Clinical Characteristics and Outcomes of Acute Kidney Injury in Hospitalized Patients with Coronavirus Disease 2019: Experience at a Major Tertiary Care Center in Pakistan.

Limited data exist on acute kidney injury (AKI) in patients hospitalized with coronavirus disease 2019 (COVID-19), its risk factors, and the outcomes from lower and middle-income countries. We determined the epidemiology of AKI and its outcomes in a retrospective observational study at a tertiary care center in Karachi, Pakistan, from October to December 2020. Demographic data, presenting clinical symptoms, laboratory results, and patient outcomes were collected from the medical records. AKI was defined according to the Kidney Disease Improving Global Outcomes criteria. Of 301 COVID-19 patients, AKI developed in 188 (62.5%). The peak stages of AKI were Stage 1 in 57%, Stage 2 in 14.9%, and Stage 3 in 27.7%. Of these, 15 (8%) required kidney replacement therapy (KRT). Patients admitted to the intensive care unit (63.8% vs. 34.5%), and those needing vasopressors (31.9% vs. 5.3%) or mechanical ventilation (25% vs. 2.7%) had a higher risk of AKI. Independent predictors of AKI were elevated blood urea nitrogen and creatinine (Cr) at presentation, mechanical ventilation, and the use of anticoagulants. AKI, the presence of proteinuria, elevated serum Cr at presentation, use of vasopressors, and a need for KRT were significantly associated with in-hospital death, and the likelihood of mortality increased with advanced stages of AKI. Compared with other countries, AKI occurred more frequently among hospitalized patients with COVID-19 in this Pakistani cohort and was associated with 7.7-fold higher odds of in-hospital death. Patients with severe AKI had a greater likelihood of mortality than those in earlier stages or without AKI.

Brain Abscess Caused by Lactococcus Lactis in a Young Male.

Lactococcus lactis cremoris is one of the gram positive cocci, not known to be pathogenic in humans. We report a case of brain abscess due to lactococcus lactis in an adolescent. An 18-year male with congenitally corrected transposition of great arteries and dextrocardia was admitted with fever, headache and right-sided numbness. Magnetic resonance imaging revealed a well circumscribed irregular heterogeneous abnormal signal intensity lesion in left temporo-parietal lobe having central area of diffusion restriction and peripheral wall enhancement on post-contrast images. He underwent mini-craniotomy for abscess drainage. Pus culture revealed growth of lactococcus lactis. He was treated with ceftriaxone and remained disability-free on six month follow-up. To our knowledge, this is one of the few reports of brain abscess caused by lactococcus lactis. Key Words: Brain abscess, Lactococcus lactis, Adolescent.

Clinical Presentation, Histology, and Outcomes of Immunoglobulin A Nephropathy: A Single-Center Experience from Pakistan.

Clinical presentation, kidney biopsy findings, and clinical outcomes of immunoglobulin A nephropathy (IgAN) are highly variable. The objective of this study is to study the clinical presentation, histologic patterns, and outcomes of IgAN in the Pakistani population, as no significant data are available in international literature from this part of the world. A retrospective chart review was conducted of all patients with biopsy-proven IgAN between January 2007 and December 2017. Of a total of 977 renal biopsies, 50 patients had biopsy-proven IgAN (5.1%). The median age at the time of biopsy was 34 years (27-42); 92% of patients were between 18 and 40 years. Thirty-eight (76%) were male. Ninety-two percent of patients had significant proteinuria of >1 g/day, with 32% having nephrotic range proteinuria. The mean estimated glomerular filtration rate (eGFR) at presentation was 46.58 mL/min/1.73 m2. Seventy-eight percent of patients were hypertensive at the time of presentation and most of them had uncontrolled hypertension (HTN). The most common lesion on light microscopy was focal necrotizing glomerulonephritis (26%), followed by mesangial expansion with segmental/global glomerulosclerosis (22%). Crescents were seen in 38% of cases. Of 50 patients, a follow-up of at least six months was available for 32 patients. Most of the patients who had an eGFR of <30 mL/min at presentation progressed to kidney failure at six-month follow-up period. IgAN usually presents in young male adults in the age range of 18-40 years, with most patients having severe clinical presentation characterized by nephrotic-range proteinuria, HTN, renal insufficiency, and severe histological stages.