Acute Kidney Injury Recovery.

Background: Acute kidney injury (AKI) is associated with both short- and long-term clinical consequences including progression to chronic kidney disease. Recovery of renal function has gained importance, as interventions to prevent or treat AKI are limited. Basing recovery on a return of serum creatinine values excludes mounting evidence that AKI, even when reversible, is a very serious clinical event that will result in a significant number of both renal and extra-renal complications such as late stage kidney disease, major cardiovascular events, and death.

Sequelae of AKI.

Large epidemiologic studies in a variety of patient populations reveal increased morbidity and mortality that occur months to years after an episode of acute kidney injury (AKI). Even milder forms of AKI have increased associated morbidity and mortality. Residual confounding may account for these findings, but considering the huge number of individuals afflicted with AKI, the sequelae of AKI may be a very large public health burden.

Impact of Acute Kidney Injury in Patients Hospitalized With Pneumonia.

Objectives: Pneumonia is a common cause of hospitalization and can be complicated by the development of acute kidney injury. Acute kidney injury is associated with major adverse kidney events (death, dialysis, and durable loss of renal function [chronic kidney disease]). Because pneumonia and acute kidney injury are in part mediated by inflammation, we hypothesized that when acute kidney injury complicates pneumonia, major adverse kidney events outcomes would be exacerbated.

Long-term consequences of acute kidney injury in the perioperative setting.

Purpose Of Review: Recent studies indicate that acute kidney injury (AKI) and chronic kidney disease (CKD) are interconnected syndromes. Although the majority of patients who suffer an episode of AKI will recover laboratory indices suggesting complete or near complete recovery of renal function, a significant portion of post-AKI survivors will develop major kidney events, including development of late-stage CKD, need for renal replacement therapies, and death.

Recent Findings: Our review highlights epidemiology of adverse post-AKI events, association of AKI with late development of nonrenal adverse outcomes, use of bedside equations that facilitate prognostication of adverse renal outcomes of AKI, and how variability in serum creatinine values in individual patients, even among those with normal baseline renal function may indicate risk for the development of CKD.

High serum creatinine nonlinearity: a renal vital sign?

Patients with chronic kidney disease (CKD) may have nonlinear serum creatinine concentration (SC) trajectories, especially as CKD progresses. Variability in SC is associated with renal failure and death. However, present methods for measuring SC variability are unsatisfactory because they blend information about SC slope and variance.

The Acute Kidney Injury to Chronic Kidney Disease Transition: A Potential Opportunity to Improve Care in Acute Kidney Injury.

Recent controlled trials, epidemiological analyses and basic research studies offer a comprehensive view of the short and long-term clinical repercussion of de novo acute kidney injury or AKI. While most post-AKI patients recover their baseline renal function, a significant number, approximately ~20% of those affected, will go on to develop long term illness characterized by an increase in late stage CKD, cardiovascular complications, and increased death rates. When AKI occurs in hospitalized patients, selected demographic and laboratory results can be incorporated into risk calculators that identify those at higher risk for long-term complications.

Exercise capacity and risk of chronic kidney disease in US veterans: a cohort study.

Objective: To assess the association between exercise capacity and the risk of developing chronic kidney disease (CKD).

Patients And Methods: Exercise capacity was assessed in 5812 male veterans (mean age, 58.4±11.

Association between AKI and long-term renal and cardiovascular outcomes in United States veterans.

Background And Objectives: AKI is associated with major adverse kidney events (MAKE): death, new dialysis, and worsened renal function. CKD (arising from worsened renal function) is associated with a higher risk of major adverse cardiac events (MACE): myocardial infarction (MI), stroke, and heart failure. Therefore, the study hypothesis was that veterans who develop AKI during hospitalization for an MI would be at higher risk of subsequent MACE and MAKE.

Procalcitonin induced cytotoxicity and apoptosis in mesangial cells: implications for septic renal injury.

Objective And Design: Immuno-neutralization of procalcitonin (ProCT) has been shown to ameliorate experimental sepsis as well as the renal complications of this disease. Accordingly, we investigated the direct effect of ProCT on mesangial cells (MCs).

Material: Primary culture of murine MCs.

The severity of acute kidney injury predicts progression to chronic kidney disease.

Acute kidney injury (AKI) is associated with progression to advanced chronic kidney disease (CKD). We tested whether patients who survive AKI and are at higher risk for CKD progression can be identified during their hospital admission, thus providing opportunities to intervene. This was assessed in patients in the Department of Veterans Affairs Healthcare System hospitalized with a primary diagnosis indicating AKI (ICD9 codes 584.

Arteriovenous fistulas among incident hemodialysis patients in Department of Defense and Veterans Affairs facilities.

A higher proportion of patients initiate hemodialysis (HD) with an arteriovenous fistula (AVF) in countries with universal health care systems compared with the United States. Because federally sponsored national health care organizations in the United States, such as the Department of Veterans Affairs (DVA) and the Department of Defense (DoD), are similar to a universal health care model, we studied AVF use within these organizations. We used the US Renal Data System database to perform a cross-sectional analysis of patients who initiated HD between 2005 and 2006.

Outcomes following diagnosis of acute renal failure in U.S. veterans: focus on acute tubular necrosis.

When patients develop acute kidney injury, a small fraction of them will develop end-stage renal disease later. The severity of renal impairment in the remaining patients is uncertain because studies have not carefully examined renal function over time or the precise timing of entry into a late stage of chronic kidney disease. To determine these factors, we used a United States Department of Veterans Affairs database to ascertain long-term renal function in 113,272 patients.

Separation of two Cl(-) currents in cultured human and murine mesangial cells: biophysical and pharmacological characteristics of I(Cl.vol) and I(Cl.Ca).

Mesangial cells, a combined smooth muscle- and fibroblast-like phenotype, are important regulators of renal function. These cells exist in a region of variable osmolarity and may require Cl(-) channels for volume regulation. Additionally, Ca(2+)-activated Cl(-) channels in these cells may participate in Ca(2+)-dependent contractile responses to vasoactive agonists.

Rheological behavior of rat mesangial cells during swelling in vitro.

The response of cells to mechanical forces depends on the rheological properties of their membranes and cytoplasm. To characterize those properties, mechanical and electrical responses to swelling were measured in rat mesangial cells (MC) using electrophysiologic and video microscopic techniques. Ion transport rates during hyposmotic exposures were measured with whole-cell recording electrodes.

Cation conductance regulated by ambient Cl- in cultured rat mesangial cells.

Several functions of mesangial cells, such as contraction and release of nitric oxide, are dependent on the ambient Cl- concentration. Herein we describe a direct effect of Cl- on mesangial cell membrane conductance. Rat mesangial cells were isolated, cultured, and were patch-clamped in the whole-cell configuration.

Mechanosensitive single channel calcium currents in rat mesangial cells.

Mechanical stimulation of mesangial cells enhances expression of early response protooncogenes in an extracellular Ca(2+)-dependent manner. This has lead investigators to postulate that a mechanosensitive Ca2+ channel may exist in these cells. At the present time, however, very little is known about single channel Ca2+ currents in mesangial cells.

Dexamethasone enhances active cation transport in cultured aortic smooth muscle cells.

Previous studies have indicated that ouabain-sensitive cation transport is increased in arteries obtained from rats with glucocorticoid-induced hypertension. However, it remained unclear whether this effect reflected direct glucocorticoid activation or rather depended on the elevated arterial pressure per se. In the present study, we examined the effect of dexamethasone on cultured rat aortic smooth muscle cells.

Membrane currents controlled by physical forces in cultured mesangial cells.

Mechanically-activated ion channels (MACs) of cultured rat mesangial cells were stimulated by applying suction to patch pipets or by exposing cells to hypoosmotic media. MAC density was estimated as 1.5 +/- 0.

Role of ionic currents in the physiological response to angiotensin II.

Studies using conventional and patch-clamp microelectrode techniques demonstrate that in a number of cell types angiotensin II (AII) causes reversible changes in transmembrane ionic currents, and that these effects can be mimicked by various membrane-associated and cytosolic messengers. AII modulates the current amplitude of ion channels, as well as their activation threshold and their open/closed time probability. Stimulatory and inhibitory effects on ion channel activity are a fundamental feature of the development of AII actions on target organs.

Intracellular chloride activity in cultured mesangial cells.

Glomerular mesangial cells require Cl ions for the development of a variety of metabolic and functional properties. In the present study the electrochemical distribution for Cl- was examined in cultured rat mesangial cells with Cl(-)-sensitive intracellular microelectrodes. It was determined that the intracellular Cl activity exceeded the levels predicted for a passively distributed ion.

Uncoupled basal sodium absorption and chloride secretion in prairie dog (Cynomys ludovicianus) gallbladder.

1. Prairie dog gallbladders mounted in a Ussing-type chamber and bathed with symmetrical Ringer's solutions exhibited a transepithelial resistance (Rt) of 51 +/- 5 omega cm2, a lumen negative potential difference (Vms) of 11.5 +/- 0.

Modulation of aortic smooth muscle cell membrane potential by extracellular calcium.

Removal of extracellular calcium may result in depolarization of the resting cell membrane potential. This has been attributed to the stabilizing action of calcium on the ionic permeability of the cell membrane. It is unknown whether this phenomenon is exclusively mediated by extracellular calcium or through associated changes in intracellular calcium.