Acute kidney injury and hantavirus disease

Author(s):  
Jan Clement

Hantavirus disease or at least its renal form, the so-called haemorrhagic fever with renal syndrome is the only globally emerging acute kidney injury (AKI) form, and currently without doubt the most underestimated form of community-acquired AKI. Hantavirus disease is a viral zoonosis, caused by inhalation of infectious aerosolized excreta from chronically infected rodents, which are both the reservoir and the vector of different hantavirus species. Clinical presentation consists of sudden flu-like symptoms (fever, headache, myalgia), followed by gastrointestinal discomfort and AKI, often with anuria or oliguria. More rarely, acute myopia and/or non-cardiogenic acute lung oedema or injury is the presenting or complicating symptom. Laboratory hallmarks are initial thrombocytopenia and proteinuria, raised C-reactive protein and lactate dehydrogenase, left-shift leucocytosis, and typical but transient serum lipid disturbances. Spontaneous remission occurs within 2–3 weeks without sequelae. Case fatality rate is between 0.1% and 15% according to the infecting hantavirus species, but most infections show in fact an asymptomatic or paucisymptomatic presentation. Treatment is only supportive, but may necessitate life-saving intensive care techniques. Together with leptospirosis, haemorrhagic fever with renal syndrome is the only form of AKI against which different vaccines are in use, but a World Health Organization-licensed hantavirus vaccine is still lacking.

2021 ◽  
Vol 4 (2) ◽  
Author(s):  
Salman Tahir Shafi

In January 2020, the pathogen was identified and named by the World Health Organization as Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-COV-2). The consequent SARS-CoV-2-related disease was defined as coronavirus disease 2019 (COVID-19). As data emerged about characteristics of the disease, it was found to be associated with increased risk of acute kidney injury (AKI). We explore the recent literature and reports emerging from the epicenters of the pandemic to help our viewers understand the nature of AKI among these patients. 


2021 ◽  
Vol 33 (3) ◽  
pp. 213
Author(s):  
Maya Wardiana ◽  
Rahmadewi Rahmadewi ◽  
Dwi Murtiastutik ◽  
Sawitri Sawitri ◽  
Damayanti Damayanti

Background: Chickenpox caused by the varicella-zoster virus (VZV) in diabetes mellitus patients might exhibit similar clinical features with monkeypox, caused by monkeypox virus (MPXV). In May 2019, Singapore notified World Health Organization (WHO) of one laboratory-confirmed case of monkeypox. Considering Singapore is located near Indonesia, awareness about the possibility of an outbreak in Indonesia should be raised. Purpose: To report a case of chickenpox mimicking monkeypox in an adult with diabetes mellitus and acute kidney injury. Case: A 51-year-old male with poorly controlled diabetes mellitus was suspected to have a chickenpox differential diagnosis with monkeypox. His chief complaint was multiple blisters on his body and vomiting. There was a history of feeding a monkey. From dermatological status on facial, trunk, and extremities there were multiple pleomorphic vesicles. Laboratory results showed elevated renal function. Polymerase chain reaction (PCR) examination using VZV as primer revealed a positive result in the range of 810 bp. He was treated with intravenous acyclovir for 3 days and oral acyclovir for 7 days then discharged with improvement in skin lesions and normal renal function. Discussion: Chickenpox in adult and diabetes mellitus patients can give severe clinical manifestation mimicking monkeypox. PCR has a significant role especially when diagnosis could not be established from the physical examination. Acyclovir can be given as the therapy. Conclusion: Adult and poorly controlled diabetes mellitus are important risk factors associated with the severity and complication of chickenpox. A careful diagnostic approach and management are needed.


2020 ◽  
Vol 10 (4) ◽  
pp. 32009.1-32009.2
Author(s):  
Solmaz Nekoueifard ◽  
◽  
Mohammad Majidi ◽  

Coronavirus disease 2019 (COVID-19) was first declared in December 2019 from Wuhan, China [1, 2]. It then has been reported a pandemic in March 2020 by the World Health Organization [3]. Clinical features of COVID-19 are different from asymptomatic to mild to moderate symptoms, such as fever, headache, myalgia, sore throat, anosmia, cough, fatigue headache, hemoptysis, and dyspnea to the life-threatening complications, including shock, pneumonia, acute respiratory distress syndrome, myocarditis, myocardial infarction, acute kidney injury, multi-organ failure, and even death [1, 2].


2021 ◽  
Vol 2 (2) ◽  
Author(s):  
Fadhil Rasyid ◽  
Bambang Pujo Semedi ◽  
Arie Utariani ◽  
Teuku Aswin

Since the World Health Organization (WHO) declared COVID-19 as pandemic in March 2020, the number of new case findings in Indonesia has continued to increase. As happened in the city of Surabaya. Even in severe cases deterioration is rapid and progressive. One of them is the high D-dimer level in COVID-19 patients, which indicates the presence of vascular thrombosis, resulting in organ failure syndromes such as Acute Kidney Injury (AKI). Such conditions clearly indicate that this virus attacks the kidneys. It is known that the prevalence of AKI is 17%, where 77% of AKI patients experienced severe COVID-19 infection, and 52% died. For this reason, this study was prepared with the aim of knowing the relationship between increased levels of D-Dimer Renal Angine Index and the incidence of Acute Kidney Injury (AKI) in COVID-19 patients in the Special Isolation Room of Dr. Soetomo Hospital Surabaya. This study was a retrospective cohort analytic observational study with a sample size of 30. The Acute Kidney Injury criteria in this study used an increase in serum creatinine ≥ 0.3 mg / dL within 48 hours, or an increase in serum creatinine ≥ 1.5 times. Through research conducted, it is known that the Renal Angina Index can be used to predict the incidence of AKI in this study with p <0.0001 and sensitivity 71%, specificity 21% (r: 0.43; strong CC> 0.3) with a limit of 7. It can be concluded that there is a relationship which is significant between the Renal Angina Index on the incidence of Acute Kidney Injury (AKI). However, there was no significant relationship between increased D-Dimer levels and the incidence of acute kidney injury.


2021 ◽  
Vol 15 (1) ◽  
Author(s):  
Haitham A. Azeem ◽  
Hytham Abdallah ◽  
Mohamad M. Abdelnaser

Abstract Background The World Health Organization (WHO) has named the virus as 2019 novel coronavirus on January 12, 2020, and has declared a public health emergency globally on January 30, 2020. The epidemic started in Wuhan, China, in December of 2019 and quickly spread to over 200 countries. COVID-19 can cause multiple organ injuries (e.g., kidney, heart, blood, and nervous system). Among them, acute kidney injury (AKI) is a critical complication due to its high incidence and mortality rate. So, it is essential to evaluate AKI in COVID-19 patients during this pandemic state. The aim of this work is to detect the occurrence of AKI in hospitalized COVID-19 patients. So, a retrospective study was conducted on hospitalized adult patients > 18 years old with confirmed SARS-CoV-2 infection admitted to the Abo Teeg Hospital at Assiut City, Egypt, from May 1, 2020, to July 1, 2020. All data were collected from medical records, patients’ follow-up, and charts. Data were verified, coded by the researcher, and analyzed using IBM-SPSS 21.0. Results Eighty-six COVID-19 patients were admitted to Abo Teeg Hospital in Assiut City, Egypt, between May and July 2020. Thirty-eight patients (33%) were of the male gender. Mean age was 58.07 ± 17.9, and 61 patients developed AKI. 32.8% of the AKI group were a stage I severity (increase in serum creatinine by 0.3 mg/dl within 48 h), 21.3% of them presented by stage II (2–2.9 times increase in serum creatinine), and 45.9% were in stage III (3 times or more increase in serum creatinine). The overall hospital mortality for the patients admitted to ICU with AKI was 6.7% (11/61), compared to 1% (4/25) in those without AKI. Conclusion Hospitalized patients with COVID-19 had a higher risk of AKI, and we recommended that those patients should be evaluated after discharge for the development of CKD.


Author(s):  
Jan Clement ◽  
Piet Maes

Hantavirus disease is a viral zoonosis, caused by inhalation of infectious aerosolized excreta from chronically infected rodents, which are both the reservoir and the vector of different hantavirus species. Hantavirus infections manifest mainly as haemorrhagic fever with renal syndrome and hantavirus pulmonary syndrome, which traditionally but incorrectly were thought to be caused by exclusively Old World hantaviruses and New World hantaviruses, respectively.Hantavirus diseases are characterized by non-specific flu-like symptoms, followed by a sometimes lethal capillary leak syndrome, haemorrhage, and rarely by shock. Infection is accompanied by augmented release of pro-inflammatory cytokines which indirectly causes organ damage. Diagnosis can be made by serology or plaque reduction neutralization tests, detection of viral proteins by Western blot assay, or detection of hantavirus genome by reverse transcription-polymerase chain reaction. Treatment is mainly supportive.Together with leptospirosis, haemorrhagic fever with renal syndrome is the only form of acute kidney injury against which vaccines are in use, but a World Health Organization-licensed vaccine is still lacking.


2020 ◽  
Vol 1 (1) ◽  
pp. 173-175
Author(s):  
Samir Singh

World Health Organization (WHO) has declared coronavirus disease 2019 (COVID-19) outbreak as a global emergency. Kidney involvement is commonly seen in COVID-19 patients with clinical findings ranging from mild proteinuria to acute kidney injury (AKI) in hospitalized patients. In this viewpoint, I would like to discuss about various mechanism contributing to AKI such as, entry of novel coronavirus into host cell, cytokine storm that destroy kidney tissues, increased blood clotting that clogs kidney, and probable direct infection of the kidney.


2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Laith J. Abu-Raddad ◽  
Hiam Chemaitelly ◽  
Houssein H. Ayoub ◽  
Zaina Al Kanaani ◽  
Abdullatif Al Khal ◽  
...  

AbstractThe overarching objective of this study was to provide the descriptive epidemiology of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) epidemic in Qatar by addressing specific research questions through a series of national epidemiologic studies. Sources of data were the centralized and standardized national databases for SARS-CoV-2 infection. By July 10, 2020, 397,577 individuals had been tested for SARS-CoV-2 using polymerase-chain-reaction (PCR), of whom 110,986 were positive, a positivity cumulative rate of 27.9% (95% CI 27.8–28.1%). As of July 5, case severity rate, based on World Health Organization (WHO) severity classification, was 3.4% and case fatality rate was 1.4 per 1,000 persons. Age was by far the strongest predictor of severe, critical, or fatal infection. PCR positivity of nasopharyngeal/oropharyngeal swabs in a national community survey (May 6–7) including 1,307 participants was 14.9% (95% CI 11.5–19.0%); 58.5% of those testing positive were asymptomatic. Across 448 ad-hoc testing campaigns in workplaces and residential areas including 26,715 individuals, pooled mean PCR positivity was 15.6% (95% CI 13.7–17.7%). SARS-CoV-2 antibody prevalence was 24.0% (95% CI 23.3–24.6%) in 32,970 residual clinical blood specimens. Antibody prevalence was only 47.3% (95% CI 46.2–48.5%) in those who had at least one PCR positive result, but 91.3% (95% CI 89.5–92.9%) among those who were PCR positive > 3 weeks before serology testing. Qatar has experienced a large SARS-CoV-2 epidemic that is rapidly declining, apparently due to growing immunity levels in the population.


2020 ◽  
Vol 73 (1-2) ◽  
pp. 5-12
Author(s):  
Miodrag Golubovic ◽  
Andrej Preveden ◽  
Ranko Zdravkovic ◽  
Jelena Vidovic ◽  
Bojan Mihajlovic ◽  
...  

Introduction. Acute kidney injury associated with cardiac surgery is a common and significant postoperative complication. With a frequency of 9 - 39% according to different studies, it is the second most common cause of acute kidney injury in intensive care units, and an independent predictor of mortality. This study aimed to investigate the importance of preoperative hemoglobin and uric acid levels as risk factors for acute kidney injury in the postoperative period in cardiac surgery patients. Material and Methods. The study included a total of 118 patients who were divided into two groups. Each group included 59 patients; the fist group included patients who developed acute kidney injury and required renal replacement therapy, and the second included patients without acute kidney injury. Types of cardiac surgery included coronary, valvular, combined, aortic dissection, and others. All necessary data were collected from patient medical records and the electronic database. Results. A statistically significant difference was found between the groups in preoperative hemoglobin levels (108.0 vs. 143.0 g/l, p = 0.0005); postoperative urea (26.4 vs. 5.8 mmol/l, p = 0.0005) and creatinine (371.0 vs. 95.0 ?mol/l, p = 0.0005), acute phase inflammatory reactants C-reactive protein (119.4 vs. 78.9 mg/l, p = 0.002) and procalcitonin (7.0 vs. 0.2 ng/ml, p = 0.0005), creatine kinase myocardial band isoenzyme (1045.0 vs. 647.0 mg/l, p = 0.014); duration of extracorporeal circulation (103.5 vs. 76.0 min, p = 0.0005) and ascending aortic clamp during cardiac surgery (89.0 vs. 67.0 min, p = 0.0005). The exception was the preoperative uric acid level, where there was no statistically significant difference (382.0 vs. 364.0 ?mol/l, p = 0.068). There was a statistically significant correlation between the use of inotropic agents and acute kidney injury development. Conclusion. There is a correlation between the preoperative low hemoglobin levels and postoperative acute kidney injury. There is no statistically significant correlation between the preoperative levels of uric acid and postoperative acute kidney injury.


2021 ◽  
Vol 10 (16) ◽  
pp. 3632
Author(s):  
Sophia Lionaki ◽  
Evangelos Mantios ◽  
Ioanna Tsoumbou ◽  
Smaragdi Marinaki ◽  
George Makris ◽  
...  

Purpose: Minimal change disease (MCD) is considered a relatively benign glomerulopathy, as it rarely progresses to end-stage kidney disease. The aim of this study was to describe the characteristics and outcomes of adults with MCD and identify potential risk factors for relapse. Patients & Methods: We retrospectively studied a cohort of adults with biopsy-proven MCD in terms of clinical features and treatment outcomes. Baseline characteristics and outcomes were recorded and predictors of relapse were analyzed using logistic regression multivariate analysis. Results: 59 patients with adult-onset primary MCD with nephrotic syndrome were included. Mean serum creatinine at diagnosis was 0.8 mg/dL (±2.5) and estimated GFR (eGFR) was 87 mL/min/1.73 m2 (±29.5). Mean serum albumin was 2.5 g/dL (±0.8) and 24 h proteinuria 6.8 g (±3.7). Microscopic hematuria was detected in 35 (58.5%) patients. 42 patients received prednisone alone, six patients received prednisone plus cyclophosphamide, five patients received prednisone plus cyclosporine, one patient received prednisone plus rituximab and five patients did not receive immunosuppression at all since they achieved spontaneous remission. During a mean follow up time of 34.7(22.1) months, 46.1% of patients experienced at least one episode of relapse. The mean age of patients who did not experience a relapse was significantly higher than that of patients who relapsed while relapsers had a significantly longer duration of 24 h proteinuria prior to biopsy compared to non-relapsers. Overall, 10% of patients experienced acute kidney injury while the mean eGFR at the end was 82 mL/min/1.73 m2 (±29.1) and one patient ended up in chronic dialysis. Overall, the proportion of non-relapsers, who experienced acute kidney injury (17%) was significantly higher than the one recorded among relapsers (0%).Conclusion: In this series of patients, almost 46% of adult-onset nephrotic MCD patients experienced a relapse, although their renal progression was rare. Younger onset age was an independent risk factor for relapse in adult-onset MCD patients.


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