Hair Dye Related Acute Kidney Injury – A Clinical and Experimental Study

We studied paraphenylenediamine (PPD)-related acute kidney injury (AKI) in 81 patients and also in albino rats experimentally. In the patients’ group AKI was found in 32.7%. Of them, 81.4% needed dialysis support. The overall mortality was 25.9%. In experimental rats the renal lesions were noted in all and they were glomerular congestion, intertubular (interstitial) hemorrhages, acute tubular necrosis, mesangial proliferation, and intratubular casts. The severity of renal injury appears to be dose dependent.     

住院患者急性肾损伤的发病及预后相关危险因素分析

目的 探讨住院患者急性肾损伤（AKI）的发病及预后情况,寻找与预后相关的危险因素,为临床更好地认识和预防AKI,改善预后提供依据。 方法 应用医院实验室网络系统筛选2009年1月至12月上海市一家三级甲等综合性医院所有住院患者,应用急性肾损伤网（AKIN）推荐的AKI定义选择病史完整的AKI患者组成研究队列,回顾性分析AKI住院患者的发病率、病因及分布特点、患者及肾脏预后情况。Logistic回归分析影响住院AKI患者预后和肾脏预后的危险因素。 结果 符合入选标准的住院AKI患者共934例,住院患者的AKI发病率为2.41%（934/38 734）。患者男女比例为1.88∶1,平均年龄（60.82±16.94）岁,AKI发病率随着年龄的增加逐渐增高,其中63.4%为外科患者,35.4%为内科患者,1.2%为妇产科患者。病因中肾前性AKI占51.7%,急性肾小管坏死（ATN）占37.7%,急性肾小球和肾小血管病变（AGV）占3.8%,急性小管间质性肾炎（AIN）占3.5%,肾后性AKI占3.3%。患者AKI后28 d存活率为71.8%。AKI后28 d时有65.7%的患者肾功能完全恢复,16.9%的患者部分恢复,17.4%的患者未恢复。AKIⅠ、Ⅱ和Ⅲ期患者的病死率分别为24.8%、31.2%和43.7%。多因素Logistic逐步回归模型结果提示,肾损伤药物史（OR = 2.313）、前1周低血压史（OR = 4.482）、少尿史（OR = 5.267）、肾外脏器衰竭数（OR = 1.376）和行肾脏替代治疗（RRT）（OR = 4.221）是住院AKI患者死亡的独立危险因素;肾外脏器衰竭数（OR = 1.529）和行RRT（OR = 2.117）是住院AKI患者肾脏丢失的独立危险因素。 结论 AKI在住院患者中常见,病死率较高,AKI后可以造成患者的肾脏丢失。预后与肾损害的严重程度密切相关。肾损伤药物史、1周内低血压史、少尿史、肾外脏器衰竭数和需要行RRT是AKI患者死亡的独立危险因素。肾外脏器衰竭数和需要行RRT是肾脏丢失的独立危险因素。     

Acute kidney injury in patients with pyogenic liver abscess

Incidence of acute kidney injury (AKI) in patients with pyogenic liver abscess is rare. In our study we found AKI in 32.6% of patients with liver abscess. Majority of the patients were in their fifties and sixties. As per acute kidney injury network trial criteria, renal failure was in stage 1 in 26.6%, stage 2 in 40%, and stage 3 in 33.3% of the patients. Dialysis support was needed in 26%. All patients except one recovered from AKI.     

Risk factors of acute renal injury in patients with acute left heart failure

Objectives To investigate the risk factors of acute renal injury (acute kidney injury) in patients with acute left heart failure. Methods Clinical data of 188 patients with acute left heart failure who were admitted to our hospital were retrospectively analyzed. Logistic regression analysis was used to assess the risk factors for AKI. Results Among 188 patients with acute left heart failure, incidence of acute kidney injury was 33.51%. Univariate and Multivariable logistic regression analyses showed that the independent predictors of acute kidney injury were lower baseline eGFR (OR=4.294, P＜0.001) and anemia (OR=3.573, P=0.006). Conclusions The incidence of acute left heart failure complicated with AKI was high. Basic state of renal function and anemia were the independent risk factors for AKI.     

Curcumin alleviates ischemia reperfusion-induced acute kidney injury through NMDA receptor antagonism in rats

Objective: The present study investigated the role of N-methyl-d-aspartate (NMDA) receptors in curcumin-mediated renoprotection against ischemia reperfusion (I/R)-induced acute kidney injury (AKI) in rats.

Methods: Rats were subjected to bilateral renal I/R (40?min I, 24?hours R) to induce AKI. Kidney injury was assessed by measuring creatinine clearance, blood urea nitrogen, plasma uric acid, potassium level, fractional excretion of sodium, and macroproteinuria. Oxidative stress in renal tissues was assessed by measuring myeloperoxidase activity, thiobarbituric acid reactive substances, superoxide anion generation, and reduced glutathione content. Hematoxylin &; eosin staining was done to assess histological changes in renal tissues. Curcumin (30 and 60?mg/kg) was administered one hour before subjecting rats to AKI. In separate groups, NMDA receptor agonists, glutamic acid (200?mg/kg), and spermidine (20?mg/kg) were administered prior to curcumin treatment in rats followed by AKI.

Results: I/R-induced AKI was demonstrated by significant change in plasma and urine parameters along with marked increase in oxidative stress and histological changes in renal tissues that were aggravated with pretreatment of glutamic acid and spermidine in rats. Administration of curcumin resulted in significant protection against AKI. However, glutamic acid and spermidine pretreatments prevented curcumin-mediated renoprotection.

Conclusion: It is concluded that NMDA receptor antagonism significantly contributes towards curcumin-mediated protection against I/R-induced AKI.     

Survival akin to injury, hospitalized patients with acute kidney injury based on the AKIN classification

Introduction: Acute kidney injury (AKI) is often associated with severe consequences. The aim of the study was to determine whether the acute kidney injury network classification predicts hospital stay, renal recovery and mortality. Methods: Hospitalized patients who were referred to the nephrology service over 6 months were studied retrospective with further 12 months prospective follow up. Statistical analysis was performed on their demography and outcome. Results: Among the 238 patients who were referred, 166 had AKI, median age 74 years and 32% were diabetics. 10% (n = 17) required acute renal replacement therapy. The overall all-cause mortality of AKI group (n = 166) compared to non-AKI group (n = 72) at 1 year was 55% as opposed to 27.8% (p < 0.001). There was a significant statistical difference in the composite outcome and survival between the AKI stages in terms of renal recovery (p = 0.018). The AKI group had a median 8 day increase in length of stay compared to the non-AKI group (20 vs. 12 days; p = 0.0175). However, there was no significant statistical difference between pre and post admission AKI (p value = 0.191). Conclusion: The AKIN staging of AKI predicts both early and late mortality. AKI has a major impact on inpatient and 1-year-survival, renal recovery and length of stay. AKI and renal recovery following the insult were independent prognosticators. Early identification and management of AKI cases can help to prevent progression of the severity of AKI and therefore, mandates timely referral to nephrology team to prevent progression of AKIN class and its consequences.     

Well-Preserved Cholinergic Neuronal Activity in the Brain Cortex of the Severely Uremic Rats

Abstract

Incidence of acute kidney injury (AKI) in patients with pyogenic liver abscess is rare. In our study we found AKI in 32.6% of patients with liver abscess. Majority of the patients were in their fifties and sixties. As per acute kidney injury network trial criteria, renal failure was in stage 1 in 26.6%, stage 2 in 40%, and stage 3 in 33.3% of the patients. Dialysis support was needed in 26%. All patients except one recovered from AKI.     

Functions of aquaporin 1 and α-epithelial Na+ channel in rat acute lung injury induced by acute ischemic kidney injury

Purpose

To establish a rat model of acute ischemic kidney injury by continually occluding the bilateral renal artery and renal veins, the functions of α-epithelial Na⁺ channel (α-ENaC) and aquaporin (AQP1) in lung injury induced by acute kidney injury (AKI) were examined and compared with lung injury induced by endotoxin.

Methods

Male Wistar rats were randomly divided into three groups: control group, AKI group, and sepsis group. The concentrations of AQP1 and α-ENaC in the lung tissue were detected. The concentrations of interleukin-6 (IL-6) and tumor necrosis factor-α (TNF-α) in the serum and bronchoalveolar lavage fluid were also detected.

Results

The arterial blood pH in AKI group and PaO₂ in sepsis group decreased 2 h after the experiment. A significant pulmonary interstitial and alveolar space edema, which showed a typical pathological change in acute lung injury, was found in AKI and sepsis group 8 h after the experiment. Two hours after the experiment, the concentration of TNF-α and IL-6 in the serum and bronchoalveolar lavage fluid (BALF) in AKI and sepsis group increased, whereas the pulmonary expression of AQP1 and α-ENaC decreased. The pulmonary AQP1 and α-ENaC of the rats were negatively correlated with TNF-α and IL-6 in BALF. The relevance among AQP1, α-ENaC, TNF-α, and IL-6 in sepsis group was higher than that in AKI group.

Conclusion

The TNF-α and IL-6 levels increased significantly and the pulmonary expression of AQP1 and α-ENaC declined at the early stage of AKI.     

Donation after cardiac death liver transplant recipients have an increased frequency of acute kidney injury

Donation after cardiac death (DCD) liver transplantation is associated with an increased frequency of hepato-biliary complications. The implications for renal function have not been explored previously. The aims of this single-center study of 88 consecutive DCD liver transplant recipients were (1) to compare renal outcomes with propensity-risk-matched donation after brain death (DBD) patients and (2) in the DCD patients specifically to examine the risk factors for acute kidney injury (AKI; peak creatinine ≥2 times baseline) and chronic kidney disease (CKD; eGFR <60 mL/min/1.73 m(2) ). During the immediate postoperative period DCD liver transplantation was associated with an increased incidence of AKI (DCD, 53.4%; DBD 31.8%, p = 0.004). In DCD patients AKI was a risk factor for CKD (p = 0.035) and mortality (p = 0.017). The cumulative incidence of CKD by 3 years post-transplant was 53.7% and 42.1% for DCD and DBD patients, respectively (p = 0.774). Importantly, increasing peak perioperative aspartate aminotransferase, a surrogate marker of hepatic ischemia reperfusion injury, was the only consistent predictor of renal dysfunction after DCD transplantation (AKI, p < 0.001; CKD, p = 0.032). In conclusion, DCD liver transplantation is associated with an increased frequency of AKI. The findings suggest that hepatic ischemia reperfusion injury may play a critical role in the pathogenesis of post-transplant renal dysfunction.     

Akutes Nierenversagen nach kardiochirurgischen Eingriffen

Acute kidney injury (AKI) occurs, according to current definitions, in up to 30% of all patients undergoing cardiac surgery. AKI that requires renal replacement therapy has an incidence of approximately 1%. The development of AKI increases mortality to 15?C30%, independently of other comorbidities. Full recovery of renal function is only observed in 50% of surviving patients. Thus, due to its significance, the term cardiac surgery-associated acute kidney injury (CSA AKI) was coined. The underlying mechanisms leading to CSA AKI are not limited to the use of cardiopulmonary bypass. In fact, predominant causes include endogenous and exogenous nephrotoxins, inflammation, hypoperfusion, and metabolic and neurohormonal disturbances. Since no causal therapy is available for CSA AKI, primary and secondary prevention is critical to correct all avoidable and modifiable risk factors of AKI. Renal replacement therapy is only supportive to bridge the gap until the kidneys recover.     

肝再生增强因子对缺血再灌注损伤肾脏局部炎性反应的影响

目的 探讨重组人肝再生增强因子( rhALR)对缺血再灌注(IR)肾损伤大鼠模型肾脏局部炎性细胞浸润及炎性因子表达的影响.方法 将SD大鼠按随机数字表法分成假手术组、IR组、rhALR低剂量(100 μg/kg)组及rhALR高剂量(200 μg/kg)组.采用双侧肾蒂夹闭60 min后再灌注建立IR肾损伤动物模型.常规生化法检测血肌酐、尿素氮的水平,HE染色观察肾脏组织学改变,比色法检测肾组织髓过氧化物酶( MPO)的活性,Western印迹法检测肾组织肿瘤坏死因子α(TNF-α)、细胞间黏附分子1(ICAM-1)、单核细胞趋化蛋白1(MCP-1)的蛋白表达.结果 rhALR组的血肌酐和尿素氮显著低于IR组(均P＜ 0.05),肾组织病理损害减轻,rhALR高剂量组较rhALR低剂量组肾功能及肾脏病理改善更明显.IR组大鼠肾组织的MPO活性、TNF-α、ICAM-1、MCP-1的蛋白表达在术后12 h较假手术组显著上升,术后24h有所下降,但仍维持在较高水平(均P＜0.05);rhALR组肾组织MPO活性、肾组织TNF-α、ICAM-1、MCP-1的蛋白表达较IR组显著下降(均P＜0.05),且rhALR高剂量组4者较rhALR低剂量组下降更显著(均P＜0.05).结论 rhALR对IR肾损伤具有保护作用,其作用机制可能与其减少肾脏局部的炎性细胞浸润、抑制炎性因子MCP-1、ICAM-1、TNF-α的表达有关.     

Renji acute kidney injury score is a useful tool to predict acute kidney injury after cardiac surgery

Objective To validate the effect of Renji acute kidney injury score (RAKIS) on predicting patients with acute kidney injury (AKI) after cardiac surgeries, and make comparison with Cleveland score, simplified renal index (SRI) and acute kidney injury following cardiac surgery (AKICS). Methods Patients undergoing open heart surgery from 2008/01/01 to 2010/10/31 in Renji hospital were enrolled, and their scores of those four scoring models were calculated. AKI patients were diagnosed by KDIGO, and those scores of AKI patients and non-AKI patients were compared. Receiver operating characteristic (ROC) curve and area under curve (AUC) were used to decide the predictive values of those models. Results A total of 1126 patients were chosen in this cohort, with the average age of (58.43±14.88) years (rang from 18 to 88). The male to female ratio was 1.47∶1. And 355(31.5%) patients were developed AKI. AKI stage Ⅰ, Ⅱ and Ⅲ were 65.4%, 23.7% and 11.0% respectively. RAKIS was significantly higher in AKI patients than in non-AKI patients (17.5 vs 9.0, P＜0.001). The AUCs of RAKIS to predict AKI, AKI Ⅱ-Ⅲ stages, renal replacement therapy (RRT) and in-hospital death were 0.818, 0.819, 0.800 and 0.784 respectively. The AUCs of Cleveland score and SRI were 0.659 to 0.710, lower than those of RAKIS and AKICS. AKICS had lower value for predicting AKI and AKI Ⅱ-Ⅲ stages (AUC 0.766 and 0.793), but good value in predicting RRT and in-hospital death after surgery (AUC 0.804 and 0.835) as compared with RAKIS. Conclusions RAKIS is valid and accurate in the discrimination of KDIGO defined AKI patients, while for predicting the composite end point, AKICS may be more useful.     

445例急性肾损伤病因与预后分析

目的探讨急性肾损伤的病因以及影响预后的危险因素。方法回顾性分析本院2013年9月至2018年9月收治的445例急性肾损伤(AKI)患者的病因、临床特征、治疗方案等,分析其与预后的关系。结果445例患者中,男性261例,女性184例,年龄(54.66±18.21)岁;肾性因素为主,共有253例(56.85%),肾毒性药物导致的急性肾损伤有119例(26.74%);肾前性因素共有123例(27.64%),感染尤其是急性胃肠炎占比比较大;肾后性44例(9.89%),病因多为泌尿系结石及肿瘤晚期压迫,另有产源性16例(3.60%),不明原因9例(2.02%)。病因在各年龄组间差异有统计学意义(P<0.05)。有序logistic回归分析,年龄、衰竭器官个数、休克、机械通气是影响预后的独立危险因素。结论药源性及肾前性急性肾损伤需要引起更多的关注;年龄、衰竭器官个数、休克、机械通气是急性肾损伤预后的危险因素。对于此类患者,早期诊断,早期干预,有助于改善预后。     

Acute kidney injury in pregnancy—a single center experience

Abstract

Background: Acute kidney injury (AKI) is a serious complication in pregnancy, resulting in significant maternal morbidity/mortality and fetal loss. Although the incidence of pregnancy-related acute kidney injury (PRAKI) has decreased in developed countries, it is still common in developing nations. Methods: A prospective observational study was done between January 2010 and December 2014 to report the incidence, clinical spectrum, maternal and fetal outcome of AKI in pregnancy. Results: Total number of patients: 130; mean age: 25.4?±?4.73 years. The incidence of AKI in pregnancy was 7.8%. Most of the AKI was noted in postpartum period (68%). Etiology of AKI was sepsis (39%), pre-eclampsia (21%), placental abruption (10%), acute diarrheal disease complicating pregnancy (10%), thrombotic microangiopathy (TMA) (9%), postpartum hemorrhage (2%) and glomerular diseases (9%). Renal biopsy (n?=?46) done in these patients showed renal cortical necrosis (16), TMA (11), acute tubular injury (9), acute tubulointerstitial disease (1) and glomerular disease (9). Live births occurred in 42% of patients with vaginal delivery in 34% cases. Thirty-four patients were managed conservatively, while 96 required dialysis. Complete recovery occurred in 56% and about 36% had persistent renal failure at 3 months. Mortality rate observed was 8%. In univariate analysis, low mean platelet count, higher peak serum creatinine, dialysis dependency at presentation and histopathologically presence of cortical necrosis and TMA predicted the progression to chronic kidney disease. Conclusion: AKI in pregnancy was common in postpartum period and sepsis being the commonest cause.     

Portulaca Oleracea-associated oxalate nephropathy complicated with an ANCA-positive acute renal injury: A case report

Oxalate nephropathy is a rare disease that can lead to acute kidney injury (AKI). In clinical practice, as renal biopsy is required for diagnosis, physicians often do not have sufficient understanding of this disease. When AKI is associated with positive blood anti-neutrophil cytoplasmic antibodies (ANCA), a diagnosis of renal injury due to ANCA-associated vasculitis is likely to be made, leading to treatment with immunosuppressive therapy. A case of AKI after eating a large quantity of Portulaca oleracea is reported. While blood P-ANCA was positive, both urine proteinuria and urine occult blood were negative. Renal biopsy was performed and identified an acute tubulointerstitial injury: disc-shaped crystals were seen in the lumen of renal tubules that demonstrated birefringence under polarized light, and an oxalate nephropathy was therefore diagnosed. Typical histological changes of an ANCA-associated vasculitis with renal injury such as cellulose-like necrosis and crescent formation were not present. After the patient stopped eating P. oleracea, and following rehydration and hemodialysis, renal function returned to normal. In patients with AKI, the secondary causes of hyperoxalemia should be sought and attention paid to excluding an oxalate nephropathy. In patients with AKI who are ANCA-positive, it is prudent to complete the renal pathological diagnostic process before assuming that the renal injury is caused by an ANCA-associated vasculitis, and before starting hormone and immunosuppressive therapy.     

Exosomal Fetuin-A identified by proteomics: a novel urinary biomarker for detecting acute kidney injury

Urinary exosomes containing apical membrane and intracellular fluid are normally secreted into the urine from all nephron segments, and may carry protein markers of renal dysfunction and structural injury. We aimed to discover biomarkers in urinary exosomes to detect acute kidney injury (AKI), which has a high mortality and morbidity. Animals were injected with cisplatin. Urinary exosomes were isolated by differential centrifugation. Protein changes were evaluated by two-dimensional difference in gel electrophoresis and changed proteins were identified by mass spectrometry. The identified candidate biomarkers were validated by Western blotting in individual urine samples from rats subjected to cisplatin injection; bilateral ischemia and reperfusion (I/R); volume depletion; and intensive care unit (ICU) patients with and without AKI. We identified 18 proteins that were increased and nine proteins that were decreased 8 h after cisplatin injection. Most of the candidates could not be validated by Western blotting. However, exosomal Fetuin-A increased 52.5-fold at day 2 (1 day before serum creatinine increase and tubule damage) and remained elevated 51.5-fold at day 5 (peak renal injury) after cisplatin injection. By immunoelectron microscopy and elution studies, Fetuin-A was located inside urinary exosomes. Urinary Fetuin-A was increased 31.6-fold in the early phase (2-8 h) of I/R, but not in prerenal azotemia. Urinary exosomal Fetuin-A also increased in three ICU patients with AKI compared to the patients without AKI. We conclude that (1) proteomic analysis of urinary exosomes can provide biomarker candidates for the diagnosis of AKI and (2) urinary Fetuin-A might be a predictive biomarker of structural renal injury.     

自噬和ASPPs在老年大鼠急性肾损伤早期的表达

目的观察自噬相关蛋白和p53凋亡刺激蛋白(ASPPs)在肾损伤早期的表达变化,初步探讨自噬相关蛋白和ASPPs是否可能成为老年大鼠AKI早期生物标志物。 方法建立顺铂致AKI青年与老年大鼠模型。雄性SD老年大鼠随机分为假手术组(Sham),顺铂模型组,同时设数量匹配的雄性SD青年大鼠为对照;模型组大鼠一次性腹腔注射顺铂4 mg/kg,Sham组相同途径注射生理盐水4 ml/kg;在给药12 h、1 d、3 d、5 d、7 d时检测大鼠Scr、BUN;光镜观察大鼠肾脏病理变化;透射电镜观察大鼠肾小管上皮细胞超微结构变化及自噬体的情况;免疫印迹法检测肾脏组织Beclin 1、溶酶体相关膜蛋白2(LAMP2)、p62、p53及ASPP抑制物(iASPP)和ASPP1表达情况。 结果顺铂诱导12 h后,与Sham组比较,青年与老年大鼠Scr无明显变化(P>0.05);电镜观察到大鼠肾小管上皮细胞自噬体出现而且数量显著增多;老年大鼠肾组织Beclin 1、p62、LAMP-2和p53表达水平明显升高(P<0.05),iASPP表达水平明显降低(P<0.05),并且老年大鼠肾组织Beclin 1、LAMP-2和p53变化时间早于青年大鼠(P<0.05)。 结论自噬和ASPPs在老年大鼠AKI发生早期即可出现,在Scr开始升高前,反应性自噬已经启动。自噬相关蛋白和ASPPs有望成为AKI早期的损伤标志物,可能是AKI早期干预的新靶点,但仍需更深入的研究。     

Transplanting Kidneys from Deceased Donors With Severe Acute Kidney Injury

Our aim was to determine outcomes with transplanting kidneys from deceased donors with acute kidney injury, defined as a donor with terminal serum creatinine ≥2.0 mg/dL, or a donor requiring acute renal replacement therapy. We included all patients who received deceased donor kidney transplant from June 2004 to October 2013. There were 162 AKI donor transplant recipients (21% of deceased donor transplants): 139 in the standard criteria donor (SCD) and 23 in the expanded criteria donor (ECD) cohort. 71% of the AKI donors had stage 3 (severe AKI), based on acute kidney injury network (AKIN) staging. Protocol biopsies were done at 1, 4, and 12 months posttransplant. One and four month formalin‐fixed paraffin embedded (FFPE) biopsies from 48 patients (24 AKI donors, 24 non‐AKI) underwent global gene expression profiling using DNA microarrays (96 arrays). DGF was more common in the AKI group but eGFR, graft survival at 1 year and proportion with IF/TA>2 at 1 year were similar for the two groups. At 1 month, there were 898 differentially expressed genes in the AKI group (p‐value <0.005; FDR <10%), but by 4 months there were no differences. Transplanting selected kidneys from deceased donors with AKI is safe and has excellent outcomes.     

Acute kidney injury in Xinjiang: a cross-sectional survey

Objective To evaluate the etiology, epidemiological characteristics, clinical diagnosis, and outcomes of hospitalized patients with AKI in Xinjiang, analyzing the risk factors of their clinical prognosis. Methods A multicenter retrospective survey was conducted, investigating adult patients admitted to four hospitals in Xinjiang in January and July 2013. Patients with AKI were screened out based on KDIGO's inclusion and exclusion criteria. Clinical variables of patients with AKI including demographics, clinical data, laboratory tests, treatment measures and prognosis were collected. Results Among 32,157 adult hospitalized patients, there were 722 AKI patients. Excluding those with incomplete data, 719 patients were enrolled in this study. The detection rate of AKI was 2.25% (722 of 32,157) by KDIGO criteria. The main cause for AKI was pre-renal injury, led mainly by cardiac output, low blood volume, and the use of nephrotoxic drugs. The non-recognition rate of AKI was 72.4%(407/557). Multivariate binary logistic regression analysis showed that AKI stage, peripheral vasodilation and renal parenchyma were protective factors of the omission diagnosis. In the short-term prognostic analysis, the overall mortality rate was 12.8%(92/719). Among the 323 patients with AKI who survived discharge, 43.7%(141) had renal function recovery; 40.2%(130) did not fully recover their renal function but ceased maintenance dialysis; 16.4%(53) were still on dialysis at discharge. Multivariate Cox regression model suggested that DIC, shock and department of obstetrics were independent risk factors for death during hospitalization of AKI. In addition, the risk of death for AKI from department of obstetrics and gynecology patients was higher than that of other departments. Conclusions The most common reason for AKI in hospitalized patients in Xinjiang was pre-renal injury. The main risk factors were low cardiac output and low blood volume. The omission diagnosis of AKI was serious; AKI stage, peripheral vasodilation and renal parenchymal injury however were its protective factors. Poor-DIC, shock, hospitalization in obstetrics were independent risk factors for death in patients with AKI.