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A case of anuric acute renal failure due to bilateral renal artery obstruction in a 42 year-old man is presented. The obstruction was caused by bilateral thrombosis secondary to arteritis. Autopsy showed granulomatous and necrotizing vasculitis in both main renal arteries. Scarring and also necrotizing vasculitis were found from interlobular to arcuate renal arteries. The present case indicates that vasculitis should be considered when there is renal artery obstruction in young patients.

Bruno C Silva, Camila E Rodrigues, Regina CRM Abdulkader, Rosilene M Elias Nephrology Division, Hospital das Clínicas, University of São Paulo, São Paulo, Brazil Background: Nephrologists have increasingly participated in the conversion from temporary catheters (TC) to tunneled-cuffed catheters (TCCs) for hemodialysis. Objective: To prospectively analyze the outcomes associated with TCC placement by nephrologists with expertise in such procedure, in different time periods at the same center. The impact of vancomycin or cefazolin as prophylactic antibiotics on the infection outcomes was also tested. Patients and methods: Hemodialysis patients who presented to such procedure were divided into two cohorts: A (from 2004 to 2008) and B (from 2013 to 2015). Time from TC to TCC conversion, prophylactic antibiotics, and reasons for TCC removal were evaluated. Results: One hundred and thirty patients were included in cohort A and 228 in cohort B. Sex, age, and follow-up time were similar between cohorts. Median time from TC to TCC conversion was longer in cohort A than in cohort B (14 [3; 30] vs 4 [1; 8] days, respectively; P

Recently, mild AKI has been considered as a risk factor for mortality in different scenarios. We conducted a retrospective analysis of the risk factors for two distinct definitions of AKI after elective repair of aortic aneurysms. Logistic regression was carried out to identify independent risk factors for AKI (defined as $25% or $50% increase in baseline SCr within 48 h after surgery, AKI 25% and AKI 50%, respectively) and for mortality. Of 77 patients studied (mean age 68 +/- 10, 83% male), 57% developed AKI 25% and 33.7% AKI 50%. There were no differences between AKI and control groups regarding comorbidities and diameter of aneurysms. However, AKI patients needed a supra-renal aortic cross-clamping more frequently and were more severely ill. Overall in-hospital mortality was 27.3%, which was markedly higher in those requiring a supra-renal aortic cross-clamping. The risk factors for AKI 25% were supra-renal aortic cross-clamping (odds ratio 5.51, 95% CI 1.05-36.12, p = 0.04) and duration of operation for AKI 25% (OR 6.67, 95% CI 2.23-19.9, p0.001). For AKI 50%, in addition to those factors, post-operative use of vasoactive drugs remained as an independent factor (OR 6.13, 95% CI 1.64-22.8, p = 0.005). The risk factors associated with mortality were need of supra-renal aortic cross-clamping (OR 9.6, 95% CI 1.37-67.88, p = 0.02), development of AKI 50% (OR 8.84, 95% CI 1.31-59.39, p = 0.02), baseline GFR lower than 49 mL/min (OR 17.07, 95% CI 2.00-145.23, p = 0.009), and serum glucose118 mg/dL in the post-operative period (OR 19.99, 95% CI 2.32-172.28, p = 0.006). An increase of at least 50% in baseline SCr is a common event after surgical repair of aortic aneurysms, particularly when a supra-renal aortic cross-clamping is needed. Along with baseline moderate chronic renal failure, AKI is an independent factor contributing to the high mortality found in this scenario.

A case of a patient developing anuric acute renal failure and a hemorrhagic syndrome resembling disseminated intravascular coagulation after contact with Lonomia caterpillars is reported. Renal histology showed only mild changes consistent with renal ischemia, although the patient never was hypotensive. The mechanisms of renal injury were obscure and might be related to transient glomerular ischemia due to microcirculation fibrin deposition or to direct venom nephrotoxicity.

Acute renal failure (ARF) determines a worse prognosis in various medical scenarios. Since the syndrome of ARF can potentially interfere with the weaning from mechanical ventilation (MV), we sought to investigate whether the presence of ARF has any impact on weaning from MV. We studied 140 patients who received invasive MV for at least 48 hours in an oncologic ICU. Exclusion criteria: neurosurgical patients, pulmonary resections or strict end-of-life care. ARF definition: at least one value of serum creatinine (SCr) ≥ 1.5 mg/dl during the ICU stay. Patients were divided into ARF (n = 93) and non-ARF groups (NRF, n = 47). Criteria for weaning: PEEP ≤ 8 cmH2O, pressure support ≤ 10 cmH2O, FiO2 ≤ 0.4 and spontaneous respiration. Primary endpoint: length of weaning. Secondary endpoints: length of MV, length of stay in ICU, and mortality. Groups were similar regarding age and gender. A higher number of ARF patients had hematological tumors (19.3 vs 6.4%, P = 0.04). The diagnosis of acute respiratory insufficiency (45 vs 44%) during the ICU stay and the diagnosis of ALI/ARDS as a cause for MV (18.2 vs 10.6%) did not differ between groups. SAPS at entry was not different (48.1 ± 1.4 vs 43.5 ± 15.1) but ARF patients had markers of more severe disease in the long term: severe sepsis or septic shock (P < 0.0001); higher number of antibiotics (P = 0.0018); longer time of vasoactive drug (VAD) usage (P = 0.0005). Oliguria (urine output

1. A lipophilic competitive angiotensin II antagonist (octanoyl-[8-leucine]-angiotensin II, OCTLEU A-II) was used to partially block the renin-angiotensin system in rats with glycerol-induced acute renal failure. The rats, which were maintained either on a normal or on a low-sodium diet, were dehydrated for 24 h before injection of glycerol. Daily intramuscular injections of OCTLEU A-II in peanut oil were started 48 h before glycerol administration to assure an angiotensin II blockade up to 48 h after glycerol administration. 2. In the low-sodium group (N = 23), acute renal failure was significantly attenuated in OCTLEU A-II-treated rats (N = 9) when compared with the controls (N = 14). The following values (means +/- 1 SD) for renal function parameters were obtained for the treated and control groups: urine volume, 15.2 +/- 11.7 vs 1.4 +/- 2.0 ml/24 h (P less than 0.01); plasma creatinine 5.5 +/- 1.3 vs 8.6 +/- 1.3 mg/dl (P less than 0.01); creatinine clearance 0.23 +/- 0.16 vs 0.03 +/- 0.03 ml min-1 kg-1 (P less than 0.01); plasma potassium 6.6 +/- 1.5 vs 10.1 +/- 1.9 mEq/1 (P less than 0.01); and sodium excretion fraction 3.0 +/- 4.0 vs 21.6 +/- 17.4% (P less than 0.02). Mean arterial blood pressure was 107 +/- 23 mmHg for the OCTLEU A-II-treated animals and 102 +/- 18 mmHg for the controls. 3. The rats on a normal sodium diet (N = 16) developed moderate non-oliguric renal insufficiency. The OCTLEU A-II-treated (N = 8) and control (N = 8) groups did not differ in any of the parameters measured. 4. The present results show that sodium restriction aggravates glycerol-induced acute renal failure and that the renin-angiotensin system participates, since its inhibition at the level of the angiotensin II receptor attenuates the extreme loss of renal function and prevents anuria.