Risk Factors for Acute Kidney Injury in Patients Receiving Antibiotic Therapy:A Systematic Review and Meta-Analysis

[Objectives]To systematically analyze the risk factors for acute kidney injury(AKI)in patients treated with antibiotics and to conduct a meta-analysis of published clinical studies.[Methods]PubMed,Web of Science,and Embase were searched for relevant cohort and case-control studies from January 1,2001,to October 31,2022.Meta-analysis was performed using RevMan5.4 and StataMP15.[Results]A total of 22 studies were included.Regarding patient factors,serum creatinine(SCr;MD=1.03,95%CI of-0.07 to-0.02)was associated with increased antibiotic-associated AKI.Regarding the comorbidities and clinical factors,diabetes(OR=1.34,95%CI of 1.06 to 1.69,tumor(OR=2.07,95%CI of 1.13 to 3.79),pneumonia(OR=1.83,95%CI of 1.24 to 2.71),mechanical ventilation(OR=3.44,95%CI of 1.93 to 6.12),and ICU admission(OR=2.83,95%CI of 2.13 to 3.75)increased the risk of AKI in patients receiving antibiotic therapy.Regarding drug factors,diuretics(OR=2.76,95%CI of 2.16 to 3.52)increased the risk of antibiotic-associated AKI.[Conclusions]This paper may assist clinicians in predicting the risk factors for AKI in patients receiving antibiotic therapy.

Exploring the Role of Serum Cystatin C in Early Detection of Acute Kidney Injury among On-Pump Cardiac Surgery Patients: A Single-Center Investigation in Bangladesh

Background: Acute Kidney Injury (AKI) stands as a prominent postoperative complication in on-pump cardiac surgery, with repercussions on morbidity, mortality, and hospitalization duration. Current diagnostic criteria relying on serum creatinine levels exhibit a delayed identification of AKI, prompting an exploration of alternative biomarkers. Aims and Objectives: This study is designed to overcome diagnostic constraints and explore the viability of serum Cystatin C as an early predictor of Acute Kidney Injury (AKI) in individuals undergoing on-pump cardiac surgery. The investigation aims to establish the relationship between serum Cystatin C levels and the onset of AKI in patients subjected to on-pump cardiac surgery. Primary objectives involve the assessment of the diagnostic effectiveness of serum Cystatin C, its comparison with serum creatinine, and the exploration of its potential for the early identification and treatment of AKI. Methodology: Conducted as a single-center study at the cardiac surgery department of BSMMU in Bangladesh from September 2020 to August 2022, a comparative cross-sectional analysis involved 31 participants categorized into No AKI and AKI groups based on Kidney Disease: Improving Global Outcomes (KDIGO) criteria. Data collection encompassed preoperative, post-CBP (cardiopulmonary bypass) conclusion at 2 hours, postoperative day 1, and postoperative day 2 intervals. Statistical analyses included Chi-squared tests, independent Student’s t-tests, and one-sample t-tests. Significance was set at P Results: The study revealed no significant differences in baseline characteristics between the No AKI and AKI groups, except for CPB time and cross-clamp time. Serum Cystatin C levels in the AKI group exhibited statistical significance at various time points, highlighting its potential as an early detector. Conversely, Serum Creatinine levels in the AKI group showed no statistical significance. The Receiver Operating Characteristic (ROC) curve analysis further supported the efficacy of serum Cystatin C, with an Area under the ROC Curve of 0.864 and a cut-off value of 0.55 (p Conclusion: This study supports the superior utility of serum Cystatin C as an early detector of AKI in on-pump cardiac surgery patients compared to serum creatinine. Its ability to identify AKI several hours earlier may contribute to reduced morbidity, mortality, and healthcare costs. The findings underscore the significance of exploring novel biomarkers for improved post-cardiac surgery renal function assessment.

Preoperative Serum Albumin Levels and Postoperative Acute Kidney Injury in Off-Pump Coronary Artery Bypass Surgery: A Single-Center Study in Bangladesh

Background: Serum albumin, a vital plasma protein, helps maintain intravascular colloidal osmotic pressure, cardiac output, and renal function. Low preoperative serum albumin is linked to poor outcomes, including acute kidney injury (AKI), after off-pump coronary artery bypass (OPCAB) surgery. This study aimed to assess the relationship between preoperative serum albumin levels and early postoperative renal injury. Methods: This prospective comparative cross-sectional study was conducted from August 2019 to February 2021 at the National Heart Foundation Hospital & Research Institute, Bangladesh. It included 160 adult patients with normal preoperative renal function undergoing OPCAB. Patients were divided into two groups: Group A (serum albumin ≥ 4.0 gm/dl) and Group B (serum albumin Results: Preoperative serum albumin was significantly different between groups (Group A: 4.21 ± 0.05 gm/dl, Group B: 3.69 ± 0.04 gm/dl, p = 0.028). Group B had a higher incidence of hypertension (71.25% vs. 51.25%, p st and 3rd postoperative days were higher in Group B (p th day. Postoperative AKI occurred in 18.75% of Group A and 36.25% of Group B. Multivariate regression indicated that low preoperative serum albumin is an independent risk factor for postoperative AKI (p = 0.012, OR = 1.815, CI: 0.675 - 1.162). Conclusion: Preoperative serum albumin level is a valuable predictor of postoperative renal function. Ensuring high normal serum albumin levels before surgery can help minimize the risk of postoperative AKI.

The Role for AVE0991 (MAS-Receptor Angiotensin II (1-7) Agonist) in Reducing Cisplatin-Induced Acute Kidney Injury on C57BL/6 Mice

Acute Kidney Injury (AKI) is a condition that causes nephrotoxicity in kidney tissues due to cisplatin-induced cancer treatments. Hence, it is proposed in this review that AVE0991 (a MAS-receptor Angiotensin II (1-7) agonist) may reduce cisplatin-induced acute kidney injury by promoting nitric oxide production.

The Hippo pathway and its correlation with acute kidney injury

Acute kidney injury(AKI) is a significant clinical complication with a substantial impact on morbidity and mortality, for which therapeutic options remain limited. The Hippo signaling pathway is an evolutionarily conserved pathway implicated in cell proliferation, dedifferentiation, and apoptosis via phosphorylation and inactivation of its downstream effectorsYes-associatedprotein(YAP)/transcriptional co-activator with PDZ-binding motif(TAZ). Recent studies have revealed that the Hippo pathway plays a pivotal role in the pathogenesis and repair of AKI. The Hippo pathway can mediate renal dysfunction through modulation of mitochondrial apoptosis under AKI conditions. Transient activation of YAP/TAZ in the acute phase of AKI may benefit renal recovery and regeneration, whereas persistent activation of YAP/TAZ in severe AKI may lead to maladaptive repair and transition to chronic kidney disease. This review aims to summarize recent findings on the associations between the Hippo pathway and AKI and to identify new therapeutic targets and strategies for AKI.

Risk factors for acute kidney injury following coronary artery bypass graft surgery in a Chinese population and development of a prediction model

BACKGROUND Acute kidney injury(AKI)after coronary artery bypass graft(CABG)surgery is associated with significant morbidity and mortality.This retrospective study aimed to establish a risk score for postoperative AKI in a Chinese population.METHODS A total of 1138 patients undergoing CABG were collected from September 2018 to May 2020 and divided into a derivation and validation cohort.AKI was defined according to the Kidney Disease Improving Global Outcomes(KDIGO)criteria.Multivariable logistic regression analysis was used to determine the independent predictors of AKI,and the predictive ability of the model was determined using a receiver operating characteristic(ROC)curve.RESULTS The incidence of cardiac surgery–associated acute kidney injury(CSA-AKI)was 24.17%,and 0.53%of AKI patients required dialysis(AKI-D).Among the derivation cohort,multivariable logistic regression showed that age≥70 years,body mass index(BMI)≥25 kg/m2,estimated glomerular filtration rate(eGFR)≤60 mL/min per 1.73 m2,ejection fraction(EF)≤45%,use of statins,red blood cell transfusion,use of adrenaline,intra-aortic balloon pump(IABP)implantation,postoperative low cardiac output syndrome(LCOS)and reoperation for bleeding were independent predictors.The predictive model was scored from 0 to32 points with three risk categories.The AKI frequencies were as follows:0-8 points(15.9%),9-17 points(36.5%)and≥18 points(90.4%).The area under of the ROC curve was 0.730(95%CI:0.691-0.768)in the derivation cohort.The predictive index had good discrimination in the validation cohort,with an area under the curve of 0.735(95%CI:0.655-0.815).The model was well calibrated according to the Hosmer-Lemeshow test(P=0.372).CONCLUSION The performance of the prediction model was valid and accurate in predicting KDIGO-AKI after CABG surgery in Chinese patients,and could improve the early prognosis and clinical interventions.

Understanding acute kidney injury (AKI) in liver cirrhosis from the acute-on-chronic liver failure (ACLF) perspective

In the field of hepatology,managing complications in patients with liver diseases is of paramount importance.Among these,acute kidney injury(AKI)in patients with acute-on-chronic liver failure(ACLF)stands out due to its prevalence and significant impact on patient outcomes(1,2).AKI in ACLF differs substantially from AKI in simple liver cirrhosis in its clinical significance(3).AKI developed in ACLF is a manifestation of a multi-organ failure syndrome and is closely associated with a high mortality rate and severe complications.

Incidence, Risk Factors and Short Term Outcome of Acute Kidney Injury among Patients with Acute Coronary Syndrome

Background: Cardio-renal syndrome is the leading cause of death globally. Acute kidney injury (AKI) is a major complication among patients admitted in Coronary Care Unit (CCU) with acute coronary syndrome (ACS). AKI in ACS patients is associated with higher morbidity, mortality and prolong hospital stay. Objective: To determine the incidence, risk factors and short term outcome of acute kidney injury (AKI) among the patients admitted in CCU with ACS. Methods: This cross sectional study was conducted at Department of Nephrology, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh from January 2013 to December 2013. Following selection criteria a total of two hundred (200) patients with ACS were studied. AKI was defined according to the KDIGO guideline and further categorized by RIFLE criteria. Data of patients with AKI and those without AKI were analyzed and compared by statistical tests. Results: Majority of the study patients were male (79.5%). AKI was developed in 40 of the 200 study patients (20.0%). The mean (±SD) age of the study patients was 60.1 ± 11.1 years in patients with AKI and 55.9 ± 10.1 years in patients without AKI. Our data analysis showed that older age (>65 years), diabetes mellitus, dyslipidemia and smoking were significantly correlated to the development of AKI. Mortality was significantly high in AKI group (7.15%) compared to no AKI group (1.25%). Out of 27 patients who achieved renal recovery most (80.8%) belonged to risk class. Severity of AKI showed significant effect on renal recovery and final outcome. Conclusion: This study demonstrated that, incidence of AKI among patients with ACS was 20%. Elderly patients, diabetes mellitus, dyslipidemia, and exposure to smoking were significantly associated with development of AKI in ACS.

The Risk of Severe Acute Kidney Injury Requiring Renal Replacement Therapy in Viral Hemorrhagic Fevers. A Review of Literature

Objective: It demonstrates the correlation of the viral hemorrhagic fever with kidney failure and the treatment as well as the outcome. Method: A PubMed search of the English literature from 1999 to 2019 was performed using “viral hemorrhagic fever, Case Report, Renal Failure” as the subject. The inclusion criteria were the following: 1) case report and case series of two or more patients;2) the report detailed the clinical presentation and reported the status of the renal system;3) the report described the management of renal failure if any;and 4) the etiology of the infection is known and is one of the known agents of viral hemorrhagic fever, listed on the centers of disease control website. We excluded infections related to vaccination related to viral hemorrhagic fever. Result: We found the mean age of these patients was 41.5. The male to female ratio was about 3.5:1. Dengue and Hantaviruses constituted 70.5% of patients. The overall mortality of the study cohort was 32.2%. Half of the patients had acute kidney injury and required renal replacement therapy. The chi-square statistic is 0.41;The p-value is 0.51;The chi-square statistic is 6.4254. Overall mortality was 32.3% in one cohort of 78 patients. The illness goes through several stages [1] [2] of clinical features and some viruses in the group have a high case fatality rate. Conclusions: Early diagnosis with aggressive supportive care is critical for improving clinical outcomes. Renal involvement is common. Amongst the cohort reviewed, of patients who had acute kidney injury, half of the patients required renal replacement support. However, some viruses cause greater kidney injury than others, for instance, kidney injury is more severe in Dengue hemorrhagic fevers when compared to Hantaviruses. Simultaneous management of public health by prevention and control of outbreaks is particularly important.

Dexamethasone protects the glycocalyx on the kidney microvascular endothelium during severe acute pancreatitis

Objective: This study demonstrated that dexamethasone(DEX) protects the endothelial glycocalyx from damage induced by the inflammatory stimulus tumor necrosis factor-α(TNF-α) during severe acute pancreatitis(SAP), and improves the renal microcirculation. Methods: Ninety mice were evenly divided into 3 groups(Sham, SAP, and SAP+DEX). The SAP mice model was established by ligature of pancreatic duct and intraperitoneal injection of cerulein. Renal perfusion and function, and morphological changes of the glycocalyx were evaluated by laser Doppler velocimetry, electron microscopy, and histopathology(hematoxylin and eosin(H&E) staining), respectively. Serum levels of syndecan-1 and TNF-α were assessed by enzyme-linked immunosorbent assay(ELISA). The proàtectiveì effects of dexamethasone on the glycocalyx and renal microcirculation were evaluated. Results: Significantly high levels of serum TNF-α were detected 3 h after the onset of SAP. These levels might induce degradation of the glycocalyx and kidney hypoperfusion, resulting in kidney microcirculation dysfunction. The application of dexamethasone reduced the degradation of the glycocalyx and improved perfusion of kidney. Conclusions: Dexamethasone protects the endothelial glycocalyx from inflammatory degradation possibly initiated by TNF-α during SAP. This is might be a significant discovery that helps to prevent tissue edema and hypoperfusion in the future.

Quantitative assessment of acute kidney injury by noninvasive arterial spin labeling perfusion MRI:a pilot study

The kidneys are essential for maintaining homeostasis,are responsible for the reabsorption of water,glucose and amino acids,and filter the blood by removing waste.Acute kidney injury(AKI) is a syndrome characterized by the rapid loss of renal excretory function and the accumulation of end metabolic products of urea and creatinine.AKI is associated with the later development of chronic kidney disease and end-stage kidney disease,and may eventually be fatal.Early diagnosis of AKI and assessments of the effects of treatment,however,are challenging.The pathophysiological mechanism of AKI is thought to be the imbalance between oxygen supply and demand in the kidneys.We have assessed the ability of arterial spin labeling(ASL) perfusion magnetic resonance imaging(MRI),without the administration of contrast media,to quantify renal blood flow(RBF) non-invasively.We found that RBF was significantly lower in AKI patients than in healthy volunteers.These results suggest that ASL perfusion MRI,a noninvasive measurement of RBF,may be useful in the early diagnosis of AKI.

Preliminary Experience of Integrative Medicine in Acute Kidney Injury

Acute kidney injury （AKI）,a concept that replaces the traditional concept known as acute renal failure（ARF）, has been adopted by more and more nephrologists and intensive-care specialists in recent years.The definition and diagnostic criteria of AKI are quite different from those of ARF. It should be noted that although the study of the pathophysiology of AKI, as well as supportive therapies such as blood purification therapy, has obtained significant progress, the incidence of end- stage renal diseases and mortality rate caused by AKI are still high. Therefore, it has a great practical significance to make efforts to study prevention and treatment of AKI.

Experiences on the Integrative Medical Diagnosis and Treatment of Acute Kidney Injury

The definition of acute renal failure（ARF） has not gotten common understanding yet in a long time,which leads to the difficulty in comparing the outcomes of some different studies,and has impacted the advance of diagnosis and treatment on the illness to certain extents. Most of the scholars hold that the attention paid to the early diagnosis and intervention of ARF was insufficient in recent years. Lots of clinical researchers indicated that even a slight impairment of renal function could result in the increasing of the morbidity and mortality of ARF.

Urine neutrophil gelatinase-associated lipocalin at SICU admission predicts for cardiac surgery-associated acute kidney injury

Background Acute Kidney Injury （AKI） is a common and serious complication of cardiovascular surgery. There is a need to find biomarkers that are involved in the etiology of cardiac surgery-associated acute kidney injury （CSA-AKI） and have an earlier response to acute kidney injury. The association between urine neutrophil gelatinase-associated lipocalin （NGAL） concentrations and AKI progression is not well established. Methods The prospective-cohort study included 1631 consecutive adult patients undergoing cardiac surgery at Fuwai Hospital between September 2012 and November 2013. AKI defined by Acute Kidney Injury Network （AKIN） criteria with a postoperative increase in plasma creatinine 〉/50% baseline or/〉0.3 mg/dL. Urine NGAL was measured us- ing latex particle-enhanced turbidimetric immunoassay. Associations between Urine NGAL levels and AKI were determined by estimating areas under receiver operating characteristic curves （AUC）. Results A total of 438 （26.9%） patients developed CSA-AKI. And the patients were divided into four groups： 1193 non-AKI patients, 368（22.6%） patients with AKIN stage I AKI, 49（3.0%） with AKIN stage 2 AKI and 21（1.3%） with AKIN stage 3 AKI. urine NGAL concentrations at surgical intensive care unit （SICU） admission were significantly related to AKI severity. The AUCs for urine NGAL were for AKIN stage 1 （0.54±0.02）, AKIN stage 2 （0.67±0.04）, and AKIN stage 3 （0.76±0.06）, respectively. Conclusions Urinary NGAL is associated with CSA-AKI and its progression, indicating their potential use as prognostic markers. Urine NGAL level measured at SICU admission predicts the development of severe AKI after cardiac surgery.

Effects of hydration in contrast-induced acute kidney injury after primary angioplasty a randomized,controlled trial

Background Intravascular volume expansion represents a beneficial measure against contrast-induced acute kidney injury （CI-AKI） in patients undergoing elective angiographic procedures. However, the efficacy of this preventive strategy has not yet been established for patients with ST-elevation-myocardial infarction （STEMI）, who are at higher risk of this complication after primary percutaneous coronary intervention （PCI）. In this randomized study we investigated the possible beneficial role of periprocedural intravenous volume expansion and we compared the efficacy of 2 different hydration strategies in patients with STEMI undergoing primary PCI.

Early high-intensity blood purification for severe wasp venom poisoning with acute kidney injury

Objective To evaluate the safety and efficacy of early high intensity blood purification for severe wasp venom poisoning with acute kidney injury(AKI).Methods We retrospectively analyzed 120 patients[(47±14)year,F/M=68/52]with severe wasp venom poisoning(creatine kinase>20,000 IU/L;lactic

Effect of acute kidney injury on short-and long-term mortality of patients with acute myocardial infarction

Objective To evaluate the role of acute kidney injury(AKI)in predicting early(30-day)and late(30-day to5-year)mortality of acute myocardial infarction(AMI)patients during hospitalization.Methods A total of 1371adult patients diagnosed with AMI in the First People’s Hospital of Changzhou from January 2008 to December2012 were analyzed retrospectively while their

精准时代中的肾脏替代治疗管理

肾脏替代治疗（RRT）是急性肾损伤（AKI）等重症患者的主要治疗方法，及时合理使用RRT可缓解患者病情。尽管早在上个世纪RRT就已经开始使用，但关于此治疗方法的许多方面仍未达成共识，而且在操作过程中临床实践差异性较大，导致AKI等重症患者病死率仍然很高。2016年第17届ADQI会议提议通过患者选择、治疗时机、溶质控制和液体管理等特定信息对患者实施个体化的“精准RRT”。

Multiple-Organ Extracorporeal Support Therapies in Critically Ill Patients

The critically ill patient is capable of presenting a multiple organ dysfunction syndrome (MODS) caused by different diseases, which can be infectious (sepsis, septic shock) as well as non-infectious (pancreatitis, large surgeries, traumatic injuries, burn patients and brain injuries), this syndrome is characterized by global hemodynamic and organ perfusion alterations accompanied by an uncontrolled and marked inflammatory response unresponsive to pharmacological treatment due to which extracorporeal organ support can be a viable option. Acute renal lesion can occur in up to 60% of patients receiving intensive care, and close to 10% - 20% require renal replacement therapy (RRT) globally this can be provided as peritoneal dialysis (PD) or intermittent hemodialysis (IHD), continuous renal replacement therapy (CRRT), hybrid therapies known as sustained slow efficiency dialysis (SLED), which combines the benefits IHD and CRRT, slow continuous ultrafiltration (SCUF). Extracorporeal membrane oxygenation (ECMO) and extracorporeal elimination of CO2, have been used more frequently lately, these are temporal artificial support used for respiratory and/or cardiac insufficiency that is refractory to conventional treatment. Acute liver failure in adults has a mortality rate close to 50% furthermore one-third of patients hospitalized for cirrhosis are likely to progress to acute liver failure which will drastically increase its mortality. Based on concepts of albumin dialysis, one of its most known is the following: Molecular Adsorbent Recirculating System (MARS), Fractionated Plasma Separation and Absorption—FPSA (Prometheus®) and also, hemoperfusion with different cartridges used in different extracorporeal therapies, used in liver failure, rhabdomyolysis, cytokine release syndrome and more in the context of the pandemic covid19. The objective of this review is to know the different extracorporeal therapies and the therapeutic utility in critical patients.

18β- glycyrrhetinic acid inhibits apoptosis of renal tubular epithelial cells via enhancing level of BMP-7 epigenetically through targeting HDAC2

Cisplatin （CP） , a highly effective and widely used chemotherapeutic agent, has a major limitation for its nephrotoxicity. We recently identified a novel strategy for attenuating its nephrotoxicity in chemotherapy by an ef- fective adjuvant via epigenetic modification through targeting Histone deacetylase 2 （HDAC2）. Glycyrrhizic acid （GA） ,a major active component of Licorice, was described here for its new application. Molecular docking and Surface Plasmon resonance （SPR） assay firstly reported that 18βGA, GA metabolite in vivo, could directly bind to HDAC2 and prevent HDAC2 activation. The effects and mechanisms of GA and its major metabolite 18βGA were assessed in CP-induced acute kidney injury （AKI） in C57BL/6 mice, and in CP-treated HK-2 and mTEC cells lines. Terminal deoxynucleotidyl transferase dUTP nick end labeling （TUNEL） and flow cytometry （FCM） results confirmed that GA and 18βGA could inhibit apoptosis of renal tubular epithelial cells induced by CP in vivo and in vitro. Western blot and immunofluorescence results demonstrated that the expression of bone morphogenetic protein- 7 （BMP-7） , a protective molecule in renal inflammation, was clearly induced by 18βGA in AKI models while siR- NA BMP-7 could reduce the inhibitory effect of 18βGA on apoptosis. Results of current study indicated that 18βGA inhibited apoptosis of renal tubular epithelial cells via enhancing level of BMP-7 epigenetically through targeting HDAC2, therefore protecting against CP-induced AKI. These available evidence, which led to an improved under- standing of molecular recognition, suggested that 18βGA could serve as a potential clinical adjuvant in chemothera-