ABSTRACT
Starting from December 2019 in China, SARS-CoV-2, a novel coronavirus strain has rapidly spread to involve more than 150 countries. SARS-CoV-2 is not only responsible for causing pneumonia, but there are also concerns regarding the involvement of other organs such as the heart, liver, and kidneys. Here, we review kidney involvement in COVID 19, the mechanism of kidney injury, and its impact on mortality. Lastly, we focus on the challenges of COVID19 in dialysis and renal transplant patients.
ABSTRACT
We hereby present a case of an atypical hemolytic uremic syndrome (aHUS) precipitated by coronavirus disease 2019 (COVID-19). A 26-year-old male was diagnosed with COVID-19 and acute kidney injury. His kidney biopsy was suggestive of thrombotic microangiopathy. Five sessions of plasmapheresis were done but were discontinued in view of nonrecovery of kidney function. He was then referred for a kidney transplant. On genetic analysis, he was found to have mutations in the complement system (CFHR1 and CFHR3), which suggested this was a case of aHUS precipitated by COVID-19. In view of the high risk of recurrence of the primary disease in live-related kidney donor transplantation, he was advised for simultaneous liver and kidney transplants.
ABSTRACT
BACKGROUND: COVID-19 is a novel acute infection that is mainly manifested as acute respiratory disease. Information on coronavirus disease-2019 (COVID-19) in CKD patients who are not on dialysis is very limited. We are reporting a single-center observational study on the effect of COVID-19 in CKD patients. METHODS: A single-center retrospective study with consecutive patients who had eGFR <60 mL/min/1.73 m2 (CKD-EPI) admitted with COVID-19, from April to July 2020 were included. RESULT: A total of 30 patients were included in the study. Patients of CKD stage 5, 4 and 3 were 50%, 13.3%, and 36.6%, respectively. The mortality rate was 53.3%. Category wise, 9 were in mild; 3 in moderate, and 18 were in the severe COVID category. Twenty-five patients (83.3%) developed acute on CKD. Twenty patients (67%) required renal replacement therapy (RRT). The prognosis of patients who required RRT was poor. High LDH and IL-6 were significantly associated with mortality. Lymphopenia, present in 50% of cases was associated with fatal outcome. There was a 100% survival rate in mild to moderate cases and 11% in severe cases. CONCLUSION: Mortality among hospitalized CKD patients is high.
ABSTRACT
INTRODUCTION: COVID -19 has gripped the whole world and patients with comorbidities especially kidney ailments are at higher risk of developing severe disease. Among kidney disease, transplant patients are the most vulnerable group. Information on coronavirus disease 2019 (COVID-19) in kidney transplant patients is very limited. METHODS: An observational study was conducted on 20 kidney transplant patients who tested positive for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) by polymerase chain reaction from April to June 2020. RESULTS: The majority of cases were males (85%). The median age of the patients was 50 years (interquartile range [IQR] 40.75-60.75). Diabetes and hypertension were present in 55% and 95% of patients, respectively. Coronary artery disease was present in three patients (15%). The median time from transplant to COVID-19 testing was 54 months (IQR 36-105). Chronic allograft nephropathy was found in 35% of patients. The mean baseline creatinine was 1.71 mg/dL. The most common symptom was fever (80%). Acute Kidney Injury was seen in 60% of patients with a mean creatinine of 2.60 mg/dL. Based on severity, 50% of patients had mild disease, 25% moderate disease, and the remaining 25% had severe disease. All 20 patients were on oral steroids, calcineurin inhibitors (18 on tacrolimus and two on cyclosporine), and antimetabolite (19 on mycophenolate mofetil and one on azathioprine). Antimetabolite agents were stopped in all patients and tacrolimus was stopped in severe cases (25%). Hydroxychloroquine was given in 15 patients (75%). Fifteen patients (75%) recovered while five (25%) died. CONCLUSION: Kidney transplant recipients infected with COVID-19 have high mortality.