BACKGROUND: The prognosis following surgery for gastric cancer has been markedly improved as a result of early diagnosis and advancements both in operative techniques and perioperative management. However, gastrointestinal surgery in the presence of hepatic cirrhosis has shown high operative morbidity and mortality due to severe perioperative complications, such as bleeding, lymphorrhea, anastomosis leakage, hepatic failure, fluid retention, acute renal failure and multiple organ failure. Recently, the frequency of gastric cancer involving liver cirrhosis has been increasing, especially early gastric cancer cases. METHODS: From June 1995 to December 1997, a total of 410 patients with gastric cancer were treated surgically. Among them, 9 cases with liver cirrhosis underwent gastric resection. RESULTS: Three major postoperative complications occurred in 2 patient, anastomosis leakage in one, and bleeding in both. CONCLUSIONS: The purposes of this study were to assess the causes of complications and to decide the appropriate operation type for improving the prognosis for these patients with liver cirrhosis.
Acute Kidney Injury ; Early Diagnosis ; Hemorrhage ; Humans ; Liver Cirrhosis* ; Liver Failure ; Mortality ; Multiple Organ Failure ; Postoperative Complications ; Prognosis ; Stomach Neoplasms*

BACKGROUND: The aim of this study was to investigate the incidence and clinical characteristics of intravenous (IV) or inhaled (IH) colistin-associated acute kidney injury (AKI) using the Risk, Injury, Failure, Loss, End-stage Renal Disease criteria. METHODS: From 2010 to 2014, 160 patients were treated with IV or IH colistin. Of these, we included 126 patients who received colistin for > 72 hours for the treatment of pneumonia and compared the incidence and clinical characteristics of patients in the IV (n = 107) and IH (n = 19) groups. RESULTS: The patients included 104 men and 22 women, with a mean age of 69 years (range, 24–91 years). The mortality rate was 45%, and AKI occurred in 75 (60%) patients. At the end of therapy, the bacteriologic cure rate was 66%. There were no differences in the clinical characteristics between the IV and IH groups except for age. In comparison with patients in the IV group, the patients in the IH group were older (74 ± 8 vs. 68 ± 12 years, P = 0.026). The incidence of AKI was not different between the 2 groups (62 vs. 47%, P = not significant), and there was no difference in the severity of AKI according to the Risk, Injury, Failure, Loss, End-stage Renal Disease criteria. Of the 83 patients with AKI, 6 and 1 patients underwent renal replacement therapy, respectively. CONCLUSION: The incidence of AKI in patients with colistin therapy is 60% in our center. It seems that IH colistin therapy could not be better in safety than IV colistin therapy.
Acute Kidney Injury* ; Colistin* ; Female ; Humans ; Incidence ; Kidney Failure, Chronic ; Male ; Mortality ; Nebulizers and Vaporizers ; Pneumonia ; Renal Replacement Therapy

BACKGROUND: Preoperative elevated serum creatinine values are associated with increased risk for both morbidity and mortality in patients undergoing on-pump coronary artery bypass surgery (CABG). We investigated the postoperative changes of renal function and proper management in the patients. MATERIAL AND METHOD: Among 74 consecutive patients who underwent isolated on-pump CABG, 17 patients with increased serum creatinine level (creatinine > or = 1.5 mg/dL) within preoperative one week were included in the study. Seven patients showed preoperative serum creatinine level of 2.0 mg/dL or higher, and 3 of them had been undergoing hemodialysis. Preoperative hemodialysis was performed in the 3 patients due to end-stage renal failure (ESRD) the day before the operation. We started peritoneal dialysis immediately after the cardiopulmonary bypass in patients with ESRD or postoperative acute renal failure if it was necessary to remove intravascular volume and lower serum creatinine level. RESULT: In most of the patients with CABG, postoperative serum creatinine level increased and recovered to the preoperative level at the discharge. In 2 of the 4 patients with serum creatinine level of 2.0 mg/dL or higher and 3 patients with ESRD, intravascular volume, serum creatinine level and serum electrolyte were controlled with peritoneal dialysis. CONCLUSION: Postoperative serum creatinine level increased transiently in most of CABG patients, and intravascular volume and serum creatinine level were controlled by peritoneal dialysis only in the patients with acute renal failure postoperatively and those depending on hemodialysis.
Acute Kidney Injury ; Cardiopulmonary Bypass ; Coronary Artery Bypass ; Creatinine* ; Humans ; Kidney Failure, Chronic ; Mortality ; Peritoneal Dialysis ; Renal Dialysis ; Renal Insufficiency

We demonstrated that a mineral aqueous solution (MAS) administered to mice functionally and histologically protected against cisplatin-induced acute renal failure (ARF) and CCl4-induced acute liver failure (ALF). In ARF model, 0.4 and 0.2% MAS decreased mortality and the serum concentrations of blood urea nitrogen (BUN) and creatine in mice. Additionally, 0.4 and 0.2% MAS reduced contraction of distal convoluted tubules and suppressed expression of the proinflammatory cytokines interlukein-6 (IL-6) and tumor necrosis factor (TNF-alpha) in the kidney. In ALF model, 0.4 and 0.2% MAS decreased serum concentrations of alanine aminotransferase and aspartate aminotransferase in mice. Additionally, 0.4 and 0.2% MAS reduced necrotic areas and suppressed expression of IL-6 and TNF-alpha in the liver. These results indicate that a MAS might have protective effects against ARF and ALF.
Acute Kidney Injury ; Alanine Transaminase ; Animals ; Aspartate Aminotransferases ; Blood Urea Nitrogen ; Contracts ; Creatine ; Cytokines ; Interleukin-6 ; Kidney* ; Liver Failure, Acute ; Liver* ; Mice* ; Mortality ; Silicon ; Tumor Necrosis Factor-alpha

BACKGROUND: Although acute renal failure (ARF) after coronary artery bypass graft (CABG) is relatively rare, but devastating complication with high mortality. Our study aims to evaluate the effectiveness of early application of CRRT in patients with ARF which developed after on-pump CABG. MATERIAL AND METHOD: Two hundred and eighty seven patients underwent isolated on-pump CABG between May 2002 and Feb. 2006 at our institution, of whom 15 (5.2%) needed CRRT (11 patients for postoperatively developed ARF and the remaining 4 patients with pre- existing dialysis-dependent chronic renal failure (CRF) for postoperative hemodynamic and metabolic control). Criteria for early application of CRRT were as follows; decreased urine output less than 0.5 cc/h/kg for 2 consecutive hours and elevated serum creatinine level greater than 2.0 mg/dL. RESULT: The incidence of ARF requiring CRRT after on-pump CABG was 3.9% (11/283) and the overall hospital mortality of patient with CRRT was 33.3% (5/15). Of 5 deaths, 4 were patients with postoperatively developed ARF, and 1 was a patient with pre-existing dialysis- dependent CRF patient. The mean time between the operation and the initiation of CRRT was 25.8+/-5.8 hours and the mean duration of CRRT was 62.1+/-41.2 hours. Of the 7 survivors who were not on dialysis-dependent preoperatively, 6 patients fully recovered renal function during hospital stay and 1 patient required permanent renal supportive treatment after discharge from hospital. CONCLUSION: Early application of CRRT could maintain stable postoperative hemodynamic status and make outcomes better than those of previous reports in patients with ARF which developed after on-pump CABG.
Acute Kidney Injury* ; Coronary Artery Bypass ; Creatinine ; Hemodynamics ; Hospital Mortality ; Humans ; Incidence ; Kidney Failure, Chronic ; Length of Stay ; Mortality ; Renal Replacement Therapy* ; Survivors ; Transplants

BACKGROUND: The prognosis following surgery for gastric cancer has been markedly improved as a result of early diagnosis and advancements both in operative techniques and perioperative management. However, gastrointestinal surgery in the presence of hepatic cirrhosis has shown high operative morbidity and mortality due to severe perioperative complications, such as bleeding, lymphorrhea, anastomosis leakage, hepatic failure, fluid retention, acute renal failure, and multiple organ failure. Recently, the number of gastric-cancer patients patient who has liver cirrhosis has been increasing, especially for early gastric-cancer cases. METHODS: From June 1995 to December 1997, a total of 410 patients with gastric cancer were treated surgically in our degartment. RESULTS: Of the 410, 9 cases with liver cirrhosis underwent a gastric resection: 5 standard subtotal gastrectomies and 4 curative subtotal gastrectomies. Three major postoperative complications occurred in 2 patient: anastomosis leakage in one and bleeding in both. CONCLUSIONS: The purpose of this study was to report our complicated cases, to assess the causes of the complications, and to decide the appropriate operation type for improving the prognosis of these patients. Serosal flap can be the solving techniques in B-I anastomosis and complicated perforation in cirrhosis.
Acute Kidney Injury ; Early Diagnosis ; Fibrosis ; Gastrectomy ; Hemorrhage ; Humans ; Liver Cirrhosis* ; Liver Failure ; Mortality ; Multiple Organ Failure ; Postoperative Complications ; Prognosis ; Stomach Neoplasms*

OBJECTIVETo compare the acute kidney injury classification systems of RIFLE,AKIN,KDIGO and conventional criteria for determining prognosis of acute-on-chronic liver failure (ACLF) patients.

METHODSPatients with ACLF admitted to our hospital between July 2008 and March 2014 were enrolled in the study. The incidence, stages, and outcomes of acute kidney injury were determined according to the RIFLE, AKIN,KDIGO and conventional criteria.ROC curves were generated to compare the predictive ability for 30-day mortality of the four systems.Chi-square test and Fisher's exact test were used for statistical analyses, as well.

RESULTSAll four classification systems detected acute kidney injury among the patients in the study population (n =358), but the detection rates were not consistent (expressed as % of total): KDIGO criteria: 45.0%, AKIN: 38.8%, rIFLE: 35.5%, conventional criterion: 20.4%. The KDIGO and AKIN criteria showed higher sensitivity (72%), especially to early kidney injury, but the conventional criterion showed higher specificity (92%). The AUC for 30-day mortality was highest for the conventional criteria (0.75), followed by AKIN (0.72), rIFLE (0.70) and KDIGO (0.69) (all, P less than 0.05). In-hospital mortality increased with severity of AKI in a stepwise manner.

CONCLUSIONAmong the four common evaluation systems for acute kidney injury, the conventional criteria has the highest specificity for predicting short-term prognosis of patients with ACLF, while the AKIN and KDIGO criteria have the highest sensitivity for the presence of acute kidney injury, especially at the early stage.

Acute Kidney Injury ; classification ; diagnosis ; Acute-On-Chronic Liver Failure ; diagnosis ; Hospital Mortality ; Humans ; Incidence ; Prognosis ; ROC Curve ; Retrospective Studies ; Sensitivity and Specificity

Necrotizing fasciitis is an uncommon severe infection involving the subcutaneous soft tissue, particularly the superficial and often deep fascia. It is usually associated with systemic toxicity, rapid progression and a mortality rate which varies between 20 and 60%. It can affect any part of the body but is most common on the extremities, especially the leg. Predisposing factors include diabetes mellitus, alcoholism, intravenous drug abusers, abdominal surgery, perineal infection. The prognosis for necrotizing fasciitis depends so heavily on early recognition and determination of the extent of necrosis. Whilist there are reports of acute renal failure occuring in the presence of necrotizing fasciitis, descriptions of the condition in patients with chronic renal failure are rare in the literature. Hence we report a case of necrotizing fasciitis, diagnosed by MRI(Magnetic Resonance Imaging) in chronic renal failure patient.
Acute Kidney Injury ; Alcoholism ; Causality ; Diabetes Mellitus ; Drug Users ; Extremities ; Fascia ; Fasciitis, Necrotizing ; Humans ; Kidney Failure, Chronic* ; Leg ; Magnetic Resonance Imaging ; Mortality ; Necrosis ; Prognosis

Hemolytic uremic syndrome is the most common cause of acute renal failure in childhood. Atypical hemolytic uremic syndrome which is not usually associated with prodromal symptoms has a higher mortality rate and more tendency to progress to chronic renal failure. Children younger than two years of age are a more susceptible to pneumococcal infection and can develop more serious disease. We report a 23 month-old male who suffered from pneumococcal pneumonia and progressed to hemolytic uremic syndrome requiring peritoneal dialysis. He recovered completely from acute renal failure after peritoneal dialysis and intravenous use of vancomycin.
Acute Kidney Injury ; Child ; Hemolytic-Uremic Syndrome* ; Humans ; Infant ; Kidney Failure, Chronic ; Male ; Mortality ; Peritoneal Dialysis ; Pneumococcal Infections* ; Pneumonia, Pneumococcal ; Prodromal Symptoms ; Streptococcus pneumoniae* ; Streptococcus* ; Vancomycin

Between January, 1990, and December, 1994, 105 elderly patients(over the age of sixty) were referred to the Division of Nephrology at the Seoul National University Hospital as acute renal failure(ARF) (serum creatinine >1.7mg/dL, patients who had been diagnosed to have acute on chronic renal failure were excluded). To find out the characteristics of ARF in the elderly, we made a retrospective study of our data. Sufficient data for analysis were available in 101 of these. Among these patients, prerenal failure occured in 5% of the cases, ischemic ATN 34%, toxic ATN 11%, renovascular obstruction 5%, glomerular disease 5%, postrenal failure 15%. Dialysis was required in 31 patients(31%). Twenty four patients were treated by hemodialysis, it was carried out in 1 patient by the peritoneal route, and the other 6 patients were treated by CAVH. The most common indication was hypervolemia(77%). Twenty seven patients died during the period of acute renal failure. The most common cause of death was infection(15 patients), and the others were underlying diseases, pulmonary complications and cardiovascular complications. Oliguria, and chronic underlying disease were poor prognostic factors. There were significant differences between living and died group in APACHE II score(P<0.05). We conclude that ischemic ATN is a more common cause of ARF in the elderly than in the younger, and presence of oliguria and chronic underlying disease are poor prognostic factors.
Acute Kidney Injury* ; Aged* ; APACHE ; Cause of Death ; Creatinine ; Dialysis ; Hemofiltration ; Humans ; Kidney Failure, Chronic ; Lung Diseases ; Mortality ; Nephrology ; Oliguria ; Renal Dialysis ; Retrospective Studies ; Seoul