Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0011849 (diabetes)
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Because of incompatible reports about the renal impairment to abdominal aortic aneurysm (AAA) repair, we conducted a prospective study to determine the differences in renal response between open (OR) and endovascular (EVAR) aneurysm repair. In a prospective, nonrandomized, single-center study, we evaluated 485 patients with AAAs undergoing OR or EVAR between January 2000 and December 2005. Only electively performed procedures were analyzed in detail. The OR group included 229 patients (males/females 203/26, median age 69.8 [range 43-90] years, aneurysm diameter in median 57 [26-95] mm), and the EVAR group integrated 144 patients (males/females 129/15, 73.1 [49-90] years [p=.001], 55 [33-100] mm). Renal function was assessed by determinating the preoperative serum creatinine (SCr) level and SCr clearance according to Cockcroft-Gault. Postoperatively, SCr level and SCr clearance were determined at defined intervals, reported as highest postoperative SCr level, SCr level at time of discharge, lowest postoperative SCr clearance, and SCr clearance at time of discharge. The parameters of height, weight, diabetes, smoking habit, serum cholesterol level, and hemoglobin were not different between the groups. Significantly different were the American Society of Anesthesiologists classification, the Society for Vascular Surgery Comorbidity Score, and the exposure to contrast dye. Moreover, significantly different were intraoperatively measured median blood loss (1,200 vs. 400 mL) and the median time of operation (164 vs. 135 min). Although, the preoperative SCr levels between the groups were not statistically different (OR group 1.0 [0.87-1.23] mg/dL [median, interquartile range], EVAR group 1.0 [0.9-1.3]; p > 0.05), the SCr clearance was (OR group 72.8 [58.2-98.8] mL/min, EVAR group 67.6 [51.3-85.1] mL/min; p = 0.007). In the postoperative period, SCr level did not change significantly in the OR group but did in the EVAR group to a level of 1.08 (0.9-1.36) mg/dL (p = 0.007). Similarly, SCr clearance decreased significantly in the EVAR group to a level of 66.7 (49.9-81.4) mL/min. These results were influenced by the stent graft design (deployment under the renal arteries vs. covering the renals with bared stents). Mortality was 3/229 in the OR group and 4/144 in the EVAR group. Acute renal impairment occurred in a subset of patients with AAAs with regard to the type of repair. EVAR showed a slight deterioration of renal function, but the evaluated tests are insensitive and without prognostic value concerning mortality or hospitalization. More sensitive markers of the differentiated renal functions (cystatin C for renal glomerular function, N-acetyl-ss-d-glucosamidase for proximal tubular function) should be evaluated in future studies.
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PMID:Renal response to open and endovascular repair of abdominal aortic aneurysm: a prospective study. 1805 73

Clofarabine is used as second-line therapy for acute myeloid leukemia. Acute renal impairment is reported with clofarabine; however, it is more likely to occur in patients with confounding factors that may underlie the adverse event. We describe a 65-year-old man treated with clofarabine for relapsed acute myeloid leukemia who experienced severe acute kidney injury and proteinuria temporally related to clofarabine administration. The morning after completion of clofarabine administration, his serum creatinine concentration increased to approximately 1.4-fold above his baseline value, and peaked at 2.8-3.6-fold over baseline within 72 hours. A 24-hour urine collection contained 4100 mg of protein. His serum creatinine concentration gradually returned to within 1.5 times his baseline value. Examination of the patient's clinical course, vital signs, and laboratory results did not yield any compelling evidence of alternative causes for acute kidney injury. The patient's comorbidities included a left ventricular ejection fraction of 35-40% and diabetes mellitus. His drug therapy with potential renal effects-lisinopril, furosemide, tobramycin, allopurinol, and valacyclovir-that preceded clofarabine administration was evaluated, and none was determined to be a major factor in the development of this adverse event. Bone marrow evaluations were negative for residual leukemia after clofarabine therapy. After approximately 11 weeks of hospitalization, the patient and his family made an informed decision to continue supportive care at home. Acute kidney injury in this patient was attributed to clofarabine administration due to the time course of events with respect to potential contributing factors. Use of the Naranjo adverse drug reaction probability scale indicated a probable relationship (score of 7) between the patient's development of renal effects and clofarabine therapy. To our knowledge, this is the first report of medically significant proteinuria associated with administration of clofarabine. Clinicians should be aware of the potential for acute kidney injury if their patients are administered clofarabine.
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PMID:Clofarabine-associated acute kidney injury and proteinuria. 2192 94