Acute kidney injury in patients with community–acquired pneumonia

V.A. Serov, A.M. Shutov, M.Ju. Kuzovenkova, N.V. Krajnova, Ju.T. Garagedjan, M.M. Staraja, Ja.V. Ivanova

1 FSBEI HPE "Ulyanovsk State University", Institute of Medicine, Ecology and Physical Culture, Medical Faculty, Department of Internal Medicine and Occupational Diseases; 2 SIH "Central Clinical Hospital of Ulyanovsk City"
The aim of the study was to investigate the incidence and severity of acute kidney injury (AKI) defined according to the KDIGO Recommendations in patients with community-acquired pneumonia (CAP). 162 patients with CAP were included in the study. It was found that CAP was complicated by AKI in 16.7% of cases. Most Aki cases were observed in elderly patients with respiratory failure, a history of urinary tract diseases, systolic hypotension of ≤90 mm Hg and diastolic hypotension of ≤60 mm Hg. AKI was associated with an increased risk of poor prognosis in patients with community-acquired pneumonia.


  1. Waikar S.S., Curhan G.C., Wald R., McCarthy E.P., Chertow G.M. Declining mortality in patients with acute renal failure, 1988 to 2002. J. Am. Soc. Nephrol. 2006;17:1143–50.
  2. Hsu C.Y., McCulloch C.E., Fan D., Ordoñez J.D., Chertow G.M., Go A.S. Community-based incidence of acute renal failure. Kidney Int. 2007;72:208–12.
  3. Ostermann M., Chang R.W.S. Acute kidney injury in the intensive care unit according to RIFLE. Critical Care Medicine. 2007;35(8):1837–43.
  4. Selby N.M., Kolhe N.V., McIntyre C.W., Monaghan J., Lawson N., Elliott D., Packington R., Fluck R.J. Defining the cause of death in hospitalised patients with acute kidney injury. PLoS One. 2012;7(11):e48580.
  5. Kute V.B., Godara S.M., Goplani K.R., Gumber M.R., Shah P.R., Vanikar A.V., Shah V.R., Trivedi H.L. High mortality in critically ill patients infected with 2009 pandemic influenza A (H1N1) with pneumonia and acute kidney injury. Saudi J. Kidney Dis. Transpl. 2011;22(1):83–9.
  6. Vandijck D. M., Oeyen S., Decruyenaere J.M., Annemans L., Hoste E.A. Acute kidney injury, length of stay, and costs in patients hospitalized in the intensive care unit. Acta Clin. Belg. Suppl. 2007;2:341–5.
  7. Brivet F.G., Kleinknecht D.J., Loirat P., Landais P.J. Acute renal failure in intensive care units--causes, outcome, and prognostic factors of hospital mortality; a prospective, multicenter study. French Study Group on Acute Renal Failure. Crit. Care Med. 1996;24(2):192–8.
  8. Hoste E.A., Clermont G., Kersten A., Venkataraman R., Angus D.C., De Bacquer D., Kellum J.A. RIFLE criteria for acute kidney injury are associated with hospital mortality in critically ill patients: a cohort analysis. Crit. Care. 2006;10(3):R73.
  9. Rodriguez A., Lisboa T., Blot S., Martin-Loeches I., Solé-Violan J., De Mendoza D., Rello J.; Community-Acquired Pneumonia Intensive Care Units (CAPUCI) Study Investigators. Mortality in ICU patients with bacterial community-acquired pneumonia: when antibiotics are not enough. Intensive Care Med. 2009;35(3):430–8.
  10. Tejerina E., Frutos-Vivar F., Restrepo M.I. Prognosis factors and outcome of community-acquired pneumonia needing mechanical ventilation. J. Crit. Care. 2005;20(3):230–8.
  11. Чучалин А.Г., Синопальников А.И., Козлов Р.С. Тюрин И.Е., Рачина С.А. Внебольничная пневмония у взрослых: практические рекомендации по диагностике, лечению и профилактике (пособие для врачей). Клиническая микробиология и антимикробная химиотерапия. 2010;12(3):186–225.
  12. KDIGO Clinical Practice Guidelines for Acute Kidney Injury. Kidney International Supplements. 2012;2:5–138.
  13. Lim W.S., van der Eerden M.M., Laing R., Boersma W.G., Karalus N., Town G.I., Lewis S.A., Macfarlane J.T. Defining community acquired pneumonia severity on presentation to hospital: an international derivation and validation study. Thorax. 2003;58(5):377–82.
  14. Bellomo R., Ronco C., Kellum J.A., Mehta R.L., Palevsky P.; Acute Dialysis Quality Initiative workgroup. Acute renal failure-definition, outcome measures, animal models, fluid therapy and information technology needs: the Second International Consensus Conference of the Acute Dialysis Quality Initiative (ADQI) Group. Crit. Care. 2004;8:204–12.
  15. Чучалин А.Г., Синопальников А.И., Козлов Р.С. Авдеев С.Н., Тюрин И.Е., Руднов В.А., Рачина С.А., Фесенко О.В. Клинические рекомендации по диагностике, лечению и профилактике тяжелой внебольничной пневмонии у взрослых. М.: Издательский дом «М-Вести», 2014.
  16. Díaz A., Alvarez M., Callejas C., Rosso R., Schnettler K., Saldías F. Clinical picture and prognostic factors for severe community-acquired pneumonia in adults admitted to the intensive care unit. Arch. Bronconeumol. 2005;41(1):20–6.
  17. Sabatier C., Peredo R., Villagrá A., Bacelara N., Mariscalb D., Ferrera R., Gallegoc M., Vallésa J. Neumonía comunitaria grave. Estudio descriptivo de 7 años y utilidad de los criterios de la Infectious Diseases Society of America y la American Thoracic Society 2007 en la identificación de los pacientes que requieren ingreso en una unidad de cuidados intensivos. Med. Intensiva. 2010;34(4):237–45.
  18. Fine M.J., Auble T.E., Yealy D.M., Hanusa B.H., Weissfeld L.A., Singer D.E., Coley C.M., Marrie T.J., Kapoor W.N. A prediction rule to identify low-risk patients with community-acquired pneumonia. N. Engl. J. Med. 1997;336(4):243–50.
  19. Mongardon N., Max A., Bouglé A., Pène F., Lemiale V., Charpentier J., Cariou A., Chiche J.D., Bedos J.P., Mira J.P. Epidemiology and outcome of severe pneumococcal pneumonia admitted to intensive care unit: a multicenter study. Crit. Care. 2012;16(4):R155.
  20. Murugan R., Karajala-Subramanyam V., Lee M., Yende S., Kong L., Carter M., Angus D.C., Kellum J.A.; Genetic and Inflammatory Markers of Sepsis (GenIMS) Investigators. Acute kidney injury in non-severe pneumonia is associated with an increased immune response and lower survival. Kidney Int. 2010;77(6):527–35.
  21. Mehta R.L., Kellum J.A., Shah S.V., Molitoris B.A., Ronco C., Warnock D.G., Levin A.; Acute Kidney Injury Network. Acute Kidney Injury Network: report of an initiative to improve outcomes in acute kidney injury. Crit. Care. 2007;11(2):R31.

About the Autors

Information about the authors:
Serov V.A. – Professor of Department of Internal Medicine and Occupational Diseases of FSBEI HPE UlSU, Ph.D.
Shutov A.M. – Professor, Head of Department of Internal Medicine and Occupational Diseases of FSBEI HPE UlSU, Ph.D.
Kuzovenkova M.Ju. – Clinical Pharmacologist of SIH "CCH of Ulyanovsk City"
Krajnova N.V. – Head of Pulmonology Department of SIH "CCH of Ulyanovsk City"
Garagedjan Ju.T. – Fifth-Year Student of Medical Faculty of FSBEI HPE UlSU
Staraja M.M. – Fifth-Year Student of Medical Faculty of FSBEI HPE UlSU
Ivanova Ja.V. – Fifth-Year Student of Medical Faculty of FSBEI HPE UlSU

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