Associations of renal dysfunction and hyperuricemia in patients with a new coronavirus infection

The purpose: to study the association of hyperuricemia and renal dysfunction in convalescents of new coronavirus infection. Materials and methods: The study included 234 people who had a new coronavirus infection COVID-19 and were observed two months after convalescence. The mean age was 54.10±12.88 years. Three groups of patients were formed according to the anamnesis according to the severity of the new coronavirus infection: mild (n=108), moderate (n=112), and severe (n=14). In patients, BMI, creatinine, and uric acid levels were determined. Statistical processing of the obtained results was performed using the SPSS software package. Results: the average level of GFR was 80.34±16.66 ml/min/1.73 m2. In patients with a mild course of coronavirus infection, the average GFR was 82.52±15.78 ml/min/1.73 m2, with a moderate course – 78.33±17.69 ml/min/1.73 m2, with a severe course – 79.71±13.38 ml/min/1.73 m2. А decrease in GFR below 90 ml/min/1.73 m2 occurred in 69.3% of cases. Significant differences were obtained between the 1st and 2nd groups (p=0.046). Hyperuricemia was registered in 33.8% of cases. Moreover, in patients with a severe course of coronavirus infection, hyperuricemia was more common than in those with a mild course (64.3% vs 26.4%, p=0.0001) and those with a moderate course (64.3% vs 31.8%, p=0.002). Decreased GFR in patients with a mild form of COVID-19 is associated with the presence of hyperglycemia. In addition, an increase in BMI by 1 kg/m2 leads to a 10% reduction in the risk of developing renal dysfunction. In patients who had moderate COVID-19, a decrease in GFR was associated only with hyperuricemia. Conclusion: hyperuricemia is observed in 33.8% of patients 2 months after a new coronavirus infection. A decrease in GFR of less than 60 ml/min/1.73 m2 was observed in 10% of patients. Hyperuricemia is directly related to the severity of COVID-19 infection. The causal relationship between hyperuricemia in patients after COVID-19 and impaired renal function requires further research. © 2022 Authors. All rights reserved.

The Effects of SARS-CoV-2 Infection on Renal Function in Patients with Hemodialysis

Objective: This study aims to demonstrate the impact of "SARS-CoV-2" infection on renal function in patients who have undergone hemodialysis in the past. Methodology: Telomerase Reverse Polymerase Chain Reaction in Real Time (RT-Real time PCR) To verify "SARS CoV-2" infection, RT-PCR was used, moreover pre and post urea and creatinine tests were confirmed by COBAS INTEGRA 400 plus analyzer was automated qualitative assays rapidly detected Creatinine, urea, and diabetes Mellitus levels. Result(s): The mean of pre-creatinine levels was 7.3336. The post-creatinine levels (11.8276) significantly increased after "SARS-CoV-2" infection with a P-value of 0.001. The mean of pre-urea levels was 163.6724. The post-urea levels (213.706897) significantly increased after "SARS-CoV-2" infection with a P-value of 0.001. Conclusion(s): SARS-CoV-2 infection in patients with pre-existing hemodialysis leads to increasing kidney dysfunction with or without comorbidities (diabetes mellitus and hypertension). Moreover, the old patients with pre-existing hemodialysis are found to be at higher risk of renal dysfunction during "SARS-CoV-2" infection than the younger groups. Copyright © 2022, Bahrain Medical Bulletin. All rights reserved.

SARS-CoV-2 infection and diabetes: Pathophysiological mechanism of multi-system organ failure.

Since the discovery of the coronavirus disease 2019 outbreak, a vast majority of studies have been carried out that confirmed the worst outcome of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection in people with preexisting health conditions, including diabetes, obesity, hypertension, cancer, and cardiovascular diseases. Likewise, diabetes itself is one of the leading causes of global public health concerns that impose a heavy global burden on public health as well as socio-economic development. Both diabetes and SARS-CoV-2 infection have their independent ability to induce the pathogenesis and severity of multi-system organ failure, while the co-existence of these two culprits can accelerate the rate of disease progression and magnify the severity of the disease. However, the exact pathophysiology of multi-system organ failure in diabetic patients after SARS-CoV-2 infection is still obscure. This review summarized the organ-specific possible molecular mechanisms of SARS-CoV-2 and diabetes-induced pathophysiology of several diseases of multiple organs, including the lungs, heart, kidneys, brain, eyes, gastrointestinal system, and bones, and sub-sequent manifestation of multi-system organ failure.

Assessment of Knowledge, Attitudes, and Practices towards COVID-19 among Hemodialysis Nurses during the COVID-19 Outbreak in Ma'an Governorate Hospitals- Jordan.

The COVID-19 pandemic remains a worldwide challenge. Despite extreme study efforts globally, effective treatment and vaccine options have eluded the investigators. Therefore, this study aimed to investigate knowledge, attitudes, and practices (KAP) towards COVID-19 among hemodialysis nurses in Ma, Governorate hospitals- Jordan. An exploratory research design (cross-sectional study design) has been utilized to achieve the aim of the current study. The study was conducted in the dialysis unit at Ma, a governmental hospital- in Jordan. Data were collected by using a self-administered structured questionnaire. Nearly half (47.5%) of nurses were male, ranging from 30 to 40 years old. More than half of them (62.5%) were married and graduated from nursing college; their years of experience were more than 5 years. The vast majority of participants reported that they have adequate knowledge and good practice about how to deal with COVID-19. The majority of participants have a favorable attitude regarding COVID -19 outbreaks. A positive correlation was found between nurses' knowledge and attitudes toward COVID19 according to their years of experience. The study found that most nurses have good knowledge and practice levels and favorable attitudes toward COVID 19 infection. Educational programs about COVID 19 should be provided to nurses in different departments and units in the hospital.

Ultrasound in COVID-19: only lung?

Although SARS-CoV-2 primarily infects the respiratory system, other clinical manifestations of COVID-19 are possible, including renal, gastrointestinal, liver, neurological, and hematological alterations. As a consequence, COVID-19 must be considered a systemic disease of which still much should be studied and analyzed because of its considerable clinical variability. Cardiac involvement has also been demonstrated, and the risk of ventilator-induced diaphragm dysfunction has become relevant due to the possibility of prolonged mechanical ventilation, as reported for similar syndromes. For these reasons, cardiac and diaphragm ultrasound evaluation are highly important in the treatment of COVID-19. Moreover, due to the thrombotic tendency of COVID-19 patients, particular attention should also be paid to vascular ultrasound. To refine the diagnostic and therapeutic process, it is necessary for specialists all over the world to constantly search for methods and machines that can be efficient and easy to use. In recent years ultrasound machines have greatly expanded their possibilities of investigation, due to improved capacity of information and signal processing systems. At the same time the specialists of the subject have implemented their knowledge on the recognition of ultrasonographic signs. This review addresses with the extrapulmonary organs that can be explored using ultrasonography, and underlines the importance of its application in critically ill patients. © 2022 Journal of Innovation Management. All rights reserved.

Utilization of apixaban anti-Xa levels in transition from apixaban to warfarin in a patient with chronic renal dysfunction.

PURPOSE: The effect of apixaban on anti-factor Xa (anti-Xa) assays and international normalized ratio (INR) complicates transitions between anticoagulant agents. When switching from apixaban to warfarin, the recommendation is to begin both a parenteral anticoagulant and warfarin at the time of the next apixaban dose and to discontinue the parenteral agent when the INR is in an acceptable range. This proves challenging in renal dysfunction, as continued presence of apixaban contributes to both a prolonged effect on the INR and continued therapeutic levels of anticoagulation. SUMMARY: This case describes the transition of apixaban to warfarin in a patient with acute on chronic kidney disease and recent deep vein thrombosis, utilizing chromogenic apixaban anti-Xa assays to assess the level of anticoagulation and avoid unnecessary parenteral anticoagulation. CONCLUSION: Utilization of apixaban anti-Xa levels aided in the transition from apixaban to warfarin in a patient with chronic renal failure and avoided need for parenteral bridging therapy.

Risks of AKI and Major Adverse Clinical Outcomes in Patients with Severe Acute Respiratory Syndrome or Coronavirus Disease 2019.

BACKGROUND: Severe acute respiratory syndrome (SARS) and coronavirus disease 2019 (COVID-19) are closely related. The effect of AKI on the clinical outcomes of these two conditions is unclear. METHODS: This retrospective, territory-wide cohort study used an electronic public healthcare database in Hong Kong to identify patients with SARS or COVID-19 by diagnosis codes, virologic results, or both. The primary endpoint was a composite of intensive care unit admission, use of invasive mechanical ventilation, and/or death. RESULTS: We identified 1670 patients with SARS and 1040 patients with COVID-19 (median ages, 41 versus 35 years, respectively). Among patients with SARS, 26% met the primary endpoint versus 5.3% of those with COVID-19. Diabetes mellitus, abnormal liver function, and AKI were factors significantly associated with the primary endpoint among patients with either SARS or COVID-19. Among patients with SARS, 7.9%, 2.1%, and 3.7% developed stage 1, stage 2, and stage 3 AKI, respectively; among those with COVID-19, 6.6%, 0.4%, and 1.1% developed stage 1, stage 2, and stage 3 AKI, respectively. In both groups, factors significantly associated with AKI included diabetes mellitus and hypertension. Among patients with AKI, those with COVID-19 had a lower rate of major adverse clinical outcomes versus patients with SARS. Renal function recovery usually occurred within 30 days after an initial AKI event. CONCLUSIONS: AKI rates were higher among patients with SARS than those with COVID-19. AKI was associated with major adverse clinical outcomes for both diseases. Patients with diabetes mellitus and abnormal liver function were also at risk of developing severe consequences after SARS and COVID-19 infection.

Renal dysfunction and prognosis of COVID-19 patients: a hospital-based retrospective cohort study.

INTRODUCTION: Increasing evidence indicate that coronavirus disease 2019 (COVID-19) is companied by renal dysfunction. However, the association of Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2)-induced renal dysfunction with prognosis remains obscure. MATERIALS AND METHODS: All 154 patients with COVID-19 were recruited from the Second People's Hospital of Fuyang City in Anhui, China. Demographic characteristics and laboratory data were extracted. Renal dysfunction was evaluated and its prognosis was followed up based on a retrospective cohort study. RESULTS: There were 125 (81.2%) mild and 29 (18.8%) severe cases in 154 COVID-19 patients. On admission, 16 (10.4%) subjects were accompanied with renal dysfunction. Serum creatinine and cystatin C were increased and estimated glomerular filtration rate (eGFR) was decreased in severe patients compared with those in mild patients. Renal dysfunction was more prevalent in severe patients. Using multivariate logistic regression, we found that male gender, older age and hypertension were three importantly independent risk factors for renal dysfunction in COVID-19 patients. Follow-up study found that at least one renal function marker of 3.33% patients remained abnormal in 2 weeks after discharge. CONCLUSION: Male elderly COVID-19 patients with hypertension elevates the risk of renal dysfunction. SARS-CoV-2-induced renal dysfunction are not fully recovered in 2 weeks after discharge.

Clinical Characteristics and Predictors of Mortality in Patients with COVID-19 Infection Outside Intensive Care.

BACKGROUND/INTRODUCTION: The coronavirus disease 2019 (COVID-19) pandemic has affected all aspects of inpatient hospital medicine with patients admitted from level 1 (general medical wards) to level 3 (intensive care). Often, there are subtle physiological differences in these cohorts of patients. In particular, in intensive care, patients tend to be younger and have increased disease severity. Data, to date, has combined outcomes from medical and intensive care cohorts, or looked exclusively at intensive care. We looked solely at the level 1 (medical) cohort to identify their clinical characteristics and predictors of outcome. PATIENTS AND METHODS: This was a retrospective study of adult patients admitted to a central London teaching hospital with a diagnosis of COVID-19 from 23rd March to 7th April 2020 identified from the hospital electronic database. Any patients who required level 2 or 3 care were excluded. RESULTS: A total of 229 patients were included for analysis. Increased age and frailty scores were associated with increased 30-day mortality. Reduced renal function and elevated troponin blood levels are also associated with poor outcome. Baseline observations showed that increased oxygen requirement was predictive for mortality. A trend of increased mortality with lower diastolic blood pressure was noted. Lymphopenia was not shown to be related to mortality. CONCLUSION: Urea and creatinine are the best predictors of mortality in the level 1 cohort. Unlike previous intensive care data, lymphopenia is not predictive of mortality. We suggest that these factors be considered when prognosticating and for resource allocation for the treatment and escalation of care for patients with COVID-19 infection.

COVID-19 and Renal Diseases: An Update.

BACKGROUND: It becomes increasingly evident that the SARS-CoV-2 infection is not limited to the respiratory system. In addition to being a target of the virus, the kidney also seems to have a substantial influence on the outcomes of the disease. METHODS: Data was obtained by a comprehensive and non-systematic search in the PubMed, Cochrane, Scopus and SciELO databases, using mainly the terms "SARS-CoV-2", "COVID-19", "chronic kidney disease", "renal transplantation", acute kidney injury" and "renal dysfunction" Discussion: The membrane-bound angiotensin-converting enzyme 2 is the receptor for SARS-CoV- -2, and this interaction may lead to an imbalance of the Renin-Angiotensin System (RAS), associated with worse clinical presentations of COVID-19, including acute pulmonary injury, hyperinflammatory state and hematological alterations. In the framework of renal diseases, the development of acute kidney injury is associated mostly with immune alterations and direct cytopathic lesions by the virus, leading to higher mortality. As for chronic kidney disease, the patients at a non-terminal stage have a worse prognosis, while the hemodialysis patients appear to have mild courses of COVID-19, probably due to lower chances of being affected by the cytokine storm. Furthermore, the current scenario is unfavorable to kidney donation and transplantation. The relationship between COVID-19 and immunosuppression in kidney transplantation recipients has been greatly discussed to determine whether it increases mortality and how it interacts with immunosuppressive medications. CONCLUSION: The kidney and the RAS exert fundamental roles in the SARS-CoV-2 infection, and more research is required to have a complete understanding of the repercussions caused by COVID-19 in renal diseases.