Aim Acute kidney injury (AKI) is a frequent complication in cirrhotic patients. As serum creatinine is a poor marker of renal function in this population, we aimed to study the utility of several biomarkers in this context. Methods A prospective study was conducted in hospitalized patients with decompensated cirrhosis. Serum creatinine (SCr), Cystatin C (CystC), NGAL and urinary NGAL, KIM‐1, protein, albumin and sodium were measured on three separate occasions. Renal resistive index (RRI) was obtained. We analyzed the value of these biomarkers to determine the presence of AKI, its aetiology [prerenal, acute tubular necrosis (ATN), or hepatorenal (HRS)], its severity and a composite clinical outcome at 30 days (death, dialysis and intensive care admission). Results We included 105 patients, of which 55 had AKI. SCr, CystC, NGAL (plasma and urinary), urinary sodium and RRI at inclusion were independently associated with the presence of AKI. SCr, CystC and plasma NGAL were able to predict the subsequent development of AKI. Pre‐renal state showed lower levels of SCr, NGAL (plasma and urinary) and RRI. ATN patients had high levels of NGAL (plasma and urinary) as well as urinary protein and sodium. HRS patients presented an intermediate pattern. All biomarkers paralleled the severity of AKI. SCr, CystC and plasma NGAL predicted the development of the composite clinical outcome with the same performance as the MELD score. Conclusions In patients with decompensated cirrhosis, early measurement of renal biomarkers provides valuable information on AKI aetiology. It could also improve AKI diagnosis and prognosis.

BackgroundHerpes simplex virus (HSV) is the most common identified cause of focal encephalitis worldwide. However, postoperative HSV encephalitis (HSVE) is a rare complication of neurosurgical procedures and a significant clinical challengeMethodWe describe 3 cases of postoperative HSVE and review all published reports. A total of 23 cases were identified.DiscussionClinical heterogeneity represents a diagnostic challenge in the postoperative setting. Cerebral magnetic resonance imaging showed typical findings in a minority of patients only, whereas HSV-specific polymerase chain reaction on the cerebrospinal fluid proved to be a valuable test. The postoperative viral pathophysiology remains a subject of debate. The rate of adverse outcome is high and early antiviral treatment seems to be a strong predictor of clinical outcome.ConclusionWe recommend early empirical treatment for any patient presenting with post-neurosurgical lymphocytic meningo-encephalitis, and prophylactic antiviral treatment for patients with a history of previous HSVE who will undergo a neurosurgical procedure.

While sodium is essential for human homeostasis, current salt consumption far exceeds physiological needs. Strong evidence suggests a direct causal relationship between sodium intake and blood pressure (BP) and a modest reduction in salt consumption is associated with a meaningful reduction in BP in hypertensive as well as normotensive individuals. Moreover, while long-term randomized controlled trials are still lacking, it is reasonable to assume a direct relationship between sodium intake and cardiovascular outcomes. However, a consensus has yet to be reached on the effectiveness, safety and feasibility of sodium intake reduction on an individual level. Beyond indirect BP-mediated effects, detrimental consequences of high sodium intake are manifold and pathways involving vascular damage, oxidative stress, hormonal alterations, the immune system and the gut microbiome have been described. Globally, while individual response to salt intake is variable, sodium should be perceived as a cardiovascular risk factor when consumed in excess. Reduction of sodium intake on a population level thus presents a potential strategy to reduce the burden of cardiovascular disease worldwide. In this review, we provide an update on the consequences of salt intake on human health, focusing on BP and cardiovascular outcomes as well as underlying pathophysiological hypotheses.

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Background The clinical utility of bone mineral density (BMD) measurement by dual-energy X-ray absorptiometry (DXA) is debated in end-stage kidney disease (ESKD). We assessed the ability of BMD measured at different anatomical sites to predict mortality and fracture risk in patients requiring renal replacement therapy (RRT). Methods We reviewed all-cause mortality as well as incident hip and overall fracture risk in RRT patients who had BMD measured at femoral neck, lumbar spine, arm, head, pelvis and total body, as part of their routine follow-up between January 2004 and June 2012 at a single university center. Results 588 patients were included. Median follow-up was 6.5 years. Mean age was 59.6 with 57.9% males. Femoral neck BMD (FNBMD) (normal/high vs low) was negatively associated with mortality in univariate and multivariate analysis (p < 0.001 and p = 0.048, respectively). Other sites of BMD measurements were not associated with mortality. In multivariate analysis, FNBMD was negatively associated with hip and any fracture risk (p = 0.004 and p = 0.013, respectively). No significant interaction was found between FNBMD and gender or PTH (p = 0.112 and p = 0.794, respectively). Conclusions BMD measured at the femoral neck is predictive of mortality in patients requiring RRT, regardless of modality. Low BMD might be a marker of global patient frailty rather than a direct causal factor in this setting. FNBMD is also a strong predictor of hip and any fracture risk in this population, regardless of bone turnover as assessed by PTH levels. FNBMD is thus an overall prognostic marker in patients requiring RRT.