ABSTRACT
Background: The epidemiology, clinical presentation, management and outcomes of COVID-19 comes from early reports from China and Europe with AKI prevalence ranging widely from 0.5% to 29%. However, knowledge about this pandemic is still emerging. With the epicenter now in the western hemisphere, we aim to determine the behavior and possible differences in presentation of AKI in COVID-19 patients in Latin America. To our knowledge, this is the first of such study. Methods: Descriptive analysis extracted from an online survey carried out among nephrologists, renal pathologists and other health workers treating kidney diseases between May 20-27, 2020 from sixteen Spanish speaking Latin American countries divided into 6 categories. We present the results for the AKI category. Results: 430 responses were obtained of which 360 (84%) were considered for analysis. 86% of the participants were nephrologists. 35% of the respondents reported the prevalence of AKI to be <5%, while 32% estimated it at 6-10%. The majority of AKI in these patients was stage 3 according to 31% of the respondents. Roughly half of the nephrologists witnessed new onset proteinuria which was almost exclusively (96%) subnephrotic. The majority (64%) reported no hematuria. Half of the participants (50.2%) reported that renal replacement therapy (RRT) was never or rarely required. Intermittent hemodialysis was the main RRT used reported by 88% of those surveyed followed by continuous renal replacement therapy (33%), peritoneal dialysis (24%) and prolonged intermittent RRT (19%). The most common complications during RRT were hypotension (60.3%) and circuit clotting (36.6%). Over one third of the participants (35%) estimated the mortality of patients with AKI and COVID to be <20%. Conclusions: Our survey highlights potential differences in the presentation, management and outcomes of AKI in patients with COVID-19 in LA;among those, a lower prevalence, higher need for RRT and lower mortality. More studies are warranted to better understand AKI in hispanic COVID-19 patients as well as its distinct characteristics compared to the rest of the world.
ABSTRACT
Background: A significant fraction of patients with COVID-19 display renal involvement (60%);however, the histological findings and pathology practice in Latin America (LA) have not been reported. The aim is to know how COVID-19 pandemic has affected the protocols for renal pathology and the main pathology findings in the kidney. Methods: An online survey with 75 questions in 6 sections, directed to pathologists, nephrologists and other specialists from 16 Spanish speaking LA countries treating COVID patients with kidney involvement. We are analyzing the impact of COVID-19 in renal pathology and pathology practice in LA. Results: From 430 responses, 360 (84%) were considered for analysis. Only13 participants from 16 countries were renal pathologists but the rest of responders also contributed with the pathology section. Only 10% is performing renal biopsies (RBx) of COVID-19 patients. Acute kidney injury (AKI) (85%) was the most frequent indication for RBx, hematuria-proteinuria (42%), nephrotic syndrome (28%) and subnephrotic proteinuria (21%). Combination of AKI and other syndrome was seen. Handling fresh tissue for immunofluorescence (IF) is a regular practice in the centers that perform IF (66%). No ultrastructural examination in 90% due to the lack of EM equipment. Postmortem studies only in 3% of the centers. Autopsy and biopsies shiwed thrombotic microangiopathy (TMA), with acute tubular injury (ATI). Pathology redeployment to clinical areas, ICU and inpatient care is seen in 12%. Only 70% of those received guidance or updating clinical courses. Conclusions: The survey has highlighted the deep shortage of renal pathologists and the lack of equipment (EM) compromising the best practice of renal pathology in LA. Protocols for tissue handling for COVID have not been established in any center, adding a burden to the practice. Most frequent indication for renal biopsy is AKI while the presence of TMA and ATI is found in autopsy and renal samples. Collapsing glomerulopathy (CG) has a high prevalence in hispanics and has been described in COVID patients, however CG was not seen. Outbreaks had forzed pathology redeployment to clinical care without proper preparation.