Acute kidney injury (AKI) increases the risk of morbidity, mortality, and progression to chronic kidney disease (CKD). There are few data on the risk of CKD following community-acquired AKI (CA-AKI) and its predictors from developing countries. We evaluated the association of a panel of serum and urine biomarkers at the time of hospital discharge with 4-month renal outcome in CA-AKI. Patients of either sex, aged between 18 and 70 years, with no underlying CKD, and with CA-AKI were recruited at the time of discharge from hospital in this prospective observational study. Levels of serum and urine biomarkers were analyzed and association between these markers and development of CKD, defined as eGFR < 60 ml/min/1.73 m2 or dialysis dependence at 4 month after discharge, were analyzed using multivariate logistic regression analysis and penalized least absolute shrinkage and selection operator logistic regression. Out of a total 126 patients followed up for 4 months, 25 developed CKD. Those who developed CKD were older (p = 0.008), had higher serum creatinine (p < 0.001) and lower serum albumin (p = 0.001) at discharge. Adjusted logistic regression showed that each 10% increase in standardized serum myo-inositol oxygenase (MIOX) level increased the odds of progression to CKD by 13.5%. With 10% increase in standardized urine Neutrophil gelatinase-associated lipocalin (NGAL), serum creatinine and urine protein creatinine ratio (uPCR), increase in the odds of progression to CKD was 10.5%, 9.6% and 8%, respectively. Multivariable logistic model including serum MIOX, discharge serum creatinine and discharge uPCR, was able to predict the progression of CKD [AUC ROC 0.88; (95% CI 0.81, 0.95)]. High level serum MIOX levels at the time of discharge from hospital are associated with progression to CKD in patients with CA-AKI.
Background: Peritoneal dialysis can be associated with various mechanical complications. Among them, pleuroperitoneal leak leading to recurrent hydrothorax is a lesser known entity. The condition can lead to life-threatening complications like respiratory distress, cardiac failure, arrhythmias, and infections. Various imaging modalities like computerized tomography, magnetic resonance imaging, and nuclear scans have been used to establish the diagnosis of pleuroperitoneal leak.
Case Presentation: An elderly gentleman with multiple co-morbidities on peritoneal dialysis presented with recurrent hydrothorax. After ruling out cardiac, infective, and neoplastic etiologies as causes for hydrothorax, the diagnosis of pleuroperitoneal leak was established using computerized tomography peritoneography. Despite temporarily interrupting peritoneal dialysis, our patient developed recurrent hydrothorax, thus requiring to be transferred to hemodialysis.
Conclusion: A high index of clinical suspicion and choice of the imaging modality will help in the timely diagnosis of pleuroperitoneal leak and appropriate therapeutic intervention.
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