Abstract No. 527 High incidence of large-bore temporary hemodialysis catheter thrombosis in patient with COVID-19–related kidney injury

Purpose: To evaluate the incidence of large bore hemodialysis catheter malfunction in the setting of COVID-19. Materials and methods: A retrospective review was performed of all patients who underwent placement of a temporary hemodialysis catheter after developing kidney injury after COVID-19 infection at our institution. Data collected included demographic information, procedure related information, and incidence of replacement due to lumen thrombosis. Groups were compared using students t-test for continuous variables and Fisher’s exact test for nominal variables. Results: Sixty-four patients (43M, mean age 63.2 ± 13.3) underwent placement of temporary hemodialysis catheter placement for kidney injury related to COVID 19 infection. Thirty-one (48.4%) of catheters were placed via an internal jugular vein (IJV) access and 33 (52.6%) of catheters were placed via a common femoral vein (CFV) access. Overall, 15 (23.4%) catheters required replacement due to catheter dysfunction. There were no differences in demographics in patients who required replacement to those who did not ( p > 0.05). Of the replacements, 5/31 (16%) were placed via an IJV access and 10/33 (30.3%) were placed via a CFV access ( p = 0.18). The average time to malfunction/replacement was 7.8 ± 4.8 days for catheters placed via an IJ access versus 3.4 ± 3.3 days for catheters placed via a CFV access ( p = 0.055). Conclusion: A high incidence of temporary dialysis catheter lumen dysfunction was present in patients with COVID-19 infection. Catheters placed via a femoral vein access had more frequent dysfunction with shorter indwelling time.

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Renal Manifestations of Covid-19: Physiology and Pathophysiology

Journal of Clinical Medicine ◽

10.3390/jcm10061216 ◽

2021 ◽

Vol 10 (6) ◽

pp. 1216

Author(s):

Zaher Armaly ◽

Safa Kinaneh ◽

Karl Skorecki

Keyword(s):

Viral Replication ◽

Virus Disease ◽

Multiorgan Failure ◽

Critical Role ◽

Kidney Injury ◽

Small Sample ◽

Renal Physiology ◽

High Morbidity ◽

Enzymatic Production ◽

High Incidence

Corona virus disease 2019 (COVID-19) imposes a serious public health pandemic affecting the whole world, as it is spreading exponentially. Besides its high infectivity, SARS-CoV-2 causes multiple serious derangements, where the most prominent is severe acute respiratory syndrome as well as multiple organ dysfunction including heart and kidney injury. While the deleterious impact of SARS-CoV-2 on pulmonary and cardiac systems have attracted remarkable attention, the adverse effects of this virus on the renal system is still underestimated. Kidney susceptibility to SARS-CoV-2 infection is determined by the presence of angiotensin-converting enzyme 2 (ACE2) receptor which is used as port of the viral entry into targeted cells, tissue tropism, pathogenicity and subsequent viral replication. The SARS-CoV-2 cellular entry receptor, ACE2, is widely expressed in proximal epithelial cells, vascular endothelial and smooth muscle cells and podocytes, where it supports kidney integrity and function via the enzymatic production of Angiotensin 1-7 (Ang 1-7), which exerts vasodilatory, anti-inflammatory, antifibrotic and diuretic/natriuretic actions via activation of the Mas receptor axis. Loss of this activity constitutes the potential basis for the renal damage that occurs in COVID-19 patients. Indeed, several studies in a small sample of COVID-19 patients revealed relatively high incidence of acute kidney injury (AKI) among them. Although SARS-CoV-1 -induced AKI was attributed to multiorgan failure and cytokine release syndrome, as the virus was not detectable in the renal tissue of infected patients, SARS-CoV-2 antigens were detected in kidney tubules, suggesting that SARS-CoV-2 infects the human kidney directly, and eventually induces AKI characterized with high morbidity and mortality. The mechanisms underlying this phenomenon are largely unknown. However, the fact that ACE2 plays a crucial role against renal injury, the deprivation of the kidney of this advantageous enzyme, along with local viral replication, probably plays a central role. The current review focuses on the critical role of ACE2 in renal physiology, its involvement in the development of kidney injury during SARS-CoV-2 infection, renal manifestations and therapeutic options. The latter includes exogenous administration of Ang (1-7) as an appealing option, given the high incidence of AKI in this ACE2-depleted disorder, and the benefits of ACE2/Ang1-7 including vasodilation, diuresis, natriuresis, attenuation of inflammation, oxidative stress, cell proliferation, apoptosis and coagulation.

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ANCA-Associated Glomerulonephritis and Anti-Phospholipid Syndrome in a Patient with SARS-CoV-2 Infection: Just a Coincidence?

Case Reports in Nephrology and Dialysis ◽

10.1159/000517513 ◽

2021 ◽

pp. 214-220

Author(s):

Federica Maritati ◽

Maria Ilaria Moretti ◽

Valentina Nastasi ◽

Roberta Mazzucchelli ◽

Manrico Morroni ◽

...

Keyword(s):

Rapidly Progressive Glomerulonephritis ◽

Kidney Injury ◽

Antineutrophil Cytoplasmic Antibody ◽

Hemodynamic Instability ◽

Tubular Necrosis ◽

Complex Processes ◽

Anca Associated Vasculitis ◽

High Incidence ◽

New Diagnosis ◽

The Relationship

Many reports have described a high incidence of acute kidney injury (AKI) among patients with COVID-19. Acute tubular necrosis has been reported to be the most common damage in these patients, probably due to hemodynamic instability. However, other complex processes may be involved, related to the cytokine storm and the activation of innate and adaptive immunity. Here, we describe a patient who developed an antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis with rapidly progressive glomerulonephritis and lung involvement and an antiphospholipid syndrome soon after severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. After viral pneumonia was excluded by bronchoalveolar lavage, the patient has been treated with rituximab for amelioration of kidney function and resolution of thrombosis without any adverse event. We conclude that COVID-19 may trigger autoimmune diseases including ANCA-associated vasculitis. Thus, this diagnosis should be taken in consideration in COVID-19 patients, especially when they develop AKI with active urinary sediment. In addition, considering the relationship between these 2 diseases, SARS-CoV-2 infection should be excluded in all patients with a new diagnosis ANCA-associated vasculitis before starting immunosuppressive therapy.

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Clinical features of acute kidney injury in Coronavirus disease 2019—A case report with review of literature

10.21203/rs.3.rs-18031/v1 ◽

2020 ◽

Author(s):

Hai Yuan ◽

Xiaohan Lu ◽

E Guo ◽

Fengqi Hu ◽

Zhao Gao

Keyword(s):

Acute Kidney Injury ◽

Case Report ◽

Kidney Function ◽

Kidney Injury ◽

Hubei Province ◽

Review Of Literature ◽

Case Presentation ◽

High Incidence ◽

Careful Management ◽

High Incidence Area

Abstract Background: In December 2019, an outbreak of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) occurred in Wuhan, Hubei province, China. We surveyed 91 patients who were diagnosis as coronavirus disease 2019 (COVID-19) in Xiangyang, Hubei province. And we found the incident of acute kidney injury (AKI) was 3.29% (3/91), which was higher than in the whole country but similar in Hubei province.Case presentation: We describe a case of 58-year-old man who was diagnosis as AKI stage 3 and non-oliguria AKI in the SARS-CoV-2 infection. After antiviral and other supporting treatment, his kidney function improved and he was transferred to normal ward.Conclusions: This case illustrated that careful management and strict monitoring of kidney function should be employed in COVID-19 patients especially in high incidence area of COVID-19.

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Pregnancy and the kidney

Oxford Desk Reference Nephrology ◽

10.1093/med/9780198777182.003.0010 ◽

2021 ◽

pp. 402-432

Keyword(s):

Chronic Kidney Disease ◽

Acute Kidney Injury ◽

Renal Disease ◽

De Novo ◽

Kidney Injury ◽

Antenatal Clinic ◽

Medical Complications ◽

Optimal Timing ◽

High Incidence ◽

Preconception Counselling

Renal disease may occur de novo during pregnancy and pregnancy may occur in women with pre-existing renal disease. The chapters in this section consider the causes and implications of acute kidney injury that may occur during pregnancy and the likely outcomes of pregnancy in women with pre-existing chronic kidney disease, including the possible maternal and foetal complications of preterm delivery and pre-eclampsia (PET). There is a high incidence of PET in women with renal disease during pregnancy and importance of diagnosis and safe treatment of hypertension during pregnancy is discussed. The authors present the current theories of the pathogenesis of PET and highlight the importance of prophylactic treatment with aspirin to reduce the risk of PET. Pregnancy is increasingly common following renal transplantation and this group requires special consideration. They may have other concurrent medical conditions that need to be considered during pregnancy, or they may be at higher risk of other medical complications e.g. urinary tract infection with potential implications for maternal health and foetal wellbeing. It is important to facilitate preconception counselling for women with pre-existing renal disease to discuss optimal timing of pregnancy, make necessary adjustments to medications, and to discuss the likely outcomes for mother and baby. Managing renal disease during pregnancy requires the input of nephrologists, obstetricians, midwives, and often other healthcare professionals which is optimally delivered in a multi-disciplinary antenatal clinic with an expertise in this area.

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High Incidence of Acute Kidney Injury after Cord Blood Transplant

Biology of Blood and Marrow Transplantation ◽

10.1016/j.bbmt.2019.12.662 ◽

2020 ◽

Vol 26 (3) ◽

pp. S137-S138

Author(s):

Elisabetta Xue ◽

Julie Chotivatanapong ◽

Emily C Pao ◽

Kelsey Baker ◽

Ted A. Gooley ◽

...

Keyword(s):

Acute Kidney Injury ◽

Cord Blood ◽

Kidney Injury ◽

Cord Blood Transplant ◽

High Incidence

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Renal involvement in other infections

10.1093/med/9780199592548.003.0198_update_001 ◽

2018 ◽

Author(s):

Raja Ramachandran ◽

Vivekanand Jha

Keyword(s):

Young Women ◽

Chronic Conditions ◽

Burkholderia Pseudomallei ◽

Post Partum ◽

Renal Involvement ◽

Kidney Injury ◽

Common Cause ◽

Tropical Regions ◽

High Incidence ◽

Avoidable Death

Renal involvement has been described in patients with many other infections and this chapter discusses several of these.Water-borne infections are a common cause of acute kidney injury (AKI) worldwide but especially in tropical regions. Cholera is notoriously dangerous but any other cause of fluid-depletion may achieve the same. Typhoid fever is more likely to cause AKI from its complications than directly, but a small proportion of patients have glomerulonephritis.Meliodosis is caused by the intracellular organism Burkholderia pseudomallei. It typically affects workers in paddy (rice) fields in the rainy season, and may cause a local, genitourinary infection or an acute melioidosis septicaemia with a high incidence of AKI and mortality. Those with other chronic conditions are at greatest risk.Obstetric infections as a result of unsafe deliberate abortion or post-partum are a very common (often the most common) cause of AKI in developing countries, and a major cause of avoidable death in young women.

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Safe Water Community Project in Jalisco, Mexico

Annals of Nutrition and Metabolism ◽

10.1159/000500346 ◽

2019 ◽

Vol 74 (Suppl. 3) ◽

pp. 51-56 ◽

Cited By ~ 1

Author(s):

Etienne Macedo ◽

Michael V. Rocco ◽

Ravindra Mehta ◽

Guillermo Garcia-Garcia

Keyword(s):

Acute Diarrhea ◽

Diarrheal Disease ◽

Kidney Injury ◽

Clean Water ◽

Gastrointestinal Infections ◽

Community Project ◽

Sanitation And Hygiene ◽

High Prevalence ◽

High Incidence ◽

Unsafe Water

Few studies have assessed kidney function in patients with gastrointestinal infections in low-resource settings. Although dehydration is a frequent complication of acute diarrhea, we do not know the frequency and severity of acute kidney injury (AKI) in this context. A high prevalence of chronic kidney disease (CKD) has been reported among the inhabitants of poor communities in Poncitlan, Mexico. Polluted drinking water has been implicated as a probable cause. These communities report a high mortality associated with gastrointestinal infection. It is possible that a high incidence of waterborne disease and consequent more episodes of AKI might contribute to the high prevalence of CKD in this population. In this study, we aim to determine the association between the use of unsafe water and the incidence of acute diarrhea and AKI, and to determine if the provision of clean water decreases these complications. The study will be conducted in 3 communities of the municipality of Poncitlan. Initially, we will determine the water, sanitation, and hygiene (WASH) characteristics in the population and evaluate the incidence of diarrheal disease. In the observation phase, outcomes will be assessed after families receive training in WASH techniques, but before they are provided with clean water. In the intervention phase, outcomes will be assessed after clean water is provided.

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Clinical Profile, Treatment and Predictors during the First COVID-19 Wave: A Population-Based Registry Analysis from Castile and Leon Hospitals

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph17249360 ◽

2020 ◽

Vol 17 (24) ◽

pp. 9360

Author(s):

Eduardo Gutiérrez-Abejón ◽

Eduardo Tamayo ◽

Débora Martín-García ◽

F. Javier Álvarez ◽

Francisco Herrera-Gómez

Keyword(s):

Kidney Injury ◽

Population Based ◽

Ventilation Mode ◽

Multiple Factors ◽

High Incidence ◽

Probability Of Death ◽

Population Based Registry ◽

Drug Use Pattern ◽

Study Hospital ◽

Registry Analysis

The first wave of the COVID-19 pandemic collapsed the hospitals in Castile and Leon (Spain). An analysis of the clinical characteristics, drug therapies and principal outcome predictors in the COVID-19 hospitalized patients from 1 March to 31 May 2020 is presented through a population-based registry study. Hospital stay variables, ventilation mode data and clinical outcomes were observed. In Castile and Leon hospitals, 7307 COVID-19 patients were admitted, with 57.05% being male and a median of 76 years. The mortality rate was 24.43%, with a high incidence of severe acute respiratory syndrome (SARS) (14.03%) and acute kidney injury (AKI) (10.87%). The most used medicines were antibiotics (90.83%), antimalarials (42.63%), steroids (44.37%) and antivirals, such as lopinavir/ritonavir (42.63%). The use of tocilizumab (9.37%) and anti-SIRS (systemic inflammatory response syndrome) medicines (7.34%) were remarkable. Fundamentally, death occurred more likely over 65 years of age (OR: 9.05). In addition, the need for ventilation was associated with a higher probability of death (OR: 3.59), SARS (OR: 5.14) and AKI (OR: 2.31). The drug-use pattern had been modified throughout the COVID-19 first wave. Multiple factors, such as age, gender and the need for mechanical ventilation, were related to the worst evolution prognosis of the disease.

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Nephrotoxicity in Patients with or without Cystic Fibrosis Treated with Polymyxin B Compared to Colistin

Antimicrobial Agents and Chemotherapy ◽

10.1128/aac.02329-16 ◽

2017 ◽

Vol 61 (4) ◽

Cited By ~ 20

Author(s):

Ryan L. Crass ◽

W. Cliff Rutter ◽

Donna R. Burgess ◽

Craig A. Martin ◽

David S. Burgess

Keyword(s):

Risk Factors ◽

Cystic Fibrosis ◽

Retrospective Cohort ◽

Loop Diuretic ◽

Cox Regression ◽

Kidney Injury ◽

Polymyxin B ◽

Baseline Serum ◽

High Incidence ◽

Stage Renal Disease

ABSTRACT Nephrotoxicity is the primary adverse effect of the polymyxins. The relative rates of toxicity of polymyxin B and colistin have not been fully elucidated, especially in patients with cystic fibrosis (CF). A retrospective cohort study of adults treated with polymyxin B or colistin for at least 48 h was conducted. The primary endpoint was the incidence of kidney injury assessed by RIFLE (i.e., risk, injury, failure, loss, end-stage renal disease) criteria. Risk factors for kidney injury were evaluated using multivariate Cox regression. A total of 414 patients were evaluated, 220 of whom had CF. In patients without CF, there was no difference in kidney injury with polymyxin B and colistin (42.9% versus 50.3%, P = 0.46). Loop diuretic exposure was a risk factor for kidney injury (adjusted hazard ratio [aHR], 1.82; 95% confidence interval [CI], 1.16 to 2.83) in this population. In patients with CF, polymyxin B and colistin were associated with similar rates of kidney injury (34.5% versus 29.8%, P = 0.77). Diabetes (aHR, 2.68; 95% CI, 1.01 to 7.11), loop diuretics (aHR, 3.02; 95% CI, 1.36 to 6.73), and progressive care unit admission (aHR, 8.21; 95% CI, 2.55 to 26.46) were risk factors for kidney injury, while higher baseline serum creatinine levels (per 1 mg/dl) were protective (aHR, 0.08; 95% CI, 0.01 to 0.48). Total unadjusted kidney injury in polymyxin-treated patients was less frequent in those who had CF (30.5% versus 48.5%, P < 0.001). Polymyxin B and colistin are associated with a high incidence of kidney injury; cystic fibrosis may be protective against polymyxin nephrotoxicity, but further investigation is needed to confirm this conjecture.

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