MO412THE RISK FACTORS OF ACUTE KIDNEY INJURY CAUSED BY HEMOPHAGOCYTIC LYMPHOHISTIOCYTOSIS

2021 ◽  
Vol 36 (Supplement_1) ◽  
Author(s):  
Siwen Wang ◽  
Jia Yang ◽  
Chen Xuelian ◽  
Jiaojiao Zhou ◽  
Lichuan Yang
Keyword(s):  
Risk Factors ◽  
Acute Kidney Injury ◽  
Hemophagocytic Lymphohistiocytosis ◽  
Strong Predictor ◽  
Laboratory Data ◽  
Clinical Manifestations ◽  
Gastrointestinal Symptoms ◽  
Kidney Injury ◽  
Total Bilirubin Level ◽  
Risk Of Death

Abstract Background and Aims Hemophagocytic lymphohistiocytosis (HLH) is a syndrome characterized by overproduction of proinflammatory cytokines and hemophagocytosis. Acute kidney injury (AKI) is the most common complication of HLH in the kidney, which is a strong predictor of poor prognosis. In this retrospective study, we aimed to find the risk factors of AKI in patients with HLH. Method We screened all adult patients with HLH admitted to West China Hospital of Sichuan University from January 2009 to June 2019. Patients in this study were secondary HLH according to the HLH diagnostic criteria revised by the Histocyte Society in 2004. Patients with HLH were excluded from the study if they had a functioning kidney transplant, received renal replacement therapy (RRT) in the past month, suffered from end-stage renal disease (ESRD), or had the renal malignant tumor. We collected basic information, clinical manifestations, and laboratory data of patients from electronic medical records. Results A total of 600 patients with confirmed diagnosis of secondary HLH are included in our analysis. There are 199(33.2%)HLH-induced AKI patients, among whom 37.2%, 32.7%, and 30.2% are classified as AKI I, II, and III, respectively, according to the 2012 KDIGO (Kidney Disease: Improving Global Outcomes) guideline. Overall hospital mortality is 176(29.3%), and the number of deaths in patients with AKI was much higher than that in patients without AKI (53.3% versus 17.5%, P < 0.001). The risk factors of AKI in patients with HLH were hyperphosphatemia (P<0.001, OR 5.448, 95%CI 2.951-10.059) , vasopressor(P<0.001, OR 3.485, 95%CI 2.114-5.746), heart failure (P=0.044, 0R 2.336, 95%CI 1.022-5.340), gastrointestinal symptoms (P=0.043, OR 1.877, 95%CI 1.021-3.453), increased heart rate (P=0.005, OR 1.017, 95%CI 1.005-1.029), elevated total bilirubin level(P<0.001, OR 1.004, 95%CI 1.002-1.007), and hypoproteinemia (P=0.034, OR 0.939, 95%CI 0.886-0.995). Conclusion The incidence of AKI was higher in patients with HLH, and the risk of death was significantly higher in HLH patients with AKI. A variety of risk factors are related to the occurrence of HLH-induced AKI. Identifying and correcting them early in clinical diagnosis and treatment may reduce the incidence of AKI in patients with HLH and improve the prognosis of them.

scholarly journals P0626THE RISK FACTORS OF ACUTE KIDNEY INJURY CAUSED BY HEMOPHAGOCYTIC LYMPHOHISTIOCYTOSIS

2020 ◽  
Vol 35 (Supplement_3) ◽  
Author(s):  
Siwen Wang ◽  
Jiaojiao Zhou ◽  
Jia Yang ◽  
Lichuan Yang ◽  
Xin Wang
Keyword(s):  
Risk Factors ◽  
Heart Failure ◽  
Heart Rate ◽  
Acute Kidney Injury ◽  
Prothrombin Time ◽  
Bilirubin Level ◽  
Hemophagocytic Lymphohistiocytosis ◽  
Total Bilirubin ◽  
Kidney Injury ◽  
Total Bilirubin Level

Abstract Background and Aims Hemophagocytic lymphohistiocytosis (HLH) is a syndrome caused by uncontrolled natural killer (NK) cell and cytotoxic T cell activation, resulting in the overproduction of proinflammatory cytokines and hemophagocytosis. Acute kidney injury (AKI) characterized by rapid loss of renal excretion function is the most common complication of HLH in the kidney. In this retrospective study, we aimed to find the risk factors of AKI in patients with HLH. Method This study included adult patients with HLH admitted in West China Hospital of Sichuan University from January 2009 to June 2019. Patients with HLH were excluded from the study if they had a functioning kidney transplant, received renal replacement therapy (RRT) in the past month, suffered from end-stage renal disease (ESRD) or had the renal malignant tumor. The diagnosis of HLH was based on the HLH diagnostic criteria revised by the Histocyte Society in 2004 and AKI was defined according to the 2012 KDIGO (Kidney Disease: Improving Global Outcomes) guideline. We collected basic information, clinical manifestations and laboratory data of patients from electronic medical records. Results We analyzed 294 patients this time, of whom 95 (32.3%) developed AKI. The patients were divided into two groups according to the occurrence of AKI. The mortality rate in the AKI group was significantly higher than that in the non-AKI group (40.0% VS 12.6%; p<0.001). The risk factors of AKI in patients with HLH were hyperphosphatemia [Odds Ratio (OR) 3.825; 95% Confidence Interval (CI) 1.647-8.886; p=0.002] ,heart failure (OR 2.972; 95% CI 1.029-8.584; p=0.044), increased heart rate (OR 1.025; 95% CI 1.008-1.043; p=0.004), prolonged prothrombin time (OR 1.025; 95% CI 1.001-1.049; p=0.041), elevated total bilirubin level (OR 1.003; 95% CI 1.000-1.007; p=0.030), and hypoproteinemia (OR 0.915; 95% CI 0.842-0.994; p=0.035). Conclusion The incidence of AKI in HLH patients is frequent, and the risk of death in HLH patients with AKI is significantly higher. The occurrence of AKI in patients with HLH is related to hyperphosphatemia, heart failure, increased heart rate, prolonged prothrombin time, elevated total bilirubin level, and hypoproteinemia.

scholarly journals 1481. A Study for Risk Factors of Acute Kidney Injury in Leptospirosis in a Tertiary Health Center in South India

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S540-S540
Author(s):  
Bhavana Surapareddy ◽  
Muralidhar Varma ◽  
Shashidhar V
Keyword(s):  
Risk Factors ◽  
Acute Kidney Injury ◽  
Early Recognition ◽  
Care Center ◽  
Tertiary Care ◽  
Laboratory Data ◽  
Kidney Injury ◽  
Serum Lactate ◽  
Significant Difference ◽  
Serum Bicarbonate Level

Abstract Background Leptospirosis is the most widespread zoonotic disease in the world. In India, it is endemic in coast lined states. Renal failure is a severe complication with mortality approaching 22%, early recognition of which helps clinicians in acting fast. This study aimed to investigate the predictors of Acute Kidney Injury (AKI) in Leptospirosis Methods This is a prospective, case–control study done in a tertiary care center in Southern India carried out between October 2017 and December 2018. Patients with confirmed Leptospirosis as per CDC 2013 and Faine’s criteria (2012) having AKI as per KDIGO criteria were defined as cases. Subjects without AKI were controls. Demographic, clinical and laboratory data were compared between the groups and analyzed. Logistic regression was performed to analyze the possible risk factors associated with AKI in Leptospirosis. Results A total of 329 subjects met the inclusion criteria of the study. 187 patients with AKI (CASES) and 142 patients without AKI (CONTROLS) were studied. Patients with AKI were older, (mean age- 46.99 ± 13.21 vs. 42.99 ± 15.15 years) had longer hospital stay (9.04 ± 5.62 vs. 6.27 ± 3.27 days) had higher SOFA (7.97 ±2.9 vs. 3.37 ± 2.6) and APACHE 2 scores (14.37±5.93 vs. 4.66 ± 4.4), lower mean arterial pressure (84.01 ± 14.45 vs. 89.01 ± 10.63 mmHg; P = 0.001) lower serum bicarbonate level (21.70 ± 2.35 vs. 18.73 ± 3.78 mEq/dL; P < 0.001). Factors like serum lactate, AST, ALT had no significant difference between the groups. Serovar identification was done in 88 patients, of which 57 had AKI. Australis (16.7%), Pyrogenes (16.7%) and Grippotyphosa (11.1%) were the commonest serovars isolated. Serovar most commonly associated with AKI was Pyrogenes (17.5%) Predictors for AKI were jaundice (P = 0.01, OR 2.25; CI 1.21 –3.26), vomiting (P = 0.017, OR 1.9, CI 1.12- 3.26) Hypotension (P = 0.02, OR = 12.3, CI 1.85 – 107.2), tachypnea (P = 0.006, OR = 2.55, CI 1.11- 3.24), leukocytosis (P < 0.001, OR 5.45, CI 1.86- 4.89), thrombocytopenia (P < 0.001, OR 6.49, CI 2.33 – 6.75) Conclusion Identification of features like hypotension, tachypnea, acidosis, leukocytosis, thrombocytopenia, the occurrence of serovar Pyrogenes should alert the clinician on risk of developing AKI Disclosures All authors: No reported disclosures.

Clinical Characterization of Staphylococcus Septicemia-Associated Hemophagocytic Lymphohistiocytosis

Blood ◽  
2016 ◽  
Vol 128 (22) ◽  
pp. 4905-4905
Author(s):  
Hongxia Qiu ◽  
Meng Song ◽  
Fang Ni ◽  
Jujuan Wang
Keyword(s):  
Bone Marrow ◽  
Hemophagocytic Lymphohistiocytosis ◽  
Therapeutic Response ◽  
Gamma Globulin ◽  
Conflicts Of Interest ◽  
Laboratory Data ◽  
Clinical Manifestations ◽  
Hepatic Function ◽  
Risk Of Death ◽  
Medical University

Abstract Abstract Objective: To analyze the epidemic characters, pathogenesis, clinical manifestations, laboratory data, therapeutic response, and prognosis in patients with staphylococcus septicemia-associated hemophagocytic lymphohistiocytosis(HLH). Methods A r Objective To analyze the epidemic characters, pathogenesis, clinical manifestations, laboratory data, therapeutic response, and prognosis in patients with staphylococcus septicemia-associated hemophagocytic lymphohistiocytosis(HLH). Methods: retrospective study was performed on 7 patients with staphylococcus septicemia-associated HLH who were admitted to The First Affiliated Hospital of Nanjing Medical University from January 2010 to December 2014. Results Seven out of 633patients(1.11%) with staphylococcus septicemia were confirmed to have HLH. The incidence of HLH in staphylococcus subspecies were:S.caprae, 12.50%;S.warneri, 12.50%;Methicillin-resistant Staphylococcusaureus(MRSA), 3.23%;S.hominis, 1.40%;S.haemolyticus, 1.25%;S.epidermidis, 0.59%, respectively. The main clinical manifestations included persistentfever(100%) and splenomegaly(85.71%). The most prominent laboratory abnormalities werehemocytopenia, abnormal hepatic function, and elevated ferritin. Bone marrow aspirations were performed on 6 patients and all of them hadhemophagocytosis shown in bone marrow smears. Among 7 patients, 4 patientssurvived(57.14%) and 3 patients died(42.86%). All the 4 cured patients were treated with antibiotic plus corticosteroid. And 2 of them used gamma globulin, while one used the COP chemotherapy regimen. Treatment with antibiotic plus corticosteroid was effective in our study. Conclusion Treatment with antibiotic plus corticosteroid was recommended for staphylococcus septicemia-associated HLH, and gamma globulin may also be useful in reducing the risk of death. Disclosures No relevant conflicts of interest to declare.

scholarly journals COVID-19-related acute kidney injury; incidence, risk factors and outcomes in a large UK cohort

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Paul D. Jewell ◽  
Kate Bramham ◽  
James Galloway ◽  
Frank Post ◽  
Sam Norton ◽  
...  
Keyword(s):  
Risk Factors ◽  
Acute Kidney Injury ◽  
Renal Impairment ◽  
Strong Predictor ◽  
Kidney Injury ◽  
Injury Incidence ◽  
Tertiary Centre ◽  
Incidence Risk ◽  
Stage 1 ◽  
Worse Prognosis

Abstract Background Acute kidney injury (AKI) is common among patients hospitalised with COVID-19 and associated with worse prognosis. The aim of this study was to investigate the epidemiology, risk factors and outcomes of AKI in patients with COVID-19 in a large UK tertiary centre. Methods We analysed data of consecutive adults admitted with a laboratory-confirmed diagnosis of COVID-19 across two sites of a hospital in London, UK, from 1st January to 13th May 2020. Results Of the 1248 inpatients included, 487 (39%) experienced AKI (51% stage 1, 13% stage 2, and 36% stage 3). The weekly AKI incidence rate gradually increased to peak at week 5 (3.12 cases/100 patient-days), before reducing to its nadir (0.83 cases/100 patient-days) at the end the study period (week 10). Among AKI survivors, 84.0% had recovered renal function to pre-admission levels before discharge and none required on-going renal replacement therapy (RRT). Pre-existing renal impairment [odds ratio (OR) 3.05, 95%CI 2.24–4,18; p <  0.0001], and inpatient diuretic use (OR 1.79, 95%CI 1.27–2.53; p <  0.005) were independently associated with a higher risk for AKI. AKI was a strong predictor of 30-day mortality with an increasing risk across AKI stages [adjusted hazard ratio (HR) 1.59 (95%CI 1.19–2.13) for stage 1; p < 0.005, 2.71(95%CI 1.82–4.05); p < 0.001for stage 2 and 2.99 (95%CI 2.17–4.11); p < 0.001for stage 3]. One third of AKI3 survivors (30.7%), had newly established renal impairment at 3 to 6 months. Conclusions This large UK cohort demonstrated a high AKI incidence and was associated with increased mortality even at stage 1. Inpatient diuretic use was linked to a higher AKI risk. One third of survivors with AKI3 exhibited newly established renal impairment already at 3–6 months.

scholarly journals Risk factors for acute kidney injury among patients with rhabdomyolysis

2020 ◽  
Author(s):  
Jia Yang ◽  
Jiaojiao Zhou ◽  
Xin Wang ◽  
Siwen Wang ◽  
Yi Tang ◽  
...  
Keyword(s):  
Risk Factors ◽  
Acute Kidney Injury ◽  
High Risk ◽  
Hospital Mortality ◽  
Laboratory Data ◽  
Elevated Serum ◽  
Kidney Injury ◽  
Chronic Alcoholism ◽  
Multiple Organ ◽  
Bee Sting

Abstract Background Acute kidney injury (AKI) is a life-threatening complication of rhabdomyolysis (RM). The aim of the present study was to assess patients at high risk for the occurrence of AKI defined by the Kidney Disease Improving Global Outcomes criteria and in-hospital mortality. Methods We performed a retrospective study of patients with creatine kinase levels >1000 U/L, who were admitted to the West China Hospital of Sichuan University between January 2011 and March 2019. The sociodemographic, clinical and laboratory data of these patients were obtained from an electronic medical records database, and univariate and multivariate regression analyses were subsequently conducted. Results For the 329 patients included in our study, the incidence of AKI was 61.4%, and the overall mortality rate was 19.8%; furthermore, patients with AKI tended to have higher mortality rates than those without AKI (24.8% vs. 11.8%; P<0.01). The clinical conditions most frequently associated with RM were trauma (28.3%), sepsis (14.6%), bee sting (12.8%), thoracic and abdominal surgery (11.2%) and exercise (7.0%). Furthermore, patients with RM resulting from sepsis, bee sting and acute alcoholism were more susceptible to AKI. The risk factors for the occurrence of AKI among RM patients included age ≥60 years (OR=3.070), chronic alcoholism (OR=3.256), hypertension (OR=4.252), multiple organ dysfunction syndrome (MODS; OR=7.244), high levels of white blood cell count (OR=1.047) and elevated serum phosphorus (OR=5.526). Age ≥60 years (OR=3.188), MODS (OR=2.262), diabetes (OR=2.746) and elevated prothrombin time (OR=1.079) were independent risk factors for in-hospital mortality in RM patients with AKI. Conclusions AKI is independently associated with mortality in patients with RM, and several risk factors were found to be associated with the occurrence of AKI and in-hospital mortality. These findings suggest that, to improve the quality of medical care, the early prevention of AKI should focus on high-risk patients and more effective management.

scholarly journals Acute kidney injury in patients with severe COVID-19 in Mexico

2020 ◽  
Author(s):  
GUSTAVO CASAS ◽  
MARIA-ISABEL LEON ◽  
MAURICIO GONZALEZ-NAVARRO ◽  
CLAUDIA ALVARADO DE LA BARRERA ◽  
Santiago Avila-Rios ◽  
...  
Keyword(s):  
Risk Factors ◽  
Mechanical Ventilation ◽  
Acute Kidney Injury ◽  
Serum Creatinine ◽  
Systemic Disease ◽  
Invasive Mechanical Ventilation ◽  
Laboratory Data ◽  
Kidney Injury ◽  
Vasoactive Drugs ◽  
D Dimer

Introduction: Some patients with COVID-19 pneumonia present systemic disease involving multiple systems. There is limited information about the clinical characteristics and events leading to acute kidney injury (AKI). We described the factors associated with the development of AKI and explored the relation of AKI and mortality in Mexican population with severe COVID-19. Methods: We retrospectively reviewed the medical records of individuals with severe pneumonia caused by SARS-CoV-2 hospitalized at the largest third-level reference institution for COVID-19 care in Mexico between March and April 2020. Demographic information, comorbidities, clinical and laboratory data, dates of mechanical ventilation and hospitalization, mechanical-ventilator settings and use of vasoactive drugs were recorded. Results: Of 99 patients studied, 58 developed AKI (58.6%). The group with AKI had higher body mass index (p=0.0003) and frequency of obesity (p=0.001); a higher requirement of invasive mechanical ventilation (p=0.008) and vasoactive drugs (p=0.004); greater levels of serum creatinine (p<0.001) and D-dimer on admission (p<0.001); and lower lymphocyte counts (p=0.001) than the non-AKI group. The multivariate analysis indicated that risk factors for AKI were obesity (adjusted hazard ratio (HR)=2.71, 95% confidence interval (CI)=1.33-5.51, p=0.005); higher serum creatinine (HR=1.44, CI=1.02-2.02, p=0.035) and D-dimer levels on admission (HR=1.14, CI=1.06-1.23, p<0.001). In-hospital mortality was higher in the AKI group than in the non-AKI group (65.5% vs. 14.6%; p=0.001). Conclusions: AKI was common in our cohort of patients with severe COVID-19 and it was associated with mortality. The risk factors for AKI were obesity, elevated creatinine levels and higher D-dimer levels on admission. Key words: Acute kidney injury; AKI; acute renal failure; COVID-19; SARS-CoV-2.

MO370PREGNANCY-RELATED ACUTE KIDNEY INJURY IN TUNISIA: A CLINICAL CHALLENGE

2021 ◽  
Vol 36 (Supplement_1) ◽  
Author(s):  
Menel Msehli ◽  
Hela Jbali ◽  
Mami Ikram ◽  
Badreddine Ben kaab ◽  
Fethi Ben hamida ◽  
...  
Keyword(s):  
Risk Factors ◽  
Acute Kidney Injury ◽  
Renal Failure ◽  
Prenatal Care ◽  
Clinical Manifestations ◽  
Kidney Injury ◽  
Morbidity And Mortality ◽  
Renal Outcome ◽  
Clinical Feature ◽  
High Morbidity

Abstract Background and Aims Acute kidney injury (AKI) is a complex disorder that occurs in several clinical settings. During pregnancy, there are additional unique conditions that contribute to AKI. The clinical manifestations of Pregnancy related acute kidney injury(PRAKI) range from a minimal elevation in serum creatinine to severe renal failure requiring renal replacement therapy and may be associated with significant morbidity and mortality in young healthy women. This study aims to describe epidemiologic features, study clinical profile and outcomes of women with PRAKI and identify risk factors related to requiring hemodialysis among patients. Method We performed a retrospective study over a 5-year period (2015–2019) in a Tunisian intensive care unit. All patients presenting PRAKI were included. Results Ninety-six cases of PRAKI were listed. The rate of AKI during pregnancy-related hospitalizations was 16% .the average age was 31 ± 5 years. Most women were from urban areas (62%) but with insufficient prenatal care (57%).Seventy-eight percent underwent cesarean section delivery. PRAKI occurred in the postpartum in 79%of the cases. Oligo-anuria was the most common clinical feature of PRAKI, noted in 82% of our patients. The leading etiological causes were pre eclampsia, eclampsia, postpartum haemorrhage and sepsis respectively, in 49%, 38%, and 24% of the cases. Hemodialysis was required in 23% of cases. In the adjusted regression analysis, factors associated with dialysis were insufficient prenatal care (p=0,010 ; O Ra=24,113), HELLP syndrome (p=0,003 ; ORa=35,129), disseminated intravascular coagulation (p=0,007 ; OR=11,854), average duration of oliguria (p=0,001; ORa=3,025) , Failure stage of RIFLE criteria while admitted (p=0,009; ORa=2,09) and length of ICU stay (p=0,042 ; ORa=1,118). Renal outcome was favorable, with a complete renal function recovery for 72 patients (75%). Only four patients (4%) developed chronic renal failure. Mortality rate was 13%. Conclusion PRAKI is a dreaded complication of pregnancy with high morbidity and mortality. Prevention of PRAKI requires an improvement of the sanitary infrastructures with the implementation of an obligatory prenatal consultation in order to prompt management of the underlying risk factors

scholarly journals Incidence and Epidemiology of Acute Kidney Injury in a Pediatric Malawian Trauma Cohort: a Prospective Observational Study

2020 ◽  
Author(s):  
Erica C. Bjornstad ◽  
William Muronya ◽  
Zachary H. Smith ◽  
Keisha Gibson ◽  
Amy K Mottl ◽  
...  
Keyword(s):  
Risk Factors ◽  
Acute Kidney Injury ◽  
Pediatric Trauma ◽  
Kidney Injury ◽  
Herbal Remedies ◽  
Trauma Patients ◽  
Tertiary Referral Hospital ◽  
Risk Of Death ◽  
Relative Risks ◽  
Baseline Creatinine

Abstract Introduction: Acute kidney injury (AKI) is highly associated with mortality risk in children worldwide. Trauma can lead to AKI and is a leading cause of pediatric death in Africa. However, there is no information regarding the epidemiology of pediatric, trauma-associated AKI in Africa.Methods: Prospective cohort study of pediatric trauma patients admitted to a tertiary referral hospital in Malawi. Participants enrolled at admission were followed prospectively throughout their hospitalization. AKI was defined by sequential serum creatinine measurements and Kidney Disease Improving Global Outcomes criteria. We calculated descriptive statistics and univariate relative risks (RR) for hypothesis-generation of potential risk factors associated with AKI.Results: We analyzed data from 114 participants. Depending on baseline creatinine definition, AKI incidence ranged from 4-10%. The new Schwartz equation estimated baseline creatinine values best and yielded an AKI incidence of 9.7%. Almost one in ten children died during hospitalization, but those with AKI (n=4) were at significantly higher risk of death compared to those without AKI (40.0% vs 6.2%; RR 6.5, 95% CI 2.2-19.1). Burn injuries were most commonly associated with AKI (63.6%). Other potential AKI risk factors included multiple injuries, trunk or facial injuries, and recent consumption of herbal remedies.Conclusions: AKI occurs in 10% of admitted pediatric trauma patients in Malawi and increases the risk of death 7-fold compared to those without AKI. This large unrecognized burden in trauma requires further investment by researchers, clinicians and policymakers to develop evidenced-based triage, recognition, and management approaches to prevent the associated sequelae and potential mortality from AKI.

scholarly journals Prevalence, Risk Factors and Outcomes Associated with Acute Kidney Injury in Patients Hospitalized for COVID-19: A Comparative Study between Diabetic and Nondiabetic Patients

2021 ◽  
Vol 2021 ◽  
pp. 1-9
Author(s):  
Shayesteh Khalili ◽  
Tahereh Sabaghian ◽  
Meghdad Sedaghat ◽  
Zahra Soroureddin ◽  
Elham Askari ◽  
...  
Keyword(s):  
Risk Factors ◽  
Acute Kidney Injury ◽  
Invasive Mechanical Ventilation ◽  
Laboratory Data ◽  
Kidney Injury ◽  
Tertiary Hospital ◽  
Diabetes Status ◽  
Patients With Diabetes ◽  
History Of ◽  
Stage 1

Background. The risk factors for acute kidney injury (AKI) development in patients with diabetes hospitalized for COVID-19 have not been fully studied yet. In this study, we aimed to estimate the rate of AKI among the hospitalized population with COVID-19 and to identify the risk factors associated with AKI among patients with diabetes. Material and Methods. This retrospective cohort study included 254 patients (127 with diabetes and 127 without diabetes) who were admitted for COVID-19 to a tertiary hospital in Tehran, Iran, between February and May 2020. Clinical characteristics and outcomes, radiological findings, and laboratory data, including data on AKI, hematuria, and proteinuria were recorded and analyzed. Results. Of 254 patients, 142 (55.9%) were male and the mean (± SD) age was 65.7 years (±12.5). In total, 58 patients (22.8%) developed AKI during hospitalization, of whom 36 patients had diabetes ( p = 0.04 ); most patients (74.1%) had stage 1 or 2 AKI. Also, 8 patients (13.8%) required renal replacement therapy (RRT) after developing AKI. Regardless of diabetes status, patients who developed AKI had significantly higher mortality rates compared with patients who did not develop AKI ( p = 0.02 ). Hematuria and proteinuria were observed in 38.1% and 55% of patients, respectively. Multivariate analysis showed that invasive mechanical ventilation, proteinuria, HBA1c level, history of cardiovascular disease, and use of statins were independent risk factors for AKI development in patients with diabetes. Conclusion. Results of this study showed that AKI develops in a considerable percentage of patients with COVID-19, especially in those with diabetes, and is significantly associated with mortality.

scholarly journals Acute kidney injury in patients with severe COVID-19 in Mexico

PLoS ONE ◽  
2021 ◽  
Vol 16 (2) ◽  
pp. e0246595
Author(s):  
Gustavo A. Casas-Aparicio ◽  
Isabel León-Rodríguez ◽  
Claudia Alvarado-de la Barrera ◽  
Mauricio González-Navarro ◽  
Amy B. Peralta-Prado ◽  
...  
Keyword(s):  
Risk Factors ◽  
Acute Kidney Injury ◽  
Stress Test ◽  
Systemic Disease ◽  
Invasive Mechanical Ventilation ◽  
Laboratory Data ◽  
Kidney Injury ◽  
Severe Pneumonia ◽  
Older Age ◽  
Vasoactive Drugs

Introduction Some patients with COVID-19 pneumonia present systemic disease involving multiple systems. There is limited information about the clinical characteristics and events leading to acute kidney injury (AKI). We described the factors associated with the development of AKI and explored the relation of AKI and mortality in Mexican population with severe COVID-19. Methods We retrospectively reviewed the medical records of individuals with severe pneumonia caused by SARS-CoV-2 hospitalized at the largest third-level reference institution for COVID-19 care in Mexico between March and April 2020. Demographic information, comorbidities, clinical and laboratory data, dates of invasive mechanical ventilation (IMV) and hospitalization, mechanical-ventilator settings and use of vasoactive drugs were recorded. Results Of 99 patients studied, 58 developed AKI (58.6%). The risk factors for AKI were older age (OR = 1.07, 95% CI = 1.01–1.13, p = 0.024); obesity (OR = 6.58, 95% CI = 1.8–24.05, p = 0.040); and the need for IMV (OR = 6.18, CI = 1.29–29.58, p = 0.023). The risk factors for mortality were obesity (OR = 5.57, 95% CI = 1.48–20.93, p = 0.011); requirement of vasoactive drugs on admission (OR = 5.35, 95% CI = 1.16–24.61, p = 0.031); and AKI (OR = 8.61, 95% CI = 2.24–33.1, p = 0.002). In-hospital mortality was significantly higher in patients with AKI stage 3 (79.3%) and AKI stage 2 (68.7%) compared with those with AKI stage 1 (25%; p = 0.004). Fifty-three patients underwent the furosemide stress test (FST) to predict progression to AKI stage 3. Of those, 12 progressed to AKI stage 3 (22%). The ROC curve for the FST had an AUC of 0.681 (p = 0.009); a sensitivity of 81.6% and a specificity of 54.5%. Conclusions AKI was common in our cohort of patients with severe pneumonia caused by SARS-CoV-2 infection. The risk factors for AKI were older age, obesity and the need for of IMV on admission. The risk factors for mortality were obesity, requirement of vasoactive drugs on admission and AKI. Mortality was more frequent in patients with AKI stages 2–3. The FST had an acceptable predictive capacity to identify patients progressing to AKI stage 3.

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