Renal failure
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The natural course of as-yet-untreated ANCA-associated vasculitis (AAV) or complications of immunosuppressive treatment may result in rapid clinical deterioration with the need of admission to an intensive care unit (ICU). The aim of this retrospective study was to assess the outcome of patients with renal AAV admitted to the ICU in a single center. We reviewed the medical records of all 218 patients with AAV followed in our department between January 2001 and December 2006 and selected those admitted to the ICU. ⋯ The APACHE II (33.5 vs. 23.8) and SOFA scores (11.9 vs. 6.6), but not BVAS (11.5 vs. 16.1), were statistically significantly higher in non-survivors than in survivors (p < 0.01). In conclusion, the in-ICU mortality in AAV patients may be predicted by APACHE II and SOFA scores. While active vasculitis is the most frequent reason for ICU admission, the mortality rate is highest in patients with infectious complications.
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Controlled Clinical Trial
Urine neutrophil gelatinase-associated lipocalin and interleukin-18 predict acute kidney injury after cardiac surgery.
About 30-50% patients develop acute kidney injury (AKI) after cardiac surgery, which is still diagnosed by serum creatinine on clinic. However, the increase of serum creatinine is insensitive and delayed. The aim of this study is to test the hypothesis that neutrophil gelatinase-associated lipocalin (NGAL) and interleukin-18 (IL-18) are early biomarkers for AKI in patients after cardiac surgery. ⋯ The concentrations of urine NGAL and IL-18 could be useful biomarkers for AKI in patients after cardiac surgery, especially after correction for urine creatinine.
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Comparative Study
Cardiac findings in asymptomatic chronic hemodialysis patients with persistently elevated cardiac troponin I levels.
The prevalence and significance of higher than normal cardiac troponin I (cTnI) levels in asymptomatic chronic hemodialysis (HD) patients remains a source of discussion. The aim of the present study was to evaluate the prevalence of higher than normal cTnI levels in asymptomatic HD patients, as determined by the last generation of immunoassay, and to perform further cardiological investigations in those patients with persistently elevated cTnI levels. ⋯ Among the asymptomatic HD patients in our center, we identified four (8%) with persistently elevated cTnI levels, as determined using the last generation AccuTnI assay. All of them had a history of severe CAD with heart failure and exhibited reversible myocardial ischemia upon D-E thallium imaging; coronary angiography revealed coronary lesions of variable severity. Overall, our data indicate that persistent low-grade cTnI elevation occurs in HD patients having longstanding severe cardiac disease, but, from our data, it is difficult to reach a conclusion as to the best clinical approach for this group of patients.
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Review of literature revealed no studies about the predominant causes and risk factors of acute renal failure in Jordan. This study identifies the most common causes of acute renal failure and the possible risk factors among hospitalized Jordanian population. A total of 111 patients were admitted to both King Abdullah University Hospital and Princess Basmah Teaching Hospital from December 2005 to April 2006 with a diagnosis of acute renal failure or developed acute renal failure in hospital during their stay. ⋯ Causes of acute renal failure included dehydration, diuretics, sepsis, contrast media, nonsteroidal anti-inflammatory drugs, glomerulonephritis, systemic lupus erythematosus, stones, and others. In conclusion, one-third of the causes of acute renal failure in this sample of hospitalized Jordanian patients were due to drugs, which makes this problem preventable. Mortality was affected by the age of patients and the duration of hospitalization.
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One hundred and four patients receiving hemodialysis and undergoing anaemia treatment with darbepoetin alfa intravenously once weekly were switched to a biweekly dosing schedule and followed for 24 weeks. The darbepoetin alfa dose was adjusted to maintain the target Hb concentration of 11-14 g/dL. A significant decline in the erythropoiesis-stimulating agent resistance index was observed over the 24-week follow-up, beginning with week 16, whereas the mean dose of darbepoetin alfa did not change significantly after switching to the biweekly dosing schedule. Other factors that might affect resistance to erythropoiesis remained unchanged.