Your browser doesn't support javascript.
Show: 20 | 50 | 100
Results 1 - 20 de 240
Filter
1.
Int J Mol Sci ; 23(13)2022 Jun 29.
Article in English | MEDLINE | ID: covidwho-1934128

ABSTRACT

Acute kidney injury (AKI) is an increasingly common problem afflicting all ages, occurring in over 20% of non-critically ill hospitalized patients and >30% of children and >50% of adults in critical care units. AKI is associated with serious short-term and long-term consequences, and current therapeutic options are unsatisfactory. Large gaps remain in our understanding of human AKI pathobiology, which have hindered the discovery of novel diagnostics and therapeutics. Although animal models of AKI have been extensively studied, these differ significantly from human AKI in terms of molecular and cellular responses. In addition, animal models suffer from interspecies differences, high costs and ethical considerations. Static two-dimensional cell culture models of AKI also have limited utility since they have focused almost exclusively on hypoxic or cytotoxic injury to proximal tubules alone. An optimal AKI model would encompass several of the diverse specific cell types in the kidney that could be targets of injury. Second, it would resemble the human physiological milieu as closely as possible. Third, it would yield sensitive and measurable readouts that are directly applicable to the human condition. In this regard, the past two decades have seen a dramatic shift towards newer personalized human-based models to study human AKI. In this review, we provide recent developments using human stem cells, organoids, and in silico approaches to advance personalized AKI diagnostics and therapeutics.


Subject(s)
Acute Kidney Injury , Organoids , Acute Kidney Injury/diagnosis , Acute Kidney Injury/therapy , Animals , Critical Illness/therapy , Humans , Intensive Care Units , Kidney Tubules, Proximal , Stem Cells
2.
BMJ Open ; 12(6): e058613, 2022 06 22.
Article in English | MEDLINE | ID: covidwho-1909756

ABSTRACT

INTRODUCTION: Acute kidney injury (AKI) affects nearly 20% of all hospitalised patients and is associated with poor outcomes. Long-term complications can be partially attributed to gaps in kidney-focused care and education during transitions. Building capacity across the healthcare spectrum by engaging a broad network of multidisciplinary providers to facilitate optimal follow-up care represents an important mechanism to address this existing care gap. Key participants include nephrologists and primary care providers and in-depth study of each specialty's approach to post-AKI care is essential to optimise care processes and healthcare delivery for AKI survivors. METHODS AND ANALYSIS: This explanatory sequential mixed-methods study uses survey and interview methodology to assess nephrologist and primary care provider recommendations for post-AKI care, including KAMPS (kidney function assessment, awareness and education, medication review, blood pressure monitoring and sick day education) elements of follow-up, the role of multispecialty collaboration, and views on care process-specific and patient-specific factors influencing healthcare delivery. Nephrologists and primary care providers will be surveyed to assess recommendations and clinical decision-making in the context of post-AKI care. Descriptive statistics and the Pearson's χ2 or Fisher's exact test will be used to compare results between groups. This will be followed by semistructured interviews to gather rich, qualitative data that explains and/or connects results from the quantitative survey. Both deductive analysis and inductive analysis will occur to identify and compare themes. ETHICS AND DISSEMINATION: This study has been reviewed and deemed exempt by the Institutional Review Board at Mayo Clinic (IRB 20-0 08 793). The study was deemed exempt due to the sole use of survey and interview methodology. Results will be disseminated in presentations and manuscript form through peer-reviewed publication.


Subject(s)
Acute Kidney Injury , Nephrology , Acute Kidney Injury/complications , Acute Kidney Injury/therapy , Aftercare , Humans , Nephrologists , Nephrology/methods , Survivors
3.
Am J Case Rep ; 23: e936264, 2022 Jun 03.
Article in English | MEDLINE | ID: covidwho-1897189

ABSTRACT

BACKGROUND Legionella infection is a common cause of atypical pneumonia, known as Legionnaires' disease when infection extends to extrapulmonary involvement, which often leads to hospitalization. The triad of Legionella pneumonia, rhabdomyolysis, and renal failure displays a rare yet fatal complication without prompt management. CASE REPORT Our patient was a 62-year-old man with no significant medical history who developed Legionnaires' disease with severely elevated creatinine phosphokinase (CPK) of 9614 mcg/L, consistent with rhabdomyolysis. He experienced severe headache, anorexia, and hematuria, which prompted him to seek medical care. Pertinent social history included recent flooding in his neighborhood, which surrounded the outer perimeter of his home. His clinical manifestations and laboratory findings were consistent with Legionella infection, with concomitant acute kidney injury. A chest X-ray revealed hazy left perihilar opacities concerning for atypical pneumonia. Immediate interventions of hydration and antigen-directed azithromycin were initiated to prevent rapid decompensation. His clinical symptoms resolved without further complications, and he was not transferred to the Intensive Care Unit (ICU). CONCLUSIONS Legionella-induced rhabdomyolysis is an uncommon association that can lead to acute kidney failure and rapid clinical deterioration. Early and aggressive management with fluid repletion and appropriate antibiotics can improve clinical manifestations and hospital length of stay. Our patient's reduction in CPK levels and clinical improvement confirmed that extrapulmonary involvement in Legionella infection can lead to rhabdomyolysis. It is important for healthcare providers to recognize the clinical triad of Legionella pneumonia, rhabdomyolysis, and renal failure as prompt and timely management to reduce associated morbidity.


Subject(s)
Acute Kidney Injury , Influenza, Human , Legionnaires' Disease , Pneumonia, Mycoplasma , Rhabdomyolysis , Acute Kidney Injury/complications , Acute Kidney Injury/therapy , Azithromycin , Humans , Influenza, Human/complications , Legionnaires' Disease/complications , Legionnaires' Disease/diagnosis , Legionnaires' Disease/therapy , Male , Middle Aged , Rhabdomyolysis/complications , Rhabdomyolysis/therapy
4.
Crit Care Clin ; 38(3): 473-489, 2022 Jul.
Article in English | MEDLINE | ID: covidwho-1878083

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
5.
Saudi J Kidney Dis Transpl ; 32(5): 1356-1364, 2021.
Article in English | MEDLINE | ID: covidwho-1835076

ABSTRACT

This paper describes the main characteristics of coronavirus diseases 2019 (COVID-19) patients suffering from acute kidney injury (AKI) assisted at a high complexity clinic in Barranquilla, Colombia. The patients included in this study (n = 48) were those with a positive diagnosis of COVID-19 confirmed by polymerase chain reaction detection of severe acute respiratory syndrome coronavirus 2, who had developed AKI during their hospital stay. Serum and urine parameters, as well as patient's viral load and clinical frailty scale (CFS) were recorded. A statistical analysis of the recorded parameters, such as comparisons, and correlations between variables of interest, were explored. The prevalence of COVID-19 induced AKI was 41%, being the majority of them classified as AKI network classification 3, with a renal replacement therapy requirement of 29%, and an associated mortality of 73%. AKI patients' mortality showed a significant positive correlation (33%) with patients' CFS score but not with their viral load. COVID-19 induced AKI significantly correlated with patients' frailty status but not to their viral load.


Subject(s)
Acute Kidney Injury , COVID-19 , Fatigue Syndrome, Chronic , Frailty , Acute Kidney Injury/diagnosis , Acute Kidney Injury/epidemiology , Acute Kidney Injury/therapy , COVID-19/complications , Female , Frailty/diagnosis , Frailty/epidemiology , Humans , Male , Retrospective Studies , Viral Load
6.
Iran J Kidney Dis ; 16(2): 147-151, 2022 03.
Article in English | MEDLINE | ID: covidwho-1823867

ABSTRACT

Acute kidney injury (AKI) , proteinuria in the nephrotic or subnephrotic range and hematuria might be seen in patients with coronavirus disease 2019 (COVID-19) infection. In this case study we present a 59 years old manwho was diagnosed with immune-complex glomerulonephritis after development of rapidly progressive kidney failure accompanied by pulmonary hemorrhage, 2 months after COVID-19 infection. The patient was hospitalised with the diagnosis of acute kidney injury and nephrotic syndrome. Hemodialysis was performed due to uremic symptoms. Cyclophosphamide, methylprednisolone and plasmapheresis were started. Pathologic examination of kidney biopsy revealed features compatible with immune complex-related acute glomerulonephritis. Cyclophosphamide and plasmapheresis were discontinued , and treatment with 1 mg/kg/day methylprednisolone was continued. Immune-complex glomerulonephritis can be seen following COVID-19 infection. It is important to diagnose this disease entity as soon as possible . Steroidtherapy and other supportive modalities might be sufficient in the treatment.  DOI: 10.52547/ijkd.6527.


Subject(s)
Acute Kidney Injury , COVID-19 , Glomerulonephritis , Acute Kidney Injury/diagnosis , Acute Kidney Injury/etiology , Acute Kidney Injury/therapy , Cyclophosphamide , Female , Glomerulonephritis/diagnosis , Glomerulonephritis/drug therapy , Humans , Male , Methylprednisolone/therapeutic use , Middle Aged
7.
Andes Pediatr ; 93(2): 174-183, 2022 Apr.
Article in Spanish | MEDLINE | ID: covidwho-1819098

ABSTRACT

OBJECTIVE: To describe a cohort of critically ill adult patients suffering from COVID-19, admitted to a pediatric intensive care unit managed by a pediatric intensive care team (ICU-MP). PATIENTS AND METHOD: Retrospective observational study of adults admitted to the ICU-MP due to COVID-19 from May 11 to July 26, 2020. Demographic, clinical, biochemical, ventilatory support characteris tics, and complications were recorded. Disease severity was characterized by Acute Physiology and Chronic Health Evaluation II score (APACHE II) using data from the first 24 hours of admission to the ICU-MP. RESULTS: Ninety-three patients over 18 years with suspected or confirmed COVID-19 were admitted to the ICU-MP. The median age was 60.3 years (SD 13.9), and 59 (63.4%) patients were male. Eighty-two (88.1%) patients had at least 1 medical comorbidity. The median APACHE II score was 9.4 points (SD 5.6). Fifty-one (54.8%) patients were invasively ventilated, for a median of 13.7 days (SD 17.9). Inotropic support was used in 45 (48%) patients. Thirty-three (35.5%) patients presented acute kidney injury (AKI) and 14 (15.1%) patients received continuous renal replacement therapy. Twenty-nine (31.2%) patients had healthcare-associated infections. The median ICU-MP stay was 10.8 days (SD 11.8). 25 (26.9%) patients died, ten of them (40%) had adequacy of thera peutic effort. CONCLUSIONS: The mortality rate of critically ill patients with COVID-19 is high. Older patients (> 70 years), those who require invasive mechanical ventilation and who develop AKI are at increased risk of death. Although this is not a comparative study, our mortality rate and complica tions seem to be similar to those reported in adult case series.


Subject(s)
Acute Kidney Injury , COVID-19 , APACHE , Acute Kidney Injury/complications , Acute Kidney Injury/therapy , Adult , COVID-19/epidemiology , COVID-19/therapy , Child , Critical Illness/therapy , Female , Humans , Intensive Care Units, Pediatric , Male , Middle Aged
8.
Ther Apher Dial ; 26(3): 566-582, 2022 Jun.
Article in English | MEDLINE | ID: covidwho-1816498

ABSTRACT

COVID-19 has challenged the global healthcare system through rapid proliferation and lack of existing treatment resulting in over 180 million cases and 3.8 million deaths since December 2019. Although pediatric patients only comprise 1%-2% of diagnosed cases, their incidence of acute kidney injury ranges from 8.2% to 18.2% compared to 49% in adults. Severe infection, initiated by dysregulated host response, can lead to multiorgan failure. In this review, we focus on the use of various blood filters approved for use in pediatric kidney replacement therapy to mitigate adverse effects of severe illness. Therapeutic effects of these blood filters range from cytokine removal (CytoSorb, HA330, HCO/MCO), endotoxin removal (Toraymyxin, CPFA), both cytokine and endotoxin removal (oXiris), and nonspecific removal of proteins (PMMA) that have already been established and can be used to mitigate the various effects of the cytokine storm syndrome in COVID-19.


Subject(s)
Acute Kidney Injury , COVID-19 , Acute Kidney Injury/epidemiology , Acute Kidney Injury/therapy , Adult , COVID-19/therapy , Child , Cytokines/metabolism , Endotoxins , Female , Humans , Male , Renal Replacement Therapy/methods
9.
Med Klin Intensivmed Notfmed ; 117(5): 342-348, 2022 Jun.
Article in German | MEDLINE | ID: covidwho-1813626

ABSTRACT

Coronavirus disease 2019 (COVID-19)-associated acute kidney injury (AKI) is common in critically ill patients. Renal tropism of severe acute respiratory syndrome coronavirus type 2 (SARS-CoV-2) appears to play only a minor role, whereas the pathological inflammatory response associated with severe COVID-19 is highly relevant. Both the consequences of invasive ventilation and acute respiratory distress syndrome (ARDS) caused by COVID-19 have a significant impact on the pathogenesis of AKI. High ventilation pressures compromise renal perfusion and, thus, may contribute to the development of AKI. The inflammatory response caused by ARDS, as well as the endothelial dysfunction typical of COVID-19 in combination with hypercoagulability are further factors that affect the kidney.


Subject(s)
Acute Kidney Injury , COVID-19 , Respiratory Distress Syndrome , Acute Kidney Injury/etiology , Acute Kidney Injury/therapy , COVID-19/complications , Humans , Inflammation/complications , Kidney , Lung , Respiration, Artificial/adverse effects , Respiratory Distress Syndrome/etiology , Respiratory Distress Syndrome/therapy , SARS-CoV-2
10.
PLoS One ; 17(4): e0266737, 2022.
Article in English | MEDLINE | ID: covidwho-1808564

ABSTRACT

BACKGROUND: Despite extensive research into acute kidney injury (AKI) in adults, research into the epidemiology, associated risk factors, treatment, and mortality of AKI in pediatric COVID-19 patients is understudied. Advancing understanding of this disease is crucial to further developing treatment and preventative care strategies to reduce morbidity and mortality. METHODS: This is a retrospective analysis of 2,546 COVID-19 pediatric patients (age ≤ 21 years) who were admitted the ICU in North America. Analysis of the Virtual Pediatric Systems (VPS) COVID-19 database was conducted between January 1, 2020, and June 30, 2021. RESULTS: Out of a total of 2,546 COVID positive pediatric patients, 10.8% (n = 274) were diagnosed with AKI. Significantly higher continuous and categorical outcomes in the AKI subset compared to the non-AKI cohort included: length of stay at the hospital (LOS) [9.04 (5.11-16.66) vs. 5.09 (2.58-9.94) days], Pediatric Index of Mortality (PIM) 2 probability of death [1.20 (0.86-3.83) vs. 0.96 (0.79-1.72)], PIM 3 probability of death [0.98 (0.72-2.93) vs. 0.78 (0.69-1.26)], mortality [crude OR (95% CI): 5.01 (2.89-8.70)], airway and respiratory support [1.63 (1.27-2.10)], cardio-respiratory support [3.57 (1.55-8.23)], kidney support [12.52 (5.30-29.58)], and vascular access [4.84 (3.70-6.32)]. CONCLUSIONS: This is one of the first large scale studies to analyze AKI among pediatric COVID-19 patients admitted to the ICU in North America. Although the course of the COVID-19 virus appears milder in the pediatric population, renal complications may result, increasing the risk of disease complication and mortality.


Subject(s)
Acute Kidney Injury , COVID-19 , Acute Kidney Injury/epidemiology , Acute Kidney Injury/etiology , Acute Kidney Injury/therapy , Adult , COVID-19/complications , COVID-19/epidemiology , Child , Female , Hospital Mortality , Humans , Intensive Care Units , Male , Retrospective Studies , Risk Factors , SARS-CoV-2 , Young Adult
11.
Nephrology (Carlton) ; 27(7): 566-576, 2022 Jul.
Article in English | MEDLINE | ID: covidwho-1794598

ABSTRACT

INTRODUCTION: COVID-19 infection and kidney disease (KD) carry a considerable risk of mortality. Understanding predictors of death and KD may help improve management and patient outcome. METHODS: This is a prospective multicentre observational study conducted in a multiracial Asian country to identify predictors of death and acute kidney injury (AKI) in hospitalized COVID-19 patients from January to June 2020. RESULTS: A total of 6078 patients were included in this study. Mean age was 37.3 (±16.8) years, 71% were male, 59.4% Malay, 6.7% Chinese, 2.3% Indian and 31.7% other ethnicities. AKI was seen in 3.5% of patients while 1.6% had pre-existing chronic kidney disease (CKD). Overall case fatality rate (CFR) was 1.3%. Patients with KD (AKI and CKD) had CFR of 20%. Many factors were associated with increased risk of death and AKI. However, significant predictors of death after adjustment for covariates were age (>70 years), Chinese ethnicity, diabetes mellitus (DM) and KD. Adjusted predictors of AKI were age (>51 years), DM and severity at presentation. Chinese were 2.58 times more likely to die (p = .036) compared to Malay. Centre capacity to manage, ventilate and dialyze patients significantly influenced death. Among those with AKI, the most common symptoms were fever, cough, and dyspnea. They had lower absolute lymphocyte count, were more likely to be admitted to ICU, required more ventilation and longer hospitalization. CONCLUSION: Patient and centre factors influence death and AKI among COVID-19 patients. This study also demonstrates death disparities across different racial groups and centre capacities in this multiracial Asian country.


Subject(s)
Acute Kidney Injury , COVID-19 , Diabetes Mellitus , Renal Insufficiency, Chronic , Acute Kidney Injury/diagnosis , Acute Kidney Injury/etiology , Acute Kidney Injury/therapy , Adult , Aged , Female , Hospital Mortality , Humans , Male , Middle Aged , Prospective Studies , Racial Groups , Renal Insufficiency, Chronic/complications , Retrospective Studies , Risk Factors
14.
Kidney360 ; 1(12): 1339-1344, 2020 12 31.
Article in English | MEDLINE | ID: covidwho-1776861

ABSTRACT

Background: AKI has been reported in patients with COVID-19 pneumonia and it is associated with higher mortality. The aim of our study is to describe characteristics, outcomes, and 60-day hospital mortality of patients with COVID-19 pneumonia and AKI in the intensive care unit (ICU). Methods: We conducted a retrospective study in which all adult patients with confirmed COVID-19 who were admitted to ICUs of Montefiore Medical Center and developing AKI were included. The study period ranged from March 10 to April 11, 2020. The 60-day follow-up data through June 11, 2020 were obtained. Results: Of 300 adults admitted to the ICUs with COVID-19 pneumonia, 224 patients (75%) presented with AKI or developed AKI subsequent to admission. A total of 218 (97%) patients required invasive mechanical ventilation for moderate to severe acute respiratory distress syndrome (ARDS). A total of 113 (50%) patients had AKI on day 1 of ICU admission. The peak AKI stages observed were stage 1 in 49 (22%), stage 2 in 35 (16%), and stage 3 in 140 (63%) patients, respectively. Among patients with AKI, 114 patients (51%) required RRT. The mortality rate of patients requiring RRT was 70%. Of the 34 patients who were survivors, 25 (74%) were able to be weaned off RRT completely before hospital discharge. Nonsurvivors were older and had significantly higher admission and peak creatinine levels, admission hemoglobin, and peak phosphate levels compared with survivors. The 60-day hospital mortality was 67%. Conclusions: COVID-19 requiring ICU admission is associated with high incidence of severe AKI, necessitating RRT in approximately half of such patients. The majority of patients with COVID-19 and AKI in ICU developed moderate to severe ARDS, requiring invasive mechanical ventilation. Timing or severity of AKI did not affect outcomes. The 60-day hospital mortality is high (67%). Patients with AKI requiring RRT have high mortality, but survivors have good rates of RRT recovery. Podcast: This article contains a podcast at https://www.asn-online.org/media/podcast/K360/2020_12_31_KID0004282020.mp3.


Subject(s)
Acute Kidney Injury , COVID-19 , Acute Kidney Injury/therapy , Adult , COVID-19/therapy , Hospital Mortality , Humans , Intensive Care Units , Renal Replacement Therapy/adverse effects , Retrospective Studies
15.
Kidney360 ; 2(7): 1152-1155, 2021 07 29.
Article in English | MEDLINE | ID: covidwho-1776829

ABSTRACT

AKI frequently occurs in patients with COVID-19, and kidney injury severe enough to require RRT is a common complication among patients who are critically ill. During the surge of the pandemic, there was a high demand for dialysate for continuous RRT, and this increase in demand, coupled with vulnerabilities in the supply chain, necessitated alternative approaches, including internal production of dialysate. Using a standard hemodialysis machine and off-the-shelf supplies, as per Food and Drug Administration guidelines, we developed a method for on-site dialysate production that is adaptable and can be used to fill multiple bags at once. The use of a central reverse osmosis unit, dedicated hemodialysis machine, sterile bags with separate ports for fill and use, and frequent testing will ensure stability, sterility, and-therefore-safety of the produced dialysate. The dialysate made in house was tested and it showed both stability and sterility for at least 30 hours. This detailed description of our process for generating dialysate can serve as a guide for other programs experiencing similar vulnerabilities in the demand versus supply of dialysate.


Subject(s)
Acute Kidney Injury , COVID-19 , Continuous Renal Replacement Therapy , Acute Kidney Injury/therapy , Dialysis Solutions , Humans , Pandemics , United States
16.
Eur Rev Med Pharmacol Sci ; 26(6): 2188-2195, 2022 03.
Article in English | MEDLINE | ID: covidwho-1776798

ABSTRACT

OBJECTIVE: COVID-19 disease can cause damage to various organs, especially the kidneys, so the main purpose of this study was to investigate the effect of different aspects of kidney damages caused by COVID-19 in a narrative review study. MATERIALS AND METHODS: To conduct this study, all studies related to the topic under discussion during 2020-2021 were reviewed by systematic search in internationally available databases including Web of Science, Science Direct, Scopus, PubMed, and Google Scholar. Finally, 42 completely related studies were selected to extract the results. RESULTS: The prevalence of acute kidney injury (AKI) varies in different parts of the world and has reached almost 70%. The results showed that, in general, a high percentage of COVID-19 patients had symptoms of renal dysfunction at the time of hospitalization, and the most important of these symptoms were proteinuria, hematuria, and increased serum creatinine. Based on the results, it can be said that AKI most likely occurs early in the disease and in parallel with lung damage. So far, various drugs have been used to control or treat COVID-19 and reduce inflammation in patients. Regardless of their usefulness, some of these drugs may adversely affect kidney function and damage the kidneys. The study results show that chronic kidney disease (CKD) in COVID-19 patients plays a minor role in renal replacement therapy (RRT), and the highest impact on the need for RRT is COVID-19. CONCLUSIONS: This study showed that one of the major negative effects of COVID-19 on the human body is kidney damage, among which acute kidney injury (AKI) is the most important one. In addition, the prevalence of AKI due to COVID-19 varies widely around the world. Although any medication may damage the kidneys, COVID-19 or anti-inflammatory drugs are not an exception to this rule, but more research is needed to gain more information.


Subject(s)
Acute Kidney Injury , COVID-19 , Acute Kidney Injury/diagnosis , Acute Kidney Injury/epidemiology , Acute Kidney Injury/therapy , Humans , Kidney , Proteinuria , Renal Replacement Therapy/adverse effects
17.
Medicine (Baltimore) ; 101(11)2022 Mar 18.
Article in English | MEDLINE | ID: covidwho-1769455

ABSTRACT

ABSTRACT: This study aimed to characterize survivors of Coronavirus disease 2019 (COVID-19) infection and acute kidney injury (AKI) that recover their renal function or progress to acute kidney disease (AKD) on discharge; and determine factors associated with progression to AKD during hospital stay.One thousand seventy four patients with COVID-19 infection were followed up until discharge/death. The incidence of AKI was 59.7%. Two hundred and sixty-six patients were discharged alive and included in the analysis, 71.8% had renal recovery (RR) while 28.2% were discharged with AKD. The AKD subset has higher rate of chronic kidney disease (CKD) ≥3 (33.4% vs 14.1%, P = .001), congestive heart failure (18.7% vs 5.8%, P = .001), use of non-invasive mechanical ventilation (10.7% vs 3.7%, P = .026) and vasopressors (25.3% vs 12.0%, P = .007). Of 19 patients in the AKI survivor cohort who received renal replacement therapy, 1 had RR while 18 progressed to AKD on discharge. Predictors to progression to AKD were CKD ≥3 (Odds Ratio [OR]: 3.23, 95% confidence interval [CI] 1.59-6.56, P = .001), congestive heart failure (OR: 4.59, 95% CI 1.76-11.78, P = .002), AKI on admission (OR: 2.71, 95% CI, 1.14-6.46, P = .025), and ongoing diarrhea (OR: 3.19, 95% CI, 1.02-9.96, P = .025).This study demonstrates a higher proportion of RR among survivors of COVID-19 infection in our minority predominant cohort. Early identification and appropriate management of patients at-risk to progress to AKD could improve outcomes, reduce long term sequalae of CKD/end stage renal disease, and have a major impact on health outcome and financial strain on healthcare system.


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 , COVID-19/therapy , Cohort Studies , Humans , Kidney/physiology , Retrospective Studies , Risk Factors
18.
Clin Nephrol ; 97(4): 232-241, 2022 Apr.
Article in English | MEDLINE | ID: covidwho-1766095

ABSTRACT

BACKGROUND: Correctional facilities have faced unique challenges during the COVID-19 pandemic. A COVID-19 outbreak was reported in the Federal Medical Center (FMC) in Lexington, Kentucky, a prison for inmates requiring medical and mental care. The main objective of this study was to examine clinical characteristics and outcomes of prisoners vs. non-prisoners admitted to the hospital due to COVID-19 disease. MATERIALS AND METHODS: We did a retrospective, comparative cohort study of 86 consecutive COVID-19 patients admitted to the University of Kentucky hospital between March 1 and June 1, 2020. Among these, 37 patients were inmates from a single local FMC and 49 were non-inmates. RESULTS: Mean (SD) age of the cohort was 59.1 (14.5) years, 68.6% were male and 61.6% white. All inmates were men. No significant differences in age or race were observed between inmates and non-inmates. Hypertension (81%), obesity (62%), COPD/asthma (43%), diabetes (41%), coronary artery diseases (38%), and chronic kidney disease (22%) were among the most common comorbidities prevalent in inmates. Inmates had overall higher serum creatinine and C-reactive protein, more proteinuria, and lower platelet counts at the time of hospital admission when compared to non-inmates. Incidence of acute kidney injury (AKI) was more frequent in inmates (68 vs. 38% in non-inmates, p = 0.008). Overall, patients who developed AKI had higher acuity of illness with more requirement of ICU care and mechanical ventilation. Kidney replacement therapy (KRT) was provided to 12.8% of patients. Inpatient mortality occurred in 15.1% of patients and was not different in inmates vs. non-inmates (13.5 vs. 16.3%, p = 0.862). All survivors became independent of KRT, and ~ 1 of 10 survivors had a reduction of eGFR ≥ 25% from baseline by the time of discharge, which was more frequent in inmates vs. non-inmates, 15.6 vs. 2.4%, p = 0.042, respectively. CONCLUSION: Inmates represent a vulnerable population with prevalent comorbidity and susceptibility to COVID-19. When compared to non-inmates with COVID-19, inmates exhibited higher incidence of AKI and, for survivors, less kidney recovery by the time of hospital discharge. Surveillance of long-term sequela of COVID-19 is warranted in this susceptible inmate population.


Subject(s)
Acute Kidney Injury , COVID-19 , Prisoners , Acute Kidney Injury/epidemiology , Acute Kidney Injury/etiology , Acute Kidney Injury/therapy , COVID-19/epidemiology , COVID-19/therapy , Cohort Studies , Humans , Male , Middle Aged , Pandemics , Retrospective Studies , SARS-CoV-2
19.
Eur Rev Med Pharmacol Sci ; 26(5): 1753-1760, 2022 03.
Article in English | MEDLINE | ID: covidwho-1754184

ABSTRACT

OBJECTIVE: Coronavirus disease-19 (COVID-19) primarily affects the respiratory system. In some cases, the heart, kidney, liver, circulatory system, and nervous system are also affected. COVID-19-related acute kidney injury (AKI) occurs in more than 20% of hospitalized patients and more than 50% of patients in the intensive care unit (ICU). In this study, we aimed to review the prevalence of COVID-19-related acute kidney injury, risk factors, hospital and ICU length of stay, the need for renal replacement therapy. We also examined the effect of AKI on mortality in patients in the ICU that we treated during a 1-year period. PATIENTS AND METHODS: The files of patients with COVID-19 (n=220) who were treated in our ICU between March 21st, 2020, and June 1st, 2021, were analyzed retrospectively. Demographic data of the patients, laboratory data, and treatments were examined. Patients were divided into two groups, group I patients without AKI and, group II patients with AKI. The patients with AKI were evaluated according to the theKidney Disease Improving Global Outcomes (KDIGO) classification and were graded. RESULTS: Of the 220 patients included in the study, 89 were female and 131 were male. The mean age of patients with AKI (70.92±11.28 years) was statistically significantly higher than among those without AKI (58.87±13.63 years) (p<0.001). In patients with AKI, ICU length of stay, Acute Physiology and Chronic Health Evaluation (APACHE) II scores, initial lactate levels, need for mechanical ventilation, duration of mechanical ventilation, and secondary infection rates were found to be statistically significantly higher. Discharge rates from the ICU in patients without AKI were statistically higher (75.3% vs. 26.6%), and mortality rates were significantly higher in patients with AKI (67.8% vs. 14.3%). CONCLUSIONS: Various studies conducted have shown that patients with COVID-19 are at risk for AKI, and this is closely related to age, sex, and disease severity. The presence of AKI in patients with COVID-19 increases mortality, and this is more evident in patients hospitalized in the ICU. In our study, the prevalence of AKI was higher in older patients with high APACHE II scores and initial lactate levels. Comorbidities such as hypertension, chronic kidney disease, and coronary artery disease in patients with AKI were higher than in those without AKI.


Subject(s)
Acute Kidney Injury/etiology , COVID-19/complications , Intensive Care Units , APACHE , Acute Kidney Injury/therapy , Age Factors , Aged , Aged, 80 and over , COVID-19/mortality , Cross Infection/complications , Female , Humans , Lactic Acid/blood , Male , Middle Aged , Prevalence , Respiration, Artificial , Retrospective Studies , Sex Factors
20.
J Crit Care ; 68: 38-41, 2022 04.
Article in English | MEDLINE | ID: covidwho-1729887

ABSTRACT

PURPOSE: To describe the kidney histopathology of patients with S-AKI and correlate the histological findings with AKI severity, presence of septic shock, and the degree of multiple organic dysfunction (MOD) using the SOFA score. MATERIALS AND METHODS: This was a prospective, observational, and analytical study of a cohort of critically ill patients with S-AKI who died from sepsis at the "Hospital Español" intensive care unit (ICU). Kidney necropsies were performed within 2 h after death. RESULTS: We considered twenty (20) patients, with all of them exhibiting S-AKI stage 3 at the same time. In renal histopathology analysis, nonspecific tubulointerstitial (TI) lesions were found in almost all patients (95%). The more frequently found nonspecific TI lesions involved leukocyte infiltration (85%). Necrotic TI lesions were found in 6 patients (30%), and necrotic tubular cell casts were the most frequent lesions (50% of patients). It was not possible to demonstrate an association between the presence of necrotic TI lesions and factors such as the APACHE II score, the global SOFA score, ICU stays, AKI length and renal replacement therapy (RRT). CONCLUSIONS: The main histopathological findings in kidney necropsies in patients with S-AKI KDIGO 3, showed nonspecific TI lesions, and TI necrosis was only observed in 30% of the cases; therefore, S-AKI cannot be considered to be synonymous with acute tubular necrosis (ATN).


Subject(s)
Acute Kidney Injury , Critical Illness , APACHE , Acute Kidney Injury/therapy , Female , Humans , Intensive Care Units , Kidney , Male , Necrosis , Prospective Studies
SELECTION OF CITATIONS
SEARCH DETAIL