Kidney international
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Kidney international · Mar 2010
Acute kidney injury in non-severe pneumonia is associated with an increased immune response and lower survival.
While sepsis is a leading cause of acute kidney injury in critically ill patients, the relationship between immune response and acute kidney injury in less severely ill patients with infection is not known. Here we studied the epidemiology, 1-year mortality, and immune response associated with acute kidney injury in 1836 hospitalized patients with community-acquired severe and non-severe pneumonia. Acute kidney injury developed in 631 patients of whom 329 had severe and 302 had non-severe sepsis. ⋯ This risk was significantly higher immediately after hospitalization but gradually fell over time in the overall cohort and in those with non-severe pneumonia. A significantly higher risk of death (hazard ratio 1.29) was also present in those never admitted to an intensive care unit. Hence acute kidney injury is common even among patients with non-severe pneumonia and is associated with higher immune response and an increased risk of death.
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Kidney international · Jan 2010
ReviewLinking an insect enzyme to hypertension: angiotensin II-epoxide hydrolase interactions.
Derived from arachidonic acid, epoxyeicosatrienoic acids function as antihypertensive and antihypertrophic mediators in the cardiovascular system. Epoxyeicosatrienoic acids are generated by soluble epoxide hydrolase, an enzyme hydrolyzing the epoxide moiety of juvenile hormones in insects, and are endothelium-derived hyperpolarizing factors that induce vessel dilation for cardioprotection. Pharmacological inhibition and genetic ablation of soluble epoxide hydrolase increases the level of epoxyeicosatrienoic acids. ⋯ Treatment with soluble epoxide hydrolase-selective inhibitors in angiotensin II-infused hypertensive rats increases the level of epoxyeicosatrienoic acids, with attendant decrease in systolic blood pressure. Shear stress, the physiological stimulation of vessel dilation, downregulates soluble epoxide hydrolase and hence increases epoxyeicosatrienoic acid level in endothelial cells. Because of the close association of the angiotensin II/soluble epoxide hydrolase/epoxyeicosatrienoic acid system and blood pressure regulation, pharmacological inhibition of soluble epoxide hydrolase would be a useful approach to prevent and treat angiotensin II-induced cardiac hypertrophy and hypertension, as well as vascular impairments.
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Kidney international · Jan 2010
Comparative StudySAPS 3 scores at the start of renal replacement therapy predict mortality in critically ill patients with acute kidney injury.
Patients can experience acute kidney injury and require renal replacement therapy at any time during their admission to intensive care units. Prognostic scores have been used to characterize and stratify patients by the severity of acute disease, but scores based on findings during the day of admission may not be reliable surrogate markers of the severity of acute illness in this population. The aim of this study was to evaluate the performance of SAPS 3 and MPM(0)-III scores, determined at the start of renal replacement therapy, in 244 patients admitted to 11 units of three hospitals in Rio de Janeiro, Brazil. ⋯ Mortality prediction and calibration approached those eventually found when a customized equation of SAPS 3 for Central and South America was used. After adjusting for other relevant covariates in multivariate analyses, both higher prognostic scores and length of stay in the unit prior to the start of renal replacement therapy were the main predictive factors for hospital mortality. Our study shows that a customized SAPS 3 model was accurate in predicting mortality and seems a promising algorithm to characterize and stratify patients in clinical studies.