Nephrology Commons^™

Kidney Recovery In Patients With Acute Kidney Injury Treated In Outpatient Hemodialysis Or Rehabilitation Facilities, Melissa Jordan, Victor M. Ortiz-Soriano, Aaron Pruitt, Lauren Chism, Lucas J. Liu, Nourhan Chaaban, Madona Elias, B. Peter Sawaya, Jin Chen, Javier A. Neyra

Internal Medicine Faculty Publications

Rationale & Objective: Since January 2017, patients with acute kidney injury requiring dialysis (AKI-D) can be discharged to outpatient dialysis centers for continued hemodialysis (HD) support. We aimed to examine the rate of kidney recovery, time to recovery, and hospitalization-related clinical parameters associated with kidney recovery in patients with AKI-D.

Study Design: Single-center prospective cohort study.

Setting & Participants: 111 adult patients who were admitted to the University of Kentucky Hospital, experienced AKI-D, and were discharged with need of outpatient HD.

Exposure: Hospitalization-related clinical parameters were evaluated.

Outcome: Kidney recovery as a composite of being alive and no longer requiring …

Anti-Neutrophil Cytoplasmic Antibodies: To Care Or Not To Care, Sara Shahid, Syed H Alam, Lillian Gaber, Salman Ahmed

Faculty, Staff and Students Publications

Anti-neutrophil cytoplasmic antibodies (ANCA) associated vasculitis is a disease process with a wide range of presentations, from asymptomatic or minimally symptomatic disease with positive laboratory testing, to florid acute end-organ damage. Consensus has not been established as to the frequency and/or protocol by which ANCA testing should be repeated. We present the case of a 53-year-old woman who initially came to medical attention with persistent dyspnea and pulmonary infiltrates presumed to be due to acute exacerbation of chronic diastolic congestive heart failure. Extensive infectious disease testing was negative, but ANCA testing was positive. However, because antinuclear antibody (ANA) interference in …

Central And Peripheral Arterial Diseases In Chronic Kidney Disease: Conclusions From A Kidney Disease: Improving Global Outcomes (Kdigo) Controversies Conference, Kirsten L Johansen, Pranav S Garimella, Caitlin W Hicks, Philip A Kalra, Dearbhla M Kelly, Sven Martens, Kunihiro Matsushita, Pantelis Sarafidis, Manish M Sood, Charles A Herzog, Michael Cheung, Michel Jadoul, Wolfgang C Winkelmayer, Holger Reinecke, Conference Participants

Faculty, Staff and Students Publications

Chronic kidney disease (CKD) affects about 10% of all populations worldwide, with about 2 million people requiring dialysis. Although patients with CKD are at high risk of cardiovascular disease and events, they are often underrepresented or excluded in clinical trials, leading to important knowledge gaps about how to treat these patients. KDIGO (Kidney Disease: Improving Global Outcomes) convened the fourth clinical Controversies Conference on the heart, kidney and vasculature in Dublin, Ireland, in February 2020, entitled Central and Peripheral Arterial Diseases in Chronic Kidney Disease. A global panel of multidisciplinary experts from the fields of nephrology, cardiology, neurology, surgery, radiology, …

Survey Of Current Practices Of Outpatient Hemodialysis For Aki Patients, Victor M. Ortiz-Soriano, Catherine R. Butler, Marla Levy, Sarah C. Huen, Jorge L. Castaneda, Ankit Sakhuja, Rajit K. Basu, Kathleen D. Liu, Jorge Cerda, Javier A. Neyra

Internal Medicine Faculty Publications

No abstract provided.

A Rare Case Of C3 Glomerulonephritis Presenting As Pulmonary Renal Syndrome, Gerardo Mederos, Harsh Patel, Menalee Hapuarachchi, Machaiah Madhrira, Ranjit Nair, Dana Ciobanu

HCA Healthcare Journal of Medicine

C3 glomerulonephritis (C3GN) is a rare disease that falls under the umbrella of C3 glomerulopathy (C3G). Classic manifestations of C3G include acute renal failure, proteinuria, and hematuria. In some cases, extrarenal manifestations can include ocular drusen. Until recent reports, C3G manifesting with pulmonary symptoms has not been reported. In this report, we describe a patient that initially presented with hemoptysis and acute renal failure, eventually leading to a diagnosis of pulmonary renal syndrome. Renal biopsy showed C3GN. The patient’s symptoms improved with pulse dose steroids, plasmapheresis and mycophenolate mofetil. C3G presenting with pulmonary symptoms is rare. Further research is needed …

Comparison Of The Performance Of The Ncdr Cathpci Score And Mehran Score To Predict Acute Kidney Injury Post-Percutaneous Coronary Intervention, Michelle Nguyen, S. Mustajab Hasan, Steven Quach, Sai Guduru, Faisal Rahim, Aiham Albaeni, Khalid Abusaada

HCA Healthcare Journal of Medicine

Background: A comparison of acute kindney injury (AKI) post-percutaneous coronary intervention (PCI) prediction models is lacking. In this study, we aim to compare the National Cardiovascular Data Registry (NCDR) CathPCI score to the Mehran score in acute coronary syndrome (ACS) vs non-ACS patients.

Methods: We included patients who received PCI at our facility between July 2015 and December 2017. We excluded patients without a pre- and/or post-PCI serum creatinine, patients on dialysis at the time of PCI and patients with missing variables required to calculate the predictive scoring model. The primary outcome of this study was AKI post-PCI. Performance of …

Acute Kidney Injury Caused By Levetiracetam In A Patient With Status Epilepticus, Burak Erdinc, Snigdha Ghanta, Alexander Andreev, Karim O Elkholy, Sonu Sahni

Touro College of Osteopathic Medicine (New York) Publications and Research

Levetiracetam is a widely used, effective and usually well-tolerated anti-epileptic medicine. It is mostly excreted by kidneys and requires dose adjustment according to the glomerular filtration rate. Very few case reports have been published in the literature about levetiracetam causing acute kidney injury (AKI). We present a case of a 26-year-old male with a seizure disorder on levetiracetam, presented with status epilepticus requiring intubation for airway protection. He received 4 g of intravenous levetiracetam as a loading dose and continued with a maintenance dose of 750 mg intravenous every 12 hours. He had signs of AKI on day two and …

Calcium Alkali Thiazide Syndrome, Mehboob A. Rehan Md, Asma Rashid Md, Reema Singh Md, Gabutti Cristina, Luma Mohsin Md, Tausha Allen Md, Paul Stanford Md, James Thomson Md

Internal Medicine

No abstract provided.

A Survey Study Of Self-Rated Patients' Knowledge About Aki In A Post-Discharge Aki Clinic, Victor M. Ortiz-Soriano, Joseph L. Alcorn Iii, Xilong Li, Madona Elias, Taha Ayach, B. Peter Sawaya, Hartmut H. Malluche, Ron Wald, Samuel A. Silver, Javier A. Neyra

Internal Medicine Faculty Publications

Background: Survivors of acute kidney injury (AKI) are at risk of adverse outcomes. Post-discharge nephrology care may improve patients’ AKI knowledge and prevent post-AKI complications.

Objective: The purpose of this study was to examine patients’ awareness about their AKI diagnosis and self-rated knowledge and severity of AKI before and after their first post-discharge AKI Clinic encounter.

Design: We conducted a pre- and post-survey study among AKI survivors who attended a post-discharge AKI Clinic.

Setting: AKI Clinic at the University of Kentucky Medical Center (October 2016 to December 2017). Education about AKI was based on transformative learning theory and provided through …

Young Man With Severe Metabolic Acidosis After Transformer Oil Ingestion: A Case Report, Farah Gul Khan, Syed Muhammad Zubair

Section of Nephrology

Background: Transformer oil is used in oil-filled transformers for its insulating as well as coolant properties. Transformer oil ingestion for attempted suicide is seldom heard of. Our patient’s case presented us with a major diagnostic as well as treatment challenge because we encountered such a case for the first time and were totally unaware of the fact that methanol might make up the main component of an aged transformer oil.

Case presentation: A 19-year-old Pakistani/Asian man was brought to our hospital with altered sensorium. He was found to have elevated anion gap acidosis, increased osmolal gap, and acute kidney injury. …

Effect Of Hyperchloremia On Acute Kidney Injury In Critically Ill Septic Patients: A Retrospective Cohort Study, Lenar Yessayan, Javier A. Neyra, Fabrizio Canepa-Escaro, George Vasquez-Rios, Michael Heung, Jerry Yee, Acute Kidney Injury In Critical Illness Study Group

Internal Medicine Faculty Publications

Background: Hyperchloremia is common in critically ill septic patients. The impact of hyperchloremia on the incidence of acute kidney injury (AKI) is not well studied. We investigated the association between hyperchloremia and AKI within the first 72 h of intensive care unit (ICU) admission.

Methods: 6490 ICU adult patients admitted with severe sepsis or septic shock were screened for eligibility. Exclusion criteria included: AKI on admission, baseline estimated glomerular filtration rate (eGFR) < 15 ml/min/1.73 m², chronic renal replacement therapy, absent baseline serum creatinine data, and absent serum chloride data on ICU admission.

Results: A total of 1045 patients were available for …

It Is Reasonable To Treat Patients With Type 1 Hepatorenal Syndrome With Midodrine And Octreotide, William Kane

Clinical Research in Practice: The Journal of Team Hippocrates

A critical appraisal and clinical application of Esrailian E, Pantangco ER, Kyulo NL, Hu KQ, Runyon BA. Octreotide/midodrine therapy significantly improves renal function and 30-day survival in patients with type 1 hepatorenal syndrome. Dig Dis Sci. 2007;52(3):742-748. doi: 10.1007/s10620-006-9312-0

Use Of Surface-Enhanced Laser Desorption/Ionization With Time Of Flight (Seldi-Tof) Of The Urine In The Assessment Of Acute Kidney Injury (Aki), David J. Kennedy, Phd, Joseph M. Chan, Dinkar Kaw, Md, Anand M. Ravindaran, Md, Shobha Ratnam, Md, Phd, Deepak Malhotra, Md, Phd, Joseph I. Shapiro Md

Marshall Journal of Medicine

Background: Urinalysis is an important component in the assessment of acute kidney injury (AKI). Proteonomics is a rapidly developing approach in the analysis of physiological states. Several techniques have been developed to screen for protein populations. In this regard SELDI-TOF is a technique based on mass spectroscopy that is being utilized in proteonomics research.

Methods:For this study, clean catch or catheterized urine was collected from normals (n=18) and patients referred to the renal service with AKI. Based upon urine and serum chemistries, clinical parameters, and microscopic urinalysis, the urines were separated into those consistent with prerenal azotemia (n=17) and acute …

Mechanisms Of Mitochondrial Dysfunction In Sepsis-Induced Kidney Injury, Joshua Andrew Smith

MUSC Theses and Dissertations

Mitochondrial dysfunction is a well-characterized pathophysiological feature of acute kidney injury (AKI). Our laboratory has previously implicated suppression of mitochondrial biogenesis, the process by which cells generate new and functional mitochondria, as an important contributor to development of mitochondrial dysfunction in multiple experimental models of AKI. However, relatively little is known about the molecular mechanisms responsible for disruption of biogenesis in renal cells. The primary goals of this project were to define signaling pathways mediating acute suppression of renal cortical mitochondrial biogenesis and to characterize changes in glycolytic metabolism that might support both cellular and organ function following sepsis-induced AKI. …

Serotonergic Stimulation Of Mitochondrial Biogenesis And Their Cheminformatic Models, Richard Edwin Trager Iii

MUSC Theses and Dissertations

Kidney disease and toxicity is increasingly being tied to mitochondrial dysfunction. Cheminformatic modeling and high-throughput phenotypic screens can discover discrete subsets of selective ligands that correlate with mitochondrial biogenesis (MB) and accelerate recovery from acute kidney injury (AKI). Serotonergic (5-HT) stimulation has been shown to cause MB. Subtype specific ligands for 5-HT1F and 5-HTA/C receptors show increased uncoupled oxygen consumption rate (OCR). Our overall goal, in a screening assay, is to discover small molecules that increase MB to be used as drugs in the treatment of diseases that exhibit mitochondrial dysfunction. To achieve this goal we created pharmacophore models of …

Clinically Significant Contrast Induced Acute Kidney Injury After Non-Emergent Cardiac Catheterization--Risk Factors And Impact On Length Of Hospital Stay., Waqar Kashif, Ali Khawaja, Syed Ather Hussain

Department of Medicine

Objective: To evaluate the frequency and risk factors associated with clinically significant contrast-induced nephropathy(CIN) in patients undergoing non-emergent coronary angiography.

Study Design: Descriptive study.

Place and Duration of Study: The Aga Khan University Hospital, Karachi, from January 2005 to December 2007.

Methodology: Case records of patients who underwent coronary angiography with a serum creatinine of ≥ 1.5 mg/dl atthe time of procedure were evaluated. Clinically significant contrast induced nephropathy (CSCIN) was defined as either doubling of serum creatinine from baseline value within a week following the procedure or need for emergency hemodialysis after the procedure.Results: One hundred …

Endoplasmic Reticulum Calcium-Independent Phospholipase A2 Gamma (Er-Ipla2Γ): Role In Oxidative Stress-Induced Lipid Peroxidation, Ca2+ Release, Phospholipid Homeostasis And Cell Death In The Kidney, Andre Chioke Eaddy

MUSC Theses and Dissertations

Acute kidney injury and chronic kidney disease are becoming more prevalent and have high morbidity and mortality, and despite several therapies targeted towards treating or preventing kidney injury, outcomes have been unchanged for many years. Calcium­independent phospholipase A2y (iPLA2γ) is one of seven Ca2+-independent PLA2 enzymes and represents a potential therapeutic target in kidney disease because of its unique subcellular localization and its potential as the putative membrane remodeling/repair enzyme. Studies in our laboratory suggest iPLA2γ is cytoprotective during oxidant injury by preventing and/or repairing oxidant-induced lipid peroxidation and pointed to ER-iPLA2γ as the major component of membrane repair and …

Promoting Mitochondrial Biogenesis With The Sirti Activator Srt1720 To Improve Mitochondrial And Renal Function After Acute Kidney Injury, Jason Allen Funk

MUSC Theses and Dissertations

Mitochondrial dysfunction is a primary pathological consequence of acute kidney injury (AKI). Induction of mitochondrial biogenesis via the nuclear coactivator of transcription PPARγ-coactivator-1α (PGC-1α), the master regulator of mitochondrial biogenesis, rescues mitochondrial function in renal cells after oxidant injury. The primary goal of this project was to evaluate the recovery of mitochondrial function after in vivo AKI, and to determine the influence of mitochondrial biogenesis during the repair process. Deacetylation of PGC-1α by the class III HDAC SIRT1 produces a more active form of the protein and stimulates mitochondrial biogenesis. The potent SIRT1 activator SRT1720 induced deacetylation of PGC-1α, increased …