Hypophosphataemia in Septicaemia: Higher Incidence in Gram-negative Than in Gram-positive Infections

Riedler, G; Scheitlin, W

doi:10.1136/bmj.1.5646.753

Cited by 87 publications

(32 citation statements)

References 18 publications

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“…This indicated the pivotal role of apical NaPiT2a for reabsorption of urinary Pi. In other words, our finding that the decrease in apical NaPiT2a is associated with the progression of ARF might explain possible hypo-phosphatemia, as noted in patients with septic ARF (2,16,24). Although further studies are required to confirm the reciprocal balance between decreased NaPiT2a and hypo-phosphatemia, it is likely that maintenance of Pi-absorbing transporters on tubular apical surfaces is important as a strategy to minimize the onset of hypo-phosphatemia, a common event during septic ARF.…”

Section: Usefulness Of Napit2a As a Negative Marker Of Renal Dysfunctmentioning

confidence: 93%

“…Since NaPiT2a is critical for re-absorption of urinary Pi (7,23,29), this marker may be helpful to predict not only renal damage but also phosphate metabolism. Given that plasma Pi levels are known to markedly decrease in septic patients (2,16,24), the loss in renal tubular NaPiT2a may provide a rationale to explain why hypo-phosphatemia occurs in septic humans (2,24) and animals (27). Although further study is required to extend the value of NaPiT2a as a predictor in other kidney diseases, the present findings may provide new diagnostic approaches to understanding pathological status during sepsis.…”

Section: Usefulness Of Napit2a As a Negative Marker Of Renal Dysfunctmentioning

confidence: 99%

“…Considering that glomerular thrombosis triggers the onsets of tubular BBM injury, hypoxia and renal dysfunction (20,30), how to inhibit the production or function of thrombosis-priming factors (such as tumor necrosis factor-α and interleukin-6) would be critical for maintenance of apical surface structure as well as for prevention of renal tubular hypoxia, especially at the earlier phase of septic ARF. By the way, it is interesting to note that hypophosphatemia occurs in more than 80% of septic patients (2,16,24). Indeed, hypophosphatemia, as defined by a serum level < 1.0 mg/dL causes severe respiratory failure, myocardial depression and seizures (24).…”

Section: Usefulness Of Napit2a As a Negative Marker Of Renal Dysfunctmentioning

confidence: 99%

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Type 2a sodium-phosphate co-transporter serves as a histological predictor of renal dysfunction and tubular apical damage in the kidneys of septic mice

et al. 2009

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Acute renal failure (ARF) occurs in septic patients and is histologically characterized by tubular apical damages, including brush border breakdown. Nevertheless, little information is available to identify the apical injury at a molecular level. Type 2a Na-phosphate (Pi) co-transporter (NaPiT2a) is constitutively expressed by brush borders of proximal tubules under a healthy condition. Therefore, we investigated if NaPiT2a could be used as a negative marker to predict the renal dysfunction, using an animal model of septic ARF. After the treatment of lipopolysaccharide (LPS), mice manifested the tubular apical injury and renal dysfunction, as evidenced by the increase in blood urea nitrogen (BUN) levels. Immunohistochemical examination revealed that the expression of NaPiT2a by renal proximal tubules became faint, being reciprocal to the development of tubular hypoxia during sepsis. Inversely, the loss in apical NaPiT2a was restored in a regenerating stage, associated with the recovery from renal hypoxia. Overall, there was a negative correlation between the NaPiT2a expression and BUN levels or tubular injury scores in septic mice. Our data indicate that the loss of NaPiT2a is a reliable marker for predicting the progression of septic ARF, while local hypoxia might be involved in the decrease of NaPiT2a expression.

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Section: Usefulness Of Napit2a As a Negative Marker Of Renal Dysfunctmentioning

confidence: 93%

Section: Usefulness Of Napit2a As a Negative Marker Of Renal Dysfunctmentioning

confidence: 99%

Section: Usefulness Of Napit2a As a Negative Marker Of Renal Dysfunctmentioning

confidence: 99%

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Type 2a sodium-phosphate co-transporter serves as a histological predictor of renal dysfunction and tubular apical damage in the kidneys of septic mice

et al. 2009

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“…Hypophosphatemia has long been reported for adult patients in the early phase of sepsis, most often caused by gram-negative bacteria [3]. Serum phosphate levels normalize within days, as the symptoms of acute septicemia subside.…”

Section: Sirsmentioning

confidence: 98%

Hypophosphatemia in meningococcal sepsis

Antachopoulos

Papassotiriou

2004

Pediatr Nephrol

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“…Hypophosphatemia has been reported as one of the early findings of severe sepsis/septic shock [4,5]. Moreover, it has been recognized as an independent risk factor for the development of cardiac arrhythmias and a high mortality rate in septic patients.…”

mentioning

confidence: 99%

Clinical outcome of critically ill patients with thrombocytopenia and hypophosphatemia in the early stage of sepsis

Brotfain¹,

Schwartz²,

Boniel³

et al. 2016

Anaesthesiol Intensive Ther

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Background: Hypophosphatemia and thrombocytopenia may both be independent risk factors for the development of multiple organ failure and correlate well with the severity of sepsis. In the present study we wanted to analyze the potential clinical role and prognostic significance of both early hypophosphatemia and thrombocytopenia on clinical outcomes of critically ill ICU patients with severe sepsis Methods: We analyzed the clinical data, including the outcome of critically ill ICU patients with severe sepsis who presented during a 5 year period with early hypophosphatemia and thrombocytopenia.This study was retrospective and single centre. All clinical and laboratory data was collected from the patients' ICU and hospital electronic records. All laboratory measurements were done on admission and during the ICU stay. Results: The included patients were distributed into one of three study groups based on the presence of hypophosphatemia and/or thrombocytopenia during the first 24 hours of admission to the ICU: group 1 -early hypophosphatemia; group 2 -early hypophosphatemia and thrombocytopenia and group 3 -early thrombocytopenia. The ICU mortality rate was significantly higher in groups 2 and 3 (25.9% and 22% vs. 9.3%, respectively, P = 0.034). An APACHE II score > 27, a TISS score > 25 following the first 24 hours of ICU stay , an age higher than 70, male gender and total parenteral nutrition were independent predictors of ICU and hospital mortality in this study population. Conclusion: It may be considered that hypophosphatemia and thrombocytopenia in the early stage of sepsis, even when severe and coexisting, reflect the degree of initial illness severity of sepsis. However, further investigations need to be done for a better understanding of the potential clinical role of these features in the septic critically ill population.

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Hypophosphataemia in Septicaemia: Higher Incidence in Gram-negative Than in Gram-positive Infections

Cited by 87 publications

References 18 publications

Type 2a sodium-phosphate co-transporter serves as a histological predictor of renal dysfunction and tubular apical damage in the kidneys of septic mice

Type 2a sodium-phosphate co-transporter serves as a histological predictor of renal dysfunction and tubular apical damage in the kidneys of septic mice

Hypophosphatemia in meningococcal sepsis

Clinical outcome of critically ill patients with thrombocytopenia and hypophosphatemia in the early stage of sepsis

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