OBJECTIVE: This study summarizes and compares clinical and laboratory characteristics of 34 patients admitted to the intensive care unit (ICU) for complications from coronavirus disease 2019 (COVID-19) at the First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China from Jan. 22 to Mar. 5, 2020. METHODS: A total of 34 patients were divided into two groups, including those who required noninvasive ventilation (NIV) and invasive mechanical ventilation (IMV) with additional extracorporeal membrane oxygenation (ECMO) in 11 patients. Clinical features of COVID-19 patients were described and the parameters of clinical characteristics between the two groups were compared. RESULTS: The rates of the acute cardiac and kidney complications were higher in IMV cases than those in NIV cases. Most patients had lymphocytopenia on admission, with lymphocyte levels dropping progressively on the following days, and the more severe lymphopenia developed in the IMV group. In both groups, T lymphocyte counts were below typical lower limit norms compared to B lymphocytes. On admission, both groups had higher than expected amounts of plasma interleukin-6 (IL-6), which over time declined more in NIV patients. The prothrombin time was increased and the levels of platelet, hemoglobin, blood urea nitrogen (BUN), D-dimer, lactate dehydrogenase (LDH), and IL-6 were higher in IMV cases compared with NIV cases during hospitalization. CONCLUSIONS Data showed that the rates of complications, dynamics of lymphocytopenia, and changes in levels of platelet, hemoglobin, BUN, D-dimer, LDH and IL-6, and prothrombin time in these ICU patients were significantly different between IMV and NIV cases.
Acute Kidney Injury ; virology ; Aged ; Aged, 80 and over ; Betacoronavirus ; Blood Urea Nitrogen ; China ; Coronavirus Infections ; complications ; therapy ; Extracorporeal Membrane Oxygenation ; Female ; Fibrin Fibrinogen Degradation Products ; analysis ; Heart Diseases ; virology ; Hemoglobins ; analysis ; Hospitalization ; Humans ; Intensive Care Units ; Interleukin-6 ; blood ; L-Lactate Dehydrogenase ; blood ; Lymphopenia ; virology ; Male ; Middle Aged ; Noninvasive Ventilation ; Pandemics ; Pneumonia, Viral ; complications ; therapy ; Positive-Pressure Respiration ; Prothrombin Time ; Retrospective Studies

OBJECTIVE: To study the clinical effect and complications of continuous blood purification (CBP) in the treatment of multiple organ dysfunction syndrome (MODS) in neonates. METHODS: A retrospective analysis was performed for the clinical data of 21 neonates with MODS who were admitted to the neonatal intensive care unit from November 2015 to April 2019 and were treated with CBP. Clinical indices were observed before treatment, at 6, 12, 24, and 36 hours of CBP treatment, and at the end of treatment to evaluate the clinical effect and safety of CBP treatment. RESULTS: Among the 21 neonates with MODS undergoing CBP, 17 (81%) had response to treatment. The neonates with response to CBP treatment had a significant improvement in oxygenation index at 6 hours of treatment, a significant increase in urine volume at 24 hours of treatment, a stable blood pressure within the normal range at 24 hours of treatment, and significant reductions in the doses of the vasoactive agents epinephrine and dopamine at 6 hours of treatment (P<0.05), as well as a significant reduction in serum K+ level at 6 hours of treatment, a significant improvement in blood pH at 12 hours of treatment, and significant reductions in blood lactic acid, blood creatinine, and blood urea nitrogen at 12 hours of treatment (P<0.05). Among the 21 neonates during CBP treatment, 6 experienced thrombocytopenia, 1 had membrane occlusion, and 1 experienced bleeding, and no hypothermia, hypotension, or infection was observed. CONCLUSIONS CBP is a safe, feasible, and effective method for the treatment of MODS in neonates, with few complications.
Blood Gas Analysis ; Blood Urea Nitrogen ; Hemofiltration ; Humans ; Infant, Newborn ; Multiple Organ Failure ; Retrospective Studies

blood glucose, blood urea nitrogen, hematocrit, and hemoglobin), and enzyme-linked immunosorbent assay kits (calcium, magnesium, creatinine, aspartate aminotransferase, alanine aminotransferase, bilirubin, and albumin). Similar trends were found for the parameters of biochemistries, electrolytes, and blood gas, and they revealed no significant changes after blood withdrawal-induced hemorrhagic shock. However, the TBS group showed more effective ability to correct metabolic acidosis than the NS and RS groups. TBS was a feasible and safe resuscitation solution in this study and may be an alternative to NS and RS for resuscitation in hemorrhagic shock patients without liver damage.]]>
Acidosis ; Alanine Transaminase ; Animals ; Aspartate Aminotransferases ; Bilirubin ; Blood Glucose ; Blood Urea Nitrogen ; Carbon Dioxide ; Creatinine ; Electrolytes ; Enzyme-Linked Immunosorbent Assay ; Hematocrit ; Hemodynamics ; Humans ; Hydrogen-Ion Concentration ; Liver ; Magnesium ; Male ; Oxygen ; Potassium ; Rats ; Resuscitation ; Shock, Hemorrhagic ; Sodium

Autophagy is a fundamental cellular process that maintains homeostasis and cell integrity, under stress conditions. Although the involvement of autophagy in various conditions has been elucidated, the role of autophagy in renal structure is not completely clarified. Our aim was to investigate the cytoprotective effect of autophagy against acute kidney injury (AKI) through cisplatin deteriorative pathway, which leads to AKI via renal cell degradation. For in vivo experiments, male Sprague Dawley rats were divided in to 2 groups (n = 6/group) as control, Cis-5D. Following a single intraperitoneal injection of cisplatin, rats were sacrificed after 5 days. Blood urea nitrogen (BUN), creatinine (Cr) and histological alterations were examined. Further, expression of key regulators of autophagy, light-clain 3 (LC3), p62, and Beclin1, was evaluated by immunohistochemistry (IHC). The rats exhibited severe renal dysfunction, indicated by elevated BUN, Cr. Hematoxylin and eosin staining revealed histological damages in cisplatin-treated rats. Furthermore, IHC analysis revealed increased expression of LC3, Beclin1 and decreased expression of p62. Furthermore, expression of aforementioned autophagy markers was restricted to proximal tubule. Taken together, our study demonstrated that cisplatin can cause nephrotoxicity and lead to AKI. This phenomenon accelerated autophagy in renal proximal tubules and guards against AKI.
Acute Kidney Injury ; Animals ; Autophagy ; Blood Urea Nitrogen ; Cisplatin ; Creatinine ; Eosine Yellowish-(YS) ; Hematoxylin ; Homeostasis ; Humans ; Immunohistochemistry ; Injections, Intraperitoneal ; Male ; Rats ; Rats, Sprague-Dawley

OBJECTIVE: The purpose of this study was to determine the effect of quercetin on the antitumor activity of cisplatin and its side-effects. METHODS: EMT6 cells, a mouse breast cancer cell line, were injected subcutaneously in mice to generate a breast tumor-bearing mouse model. Experimental groups were divided into four groups: control (C), quercetin (Q), cisplatin (CP), and cisplatin+quercetin (CP+Q). RESULTS: The tumor volume of the CP+Q group was significantly lower than that of the CP group. Serum blood urea nitrogen and creatinine levels in the CP+Q group were lower than those in the CP group. Renal γ-glutamyltranspeptidase and alkaline phosphatase activities were significantly higher in the CP+Q group than in the CP group, and the content of renal thiobarbituric acid reactive substance was significantly lower in the CP+Q group than that in the CP group. These results suggested that quercetin and cisplatin synergistically increased cellular toxicity in breast cancer cells and mediated cancer growth inhibition, thereby enhancing the antitumor effect of cisplatin compared to when only cisplatin was administered. Quercetin also reduced renal toxicity, which arose as a potential a side effect of cisplatin. CONCLUSION: The enhanced antitumor effect of cisplatin and decreased renal toxicity after quercetin treatment suggested the applicability of quercetin as an adjuvant for chemotherapeutic agents.
Alkaline Phosphatase ; Animals ; Blood Urea Nitrogen ; Breast Neoplasms ; Breast ; Cell Line ; Cisplatin ; Creatinine ; Mice ; Quercetin ; Tumor Burden

Renal cortical necrosis (RCN) is patchy or diffuse ischemic destruction of the renal cortex caused by significantly reduced renal arterial perfusion. It is a rare cause of acute kidney injury (AKI) and is associated with high mortality. Here, we review the case of RCN in a 15-year-old boy who developed AKI. A 15-year-old boy was referred to our hospital from a local hospital due to a sharp decrease in his renal function. He presented with acute flank pain, nausea with vomiting, and oliguria for the past two days. He had taken a single dose of antihistamine for nasal congestion. At our hospital, his peak blood pressure was 148/83 mmHg and he had a high body mass index of 32.9 kg/m². The laboratory data showed a blood urea nitrogen (BUN) of 28.4 mg/dL, a creatinine of 4.26 mg/dL, and a glomerular filtration rate estimated from the serum cystatin C of 20.2 mL/min/1.73m². Proteinuria (spot urine protein to creatinine ratio 1.66) with pyuria was observed. Kidney sonography showed parenchymal swelling and increased renal echogenicity. Due to rapidly progressing nephritis, steroid pulse therapy (750 mg/IV) was done on the second day of his admission and the patient showed complete recovery with normal renal function. However, the kidney biopsy findings revealed renal cortical hemorrhagic necrosis. Multifocal, relatively well-circumscribed, hemorrhagic necrotic areas (about 25%) were detected in the tubulointerstitium. Although RCN is an unusual cause of AKI, especially in children, pediatricians should consider the possibility of RCN when evaluating patients with rapidly decreasing renal function.
Acute Kidney Injury ; Adolescent ; Biopsy ; Blood Pressure ; Blood Urea Nitrogen ; Body Mass Index ; Child ; Creatinine ; Cystatin C ; Estrogens, Conjugated (USP) ; Flank Pain ; Glomerular Filtration Rate ; Humans ; Kidney ; Kidney Cortex Necrosis ; Male ; Mortality ; Nausea ; Necrosis ; Nephritis ; Obesity ; Oliguria ; Perfusion ; Proteinuria ; Pyuria ; Vomiting

BACKGROUND AND OBJECTIVES: The burden of acute kidney injury (AKI) has not been explored in Jordanian patients who receive hematopoietic stem cell transplant (HSCT). The aim of this study was to evaluate the frequency, risk factors, and mortality of AKI among patients who underwent HSCT. METHODS: A retrospective pilot study included 70 adult patients who received peripheral HSCT was conducted. Weekly measurement of serum creatinine (SCr) was obtained for 3 months after chemotherapy and HSCT. Then, stages of Risk, Injury, and Failure of Kidney were determined based on the Kidney Disease for Improving Global Outcomes (KDIGO). RESULTS: The median follow-up was 41 months. Mortality was reported in 16 patients (23%). Out of 60 patients that had SCr values, 19 patients (31.6%) had AKI in 90 days after chemotherapy. Allogeneic HSCT, male donors, high-dose melphalan protocols and values of blood urea nitrogen (BUN) were significantly higher among patients with AKI. CONCLUSIONS: Combining many nephrotoxic drugs and dosing adjustments should be considered in uniform protocols. Multidisciplinary care should be utilized to assess early kidney dysfunction that decreases adverse events and improves outcomes.
Acute Kidney Injury ; Adult ; Blood Urea Nitrogen ; Clothing ; Creatinine ; Drug Therapy ; Follow-Up Studies ; Hematopoietic Stem Cells ; Humans ; Incidence ; Jordan ; Kidney ; Kidney Diseases ; Male ; Melphalan ; Mortality ; Pilot Projects ; Prognosis ; Retrospective Studies ; Risk Factors ; Tissue Donors

OBJECTIVE: Unperforated and perforated acute appendicitis need to be differentiated because appendicitis with a free perforation requires an emergency operation to prevent contamination inside the bowel from spreading into the peritoneal cavity. The sensitivity of imaging tests is not reliable enough alone for determining the existence of a perforation. The aim of this study was to determine the differences in laboratory values between unperforated and perforated acute appendicitis to help distinguish perforated acute appendicitis. METHODS: The laboratory values and demographic data of a total of 175 patients who visited the emergency room and were diagnosed with acute appendicitis were collected. The time elapsed from symptom presentation to the ER visit, length of admission, patient demographics, and laboratory values, including sex, age, leukocyte count, neutrophil %, neutrophil count, C-reactive protein (CRP), platelet count, prothrombin time (PT), activated partial thromboplastin time, international normalized ratio (INR), serum glucose, blood urea nitrogen, creatinine, total and direct bilirubin, aspartate aminotransferase, alanine aminotransferase, alkaline phosphatase, and gamma-glutamyltransferase were analyzed. RESULTS: The factors associated with appendix perforations were an elevated leukocyte count, neutrophil count, neutrophil %, CRP, serum glucose and total bilirubin; and delayed PT and INR. CONCLUSION: Acute appendicitis patients without definite imaging evidence of the perforation but with the laboratory values suggesting a perforation, such as elevated leukocyte count, neutrophil count, neutrophil %, CRP, serum glucose, and total bilirubin; and delayed PT, and INR should raise concern for a possible undiscovered perforation.
Abdomen, Acute ; Alanine Transaminase ; Alkaline Phosphatase ; Appendicitis ; Appendix ; Aspartate Aminotransferases ; Bilirubin ; Blood Glucose ; Blood Urea Nitrogen ; C-Reactive Protein ; Creatinine ; Demography ; Diagnosis, Differential ; Emergencies ; Emergency Service, Hospital ; gamma-Glutamyltransferase ; Humans ; International Normalized Ratio ; Leukocyte Count ; Neutrophils ; Partial Thromboplastin Time ; Patient Admission ; Peritoneal Cavity ; Platelet Count ; Prothrombin Time

BACKGROUND: Compared to the general population, patients with end-stage renal disease have more gastrointestinal symptoms and a higher prevalence of peptic ulcer. Risk factors for peptic ulcer disease in patients with end-stage renal disease, however, remain poorly defined. This study aims to better identify those risk factors. METHODS: We analyzed 577 patients with end-stage renal disease from 2004 to 2016. We excluded patients with life-threatening conditions. All patients underwent upper endoscopy. We analyzed patient medical records, medication history, and endoscopic findings. Independent sample t test, chi-square test, Fisher’s exact test, and multiple logistic regression analysis were used in statistical analyses. RESULTS: Of the 577 patients with end-stage renal disease, 174 had peptic ulcer disease (gastric or duodenal ulcer). Patients on hemodialysis had a higher prevalence of peptic ulcer disease than those on peritoneal dialysis. Patients with peptic ulcer disease had lower serum albumin level and higher blood urea nitrogen level than those without peptic ulcer disease. Positive scores on two or more nutritional indices (albumin, serum cholesterol, uric acid, and creatinine levels) were associated with peptic ulcer disease in end-stage renal disease. CONCLUSION: Hemodialysis, hypoalbuminemia, and multiple malnutrition indices were associated with the prevalence of peptic ulcer disease in patients with end-stage renal disease receiving dialysis.
Blood Urea Nitrogen ; Cholesterol ; Creatinine ; Dialysis ; Endoscopy ; Humans ; Hypoalbuminemia ; Kidney Failure, Chronic ; Logistic Models ; Malnutrition ; Medical Records ; Nutrition Assessment ; Peptic Ulcer ; Peritoneal Dialysis ; Prevalence ; Renal Dialysis ; Risk Factors ; Serum Albumin ; Uric Acid

PURPOSE: The purpose of this study was to identify the risk factors for postoperative pulmonary complications (PPCs) after upper or lower abdominal digestive tract surgery. METHODS: Participants in this retrospective observational study had undergone upper or lower digestive tract surgery and entered the surgical intensive care unit between March 1, 2016 and February 28, 2017. Data were collected from the medical records, operative records, results of laboratory test, and the nursing records of the hospitals.
Blood Transfusion ; Critical Care ; Gastrointestinal Tract ; Humans ; Intensive Care Units ; Logistic Models ; Medical Records ; Nitrogen ; Nursing ; Nursing Records ; Observational Study ; Postoperative Complications ; Retrospective Studies ; Risk Factors ; Urea