Background: Endothelins (ET) are a family of peptides that act as potent vasoconstrictors and pro-fibrotic growth factors. ET-1 is integral to renal and cardiovascular pathophysiology and exerts effects via autocrine, paracrine and endocrine signaling pathways tied to regulation of aldosterone, catecholamines, and angiotensin. In the kidney, ET-1 is critical to maintaining renal perfusion and controls glomerular arteriole tone and hemodynamics. It is hypothesized that
Acute kidney injury (AKI) in paediatric critical care.
Creator
Raina Rupesh; Chauvin Abigail; Deep Akash
Publisher
Paediatrics & Child Health
Date
2017
2017-05
Description
Incidence of acute kidney injury (AKI) is gradually increasing in children admitted to critical care units partly because of increased awareness of this entity. Though serum creatinine has been used in most definitions, its inability to accurately reflect kidney function has resulted in problems for clinical research in paediatric AKI. This has resulted in the use of more than 35 definitions of AKI in clinical studies, ranging from small changes in serum creatinine to requirement for dialysis. Therefore, comparisons among studies are difficult, resulting in a wide range of quoted epidemiology, morbidity, and mortality rates in the AKI paediatric literature. Acute kidney injury may be precipitated by critical illness, pre-existing medical conditions, and treatments received both before and during ICU admission. In this review we have attempted to outline the current definitions used for AKI, presence of AKI in various critical care conditions (bone marrow transplant, liver, sepsis, cardiac, primary renal conditions leading to glomerulonephritis) and outline the basic management.
Subject
Dialysis; Child; Intensive Care Units; Kidney Function Tests; Pediatric; Kidney Failure; Creatinine; Acute – In Infancy and Childhood; Critical Care – In Infancy and Childhood
Effect of Immunosuppressive Therapy on the Occurrence of Atypical Hemolytic Uremic Syndrome in Renal Transplant Recipients.
Creator
Raina Rupesh; Chauvin Abigail; Fox Kelli; Kesav Natasha; Ascha Mustafa S; Vachharajani Tushar J; Krishnappa Vinod
Publisher
Annals of transplantation
Date
2018
2018-09
Description
BACKGROUND Atypical hemolytic uremic syndrome (aHUS), a rare thrombotic microangiopathy, is characterized by hemolytic anemia, thrombocytopenia, and acute renal failure. Caused by genetic mutations in the alternative complement cascade, aHUS often will culminate in end-stage renal disease and occasionally death. Renal transplantation in aHUS patients has been contraindicated in the past due to the recurrence risk, with certain immunosuppressive regimens being commonly attributed. In this study, we analyzed the association between aHUS and immunosuppressive agents so as to offer evidence for the use of certain immunosuppressive regimens in renal transplant recipients. MATERIAL AND METHODS Our study is a retrospective analysis using data from the United States Renal Data System from 2004 to 2012. A cohort of renal transplantation patients diagnosed with aHUS were identified to include in the study. The primary endpoint was the determination of aHUS incidence in renal transplant recipients due to various immunosuppressive agents. The secondary endpoints were to check the relationship between the drug type as well as the demographic variables that increase the risk for aHUS. RESULTS It was found that there was a higher usage of sirolimus (P=0.015) and corticosteroids (P=0.030) in the aHUS patients compared to patients in other diagnoses group. CONCLUSIONS There was a higher usage of sirolimus and corticosteroids in renal transplantation patients diagnosed with aHUS. Unfortunately, due to the rarity of this disease, the sample size was small (n=14). Despite the small sample size, this data analysis throws light on the relationship between aHUS and immunosuppressive agents in renal transplant recipients, although we still have much to learn.