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This paper presents the case of a patient who developed acute kidney injury and nephrotic syndrome following streptococcal cutaneous infection. He presented with microhematuria, severe proteinuria and systemic edema 5 days after infection. Blood examination showed elevated creatinine level, hypocomplementemia, and elevated anti‐streptolysin O level. Renal biopsy revealed endocapillary proliferative glomerulonephritis with tubulointerstitial nephritis (TIN). Immunofluorescence revealed C3‐dominant glomerular staining, while electron microscopy showed hump‐shaped subepithelial deposits. The patient was therefore diagnosed with poststreptococcal glomerulonephritis. The unique histological feature was C3 deposition in the tubular basement membrane (TBM), in which we detected streptococcal pyrogenic exotoxin B (SpeB), a nephritogenic antigen produced by streptococci. No nephritis‐associated plasmin receptor or plasmin activity was evident in the TBM. These nephritogenic antigens and upregulation of plasmin activity were observed in glomeruli. This case suggests that TIN after poststreptococcal infection might be partially attributable to SpeB toxicity. [ABSTRACT FROM AUTHOR]

Aims and objectives. The aim of this paper is to reflect on how an acute hospital trust involved a youth council comprising 17 young people aged 11–18 years to improve children’s service delivery in one NHS trust in the UK. Background. Over the last decade, there has been an increased emphasis on the active involvement and participation of children and young people in the decision-making processes that affect them. However, one challenge in involving users in acute hospital trusts is how their views are used to develop services. For this reason, University Hospitals Coventry and Warwickshire NHS Trust, UK (University Hospitals Coventry and Warwickshire NHS Trust have given permission to have their name cited in the publication of this article) recognising the emerging national patient and public involvement agenda, planned and developed a youth council for the Trust in 2006. Process. The process of setting up the youth council is outlined. An evaluation workshop took place with 15 members of the youth council and their views are incorporated around three specific areas: • Evidence that their involvement has improved trust services; • Barriers to young people’s voices being heard in service delivery; • What could promote young people’s involvement in healthcare services. Conclusion/Relevance to clinical practice. This paper describes the setting up of a youth council but also discusses the potential barriers and how to overcome them to promote young people’s involvement in hospital trust service planning and development. Whilst the focus of the council was young people, the principles are of use to a wide range of clinical professionals faced with similar challenges. [ABSTRACT FROM AUTHOR]

Influenza A viruses typically cause acute respiratory infections in humans. However, virus-induced acute kidney injury (AKI) has dramatically increased mortality. The pathogenesis remains poorly understood due to limited disease models. Here, a distal renal tubular system-on-a-chip (dRTSC) was constructed to explore the pathogenesis. The renal tubule–vascular reabsorption interface was recapitulated by co-culturing the distal renal tubule and peritubular vessel with a collagen-coated porous membrane. To study the pathways of influenza virus entry into the kidney, dynamic tracking of fluorescence-labeled virus-infected blood vessels was performed. For the first time, the virus was shown to enter the kidney rapidly by cell-free transmission without disrupting the vascular barrier. Direct virus infection of renal tubules in dRTSC reveals disruption of tight junctions, microvilli formation, polar distribution of ion transporters, and sodium reabsorption function. This robust platform allows for a straightforward investigation of virus-induced AKI pathogenesis. The combination with single-virus tracking technology provides new insights into understanding influenza virus-induced extra-respiratory disease. [ABSTRACT FROM AUTHOR]

Background and Objectives: acute kidney injury (AKI), formerly called acute renal failure (ARF), is commonly defined as an abrupt decline in renal function, clinically manifesting as a reversible acute increase in nitrogen waste products—measured by blood urea nitrogen (BUN) and serum creatinine levels—over the course of hours to weeks. AKI occurs in about 20% of all hospitalized patients and is more common in the elderly. Therefore, it is necessary to prevent the occurrence of AKI, and to detect and treat early, since it is known that a prolonged period of kidney injury increases cardiovascular complications and the risk of death. Despite advances in modern medicine, there are no consistent treatment strategies for preventing the progression to chronic kidney disease. Through many studies, the safety and efficacy of natural products have been proven, and based on this, the time and cost required for new drug development can be reduced. In addition, research results on natural products are highly anticipated in the prevention and treatment of various diseases. In relation to AKI, many papers have reported that many natural products can prevent and treat AKI. Conclusions: in this paper, the results of studies on natural products related to AKI were found and summarized, and the mechanism by which the efficacy of AKI was demonstrated was reviewed. Many natural products show that AKI can be prevented and treated, suggesting that these natural products can help to develop new drugs. In addition, we may be helpful to elucidate additional mechanisms and meta-analysis in future natural product studies. [ABSTRACT FROM AUTHOR]

Background: The rising number of infections due to Severe Acute Respiratory Syndrome Coronavirus-2 (popularly known as COVID-19) has brought to the fore new antiviral drugs as possible treatments, including favipiravir. However, there is currently no data regarding the safety of this drug in patients with kidney impairment. The aim of this paper, therefore, is to share our experience of the use of favipiravir in pediatric patients affected by COVID-19 with any degree of kidney impairment. Methods: The study enrolled pediatric patients aged under 18 years and confirmed as suffering from COVID-19 and multisystem inflammatory syndrome in children (MIS-C) with any degree of kidney injury, who were treated with favipiravir at the time of admission. Results: Out of a total of 11 patients, 7 were diagnosed with MIS-C and 4 with severe COVID-19. The median age of the cases was 15.45 (9–17.8) years and the male/female ratio was 7/4. At the time of admission, the median serum creatinine level was 1.1 mg/dl. Nine patients were treated with favipiravir for 5 days, and 2 patients for 5 days followed by remdesivir for 5–10 days despite kidney injury at the time of admission. Seven patients underwent plasma exchange for MIS-C while 2 severely affected cases underwent continuous kidney replacement therapy (CKRT) as well. One severe COVID-19 patient received plasma exchange as well as CKRT. Serum creatinine values returned to normal in mean 3.07 days. Conclusions: Favipiravir seems a suitable therapeutic option in patients affected by COVID-19 with kidney injury without a need for dose adjustment. [ABSTRACT FROM AUTHOR]

Given the known deleterious consequences of acute kidney injury (AKI), exciting recent research efforts have focused on developing strategies for the earlier recognition of AKI in the pediatric population. Recognizing the limitations of serum creatinine, investigators have focused on the study of novel biomarkers and practical bedside tools for identifying patients at risk for AKI prior to a rise in serum creatinine. In PubMed, there are presently over 30 original research papers exploring the use of pediatric AKI risk prediction tools in just the last 2 years. The following review highlights the most recent advances in the literature regarding opportunities to refine our ability to detect AKI early. Importantly, this review discusses how prediction tools including novel urine and serum biomarkers, practical risk stratification tests, renal functional reserve, and electronic medical record alerts may ultimately be applied to routine clinical practice. [ABSTRACT FROM AUTHOR]

Background: A bundle of preventive measures can be taken to avoid acute kidney injury (AKI) or progression of AKI. We performed a systematic review and meta-analysis to evaluate the compliance to AKI care bundles in hospitalized patients and its impact on kidney and patient outcomes.Methods: Randomized controlled trials, observational and interventional studies were included. Studied outcomes were care bundle compliance, occurrence of AKI and moderate-severe AKI, use of kidney replacement therapy (KRT), kidney recovery, mortality (ICU, in-hospital and 30-day) and length-of-stay (ICU, hospital). The search engines PubMed, Embase and Google Scholar were used (January 1, 2012 - June 30, 2021). Meta-analysis was performed with the Mantel Haenszel test (risk ratio) and inverse variance (mean difference). Bias was assessed by the Cochrane risk of bias tool (RCT) and the NIH study quality tool (non-RCT).Results: We included 23 papers of which 13 were used for quantitative analysis (4 RCT and 9 non-randomized studies with 25,776 patients and 30,276 AKI episodes). Six were performed in ICU setting. The number of trials pooled per outcome was low. There was a high variability in care bundle compliance (8 to 100%). Moderate-severe AKI was less frequent after bundle implementation [RR 0.78, 95%CI 0.62-0.97]. AKI occurrence and KRT use did not differ between the groups [resp RR 0.90, 95%CI 0.76-1.05; RR 0.67, 95%CI 0.38-1.19]. In-hospital and 30-day mortality was lower in AKI patients exposed to a care bundle [resp RR 0.81, 95%CI 0.73-0.90, RR 0.95 95%CI 0.90-0.99]; this could not be confirmed by randomized trials. Hospital length-of-stay was similar in both groups [MD -0.65, 95%CI -1.40,0.09].Conclusion: This systematic review and meta-analysis shows that implementation of AKI care bundles in hospitalized patients reduces moderate-severe AKI. This result is mainly driven by studies performed in ICU setting. Lack of data and heterogeneity in study design impede drawing firm conclusions about patient outcomes. Moreover, compliance to AKI care bundles in hospitalized patients is highly variable. Additional research in targeted patient groups at risk for moderate-severe AKI with correct and complete implementation of a feasible, well-tailored AKI care bundle is warranted. (CRD42020207523). [ABSTRACT FROM AUTHOR]

In this section, Nikki Welyczko presents a brief synopsis of a range of recently published articles that may be of interest to nurses working in the renal setting. The aim of this roundup is to provide an overview, rather than a detailed summary and critique, of the research papers selected. Should you wish to look at any of the papers in more detail, a full reference is provided. [ABSTRACT FROM AUTHOR]

In this section, Nikki Welyczko presents a brief synopsis of a range of recently published articles that may be of interest to nurses working in the renal setting. The aim of this roundup is to provide an overview, rather than a detailed summary and critique, of the research papers selected. Should you wish to look at any of the papers in more detail, a full reference is provided. [ABSTRACT FROM AUTHOR]

In this section, Nikki Welyczko presents a brief synopsis of a range of recently published articles that may be of interest to nurses working in the renal setting. The aim of this roundup is to provide an overview, rather than a detailed summary and critique, of the research papers selected. Should you wish to look at any of the papers in more detail, a full reference is provided. [ABSTRACT FROM AUTHOR]

Copyright of Serbian Journal of Experimental & Clinical Research is the property of Sciendo and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background. Renal replacement therapy (RRT), as a cornerstone of supportive treatment, has long been performed in critically ill patients with acute kidney injury (AKI). However, the majority of studies may have neglected the effect of the duration of RRT on the outcome of AKI patients. This paper is aiming to explore the effect of the long duration of RRT on the outcome of critically ill patients with AKI. Methods. This retrospective study was conducted by using the Multiparameter Intelligent Monitoring in Intensive Care II (MIMIC-II) database. The primary outcome measure of this study was the mortality at 28 days, 60 days, and 90 days in the long-duration RRT group and the non-long-duration RRT group. The secondary outcomes assessed the difference in clinical outcome in these two groups. Lastly, the effect of the duration of RRT on mortality in AKI patients was determined as the third outcome. Results. We selected 1,020 patients in total who received RRT according to the MIMIC-II database. According to the inclusion and exclusion criteria, we finally selected 506 patients with AKI: 286 AKI patients in the non-long-duration RRT group and 220 in the long-duration RRT group. After 28 days, there was a significant difference in all-cause mortality between the long-duration RRT group and the non-long-duration RRT group (P = 0.001). However, the difference disappeared after 60 days and 90 days (P = 0.803 and P = 0.925 , respectively). The length of ICU stay, length of hospital stay, and duration of mechanical ventilation were significantly longer in the long-duration RRT group than those in the non-long-duration RRT group. Considering 28-day mortality, the longer duration of RRT was shown to be a protective factor (HR = 0.995, 95% CI 0.993–0.997, P < 0.0001), while 60-day and 90-day mortality were not correlated with improved protection. Conclusions. The long duration of RRT can improve the short-term prognosis of AKI patients, but it does not affect the long-term prognosis of these patients. Prognosis is determined by the severity of the illness itself. This suggests that RRT can protect AKI patients through the most critical time; however, the final outcome cannot be altered. [ABSTRACT FROM AUTHOR]

Aim: Kidney biopsy (KBx) is the gold standard for evaluation of kidney disease, but is associated with a higher risk of complications in patients with reduced glomerular filtration rate (GFR). We studied the safety and utility of KBx in patients with eGFR <30 ml/min/1.73 m2. Methods: Consecutive adult patients with eGFR <30 ml/min/1.73 m2, who were planned for a KBx and consented to participate were prospectively enrolled. Patients with solitary/transplant kidney or acute kidney injury were excluded. Haemoglobin was checked on the day of KBx and repeated 18–24 h later along with a screening ultrasound. Post‐KBx complications were noted and their risk‐factors analysed. The utility of the KBx was graded as effecting significant, some, or no change to subsequent management. Results: Of the 126 patients included, 75% were male, 27.7% were diabetic, and the median eGFR was 13.5 ml/min/1.73m2. Major complications occurred in 5.6%. Peri‐renal haematomas were detected in 37.3%, and haematomas ≥2 cm were significantly more frequent in those with eGFR <15 ml/min/1.73 m2 (29.2% vs. 13%, p =.032). Dialysis was a risk factor, while pre KBx blood transfusion, diabetes and higher serum albumin were protective against any complication. KBx was more likely to make a significant difference in management in those with eGFR 15–29 ml/min/1.73m2 (44.1% vs. 11.1%, p <.001). Increasing age, lower serum creatinine and albumin were independently associated with KBx utility. Conclusion: KBx is relatively safe in severe kidney disease but its risk to benefit balance needs to be carefully considered when eGFR is <15 ml/min/1.73m2. SUMMARY AT A GLANCE: The utility and safety of kidney biopsies in patients with significantly reduced kidney function is a common clinical conundrum. This paper reports a single centre case series of kidney biopsies in patients with an eGFR < 30 ml/min/1.73 m2, where clinical suspicion of an alternative diagnosis is high. The authors demonstrate that in a high volume centre, biopsies in advanced kidney disease are relatively safe and can alter management decisions. [ABSTRACT FROM AUTHOR]

Featured Application: The proposed method has been applied and landed in the ICU at Taichung Veterans General Hospital since 2021. Acute kidney injury (AKI) refers to rapid decline of kidney function and is manifested by decreasing urine output or abnormal blood test (elevated serum creatinine). Electronic health records (EHRs) is fundamental for clinicians and machine learning algorithms to predict the clinical outcome of patients in the Intensive Care Unit (ICU). Early prediction of AKI could automatically warn the clinicians to review the possible risk factors and act in advance to prevent it. However, the enormous amount of patient data usually consists of a relatively incomplete data set and is very challenging for supervised machine learning process. In this paper, we propose an entropy-based feature engineering framework for vital signs based on their frequency of records. In particular, we address the missing at random (MAR) and missing not at random (MNAR) types of missing data according to different clinical scenarios. Regarding its applicability, we applied it to establish a prediction model for future AKI in ICU patients using 4278 ICU admissions from a tertiary hospital. Our result shows that the proposed entropy-based features are feasible to be used in the AKI prediction model and its performance improves as the data availability increases. In addition, we study the performance of AKI prediction model by comparing different time gaps and feature windows with the proposed vital sign entropy features. This work could be used as a guidance for feature windows selection and missing data processing during the development of a prediction model in ICU. [ABSTRACT FROM AUTHOR]

Clinicians could intervene during what may be a crucial stage for preventing permanent kidney injury if patients with incipient Acute Kidney Injury (AKI) and those at high risk of developing AKI could be identified. This paper proposes an improved mechanism to machine learning imputation algorithms by introducing the Particle Swarm Levy Flight algorithm. We improve the algorithms by modifying the Particle Swarm Optimization Algorithm (PSO), by enhancing the algorithm with levy flight (PSOLF). The creatinine dataset that we collected, including AKI diagnosis and staging, mortality at hospital discharge, and renal recovery, are tested and compared with other machine learning algorithms such as Genetic Algorithm and traditional PSO. The proposed algorithms' performances are validated with a statistical significance test. The results show that SVMPSOLF has better performance than the other method. This research could be useful as an important tool of prognostic capabilities for determining which patients are likely to suffer from AKI, potentially allowing clinicians to intervene before kidney damage manifests. [ABSTRACT FROM AUTHOR]

Aim: This systematic review aims to assess dehydration prevalence and dehydration‐related morbidity from diverting ileostomy compared to resections without ileostomy formation in adults undergoing colorectal resection for cancer. Method: MEDLINE, Embase, CENTRAL and ClinicalTrials.gov were searched for studies of any design that reported dehydration, renal function and dehydration‐related morbidity in adult colorectal cancer patients with diverting ileostomy (last search 12 August 2020). Bias was assessed using the Cochrane Collaboration's tool for assessing risk of bias in randomized trials and the Risk of Bias in Non‐randomized Studies of Interventions tool. Results: Of 1927 screened papers, 22 studies were included (21 cohort studies and one randomized trial) with a total of 19 485 patients (12 209 with ileostomy). The prevalence of dehydration was 9.00% (95% CI 5.31–13.45, P < 0.001). The relative risk of dehydration following diverting ileostomy was 3.37 (95% CI 2.30–4.95, P < 0.001). Three studies assessing long‐term trends in renal function demonstrated progressive renal impairment persisting beyond the initial insult. Consequences identified included unplanned readmission, delay or non‐commencement of adjuvant chemotherapy, and development of chronic kidney disease. Discussion: Significant dehydration is common following diverting ileostomy; it is linked to acute kidney injury and has a long‐term impact on renal function. This study suggests that ileostomy confers significant morbidity particularly related to dehydration and renal impairment. [ABSTRACT FROM AUTHOR]

(B) The relative luciferase activity was detected by dual-luciferase reporter assay. Mol Med Rep 24: 795, 2021; DOI: 10.3892/mmr.2021.12435 Subsequently to the publication of this paper, the authors have noticed that Fig. [Extracted from the article]

C-reactive protein is a well-known marker of inflammation and may be preoperatively elevated in the absence of infection in adult cardiac surgery patients, indicating a baseline inflammatory process. We conducted a literature search to assess the available evidence on whether there is an association between preoperative C-reactive protein and acute kidney injury after coronary artery bypass grafting. Included only were observational studies which investigated this association. We excluded abstracts, case reports, animal studies and articles in languages other than English. Altogether, 199 papers were retrieved from the search strategy reported, of which 6 studies were included in the final review. The study types, publication details, patient groups and key results are tabulated. A qualitative assessment of these papers was conducted. We conclude that there is some evidence to support the association between high preoperative C-reactive protein level and postoperative acute kidney injury and complications after coronary artery bypass grafting. Owing to variability in acute kidney injury definitions and C-reactive protein levels for different cohorts in the observational studies reviewed, it is unclear from current evidence what serum C-reactive protein cut-off level is significantly associated with postoperative acute kidney injury. Further evidence is needed to investigate whether raised preoperative C-reactive protein in the absence of an infective cause could have a role in risk prediction models for cardiac surgery–associated acute kidney injury. [ABSTRACT FROM AUTHOR]

Copyright of Journal of the Child / Çocuk Dergisi is the property of Journal of Child and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Kidney is one of the most common organs affected by coronavirus disease 2019 (COVID-19) after the respiratory and immune systems. Among the renal parenchymal components, the tubulointerstitial compartment is presumed to be the prime target of injury in COVID-19. The main mechanism of renal tubular damage by COVID-19 is considered to be indirect, i.e., cytokine-mediated injury. A proportion of infected individuals mount a strong inflammatory response to the virus by an exaggerated immune response of the body, namely cytokine storm. Sudden and massive release of cytokines may lead to serious systemic hyper-inflammation and renal tubular injury and inflammation resulting in acute renal failure. In addition, a number of cases of glomerulopathies, particularly collapsing glomerulopathy (CG) have been reported, predominantly in people of African ancestry, as a rare form of kidney involvement by SARS-CoV-2 that may originate from the background genetic susceptibility in this population complicated by the second hit of SARS-CoV-2 infection, either directly or indirectly. It is noteworthy that renal injury in COVID-19 could be severe in individuals of African origin due to the aforementioned genetic susceptibility, especially the presence of high-risk apolipoprotein L1 (APOL1) genotypes. Although the exact mechanism of kidney injury by SARS-CoV-2 is as yet unknown, multiple mechanisms are likely involved in renal damage caused by this virus. This review was aimed to summarize the salient points of pathogenesis of kidney injury, particularly glomerular injury in COVID-19 disease in the light of published data. A clear understanding of these is imperative for the proper management of these cases. For this review, a search was made of Google Scholar, Web of Science, Scopus, EBSCO and PubMed for finding English language articles related to COVID-19, kidney injury and glomerulopathy. From the information given in finally selected papers, the key aspects regarding glomerular involvement in COVID-19 were drawn out and are presented in this descriptive review. [ABSTRACT FROM AUTHOR]

According to epidemiological studies, chronic kidney disease (CKD) affects more women than men, but the incidence of end‐stage renal disease is higher in men than in women. However, most of these studies have not considered the incidence of CKD in women of reproductive or post‐menopausal age, and even fewer with hormone replacement therapy. Some meta‐analyses have reported an exacerbated progression of CKD in men compared with women. Consequently, in most of the experimental models of renal injury, men of reproductive age exhibit more abnormalities in renal function and structure that lead to greater progression to CKD than women, which suggests that these differences are mediated by sex hormones rather than by other factors. This review intends to show the mechanisms regulated by oestrogen or testosterone that may explain the different risks and evolution of renal diseases between men and women. Regardless of the initial cause of kidney disease, sex hormones have been implicated in modulating vascular tone, oxidative stress, inflammation and apoptosis. Finally, our previous study highlights the mechanisms by which the transition from acute kidney injury to CKD does not occur in female rats as commonly as it does in male rats. This review not only identifies sex differences in several kidney diseases but also supports potential therapeutic opportunities to reduce or prevent the progression of CKD and highlights the importance of considering sex differences in the design of any clinical study. SUMMARY AT A GLANCE: This paper reviews the area of sex in the development of renal injury. The authors discuss the mechanisms by which oestrogens and testosterone can mediate the development of acute and chronic kidney diseases and highlight the importance of considering sex differences in clinical trial design. [ABSTRACT FROM AUTHOR]

We read with interest the paper by White et al. [[1]] reporting that up to 18% of patients admitted to the intensive care unit (ICU) met sepsis-associated acute kidney injury (SA-AKI) criteria. This is three times the occurrence of sepsis reported by some of the same authors in a prior publications, suggesting an occurrence of sepsis (then referred to as severe sepsis) in Australia of 9.7% [[2]]. [Extracted from the article]

8 Robson, M, Chew D, Aalast Van S. Intrinsic acute renal failure (ARF) associated with non-steroidal anti-inflammatory drug (NSAID) use in juvenile cats undergoing routine desexing- 16 cases 1998-2005. Pain behaviors before and after treatment of oral disease in cats using video assessment: a prospective, blinded, randomized clinical trial. We are writing on behalf of our respective organisations with regards to the paper " I Acute kidney injury in 18 cats after subcutaneous meloxicam and an update on non-steroidal anti-inflammatory drug usage in feline patients in Australia i ", published in the AVJ 2023 Mar;101 (3):90-98. [Extracted from the article]

Sepsis is a major cause of acute kidney injury (AKI) among patients in the intensive care unit. However, the numbers of basic science papers for septic AKI account for only 1% of all publications on AKI. This may be partially attributable to the specific pathophysiology of septic AKI as compared to that of the other types of AKI because it shows only modest histological changes despite functional decline and often requires real-time functional analysis. To increase the scope of research in this field, this article reviews the basic research information that has been reported thus far on the subject of septic AKI, mainly from the viewpoint of functional dysregulation, including some knowledge acquired with multiphoton intravital imaging. Moreover, the efficacy and limitation of the potential novel therapies are discussed. Finally, the author proposes several points that should be considered when designing the study, such as monitoring the long-term effects of the intervention and reflecting the clinical settings for identifying the molecular mechanisms and for challenging the intervention effects. [ABSTRACT FROM AUTHOR]

AKI biomarkers (…) appear to have value, (…) informing on the pathobiology of AKI. However, their performance is influenced by patient characteristics, co-morbid illness, inciting kidney injury event, timing of measurement and selected thresholds for diagnosis.Background Acute kidney injury (AKI) remains associated with high morbidity and mortality, despite progress in medical care. Although the RIFLE (Risk, Injury, Failure, Loss, End-Stage Kidney Disease) and AKIN (Acute Kidney Injury Network) criteria, based on serum creatinine and urine output, were a step forward in diagnosing AKI, a reliable tool to differentiate between true parenchymal and pre-renal azotaemia in clinical practice is still lacking. In the last decade, many papers on the use of new urinary and serum biomarkers for the diagnosis and prognostication of AKI have been published. Thus, the question arises which biomarker is a reliable differential diagnostic tool under which circumstances. Methods We searched Medline from inception to April 2012 using medical subject heading and text words for AKI and biomarkers [neutrophil gelatinase-associated lipocalin (NGAL), kidney injury molecule-1 (KIM-1), Cystatin C, interleukin-6 (IL-6), interleukin-8 (IL-8), interleukin-18 (IL-18), N-acetyl-glucosaminidase (NAG), glutathione transferases (GST) and liver fatty acid binding protein (LFABP)] to identify relevant papers in five different settings (paediatrics, cardiac surgery, emergency department, critically ill and contrast-induced nephropathy). Results We included 87 relevant papers, reporting on 74 studies. Depending upon the setting, 7–27 different definitions of AKI were used. Reported diagnostic performance of the different biomarkers was variable from poor to excellent, and no consistent generalizable conclusions can be drawn on their diagnostic value. Conclusions Early diagnosing of AKI in clinical conditions by using new serum and urinary biomarkers remains cumbersome, especially in those settings where timing and aetiology of AKI are not well defined. Putting too much emphasis on markers that have not convincingly proven reliability might lead to incorrect interpretation of clinical trials. Further research in this field is warranted before biomarkers can be introduced in clinical practice. [ABSTRACT FROM AUTHOR]

Hip fractures in the elderly are associated with an increased mortality rate, even if they are operated within the recommended time window. However, the causes of mortality vary considerably depending on the postoperative period and the patients' comorbidities. In the 30-day postoperative period, the most common causes of death are acute processes such as bacterial and aspiration pneumonia followed by myocardial infarction, cancer, gastrointestinal hemorrhage, stroke, pulmonary embolism, and acute renal failure. In the 6-month and 1-year postoperative period, chronic processes appear to be the most important causes of death, as well as decompensation of patients' chronic diseases. To enhance the literature, we performed this literature review to summarize and discuss the causes of mortality of elderly hip fracture patients depending on the postoperative period that they occur, and possibly to address the question what do hip fracture patients die from? Our aim was to perform an interesting and concise paper that the curious reader will find interesting and informative. [ABSTRACT FROM AUTHOR]

Background: Severe leptospirosis requires critical care and has a high mortality. We reviewed the literature to identify factors predicting mortality, and such predictors were classified according to the predisposition, infection, response, organ dysfunction (PIRO) concept, which is a risk stratification model used in severe sepsis. Material and Methods: PUBMED was searched for all articles (English), with the key word "leptospirosis" in any field, within the last 20 years. Data were collected from 45 relevant papers and grouped into each component of the PIRO model. Results: The following correlated with increased mortality: predisposition - increasing age and chronic alcoholism; infection - leptospiraemic burden; response - hemodynamic disturbances, leukocytosis; organ dysfunction - multiple organ dysfunction syndrome, pulmonary involvement and acute renal failure. Conclusions: Further research is needed to identify the role of infecting serovars, clinical signs, inflammatory markers, cytokines and evidence of hepatic dysfunction as prognostic indicators. It is hoped that this paper will be an initiative to create a staging system for severity of leptospirosis based on the PIRO model with an added component for treatment-related predictors. [ABSTRACT FROM AUTHOR]

Critical care in the era of novel coronavirus disease-2019 (COVID-19) infection has multiple challenges including management of the patient, underlying comorbidities, and the complications. With no end in sight to the pandemic, intensive care unit (ICU) practitioners and hospital administrators have to join hands to prepare for the long battle ahead. Critically ill COVID-19 patients need imaging or image-guided interventions in one form or the other including X-rays, ultrasonography (USG), echocardiography (ECHO), and CT scan. These patients often require renal replacement therapy (RRT) for either the preexisting chronic renal insufficiency or acutely developing kidney injury. Another important component of care is transfer of the patient to and fro from the ICU or to higher care centers. Most of the ICUs are equipped with modern facilities but with increasing number of patients a large number of makeshift arrangements are being made for managing these patients. This position paper outlines important tips to formulate protocols and procedures for critically ill patients, who are managed in the ICU. [ABSTRACT FROM AUTHOR]

Objectives: Acute kidney injury (AKI) is a major cause of morbidity and mortality. Whether aminophylline administration can prevent or treat AKI among pediatric patients are not clear. This meta-analysis aimed to assess the efficacy and effectiveness of aminophylline for pediatric AKI. Methods: We carried out a systematic search of six databases: PubMed, EMBASE/ Excerpta Medica, Scopus, Cochrane library, and Google Scholar from January 1995 up till May 2019. Summary measures of risk ratios and standard mean difference were calculated using the random effects model. Results: We identified seven papers containing data on aminophylline use in children with AKI. Meta-analysis of single-arm studies indicated no statistically significant difference in mean rate of serum creatinine clearance (−0.39 [−0.80–1.58], P = 0.52), mean urine output (1.99 [−1.43–5.42]; P = 0.25), or mean blood urea nitrogen levels (0.83 [−1.86–3.03], P = 0.54) before and after aminophylline administration. However, among double-arm studies, aminophylline administration in the intervention arm significantly reduced the serum creatinine level as compared to control arm (mean diff = −34 [−55.18–−12.83]; P = 0.002). Mean urine output (−112.68 [−27.43–48.9], P = 0.17), incidence of AKI (RR = 1.05 [0.80–1.37], P = 0.72), and mortality rates (RR = 0.79 [0.42–1.47], P = 0.45) were found to be statistically insignificant. Conclusions: Aminophylline administration in children with AKI reduces serum creatinine level without significant adverse effects or effect on the incidence of AKI, urine output, or mortality. Further, large-scale well-planned randomized controlled trials are needed to evaluate its use and its potential long-term effects. [ABSTRACT FROM AUTHOR]

Acute kidney injury (AKI) is a life-threatening illness that continues to have an in-hospital mortality rate of patients with AKI ranges from 20% to 50% or greater, depending on underlying conditions. However, it has only marginally declined over the past 25 years. Previous authoritative publications have been pointed out that the lack of useful biomarkers for AKI has limited progress in improving the outcomes of this disorder. The purpose of this paper is to review the recent biomarkers involved in the early detection of AKI and main reasons for the failure to identify new AKI biomarkers. So far, several new AKI biomarkers have been discovered and validated to improve early diagnosis, degree of severity, pathophysiology, differential diagnosis, prediction for major kidney adverse events (MAKE, risk groups for progressive renal failure, need for renal replacement therapy [RRT], or death). These biomarkers can be classified into functional, damage and pre-injury phase biomarkers. However, the clinical use of the studied biomarkers in AKI prediction remains unclear because large prospective multicenter trials have failed to demonstrate troponin-like diagnostic performance. Reasons for the failure to identify AKI biomarkers are the heterogeneity of AKI itself, biomarker limitations and long roads to the validation of candidates for new AKI biomarkers. In an effort to overcome these barriers to identifying new AKI biomarkers, kidney biopsy specimens should be obtained and assessed in human AKI populations. Research in this field should be carried out in a pan-social approach rather than conducted by just a few medical institutions. [ABSTRACT FROM AUTHOR]

Prof. Dr. Dimitar T. Hrisoho was born on June 11, 1924 in Bitola, R. Macedonia. He died in Struga on September 22, 1986, and was buried in Skopje. He completed primary and secondary education in Bitola. He graduated from the Medical Faculty in Belgrade in 1951 as one of the best students of his generation (average grade of 9.75). In 1953 he was employed at the Internal Clinic of the Medical Faculty in Skopje, where in 1955 he passed the specialist exam in internal medicine. He successfully defended his habilitation "Polyarthritis chronica evolutiva" and his doctoral dissertation "Clinical features of Vitina nephropathy". The doctoral dissertation indicates that Vitina nephropathy is a new site of the Balkan Endemic Nephropathy entity and that more genetic testing of patients were needed. Based on numerous clinical and scientific researches published in over 200 papers, he was elected a Full Professor of internal medicine at the Medical Faculty of the Ss. Cyril and Methodius University in Skopje in 1971. In 1970, he formed the nephrology section of the Macedonian Medical Association (MMA), which grew into the nephrology Association of MMA. Through the Association, the education of the medical staff from the field of nephrology was performed. He also set up a bio-cybernetics association. He achieved his vision and desire to transfer and apply the achievements of modern nephrology in the diagnosis and treatment of kidney patients in Macedonia at the Clinic of Nephrology of the Medical Faculty in Skopje, which was the first specialized institution established for examination and treatment of kidney patients in the former Yugoslavia and the Balkans. The Clinic educated nephrological staff and examined and treated kidney patients with new methods and drugs that positively affected the development of nephrology as a subspecialty of the internal medicine. D. Hrisoho was actively involved in the introduction of new methods for examination of kidney patients, as well as in the treatment of patients with acute and chronic renal insufficiency with dialysis since 1965. He also participated in the first two kidney transplantations from living donors performed in 1977. He wrote a chapter on "kidney examination", printed in the book of Prof. A. J. Ignjatovski "Fundamentals of Internal Propedeutics" Part III, published by "Prosvetno delo", 1963, in Skopje. This is the first text to investigate a patient with kidney disease published in a textbook in R. Macedonia. In 1984 he published the textbook "Clinical Nephrology" printed by the University of the Ss. Cyril and Methodius University in Skopje. Prof. D. Hrisoho organized the First Scientific Meeting of Yugoslav Nephrologists with international participation, from 26 to 28 September 1977, in Struga, R. Macedonia. The meeting was attended by prominent nephrologists from the former Yugoslavia, the Balkans, Europe and the United States, among them: J.S. Cameron from UK, J.L. Funck-Brentano from France, M. Burg and P. Ivanovich from the USA, R. Kluthe from Germany and A. Puchlev from Bulgaria. The scientific meeting was the largest nephrology event until then organized in the former Yugoslavia. The meeting provided an exchange of experiences with world-renowned nephrologists. D. Hrisoho presented the paper Artificial intelligence in nephrology. The author tried to apply bio-cybernetics in nephrology. Prof. D. Hrisoho was Vice Dean of the Medical Faculty in Skopje in the period 1963-1965 and Vice Rector of the University of the Ss. Cyril and Methodius University in Skopje in the period 1974-1975. Prof. Hrisoho was also active in socio-political organizations. For his medical, educational and scientific activities he received several awards and recognitions in the country and abroad. Thus, the work of Prof. D. Hrisoho was permanently embedded in the nephrology of R. Macedonia. [ABSTRACT FROM AUTHOR]

Pharmacists are responsible for dispensing drugs and protecting the patient by making sure that they use drugs appropriately. They play an important role not only in the overall cost implications of healthcare but also in the concerns about patient safety when using medication. The scope of this paper was to evaluate the practice of navigation of medical resources among pharmacy students through a simulated event of acute kidney injury using a prospective research methodology. A sample of 65 students was used, among which 2 failed to identify the error in dosing (3.1%) while 56 (86.2%) responded with the presence of error in renal dosing and recommended correctly. Only 7 (10.8%) of the study population had an incomplete recommendation. Even though a greater percentage of the student populations were able to identify dosing errors, there were a few that were unable to identify the errors. Even though this percentage is small, it is much significant when placed in various healthcare institutions and is likely to have a significant impact on patient safety. [ABSTRACT FROM AUTHOR]

An estimated 6,500 undocumented immigrants in the United States have been diagnosed with end-stage renal disease (ESRD). These individuals are ineligible for the federal insurance program that covers dialysis and/or transplantation for citizens, and consequently are subject to local or state policies regarding the provision of healthcare. In 76% of states, undocumented immigrants are ineligible to receive scheduled outpatient dialysis treatments, and typically receive dialysis only when presenting to the emergency center with severe life-threatening symptoms. 'Emergency-only hemodialysis' (EOHD) is associated with higher healthcare costs, higher mortality, and longer hospitalizations. In this paper, we present an ethical critique of existing federal policy. We argue that EOHD represents a failure of fiduciary and professional obligations, contributes to moral distress, and undermines physician obligations to be good stewards of medical resources. We then explore potential avenues for reform based upon policies introduced at the state level. We argue that, while reform at the federal level would ultimately be a more sustainable long-term solution, state-based policy reforms can help mitigate the ethical shortcomings of EOHD. [ABSTRACT FROM AUTHOR]

Copyright of Mycosystema is the property of Mycosystema Editorial Board and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Following disasters, children are physically, psychologically and socially more vulnerable than adults; consequently, their morbidity and mortality are higher. The risks are especially high for orphans and unaccompanied children who are separated from their families, making them frequently victims of human trafficking, slavery, drug addiction, crime or sexual exploitation. Education of children and families about disaster-related risks and providing special protection in disaster preparedness plans may mitigate these threats. Kidney disease patients, both paediatric and adult, are extra vulnerable during disasters, because their treatment is dependent on technology and functioning infrastructure. Acute kidney injury, chronic kidney disease patients not on dialysis and dialysis and transplant patients are faced with extensive problems. Overall, similar treatment principles apply both for adults and paediatric kidney patients, but management of children is more problematic, because of substantial medical and logistic difficulties. To minimize drawbacks, it is vital to be prepared for renal disasters. Preparedness plans should address not only medical professionals, but also patients and their families. If problems cannot be coped with locally, calling for national and/or international help is mandatory. This paper describes the spectrum of disaster-related problems in children and the specific features in treating acute and chronic kidney disease in disasters. [ABSTRACT FROM AUTHOR]

Aim: Acute kidney injury (AKI) after cardiac surgery increases morbidity and mortality. Different definitions for AKI have been used such as Acute Kidney Injury Network (AKIN), Kidney Disease: Improving Global Outcomes (KDIGO) or risk, injury, failure, loss, end‐stage kidney disease (RIFLE). The aim of this study is to determine the best definition of AKI after cardiac surgery with the largest impact on the outcome. Methods: This retrospective study of cardiac surgery patients compared the incidence and effect on outcome (90‐day and 1‐year mortality) of different definitions of AKI: RIFLE, AKIN and KDIGO. Additionally, we defined transient AKI (increase in serum creatinine that resolved in <72 hours), sustained (increase in serum creatinine within 48 hours that remained for >72 hours), and late (increase in serum creatinine after 48 hours). Results: Of the included 1551 patients, 410 patients developed AKI defined by AKIN criteria, 449 defined by KDIGO and 217 defined by RIFLE‐Risk criteria. Hundred and nine patients developed transient AKI (6.9%), 183 patients had sustained AKI (11.6%), and 106 patients had late AKI (6.7%). The best definition with the highest positive likelihood ratio was RIFLE‐Risk (positive likelihood ratio = 2.32) followed by "sustained AKI" (positive likelihood ratio = 2.27). AKI defined by AKIN criteria missed all 80 patients with late AKI and 39 patients with KDIGO AKI. Conclusion: Risk, injury, failure, loss, end‐stage kidney disease‐risk was the best definition of AKI as determined by the ability to predict short‐term mortality. A substantial number of patients developed AKI only after 48 hours, and these were missed when using AKIN criteria. AKIN criteria are not sensitive enough to capture all episodes of AKI in this population. Summary at a glance: This paper compares acute kidney injury scoring systems retrospectively applied to patients undergoing cardiac procedures. It highlights the differences in specificity and sensitivity of these scoring systems for predicting mortality and underscores the deficiencies of relying on a single scoring system to determine risk. [ABSTRACT FROM AUTHOR]

Aim: In addition to immunological complications, non‐immunological events should be considered following kidney transplantation. Among them, diarrhoea is the most common gastrointestinal complication, but its effect on transplant outcomes remains unclear. Methods: This retrospective study enrolled patients who underwent kidney transplantation between May 1993 and December 2017. Patients with diarrhoea as the chief complaint at admission were defined as the diarrhoea group. Transplant outcomes were compared between the diarrhoea and non‐diarrhoea groups. Results: Among a total of 1704 kidney recipients, severe diarrhoea that required hospitalization was identified in 84 (4.9%) patients. Patients with diarrhoea showed higher risks of graft failure (adjusted hazard ratio, 4.77 (2.98–7.64)) and all‐cause mortality (adjusted hazard ratio, 7.17 (4.09–12.58)) than did patients without diarrhoea. The risk of de novo donor‐specific antibody was also elevated in the diarrhoea group, although there was no change in the risk of biopsy‐proven rejection. In subgroup analysis, the aetiology of diarrhoea, as well as a change in immunosuppressant following diarrhoea, showed no significant differences in graft survival. However, incomplete recovery from concurrent acute kidney injury was significantly associated with graft loss. Conclusion: Diarrhoea is related to poor graft and patients' outcomes in kidney recipients. An effort to recover from concurrent acute kidney injury is important for improved graft survival. SUMMARY AT A GLANCE: Diarrhoea after kidney transplant has many underlying causes. This paper examines patients transplanted from 1993 to 2017 (analysed by era) who presented with diarrhoea as their main complaint and describes a significant increase in subsequent graft loss, all‐cause mortality and de novo donor‐specific antibody development in this cohort. [ABSTRACT FROM AUTHOR]

Objective: The Northern Territory has the highest incidence of haemodialysis care for end-stage kidney disease in Australia. Although acute kidney injury (AKI) is a recognised risk for chronic kidney disease (CKD), the effect of AKI causing incident haemodialysis (iHD) is unknown. Audits identifying antecedents of iHD may inform health service planning. Thus, the aims of this study were to describe: (1) the development of an iHD recording system involving patients with AKI and CKD; and (2) the incidence, patient characteristics and mortality for patients with dialysis-requiring AKI. Methods: A retrospective data linkage study was conducted using eight clinical and administrative datasets of adults receiving iHD during the period from July 2011 to December 2012 within a major northern Australian hospital for AKI without CKD (AKI), AKI in people with pre-existing CKD (AKI/CKD) and CKD (without AKI). The time to death was identified by the Northern Territory Register of deaths. Results: In all, 121 iHD treatments were provided for the cohort, whose mean age was 51.5 years with 53.7% female, 68.6% Aboriginal ethnicity and 46.3% with diabetes. iHD was provided for AKI (23.1%), AKI/CKD (47.1%) and CKD (29.8%). The 90-day mortality rate was 25.6% (AKI 39.3%, AKI/CKD 22.8%, CKD 19.4%). The 3-year mortality rate was 45.5% (AKI 53.6%, AKI/CKD 22.8%, CKD 19.4%). The time between requesting data from custodians and receipt of data ranged from 15 to 1046 days. Conclusion: AKI in people with pre-existing CKD was a common cause of iHD. Health service planning and community health may benefit from AKI prevention strategies and the implementation of sustainable and permanent linkages with the datasets used to monitor prospective incident haemodialysis. What is known about the topic?: AKI is a risk factor for CKD. The Northern Territory has the highest national incidence rates of dialysis-dependent end-stage kidney disease, but has no audit tool describing outcomes of dialysis-requiring AKI. What does this paper add?: We audited all iHD and showed 25.6% mortality within the first 90 days of iHD and 45.5% overall mortality at 3 years. AKI in people with pre-existing CKD caused 47.1% of iHD. What are the implications for practitioners?: Health service planning and community health may benefit from AKI prevention strategies and the implementation of sustainable and permanent linkages with the datasets used to monitor prospective incident haemodialysis. [ABSTRACT FROM AUTHOR]

BACKGROUND: High-altitude decompression sickness (HADCS) is a rare condition that lias been associated with aircraft accidents. To the best of our knowledge, the present paper is the first case report of a patient treated for severe HADCS using recompression therapy and veno-venous extracorporeal oxygenation (VV-ECMO) with a complete recovery. CASE REPORT: After depressurization of a cabin, the 51-yr-old jet pilot was admitted to the Military Institute of Medicine with a life-threatening HADCS approximately 6 h after landing from a high-altitude flight, in a dynamically deteriorating condition, with progressing dyspnea and edema, reporting increasing limb paresthesia, fluctuating consciousness, and right-sided paresis. Hyperbaric oxygen therapy in the intensive care mode was initiated. A therapeutic recompression with U.S. Navy Treatment Table 6 was performed with neurological improvement. Due to cardiovascular collapse, sedation, mechanical ventilation, and significant doses of catecholamines were started, followed by continuous veno-venous hemodialysis. In the face of disturbances in oxygenation, during the second day of treatment the patient was commenced on veno-venous extracorporeal oxygenation. Over the next 6 d, the patient's condition slowly improved. On day 7, VV-ECMO was discontinued. On day 19, the patient was discharged with no neurological deficits. DISCUSSION: We observed two distinct stages during the acute (abase of the disease. During the first stage, signs of hypoperfusion, neurological symptoms, and marbled skin were observed. During the second stage, multiple organ dysfunction dominated, including heart failure, pulmonary edema, acute kidney injury, and fluid overload, all of which can be attributed to extensive endothelial damage. [ABSTRACT FROM AUTHOR]

Carbon monoxide (CO) is not only known as a toxic gas due to its characteristics as an odorless molecule and its rapid binding to haem-containing molecules, thus inhibiting the respiratory chain in cells resulting in hypoxia. For decades, scientists established evidence about its endogenously production in the breakdown of haem via haem-oxygenase (HO-1) and its physiological effects. Among these, the modulation of various systems inside the body are well described (e.g., anti-inflammatory, anti-oxidative, anti-apoptotic, and anti-proliferative). Carbon monoxide is able to modulate several extra- and intra-cellular signaling molecules leading to differentiated response according to the specific stimulus. With our growing understanding in the way CO exerts its effects, especially in the mitochondria and its intracellular pathways, it is tempting to speculate about a clinical application of this substance. Since HO-1 is not easy to induce, research focused on the application of the gaseous molecule CO by itself or the implementation of carbon monoxide releasing molecules (CO-RM) to deliver the molecule at a time- and dose dependently safe way to any target organ. After years of research in cellular systems and animal models, summing up data about safety issues as well as possible target to treat in various diseases, the first feasibility trials in humans were established. Up-to-date, safety issues have been cleared for low-dose carbon monoxide inhalation (up to 500 ppm), while there is no clinical data regarding the injection or intake of any kind of CO-RM so far. Current models of human research include sepsis, acute lung injury, and acute respiratory distress syndrome as well as acute kidney injury. Carbon monoxide is a most promising candidate in terms of a therapeutic agent to improve outbalanced organ conditions. In this paper, we summarized the current understanding of carbon monoxide's biology and its possible organ targets to treating the critically ill patients in tomorrow's ICU. [ABSTRACT FROM AUTHOR]

Copyright of Ciencia, Tecnología y Salud is the property of Ciencia, Tecnologia y Salud and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background: Surgical patients are getting older with increasing comorbidity. Acute kidney injury (AKI) is a commonly underestimated perioperative complication. 2-18% of hospitalized patients and 22-57% of patients in the intensive care unit develop AKI. Even though it has a major impact on patients' outcomes, it goes unrecognized in 57-75.6% of cases. Methods: This review is based on pertinent papers retrieved by a selective search in PubMed and the Cochrane Library employing the searching terms "acute kidney injury," "biomarker," "perioperative," "renal function," and "KDIGO." Results: The pathophysiology of AKI is complex. Conventional biomarkers are either not specific enough (urine output) or not sensitive enough (serum creatinine) for timely diagnosis. In view of the pathophysiology of the condition and the limited treatment options for it, the early detection of subclinical AKI (kidney damage without functional impairment) would seem to be a reasonable first step toward the prevention of worsening or permanent renal injury. New biomarkers of damage enable the early initiation of nephroprotective interventions. According to the "Kidney Disease: Improving Global Outcomes" (KDIGO) statement, a multimodal treatment approach is needed, including, among other things, optimization of hemodynamics and the discontinuation of nephrotoxic drugs. Conclusion: It is essential to identify patients at risk and sensitize the treating personnel to the implementation of the guidelines. The incorporation of new biomarkers into routine clinical practice is also reasonable and necessary. Future clinical trials must show in what form these biomarkers should be used (singly or collectively). [ABSTRACT FROM AUTHOR]

Acute interstitial nephritis (AIN) is a common cause of acute kidney injury that was first described in 1898. It is most commonly caused by drugs and infections, although other aetiologies are implicated. Here we review two papers published in this issue of Clinical Kidney Journal and provide an update on current advances and controversies relating to AIN. Nussbaum and Perazella describe the diagnostic tools (namely urinary and serum biomarkers) available for AIN and highlight that there is no single test that can accurately predict the diagnosis. As such, renal biopsy remains the gold standard. Wendt et al. present findings from a 20-year retrospective study of biopsy-proven AIN. They found that a high degree of inflammation was associated with a greater chance of renal recovery, in contrast to the presence of cortical scars, which were associated with a worse outcome. There was also a significant number who required renal replacement therapy. They advocate the use of a scoring system for AIN to help direct management. We also discuss new drugs associated with AIN (in particular new anticancer drugs) and unusual forms including granulomatous AIN. Finally, we discuss the opportunities for future research and how this may impact clinical practice. [ABSTRACT FROM AUTHOR]

In the paper "Black Race and Body Mass Index are Risk Factors for Rhabdomyolysis and Acute Kidney Injury in Trauma", the authors investigated body mass index (BMI) and race as risk factors for the development of rhabdomyolysis and acute kidney injury (AKI) in trauma patients. Future studies should compare all the risk factors of rhabdomyolysis, such as trauma, sepsis, muscular disease, immobilization, and now black race and high BMI, and determine which are most significantly associated with rhabdomyolysis [[1]]. Black Race and Body Mass Index are risk factors for rhabdomyolysis and acute kidney injury in trauma. [Extracted from the article]

Ruth Paterson provides an overview of recently published articles that may be of interest to non-medical prescribers. Should you wish to look at any of the papers in more detail, a full reference is provided [ABSTRACT FROM AUTHOR]

This figure presents an analysis of a subset of 32,971 patients identified with sepsis from the MIMIC-IV database. 10499944 2 Uhel F, Peters-Sengers H, Falahi F. Mortality and host response aberrations associated with transient and persistent acute kidney injury in critically ill patients with sepsis: a prospective cohort study. Shown are trends of clinical outcomes for each of the groups with sepsis-associated acute kidney injury (SA-AKI) classified using data from each time window after sepsis diagnosis. [Extracted from the article]