COVID-19 and its relationship with kidney diseases: a scope review / COVID-19 e a relação com afecções renais: uma revisão de escopo

BACKGROUNG: COVID-19 is an acute respiratory disease originally from China that emerged in December 2019 and quickly spread around the world, affecting 230,418.415 people, and causing 4,724,876 deaths. Coming from the coronavirus family, SARS-CoV-2 is a new subtype of virus that affects the respiratory tract in different levels and can spread and affect other vital structures in the body. OBJECTIVE: to identify the risk factors that lead patients infected by the new coronavirus to develop kidney disease. METHODS: this is a systematic review of the Scoping Review type (scope review), according to the method proposed by the Joanna Briggs Institute, with the implementation of a checklist structured by PRISMA-ScR that contains 22 mandatory items. The following descriptors were used: coronavirus infection, acute kidney injury and risk factors in five databases, namely PudMed, Scopus, Embase, Virtual Health Library and Web of Science. RESULTS: while reading the studies, it was concluded that Acute Kidney Injury was the main renal finding in patients contaminated by SARS-CoV-2. The risk factors for developing renal worsening in patients with COVID-19 were the extremes of age, race, sex, pre-existing diseases, and the disease evolution. CONCLUSION: it is assumed that renal involvement does not occur only for an exclusive reason, but as a set of factors. It is up to the health team to pay constant attention to the warning signs by monitoring the contaminated patient.

INTRODUÇÃO: COVID-19 é uma doença respiratória aguda original da China que surgiu em dezembro de 2019 e se alastrou rapidamente pelo mundo, atingindo 230.418.415 pessoas e levando 4.724.876 pessoas a óbito. Vindo da família do coronavírus, o SARS-CoV-2 é o novo subtipo de vírus que afeta o trato respiratório em diversos níveis, podendo se alastrar e afetar outras estruturas vitais do corpo. OBJETIVO: identificar os fatores de risco que levam o paciente contaminado pelo SARS-CoV-2 a desenvolver afecções renais. MÉTODO: trata-se de uma revisão sistemática do tipo Scoping Review (revisão de escopo), de acordo com o método de revisão proposto pelo Joanna Briggs Institute (JBI), com a implementação de um check-list estruturado pelo PRISMA-ScR que contém 22 itens de carácter obrigatórios na revisão. Utilizado os descritores: infecção por coronavírus (coronavírus infection), lesão renal aguda (acute kidney injury) e fatores de risco (risk factors) em cinco bases de dados, sendo elas PudMed, Scopus, Embase, BVS (Biblioteca Virtual em Saúde) e Web of Science. RESULTADOS: durante a leitura dos estudos, chegou-se em conclusão de que a Lesão Renal Aguda (LRA) fora o principal achado renal em pacientes contaminados pelo SARS-Cov-2. Os fatores de risco para desenvolver o agravamento renal em pacientes com COVID-19 foi o extremo da idade, raça, sexo, doenças pré-existentes e a evolução da doença. CONCLUSÃO: supõe-se que o acometimento renal não ocorra apenas por um motivo exclusivo, mas como uma conjuntura de fatores. Cabe a equipe de saúde se atentar de forma constante para os sinais de alerta mediante o acompanhamento do paciente contaminado.

Insuficiencia renal aguda secundaria a rabdomiolisis como manifestación de infección por SARS-CoV-2 / Acute kidney injury caused by rhabdomyolysis as a SARS-CoV-2 infection manifestation: report of one case

SARS-CoV-2 infection has a wide spectrum of clinical manifestations secondary to the impairment of different organs, including kidney. Rhabdomyolysis is produced by disintegration of striated muscle and the liberation of its contents to the extracellular fluid and bloodstream. This may produce hydro electrolytic disorders and acute kidney injury. We report a 35-year-old female with a history of SARS-CoV-2 infection who was hospitalized because of respiratory failure and developed renal failure. The etiologic study showed elevated total creatine kinase levels and a magnetic resonance imaging confirmed rhabdomyolysis. The patient required supportive treatment with vasoactive drugs, mechanic ventilation and kidney replacement therapy. She had a favorable evolution with resolution of respiratory failure and improvement of kidney function.

Renal changes in COVID-19 infection

SUMMARY The COVID-19 (SARS-CoV-2) infection started in China, Wuhan City, Hubei Province, in December 2019, and it was declared a pandemic in mid-March 2020, caused by a new coronavirus strain called SARS-CoV-2. The pathogenesis of kidney injury attributed to SARS- CoV-2 is not well defined yet. Observations show that the kidney damage caused by the new virus mutation is mainly tubular, with impairment of glomerular filtration and high levels of urea and creatinine. A study with seriously ill patients with COVID-19 showed that acute kidney injury was present in 29%. In the face of this evidence, based on recent studies, we can see the great renal contribution as an impact factor in the evolution of COVID-19, not just as a complicator of severity, but maybe part of the initial cascade of the process, requiring a deeper analysis using conventional biomarkers of kidney injury and more aggressive clinical intervention in patients at risk, in an attempt to reduce mortality.

RESUMO Infecção pelo COVID-19 (SARS-CoV-2) começou na China, cidade de Wuhan, província de Hubei, em dezembro de 2019, e foi declarada pandemia em meados de março de 2020, causada por uma nova cepa de coronavírus chamada SARS-CoV-2. A patogênese da lesão renal atribuída à SARS-CoV-2 ainda não está bem definida. Observações mostram que o dano renal causado pela nova mutação viral é principalmente tubular, com comprometimento da filtração glomerular e apresentação de altos níveis de uréia e creatinina. Estudo com pacientes gravemente enfermos com COVID-19 mostrou que a lesão renal aguda estava presente em 29%. Diante dessas evidências, com base em estudos recentes, podemos ver a grande contribuição renal como um fator de impacto na evolução do COVID-19, não apenas como um complicador da gravidade, mas talvez como parte da cascata inicial do processo, exigindo uma investigação de análise mais profunda usando biomarcadores convencionais de lesão renal e intervenção clínica mais agressiva em pacientes em risco, na tentativa de reduzir a mortalidade.

Influenza A não H1N1 associada à insuficiência respiratória e à insuficiência renal aguda em paciente com fibrose cística previamente vacinado / Influenza A non-H1N1 associated with acute respiratory failure and acute renal failure in a previously vaccinated cystic fibrosis patient

RESUMO No período sazonal compreendido entre 2014 e 2015, a maior parte das infecções por influenza decorreu do vírus influenza A H3N2. Mais de dois terços dos vírus influenza A H3N2 circulante eram antigênica e geneticamente diferentes (drift) do componente A H3N2 da vacina da influenza sazonal 2014 - 2015 para os hemisférios norte e sul. O objetivo deste trabalho foi relatar um caso de infecção por influenza A sazonal não H1N1 ocorrido em junho de 2015 em um paciente adulto com fibrose cística com doença pulmonar grave, previamente vacinado com a vacina antigripal trivalente. O paciente evoluiu com insuficiências respiratória e renal (sem rabdomiólise), sendo submetido à ventilação mecânica e à hemodiálise. A evolução clínica foi positiva após 39 dias de permanência hospitalar. Ainda, o paciente permaneceu clinicamente estável após seguimento de 18 meses. Com os avanços recentes na medicina intensiva e no tratamento, a sobrevivência com uma doença pulmonar avançada na fibrose cística apresenta novas questões e problemas potenciais, que ainda estão sendo formulados.

ABSTRACT In the 2014 - 2015 season, most influenza infections were due to A (H3N2) viruses. More than two-thirds of circulating A (H3N2) viruses are antigenically and genetically different (drifted) from the A (H3N2) vaccine component of 2014 - 2015 northern and southern Hemisphere seasonal influenza vaccines. The purpose of this paper is to report a case of seasonal influenza A non-H1N1 infection that occurred in June 2015 in an adult cystic fibrosis patient with severe lung disease previously vaccinated with the anti-flu trivalent vaccine. The patient evolved to respiratory and renal failure (without rhabdomyolysis) and was placed under mechanical ventilation and hemodialysis. The clinical outcome was positive after 39 days of hospital stay. In addition, the patient was clinically stable after 18 months of follow-up. With the recent advances in critical care medicine and in cystic fibrosis treatment, survival with advanced pulmonary disease in cystic fibrosis presents new questions and potential problems, which are still being formulated.

Glomerulonefritis aguda con requerimiento de diálisis asociada a influenza A H1N1pdm09: comunicación de dos casos / Acute glomerulonephritis with hemodialysis requirement secondary to influenza A H1N1pdm09 infection: report of two cases

Acute renal failure (ARF) requiring hemodialysis is not common among patients affected by influenza. We report two unvaccinated adult patients with smoking habit, which were admitted with severe influenza A H1N1pdm09 that evolved with shock and required mechanical ventilation. Both patients developed progressive renal failure with oliguria/anuria, associated with urinary of inflammatory sediment with proteinuria, microhematuria and in one case also with hypocomplementemia, suggesting acute glomerulonephritis. Renal replacement therapy (RRT) was required in both cases. In one patient, who died of late complications, sequencing of the HA1 segment revealed the previously described D222N mutation associated to severe cases. ARF with RRT appears to be an uncommon complication of patients hospitalized for influenza A H1N1pdm09 and may be secondary to acute glomerulonephritis.

La insuficiencia renal aguda (IRA) que requiere hemodiálisis no es una complicación común entre los pacientes afectados por influenza. Se comunican los casos clínicos de dos pacientes adultos fumadores no vacunados, que se internaron por influenza A H1N1pdm09 grave por shock y necesidad de ventilación mecánica. Ambos desarrollaron una falla renal progresiva con oliguria/anuria, asociada a un sedimento de orina inflamatorio con proteinuria, microhematuria y en un caso además con hipocomplementemia, sugiriendo una glomerulonefritis aguda. Se requirió terapia de reemplazo renal (TRR) en ambos casos. En uno de los pacientes, que falleció por complicaciones tardías, la secuenciación del segmento HA1 reveló la mutación D222N previamente descrita en casos graves. La IRA con TRR parece ser una complicación infrecuente de los pacientes ingresados por influenza A H1N1pdm09 y puede ser secundaria a una glomerulonefritis aguda.

Insuficiência renal aguda em pacientes infectados pelo H1N1: correlação clínico-histológica em uma série de casos / Acute kidney injury in patients infected by H1N1: clinical histological correlation in a series of cases

INTRODUÇÃO: O vírus Influenza A (H1N1) foi primeiramente descrito em abril de 2009 e, desde então, diversos estudos relataram as características pertinentes à apresentação clínica e ao acometimento pulmonar da doença. Contudo, informações precisas referentes à insuficiência renal aguda (IRA) e às alterações histopatológicas renais nesses pacientes ainda são escassas. OBJETIVO: O objetivo deste estudo é descrever os achados histopatológicos renais de seis pacientes comprovadamente infectados pelo H1N1, que desenvolveram IRA e realizaram biópsia renal, correlacionando-os com os aspectos clínicos. MÉTODOS: Avaliamos seis pacientes do Hospital de Clínicas da UFPR com diagnóstico de H1N1 por PCR viral em 2009 que evoluíram com IRA e que foram submetidos à biópsia renal. Foram revisados os seus prontuários e das lâminas da biópsia renal. RESULTADOS: Todos os casos estudados apresentaram dados clínicos e/ou laboratoriais de IRA, sendo que somente um não apresentou oligúria. À biópsia renal, dois pacientes apresentaram alterações glomerulares: um deles, portador de lupus eritematoso sistêmico, apresentou lesões compatíveis com nefrite lúpica classe III A-C da ISN/RPS 2003 e microangiopatia trombótica focal; outro paciente apresentou glomerulosclerose nodular intercapilar, porém, sem comemorativos clínicos ou laboratoriais de diabetes. Todos os pacientes mostraram graus variáveis de alterações degenerativas vacuolares dos túbulos, com focos de oxalose em dois casos. Dois pacientes possuíam arteriosclerose em grau discreto a moderado. CONCLUSÃO: Em nosso estudo, todos os pacientes apresentarem graus variáveis de alteração degenerativa vacuolar, contudo, não foram encontrados sinais evidentes de necrose tubular aguda, parecendo existir um componente pré-renal como a causa principal de IRA nestes pacientes.

INTRODUCTION: Influenza A (H1N1) virus was first reported on April 2009 and, since then, several studies have reported the characteristics concerning the clinical presentation and pulmonary involvement. However, accurate information about the acute kidney injury (AKI) and kidney histopathological findings in these patients remain scarce. OBJECTIVE: To describe the kidney histopathological findings of 6 patients with H1N1 who developed AKI and underwent kidney biopsy, correlating them with clinical features. METHODS: We studied six patients admitted to Hospital de Clínicas UFPR with a PCR-confirmed diagnosis of H1N1who developed ARF and underwent kidney biopsy. We reviewed their medical file and the microscopy findings of the biopsy. RESULTS: Clinical and/or laboratory evidence of AKI was present in all cases, and only one did not present oliguria. Kidney tissues revealed glomerular lesions in two patients: one patient, with systemic lupus erythematosus, showed changes consistent with lupus nephritis class III A-C according to the ISN/RPS 2003 and focal thrombotic microangiopathy; the other one had intercapillary nodular glomerulosclerosis, but without clinical or laboratory evidence of diabetes. Vacuolar degenerative tubular changes were present in all cases, with focus of oxalosis in two cases. Mild to moderate atherosclerosis was found in two patients. CONCLUSION: In this study, varying degrees of vacuolar degenerative tubular changes were present in all patients, but there were no signs of acute tubular necrosis. It seems that in the present study a prerenal cause of acute renal failure was the main involved mechanim to explain the cause of renal failure in these patients.

Clinical Features of Acute Viral Hepatitis A Complicated with Acute Renal Failure / 대한간학회지

BACKGROUND: Most patients with acute viral hepatitis A (AVHA) spontaneously recover, but a few patients experience complications. This study was carried out to examine clinical features of AVHA complicated with acute renal failure (ARF). METHOD: Medical records of 404 patients with AVHA were reviewed. Clinical features of AVHA patients with ARF (group A) were compared with those of AVHA patients without ARF (group B). RESULT: ARF complication was present in 11 patients (3%). There were no differences between group A and B in sex ratio and age. Microscopic hematuria (7 cases), proteinuria (7 cases), metabolic acidosis (4 cases), oliguria (4 cases), pulmonary edema (3 cases) and hyperkalemia (2 cases) were found in group A. The prevalence of heavy alcohol drinking (64% vs 3%, p<0.001) and diabetes mellitus (18% vs 1%, p=0.01) was higher in group A than B. The peak value of ALT (median: 4,290 IU/L vs 1,266 IU/L, p=0.006) and total bilirubin (median: 10.8 mg/dL vs 6.0 mg/dL, p=0.001) was higher in group A than B. Duration of admission was longer in group A than B (median: 14 days vs 5 days, p<0.001). Four patients of group A recovered with renal replacement therapy, while 7 patients recovered with conservative treatment. CONCLUSIONS: The AVHA patients with ARF experienced more severe hepatitis than those without ARF, but they had a good prognosis with the proper treatment.