Caution on Kidney Dysfunctions of COVID-19 Patients

SummaryBackgroundTo date, large amounts of epidemiological and case study data have been available for the Coronavirus Disease 2019 (COVID-19), which suggested that the mortality was related to not just respiratory complications. Here, we specifically analyzed kidney functions in COVID-19 patients and their relations to mortality.MethodIn this multi-centered, retrospective, observational study, we included 193 adult patients with laboratory-confirmed COVID-19 from 2 hospitals in Wuhan, 1 hospital in Huangshi (Hubei province, 83 km from Wuhan) and 1 hospital in Chongqing (754 km from Wuhan). Demographic data, symptoms, laboratory values, comorbidities, treatments, and clinical outcomes were all collected, including data regarding to kidney functions. Data were compared among three groups: non-severe COVID-19 patients (128), severe COVID-19 patients (65) and a control group of other pneumonia (28). For the data from computed tomographic (CT) scans, we also included a control group of healthy subjects (110 cases, without abnormalities in the lung and without kidney diseases). The primary outcome was a common presence of kidney dysfunctions in COVID-19 patients and the occurrence of acute kidney injury (AKI) in a fraction of COVID-19 patients. Secondary outcomes included a survival analysis of COVID-19 patients in conditions of AKI or comorbid chronic illnesses.FindingsWe included 193 COVID-19 patients (128 non-severe, 65 severe (including 32 non-survivors), between January 6th and February 21th,2020; the final date of follow-up was March 4th, 2020) and 28 patients of other pneumonia (15 of viral pneumonia, 13 of mycoplasma pneumonia) before the COVID-19 outbreak. On hospitaladmission, a remarkable fraction of patients had signs of kidney dysfunctions, including 59% with proteinuria, 44% with hematuria, 14% with increased levels of blood urea nitrogen, and 10% with increased levels of serum creatinine, although mild but worse than that in cases with other pneumonia. While these kidney dysfunctions might not be readily diagnosed as AKI at admission, over the progress during hospitalization they could be gradually worsened and diagnosed as AKI. A univariate Cox regression analysis showed that proteinuria, hematuria, and elevated levels of blood urea nitrogen, serum creatinine, uric acid as well as D-dimer were significantly associated with the death of COVID-19 patients respectively. Importantly, the Cox regression analysis also suggested that COVID-19 patients that developed AKI had a ∼5.3-times mortality risk of those without AKI, much higher than that of comorbid chronic illnesses (∼1.5 times risk of those without comorbid chronic illnesses).InterpretationTo prevent fatality in such conditions, we suggested a high degree of caution in monitoring the kidney functions of severe COVID-19 patients regardless of the past disease history. In addition, upon day-by-day monitoring, clinicians should consider any potential interventions to protect kidney functions at the early stage of the disease and renal replacement therapies in severely ill patients, particularly for those with strong inflammatory reactions or a cytokine storm.FundingNone.

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The Value of Blood Urea Nitrogen in the Prediction of Risks of Cardiovascular Disease in an Older Population

Frontiers in Cardiovascular Medicine ◽

10.3389/fcvm.2021.614117 ◽

2021 ◽

Vol 8 ◽

Author(s):

Qin Lan ◽

Liang Zheng ◽

Xiaohui Zhou ◽

Hong Wu ◽

Nicholas Buys ◽

...

Keyword(s):

Cardiovascular Disease ◽

Regression Analysis ◽

Kidney Disease ◽

Blood Urea Nitrogen ◽

Cox Regression ◽

Older Population ◽

Urea Nitrogen ◽

Cox Regression Analysis ◽

Increased Risk

Background: High blood urea nitrogen (BUN) is associated with adverse outcomes in patients with cardiac disease risks. However, no study has explored whether BUN can predict the risk of cardiovascular disease (CVD) in the healthy older population. This study aims to explore the incidence and risk factors of CVD among a healthy older population community in China.Design and Methods: This study was designed as a cohort study with a 4-year follow-up. We recruited 5,000 older people among 137,625 residents of the Gaohang community. In the baseline, subjects were asked to participate in medical screening and biological tests, and answered survey questions. During the follow-up period (2014–2017), the researchers regularly tested the subjects' indicators and assessment scales. We monitored the occurrence of CVD and explored the relationship between BUN and CVD via a Cox regression analysis.Results: During the follow-up, subjects were newly diagnosed with CVD including heart failure (HF), heart disease events, atrial fibrillation, diabetes, hypertension, metabolic syndrome, and kidney disease. The Cox regression analysis found an association between baseline BUN and incident CVD in female subjects, with higher BUN associated with increased risk of AF in females and kidney disease in both male and females. No association was found between BUN and CVD in male subjects.Conclusions: Current results indicate that BUN is a valuable predictive biomarker of CVD. A higher BUN level (>13.51 mg/dL) is associated with an increased occurrence of HF but a decreased occurrence of diabetes and metabolic symptoms in normal older females.

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Protective role of Nigella sativa oil on renal damage induced by acetaminophen in male rats

The Iraqi Journal of Veterinary Medicine ◽

10.30539/iraqijvm.v40i2.116 ◽

2017 ◽

Vol 40 (2) ◽

pp. 77-81

Author(s):

Zena M. Hamad

Keyword(s):

Serum Creatinine ◽

Blood Urea Nitrogen ◽

Nigella Sativa ◽

Nitrogen Concentration ◽

Antioxidant Properties ◽

Male Rats ◽

Control Group ◽

Urea Nitrogen ◽

Nigella Sativa Oil ◽

Nitrogen Concentrations

Acetaminophen also called paracetamol is commonly used as analgesic and antipyretic agent which in high doses causes liver and kidney damage in man and animals. Nigella sativa oil have antioxidant properties. Thirty adult male rats were used and randomly divided into three equal groups. Group (A) untreated and served as control group; Group (B) rats were orally intubated (by gavages needle) acetaminophen suspension (150mg/kg B.W). Group (C) rats were given orally acetaminophen suspension (150mg/kg) plus 1ml/kg B.W of Nigella sativa oil for 42 days in both treated group. Fasting blood samples were collected at 21 and 42 days of experiment to study the following parameters: Serum creatinine concentration and blood urea nitrogen concentration. The results revealed a significant increase of acetaminophen group in serum creatinine and blood urea nitrogen concentrations as compression with GA. Animals treated with Nigella sativa oil plus acetaminophen (C) showed a significant decline in serum creatinine and blood urea nitrogen concentrations. In conclusion, the acetaminophen was effective in induction of oxidative stress and change in some biological markers related to kidney disease. Also it seems that Nigella sativa oil exerts protective actions against the damaging effect of acetaminophen

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THE NEPHROTOXICITY OF CONCURRENT USE OF ENALAPRIL AND GENTAMICIN IN RATS

Asian Journal of Pharmaceutical and Clinical Research ◽

10.22159/ajpcr.2018.v11i9.26853 ◽

2018 ◽

Vol 11 (9) ◽

pp. 348

Author(s):

Imad M Al-ani ◽

Khaleed R Algantri ◽

Emad M Nafie ◽

Sinan Mohammed Abdullah Al-mahmood

Keyword(s):

Experimental Study ◽

Serum Creatinine ◽

Blood Urea Nitrogen ◽

Normal Saline ◽

Control Group ◽

Sprague Dawley ◽

Concurrent Administration ◽

Urea Nitrogen ◽

Concurrent Use ◽

Sprague Dawley Rats

Objective: The present study was aimed to assess the concurrent administration of Enalapril (ENAL) and Gentamicin (GM) in the kidney of rats.Methods: Sixty male Sprague Dawley rats were divided into 4 main groups (n=15) according to the administered dose. Each main group was further subdivided into three subgroups according to the day of sacrificing (n=5). Group (C) was administered daily with normal saline as control, Group (E) was treated with oral ENAL (2 mg/kg/day), Group (G) was treated with GM (75 mg/kg/day), and Group (EG) was treated ENAL (2 mg/kg/day) and GM (75 mg/kg/day). The handling of the experiment persisted daily for 15 days, and the investigational examination carried out on days 5, 10, and 15.Results: The result showed that GM nephrotoxicity augmented with the period of the experimental study, there was rising in the levels of serum creatinine and blood urea nitrogen on the 10th day and persisted in rising significantly during the period on the 15th day of the experiment. Administration of ENAL showed no significant alteration from those of controls. While the concurrent administration of ENAL and GM showed that ENAL gradually increased GM nephrotoxicity, these physiological retrogressions were accompanied with intensive renal histopathological deteriorations.Conclusion: The present study has revealed that the concurrent administration of ENAL enormously aggravated the functional and histological nephrotoxicity of GM in rats.

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Effects of injection Shenkang and alprostadil combination on contrast-induced nephropathy in patient with diabetes complicated with mild to moderate renal insufficiency

Bangladesh Journal of Pharmacology ◽

10.3329/bjp.v12i3.32070 ◽

2017 ◽

Vol 12 (3) ◽

pp. 308 ◽

Cited By ~ 1

Author(s):

Yanfang Zhang ◽

Jianxun Sun ◽

Hui Liu ◽

Xiaolin Zhai

Keyword(s):

Renal Insufficiency ◽

Serum Creatinine ◽

Creatinine Clearance ◽

Blood Urea Nitrogen ◽

Control Group ◽

Diabetic Patients ◽

Observation Group ◽

Contrast Induced Nephropathy ◽

Urea Nitrogen ◽

Moderate Renal Insufficiency

<p class="Abstract">The diabetic patients (n=109) with mild or moderate renal insufficiency underwent coronary intervention were randomly divided into control group and observation group. The patients in observation group were treated with injection Shenkang and alprostadil before operation. The results showed that the level of serum creatinine, creatinine clearance and blood urea nitrogen had no significant difference (p>0.05) before and postoperative day 1 and day 2 in both groups. However, the value of serum creatinine, creatinine clearance and blood urea nitrogen were significantly different on post-operative day 3 (p<0.05). The incidence of contrast-induced nephropathy was 14.8% in control group, and markedly higher than observation group (3.6%) (p<0.05). Shenkang injection combined with alprostadil injection decreased the incidence of contrast-induced nephropathy in elderly patients with diabetes mellitus complicated with mild to moderate renal insufficiency.</p>

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Renal-protective Activity of Dried Gel of Aloe barbadensis (Elwa) on Gentamicin- Induced Nephrotoxicity in Albino Rats

Current Traditional Medicine ◽

10.2174/2215083806999201020211934 ◽

2020 ◽

Vol 06 ◽

Author(s):

Aslam M. ◽

Shabana Rahman ◽

Kalim Javed ◽

Fahamiya Nazeem ◽

Shiffa Mohamed

Keyword(s):

Blood Urea Nitrogen ◽

Renal Damage ◽

Skin Diseases ◽

Kidney Diseases ◽

Control Group ◽

Albino Rats ◽

Histopathological Analysis ◽

Aloe Barbadensis ◽

Urea Nitrogen ◽

Group I

Introduction:: Elwa (Aloe barbadensis / Aloe vera) also known as Sibr in Unani medicine which is dried juice obtained by the inspissations and used to treat many diseases, especially digestive disorders, arthritis, gastric ulcer, jaundice, amenorrhoea, kidney diseases, diseases of spleen and liver, constipation, nervine disorders, wounds, burns, scalds and other skin diseases. Methods:: The aim of this study was to evaluate the nephroprotective activity of Aloe barbadensis gel (ABG) on gentamicin-induced nephrotoxicity in rats. Wistar rats were divided into four groups of six animals in each. Group I (control); group II, III and IV were administered gentamicin 100 mg/kg/d subcutaneously from day four to eight. The lower (350 mg/kg) and higher doses (1260 mg/kg) of crude ABG were co-administrated orally in group III and group IV from day 1. On 9th day animals were sacrificed and serum was studied for blood urea nitrogen and serum creatinine and kidneys were prepared for histo-pathological analysis. Gentamicin alone treated group showed increased levels of blood urea nitrogen (118.76  0.90) and creatinine (3.42  0.13) were significantly inhibited in groups pretreated with lower [blood urea nitrogen (40.130.56); creatinine (1.640.13)] and higher [blood urea nitrogen (55.79  0.71); creatinine (2.50  0.06)] doses of crude Aloe barbadensis gel. Results:: The histopathological analysis also showed the protective nature of Aloe barbadensis gel in gentamicin-induced renal damage. Discussion:: In conclusion, the biochemical parameters and histopathological results confirmed nephroprotective effect of the crude Aloe barbadensis gel against gentamicin induced renal damage.

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Development and Validation of a Simple Equation to Evaluate Dietary Protein Intake Using the Blood Urea Nitrogen/Serum Creatinine Ratio in Patients With Stage 3 Chronic Kidney Disease

10.21203/rs.3.rs-112166/v1 ◽

2020 ◽

Author(s):

Yanhui Wang ◽

Zujiao Chen ◽

Jing Li ◽

Zhen Li ◽

Jianteng Xie ◽

...

Keyword(s):

Chronic Kidney Disease ◽

Regression Analysis ◽

Kidney Disease ◽

Serum Creatinine ◽

Blood Urea Nitrogen ◽

Dietary Protein ◽

Protein Intake ◽

Simple Equation ◽

Dietary Protein Intake ◽

Urea Nitrogen

Abstract Background: A simple, effective and convenient method to assess dietary protein intake (DPI) for chronic kidney disease (CKD) patients is urgently needed in clinical practice. We developed a simple equation to evaluate DPI in patients with stage 3 CKD with the blood urea nitrogen (BUN)/serum creatinine (SCr) ratio (BUN/SCr).Methods: In a prospective cohort of 136 inpatients with stage 3 CKD from 2 centres, we developed estimation equations based on BUN/SCr and the spot urinary urea nitrogen (UUN)/urinary creatinine (UCr) ratio (UUN/UCr) in combination with sex and body mass index (BMI). These equations were then internally and externally validated.Results: The following candidate parameters were derived from univariate regression analysis for 5 established models: sex, BMI, BUN/SCr, UUN and UUN/UCr. Sex and BMI were included in all models after variable evaluation using multiple regression analysis. UUN, UUN/UCr and BUN/SCr were included in model 3, model 4 and model 5, respectively. Both internal validation and external validation indicated that model 5 resulted in the lowest values of bias and root mean square error and the highest P30 compared with model 3 and model 4. Therefore, the model 5 equation, DPI= -5.18 (-14.49 if the patient is female) +1.89×BMI+1.38×BUN/SCr, was selected because of the higher correlation [r = 0.498 (95% confidence interval 0.163,0.719)] and the smaller distribution of the difference between the predicted and measured protein intakes than those of the other models.Conclusion: The DPI equation developed using BUN/SCr, sex and BMI may be used to estimate protein intake for patients with stage 3 CKD.Trial registrationChinese Clinical Trial Registry Center (ChiCTR-ROC-17011363). Registered in 11 May 2017, Retrospectively registered, http://www.chictr.org.cn/index.aspx

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Clinical and prognostic significance of PMN in children with glomerular C1q deposition

10.21203/rs.3.rs-23486/v1 ◽

2020 ◽

Author(s):

Ren Wang ◽

Meiqiu Wang ◽

Zhengkun Xia ◽

Chunlin Gao ◽

Zhuo Shi ◽

...

Keyword(s):

Regression Analysis ◽

Renal Dysfunction ◽

Cox Regression ◽

Age At Onset ◽

Prognostic Significance ◽

Control Group ◽

Cox Regression Analysis ◽

Pathological Characteristics ◽

Kaplan Meier ◽

Renal Prognosis

Abstract Background Currently, studies to data in MN are consistent with complement activation has an essential role in mediating renal injury, and the LP is considered to be the principal pathway in PMN. CP activation initiated by C1q which deposits are suggestive of SMN. However, C1q deposition together with IgG and C3 granular deposit is found in many cases of PMN. Currently, the clinical and prognostic significance of C1q deposition in PMN is unclear. Therefore, we conduct this single-center research to explore the clinical and prognostic significance of C1q deposition in children with PMN. Method: 73 patients with C1q deposition were enrolled in this study. According to the “Case-control matching principle”, 73 patients without C1q deposition during the same period of the renal biopsy were selected as a control group. The clinical and pathological characteristics, treatment response, and long-term renal prognosis were compared between patients with and without C1q deposition. Result A total of 146 pediatric patients with PMN included with 86 men(58.9%) and 60 women (41.1%). The median age at onset was 15.0 (14.0—16.0) years. During an average follow-up of 52.4 ± 35.6 months, 8 patients (5.5%) progressed ESKD, 12 (8.2%) patients developed ESRD or renal dysfunction. The frequency of glomerular C4 deposits in the C1q deposits group was significantly higher than no C1q deposits group (34.2% vs 5.5%, p = 0.000). There were no other distinct differences in clinical and pathological characteristics between the two groups. Glomerular IgG subclasses were available in 79 patients, there was no difference in the glomerular IgG subclass distribution between the two groups (p IgG1=0.468,p IgG2=1.000༌p IgG3=0.988༌p IgG4=0.216). The Kaplan-Meier survival analysis found that there was no difference in the renal survival of ESRD (p = 0.415) and a combined event of ESRD and/or renal dysfunction (p = 0.214) between the two groups. The logistic regression analysis (p = 0.553) and Cox regression analysis (p = 0.618) revealed that C1q deposition failed to associate with renal dysfunction. Conclusion The CP does occur in some patients of PMN. However, it may be unrelated to the progression of the disease.

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Analysis of the Factors Associated with Negative Conversion of Severe Acute Respiratory Syndrome Coronavirus 2 RNA of Coronavirus Disease 2019

Open Access Macedonian Journal of Medical Sciences ◽

10.3889/oamjms.2020.5488 ◽

2020 ◽

Vol 8 (T1) ◽

pp. 436-442

Author(s):

Nan Jiang ◽

Yang Liu ◽

Bo Yang ◽

Zhijun Li ◽

Daoyuan Si ◽

...

Keyword(s):

Regression Analysis ◽

Severe Acute Respiratory Syndrome ◽

Cox Regression ◽

Univariate Analysis ◽

The Body ◽

Control Group ◽

Cox Regression Analysis ◽

Factors Associated ◽

And Control ◽

Negative Conversion

AIM: To understand the factors associated with negative conversion of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) RNA, targeted surveillance and control measures can be taken to provide scientific basis for the treatment of the disease and to improve the prognosis of the disease. METHODS: Using the method of retrospective cohort study, we collected the data of Coronavirus Disease 2019 (COVID-19) patients in Tongji Hospital of Wuhan, China from 10 January to 25 March, 2020. Among the data of 282 cases, 271 patients, according to whether the negative conversion happened, were divided into negative conversion group and control group. We made the quantitative variables into classification; Chi-square test single-factor and Cox regression were used in univariate analysis and extracted 30 meaningful variables, then through the collinearity diagnosis, excluded the existence of collinear variables. Finally, 22 variables were included in Cox regression analysis. RESULTS: The gender distribution was statistically significant between two groups (p < 0.05). While in the negative conversion group, the patients of non-severe group occupied a large proportion (p < 0.001). The median time for the negative conversion group was 17 days, and at the end of the observation period, the virus duration in control group was 24 days (p < 0.05). A total of 55 variables were included in univariate analysis, among which 30 variables were statistically different between the two groups. After screening variables through collinearity diagnosis, 22 variables were included in the Cox regression analysis. Last, lactate dehydrogenase (LDH), age, fibrinogen (FIB), and disease severity were associated with negative conversion of SARS-CoV-2 RNA. CONCLUSION: Our results suggest that in the treatment of COVID-19, focus on the age of more than 65 years old, severe, high level of LDH, FIB patients, and take some targeted treatment, such as controlling of inflammation, reducing organ damage, so as to provide good conditions for virus clearance in the body.

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Effect of changing treatment to high-flux hemodialysis (HFHD) on mortality in patients with long-term low flux hemodialysis (LFHD): a propensity score matched cohort study

BMC Nephrology ◽

10.1186/s12882-020-02145-5 ◽

2020 ◽

Vol 21 (1) ◽

Author(s):

Shuxin Liu ◽

Hong Liu ◽

Zhihong Wang ◽

Lanbo Teng ◽

Cui Dong ◽

...

Keyword(s):

Regression Analysis ◽

Propensity Score ◽

Cox Regression ◽

Survival Rates ◽

Stable Condition ◽

Rank Test ◽

Control Group ◽

High Flux ◽

Cox Regression Analysis

Abstract Background The purpose of this study was to explore the effect of changing treatment to high-flux hemodialysis (HFHD) on mortality rate in patients with long-term low flux hemodialysis (LFHD). Methods The patients with end-stage renal disease (ESRD) who underwent LFHD with dialysis age more than 36 months and stable condition in our hospital before December 31, 2014 were included in this study. They were divided into control group and observation group. Propensity score matched method was used to select patients in the control group. The hemodialysis was performed 3 times a week for 4 h. The deadline for follow-up is December 31, 2018. End-point event is all-cause death. The survival rates of the two groups were compared and multivariate Cox regression analysis was carried out. Results K-M survival analysis showed that the 1-year, 2-year, 3-year and 4-year survival rates of HFHD group were 98, 96, 96 and 96%, respectively. The 1-year, 2-year, 3-year and 4-year survival rates of LFHD group were 95, 85, 80 and 78%, respectively. Log-rank test showed that the survival rate of HFHD group was significantly higher than that of LFHD group (x2= 7.278, P = 0.007). Multivariate Cox regression analysis showed that male, age, hemoglobin and low-throughput dialysis were independent predictors of death (P < 0.05). Compared with LFHD, HFHD can significantly reduce the mortality risk ratio of patients, as high as 86%. Conclusion The prognosis of patients with ESRD who performed long-term LFHD can be significantly improved after changing to HFHD.

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Effects Of Metformin Addition To a Standard Chemotherapy Regimen For The Treatment Of Adult Acute Lymphoblastic Leukemia. An In Vitro and In Vivo study

Blood ◽

10.1182/blood.v122.21.5024.5024 ◽

2013 ◽

Vol 122 (21) ◽

pp. 5024-5024

Author(s):

Christian Omar Ramos Peñafiel ◽

Irma Olarte Carrillo ◽

Jorge Zamora Domínguez ◽

Humberto Baldemar Castellanos Sinco ◽

Etta Rozen Fuller ◽

...

Keyword(s):

Regression Analysis ◽

Acute Lymphoblastic Leukemia ◽

Odds Ratio ◽

Cox Regression ◽

Lymphoblastic Leukemia ◽

Control Group ◽

Cox Regression Analysis ◽

Adult Acute Lymphoblastic Leukemia

Abstract Antitumor effects of metformin are widely known. Unfortunately their use in the treatment of acute lymphoblastic leukemia is limited. Study design The study consisted of two stages Phase 1: Cell assay adding metformin (40mM) assessing the viability and cell cycle in the cell line molt 4 Phase 2: Pilot study adding Metformin (850mg three time day) during the pre-treatment with steroids and the induction remission phase versus a control group (2:1 randomization) Statistical analysis Chi-square analysis was used to corroborate the hypothesis. The odds ratio was calculated for both, the absence of Good steroid response and refractory leukemia. Cox regression analysis and Kaplan-Meier curves were used for the survival analysis Results Celular assay. Metformin inhibited cell viability at 120hours reducing the percentage of cells in phase S. Clinical assay. 151 patients were studied, 44 (29.1%) on Metformin arm, of these 59.1% ( n=26) archived a GSR compared with the control group (26.2%, n=28). A greater number of complete remission were presented in Metformin arm (81.8% versus 57.9%) shown to be a protective factor for GSR and complete remissions (odds ratio ; 0.2454 y 0.3062 respectively). In the Cox regression analysis, Metformin significantly impact in the global survival (p=0,012,95% IC) versus the other variables studied. Conclusions Metformin is useful both in vivo and in vitro treatment of adult acute lymphoblastic leukemia. Disclosures: No relevant conflicts of interest to declare.

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