scholarly journals MO358ACUTE KIDNEY INJURY AND MORTALITY RISK IN OLDER ADULTS WITH AND WITHOUT COVID-19: DATA FROM GEROCOVID STUDY

2021 ◽  
Vol 36 (Supplement_1) ◽  
Author(s):  
Hong Xu ◽  
Sara Garcia-Ptacek ◽  
Martin Annetorp ◽  
Annette Bruchfeld ◽  
Tommy Cederholm ◽  
...  
Keyword(s):  
Risk Factors ◽  
Older Adults ◽  
Kidney Function ◽  
Geriatric Patients ◽  
Vital Signs ◽  
Kidney Injury ◽  
Adverse Outcomes ◽  
Hospital Death ◽  
The Difference ◽  
Hospitalized Older Adults

Abstract Background and Aims Research regarding COVID-19 and acute kidney injury (AKI) in older adults is scarce. We evaluated the risk factors and outcomes of AKI in hospitalized older adults with and without COVID-19. Method Observational study of patients admitted to two geriatric clinics in the Stockholm Region of Sweden during the first wave of the COVID-19 pandemic from March 1st to June 15th 2020. The difference in incidence, risk factors and adverse outcomes for AKI between patients with or without COVID-19 were examined. Odds ratios (ORs) for AKI were obtained from logistic regressions. The hazard ratios (HRs) for the risk of in-hospital death were calculated from Cox proportional hazard regression models. Results We analyzed 316 older patients hospitalized for COVID-19 and 876 patients for non-COVID-19 diagnoses. The mean age was 83±9 years, 57% were women, and mean baseline kidney function as depicted by estimated glomerular filtration rate (eGFR) was 62±23 ml/min/1.73m2. AKI occurred in 92 (29%) of patients with COVID-19 vs. 159 (18%) without COVID-19. The severity of AKI was significantly worse in patients with COVID-19 compared with non-COVID patients. The odds for developing AKI were higher in patients with COVID-19 (adjusted OR, 1.70; 95% CI, 1.04-2.76), low baseline kidney function [4.19 (2.48-7.05), for eGFR 30 ∼ <60 ml/min/1.73m2, and 20.3 (9.95-41.3) for eGFR <30ml/min/1.73m2], and higher C-reactive protein (CRP) level (OR 1.81(1.11-2.95)). The risk of in-hospital death was highest in patients with COVID-19 and AKI [adjusted HR 23.5, 95% CI (8.75-63.0)], followed by COVID-19 without AKI [9.10 (3.52-23.6)] and by patients without COVID-19 and with AKI [6.38 (2.28-17.9)] after adjusting for patient demographics, vital signs, baseline kidney function and medications and using non-COVID patients with no AKI as reference. Conclusion Geriatric patients hospitalized with COVID-19 had a higher incidence of AKI compared with patients hospitalized with other diagnoses. AKI and COVID-19 were associated with in-hospital death. Optimal management of AKI may improve the outcome of COVID-19 in geriatric patients.

scholarly journals Acute kidney injury and mortality risk in older adults with COVID-19

2021 ◽  
Vol 34 (2) ◽  
pp. 295-304
Author(s):  
Hong Xu ◽  
Sara Garcia-Ptacek ◽  
Martin Annetorp ◽  
Annette Bruchfeld ◽  
Tommy Cederholm ◽  
...  
Keyword(s):  
Risk Factors ◽  
Older Adults ◽  
Acute Kidney Injury ◽  
Kidney Function ◽  
Kidney Injury ◽  
Adverse Outcomes ◽  
Hospital Death ◽  
Incidence Risk ◽  
The Difference ◽  
Hospitalized Older Adults

Abstract Background Research regarding COVID-19 and acute kidney injury (AKI) in older adults is scarce. We evaluated risk factors and outcomes of AKI in hospitalized older adults with and without COVID-19. Methods Observational study of patients admitted to two geriatric clinics in Stockholm from March 1st to June 15th, 2020. The difference in incidence, risk factors and adverse outcomes for AKI between patients with or without COVID-19 were examined. Odds ratios (OR) for the risk of AKI and in-hospital death were obtained from logistic regression. Results Three hundred-sixteen older patients were hospitalized for COVID-19 and 876 patients for non-COVID-19 diagnoses. AKI occurred in 92 (29%) patients with COVID-19 vs. 159 (18%) without COVID-19. The odds for developing AKI were higher in patients with COVID-19 (adjusted OR, 1.70; 95% confidence interval [CI] 1.04–2.76), low baseline kidney function as depicted by estimated glomerular filtration rate (eGFR) [4.19 (2.48–7.05), for eGFR 30 to  < 60 mL/min, and 20.3 (9.95–41.3) for eGFR < 30 mL/min], and higher C reactive protein (CRP) (OR 1.81 (1.11–2.95) in patients with initial CRP > 10 mg/L). Compared to patients without COVID-19 and without AKI, the risk of in-hospital death was highest in patients with COVID-19 and AKI [OR 80.3, 95% CI (27.3–235.6)], followed by COVID-19 without AKI [16.3 (6.28–42.4)], and by patients without COVID-19 and with AKI [10.2 (3.66–28.2)]. Conclusions Geriatric patients hospitalized with COVID-19 had a higher incidence of AKI compared to patients hospitalized for other diagnoses. COVID-19 and reduced baseline kidney function were risk factors for developing AKI. AKI and COVID-19 were associated with in-hospital death.

scholarly journals Is acute kidney injury age-dependent in older adults: an observational study in two centers from North China

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Libin Xu ◽  
◽  
Yanhua Wu ◽  
Yuanhan Chen ◽  
Ruiying Li ◽  
...  
Keyword(s):  
Older Adults ◽  
Acute Kidney Injury ◽  
Hospital Admissions ◽  
Multivariable Analysis ◽  
Kidney Injury ◽  
Adverse Outcomes ◽  
Charlson Comorbidity Index Score ◽  
Hospital Death ◽  
Dependent Manner ◽  
Age Dependent

Abstract Background Although aging increases susceptibility to acute kidney injury (AKI), whether the AKI risk and the association between AKI and adverse outcomes are age-dependent remain unclear in older adults. The current study aimed to identify whether AKI risk was age-dependent in older adults and to investigate whether the association between AKI and mortality increased with increasing age. Methods Medical records from 47,012 adult hospital admissions, including 30,194 older adults aged 60 or older, in two tertiary general hospitals were studied retrospectively. AKI was identified based on changes in blood creatinine levels according to the Kidney Disease: Improving Global Outcomes criteria. Results Among the total population and 30,194 older adult patients, the raw incidences of AKI were 8.2 and 8.3%, respectively. The curve of the age-grouped AKI incidence was “U-shaped”, which revealed a positive relationship between the AKI incidence and age among the older adults aged 75 years or older. This trend of the age-AKI relationship was supported by further multivariable analysis. After adjusting for the Charlson Comorbidity Index score, the AKI was associated with in-hospital mortality; however, the associations did not increase with increasing age. Conclusion The AKI risk does not increase with age in older adults, except for those aged 75 and above. The association between AKI and in-hospital death did not increase in an age-dependent manner in older adults. Trial registration This study was retrospectively registered at clinicaltrials.gov (NCT03054142) on February 13, 2017.

Abstract TP161: Gastrointestinal Bowel Obstruction in Acute Ischemic Stroke: Incidence, Risk Factors, and Outcomes

Stroke ◽  
2016 ◽  
Vol 47 (suppl_1) ◽  
Author(s):  
Kavelin Rumalla ◽  
Adithi Y Reddy ◽  
Vijay Letchuman ◽  
Paul A Berger ◽  
Manoj K Mittal
Keyword(s):  
Risk Factors ◽  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Bowel Obstruction ◽  
Kidney Injury ◽  
Hospital Death ◽  
Stroke Incidence ◽  
Black Race ◽  
Electrolyte Disorder ◽  
Incidence Risk

Introduction: The prognosis of patients suffering acute ischemic stroke (AIS) is worsened by medical complications that occur during subsequent hospitalization. The incidence, risk factors, and outcomes of gastrointestinal bowel obstruction (GIBO) in AIS have not been previously reported. Methods: We employed the Nationwide Inpatient Sample from 2002 to 2011 to identify all patients admitted with a primary diagnosis of AIS and subsets with and without a secondary diagnosis of GIBO without hernia. Multivariate logistic regression was utilized to analyze predictors of GIBO in AIS patients and the association between GIBO, in-hospital complications, and outcomes. Results: We identified 16,987 patients with GIBO (425 per 100,000) among 3,988,667 AIS hospitalizations and 4.2% of patients of these patients underwent repair surgery for intestinal obstruction. Multivariate predictors of GIBO included: age 55-64 (OR: 1.52, 95% CI: 1.40-1.64), age 65-74 (OR: 1.69, 95% CI: 1.56-1.84), age 75+ (OR: 1.97, 95% CI: 1.81-2.13), black race (OR: 1.42, 95% CI: 1.36-1.49), coagulopathy (OR: 1.39, 95% CI: 1.29-1.50), cancer (OR: 1.59, 95% CI: 1.44-1.75), blood loss anemia (OR: 2.51, 95% CI: 2.22-2.84), fluid/electrolyte disorder (OR: 2.91, 95% CI: 2.81-3.02), weight loss (OR: 3.08, 95% CI: 2.93-3.25), and thrombolytic therapy (OR: 1.30, 95% CI: 1.20-1.42) (all p<0.0001). Patients with GIBO had a greater likelihood of suffering intubation (OR: 1.79, 95% CI: 1.70-1.90), deep vein thrombosis (OR: 1.35, 95% CI: 1.25-1.46), pulmonary embolism (OR: 1.84, 95% CI: 1.53-2.21), sepsis (OR: 2.39, 95% CI: 2.22-2.56), acute kidney injury (OR: 1.85, 95% CI: 1.76-1.95), gastrointestinal hemorrhage (OR: 2.82, 95% CI: 2.63-3.03), and blood transfusions (OR: 2.02, 95% CI: 1.90-2.15) (all p<0.0001). In adjusted analyses, AIS patients with GIBO were 284% and 39% more likely to face moderate to severe disability and in-hospital death, respectively (p<0.0001). GIBO occurrence increased length of stay and total costs by an average of 9.7 days and $22,342 (p<0.0001). Conclusion: Advanced age, black race, and several pre-existing comorbidities increase the likelihood of post-AIS GIBO, which is an independent predictor of in-hospital complications, disability, and mortality.

scholarly journals Rhabdomyolysis is Associated with Hospital Mortality in Patients with COVID-19

2020 ◽  
Author(s):  
Yan Geng ◽  
Yong-sheng Du ◽  
Na Peng ◽  
Ting Yang ◽  
Shi-yu Zhang ◽  
...  
Keyword(s):  
Kidney Injury ◽  
Adverse Outcomes ◽  
Hospital Death ◽  
Proportional Hazard ◽  
Coagulation Activation ◽  
Virus Clearance ◽  
Cox Proportional Hazard ◽  
Independent Risk Factors ◽  
Cox Proportional Hazard Regression ◽  
Serum Myoglobin

Abstract Purpose: To evaluate the clinical features and outcomes of rhabdomyolysis (RM) in patients with COVID-19. Method: A single center retrospective cohort study of 1,014 consecutive hospitalized patients with confirmed COVID-19 at the Huoshenshan hospital in Wuhan, China, between February 17 and April 12, 2020. Results: The overall incidence of RM was 2.2%. Comparing with patients without RM, patients with RM tended to have a higher risk of deterioration, representing by higher ratio to be admitted to the intensive care unit (ICU) (90.9 % vs 5.3%, P<0.001), and to undergo mechanical ventilation (86.4 % vs 2.7% P<0.001). Compared with patients without RM, patients with RM had laboratory test abnormalities, including indicators of inflammation, coagulation activation and kidney injury. Patients with RM had a higher risk of hospital death (P < 0.001). Cox proportional hazard regression model confirmed that RM indicators, including peak creatine kinase (CK) >1000 IU/L (HR=6.46, 95% CI: 3.02-13.86), peak serum myoglobin (MYO) >1000 ng/mL (HR=9.85, 95% CI: 5.04-19.28) were independent risk factors for in-hospital death. Additionally, patients with COVID-19 that developed RM tended to have a delayed virus clearance.Conclusion: RM might be an important factor contributing to adverse outcomes of patients with COVID-19. Early detection and effective intervention of RM may help reduce deaths of patients with COVID-19.

scholarly journals RISK FACTORS FOR LOW GAIT SPEED: A NESTED CASE-CONTROL SECONDARY ANALYSIS OF THE MEXICAN HEALTH AND AGING STUDY

2015 ◽  
pp. 1-5
Author(s):  
M.U. PÉREZ-ZEPEDA ◽  
J.G. GONZÁLEZ-CHAVERO ◽  
R. SALINAS-MARTINEZ ◽  
L.M. GUTIÉRREZ-ROBLEDO
Keyword(s):  
Risk Factors ◽  
Older Adults ◽  
Physical Performance ◽  
Gait Speed ◽  
Representative Sample ◽  
Performance Test ◽  
Subsequent Development ◽  
Case Control ◽  
Adverse Outcomes ◽  
Aging Study

Background: Physical performance tests play a major role in the geriatric assessment. In particular, gait speed has shown to be useful for predicting adverse outcomes. However, risk factors for slow gait speed (slowness) are not clearly described. Objectives: To determine risk factors associated with slowness in Mexican older adults. Design: A two-step process was adopted for exploring the antecedent risk factors of slow gait speed. First, the cut-off values for gait speed were determined in a representative sample of Mexican older adults. Then, antecedent risk factors of slow gait speed (defined using the identified cut-points) were explored in a nested cohort case-control study. Setting, participants: One representative sample of a cross-sectional survey for the first step and the Mexican Health and Aging Study (a cohort characterized by a 10-year follow-up). Measurements: A 4-meter usual gait speed test was conducted. Lowest gender and height-stratified groups were considered as defining slow gait speed. Sociodemographic characteristics, comorbidities, psychological and health-care related variables were explored to find those associated with the subsequent development of slow gait speed. Unadjusted and adjusted logistic regression models were performed. Results: In the final model, age, diabetes, hypertension, and history of fractures were associated with the development of slow gait speed. Conclusions: Early identification of subjects at risk of developing slow gait speed may halt the path to disability due to the robust association of this physical performance test with functional decline.

Obesity as a risk factor of contrast-induced acute kidney injury in patients with arterial hypertension and stable coronary artery disease

2021 ◽  
Vol 17 (4) ◽  
pp. 63-67
Author(s):  
Olga Iu. Mironova ◽  
Olga A. Sivakova ◽  
Viktor V. Fomin
Keyword(s):  
Risk Factors ◽  
Serum Creatinine ◽  
Contrast Media ◽  
Stable Coronary Artery Disease ◽  
Kidney Injury ◽  
Before And After ◽  
The Difference ◽  
Artery Disease ◽  
Stable Cad ◽  
Contrast Media Administration

Background. The prevalence of obesity in patients with stable coronary artery disease (CAD) and arterial hypertension (AH) is increasing each year. As the number of percutaneous coronary interventions requiring contrast media administration is rising in this group of patients, the risk of contrast-induced acute kidney injury (CI-AKI) remains high. The most important risk factors of CI-AKI in this group of patients remain to be determined as well as their prognostic significance. Aim. The aim of the study was to assess the role of obesity as a risk factor of CI-AKI in patients with stable CAD and AH. Materials and methods. 863 patients with stable CAD and AH were included in the prospective open observational cohort study (ClinicalTrials.gov ID NCT04014153). 398 patients were obese and 465 had body mass index (BMI) below 30 kg/m2. CI-AKI was defined as the 25% rise (or 0.5 mg/dl) of serum creatinine from baseline assessed 48 hours after administration of contrast media. The primary endpoint was the development of CI-AKI. Results. The rate of CI-AKI in patients with obesity was 12.6%, without obesity 12.7%, but the difference between groups was not statistically significant (p=0.935, 95% CI -0.0430.046). The rate of CI-AKI in male patients with obesity was higher than in female ones. The logistic regression model of CI-AKI development in patients with stable CAD, AH and obesity was build (AUC 0.9928, р0,0001, 95% CI 0.98191) and included age, weight, body mass index, female gender, heart failure, diabetes mellitus, proteinuria, anemia, baseline creatinine, contrast volume and the difference between baseline serum creatinine and creatinine level after the contrast media exposure. The baseline level of creatinine and the difference between the levels of creatinine before and after contrast media administration were statistically significant risk factors in the model. Conclusion. The rate of CI-AKI in patients with stable CAD, AH and obesity was 12.6%. The main risk factors of CI-AKI development in multiple logistic regression model were the baseline level of creatinine and the difference between levels of serum creatinine before and after contrast media administration.

scholarly journals ADVANCING AN INTERDISCIPLINARY SCIENCE OF AGING THROUGH A PRACTICE-BASED DATA SCIENCE APPROACH

2019 ◽  
Vol 3 (Supplement_1) ◽  
pp. S480-S480
Author(s):  
Robert Lucero ◽  
Ragnhildur Bjarnadottir
Keyword(s):  
Machine Learning ◽  
Risk Factors ◽  
Older Adults ◽  
Text Mining ◽  
Language Processing ◽  
Fall Risk ◽  
Data Science ◽  
Care Quality ◽  
Science Approach ◽  
Hospitalized Older Adults

Abstract Two hundred and fifty thousand older adults die annually in United States hospitals because of iatrogenic conditions (ICs). Clinicians, aging experts, patient advocates and federal policy makers agree that there is a need to enhance the safety of hospitalized older adults through improved identification and prevention of ICs. To this end, we are building a research program with the goal of enhancing the safety of hospitalized older adults by reducing ICs through an effective learning health system. Leveraging unique electronic data and healthcare system and human resources at the University of Florida, we are applying a state-of-the-art practice-based data science approach to identify risk factors of ICs (e.g., falls) from structured (i.e., nursing, clinical, administrative) and unstructured or text (i.e., registered nurse’s progress notes) data. Our interdisciplinary academic-clinical partnership includes scientific and clinical experts in patient safety, care quality, health outcomes, nursing and health informatics, natural language processing, data science, aging, standardized terminology, clinical decision support, statistics, machine learning, and hospital operations. Results to date have uncovered previously unknown fall risk factors within nursing (i.e., physical therapy initiation), clinical (i.e., number of fall risk increasing drugs, hemoglobin level), and administrative (i.e., Charlson Comorbidity Index, nurse skill mix, and registered nurse staffing ratio) structured data as well as patient cognitive, environmental, workflow, and communication factors in text data. The application of data science methods (i.e., machine learning and text-mining) and findings from this research will be used to develop text-mining pipelines to support sustained data-driven interdisciplinary aging studies to reduce ICs.

scholarly journals Acute Kidney Injury among Hospitalized Children in China

2018 ◽  
Vol 13 (12) ◽  
pp. 1791-1800 ◽  
Author(s):  
Xin Xu ◽  
Sheng Nie ◽  
Aihua Zhang ◽  
Jianhua Mao ◽  
Hai-Peng Liu ◽  
...  
Keyword(s):  
Risk Factors ◽  
Kidney Injury ◽  
Hospital Death ◽  
Hospitalized Children ◽  
Clinical Procedures ◽  
Cox Proportional Hazard ◽  
Hazard Ratios ◽  
Level Data ◽  
Nephrotoxic Drugs ◽  
Hospital Acquired

Background and objectivesHigh-quality epidemiologic data on AKI in children are particularly lacking in developing countries. This study aimed to assess the epidemiology and clinical correlates of AKI among hospitalized children in China.Design, setting, participants, & measurementsWe performed a multicenter study, in a cohort of hospitalized children aged 1 month to 18 years, from 25 general and children’s hospitals in China during 2013–2015. We obtained patient-level data from the electronic hospitalization information system and laboratory databases of all children who had at least two serum creatinine tests within any 7-day window during their first 30 days of hospitalization. We identified AKI events according to the creatinine criteria of Kidney Disease Improving Global Outcomes. The in-hospital outcomes of AKI, including mortality, kidney recovery, and length of stay, were assessed. We estimated the corresponding hazard ratios using a Cox proportional hazard model, with adjustment for age, sex, comorbidities, and clinical procedures.ResultsA total of 19,908 (20%) patients with AKI were identified among 101,836 pediatric inpatients, of which 7220 (7%) were community acquired and 12,688 (13%) were hospital acquired. Up to 96% of these AKI events were not diagnosed on the discharge records. The cumulative incidence of AKI in infants (28%) was twice that in adolescents (12%). The profiles of risk factors differed between community-acquired and hospital-acquired AKI and varied with age. Diarrhea and sepsis were the top risk factors for community-acquired AKI, each contributing 6% of the risk. Congenital heart disease/cardiac surgery was the major risk factor for hospital-acquired AKI, contributing to 19% of cases. Exposure to nephrotoxic drugs, mostly nonsteroidal anti-inflammatory drugs and proton pump inhibitors, was common in hospitalized children and was associated with a higher risk of AKI. Death occurred in 842 out of 19,908 patients (4%) with AKI versus 450 out of 81,478 children (0.5%) without AKI. The risk of in-hospital death was higher among children with severe AKI, shock, and respiratory failure. Pediatric AKI was associated with longer hospital stay and higher daily cost, even after adjustment for covariates.ConclusionsPediatric AKI is common and is substantially underdiagnosed in China.

scholarly journals Associations of Urine Biomarkers with Kidney Function Decline in HIV-Infected and Uninfected Men

2019 ◽  
Vol 50 (5) ◽  
pp. 401-410 ◽  
Author(s):  
Simon B. Ascher ◽  
Rebecca Scherzer ◽  
Michelle M. Estrella ◽  
Michael G. Shlipak ◽  
Derek K. Ng ◽  
...  
Keyword(s):  
Risk Factors ◽  
Kidney Disease ◽  
Kidney Function ◽  
Disease Risk ◽  
Kidney Injury ◽  
Procollagen Type ◽  
Urine Albumin ◽  
Urine Biomarkers ◽  
Increased Risk ◽  
Egfr Decline

Background: HIV-infected (HIV+) persons are at increased risk of chronic kidney disease, but serum creatinine does not detect early losses in kidney function. We hypothesized that urine biomarkers of kidney damage would be associated with subsequent changes in kidney function in a contemporary cohort of HIV+ and HIV-uninfected (HIV–) men. Methods: In the Multicenter AIDS Cohort Study, we measured baseline urine concentrations of 5 biomarkers from 2009 to 2011 in 860 HIV+ and 337 HIV– men: albumin, alpha-1-microglobulin (α1m), interleukin-18 (IL-18), kidney injury molecule-1 (KIM-1), and procollagen type III N-terminal propeptide (PIIINP). We evaluated associations of urine biomarker concentrations with annual changes in estimated glomerular filtration rate (eGFR) using multivariable linear mixed models adjusted for demographics, traditional kidney disease risk factors, HIV-related risk factors, and baseline eGFR. Results: Over a median follow-up of 4.8 years, the average annual eGFR decline was 1.42 mL/min/1.73 m2/year in HIV+ men and 1.22 mL/min/1.73 m2/year in HIV– men. Among HIV+ men, the highest vs. lowest tertiles of albumin (–1.78 mL/min/1.73 m2/year, 95% CI –3.47 to –0.09) and α1m (–2.43 mL/min/1.73 m2/year, 95% CI –4.14 to –0.73) were each associated with faster annual eGFR declines after multivariable adjustment. Among HIV– men, the highest vs. lowest tertile of α1m (–2.49 mL/min/1.73 m2/year, 95% CI –4.48 to –0.50) was independently associated with faster annual eGFR decline. Urine IL-18, KIM-1, and PIIINP showed no independent associations with eGFR decline, regardless of HIV serostatus. Conclusions: Among HIV+ men, higher urine albumin and α1m are associated with subsequent declines in kidney function, independent of eGFR.

P0647ACUTE KIDNEY INJURY SECONDARY TO SUCROSE CONTAING INTAVENOUS IMMUNOGLOBULIN

2020 ◽  
Vol 35 (Supplement_3) ◽  
Author(s):  
Sadiq Al Lawati ◽  
Issa Al Salmi ◽  
SUAD Hannawi
Keyword(s):  
Acute Kidney Injury ◽  
Serum Level ◽  
Kidney Function ◽  
Viral Infections ◽  
Kidney Transplant Recipient ◽  
Transplant Rejection ◽  
Organ Transplant ◽  
Vital Signs ◽  
Kidney Injury ◽  
Kaposi Sarcoma

Abstract Background and Aims Intravenous immunoglobulins (IVIG) are pooled polyvalent IgG antibodies extracted from the human plasma. While the initial indications were mainly immune deficiency states and some autoimmune diseases, the usage has been widened to include several immune mediated diseases, viral infections, and organ transplant rejection. Stabilizers in IVIG may include sugars, such as sucrose, glucose, or maltose. Sucrose in IVIG preparations may cause acute kidney injury. We report the case of a renal transplant patient who developed acute kidney injury due to sucrose nephropathy following the administration of sucrose containing IVIG. Method Four months after transplantation he was referred to our Hospital for deterioration of kidney function with eGFR (by MDRD formula) of 27ml/min. Cytomegalovirus virus (CMV) PCR turned positive (3300 copies/ml). Cyclosporine levels were high (C2: 2937 ng/ml) and hence, cyclosporine dose was adjusted. Induction therapy with Injection Ganciclovir for 2 weeks, followed by therapeutic dose of oral Valganciclovir was administered for the treatment of CMV infection. Skin examination revealed annular purple patches, suspicious of Kaposi Sarcoma, on the upper limbs. Skin biopsy confirmed the diagnosis. It was planned to give total IVIG of 2 gm/ kg in four daily divided doses. After completion of the second dose, serum creatinine increased to 370 µmol/L. He was clinically asymptomatic, euvolumic, vital signs were stable, and his urine output remained normal and his urinalysis was inactive. Results The ultrasound of the transplant kidney was normal with normal resistivity index. IVIG was stopped. He was well hydrated and underwent ultrasound guided biopsy. The graft biopsy showed acute tubular injury with flattening and vacuolation of tubular epithelial cells. Mitosis indicating tubular regeneration was seen. There was mild focal interstitial inflammation (20%) with mild lymphocytic tubulitis not amounting to graft rejection. Immunohistochemistry for C4d and polyomavirus (BKV) were both negative. The features were most consistent with sucrose induced nephropathy (Figure 1). Subsequent visits showed a decrease in BKV-PCR serum level and eventually undetected serum level of BKV-PCR at follow up about a month later. Conclusion In this paper, we presented a case of a living unrelated kidney transplant recipient who developed BKV nephropathy and developed impaired kidney function. The patient also had new onset diabetes mellitus after kidney transplantation (NODAT) but was otherwise in good general health. Treatment included sucrose containing IVIG. The patient subsequently developed acute kidney injury. The outcome was favorable with recovery of filtration rate to the baseline within 21 days without the need for dialysis. We conclude that the administration of sucrose containing IVIG may lead to acute kidney injury. We recommend the use of sucrose-free IVIG whenever possible. In all cases, caution is required when administrating IVIG.

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