ABSTRACT
ABSTRACT BACKGROUND: Coronavirus disease 19 (COVID-19) is a multisystemic disease with high incidence of acute kidney injury (AKI). OBJECTIVE: To describe the clinical characteristics and factors associated with AKI among patients hospitalized with COVID-19. DESIGN AND SETTING: Retrospective cohort conducted at Hospital Civil de Culiacan, Mexico. METHODS: We included 307 patients hospitalized due to COVID-19. AKI was defined and staged based on serum creatinine levels in accordance with the criteria of the Acute Kidney Injury Network (AKIN). Multivariate logistic regression analysis was used to determine factors associated with AKI. RESULTS: The patients' age was 56 ± 15 years (64.5% male). The incidence of AKI was 33.6% (n = 103). Overall, 53.4% of patients had community-acquired AKI, and 46.6% had hospital-acquired AKI. Additionally, 15.5% of them presented AKIN stage 1; 34% had AKIN stage 2; and 50.5% had AKIN stage 3. Hemodialysis was required for 10.7% of the patients. The factors associated with AKI were chronic kidney disease (odds ratio, OR: 10.8; P = 0.04), use of norepinephrine (OR: 7.3; P = 0.002), diabetes mellitus (OR: 2.9; P = 0.03), C-reactive protein level (OR: 1.005; P = 0.01) and COVID-19 severity index based on chest tomography (OR: 1.09; statistical trend, P = 0.07). Hospital stay (11 ± 7 days; P < 0.001) and mortality (83.5 versus 31.4%; P < 0.05) were greater among patients with AKI. CONCLUSION: AKI was a frequent and serious complication in our cohort of patients hospitalized with COVID-19, which was associated with high mortality and long hospital stay.
ABSTRACT
Purpose:Blunt abdominal trauma in children results in renal injury in approximately 10 to 20% of cases. In about 20% of these patients, significant complications may arise; for example urinoma(1%) and post trauma extravasation (2-18%). Urinomas and persistent hematuria were traditionally managed surgically by partial or total nephrectomy. Today, nonoperative management is well accepted for the majorityof high grade renal injuries, as organ preservation is highly desirable due to patients’ projected lifespan. We present a retrospective review of two cases of high renal injuries seen at GPHC’s Paediatric Surgical Department.Methods:In February and April 2019, two patients met the criteria for grade four renal injury. All medical records were reviewed. Cause of injury, complications, interventions and hospital stay were analyzed. These patients were followed up post discharge, clinically and radiologically. Results:Two males, ages 11 and 10 years, sustained blunt abdominal trauma and presented to GPHC with hematuria and abdominal tenderness. On initial assessment, they were hemodynamically stable and were diagnosed with grade four renal injuries by computed tomography. Complications developed after one week of hospitalization. One patient had persistent hematuria lasting over a week, requiring blood transfusions in excess of 4 units, and the other developed a urinoma, urinary tract infection and deep vein thrombosis. Both patients hadparalytic ileus and acute hypertension. These complications were all managed nonoperatively. The very large urinoma was successfully treated with percutaneous drainage after 25 days. Average hospital stay was 35 days and both patients had complete resolution of their renal injuries within 90 days post trauma. Conclusion:Nonoperative management of high-grade renal injury is highly successful and safe in children. Even in the presence of significant complications, preservation of renal tissue should be considered
ABSTRACT
To determine the epidemiological pattern of renal injuries and to define appropriate methods for their evaluation and management. Material and Methods: We reviewed retrospectively the medical records of 65 patients who were admitted to Siriraj Hospital, between September 1996 and February 2000. Details of patients, mechanism of injury, chief complaint, hematuria, associated injuries, radiographic assessment, management and complications of renal injury were analysed. Results: The study group consisted of 54 men and 11 women with a mean age of 31 years. Blunt and penetrating trauma occurred in 55 (85%) and 10 (15%) patients, respectively. Hematuria was present in 62 patients (95%) and absent in 3 patients (5%). Associated organ injuries were present in 37 patients (57%) and mostly occurred in blunt trauma patients. Chest injuries were the most common cause of associated injuries. Associated abdominal injuries in 17 patients (26%) involved primarily the liver and spleen. In hemodynamically stable patients, preoperative staging was performed in 47 patients (72.3%) with an intravenous pyelogram (IVP). Of 55 patients with blunt renal injuries, 32 (58%) were managed nonoperatively and 23 (42%) underwent exploratory laparotomy. In patient with blunt trauma requiring laparotomy, 6 (26%) underwent renal exploration while the remaining 17 (74%) were treated with expec-tant management and 3 (17.6%) of them had renal complications. Nine out of 10 penetrating trauma patients required laparotomy with renal exploration, but none of them had renal complications. Conclusion: In the evaluation of renal injuries and the accurate staging of these, it is important to define the full extent of the injury in order to decide on the most appropriate management. This will avoid unnecessary surgery in patients with minor injuries and these with limited major injuries, and will avoid the risk of secondary surgery, renal loss and other complications in patients with extensive injuries treated by operation.