Browsing by Autor "Claure-Del Granado, Rolando"

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Acute Kidney Injury in Latin America.
(2025) Claure-Del Granado, Rolando; Lombardi, Raúl; Chávez-Íñiguez, Jonathan; Rizo-Topete, Lilia; Ponce, Daniela
Acute kidney injury (AKI) is a major global health issue with significant morbidity and mortality, particularly in low- and middle-income regions like Latin America. AKI prevalence varies across Latin America, with higher rates in rural and underserved areas. Key risk factors include socioeconomic disparities, comorbid conditions such as diabetes and hypertension, and environmental hazards. Infections, especially tropical diseases, and exposure to nephrotoxins, including herbal remedies, are common causes of AKI. Management of AKI faces significant hurdles because of limited access to diagnostic tools, variability in clinical practices, and a shortage of trained health care professionals. The availability of dialysis and renal replacement therapies is often constrained by economic and infrastructural limitations. Public health initiatives focusing on prevention, screening, and early detection are critical to mitigate the impact of AKI. Research in AKI across Latin America is hampered by data gaps and limited funding. Multicenter collaborations and the development of region-specific guidelines are essential to improving outcomes. Addressing these challenges will help reduce the burden of AKI and improve health care systems across the region. This review examines the unique epidemiology, risk factors, and health care challenges surrounding AKI in the region.
Biomarkers for Early Diagnosis of AKI: Could It Backfire?
(2022) Claure-Del Granado, Rolando; Macedo, Etienne; Chávez-Íñiguez, Jonathan S
Dose in continuous renal replacement therapy.
(2018) Claure-Del Granado, Rolando
Continuous renal replacement therapy (CRRT) is one of the most used types of renal replacement therapies for the treatment of critically ill patients with acute kidney injury (AKI). Recent practice clinical guidelines based on recent clinical trials recommend a prescribed dose of 20-25 mL/kg/h of effluent since these trials could not find differences between high-intensity versus low-intensity CRRT dose and different outcomes as mortality and recovery of renal function. Nevertheless, the results of these recent trials do not mean that CRRT dose is not important, and on the contrary, these trials inform us that dose needs to be continuously assessed and modified according to clinical, metabolic, and physiological needs of each patient. Dose prescription in CRRT needs to be a dynamic and precise process, in which evidence-based quality measures will be used to guide CRRT dose prescription that will match daily patients needs. Delivered dose should be routinely monitored to ensure that it will be achieved. Quality measures for monitoring delivered dose of CRRT have been proposed, but they still need validation, before be implemented into clinical practice.
Global Perspectives in Acute Kidney Injury: Bolivia.
(2023) Claure-Del Granado, Rolando; Plata-Cornejo, Raúl
Herbal Nephropathy.
(2021) Claure-Del Granado, Rolando; Espinosa-Cuevas, María
An estimated one-third of adults in developed countries and more than 80% of the population in many low- and middle-income countries use herbal and traditional medicines to promote health or for the treatment of common diseases. Herbal medicines can cause kidney damage as a result of intrinsic toxicity, adulteration, contamination, replacement, misidentification, mistaken labeling, and unfavorable herb-drug interactions. The kidneys, due to their high blood flow rate, large endothelial surface area, high metabolic activity, active uptake by tubular cells, medullary interstitial concentration, and low urine pH are particularly vulnerable to development of toxic injury in the form of different syndromes like acute kidney injury, nephrolithiasis, chronic interstitial fibrosis, or uroepithelial cancer. Herbal medicines can also cause crystalluria or hypertension and some could increase potassium blood levels in patients with kidney damage. It is of critical importance that health care organizations around the world regulate herbal and traditional remedies in order to reduce the risk of herb-toxic acute kidney injury or chronic kidney disease. The nephrologist must be aware of the potential nephrotoxicity from herbal medicine and supplements. A careful history and specific questioning about use of herbal medicines use is essential.
Indications and timing of renal replacement therapy.
(2018) Claure-Del Granado, Rolando; Macedo, Etienne
The management of patients with acute kidney injury is mainly supportive in nature, with no available proven therapeutic modalities to treat the condition. Renal replacement therapy (RRT) is indicated in patients with severe kidney injury, or increased volume or metabolic demands. In the absence of clinically significant uremic symptoms or specific indications such as severe electrolyte abnormalities or volume overload, the optimal timing of RRT initiation is controversial. Randomized, controlled trials that have compared strategies of early versus delayed initiation of RRT in the absence of obvious indications have yielded conflicting results. The implementation of decision support systems is challenging but could provide clinicians a framework with specific recommendations for interventions. Recently, some algorithms have been proposed to guide physicians in the decision to initiate, and their application in clinical practice may reduce variations across physicians and centers. The decision on the appropriate time to start RRT is complex, integrating numerous variables, and should largely be individualized, however the lack of definitive parameters to define early or late initiation reveals a great need to continue research on this field. Such evidence is important for reducing variations in the clinical practice of RRT prescription and improving patient outcomes.
[Terapia de soporte renal continuo en lesión renal aguda].
(2018) Vázquez-Rangel, Armando; Claure-Del Granado, Rolando
The Utility of Urine Microscopy Score for Early Detection and Prediction of Acute Kidney Injury in At-Risk Patients.
(2025) Claure-Del Granado, Rolando; Torrico-Moreira, Diego; Zhang, Jingyao; Breunig, Jacqueline; Shamel, Basmh; Gupta, Vineet; Chopra, Tushar; Dasgupta, Subhasis; Malhotra, Rakesh
KEY POINTS: Early recognition of subclinical AKI enables timely interventions that may mitigate progression and improve outcomes. This study evaluated the urine microscopy score as a tool for early detection of subclinical AKI and prediction of clinical AKI development in resource-limited settings. BACKGROUND: AKI is a global health concern associated with high morbidity and mortality. Early diagnosis and treatment of subclinical AKI (AKI-1S) are critical for mitigating adverse outcomes. Here, we evaluated whether the urine microscopy score (UMS), a simple and cost-effective method for detecting structural kidney injury, could serve as a substitute biomarker within the AKI Risk Assessment Model (ARA-F4) to identify AKI-1S and predict clinical AKI development. METHODS: A prospective cohort study was conducted, enrolling hospitalized adult patients (non-intensive care unit) at moderate to high risk of AKI according to ARA-F4 model. At admission, urine microscopy was performed, and patients with UMS ≥2 without concurrent serum creatinine elevation were classified as AKI-1S; those with UMS≤1 were classified as non-AKI. The primary outcomes were development of clinical AKI within 48 hours, the need for KRT, and mortality. The discriminative ability of the UMS for predicting AKI was assessed using the area under the receiver operating characteristic curve (area under the curve). RESULTS: A total of 103 patients were included in the study, with 39 (37.9%) classified as AKI-1S and 64 (62.1%) as non-AKI at admission. Among the AKI-1S group, 89.7% developed clinical AKI within 48 hours compared with 10.9% of non-AKI patients (P < 0.05). The AKI-1S group had significantly higher requirement for KRT (10.3% versus 1.6%, P < 0.05) and increased mortality rate (43.6% versus 14.1%, P < 0.05). The UMS demonstrated good predictive performance for AKI development, with an area under the curve of 0.84 (95% confidence interval, 0.75 to 0.92). The sensitivity and specificity of the UMS were 74.5% and 92.9%, respectively. CONCLUSIONS: The UMS can be used in the ARA-F4 model to identify patients with AKI-1S and predict the subsequent development of clinical AKI. Early recognition of AKI-1S using the UMS can facilitate timely interventions and may reduce the burden of AKI in low- and middle-income countries.