الفهرس 
AcknowledgementsOnly 14 pages are availabe for public view
 |  | from | 137 |  |  |
| | | from | 137 | | |
Abstract
Acute renal failure (ARF) is a common problem in intensive care medicine. Even modest degrees of ARF not requiring dialysis treatment increase the risk of death approximately five fold. Today, patients with ARF have increased co-morbidity, an increased complication rate. In addition to effects on patient mortality, ARF prolongs hospitalization by an average of 10 days. ( Evenepoel, 2004).
Acute kidney injury (AKI) develops in many of the patients admitted with history of envenomation and poisoning. (SivaKumar and Karthikeyan, 2018)
The present study was a retro and prospective cross-sectional study. It was carried out on 70 patients with ARF from drug or toxin intake admitted to Ain Shams Poison Control Center retrospectively during the period from January 2018 to the end of December 2018 and prospectively during the period of April 2019 to the end of September 2019.
The study aimed to detect the percentage of acute kidney injury among acute poisoning patients, identify the causes and mechanism of acute kidney injury in acute toxicity and analyze the outcome and prognosis according to RIFLE criteria (risk, injury, failure, loss and end stage renal disease) for acute kidney injury.
During the study, data were recorded in a special sheet and statistically analyzed and presented in tables, graphs and figures. The data was recorded in the following: Socio-demographic data, Clinical data, Investigational data, Therapeutic interventions, RIFLE staging system and Outcome.
The present study revealed that:
o During period of study, the percentage of studied patients from total number (10893) of patients admitted to Ain Shams Poisoning Control Center (ASPCC) was 0.0064%.
o The most common drugs and toxins causing acute kidney injury were opiate, organophosphorous, methanol, PPD, hashish, tramadol, carbamate, dormex, corrosive, aluminum phosphide, theophylline, snake bite, metformin, clozapine, CO toxicity, digoxin, warfarin, ibuprofen, lithium and carbamazepine respectively.
o The majority of patients fell in the age group 31-40 years & the age group 41-50years.
o Male intoxicated patients were more than females in the study.
o The route of exposure in the studied patients was mostly oral.
o The mode of poisoning in the studied patients was mostly accidental addict and suicidal.
o Most of patients had normal blood pressure. Approximately one third of them had hypotension.
o Majority of the studied patients had no urinary manifestations.
o Less than half of the studied cases had metabolic acidosis.
o Majority of the studied patients were admitted in ICU.
o Dialysis was performed in a few patients but the majority had no dialysis.
o Majority of the studied patients were in failure stage followed by injury stage, risk stage, loss of function stage and end stage kidney disease respectively.
o About 51.43% of the studied patients had complete recovery, where 42.86% died and only 5.71% had chronic kidney disease.
o The study showed that there was statistical significant difference in patients with organophosphorous poisoning as regard presence of hypotension.
o All patients with dormex, aluminum phosphide, digoxin, theophylline, snake bite and lithium toxicity had hypotension.
o All patients with corrosive, PPD, metformin, warfarin, ibuprofen, clozapine, carbamazepine and CO toxicity had no hypotension.
o There was statistical significant difference as regard presence of hypotension in relation to the injury stage.
o There was hypotension in all patients with end stage kidney disease.
o There was statistical significant difference as regard presence of hypotension in relation to complete recovery.
o There was statistical significant difference as regard presence of hypotension in relation to both coma 0 & coma IV.
o The present study showed that there was statistical significant difference in patients with different urinary system manifestations in relation to both opiate poisoning & organophosphorous poisoning.
o All patients with tramadol, hashish, corrosive, aluminum phosphide, theophylline, snake bite, metformin, ibuprofen, lithium, carbamazepine and CO toxicity had no urinary manifestations. All patients with digoxin toxicity had anuria. All patients with warfarin toxicity had heamaturia.
o There was statistical significant difference in the mean value ±SD of serum urea in relation to different urinary system manifestations.
o There was statistical significant difference in patients with different urinary manifestations in relation to both injury & failure stages .All patients in the risk stage had no urinary manifestations. All patients in the end stage kidney disease had anuria.
o There was statistical significant difference in patients with different urinary manifestations in relation to both complete recovery and death.
o There was statistical significant difference in patients with different grades of coma in relation to both complete recovery and death.
o There was statistical significant difference as regard presence of metabolic acidosis in relation to opiate toxicity.
o All patients with dormex, methanol, corrosive, warfarin, ibuprofen and lithium toxicity had metabolic acidosis. All patients with PPD, digoxin, snake bite and carbamazepine toxicity had no metabolic acidosis.
o All patients in the end stage kidney disease had metabolic acidosis.
o There was statistical significant difference in the mean value of serum creatinine in acutely injured patients in relation to different outcomes.
o There was statistical significant difference in the mean value of serum creatinine in acutely injured patients in relation to different RIFLE stages.
o There was statistical significant difference in the mean value of serum urea in acutely injured patients in relation to different RIFLE stages.
o There was statistical significant difference in the mean value of eGFR in acutely injured patients in relation to different RIFLE stages.
o There was statistical significant difference in the mean value of eGFR in acutely injured patients in relation to different outcomes.
o All patients with carbamate, aluminum phosphide, digoxin, theophylline, metformin and carbamazepine toxicity had normal serum k level. All patients with warfarin and ibuprofen toxicity had low serum K level. All patients with snake bite had high serum K level.
o There was statistical significant difference in patients with different serum K levels in relation to the failure stage. All patients in the loss of function stage had normal K level. All patients in the end stage kidney disease had high K level.
o There was statistical significant difference in patients with different serum K levels in relation to both outcomes as complete recovery and death.
o The present study showed that there was statistical significant difference in patients with different RIFLE stages in relation to opiate toxicity.
o All patients with carbamazepine toxicity were in the risk stage. All patients with clozapine and CO toxicity were in the injury stage. All patients with dormex, theophylline, snake bite, warfarin, ibuprofen and lithium toxicity were in the failure stage. All patients with digoxin toxicity were in the loss of function stage.
o There was statistical significant difference in patients with different age groups in relation to the failure stage. All patients in the end stage kidney disease fell in age group 21-30 years.
o There was statistical significant difference in patients with different outcomes in relation to the failure stage. All patients in the loss of function & end stage kidney disease stages had chronic kidney disease as an outcome.
o All patients with tramadol, corrosive, warfarin, ibuprofen, carbamazepine and CO toxicity had complete recovery. All patients with digoxin toxicity had chronic kidney disease. All patients with dormex, snake bite, lithium and clozapine toxicity died.
o There was statistical significant difference in patients with different outcomes in relation to age groups of (31-40) years & (41-50) years.
o ROC curve analysis was used to assess systolic blood pressure as a predictor of survival in the current study with a cut off value ˃ 90 had a corresponding sensitivity (80%), specificity (63.33%), PPV (74.4%) and NPV (70.4%) with accuracy rate (70%).
o ROC curve analysis was used to assess diastolic blood pressure as a predictor of survival in the current study with a cut off value ˃ 50 had a corresponding sensitivity (85%), specificity (56.67%), PPV (72.3%) and NPV (73.9%) with accuracy rate (70.7%).
The present study revealed that:
o During the period of study, the percentage of studied patients from total number (10893) of patients admitted to Ain Shams poisoning control center (ASPCC) was 0.0064%.
o The most common drugs and toxins causing acute kidney injury were opiate, organophosphorous, methanol, PPD, hashish, tramadol, carbamate, dormex, corrosive, aluminum phosphide, theophylline, snake bite, metformin, clozapine, CO toxicity, digoxin, warfarin, ibuprofen, lithium and carbamazepine respectively.
o Majority of studied patients were in failure stage followed by injury stage, risk stage, loss of function stage and end stage kidney disease respectively.
o About 51.43% of studied patients had complete recovery, where 42.86% died and only 5.71% had chronic kidney disease.
Recommendations
The present study recommends that:
o Careful assessment of hemodynamic and volume status using vital signs and physical examination.
o Patients should be pre-hydrated and GFR should be frequently monitored during the administration of a potentially nephrotoxic drug.
o Future research should evaluate whether the use of early markers of tubular damage like KIM-1, NGAL, IL-18, Clusterin, and Cystatin C can reduce the incidence of nephrotoxicity.