Prostatic surgery associated acute kidney injury

Acute kidney injury (AKI) is associated with extended hospital stays, high risks of in-hospital and long-term mortality, and increased risk of incident and progressive chronic kidney disease. Patients with urological diseases are a high-risk group for AKI owing to the coexistence of obstructive uropathy, older age, and preexistent chronic kidney disease. Nonetheless, precise data on the incidence and outcomes of postoperative AKI in urological procedures are lacking. Benign prostatic hyperplasia and prostate cancer are common diagnoses in older men and are frequently treated with surgical procedures. Whereas severe AKI after prostate surgery in general appears to be unusual, AKI associated with transurethral resection of the prostate (TURP) syndrome and with rhabdomyolysis (RM) after radical prostatectomy have been frequently described. The purpose of this review is to discuss the current knowledge regarding the epidemiology, risk factors, outcomes, prevention, and treatment of AKI associated with prostatic surgery. The mechanisms of TURP syndrome and RM following prostatic surgeries will be emphasized.     

Multidisciplinary basic and clinical research of acute kidney injury with COVID-19: Pathophysiology,mechanisms, incidence,management and kidney transplantation

Acute kidney injury (AKI) linked to coronavirus disease 2019 (COVID-19) has been identified in the course of the disease. AKI can be mild or severe and that is dependent on the presence of comorbidities and the severity of COVID-19. Among patients who had been hospitalized with COVID-19, some were admitted to intensive care unit. The etiology of AKI associated with COVID-19 is multifactorial. Prevention of severe AKI is the prime task in patients with COVID-19 that necessitates a battery of measurements and precautions in management. Patients with AKI who have needed dialysis are in an increased risk to develop chronic kidney disease (CKD) or a progression of their existing CKD. Kidney transplantation patients with COVID-19 are in need of special management to adjust the doses of immunosuppression drugs and corticosteroids to guard against graft rejection but not to suppress the immune system to place the patient at risk of developing a COVID-19 infection. Immunosuppression drugs and corticosteroids for patients who have had a kidney transplant has to be adjusted based on laboratory results and is individualized aiming at the protection of the transplanted from rejection.     

Epidemiology,clinical characteristics,and management of chronic kidney disease in human immunodeficiency virusinfected patients

Antiretroviral therapy has markedly reduced acquired immune deficiency syndrome-related deaths and opportunistic infectious diseases.This has resulted in prolonged survival of individuals infected with the human immunodeficiency virus(HIV).However,this improvement in survival has been accompanied by an increase in the incidence of chronic kidney disease(CKD) and end-stage renal disease.CKD is now epidemic among HIV-infected populations in both Western and Eastern countries.Risk factors associated with CKD in HIV-infected populations include aging,hypertension,diabetes mellitus,co-infection with hepatitis C virus,a low CD4 cell count,and a high HIV viral load.Clinical experience has shown that HIVinfected individuals often have one or more concurrent risk factors for CKD.The cumulative effect of multiple risk factors on the development of CKD should be noted in this population.Glomerular disease directly related to HIV infection,so-called HIV-associated nephropathy,remains an important cause of CKD among a limited HIV population of African descent,but is less likely to be common among other urban HIV populations.The impact of exposure to nephrotoxic antiretroviral agents on the development of kidney disease is both an old and a new concern.In particular,the association of tenofovir with kidney tubular injury has been an area of great interest.The findings regarding tenofovir's adverse effect on long-term kidney function vary among studies.The early identification and treatment of CKD is recommended for reducing the burden of patients requiring dialysis in HIV-infected populations.Periodic monitoring of urinary concentrations of albumin,protein,and tubular injury markers such as low-molecular-weight proteins may be useful for the early diagnosis of patients at risk for incident CKD.This review focuses on recent epidemiology,clinical characteristics,and management of CKD in a contemporary HIV-infected population.     

Point of care ultrasonography in onco-nephrology: A stride toward better physical examination

Onco-Nephrology is an emerging subspecialty of Nephrology that focuses on a broad spectrum of renal disorders that can arise in patients with cancer. It encompasses acute kidney injury (AKI), complex fluid, electrolyte, and acid-base disorders, as well as chronic kidney disease caused or exacerbated by cancer and/or its treatment. In many such scenarios including AKI and hyponatremia, objective evaluation of hemodynamics is vital for appropriate management. Point of care ultrasonography (POCUS) is a limited ultrasound exam performed at the bedside and interpreted by the treating physician intended to answer focused clinical questions and guide therapy. Compared to conventional physical examination, POCUS offers substantially higher diagnostic accuracy for various structural and hemodynamic derangements. In this narrative review, we provide an overview of the utility of POCUS enhanced physical examination for the Onconephrologist supported by the current evidence and our experience-based opinion.     

Hepatorenal syndrome: Update on diagnosis and treatment

Acute kidney injury(AKI) is a common complication in patients with end-stage liver disease and advanced cirrhosis regardless of the underlying cause. Hepatorenal syndrome(HRS), a functional form of kidney failure, is one of the many possible causes of AKI. HRS is potentially reversible but involves highly complex pathogenetic mechanisms and equally complex clinical and therapeutic management. Once HRS has developed, it has a very poor prognosis. This review focuses on the diagnostic approach to HRS and discusses the therapeutic protocols currently adopted in clinical practice.     

Pre-treatment considerations in childhood hypertension due to chronic kidney disease

Hypertension(HTN) develops very early in childhood chronic kidney disease(CKD). It is linked with rapid progression of kidney disease, increased morbidity and mortality hence the imperative to start antihypertensive medication when blood pressure(BP)is persistently 90 th percentile for age, gender, and height in non-dialyzing hypertensive children with CKD. HTN pathomechanism in CKD is multifactorial and complexly interwoven. The patient with CKD-associated HTN needs to be carefully evaluated for co-morbidities that frequently alter the course of the disease as successful treatment of HTN in CKD goes beyond life style modification and anti-hypertensive therapy alone. Chronic anaemia, volume overload, endothelial dysfunction, arterial media calcification, and metabolic derangements like secondary hyperparathyroidism, hyperphosphataemia, and calcitriol deficiency are a few co-morbidities that may cause or worsen HTN in CKD. It is important to know if the HTN is caused or made worse by the toxic effects of medications like erythropoietin, cyclosporine, tacrolimus, corticosteroids and non-steroidal anti-inflammatory drugs. Poor treatment response may be due to any of these co-morbidities and medications. A satisfactory hypertensive CKD outcome, therefore, depends very much on identifying and managing these co-morbid conditions and HTN promoting medications promptly and appropriately. This review attempts to point attention to factors that may affect successful treatment of the hypertensive CKD child and how to attain the desired therapeutic BP target.     

Sexually transmitted diseases and acquired immunodeficiency syndrome (AIDS). Changes in risk reduction behaviors among young adults

Increasing attention has focused on the medical risk to young, unmarried, sexually active adults of contracting sexually transmitted diseases (STDs) in general and acquired immunodeficiency syndrome (AIDS) in particular. Yet little is known empirically about the extent to which this group perceives themselves to be at risk for contracting specific STDs or is changing their behaviors to reduce their risk. In the current study, the authors report findings from two matched samples of unmarried young adults, 182 assessed in the winter of 1986 and 182 in the fall of 1987. Results demonstrated greater worry and concerns about all STDs, including AIDS, in the second sample assessed than in the first. Some behavioral changes also were noted in the second group, including increased use of condoms. Nevertheless, 44% of sexually experienced participants in the fall of 1987 reported that they had not changed their behavior in any way to reduce their risk of acquiring human immunodeficiency virus (HIV) infection.     

SCAD syndrome: A vicious cycle of kidney stones,CKD, and AciDosis

Cumulative evidence has shown that kidney stone formers are at high risk for developing end-stage renal disease(ESRD) and cardiovascular disease. The aim of this mini-review is to summarize the present knowledge about the close relationships among kidney stone formation, chronic kidney disease(CKD), and plasma and urine acidosis(SCAD). Part of the cause of the positive relationships between higher risk of developing ESRD and cardiovascular diseases in stone formers may be explained by inflammation and cell death due to the components of kidney stones. In CKD patients, acidic urine and loss of anti-crystallization factors may cause stone formation. Acidosis can promote tissue inflammation and may affect vascular tone. Correction of plasma and urine acidosis may improve renal and cardiovascular outcome of stone formers and CKD patients. More intensive and long-term interventions, which include correction of plasma and urine p H in patients with reduced renal function and correction of urine p H in patients with normal renal function, may be considered in treating patients with SCAD syndrome.     

Dynamics of circulating microparticles in chronic kidney disease and transplantation:Is it really reliable marker?

The deterioration of endothelial structure plays a very important role in the development of vascular diseases. It is believed that endothelial dysfunction starts in the early stage of kidney disease and is a risk factor of an unfavorable cardiovascular prognosis. Because a direct assessment of biological states in endothelial cells is not applicable, the measurement of endothelial microparticles(EMPs) detached from endothelium during activation or apoptosis is thought to be a marker of early vascular disease and endothelial dysfunction in children with chronic kidney disease(CKD). Few studies have shown increased circulating EMPs and its relationship with cardiovascular risk factors in patients with CKD.MPs contain membrane proteins and cytosolic material derived from the cell from which they originate. EMPs having CD144, CD 146, CD31+/CD41-, CD51 and CD105 may be used to evaluate the vascular endothelial cell damage and determine asymptomatic patients who might be at higher risk of developing cardiovascular disease in CKD and renal transplant.     

Teenagers and the risks of sexually transmitted diseases: a need for the provision of balanced information.

OBJECTIVE--Evaluation of teenagers' knowledge and understanding about sexually transmitted disease, conception and contraception. DESIGN--A questionnaire study. SETTING--Schools SUBJECTS--1025 teenagers aged 15/16 years (mean 16.00). MAIN OUTCOME MEASURES--Scores attained in response to questions about sexually transmitted disease related to the sources of information given as most helpful. RESULTS--Teenagers have an incorrect understanding of the risks of sexually transmitted diseases. CONCLUSIONS--Teenagers may substantially underestimate their personal risk of contracting sexually transmitted diseases following the promotion of information about HIV/AIDS. Apparently simple messages about HIV and AIDS given in mass media advertising programmes may have unwanted results and need to be balanced by appropriate professional interpretation to teenagers.     

Recent developments in sexually transmitted diseases: is Kaposi's sarcoma a sexually transmitted disease?

Kaposi's sarcoma (KS), a major complication of AIDS, is found more frequently in the Western hemisphere among homosexual and bisexual male AIDS patients than among other patients with AIDS. Theory and arguments for the possibility of infectious cofactors playing a role in the cause and transmission of the sarcoma are reviewed. While cytomegalovirus, Epstein-Barr, and human herpesvirus have been explored as potential cofactors in AIDS-related KS, the focus here is on the suggestion that Kaposi's sarcoma in a person with AIDS may be caused by an unidentified infectious agent spread through sexual contact. The 1st of 4 arguments supporting this theory is that patients acquiring HIV via sexual contact instead of through parenteral or vertical means experience a much greater risk of KS. 2nd, women acquiring HIV heterosexually from bisexual men experienced a 4 times greater risk of KS than those having other sexual partners. The identification of benign and localized KS in 6 homosexual or bisexual men from New York City without HIV antibodies suggests that the KS causal agent is the same regardless of the presence or absence of HIV infection. There is some evidence that circumstances permitting the heterosexual spread of AIDS in Africa also facilitate the transmission of the KS causal agent. Laboratory and epidemiologic investigations are needed to identify the sexually transmitted cofactor or cause of KS. KS in its classic and endemic African forms is described, followed by discussion of KS and immunodeficiency. 2 sections are then devoted to exploration of AIDS-associated KS in the US and the AIDS-related KS epidemic in Africa, respectively.     

Changing picture of renal cortical necrosis in acute kidney injury in developing country

Renal cortical necrosis(RCN) is characterized by patchy or diffuse ischemic destruction of all the elements of renal cortex resulting from significantly diminished renal arterial perfusion due to vascular spasm and microvascular injury. In addition, direct endothelial injury particularly in setting of sepsis, eclampsia, haemolytic uremic syndrome(HUS) and snake bite may lead to endovascular thrombosis with subsequent renal ischemia. Progression to end stage renal disease is a rule in diffuse cortical necrosis. It is a rare cause of acute kidney injury(AKI) in developed countries with frequency of 1.9%-2% of all patients with AKI. In contrast, RCN incidence is higher in developing countries ranging between 6%-7% of all causes of AKI. Obstetric complications(septic abortion, puerperal sepsis, abruptio placentae, postpartum haemorrhage and eclampsia) are the main(60%-70%) causes of RCN in developing countries. The remaining 30%-40% cases of RCN are caused by non-obstetrical causes, mostly due to sepsis and HUS. The incidence of RCN ranges from 10% to 30% of all cases of obstetric AKI compared with only 5% in non-gravid patients. In the developed countries, RCN accounts for 2% of all cases of AKI in adults and more than 20% of AKI during the third trimester of pregnancy. The reported incidence of RCN in obstetrical AKI varies between 18%-42.8% in different Indian studies. However, the overall incidence of RCN in pregnancy related AKI has decreased from 20%-30% to 5% in the past two decades in India. Currently RCN accounts for 3% of all causes of AKI. The incidence of RCN in obstetrical AKI was 1.44% in our recent study. HUS is most common cause of RCN in non-obstetrical group, while puerperal sepsis is leading cause of RCN in obstetric group. Because of the catastrophic sequelae of RCN, its prevention and aggressive management should always be important for the better renal outcome and prognosis of the patients.     

Is smoking tobacco an independent risk factor for HIV infection and progression to AIDS? A systemic review

OBJECTIVES: To systematically review the evidence of the relation between smoking tobacco and HIV seroconversion and progression to AIDS. METHODS: A systematic review was undertaken of studies to look at tobacco smoking as a risk factor for either HIV seroconversion or progression to AIDS. RESULTS: Six studies were identified with HIV seroconversion as an outcome measure. Five of these indicated that smoking tobacco was an independent risk factor after adjusting for important confounders with adjusted odds ratios ranging from 1.6 to 3.5. 10 studies were identified using progression to AIDS as an end point of which nine found no relation with tobacco smoking. CONCLUSIONS: Tobacco smoking may be an independent risk factor for HIV infection although residual confounding is another possible explanation. Smoking did not appear to be related to progression to AIDS although this finding may not be true in developing countries or with the longer life expectancies seen with highly active antiretroviral therapy.     

Literature review of the mechanisms of acute kidney injury secondary to acute liver injury

People exposed to liver ischaemia reperfusion (IR) injury often develop acute kidney injury and the combination is associated with significant morbidity and mortality. Molecular mediators released by the liver in response to IR injury are the likely cause of acute kidney injury (AKI) in this setting, but the mediators have not yet been identified. Identifying the mechanism of injury will allow the identification of therapeutic targets which may modulate both liver IR injury and AKI following liver IR injury.     

Human papillomavirus in the era of highly active antiretroviral therapy for human immunodeficiency virus: an immune reconstitution‐associated disease?

Human immunodeficiency virus (HIV)-related cutaneous and anogenital disease in the highly active antiretroviral therapy (HAART) era presents challenging problems for dermatologists. Immune reconstitution-associated diseases (IRADs) are common and important consequences of HAART. Dermatologists should be aware of the cutaneous manifestations of IRAD. The prevalence of clinical human papillomavirus (HPV)-related disease is increased in HIV and does not appear to be diminished by HAART. Many patients on HAART are dogged by persistent cutaneous warts. Anogenital precancer is also common in HIV and may be burgeoning with HAART. Clinicians should be aware of the increased risk of cervical, penile and vulval/vaginal cancers in treated and untreated patients with HIV. The increase in HPV infection in HIV-infected individuals may be, at least partly, due to increased exposure to diverse HPV types, particularly high-risk types that might be able to persist for longer in anogenital regions. Alternatively, persistent/emergent HPV disease in HIV infection might represent persistent or modulated immunodysregulation after HAART and be viewed as a form of IRAD. The immunopathogenesis of HPV IRAD is fascinating and possibly determined by host genotype.     

Perianal Bowen Disease in a Child with Human Immunodeficiency Virus

Abstract: Individuals infected with the human immunodeficiency virus (HIV) are at increased risk for human papillomavirus (HPV)‐related cancers of the anogenital region. A majority of these cancers have been reported in adult patients; few reports are available regarding anogenital HPV‐associated carcinomas developing in children. We report a case of perianal Bowen disease in an HIV‐positive child. An 8‐year‐old HIV‐positive boy with a history of perianal verrucous lesions presented to a clinic in Lesotho because his caregiver noted his lesions were changing in color, texture, and extent. Histologic sections revealed squamous cell carcinoma in situ. Several cases of anogenital condyloma in HIV‐positive children have been reported, but very few cases of HPV‐associated cancer. Children with vertically transmitted HIV may be uniquely susceptible to persistent infection with strains of HPV acquired perinatally. While the introduction of highly active antiretroviral therapy has resulted in immune restoration, decreased opportunistic infection, and increased life expectancy for children and adults with HIV, it has not affected the incidence of HPV‐related cancers in these patients. The increased life expectancy of children with HIV may actually put them at risk for developing an HPV‐related anogenital cancer.     

Persistence of high-risk sexual activity among homosexual men in an area of low incidence of the acquired immunodeficiency syndrome

Before 1985 only five cases of the acquired immunodeficiency syndrome (AIDS) had been diagnosed in New Mexico, and there was no information regarding prevalence of antibody to the human immunodeficiency virus (HIV). Of 166 gay and bisexual men tested in 1985 in New Mexico, 20% were found to have antibody to HIV. Of 153 responding participants, 107 (70%) reported practicing receptive anal intercourse in the last 12 months, and only 13% of the 107 reported the regular use of condoms. High-risk sexual activity may have persisted in part because of underestimation of the local risk of acquiring HIV infection. Voluntary serologic testing and education of members of high-risk groups should be stressed in areas where the incidences of AIDS and of seropositivity to HIV are low but where high-risk sexual activity may still be prevalent.     

Level of AIDS and HIV knowledge and sexual practices among sexually transmitted disease patients in China

BACKGROUND: Little is known about sex practices that increase the risk of contracting HIV infection or the level of HIV and AIDS knowledge among sexually transmitted disease (STD) patients in China. OBJECTIVE: To describe AIDS and HIV knowledge, sexual practices, and factors associated with never using condoms among patients at an STD clinic in Jinan, China. STUDY DESIGN: Clinic patients (n = 498) were randomly sampled to answer AIDS and HIV knowledge questions and to report sexual practices, including condom use. RESULTS: Patients had low levels of AIDS and HIV knowledge and engaged in high-risk sex behaviors. The majority of patients reported having had multiple sex partners. When having sex, few men and no women reported always using condoms. Gender, age, residence, AIDS and HIV knowledge, and having multiple sex partners were significantly associated with never using condoms. CONCLUSION: STD clinic patients report having engaged in high-risk sex behaviors. More research is needed to better understand the factors relevant to developing risk-reduction interventions for these patients in China.     

Use of etanercept in human immunodeficiency virus (HIV) and acquired immunodeficiency syndrome (AIDS) patients

BACKGROUND: Etanercept (Enbrel, Amgen, Thousand Oaks, CA), a soluble p75 tumor necrosis factor receptor:FC (TNFR:FC) fusion protein for plasma cytokines, specifically tumor necrosis factor-alpha (TNF-alpha), is used in the treatment of immune-mediated rheumatic diseases. To our knowledge, the use of etanercept in patients with human immunodeficiency virus (HIV) and acquired immunodeficiency syndrome (AIDS) is relatively uncommon. OBJECTIVE: The main purpose of this short review is to examine the safety of etanercept in patients with HIV/AIDS. METHODS: A Medline search was conducted using the keywords etanercept and HIV and/or AIDS for any published articles between 1966 to the present (September 2004). RESULTS: A case report, one case series, and one clinical trial pertained to the use of etanercept in HIV patients. No reports were found on the use of etanercept in AIDS. In addition, two case reports were found documenting the use of infliximab in HIV patients. DISCUSSION: Preliminary reports indicate that the administration of etanercept does not appear to increase the morbidity or mortality rates in HIV. The inhibition of TNF-alpha may actually improve the symptoms of HIV/AIDS-associated aphthous ulcers, cachexia, dementia, fatigue, and fever, as well as help manage concomitant rheumatic diseases and psoriasis. CONCLUSION: The use of etanercept shows promise for applications in disease management in patients with HIV/AIDS. Continued research efforts are necessary to establish the long-term safety and efficacy of etanercept and other biologic agents in this patient population.