Prevalence and associated factors for kidney dysfunction in hospitalized patients with COVID-19 pneumonia in Zambia

Abstract Background: A significant link has been reported between COVID-19 pneumonia, disease severity and development of kidney dysfunction. This study assessed the prevalence and correlated factors for kidney impairment in hospitalized patients with COVID-19 infection Methods: This nested retrospective study examined medical files of patients with confirmed COVID-19 pneumonia. The outcome variable was kidney dysfunction ( defined as functional renal indexes beyond the normal range) and associated factors. Multivariate logistic regression was employed to establish factors associated with renal dysfunction. Results: 179 patients were included in this nested study and the mean age was 58.3 years (SD 16.5) and 49.0% were female. The prevalence of renal dysfunction was 51.9% and 39.3% these patients renal had eGFR<60 mL/min/1.73m2 The proportion of kidney impairment was higher in males than females (59.3% vs.44.3 %), patients with underlying hypertension than normotensive (60.5% vs. 39.5 %) and those with chronic kidney disease (CKD) than those without (90% vs. 10%). After adjusting for age, male gender, critical COVID-19 disease, and raised white cell count, hypertension was an independent predictor of kidney impairment with a AOR 1.54 (95% CI [1.06-2.23],p=0.022). Presence of HIV or diabetes mellitus showed a non statistical significance with renal dysfunction. Conclusion: The study demonstrated a high prevalence of kidney dysfunction in hospitalized patients with COVID-19 pneumonia and presence of hypertension predicted nearly 2-fold development renal impairment.

The value of N-terminal pro-B type natriuretic peptide in predicting the outcome of spontaneous breathing trials in elderly renal dysfunction patients / 中华危重病急救医学

Objective To investigate the value of N-terminal pro-B type natriuretic peptide (NT-proBNP) in predicting the outcome of spontaneous breathing trial (SBT) in ventilated elderly renal dysfunction patients. Methods The clinical data of patients who received mechanical ventilation in the Department of Critical Care Medicine of the First Affiliated Hospital of Guangzhou Medical University, Guangzhou Institute of Respiratory Disease from January 2011 to December 2014 were analyzed retrospectively. AU the patients conformed to the following criteria: age > 65 years, endogenous creatinine clearance rate (CCr) 72 hours and undergone at least one SBT. The patients were assigned to a SBT success group and a SBT failure group according to the outcome of first SBT. The following factors were recorded: gender, age, the underlying disease [chronic obstructive pulmonary disease (COPD), heart failure (HF) and others], body mass index (BMI), serum pre-albumin (pre-ALB), and acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ) score, CCr and the concentration of the plasma NT-proBNP before SBT. Receiver operator characteristic curve (ROC) was plotted, and the predict value of NT-proBNP for the outcome of SBT in elder patients with kidney dysfunction was determined. Results A total of 58 patients with complete data were enrolled, with 41 cases in SBT success group, and 17 in SBT failure group. There were no significant differences in gender [male/female (cases): 26/15 vs. 13/4, χ2 = 0.930, P = 0.335], age (years: 70.2±7.4 vs. 74.6±10.1, t = 0.833, P = 0.339), the stratification of underlying diseases [COPD/HF/COPD+HF/others (cases): 15/9/13/4 vs. 7/3/5/2, χ2 = 0.242, P = 0.971], BMI (kg/m2: 25.2±11.3 vs. 27.4±6.43, t = 1.038, P = 0.221), pre-ALB (mg/L: 201.0±13.2 vs. 189.0±7.6, t = 0.688, P = 0.519), and APACHE Ⅱ score (12.2±3.2 vs. 13.5±6.3, t = 1.482, P = 0.147) and CCr (mL·min-1·1.73 m-2: 51.3±7.7 vs. 54.2±6.4, t = 0.711, P = 0.487) before SBT between SBT success group and SBT failure group. The concentration of plasma NT-proBNP in SBT failure group was significantly higher than that of the SBT success group (μg/L: 4.162±1.128 vs. 2.284±1.399, t = 4.905, P = 0.000). The area under ROC curve for plasma NT-proBNP in predicting successful SBT among elder patients with kidney dysfunction was 0.878, with 95% confidence interval (95%CI) 0.786 - 0.970. The cut-off method was used, and it was identified that the concentration of NT-proBNP < 3.350 μg/L as a predictor for successful SBT, with sensitivity of 82.4%, specificity of 87.8%, positive prediction value of 88.1% and negative predictive value of 76.5%. Conclusion The concentration of plasma NT-proBNP may increase in elderly kidney dysfunction patients undergoing ventilation, and NT-proBNP < 3.350 μg/L can serve as a good predictor for SBT success.

Leprosy nephroptthy: a review of clinical and histopathological features / Nefropatia da hanseníase: revisão dos aspectos clínicos e histopatológicos

Leprosy is a chronic disease caused by Mycobacterium leprae, highly incapacitating, and with systemic involvement in some cases. Renal involvement has been reported in all forms of the disease, and it is more frequent in multibacillary forms. The clinical presentation is variable and is determined by the host immunologic system reaction to the bacilli. During the course of the disease there are the so called reactional states, in which the immune system reacts against the bacilli, exacerbating the clinical manifestations. Different renal lesions have been described in leprosy, including acute and chronic glomerulonephritis, interstitial nephritis, secondary amyloidosis and pyelonephritis. The exact mechanism that leads to glomerulonephritis in leprosy is not completely understood. Leprosy treatment includes rifampicin, dapsone and clofazimine. Prednisone and non-steroidal anti-inflammatory drugs may be used to control acute immunological episodes.

A hanseníase é doença crônica causada pelo Mycobacterium leprae, altamente incapacitante e com envolvimento sistêmico em alguns casos. O envolvimento renal tem sido relatado em todas as formas da doença, sendo mais frequente nas formas multibacilares. A apresentação clínica é variável e determinada pela reação do sistema imunológico do hospedeiro ao bacilo. Durante o curso da doença podem ocorrer os chamados estados reacionais, nos quais o sistema imune reage contra o bacilo, exacerbando as manifestações clínicas. Diferentes lesões renais tem sido descritas na hanseníase, incluindo glomerulonefrites, nefrite intersticial, amiloidose secundária e pielonefrite. O mecanismo exato que leva à glomerulonefrite na hanseníase ainda não está completamente esclarecido. O tratamento da hanseníase inclui o uso de rifampicina, dapsona e clofazimina. Prednisona e antiinflamatórios não-hormonais podem ser usados no controle dos episódios imunológicos agudos.

Prevention of renal dysfunction by nutraceuticals prepared from oil rich plant foods

<p><b>OBJECTIVE</b>To investigate the protective effect of extracts prepared from avocado, walnut, flaxseed and Eruca sativa seeds in a rat model of kidney dysfunction induced by intraperitoneal cisplatin.</p><p><b>METHODS</b>Ethanol and petroleum ether extracts mixture was prepared from each plant. Six groups of rats were conducted; control healthy, cisplatin group and four test groups where rats were given daily oral dose of each extract mixture before cisplatin injection. Different biochemical and cytogenetic parameters and kidney histopathology were determined. Acute toxicity was tested for the nutraceuticals. Total phenolic contents, fatty acids (FA) and unsaponifiable matter were assessed in the extracts.</p><p><b>RESULTS</b>Walnut ethanol extract showed the highest content of total phenolic. FA analysis revealed that all the studied plants were rich in unsaturated FA. Gas-liquid chromatographic investigation of the unsaponifiable matter showed the presence of campesterol, stigmasterol and β-sitosterol in all the studied plants. Cisplatin treatment induced significant increase in plasma urea, creatinine and malondialdehyde along with significant reduction of plasma albumin, total protein, catalase and total antioxidant as well as reduction in creatinine clearance. Histopathological examination proved the induction of kidney dysfunction. Some sorts of chromosomal aberration and sperm-shape abnormalities were noticed after cisplatin treatment. Administration of extracts mixtures produced improvements in biochemical, histopathological and cytogenetic parameters.</p><p><b>CONCLUSIONS</b>Administration of the studied nutraceuticals proved to possess protective role against cisplatin-induced nephrotoxicity, chromosomal aberration and abnormal sperms. All studied nutraceuticals showed complete safety.</p>

Prevention of renal dysfunction by nutraceuticals prepared from oil rich plant foods

Objective: To investigate the protective effect of extracts prepared from avocado, walnut, flaxseed and Eruca sativa seeds in a rat model of kidney dysfunction induced by intraperitoneal cisplatin. Methods: Ethanol and petroleum ether extracts mixture was prepared from each plant. Six groups of rats were conducted; control healthy, cisplatin group and four test groups where rats were given daily oral dose of each extract mixture before cisplatin injection. Different biochemical and cytogenetic parameters and kidney histopathology were determined. Acute toxicity was tested for the nutraceuticals. Total phenolic contents, fatty acids (FA) and unsaponifiable matter were assessed in the extracts. Results: Walnut ethanol extract showed the highest content of total phenolic. FA analysis revealed that all the studied plants were rich in unsaturated FA. Gas-liquid chromatographic investigation of the unsaponifiable matter showed the presence of campesterol, stigmasterol and β-sitosterol in all the studied plants. Cisplatin treatment induced significant increase in plasma urea, creatinine and malondialdehyde along with significant reduction of plasma albumin, total protein, catalase and total antioxidant as well as reduction in creatinine clearance. Histopathological examination proved the induction of kidney dysfunction. Some sorts of chromosomal aberration and sperm-shape abnormalities were noticed after cisplatin treatment. Administration of extracts mixtures produced improvements in biochemical, histopathological and cytogenetic parameters. Conclusions: Administration of the studied nutraceuticals proved to possess protective role against cisplatin-induced nephrotoxicity, chromosomal aberration and abnormal sperms. All studied nutraceuticals showed complete safety.

Kidney Dysfunction and Long-Term Outcome in Post-PCI Acute Coronary Syndrome Patients Treated by High-Dose Tirofiban: The Role of Creatinine Clearance.

Aims: Few data exist on kidney dysfunction (KD) and glycoprotein IIb/IIIa inhibitors (GPI) in acute coronary syndrome (ACS) patients treated by percutaneous coronary intervention (PCI) and whether they impact on long-term outcome since most frequently patients with various degrees of KD are excluded. Study Design: Comparison of independent but concomitant arms of a randomized investigation on GPI. Place and Duration of Study: The Sant’ANna TIrofiban Safety study (SANTISS www.clinicaltrials.gov Identifier: NCT00566891) was an open-label investigator-initiated single centre registry at Sant’Anna Hospital, Catanzaro, during a 5-year enrollment period. Methodology: We considered 726 ACS patients with PCI under either triple (aspirin, clopidogrel including high-dose tirofiban) or double (aspirin and clopidogrel) antiaggregating drugs (AAD). Serum creatinine levels, creatinine clearance (CrCl, using the Cockcroft-Gault formula) and estimated glomerular filtration rate (eGFR, using both MDRD and CKD_EPI formulas) were used as continuous co-variables. Cox’s proportional hazards model tested the multivariable contribution of covariates all fitted simultaneously (forced method) in order to predict the incidence of 1-year cumulative ischemic events (CIE). Results: There were 69 (9.5%) 1-year CIE. Incidences were 5.4, 9.8 and 13.4% (P=0.012) in CrCl tertiles 1 (96-216 ml/min), 2 (73-95 ml/min) and 3 (15-72 ml/min), respectively. Compared to CrCl, the percentile distributions of eGFR, by MDRD or CKD_EPI formulas were similar: all were comparable and significant predictors multivariately (p<0.001) of long-term CIE. The presence of diabetes (hazard ratios, HRs 1.84-1.91), intra aortic balloon pump (HRs 3.59-4.03), and thrombolysis (a protective factor) by tenecteplase (HRs 0.30-0.30) were further significant risk factors. With highdose tirofiban there was a 20% lower but not statistically different incidence of 1-year CIE. Conclusion: KD assessed by CrCl or eGFR in ACS patients treated by PCI equally predicted and similarly impacted on 1-year CIE, independent of the formula adopted for eGFR calculation and the presence of GPI with high-dose tirofiban.

Investigation on Health Effects of an Abandoned Metal Mine

To investigate potential health risks associated with exposure to metals from an abandoned metal mine, the authors studied people living near an abandoned mine (n=102) and control groups (n=149). Levels of cadmium, copper, arsenic, lead, and zinc were measured in the air, soil, drinking water, and agricultural products. To assess individual exposure, biomarkers of each metal in blood and urine were measured. beta2-microglobulin, alpha1-microglobulin, and N-acetyl-beta-glucosaminidase and bone mineral density were measured. Surface soil in the study area showed 2-10 times higher levels of metals compared to that of the control area. Metal concentrations in the groundwater and air did not show any notable differences between groups. Mean concentrations of cadmium and copper in rice and barley from the study area were significantly higher than those of the control area (p<0.05). Geometric means of blood and urine cadmium in the study area were 2.9 microgram/L and 1.5 microgram/g Cr, respectively, significantly higher than those in the control area (p<0.05). There were no differences in the levels of urinary markers of early kidney dysfunction and bone mineral density. The authors conclude that the residents near the abandoned mine were exposed to higher levels of metals through various routes.

Serum Cystatin C As an Early Renopathy Markers for Pregnancy-induced Hypertension / 中华高血压杂志

Objective To evaluate cystatin C(CysC)in early impairment of renal function in patients of gestational hypertension(GH).Methods Forty patients of GH,70 normotensive pregnant women(35 of early pregnany and 35 of late pregnancy)and 30 normotensive healthy women were enrolled.CysC and ?2-M were measured by particle enhanced nephelometric assay,SCr,BUN and UA were measured by biochemistry analysis.Results The level of CysC in normotensive late pregnancy subjects(1.22?0.19 mg/L)and GH patients(1.93?0.48 mg/L)were higher than that in normal healthy women(0.78?0.22 mg/L,P