Acute kidney injury in critically ill cancer patients : an update

Patients with cancer represent a growing group among actual ICU admissions (up to 20 %). Due to their increased susceptibility to infectious and noninfectious complications related to the underlying cancer itself or its treatment, these patients frequently develop acute kidney injury (AKI). A wide variety of definitions for AKI are still used in the cancer literature, despite existing guidelines on definitions and staging of AKI. Alternative diagnostic investigations such as Cystatin C and urinary biomarkers are discussed briefly. This review summarizes the literature between 2010 and 2015 on epidemiology and prognosis of AKI in this population. Overall, the causes of AKI in the setting of malignancy are similar to those in other clinical settings, including preexisting chronic kidney disease. In addition, nephrotoxicity induced by the anticancer treatments including the more recently introduced targeted therapies is increasingly observed. However, data are sometimes difficult to interpret because they are often presented from the oncological rather than from the nephrological point of view. Because the development of the acute tumor lysis syndrome is one of the major causes of AKI in patients with a high tumor burden or a high cell turnover, the diagnosis, risk factors, and preventive measures of the syndrome will be discussed. Finally, we will briefly discuss renal replacement therapy modalities and the emergence of chronic kidney disease in the growing subgroup of critically ill post-AKI survivors

Uraemic toxin concentration variability in HD patients: can we still rely on the results of cross-sectional studies?

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Prognostic robustness of serum creatinine based AKI definitions in patients with sepsis: a prospective cohort study

Background: It is unclear how modifications in the way to calculate serum creatinine (sCr) increase and in the cut-off value applied, influences the prognostic value of Acute Kidney Injury (AKI). We wanted to evaluate whether these modifications alter the prognostic value of AKI for prediction of mortality at 3 months, 1 and 2 years. Methods: We prospectively included 195 septic patients and evaluated the prognostic value of AKI by using three different algorithms to calculate sCr increase: either as the difference between the highest value in the first 24 h after ICU admission and a pre-admission historical (Delta HIS) or an estimated (Delta EST) baseline value, or by subtracting the ICU admission value from the sCr value 24 h after ICU admission (Delta ADM). Different cut-off levels of sCr increase (0.1, 0.2, 0.3, 0.4 and 0.5 mg/dl) were evaluated. Results: Mortality at 3 months, 1 and 2 years in AKI defined as Delta ADM > 0.3 mg/dl was 48.1 %, 63.0 % and 63.0 % vs 27.7 %, 39.8 % and 47.6 % in no AKI respectively (OR(95%CI): 2.42(1.06-5.54), 2.58(1.11-5.97) and 1.87(0.81-4.33); 0.3 mg/dl was the lowest cut-off value that was discriminatory. When AKI was defined as Delta HIS > 0.3 mg/dl or Delta EST > 0.3 mg/dl, there was no significant difference in mortality between AKI and no AKI. Conclusions: The prognostic value of a 0.3 mg/dl increase in sCr, on mortality in sepsis, depends on how this sCr increase is calculated. Only if the evolution of serum creatinine over the first 24 h after ICU admission is taken into account, an association with mortality is found

Censoring and Selling Film Noir

Film noir is known for its duplicity. Industry censors considered 1940s noir cinema provocative, salacious and ‘sordid.’ Hollywood studios walked a fine line between appearing to comply with Hays office Production Code censorship while simultaneously pushing the envelope of its moral constraints, then hyping and sensationalizing censorable sex, violence and hard-hitting themes to sell noir films to the public. In fact, studios capitalized on the racy explicit nature of noir pictures in publicity contradicting assurances of censorial compliance. For instance, censor Joseph Breen was “shocked” when MGM purchased James Cain’s The Postman Always Rings Twice. It was banned for a decade. Yet, ten years later as filmmakers adapted hardboiled fiction, Breen assured religious groups it would “not be offensive.” Yet, it was promoted as “torrid,” “too hot to handle” with Lana Turner in a bathing suit finding “Love at Laguna Beach” with hunky John Garfield who clamored, “You must be a she-devil,” suggesting far more sex, skin and “savage boldness” than is shown in the film. Film noir responded to Production Code censorship and other regulatory factors, including Office of War Information Bureau of Motion Pictures restrictions on Hollywood screen depictions of the domestic American home front (or overseas combat front), and Office of Censorship strictures such as a wartime ban on screen gangsters as ‘un-American’ for propaganda purposes in World War II-era noir films centering on criminals. These multiple censorship entities often collided. This regulatory climate catalyzed the development of film noir, a dark cycle of shadowy 1940s-50s crime films that boomed by World War II and evolved over the postwar era. I will investigate extensive primary archival research—including scripts, memos from industry censors, writers, directors, producers, and publicity records—to compare how film noir was censored and sold

Micro-computed tomography for the quantification of blocked fibers in hemodialyzers

A novel technique based on micro-CT scanning is developed to quantify coagulation in fibers of hemodialyzers. This objectivation is needed to allow accurate assessment of thrombogenicity of dialyzers used during hemodialysis, for example when comparing different strategies to avoid coagulation and/or fiber blocking. The protocol allowed imaging at a resolution of 25 mu m, making it possible to count the open, non-coagulated fibers in a non-invasive way. In 3 fresh, non-used FX600 hemodialyzers, patent fiber counts were extremely consistent (10748 +/- 2). To illustrate the potential of this technique, different dialysis parameters currently used as surrogates for fiber blocking were evaluated during 20 hemodialysis sessions. After dialysis, the FX600 dialyzers were visually scored for clotting, dried and subsequently weighed and scanned. The number of patent fibers (10003 [ 8763,10330], range 534-10692) did not correlate with any of the recorded surrogate parameters. Micro-CT scanning is a feasible, objective, non-invasive, accurate and reproducible tool for quantification of the degree of fiber blocking in a hemodialyzer after use, making it a potential gold standard for use in studies on fiber blocking during renal replacement therapies