Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 6.082
Filtrar
1.
Clin Interv Aging ; 15: 2095-2107, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33204075

RESUMO

Objective: Severe or critical patients with coronavirus disease 2019 (COVID-19) are at increased risk for developing acute kidney injury (AKI). However, the rate of AKI in patients of different severities and independent predictive factors associated with AKI are not well understood. Patients and Methods: We enrolled 107 severely or critically ill elderly patients with COVID-19 who were admitted to the intensive care unit (ICU) in Wuhan, China. AKI was defined according to the 2012 KDIGO criteria. We explored the association between AKI and in-hospital mortality using logistic regression. A predictive nomogram was formulated to predict the AKI development of patients with COVID-19 based on multivariate logistic regression. Results: A total of 107 elderly patients were enrolled during the study period. The mean age was 70 (64-78) years, and 69 (64.5%) were men. For the 107 patients, the degree of severity of COVID-19 was categorized as 37 patients with the severe type (34.6%) and 70 patients with the critical type (65.4%). Overall, 48 of the 107 patients (44.9%) developed AKI during their hospitalization, while AKI occurred in 7 (18.9%) out of the 37 severe patients and 41 (44.9%) out of the 70 critical patients. Of the AKI patients, 35.4% (17/48) required continuous renal replacement therapy, including 14.3% of AKI patients in severe cases and 39.0% of AKI patients in critical cases. Kaplan-Meier analysis demonstrated that patients with AKI had a significantly higher risk for in-hospital mortality than severely and critically ill patients without AKI. Multivariate logistic regression analysis showed that AKI (OR = 33.74; 95% CI = 3.34-341.29; P = 0.003), septic shock (OR = 15.58; 95% CI = 2.08-116.78; P = 0.008), invasive mechanical ventilation (OR = 18.44; 95% CI = 2.35-144.69; P = 0.006), and oxygenation index (OR = 0.99; 95% CI = 0.98-1.000; P = 0.014) were independent risk factors for in-hospital mortality. A nomogram was established based on the multivariate analysis results. The C-index for the developed AKI model was 0.935 (95% CI, 0.892-0.978); when 10-fold cross validation was used to validate the model, the corrected C-index was 0.825. Conclusion: AKI is common among COVID-19 patients admitted to the ICU and is recognized as a marker of disease severity. The proposed nomogram accurately predicted AKI development in ICU patients with COVID-19 based on individual characteristics. Therefore, the strategy for kidney protection against severe or critical pneumonia is appropriate.


Assuntos
Lesão Renal Aguda , Infecções por Coronavirus , Mortalidade Hospitalar , Pandemias , Pneumonia Viral , Lesão Renal Aguda/diagnóstico , Lesão Renal Aguda/epidemiologia , Lesão Renal Aguda/etiologia , Idoso , Betacoronavirus/isolamento & purificação , China/epidemiologia , Infecções por Coronavirus/complicações , Infecções por Coronavirus/mortalidade , Estado Terminal/mortalidade , Feminino , Humanos , Unidades de Terapia Intensiva/estatística & dados numéricos , Masculino , Nomogramas , Pneumonia Viral/complicações , Pneumonia Viral/mortalidade , Prognóstico , Estudos Retrospectivos , Fatores de Risco , Índice de Gravidade de Doença
2.
BMC Pulm Med ; 20(1): 290, 2020 Nov 09.
Artigo em Inglês | MEDLINE | ID: mdl-33167955

RESUMO

BACKGROUND: The clinical correlates, prognosis and determinants of acute kidney injury (AKI) in patients with coronavirus disease 2019 (Covid-19) remain largely unclear. METHODS: We retrospectively reviewed medical records of all adult patients with laboratory-confirmed Covid-19 who were admitted to the intensive care unit (ICU) between January 23rd 2020 and April 6th 2020 at Wuhan JinYinTan Hospital and The First Affiliated Hospital of Guangzhou Medical University. RESULTS: Among 210 patients, 131 were males (62.4%). The median Age was 64 years (IQR: 56-71). Of 92 (43.8%) patients who developed AKI during hospitalization, 13 (14.1%), 15 (16.3%) and 64 (69.6%) were classified as being at stage 1, 2 and 3, respectively. 54 patients (58.7%) received continuous renal replacement therapy. Age, sepsis, nephrotoxic drug, invasive mechanical ventilation and elevated baseline serum creatinine levels were associated with the occurrence of AKI. Renal recovery during hospitalization was identified among 16 patients with AKI (17.4%), who had a significantly shorter time from admission to AKI diagnosis, lower incidence of right heart failure and higher ratio of partial pressure of oxygen to the fraction of inspired oxygen. Of 210 patients, 93 deceased within 28 days of ICU admission. AKI stage 3, critical disease, greater Age and the lowest ratio of partial pressure of oxygen to the fraction of inspired oxygen being < 150 mmHg were independently associated with death. CONCLUSIONS: Among patients with Covid-19, the incidence of AKI was high. Our findings of the risk factors of the development of AKI and factors associated with renal function recovery may inform clinical management of patients with critical illness of Covid-19.


Assuntos
Lesão Renal Aguda/virologia , Betacoronavirus , Infecções por Coronavirus/complicações , Pneumonia Viral/complicações , Lesão Renal Aguda/diagnóstico , Lesão Renal Aguda/epidemiologia , Adulto , Idoso , Idoso de 80 Anos ou mais , China , Estado Terminal , Feminino , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Pandemias , Prognóstico , Estudos Retrospectivos , Fatores de Risco
3.
Pol Merkur Lekarski ; 48(287): 307-311, 2020 Oct 23.
Artigo em Inglês | MEDLINE | ID: mdl-33130788

RESUMO

AIM: The aim of the study was to assess clinical profile of neonates with hypernatremic dehydration (HD) and identify risk factors associated with acute kidney injury (AKI). MATERIALS AND METHODS: A retrospective study included 18 neonates with HD (serum Na ≥150 mmol/L) hospitalized in the Department of Pediatrics and Nephrology between the years 2009-2019. RESULTS: The age at presentation was 7.5±4.7 days (range 2-18), weight loss was 15.9±8.3% (range 7.1-32.6) and serum Na range was 151- 192 mmol/L (median 155.5 mmol/L). In 12 (67%) neonates, breast or mixed fed, HD occurred due to inadequate milk intake, in 6 (33%) neonates feeding difficulties were secondary to an acute infection. There was positive correlation between serum Na level and percentage weight loss at presentation (r=0.88; p<0.001). In 6 (33%) patients serious complications of HD were found: AKI in 5 patients, convulsions in one. Percentage weight loss was significantly higher in neonates with HD-associated AKI than in neonates with HD without AKI (p<0.01). Serum Na level was marginally higher in neonates with AKI than in those without AKI (p=0.08). In univariate logistic regression analysis, higher percentage of weight loss and higher serum Na level at presentation were important diagnostic factors of AKI in neonates with HD (both p<0.05). ROC analysis determined good diagnostic profile only for percentage weight loss, with a best cut-off value of 24.8%, for predicting AKI in neonates with HD (AUC 0.862, sensitivity 80%, specificity 100%). CONCLUSIONS: Neonatal HD mostly occurs due to inadequate milk intake in breast or mixed fed babies, and rarely due to feeding difficulties in babies affected by an acute infection. Percentage weight loss at presentation has strong association with neonatal HD and is the most important factor of AKI in neonates with HD.


Assuntos
Lesão Renal Aguda , Hipernatremia , Nefrologia , Lesão Renal Aguda/diagnóstico , Lesão Renal Aguda/epidemiologia , Lesão Renal Aguda/etiologia , Aleitamento Materno , Criança , Desidratação , Feminino , Humanos , Hipernatremia/complicações , Hipernatremia/epidemiologia , Lactente , Recém-Nascido , Estudos Retrospectivos
6.
Am J Nephrol ; 51(10): 786-796, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33011717

RESUMO

BACKGROUND: Although diffuse alveolar damage and respiratory failure are the key features of coronavirus disease 2019 (COVID-19), the involvement of other organs such as the kidney has also been reported. The reports of the incidence of acute kidney injury (AKI) in COVID-19 patients vary widely. In this study, we report our unique experience with AKI in COVID-19 patients in a low socioeconomic and predominantly ethnic minority group and provide its incidence, risk factors, and prognosis to expand the current understanding of this complication. METHODS: In this single-center, retrospective cohort study, we analyzed the data of 469 COVID-19 patients admitted to the Brookdale University Hospital in Brooklyn, NY, from March 18 through April 23, 2020. Information regarding demographics, comorbidities, medications, clinical and laboratory data, and outcomes was collected from the electronic medical records. Both univariate and multivariate analyses were performed to determine the association of AKI with in-hospital mortality. RESULTS: The median age was 66 years (interquartile range [IQR] 25-75; range 19-101 years), and 268 (57.14%) patients were male. Estimated glomerular filtration rate (eGFR) as determined by the Modification of Diet in Renal Disease Study Equation was low (<60 mL/min/1.73 m2) in 207 (44.1%) patients. During hospitalization, 128 (27.3%) patients developed AKI, and the incidence was significantly higher in those patients presenting with a low eGFR (N = 81, 39.1%; p < 0.001). Male sex, hypertension, the use of angiotensin-converting enzyme inhibitors and non-steroidal anti-inflammatories, hemodynamic instability, mechanical ventilation, acute respiratory distress syndrome, and admission elevated ferritin, creatinine kinase, brain natriuretic peptide, and troponin 1 were identified as the risk factors for in-hospital AKI. Ninety-seven (28.45%) patients died in the non-AKI group versus 91 (71.1%) in the AKI group (p < 0.001). The Cox proportional hazard model after adjusting for age, gender, comorbidities, hemodynamic status, and PF ratio (arterial oxygen partial pressure [PaO2]/fractional inspired oxygen [FiO2]) determined that on admission, an elevated blood urea nitrogen (hazard ratio [HR]: 1.75; 95% confidence interval [CI] 1.23-2.48), a low eGFR (HR 1.43; CI 1.1-2.03), AKI stage 1 (HR 1.14; CI 0.64-2.03), AKI stage 2 (HR 1.86; CI 1.03-3.56), and AKI stage 3 (HR 2.1; CI 1.3-2.81) were independent risk factors for in-hospital mortality. Renal replacement therapy (RRT) did not improve survival in stage III AKI. CONCLUSION: AKI in our hospitalized COVID-19 patients was common and carried a high mortality, especially in patients with AKI stage 3. RRT did not improve survival. Policy changes and planning for this high incidence of AKI in COVID-19 patients and its associated high mortality are necessary at the local and national levels.


Assuntos
Lesão Renal Aguda/mortalidade , Betacoronavirus/patogenicidade , Infecções por Coronavirus/complicações , Hospitais Urbanos/organização & administração , Pneumonia Viral/complicações , Políticas , Lesão Renal Aguda/diagnóstico , Lesão Renal Aguda/terapia , Lesão Renal Aguda/virologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Betacoronavirus/isolamento & purificação , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/virologia , Grupos Étnicos/estatística & dados numéricos , Feminino , Mortalidade Hospitalar , Hospitais Urbanos/estatística & dados numéricos , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Grupos Minoritários/estatística & dados numéricos , Cidade de Nova Iorque/epidemiologia , Pandemias , Pneumonia Viral/epidemiologia , Pneumonia Viral/virologia , Prognóstico , Terapia de Substituição Renal/estatística & dados numéricos , Estudos Retrospectivos , Fatores de Risco , Fatores Socioeconômicos , Análise de Sobrevida , Resultado do Tratamento , Adulto Jovem
7.
J Investig Med High Impact Case Rep ; 8: 2324709620963635, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33019829

RESUMO

As COVID-19 (coronavirus disease 2019) spreads across the world multiple therapeutic interventions have been tried to reduce morbidity and mortality. We describe a case of collapsing focal sclerosing glomerulosclerosis (FSGS) and acute oxalate nephropathy in a patient treated with high-dose intravenous vitamin C for severe COVID-19 infection. Collapsing FSGS has been described in patients with COVID-19 infection associated with APOL-1; however, this case had collapsing FSGS developing in low-risk heterozygous APOL-1 variant, and we postulate that the intensity of the COVID-19 cytokine storm overwhelmed the protective state of APOL-1 heterozygosity. This case illustrates the importance of assessing the risk and benefit of planned therapeutic interventions on a case-by-case basis especially when there are still so many unknowns in the management of COVID-19 infection. Strong consideration should be given for performing a renal biopsy in patients who develop multifactorial acute kidney injury.


Assuntos
Ácido Ascórbico/efeitos adversos , Betacoronavirus , Infecções por Coronavirus/tratamento farmacológico , Glomerulosclerose Segmentar e Focal/induzido quimicamente , Hiperoxalúria/induzido quimicamente , Glomérulos Renais/patologia , Oxalatos/metabolismo , Pneumonia Viral/tratamento farmacológico , Doença Aguda , Lesão Renal Aguda/diagnóstico , Lesão Renal Aguda/etiologia , Ácido Ascórbico/administração & dosagem , Biópsia , Infecções por Coronavirus/epidemiologia , Progressão da Doença , Glomerulosclerose Segmentar e Focal/diagnóstico , Humanos , Hiperoxalúria/diagnóstico , Hiperoxalúria/metabolismo , Injeções Intravenosas , Masculino , Pessoa de Meia-Idade , Pandemias , Pneumonia Viral/epidemiologia , Vitaminas/administração & dosagem , Vitaminas/efeitos adversos
8.
Annu Int Conf IEEE Eng Med Biol Soc ; 2020: 5606-5609, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-33019248

RESUMO

Acute Kidney Injury (AKI) is a common complication after surgery. Recognition of patients at risk of AKI at an earlier stage is a priority for researchers and health care providers. The objective of this study is to develop machine learning prediction models of acute kidney injury (AKI) in patients who undergo surgery. The dataset used in this study consists of in-hospital patients' data of five different cohorts coming from different major procedure types. This data was collected from the SunRiseClinical Manager (SCM) electronic medical records system that is used in the Calgary Zone, Alberta, Canada from 2008 to 2015 where the patients are >=18 years of age. Five classifiers were experimented with: support vector machine, random forest, logistic regression, k-nearest neighbors, and adaptive boosting. The area under the receiver operating characteristics curve (AUROC) ranged between 0.62-0.84 and sensitivity and specificity ranged between 0.81-0.83 and 0.43-0.85, respectively. Predictions from these models can facilitate early intervention in AKI treatment.


Assuntos
Lesão Renal Aguda , Lesão Renal Aguda/diagnóstico , Alberta , Área Sob a Curva , Humanos , Aprendizado de Máquina , Curva ROC
9.
Ther Umsch ; 77(8): 401-405, 2020.
Artigo em Alemão | MEDLINE | ID: mdl-33054652

RESUMO

Incidental finding of a high creatinine Abstract. In up to 10 % of patient visiting their General Practitioner and having blood tests an elevated creatinine or reduced kidney function are detected incidentally by the often automatically reported estimation of glomerular filtration rate (eGFR) by a creatinine-based formula. The most important step in this situation is to evaluate whether reduced kidney function is due to chronic kidney disease or whether the patient presents with an acute kidney injury (AKI). Early detection of AKI is crucial as any delay in accurate therapy can lead to further decline of kidney function and elevated mortality. In addition, intrinsic kidney diseases, which are less common should not be missed because early access to specialised management is crucial. Clinical history including history of medication, context of consultation, clinical evaluation and additional laboratory values will help to provide a first suspicion diagnosis. Further investigations (abdominal sonography, urinary sediment, proteinuria) will help to confirm the diagnosis. In any case of absence of an obvious cause of AKI, young patient, threatening severe renal insufficiency with rapid progression of kidney failure or suspicious laboratory abnormalities, the patient should be referred without any delay to a nephrologist for further evaluation and management.


Assuntos
Lesão Renal Aguda , Insuficiência Renal Crônica , Lesão Renal Aguda/diagnóstico , Creatinina , Taxa de Filtração Glomerular , Humanos , Achados Incidentais
10.
Perit Dial Int ; 40(5): 496-498, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32998645

RESUMO

Coronavirus Disease 2019 (COVID-19) is a pandemic disease that increased the burden on health-care system. In the Kingdom of Saudi Arabia, 74,795 cases have been reported until 26 May 2020 and the number of cases is rapidly increasing. The mortality rate of COVID-19 worldwide is 6.37%. Here we report three cases of acute kidney injury (AKI) secondary to pneumonia of severe COVID-19; they were treated with automated peritoneal dialysis (PD) with full recovery. To the best of our knowledge, few reports in the literature have discussed the use of PD in AKI secondary to COVID-19.


Assuntos
Lesão Renal Aguda/epidemiologia , Lesão Renal Aguda/terapia , Infecções por Coronavirus/epidemiologia , Pandemias/estatística & dados numéricos , Diálise Peritoneal/métodos , Pneumonia Viral/epidemiologia , Lesão Renal Aguda/diagnóstico , Idoso , Infecções por Coronavirus/diagnóstico , Feminino , Humanos , Testes de Função Renal , Masculino , Pessoa de Meia-Idade , Pandemias/prevenção & controle , Pneumonia Viral/diagnóstico , Amostragem , Arábia Saudita , Resultado do Tratamento
11.
Clin J Am Soc Nephrol ; 15(10): 1394-1402, 2020 10 07.
Artigo em Inglês | MEDLINE | ID: mdl-32963018

RESUMO

BACKGROUND AND OBJECTIVES: Since December 2019, coronavirus disease 2019 (COVID-19) outbreak occurred and has rapidly spread worldwide. However, little information is available about the AKI in COVID-19. We aimed to evaluate the incidence, risk factors, and prognosis of AKI in adult patients with COVID-19. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: This was a retrospective cohort study of 1392 patients with COVID-19 admitted to a tertiary teaching hospital. Clinical characteristics and laboratory data were extracted from electronic hospitalization and laboratory databases. AKI was defined and staged according to the 2012 Kidney Disease: Improving Global Outcomes criteria. Risk factors for AKI and the association of AKI with in-hospital mortality were assessed. RESULTS: A total of 7% (99 of 1392) of patients developed AKI during hospitalization, 40% (40 of 99) of which occurred within 1 week of admission. Factors associated with a higher risk of AKI include severe disease (odds ratio [OR], 2.25; 95% confidence interval [CI], 1.37 to 3.67), higher baseline serum creatinine (OR, 2.19; 95% CI, 1.17 to 4.11), lymphopenia (OR, 1.99; 95% CI, 1.12 to 3.53), and elevated D-dimer level (OR, 2.68; 95% CI, 1.07 to 6.70). The in-hospital mortality in patients with AKI stage 1, stage 2, and stage 3 was 62%, 77%, and 80%, respectively. AKI was associated with in-hospital mortality even after adjustment for confounders (OR, 5.12; 95% CI, 2.70 to 9.72). CONCLUSIONS: AKI is uncommon but carries high in-hospital mortality in patients with COVID-19.


Assuntos
Lesão Renal Aguda/mortalidade , Betacoronavirus/patogenicidade , Infecções por Coronavirus/mortalidade , Mortalidade Hospitalar , Pneumonia Viral/mortalidade , Lesão Renal Aguda/diagnóstico , Lesão Renal Aguda/terapia , Lesão Renal Aguda/virologia , Idoso , China , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/terapia , Infecções por Coronavirus/virologia , Feminino , Interações Hospedeiro-Patógeno , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Pandemias , Pneumonia Viral/diagnóstico , Pneumonia Viral/terapia , Pneumonia Viral/virologia , Prognóstico , Estudos Retrospectivos , Fatores de Risco , Fatores de Tempo
13.
Vnitr Lek ; 66(3): 71-75, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32972169

RESUMO

Hepatorenal syndrome (HRS) is a serious complication in patients with advanced liver cirrhosis and ascites occurring simultaneously. According to current diagnostic criteria it is considered as one of the less common forms of acute kidney injury (AKI), referred to as HRS-AKI. As a result of the revision of the diagnostic criteria, there was a significant shift in the diagnosis of AKI in patients with liver cirrhosis, allowing early initiation of adequate measures and appropriate treatment. The following article describes the issue of AKI in liver cirrhosis in a wider context, the diagnostic criteria and algorithm of HRS-AKI treatment.


Assuntos
Lesão Renal Aguda , Síndrome Hepatorrenal , Transplante de Fígado , Lesão Renal Aguda/diagnóstico , Lesão Renal Aguda/etiologia , Ascite , Síndrome Hepatorrenal/diagnóstico , Síndrome Hepatorrenal/etiologia , Síndrome Hepatorrenal/terapia , Humanos , Cirrose Hepática/complicações
14.
BMJ Case Rep ; 13(9)2020 Sep 02.
Artigo em Inglês | MEDLINE | ID: mdl-32878841

RESUMO

We report the case of a 38-year-old man who presented to the emergency department with fever, myalgia, nausea, vomiting, dry cough, breathlessness and abdominal pain. He was admitted due to hypoxaemia and was diagnosed with SARS-CoV-2 and was subsequently referred to the intensive care unit for intubation and mechanical ventilation. Severe rhabdomyolysis and acute kidney injury developed 4 days later and were suspected after noticing discolouration of the urine and a marked increase in plasma myoglobin levels. Treatment included hydration, forced diuresis and continuous renal replacement therapy. In addition to the coronavirus disease acute respiratory distress syndrome, he was diagnosed with possible SARS-CoV-2-induced myositis with severe rhabdomyolysis and kidney failure. The patient survived and was discharged from intensive care after 12 days, returning home 23 days after hospitalisation, fully mobilised with a partially restored kidney function.


Assuntos
Lesão Renal Aguda/diagnóstico , Betacoronavirus/isolamento & purificação , Infecções por Coronavirus/diagnóstico , Pneumonia Viral/diagnóstico , Rabdomiólise/diagnóstico , Doença Aguda , Lesão Renal Aguda/etiologia , Lesão Renal Aguda/terapia , Adulto , Antibacterianos/uso terapêutico , Infecções por Coronavirus/complicações , Infecções por Coronavirus/terapia , Humanos , Masculino , Pandemias , Pneumonia Viral/complicações , Pneumonia Viral/terapia , Terapia de Substituição Renal/métodos , Rabdomiólise/etiologia , Rabdomiólise/terapia , Resultado do Tratamento
15.
PLoS One ; 15(9): e0238680, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32881976

RESUMO

BACKGROUND: Recent data have suggested the presence of a reciprocal relationship between COVID-19 and kidney function. To date, most studies have focused on the effect of COVID-19 on kidney function, whereas data regarding kidney function on the COVID-19 prognosis is scarce. Therefore, in this study, we aimed to investigate the association between eGFR on admission and the mortality rate of COVID-19. METHODS: We recruited 336 adult consecutive patients (male: 57.1%, mean age: 55.0±16.0 years) that were hospitalized with the diagnosis of COVID-19 in a tertiary care university hospital. Data were collected from the electronic health records of the hospital. On admission, eGFR was calculated using the CKD-EPI formula. Acute kidney injury was defined according to the KDIGO criteria. Binary logistic regression and Cox regression analyses were used to assess the relationship between eGFR on admission and in-hospital mortality of COVID-19. RESULTS: Baseline eGFR was under 60 mL/min/1.73m2 in 61 patients (18.2%). Acute kidney injury occurred in 29.2% of the patients. In-hospital mortality rate was calculated as 12.8%. Age-adjusted and multivariate logistic regression analysis (p: 0.005, odds ratio: 0.974, CI: 0.956-0.992) showed that baseline eGFR was independently associated with mortality. Additionally, age-adjusted Cox regression analysis revealed a higher mortality rate in patients with an eGFR under 60 mL/min/1.73m2. CONCLUSIONS: On admission eGFR seems to be a prognostic marker for mortality in patients with COVID-19. We recommend that eGFR be measured in all patients on admission and used as an additional tool for risk stratification. Close follow-up should be warranted in patients with a reduced eGFR.


Assuntos
Lesão Renal Aguda/epidemiologia , Infecções por Coronavirus/mortalidade , Mortalidade Hospitalar , Pneumonia Viral/mortalidade , Lesão Renal Aguda/diagnóstico , Adulto , Idoso , Comorbidade , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/epidemiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Pandemias , Pneumonia Viral/diagnóstico , Pneumonia Viral/epidemiologia , Prognóstico
16.
Medicine (Baltimore) ; 99(37): e21386, 2020 Sep 11.
Artigo em Inglês | MEDLINE | ID: mdl-32925711

RESUMO

Serum creatinine (SCr) and estimated glomerular filtration rate (eGFR) are standard biomarkers of contrast-induced nephropathy (CIN). However, recent studies suggest that serum neutrophil gelatinase-associated lipocalin (sNGAL) and urine neutrophil gelatinase-associated lipocalin (uNGAL) may be better predictors, particularly within 24 hours of contrast medium exposure.We conducted a prospective, observational cohort study of 107 consecutive patients diagnosed with arteriosclerosis obliterans between February 2016 and October 2018. We divided the patients into 2 groups: CIN (n = 22) and non-CIN (n = 85). We assessed the correlation between sNGAL and uNGAL concentrations and standard renal markers at baseline, 6, 24, and 48 hours post-procedure. We constructed conventional receiver operating characteristic (ROC) curves and calculated the area under the curve to assess the performance of SCr, eGFR, sNGAL, and uNGAL. We derived biomarker cutoff levels from ROC analysis to maximize sensitivity and specificity.The incidence of CIN within our cohort was 20.6%. sNGAL levels correlated significantly with SCr and eGFR at baseline, 6, 24, and 48 hours post-contrast medium exposure. Similarly, uNGAL levels correlated with SCr and eGFR at baseline, 24, and 48 hours post-exposure. sNGAL and uNGAL were significantly elevated as early as 6 hours post-catheterization in the CIN group, whereas only minor changes were observed in the non-CIN group. SCr was also significantly elevated in the CIN group, but not until 24 hours post-catheterization.Both sNGAL and uNGAL may be superior to SCr and eGFR as early biomarkers of CIN in patients with peripheral vascular disease undergoing endovascular therapy.


Assuntos
Lesão Renal Aguda/diagnóstico , Meios de Contraste/efeitos adversos , Procedimentos Endovasculares/efeitos adversos , Lipocalina-2/análise , Complicações Pós-Operatórias/diagnóstico , Lesão Renal Aguda/induzido quimicamente , Idoso , Área Sob a Curva , Arteriosclerose Obliterante/cirurgia , Biomarcadores/sangue , Biomarcadores/urina , Feminino , Humanos , Masculino , Complicações Pós-Operatórias/induzido quimicamente , Estudos Prospectivos , Curva ROC , Sensibilidade e Especificidade
20.
Arq Bras Cardiol ; 115(1): 127-133, 2020 07.
Artigo em Inglês, Português | MEDLINE | ID: mdl-32813824

RESUMO

The absence of a consensus about the diagnostic criteria for acute cardiorenal syndrome (ACRS) affects its prognosis. This study aimed at assessing the diagnostic criteria for ACRS and their impact on prognosis. A systematic review was conducted using PRISMA methodology and PICO criteria in the MEDLINE, EMBASE and LILACS databases. The search included original publications, such as clinical trials, cohort studies, case-control studies, and meta-analyses, issued from January 1998 to June 2018. Neither literature nor heart failure guidelines provided a clear definition of the diagnostic criteria for ACRS. The serum creatinine increase by at least 0.3 mg/dL from baseline creatinine is the most used diagnostic criterion. However, the definition of baseline creatinine, as well as which serum creatinine should be used as reference for critical patients, is still controversial. This systematic review suggests that ACRS criteria should be revised to include the diagnosis of ACRS on hospital admission. Reference serum creatinine should reflect baseline renal function before the beginning of acute kidney injury.


Assuntos
Lesão Renal Aguda , Síndrome Cardiorrenal , Insuficiência Cardíaca , Lesão Renal Aguda/diagnóstico , Síndrome Cardiorrenal/diagnóstico , Creatinina , Insuficiência Cardíaca/diagnóstico , Humanos , Prognóstico
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA