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Acute kidney injury (AKI) has diverse causes and is associated with increased mortality and morbidity. In less developed countries (LDC), nephrotoxic AKI (ToxAKI) is common and mainly due to deliberate ingestion of nephrotoxic pesticides, toxic plants or to snake envenomation. ToxAKI shares some pathophysiological pathways with the much more intensively studied ischaemic AKI, but in contrast to ischaemic AKI, most victims are young, previously healthy adults. Diagnosis of AKI is currently based on a rise in serum creatinine. However this may delay diagnosis because of the kinetics of creatinine. Baseline creatinine values are also rarely available in LDC. Novel renal injury biomarkers offer a way forward because they usually increase more rapidly in AKI and are normally regarded as absent or very low in concentration, thereby reducing the need for a baseline estimate. This should increase sensitivity and speed of diagnosis. Specificity should also be increased for urine biomarkers since many originate from the renal tubular epithelium. Earlier diagnosis of ToxAKI should allow earlier initiation of appropriate therapy. However, translation of novel biomarkers of ToxAKI into clinical practice requires better understanding of non-renal factors in poisoning that alter biomarkers and the influence of dose of nephrotoxin on biomarker performance. Further issues are establishing LDC population-based normal ranges and assessing sampling and analytical parameters for low resource settings. The potential role of renal biomarkers in exploring ToxAKI aetiologies for chronic kidney disease of unknown origin (CKDu) is a high research priority in LDC. Therefore, developing more sensitive biomarkers for early diagnosis of nephrotoxicity is a critical step to making progress against AKI and CKDu in the developing world.
Acute kidney injury (AKI) has diverse causes and is associated with increased mortality and morbidity. In less developed countries (LDC), nephrotoxic AKI (ToxAKI) is common and mainly due to deliberate ingestion of nephrotoxic pesticides, toxic plants or to snake envenomation. ToxAKI shares some pathophysiological pathways with the much more intensively studied ischaemic AKI, but in contrast to ischaemic AKI, most victims are young, previously healthy adults. Diagnosis of AKI is currently based on a rise in serum creatinine. However this may delay diagnosis because of the kinetics of creatinine. Baseline creatinine values are also rarely available in LDC. Novel renal injury biomarkers offer a way forward because they usually increase more rapidly in AKI and are normally regarded as absent or very low in concentration, thereby reducing the need for a baseline estimate. This should increase sensitivity and speed of diagnosis. Specificity should also be increased for urine biomarkers since many originate from the renal tubular epithelium. Earlier diagnosis of ToxAKI should allow earlier initiation of appropriate therapy. However, translation of novel biomarkers of ToxAKI into clinical practice requires better understanding of non-renal factors in poisoning that alter biomarkers and the influence of dose of nephrotoxin on biomarker performance. Further issues are establishing LDC population-based normal ranges and assessing sampling and analytical parameters for low resource settings. The potential role of renal biomarkers in exploring ToxAKI aetiologies for chronic kidney disease of unknown origin (CKDu) is a high research priority in LDC. Therefore, developing more sensitive biomarkers for early diagnosis of nephrotoxicity is a critical step to making progress against AKI and CKDu in the developing world.
A AB BS ST TR RA AC CT T O Ob bj je ec ct ti iv ve e: : Poisoning is among the common health care problems which may be fatal and 3-5% of the acutely poisoned patients need intensive care admission. The aim of this study was to examine the acutely poisoned patients admitted to intensive care unit (ICU) in terms of individual, etiological and demographical characteristics and also to determine the factors affecting mortality. M Ma at te er ri ia al l a an nd d M Me et th ho od ds s: : This study was retrospectively conducted on the patients admitted to medical ICU of a university hospital due to acute poisoning over a six year period. The patients' age, gender, comorbid disease status, sociocultural characteristics, cause of the poisoning, transfer time to hospital and to the ICU, signs and symptoms, laboratory data, Glasgow coma score, Acute Physiology and Chronic Health Evaluation II (APACHE II) score, Sequential Organ Failure Assessment score, length of stay in ICU, the treatments employed and their results were analyzed. R Re es su ul lt ts s: : The total number of the patients included in the study was 190. The median age of the patients was 28.5 (16-72) years and 97 (51%) patients were females. The mean length of stay in ICU was 4.2±3.6 days. The overall mortality rate was 8.4%. Independent risk factors for mortality were presence of concomitant physical disorders, time to ICU admission, and higher APACHE II scores. C Co on nc cl lu us si io on n: : Individual characteristics, cause of poisoning and type of toxic agent should be clearly determined since they are predictors for mortality. Early intervention is life saving. ICU scoring systems in predicting mortality are very valuable and should be used. K Ke ey y W Wo or rd ds s: : Intensive care; mortality; poisoning Ö ÖZ ZE ET T A Am ma aç ç: : Zehirlenme ölümcül olabilen ve akut zehirlenmiş hastaların %3-5'inin yoğun bakıma yatışını gerekebilen yaygın bir sağlık problemidir. Bu çalışmanın amacı mortaliteyi etkileyen faktörleri belirlemek amacıyla yoğun bakım ünitesine (YBÜ) kabul edilen akut zehirlenmiş hastaların bireysel, etyolojik ve demografik özelliklerini incelemektir. G Ge er re eç ç v ve e Y Yö ön nt te em ml le er r: : Bu çal-ışma retrospektif olarak altı yıl içinde akut zehirlenme nedeniyle bir üniversite hastanesi medikal yoğun bakımına yatan hastalar üzerinde yapıldı. Hastaların yaş, cinsiyet, eşlik eden hastalık durumu ve sosyokültürel özellikleri, zehirlenme nedeni, hastane ve yoğun bakıma transfer süresi, belirti ve bulguları, laboratuvar verileri, Glasgow koma skoru, Akut Fizyoloji ve Kronik Sağlık Değerlendirmesi II (APACHE II) skoru, Ardışık Organ Yetersizliğinin Değerlendirilmesi skoru, YBÜ yatış süresi, tedavileri ve sonuçları analiz edildi. B Bu ul lg gu ul la ar r: : Çalışmaya dahil edilen hastaların toplam sayısı 190 idi. Hastaların ortanca yaşı 28,5 (16-72) yıldı ve 97 (%51) hasta kadın idi. Yoğun bakımda kalış süresi ortalama 4,2±3,6 gün idi. Mortalite oranı % 8,4 idi. Mortalite için bağımsız risk faktörleri fiziksel alt hastalığı...
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