Background:Acute kidney injury (AKI) is an uncommon but serious complication after trauma. The objective of this study was to evaluate the prevalence, clinical characteristics and outcome of AKI after trauma.Patients and Methods:This was a retrospective study performed from January 2006 to January 2008 in an emergency specialized hospital in Fortaleza city, northeast of Brazil. All patients with AKI admitted in the study period were included. Prevalence of AKI, clinical characteristics and outcome were investigated.Results:Of the 129 patients admitted to the intensive care unit (ICU), 52 had AKI. The mean age was 30.1 ± 19.2 years, and 79.8% were males. The main causes of AKI were sepsis in 27 cases (52%) and hypotension in 18 (34%). Oliguria was observed in 33 cases (63%). Dialysis was required for 19 patients (36.5%). Independent risk factors associated with AKI were abdominal trauma [odds ratio (OR) = 3.66, P = 0.027] and use of furosemide (OR = 4.10, P = 0.026). Patients were classified according to RIFLE criteria as Risk in 12 cases (23%), Injury in 13 (25%), Failure in 24 (46%), Loss in 1 (2%) and End-stage in 2 (4%). Overall in-hospital mortality was 95.3%. The main cause of death was sepsis (24%). Mortality was 100% among patients with AKI.Conclusions:AKI is a fatal complication after trauma, which presented with a high mortality in the studied population. A better comprehension of factors associated with death in trauma-associated AKI is important, and more effective measures of prevention and treatment of AKI in this population are urgently needed.

Visceral leishmaniasis is an endemic disease caused by various species of Leishmania. We made a retrospective study of 57 consecutive patients with visceral leishmaniasis in Brazil. Patients with visceral leishmaniasis were identified using the registries of the São José Infectious Diseases Hospital. The sample was divided into two groups: patients with serum creatinine (Scr) <1.3mg/dL and Scr ≥ ≥ ≥ ≥ ≥ 1.3mg/dL. We compared these two groups for differences in clinical manifestations and laboratory features. Patients' mean age was 28 ± 18 years old; 74% were male. The main clinical symptoms and signs presented in the initial evaluation were: fever (97%), splenomegaly (96.4%), weight loss (95.5%), pallor (93.6%), cough (89.7%), hepatomegaly (87.2%), asthenia (83.3%), anorexia (82.9%) and vomiting (73.9%). Acute renal failure was found in 15 patients (26.3%) and eight of these patients had ARF before amphotericin B administration. The mean age was higher in the group with Scr ≥ ≥ ≥ ≥ ≥ 1.3mg/dL. Death occurred in three cases; all deaths occurred with Scr ≥ ≥ ≥ ≥ ≥ 1.3mg/dL. There were no significant differences in the frequencies of the clinical symptoms and signs between the two groups. The laboratory data and demographic characteristics were significantly worse in the Scr ≥ ≥ ≥ ≥ ≥ 1.3mg/dL group. Renal dysfunction is an important feature of this disease; it is associated with important morbidity and can increase mortality.

Among the 340 stones analyzed, 34.7% were pure. The most frequent stone was calcium oxalate (CaOx) (59.3%), followed by uric acid (23.7%). CaOx was more frequently seen in women (p=0.024), while uric acid was more common in men (p<0.001). Among the mixed stones, CaOx (67.1%) was the most frequent major component, followed by carbapatite (11.2%) and struvite (7.9%). CaOx (p<0.001) and uric acid (p=0.014) were more frequently the major components in men, while carbapatite (p<0.001) and struvite (p=0.011) were more frequent in women. The major component of both pure and mixed stones was CaOx (65.1%), followed by uric acid (10.9%), carbapatite (10%), struvite (6.7%), ammonium urate (5.1%), cystine (1.8%) and protein (0.4%). These findings may be related to regional factors, such as weather and nutritional habits.

The chance of CHIKV infection becoming chronic arthralgia in KTR was not different from data in literature. Seven patients presented AKI in the acute phase of infection, although that did not persist. Previous costicosteroids use did not relate with AKI or chronic arthralgia.