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Query: UMLS:C0243026 (sepsis)
 52,417 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The acute onset of oliguria and azotemia in the postoperative setting may be caused by prerenal or postrenal causes or intrinsic renal damage. The first step in arriving at a diagnosis is to review the history in order to elicit the extrarenal factors. Certain simple laboratory tests are of tremendous value in differentiating these conditions. The development of acute renal failure with renal parenchymal damage usually occurs in the setting of hypotension, sepsis, dehydration, and with exposure to nephrotoxins. Most patients will be excreting scant amounts of isotonic urine containing more than 20 to 30 mEq per liter of sodium. Their urine:plasma creatinine ratio is less than or equal to 20:1 and their urinary sediment reveals many epithelial cells and casts. The condition is usually reversible and the treatment is expectant. However, it is still associated with a high mortality, although the survival of patients with acute renal failure may be substantially higher than previously reported. Early dialysis and nutritional support may play an important role in the improved survival. Patients with nonoliguric acute renal failure have urine outputs that may exceed 2 liters per day. Despite this output they demonstrate a stepwise increase in serum urea and creatinine. Urine sodium and osmolality are not very helpful. Many such patients do have low (less than 20 mEq per liter) urine sodium concentration and excrete isotonic urine.
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PMID:Acute renal failure in cardiovascular and other surgical patients. 743 57

Although the incidence of Gram-positive sepsis has risen strongly, it is unclear how Gram-positive organisms (without endotoxin) initiate septic shock. We investigated whether two cell wall components from Staphylococcus aureus, peptidoglycan (PepG) and lipoteichoic acid (LTA), can induce the inflammatory response and multiple organ dysfunction syndrome (MODS) associated with septic shock caused by Gram-positive organisms. In cultured macrophages, LTA (10 micrograms/ml), but not PepG (100 micrograms/ml), induces the release of nitric oxide measured as nitrite. PepG, however, caused a 4-fold increase in the production of nitrite elicited by LTA. Furthermore, PepG antibodies inhibited the release of nitrite elicited by killed S. aureus. Administration of both PepG (10 mg/kg; i.v.) and LTA (3 mg/kg; i.v.) in anesthetized rats resulted in the release of tumor necrosis factor alpha and interferon gamma and MODS, as indicated by a decrease in arterial oxygen pressure (lung) and an increase in plasma concentrations of bilirubin and alanine aminotransferase (liver), creatinine and urea (kidney), lipase (pancreas), and creatine kinase (heart or skeletal muscle). There was also the expression of inducible nitric oxide synthase in these organs, circulatory failure, and 50% mortality. These effects were not observed after administration of PepG or LTA alone. Even a high dose of LTA (10 mg/kg) causes only circulatory failure but no MODS. Thus, our results demonstrate that the two bacterial wall components, PepG and LTA, work together to cause systemic inflammation and multiple systems failure associated with Gram-positive organisms.
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PMID:The cell wall components peptidoglycan and lipoteichoic acid from Staphylococcus aureus act in synergy to cause shock and multiple organ failure. 747 84

Blood serum levels of myoglobin, creatinine, urea, beta 2-microglobulin were measured in 37 patients with the prolonged crush syndrome (PCS) injured during the Yerevan earthquake. A drastic increase of myoglobin level in the blood was observed in all the patients by the moment of hospitalization, this level being the higher, the more severe the injury. If PCS complications developed, such as sepsis or acute renal failure, myoglobin level increased by several tens of times. Effective treatment normalized myoglobin level before discharge from hospital.
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PMID:[Myoglobin concentration in blood: a criterion in the evaluation of muscular tissue injury in patients with prolonged crush syndrome]. 748 97

Previous studies of experimental sepsis suggested that excessive systemic vasodilatation might be the stimulus to renal hypofiltration and fluid retention in sepsis. Successful therapy for this syndrome requires agents that either act to improve systemic haemodynamics without adverse renal effects, or that act directly on the kidney without impairing circulatory homeostasis. The plasma kallikrein-kinin system is a potent vasodilator pathway, activated by endotoxin. We studied the effect of aprotinin (Trasylol), which inhibits plasma kallikrein, in an ovine model of surgically-induced intra-abdominal sepsis. Given either as an early or late intervention, aprotinin was associated with increased mean arterial pressure and systemic vascular resistance, improved glomerular filtration rate, and increased urinary sodium excretion. In further studies, treatment with the thromboxane synthetase inhibitor, U63,557A (Upjohn), either before or after the surgical induction of peritonitis, was associated with increased glomerular filtration rate and sodium excretion, without any effect on systemic haemodynamics. Logical use of specific antagonists, based on an understanding of the pathophysiology of the septic ARF syndrome, is a desirable strategy.
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PMID:Acute renal failure and sepsis: therapeutic approaches. 752 64

Butyrate analogues have been shown to increase fetal hemoglobin (HbF) production in vitro and in vivo. Sodium phenylbutyrate (SPB), an oral agent used to treat individuals with urea-cycle disorders, has been shown to increase HbF in nonanemic individuals and in individuals with sickle cell disease. We have treated eleven patients with homozygous beta thalassemia (three transfusion dependent) and one sickle-beta-thalassemia patient with 20 g/d (forty 500-mg tablets) of SPB for 41 to 460 days. All patients showed an increase in the percent of F reticulocytes associated with treatment, but only four patients responded by increasing their Hb levels by greater than 1 g/dL (mean increase, 2.1 g/dL; range, 1.2 to 2.8 g/dL). None of the transfusion-dependent thalassemia subjects responded. Increase in Hb was associated with an increase in red blood cell number (mean increase, 0.62 x 10(12)/L), and mean corpuscular volume (mean increase, 6 fL). Changes in percent HbF, absolute HbF levels, or alpha- to non-alpha-globin ratios as measured by levels of mRNA and globin protein in peripheral blood did not correlate with response to treatment. Response to treatment was not associated with the type of beta-globin mutation, but baseline erythropoietin levels of greater than 120 mU/mL was seen in all responders and only two of eight nonresponders to SPB. Compliance with treatment was greater than 90% as measured by pill counts. Side effects of the drug included weight gain and/or edema caused by increase salt load in 2/12, transient epigastric discomfort in 7/12, and abnormal body odor in 3/12 subjects. Two splenectomized patients who were not on prophylactic antibiotics developed sepsis while on treatment. We conclude that SPB increases Hb in some patients with thalassemia, but the precise mechanism of action is unknown.
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PMID:Oral sodium phenylbutyrate therapy in homozygous beta thalassemia: a clinical trial. 752 72

The syndrome of sepsis-associated severe acute renal failure is a frequent component of sepsis-induced multiorgan failure. Continuous hemofiltration techniques are often used in its dialytic management but little is known about their impact. The aim of this study is to define the biochemical and clinical impact of continuous hemodiafiltration (CHD) in the management of this syndrome and to retrospectively compare it to that of conventional dialysis. A prospective, cohort study and retrospective comparison with historical controls was conducted at an intensive care unit (ICU) of a tertiary institution. Eighty-seven consecutive septic patients with acute renal failure were treated by continuous hemodiafiltration and 40 consecutive similar patients by conventional dialysis. All new cases of severe acute renal failure with sepsis were treated by means of continuous hemodiafiltration. Historical controls were treated by means of conventional dialysis. Illness and sepsis severity were assessed on admission and prior to initiation of treatment. Biochemical variables were assessed daily. Outcome was measured as discharge from the ICU, duration of oliguria and discharge from hospital. Of the 87 patients treated by hemodiafiltration, 86 had multiorgan failure, 71 (81.6%) septic shock and 52 (59.8%) bacteremia/fungemia. Their APACHE II score on admission was 29.9 and their mean organ failure score prior to treatment was 4.3. Hemodiafiltration resulted in a significant fall in mean urea and creatinine levels within 24 h and in the correction of acidosis. The mean alveolar-arterial gradient fell from 276 to 211 mm Hg (p < 0.02) within 24 h of therapy. Complications were few and mostly related to vascular access.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Treatment of sepsis-associated severe acute renal failure with continuous hemodiafiltration: clinical experience and comparison with conventional dialysis. 754 27

Increased dialysis dose has been shown to improve morbidity and survival in chronic hemodialysis patients. Despite improvement in care and technological aspects of renal replacement therapy, mortality rates of acute renal failure (ARF) have remained essentially unchanged for over two decades, exceeding 50% in most studies. The occurrence of ARF in older patients with more complicated medical and surgical conditions has contributed to this lack of outcome amelioration, and death of ARF patients is now more frequently caused by underlying disease than ARF itself. A recent prospective survey at this institution found a mortality rate of 79.1% among a total of 363 ARF medical and surgical intensive care unit patients, with a mean age near 60 years and a mean admission APACHE II score of over 20, who were treated by intermittent hemodialysis and continuous renal replacement therapy (CRRT). Nonsurvivors had a mean of over four failed systems, in addition to the renal failure, compared with survivors who had less than four. The standards for dialysis adequacy in ARF are not currently defined. Increased catabolism seen in ARF patients in the intensive care unit may justify large dialysis dose delivery. An apparent influence of delivered dialysis dose on the outcome of ARF intensive care unit patients has been recently observed at our institution. Compared with nonsurvivors, survivors had received significantly higher dialysis dose, as assessed by Kt/V and urea reduction ratio. In ARF patients, the discrepancy between delivered versus prescribed dialysis dose may be particularly important and contributed to by the following: reduced blood flow rate and dialysis time consequent to patient intolerance; lower dialyzer in vivo clearances, particularly in heparin-free dialysis; blood recirculation when using temporary vascular access; and postdialysis urea rebound. Prolonging the course of renal failure is one of the risks attributed to frequent dialysis; hypotension and ultrafiltration combined with a deficient renal autoregulation can result in further renal damage. The detrimental effects of bioincompatible membranes have been demonstrated with an induced-delay of renal function recovery. A recent study has reported benefits of biocompatible membranes in terms of potential for renal recovery and maintenance of urine output during dialytic support when compared with bioincompatible membranes. CRRT offers many advantages over intermittent hemodialysis for ARF intensive care unit patients: better hemodynamic tolerance, avoidance of solute rebound, and removal of serum sepsis mediators. However, CRRT have not yet been firmly shown to improve survival rates. Recently, urea kinetics have been used to estimate dialysis dose provided by CRRT.(ABSTRACT TRUNCATED AT 400 WORDS)
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PMID:What dialysis dose should be provided in acute renal failure? A review. 761 62

Struvite renal stones are caused by infection of the urine with bacteria that synthesize the enzyme urease. Ammonium is released by the breakdown of urea by urease, the urine becomes highly alkaline, and magnesium ammonium phosphate (struvite) and carbonate apatite crystallize. Incorporation of the infecting bacteria within the developing stone, results in a focus of infection that is resistant to conventional antimicrobial therapy, and which is manifested clinically by repeated urinary tract infection caused by persistent bacteriuria. Extracorporeal shock wave lithotripsy (ESWL) currently is accepted as the election treatment for most renal calculi. This trial examines the bacteriologic aspects pre and post-ESWL. Eighty adult patients, 47 females and 33 males, without clinical signs of urinary tract infections (UTI) were submitted to urine cultures pre and post-ESWL. The first 50 patients underwent during and post-ESWL, 150 blood cultures, which all proved to be negative, confirming very low risk of generalized sepsis. No patient presented fever, chills or rigors pre or postprocedures. With respect to urine cultures 43 patients (52.5%) had a pre-ESWL UTI, in comparison to 49 (60%) who had a UTI post-ESWL. The distribution of organisms pre and post-ESWL was as follows: Proteus mirabilis (22/22), Escherichia coli (11/11), Pseudomonas aeruginosa (4/5), Klebsiella pneumoniae (2/2), Enterobacter cloacae (0/1), Alcaligenes odorans (1/2) Enterococcus faecalis (1/3), Staphylococcus saprophyticus (1/2) and Candida albicans (1/1). In this study 6 patients presented bacteriuria post-ESWL probably due to bacteria from inside the calculi. According to these results, the risk of bacteremia seems to be very low. In 60% of staghorn renal stones we could demonstrate a bacterial infection.
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PMID:[Staghorn renal lithiasis treated with shock waves. Bacteriologic aspects]. 765 75

The characteristics of two types of intraperitoneal (i.p.) soilage sepsis models, autologous fecal inoculum (FEC) and a pure culture of Escherichia coli (EC), were studied in 26 male Yucatan minipigs (20-30 kg). Early (1-4 h) and late (24-72 h) changes were different between the two groups. The EC group was characterized early by hypotension, low cardiac output, and increased systemic and pulmonary vascular resistances, along with leukopenia, hypoglycemia, lactacidemia, and elevated blood urea nitrogen. Of the pigs in the EC group that survived the early effects, there were few significant differences in physiological parameters, compared to control pigs, that would indicate ongoing pathological processes. In contrast, the FEC group pigs demonstrated early hypotension, but with increased cardiac output and reduced systemic vascular resistance. Other parameter changes were similar to those seen in the EC pigs, but to a lesser degree, with the exception of elevations in serum lactate dehydrogenase. Also in contrast to the EC group, most of the changes in the FEC group persisted in later days, and FEC pigs demonstrated leukocytosis. There were also greater elevations in circulating lipopolysaccharide (LPS) concentrations in the EC group that returned later to baseline levels. In the FEC group, there were persistently elevated LPS concentrations over 72 h. These observations suggest that pigs challenged with intraperitoneal E. coli demonstrated an initial acute peritonitis and damaging physiologic effects of high levels of circulating LPS. Survivors in this group improved and were physiologically stable after 24 h. Pigs that received i.p. autologous feces developed an early acute peritonitis phase with lower levels of circulating LPS, and later developed pronounced peritoneal reaction as demonstrated by multiple abdominal abscesses, pyogenic granuloma formation, and adhesions with physiological evidence of developing sepsis over 72 h. These observations indicate that i.p. EC models evoke a systemic response not unlike intravenous administration of LPS or EC, however, the FEC model produced a systemic response akin to a slower developing septic process.
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PMID:Porcine peritoneal sepsis: modeling for clinical relevance. 773 52

The aim of this work was to evaluate the use of 1 m2 Cuprophan hollow fiber filters for continuous arteriovenous hemodialysis procedures. Thirty one critically ill patients (18 male) aged between 20 and 80 years old, subjected to 35 hemodialysis procedures were studied. Sixteen patients had acute renal failure (10 of these had multiorgan failures) and 15 terminal chronic renal failure. Femoral vessels were used for vascular access and isotonic peritoneal dialysis solution flowing at 16.6 ml/seg as dialyzing solution. No extracorporeal pump assistance was used. Mean procedure time was 76 +/- 69.7 h, filter consumption was 2.8 +/- 2.1 filters/procedure, ultrafiltration rate was 168 ml/min and urea clearance was 19.9 +/- 4.4 ml/min. No replacement solutions were required and good electrolyte and circulating volume control was achieved with excellent hemodynamic stability. Blood urea fell from 116.9 +/- 49.1 to 64 +/- 27.2 mg/dl after the procedure (p < 0.001). Hyperglycemia was observed in eight procedures, six patients developed non infectious vascular access complications and two patients catheter related sepsis. We conclude that continuous arteriovenous hemodialysis using cuprophan membranes is a good renal substitution technique for critically ill patients.
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PMID:[Continuous hemodialysis with cuprophan membranes in critical patients]. 780 33


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