Obstructive uropathy is known to be associated with acute kidney injury (AKI). This study aimed to investigate the etiologies, clinical characteristics, consequences and also assess the impact of AKI on long-term outcomes. This multicenter, retrospective study of 1683 patients with obstructive uropathy who underwent percutaneous nephrostomy (PCN) analyzed clinical characteristics, outcomes including progression to end-stage kidney disease (ESKD), overall mortality, and the impact of AKI on long-term outcomes. Obstructive uropathy in adults was most commonly caused by malignancy, urolithiasis, and other causes. AKI was present in 78% of the patients and was independently associated with preexisting chronic kidney disease (CKD). Short-term recovery was achieved in 56.78% after the relief of obstruction. ESKD progression rate was 4.4% in urolithiasis and 6.8% in other causes and older age, preexisting CKD, and stage 3 AKI were independent factors of progression. The mortality rate (34%) was highly attributed to malignant obstruction (52%) stage 3 AKI was also an independent predictor of mortality in non-malignant obstruction. AKI is a frequent complication of adult obstructive uropathy. AKI negatively affects long-term kidney outcomes and survival in non-malignant obstructions. A better understanding of the epidemiology and prognostic factors is needed for adult obstructive uropathy.
Background: Recent several reports have demonstrated that periodontitis is prevalent and adversely affects the survival in patients with chronic kidney disease (CKD) or end-stage kidney disease. However, its impact on transplant outcomes remains uncertain.Methods: This retrospective cohort study included 136 and 167 patients, respectively, who underwent living donor kidney transplantation (KT) at Seoul National University Hospital from July 2012 to August 2016 and Korea University Hospital from April 2008 to October 2018. We divided patients into three groups according to stages of periodontitis based on a new classification system. Results: Patients with severe periodontitis were older, had a higher prevalence of diabetes, a higher body mass index and C-reactive protein level, a lower cardiac output, and were more likely to be smokers, indicating its association with chronic systemic inflammation. After KT, stage IV periodontitis was independently associated with a lower incidence of acute T cell-mediated rejection, suggesting the possible effect of periodontitis on immune function. However, 1-year and 3-year estimated glomerular filtration rates were not different. Among the KT recipients followed up more than 3 years, new-onset cardiovascular disease occurred in nine patients, and coronary artery disease occurred more frequently in patients with stage IV periodontitis. However, diabetes was the independent predictor of new-onset coronary artery disease in multivariate logistic regression analysis.Conclusion: Our findings showed that periodontitis might be an important player in determining posttransplant outcomes in recipients. Further interventional trials to test whether treating periodontitis could modify transplant outcome are needed.
Vaccine-induced immune thrombotic thrombocytopenia (VITT) is a rare but life-threatening complication. VITT strongly mimics heparin-induced thrombocytopenia (HIT) and shares clinical features. Heparin is commonly used to prevent coagulation during hemodialysis. Therefore, nephrologists might encounter patients needing dialysis with a history of heparin exposure who developed thrombotic thrombocytopenia after vaccination. A 70-year-old male presented with acute kidney injury and altered mental status due to lithium intoxication. He needed consecutive hemodialysis using heparin. Deep vein thrombosis of left lower extremity and accompanying severe thrombocytopenia of 15,000/µL on 24 days after vaccination and at the same time, nine days after heparin use. Anti-platelet factor 4 antibody test was positive. Anticoagulation with apixaban and intravenous immunoglobulin (IVIG) infusion resolved swelling of his left calf and thrombocytopenia. There were no definitive diagnostic tools capable of differentiating between VITT and HIT in this patient. Although VITT and HIT share treatment with IVIG and non-heparin anticoagulation, distinguishing between VITT and HIT will make it possible to establish a follow-up vaccination plan in a person who has had a thrombocytopenic thrombotic event. Further research is needed to develop the tools to make a clear distinction between the clinical syndromes.
Background and Aims Urinary tract obstruction (UTO) is a common clinical problem leading to acute or chronic renal impairment. Unlike pediatric population in which congenital anomalies of urinary tract account for a majority of UTO and contribute to end stage renal disease (ESRD), etiologies, clinical manifestation and outcome in adult UTO remain uncertain due to lack of large epidemiological data. Method We performed a multi-center, retrospective study analyzing 1,711 patients who underwent percutaneous nephrostomy (PCN) from 2001 to 2015. Results The most common cause of UTO was malignancies (55.6%) followed by urolithiasis (28.5%) and others. Metastatic colorectal cancer were the most common type of malignancies. Patients with UTO caused by malignancies were significantly older, had more advanced stage acute kidney injury (AKI) and higher mortality rate, while those with urolithiasis had higher prevalence of hypertension, diabetes, cardio-cerebro-vascular diseases. Eighty two percentage of patients developed AKI and 15.2% of patients needed a temporary dialysis. Older age, malignancy associated UTO and high uric acid level were independently associated with AKI. Among patients with AKI, 38.2% patients showed a renal functional recovery defined as eGFR ≥60ml/min/1.73m2 on day 7 after PCN. Multivariate analysis showed that older age and lower hemoglobin level were independent factors predicting a nonrecovery of renal function. During the median follow up period of ∼∼months, overall mortality rate was 33.9% with the highest rate was found in malignancy associated UTO (51.9%), followed by other causes (15.9%) and urolithiasis (8.8%). Malignancy associated UTO (OR 4.754, 95% CI 3.151-7.174, p<0.001), lower albumin level (OR 0.731, 95% CI 0.568-0.942, p<0.001) and stage 3 AKI (OR 2.529, 95% CI 1.332-4.803, p=0.005) were found to be independently associated with mortality. However, the impact of AKI on overall mortality was more prominent in non-malignancy associated UTO with stepwise increase of mortality as KDIGO stage increased. Conclusion In conclusion, malignancy is the most common cause of upper UTO in adults and AKI is frequently associated. Short term renal recovery after PCN was observed only in 38.2% patients and older age, lower hemoglobin level were associated with nonrecovery of renal function. Malignancy associated UTO showed the highest mortality rate compared to urolithiasis or other causes and stage 3 AKI as well as lower hemoglobin and lower albumin level were found to be independent predictors of mortality in UTO.
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