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1.
Br J Hosp Med (Lond) ; 81(10): 1-8, 2020 Oct 02.
Artigo em Inglês | MEDLINE | ID: mdl-33135911

RESUMO

Despite initial reports, renal involvement, including acute kidney injury, has emerged as a serious complication of COVID-19 disease, particularly in critically ill patients. The reported prevalence varies considerably, which may reflect reporting practices, although differences in pre-existing comorbidities and socioeconomic factors, and differences between ethnic groups, almost certainly contribute. Renal involvement may present as an active urinary sediment or as changes in serum creatinine levels and urine output leading to acute kidney injury. In common with acute kidney injury complicating critical illness, the cause is often multifactorial and often presents as part of a multiorgan dysfunction syndrome. Treatment is, in the main, supportive, with kidney replacement therapy required in nearly 25% of reported cases. Few data currently exist as to the long-term burden of COVID-19-associated acute kidney injury but evidence suggests that only approximately one-third of patients are discharged with recovered renal function.


Assuntos
Lesão Renal Aguda , Infecções por Coronavirus/complicações , Administração dos Cuidados ao Paciente/métodos , Pneumonia Viral/complicações , Lesão Renal Aguda/epidemiologia , Lesão Renal Aguda/etiologia , Lesão Renal Aguda/terapia , Betacoronavirus , Infecções por Coronavirus/fisiopatologia , Infecções por Coronavirus/terapia , Estado Terminal/terapia , Humanos , Testes de Função Renal , Pandemias , Pneumonia Viral/fisiopatologia , Pneumonia Viral/terapia , Terapia de Substituição Renal/métodos , Fatores de Risco
2.
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
3.
World J Gastroenterol ; 26(39): 6087-6097, 2020 Oct 21.
Artigo em Inglês | MEDLINE | ID: mdl-33132657

RESUMO

BACKGROUND: The coronavirus disease 2019 (COVID-19) is spreading rapidly around the world. Most critically ill patients have organ injury, including acute respiratory distress syndrome, acute kidney injury, cardiac injury, or liver dysfunction. However, few studies on acute gastrointestinal injury (AGI) have been reported in critically ill patients with COVID-19. AIM: To investigate the prevalence and outcomes of AGI in critically ill patients with COVID-19. METHODS: In this retrospective study, demographic data, laboratory parameters, AGI grades, clinical severity and outcomes were collected. The primary endpoints were AGI incidence and 28-d mortality. RESULTS: From February 10 to March 10 2020, 83 critically ill patients out of 1314 patients with COVID-19 were enrolled. Seventy-two (86.7%) patients had AGI during hospital stay, of these patients, 30 had AGI grade I, 35 had AGI grade II, 5 had AGI grade III, and 2 had AGI grade IV. The incidence of AGI grade II and above was 50.6%. Forty (48.2%) patients died within 28 days of admission. Multiple organ dysfunction syndrome developed in 58 (69.9%) patients, and septic shock in 16 (19.3%) patients. Patients with worse AGI grades had worse clinical variables, a higher incidence of septic shock and 28-d mortality. Sequential organ failure assessment (SOFA) scores (95%CI: 1.374-2.860; P < 0.001), white blood cell (WBC) counts (95%CI: 1.037-1.379; P = 0.014), and duration of mechanical ventilation (MV) (95%CI: 1.020-1.340; P = 0.025) were risk factors for the development of AGI grade II and above. CONCLUSION: The incidence of AGI was 86.7%, and hospital mortality was 48.2% in critically ill patients with COVID-19. SOFA scores, WBC counts, and duration of MV were risk factors for the development of AGI grade II and above. Patients with worse AGI grades had a higher incidence of septic shock and 28-d mortality.


Assuntos
Infecções por Coronavirus/fisiopatologia , Gastroenteropatias/fisiopatologia , Mortalidade Hospitalar , Pneumonia Viral/fisiopatologia , Lesão Renal Aguda/epidemiologia , Idoso , Betacoronavirus , China/epidemiologia , Infecções por Coronavirus/epidemiologia , Estado Terminal , Feminino , Gastroenteropatias/epidemiologia , Humanos , Incidência , Contagem de Leucócitos , Hepatopatias/epidemiologia , Masculino , Pessoa de Meia-Idade , Mortalidade , Insuficiência de Múltiplos Órgãos/epidemiologia , Escores de Disfunção Orgânica , Pandemias , Pneumonia Viral/epidemiologia , Prevalência , Respiração Artificial/estatística & dados numéricos , Síndrome do Desconforto Respiratório do Adulto/epidemiologia , Estudos Retrospectivos , Fatores de Risco , Índice de Gravidade de Doença , Choque Séptico/epidemiologia
4.
PLoS One ; 15(11): e0241544, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33141867

RESUMO

INTRODUCTION: COVID-19 has spread globally to now be considered a pandemic by the World Health Organisation. Initially patients appeared to have a respiratory limited disease but there are now increasing reports of multiple organ involvement including renal disease in association with COVID-19. We studied the development and outcomes of acute kidney injury (AKI) in patients with COVID-19, in a large multicultural city hospital trust in the UK, to better understand the role renal disease has in the disease process. METHODS: This was a retrospective review using electronic records and laboratory data of adult patients admitted to the four Manchester University Foundation Trust Hospitals between March 10 and April 30 2020 with a diagnosis of COVID-19. Records were reviewed for baseline characteristics, medications, comorbidities, social deprivation index, observations, biochemistry and outcomes including mortality, admission to critical care, mechanical ventilation and the need for renal replacement therapy. RESULTS: There were 1032 patients included in the study of whom 210 (20.3%) had AKI in association with the diagnosis of COVID-19. The overall mortality with AKI was considerably higher at 52.4% compared to 26.3% without AKI (p-value <0.001). More patients with AKI required escalation to critical care (34.8% vs 11.2%, p-value <0.001). Following admission to critical care those with AKI were more likely to die (54.8% vs 25.0%, p-value <0.001) and more likely to require mechanical ventilation (86.3% vs 66.3%, p-value 0.006). DISCUSSION: We have shown that the development of AKI is associated with dramatically worse outcomes for patients, in both mortality and the requirement for critical care. Patients with COVID-19 presenting with, or at risk of AKI should be closely monitored and appropriately managed to prevent any decline in renal function, given the significant risk of deterioration and death.


Assuntos
Lesão Renal Aguda/epidemiologia , Lesão Renal Aguda/etiologia , Infecções por Coronavirus/complicações , Infecções por Coronavirus/epidemiologia , Pandemias , Pneumonia Viral/complicações , Pneumonia Viral/epidemiologia , Lesão Renal Aguda/mortalidade , Lesão Renal Aguda/virologia , Idoso , Idoso de 80 Anos ou mais , Infecções por Coronavirus/mortalidade , Infecções por Coronavirus/virologia , Feminino , Mortalidade Hospitalar , Hospitalização , Hospitais Urbanos , Humanos , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Pneumonia Viral/mortalidade , Pneumonia Viral/virologia , Respiração Artificial/métodos , Estudos Retrospectivos , Reino Unido/epidemiologia
5.
PLoS One ; 15(11): e0241953, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33196669

RESUMO

BACKGROUND: The novel coronavirus is pandemic around the world. Several researchers have given the evidence of impacts of COVID-19 on the respiratory, cardiovascular and gastrointestinal system. Studies still have debated on kidney injury of COVID-19 patients. The purpose of the meta-analysis was to evaluate the association of kidney impairment with the development of COVID-19. METHODS: The PubMed, Embase and MedRxiv databases were searched until May 1, 2020. We extracted data from eligible studies to summarize the clinical manifestations and laboratory indexes of kidney injury on COVID-19 infection patients and further compared the prevalence of acute kidney injury (AKI) and the mean differences of three biomarkers between in ICU/severe and non-ICU/non-severe cases. Heterogeneity was evaluated using the I2 method. RESULTS: In the sum of 24 studies with 10180 patients were included in this analysis. The pooled prevalence of AKI, increased serum creatinine (Scr), increased blood urea nitrogen (BUN), increased D-dimer, proteinuria and hematuria in patients with COVID-19 were 16.2%, 8.3%, 6.2%, 49.8%, 50.1% and 30.3% respectively. Moreover, the means of Scr, BUN and D-dimer were shown 6.4-folds, 1.8-folds and 0.67-folds, respectively, higher in ICU/severe cases than in corresponding non-ICU/non-severe patients. The prevalence of AKI was about 30 folds higher in ICU/severe patients compared with the non-ICU/non-severe cases. CONCLUSIONS: Overall, we assessed the incidences of the clinic and laboratory features of kidney injury in COVID-19 patients. And kidney dysfunction may be a risk factor for COVID-19 patients developing into the severe condition. In reverse, COVID-19 can also cause damage to the kidney.


Assuntos
Lesão Renal Aguda/epidemiologia , Infecções por Coronavirus/epidemiologia , Pneumonia Viral/epidemiologia , Betacoronavirus , Humanos , Incidência , Unidades de Terapia Intensiva , Pandemias , Fatores de Risco
6.
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
7.
Kyobu Geka ; 73(11): 895-900, 2020 Oct.
Artigo em Japonês | MEDLINE | ID: mdl-33130709

RESUMO

OBJECTIVE: We aimed to determine the incidence and risk of acute kidney injury (AKI) in patients after cardiac surgery, and to assess the effects of less invasive cardiac surgery on the prevention of postoperative AKI. METHODS: We retrospectively analyzed perioperative parameters in patients who underwent cardiac surgery. Risk factors for AKI were determined using univariate and multiple logistic regression models. The incidence of postoperative AKI was also compared between conventional and minimally invasive cardiac surgeries. RESULTS: Among 126 patients, 36 (28.6%) who developed postoperative AKI stayed significantly longer in the intensive care unit(ICU), required prolonged postoperative ventilation and had a higher frequency of renal replacement therapy. Multivariate analysis revealed cardio-pulmonary bypass (CPB) duration and red blood cell transfusion as independent risk factors for postoperative AKI. The incidence of postoperative AKI was significantly lower after off-pump coronary artery bypass grafting than conventional coronary artery bypass grafting (CABG)(0% versus 11%, p=0.025), and after minimally invasive cardiac surgery compared with conventional valve surgery( 4% versus 44%, p=0.01) Conclusion:The duration of CPB and red blood cell transfusion were considered independent factors for the development of postoperative AKI. Less invasive cardiac surgeries might protect against postoperative AKI.


Assuntos
Lesão Renal Aguda , Ponte de Artéria Coronária sem Circulação Extracorpórea , Lesão Renal Aguda/epidemiologia , Lesão Renal Aguda/etiologia , Lesão Renal Aguda/prevenção & controle , Humanos , Incidência , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/prevenção & controle , Terapia de Substituição Renal , Estudos Retrospectivos , Fatores de Risco
8.
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
9.
BMJ Open ; 10(11): e042573, 2020 11 10.
Artigo em Inglês | MEDLINE | ID: mdl-33172950

RESUMO

OBJECTIVE: To analyse the incidence, risk factors and impact of acute kidney injury (AKI) on the prognosis of patients with COVID-19. DESIGN: Meta-analysis. DATA SOURCES: PubMed, Embase, CNKI and MedRxiv of Systematic Reviews from 1 January 2020 to 15 May 2020. STUDY SELECTION: Studies examining the following demographics and outcomes were included: patients' age; sex; incidence of and risk factors for AKI and their impact on prognosis; COVID-19 disease type and incidence of continuous renal replacement therapy (CRRT) administration during COVID-19 infection. RESULTS: A total of 79 research articles, including 49 692 patients with COVID-19, met the systemic evaluation criteria. The mortality rate and incidence of AKI in patients with COVID-19 in China were significantly lower than those in patients with COVID-19 outside China. A significantly higher proportion of patients with COVID-19 from North America were aged ≥65 years and also developed AKI. European patients with COVID-19 had significantly higher mortality and a higher CRRT rate than patients from other regions. Further analysis of the risk factors for COVID-19 combined with AKI showed that age ≥60 years and severe COVID-19 were independent risk factors for AKI, with an OR of 3.53, 95% CI (2.92-4.25) and an OR of 6.07, 95% CI (2.53-14.58), respectively. The CRRT rate in patients with severe COVID-19 was significantly higher than in patients with non-severe COVID-19, with an OR of 6.60, 95% CI (2.83-15.39). The risk of death in patients with COVID-19 and AKI was significantly increased, with an OR of 11.05, 95% CI (9.13-13.36). CONCLUSION: AKI was a common and serious complication of COVID-19. Older age and having severe COVID-19 were independent risk factors for AKI. The risk of in-hospital death was significantly increased in patients with COVID-19 complicated by AKI.


Assuntos
Lesão Renal Aguda/epidemiologia , Infecções por Coronavirus/fisiopatologia , Mortalidade Hospitalar , Pneumonia Viral/fisiopatologia , Lesão Renal Aguda/etiologia , Lesão Renal Aguda/terapia , Fatores Etários , Betacoronavirus , China/epidemiologia , Terapia de Substituição Renal Contínua , Infecções por Coronavirus/complicações , Infecções por Coronavirus/terapia , Europa (Continente)/epidemiologia , Humanos , América do Norte/epidemiologia , Pandemias , Pneumonia Viral/complicações , Pneumonia Viral/terapia , Prognóstico , Fatores de Risco , Índice de Gravidade de Doença , Fatores Sexuais
10.
PLoS Med ; 17(10): e1003406, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-33125416

RESUMO

BACKGROUND: Initial reports indicate a high incidence of acute kidney injury (AKI) in Coronavirus Disease 2019 (COVID-19), but more data are required to clarify if COVID-19 is an independent risk factor for AKI and how COVID-19-associated AKI may differ from AKI due to other causes. We therefore sought to study the relationship between COVID-19, AKI, and outcomes in a retrospective cohort of patients admitted to 2 acute hospitals in Derby, United Kingdom. METHODS AND FINDINGS: We extracted electronic data from 4,759 hospitalised patients who were tested for COVID-19 between 5 March 2020 and 12 May 2020. The data were linked to electronic patient records and laboratory information management systems. The primary outcome was AKI, and secondary outcomes included in-hospital mortality, need for ventilatory support, intensive care unit (ICU) admission, and length of stay. As compared to the COVID-19-negative group (n = 3,374), COVID-19 patients (n = 1,161) were older (72.1 ± 16.1 versus 65.3 ± 20.4 years, p < 0.001), had a greater proportion of men (56.6% versus 44.9%, p < 0.001), greater proportion of Asian ethnicity (8.3% versus 4.0%, p < 0.001), and lower proportion of white ethnicity (75.5% versus 82.5%, p < 0.001). AKI developed in 304 (26.2%) COVID-19-positive patients (COVID-19 AKI) and 420 (12.4%) COVID-19-negative patients (AKI controls). COVID-19 patients aged 65 to 84 years (odds ratio [OR] 1.67, 95% confidence interval [CI] 1.11 to 2.50), needing mechanical ventilation (OR 8.74, 95% CI 5.27 to 14.77), having congestive cardiac failure (OR 1.72, 95% CI 1.18 to 2.50), chronic liver disease (OR 3.43, 95% CI 1.17 to 10.00), and chronic kidney disease (CKD) (OR 2.81, 95% CI 1.97 to 4.01) had higher odds for developing AKI. Mortality was higher in COVID-19 AKI versus COVID-19 patients without AKI (60.5% versus 27.4%, p < 0.001), and AKI was an independent predictor of mortality (OR 3.27, 95% CI 2.39 to 4.48). Compared with AKI controls, COVID-19 AKI was observed in a higher proportion of men (58.9% versus 51%, p = 0.04) and lower proportion with white ethnicity (74.7% versus 86.9%, p = 0.003); was more frequently associated with cerebrovascular disease (11.8% versus 6.0%, p = 0.006), chronic lung disease (28.0% versus 19.3%, p = 0.007), diabetes (24.7% versus 17.9%, p = 0.03), and CKD (34.2% versus 20.0%, p < 0.001); and was more likely to be hospital acquired (61.2% versus 46.4%, p < 0.001). Mortality was higher in the COVID-19 AKI as compared to the control AKI group (60.5% versus 27.6%, p < 0.001). In multivariable analysis, AKI patients aged 65 to 84 years, (OR 3.08, 95% CI 1.77 to 5.35) and ≥85 years of age (OR 3.54, 95% CI 1.87 to 6.70), peak AKI stage 2 (OR 1.74, 95% CI 1.05 to 2.90), AKI stage 3 (OR 2.01, 95% CI 1.13 to 3.57), and COVID-19 (OR 3.80, 95% CI 2.62 to 5.51) had higher odds of death. Limitations of the study include retrospective design, lack of urinalysis data, and low ethnic diversity of the region. CONCLUSIONS: We observed a high incidence of AKI in patients with COVID-19 that was associated with a 3-fold higher odds of death than COVID-19 without AKI and a 4-fold higher odds of death than AKI due to other causes. These data indicate that patients with COVID-19 should be monitored for the development of AKI and measures taken to prevent this. TRIAL REGISTRATION: ClinicalTrials.gov NCT04407156.


Assuntos
Lesão Renal Aguda/etiologia , Infecções por Coronavirus/complicações , Mortalidade Hospitalar , Pneumonia Viral/complicações , Lesão Renal Aguda/epidemiologia , Lesão Renal Aguda/mortalidade , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Betacoronavirus , Comorbidade , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/terapia , Infecções por Coronavirus/virologia , Grupos Étnicos , Feminino , Hospitalização , Humanos , Incidência , Unidades de Terapia Intensiva , Masculino , Pessoa de Meia-Idade , Pandemias , Pneumonia Viral/epidemiologia , Pneumonia Viral/terapia , Pneumonia Viral/virologia , Insuficiência Renal Crônica/complicações , Respiração Artificial , Estudos Retrospectivos , Fatores de Risco , Reino Unido/epidemiologia , Adulto Jovem
12.
BMC Nephrol ; 21(1): 449, 2020 10 27.
Artigo em Inglês | MEDLINE | ID: mdl-33109103

RESUMO

The pandemic of coronavirus disease 2019 (CoVID-19) has been an unprecedented period. The disease afflicts multiple organ systems, with acute kidney injury (AKI) a major complication in seriously ill patients. The incidence of AKI in patients with CoVID-19 is variable across numerous international studies, but the high incidence of AKI and its associated worse outcomes in the critical care setting are a consistent finding. A multitude of patterns and mechanisms of AKI have been elucidated, and novel strategies to address shortage of renal replacement therapy equipment have been implemented. The disease also has had consequences on longitudinal management of patients with chronic kidney disease and end stage kidney disease. Kidney transplant recipients may be especially susceptible to CoVID-19 as a result of immunosuppression, with preliminary studies demonstrating high mortality rates. Increased surveillance of disease with low threshold for testing and adjustment of immunosuppression regimen during acute periods of illness have been recommended.


Assuntos
Lesão Renal Aguda/etiologia , Betacoronavirus , Infecções por Coronavirus/complicações , Falência Renal Crônica/terapia , Transplante de Rim , Pneumonia Viral/complicações , Insuficiência Renal Crônica/tratamento farmacológico , Lesão Renal Aguda/epidemiologia , Lesão Renal Aguda/terapia , Fatores Etários , Inibidores da Enzima Conversora de Angiotensina/uso terapêutico , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/mortalidade , Cuidados Críticos , Disparidades em Assistência à Saúde , Humanos , Imunossupressão/efeitos adversos , Imunossupressão/métodos , Incidência , Falência Renal Crônica/complicações , Transplante de Rim/efeitos adversos , Transplante de Rim/métodos , Transplante de Rim/mortalidade , Pandemias , Peptidil Dipeptidase A , Pneumonia Viral/epidemiologia , Pneumonia Viral/mortalidade , Insuficiência Renal Crônica/complicações , Terapia de Substituição Renal/instrumentação , Fatores de Risco , Fatores Sexuais , Transplantados , Populações Vulneráveis
14.
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
15.
Cir Cir ; 88(5): 569-575, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33064694

RESUMO

Objective: To describe the clinical characteristics and management of severe COVID-19 patients. Method: Observational, descriptive, longitudinal, and retrospective study. Results: 56 patients were admitted, of whom 80.3% (n = 45) were males with a mean age of 58 years [46-67]. The main comorbidities were obesity, high blood pressure, and diabetes. Symptoms onset time at admittance to the ICU was 9 [7-14] days, of which the most frequent were dyspnea, fever, and dry cough. Laboratory data were lymphopenia; elevation of LDH, fibrinogen, D-dimer, ferritin and CRP. 100% of the patients required mechanical ventilation, the median mechanical ventilation time was 12 [6-17] days, and 66% (n= 37) required a prone position. The pharmacological treatment was mainly based on azithromycin, hydroxychloroquine, tocilizumab and steroids. The most frequent complications were acute kidney injury, venous thromboembolism and acute myocardial infarction. Mortality rate was 17.8% (n = 10). Conclusion: The characteristics of the critically ill patients in our hospital were mostly elderly and obese, with the variables of higher SOFA score and acute kidney injury associated with higher mortality.


Assuntos
Betacoronavirus , Infecções por Coronavirus/terapia , Cuidados Críticos/métodos , Unidades de Terapia Intensiva , Pandemias , Pneumonia Viral/terapia , Lesão Renal Aguda/epidemiologia , Lesão Renal Aguda/etiologia , Corticosteroides/uso terapêutico , Idoso , Anticorpos Monoclonais Humanizados/uso terapêutico , Antivirais/uso terapêutico , Azitromicina/uso terapêutico , Doenças Cardiovasculares/epidemiologia , Doenças Cardiovasculares/etiologia , Terapia Combinada , Comorbidade , Infecções por Coronavirus/sangue , Infecções por Coronavirus/complicações , Infecções por Coronavirus/tratamento farmacológico , Infecções por Coronavirus/epidemiologia , Feminino , Mortalidade Hospitalar , Hospitais Universitários/organização & administração , Humanos , Hidroxicloroquina/uso terapêutico , Masculino , México/epidemiologia , Pessoa de Meia-Idade , Escores de Disfunção Orgânica , Pneumonia Viral/sangue , Pneumonia Viral/complicações , Pneumonia Viral/epidemiologia , Respiração Artificial , Avaliação de Sintomas
17.
Rev Cardiovasc Med ; 21(3): 433-442, 2020 09 30.
Artigo em Inglês | MEDLINE | ID: mdl-33070547

RESUMO

The coronavirus disease 2019 (COVID-19) is a novel coronavirus infection that has rapidly spread worldwide, causing a pandemic. The main objective of this meta-analysis was to evaluate the prevalence of the most common symptoms and complications of COVID-19. All relevant studies on the clinical complications of COVID-19 have been identified by searching two web databases (i.e., PubMed and Scopus). Afterward, the relevant data were extracted from the selected studies, and then analyzed by the STATA (Version 14) random-effects model. The 30 studies selected for our meta-analysis covered 6,389 infected patients. The prevalence rates of the most common symptoms were as follows: fever: 84.30% (95% CI: 77.13-90.37; I2 = 97.74%), cough: 63.01% (95% CI: 57.63-68.23; I2 = 93.73%), dyspnea: 37.16% (95% CI: 27.31-47.57%; I2 = 98.32%), fatigue: 34.22% (95% CI: 26.29-42.62; I2 = 97.29%), and diarrhea: 11.47% (95% CI: 6.96-16.87; I2 = 95.58%). Moreover, the most prevalent complications were found to be acute respiratory distress syndrome (ARDS) with 33.15% (95% CI: 23.35-43.73; I2 = 98.56%), arrhythmia with 16.64% (95% CI: 9.34-25.5; I2 = 92.29%), acute cardiac injury with 15.68% (95% CI: 11.1-20.97; I2 = 92.45%), heart failure with 11.50% (95% CI: 3.45-22.83; I2 = 89.48%), and acute kidney injury (AKI) with 9.87% (95% CI: 6.18-14.25; I2 = 95.64%). In this study, we assessed the prevalence of the main clinical complications of COVID-19, and found that following respiratory complications, cardiac and renal complications are the most common clinical complications of COVID-19.


Assuntos
Lesão Renal Aguda/etiologia , Betacoronavirus , Infecções por Coronavirus/complicações , Pandemias , Pneumonia Viral/complicações , Lesão Renal Aguda/epidemiologia , Infecções por Coronavirus/epidemiologia , Saúde Global , Humanos , Pneumonia Viral/epidemiologia , Prevalência
18.
Anesth Analg ; 131(4): 1260-1269, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32925347

RESUMO

BACKGROUND: Although previous studies have reported nephrotoxicity associated with hydroxyethyl starch (HES), the long-term effect of HES on renal function after nephrectomy has rarely been reported. We evaluated the association between intraoperative HES administration and short- and long-term renal function after nephrectomy. METHODS: We retrospectively reviewed 1106 patients who underwent partial or radical nephrectomy. The patients were divided into 2 groups: patients who received (HES group) or did not receive 6% HES 130/0.4 intraoperatively (non-HES group). The primary outcome was new-onset chronic kidney disease (CKD) stage 3a (estimated glomerular filtration rate [eGFR] <60 mL/min/1.73 m) or higher or all-cause mortality during 60 months after surgery. Propensity score matching was performed to address baseline differences between the 2 groups. Renal survival determined by stage 3a and stage 5 CKD (eGFR <15 mL/min/1.73 m) or all-cause mortality were compared up to 60 months before and after matching. We compared postoperative acute kidney injury (AKI) and CKD upstaging in the matched cohort as secondary outcomes. Ordinal logistic regression and Cox proportional hazards regression analyses using inverse probability of treatment weighting were performed for postoperative AKI and our primary outcome, respectively. A subgroup analysis of partial nephrectomy was performed. RESULTS: Thirty percent of patients received HES intraoperatively. Balanced solution and 0.9% normal saline was administered during surgery in both groups. Renal survival was not significantly different between groups after matching (log-rank test P = .377 for our primary outcome, and P = .981 for stage 5 or all-cause mortality, respectively). In the matched cohort (HES group: n = 280, non-HES group: n = 280), the incidence of AKI or CKD upstaging at 1 year was not significantly different (AKI: n = 94, 33.6% in HES group versus n = 90, 32.1% in non-HES group; CKD upstaging: n = 132, 47.1% in HES group versus n = 122, 43.6% in non-HES group; odds ratio [OR], 1.16; 95% confidence interval [CI], 0.83-1.61; P = .396). Intraoperative HES administration was not associated with postoperative renal outcomes (AKI: OR, 0.97; 95% CI, 0.81-1.16; P = .723; CKD stage 3a or higher or all-cause mortality: hazard ratio, 1.01; 95% CI, 0.89-1.14; P = .920). Subgroup analysis yielded similar results. CONCLUSIONS: Intraoperative 6% HES 130/0.4 administration was not significantly associated with short- and long-term renal function or renal survival up to 5 years in patients undergoing partial or radical nephrectomy. However, wide CI including large harm effect precludes firm conclusion and inadequate assessment of safety cannot be ruled out by our results.


Assuntos
Derivados de Hidroxietil Amido/efeitos adversos , Nefropatias/epidemiologia , Testes de Função Renal , Nefrectomia , Soluções Farmacêuticas/efeitos adversos , Substitutos do Plasma/efeitos adversos , Lesão Renal Aguda/tratamento farmacológico , Lesão Renal Aguda/epidemiologia , Idoso , Estudos de Coortes , Feminino , Hidratação , Taxa de Filtração Glomerular , Humanos , Incidência , Nefropatias/induzido quimicamente , Masculino , Pessoa de Meia-Idade , Período Pós-Operatório , Pontuação de Propensão , Resultado do Tratamento
20.
J Am Soc Nephrol ; 31(11): 2725-2735, 2020 11.
Artigo em Inglês | MEDLINE | ID: mdl-32963090

RESUMO

BACKGROUND: AKI commonly occurs in patients with coronavirus disease 2019 (COVID-19). Its pathogenesis is poorly understood. The urokinase receptor system is a key regulator of the intersection between inflammation, immunity, and coagulation, and soluble urokinase plasminogen activator receptor (suPAR) has been identified as an immunologic risk factor for AKI. Whether suPAR is associated with COVID-19-related AKI is unknown. METHODS: In a multinational observational study of adult patients hospitalized for COVID-19, we measured suPAR levels in plasma samples from 352 adult patients that had been collected within 48 hours of admission. We examined the association between suPAR levels and incident in-hospital AKI. RESULTS: Of the 352 patients (57.4% were male, 13.9% were black, and mean age was 61 years), 91 (25.9%) developed AKI during their hospitalization, of whom 25 (27.4%) required dialysis. The median suPAR level was 5.61 ng/ml. AKI incidence rose with increasing suPAR tertiles, from a 6.0% incidence in patients with suPAR <4.60 ng/ml (first tertile) to a 45.8% incidence of AKI in patients with suPAR levels >6.86 ng/ml (third tertile). None of the patients with suPAR <4.60 ng/ml required dialysis during their hospitalization. In multivariable analysis, the highest suPAR tertile was associated with a 9.15-fold increase in the odds of AKI (95% confidence interval [95% CI], 3.64 to 22.93) and a 22.86-fold increase in the odds of requiring dialysis (95% CI, 2.77 to 188.75). The association was independent of inflammatory markers and persisted across subgroups. CONCLUSIONS: Admission suPAR levels in patients hospitalized for COVID-19 are predictive of in-hospital AKI and the need for dialysis. SuPAR may be a key component of the pathophysiology of AKI in COVID-19.


Assuntos
Lesão Renal Aguda/etiologia , Betacoronavirus , Infecções por Coronavirus/complicações , Pneumonia Viral/complicações , Receptores de Ativador de Plasminogênio Tipo Uroquinase/sangue , Lesão Renal Aguda/sangue , Lesão Renal Aguda/epidemiologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Pandemias
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