digitoxin and Acute-Kidney-Injury

Topics: Acute Kidney Injury; Administration, Oral; Arrhythmias, Cardiac; Digitoxin; Digoxin; Drug Interactions; Electric Countershock; Half-Life; Humans; Injections, Intramuscular; Injections, Intravenous; Liver Diseases; Malabsorption Syndromes; Pharmaceutical Vehicles; Phenytoin; Potassium; Thyroid Diseases

While several intoxications can be successfully treated with specific antidotes, intoxications with the steroid glycoside digitoxin still represent a major challenge. Besides conventional approaches, CytoSorb® hemoadsorption might be another treatment option. We report on an 81-year-old female patient treated in our intensive care unit (ICU) with severe digitoxin intoxication, acute renal failure, and urinary tract infection (UTI). As physiological digitoxin elimination kinetics are known to appear slow, and also in regard to the renal failure, the decision was made to initiate continuous renal replacement therapy combined with CytoSorb hemoadsorption. The patient was hemodynamically stabilized within the first 4 h of treatment and initially required catecholamines to be stopped within 24 h of treatment. Pre- and post-adsorber drug level measurements showed a rapid elimination of digitoxin. Antibiotic treatment with piperacillin/tazobactam was initiated, and despite CytoSorb hemoadsorption therapy and its known potential to reduce plasma concentrations of several drugs, the UTI was successfully treated. After 3 days of CytoSorb treatment, digitoxin plasma levels were stable and almost normalized, and no clinical signs of intoxication were present. Five days after presentation, the patient was transferred from the ICU in a stable condition. CytoSorb hemoadsorption may be an easily available, efficient, and less cost-intensive therapy option than treatment with the Fab fragment, which is the currently recommended therapy for digitalis intoxications. Therefore, the use of CytoSorb might represent an alternative treatment for life-threatening complications of digitoxin intoxications.

Topics: Acute Kidney Injury; Aged, 80 and over; Continuous Renal Replacement Therapy; Digitoxin; Female; Hemoperfusion; Humans; Piperacillin, Tazobactam Drug Combination; Urinary Tract Infections

Renal tubule cells can recover after they undergo AKI (acute kidney injury). An incomplete repair of renal tubules can result in progressive fibrotic CKD (chronic kidney disease). Studies have revealed the relationship between tubular epithelial cells and kidney fibrogenesis. However, the underlying mechanism remains unclear. Hippo pathway components were evaluated in complete/incomplete repair of I/R (ischaemia/reperfusion) AKI rat models, HK-2 cells and AKI human renal biopsy samples. We found that the expression levels of the Hippo pathway components changed dynamically during kidney regeneration and fibrogenesis in rat models of I/R-induced AKI and human renal biopsy samples. The transcription cofactor YAP (Yes-associated protein) might be a key effector of renal regeneration and fibrogenesis. Our results showed further that YAP might elicit both beneficial and detrimental effects on I/R AKI. After I/R injury occurred, YAP could promote the repair of the injured epithelia. The constant YAP increase and activation might be related to interstitial fibrosis and abnormal renal tubule differentiation. These results indicate that the proper modulation of the Hippo pathway, specifically the transcription cofactor YAP, during repair might be a potent therapeutic target in AKI-CKD transition after I/R injury.

Topics: Acute Kidney Injury; Adaptor Proteins, Signal Transducing; Adolescent; Adult; Aged; Animals; Apoptosis Regulatory Proteins; Cell Differentiation; Cell Proliferation; Cells, Cultured; Digitoxin; Female; Fibrosis; Gene Knockdown Techniques; Hepatocyte Growth Factor; Humans; Kidney; Male; Middle Aged; Phosphoproteins; Protein Serine-Threonine Kinases; Proto-Oncogene Proteins; Rats, Sprague-Dawley; Regeneration; Reperfusion Injury; Signal Transduction; Transcription Factors; Up-Regulation; YAP-Signaling Proteins; Young Adult

Topics: Acute Disease; Acute Kidney Injury; Aged; Antibodies; Digitalis; Digoxin; Humans; Immunoglobulin Fab Fragments; Immunoglobulin Fragments; Plasmapheresis

Topics: Acute Kidney Injury; Aged; Atrial Fibrillation; Bundle-Branch Block; Digitalis; Digoxin; Electrocardiography; Humans; Male; Metoprolol; Tachycardia, Ventricular

Cardiac glycoside toxicity is frequently associated with hyperkalemia and dysrhythmias in patients with renal insufficiency. Two common therapeutic options for these complications (calcium and transvenous cardiac pacing) are considered contraindicated in the setting of cardiac glycoside toxicity. We present the case of a patient presenting with a pronounced bradydysrhythmia and hyperkalemia who was treated with intravenous calcium and transvenous cardiac pacing and later found to have digitalis toxicity and acute renal failure. There were no adverse events associated with the therapies. The patient received digoxin-specific Fab fragments and hemodialysis as definitive therapeutic modalities. The case and the relevant literature evaluating the interaction of calcium salts and cardiac pacing in the setting of cardiac glycoside toxicity are discussed.

Topics: Acute Kidney Injury; Aged; Aged, 80 and over; Digitalis; Female; Humans; Hyperkalemia; Renal Dialysis

The possibility of interference by apparent digitoxin-like immunoreactive substance (DTLIS) with three radioimmunoassays was studied in patients with renal insufficiency. From each of 25 adult patients with renal insufficiency and 25 age-matched and sex-matched control subjects with normal renal function, a single serum sample was obtained and assayed for digitoxin content by three commercially available radioimmunoassays (GammaCoat, Coat-A-Count, and the Wien assay). Although two of the three assays found measurable concentrations, the difference in apparent digitoxin concentrations between the control subjects and those with renal insufficiency was not significant. Assay interference could not be explained on the basis of differences in age, serum creatinine concentration, or weight. The magnitude of DTLIS interference in relation to the digitoxin therapeutic range appears to be small with the radioimmunoassays used in this study.

Topics: Acute Kidney Injury; Adult; Aged; Aged, 80 and over; Aging; Body Weight; Creatinine; Digitoxin; Humans; Middle Aged; Radioimmunoassay

Topics: Acute Kidney Injury; Animals; Digitoxin; Dogs; Female; Ligation; Male; Nephrectomy; Tissue Distribution; Ureter

The kinetics of digitoxin and two of its major metabolites, the bis- and monodigitoxosides of digitoxigenin, were determined in six subjects with renal insufficiency and compared to those in six age- and sex-matched normal control subjects. No significant differences between the two groups were found in elimination t 1/2, total body clearance, or volume of distribution. Average renal clearances of all three drugs were reduced in subjects with renal failure, but the differences were significant only in the case of digitoxin. The bis-digitoxoside of digitoxigenin has kinetic properties that offer clinical advantages.

Topics: Acute Kidney Injury; Adult; Aged; Creatinine; Digitoxigenin; Digitoxin; Drug Evaluation; Female; Half-Life; Humans; Injections, Intravenous; Kinetics; Male; Middle Aged; Radioimmunoassay; Random Allocation

Serum protein binding of phenylbutazone has been measured in the rat, guinea pig, cat, rabbit and dog, and the influence on it of renal failure induced by uranyl nitrate injection has been studied. In all speciies a clearcut decrease in binding was observed after the occurrence of renal failure; the time course of the fall in binding correlated well with development of renal failure. In further experiments, serum protein binding of two acidic drugs (phenylbutazone, warfarin), two basic drugs (papaverine, quinidine) and one neutral drug (digitoxin) was studied in rabbits with experimental renal failure, and the results compared with those obtained in patients with acute renal failure. In the rabbits, a decrease in the binding of phenylbutazone, warfarin, papaverine and quinidine was found, whereas protein binding of digitoxin was unchanged. In man, there was a definite fall in protein binding of phenylbutazone and digitoxin, a small decrease for warfarin and papaverine, and a slight increase for quinidine.

Topics: Acute Kidney Injury; Animals; Blood Proteins; Cats; Digitoxin; Dogs; Female; Guinea Pigs; Humans; Male; Papaverine; Pharmaceutical Preparations; Phenylbutazone; Protein Binding; Quinidine; Rabbits; Rats; Species Specificity; Time Factors; Uranyl Nitrate; Urea; Warfarin

Topics: Acute Disease; Acute Kidney Injury; Anticoagulants; Contraceptives, Oral; Digitoxin; Female; Hemolysis; Humans; Nephritis, Interstitial; Rifampin; Thrombocytopenia; Tuberculosis

Plasma digoxin and digitoxin determination has proven to have an important bearing, particularly in patients with renal failure. It permits early detection of digitalis intoxication in the absence of marked clinical and ECG evidence, and adjustment of dosage accordingly. Also, in patent intoxication it makes it possible to select the right moment for resumption of therapy. To illustrate the importance of the method some cases are cited involving plasma digoxin and digitoxin determination.

Topics: Acute Kidney Injury; Bradycardia; Creatinine; Digitalis Glycosides; Digitoxin; Digoxin; Heart Failure; Humans; Kidney Failure, Chronic

Topics: 1-Propanol; Acute Kidney Injury; Aged; Albumins; Antidepressive Agents; Antihypertensive Agents; Benzyl Compounds; Cephaloridine; Coumarins; Digitoxin; Diuretics; Drug Interactions; Ethacrynic Acid; Guanethidine; Guanidines; Heart; Heart Block; Heart Conduction System; Humans; Hypoglycemia; Hypotension; Kidney; Pancreas; Phenylbutazone; Salicylates; Sympathetic Nervous System; Tolbutamide; Warfarin

Topics: Acute Kidney Injury; Animals; Digitalis; Digoxin; Hypokalemia; Membrane Potentials; Mice; Myocardium; Plants, Medicinal; Plants, Toxic; Potassium Deficiency; Tritium

Topics: Acute Kidney Injury; Digitalis; Digitalis Glycosides; Glomerulonephritis; Pyelonephritis; Renal Insufficiency; Toxicology

Topics: Acute Kidney Injury; Blood Pressure; Carbohydrate Metabolism; Chemical Phenomena; Chemistry; Coronary Disease; Digitalis; Digitalis Glycosides; Heart Rate; Mitral Valve Stenosis; Nephritis; Pulse; Renal Insufficiency; Strophanthins; Toxicology

Topics: Acute Kidney Injury; Adolescent; Anemia, Hemolytic; Antistreptolysin; Blood Transfusion; Bone Marrow Examination; Child; Dialysis; Diet; Diet Therapy; Digitalis; Electrocardiography; Electroencephalography; Electrophoresis; Erythrocytes; Heart Failure; Hemolytic-Uremic Syndrome; Humans; Infant; Kidney; Neurologic Manifestations; Pathology; Prednisone; Renal Dialysis; Renal Insufficiency; Statistics as Topic; Thrombocytopenia; Uremia; Water-Electrolyte Balance

Topics: Acute Kidney Injury; Adolescent; Bacillus; Child; Digitalis; Digitalis Glycosides; Dysentery; Dysentery, Bacillary; Escherichia coli Infections; Humans; Sulfamethoxypyridazine; Toxicology

Topics: Acute Kidney Injury; Digitalis; Digitalis Glycosides; Humans; Plant Extracts