povidone-iodine and Acute-Kidney-Injury

Subclavian catheter (SCC) related infections are a major cause of morbidity in hemodialysis patients, the vast majority due to staphylococci species. Povidone-iodine (PI) has proven anti-staphylococcal activity. Therefore, a randomized controlled trial of topical PI ointment was undertaken to evaluate the impact of this prophylactic intervention on the incidence of SCC related infections in hemodialysis patients. The role of S. aureus nasal carrier state in the acquisition of infection was also evaluated. Patients requiring SCC for temporary hemodialysis access were randomized to receive the treatment (T; N = 63) or sterile gauze dressings alone (C; N = 66). Catheter duration ranged from 2 to 210 days in both groups, with a mean of 38.6 days in T and 36.2 days in C (NS). Exit site (ES) infections were significantly less in T (5%) versus C (18%) (P less than 0.02); tip colonization (TC) was 17% in T versus 36% in C (P less than 0.01), while the incidence of septicemia (S) was also significantly less in T (2%) versus C (17%; P less than 0.01). S. aureus nasal carriers were at a threefold higher risk of SCC related septicemia (0.009/day) than noncarriers (0.003/day; P less than 0.05). The beneficial effect of PI ointment was most evident in this high risk group of S. aureus carriers: ES = 0% T versus 24% C, TC = 12% T versus 42% C, S = 0% T versus 29% C, P less than 0.05. There were no adverse effects of the treatment. The routine application of topical PI ointment to temporary hemodialysis catheter exit sites is effective in reducing SCC related infections.

Topics: Acute Kidney Injury; Administration, Topical; Catheterization, Central Venous; Humans; Kidney Failure, Chronic; Middle Aged; Povidone-Iodine; Renal Dialysis; Sepsis; Staphylococcal Infections; Subclavian Vein

Povidone-iodine is a broad-spectrum antiseptic applied topically to treat wounds and prevent their infection. There have been several case reports of acute kidney injury (AKI) in burn patients after povidone-iodine irrigation and in patients receiving the substance as a sclerotherapy agent for management of lymphocele after renal transplantation. However, biopsy-confirmed AKI after ingestion of povidone-iodine has not previously been described.. A 47-year-old man who had apparently ingested povidone-iodine solution and presented with nausea, vomiting, and reduced urine output. Laboratory data revealed blood urea nitrogen of 124 mg/dL, serum creatinine of 6.3 mg/dL, impaired liver function, and leukocytosis. Urine iodine/creatinine ratio was markedly elevated.. Acute tubular necrosis and interstitial nephritis secondary to povidone-iodine ingestion.. The patient was admitted to the intensive care unit and underwent continuous venovenous hemodiafiltration. Kidney biopsy showed acute tubular necrosis and interstitial nephritis. Unstained sections showed tan objects in the tubular lumina that were suspected to be povidone-iodine casts. Corticosteroid therapy (1 mg/kg/day) was started after kidney biopsy.. Renal function recovered after hemodialysis and corticosteroid medication, but not completely.. We have reported the first case of biopsy-confirmed AKI accompanied by increased urine iodine concentration following povidone-iodine ingestion.

Topics: Acute Kidney Injury; Adrenal Cortex Hormones; Anti-Infective Agents, Local; Biopsy; Humans; Kidney Function Tests; Male; Middle Aged; Povidone-Iodine; Renal Dialysis

Using iodine povidone in internal way may be responsible of severe adverse effects, sometimes causing death of the patients.. A 36th years old woman, with a secondary sterility has benefitted of an uterine opacification by iodine povidone before a laparotomy and a salpingotomy. In post surgery she presented an anuric acute renal failure and a severe anaemia which have needed a transfusion. Outcome was favourable with a recuperation of diuresis and a full normalization of the renal function.. The authors recommend to respect the indications of iodine povidone.

Topics: Acute Kidney Injury; Adult; Anti-Infective Agents, Local; Fallopian Tubes; Female; Humans; Laparotomy; Povidone-Iodine

Povidone iodine is a widely-used antiseptic agent, especially for cutaneous lesions. Despite its apparent innocuousness, some cases of acute renal failure are reportedly due to iodine toxicity.. We report a case of an acute renal failure secondary to povidone iodine exposure in a 37-year-old woman. She underwent a hysteroscopy for diagnosis of primary sterility, and povidone iodine was used as the contrast agent. She developed acute renal failure with oliguria during the postoperative period. Treatment with diuretics and hemodialysis led to a favorable outcome and return of normal kidney function.. Mucosal administration of povidone iodine appears to lead to greater iodine toxicity than cutaneous administration. The clinical feature of our patient suggested tubular necrosis caused by iodine, after the other possible causes of acute renal failure were ruled out.. Acute renal failure secondary to povidone iodine administration is possible, especially through mucosal surfaces. Outcome is favorable after the conclusion of exposure and symptomatic treatment.

Topics: Acute Kidney Injury; Adult; Anti-Infective Agents, Local; Contrast Media; Diuretics; Female; Furosemide; Humans; Hysteroscopy; Povidone-Iodine; Renal Dialysis; Time Factors; Treatment Outcome

Povidone-iodine sclerosis has been suggested in the literature as a safe and effective treatment for post-renal transplant lymphoceles. No significant complications of this method have been described. We report on a kidney allograft recipient with recurrent lymphoceles treated with povidone-iodine instillations who developed acute renal failure secondary to iodine intoxication. Four days after the beginning of the povidone-iodine irrigations, metabolic acidosis was present, and renal function started to deteriorate. After a few days, despite the suspension of irrigations, the patient developed oliguria, and dialysis was needed. A renal biopsy was performed, and intense acute tubular necrosis was the only relevant finding. The lymphocele was corrected surgically, and the patient eventually recovered. As has been described in other settings, povidone-iodine instillation for the treatment of post-renal transplant lymphoceles may lead to iodine kidney toxicity and acute renal failure.

Topics: Acute Kidney Injury; Adult; Cyclosporine; Diagnosis, Differential; Drainage; Female; Humans; Immunosuppressive Agents; Kidney Transplantation; Lymphocele; Povidone-Iodine; Recurrence; Renal Dialysis; Therapeutic Irrigation

Topics: Acute Kidney Injury; Anti-Infective Agents, Local; Coronary Artery Bypass; Female; Humans; Mediastinitis; Mediastinum; Middle Aged; Povidone-Iodine; Suppuration; Therapeutic Irrigation

Povidone-iodine ointment is a widely used topical antimicrobial agent in thermally injured patients. In 17 patients with burns ranging from 4 to 85% TBSA this agent was applied to both partial- and full-thickness burns. Peak serum iodine levels in patients treated within 24 hours of injury ranged from 595 to 4,900 micrograms per dL. The amount of iodine absorbed was directly related to the size of the burn. Serum iodine levels continued to rise until the drug was discontinued and remained elevated for as long as 7 days after discontinuance. Iodine excretion was directly related to renal function. The highest serum and lowest urinary iodine levels were present in patients who developed renal failure. Thyroid function was not affected by drug usage. A proven cause-and-effect relationship between the elevated serum iodine attributed to the absorption of povidone-iodine and metabolic acidosis, hypernatremia, and hyperosmolarity was not established. Close monitoring of the patient's fluid and electrolyte balance is imperative during drug usage. The drug is contraindicated in any patient with impaired renal function. The high serum levels of this inorganic ion imply potential toxicity, but clinical evidence of cell or organ toxicity is as yet undetermined.

Topics: Absorption; Acute Kidney Injury; Body Surface Area; Burns; Humans; Iodine; Povidone; Povidone-Iodine; Tissue Distribution