Renal failure in melioidosis

In a restrospective study of 220 patients with melioidosis admitted to the hospital over a period of 3.5 years, acute renal failure was noted in 77 patients. Interesting clinical features included hypercatabolism, hypoalbuminemia, hyponatremia, jaundice and multisystem involvement. Prognosis was poor especially when associated with jaundice, lung involvement and the presence of underlying diseases. Mortality rate was 89.6%. Renal failure is believed to the due to renal ischemia from multiple nonspecific factors. In a limited pathological study renal changes consisted of tubular necrosis, microabscesses, interstitial nephritis and mild tubular degeneration.     

Renal failure in paroxysmal nocturnal hemoglobinuria

Paroxysmal nocturnal hemoglobinuria (PNH) is a rare, acquired hemolytic disorder characterized by a membrane abnormality of red cells, and characterized by two major clinical features of gross hemoglobinuria and diffuse venous thrombosis. In Japan, the present report records the first case of acute renal failure complicating PNH with treated by hemodialysis and was almost completely reversible. Case: A 41 year-old woman was admitted for high fever (39.8 degrees C), dyspnea and clinical signs of a respiratory infection. She was started on Cefotax 1,000 mg 3 times daily. She subsequently developed acute renal failure and which treated by hemodialysis and was almost completely reversible. Following treatment of her renal failure, respiratory infection and anemia, she initially made good progress and was discharged.     

Renal biopsy in acute renal failure

Renal biopsies were performed on 91 out of 99 patients with acute intrinsic renal failure. In all these 91 cases a clinical diagnosis was suggested by an experienced nephrologist unaware of the renal biopsy findings. Most diagnoses agreed with the histopathological findings, but there were important exceptions. On clinical grounds, acute tubulointerstitial renal disease was diagnosed correctly in 77% and acute glomerulonephritis in 56%. In 15% of the patients the clinical data did not permit any certain diagnostic suggestion. In about 20% the biopsy finding definitely influenced the choice of medical treatment. In those 15 patients who needed dialysis treatment, the biopsy findings helped in determining whether this need was temporary or permanent. Our results show that renal biopsy is valuable in settling the diagnosis, in determining the prognosis, and in planning the treatment of acute intrinsic renal failure.     

Renal osteodystrophy in chronic renal failure

Bone disease develops relatively early in the development of chronic renal failure. Much of what is known about the evaluation and management of renal osteodystrophy in chronic renal failure is based on knowledge obtained in the dialysis population. The classic bone lesion found in the dialysis population is osteitis fibrosa, the high turnover lesion of secondary hyperparathyroidism. Clearly, hypocalcemia, hyperphosphatemia, and calcitriol deficiency play major roles in the development and maintenance of the high turnover disease. Interestingly, in both the dialysis and nondialysis patients, the incidence of adynamic bone disease, a low turnover lesion, is increasing. It is postulated that the aggressive use of calcium-containing phosphate binders and the use of calcitriol and other vitamin D analogs to treat secondary hyperparathyroidism may contribute to this shift in bone lesions. Treatment in the nondialysis kidney disease patient remains aggressive correction of hypocalcemia and hyperphosphatemia. The use of calcitriol and other agents to maintain serum calcium and to suppress elevated parathyroid hormone remains well supported. However, the increase in extraskeletal calcifications and incidence of adynamic bone disease in these patients raises concern about current management techniques.     

Renal failure in giant cell vasculitis

A 59-year-old white woman with temporal arteritis developed progressive renal failure. Renal biopsy results showed focal and segmental necrotizing glomerulonephritis; furthermore, giant cells were present in the destructed vessel walls. Immunosuppressive therapy did not prevent terminal renal failure. This case shows that renal involvement may be a feature of temporal arteritis.     

Renal failure in temporal arteritis.

We report a case of biopsy-proven temporal arteritis and polymyalgia rheumatica with improved clinical symptoms with steroid treatment but with subsequent renal failure while on steroids. Kidney biopsy showed focal segmental necrotizing glomerulonephritis with crescents and small-vessel vasculitis. Treatment with methylprednisolone and cyclophosphamide achieved normalization of renal function. We emphasize the importance of kidney biopsy because of its therapeutic implications. The previous literature concerning renal disease in temporal arteritis is discussed.     

Renal failure in vibrio vulnificus infection

Vibrio vulnificus infection with septicemia is a life threatening disease in the immunocompromised hosts. Renal involvement has not been documented. We reported herein 8 patients with V. vulnificus septicemia. All were immunocompromised hosts. Four patients had cirrhosis of the liver, 3 were heavy alcohol drinkers and one had systemic lupus erythematosis. Presenting symptomatology included fever, chills, leg pain and skin rash. Renal failure was observed in 6 patients. Four patients died shortly after admission. Two survived with clinical course of tubular necrosis. Renal failure is therefore common in V. vulnificus infection. This should be brought to attention, and vigorous antibiotic treatment is required. The disease may be confused with leptospirosis, scrub typhus, malaria and other forms of sepsis which also present with renal failure.     

Renal failure and its treatment

Kidney disease can be defined as acute or chronic kidney injury. Acute kidney injury is measured directly via glomerular filtration rate (GFR) and indirectly via urea and electrolyte levels. Acute kidney injury can be classified via the RIFLE criteria.Chronic kidney injury is a progressive and irreversible condition, which is defined as an estimated GFR (eGFR) less than 60 ml/minute/1.73 m² or where there is evidence of chronic kidney damage (irrespective of eGFR) on at least two occasions more than 3 months apart. As chronic kidney injury progresses there are a number of co-morbidities associated with the disease process, cardiovascular, respiratory and endocrine. These co-morbidities must be considered when anaesthetizing a patient with kidney injury.Renal replacement therapy may be necessary for patients who acutely deteriorate to end-stage renal failure or in those with a slow progression to this point. Haemofiltration or haemodiafiltration may be used in the acute setting and haemodialysis or peritoneal dialysis may be used in cases where the deterioration of renal function takes a more progressive course.     

Renal failure and its treatment

Impaired renal function is increasingly common amongst hospital patients and is associated with significant morbidity and mortality. There has been a recent shift from traditional methods of assessing the glomerular filtration rate (GFR) towards biochemistry laboratories routinely reporting formulaic estimates of GFR. Knowledge of the treatment of and pathophysiological complications associated with chronic kidney disease are essential for anaesthetists and intensivists to provide safe and effective care to these patients. The term acute kidney injury (AKI) is now preferred to refer to the full spectrum of acute renal failure. The consensus definition and classification of AKI has recently been modified in the light of evidence that small changes in serum creatinine are associated with adverse outcome. The aetiology, identification and management of AKI is reviewed. The number of patients receiving renal replacement therapy (RRT) in the UK is rising, the cost of which already accounts for 2% of the total NHS budget. The various types of RRT used in both end-stage renal failure and AKI are discussed along with some of the controversies associated with their use in critically ill patients.     

Renal failure complicating obstructive jaundice

Postoperative acute renal failure in patients with obstructive jaundice remains a clinically significant complication. Acute renal failure occurs in approximately 9 percent of patients requiring surgery for relief of obstructive jaundice, and contributes to eventual mortality in 76 percent of those who develop it. The overall mortality rate for patients undergoing surgery for obstructive jaundice is 16 percent. Despite advances in perioperative care, these figures have changed very little over the past 25 years. This article describes the clinical association between jaundice and renal failure and reviews the studies that have contributed to the delineation of the possible underlying pathophysiologic mechanisms, as well as possible preventive measures which have been developed as a result of these investigations. With increased awareness of the potential risk of developing postoperative acute renal failure, the institution of prophylactic measures may result in an improvement in the mortality rate seen after surgery for obstructive jaundice.     

Renal failure and acquired hypothyroidism

The effects of thyroid metabolism on renal function in children are barely referred to in the literature. Primary hypothyroidism is known to be associated with a consistent elevation in serum creatinine levels. This is essentially because of the hypodynamic state that occurs in hypothyroidism, leading to a reduced glomerular filtration rate and hypercreatinemia. A teenager who developed renal failure due to primary hypothyroidism is reported. He displayed diverse serum biochemistry anomalies with an unremarkable physical examination. Thyroxine replacement therapy completely restored the euthyroid state and renal function. We propose, in accordance with other authors, measurement of thyrotropin levels in patients with hypercreatinemia.     

Renal failure and its treatment

Acute kidney injury (AKI) is a common complication of acute illness. It is associated with significant morbidity and mortality as well as a high cost to healthcare systems. There are a broad range of causes of AKI which should be considered in a systematic fashion to avoid missing multiple potential causative factors. These include pre-renal causes from hypovolaemia, intrinsic renal causes such as glomerular diseases and post-renal obstructive causes. In the intensive care unit, two-thirds of AKI cases result from renal hypoperfusion, sepsis, contrast and nephrotoxic agents; up to 5% will require renal replacement therapy. Modalities of renal replacement therapy include intermittent haemodialysis, peritoneal dialysis and continuous haemofiltration. Continuous haemofiltration is usually favoured in the intensive care setting as it has greater haemodynamic stability and greater capacity to extract fluid from patients with fluid overload. Anticoagulation is recommended with haemodialysis and haemofiltration and systemic heparin, regional citrate or zero anticoagulation are the usual options.     

Renal failure and its treatment

Acute kidney injury (AKI) is a common complication of acute illness. It is associated with signicant morbidity and mortality as well as a high cost to healthcare systems. There are a broad range of causes of AKI which should be considered in a systematic fashion to avoid missing multiple potential causative factors. These include pre-renal causes from hypovolaemia, intrinsic renal causes such as glomerular diseases and post-renal obstructive causes. In the intensive care unit, two-thirds of AKI cases result from renal hypoperfusion, sepsis, contrast and nephrotoxic agents; up to 5% will require renal replacement therapy. Modalities of renal replacement therapy include intermittent haemodialysis, peritoneal dialysis and continuous haemoltration. Continuous haemoltration is usually favoured in the intensive care setting as it has greater haemodynamic stability and greater capacity to extract uid from patients with fluid overload. Anticoagulation options can be achieved with systemic anticoagulation such as heparin or regional anticoagulation with citrate.     

Renal and respiratory failure in Scottish ICUs

The purpose of this study was to define the outcome of patients receiving both renal replacement therapy and mechanical ventilation in 16 Scottish intensive care units over a 2-year period. Patients were identified from the Scottish Intensive Care Society's database. Survivors developing end-stage renal failure were identified after examination of the Scottish Renal Registry's database. Mortality was 64.2% (392/612) for all patients receiving renal replacement therapy and mechanical ventilation. End-stage renal failure developed in 1.6% (3/188) of the survivors of acute renal failure and in 33% (4/11) of the survivors with pre-existing chronic renal failure. Mortality has not improved when compared with earlier studies. End-stage renal failure rarely develops following acute renal failure in the intensive care unit.