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Since December 2019, a new type of coronavirus called novel coronavirus (2019-nCoV, or COVID-19) was identified in Wuhan, China and on March 11, 2020, the World Health Organization (WHO) has declared the novel coronavirus (COVID-19) outbreak a global pandemic. With more than 101,797,158 confirmed cases, resulting in 3,451,354 deaths as of May 21, 2021, the world faces an unprecedented economic, social, and health impact. The clinical spectrum of COVID-19 has a wide range of manifestations, ranging from an asymptomatic state or mild respiratory symptoms to severe viral pneumonia and acute respiratory distress syndrome. Several diagnostic methods are currently available for detecting the coronavirus in clinical, research, and public health laboratories. Some tests detect the infection directly by detecting the viral RNA using real time reverse transcriptase polymerase chain reaction (RT-PCR) and other tests detect the infection indirectly by detecting the host antibodies. Additional techniques are using medical imaging diagnostic tools such as X-ray and computed tomography (CT). Various approaches have been employed in the development of COVID-19 therapies. Some of these approaches use drug repurposing (e.g. Remdesivir and Dexamethasone) and combinational therapy (e.g. Lopinavir/Ritonavir), whilst others aim to develop anti-viral vaccines (e.g. mRNA and antibody). Additionally, health experts integrate data sharing, provide with guidelines and advice to minimize the effects of the pandemic. These guidelines include wearing masks, avoiding direct contact with infectious people, respiratory and personal hygiene. Taken together, an extensive knowledge on transmission mechanisms, clinical spectrums, specific diagnostics methods, host-virus interactions are required to tackle this pandemic.
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Background: Membranous nephropathy is a relatively common glomerular pathology that manifests with either nephrotic or sub-nephrotic range proteinuria. Evidence is emerging of COVID-19 and its vaccines having an influence on various glomerular diseases, including IgA nephropathy and minimal change disease, with limited information on membranous nephropathy. Data from our tertiary centre suggested a rise in cases of membranous nephropathy within a month after vaccination. Method(s): Patients who had renal biopsies in 2021 were identified from pathology results and online clinical records. Information on COVID-19 status, COVID vaccinations and biochemical results were compared. Patients were then split into 2 groups;those presenting within 1 month of vaccination or COVID infection and those who hadn't had vaccinations or a COVID infection within 4 weeks of presentation. Result(s): Complete vaccination and COVID infection history was present in 17 of the 24 patients. Of the 17 patients, 6 were in group 1 and 11 in group 2. 16 out of the 17 patients had nephrotic range proteinuria, 6 also had an AKI at presentation. There was no significant difference in presentation between the groups (see table 1). Conclusion(s): Our data has not conclusively shown a difference between the two groups probably because of the low numbers. But further studies are needed to see if there is a link between either COVID infections or COVID vaccinations and glomerular disease.
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Background: Presenting features for glomerular disease can be varied, including but not exclusively, acute kidney injury, nephrotic syndrome or haemo-proteinuria. At our regional tertiary centre we conducted a retrospective study to see whether clinical presentations of glomerular diseases had changed during the COVID-19 pandemic. Method(s): In this study, new and repeat native renal biopsies were included from January 2018 to October 2021. Glomerular pathologies of interest included minimal change disease, membranous nephropathy, IgA nephropathy, lupus nephritis and pauciimmune glomerulonephritis. We looked at three periods of time: prior to the start COVID-19 pandemic in 2018/19;during the COVID-19 pandemic in 2020;and after the introduction of COVID-19 vaccines in 2021. Result(s): 263 biopsies were identified over the 4-year period. IgA nephropathy - n = 13. Lupus nephritis - n = 43. The different classes of lupus nephritis are shown in (see figure 1) Minimal change disease - n = 57. All presented with the nephrotic syndrome. Between 6-25% over the study period presented with AKI (mean 19%) Pauci-immune glomerulonephritis - n = 85. Between 81%-91% over the study period presented with AKI, or AKI on CKD (mean 84%) Membranous glomerulopathy - n = 66. 50%, presented with the nephrotic syndrome. 20% presented with AKI in addition to proteinuria. Conclusion(s): Our analysis has not shown a significant change in clinical presentations of glomerular disease. There has not been an increased propensity in presenting with AKI in minimal change disease or membranous nephropathy. We saw the highest proportion of class IV lupus nephritis in 2021.
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Background: Glomerular disease carries a significant burden of morbidity and mortality. There is emerging evidence of the impact of the COVID-19 pandemic and COVID-19 vaccination on glomerular disease. The aim of the study was to retrospectively analyse our experience of the incidence of glomerular disease between 2018 and 2021. Method(s): Native renal biopsy results were reviewed to compare the incidence of glomerular disease prior to the COVID-19 pandemic (2018/19);prior to development of COVID-19 vaccination (2020);and after the introduction of COVID-19 vaccines (2021). Biopsy data from January 2018 to October 2021 were collated from pathology records for all glomerular disease patients in our unit. We focused on the incidence of IgA nephropathy, lupus nephritis, minimal change disease, membranous nephropathy and pauci-immune glomerulonephritis. Result(s): 263 native biopsies were performed;45 biopsies in 2018, 75 in 2019, 65 in 2020 and 78 in the first ten months of 2021. The proportional incidence of each disease is shown in figure 1. The incidence of membranous nephropathy was noted to be higher in 2021, coinciding with the introduction of the COVID-19 vaccine programme in the UK, from an average of 23% of cases between 2018-2020, to 31% in the first ten months of 2021. The overall incidence of glomerular disease, excluding vasculitis, seemed to have fallen during 2020. Conclusion(s): The emergence of COVID-19 does not appear to have caused a significant increase in the overall incidence of glomerular disease in our population. We noted an increase in the incidence of membranous nephropathy following the introduction of the COVID-19 vaccination programme in 2021. The relatively lower incidence in 2020 could be related to limited access to primary health care practitioners and consequent reduction in referrals to secondary care at the time.
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AJOL : Background: The severe acute respiratory syndrome coronavirus-2 was first reported by the World Health Organization in December 2019 and thereafter declared a pandemic. Its emergence affected all spheres of daily life including widespread lockdowns at the peak of the first wave of the pandemic. Several nonpharmacological preventive practices were adopted to curb the spread of the novel coronavirus amid the initial paucity of supporting scientific data. Aim: The study aimed to evaluate the level of awareness and preventive practices among the family caregivers of the patients admitted to a mixed hospital during the first wave of the COVID-19 pandemic in Nigeria. Methods to Materials: This study was a self-administered questionnaire-based cross-sectional survey carried out in June 2020 during the lockdown for the first wave of the COVID-19 pandemic. The study participants were selected by the convenience sampling method. Participants consisted of one hundred family caregivers of the inpatients admitted for various ailments other than COVID-19 in our hospital. Data on demography, awareness of COVID-19, and preventive practices were obtained and analysed using IBM SPSS version 20. The results were presented using tables. Categorical data were summarised by frequencies and percentages, whereas continuous data were summarised using means and standard deviations (SDs). Results: The respondents were mainly married young adults (74%) with an age range between 15 and 66 years. The mean age was 37.7 ± 13.9 SD. Sixty-four percent of the respondents were female, 92% were of the Yoruba ethnic group, and 60% were university graduate. Most family caregivers were first-degree relatives (86%), and 14% were acquaintances or friend. The findings showed that 98% of the respondents were aware of the COVID-19 pandemic, and 56% never experienced fear of contracting the disease. Fifty-eight percent of the respondents observed physical distancing, whereas the remaining 42% practiced normal physical interaction despite the pandemic. Regular handwashing and the use of face masks were the most common nonpharmacological preventive practices. Cloth face masks were the most commonly used. Only 38% of the respondents were aware of the inhospital COVID-19-positive patients, and a majority of them got the information through the radio and from discussions among the patients' relatives. Conclusion: Family caregivers are an integral part of the health-care system, and females are more involved than males. Regular handwashing and the use of cloth face masks were the most common COVID-19 nonpharmacological preventive practices among the family caregivers
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Introduction: Patients with COVID-19 can be asymptomatic or have severe illness. Oxidative stress may be a cause of increased severity and mortality in COVID-19 patients. Methaemoglobinaemia (MetHb) and haemolysis can occur as a result of oxidative stress. MetHb is associated with sepsis, exposure to drugs and inborn errors of metabolism. Glucose-6-phosphate dehydrogenase (G6PD) deficiency may also manifest with MetHb and severe haemolysis. Case Description: A 31-year old man, originally from West Africa, with no comorbidities, presented with dyspnoea, cough, anosmia and oligo-anuria. He had type 1 respiratory failure and stage 3 AKI, which led to critical care admission for intubation, ventilation and haemofiltration. COVID-19 pneumonia was confirmed by nasopharyngeal swab and radiological imaging. He developed haemolytic anaemia. The MetHb was 3.5% (normal <1.5%). It rose to a peak of 10.7% with persisting anaemia and further investigations showed G6PD deficiency. He had no exposure to medications known to trigger haemolytic crises, such as Hydroxychloroquine. He was treated with supportive management including red cell transfusions and also with Tocilizumab for COVID-19. He was extubated after 15 days and recovered renal function. Data on 9 other patients admitted during this period to the ITU with COVID-19 and AKI showed 7 had normal MetHb levels and 2 had modest elevations (<3%). Discussion: Triggers of G6PD deficiency include stress from infections, fava beans, or drugs e.g Hydroxychloroquine. It typically presents as haemolytic anaemia, jaundice and AKI. Although MetHb is linked to severe illness including sepsis, little is known about a possible association with COVID-19. Our report highlights the importance of considering alternative diagnoses of very high MetHb levels such as G6PD deficiency in COVID-19 patients. This is of particular relevance as Hydroxychloroquine has been used as experimental treatment for COVID-19 and in the current climate, G6PD deficiency should be suspected in COVID-19 patients with AKI, acute haemolytic anaemia and signikficantly elevated MetHb, particularly in those from regions of high prevalence and those treated with known triggers such as Hydroxychloroquine.
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Background: The COVID-19 PCR swab test has low sensitivity and some infected people are asymptomatic, which makes it possible for inadvertent spread of the virus to occur. We reviewed laboratory data in haemodialysis (HD) patients to investigate the utility of routine blood tests as surrogate markers of COVID-19 infection. Methods: Retrospective cohort study of data in prevalent patients on HD from 1st March 2020. Blood test results from June 2018 to May 2020 were analysed. Results: There were 708 patients. 473 were on HD since June 2018. 150 had ≥1 PCR test for COVID-19: 69 were positive. 268 (37.9%) were female and 282 (39.8%) were of non-white race. Median age was 69 years (IQR 56-78). Lymphocytes Mean lymphocyte count at baseline was 1.5 (SD 4.3). Prior to March 2020, the mean monthly prevalence of lymphopaenia was stable at 32 %, but rose to 67 % in COVID +ve patients and 36 % in COVID -ve patients (p<0.001) during the peak of the COVID crisis in April. Ferritin Mean monthly ferritin at baseline was 395μg/L. Prior to March 2020, only 3% of patients each month had a ferritin of >;1000μg/L. In April, 68 % of COVID +ve individuals had a ferritin of >;1000μg/L compared to 18 % of COVID -ve patients (p<0.001). No significant differences were noted in platelet count, neutrophils and CRP over the study period. Conclusions: Our data show a high prevalence of lymphopaenia which was more pronounced in COVID +ve patients. There was no similar rise over the previous 2 winter periods, so we feel this was a COVID specific, rather than just a viral phenomenon. A low lymphocyte count has recently been associated with adverse prognosis in our patients with COVID-19. Our data support reports which suggest that ferritin could aid screening for COVID-19 in HD patients. The degree of elevation of ferritin during the 'COVID months' in our COVID +ve group suggests that the disease was contributing to this. This may be due to a cytokine storm and multi-organ involvement and ferritin may prove to be a prognostic factor for COVID-19.
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Background: Dialysis patients, with frequent co-morbidities, advanced age and frailty, visiting treatment facilities frequently are perhaps more prone to SARS-Cov-2 infection and related death - the risk-factors and dynamics of which are unknown. The aim of this study was to investigate the hospital outcomes in SARS-CoV-2 infected dialysis patients. Methods: This prospective, observational, multi-centre study collected data on SARS-CoV-2 infected HD patients between 29/02/2020 and 15/05/2020. Data was collected on demographics, comorbidities, WHO performance status, clinical symptoms, laboratory parameters, hospital management and outcomes. Treatment was predominantly supportive, unless patients were part of an approved clinical trial. The study was approved by NHS Research Ethics Committee 20/SW/0077 and Heath Research Authority IRAS 283130. Results: Of 1737 HD patients at the 3 renal centres, 224 (13%) were COVID-19 positive over the study period. The characteristics of the COVID-19 HD patients were: mean age 65.8;59% male;38% Caucasian;81% hypertension;54% diabetes;25% chronic lung disease;29% ischaemic heart disease and 22% cerebrovascular disease. The most common symptoms at presentation were fever (62%) and cough (53%). About 143 (64%) patients were managed as an inpatient and 81 (36%) as an outpatient. Of 9 patients that required mechanical ventilation: 6 died, 1 patient was discharged and 2 are still under clinical care. Overall 51 patients died (23%), 154 (69%) were discharged alive and 19 (8%) were still under clinical care as of 15/05/2020. Preliminary analyses suggested that those that died were significantly older (p=0.0028), more likely to have ischaemic heart disease (p=0.003), cerebrovascular disease (p=0.019), smoking history (p=0.006), WHO performance status 3-4 (p=0.004), higher neutrophil: lymphocyte ratio at presentation (p=0.0001) and higher CRP at presentation (p=0.0021). Conclusions: This large cohort of COVID-19 positive haemodialysis demonstrates a high case fatality ratio, which increased significantly with age, cardiovascular disease, smoking history, frailty and markers of inflammation.