Tag Archives: #kidneyinjury

Prolonged Exposure to Extreme Heat and Humidity Increases Risk of Acute Kidney Injury (Medicine)

Findings could help future treatment and prevention measures

Exposure to extreme heat (95 degrees Fahrenheit and above) and humidity for eight hours raises the core body temperature and causes dehydration, resulting in an increased risk of acute kidney injury, according to a new study. The researchers, from the Indiana University School of Public Health-Bloomington and University at Buffalo Center for Research and Education in Special Environments in New York, will present their findings virtually at the American Physiological Society’s (APS) annual meeting at Experimental Biology 2021.

Acute kidney injury, which is defined as a sudden decline in kidney function, is a major cause of hospitalization during heat waves, especially in vulnerable populations such as older adults and obese individuals. This disorder is expected to worsen as the frequency, intensity and duration of heat waves expand in the U.S. due to climate change, according to study co-author Hayden Hess, PhD. As a result, there is concern the public health burden during these extreme hot weather events will be exacerbated.

The study was conducted in a group of adult men who were subjected to a heat- and humidity-controlled environmental chamber. The findings also indicate the risk of acute kidney injury was only evident when environmental conditions outpaced the ability of study participants to maintain core body temperature when cooling and hydrating were not permitted.

Researchers say this information will help lay a foundation for additional studies that improve understanding of the causal mechanisms that lead to a higher risk of acute kidney injury induced by extreme heat exposure. The findings will also be used to develop treatment and prevention measures– such as cooling strategies and hydration recommendations–to reduce the risk of acute kidney injury in vulnerable populations.

NOTE TO JOURNALISTS: To schedule an interview with a member of the research team, and/or request the abstract, “Acute kidney injury risk is exacerbated during prolonged exposure to uncompensable heat,” please contact the APS Communications Office or call 301.634.7314. Find more research highlights in the APS Newsroom.

Featured image: Hayden Hess, PhD © H. Hess

Provided by American Physiological Society

About Experimental Biology 2021

Experimental Biology is the annual meeting of five societies that explores the latest research in physiology, anatomy, biochemistry and molecular biology, investigative pathology and pharmacology. With a mission to share the newest scientific concepts and research findings shaping clinical advances, the meeting offers an unparalleled opportunity for global exchange among scientists who represent dozens of scientific areas, from laboratory to translational to clinical research.

About the American Physiological Society

Physiology is a broad area of scientific inquiry that focuses on how molecules, cells, tissues and organs function in health and disease. The American Physiological Society connects a global, multidisciplinary community of more than 10,000 biomedical scientists and educators as part of its mission to advance scientific discovery, understand life and improve health. The Society drives collaboration and spotlights scientific discoveries through its 16 scholarly journals and programming that support researchers and educators in their work.

COVID-19 Drives a More Severe Form of Acute Kidney Injury, Yale Study Finds (Medicine)

Patients who develop acute kidney injury (AKI) while being treated for COVID-19 have significantly worse kidney function in the months after their hospital discharge than non-COVID patients with AKI, new Yale research finds.

In a study of patients who experienced AKI at five hospitals, researchers found that individuals who were also diagnosed with COVID-19 had a 12-fold greater loss of kidney function six months after hospitalization than those who did not have COVID. The findings were published in JAMA Network Open.

“COVID-AKI looks like a different form of AKI in terms of long-term effects,” said lead author Dr. F. Perry Wilson, associate professor of medicine and director of Yale’s Clinical and Translational Research Accelerator.

Acute kidney injury is an abrupt decline in the kidney’s filtration function that is typically found in 15% of hospitalized patients and increases a patient’s likelihood of death ten-fold.

For reasons that are still not clear, the condition is more common in patients with COVID-19. Earlier research has shown that 24% to 57% of patients hospitalized with COVID-19 developed AKI. In fact, this latest research suggests that the disease may cause a more serious form of AKI to develop.

To measure kidney function, researchers looked at the estimated glomerular filtration rate (eGFR), which measures how much blood passes through the glomeruli, small filters in the kidney, each minute. Specifically, they look at how much creatinine — a chemical waste produced by the muscles — is in the blood. A healthy person has an eGFR of 90 or more milliliters per minute. A person with AKI will see a decline of 1 to 2 milliliters per minute, representing a mild loss of kidney function. But in the COVID-AKI patients, Perry said, the decline is about 12 milliliters per minute.

The observed drop in eGFR among patients with COVID-AKI was independent of patient demographics, comorbidities, or the severity of the AKI, suggesting it was the result of the hyperinflammatory state associated with COVID-19 or the residual effects of the virus, researchers said. These patients continued to have faster decline in eGFR after discharge, increasing the likelihood of long-term kidney disease, dialysis, and death.

The study involved 182 patients with COVID-19-associated AKI and 1,430 patients who had AKI but not COVID-19 at five hospitals in Connecticut and Rhode Island.

While researchers do not know what is driving this more aggressive form of AKI in COVID patients, they speculate in the study that COVID-AKI may induce tubulointerstitial fibrosis, or scarring driven by inflammation within the kidney.

It may be possible, in part, to mitigate this progression by optimizing blood pressure control and making sure any diabetes is well controlled, Wilson said. His team will continue to follow these COVID-AKI patients to further understand the long-term effects of the condition, he said.

Featured image: Illustration kidney being attacked by virus © stock.adobe.com

Reference: James Nugent, Abinet Aklilu, Yu Yamamoto, Michael Simonov, Aditya Biswas, Lama Ghazi, Jason Greenberg, Sherry Mansour, Dennis Moledina, F. Perry Wilson, “Assessment of Acute Kidney Injury and Longitudinal Kidney Function After Hospital Discharge Among Patients With and Without COVID-19”, JAMA Netw Open. 2021;4(3):e211095. doi: 10.1001/jamanetworkopen.2021.1095

Provided by Yale University

Study Examines Role of Biomarkers to Evaluate Kidney Injury in Cancer Patients Undergoing Immunotherapy (Medicine)

study by Mayo Clinic researchers published in Kidney International Reports finds that immune checkpoint inhibitors, may have negative consequences in some patients, including acute kidney inflammation, known as interstitial nephritis. Immune checkpoint inhibitors are used to treat cancer by stimulating the immune system to attack cancerous cells.

“Immune checkpoint inhibitors have improved the prognosis for patients with a wide range of malignancies including melanomanon-small cell lung cancer and renal cancer,” says Sandra Herrmann, M.D., a Mayo Clinic nephrologist and the study’s senior author. “In some patients, this enhanced immune response may target kidney tissue, leading to acute kidney inflammation known as interstitial nephritis.”

Dr. Herrmann says a kidney biopsy is the gold standard to diagnose this condition. However, a kidney biopsy is an invasive procedure that some patients may not be able to undergo because of the risk of bleeding.

“Our study provides important, first-time data for clinicians and patients on the use of biomarkers to routinely evaluate the cause of acute kidney injury in patients undergoing immune checkpoint inhibitor therapy for cancer,” says Dr. Herrmann. “These biomarkers could assist with helping doctors discriminate treatment associated kidney injury from other causes and may also help aid clinical decision-making related to whether immune checkpoint inhibitor therapy should be continued if the injury found is not related to immunotherapy.”

For this study, researchers followed patients who were seen at Mayo Clinic for acute kidney injury from 2014 to 2020. They found that blood markers of kidney function and inflammation, serum creatinine and C-reactive protein, respectively, as well as urine markers ― urine retinol binding protein-to-urine creatinine ratio ― were significantly higher in patients with acute kidney injury due to interstitial nephritis associated with immune checkpoint inhibitor therapy when compared to other patients treated with immunotherapy but with acute kidney injury due to other causes, such as acute tubular necrosis associated with other cancer therapies.

“Being able to tell if acute kidney injury in a cancer patient is due to a certain type of cancer therapy without the need for an invasive test is extremely important,” says Dr. Herrmann. “It simplifies the work-up for patients, makes the approach safer and quicker, and helps physicians better guide patients through their care.”

Dr. Herrmann says that being able to attribute acute kidney failure to a cause other than immune checkpoint inhibitor therapy allows patients to continue with their cancer immunotherapy, which can be lifesaving. In addition, she says acute kidney failure has profound prognostic implications for patients and needs to be properly treated, so promptly identifying the cause is important.

Reference: Busra Isik, Mariam P. Alexander, Sandhya Manohar et al., “Biomarkers, Clinical Features and Rechallenge for Immune Checkpoint Inhibitor Renal Immune-Related Adverse Events”, Ki reports, 2021. https://doi.org/10.1016/j.ekir.2021.01.013

Provided by Mayo Clinic

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Kidney Injury in Diabetic Ketoacidosis Linked to Brain Injury (Medicine)

Researchers from a consortium of hospitals including Children’s Hospital of Philadelphia (CHOP) have identified factors that make children with diabetic ketoacidosis more likely to experience acute kidney injury. Analyzing data from a large, multicenter clinical trial, the researchers also found that children who experience acute kidney injury are more likely to also experience subtle cognitive impairment and demonstrate lower IQ scores, suggesting a pattern of multiple organ injury. The findings were published online today in JAMA Network Open.

Multiple recent studies have shown that organ injuries in children with diabetic ketoacidosis occur more frequently than previously thought. One recent retrospective study found that acute kidney injury commonly occurs in these children. Earlier analysis of a large, multicenter study demonstrated cerebral injury commonly occurs in diabetic ketoacidosis. Together, these studies raised the possibility of an underlying pathophysiology that connects these injuries across the body if the presence of these injuries were linked in patients.

“We wanted to look at these issues in a more prospective manner,” said Sage Myers, MD, an attending physician in the Emergency Department at CHOP and first author of the study. “With 13 participating emergency departments in the Pediatric Emergency Care Applied Research Network, we had the ability to not only study the frequency of acute kidney injury in these children, but also the underlying factors associated with injury and whether there is an association between the occurrence of acute kidney injury and cerebral injury, which would suggest a possible linkage between the mechanisms of injury underlying both.”

The researchers studied 1,359 episodes of diabetic ketoacidosis in children. Acute kidney injury occurred in 584 (43%) of those episodes, and 252 of those episodes (43%) were classified as either stage 2 or 3, representing more severe cases of kidney injury. When assessing whether acute kidney injury was associated with cognitive issues, children with kidney injuries had lower scores on short-term memory tests during diabetic ketoacidosis, as well as lower IQ scores three to six months after recovering from the condition. These differences persisted after adjusting for the severity of diabetic ketoacidosis and demographic factors like socioeconomic status.

“If we can identify the mechanisms of kidney injury after diabetic ketoacidosis, it can help in the development of new therapeutic and preventive strategies,” said Nathan Kuppermann, MD, professor and chair of emergency medicine at UC Davis Health, and senior author and co-principal investigator of the study. “We’re also hoping to focus future research on how diabetic ketoacidosis causes simultaneous, multi-organ injuries such as what we demonstrated in this study.”

Reference: Myers et al, “Acute Kidney Injury During Diabetic Ketoacidosis in Children: Frequency, Risk Factors, and Association with Neurocognitive Outcomes.” JAMA Network Open (2020). DOI: 10.1001/jamanetworkopen.2020.25481

Provided by Children’s Hospital of Philadelphia