Blood urea nitrogen/creatinine ratio in rhabdomyolysis
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Abstract:
Rhabdomyolysis, a potentially life-threatening syndrome, is not an uncommon condition with around 38,000 cases been reported in the USA in 2000. The risk of developing acute renal failure in the initial days of presentation can be as high as 40% and approximately 28-37% of patients require short-term hemodialysis. This report discusses a case of rhabdomyolysis after seizures in which blood urea nitrogen (BUN), creatinine, and BUN/creatinine levels were examined during the course of illness in the hospital. We found that the BUN/creatinine ratio is not a reliable indicator of renal function in rhabdomyolysis. Potassium levels can be a better marker for the early recognition of acute renal failure and an indication for prompt treatment with dialysis, which is crucial to prevent fatal complications.Keywords:
Blood urea nitrogen
Rhabdomyolysis, a potentially life-threatening syndrome, is not an uncommon condition with around 38,000 cases been reported in the USA in 2000. The risk of developing acute renal failure in the initial days of presentation can be as high as 40% and approximately 28-37% of patients require short-term hemodialysis. This report discusses a case of rhabdomyolysis after seizures in which blood urea nitrogen (BUN), creatinine, and BUN/creatinine levels were examined during the course of illness in the hospital. We found that the BUN/creatinine ratio is not a reliable indicator of renal function in rhabdomyolysis. Potassium levels can be a better marker for the early recognition of acute renal failure and an indication for prompt treatment with dialysis, which is crucial to prevent fatal complications.
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Data on long-term follow up after acute kidney injury (AKI) requiring dialysis are scarce. The aim of this study was to describe and identify factors associated with survival, recovery of kidney function at discharge, and long-term follow up of renal function in AKI patients requiring dialysis. All AKI patients requiring dialysis during calendar year 2000-2011 treated with conventional hemodialysis and daily shift continuous venovenous hemodialysis (8-hour 40 L dialysate) were included. The data were mean and SD. The results were: 65.8% male; 33.9% diabetic; 75% dipstick positive proteinuria on admission; 72.5% medical AKI; and 27.6% surgical AKI of those (14.2%) who had postcardiovascular surgery. At discharge mortality by cause of AKI: medical 25%, surgical 29.8%; and at the end of study: medical 35.3%, surgical 43.6%. Two-hundred thirty-four patients were discharged alive (mortality 26%). Forty-two died after discharge; 50% in the first 156 days post discharge. Mortality at the end of study was 37.8%. Follow-up (F/U) (1-86 m). At discharge, 200 recovered from kidney function (63.2%), and of those who died in the hospital 80.5% did not recover from kidney function (died dialysis dependent). Baseline serum creatinine was 1.33 mg/dL (0.64), estimated glomerular filtration rate (eGFR) 63.4 mL/minute (29.3), peak creatinine 6.3 mg/dL (2.9), and peak blood urea nitrogen 88.1 mg/dL (39.9). At discharge, serum creatinine was 3.1 mg/dL (2.1) and eGFR was 31.6 mL/minute (27.4); at 6 months, creatinine was 1.66 mg/dL (1.1) and eGFR was 60.8(36); at all F/U times, the creatinine was higher and eGFR was lower than the baseline values (P < 0.05). Of the nonsurvivors, the only significant difference was a lower albumin at baseline (2.9 vs. 3.1 g/dL) (P < 0.05) and lower peak creatinine (5.5 vs. 6.8 mg/dL) (P < 0.05). The mean survival time was 45.4 months. The survival of the patients who recovered from kidney function at discharge was longer than the ones who did not recover (59.7 vs. 16 m, P < 0.05). By Cox regression, the factors significant for survival were peak creatinine and status at discharge. During follow up (data up to 54 months), the percentage of patients with eGFR < 60 mL/minute decreased from 90.9% at discharge to 63.6% at 24 months, then increased to 81.8% at 30 months and longer. The percentage of patients with eGFR < 30 mL/minute decreased from 45.4% at discharge to 18.2% at 24 months to increase at a later date (27-36%). The percentage of patients with eGFR < 15 mL/minute decreased from 45.45% at discharge to 18% until 24 months of follow up (to increase to 27.7% at later dates). AKI requiring dialysis has a significant effect on GFR with almost 80% of the survivors having chronic kidney disease stage 3 or worse. Furthermore, progression was observed on the long-term follow up. Factors affecting the survival included peak creatinine and status of recovery of kidney function at discharge.
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SUMMARY Cystatin C has emerged as a possible, usable surrogate marker of renal function. We present a case that illustrates the clinical utility of cystatin C in the setting of acute kidney injury secondary to rhabdomyolysis. An African American male whose baseline cystatin C and serum creatinine levels taken a month prior to admission were compared against their daily values during his admission and at follow up. On admission, the patient's reduction in glomerular filtration rate (GFR) from baseline was much less when calculated with cystatin C than with serum creatinine. His clinical recovery was more reflective of the higher GFR with cystatin C than what would be assumed with his serum creatinine, which at its worst was 5 ml/min/1.73 m 2 . The patient was eventually discharged from the hospital with a GFR of 40 ml/min by cystatin C despite his GFR by the MDRD equation being 12. Cystatin C may be a more accurate marker of the both the amount of injury and the rate of resolution of acute kidney injury than serum creatinine in rhabdomyolysis.
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Objective To compare the clearance of vasoactive substances of different dialysis membranes and different blood purification for patients on hemodialysis.Methods Polysulfone membrane hemodiafiltration HDF group which measured indicators of radioimmunoassay before and after dialysis,endothelin(ET-1),blood urea nitrogen(BUN),creatinine(Serum) and Latex and measured indicators by enhanced immunoturbidimetric method for measuring serum cystatin C(Cys-c) and other indicators.Review ET-1 and other indicators after one month before dialysis.Diacetate membrane(FB-130) HD group,also measured by radioimmunoassay before and after dialysis,endothelin(ET-1),urea nitrogen(BUN),creatinine(SCr) latex indicators,with the enhanced immunoturbidimetric method for measuring serum cystatin C(Cys-c) and other indicators.ET-1 will be reviewed of pre-dialysis and other indicators after one month.Results HDF group's ET-1 decreases(P0.05) after hemodialysis than before hemodialysis which tested by Polysulfone membrane dialysis single,while the HD group was no significant difference before and after dialysis.Polysulfone membrane HDF group's ET-1 decreased(P0.01) than a month before.Conclusion HDF can clear part of the plasma ET-1 levels in hemodialysis patients,HDF can reduce inflammation and tissue damage.Regular hemodialysis patients using HDF treatment can enhance treatment effect and improve quality of life.
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Acute kidney injury (AKI) often complicates the progression of COVID-19 and increases in-hospital mortality.
The aim of the study is to analyze AKI frequency, the time of its development and the possibility of using the ratio blood urea nitrogen/blood creatinine (BUN/Cr) as a biomarker for AKI progression in COVID-19 patients.
Materials and methods. The authors examined 329 patients hospitalized with COVID-19 (157 women (47.7 %) and 172 men (52.3 %), mean age 58.0±14.3 years). The follow-up period was 12 months. COVID-19 was confirmed by a PCR test. AKI frequency, severity and time of development were studied in all patients. Moreover, the authors calculated the ratio blood urea nitrogen/blood creatinine (BUN/Cr, mg/dl:mg/dl).
Results. AKI was diagnosed in 70 patients (21.3 %), including 12 patients (17.1 %) with an increase in creatinine level after hospitalization (in-hospital AKI) and 58 patients (82.9 %) with a high creatinine level (pre-hospital AKI). AKI stage 1 was observed in 55 patients (78.6 %), stage 2 – in 11 patients (15.7 %), stage 3 – in 4 patients (5.7 %). In-hospital mortality in COVID-19 patients with AKI was 10 %, the relative mortality risk in COVID-19 patients with AKI was 5.3 (95 %, CI 1.7–16.1; p=0.01). In patients hospitalized with AKI, AUB/Cr>20 was observed on hospitalization in 16 patients (27.6 %). In patients with in-hospital AKI, AUB/Cr>20 was detected only in 1 person (8 %).
Conclusion. One in four patients hospitalized with COVID-19 develop AKI, predominantly stage 1. AKI increases in-hospital mortality. In most patients, AKI develops before hospitalization. In 27.6 % of patients with pre-hospital AKI, AUB/Cr>20 on hospitalization, which indicates the prerenal nature of AKI and the importance of dehydration (hypovolemia) as a risk factor for AKI progression in COVID-19 patients.
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Objective To investigate the cause,clinical manifestation,therapy and prognosis of rhabdomyolysis-induced acute kidney injury(RM-AKI),and to analyze the clinical features of traumatic and nontraumatic RM-AKI.Methods A total of 51RM-AKI patients were enrolled in this retrospective study.There were40 males and 11 females with a mean age of(45.0±21.1)years old.Serum creatine phosphokinase(CPK),serum lactate dehydrogenase(LDH),serum myoglobin(Mb),uric acid(UA),blood urea nitrogen(BUN),serum creatinine and electrolytes were tested.All the patients received combined therapy,and blood purification was applied when necessary.Results There were 24(47.1%)cases of traumatic RM-AKI and 27(52.9%)cases of non-traumatic RM-AKI.Infection(23.5%)was the most common cause.The serum levels of creatinine,phosphorus and potassium were significantly higher in traumatic RM-AKI patients than those in non-traumatic ones(all P0.05).Thirty-one(60.8%)patients received blood purification.One-year mortality was 29.4% and91.7% of the survivals completely recovered their renal function.Conclusion Rhabdomyolysis has various causes and infection are very common.Traumatic RM-AKI is more severe than the non-traumatic one.Though RMAKI is coupled with critical conditions and high mortality,the recovery of renal function is not bad.
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Objective: To explore potential mechanism about the experience that hypertension is associated with poor outcome in patients with coronavirus disease 2019 (COVID-19). Methods: In this retrospective study, 134 hypertensive patients diagnosed with COVID-19 were included from February 1, 2020 to March 15, 2020. We assessed the associations between renal injury on admission and risks of acute kidney injury (AKI) and in-hospital mortality and analyzed the dynamic changes of serum creatinine and blood urea nitrogen (BUN). Result: Among the 134 COVID-19 patients, 95 (70.9%) were discharged and survived, and 39 (29.1%) died. On admission, BUN and serum creatinine were elevated in 24 (17.9%) and 39 (29.1%) patients, respectively. Estimated glomerular filtration rate (eGFR) < 60 ml/min/1.73 m2 was reported in 18 (13.4%) patients. Multiple regression analysis showed that elevated baseline BUN and eGFR less than 60 ml/min/1.73 m2 on admission were independent risk factors for both AKI and in-hospital death in COVID-19 patients with hypertension. Level of serum creatinine or BUN increased faster in patients with elevated baseline serum creatinine or BUN respectively than those with normal levels. Conclusion: Renal injury of hypertensive patients can result in poor outcomes including AKI and death after they are infected with SARS-CoV-2, and clinicians should be vigilant for these patients with abnormal renal function at admission.
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Clinical analysis in patients with rhabdomyolysis and acute kidney injury caused by intense exercise
Objective
To investigate the clinical features of patients with rhabdomyolysis and acute kidney injury (AKI) caused by intense exercise.
Methods
Data on patients with rhabdomyolysis and AKI due to intense military exercise from January 2002 to December 2017 in a single Chinese nephrology center were retrospectively reviewed. Parameters included clinical manifestations, markers of renal function and muscle damage, treatment and prognosis.
Results
Twenty-two male servicemen with AKI caused by rhabdomyolysis were included. They took part in the military running training before onset. 95.5%(21/22) took part in 5-kilometer race, of which cross-country was 86.4% (19 cases) and bare-handed was 9.1% (2 cases). Most cases occurred in summer, in which 72.7% (16 cases) took part in 5-kilometer cross-country race. The levels of serum creatinine (Scr), blood urea nitrogen (BUN), uric acid (UA) and creatine kinase (CK) significantly increased in patients, with 9.1% (2 cases) reaching AKI stage 1, 31.8% (7 cases) reaching AKI stage 2, and 59.1% (13 cases) reaching AKI stage 3, respectively. Serum CK levels were positively correlated with AKI stage (r=0.453, P<0.05), Scr (r=0.494, P<0.05) and BUN (r=0.545, P<0.01), while negatively correlated with UA (r=- 0.487, P<0.05). Serum LDH levels were positively correlated only with age (r=0.533, P<0.05). Serum UA presented inverse correlations with BUN (r=- 0.513, P<0.05), K+ (r=- 0.642, P<0.01) and CK (r=- 0.487, P<0.05), and positive correlation with age (r=0.431, P<0.05). In particular, duration from onset of disease had a stronger positive association with BUN (r=0.907, P<0.01) and Scr (r=0.690, P<0.01). Of these patients with AKI, 21 cases(95.5%) reached complete recovery of kidney function and 1 case (4.5%) changed to chronic renal failure within 3 months after comprehensive treatments, including 8 cases(36.4%) who received appropriate continuous venovenous hemofiltration.
Conclusions
Intense exercise in summer is likely to cause rhabdomyolysis and AKI. Early diagnosis and comprehensive treatment including appropriate blood purification are crucial for a successful treatment. Our findings also emphasize the importance of age on muscle injury and the monitoring of electrolysts, markers of muscle damage and renal function for prevention of rhabdomyolysis and its related complications.
Key words:
Rhabdomyolysis; Acute kidney injury; Intense exercise; Blood purification
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