Risk factors associated with acute kidney injury in a cohort of hospitalized patients with COVID-19.

BACKGROUND: Patients with COVID-19 have a high incidence of acute kidney injury (AKI), which is associated with mortality. The objective of the study was to determine the factors associated with AKI in patients with COVID-19. METHODOLOGY: A retrospective cohort was established in two university hospitals in Bogotá, Colombia. Adults hospitalized for more than 48 h from March 6, 2020, to March 31, 2021, with confirmed COVID-19 were included. The main outcome was to determine the factors associated with AKI in patients with COVID-19 and the secondary outcome was estimate the incidence of AKI during the 28 days following hospital admission. RESULTS: A total of 1584 patients were included: 60.4% were men, 738 (46.5%) developed AKI, 23.6% were classified as KDIGO 3, and 11.1% had renal replacement therapy. The risk factors for developing AKI during hospitalization were male sex (OR 2.28, 95% CI 1.73-2.99), age (OR 1.02, 95% CI 1.01-1.03), history of chronic kidney disease (CKD) (OR 3.61, 95% CI 2.03-6.42), High Blood Pressure (HBP) (OR 6.51, 95% CI 2.10-20.2), higher qSOFA score to the admission (OR 1.4, 95% CI 1.14-1.71), the use of vancomycin (OR 1.57, 95% CI 1.05-2.37), piperacillin/tazobactam (OR 1.67, 95% CI 1.2-2.31), and vasopressor support (CI 2.39, 95% CI 1.53-3.74). The gross hospital mortality for AKI was 45.5% versus 11.7% without AKI. CONCLUSIONS: This cohort showed that male sex, age, history of HBP and CKD, presentation with elevated qSOFA, in-hospital use of nephrotoxic drugs and the requirement for vasopressor support were the main risk factors for developing AKI in patients hospitalized for COVID-19.

Litiasis urinaria en el donante cadavérico: respuestas a la penumbra urológica desde un análisis bibliométrico / Urolithiasis in the brain-dead donor: responses to the urological penumbra from a bibliometric analysis

La literatura disponible sobre las implicaciones de la urolitiasis en la donación y trasplante renal (TxR) con injertos de donante cadavérico es limitada; la información disponible tiene especial énfasis en el donante vivo. Objetivo: Exponer la producción bibliográfica y las implicaciones clínicas de la urolitiasis en el proceso de donación y TxR incluyendo la perspectiva con injertos de donante cadavérico. Métodos: Análisis bibliométrico ejecutado mediante una búsqueda sistemática de la literatura en Medline, Embase, SciELO, Cochrane Central, Google Académico y Web of Science utilizando combinaciones de los términos MesH "urolithiasis", "kidney calculi", "ureteral calculi", "tissue and organ procurement", "brain death", "living donors" y "kidney transplantation". Se limitó la búsqueda a artículos publicados entre los años 2000-2022. Resultados: Se analizaron 23 artículos. El 95.6% de ellos fueron publicados en inglés, el 26% se publicaron en revistas del cuartil 1, solo un tercio de ellos tienen relación con el donante cadavérico. La urolitiasis en el injerto renal no es una contraindicación absoluta para el trasplante, se puede ofrecer manejo quirúrgico activo ex vivo durante la cirugía de banco para cálculos > 4 mm y el trasplante con observación para injertos renales con cálculos < 4 mm. Conclusiones: La producción científica en términos de litiasis urinaria y donación/TxR es limitada. El hallazgo incidental de urolitiasis en el donante vivo o cadavérico de riñón no es una contraindic

The clinical literature about the implications of urolithiasis in the process of kidney donation/transplantation (KTx) from deceased donors is scarce. Objectives: To expose the current state of bibliographic production and the clinical implications of urolithiasis in the process of kidney donation/transplantation focus on cadaveric donor grafts. Methods: We performed a bibliometric analysis based on a systematic review of the literature in Medline, Embase, SciELO, Cochrane Central, Google Scholar and Web of Science using combinations (OR, AND) of MesH terms: "urolithiasis", "kidney calculi", "ureteral calculi", "tissue and organ procurement", "brain death", "living donors" and "kidney transplantation". The search was limited to primary articles, systematic reviews or meta-analyses performed in humans published between 2000-2022. Results: Twenty-three articles were included for analysis; 95.6% of the bibliographic production was published in English, 26% were published into quartile 1 journals. One third of the references were focused on cadaveric donors. The information obtained concludes that presence of urolithiasis in the kidney graft is not an absolute contraindication for KTx and proposes the ex vivo surgical management of urolithiasis during the bench surgery for stones > 4 mm and to proceed with KTx and then follow-up for kidney grafts with stones < 4 mm. Conclusions: The scientific production related to urolithiasis and kidney donation/transplantation is limited. The literature available concludes that incidental kidney stones in kidney grafts should not be considered an absolute contraindication for KTx. Ex vivo surgical management of urolithiasis is a feasible and safe prior to KTx

ANCA vasculitis and membranoproliferative glomerulonephritis associated with Sjögren's syndrome: Case report and literature review

ANCA-associated vasculitis may occur concomitantly with primary Sjögren's syndrome (SS) or arise during its evolution. We present the case of a patient who underwent dry symptoms, a positive Schirmer test and an SS-compatible autoimmunity profile and, simultaneously, deterioration of renal function, anaemia, and dyspnoea, requiring renal biopsy and fibro-bronchoscopy. Complementary studies documented acute necrotizing glomerulonephritis with extracapillary proliferation, and membranoproliferative pattern with immune complex deposition. Bronchoalveolar lavage was compatible with alveolar haemorrhage. Kidney lung syndrome secondary to ANCA vasculitis was diagnosed and treatment with steroid and intravenous cyclophosphamide with clinical and paraclinical improvement was instituted. Mixed renal involvement found in this case is uncommon in patients with SS, and treatment changes significantly, hence the importance of differential diagnosis and reporting in the literature.

La vasculitis asociada con anticuerpos anticitoplasma de neutrófilos-ANCA puede presentarse concomitantemente con síndrome de Sjögren primario o surgir durante su evolución. Se presenta el caso de una paciente que cursó con síntomas secos, test de Schirmer positivo, perfil de autoinmunidad compatible con síndrome de Sjögren y, de forma simultánea, deterioro de la función renal, anemia y disnea, por lo que requirió biopsia renal y fibrobroncoscopia. Los estudios complementarios documentaron glomerulonefritis aguda necrosante con proliferación extracapilar y patrón membranoproliferativo con depósito de complejos inmunes. El lavado broncoalveolar fue compatible con hemorragia alveolar. Se hizo diagnóstico de síndrome de pulmón-rinón secundario a vasculitis ANCA y se instauró tratamiento con esteroide y ciclofosfamida intravenosa, con mejoría clínica y paraclínica. El compromiso renal mixto encontrado en este caso es infrecuente en pacientes con SS, y el tratamiento cambia ostensiblemente, de ahí la importancia del diagnóstico diferencial y el reporte en la literatura.

Glomerular diseases related to HIV in Colombian population: Better outcomes with highly active antiretroviral therapy?

INTRODUCTION: End-stage renal disease (ESRD) related to HIV is becoming a leading cause of renal replacement therapy requirement is some areas of the world. Our study aims to describe the incidence and renal outcomes of HIV-associated nephropathy (HIVAN), and immune-mediated kidney disease related to HIV (HIVICK) in Colombia. METHODOLOGY: A retrospective cohort study was performed, including all HIVAN or HIVICK incident cases assessed by the infectious diseases division in a high complexity institution in Colombia, between 2004 and 2018. A longitudinal data model under the Generalized Estimating Equations (GEE) method was used to determine changes on the glomerular filtration rate (GFR) over time. RESULTS: Within a cohort composed by 1509 HIV-infected patients, we identified 22 with HIV-associated glomerular disease. Cumulative incidence was 1.45%. At diagnosis, GFR was above 30 mL/min in 90.8% of patients, and 77.2% displayed sub-nephrotic proteinuria. Factors associated with GFR at diagnosis were: level of CD4 (Coefficient 0.113, CI 95 %: 0.046, 0.179, p < 0.01), and the inverse of the CD4/CD8 ratio. The GEE model did not demonstrate significant changes in the GFR over a 3-year period. Findings were similar when comparing GFR at diagnosis with GFR at 12 (-3.9 mL/min/1.73m2, CI 95% -7.3, 0.4, p = 0.98), 24 (-2.47 mL/min/1.73m2, CI 95% -7.0, 2.1, p=0.85), and 36 months (0.39 mL/min/1.73m2, CI 95% -4.4, 5.2, p = 0.43) of follow-up. CONCLUSIONS: Patients with glomerular disease associated with HIV have stable GFR over a 3-year period, and low rates of progression towards dialysis requirement. Differences with previous reports could be related with early diagnosis and treatment with highly active antiretroviral therapy.

Demographic and clinical characteristics of patients with ANCA-positive vasculitis in a Colombian University Hospital over a 12-year period: 2005-2017.

Vasculitides associated with anti-neutrophil cytoplasmic antibodies are heterogeneous, systemic, low prevalence and high morbidity and mortality entities. They include granulomatosis with polyangiitis, microscopic polyangiitis and eosinophilic granulomatosis with polyangiitis. In Latin America, there are few descriptive registries of these patients. The objective of the study was to describe the demographic and clinical characteristics and in-hospital morbidity and mortality of patients with vasculitis associated with anti-neutrophil cytoplasmic antibodies in a university hospital in Colombia. This was a cross-sectional descriptive study. We performed computer searches with terms related to patients with anti-neutrophil cytoplasmic antibody-associated vasculitis, between 2005 and 2017 who met the American College of Rheumatology classification criteria for vasculitis associated with anti-neutrophil cytoplasmic antibodies, and their clinical and laboratory characteristics. One hundred and six patients with anti-neutrophil cytoplasmic antibody-associated vasculitis were included in the study. The average age was 55 years, and 57.5% were women. In 68.8% of the cases, the diagnosis was made during hospitalization, with an average hospital stay of 16.6 days (± 12.22). The distribution by type of vasculitis was: granulomatosis with polyangiitis 52%, microscopic polyangiitis 45.2% and eosinophilic granulomatosis with polyangiitis 1.8%. Alveolar hemorrhage occurred in 35% of patients; 20.7% had variable renal involvement, of which 53.8% progressed to advanced kidney disease. Treatment included glucocorticoids 91.5%, cyclophosphamide 62.2%, plasmapheresis 14.1%, and 41.5% required renal replacement therapy. In-hospital mortality was 16.5%, Sepsis was the most common cause of death. We present clinical information on a group of patients with anti-neutrophil cytoplasmic antibody-associated vasculitis; renal involvement was the the most common type of affectation. Both the clinical and serological characteristics of our registry were similar to those described in other Latin American and European cohorts, and a lower in-hospital mortality rate was evidenced.

Impact of Complicated Urinary Tract Infection on Renal Graft Function.

BACKGROUND: Urinary tract infection (UTI) is the most common infectious complication after renal transplantation. It is uncertain whether the development of UTI has an impact on renal graft function. The objective of this study was to evaluate the effects of complicated and recurrent UTI on 2-year renal graft function. METHODS: This was a historical cohort study in renal transplantation patients in a kidney transplant center. All renal transplant recipients from June 2004 to September 2016 were included. A linear regression analysis was performed to study the association between the outcome (variation in estimated glomerular filtration rate [eGFR] by the Chronic Kidney Disease Epidemiology Collaboration [CKD-EPI] equation between month 1 and month 24 post-transplant) and the UTI. The approval of the Ethics and Research Committee to carry out this study was obtained. RESULTS: In total, 276 kidney transplants were performed during the observation period. Of the transplant patients, 193 (69.9%) did not develop a UTI and 83 (30.1%) presented at least 1 complicated UTI. Patients who presented at least 1 UTI had a variation in eGFR during the observation period of -12.6 mL/min/1.73 m2 (95% confidence interval [CI] -4.5 to -20.7 mL/min/1.73 m2; P = .02), compared with those without a UTI. Said difference persisted in the adjusted model controlling for variables that have an impact on the eGFR. This difference was -10.7 mL/min/1.73 m2 (95% CI -3.1 to -18.2 mL/min/1.73 m2; P = .006). CONCLUSION: The findings suggest that the occurrence of complicated UTI has a negative impact on graft function and that prevention and monitoring of UTIs should be stepped up to avoid their deleterious effects on graft function.

Characterization of kidney transplant patients with expanded criteria donors / Caracterización de trasplantados renales con donantes de criterios expandidos

Abstract Introduction: Kidney transplantation is the treatment of choice for patients with chronic kidney disease; however, the number of donors is insufficient, and waiting lists grow exponentially each year. Transplantation from expanded criteria donors benefits a significant number of patients, improving their survival when compared to those who remain on dialysis. The objective of this study is to describe the characteristics of patients who have received transplants from expanded criteria donors and their renal function at the first and third years after transplantation. Methods: A descriptive observational study was conducted. Patients older than 18 years who received transplants from an expanded criteria donor were chosen between 2007 and 2015. Results: Of a total of 227 patients analyzed, 18 received transplants from an expanded criteria donor. The recipients were 59.5 years old (37-79) and had spent 22.4 months on the waiting list (2.6-77.8) and 4.5 years on dialysis (0.5-18.4). The donors' age was 61 years (50-73). Graft survival at one year was 88.9%; at three years, it was 80%. A total of 11.1% of the patients presented acute cellular rejection at one year, and the average glomerular filtration rate at the first and third years was 58.4 mL/min/1.73 m2. Conclusion: Patients who received transplants from expanded criteria donors have good kidney graft function at three years, with graft and patient survival, similar to that reported for patients who received transplants from standard criteria donors (Acta Med Colomb 2019; 44. DOI: https://doi.org/ 10.36104/amc.2019.1185).

Resumen Introducción: el trasplante renal es el tratamiento de elección para pacientes con enfermedad renal crónica, sin embargo, el número de donantes es insuficiente y las listas de espera crecen exponencialmente cada año. El trasplante con donante de criterios expandidos beneficia a un número importante de pacientes, mejorando su supervivencia al compararlos con los que permanecen en diálisis. El objetivo de este estudio es describir las características de pacientes trasplantados con donantes de criterios expandidos y su función renal al primer y tercer año del trasplante. Métodos: se realizó un estudio descriptivo observacional. Se eligieron pacientes mayores de 18 años trasplantados con donante de criterios expandidos entre 2007 y 2015. Resultados: de un total de 227 pacientes analizados, 18 fueron trasplantados con donante de criterios expandidos. Los receptores tenían 59.5 años (37-79), tiempo en lista de espera de 22.4 meses (2.6-77.8), tiempo en diálisis de 4.5 años (0.5-18.4). La edad del donante fue 61 años (50-73). La supervivencia del injerto al año fue 88.9% y a los tres años de 80%. El 11.1% de los pacientes presentaron rechazo celular agudo al año y el promedio de la tasa de filtración glomerular al primer y tercer año fue de 58.4 mL/min/1.73m2 Conclusión: los pacientes trasplantados con donante de criterios expandidos tienen una buena función del injerto renal a tres años, con supervivencia del injerto y del paciente, similar a la reportada con donante con criterio estándar. (Acta Med Colomb 2019; 44. DOI: https://doi.org/10.36104/amc.2019.n85).

Hemorragia alveolar difusa secundaria a vasculitis asociada a ANCA. Recaída durante hemodiálisis / Diffuse alveolar hemorrhage secondary to ANCA-associated vasculitis. Relapse during hemodialysis

Resumen La hemorragia alveolar difusa (HAD) masiva es una complicación inusual de los pacientes con vasculitis ANCA, frecuentemente amenaza la vida y está asociada con una mortalidad de hasta el 100%. La información en la literatura acerca del tratamiento en casos refractarios y cuando el paciente se encuentra en diálisis es escasa. Se presenta el caso de un paciente con vasculitis p-ANCA con compromiso renal y pulmonar en el escenario de síndrome pulmón-riñón, con múltiples recaídas de hemorragia alveolar a pesar de tratamiento con corticoide, azatioprina, ciclofosfamida y terapia de recambio plasmático. Se instauró manejo con anticuerpo monoclonal anti CD20 e inmunoglobulina, logrando resolución del episodio de hemorragia alveolar y permaneciendo sin actividad. Se resalta la utilidad del rituximab como estrategia terapéutica en casos refractarios. (Acta Med Colomb 2019; 44: 111-114).

Abstract Massive diffuse alveolar hemorrhage (DAH) is an unusual complication of patients with ANCA vasculitis that frequently threatens life and is associated with mortality up to 100%. In formation in the literature about treatment in refractory cases and when the patient is on dialysis is scarce. The case of a patient with p-ANCA vasculitis with renal and pulmonary involvement in the lung-kidney syndrome scenario, with multiple relapses of alveolar hemorrhage despite treatment with corticosteroid, azathioprine, cyclophosphamide and plasma exchange therapy is presented. Management with anti-CD20 monoclonal antibody and immunoglobulin was estab lished, achieving resolution of the episode of alveolar hemorrhage and remaining without activity. The usefulness of rituximab as a therapeutic strategy in refractory cases is highlighted. (Acta Med Colomb 2019; 44: 111-114).

Gastric sleeve surgery in hemodialysis: A case report.

INTRODUCTION: Morbid obesity in chronic kidney disease patients on hemodialysis limits access to renal transplantation. We report here a case of a surgical procedure for weight reduction in a hemodialysis patient and adjustment of dry weight through bioelectrical impedance. CASE PRESENTATION: A 44-year-old male with CKD on hemodialysis for 26 years. After 3 years on dialysis, he underwent a cadaveric kidney transplant. However, after 8 years of transplant, he loses the kidney graft and returns to dialysis treatment. The patient's BMI increased to 42 kg/m2 and he had difficult-to-control hypertension and severe sleep apnea. Behavioral, nutritional and pharmacologic measures were not sufficient to achieve an adequate weight control. Thus, a surgical procedure for weight reduction was considered. The patient underwent a laparoscopic gastric sleeve without any complications. Dry weight was adjusted through bioelectrical impedance before each hemodialysis session. The patient did not display hypotension, cramps, or fluid overload. After a 30 kg weight loss, the patient's BMI was 28.3 kg/m2, allowing registration on the kidney transplant waitlist. DISCUSSION: Obesity in CKD restricts access to kidney transplant waitlist. Bariatric surgery has proven to be safe and effective for sustained weight loss and it seems that the fact that a patient is dialysis dependent does not independently increase post-operatory complications. CONCLUSION: Surgical procedures for weight reduction in dialysis patients does not independently increase the risk for adverse outcomes after bariatric surgery. The estimation of DW through BIA is an effective method for avoiding complications generated by excessive or deficient ultrafiltration.

Glomerulopatía membranosa con glomerulonefritis necrosante. Una asociación infrecuente / Membranous glomerulopathy with necrotizing glomerulonephritis. An infrequent association

Resumen Antecedentes: la asociación entre glomerulopatía membranosa y glomerulonefritis necrosante crescéntica es infrecuente: 0.4%, confiriendo un escenario de peor pronóstico. Se requieren estudios que precisen el esquema de tratamiento óptimo, sin embargo, el rápido inicio de terapia inmunosupresora impacta en la preservación de la función renal. Objetivo: exponer un caso en el cual se presenta esta asociación y tiene adecuada respuesta con el tratamiento realizado. Métodos: en este artículo se presenta un caso de una mujer con síndrome nefrótico a quien se le documenta glomerulopatía membranosa con proliferación extracapilar confirmada con biopsia renal, sin evidencia de autoinmunidad, neoplasia ni proceso infeccioso. Tras el diagnóstico se inició manejo con metilprednisolona y ciclofosfamida con adecuada evolución, sin deterioro de la función renal y con mejoría de proteinuria. Conclusión: la presencia de proliferación extracapilar da peor pronóstico en los pacientes con glomerulopatía membranosa, el inicio oportuno del tratamiento es fundamental. (Acta Med Colomb 2019; 44: 39-42).

Abstract Background: the association between membranous glomerulopathy and crescentic necrotizing glomerulonephritis is infrequent: 0.4%, conferring a worst prognosis scenario. Studies that require the optimal treatment scheme are required; however, it has been described that the rapid onset of immunosuppressive therapy impacts on the preservation of renal function. Objective: to present a case in which this association is presented and has an adequate response to the performed treatment. Methods: in this article, a case of a woman with nephrotic syndrome with a documented membranous glomerulopathy with extracapillary proliferation confirmed by renal biopsy, without evidence of autoimmunity, neoplasia or infectious process is presented. After the diagnosis, treatment with methylprednisolone and cyclophosphamide was started with adequate evolution, without deterioration of renal function and with improvement of proteinuria. Conclusion: the presence of extracapillary proliferation gives worse prognosis in patients with membranous glomerulopathy. The timely initiation of treatment is essential. (Acta Med Colomb 2019; 44: 39-42).

Placental site tumour associated with IgA nephropathy as paraneoplastic manifestation: case report / Tumor del lecho placentario asociado a nefropatía por IgA como manifestación paraneoplásica: reporte de caso

ABSTRACT Objective: To report the case of a placental site tumour which presented clinically in the form of a nephrotic syndrome secondary to IgA nephropathy. Case presentation: A 24-year-old woman, primigravida, referred to a Level IV complexity institution in Bogotá (Colombia), where she was diagnosed with IgA nephropathy as a paraneoplastic manifestation of a placental site trophoblastic tumour. After total hysterectomy as treatment, the patient evolved well, with oedema resolution and a drop in proteinuria. The patient completed one year of medical follow-up, with no evidence of disease. Discussion: Placental site trophoblastic tumour is rare, is part of the differential diagnosis for gestational trophoblastic disease and may present as a renal paraneoplastic manifestation which usually resolves once the tumour is treated. IgA nephropathy may be secondary to chronic inflammatory diseases and neoplastic diseases, as in this case.

RESUMEN Objetivo: reportar un caso de tumor del lecho placentario, cuya manifestación clínica fue síndrome nefrótico secundario a nefropatía IgA. Presentación del caso: se describe el caso de una paciente de 24 años, primigestante, quien fue remitida a una institución de cuarto nivel de complejidad localizada en Bogotá (Colombia), en donde se le hizo diagnóstico de nefropatía por IgA como manifestación paraneoplásica de un tumor trofoblástico del lecho placentario. Se realizó histerectomía total como tratamiento, con evolución satisfactoria, con resolución de los edemas y descenso de proteinuria; completó un año en seguimiento médico, sin evidencia de enfermedad. Discusión: el tumor trofoblástico del lecho placentario es infrecuente, hace parte del diagnóstico diferencial de la enfermedad trofoblástica gestacional (ETG), y puede manifestarse con fenómenos paraneoplásicos a nivel renal, que generalmente se resuelven con el tratamiento del tumor. La nefropatía por IgA puede ser secundaria a enfermedades inflamatorias crónicas y a patologías neoplásicas, como en este caso.