Acute kidney injury (AKI) is a common complication in the neonatal intensive care unit that causes a high mortality of preterm infants and various chronic kidney diseases in adulthood. Preterm infants have immature development of the kidneys at birth. The kidneys continue to develop within a specific time window after birth. However, due to various factors during pregnancy and after birth, preterm infants tend to develop AKI. At present, serum creatinine and urine volume are used for the assessment of kidney injury, and their early sensitivity and specificity have attracted increasing attention. In recent years, various new biomarkers have been identified for early recognition of AKI. This article reviews the features, risk factors, renal function assessment, and prevention/treatment of AKI of preterm infants, in order to provide a reference for improving early diagnosis and treatment of AKI in preterm infants and long-term quality of life.
Acute Kidney Injury ; diagnosis ; etiology ; therapy ; Biomarkers ; Humans ; Infant, Newborn ; Infant, Premature

Acute Kidney Injury ; diagnosis ; drug therapy ; etiology ; Adult ; Anti-Bacterial Agents ; therapeutic use ; Cyclophosphamide ; therapeutic use ; Female ; Humans ; Kidney Diseases ; diagnosis ; drug therapy ; Levofloxacin ; therapeutic use ; Malacoplakia ; complications ; diagnosis ; drug therapy ; Prednisone ; therapeutic use

BACKGROUND/AIMS: New definitions of acute kidney injury (AKI) have recently emerged. Some studies have suggested that duration of AKI is an additional predictive parameter for mortality. Here, we evaluated whether AKI duration was predictive of long-term mortality in patients with hospital-acquired acute kidney injury (HAAKI). METHODS: We prospectively enrolled patients who developed HAAKI at an urban university hospital, from September 2007 to August 2008 and followed them until December 2011. Patients were divided into two groups by duration of the AKI (1 to 5 days vs. > or = 6 days), and long-term mortality was compared. RESULTS: HAAKI developed in 1.2% of patients during the enrollment period. The median follow-up period was 240 days (interquartile range, 53 to 1,428). In 42.3% of patients (n = 52), the AKI lasted 1 to 5 days, while it lasted > or = 6 days in 57.7% (n = 71). Survival analysis showed that a longer duration of AKI increased the risk of death. Long-term survival was significantly different in the two groups. CONCLUSIONS: The duration of AKI influenced mortality rates in hospitalized patients. Thus, AKI duration is a parameter affecting mortality in HAAKI.
Acute Kidney Injury/diagnosis/etiology/*mortality/therapy ; Aged ; Female ; *Hospitalization ; Hospitals, University ; Humans ; Kaplan-Meier Estimate ; Male ; Middle Aged ; Prognosis ; Proportional Hazards Models ; Prospective Studies ; Republic of Korea ; Risk Factors ; Time Factors

BACKGROUND/AIMS: The potential physiologic roles of Klotho in acute kidney injury (AKI) have recently been demonstrated in animal models. However, to date, there have been no human studies investigating the expression of renal Klotho in AKI. METHODS: We retrospectively collected biopsy specimens and clinical data of AKI patients between January 2001 and December 2012. Klotho expression was determined by immunohistochemical staining, and the clinical-pathological correlation was examined. RESULTS: Among the 34 patients diagnosed with acute tubular necrosis or acute tubulointerstitial nephritis, 21 patients without chronic histological lesions were included. The mean age was 37.3 +/- 18.5 years and the mean peak creatinine level was 8.2 +/- 5.5 mg/dL. In total, 10 patients (47.6%) received temporary renal replacement therapy (RRT); however, 17 patients (81%) showed functional recovery with creatinine levels of < 1.3 mg/dL after 1 month. The intensity of Klotho expression was scored as a percentage of Klotho-positive area. The renal Klotho score showed a significant negative correlation with the initial or peak creatinine level. When the patients were divided into three groups according to the Klotho score (low, middle, high), the low group had a significantly higher peak creatinine level and a more frequent requirement for RRT. However, the Klotho score was not a significant predictor of renal recovery. CONCLUSIONS: The results demonstrated that renal Klotho expression in humans decreased significantly according to the severity of AKI, regardless of the etiology, and that low expression was associated with a poor short-term outcome.
Acute Kidney Injury/diagnosis/etiology/*metabolism/physiopathology/therapy ; Adolescent ; Adult ; Biomarkers/analysis ; Biopsy ; Down-Regulation ; Female ; Glucuronidase/*analysis ; Humans ; Immunohistochemistry ; Kidney/*chemistry/pathology/physiopathology ; Kidney Tubular Necrosis, Acute/diagnosis/etiology/*metabolism/physiopathology/therapy ; Male ; Middle Aged ; Necrosis ; Predictive Value of Tests ; Recovery of Function ; Renal Replacement Therapy ; Retrospective Studies ; Risk Factors ; Severity of Illness Index ; Time Factors ; Treatment Outcome ; Young Adult

No abstract available.
Acute Kidney Injury/diagnosis/*etiology/therapy ; Biopsy ; Fluid Therapy ; Glucocorticoids ; Humans ; Hypercalcemia/diagnosis/*etiology/therapy ; Male ; Middle Aged ; Multimodal Imaging ; Positron-Emission Tomography ; Renal Dialysis ; Sarcoidosis/*complications/diagnosis/therapy ; Subcutaneous Tissue/pathology ; Tomography, X-Ray Computed ; Treatment Outcome

PURPOSE: Acute kidney injury (AKI) caused by hypothyroidism-induced rhabdomyolysis is a rare and potentially life-threatening syndrome. The aim of this study was to investigate the clinical characteristics of such patients. MATERIALS AND METHODS: We retrospectively analyzed five patients treated at the Second Affiliated Hospital of Chongqing Medical University with AKI secondary to hypothyroidism-induced rhabdomyolysis from January 2006 to December 2010. RESULTS: Of the five cases reviewed (4 males, age range of 37 to 62 years), adult primary hypothyroidism was caused by amiodarone (1 case), chronic autoimmune thyroiditis (1 case), and by uncertain etiologies (3 cases). All patients presented with facial and lower extremity edema. Three patients presented with weakness, while two presented with blunted facies and oliguria. Only one patient reported experiencing myalgia and proximal muscle weakness, in addition to fatigue and chills. Creatine kinase, lactate dehydrogenase, and renal function normalized after thyroid hormone replacement, except in two patients who improved through blood purification. CONCLUSION: Hypothyroidism should be considered in patients presenting with renal impairment associated with rhabdomyolysis. Moreover, further investigation into the etiology of the hypothyroidism is warranted.
Acute Kidney Injury/*etiology/therapy ; Adult ; Amiodarone/adverse effects ; Creatine Kinase/blood ; Female ; Humans ; Hypothyroidism/*complications ; Kidney Function Tests ; L-Lactate Dehydrogenase/blood ; Male ; Middle Aged ; Retrospective Studies ; Rhabdomyolysis/diagnosis/*etiology ; Thyroiditis, Autoimmune/complications ; Treatment Outcome ; Vasodilator Agents/adverse effects

Acute Kidney Injury ; blood ; etiology ; therapy ; Anti-Retroviral Agents ; administration & dosage ; CD4 Lymphocyte Count ; Disease Progression ; Embolization, Therapeutic ; methods ; Fatal Outcome ; Gastrointestinal Hemorrhage ; diagnostic imaging ; etiology ; physiopathology ; therapy ; Glucocorticoids ; administration & dosage ; HIV Infections ; complications ; diagnosis ; immunology ; HIV-1 ; drug effects ; isolation & purification ; Humans ; Male ; Middle Aged ; Purpura, Schoenlein-Henoch ; complications ; diagnosis ; physiopathology ; Radiography ; Renal Dialysis ; methods

OBJECTIVETo explore the management of fungal pyelonephritis in infants.

METHODData from 5 cases with fungal pyelonephritis, including the clinical situation, laboratory examination, feature of imaging, and treatment were analyzed.

RESULTAll the 5 cases were preterm and low birth weight infants. In 3 cases the disease was unilateral, in 2 cases were bilateral, and acute renal failure occurred. Fungus balls presented on imaging. Urine culture was positive of Candida albicans. Treatment with percutaneous nephrostomy, irrigation and antifungal agent were associated with good prognosis. Only 1 case died. The surviving patients were followed up for 10 - 20 months and the results showed normal growth and development. B-mode ultrasound examination did not show any malformation of the urinary system.

CONCLUSIONFungal pyelonephritis was commom in preterm infants. Candida albicans was the major pathogenic microorganism. Percutaneous nephrostomy and drainage were effective in patients with urinary obstruction in relief of obstruction, early diagnosis and control of infection.

Acute Kidney Injury ; etiology ; therapy ; Amphotericin B ; administration & dosage ; Antifungal Agents ; administration & dosage ; therapeutic use ; Candida albicans ; isolation & purification ; Candidiasis ; complications ; diagnosis ; therapy ; Chymotrypsin ; administration & dosage ; Female ; Humans ; Infant ; Infant, Newborn ; Infant, Premature ; Male ; Nephrostomy, Percutaneous ; Pyelonephritis ; diagnosis ; microbiology ; therapy ; Treatment Outcome ; Ultrasonography, Doppler, Color ; Ureteral Obstruction ; etiology ; therapy ; Urine ; microbiology

Acute Kidney Injury ; etiology ; Adult ; Diagnosis, Differential ; Female ; HELLP Syndrome ; pathology ; Hemolytic-Uremic Syndrome ; complications ; pathology ; therapy ; Humans ; Plasma Exchange ; Postpartum Period ; Pregnancy ; Purpura, Thrombotic Thrombocytopenic ; pathology ; Young Adult

Hepatitis A virus (HAV) infections occur predominantly in children, and are usually self-limiting. However, 75-95% of the infections in adults are symptomatic (mostly with jaundice), with the illness symptoms usually persisting for a few weeks. Atypical manifestations include relapsing hepatitis, prolonged cholestasis, and complications involving renal injury. Drug rash with eosinophilia and systemic symptoms (DRESS) syndrome is a severe, drug-induced hypersensitivity reaction characterized by skin rash, fever, lymph-node enlargement, and internal organ involvement. We describe a 22-year-old male who presented with acute kidney injury and was diagnosed with prolonged cholestatic hepatitis A. The patient also developed DRESS syndrome due to antibiotic and/or antiviral treatment. To our knowledge, this is the first report of histopathologically confirmed DRESS syndrome due to antibiotic and/or antiviral treatment following HAV infection with cholestatic features and renal injury.
Acute Kidney Injury/diagnosis ; Anti-Bacterial Agents/*adverse effects/therapeutic use ; Cefotaxime/adverse effects/therapeutic use ; Cholestasis/complications/*diagnosis ; Cytomegalovirus/genetics ; Cytomegalovirus Infections/drug therapy/virology ; DNA, Viral/analysis ; Eosinophilia/etiology ; Exanthema/*chemically induced/pathology ; Ganciclovir/therapeutic use ; Hepatitis A/complications/*diagnosis/drug therapy ; Humans ; Hydrocortisone/therapeutic use ; Immunoglobulins/therapeutic use ; Male ; Syndrome ; Young Adult