Association between Postmortem Kidney Biopsy Findings and Acute Kidney Injury from Patients with SARS-CoV-2 (COVID-19).

BACKGROUND AND OBJECTIVES: AKI in coronavirus disease 2019 (COVID-19) is associated with higher morbidity and mortality. The objective of this study was to identify the kidney histopathologic characteristics of deceased patients with diagnosis of COVID-19 and evaluate the association between biopsy findings and clinical variables, including AKI severity. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: Our multicenter, observational study of deceased patients with COVID-19 in three third-level centers in Mexico City evaluated postmortem kidney biopsy by light and electron microscopy analysis in all cases. Descriptive and association statistics were performed between the clinical and histologic variables. RESULTS: A total of 85 patients were included. Median age was 57 (49-66) years, 69% were men, body mass index was 29 (26-35) kg/m2, 51% had history of diabetes, 46% had history of hypertension, 98% received anticoagulation, 66% were on steroids, and 35% received at least one potential nephrotoxic medication. Severe AKI was present in 54% of patients. Biopsy findings included FSGS in 29%, diabetic nephropathy in 27%, and arteriosclerosis in 81%. Acute tubular injury grades 2-3 were observed in 49%. Histopathologic characteristics were not associated with severe AKI; however, pigment casts on the biopsy were associated with significantly lower probability of kidney function recovery (odds ratio, 0.07; 95% confidence interval, 0.01 to 0.77). The use of aminoglycosides/colistin, levels of C-reactive protein and serum albumin, previous use of angiotensin-converting enzyme inhibitors or angiotensin II receptor blockers, antivirals, nonsteroid anti-inflammatory drugs, and anticoagulants were associated with specific histopathologic findings. CONCLUSIONS: A high prevalence of chronic comorbidities was found on kidney biopsies. Nonrecovery from severe AKI was associated with the presence of pigmented casts. Inflammatory markers and medications were associated with specific histopathologic findings in patients dying from COVID-19.

Acute kidney injury in pregnancy and the role of underlying CKD: a point of view from México.

The incidence of acute kidney injury in pregnancy (P-AKI) in developed countries is significantly lower than in developing ones, where it is estimated to range between 4 and 26%. Mortality in cases of P-AKI requiring dialysis is high, varying from 20 to 80%. In developing countries, clinical decisions are often based on the availability of services and not on needs. Prenatal surveillance in Mexico does not include serum creatinine, limiting the potential for early diagnosis of AKI and CKD and their differential diagnosis. There are few specialized centers for the care of a pregnancy complicated with kidney disease in Mexico. P-AKI superimposed on preexistent, and usually undiagnosed CKD, is common: in Guadalajara 10 out of the 27 patients with Stage 3-5 CKD or nephrotic proteinuria, that were followed in 2013-2015, required renal replacement therapy (RRT) in pregnancy; in the same period in Mexico City out of 18 patients with P-AKI requiring dialysis, 5 remained dialysis dependent, 3 started dialysis in the following year after their pregnancy and only 1 fully recovered renal function. The grim prognosis is exacerbated by the fact that 70% of Mexicans are not reimbursed for dialysis, and pregnancy-related coverage lasts for only 42 days after delivery. Perinatal results are no less troubling, as most patients with P-AKI give birth preterm to small or very small babies. While our data do not allow us to evaluate needs, they do make it possible to define the complexity of the problems faced in the care of P-AKI in Mexico. Early diagnosis of P-AKI and chronic kidney disease (CKD) is needed to protect mothers and children and the country urgently needs programs to enable it to fulfil the World Health Organization's imperative that we "make every mother and child count".

Características clínico-epidemiológicas de niños con sobrepeso y obesidad de 2 a 15 años con esteatosis hepática no alcoholica. Instituto Nacional de Salud del Niño. Años 2010-2011 / Characteristics clinical - epidemiologics of children with overweight and obesity from 2 to 15 years with esteatosis hepatic not alcoholic. National institute of Health of the Child. Years 2010-2011

Objetivos: El propósito de este estudio fue describir las características clínicas û epidemiológicas presentes en niños con sobrepeso y obesidad de 2 a 15 años con EHNA atendidos ambulatoriamente a través de la consulta externa del departamento de medicina en el INSN en el periodo 2011. Materiales y métodos: diseño de estudio: Descriptivo retrospectivo. Muestra: Pacientes con sobrepeso y obesidad de 2 a 15 años atendidos ambulatoriamente a través de la consulta externa del departamento de medicina en el INSN en el periodo 2010û 2011. Nuestra fuente de información será la Historia Clínica de los pacientes atendidos ambulatoriamente en el INSN en el periodo 2010û 2011, las cuales se seleccionarán en base a los criterios de inclusión y exclusión. Luego, de ellas se recolectará la información requerida en la matriz de recolección de datos para su posterior análisis. Conclusiones: la prevalencia de esteatosis hepática en pacientes con sobrepeso y obesidad es de 1.9 por ciento para el año 2011. Se estableció relación estadísticamente significativa entre las variables, diagnostico ecográfico y grupo etario

Objectives: The objective of this study is to describe the clinical - epidemiological characteristics expressed in overweight and obese children from 2 to 15 years with NASH, attended as ambulatory outpatients at the Department of Medicine, from the INSN, during 2011. Methods and Materials: Study design: Retrospective Descriptive Sample: Overweight and obese patients from 2 to 15 years who attended as ambulatory outpatients at the Department of Medicine, from the INSN, during 2010 and 2011. Our source of information will be the clinical history record of patients attended at the INSN, during 2010 - 2011, which will be selected using inclusion and exclusion criteria. All data will be thrown into the data collection matrix for further analysis. Conclusions: The prevalence of hepatic steatosis on overweight and obese patients is 1.9 per cent for 2011. Statistically significant relationship was established between the variables, ultrasound diagnosis and age group

Transferring the financial risks of pharmaceutical benefits from a large health care provider in Argentina to a consortium of pharmaceutical companies.

OBJECTIVE: The National Institute of Social Services for Retirees and Pensioners (NISSRP) is a nationwide health care financing agency and service provider in Argentina. Among its services, the NISSRP provides outpatient drug coverage to more than 3.3 million beneficiaries, mainly senior citizens and disabled persons. In 1997, to help cope with its rising costs, the NISSRP agreed to transfer the risk for the cost of outpatient medications and cancer-treatment drugs to a consortium of pharmaceutical companies in exchange for a fixed monthly payment. The objective of this study was to determine the impact that this new approach had on three things: (1) the level of expenditures for the medicines that were included in the agreement, (2) the pattern of nonrational prescribing for NISSRP beneficiaries, and (3) this pattern's relationship with macroeconomic variables and the pattern of prescribing for Argentina as a whole. METHODS: We compared outpatient-medicine consumption in 1999 with consumption before the agreement went into effect. RESULTS: The actual amount that NISSRP beneficiaries spent out-of-pocket climbed from US$ 336.13 million in 1996 to US$ 473.36 million in 1999, an increase of almost 41%. The nominal amount "spent" by the NISSRP in 1999 was US$ 601.11 million, versus a real amount of US$ 374.75 million in 1996, an "increase" of 60% (that increase for the NISSRP was only theoretical since the agreement specified the fixed monthly amount that the NISSRP would have to pay to the pharmaceutical consortium). In contrast with the increased real spending by NISSRP beneficiaries, Argentina's economy remained stable over the assessed period, with the consumer price index even falling by 0.8%. We found high levels of nonrational drug use in the NISSRP system in both 1996 and 1999, indicating a serious ongoing problem. CONCLUSIONS: An agreement with pharmaceutical companies, like the one we have described, might add an element of financial predictability for institutions such as the NISSRP. However, such an agreement can easily result in an increased economic burden for health care beneficiaries, and without any improvement in the services that they receive. This type of agreement requires extensive mechanisms for control, follow-up, and updating, and it also risks making nonrational drug prescribing the accepted rule. While perhaps feasible, the requirements for this kind of agreement are actually very difficult to put into place, requiring additional efforts from institutions such as the NISSRP.

Transferring the financial risks of pharmaceutical benefits from a large health care provider in Argentina to a consortium of pharmaceutical companies

OBJECTIVE: The National Institute of Social Services for Retirees and Pensioners (NISSRP) is a nationwide health care financing agency and service provider in Argentina. Among its services, the NISSRP provides outpatient drug coverage to more than 3.3 million beneficiaries, mainly senior citizens and disabled persons. In 1997, to help cope with its rising costs, the NISSRP agreed to transfer the risk for the cost of outpatient medications and cancer-treatment drugs to a consortium of pharmaceutical companies in exchange for a fixed monthly payment. The objective of this study was to determine the impact that this new approach had on three things: (1) the level of expenditures for the medicines that were included in the agreement, (2) the pattern of nonrational prescribing for NISSRP beneficiaries, and (3) this pattern's relationship with macroeconomic variables and the pattern of prescribing for Argentina as a whole. METHODS: We compared outpatient-medicine consumption in 1999 with consumption before the agreement went into effect. RESULTS: The actual amount that NISSRP beneficiaries spent out-of-pocket climbed from US$ 336.13 million in 1996 to US$ 473.36 million in 1999, an increase of almost 41 percent. The nominal amount "spent" by the NISSRP in 1999 was US$ 601.11 million, versus a real amount of US$ 374.75 million in 1996, an "increase" of 60 percent (that increase for the NISSRP was only theoretical since the agreement specified the fixed monthly amount that the NISSRP would have to pay to the pharmaceutical consortium). In contrast with the increased real spending by NISSRP beneficiaries, Argentina's economy remained stable over the assessed period, with the consumer price index even falling by 0.8 percent. We found high levels of nonrational drug use in the NISSRP system in both 1996 and 1999, indicating a serious ongoing problem. CONCLUSIONS: An agreement with pharmaceutical companies, like the one we have described, might add an element of financial predictability for institutions such as the NISSRP. However, such an agreement can easily result in an increased economic burden for health care beneficiaries, and without any improvement in the services that they receive. This type of agreement requires extensive mechanisms for control, follow-up, and updating, and it also risks making nonrational drug prescribing the accepted rule. While perhaps feasible, the requirements for this kind of agreement are actually very difficult to put into...