The risk of developing perioperative acute kidney injury (AKI) in elderly patients increases with age. The combined involvement of aging kidneys, coexisting multiple underlying chronic diseases, and increased exposure to potential renal stressors and nephrotoxic drugs or invasive procedures constitute susceptibility factors for AKI in elderly patients. The perioperative AKI in elderly patients undergoing noncardiac surgery has its own specific population characteristics, so it is necessary to further explore the characteristics of AKI in elderly patients in terms of epidemiology, clinical diagnosis, risk factors, and preventive and curative measures to provide meaningful clinical advice to improve prognosis, accelerate recovery, and reduce medical burden in elderly patients. Since AKI has the fastest-growing incidence in older patients and is associated with a worse prognosis, early detection, early diagnosis, and prevention of AKI are important for elderly patients in the perioperative period. Large, multicenter, randomized controlled clinical studies in elderly non-cardiac surgery patients with AKI can be conducted in the future, with the aim of providing the evidence to reduce of the incidence of AKI and to improve the prognosis of patients.
Humans ; Aged ; Acute Kidney Injury/prevention & control* ; Kidney ; Risk Factors ; Prognosis ; Incidence ; Postoperative Complications/prevention & control*

Acute Kidney Injury ; physiopathology ; prevention & control ; therapy ; Humans ; Integrative Medicine ; Kidney ; injuries ; Kidney Function Tests ; Syndrome

Acute Kidney Injury ; etiology ; prevention & control ; Ascites ; etiology ; prevention & control ; Humans ; Hyponatremia ; etiology ; prevention & control ; Liver Cirrhosis ; complications ; prevention & control

Acute kidney injury (AKI) is characterized by a reversible increase in blood concentration of creatinine and nitrogenous waste products and by the inability of the kidney to regulate fluid and electrolyte homeostasis appropriately. AKI in hospitalized patients is independently associated with increased morbidity and mortality in pediatric and adult populations. Continued reliance on serum creatinine and urine output for the diagnosis of AKI has resulted in an inability to provide successful therapeutic and supportive interventions to prevent and mitigate AKI. Research efforts over the last decade have foused on the discovery and validation of novel biomarkers to detect AKI prior to a change in kidney function and to make a differential diagnosis of AKI.
Acute Kidney Injury ; classification ; diagnosis ; prevention & control ; Biomarkers ; Child ; Creatinine ; urine ; Humans

BACKGROUNDLow potassium dextran (LPD) solution can attenuate acute lung injury (ALI). However, LPD solution for treating acute kidney injury secondary to ALI has not been reported. The present study was performed to examine the renoprotective effect of LPD solution in ALI induced by oleic acid (OA) in piglets.

METHODSTwelve animals that suffered an ALI induced by administration of OA into the right atrium were divided into two groups: the placebo group (n = 6) pretreated with normal saline and the LPD group (n = 6), pretreated with LPD solution. LPD solution was injected intravenously at a dose of 12.5 ml/kg via the auricular vein 1 hour before OA injection.

RESULTSAll animals survived the experiments with mild histopathological injury to the kidney. There were no significant differences in mean arterial pressure (MAP), creatinin and renal damage scores between the two groups. Compared with the placebo group, the LPD group had better gas exchange parameters at most of the observation points ((347.0 ± 12.6) mmHg vs. (284.3 ± 11.3) mmHg at 6 hours after ALI, P < 0.01). After 6 hours of treatment with OA, the plasma concentrations of NGAL and interleukin (IL)-6 in both groups increased dramatically compared to baseline ((6.0 ± 0.6) and (2.50 ± 0.08) folds in placebo group; and (2.5 ± 0.5) and (1.40 ± 0.05) folds in LPD group), but the change of both parameters in the LPD group was significantly lower (P < 0.01) than in the placebo group. And 6 hours after ALI the kidney tissue concentration of IL-6 in the LPD group ((165.7 ± 22.5) pg×ml(-1)×g(-1) protein) was significantly lower (P < 0.01) than that in placebo group ((67.2 ± 25.3) pg×ml(-1)×g(-1) protein).

CONCLUSIONThese findings suggest that pretreatment with LPD solution via systemic administration might attenuate acute kidney injury and the cytokine response of IL-6 in the ALI piglet model induced by OA injection.

Acute Kidney Injury ; prevention & control ; Acute Lung Injury ; drug therapy ; physiopathology ; Animals ; Dextrans ; therapeutic use ; Disease Models, Animal ; Hemodynamics ; Interleukin-6 ; blood ; Kidney ; pathology ; Oleic Acid ; toxicity ; Swine

OBJECTIVE: To explore the effect of a reforming leukocyte depletion filter (LDF-1) on the functional and pathologic changes of canine kidney during cardiopulmonary bypass (CPB). METHODS: Twelve Mongolian dogs were randomly allocated into a control group (no LDF-1, n = 6) or a leukocyte-depleted filter group (LDF-1 placed in venous line, n = 6). CPB of the dogs anestheitized with sodium pentobarbitone at 25 mg/kg was set up. After 10 min of CPB, aorta was clamped and St. Thomas cardioplegic solution at 20 mg/kg was immediately injected into the root of aorta. The aortic cross-clamp was released and CPB was closed at 70 min. Dogs were observed for 2 h after weaning from CPB. LDF-1 was opened at 2 min and stoped at 7 min during initially running CPB in the LDF-1 group. Circulating leukocytes, plasma L-selectin, and plasma IL-8 were respectively counted before CPB, at 10 minutes, 40 min, and 75 min during CPB, the end of CPB, and 2 h after CPB. The urine analysis and renal pathology, which were obtained before CPB and 2 h after CPB, were observed. RESULTS: The number of leukocytes significantly decreased by 55% - 68% in the LDF-1 group compared with the baseline during CPB. The value at 10 min of CPB in the LDF-1 group was lower than that in the control group (P < 0.05). Plasma levels of L-selectin and IL-8 obviously increased in the 2 groups compared with the baseline during CPB, but both levels at 2 h after CPB in the LDF-1 group were lower than those in the control group (P <0. 05). No statistic difference was found in plasma levels of urea and creatinine, but hematuria was observed in the 2 groups at 2 hours after CPB. The pathologic changes of kidney, which was mainly renal tubule swelling accompanied partly with vacuolar degeneration, were similar under the light microscope in the 2 groups at 2 h after CPB. Obvious glomerular damage was not found. CONCLUSION LDF-1 can effectively decrease leukocyte counts and the inflammatory reaction, but it can not bring about excellent protective effect on kidney during CPB when used alone. Attention to should be paid the renal protection in the postoperative CPB.
Acute Kidney Injury ; prevention & control ; Animals ; Cardiopulmonary Bypass ; Dogs ; Female ; Filtration ; Kidney Function Tests ; Leukocyte Reduction Procedures ; methods ; Leukocytes ; Male ; Random Allocation

OBJECTIVE: To investigate the effect of dexmedetomidine (DEX) on renal function after laparoscopic radical nephrectomy. METHODS: We reviewed the clinical data of 282 patients with renal cell carcinoma (RCC), who underwent laparoscopic radical nephrectomy (LRN) in the Department of Urology, Third Medical Center of PLA General Hospital from November, 2020 and June, 2022.According to whether DEX was used during the operation, the patients were divided into DEX group and control group, and after propensity score matching, 99 patients were finally enrolled in each group.The incidence of acute kidney injuries were compared between the two groups.Serum creatinine (sCr) data within 3 months to 1 year after the operation were available in 51 patients, including 26 in DEX group and 25 in the control group, and the incidence of chronic kidney disease (CKD) was compared between the two groups. RESULTS: After propensity score matching and adjustment for significant covariates, there were no significant differences in postoperative levels of sCr, cystatin C (CysC), β2-microglobulin (β2-MG), hemoglobin (Hb), or C-reactive protein (CRP), extubation time, incidence of AKI, or length of hospital stay between the two groups (P>0.05).The intraoperative urine volume was significantly higher in DEX group than in the control group (P < 0.05).A significant correlation between AKI and CKD was noted in the patients (P < 0.05).The incidence of CKD did not differ significantly between the two groups (P>0.05). CONCLUSION DEX can not reduce the incidence of AKI or CKD after LRN.
Humans ; Dexmedetomidine ; Incidence ; Propensity Score ; Renal Insufficiency, Chronic/epidemiology* ; Kidney Neoplasms/surgery* ; Nephrectomy/adverse effects* ; Laparoscopy/adverse effects* ; Acute Kidney Injury/prevention & control* ; Retrospective Studies

OBJECTIVETo investigate the prevention of Danhong Injection (DHI) on contrast-induced renal impairment after percutaneous coronary intervention (PCI).

METHODSEighty patients receiving PCI were randomly assigned to the control group and the treatment group, 40 in each. All patients used loperamide injection as the contrast media, and received routine medicines such as enteric coated aspirin and Betaloc, as well as routine rehydration therapy. As for patients in the treatment group, 20 mL DHI was intravenously dripped by adding in 250 mL 0.9% sodium chloride injection from 2 -3 days before PCI to 3 days after PCI, once daily. The levels of serum creatinine (SCr), cystatin C (CysC), urine micro-albumin (mAlb), and beta2-microglobulin (beta2-MG) were measured before PCI, and 24, 48, 72 h after PCI. The occurrence of radio contrast-induced nephropathy (RCIN) of the two groups was observed.

RESULTSThe serum SCr and CysC levels of the two groups reached the peak 24 h after PCI (P < 0.05, P < 0.01). But they respectively restored to the pre-PCI levels at 48 and 72 h after PCI in the treatment group. In the control group the serum SCr level basically restored to the pre-PCI level at 72 h after PCI. The urinary mAlb and beta2-MG levels of the two groups reached the peak at 24 and 48 h after PCI (P < 0.05, P < 0.01), and basically restored to the pre-PCI level at 72 h after PCI. But they did not restore in the control group (P < 0.05). Seven patients suffered from RCIN in the two groups, of them 5 (12.5%) in the control group and 2 (5.0%) in the treatment group, with no statistical difference (P > 0.05).

CONCLUSIONSDHI could effectively prevent contrast-induced renal impairment and shorten the recovery time of renal impairment. It was worth further studies.

Acute Kidney Injury ; chemically induced ; prevention & control ; Adult ; Aged ; Contrast Media ; adverse effects ; Drugs, Chinese Herbal ; therapeutic use ; Female ; Humans ; Injections ; Male ; Middle Aged ; Percutaneous Coronary Intervention

OBJECTIVEThe present study is to investigate the protective effects of asiaticoside on sepsis-induced acute kidney injury in mice.

METHODWith the sepsis induced by cecal ligation and puncture (CLP), forty eight kunming mice were randomly divided into four groups as sham operated, CLP treated, CLP + asiaticoside 15, 45 mg x kg(-1) groups. General conditions and the amount of dead rate of mice were observed. The BUN and Cr levels were observed by the kits. IL-6 in serum was assayed by enzyme-linked immunosorbent assay (ELISA). Kidney tissues were harvested for determination of iNOS expression by Western blotting analysis. The pathologic changes were observed under electron microscope via hematoxylin-eosin (HE) stain.

RESULTCompared with CLP group, the death rate, the levels of BUN, Cr, IL-6, and iNOS protein expression of asiaticoside groups were significantly reduced. The pathologic changes in kidney tissues induced by sepsis were significantly attenuated dose-dependently by asiaticoside under electron microscope.

CONCLUSIONAsiaticoside has protective effects against sepsis-induced acute kidney injury, which were probably associated with the inhibition of IL-6 in serum and iNOS protein in kidney tissues.

Acute Kidney Injury ; drug therapy ; etiology ; prevention & control ; Animals ; Disease Models, Animal ; Female ; Humans ; Male ; Mice ; Plant Extracts ; administration & dosage ; Random Allocation ; Sepsis ; complications ; Triterpenes ; administration & dosage

OBJECTIVES: Contrast-induced acute kidney injury (CI-AKI) is the third cause of hospital-acquired AKI, and existing clinical prevention and treatment measures such as hydration therapy and/or administration of antioxidants N-acetylcysteine treatment and other treatments still show little effect on the prevention and treatment of CI-AKI. This study aims to explore the effect of Danhong injection on prevention of CI-AKI. METHODS: A total of 12 867 patients, who received coronary angiography, percutaneous coronary intervention, enhanced CT or vascular intervention in a tertiary hospital, were enrolled for this study. Among them, 423 in the treatment group received intravenous drip of Danhong injection, and 12 444 in the control group received routine medicine. Propensity score matching was conducted to balance confounding factors between the 2 groups and then the prevention effect of Danhong injection on CI-AKI was compared between them. RESULTS: A total of 423 pairs of patients were matched successfully. The incidence of CI-AKI in the non-Danhong control group was higher than that in the Danhong treatment group (5.7% vs 2.4%). The difference between the 2 groups was statistically significant ( CONCLUSIONS The results of this study support the use of Danhong injection in the prevention of the Stage 1 of CI-AKI.
Acute Kidney Injury/prevention & control* ; Contrast Media/adverse effects* ; Drugs, Chinese Herbal ; Humans ; Injections ; Percutaneous Coronary Intervention ; Propensity Score ; Risk Factors ; Treatment Outcome