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1.
Front Immunol ; 13: 874426, 2022.
Article in English | MEDLINE | ID: covidwho-2141856

ABSTRACT

Background: Several reports suggested that acute kidney injury (AKI) is a relatively common occurrence in hospitalized COVID-19 patients, but its prevalence is inconsistently reported across different populations. Moreover, it is unknown whether AKI results from a direct infection of the kidney by SARS-CoV-2 or it is a consequence of the physiologic disturbances and therapies used to treat COVID-19. We aimed to estimate the prevalence of AKI since it varies by geographical settings, time periods, and populations studied and to investigate whether clinical information and laboratory findings collected at hospital admission might influence AKI incidence (and mortality) in a particular point in time during hospitalization for COVID-19. Methods: Herein we conducted a prospective longitudinal study investigating the prevalence of AKI and associated factors in 997 COVID-19 patients admitted to the Baqiyatallah general hospital of Tehran (Iran), collecting both clinical information and several dates (of: birth; hospital admission; AKI onset; ICU admission; hospital discharge; death). In order to examine how the clinical factors influenced AKI incidence and all-cause mortality during hospitalization, survival analysis using the Cox proportional-hazard models was adopted. Two separate multiple Cox regression models were fitted for each outcome (AKI and death). Results: In this group of hospitalized COVID-19 patients, the prevalence of AKI was 28.5% and the mortality rate was 19.3%. AKI incidence was significantly enhanced by diabetes, hyperkalemia, higher levels of WBC count, and blood urea nitrogen (BUN). COVID-19 patients more likely to die over the course of their hospitalization were those presenting a joint association between ICU admission with either severe COVID-19 or even mild/moderate COVID-19, hypokalemia, and higher levels of BUN, WBC, and LDH measured at hospital admission. Diabetes and comorbidities did not increase the mortality risk among these hospitalized COVID-19 patients. Conclusions: Since the majority of patients developed AKI after ICU referral and 40% of them were admitted to ICU within 2 days since hospital admission, these patients may have been already in critical clinical conditions at admission, despite being affected by a mild/moderate form of COVID-19, suggesting the need of early monitoring of these patients for the onset of eventual systemic complications.


Subject(s)
Acute Kidney Injury , COVID-19 , Acute Kidney Injury/etiology , COVID-19/complications , Hospital Mortality , Humans , Iran/epidemiology , Longitudinal Studies , Prospective Studies , Retrospective Studies , Risk Factors , SARS-CoV-2
2.
J Am Soc Nephrol ; 33(2): 326-341, 2022 02.
Article in English | MEDLINE | ID: covidwho-2141035

ABSTRACT

BACKGROUND: Hereditary renal hypouricemia type 1 (RHUC1) is caused by URAT1/SLC22A12 dysfunction, resulting in urolithiasis and exercise-induced AKI (EIAKI). However, because there is no useful experimental RHUC1 animal model, the precise pathophysiologic mechanisms underlying EIAKI have yet to be elucidated. We established a high HPRT activity Urat1-Uox double knockout (DKO) mouse as a novel RHUC1 animal model for investigating the cause of EIAKI and the potential therapeutic effect of xanthine oxidoreductase inhibitors (XOIs). METHODS: The novel Urat1-Uox DKO mice were used in a forced swimming test as loading exercise to explore the onset mechanism of EIAKI and evaluate related purine metabolism and renal injury parameters. RESULTS: Urat1-Uox DKO mice had uricosuric effects and elevated levels of plasma creatinine and BUN as renal injury markers, and decreased creatinine clearance observed in a forced swimming test. In addition, Urat1-Uox DKO mice had increased NLRP3 inflammasome activity and downregulated levels of Na+-K+-ATPase protein in the kidney, as Western blot analysis showed. Finally, we demonstrated that topiroxostat and allopurinol, XOIs, improved renal injury and functional parameters of EIAKI. CONCLUSIONS: Urat1-Uox DKO mice are a useful experimental animal model for human RHUC1. The pathogenic mechanism of EIAKI was found to be due to increased levels of IL-1ß via NLRP3 inflammasome signaling and Na+-K+-ATPase dysfunction associated with excessive urinary urate excretion. In addition, XOIs appear to be a promising therapeutic agent for the treatment of EIAKI.


Subject(s)
Acute Kidney Injury/drug therapy , Hypoxanthine Phosphoribosyltransferase/metabolism , Organic Anion Transporters/deficiency , Urate Oxidase/deficiency , Xanthine Dehydrogenase/antagonists & inhibitors , Acute Kidney Injury/etiology , Acute Kidney Injury/metabolism , Allopurinol/pharmacology , Animals , Disease Models, Animal , Enzyme Inhibitors/pharmacology , Hypoxanthine Phosphoribosyltransferase/genetics , Kidney/drug effects , Kidney/metabolism , Kidney/pathology , Male , Mice , Mice, Inbred C57BL , Mice, Knockout , NLR Family, Pyrin Domain-Containing 3 Protein/metabolism , Nitriles/pharmacology , Organic Anion Transporters/genetics , Physical Exertion , Pyridines/pharmacology , Renal Tubular Transport, Inborn Errors/drug therapy , Renal Tubular Transport, Inborn Errors/etiology , Renal Tubular Transport, Inborn Errors/metabolism , Sodium-Potassium-Exchanging ATPase/metabolism , Urate Oxidase/genetics , Urinary Calculi/drug therapy , Urinary Calculi/etiology , Urinary Calculi/metabolism
3.
Crit Care Clin ; 38(3): 473-489, 2022 Jul.
Article in English | MEDLINE | ID: covidwho-2114478

ABSTRACT

Initial reporting suggested that kidney involvement following COVID-19 infection was uncommon but this is now known not to be the case. Acute kidney injury (AKI) may arise through several mechanisms and complicate up to a quarter of patients hospitalized with COVID-19 infection being associated with an increased risk for both morbidity and death. Mechanisms of injury include direct kidney damage predominantly through tubular injury, although glomerular injury has been reported; the consequences of the treatment of patients with severe hypoxic respiratory failure; secondary infection; and exposure to nephrotoxic drugs. The mainstay of treatment remains the prevention of worsening kidney damage and in some cases they need for renal replacement therapies (RRT). Although the use of other blood purification techniques has been proposed as potential treatments, results to-date have not been definitive.


Subject(s)
Acute Kidney Injury , COVID-19 , Acute Kidney Injury/etiology , Acute Kidney Injury/therapy , COVID-19/complications , COVID-19/therapy , Humans , Renal Replacement Therapy , SARS-CoV-2
4.
Int J Environ Res Public Health ; 19(21)2022 Nov 07.
Article in English | MEDLINE | ID: covidwho-2099560

ABSTRACT

Cystatin C is a specific biomarker of kidney function. We perform this meta-analysis to determine the association of Cystatin C with the COVID-19 severity. In this systematic review and meta-analysis, we searched PubMed, EMBASE, Cochrane library, and Web of Science for studies published until 2nd September 2022 that reported associations between Cystatin C levels and COVID-19 severity. The analysis was performed using a random-effects model to calculate pooled standard mean difference (SMD). Twenty-five studies were included in the meta-analysis. Pooled analysis showed statistically significant differences of Cystatin C levels among survive vs. decreased patients (0.998 ± 0.225 vs. 1.328 ± 0.475 mg/dL, respectively; SMD = -2.14; 95%CI: -3.28 to -1.01; p < 0.001). Cystatin C levels in COVID-19 severe vs. non-severe groups varied and amounted to 1.485 ± 1.191 vs. 1.014 ± 0.601 mg/dL, respectively (SMD = 1.81; 95%CI: 1.29 to 2.32; p < 0.001). Additionally, pooled analysis showed that Cystatin C levels in patients with acute kidney injury (AKI) was 1.562 ± 0.885 mg/dL, compared to 0.811 ± 0.108 mg/dL for patients without AKI (SMD = 4.56; 95%CI: 0.27 to 8.85; p = 0.04). Summing up, Cystatin C is a potentially very good marker to be used in the context of COVID-19 disease due to the prognosis of patients' serious condition, risk of AKI and mortality. In addition, Cystatin C could be used as a marker of renal complications in COVID-19 other than AKI due to the need to monitor patients even longer after leaving the hospital.


Subject(s)
Acute Kidney Injury , COVID-19 , Humans , Acute Kidney Injury/epidemiology , Acute Kidney Injury/etiology , Biomarkers , Cystatin C , Prognosis
5.
Biomolecules ; 12(11)2022 Oct 23.
Article in English | MEDLINE | ID: covidwho-2081930

ABSTRACT

Acute kidney injury (AKI) has been increasingly reported in critically-ill COVID-19 patients. Moreover, there was significant positive correlation between COVID-19 deaths and renal disorders in hospitalized COVID-19 patients with underlying comorbidities who required renal replacement therapy. It has suggested that death in COVID-19 patients with AKI is 3-fold higher than in COVID-19 patients without AKI. The pathophysiology of COVID-19-associated AKI could be attributed to unspecific mechanisms, as well as COVID-19-specific mechanisms such as direct cellular injury, an imbalanced renin-angiotensin-aldosterone system, pro-inflammatory cytokines elicited by the viral infection and thrombotic events. To date, there is no specific treatment for COVID-19 and its associated AKI. Luteolin is a natural compound with multiple pharmacological activities, including anticoronavirus, as well as renoprotective activities against kidney injury induced by sepsis, renal ischemia and diverse nephrotoxic agents. Therefore, in this review, we mechanistically discuss the anti-SARS-CoV-2 and renoprotective activities of luteolin, which highlight its therapeutic potential in COVID-19-AKI patients.


Subject(s)
Acute Kidney Injury , COVID-19 , Humans , COVID-19/complications , COVID-19/drug therapy , Luteolin/pharmacology , Luteolin/therapeutic use , SARS-CoV-2 , Acute Kidney Injury/drug therapy , Acute Kidney Injury/etiology , Critical Illness
6.
Arch Argent Pediatr ; 120(5): 310-316, 2022 10.
Article in English, Spanish | MEDLINE | ID: covidwho-2056103

ABSTRACT

INTRODUCTION: Renal involvement among pediatric patients with coronavirus disease 2019 (COVID-19) ranges between 1.2% and 44%. Given the limited information available locally, the primary objective of this study was to estimate the prevalence of renal involvement in our setting. POPULATION AND METHODS: Cross-sectional study conducted in 13 Argentine sites between March and December 2020. Patients aged 1 month to 18 years hospitalized due to COVID-19 and with at least one measurement of serum creatinine and/or a urinalysis were included. Those with a known kidney disease were excluded. Renal involvement was defined as the presence of acute kidney injury (AKI), proteinuria, hematuria, leukocyturia and/or arterial hypertension (HTN). RESULTS: Among 528 eligible medical records, 423 patients were included (55.0% were males; median age: 5.3 years). The clinical presentation was asymptomatic in 31%; mild, in 39.7%; moderate, in 23.9%; severe, in 1.2%; critical, in 0.7%; and 3.5% had multisystem inflammatory syndrome in children (MIS-C). Two patients (0.47%) died. The prevalence of renal involvement was 10.8% (95% confidence interval: 8.2-14.2); it was described as leukocyturia (16.9%), proteinuria (16.0%), hematuria (13.2%), HTN (3.7%), and AKI (2.3%). No patient required dialysis. Renal involvement was associated with severe forms of disease (p < 0.0001). CONCLUSIONS: The prevalence of renal involvement among pediatric patients hospitalized due to COVID-19 in 13 Argentine sites was 10.8%; severe forms of disease prevailed.


Introducción. El compromiso renal (CR) en niños internados con enfermedad por coronavirus 2019 (COVID-19, por su sigla en inglés) varía entre el 1,2 % y el 44 %. Dado que existe limitada información local, el objetivo primario de este estudio fue estimar la prevalencia de CR en nuestro medio. Población y métodos. Estudio transversal realizado en 13 centros de Argentina entre marzo y diciembre de 2020. Se incluyeron pacientes internados con COVID-19, de 1 mes a 18 años y que tuvieran al menos una determinación de creatinina sérica y/o de orina completa. Se excluyeron aquellos con enfermedad renal conocida. Se consideró CR la presencia de lesión renal aguda (LRA), proteinuria, hematuria, leucocituria y/o hipertensión arterial (HTA). Resultados. De 528 historias clínicas elegibles, se incluyeron las de 423 pacientes (el 55,0 % de sexo masculino, mediana de edad 5,3 años). El cuadro clínico fue asintomático en el 31 %, leve en el 39,7 %, moderado en el 23,9 %, grave en el 1,2 %, crítico en el 0,7 %, y el 3,5 % presentó síndrome inflamatorio multisistémico pediátrico (SIMP). Dos pacientes (0,47 %) fallecieron. La prevalencia de CR fue del 10,8 % (intervalo de confianza 95% 8,2-14,2), expresada por leucocituria (16,9 %), proteinuria (16,0 %), hematuria (13,2 %), HTA (3,7 %) y LRA (2,3 %). Ninguno requirió diálisis. Presentar CR se asoció (p <0,0001) con formas graves de enfermedad. Conclusión. La prevalencia de CR en pacientes pediátricos internados con COVID-19 en 13 centros de nuestro país fue del 10,8 % y predominó en las formas clínicas graves.


Subject(s)
Acute Kidney Injury , COVID-19 , Hypertension , Acute Kidney Injury/epidemiology , Acute Kidney Injury/etiology , COVID-19/complications , COVID-19/epidemiology , Child , Child, Preschool , Creatinine , Cross-Sectional Studies , Female , Hematuria/epidemiology , Hematuria/etiology , Humans , Hypertension/epidemiology , Male , Prevalence , Proteinuria/epidemiology , Retrospective Studies , SARS-CoV-2 , Systemic Inflammatory Response Syndrome
7.
Curr Opin Crit Care ; 28(6): 630-637, 2022 Dec 01.
Article in English | MEDLINE | ID: covidwho-2051669

ABSTRACT

PURPOSE OF REVIEW: While it is now widely established acute kidney injury (AKI) is a common and important complication of coronavirus disease (COVID-19) disease, there is marked variability in its reported incidence and outcomes. This narrative review provides a mid-2022 summary of the latest epidemiological evidence on AKI in COVID-19. RECENT FINDINGS: Large observational studies and meta-analyses report an AKI incidence of 28-34% in all inpatients and 46-77% in intensive care unit (ICU). The incidence of more severe AKI requiring renal replacement therapy (RRT) in ICU appears to have declined over time, in data from England and Wales RRT use declined from 26% at the start of the pandemic to 14% in 2022. The majority of survivors apparently recover their kidney function by hospital discharge; however, these individuals appear to remain at increased risk of future AKI, estimated glomerular filtration rate (eGFR) decline and chronic kidney disease. Importantly even in the absence of overt AKI a significant proportion of survivors of COVID-19 hospitalisation had reduced eGFR on follow-up. SUMMARY: This review summarises the epidemiology, risk factors, outcomes and treatment of COVID-19-associated AKI across the global pandemic. In particular the long-term impact of COVID-19 disease on kidney health is uncertain and requires further characterisation.


Subject(s)
Acute Kidney Injury , COVID-19 , Humans , COVID-19/complications , Renal Replacement Therapy , Acute Kidney Injury/epidemiology , Acute Kidney Injury/etiology , Acute Kidney Injury/therapy , Intensive Care Units , Glomerular Filtration Rate , Risk Factors , Retrospective Studies
8.
Ter Arkh ; 94(6): 743-747, 2022 Aug 04.
Article in Russian | MEDLINE | ID: covidwho-2044340

ABSTRACT

AIM: To determine the incidence and risk factors of acute kidney injury (AKI) in Russian cohort of patients with COVID-19. MATERIALS AND METHODS: We included 315 patients, who were hospitalized with COVID-19 from October 2020 till February 2021. The diagnosis was established on the basis of the positive SARS-CoV-2 swab test and/or typical radiologic findings on CT scans. RESULTS: AKI complicated the clinical course in 92 (29.21%) cases. The independent risk factors of AKI were female sex, underline chronic kidney disease and the highest level of C-reactive protein during hospitalization. In the general group of patients were 41 (13%) lethal cases, in the group with AKI 32 (34.8%). Compared with those without AKI, patients with AKI had 4.065 (95% confidence interval 2.154 to 7.671) times the odds of death. Respiratory support, the highest serum creatinine and glucose levels appeared to be the risk factors of death among patients with AKI in the multivariable Cox regression. CONCLUSION: The clinical course of COVID-19 was complicated by AKI in 29% cases. The independent risk factors of AKI in patients with COVID-19 are underline chronic kidney disease, circulatory disorder and the highest level of C-reactive protein during hospitalization.


Subject(s)
Acute Kidney Injury , COVID-19 , Renal Insufficiency, Chronic , Humans , Female , Male , COVID-19/complications , COVID-19/epidemiology , SARS-CoV-2 , Creatinine , C-Reactive Protein , Retrospective Studies , Risk Factors , Acute Kidney Injury/diagnosis , Acute Kidney Injury/epidemiology , Acute Kidney Injury/etiology , Kidney , Renal Insufficiency, Chronic/diagnosis , Renal Insufficiency, Chronic/epidemiology , Renal Insufficiency, Chronic/etiology , Glucose , Hospital Mortality
9.
Int J Mol Sci ; 23(18)2022 Sep 14.
Article in English | MEDLINE | ID: covidwho-2039871

ABSTRACT

The coronavirus disease 2019 (COVID-19) pandemic has claimed the lives of millions of people around the world. Severe vitamin D deficiency can increase the risk of death in people with COVID-19. There is growing evidence that acute kidney injury (AKI) is common in COVID-19 patients and is associated with poorer clinical outcomes. The kidney effects of SARS-CoV-2 are directly mediated by angiotensin 2-converting enzyme (ACE2) receptors. AKI is also caused by indirect causes such as the hypercoagulable state and microvascular thrombosis. The increased release of soluble urokinase-type plasminogen activator receptor (suPAR) from immature myeloid cells reduces plasminogen activation by the competitive inhibition of urokinase-type plasminogen activator, which results in low plasmin levels and a fibrinolytic state in COVID-19. Frequent hypercoagulability in critically ill patients with COVID-19 may exacerbate the severity of thrombosis. Versican expression in proximal tubular cells leads to the proliferation of interstitial fibroblasts through the C3a and suPAR pathways. Vitamin D attenuates the local expression of podocyte uPAR and decreases elevated circulating suPAR levels caused by systemic inflammation. This decrease preserves the function and structure of the glomerular barrier, thereby maintaining renal function. The attenuated hyperinflammatory state reduces complement activation, resulting in lower serum C3a levels. Vitamin D can also protect against COVID-19 by modulating innate and adaptive immunity, increasing ACE2 expression, and inhibiting the renin-angiotensin-aldosterone system. We hypothesized that by reducing suPAR levels, appropriate vitamin D supplementation could prevent the progression and reduce the severity of AKI in COVID-19 patients, although the data available require further elucidation.


Subject(s)
Acute Kidney Injury , COVID-19 , Thrombosis , Acute Kidney Injury/drug therapy , Acute Kidney Injury/etiology , Angiotensin-Converting Enzyme 2 , Angiotensins , COVID-19/complications , COVID-19/drug therapy , Fibrinolysin , Humans , Plasminogen , Receptors, Urokinase Plasminogen Activator , SARS-CoV-2 , Thrombosis/complications , Urokinase-Type Plasminogen Activator , Versicans , Vitamin D , Vitamins
10.
PLoS One ; 17(6): e0264510, 2022.
Article in English | MEDLINE | ID: covidwho-2021614

ABSTRACT

INTRODUCTION: The SARS-CoV-2 pandemic is a major challenge for patients, healthcare professionals, and populations worldwide. While initial reporting focused mainly on lung involvement, the ongoing pandemic showed that multiple organs can be involved, and prognosis is largely influenced by multi-organ involvement. Our aim was to obtain nationwide retrospective population-based data on hospitalizations with COVID-19 and AKI in Germany. MATERIALS & METHODS: We performed a query of G-DRG data for the year 2020 via the Institute for the hospital remuneration system (Institut für das Entgeltsystem im Krankenhaus GmbH, InEK) data portal and therefore included hospitalizations with a secondary diagnosis of RT-PCR proven COVID-19 infection, aged over 15 years. We included hospitalizations with acute kidney injury (AKI) stages 1 to 3. Age-specific and age-standardized hospitalization and in-hospital mortality rates (ASR) per 100.000 person years were calculated, with the German population of 2011 as the standard. RESULTS: In 2020, there were 16.776.845 hospitalizations in German hospitals. We detected 154.170 hospitalizations with RT-PCR proven COVID-19 diagnosis. The age-standardized hospitalization rate for COVID-19 in Germany was 232,8 per 100.000 person years (95% CI 231,6-233,9). The highest proportion of hospitalizations associated with COVID-19 were in the age group over 80 years. AKI was diagnosed in 16.773 (10.9%) of the hospitalizations with COVID-19. The relative risk of AKI for males was 1,49 (95%CI 1,44-1,53) compared to females. Renal replacement therapy (RRT) was performed in 3.443 hospitalizations, 20.5% of the hospitalizations with AKI. For all hospitalizations with COVID-19, the in-hospital mortality amounted to 19.7% (n = 30.300). The relative risk for in-hospital mortality was 3,87 (95%CI 3,80-3,94) when AKI occurred. The age-standardized hospitalization rates for COVID-19 took a bimodal course during the observation period. The first peak occurred in April (ASR 23,95 per 100.000 person years (95%CI 23,58-24,33)), hospitalizations peaked again in November 2020 (72,82 per 100.000 person years (95%CI 72,17-73,48)). The standardized rate ratios (SRR) for AKI and AKI-related mortality with the overall ASR for COVID-19 hospitalizations in the denominator, decreased throughout the observation period and remained lower in autumn than they were in spring. In contrast to all COVID-19 hospitalizations, the SRR for overall mortality in COVID-19 hospitalizations diverged from hospitalizations with AKI in autumn 2020. DISCUSSION: Our study for the first time provides nationwide data on COVID-19 related hospitalizations and acute kidney injury in Germany in 2020. AKI was a relevant complication and associated with high mortality. We observed a less pronounced increase in the ASR for AKI-related mortality during autumn 2020. The proportion of AKI-related mortality in comparison to the overall mortality decreased throughout the course of the pandemic.


Subject(s)
Acute Kidney Injury , COVID-19 , Acute Kidney Injury/etiology , Aged , Aged, 80 and over , COVID-19/epidemiology , COVID-19 Testing , Female , Hospital Mortality , Hospitalization , Hospitals , Humans , Male , Retrospective Studies , Risk Factors , SARS-CoV-2
11.
J Clin Anesth ; 82: 110933, 2022 11.
Article in English | MEDLINE | ID: covidwho-2015587

ABSTRACT

OBJECTIVE: This study evaluated postoperative AKI severity and its relation to short- and long-term patient outcomes. DESIGN: A retrospective, single-center cohort study of patients undergoing surgery from January 2015 to May 2020. SETTING: An urban, academic medical center. PATIENTS: Adult patients undergoing elective, non-cardiac surgery at our institution with a postoperative length of stay (LOS) of at least 24 h were included. Patients were included in 1-year mortality analysis if their procedure occurred prior to June 2019. INTERVENTIONS: None. MEASUREMENTS: Postoperative AKI was identified and staged using the Kidney Disease Improving Global Outcomes definitions. The outcomes analyzed were in-hospital mortality, LOS, total cost of the surgical hospitalization, and 1-year mortality. MAIN RESULTS: Of the 8887 patients studied, 648 (7.3%) had postoperative AKI. AKI was associated with severity-dependent increases in all outcomes studied. Patients with AKI had rates of in-hospital mortality of 2.0%, 3.8%, and 12.5% for stage 1, 2, and 3 AKI compared to 0.3% for patients without AKI. Mean total costs of the surgical hospitalization were $23,896 (SD $23,736) for patients without AKI compared to $33,042 (SD $27,115), $39,133 (SD $34,006), and $73,216 ($82,290) for patients with stage 1, 2, and 3 AKI, respectively. In the 6729 patients who met inclusion for 1-year mortality analysis, AKI was also associated with 1-year mortality rates of 13.9%, 19.4%, and 22.7% compared to 5.2% for patients without AKI. In multivariate models, stage 1 AKI patients still had a higher probability of 1-year mortality (OR 1.9, 95% CI 1.3-2.6, p < 0.001) in addition to $4391 of additional costs when compared to patients without AKI (95% CI $2498-$6285, p < 0.001). CONCLUSIONS: All stages of postoperative AKI were associated with increased LOS, surgical hospitalization costs, in-hospital mortality, and 1-year mortality. These findings suggest that patients with even a low-grade or stage 1 AKI are at higher risk for short- and long-term complications.


Subject(s)
Acute Kidney Injury , Postoperative Complications , Acute Kidney Injury/etiology , Adult , Cohort Studies , Hospital Mortality , Humans , Postoperative Complications/etiology , Retrospective Studies , Risk Factors
12.
Transpl Int ; 35: 10375, 2022.
Article in English | MEDLINE | ID: covidwho-1993916

ABSTRACT

Kidney transplant recipients present higher rates of pre-existing comorbidities, in particular diabetes mellitus (DM), hypertension, and cardiac disease. We aimed to verify the main risk factors related to DM that contribute to COVID-19 progression and mortality in a kidney transplant setting. From March to August 2020, we evaluated 300 kidney transplant recipients affected by COVID-19. We used propensity score matching (PSM) to estimate the impact of DM on COVID-19. After matching, all baseline characteristics were well balanced between those with and without DM (n = 100 in each group). Case fatality rate, the requirement of invasive mechanical ventilation (IMV), and acute kidney injury (AKI) were associated with previous fasting blood glucose, and C-reactive protein (CRP), and lactate dehydrogenase (LDH) levels on admission. These findings were similar in kidney transplant patients with and without DM. Glycemia on admission and estimated glomerular filtration rate (eGFR) either on admission or basal correlated to the need of IMV and development of AKI, respectively. Poor glycaemic control, eGFR, markers of inflammation (CRP) and tissue damage (LDH) were indicative of COVID-19 burden in kidney transplant recipients and may be useful tools for risk-stratifying this population, independently of the DM status, during the pandemic.


Subject(s)
Acute Kidney Injury , COVID-19 , Diabetes Mellitus , Kidney Transplantation , Acute Kidney Injury/etiology , Diabetes Mellitus/epidemiology , Diabetes Mellitus/etiology , Humans , Kidney Transplantation/adverse effects , Propensity Score , Retrospective Studies , Risk Factors , Transplant Recipients
13.
Int J Infect Dis ; 122: 802-810, 2022 Sep.
Article in English | MEDLINE | ID: covidwho-1983201

ABSTRACT

OBJECTIVES: This study used the long-short-term memory (LSTM) artificial intelligence method to model multiple time points of clinical laboratory data, along with demographics and comorbidities, to predict hospital-acquired acute kidney injury (AKI) onset in patients with COVID-19. METHODS: Montefiore Health System data consisted of 1982 AKI and 2857 non-AKI (NAKI) hospitalized patients with COVID-19, and Stony Brook Hospital validation data consisted of 308 AKI and 721 NAKI hospitalized patients with COVID-19. Demographic, comorbidities, and longitudinal (3 days before AKI onset) laboratory tests were analyzed. LSTM was used to predict AKI with fivefold cross-validation (80%/20% for training/validation). RESULTS: The top predictors of AKI onset were glomerular filtration rate, lactate dehydrogenase, alanine aminotransferase, aspartate aminotransferase, and C-reactive protein. Longitudinal data yielded marked improvement in prediction accuracy over individual time points. The inclusion of comorbidities and demographics further improves prediction accuracy. The best model yielded an area under the curve, accuracy, sensitivity, and specificity to be 0.965 ± 0.003, 89.57 ± 1.64%, 0.95 ± 0.03, and 0.84 ± 0.05, respectively, for the Montefiore validation dataset, and 0.86 ± 0.01, 83.66 ± 2.53%, 0.66 ± 0.10, 0.89 ± 0.03, respectively, for the Stony Brook Hospital validation dataset. CONCLUSION: LSTM model of longitudinal clinical data accurately predicted AKI onset in patients with COVID-19. This approach could help heighten awareness of AKI complications and identify patients for early interventions to prevent long-term renal complications.


Subject(s)
Acute Kidney Injury , COVID-19 , Acute Kidney Injury/diagnosis , Acute Kidney Injury/etiology , Artificial Intelligence , COVID-19/diagnosis , Humans , Machine Learning , Memory, Short-Term , Prognosis , Retrospective Studies , Risk Factors
14.
Ren Fail ; 44(1): 1280-1288, 2022 Dec.
Article in English | MEDLINE | ID: covidwho-1978081

ABSTRACT

The coronavirus disease-2019 (COVID-19) outbreak has been declared a global pandemic. COVID-19-associated acute kidney injury (COVID-19 AKI) is related to a high mortality rate and serves as an independent risk factor for hospital death in patients with COVID-19. Early diagnosis would allow for earlier intervention and potentially improve patient outcomes. The goal of early identification of AKI has been the primary impetus for AKI biomarker research, and several kidney injury biomarkers have been demonstrated to be beneficial in predicting COVID-19 AKI as well as disease progression in COVID-19. Furthermore, such data provide valuable insights into the molecular mechanisms underlying this complex and unique disease and serve as a molecular phenotyping tool that could be utilized to direct clinical intervention. This review focuses on a number of kidney injury biomarkers, such as CysC, NAGAL, KIM-1, L-FABP, IL-18, suPAR, and [TIMP-2] • [IGFBP7], which have been widely studied in common clinical settings, such as sepsis, cardiac surgery, and contrast-induced AKI. We explore the role of kidney injury biomarkers in COVID-19 and discuss what remains to be learned.


Subject(s)
Acute Kidney Injury , COVID-19 , Acute Kidney Injury/diagnosis , Acute Kidney Injury/etiology , Biomarkers , COVID-19/complications , Humans , Insulin-Like Growth Factor Binding Proteins , Kidney , Predictive Value of Tests
15.
Perit Dial Int ; 42(6): 554-561, 2022 Nov.
Article in English | MEDLINE | ID: covidwho-1978692

ABSTRACT

Acute kidney injury (AKI) has been shown to be associated with significant morbidity and mortality in patients with severe COVID-19 disease. Due to increasing number of cases in pandemic, there is a significant shortage of medical facilities and equipment in relation to patient load. In low resource settings where access to intermittent haemodialysis (HD) or continuous kidney replacement therapy (CKRT) is limited, peritoneal dialysis (PD) may play a vital role in the management of COVID-19-induced AKI. A literature search using Medline/PubMed, Embase, Google Scholar and Cochrane register was performed using following search strategy: (((COVID 19) OR (SARS-CoV-2)) AND (((acute kidney injury) OR (acute renal failure)) OR (acute renal dysfunction))) AND (peritoneal dialysis). Search strategy yielded total 79 articles. After going through titles and abstracts, full text of 15 articles was obtained. Finally, six studies were included in the review after exclusion of 10 studies. Five studies were single centre and one study was multicentric; four studies were conducted in the United States and one in the United Kingdom; PD catheter placement was done by surgeons in three studies and by nephrologist in one study. The mortality reported in the studies varied from 43% to as high as 63%.


Subject(s)
Acute Kidney Injury , COVID-19 , Peritoneal Dialysis , Humans , Acute Kidney Injury/etiology , Acute Kidney Injury/therapy , Acute Kidney Injury/epidemiology , COVID-19/complications , Pandemics , Peritoneal Dialysis/adverse effects , Renal Dialysis , SARS-CoV-2
16.
Clin Nephrol ; 98(4): 188-197, 2022 Oct.
Article in English | MEDLINE | ID: covidwho-1975230

ABSTRACT

BACKGROUND: Previous evidence suggests that acute kidney injury (AKI) is common in patients with COVID-19 and associated with adverse outcomes. Moreover, the incidence and mortality of AKI in Asia are ambiguous. OBJECTIVE: Evaluating the risk factors and risk of death from AKI in -COVID-19 patients in Asia. MATERIALS AND METHODS: We conducted a meta-analysis of clinical observational studies of -COVID-19 patients in Asia. Outcome measures included: AKI in COVID-19 patients, overall mortality in COVID-19 patients, and mortality assessment in patients with AKI. The random-effects model was adopted, with heterogeneity and sensitivity analysis. RESULTS: 27 clinical studies (18,216 Asian patients with COVID-19) have been included in the study. The pooled incidence of AKI was 0.19 (95% CI 16 - 23%; I2 = 98.9%, p < 0.001); the pooled incidence of total mortality was 0.19 (95% CI 17 - 22%; I2 = 98.9%, p < 0.001). No publication bias was found (Egger's test, p = 0.396, 0.213). The pooled mortality in AKI patients with COVID-19 was 50% (95% CI 33 - 67%; I2 by random-effects model = 98.4%, p < 0.001). AKI was found to be a risk factor for death in stepwise regression analysis; age, diabetes, and hypertension were influencing factors for AKI risk in -COVID-19 patients. CONCLUSION: AKI is a common complication in Asian COVID-19 patients, and it is associated with an increase in mortality of Asian COVID-19 patients. Any treatment that protects the kidney may be a practical intervention to reduce the mortality of COVID-19 patients in Asia.


Subject(s)
Acute Kidney Injury , COVID-19 , Acute Kidney Injury/etiology , Asia , COVID-19/complications , Humans , Incidence , Risk Factors
17.
Saudi J Kidney Dis Transpl ; 32(6): 1543-1551, 2021.
Article in English | MEDLINE | ID: covidwho-1975052

ABSTRACT

Initial reports early on in the pandemic in 2020 indicate a high incidence of acute kidney injury (AKI) in coronavirus disease 2019 (COVID-19). There is a need to better understand risk factors for AKI in patients with COVID-19. It is also unclear if AKI in patients with COVID-19 differs from AKI due to other causes. More data are required to clarify if COVID-19 is an independent risk factor for AKI and how COVID-19-associated AKI may differ from AKI due to other causes. We, therefore, sought to review the published evidence about the reported relationship between COVID-19, AKI, and outcomes. We performed a systematic search via PubMed and EMBASE using key words "COVID-19" and "AKI" to identify relevant observational studies, case series, and cohort studies published between March 2020 and April 2021. We also manually examined the reference lists of included studies and reviewed the AKI reports published in general medicine journals such as BMJ, Lancet, NEJM, and JAMA. The prevalence of AKI in hospitalized patients with COVID-19 differed across various regions of the world. Initial reports from China where cases of COVID-19 began initially have shown a much lower prevalence compared to those from Europe and North America, especially in critically ill patients in the intensive care unit with acute respiratory distress syndrome. The various components of severe acute respiratory syndrome-associated AKI appear in large parts to be similar to sepsis-induced AKI. However, affinity of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) specifically to the angiotensin-converting enzyme 2 receptors located on podocytes and endothelial cells of the kidney also points toward the direct cytotoxic effects of the virus on the kidney. Numerous mechanisms likely occur simultaneously and hence more treatment approaches need to be streamlined based on pathophysiology. Although data from published literature regarding previous SARS coronaviruses can give some useful insights, we will know more going forward about the nature of kidney injury associated with COVID-19 virus as well as optimum-specific therapeutic management.


Subject(s)
Acute Kidney Injury , COVID-19 , Acute Kidney Injury/epidemiology , Acute Kidney Injury/etiology , Acute Kidney Injury/therapy , COVID-19/complications , COVID-19/epidemiology , Endothelial Cells , Humans , Pandemics , SARS-CoV-2
18.
J Investig Med High Impact Case Rep ; 10: 23247096221114517, 2022.
Article in English | MEDLINE | ID: covidwho-1968530

ABSTRACT

Acute kidney injury (AKI) in patients with coronavirus disease 2019 (COVID-19) is common, especially among severely ill patients. While acute tubular necrosis (ATN) is one of the most common findings in published kidney biopsy series for patients with COVID-19 infections, a number of glomerular pathologies have been described as well. Among glomerular pathologies in COVID-19, COVID-19-Associated Collapsing Glomerulopathy (COVAN) remains the most common pattern of injury. Patients with 2 high-risk APOL1 alleles appear to be at increased risk for COVAN, similar to other forms of collapsing glomerulopathy such as HIV-Associated Nephropathy. Acute interstitial nephritis (AIN) is a less common finding in patients with COVID-19 and reported cases have been mild. Reports of a subtype of AIN, granulomatous interstitial nephritis (GIN), among COVID-19 patients are extremely rare and have not been reported in association with COVAN. Here, we report a case of COVAN associated with severe GIN.


Subject(s)
Acute Kidney Injury , COVID-19 , Nephritis, Interstitial , Acute Kidney Injury/etiology , Acute Kidney Injury/pathology , Apolipoprotein L1 , COVID-19/complications , Granuloma/complications , Humans , Kidney/pathology , Nephritis, Interstitial/etiology , Nephritis, Interstitial/pathology
19.
Clin Nephrol ; 98(4): 205-208, 2022 Oct.
Article in English | MEDLINE | ID: covidwho-1964358

ABSTRACT

Fibrillary glomerulonephritis (FGN) is a rare glomerular disease manifesting with proteinuria, renal impairment, hematuria, hypertension, and in a very small proportion can be associated with rapidly progressive glomerulonephritis and, rarely, crescent formation. The main modality for diagnosis is kidney biopsy, which ultrastructurally demonstrates randomly arranged non-branching mesangial and glomerular basement membrane (GBM) fibrils and positive staining for the biomarker DNAJB9. The pathogenesis is largely unknown. It was previously hypothesized to represent an immune-complex-type glomerulonephritis, as most cases show IgG4 restriction. We present the first case of crescentic FGN after mRNA Pfizer vaccine for COVID-19. A strong temporal association between vaccination, elevated creatinine, and diffuse crescentic fibrillary process was found. Immunological, neoplastic, and infectious causes were ruled out. We hypothesized that the vaccine stimulated an immune response that triggered crescentic FGN, however, further investigations will be needed to elucidate the direct role of COVID-19 vaccination in crescentic glomerular disease.


Subject(s)
Acute Kidney Injury , COVID-19 , Glomerulonephritis, Membranoproliferative , Glomerulonephritis , Acute Kidney Injury/etiology , Acute Kidney Injury/pathology , Biomarkers , Biopsy , COVID-19/complications , COVID-19/prevention & control , COVID-19 Vaccines/adverse effects , Creatinine , Glomerular Basement Membrane/pathology , Glomerulonephritis/diagnosis , Glomerulonephritis, Membranoproliferative/pathology , HSP40 Heat-Shock Proteins , Humans , Immunoglobulin G , Membrane Proteins , Molecular Chaperones , RNA, Messenger
20.
Crit Care ; 26(1): 225, 2022 07 25.
Article in English | MEDLINE | ID: covidwho-1962881

ABSTRACT

BACKGROUND: Acute kidney injury (AKI) has been reported as a frequent complication of critical COVID-19. We aimed to evaluate the occurrence of AKI and use of kidney replacement therapy (KRT) in critical COVID-19, to assess patient and kidney outcomes and risk factors for AKI and differences in outcome when the diagnosis of AKI is based on urine output (UO) or on serum creatinine (sCr). METHODS: Multicenter, retrospective cohort analysis of patients with critical COVID-19 in seven large hospitals in Belgium. AKI was defined according to KDIGO within 21 days after ICU admission. Multivariable logistic regression analysis was used to explore the risk factors for developing AKI and to assess the association between AKI and ICU mortality. RESULTS: Of 1286 patients, 85.1% had AKI, and KRT was used in 9.8%. Older age, obesity, a higher APACHE II score and use of mechanical ventilation at day 1 of ICU stay were associated with an increased risk for AKI. After multivariable adjustment, all AKI stages were associated with ICU mortality. AKI was based on sCr in 40.1% and UO in 81.5% of patients. All AKI stages based on sCr and AKI stage 3 based on UO were associated with ICU mortality. Persistent AKI was present in 88.6% and acute kidney disease (AKD) in 87.6%. Rapid reversal of AKI yielded a better prognosis compared to persistent AKI and AKD. Kidney recovery was observed in 47.4% of surviving AKI patients. CONCLUSIONS: Over 80% of critically ill COVID-19 patients had AKI. This was driven by the high occurrence rate of AKI defined by UO criteria. All AKI stages were associated with mortality (NCT04997915).


Subject(s)
Acute Kidney Injury , COVID-19 , Acute Kidney Injury/diagnosis , Acute Kidney Injury/epidemiology , Acute Kidney Injury/etiology , Belgium/epidemiology , COVID-19/complications , Cohort Studies , Critical Illness , Hospitals , Humans , Intensive Care Units , Retrospective Studies
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