metformin and lactate to accumulate, contributing to the mixed pattern of metabolic acidosis. This case report describes a mixed organic and non-organic metabolic acidosis associated with acute renal failure, presumably resulting from a combination of drugs and diseases often found in the elderly - metformin for diabetes mellitus and a non-steroidal anti-inflammatory drug for cholecystolithiasis. Acid-base balance and electrolyte changes were rapidly normalized by continuous renal replacement therapy.     

Acute renal failure after massive ingestion of gliclazide in a suicide attempt

Gliclazide, a sulfonlyurea class molecule, is used to control glycaemic levels in non insulin-dependent diabetes mellitus. Acute and chronic toxicity studies, conducted in various animal species, have demonstrated a very low toxicity. We report a patient who developed acute renal failure due to acute tubular necrosis following a massive ingestion of gliclazide in an suicide attempt. The patient ingested 28 grams of gliclazide; the normal dose of gliclazide is 80 mg one or twice a day. Al admission the patient was hypoglycaemia and in a few days became oliguric with an increase in the serum creatinine concentration, but with a normal blood urea nitrogen level. He underwent dialysis and ten days after ingestion of gliclazide, his renal function improved rapidly.     

Renal Syndromes in the Acquired Immunodeficiency Syndrome (AIDS): Lessons Learned from Analysis Over 5 Years

Renal syndromes associated with the Acquired immunodeficiency syndrome include: potentially reversible acute renal failure, AIDS associated nephropathy which leads to end stage renal disease, and AIDS developing in patients who are being treated by maintenance hemodialysis. The longitudinal study of 95 patients with AIDS and various forms of renal syndrome at two urban institutions indicates that both acute and chronic renal failure is increasing yearly. While some patients with acute renal failure recover renal function and survive for prolonged period, the mortality of dialyzed patients with irreversible renal failure continues to be unsatisfactory. There is a great need for collecting data from high risk areas to analyze the results of maintenance dialysis therapy in patients with AIDS, to assess the economic impact of uremia therapy, and for long-term planning of available resources.     

Acute Renal Failure Complicating Severe Acute Pancreatitis

The records of 563 patients admitted to the hospital with diagnosis of acute pancreatitis have been studied retrospectively. The aim of the study was to investigate the prevalence of acute renal failure (ARF) in these patients, and to evaluate the most important risk factors for ARF development and mortality. The prevalence of ARF in studied population was 14%, but only 3.8% of ARF patients with acute pancreatitis had isolated renal failure. Other patients had additional failure of other organ systems, 68.4% of whom had multiorgan failure (MOF) before the onset of ARF. In only 8.9% of ARF patients was the renal system the first organ system to fail. Patients with ARF were significantly older, had more preexisting chronic diseases (including chronic renal failure), usually had MOF, and local pancreatic complications relative to these in the group with normal renal function. The development of ARF was directly influenced by severity of acute pancreatitis. The mortality rate in ARF patients was 74.7%, compared to an 7.4% mortality of patients with acute pancreatitis and normal renal function. Preexisting chronic disease, the presence of MOF and their number, local pancreatic complications, and older age of the patients increased mortality in ARF patients. The prognosis of patients with oliguric ARF requiring renal replacement therapy was extremely poor, indicating the importance of prevention of ARF in the patients with acute pancreatitis.     

Legionella infection with acute renal failure and thrombocytopenia mimicking allograft rejection: A pitfall in post-transplantation diagnosis

Abstract. A patient is described who developed cavitary Legionella pneumonia 2 weeks after kidney transplantation. The initial pulmonary symptoms were followed by severe thrombocytopenia and acute renal failure. Although acute irreversible graft rejection was suspected, this was not supported by the pathology findings in the resected kidney, which were compatible with tubular damage. We presume that the extrapulmonary symptoms were caused by Legionellosis.     

Acute liver failure due to leptospirosis successfully treated with MARS (molecular adsorbent recirculating system) dialysis

Background Leptospirosis is a re-emerging infectious disease, which may lead to multiple organ failure (MOF)and death. Case presentation We report the first case of severe leptospirosis complicated with acute renal and liver failure, successfully treated with albumin dialysis––molecular adsorbent recirculating system (MARS). Despite antibiotic therapy, optimum medical supportive treatment and timely initiated haemodialysis, the outcome was complicated by severe liver failure: hepatic encephalopathy grade III, hypoglycemia, prominent hyperbilirubinemia (TBIL 31.3 mg/dl, DBIL 28.6 mg/dl)and hepatic cytolysis (ALT 535 IU/l, AST 179 IU/l) and prolongation of the prothrombine time (68.4 sec). The patient underwent two sesions of albumin dialysis with the MARS procedure with complete recovery of hepatic and renal function. Conclusion Albumin dialysis may confer a significant survival benefit on patients with leptospirosis-induced acute liver failure (ALF).