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introduction:Acute kidney injury (AKI) is a frequent and potentially fatal complication in infectious diseases. The aim of this study was to investigate the clinical aspects of AKI associated with infectious diseases and the factors associated with mortality. Methods: This retrospective study was conducted in patients with AKI who were admitted to the intensive care unit (ICU) of a tertiary infectious diseases hospital from January 2003 to January 2012. The major underlying diseases and clinical and laboratory fi ndings were evaluated. Results: A total of 253 cases were included. The mean age was 46±16 years, and 72% of the patients were male. The main diseases were human immunodefi ciency virus (HIV) infection, HIV/acquired immunodefi ciency syndrome (AIDS) (30%), tuberculosis (12%), leptospirosis (11%) and dengue (4%). Dialysis was performed in 70 cases (27.6%). The patients were classifi ed as risk (4.4%), injury (63.6%) or failure (32%). The time between AKI diagnosis and dialysis was 3.6±4.7 days. Oliguria was observed in 112 cases (45.7%). The Acute Physiology and Chronic Health Evaluation (APACHE) II scores were higher in patients with HIV/AIDS (57±20, p-value=0.01) and dengue (68±11, p-value=0.01). Death occurred in 159 cases (62.8%). Mortality was higher in patients with HIV/AIDS (76.6%, p-value=0.02). A multivariate analysis identifi ed the following independent risk factors for death: oliguria, metabolic acidosis, sepsis, hypovolemia, the need for vasoactive drugs, the need for mechanical ventilation and the APACHE II score. Conclusions: AKI is a common complication in infectious diseases, with high mortality. Mortality was higher in patients with HIV/AIDS, most likely due to the severity of immunosuppression and opportunistic diseases.

AKI is a rare but potential fatal complication in obstetric patients. RIFLE criteria seem to have association with mortality. There are important factors associated with oliguria and death, which must be prompt recognized to the institution of adequate therapeutic measures.

Background: Acute kidney injury (AKI) is a frequent complication in hospitalized patients, especially in those in intensive care units (ICU). The RIFLE classification might be a valid prognostic factor for critically ill cancer patients. The present study aims to evaluate the discriminatory capacity of RIFLE versus other general prognostic scores in predicting hospital mortality in critically ill cancer patients. Methods: This is a single-center study conducted in a cancer-specialized ICU in Brazil. All of the 288 patients hospitalized from May 2006 to June 2008 were included. RIFLE classification, APACHE II, SOFA, and SAPS II scores were calculated and the area under receiver operating characteristic (AROC) curves and logistic multiple regression were performed using hospital mortality as the outcome. Results: AKI, defined by RIFLE criteria, was observed in 156 (54.2%) patients. The distribution of patients with any degree of AKI was: risk, n = 96 (33.3%); injury, n = 30 (10.4%), and failure, n = 30 (10.4%). Mortality was 13.6% for non-AKI patients, 49% for RIFLE ‘R’ patients, 62.3% for RIFLE ‘I’ patients, and 86.8% for RIFLE ‘F’ patients (p = 0.0006). Logistic regression analysis showed that RIFLE criteria, APACHE II, SOFA, and SAPS II were independent factors for mortality in this population. The discrimination of RIFLE was good (AROC 0.801, 95% CI 0.748–0.854) but inferior compared to those of APACHE II (AROC 0.940, 95% CI 0.915–0.966), SOFA (AROC 0.910, 95% CI 0.876–0.943), and SAPS II (AROC 0.869, 95% CI 0.827–0.912). Conclusion: AKI is a frequent complication in ICU patients with cancer. RIFLE was inferior to commonly used prognostic scores for predicting mortality in this cohort of patients.

AKI is a frequent and frequently fatal condition. Mortality was higher in community and ICU-acquired than hospital ward-acquired AKI.

Visceral leishmaniasis is an endemic disease caused by various species of Leishmania. We made a retrospective study of 57 consecutive patients with visceral leishmaniasis in Brazil. Patients with visceral leishmaniasis were identified using the registries of the São José Infectious Diseases Hospital. The sample was divided into two groups: patients with serum creatinine (Scr) <1.3mg/dL and Scr ≥ ≥ ≥ ≥ ≥ 1.3mg/dL. We compared these two groups for differences in clinical manifestations and laboratory features. Patients' mean age was 28 ± 18 years old; 74% were male. The main clinical symptoms and signs presented in the initial evaluation were: fever (97%), splenomegaly (96.4%), weight loss (95.5%), pallor (93.6%), cough (89.7%), hepatomegaly (87.2%), asthenia (83.3%), anorexia (82.9%) and vomiting (73.9%). Acute renal failure was found in 15 patients (26.3%) and eight of these patients had ARF before amphotericin B administration. The mean age was higher in the group with Scr ≥ ≥ ≥ ≥ ≥ 1.3mg/dL. Death occurred in three cases; all deaths occurred with Scr ≥ ≥ ≥ ≥ ≥ 1.3mg/dL. There were no significant differences in the frequencies of the clinical symptoms and signs between the two groups. The laboratory data and demographic characteristics were significantly worse in the Scr ≥ ≥ ≥ ≥ ≥ 1.3mg/dL group. Renal dysfunction is an important feature of this disease; it is associated with important morbidity and can increase mortality.

Abstract. The aim of this study is to investigate the changes in clinical pattern and therapeutic measures in leptospirosis-associated acute kidney injury; a retrospective study with 318 patients in Brazil. Patients were divided according to the time of admission: 1985-1996 (group I) and 1997. Patients were younger in group I (36 ± 13 versus 41 ± 16 years, P = 0.005) and the numbers of oliguria increased (21% versus 41% in group II, P = 0.014). Higher frequency of lung manifestations was observed in group II ( P < 0.0001). Although increased severity, there was a significant reduction in mortality (20% in group I versus 12% in group II, P = 0.03). Mortality was associated with advanced age, low diastolic blood pressure, oliguria, arrhythmia, and peritoneal dialysis, besides a trend to better mortality with penicillin administration. Leptospirosis is occurring in an older population, with a higher number of oliguria and lung manifestations. However, mortality is decreasing and can be the result of changes in treatment.* Address correspondence to Alexandre B. Libório, Av. Abolição, 4043 ap 1203, Fortaleza, CE, Brazil -CEP: 60.165-082. E-mail: alexandreli borio@yahoo.com.br 480 DAHER AND OTHERS 3. Antibiotic therapy: physicians were oriented to administer penicillin to patients even in later disease presentation. 4. Dialysis therapy: hemodialysis therapy was the preferred method instead of peritoneal dialysis and it was intended to be initiated early after intensive care unit admission and performed daily.All clinical manifestations and laboratory tests were evaluated. A comparison of clinical and laboratory data was performed between the two groups to investigate if there was any difference in the pattern of leptospirosis presentation in the two periods analyzed. A comparison between survivors and non-survivors in the two periods was also done.Ethics. The protocol of this study was approved by the Ethical Committee of the Walter Cantídio University Hospital and São José Infectious Diseases Hospital.Statistical analysis. The results were expressed through tables and summary measures (mean ± standard deviation) in the cases of quantitative variables. All data were analyzed with the programs SPSS version 10.0 (SPSS Inc., Chicago, IL) and Epi Info version 6.04b (Centers for Disease Control and Prevention, Atlanta, GA). Comparison of parameters was done with Student's t test, Mann-Whitney, and Fisher's exact test when appropriated. Mann-Whitney test was used for the parameters with a non-normal distribution. Stepwise backward elimination multivariate analysis was performed for the investigation of factors associated with death. All variables presented were considered and it included the factors that presented a significance level < 10% in the univariate analysis. Allocation into the two defined groups was considered an independent variable. P value < 0.05 was considered as statistically significant in all other cases. RESULTSA total of 374 patients were evaluated initially. Three hundred eighteen patients were include...

ObjectiveTo examine the factors associated with acute kidney injury and outcome in patients with lung disease. MethodsA prospective study was conducted with 100 consecutive patients admitted to a respiratory intensive care unit in Fortaleza (CE), Brazil. The risk factors for acute kidney injury and mortality were investigated in a group of patients with lung diseases. ResultsThe mean age of the study population was 57 years, and 50% were male. The incidence of acute kidney injury was higher in patients with PaO2/FiO2<200 mmHg (54% versus 23.7%; p=0.02). Death was observed in 40 cases and the rate of mortality of the acute kidney injury group was higher (62.8% versus 27.6%; p=0.01). The independent factor that was found to be associated with acute kidney injury was PaO2/FiO2<200 mmHg (p=0.01), and the independent risk factors for death were PEEP at admission (OR: 3.6; 95%CI: 1.3-9.6; p=0.009) and need for hemodialysis (OR: 7.9; 95%CI: 2.2-28.3; p=0.001). ConclusionThere was a higher mortality rate in the acute kidney injury group. Increased mortality was associated with mechanical ventilation, high PEEP, urea and need for dialysis. Further studies must be performed to better establish the relationship between kidney and lung injury and its impact on patient outcome.