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Sepsis and renal function

Masayuki Chuma, Makoto Makishima, Toru Imai, Naohiro Tochikura, Shinichiro Suzuki, Tsukasa Kuwana, Nami Sawada, So Iwabuchi, Masao Sekimoto, Takahiro Nakayama, Takako Sakaue, Norikazu Kikuchi, Yoshikazu Yoshida, Kosaku Kinoshita
PURPOSE: It is important to accurately estimate accurate vancomycin (VCM) clearance (CLvcm) for appropriate VCM dosing in the treatment of patients with sepsis. However, the pathophysiology of sepsis can make CLvcm prediction less accurate. Clearance of hydrophilic antibiotics is disturbed by organ dysfunction, and hemoglobin levels are negatively correlated with sequential organ function assessment scores. We investigated whether hemoglobin levels are associated with CLvcm in sepsis patients...
March 14, 2019: European Journal of Clinical Pharmacology
Jie Du, Siqing Jiang, Zhaoxin Hu, Shiqi Tang, Yue Sun, Jinrong He, Zhi Li, Bin Yi, Jianwen Wang, Hao Zhang, Yan Chun Li
Acute kidney injury (AKI) is a common complication of sepsis characterized by a rapid degradation of renal function. The effect of vitamin D on AKI remains poorly understood. Here we showed that vitamin D receptor (VDR) activation protects against lipopolysaccharide (LPS)-induced AKI by blocking renal tubular epithelial cell apoptosis. Mice lacking VDR developed more severe AKI than wild-type (WT) controls following LPS treatment, manifested by marked increases in body weight loss, accumulation of serum BUN and creatinine as well as the magnitude of apoptosis of tubular epithelial cells...
March 13, 2019: American Journal of Physiology. Renal Physiology
Brittany N Burton, Boya Abudu, Pradhan Bhat, Rodney A Gabriel, Ulrich H Schmidt
OBJECTIVE: To examine risk factors associated with 30-day unplanned reintubation after pleurodesis. DESIGN: A retrospective cohort study using the American College of Surgeons National Surgical Quality Improvement Program surgical outcomes registry. SETTING: United States hospitals participating in the American College of Surgeons National Surgical Quality Improvement Program. PARTICIPANTS: The study comprised 2,358 patients who underwent video-assisted thorascopic surgery for pleurodesis from 2007 to 2016...
February 8, 2019: Journal of Cardiothoracic and Vascular Anesthesia
Saki Manabe, Hidetaka Yanagi, Hideki Ozawa, Atsushi Takagi
A 65-year-old Japanese woman with Parkinson's disease, later diagnosed with Lewy body disease, presented with a 2-day history of systemic tremors. She also had fever without rigidity or creatine kinase (CK) elevation. She was diagnosed with sepsis caused by pyelonephritis with acute kidney injury and parkinsonism exacerbation. Although antibiotic and fluid therapy improved her pyuria and renal function, her fever and tremors persisted. On the fourth day, her symptoms worsened and resulted in cardiopulmonary arrest; however, quick resuscitation allowed the return of spontaneous circulation...
February 28, 2019: BMJ Case Reports
Gajanan Kale, Tarun Jeloka, S Shrividya, Atul Mulay, Manisha Deshmukh, S Krishnan, Sagar Nigwekar
Calciphylaxis, also known as calcific uremic arteriolopathy, is a rare, life-threatening complication of end-stage renal disease. However, it may also occur in patients without renal failure, the nonuremic calciphylaxis. Most patients present with painful skin ulcers. Delayed diagnosis can lead to sepsis-related morbidity and mortality. Aberrations in calcium, phosphate, and parathyroid hormone physiology are common and biopsy is diagnostic. Early diagnosis and correction of vascular and metabolic aberrations may assist in healing as may the use of sodium thiosulfate and hyperbaric oxygen therapy...
January 2019: Saudi Journal of Kidney Diseases and Transplantation
Katsuhito Ihara, Junichi Ishigami, Seiji Inoshita
BACKGROUND: Although recovery of renal function after an episode of acute kidney injury (AKI) is an important clinical measure of morbidity, predictors of withdrawal from renal replacement therapy (RRT) among AKI patients remain unclear. METHODS: In this single-center retrospective cohort study, we examined the clinical records of AKI patients requiring RRT who were hospitalized in the ICU or general wards at our hospital from January 2010 to December 2013. A priori-determined covariates of age, sex, cardiovascular disease, chronic kidney disease (CKD), mean arterial pressure (MAP), sepsis, nephrotoxic agents, and hypoalbuminemia were assessed in Cox hazard models to estimate hazard ratio (HR)...
February 16, 2019: Clinical and Experimental Nephrology
Hitesh Arora, Sara Morgan Wilcox, Laura Alexandra Johnson, Lonna Munro, Brett Alexander Eyford, Cheryl Gurine Pfeifer, Ian Welch, Wilfred Arthur Jefferies
Sepsis is a bi-phasic inflammatory disease that threatens approximately 30 million lives and claims over 14 million annually, yet little is known regarding the molecular switches and pathways that regulate this disease. Here, we have described ABCF1, an ATP-Binding Cassette (ABC) family member protein, which possesses an E2 ubiquitin enzyme activity, through which it controls the Lipopolysaccharide (LPS)- Toll-like Receptor-4 (TLR4) mediated gram-negative insult by targeting key proteins for K63-polyubiquitination...
February 6, 2019: Immunity
Ming Xue, Xiwen Zhang, Feng Liu, Wei Chang, Jianfeng Xie, Jingyuan Xu, Yi Yang, Haibo Qiu
BACKGROUND: Intravenous crystalloid solutions are administered commonly for critically ill patients. We performed this meta-analysis of randomized trials with trial sequential analysis (TSA) to evaluate effects of chloride content of intravenous crystalloid solutions on clinical outcomes among critically ill adult patients. METHODS: Electronic databases were searched up to June 1, 2018, for randomized trials of use of balanced crystalloids versus 0.9% saline solutions in critically ill adult patients...
February 13, 2019: Annals of Intensive Care
L M Wirtz, S Kreuer, T Volk, T Hüppe
BACKGROUND: Analysis of exhaled air is a risk-free option for bedside diagnostics. Modern breath analysis can detect very low concentrations of volatile components. Current research focuses on drug monitoring and diagnosis of various diseases. OBJECTIVES: Presentation and discussion of current breath research relevant to intensive care medicine. MATERIALS AND METHODS: The literature in PubMed was searched using the following terms: "breath analysis", "volatile organic compounds", "critically ill" combined with "drug monitoring", "propofol", "heart failure", "pneumonia", "ARDS", "renal failure", "liver failure", "sepsis" or "hemorrhage"...
February 6, 2019: Medizinische Klinik, Intensivmedizin und Notfallmedizin
Yoshio Funahashi, Noritoshi Kato, Tomohiro Masuda, Fumitoshi Nishio, Hiroki Kitai, Takuji Ishimoto, Tomoki Kosugi, Naotake Tsuboi, Naoyuki Matsuda, Shoichi Maruyama, Kenji Kadomatsu
Development of a novel agent against life-threatening sepsis requires the in-depth understanding of the relevant pathophysiology and therapeutic targets. Given the function of microRNAs (miRNAs) as potent oligonucleotide therapeutics, here we investigated the pathophysiological role of exogenously applied miRNA in sepsis-induced multiple organ injury. In vitro, miR-16, miR-126, miR-146a, and miR-200b suppressed the production of pro-inflammatory cytokines in RAW264.7 macrophage cells after lipopolysaccharide (LPS) stimulation...
January 30, 2019: Laboratory Investigation; a Journal of Technical Methods and Pathology
Gannon L Curtis, Aws Hammad, Hiba K Anis, Carlos A Higuera, Bryan E Little, Hussein F Darwiche
BACKGROUND: As the population ages, the need for total hip arthroplasty (THA) will increase. However, this will be associated with an increase in comorbidities and a decrease in the ability to independently perform activities of daily living (ADLs). This study was designed to evaluate the impact preoperative functional status has on short-term outcomes after THA. METHODS: Primary THAs performed from 2012 to 2016 were identified in the National Surgical Quality Improvement Program database...
January 6, 2019: Journal of Arthroplasty
Bianca Davidson, Tinus Du Toit, Erika S W Jones, Zunaid Barday, Kathryn Manning, Fiona Mc Curdie, Dave Thomson, Brian L Rayner, Elmi Muller, Nicola Wearne
INTRODUCTION: Access to dialysis and transplantation in the developing world remains limited. Therefore, optimising renal allograft survival is essential. This study aimed to evaluate clinical outcomes and identify poor prognostic factors in the renal transplant programme at Groote Schuur Hospital [GSH], Cape Town.     . METHOD: Data were collected on all patients who underwent a kidney transplant at GSH from 1st July 2010 to the 30 June 2015. Analyses were performed to assess baseline characteristics, graft and patient survival, as well as predictors of poor outcome...
2019: PloS One
Mamta Sharma, Kaylin Braekevelt, Pramodini Kale-Pradhan, Susan Szpunar, Riad Khatib
BACKGROUND: Black individuals have a higher lifetime risk of acute kidney injury (AKI) and chronic kidney disease than whites. Vancomycin has a potential for nephrotoxicity. The objective of this study was to determine whether the incidence of AKI among patients being treated with vancomycin differs by race. METHODS: Retrospective study of adult (3 ≥18 years) inpatients who were on vancomycin for 3 48 hours between January 2012 and December 2014. Data on demographics, comorbid conditions, clinical characteristics, vancomycin dose, duration, and nephrotoxic drugs were collected...
January 22, 2019: Journal of Pharmacy Practice
Jun Shen, Li Liu, Facai Zhang, Jiang Gu, Guanghui Pan
OBJECTIVE: To explore the possible mechanism of lncRNA TapSAKI in urine derived sepsis-induced kidney injury. MATERIALS AND METHODS: In vivo urine-derived sepsis (US) rat model and in vitro LPS-induced HK-2 cells were established, and TapSAKI, miR-22, PTEN, TLR4 and p-p65 expressions were detected by qRT-PCR and western blot. RNA precipitation and RNA pull-down were performed to confirm the interaction between TapSAKI and miR-22. RESULTS: TapSAKI was up-regulated, miR-22 was down-regulated, PTEN, TLR4 and p-p65 expressions, and inflammatory factors TNF-α and IL-6 levels were up-regulated in kidney tissue of US rats and LPS-induced HK-2 cells...
January 21, 2019: Journal of Pharmacy and Pharmacology
A Bertacco, S Barbieri, G Guastalla, R Boetto, A Vitale, G Zanus, U Cillo, P Feltracco
BACKGROUND: Liver transplantation (LT) is an established treatment for patients with end-stage liver disease. The significant advances in surgical technique, immunosuppression therapy, and anesthesiological management have dramatically improved short- and long-term outcomes. The aim of this study is to correlate specific surgical and anesthesiological variables with causes of early death in LT recipients. METHODS: A retrospective observational analysis of adult patients who underwent LT in the period 2012 to 2016 and died within 90 days following LT was conducted...
June 28, 2018: Transplantation Proceedings
Douglas J Weaver, Azeem Tariq Malik, Nikhil Jain, Elizabeth Yu, Jeffery Kim, Safdar N Khan
BACKGROUND: The modified 5-item frailty index (mFI-5) is a concise co-morbidity based risk stratification tool that has been shown to predict the occurrence of adverse outcomes following various orthopaedic surgeries. METHODS: The 2012-2016 American College of Surgeons - National Surgical Quality Improvement Program (ACS-NSQIP) dataset was used to identify patients undergoing an elective 1-to-2 level posterior lumbar fusion for degenerative lumbar pathology. The mFI-5 score was calculated on the basis of the presence of the five co-morbidities - congestive heart failure within 30 days prior to surgery, insulin-dependent or non-insulin dependent diabetes mellitus, chronic obstructive pulmonary disease or pneumonia, partially dependent or totally dependent functional health status at time of surgery and hypertension requiring medication...
January 10, 2019: World Neurosurgery
Matthew W Semler, David R Janz, Jonathan D Casey, Wesley H Self, Todd W Rice
RATIONALE: The feasibility and clinical outcomes of conservative fluid management after sepsis resuscitation remain unknown. OBJECTIVES: To evaluate the effect of a conservative fluid management protocol on fluid balance and intensive care unit (ICU)-free days among patients with sepsis. METHODS: In a single-center phase II/III randomized trial, we enrolled adults with suspected infection, ≥2 systemic inflammatory response syndrome criteria, and either shock (mean arterial pressure <60 mm Hg or vasopressors) or respiratory insufficiency (mechanical ventilation or oxygen saturation <97% and fraction of inspired oxygen ≥0...
January 10, 2019: Journal of Intensive Care Medicine
Jordan S Cohen, Alex Gu, Chapman Wei, Shane A Sobrio, Jiabin Liu, Matthew P Abdel, Peter K Sculco
BACKGROUND: Revision total knee arthroplasty (TKA) is an increasingly common procedure, but complication rates are higher than for primary TKA. A requirement for dialysis has been shown to predict postoperative complications in this patient population, but the impact of less severe, but clinically significant, renal impairment has not been addressed. METHODS: A retrospective cohort study was conducted using the American College of Surgeons National Quality Improvement Program Database...
December 8, 2018: Journal of Arthroplasty
Maximilian Peter Brandt, Thomas Lehnert, Theresa Czilwik, Hendrik Borgmann, Tatjana Gruber-Rouh, Axel Thalhammer, Elisabeth Hannah Adam, Christian Thomas, Georg Bartsch, Axel Haferkamp, Thomas Joseph Vogl, Igor Tsaur
INTRODUCTION & OBJECTIVES: Percutaneous nephrostomy [1] has emerged as a pivotal approach in the therapeutic management of the obstructed urinary tract. A consecutive incorporation of ultrasonic and radiographic guidance, the approach experienced an almost ubiquitious distribution while most centers currently applying either one or both of these tools jointly. However, success of ultrasound-guidance is limited in obese patients and non-dilated uropathy. In turn, fluoroscopy usually requires an opacification of the urinary collecting system by intravenous or antegrade contrast media injection, which might be harmful for already impaired renal function, raise intrapelvic pressure and augment the risk of sepsis and hemorrhage...
January 2019: European Journal of Radiology
Naif O Al-Harbi, Ahmed Nadeem, Sheikh F Ahmad, Mohammed M Alanazi, Abdullah A Aldossari, Fawaz Alasmari
Sepsis often leads to complications such as acute kidney injury (AKI) which is reported to range from 30-50% in critically ill patients. Dendritic (DCs) and neutrophils play a decisive role in the advancement of AKI through release of inflammatory cytokines and reactive oxygen species (ROS) respectively. Both of these processes are assumed to be controlled by spleen tyrosine kinase (Syk) signaling in DCs and neutrophils. However, the role of Syk signaling in these immune cells in sepsis-induced AKI has not been investigated...
December 29, 2018: Biochimie
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