No Evidence for Persisting or Progressive Kidney Disease After Non-Severe COVID-19

Background: Diverse abnormal findings have been described after non-severe coronavirus disease 2019 (COVID-19) but kidney outcomes remain largely unknown. Here we analyze various kidney parameters after non-severe COVID-19 to test the hypothesis of a relevant kidney sequela. Method(s): This cross-sectional study investigates patients after non-severe COVID-19 and matched control subjects without prior COVID-19. Patients were recruited by the population-based Hamburg City Health Study (HCHS) as well as its associated COVID program. The HCHS is a prospective population-based cohort study on randomly selected residents of the city of Hamburg, Germany. During the COVID-19 pandemic the study also invited patients at least 4 months after a PCR proven severe acute respiratory syndrome coronavirus type 2 (SARS-CoV-2) infection via newspaper announcements and an official COVID-19 test center. All patients had to be between 45 and 74 years of age. Matching was performed by age, sex, and education. Main outcomes were eGFR, albuminuria, Dickkopf3, hematuria, and pyuria. Descriptive analysis and mixed regression models were performed with adjustment for multiple testing by Bonferroni corrections. Result(s): The non-COVID cohort consisted of 1328 subjects, the post-COVID cohort of 443 patients in median 9 months after SARS-CoV-2 infection. Most patients had mild COVID-19. Only 31 patients were hospitalized with COVID-19 and no patient was treated on an intensive care unit. The risk for chronic kidney disease (CKD), defined by an eGFR < 60 ml/min/1.73m2, (OR 0.9, adjusted p=1.000) or severely increased albuminuria (OR 0.79, adj. p=0.893) was not increased in the post-COVID compared to the non-COVID cohort. This also applied for early CKD stages. However, mean eGFR was mildly lower in post-COVID subjects, even after adjusting for known risk factors (beta -1.84, adj. p=0.032). We found no elevation of hematuria, pyuria, and proteinuria for the post-COVID cohort suggesting no systematic ongoing kidney involvement. Urinary Dickkopf3 even tended to be lower in post-COVID patients indicating no risk for ongoing GFR decline in this cohort (beta -72.19, adj. p=0.072). Conclusion(s): While there is a subclinical eGFR drop after non-severe COVID-19, we found no evidence for a relevant kidney sequela nor ongoing renal involvement.

[Testing of practical surgical teaching at a distance-Experiences with a hybrid OSCE in surgery]. / Prüfung praktisch-chirurgischer Lehre auf Distanz ­ Erfahrungen mit einem Hybrid-OSCE in der Chirurgie.

BACKGROUND: The COVID-19 pandemic has changed medical teaching worldwide. Digital teaching and examinations are successful for cognitive learning objectives, whereas practical skills had to be carried out predominantly in person under strict hygiene standards. AIM: This study presents the opportunities and challenges of using a presence objective structured clinical examination (OSCE) at a distance with digital support. METHOD: Following surgical practical teaching an OSCE was conducted in presence, where students demonstrated practical skills in one room while the examiners were connected via videoconference from another room. Students were surveyed about the OSCE and sustained learning via a standardized online questionnaire after completion of the surgical teaching. Additionally, examiners were surveyed on their experiences. RESULTS: In the online survey 40 students participated (25% of n = 157 students contacted) and 36 completed questionnaires were analyzed. Overall, the implementation of an OSCE even under pandemic conditions was perceived as very positive by the students (92% of students n = 33). In particular, the acquisition of practical skills was rated as very high. For 78% (n = 28) of the students, the acquisition of competencies through the practical examination was particularly sustainable. The vast majority of students and examiners felt safe regarding infection control because of the hygiene concept (92%, n = 33). Overall, 80 students achieved grade 1 (51%), 71 students grade 2 (45.2%) and 6 students grade 3 (3.8%) (grade 1 = very good, grade 6 = very bad). CONCLUSION: Practical examinations are essential for checking practical learning objectives and can be implemented at a distance with a well-developed hygiene concept and digital support.

Prüfung praktisch-chirurgischer Lehre auf Distanz – Erfahrungen mit einem Hybrid-OSCE in der Chirurgie Testing of practical surgical teaching at a distance—Experiences with a hybrid OSCE in surgery

Hintergrund Die COVID-19-Pandemie hat die medizinische Lehre weltweit verändert. Digitale Lehrformate und Prüfungen konnten für kognitive Lernziele häufig gut eingesetzt werden, wohingegen praktische Fertigkeiten in Lehre und Prüfung überwiegend in Präsenz unter strengen Hygienestandards durchgeführt werden mussten. Ziel der Arbeit Die vorliegende Untersuchung stellt die Chancen und Herausforderungen des Einsatzes eines OSCE („objective structured clinical examination“) in Präsenz und trotzdem „auf Distanz“ mit digitaler Unterstützung dar. Methode Im Anschluss an das chirurgische Praktikum des 8. Semesters wurde eine OSCE-Prüfung in Präsenz durchgeführt, bei welcher die Studierenden in einem Raum praktische Fertigkeiten nachwiesen, während die Prüfer*innen per Videokonferenz aus einem anderen Raum zugeschaltet wurden. Die Studierenden wurden nach Abschluss der chirurgischen Lehre zur OSCE-Prüfung und zum nachhaltigen Lernen mittels standardisiertem Onlinefragebogen befragt. Zusätzlich wurden die Prüfenden zu ihren Erfahrungen befragt. Ergebnisse Von den 157 Studierenden des Jahrgangs nahmen 25 % (n = 40) an der Onlinebefragung teil, wobei 36 vollständige Fragebögen ausgewertet werden konnten. Insgesamt wurde die Implementierung einer OSCE-Prüfung auch unter Pandemiebedingungen von den Studierenden als sehr positiv und sinnvoll aufgefasst (92 % der Studierenden, n = 33). Der Erwerb praktischer Kompetenzen wurde als sehr hoch eingeschätzt. Für 78 % (n = 28) der Studierenden war der Kompetenzerwerb durch die praktische Prüfung nachhaltig. Die große Mehrheit der Studierenden und Prüfenden fühlte sich durch das Hygienekonzept hinsichtlich des Infektionsschutzes sicher (92 %, n = 33). Insgesamt schlossen 80 Studierende (51 %) die OSCE-Prüfung nach Schulnoten (Note 1 = sehr gut, Note 6 = ungenügend) mit der Note 1, 71 Studierende (45,2 %) mit der Note 2 und 6 Studierende (3,8 %) mit der Note 3 ab. Schlussfolgerung Praktische Prüfungen sind als Lernerfolgskontrolle psychomotorischer Lernziele unerlässlich und mit gut erarbeitetem Hygienekonzept und digitaler Unterstützung auch auf Distanz umsetzbar.

COVID-19-associated kidney injury is characterized by acute tubular necrosis and capillary congestion with evidence for SARS-CoV-2 in the nephron

BACKGROUND AND AIMS: Kidney damage has been reported in COVID-19 patients. Despite numerous reports about COVID-19-associated nephropathy, the factual presence of the SARS-CoV-2 in the renal parenchyma remains controversial. METHOD: We consecutively performed 16 immediate (≤3h) post-mortem renal biopsies in patients diagnosed with COVID-19. Kidney samples from 5 patients who died from sepsis and were free from COVID-19 were used as controls. Samples were methodically evaluated by 3 pathologists. Virus detection in the renal parenchyma was performed in all samples by bulk RNA RT-PCR (E and N1/N2 genes), immunostaining (nCoV2019 N-Protein), fluorescent in situ hybridization (nCoV2019-S) and electron microscopy. The first (overview) and second (targeted zoom) columns display positive signal for viral RNA in different renal compartments, including proximal and distal tubules, glomeruli and vessels. nCoV2019-S RNA is in green;Lotus tetragonolobus lectin (LTL) is in red;DAPI is in blue. RESULTS: The mean age of our COVID-19 cohort was 68.2±12.8 years, most of whom were males (68.7%). Proteinuria was observed in 53.3% of cases, while acute kidney injury occurred in 60% of cases. Acute tubular necrosis of variable severity was found in all cases, with no tubular or interstitial inflammation. There was no difference in acute tubular necrosis severity between the patients with COVID-19 versus control samples. Congestion in glomerular and peri-tubular capillaries was respectively observed in 56.3 and 87.5% of patients with COVID-19 compared to 20% of controls, with no evidence of thrombi. The nCoV2019 N-Protein was detected in proximal tubules and also at the basolateral pole of scattered cells of the distal tubules in 9/16 cases. In situ hybridization confirmed these findings. RT-PCR of kidney total RNA detected SARS-CoV-2 N gene in one case. Electron microscopy did not show typical viral inclusions. CONCLUSION: Our immediate post-mortem kidney samples from patients with COVID-19 highlight a congestive pattern of acute kidney injury, with no significant glomerular or interstitial inflammation. Immunostaining and in situ hybridization suggest that SARS-CoV-2 is present in various segments of the nephron.