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1.
J Assoc Physicians India ; 70(4): 11-12, 2022 Apr.
Article in English | MEDLINE | ID: covidwho-1801740

ABSTRACT

Renal involvement in patients with COVID-19 ranges from proteinuria and hematuria to acute kidney injury (AKI). The occurrence of AKI range from 0.5% to 80% across various studies. Our study was conducted to know the renal manifestations of COVID-19 in south Indian population and its association with severity. MATERIAL: The study assessed COVID-19 positive adult patients admitted from 1/9/2020 to 31/10/2020. Data was collected by accessing electronic medical records of patients. Proteinuria and hematuria were assessed by urine dipstick. Lab data including S. Creatinine at admission was accessed. S. Creatinine at a mean duration of 7±2, 14±4 days during hospitalization and on follow-up at a mean duration of 45 days after discharge was also captured. OBSERVATION: A total of 1561 patients admitted during the study period were screened. After the exclusion criteria, 426 patients admitted with COVID-19 infection were enrolled. The occurrence of AKI was 14.8%. Proteinuria was positive in 75 patients (17.6%) hematuria in 39 patients (9.15 %). Patients with AKI, proteinuria and/or hematuria were more likely to have severe COVID-19 illness. 47.5% patients with AKI, 45.9 % with proteinuria and 34.4 % with hematuria had severe COVID-19 illness. The recovery of AKI at a mean duration of 45±15 days post discharge was 83.63 %. CONCLUSION: Renal involvement is not uncommon in patients with COVID-19 infection especially in patients with severe illness. Presence of AKI, proteinuria and/or hematuria is associated with increased mortality among patients hospitalized with COVID-19 infection.


Subject(s)
Acute Kidney Injury , COVID-19 , Acute Kidney Injury/epidemiology , Acute Kidney Injury/etiology , Adult , Aftercare , COVID-19/complications , Creatinine , Female , Hematuria/epidemiology , Hematuria/etiology , Hospital Mortality , Humans , India/epidemiology , Male , Patient Discharge , Proteinuria/epidemiology , Proteinuria/etiology , Retrospective Studies , Risk Factors , Severity of Illness Index , Tertiary Care Centers
2.
Front Public Health ; 10: 847533, 2022.
Article in English | MEDLINE | ID: covidwho-1776061

ABSTRACT

Frailty is a commonly occurring geriatric condition that increases the risk of adverse health outcomes. The factors and predictors behind frailty are not yet well understood. A better understanding of these factors can enable prevention of frailty in elderly patients. The objective of this study was to determine the association between proteinuria and frailty in US individuals with metabolic syndrome (MetS). Data from the National Health and Nutrition Examination Survey III (NHANES III, 1988-1994) conducted by the National Center for Health Statistics of the Centers for Disease Control and Prevention. This is a cross-sectional study, and proteinuria and frailty were measured only once at enrollment. The study included 2,272 participants with MetS aged 40-90 years from the NHANES III. The participants underwent assessments to evaluate frailty and frailty components (low body weight, weakness, exhaustion, low physical activity, and slow walking). Proteinuria was represented as albumin-to-creatinine ratio (ACR) (mg/g) and divided into tertiles: T1-normal range (ACR <30 mg/g), T2-microalbuminuria (ACR 30-299 mg/g), and T3-macroalbuminuria (ACR ≥ 300 mg/g). We applied multiple logistic regression to determine the odds ratios (ORs) of frailty for T2 vs. T1 and T3 vs. T1 in both sexes. In the adjusted analysis for male participants, the ORs of frailty for T2 and T3 vs. T1 were 3.106 (95% confidence interval [CI] = 1.078-8.948, P = 0.036) and 14.428 (95% CI = 4.231-49.193, P < 0.001), respectively. For female participants, the ORs of frailty for T2 and T3 vs. T1 were 1.811 (95% CI = 1.071-3.063, P = 0.027) and 2.926 (95% CI = 1.202-7.124, P = 0.018), respectively. The positive association between T2 and T3 vs. T1, and frailty were statistically significant. The trends of higher likelihood of every frailty component were also statistically significant across increasing tertiles of proteinuria after multiple levels of adjustment for covariates (P < 0.05). Increased proteinuria levels were positively associated with frailty and each frailty component. Proteinuria might be a useful maker for frailty in individuals with MetS.


Subject(s)
Frailty , Metabolic Syndrome , Proteinuria , Adult , Aged , Aged, 80 and over , Cross-Sectional Studies , Female , Frail Elderly , Frailty/epidemiology , Humans , Male , Metabolic Syndrome/epidemiology , Middle Aged , Nutrition Surveys , Proteinuria/epidemiology
3.
Clin Exp Nephrol ; 26(4): 316-322, 2022 Apr.
Article in English | MEDLINE | ID: covidwho-1513987

ABSTRACT

BACKGROUND: Recent clinical reports indicate a correlation between gross hematuria after the coronavirus 2019 (COVID-19) vaccination in patients with glomerulonephritis, especially immunoglobulin A nephropathy (IgAN). Furthermore, healthcare workers in Japan were initially vaccinated with an mRNA vaccine from February 17, 2021, and some of them experienced gross hematuria after receiving the vaccination. METHODS: We conducted a web-based survey of the councilor members of the Japanese Society of Nephrology (581 members, 382 facilities) to elucidate the relationship between gross hematuria and COVID-19 vaccination. RESULTS: In the first survey, 27 cases (female: 22, 81.5%) of gross hematuria were reported after receiving a COVID-19 vaccination. Of them, 19 (70.4%) patients were already diagnosed with IgAN at the occurrence of gross hematuria. Proteinuria appeared in eight of the 14 (57.1%) cases with no proteinuria before vaccination and hematuria in five of the seven (71.4%) cases with no hematuria before vaccination. The second survey revealed that a renal biopsy was performed after vaccination in four cases, all of whom were diagnosed with IgAN. Only one case showed a slightly increased serum creatinine level, and no patients progressed to severe renal dysfunction. CONCLUSION: This study clarified the clinical features of gross hematuria after a COVID-19 vaccination. Because there was no obvious progression to severe renal dysfunction, safety of the COVID-19 vaccination is warranted at least in the protocol of inoculation twice.


Subject(s)
COVID-19 Vaccines/adverse effects , Hematuria/epidemiology , Hematuria/etiology , Vaccination/adverse effects , Adult , Biopsy , Creatinine/blood , Female , Humans , Japan/epidemiology , Kidney/pathology , Male , Middle Aged , Proteinuria/epidemiology , Proteinuria/etiology , Surveys and Questionnaires , Young Adult
4.
Pan Afr Med J ; 40: 37, 2021.
Article in English | MEDLINE | ID: covidwho-1497891

ABSTRACT

Proteinuria is a marker of severity and poor outcome of patients in intensive care unit (ICU). The objective of this study was to determine the frequency of proteinuria and the risk factors associated with proteinuria in Congolese COVID-19 patients. The present cross sectional study of proteinuria status is a post hoc analysis of data from 80 COVID-19 patients admitted at Kinshasa Medical Center (KMC) from March 10th to July 10th, 2020. The population under study came from all adult inpatients (≥18 years old) with a laboratory diagnosis by polymerase chain reaction (PCR) of COVID-19 were selected and divided into two groups (positive proteinuria and negative proteinuria group). Logistic regression models helped to identify the factors associated with proteinuria. The P value significance level was 0.05. Among 80 patients who tested positive for SARS-CoV-2 RT-PCR, 55% had proteinuria. The mean age was 55.2 ± 12.8 years. Fourty-seven patients (58.8%) had history of hypertension and 26 patients (32.5%) diabetes. Multivariable analysis showed age ≥ 65 years (aOR 5,04; 95% CI: 1.51-16.78), diabetes (aOR 3,15; 95% CI: 1.14-8.72), ASAT >40 UI/L (aOR 7,08; 95% CI: 2.40-20.87), ferritin >300 (aOR 13,47; 95% CI: 1.56-26.25) as factors independently associated with proteinuria in COVID-19 patients. Proteinuria is common in Congolese COVID-19 patients and is associated with age, diabetes, ferritin and aspartate aminotransferase (ASAT).


Subject(s)
COVID-19/complications , Diabetes Mellitus/epidemiology , Hypertension/epidemiology , Proteinuria/epidemiology , Adult , Age Factors , Aged , COVID-19/diagnosis , Cross-Sectional Studies , Democratic Republic of the Congo , Female , Humans , Intensive Care Units , Male , Middle Aged , Polymerase Chain Reaction , Proteinuria/etiology , Retrospective Studies , Risk Factors
5.
Clin Exp Nephrol ; 25(11): 1203-1214, 2021 Nov.
Article in English | MEDLINE | ID: covidwho-1289778

ABSTRACT

BACKGROUND: Acute kidney injury (AKI) is a severe complication of coronavirus disease-2019 (COVID-19). This study aims to evaluate incidence, risk factors and case-fatality rate of AKI in patients with COVID-19. METHODS: We reviewed the health medical records of 307 consecutive patients with COVID-19 hospitalized at the University Hospital of Modena, Italy. RESULTS: AKI was diagnosed in 69 out of 307 (22.4%) COVID-19 patients. Stages 1, 2, or 3 AKI accounted for 57.9%, 24.6% and 17.3%, respectively. AKI patients had a mean age of 74.7 ± 9.9 years. These patients showed higher serum levels of the main markers of inflammation and higher rate of severe pneumonia than non-AKI patients. Kidney injury was associated with a higher rate of urinary abnormalities including proteinuria (0.44 ± 0.85 vs 0.18 ± 0.29 mg/mg; P = < 0.0001) and microscopic hematuria (P = 0.032) compared to non-AKI patients. Hemodialysis was performed in 7.2% of the subjects and 33.3% of the survivors did not recover kidney function after AKI. Risk factors for kidney injury were age, male sex, CKD and higher non-renal SOFA score. Patients with AKI had a mortality rate of 56.5%. Adjusted Cox regression analysis revealed that COVID-19-associated AKI was independently associated with in-hospital death (hazard ratio [HR] = 4.82; CI 95%, 1.36-17.08) compared to non-AKI patients. CONCLUSION: AKI was a common and harmful consequence of COVID-19. It manifested with urinary abnormalities (proteinuria, microscopic hematuria) and conferred an increased risk for death. Given the well-known short-term sequelae of AKI, prevention of kidney injury is imperative in this vulnerable cohort of patients.


Subject(s)
Acute Kidney Injury/epidemiology , COVID-19/epidemiology , Acute Kidney Injury/diagnosis , Acute Kidney Injury/mortality , Aged , Aged, 80 and over , COVID-19/diagnosis , COVID-19/mortality , Female , Hematuria/epidemiology , Humans , Incidence , Italy/epidemiology , Male , Middle Aged , Prognosis , Proteinuria/epidemiology , Retrospective Studies , Risk Assessment , Risk Factors
6.
BMC Infect Dis ; 21(1): 397, 2021 Apr 29.
Article in English | MEDLINE | ID: covidwho-1216886

ABSTRACT

BACKGROUND: Coronavirus disease 2019 (COVID-19) has emerged as a major global health threat with a great number of deaths worldwide. Despite abundant data on that many COVID-19 patients also displayed kidney disease, there is limited information available about the recovery of kidney disease after discharge. METHODS: Retrospective and prospective cohort study to patients with new-onset kidney disease during the COVID-19 hospitalization, admitted between January 28 to February 26, 2020. The median follow-up was 4 months after discharge. The follow-up patients were divided into the recovery group and non-recovery group. Descriptive statistics and between-groups comparison were used. RESULTS: In total, 143 discharged patients with new-onset kidney disease during the COVID-19 hospitalization were included. Patients had a median age was 64 (IQR, 51-70) years, and 59.4% of patients were men. During 4-months median follow-up, 91% (130 of 143) patients recovered from kidney disease, and 9% (13 of 143) patients haven't recovered. The median age of patients in the non-recovery group was 72 years, which was significantly higher than the median age of 62 years in the recovery group. Discharge serum creatinine was significantly higher in the non-recovery group than in the recovery group. CONCLUSIONS: Most of the new-onset kidney diseases during hospitalization of COVID-19 patients recovered 4 months after discharge. We recommend that COVID-19 patients with new-onset kidney disease be followed after discharge to assess kidney recovery, especially elderly patients or patients with high discharge creatinine.


Subject(s)
COVID-19/etiology , Creatinine/blood , Kidney Diseases/etiology , Aged , Antiviral Agents/therapeutic use , COVID-19/complications , COVID-19/epidemiology , COVID-19/therapy , China/epidemiology , Comorbidity , Female , Follow-Up Studies , Glomerular Filtration Rate , Hospitalization/statistics & numerical data , Humans , Incidence , Kidney Diseases/epidemiology , Kidney Diseases/therapy , Male , Middle Aged , Patient Discharge , Prospective Studies , Proteinuria/epidemiology , Proteinuria/virology , Respiration, Artificial , Retrospective Studies
7.
J Diabetes Res ; 2021: 6666086, 2021.
Article in English | MEDLINE | ID: covidwho-1052339

ABSTRACT

BACKGROUND: The risk factors for acute kidney injury (AKI) development in patients with diabetes hospitalized for COVID-19 have not been fully studied yet. In this study, we aimed to estimate the rate of AKI among the hospitalized population with COVID-19 and to identify the risk factors associated with AKI among patients with diabetes. Material and Methods. This retrospective cohort study included 254 patients (127 with diabetes and 127 without diabetes) who were admitted for COVID-19 to a tertiary hospital in Tehran, Iran, between February and May 2020. Clinical characteristics and outcomes, radiological findings, and laboratory data, including data on AKI, hematuria, and proteinuria were recorded and analyzed. RESULTS: Of 254 patients, 142 (55.9%) were male and the mean (± SD) age was 65.7 years (±12.5). In total, 58 patients (22.8%) developed AKI during hospitalization, of whom 36 patients had diabetes (p = 0.04); most patients (74.1%) had stage 1 or 2 AKI. Also, 8 patients (13.8%) required renal replacement therapy (RRT) after developing AKI. Regardless of diabetes status, patients who developed AKI had significantly higher mortality rates compared with patients who did not develop AKI (p = 0.02). Hematuria and proteinuria were observed in 38.1% and 55% of patients, respectively. Multivariate analysis showed that invasive mechanical ventilation, proteinuria, HBA1c level, history of cardiovascular disease, and use of statins were independent risk factors for AKI development in patients with diabetes. CONCLUSION: Results of this study showed that AKI develops in a considerable percentage of patients with COVID-19, especially in those with diabetes, and is significantly associated with mortality.


Subject(s)
Acute Kidney Injury/epidemiology , COVID-19/complications , COVID-19/epidemiology , Diabetes Complications/epidemiology , Diabetes Mellitus/epidemiology , Aged , Cardiovascular Diseases/complications , Female , Glycated Hemoglobin A/analysis , Hematuria/epidemiology , Hospital Mortality , Hospitalization , Humans , Hydroxymethylglutaryl-CoA Reductase Inhibitors/pharmacology , Iran/epidemiology , Male , Middle Aged , Multivariate Analysis , Prevalence , Proteinuria/epidemiology , Renal Replacement Therapy/adverse effects , Respiration, Artificial , Retrospective Studies , Reverse Transcriptase Polymerase Chain Reaction , Risk Factors , Treatment Outcome
8.
J Nephrol ; 34(2): 355-364, 2021 04.
Article in English | MEDLINE | ID: covidwho-1042399

ABSTRACT

BACKGROUND: Proteinuria has been commonly reported in patients with COVID-19. However, only dipstick tests have been frequently used thus far. Here, the quantification and characterization of proteinuria were investigated and their association with mortality was assessed. METHODS: This retrospective, observational, single center study included 153 patients, hospitalized with COVID-19 between March 28th and April 30th, 2020, in whom total proteinuria and urinary α1-microglobulin (a marker of tubular injury) were measured. Association with mortality was evaluated, with a follow-up until May 7th, 2020. RESULTS: According to the Kidney Disease Improving Global Outcomes staging, 14% (n = 21) of the patients had category 1 proteinuria (< 150 mg/g of urine creatinine), 42% (n = 64) had category 2 (between 150 and 500 mg/g) and 44% (n = 68) had category 3 proteinuria (over 500 mg/g). Urine α1-microglobulin concentration was higher than 15 mg/g in 89% of patients. After a median follow-up of 27 [14;30] days, the mortality rate reached 18%. Total proteinuria and urinary α1-microglobulin were associated with mortality in unadjusted and adjusted models. This association was stronger in subgroups of patients with normal renal function and without a urinary catheter. CONCLUSIONS: Proteinuria is frequent in patients with COVID-19. Its characterization suggests a tubular origin, with increased urinary α1-microglobulin. Tubular proteinuria was associated with mortality in COVID-19 in our restropective, observational study.


Subject(s)
COVID-19/complications , Proteinuria/epidemiology , Aged , Aged, 80 and over , Belgium/epidemiology , Biomarkers/urine , COVID-19/epidemiology , COVID-19/urine , Female , Humans , Male , Middle Aged , Prevalence , Prognosis , Proteinuria/etiology , Proteinuria/urine , Retrospective Studies , Survival Rate/trends
9.
Diabetes Metab Syndr ; 15(1): 187-191, 2021.
Article in English | MEDLINE | ID: covidwho-987526

ABSTRACT

BACKGROUND AND AIMS: Renal involvement in Covid-19 infection is varied and can affect glomeruli, tubules, interstitium and can cause acute kidney injury (AKI). AKI is a strong predictor of mortality. Routine urinalysis gives an insight into the renal pathology of the patient. We studied the incidence of urinary abnormalities in hospitalised Covid-19 patients and analysed their impact on development of AKI and mortality. METHODS: Information on 110 hospitalised patients with confirmed Covid-19 was retrospectively collected and analysed. The demographic data such as age, gender, comorbid conditions such as diabetes mellitus, the need for dialysis and laboratory data such as urine for albumin, glucose, RBC and WBC, and serum creatinine were collected. The diagnosis of AKI was based on the KDIGO criteria. The outcomes studied were development of AKI and hospital mortality. RESULTS: Urine abnormalities were seen in 71% of the patients. Proteinuria in 58.2%, haematuria in 17.3%, pyuria in 8.2% of patients and concurrent proteinuria and haematuria was seen in 13.6% of patients. AKI was seen in 28.2% of patients and hospital mortality was 24.5%. AKI was strongly associated with mortality. Proteinuria and haematuria were good predictors of development of AKI, more strongly when they occurred concurrently (p < 0.01). CONCLUSION: Our results suggest that urine analysis is a simple test, which can be used to predict development of AKI and mortality and may be used for risk stratification of Covid-19 patients, especially in low resource settings.


Subject(s)
Acute Kidney Injury/epidemiology , Acute Kidney Injury/urine , COVID-19/epidemiology , COVID-19/urine , Acute Kidney Injury/diagnosis , Adult , Aged , COVID-19/diagnosis , Female , Hospitalization/trends , Humans , India/epidemiology , Male , Middle Aged , Predictive Value of Tests , Proteinuria/diagnosis , Proteinuria/epidemiology , Proteinuria/urine , Retrospective Studies , Urinalysis/trends
10.
Clin J Am Soc Nephrol ; 15(11): 1549-1556, 2020 11 06.
Article in English | MEDLINE | ID: covidwho-781834

ABSTRACT

BACKGROUND AND OBJECTIVES: Coronavirus disease 2019 is spreading rapidly across the world. This study aimed to assess the characteristics of kidney injury and its association with disease progression and death of patients with coronavirus disease 2019. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: This is a retrospective study. Two representative cohorts were included. Cohort 1 involved severe and critical patients with coronavirus disease 2019 from Wuhan, China. Cohort 2 was all patients with coronavirus disease 2019 in Shenzhen city (Guangdong province, China). Any kidney injury was defined as the presence of any of the following: hematuria, proteinuria, in-hospital AKI, or prehospital AKI. AKI was defined according to the Kidney Disease Improving Global Outcomes (KDIGO) creatinine criteria. The primary outcome was death at the end of follow-up. The secondary outcome was progression to critical illness during the study period. RESULTS: A total of 555 patients were enrolled; 42% of the cases (229 of 549) were detected with any kidney injury, 33% of the cases (174 of 520) were detected with proteinuria, 22% of the cases (112 of 520) were detected with hematuria, and 6% of the cases (29 of 520) were detected with AKI. Of the 29 patients with AKI, 21 cases were recognized as in-hospital AKI, and eight were recognized as prehospital AKI. Altogether, 27 (5%) patients died at the end of follow-up. The death rate was 11% (20 of 174) in patients with proteinuria, 16% (18 of 112) in patients with hematuria, and 41% (12 of 29) in the AKI settings. Multivariable Cox regression analysis showed that proteinuria (hazard ratio, 4.42; 95% confidence interval, 1.22 to 15.94), hematuria (hazard ratio, 4.71; 95% confidence interval, 1.61 to 13.81), and in-hospital AKI (hazard ratio, 6.84; 95% confidence interval, 2.42 to 19.31) were associated with death. Among the 520 patients with noncritical illness at admission, proteinuria (hazard ratio, 2.61; 95% confidence interval, 1.22 to 5.56) and hematuria (hazard ratio, 2.50; 95% confidence interval, 1.23 to 5.08) were found to be associated with progression to critical illness during the study period. CONCLUSIONS: Kidney injury is common in coronavirus disease 2019, and it is associated with poor clinical outcomes. PODCAST: This article contains a podcast at https://www.asn-online.org/media/podcast/CJASN/2020_09_18_CJN04780420.mp3.


Subject(s)
Acute Kidney Injury/epidemiology , Coronavirus Infections/complications , Hematuria/epidemiology , Pneumonia, Viral/complications , Proteinuria/epidemiology , Acute Kidney Injury/mortality , Acute Kidney Injury/virology , Adult , Aged , Betacoronavirus , COVID-19 , China/epidemiology , Critical Illness , Disease Progression , Female , Hematuria/mortality , Hematuria/virology , Humans , Kaplan-Meier Estimate , Male , Middle Aged , Pandemics , Prevalence , Proportional Hazards Models , Proteinuria/mortality , Proteinuria/virology , Retrospective Studies , SARS-CoV-2 , Survival Rate
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