A Case Report of Nearly Missed Renal Tubular Acidosis in the Setting of Sjögren's Syndrome.

The association of renal tubular acidosis (RTA) and Sjögren's syndrome (SS) has been well-documented in the literature previously but is often undiagnosed in clinical practice. In this case report, we present a case of a woman with distal RTA who presented with nausea, vomiting, and confusion. The case shows the diagnostic value of urine studies when evaluating a patient who has exaggerated and unexplained electrolyte losses and how this will change management. Recognizing the extra glandular manifestations of patients with SS is important for patient care to prevent delays in care and treatment.

Association between Renal Function at Admission and COVID-19 in-Hospital Mortality in Southern Italy: Findings from the Prospective Multicenter Italian COVOCA Study.

BACKGROUND: Evidence has shown a close association between COVID-19 infection and renal complications in both individuals with previously normal renal function and those with chronic kidney disease (CKD). METHODS: The aim of this study is to evaluate the in-hospital mortality of SARS-CoV-2 patients according to their clinical history of CKD or estimated glomerular filtration rate (eGFR). This is a prospective multicenter observational cohort study which involved adult patients (≥18 years old) who tested positive with SARS-CoV-2 infection and completed their hospitalization in the period between November 2020 and June 2021. RESULTS: 1246 patients were included in the study, with a mean age of 64 years (SD 14.6) and a median duration of hospitalization of 15 days (IQR 9-22 days). Cox's multivariable regression model revealed that mortality risk was strongly associated with the stage of renal impairment and the Kaplan-Meier survival analysis showed a progressive and statistically significant difference (p < 0.0001) in mortality according to the stage of CKD. CONCLUSION: This study further validates the association between CKD stage at admission and mortality in patients hospitalized for COVID-19. The risk stratification based on eGFR allows clinicians to identify the subjects with the highest risk of intra-hospital mortality despite the duration of hospitalization.

Ramadan fasting outcome among high-risk patients.

BACKGROUND: There is a growing literature on guidelines regarding Ramadan fasting for chronic kidney disease (CKD) patients. However, most studies only consider the impact of fasting on renal function. This study additionally aims to assess factors influencing Ramadan fasting in patients with CKD. METHOD: This is a prospective before and after cohort study. CKD patients were counseled regarding fasting and followed-up post-Ramadan for renal function status, actual fasting behavior, and other relevant outcomes. RESULTS: Of the 360 patients who attended the pre-Ramadan consultation, 306 were reachable after Ramadan of whom 55.3% were female. Of these 306 67.1% reported that they had fasted, 4.9% had attempted to fast but stopped, and 28% did not fast at all. Of these 74 has a post-fasting kidney test. Of the patients, 68.1% had stage 3A CKD, 21.7% had stage 3B, 7.9% stage 4, and only 2% stage 5. Of those who fasted, 11.1% had a drop in Glomerular Filtration Rate (eGFR) of 20% or more. Those who did not fast (16.7%) presented a similar drop. Conversely, among the few who attempted to fast and had to stop, half showed a drop in eGFR of more than 20%. In linear regression, fasting was not associated with post-Ramadan eGFR, when controlling for age and baseline eGRF. There were 17 (5.6%) significant events, including one death. More significant events occurred among the group who fasted some of Ramadan days, 26.7% of the subjects experienced an adverse event-while 4.7% of the group who did not fast had a significant adverse event compared to 4.4% among those who fasted all Ramadan. CONCLUSION: Fasting was not a significant determining factor in renal function deterioration in the study's population, nor did it have any significant association with adverse events.

Prevalence And Impact of Hyponatremia in Chronic Kidney Disease Patients with Coronavirus Disease 2019

Background: Coronavirus disease 2019 (COVID-19) is frequently associated with hyponatremia. Individuals with history of chronic kidney disease (CKD) are more likely to experience critical complications related to COVID-19. Objective: This study aimed to identify the prevalence and outcomes of admittance of hyponatremia in COVID-19 patients with history of CKD. Patients and Methods: The study involved admitted CKD patients with COVID-19 between January 2021 and April 2021. It was performed at Zagazig University hospital. Subjects were divided according to admittance serum sodium into group 1 with hyponatremia (80 subjects) and group 2 with normonatremia (68 subjects). Hypernatremic patients were excluded. Clinical and laboratory data were collected from all subjects. Patients were observed for the occurrence of acute respiratory failure, and acute renal failure. Additionally, mortality rates were recorded. Results: Patients in group 1 stayed longer in the hospital than in group 2 (p = 0.034). Additionally, they had higher systolic blood pressure records (p < 0.001). Group 1 had significantly shorter survival and higher incidence rates of acute kidney injury (AKI) than group 2. Finally, multivariate analysis revealed that the significant risk factors for in-hospital mortality in group 1 were older age, longer hospital stay, higher serum potassium, and higher LDH. Conclusion: In our study, hyponatremia affected 54% of CKD patients with COVID-19 and was attributed to higher rates of AKI and in-hospital mortality. © 2022, Ain Shams University Faculty of Medicine. All rights reserved.

Remdesivir for COVID-19 pneumonia in patients with severe chronic kidney disease: A Case series and review of the literature.

Remdesivir was the first antiviral agent to receive FDA authorization for severe COVID-19 management, which restricts its use with severe renal impairment due to concerns that active metabolites might accumulate, causing renal toxicities. With limited treatment options, available evidence on such patient groups is important to assess for future safety.

Impact of the COVID-19 pandemic on symptoms of anxiety and depression and health-related quality of life in older patients with chronic kidney disease.

BACKGROUND: Older patients with advanced chronic kidney disease are at increased risk for a severe course of the coronavirus disease-2019 (COVID-19) and vulnerable to mental health problems. We aimed to investigate prevalence and associated patient (demographic and clinical) characteristics of mental wellbeing (health-related quality of life [HRQoL] and symptoms of depression and anxiety) before and during the COVID-19 pandemic in older patients with advanced chronic kidney disease. METHODS: An ongoing Dutch multicentre prospective cohort study enrols patients of ≥70 years with an eGFR < 20 mL/min/1.73m2 from October 2018 onward. With additional questionnaires during the pandemic (May-June 2020), disease-related concerns about COVID-19 and general anxiety symptoms were assessed cross-sectionally, and depressive symptoms, HRQoL, and emotional symptoms longitudinally. RESULTS: The 82 included patients had a median age of 77.5 years (interquartile range 73.9-82.1), 77% were male and none had tested positive for COVID-19. Cross-sectionally, 67% of the patients reported to be more anxious about COVID-19 because of their kidney disease, and 43% of the patients stated that their quality of life was reduced due to the COVID-19 pandemic. Compared to pre-COVID-19, the presence of depressive symptoms had increased (11 to 22%; p = .022) and physical HRQoL declined (M = 40.4, SD = 10.1 to M = 36.1, SD = 10.4; p < .001), particularly in males. Mental HRQoL (M = 50.3, SD = 9.6 to M = 50.4, SD = 9.9; p = .913) and emotional symptoms remained similar. CONCLUSIONS: Older patients with advanced chronic kidney disease suffered from disease-related anxiety about COVID-19, increased depressive symptoms and reduced physical HRQoL during the COVID-19 pandemic. The impact of the pandemic on this vulnerable patient group extends beyond increased mortality risk, and awareness of mental wellbeing is important. TRIAL REGISTRATION: The study is registered at the Netherlands Trial Register (NTR), trial number NL7104. Date of registration: 06-06-2018.