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Background: The standard rate of sodium removal in adult anuric patients on continuous ambulatory peritoneal dialysis (CAPD) is 7.5 g/L of ultrafiltration volume (UFV). Although automated PD (APD) is widely used in pediatric patients, no attempt has yet been made to estimate sodium removal in APD. Methods: The present, retrospective cohort study included pediatric patients with APD who were managed at Tokyo Metropolitan Children's Medical Center between July 2010 and November 2017. The patients underwent a peritoneal equilibrium test (PET) at our hospital. Sodium removal per UFV was calculated by peritoneal function and dwell time using samples from patients on APD with 1- and 2-h dwell effluent within three months of PET and 4- and 10-h dwell effluent at PET. Results: In total, 217 samples from 18 patients were included, with 63, 81, and 73 of the samples corresponding to the High [H], High-average [HA], and Low-average [LA] PET category, respectively. Sodium removal per UFV (g/L in salt equivalent) for dwell times of one, two, four, and ten hours was 5.2, 8.8, 8.0, and 11.5 for PET [H], 5.3, 5.8, 5.6, and 8.1 for PET [HA], and 4.6, 5.1, 5.1, and 7.1 for PET [LA], respectively. Conclusions: Sodium removal per UFV in pediatric APD was less than the standard adult CAPD and tended to be lower with shorter dwell times, leading to sodium accumulation. Therefore, salt intake should be restricted in combination with one or more long daytime dwells, especially in anuric patients. [ABSTRACT FROM AUTHOR]

This article presents a case study of a patient with systemic lupus erythematosus (SLE) and antiphospholipid antibody syndrome (APS) who developed acute kidney injury (AKI) due to urinary tract obstruction caused by blood clots. The patient was diagnosed with secondary immune thrombocytopenic purpura (ITP) and received treatment with glucocorticoids, intravenous immunoglobulin, and continuous hemodialysis/hemofiltration. The treatment resulted in the rapid improvement of symptoms and renal function. The article emphasizes the importance of diagnosing and treating secondary ITP in patients with rheumatic diseases to improve renal prognosis. [Extracted from the article]

Abstract Background Primary focal segmental glomerulosclerosis (FSGS) is a glomerular disease that sometimes recurs in patients after kidney transplantation (KT) and increases the risk of graft loss. Proteinuria is a common early sign of recurrent FSGS, but an abrupt decrease in urine volume is rare. Herein, we report a patient with early recurrence of FSGS with anuria following KT. Case presentation A 55-year-old man with end-stage kidney disease caused by primary FSGS experienced anuria on postoperative day 2 following deceased donor KT. Laboratory results revealed that serum tacrolimus trough levels were consistently elevated at the time of anuria. At first, we considered acute calcineurin inhibitor (CNI) nephrotoxicity based on graft biopsy on light microscopy, laboratory findings, and clinical courses. However, the allograft function did not recover even after discontinuation of CNI, and recurrent FSGS was diagnosed 2 weeks later on electron microscopy. A total of 13 sessions of plasmapheresis and two administrations of rituximab (375 mg/m2) were required to treat recurrent FSGS. The patient achieved a partial response, and the spot urine protein-to-creatinine ratio decreased from 15.5 g/g creatinine to 5.2 g/g creatinine. At 5 months following KT, the serum creatinine level was stable at 1.15 mg/dL. Conclusions These findings highlight that anuria can occur in cases of early recurrence of FSGS combined with acute CNI nephrotoxicity.

The article offers information on a case study where a PICC line was not placed centrally, leading to necrotizing fasciitis in a neonate. Topics include the patient's presentation, the difficulty in PICC line placement, subsequent complications including anuria and metabolic acidosis, and the eventual treatment and outcome of the case.

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Gangrenous cystitis is an exceedingly uncommon diagnosis characterized by bladder mucosa and submucosal necrosis. The presence of non-specific symptoms and signs complicates the diagnostic process. Necrotizing fasciitis is a rare infection affecting the deep soft tissues, causing progressive destruction of the muscle fascia and rapid systemic spread. This study aimed to elucidate the atypical presentation of rare gangrenous cystitis in the literature, highlighting its potential to lead to necrotizing fasciitis. An 82-year-old female patient was admitted with abdominal and pelvic pain complaints. Computed tomography of the lower abdomen revealed free air-fluid densities in the pelvic region, raising the suspicion of intestinal perforation. Exploratory laparotomy diagnosed the patient with gangrenous cystitis and necrotizing fasciitis. Pathological examination confirmed the presence of necrosis. In patients presenting with acute abdominal symptoms, when free air-fluid levels are observed in imaging studies of the pelvis, rare diagnoses such as gangrenous cystitis should not be overlooked, even if the patient’s history indicates anuria. [ABSTRACT FROM AUTHOR]

Background: Dengue is the most common arboviral illness reported globally, endemic to most tropical and sub-tropical regions of the world. Dengue Shock Syndrome is a rare complication of severe Dengue infection resulting in haemorrhagic complications and refractory hypotension. We report on a case of severe dengue diagnosed in a patient with major trauma and illustrate some of the potential challenges and considerations in the clinical management of such cases. Case Presentation: A 49-year-old female presented following a road trauma incident with multiple abdominal injuries requiring urgent laparotomy. Her recovery in Intensive Care Unit was complicated by the development of Dengue Shock Syndrome characterised by a falling haemoglobin and platelet count, multiorgan dysfunction and prolonged hospital stay. Conclusions: Dengue Shock Syndrome may complicate fluid management and bleeding control in major trauma cases. Awareness of Dengue, particularly in endemic areas and returned travellers may help facilitate early diagnosis and management of complications. [ABSTRACT FROM AUTHOR]

Abstract Background Outcomes of dogs with acute kidney injury secondary to leptospirosis (AKI‐L) treated using renal replacement therapies (RRT) are poorly characterized. Hypothesis/Objectives Describe survival to discharge, short (≤30 days) and long‐term (≥6 months) outcomes of AKI‐L dogs receiving RRT and determine if there is a significant difference in maximum blood urea nitrogen (maxBUN), maximum creatinine (maxCr), maximum bilirubin (maxBili) and the number of body systems affected between survivors and non‐survivors. Animals Twenty‐two client‐owned dogs with AKI‐L receiving RRT. Methods Retrospective medical record review of dogs with AKI‐L that received RRT between 2018 and 2021. Results Sixteen of 22 (73%) dogs survived to discharge. Of the survivors, 13 (81%) were alive >30 days from discharge and 12 (75%) were alive at 6 months from discharge. Factors significantly higher in non‐survivors included number of body systems affected (survivors: 1 (19%), 2 (50%), 3 (25%) and 4 (6%) vs non‐survivors: 3 (33.3%), and 4 (66.7%); P = .01) and median maxBili (survivors: 1.9 mg/dL; range, 0.1‐41.6 vs non‐survivors: 21.0 mg/dL; range, 12.3‐38.9; P = .02). There was no significant difference in median maxBUN (survivors: 153.0 mg/dL; range, 67‐257 vs non‐survivors: 185.5 mg/dL; range, 102‐218; P = .44) and median maxCr (survivors: 9.8 mg/dL; range, 6.2‐15.9 vs non‐survivors: 9.8 mg/dL; range, 8.4‐13.5; P = .69) between survivors and non‐survivors. Conclusions and Clinical Importance Regardless of azotemia severity, dogs with AKI‐L receiving RRT have a good survival rate to discharge. The number of body systems affected and hyperbilirubinemia might be associated with worse outcomes.

Rationale & Objective: The development of anuria has been linked to worse clinical outcomes in patients undergoing peritoneal dialysis (PD). Our objective was to investigate the incidence, risk factors, and associated clinical outcomes of anuria within the first year after starting PD. Study Design: Retrospective cohort study. Setting & Participants: Patients who started continuous ambulatory peritoneal dialysis at our center between 2006 and 2020 were included and followed up until January 31, 2023. Exposure: Age, sex, diabetes, temporary hemodialysis, angiotensin-converting enzyme inhibitors (ACEis) or angiotensin II receptor blockers (ARBs), diuretics, baseline urine volume, serum albumin, daily glucose exposure, peritonitis, and incremental PD. Outcomes: The primary outcome was early anuria, defined as 24-hour urine volume ≤100 mL within the first year of PD initiation. Secondary outcomes included all-cause mortality, cardiovascular disease mortality, technique failure, and peritonitis. Analytical Approach: Cox proportional hazards model. Results: A total of 2,592 patients undergoing continuous ambulatory peritoneal dialysis aged 46.7 ± 14.9 years were recruited. Among them, 58.9% were male, and 24.0% had diabetes. Within the first year of PD therapy, 159 (6.13%) patients developed anuria, with a median duration of 7.53 (interquartile range, 3.93-10.0) months. Higher baseline urine volume (hazard ratio [HR], 0.93; 95% confidence interval [CI], 0.90-0.97), higher serum albumin (HR, 0.92; 95% CI, 0.88-0.95), having diabetes before PD (HR, 0.57; 95% CI, 0.35-0.92), and prescribed incremental PD (HR, 0.27; 95% CI, 0.14-0.51) were associated with a reduced risk for early anuria, whereas a higher level of daily glucose exposure (HR, 1.01; 95% CI, 1.00-1.01) was identified as a risk factor for early anuria. Subgroup analyses showed that using ACEis or ARBs was linked to a lower risk of early anuria (HR, 0.25; 95% CI, 0.09-0.69) in diabetic patients. Treating early anuria as a time-dependent covariate, early anuria was associated with a higher risk for all-cause mortality (HR, 1.69; 95% CI, 1.23-2.32) and technique failure (HR, 1.43; 95% CI, 1.00-2.04) after adjusting for confounding factors. Limitations: Single-center and observational study. Conclusions: Among PD patients at a single center in China, early anuria was relatively uncommon but associated with an increased risk of mortality and PD technique failure. Incremental PD, higher baseline urine output and serum albumin, and lower daily glucose exposure were associated with a lower risk of early anuria. Clinical trials are needed to evaluate the optimal PD techniques to preserve residual kidney function and maximaze outcomes. Plain-Language Summary: The development of anuria has been linked to worse clinical outcomes in patients undergoing peritoneal dialysis (PD). However, does the development of early anuria, which is defined as 24-hour urine volume ≤100 mL, within the first year after PD initiation influence the clinical outcomes of these patients? What are the predictors of early anuria? We conducted a single-center retrospective cohort study and found lower baseline urine volume, lower serum albumin, full-dose PD start, absence of diabetes mellitus, higher daily glucose exposure, and in patients with diabetes mellitus, non-use of angiotensin-converting enzyme inhibitors/angiotensin II receptor blockers were associated with early anuria. Early anuria was related to a higher risk for all-cause mortality and technique failure. The results provide information for optimizing patient care and improving the prognosis of patients undergoing PD.

Background: Outcomes of dogs with acute kidney injury secondary to leptospirosis (AKI‐L) treated using renal replacement therapies (RRT) are poorly characterized. Hypothesis/Objectives: Describe survival to discharge, short (≤30 days) and long‐term (≥6 months) outcomes of AKI‐L dogs receiving RRT and determine if there is a significant difference in maximum blood urea nitrogen (maxBUN), maximum creatinine (maxCr), maximum bilirubin (maxBili) and the number of body systems affected between survivors and non‐survivors. Animals: Twenty‐two client‐owned dogs with AKI‐L receiving RRT. Methods: Retrospective medical record review of dogs with AKI‐L that received RRT between 2018 and 2021. Results: Sixteen of 22 (73%) dogs survived to discharge. Of the survivors, 13 (81%) were alive >30 days from discharge and 12 (75%) were alive at 6 months from discharge. Factors significantly higher in non‐survivors included number of body systems affected (survivors: 1 (19%), 2 (50%), 3 (25%) and 4 (6%) vs non‐survivors: 3 (33.3%), and 4 (66.7%); P =.01) and median maxBili (survivors: 1.9 mg/dL; range, 0.1‐41.6 vs non‐survivors: 21.0 mg/dL; range, 12.3‐38.9; P =.02). There was no significant difference in median maxBUN (survivors: 153.0 mg/dL; range, 67‐257 vs non‐survivors: 185.5 mg/dL; range, 102‐218; P =.44) and median maxCr (survivors: 9.8 mg/dL; range, 6.2‐15.9 vs non‐survivors: 9.8 mg/dL; range, 8.4‐13.5; P =.69) between survivors and non‐survivors. Conclusions and Clinical Importance: Regardless of azotemia severity, dogs with AKI‐L receiving RRT have a good survival rate to discharge. The number of body systems affected and hyperbilirubinemia might be associated with worse outcomes. [ABSTRACT FROM AUTHOR]

The article presents a case study of a critically ill 14-year-old patient with atypical hemolytic uremic syndrome (aHUS) triggered by a severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, emphasizing the potential association between COVID-19 and renal complications. The patient, with preexisting renal disease due to nephrotic syndrome, experienced a severe clinical course of aHUS.

Recurrent focal segmental glomerulosclerosis (FSGS) after kidney transplantation is a serious concern with poor allograft outcomes. Possible circulating permeability factors are postulated as pathogenetic factors leading to recurrence. Genetic FSGS is said to have a negligible risk of posttransplant recurrence. Here, we describe an unfortunate patient of genetic FSGS (pathogenic genetic variant) who had a recurrence within hours after transplant and presented with a sudden onset of anuria. The patient did not respond to plasma exchange and subsequently underwent allograft nephrectomy. [ABSTRACT FROM AUTHOR]

Relevance. A clinical case of hypothyroidism presenting with an unusual combination of symptoms is presented. Possible mechanisms for the development of the present clinical manifestations are reviewed, and the relationship to other disciplines is discussed. Aim and Objectives. To describe a clinical case in order to sensitize physicians to the neurologic manifestations of somatic diseases. Materials and methods. The patient was examined upon admission to the hospital, dynamic observation, and medical history was analyzed. Results. The presence in the patient of disorders of consciousness and higher cortical functions in combination with anuria and pronounced static and dynamic ataxia can be fully explained by decompensation of hypothyroidism. Conclusions. The presented clinical case demonstrates multisystemic manifestations of hypothyroidism; the patient's symptoms could require the attention of urologists, nephrologists, neurologists, therapists, and endocrinologists. The subacute onset of symptoms is important.

Fungal bezoar formation is a complication of fungal urinary tract infections that are usually caused by Candida species and other fungal types. They can form in any site along the urinary tract and may cause an obstruction to the urine flow that would require drainage by nephrostomy, a ureteric stent, and sometimes surgical intervention is needed. In this case report we discuss a case of an adult male who had an extensive fungal bezoar infection caused by Candida tropicalis causing him anuria and acute kidney injury. The bezoars were found in the bladder, the ureters, and both kidneys. The patient was treated with bilateral ureteric stent insertion and with fluconazole for 3 weeks. Bilateral ureteroscopy and urine culture were done after 2 months and they showed that the bezoars have been eradicated on both gross and microscopic levels. [ABSTRACT FROM AUTHOR]

Objectives: Urine output is used to evaluate fluid status and is an important marker for acute kidney injury (AKI). Our primary aim was to validate a new automatic urine output monitoring device by comparison to the current practice – the standard urometer. Methods: We conducted a prospective observational study in three ICUs. Urine flow measurements by Serenno Medical Automatic urine output measuring device (Serenno Medical, Yokneam, Israel) were compared to standard urometer readings taken automatically at 5-minutes intervals by a camera, and to hourly urometer readings by the nurses, both over 1 to 7 days. Our primary outcome was the difference between urine flow assessed by the Serenno device and reference camera-derived measurements (Camera). Our secondary outcome was the difference between urine flow assessed by the Serenno device and hourly nursing assessments (Nurse), and detection of oliguria. Results: Thirty-seven patients completed the study, with 1,306 h of recording and a median of 25 measurement hours per patient. Bland and Altman analysis comparing the study device to camera measurements demonstrated good agreement, with a bias of -0.4 ml/h and 95% confidence intervals ranging from − 28 to 27ml/h. Concordance was 92%. The correlation between Camera and hourly nursing assessment of urine output was distinctly worse with a bias of 7.2 ml and limits of agreement extending from − 75 to + 107 ml. Severe oliguria (urine output < 0.3 ml/kg/h) lasting 2 h or more was common and observed in 8 (21%) of patients. Among the severe oliguric events lasting more than 3 consecutive hours, 6 (41%) were not detected or documented by the nursing staff. There were no device-related complications. Conclusion: The Serenno Medical Automatic urine output measuring device required minimal supervision, little ICU nursing staff attention, and is sufficiently accurate and precise. In addition to providing continuous assessments of urine output, it was considerably more accurate than hourly nursing assessments. [ABSTRACT FROM AUTHOR]

Abstract Background Xanthii Fructus was used in the treatment of rhinitis and related nasal disease. It is the most commonly used chemically active component in compounds formulated for the treatment of rhinitis. However, poisoning, resulting in serious consequences, can easily occur owing to cocklebur overdose, improper processing, or usage without processing. Case presentation We reported on a 55-year-old man who experienced allergic rhinitis for 2.5 years. He ingested unprocessed Xanthii Fructus for 2 months as treatment. However, he developed anorexia; nausea; abdominal pain; general weakness; hiccups; oliguria and anuria; significantly elevated serum alanine aminotransferase, aspartate aminotransferase, and creatinine levels; and abnormalities in blood coagulation series. Nutritional support; daily drugs for liver protection, gastric protection, inflammation reduction; fresh plasma; and cryoprecipitate infusion were administered. Continuous venovenous hemodialysis (Prismaflex ST100) was also administered. However, the patient’s multiple organ failure gradually worsened, ultimately leading to death. Conclusion Xanthii Fructus poisoning affects multiple systems, and its clinical manifestations are complex. Therefore, it is easily misdiagnosed and missed. Along with careful inquiry of medical and medication history, early diagnosis and intervention are vital for a successful treatment. It is also important to educate people and create awareness about this poisoning. Therefore, this intractable case has great clinical significance.

Background: Xanthii Fructus was used in the treatment of rhinitis and related nasal disease. It is the most commonly used chemically active component in compounds formulated for the treatment of rhinitis. However, poisoning, resulting in serious consequences, can easily occur owing to cocklebur overdose, improper processing, or usage without processing. Case presentation: We reported on a 55-year-old man who experienced allergic rhinitis for 2.5 years. He ingested unprocessed Xanthii Fructus for 2 months as treatment. However, he developed anorexia; nausea; abdominal pain; general weakness; hiccups; oliguria and anuria; significantly elevated serum alanine aminotransferase, aspartate aminotransferase, and creatinine levels; and abnormalities in blood coagulation series. Nutritional support; daily drugs for liver protection, gastric protection, inflammation reduction; fresh plasma; and cryoprecipitate infusion were administered. Continuous venovenous hemodialysis (Prismaflex ST100) was also administered. However, the patient's multiple organ failure gradually worsened, ultimately leading to death. Conclusion: Xanthii Fructus poisoning affects multiple systems, and its clinical manifestations are complex. Therefore, it is easily misdiagnosed and missed. Along with careful inquiry of medical and medication history, early diagnosis and intervention are vital for a successful treatment. It is also important to educate people and create awareness about this poisoning. Therefore, this intractable case has great clinical significance. [ABSTRACT FROM AUTHOR]

This paper presents a case of urosepsis caused by Escherichia coli in an 11-year-old girl with a neurogenic bladder. The patient had not previously been supervised by a nephrologist or urologist. On admission, significantly elevated serum markers of inflammation (C-reactive protein 32.4 mg/dl, procalcitonin 64.2 ng/ml), kidney failure (creatinine 6.9 mg/dl, pH 7.22, HCO3 6.3 mmol/l), and increased serum urea (399 mg/dl) were detected. Antibiotic therapy with rehydration was started and improved renal function without dialysis. However, a 9-cm-long perirenal abscess site was diagnosed. It required surgical treatment, which was complicated by an anaphylactic reaction to latex. Colitis caused by Clostridium difficile was also diagnosed. Hospital treatment lasted 38 days. After 4 months the patient's glomerular filtration rate was 66 ml/min/1.73 m² and indicated stage 2 chronic kidney disease. Because early diagnosis of urinary tract infection is crucial for preventing complications in children with neurogenic bladder, they should undergo regular nephro-urological care. [ABSTRACT FROM AUTHOR]

For better management of acute kidney injury (AKI) and prevention of progressive renal injury, it is extremely important to manage infections such as gastroenteritis. In addition, anuria is considered a risk factor for AKI and even causes death in patients. An 18-month-old boy with vomiting and diarrhea for three days and anuria for 24 hours was referred to Farsan hospital. The patient had bulky and watery diarrhea about 7-8 times a day and vomited 3-4 times a day which was containing food particles. He had a fever on the first and second days. Ultrasound findings revealed that the right kidney did not exist, and the left kidney was affected by compensatory hypertrophy. Disorders in the patient’s blood biochemical factors were also observed. Acidosis and other biochemical disorders were treated with bicarbonate drip, allopurinol, Lasix drip, and dopamine drip. After about 18 hours, anuria was treated.

ObjectiveTo describe the successful outcome of a case of oligo-anuric acute kidney injury in a cat secondary to lily ingestion.Case summaryA 12-week-old intact male domestic short-hair cat weighing 1.64 kg (3.6 lb) presented with a 12-h duration of vomiting and lethargy after exposure to lilies of the genera Lilium species 24 h prior to presentation. Severe azotemia (Creatinine 5.8 mg/dL, BUN > 100 mg/dL) and hyperkalemia (9.36 mmol/L) were noted on the day of presentation. Treatment of hyperkalemia was instituted with calcium gluconate, lactated ringers solution, dextrose, regular short-acting insulin, albuterol, and sodium bicarbonate, Oliguria to anuria was highly suspected based on a lack of urine production 21 h after hospitalization with intravenous fluid administration and a static bladder size. The cat was administered 4 mg/kg of furosemide, and urinated at 6 h following administration and continued to produce over 6 ml/kg/h of urine in the next 24 h. Two days following furosemide administration, the cat's hyperkalemia and azotemia resolved. The cat was discharged after 4 days of hospitalization, and a recheck revealed no persistent azotemia or hyperkalemia.Unique informationAnuric acute kidney injury secondary to lily toxicity is associated with a poor prognosis, and the only treatment modality previously described is hemodialysis. The cat in this report was successfully managed with medical intervention and furosemide administration, with complete resolution of the acute kidney injury.

Acute kidney injury is a frequent complication for critical newborns. Its management is a significant challenge, especially in extremely low-birth-weight (ELBW) infants. Currently, peritoneal dialysis (PD) is the most manageable treatment. However, data are lacking regarding when diuresis can be declared irreversible relative to the start of PD. A female infant born at 28 + 0 weeks with a birth weight of 800 g by monochorionic diamniotic pregnancy, complicated by twin-to-twin transfusion syndrome, developed acute renal failure on the second day of life because of long-term intrauterine hypoperfusion. PD was started on day 7. The patient remained anuric until the 52nd day of dialysis, when she presented adequate urine output of 2.5 mL/kg/h and PD was suspended for 11 days. After an episode of sepsis, PD was re-started, and after 50 days of treatment, given a urine output of 1.5 mL/kg/h, it was discontinued. The patient died on day 132 after a disseminate infection, which led to multiorgan failure. In ELBW infants, PD is a valid therapeutic instrument to treat patients with renal failure. Despite the evidence of low renal functional reserve in these patients, the duration of recovery from diuresis after a period of anuria can be very long. [ABSTRACT FROM AUTHOR]

Background: Hemolytic uremic syndrome secondary to Shiga-toxin-producing Escherichia coli infection (STEC-HUS) generally shows a favorable outcome. Few cases develop extra-renal complications, since neurological involvement is an important cause of morbidity and mortality. The role of complement in STEC-HUS has been recently highlighted, and the use of eculizumab in severe cases has been communicated. HUS results from environmental and genetic factors, but the simultaneous occurrence of STEC and complement mutations remains undetermined. Methods: A pediatric case with severe STEC-HUS carrying CFH mutations, with favorable response to eculizumab is analyzed. Results: STEC-HUS was diagnosed in a 4-year-old girl with classic HUS, including low C3. Peritoneal dialysis was started due to hypertension, oligoanuria, and pleural effusion. She evolved with generalized tonic–clonic seizures and required mechanical ventilation. MRI reported multiple supra- and infratentorial ischemic lesions with laminar/striatal cortical necrosis and leukoencephalopathy. After two eculizumab doses, a significative stabilization in diuresis, blood pressure, creatinine, and C3 was achieved. At the third week, episodes of massive digestive bleeding and a life-threatening condition required a colectomy thus preserving the ileocecal valve. Due to atypical evolution, a genetic study was considered, identifying two heterozygous variants (CFH S1191L/V1197A). Conclusion: STEC-HUS in patients with a genetic predisposition has been previously reported, but the low frequency of occurrence makes it a rare disease. As in the present case, patients with atypical course might benefit from genetic analysis to evaluate early eculizumab initiation and to better understand its phenotype. A higher resolution version of the Graphical abstract is available as Supplementary information [ABSTRACT FROM AUTHOR]

Copyright of Summa, Animali da Compagnia is the property of Point Veterinaire Italie s.r.l. 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.)

Most newborns begin urinating within 24hours of life, and almost always by 48hours. Rarely, some of them are anuric beyond 24hours, thereby causing concern to parents and treating doctors. We report the case of a newborn who presented with anuria till 48hours after birth. High-resolution ultrasound examination, focusing on the renal medulla, demonstrated increased echogenicity at the tip of the pyramids. This was attributed to slow clearance of urinary sediment deposited there, which was causing obstruction to the urinary outflow. On monitoring serially over the next few days, the echogenic sludge was observed being slowly eliminated leading thereby to improvement in the urinary output. High-resolution ultrasound focusing on the renal pyramids played an important role in the observation and management of this transient event unfolding, in the urinary tract.

Abstract Background Acute kidney injury (AKI) in dogs has a high case fatality rate. Diltiazem might improve renal function, but effect of intravenous infusion has not been adequately studied in dogs. Hypothesis/Objectives To determine if an intravenous infusion of diltiazem improves renal function through changes in glomerular filtration rate (GFR), fractional excretion of sodium (FENa), and urine output (UOP) in healthy dogs. Animals Ten healthy adult dogs. Methods Prospective, unmasked, crossover study. Dogs were randomized to receive diltiazem (loading dose of 240 μg/kg followed by 6 μg/kg/min for 300 min) or the same volume of 5% dextrose in water (D5W). The opposite treatment was given after a 7‐day washout period. GFR and FENa were obtained at baseline and after infusion. UOP was measured starting 1 hour before diltiazem administration. Results GFR did not significantly increase from baseline with diltiazem (before diltiazem median = 2.371 mL/min/kg, range = 1.605‐4.359; after diltiazem median = 2.305 mL/min/kg, range = 1.629‐4.387; median difference = 0.080 mL/min/kg, 95% confidence interval [CI] = −0.417 to 0.757; P = .85), and there was no difference in D5W GFR before and after diltiazem (median = 2.389 mL/min/kg, range = 1.600‐3.557; median difference = 0.036 mL/min/kg, 95% CI = −0.241 to 1.112; P = .69). FENa did not increase from baseline after administration of diltiazem (median difference = 0%, 95% CI = −0.1 to 0.1; P = .81), and there was no difference in D5W FENa (median difference = 0.1%, 95% CI = −0.1 to 0.2; P = .26). UOP did not increase with diltiazem (P = .06). Conclusion and Clinical Importance Intravenous administration of diltiazem does not improve markers of renal function in healthy dogs. Further studies are needed in dogs with AKI.

To compare the role of primary and deferred ureteroscopy (URS) in the management of obstructive anuria secondary to ureteric urolithiasis in pediatric patients. This prospective randomized study included 120 children aged ≤ 12 years who presented with obstructive anuria secondary to ureteric urolithiasis between March 2019 and January 2021. The children were subdivided into group A, which included children who had undergone primary URS without pre-stenting, and group B, which included children who had undergone URS after ureteric stenting. All children were clinically compensated and sepsis-free. Patients with underlying urological structural abnormalities were excluded. The operative time, improvement of renal functions, stone-free rate, and complications were compared between the two groups. At the 1-month follow-up, urine analysis; kidney, ureter, and bladder radiography; and ultrasonography were performed. The patient characteristics of both groups did not show any significant difference. Primary URS had failed in ten children (16.6%) in group A. Moreover, failure of stenting was noted in six patients (11%) in group B. The mean operative time for group B was significantly lower than that for group A (p ≤ 0.001). The stone-free rate was significantly higher in group B (p ≤ 0.001). The rate of overall complications was higher in group A. Deferred URS is preferable over primary URS in the management of obstructive anuria secondary to ureteric urolithiasis". In children because of the lower need for ureteric dilatation, higher stone- free rate, shorter procedure time, and lower complication rate. [ABSTRACT FROM AUTHOR]

With babesiosis in dogs, the capillary network is especially strongly affected due to the stimulation of the hemostasis system and the development of thrombus formation in the microvasculature. Acute renal failure and even death of animals are caused by shock phenomena and the syndrome of disseminated intravascular coagulation. Clinical, laboratory (hematological, biochemical, coagulometric, hemodynamic, enzyme immunoassay) methods of research were conducted. Dogs with babesiosis have fever, anemia, and hemoglobinuria, hematologically established anemia, systemic inflammation, thrombotic condition. Hemodynamic parameters determine the state of shock, which in dynamics becomes decompensated and irreversible. The appearance of poikilocytes in the blood of sick dogs indicates significant metabolic disorders in their body. The coagulogram reveals the syndrome of disseminated intravascular coagulation. Syndrome markers significantly changed with a trend to increase during nephropathy. In addition, uremia, hyperuricemia, hyperkalemia, hyponatremia, hyperphosphatemia, creatininemia were found in the sick dogs, which are reliable indicators and determine the development of an acute form of glomerulonephritis and progressive acute renal failure. According to the study of the general biochemical status in animals, hepatopathy in the form of acute hepatitis and pancreatitis, and general intoxication syndrome were established. In our findings: during acute spontaneous babesiosis, dogs developed nephropathy, which has two clinical stages: hemoglobinuria and oliguria/anuria. The pathogenetic basis for the development of glomerulonephritis and acute renal failure is the syndrome of disseminated intravascular coagulation in response to the influence of a pathogen, which causes shock, forming a vicious circle of shock. Under such conditions, renal failure increases and eventually leads to the death of the animal. The studied data will contribute to the expansion of the conceptual understanding of the pathogenesis of canine babesiosis and determine the leading role of complications in the development of kidney failure. [ABSTRACT FROM AUTHOR]

The current report presents a clinical case of a true vaginal prolapse complicated with unicornual uterine intussusception and anuria caused by urethral obstruction due to compression in a postpartum bitch. Transabdominal ultrasonographic examination showed no presence of retained fetuses into the birth canal, but an extremely enlarged urinary bladder. After repositioning of the protruded vaginal wall, laparotomy was performed, invagination of the right uterine horn into the uterus was observed, placed back to normal position, and spontaneous urination occurred. Ovariohysterectomy and cervicopexy to the abdominal wall for prevention of recurrence were done. The bitch had full recovery at one month follow-up. True vaginal prolapse in a bitch could be complicated with urethral obstruction due to compression, which may secondarily cause life-threatening azotemia. Reposition of the prolapsed vaginal tissue in the bitch is recommended to be followed by laparotomy in order to correct intussusception of the uterine horns and the body if presented. [ABSTRACT FROM AUTHOR]

Introduction: Renal colic is a colicky-type of flank pain that can commonly be presented in patients undergoing dialysis especially if they are anuric considering the fact that there are multiple controversies and little published experience on this topic, we found it very important to report this case. We also aimed to increase awareness and emphasize the importance of renal colic in anuric patients on dialysis. Case description: We herein report a case of a 42-year old man with a chief complaint of bilateral colic flank pain, He had developed end stage renal disease due to ADPKD and was on hemodialysis since the past 5 years. Previously, he went through a series of workup but was left undiagnosed. Abdomen-pelvic and chest CT scan without contrast was performed showing bilateral renal pelvic stones and some nephrocalcinosis in both kidneys. bilateral ureteroscopy was performed and bilateral DJ was installed for a total of 6 weeks and extracorporeal shock wave lithotripsy was done. With prompt diagnosis, the patient was pain free and stone free before discharge. The patient is also reported to be stone free 6 months after the procedure. Conclusion: Patients on dialysis are still capable of forming symptomatic renal tract stones even if they are anuric. [ABSTRACT FROM AUTHOR]

Most newborns begin urinating within 24hours of life, and almost always by 48hours. Rarely, some of them are anuric beyond 24hours, thereby causing concern to parents and treating doctors. We report the case of a newborn who presented with anuria till 48hours after birth. High-resolution ultrasound examination, focusing on the renal medulla, demonstrated increased echogenicity at the tip of the pyramids. This was attributed to slow clearance of urinary sediment deposited there, which was causing obstruction to the urinary outflow. On monitoring serially over the next few days, the echogenic sludge was observed being slowly eliminated leading thereby to improvement in the urinary output. High-resolution ultrasound focusing on the renal pyramids played an important role in the observation and management of this transient event unfolding, in the urinary tract. [ABSTRACT FROM AUTHOR]

Background: Acute kidney injury (AKI) in dogs has a high case fatality rate. Diltiazem might improve renal function, but effect of intravenous infusion has not been adequately studied in dogs. Hypothesis/Objectives: To determine if an intravenous infusion of diltiazem improves renal function through changes in glomerular filtration rate (GFR), fractional excretion of sodium (FENa), and urine output (UOP) in healthy dogs. Animals: Ten healthy adult dogs. Methods: Prospective, unmasked, crossover study. Dogs were randomized to receive diltiazem (loading dose of 240 μg/kg followed by 6 μg/kg/min for 300 min) or the same volume of 5% dextrose in water (D5W). The opposite treatment was given after a 7‐day washout period. GFR and FENa were obtained at baseline and after infusion. UOP was measured starting 1 hour before diltiazem administration. Results: GFR did not significantly increase from baseline with diltiazem (before diltiazem median = 2.371 mL/min/kg, range = 1.605‐4.359; after diltiazem median = 2.305 mL/min/kg, range = 1.629‐4.387; median difference = 0.080 mL/min/kg, 95% confidence interval [CI] = −0.417 to 0.757; P =.85), and there was no difference in D5W GFR before and after diltiazem (median = 2.389 mL/min/kg, range = 1.600‐3.557; median difference = 0.036 mL/min/kg, 95% CI = −0.241 to 1.112; P =.69). FENa did not increase from baseline after administration of diltiazem (median difference = 0%, 95% CI = −0.1 to 0.1; P =.81), and there was no difference in D5W FENa (median difference = 0.1%, 95% CI = −0.1 to 0.2; P =.26). UOP did not increase with diltiazem (P =.06). Conclusion and Clinical Importance: Intravenous administration of diltiazem does not improve markers of renal function in healthy dogs. Further studies are needed in dogs with AKI. [ABSTRACT FROM AUTHOR]

Nephrotic syndrome (NS) may have complications like infection, thromboembolism, acute kidney injury (AKI) and hypovolemia in children. However, severe AKI with anuria is unusual and rarely reported. In this study, 9 year-old girl hospitalized with first episode of NS after recent antibiotic and ibuprofen use was presented. Despite albumin and furosemide, as she became anuric on the third day of hospitalization, hemodialysis was started and pulse methylprednizolone was given. Renal biopsy revealed minimal mesangial proliferation with widespread acute tubular injury findings. She was discharged at the 15th day with normal urine volume after 11 hemodialysis sessions. After six weeks of oral prednisolone, complete remission in NS was achieved. Acute tubular necrosis was the underlying diagnosis for anuric AKI in the setting of NS. Heavy proteinuria leading to tubular obstruction, presence of decreased effective intravascular volume due to severe hypoalbuminemia, and ibuprofen use may have caused acute tubular necrosis. [ABSTRACT FROM AUTHOR]

The key factors in the diagnosis of nephrotic syndrome (NS) in children are as follows: proteinuria > 50 mg/kg/day and serum albumin level = 30 g/l (prevalence: 16/100,000; incidence: 2-7/100,000 cases per year). Glucocorticoids are preferred to obtain remission. Diuretics and albumin infusions are used in oedema reduction. In cases of extreme overhydration, renal replacement therapy (RRT) is advised. A 16-year-old boy with no past medical history was admitted in critical condition due to massive oedema and anuria. Standard NS treatment was introduced on admission. The patient underwent continuous RRT combined with loop diuretics and albumin administration. Thirty-six litres of ultrafiltrate was achieved. No relapse was observed within 6 months of discharge. The presented case is unusual due to the enormous oedema, reaching approximately 30% of the initial body weight, which led to a vital clinical problem. The use of continuous RRT combined with steroid therapy allowed for a safe evacuation of the oedema and remission. [ABSTRACT FROM AUTHOR]

Euphorbia lathyris L. (EL) is a traditional poisonous herbal medicine used to treat dropsy, ascites, amenorrhea, anuria and constipation. Processing to reduce toxicity of EL is essential for its safe and effective application. However, there is little known regarding the molecular mechanism of reducing toxicity after EL processing. This research aimed to screen the differential markers for EL and PEL, explore the differential mechanisms of inflammatory injury induced by EL and processed EL (PEL) to expound the mechanism of alleviating toxicity after EL processing. The results showed that 15 potential biomarkers, mainly belonging to diterpenoids, were screened to distinguish EL from PEL. EL promoted the expressions of TLR4, NLRP3, NF-κB p65, IL-1β and TNF-α, increased lipid rafts abundance and promoted TLR4 positioning to lipid rafts. Meanwhile, EL decreased LXRα and ABCA1 expression, and reduced cholesterol efflux. In contrast to EL, the effects of PEL on these indicators were markedly weakened. In addition, Euphorbia factors L 1 , L 2 , and L 3 affected LXRα, ABCA1, TLR4, NLRP3, NF-κB p65, TNF-α and IL-1β expression, influenced cholesterol efflux and lipid rafts abundance, and interfered with the colocalization of TLR4 and lipid rafts. The inflammatory injury caused by processed EL was significantly weaker than that caused by crude EL, and reduction of Euphorbia factors L 1 , L 2 , and L 3 as well as attenuation of inflammatory injury participated in processing-based detoxification of EL. Our results provide valuable insights into the attenuated mechanism of EL processing and will guide future research on the processing mechanism of toxic traditional Chinese medicine. [Display omitted] • Euphorbia lathyris L. (EL) is a classic traditional herbal medicine with toxicity. • Processing to attenuate the toxicity of EL is important for its clinical use. • The detoxification of EL processing is related to Euphorbia factors L 1 , L 2 and L 3. • Attenuation of inflammatory injury participates in detoxification of EL processing. • Processed EL reduces inflammation via LXRα/ABCA1 and TLR4 recruitment to lipid raft. [ABSTRACT FROM AUTHOR]

Introduction: Injury to ureter is a risk to any pelvic or lower abdominal surgery. Gynecologic surgery remains the most common cause of ureteric injury. Most cases of ureteric injury present as uretero-vaginal fistula with continuous incontinence with normal voiding after several days of primary surgery. Aims And Objectives: The objective of the study was to evaluate management of iatrogenic ureteral injuries including those Uretero-vaginal Fistulas after elective or emergency gynecologic surgeries. Methods: 22 patients of iatrogenic ureteral injuries after operative procedures were evaluated from May, 2015 to January 2021 by retrospective data collection and prospective observation. The diagnosis of Uretero-vaginal Fistula was based on clinical features, CECT scan with urography, cystoscopy, Retro Grade Pyelogram depending on clinical situation. Results: Among 22 cases, 20 cases were from gynecologic operations in which 14 cases were Elective Hysterectomy, 4cases were Emergency Hysterectomy due to intractable PPH, and 2 cases were ovarian cystectomy. In 14 cases of Hysterectomy 12 cases were Abdominal Hysterectomy (4 were laparoscopic and 8 open) and 2 cases were Vaginal Hysterectomy. In remaining 2 non gynecologic surgeries were due to ureteric injury during URSL. 3 cases presented with B/L ureteric injury, one from elective and two from emergency hysterectomy with anuria and sepsis managed with B/L PCN, later by B/L open ureteric reimplantation. 2 cases of URSL and 5 cases of Hysterectomy were diagnosed as ureteric injury during primary procedure and double J Stent was inserted on table. Another patient underwent RGP f/b stenting on Right side, but on Left, PCN was done, f/b antegrade stenting. 3 patients presented with pyonephrosis after 2 weeks of primary surgery, managed with PCN, f/b ureteric reimplantation. In remaining 8 cases RGP was done f/b double J Stenting in 3 cases (presented within 10 days of injury) and in 5 cases (which shows complete cut off in RGP) open ureteric reimplantation was done. All reimplantation was extravesical, refiuxing (Leich-Gregor technique) and stented; among them 8 in open method and 3 laparoscopically. Follow up were done on post op 6 weeks, 2 month, 6 month and after yearly up to 2 year. In total 11 reimplantation there was reflux and hydronephrosis in 2 cases in imaging studies and all patients were asymptomatic. Only 1 patient managed by antegrade stenting showed lower ureteric stricture in 1 year follow up - later managed successfully with laparoscopic extravesical ureteric reimplantation. Conclusion: Earliest intervention within 10 days of injury gives best result even with endoscopic intervention of least morbidity. The cases which present as uretero-vaginal fistula after 2 weeks of injury are best managed by open or laparoscopic extravesical non refluxing ureteric reimplantation. [ABSTRACT FROM AUTHOR]

For better management of acute kidney injury (AKI) and prevention of progressive renal injury, it is extremely important to manage infections such as gastroenteritis. In addition, anuria is considered a risk factor for AKI and even causes death in patients. An 18-month-old boy with vomiting and diarrhea for three days and anuria for 24 hours was referred to Farsan hospital. The patient had bulky and watery diarrhea about 7-8 times a day and vomited 3-4 times a day which was containing food particles. He had a fever on the first and second days. Ultrasound findings revealed that the right kidney did not exist, and the left kidney was affected by compensatory hypertrophy. Disorders in the patient’s blood biochemical factors were also observed. Acidosis and other biochemical disorders were treated with bicarbonate drip, allopurinol, Lasix drip, and dopamine drip. After about 18 hours, anuria was treated. [ABSTRACT FROM AUTHOR]

BackgroundAlthough angiotensin-converting enzyme inhibitors (ACEI) and angiotensin-II receptor blockers (ARB) have been shown to preserve residual kidney function in a select group of Asian patients undergoing continuous ambulatory peritoneal dialysis (PD) in two small randomized clinical trials, the effectiveness of these drugs has yet to be demonstrated in a more diverse population of patients with multiple comorbid conditions. We investigated the association between ACEI/ARB use and development of recorded anuria in a cohort of patients initiating PD in the U.S.MethodsWe conducted a retrospective observational cohort study using the US Renal Data System and electronic health records data from a large national dialysis provider. We identified adult patients who initiated PD from 2007 to 2011. Only patients who participated in the federal prescription drug benefit program, Medicare Part D, for the first 90 days of dialysis were included. Patients who filled a prescription for an ACEI or ARB during those 90 days were considered users. We applied Cox proportional hazards models to an inverse probability of treatment-weighted (IPTW) cohort to estimate the hazard ratio (HR) for anuria (24-h urine volume

Acute kidney injury (AKI) in deceased organ donors is increasing due to the escalation in anoxic brain‐deaths. The management of an organ donor with oligoanuric AKI is frequently curtailed due to hemodynamic and electrolyte instability. Although continuous renal replacement therapy (CRRT) corrects the effects of AKI, it is rarely started after the diagnosis of brain‐death (BD). Since 2017, we have initiated CRRT in organ donors with oligoanuric AKI to allow more time to stabilize the donor and improve the function of the thoracic organs. We now report our experience with the first 27 donors with oligoanuric AKI that received CRRT after the diagnosis of BD, with organs transplanted as the primary outcome. The average duration of CRRT was 30.1 ± 14.4 h and the mean ultrafiltration volume was 5141 ± 4272 ml. The time from BD declaration to cross clamp was significantly longer in the CRRT group versus a historical cohort with oligoanuric AKI that was not dialyzed (62.8 ± 18.3 vs. 37.1 ± 14.9 h; P <.01). The mean number of total organs transplanted per donor in the CRRT group was greater than the historical cohort, 2.9 ± 1.7 vs. 1.4 ±.6 (P =.< 01), respectively. The mean number of thoracic organs transplanted per donor also increased between the two groups, 1.4 ± 1.2 versus.6 ±.9 (P =.02). Thirty‐seven percent of the kidneys were successfully transplanted with a mean serum creatinine of 1.4 mg/dl at 6 months. We suggest that OPOs consider starting CRRT in organ donors with oligoanuric AKI to possibly increase the number of organs transplanted. [ABSTRACT FROM AUTHOR]

Cardiorenal syndrome is the term that describes the interaction between the heart and kidney that leads to diuretic resistance and worsening renal function. Prolonged anuria generally represents irreversible renal failure, and recovery of renal function after prolonged anuria in patients with heart failure has rarely been reported. Moreover, increased central venous pressure including heart failure is associated with impaired renal function. We herein report a rare case of a 46-year-old man with dilated cardiomyopathy who presented with dyspnea and generalized edema. His body weight increased from 90 kg to 128 kg in one year and he was hospitalized. Central venous pressure (CVP) on admission was 33 mmHg. Intravenous catecholamines were not effective; thus, he was started on continuous hemodiafiltration. Anuria occurred after hemodiafiltration due to heart failure, sepsis, and antibiotics use. However, he experienced weight reduction of over 70 kg, under hemodialysis guided by central venous pressure measurement, and renal function recovery after 87 days of anuria. His CVP had improved to 5 mmHg at discharge. This case showed continuous trial to reduce the CVP and raise cardiac output could result in the recovery of impaired renal function even in the presence of prolonged anuria. < Learning objective: We report a rare case of a patient with dilated cardiomyopathy who experienced weight reduction of over 70 kg under hemodialysis guided by central venous pressure (CVP) measurement and renal function recovery after 87 days of anuria due to chronic heart failure. Even in the presence of prolonged anuria, continuous trial to reduce the CVP and raise cardiac output could result in the recovery of impaired renal function.> [ABSTRACT FROM AUTHOR]

Rationale & Objective: The development of anuria has been linked to worse clinical outcomes in patients undergoing peritoneal dialysis (PD). Our objective was to investigate the incidence, risk factors, and associated clinical outcomes of anuria within the first year after starting PD., Study Design: Retrospective cohort study., Setting & Participants: Patients who started continuous ambulatory peritoneal dialysis at our center between 2006 and 2020 were included and followed up until January 31, 2023., Exposure: Age, sex, diabetes, temporary hemodialysis, angiotensin-converting enzyme inhibitors (ACEis) or angiotensin II receptor blockers (ARBs), diuretics, baseline urine volume, serum albumin, daily glucose exposure, peritonitis, and incremental PD., Outcomes: The primary outcome was early anuria, defined as 24-hour urine volume ≤100 mL within the first year of PD initiation. Secondary outcomes included all-cause mortality, cardiovascular disease mortality, technique failure, and peritonitis., Analytical Approach: Cox proportional hazards model., Results: A total of 2,592 patients undergoing continuous ambulatory peritoneal dialysis aged 46.7 ± 14.9 years were recruited. Among them, 58.9% were male, and 24.0% had diabetes. Within the first year of PD therapy, 159 (6.13%) patients developed anuria, with a median duration of 7.53 (interquartile range, 3.93-10.0) months. Higher baseline urine volume (hazard ratio [HR], 0.93; 95% confidence interval [CI], 0.90-0.97), higher serum albumin (HR, 0.92; 95% CI, 0.88-0.95), having diabetes before PD (HR, 0.57; 95% CI, 0.35-0.92), and prescribed incremental PD (HR, 0.27; 95% CI, 0.14-0.51) were associated with a reduced risk for early anuria, whereas a higher level of daily glucose exposure (HR, 1.01; 95% CI, 1.00-1.01) was identified as a risk factor for early anuria. Subgroup analyses showed that using ACEis or ARBs was linked to a lower risk of early anuria (HR, 0.25; 95% CI, 0.09-0.69) in diabetic patients. Treating early anuria as a time-dependent covariate, early anuria was associated with a higher risk for all-cause mortality (HR, 1.69; 95% CI, 1.23-2.32) and technique failure (HR, 1.43; 95% CI, 1.00-2.04) after adjusting for confounding factors., Limitations: Single-center and observational study., Conclusions: Among PD patients at a single center in China, early anuria was relatively uncommon but associated with an increased risk of mortality and PD technique failure. Incremental PD, higher baseline urine output and serum albumin, and lower daily glucose exposure were associated with a lower risk of early anuria. Clinical trials are needed to evaluate the optimal PD techniques to preserve residual kidney function and maximaze outcomes., (© 2024 The Authors.)

Systemic lupus erythematosus (SLE) is often seen with antiphospholipid antibody syndrome (APS), and these conditions may occur concurrently with severe immune thrombocytopenia (ITP) and even acute kidney injury (AKI); however, post-renal AKI due to bleeding is uncommon. Here, we describe a case of post-renal AKI and anuria in a patient with SLE and APS, which were attributable to urinary tract obstruction due to massive blood clots caused by secondary ITP. A 50-year-old Japanese woman was admitted to our hospital with anuria, abdominal tenderness, purpura in the trunk and in both legs, and severe thrombocytopenia. She had been receiving medical treatment for APS and SLE till the age of 45 years. Computed tomography revealed a blood clot without extravasation in both urinary tracts, and she was diagnosed with post-renal AKI due to complete obstruction of the urinary system. Additionally, based on her medical history, elevated platelet-associated Immunoglobulin G (IgG) levels, and increased megakaryocyte count, she was diagnosed with secondary ITP complicated by SLE and APS. She also had elevated APS-related autoantibodies, including antiphosphatidylserine/prothrombin Immunoglobulin M (IgM), and IgG. However, concomitant serositis such as lupus enteritis or cystitis was not seen. She was treated with a combination of glucocorticoids, intravenous immunoglobulin, and continuous haemodialysis/haemofiltration, which resulted in rapid improvement of her symptoms and renal dysfunction. Secondary ITP-induced massive bleeding of urinary tract can cause post-renal AKI. Appropriate diagnosis and aggressive treatment are necessary to improve prognosis in such patients., (© Japan College of Rheumatology 2024. Published by Oxford University Press. All rights reserved. For commercial re-use, please contact reprints@oup.com for reprints and translation rights for reprints. All other permissions can be obtained through our RightsLink service via the Permissions link on the article page on our site–for further information please contact journals.permissions@oup.com.)

Introduction: Sacubitril/valsartan is increasingly used in hemodialysis patients due to its cardioprotective benefits. However, its impact on serum potassium levels in anuric patients undergoing hemodialysis remains controversial., Methods: We conducted a retrospective data from patients undergoing hemodialysis at two dialysis centers. A total of 71 out of 332 patients receiving hemodialysis treatment were enrolled. Mean serum potassium (mean value of 6-8 determinations), peak serum potassium (maximum K value observed during follow-up observations), and other biochemical parameters were recorded at baseline and during the follow-up period., Findings: After 6 months of follow-up, mean serum potassium increased from 4.84 ± 0.45 mmol/L at baseline to 5.07 ± 0.46 mmol/L at 3 months and 5.04 ± 0.46 mmol/L at 6 months (p < 0.001). Notably, no significant group differences were found in peak serum potassium concentrations between baseline and 6 months after sacubitril/valsartan therapy (5.69 ± 0.56 vs. 5.75 ± 0.41, p = 0.419). Prior to starting sacubitril/valsartan treatment, none of the patients had severe hyperkalemia; however, after 3 and 6 months of sacubitril/valsartan therapy, two (2.80%) and three (4.20%) patients experienced severe hyperkalemia, respectively; however, this difference was not statistically significant. Additionally, there was a significant reduction in blood pressure; however, serum sodium, bicarbonate, and Kt/V values did not change significantly during either period., Discussion: Sacubitril/valsartan therapy is associated with an increase in serum potassium levels in anuric hemodialysis patients. Nevertheless, the proportion of patients with severe hyperkalemia did not increase significantly. This suggests that the use of sacubitril/valsartan in anuric patients on hemodialysis is relatively safe., (© 2024 International Society for Hemodialysis.)

Leptospirosis, an underreported disease, is a highly prevalent spirochaetal zoonotic disease in both tropical and temperate climates. Symptoms can range from mild illness to potentially life-threatening infection. Laboratory tests are nonspecific. Microbiological confirmation is not widely available in endemic developing countries like Nepal. We need to rely on the serologic test, which has its own pitfalls in the initial days of illness. Here, we report a case of 56 years old female from the western region of Nepal who presented with fever, jaundice and anuria. She initially tested negative for leptospirosis but was later found to be positive in the second week of illness. Unlike the usual non-oliguric renal failure in leptospirosis, she presented with anuria requiring haemodialysis and subsequently had a good recovery with treatment. We highlight the importance of clinical suspicion and logical interpretation of serologic tests based on its timing from the onset of illness.

An unusual case of kidney allograft dysfunction following mechanical obstruction of the allograft at distal ureter, secondary to scarred vas deferens, testicular vessels, and lower abdominal muscles due to the previous right inguinal hernia mesh repair. This led to anuric renal allograft failure on the 2nd postoperative day, which was successfully managed with a multidisciplinary team. [ABSTRACT FROM AUTHOR]

In this case report, we report a pediatric patient with COVID-19 and atypical hemolytic uremic syndrome (aHUS). A 3-year-old girl with fever and respiratory distress was admitted to the hospital. The patient tested positive for COVID-19 by a PCR test. As her respiratory distress increased and blood gas indicated deep respiratory acidosis on the third day of the pediatric intensive care unit follow-up, the patient was intubated and ventilated. Thorax computerized tomography (CT) showed bilateral effusion and atelectasis. During her follow-up, the pleural effusion resolved but there were marked consolidation areas and ground glass opacities compatible with COVID-19 on the follow-up CT. On the 10th day, she became anuric and developed progressive thrombocytopenia and persistent microangiopathic hemolytic anemia, which were suggestive of HUS given a high creatinine level (1.9 mg/dl), an undetectable haptoglobin level, reticulocytosis (8%), and an LDH level of 2540 U/l. Direct Coombs test returned negative. Examination of a peripheral blood smear revealed schistocytes. Disseminated intravascular coagulation was ruled out by normal INR and PTT. In the light of the available findings, we considered the patient to have thrombotic microangiopathy (TMA) triggered by COVID-19. It was not a TTP-form of TMA but rather an aHUS type, based on an ADAMTS13 activity level >5%. Hence, plasmapheresis was performed with fresh frozen plasma (FFP). After 4 weeks, she became completely asymptomatic, and her hemodynamic parameters normalized. COVID-19 induced uncontrolled complement activation leading to the development of aHUS. Early diagnosis and treatment may reduce morbidity and mortality since its treatment options. [ABSTRACT FROM AUTHOR]