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Sepsis and renal function

Francisco Adelvane de Paulo Rodrigues, Alan Diego da Conceição Santos, Pedro Henrique Quintela Soares de Medeiros, Mara de Moura Gondim Prata, Tailane Caína de Souza Santos, James Almada da Silva, Gerly Anne de Castro Brito, Armênio Aguiar Dos Santos, Edilberto Rocha Silveira, Aldo Ângelo Moreira Lima, Alexandre Havt
Acute kidney injury (AKI) and metabolic dysfunction are critical complications in sepsis syndrome; however, their pathophysiological mechanisms remain poorly understood. Therefore, we evaluated whether the pharmacological properties of 6-gingerol (6G) and 10-gingerol (10G) could modulate AKI and metabolic disruption in a rat model of sepsis (faecal peritonitis). Animals from the sham and AKI groups were intraperitoneally injected with 6G or 10G (25 mg/kg). Septic AKI decreased creatinine clearance and renal antioxidant activity, but enhanced oxidative stress and the renal mRNA levels of tumour necrosis factor-α, interleukin-1β, and transforming growth factor-β...
August 14, 2018: Scientific Reports
Youn H Kim, Martine Bagot, Lauren Pinter-Brown, Alain H Rook, Pierluigi Porcu, Steven M Horwitz, Sean Whittaker, Yoshiki Tokura, Maarten Vermeer, Pier Luigi Zinzani, Lubomir Sokol, Stephen Morris, Ellen J Kim, Pablo L Ortiz-Romero, Herbert Eradat, Julia Scarisbrick, Athanasios Tsianakas, Craig Elmets, Stephane Dalle, David C Fisher, Ahmad Halwani, Brian Poligone, John Greer, Maria Teresa Fierro, Amit Khot, Alison J Moskowitz, Amy Musiek, Andrei Shustov, Barbara Pro, Larisa J Geskin, Karen Dwyer, Junji Moriya, Mollie Leoni, Jeffrey S Humphrey, Stacie Hudgens, Dmitri O Grebennik, Kensei Tobinai, Madeleine Duvic
BACKGROUND: Cutaneous T-cell lymphomas are rare non-Hodgkin lymphomas with substantial morbidity and mortality in advanced disease stages. We compared the efficacy of mogamulizumab, a novel monoclonal antibody directed against C-C chemokine receptor 4, with vorinostat in patients with previously treated cutaneous T-cell lymphoma. METHODS: In this open-label, international, phase 3, randomised controlled trial, we recruited patients with relapsed or refractory mycosis fungoides or Sézary syndrome at 61 medical centres in the USA, Denmark, France, Italy, Germany, the Netherlands, Spain, Switzerland, the UK, Japan, and Australia...
August 9, 2018: Lancet Oncology
Chaoyang Xie, Lei Liu, Zhigang Wang, Hongchang Xie, Yonghua Feng, Jingjun Suo, Menghao Wang, Wenjun Shang, Guiwen Feng
OBJECTIVES: Icariin (ICA) is a bioactive flavonoid with renal protective actions. This study investigated the effects of ICA on renal injury, inflammation, oxidative damage, apoptosis, and survival in a mouse model of cecal ligation and perforation (CLP)-induced sepsis. METHODS: Sepsis was induced by CLP. Mice were treated with ICA (30 or 60 mg/kg) for 3 days before CLP. Renal functions, inflammatory responses, oxidative damage, histological changes, apoptosis, and vascular permeability were examined...
August 10, 2018: Pharmacology
Alexandra L Martin, J Ryan Stewart, Harshitha Girithara-Gopalan, Jeremy T Gaskins, Nicole J McConnell, Erin E Medlin
OBJECTIVES: The objective of this study was to determine complications associated with primary closure compared with reconstruction after vulvar excision and predisposing factors to these complications. METHODS: Patients undergoing vulvar excision with or without reconstruction from 2011 to 2015 were abstracted from the National Surgical Quality Improvement Program database. Common Procedural Terminology codes were used to characterize surgical procedures as vulvar excision alone or vulvar excision with reconstruction...
August 7, 2018: International Journal of Gynecological Cancer
Tatsuro Tamatsukuri, Masayuki Ohbayashi, Noriko Kohyama, Yasuna Kobayashi, Toshinori Yamamoto, Kenichiro Fukuda, Shunsuke Nakamura, Yasufumi Miyake, Kenji Dohi, Mari Kogo
In recent years, augmented renal clearance (ARC), in which renal function is excessively enhanced, has been reported, and its influence on β-lactam antibiotics has been investigated. In this study, we aimed to determine the optimum population pharmacokinetic model of meropenem in patients with sepsis with ARC, and evaluated dosing regimens based on renal function. Seventeen subjects (6 with ARC and 11 without) were enrolled in this study. Predicted meropenem concentrations were evaluated for bias and precision using the Bland-Altman method...
August 4, 2018: Journal of Infection and Chemotherapy: Official Journal of the Japan Society of Chemotherapy
Esther Peters, Massimo Antonelli, Xavier Wittebole, Rahul Nanchal, Bruno François, Yasser Sakr, Jean-Louis Vincent, Peter Pickkers
BACKGROUND: Acute kidney injury (AKI) is a common complication of critical illness and is associated with worse outcomes. However, the influence of deterioration or improvement in renal function on clinical outcomes is unclear. Using a large international database, we evaluated the prevalence and evolution of AKI over a 7-day period and its effects on clinical outcomes in septic and non-septic critically ill patients worldwide. METHODS: From the 10,069 adult intensive care unit (ICU) patients in the Intensive Care Over Nations database, all those with creatinine and urine output data were included in this substudy...
August 3, 2018: Critical Care: the Official Journal of the Critical Care Forum
Aileen Hill, Sebastian Wendt, Carina Benstoem, Christina Neubauer, Patrick Meybohm, Pascal Langlois, Neill Kj Adhikari, Daren K Heyland, Christian Stoppe
The pleiotropic biochemical and antioxidant functions of vitamin C have sparked recent interest in its application in intensive care. Vitamin C protects important organ systems (cardiovascular, neurologic and renal systems) during inflammation and oxidative stress. It also influences coagulation and inflammation; its application might prevent organ damage. The current evidence of vitamin C's effect on pathophysiological reactions during various acute stress events (such as sepsis, shock, trauma, burn and ischemia-reperfusion injury) questions whether the application of vitamin C might be especially beneficial for cardiac surgery patients who are routinely exposed to ischemia/reperfusion and subsequent inflammation, systematically affecting different organ systems...
July 27, 2018: Nutrients
Alice Cernogoraz, Luigi Schiraldi, Deborah Bonazza, Giuseppe Ricci
Disseminated intravascular coagulation (DIC) is a high mortality coagulopathy that leads to simultaneous thrombotic and bleeding problems. It occurs as a complication in different disease as malignancies, obstetrical catastrophes, bacterial sepsis and traumas. We report on an extremely rare case of acute DIC in a patient with misdiagnosed adenomyosis and massive methrorragia which led to acute kidney failure. The patient was successfully treated with hysterectomy and blood product transfusions; however, a slight reduction of renal function persisted...
July 25, 2018: Gynecological Endocrinology
Zubaidah Nor Hanipah, Suriya Punchai, Toms Augustin, Stacy A Brethauer, Philip R Schauer, Ali Aminian
BACKGROUND: Bariatric surgery can improve renal dysfunction associated with obesity and diabetes. However, acute kidney injury (AKI) can complicate the early postoperative course after bariatric surgery. The long-term consequences of early postoperative AKI on renal function are unknown. METHODS: Patient undergoing bariatric surgery from 2008 to 2015 who developed AKI within 60 days after surgery were studied. Patients on dialysis before surgery were excluded. RESULTS: Out of 4722 patients, 42 patients (0...
July 24, 2018: Obesity Surgery
Tomohiro Mizuno, Tatsuki Fujiwara, Hidehito Kuroki, Kiyotoshi Oishi, Toshihiro Kubo, Keiji Oi, Masafumi Yashima, Seishi Takeshita, Yushi Okumura, Junya Nabeshima, Hirokuni Arai
BACKGROUND: Salvage rates for patients requiring extracorporeal membrane oxygenation (ECMO)due to acute cardiogenic shock remain poor due to difficulties in decision making on optical timing of ECMO removal or conversion to ventricular assist devices( VAD). METHOD: From 2005 to 2018, 37 patients supported with ECMO due to acute circulatory deterioration were referred to our department for implantation of VAD. Their outcomes were analyzed using multi-variate analysis to assess the risk factors of VAD implantation, and we adopted a new decision-tree to improve the outcomes...
July 2018: Kyobu Geka. the Japanese Journal of Thoracic Surgery
Eric Jorge García-Lamberechts, Francisco Javier Martín-Sánchez, Agustín Julián-Jiménez, Ferran Llopis, Mikel Martínez-Ortiz de Zarate, María Jesús Arranz-Nieto, Félix González-Martínez, Pascual Piñera Salmerón, Carmen Navarro-Bustos, Juan González-Del Castillo
OBJECTIVES: To build a model to predict 30-day mortality and compare it to prediction based on the Mortality in Emergency Department Sepsis (MEDS) score in patients aged 75 years or older treated for infection and systemic inflammatory response syndrome (SIRS) in the emergency department. MATERIAL AND METHODS: Prospective analysis of a convenience cohort of patients aged 75 years or older treated for infection and SIRS in 13 Spanish emergency departments in 2013...
2018: Emergencias: revista de la Sociedad Española de Medicina de Emergencias
Pietro Caironi, Roberto Latini, Joachim Struck, Oliver Hartmann, Andreas Bergmann, Valentina Bellato, Sandra Ferraris, Gianni Tognoni, Antonio Pesenti, Luciano Gattinoni, Serge Masson
BACKGROUND: Acute kidney injury (AKI)9 occurs in many critically ill patients and is associated with high mortality. We examined whether proenkephalin could predict incident AKI and its improvement in septic patients. METHODS: Plasma proenkephalin A 119-159 (penKid) was assayed in 956 patients with sepsis or septic shock enrolled in the multicenter Albumin Italian Outcome Sepsis (ALBIOS) trial to test its association with incident AKI, improvement of renal function, need for renal replacement therapy (RRT), and mortality...
July 16, 2018: Clinical Chemistry
Franco Díaz, María José Nuñez, Pablo Pino, Benjamín Erranz, Pablo Cruces
BACKGROUND: Fluid overload (FO) is associated with unfavorable outcomes in critically ill children. Clinicians are encouraged to avoid FO; however, strategies to avoid FO are not well-described in pediatrics. Our aim was to implement a bundle strategy to prevent FO in children with sepsis and pARDS and to compare the outcomes with a historical cohort. METHODS: A quality improvement initiative, known as preemptive fluid strategy (PFS) was implemented to prevent early FO, in a 12-bed general PICU...
June 26, 2018: BMC Pediatrics
Esteban Emiliani, Jose Daniel Subiela, Federica Regis, Oriol Angerri, Joan Palou
BACKGROUND: Urolithiasis has been reported in up to 1.8% of patients after renal transplantation. Limited data are available regarding the treatment of such patients owing to this low prevalence. OBJECTIVE: To analyse a consecutive series of 2115 renal transplantations to elucidate the prevalence of renal graft stones (RGS) and their treatment. DESIGN, SETTING, AND PARTICIPANTS: A retrospective review was performed of a consecutive series of renal transplants from 1983 to 2017...
June 22, 2018: European Urology Focus
Lillie M A Barnett, Brian S Cummings
The kidney consists of numerous cell types organized into the nephron, which is the basic functional unit of the kidney. Any stimuli that induce loss of these cells can induce kidney damage and renal failure. The cause of renal failure can be intrinsic or extrinsic. Extrinsic causes include cardiovascular disease, obesity, diabetes, sepsis, and lung and liver failure. Intrinsic causes include glomerular nephritis, polycystic kidney disease, renal fibrosis, tubular cell death, and stones. The kidney plays a prominent role in mediating the toxicity of numerous drugs, environmental pollutants and natural substances...
August 1, 2018: Toxicological Sciences: An Official Journal of the Society of Toxicology
Sherree Gray, Martin Christensen, Judy Craft
Intra-abdominal hypertension is classified as either primary or secondary - primary occurs due to intra-abdominal or retro-peritoneal pathophysiology, whereas secondary results in alterations in capillary fluid dynamics due to factors, such as massive fluid resuscitation and generalised inflammation. The renal and gastro-intestinal effects occur early in the progression of intra-abdominal hypertension, and may lead to poor patient outcomes if not identified. As a direct response to intra-abdominal hypertension, renal function is reduced with remarkable impairment from pressures of around 10 mmHg, oliguria developing at 15 mmHg and anuria developing at 30 mmHg...
June 21, 2018: Intensive & Critical Care Nursing: the Official Journal of the British Association of Critical Care Nurses
Sylvie Breton, Dennis Brown
BACKGROUND: Serious and often fatal acute kidney injury (AKI) is frequently seen after major surgery, local and remote organ damage, and sepsis. It is associated with uncontrolled inflammation, and is usually diagnosed only after the kidneys have gone through significant and often irreversible damage. SUMMARY: During our work involving another type of kidney disease that leads to acid-base disorders of the blood, we unexpectedly found high levels of a protein called the P2Y14 "purinergic" receptor, in specialized kidney epithelial cells called intercalated cells (ICs)...
2018: Annals of Nutrition & Metabolism
Koji Hosokawa, Fuhong Su, Fabio Silvio Taccone, Emiel Hendrik Post, Jacques Creteur, Jean-Louis Vincent
BACKGROUND: Acute ethanol intoxication has been shown to have contrasting effects on outcomes in sepsis. The aim of this study was to explore the effects of acute ethanol intoxication on hemodynamics, renal function, brain perfusion and lactate/pyruvate in an ovine sepsis model. METHODS: Anesthetized, mechanically ventilated female sheep were randomized to an ethanol group (n = 7), which received 1 g/kg ethanol diluted in intravenous (i.v.) saline infusion or a control group (n = 7), which received the same volume of i...
June 19, 2018: BMC Anesthesiology
Shuai Ma, Roger G Evans, Naoya Iguchi, Marianne Tare, Helena C Parkington, Rinaldo Bellomo, Clive N May, Yugeesh R Lankadeva
AKI is a common complication of sepsis and is significantly associated with mortality. Sepsis accounts for more than 50% of the cases of AKI, with a mortality rate of up to 40%. The pathogenesis of septic AKI is complex, but there is emerging evidence that, at least in the first 48 hours, the defects may be functional rather than structural in nature. For example, septic AKI is associated with an absence of histopathological changes, but with microvascular abnormalities and tubular stress. In this context, renal medullary hypoxia due to redistribution of intra-renal perfusion is emerging as a critical mediator of septic AKI...
June 16, 2018: Microcirculation: the Official Journal of the Microcirculatory Society, Inc
Jing Liu, Zheng Han, Guoli Chen, Yuguo Li, Jia Zhang, Jiadi Xu, Peter C M van Zijl, Shuixing Zhang, Guanshu Liu
Sepsis-induced acute kidney injury (SAKI) is a major complication of kidney disease associated with increased mortality and faster progression. Therefore, the development of imaging biomarkers to detect septic AKI is of great clinical interest. In this study, we aimed to characterize the endogenous chemical exchange saturation transfer (CEST) MRI contrast in the lipopolysaccharide (LPS)-induced SAKI mouse model and to investigate the use of CEST MRI for detecting such injury. We used a SAKI mouse model that was generated by i...
June 13, 2018: NMR in Biomedicine
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