Emerson Q. Lima

Viral Hemorrhagic Fever-Induced Acute Kidney Injury

Viral hemorrhagic fevers (VHFs) are diseases caused by the RNA virus from 4 different families (Flaviridiae, Arenaviridae, Bunyaviridae, and Filoviridae) that are acquired through the bite of an infected arthropod or by the inhalation of particles of rodent excreta. Among the VHFs, dengue and yellow fever are the most prevalent in tropical regions worldwide. The clinical presentation is characterized by fever, malaise, increased vascular permeability, and coagulation defects that can result in bleeding. Acute kidney injury is an uncommon complication but renal dysfunction has been associated with various VHFs. In this article we review the renal manifestations of dengue and yellow fever infections.

Renal Biopsies in Acute Kidney Injury: Who Are We Missing?

What one finds on a renal biopsy is a function of whom one chooses to biopsy. This is especially true with regards to acute kidney injury (AKI). AKI is a common entity in the hospital setting (1), even given the problems of definition and terminology that have recently received attention (2), and its causes are highly dependent on the population studied. Despite its enormous clinical impact, there have been few series of renal histology data published on the etiologies leading to AKI. Our need for more data is further complicated by the fact that the overwhelming majority of AKI cases are never biopsied. Why is this so? In many cases, the clinical context suggests the cause, often either “acute tubular necrosis” (ATN) or “prerenal,” with a reasonable degree of certainty. In others, the lack of efficient therapeutic options coupled with the risks and costs of a biopsy make it appear unwise. There are other considerations as well. In current practice, most nephrologists choose to biopsy when they are not confident as to the cause of the AKI or when the renal injury has an obscure etiology. Is this appropriate?nnThis is one context in which to approach the important contribution by Lopez-Gomez et al. appearing in this issue, detailing the latest findings from the Spanish Registry of Glomerulonephritis, one of the largest in the world and one from which we have earlier reports (3–5). An important advantage of this registry is that the indication for biopsy was …

Prevention of intradialytic hypotension in patients with acute kidney injury submitted to sustained low-efficiency dialysis.

Objectives: This study evaluated the effects of a protocol aiming to reduce hypotension in acute kidney injury (AKI) patients submitted to sustained low-efficiency dialysis (SLED). Methods: Patients were randomly assigned to two SLED prescriptions—control group, dialysate temperature was 37.0°C with a fixed sodium concentration [138 mEq/L] and ultrafiltration (UF) rate; and profiling group, dialysate temperature was 35.5°C with a variable sodium concentration [150–138 mEq/L] and UF rate. Results: Sixty-two SLED sessions were evaluated (34 in profiling and 28 in control). Patients (n = 31) were similar in terms of gender, age, and Sequential Organ Failure Assessment (SOFA) score. Dialysis time, dialysis dose, and post-dialysis serum sodium were similar in both groups. The profiling group had significantly less hypotension episodes (23% vs. 57% in control, p = 0.009) and achieved higher UF volume (2.23 ± 1.25 L vs. 1.59 ± 1.03 L in control, p = 0.04) when compared with control group. Conclusions: SLED protocol with modulation of dialysate temperature, sodium, and UF profiling showed similar efficacy but less intradialytic hypotension when compared with a standard SLED prescription.