We present an unusual case of acute lymphoblastic leukemia presenting as non-oliguric renal failure and hypertension in an adult patient along with the review of literature. To access this article, please choose from the options below [lrjournal.com]

Both cases presented during the monsoon season, with fever, abdominal pain and elevated concentrations of serum creatinine (4.3 and 5.6 mg/dl). Neither case required dialysis and both were successfully treated with penicillin. [ncbi.nlm.nih.gov]

In terms of clinical presentation, two presented with flu-like symptoms, two with Weil's disease and six with atypical manifestations. Table 2 shows the microbiological diagnostic techniques used and the titres of the different varieties. [revistanefrologia.com]

ARF due to other causes as partial obstruction may present as polyuria. ARF due to postrenal obstruction may present as anuria. Diagnosis Renal failure is manifested by the rise of serum creatinine. [doctorslounge.com]

• Fever

  Both cases presented during the monsoon season, with fever, abdominal pain and elevated concentrations of serum creatinine (4.3 and 5.6 mg/dl). Neither case required dialysis and both were successfully treated with penicillin. [ncbi.nlm.nih.gov]

  "Myoglobinuria and renal failure associated with typhoid fever" JAMA 238(4): 341, July 1977. Retrieved from: http://www.ncbi.nlm.nih.gov/pubmed/577542 17. Hall, J W, Johnson, W J, Maher, F T, Hunt, J C. [herdin.ph]

  Mortality in leptospirosis-associated AKI is around 22%. 4 Case presentation In October 2010 a 74-year-old Caucasian male was admitted because of fever, anuria and mialgia lasting for 2 days. [elsevier.es]

  Symptoms include fever and rash. Serum and urine eosinophil counts may be elevated. Autoimmune diseases, infection, and infiltrative diseases also can lead to interstitial nephritis. [aafp.org]

• Asymptomatic

  […] manifestations are highly variable, from flu-like symptoms to very serious forms (Weil's disease with liver, kidney and meningeal involvement and alterations in haemostasis).1–3 Leptospirosis causes acute interstitial nephritis which often presents either as asymptomatic [revistanefrologia.com]

  The hypocalcemia associated with AKI is usually asymptomatic and does not require specific treatment. [renalandurologynews.com]

  Presence of systolic dysfunction in the studied groups Urine volumes were significantly lower in patients with systolic dysfunction, even in asymptomatic patients – Fig. 10. [ncbi.nlm.nih.gov]

• Malnutrition

  Systolic left ventricular dysfunction, glomerular etiology, malnutrition and late initiating of hemodialysis were proved to be associated with low residual diuresis in our study. [ncbi.nlm.nih.gov]

  On This Site Tests: PT and INR Conditions: Liver Disease, Cystic Fibrosis, Celiac Disease, Inflammatory Bowel Disease, Malnutrition, Excessive Clotting Disorders Elsewhere On The Web MedlinePlus Medical Encyclopedia: Vitamin K MedlinePlus Medical Encyclopedia [labtestsonline.kr]

• Weakness

  Patients may present with generalized swelling, nausea & vomiting, oliguria, decreased LOC, uremic tongue, anorexia, GI bleeding, muscle weakness and/or twitching. [quizlet.com]

  Furosemide is a weak organic acid, cleared mainly by the kidneys, half of which is actively secreted in an unchanged form by organic acid transporters in the proximal tubule [13]. [austinpublishinggroup.com]

• Intravenous Administration

  "Intravenous Administration of Gentamicin Once Daily versus Thrice Daily in Adults." Eur. J. Clin. Microbiol. Infect. Dis. (1995) 88-91. 36. [antibiotikamonitor.at]

  administration of aminoglycosides, amphotericin B, or contrast media; (d) rhabdomyolysis, defined as serum myoglobin >10 mg/L; (e) fractionated sodium excretion >1% ( 29 )( 30 )( 31 ); (f) fractionated urea nitrogen excretion >35% ( 31 ); (g) blood urea [clinchem.aaccjnls.org]

• Pneumonia

  Welage L.S., Walawander C.A., Timm E.G., Grasela T.H.: "Risk Factors for Acute Renal Insufficiency in Patients With Suspected or Documented Bacterial Pneumonia." Ann. Pharmacother. 28 (1994) 515-522. 43. Hsu C.H., Kurtz T. [antibiotikamonitor.at]

  […] and Mycoplasma Pneumoniae screening were negative. [elsevier.es]

• Abdominal Pain

  Both cases presented during the monsoon season, with fever, abdominal pain and elevated concentrations of serum creatinine (4.3 and 5.6 mg/dl). Neither case required dialysis and both were successfully treated with penicillin. [ncbi.nlm.nih.gov]

  pain radiating from flank to groin Urolithiasis Genitourinary system Symptoms of benign prostatic hypertrophy Obstruction Musculoskeletal system Bone pain in older patient Multiple myeloma, prostate cancer Trauma, prolonged immobilization Rhabdomyolysis [aafp.org]

  In Postrenal Azotemia, Patients may be anuric or polyuric, and may c/o lower abdominal pain AND Obstruction can be constant or intermittent, and partial or complete Exam may reveal enlarged prostate, distended bladder, or mass palpable with pelvic exam [quizlet.com]

• Loss of Appetite

  Accumulation of urea and other nitrogen-containing substances in the bloodstream lead to a number of symptoms, such as fatigue, loss of appetite, headache, nausea and vomiting.[4] Marked increases in the potassium level can lead to abnormal heart rhythms [en.wikipedia.org]

• Heart Disease

  In some studies, the mortality rate in oliguric ARF due to aquired conditions such as asphyxia and sepsis was 60% and there are reports of higher mortality rate in the presence of heart disease. [pjms.com.pk]

• Jaundice

  The most severe form of Leptospirosis, characterized by jaundice, acute kidney injury and haemorrhagic diathesis, is referred as Weil's disease. [elsevier.es]

  As in this series, most cases of AKI are associated with jaundice.4 Although the most common is non-oliguric AKI, in cases associated with jaundice and/or hypotension, oliguric or anuric AKI can occur and if necessary, both haemodialysis and peritoneal [revistanefrologia.com]

  Acute post-operative renal failure in obstructive jaundice. Ann R Coll Surg 1968;42:163-7. 5. Suen WS, Mok CK, Chiu SW, Cheung KL, Lee WT, Cheung D, et al. [jpgmonline.com]

  Liano score) was recorded from clinical and laboratory data obtained on the day of inclusion by the following equation ( 12 ): 0.032 (age in decades) − 0.086 (male) − 0.109 (nephrotoxic origin of ATN) + 0.109 (oliguria) + 0.116 (hypotension) + 0.122 (jaundice [clinchem.aaccjnls.org]

• Ulcer

  Gastrointestinal and Nutritional Complications The major gastrointestinal complications associated with acute kidney injury include anorexia, nausea and vomiting and upper gastrointestinal bleeding, primarily due to stress ulcers and gastritis. [renalandurologynews.com]

• Seizure

  Management of uremia <ul><li>Fatigue, lethargy, mental dullness, norexia and nausea </li></ul><ul><li>More serious– myoclonus, confusion, delirium or coma, seizure and pericarditis </li></ul><ul><li>Diet protein control </li></ul><ul><li>Check GI bleeding [slideshare.net]

  Signs and symptoms of AKI include: decreased urine output (although occasionally, urine output remains normal) chest pain or pressure jugular vein distention fluid retention, causing edematous legs, ankles, or feet shortness of breath confusion nausea seizures [americannursetoday.com]

• Headache

  Leptospirosis has a biphasic course: initially the leptospiremic phase (lasting 3–10 days) with acute fever, severe headache, anorexia, diarrhoea; later the immune phase with more severe symptoms, such as meningitis and uveitis. [elsevier.es]

  Accumulation of urea and other nitrogen-containing substances in the bloodstream lead to a number of symptoms, such as fatigue, loss of appetite, headache, nausea and vomiting.[4] Marked increases in the potassium level can lead to abnormal heart rhythms [en.wikipedia.org]

• Lethargy

  Management of uremia <ul><li>Fatigue, lethargy, mental dullness, norexia and nausea </li></ul><ul><li>More serious– myoclonus, confusion, delirium or coma, seizure and pericarditis </li></ul><ul><li>Diet protein control </li></ul><ul><li>Check GI bleeding [slideshare.net]

Acute kidney injury 2016: diagnosis and diagnostic workup. Crit Care. 2016;20(1):299. [PubMed] 7. Muriithi A, Nasr S, Leung N. Utility of urine eosinophils in the diagnosis of acute interstitial nephritis. [emcrit.org]

• Hyperuricemia

  Mild hyperuricemia, as a result of decreased renal uric acid excretion, is common in AKI. More severe elevations in serum uric acid develop when AKI develops in the setting of hypercatabolism or cell lysis. [renalandurologynews.com]

  […] maintenance fluid (as long as patient in nonoliguric) Alkalinize urine with sodium bicarbonate in maintenance fluid to achieve urine pH greater than 7 Prescribe oral phosphorus binders Prescribe urate oxidase Renal replacement therapy for patients with hyperuricemia [clinicaladvisor.com]

  In addition to the elevated Cr, there is typically hyperuricemia, hyperphosphatemia, and hypocalcemia. [unboundmedicine.com]

• Hyponatremia

  Treatment of hyponatremia is generally free-water restriction. In patients with severe AKI and more profound hyponatremia, renal replacement therapy may be necessary. [renalandurologynews.com]

  Management of electrolyte homeostais <ul><li>Hypernatremia and hyponatremia </li></ul><ul><li>Hyperkalemia </li></ul><ul><li>Hypocalcemia </li></ul><ul><li>Hypomagnesemia </li></ul><ul><li>Hyperphosphatemia </li></ul> 20. [slideshare.net]

  Hypertonic bicarbonate ampules (50 ml ampules of 1 mEq/ml bicarbonate) are great for patients with hyponatremia. For example, two ampules (100 mEq/L) will typically increase the bicarbonate and sodium by ~3 mEq/L. [emcrit.org]

• Abnormal Renal Function

  Lema G, Urzua J, Jalil R, Canessa R, Moran S, Sacco C, et al Renal protection in patients undergoing cardiopulmonary bypass with preoperative abnormal renal function. Anesth Analg 1998; 86:3-8. 59. Flancbaum L, Dick M, Choban PS, Dasta JP. [jpgmonline.com]

A case of acute interstitial nephritis (AIN) developing after cefaclor treatment is reported. Diagnosis was proofed by kidney biopsy and lymphocyte transformation test. [ncbi.nlm.nih.gov]

545 Dialysis ultrafiltration and hemofiltration 555 Use of drugs in uremia and dialysis 567 Donor and recipient selection in renal transplantation 587 Immunosuppression and treatment of rejection in renal transplantation 595 XIII 606 Renal tubular and [books.google.de]

This acute renal failure improved upon cessation of zomepirac treatment. Renal biopsy disclosed the presence of a tubulointerstitial nephritis, which was thought to have been responsible for the acute renal failure in this patient. [mayoclinic.pure.elsevier.com]

Both recovered completely and gave normal results in their post-treatment renal-function tests. [tandfonline.com]

Otherwise, predicting prognosis of ARF/AKI from a heterogenous group of patients with renal dysfunction would be problematic. [ndt.oxfordjournals.org]

"Immediate and long-term prognosis in acute renal failure" Ann Intern Med 73(4): 515-521, October 1970. Retrieved from: http://www.ncbi.nlm.nih.gov/pubmed/5506002 18. Mudge, G H. [herdin.ph]

Classification into such groups, which can be simply made, is valuable in assessing prognosis and the results of treatment. [onlinelibrary.wiley.com]

Indicators of poor prognosis include older age, multiple organ failure, oliguria, hypotension, number of transfusions and acute on chronic kidney disease. Prognosis is closely related to the underlying cause. [patient.info]

Children less than 1 year of age have worse survival prognosis. Children admitted to an intensive care unit (ICU) have worse survival than those who are not. [clinicaladvisor.com]

The possible etiology of the renal failure was multiple in all cases and did not differ from that seen in oliguric acute tubular necrosis (ATN). [ncbi.nlm.nih.gov]

While they may help in the diagnosis and management of very specific etiologies like hepatorenal syndrome, most of the time a fluid challenge or diuresis will be the diagnostic and therapeutic tests of choice. JAMA. 1976 Aug 9;236(6):579-81. [medicine-matters.blogs.hopkinsmedicine.org]

A low FeNa, or low urine sodium reflects poor renal perfusion of any cause, not exclusively volume depletion as an etiology of AKI, and there are many causes of “low FeNa ATN” as listed above (Table 2). [hindawi.com]

Leptospirosis renal disease: emerging culprit of chronic kidney disease unknown etiology. Nephron, 138 (2018), pp. 129-136 [9] F.J. Gifford, R.M. Gifford, M. Eddleston, N. Dhaun. Endemic nephropathy around the world. [revistanefrologia.com]

Etiology Etiologies of AKI are classically divided according to the anatomic location of the physiologic defect. [unboundmedicine.com]

(Demonstrates changing pediatric AKI epidemiology over 2 decades) Bailey, D, Phan, V, Litalien, C. “Risk factors of acute renal failure in critically ill children: a prospective descriptive epidemiological study”. [clinicaladvisor.com]

The RIFLE criteria, however, has allowed for a more systematic approach which is useful in epidemiological and research studies [ 3 ]. [ndt.oxfordjournals.org]

Acute kidney injury: epidemiology and diagnostic criteria. Curr Opin Crit Care. 2006; 12: 531-537. Mehta RL, Kellum JA, Shah SV, Molitoris BA, Ronco C, Warnock DG. Acute Kidney Injury Network. [austinpublishinggroup.com]

The Emerging Infections Network (EIN) is a forum for infectious diseases consultants and public health officials to report information on clinical phenomena and epidemiological issues with public health significance. [news.idsociety.org]

This edition has been thoroughly revised by world-renowned contributors to reflect recent developments in renal pathophysiology. [books.google.de]

Pathophysiology of hemodynamically mediated acute renal failure in man. Kidney Int 18: 594–604, 1980. Google Scholar 45. Blantz RC. Mechanisms of acute renal failure after uranyl nitrate. J Clin Invest 55: 621–635, 1975. [link.springer.com]

Neonatology: Pathophysiology and management of newborn. 6th ed. Philadelphia. Lippincott Williams & Wilkins. 2005;2:1000-9. 3. Gouyon JB, Guignard JP. Management of acute renal failure in newborns. Pediatr Nephrol 2000;14(10-11):1037-44. 4. [pjms.com.pk]

[…] use of fenoldopam in the prevention of ARF. [jpgmonline.com]

Prevention of post procedural acute kidney injury in the catheterization laboratory in a real-world population. Int J Cardiol. 2016 Oct 11. 226:42-47. [Medline]. Briguori C. [medscape.com]

[…] underlying renal impairment probable that other disturbances in potassium homeostasis, such as hyopoaldosteronism and treatment with medications that impair renal potassium excretion, are also risk factors for hyperkalaemia with trimethoprim therapy prevention [gpnotebook.co.uk]

Prevention of contrast nephropathy by furosemide with matched hydration: the MYTHOS(induced diuresis with matched hydration compared to standard hydration for contrast induced nephropathy prevention) trial. JACC Cardiovasc Interv. 2012; 5: 90-97. [austinpublishinggroup.com]