Detection of SARS-CoV-2 in peritoneal fluid from patients with kidney disease and COVID-19: report of two cases

Abstract Background: Coronavirus disease-2019 (COVID-19) has a broad clinical presentation, involving multiple organs besides the respiratory system. Currently, there is little evidence available on the presence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in peritoneal fluid (PF). In this study, we describe the detection of SARS-CoV-2 in the PF of two patients with COVID 19 and kidney disease.Case presentation: Case 1: A 71-year-old woman with a history of end-stage kidney disease who presented with a 15-day evolution of progressive dyspnea, accompanied by dry cough and fever; IgM antibodies to SARS-CoV-2 were detected on admission. Real-time SARS-CoV-2 polymerase chain reaction (qRT-PCR) in the PF was positive. Three days after admission the patient's respiratory distress improved and she was discharged after 8 days of hospitalization.Case 2: A 78-year-old woman, with type 2 diabetes, hypertension, a 15-day history of polypnea, and a 5-day onset of fever and dyspnea. IgM and IgG antibodies to SARS-CoV-2 were detected on admission, as well as a positive nasopharyngeal qRT-PCR test for SARS-CoV-2. During hospitalization she developed acute kidney injury, requiring peritoneal dialysis, SARS-CoV-2 was confirmed in PF by qRT-PCRConclusions: These two cases highlights the importance of increasing the level of awareness for the presence and possible SARS-CoV-2 transmission through non-respiratory routes, like peritoneal fluid.Emphasis should be given to appropriate preventive strategies for minimizing the risk of transmission of COVID-19 from patients on peritoneal dialysis in both inpatient and outpatient settings.

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Chronic kidney disease and dialysis

10.1093/med/9780199659579.003.0128 ◽

2017 ◽

Author(s):

Richard J Haynes ◽

James A Gilbert

Keyword(s):

Chronic Kidney Disease ◽

Peritoneal Dialysis ◽

Kidney Disease ◽

Abdominal Cavity ◽

Kidney Injury ◽

Well Being ◽

Prosthetic Graft ◽

Dialysis Access ◽

Stage Renal Disease ◽

End Stage

Chronic kidney disease (CKD) is a common disorder as currently defined. Patients with CKD face two major hazards: cardiovascular disease and—in a minority—progression to end-stage renal disease (ESRD). Advanced CKD also causes numerous metabolic and other complications. The management of CKD involves excluding acute kidney injury, diagnosing the cause of CKD, slowing progression, and detecting and treating complications. If patients do reach ESRD, then renal replacement therapy (RRT) options must be considered. These include haemodialysis, peritoneal dialysis, or transplantation. Haemodialysis requires creation of an arteriovenous fistula or insertion of a prosthetic graft while peritoneal dialysis necessitates the insertion of a catheter into the abdominal cavity. All forms of dialysis access are associated with complications both in the short and long term. However, they remain vital and central to the life and the well-being of the end-stage renal patient on dialysis.

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Recent Advances in Diabetic Kidney Diseases: From Kidney Injury to Kidney Fibrosis

International Journal of Molecular Sciences ◽

10.3390/ijms222111857 ◽

2021 ◽

Vol 22 (21) ◽

pp. 11857

Author(s):

Peir-Haur Hung ◽

Yung-Chien Hsu ◽

Tsung-Hsien Chen ◽

Chun-Liang Lin

Keyword(s):

Kidney Disease ◽

Kidney Diseases ◽

Epigenetic Modification ◽

Kidney Injury ◽

Diabetic Kidney ◽

Kidney Fibrosis ◽

Recent Advances ◽

History Of ◽

Stage Renal Disease ◽

End Stage

Diabetic kidney disease (DKD) is the leading cause of chronic kidney disease and end-stage renal disease. The natural history of DKD includes glomerular hyperfiltration, progressive albuminuria, declining estimated glomerular filtration rate, and, ultimately, kidney failure. It is known that DKD is associated with metabolic changes caused by hyperglycemia, resulting in glomerular hypertrophy, glomerulosclerosis, and tubulointerstitial inflammation and fibrosis. Hyperglycemia is also known to cause programmed epigenetic modification. However, the detailed mechanisms involved in the onset and progression of DKD remain elusive. In this review, we discuss recent advances regarding the pathogenic mechanisms involved in DKD.

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Determinants of Outcomes of Acute Kidney Injury: Clinical Predictors and Beyond

Journal of Clinical Medicine ◽

10.3390/jcm10061175 ◽

2021 ◽

Vol 10 (6) ◽

pp. 1175

Author(s):

Emaad M. Abdel-Rahman ◽

Faruk Turgut ◽

Jitendra K. Gautam ◽

Samir C. Gautam

Keyword(s):

Acute Kidney Injury ◽

Kidney Disease ◽

Kidney Injury ◽

Complete Recovery ◽

Severe Form ◽

Clinical Syndrome ◽

Current Evidence ◽

Clinical Predictors ◽

End Stage

Acute kidney injury (AKI) is a common clinical syndrome characterized by rapid impairment of kidney function. The incidence of AKI and its severe form AKI requiring dialysis (AKI-D) has been increasing over the years. AKI etiology may be multifactorial and is substantially associated with increased morbidity and mortality. The outcome of AKI-D can vary from partial or complete recovery to transitioning to chronic kidney disease, end stage kidney disease, or even death. Predicting outcomes of patients with AKI is crucial as it may allow clinicians to guide policy regarding adequate management of this problem and offer the best long-term options to their patients in advance. In this manuscript, we will review the current evidence regarding the determinants of AKI outcomes, focusing on AKI-D.

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Age dependence of brachial cuff-based ambulatory PWV in end-stage kidney disease patients undergoing long-term peritoneal dialysis

Peritoneal Dialysis International ◽

10.1177/0896860821996927 ◽

2021 ◽

pp. 089686082199692

Author(s):

Vasilios Vaios ◽

Panagiotis I Georgianos ◽

Georgia Vareta ◽

Dimitrios Divanis ◽

Evangelia Dounousi ◽

...

Keyword(s):

Risk Factors ◽

Blood Pressure ◽

Heart Rate ◽

Peritoneal Dialysis ◽

Kidney Disease ◽

Pulse Wave ◽

Age Dependence ◽

End Stage Kidney Disease ◽

End Stage

Background: The newly introduced device Mobil-O-Graph (IEM, Stolberg, Germany) combines brachial cuff oscillometry and pulse wave analysis, enabling the determination of pulse wave velocity (PWV) via complex mathematic algorithms during 24-h ambulatory blood pressure monitoring (ABPM). However, the determinants of oscillometric PWV in the end-stage kidney disease (ESKD) population remain poorly understood. Methods: In this study, 81 ESKD patients undergoing long-term peritoneal dialysis underwent 24-h ABPM with the Mobil-O-Graph device. The association of 24-h oscillometric PWV with several demographic, clinical and haemodynamic parameters was explored using linear regression analysis. Results: In univariate analysis, among 21 risk factors, 24-h PWV exhibited a positive relationship with age, body mass index, overhydration assessed via bioimpedance spectroscopy, diabetic status, history of dyslipidaemia and coronary heart disease, and it had a negative relationship with female sex and 24-h heart rate. In stepwise multivariate analysis, age ( β: 0.883), 24-h systolic blood pressure (BP) ( β: 0.217) and 24-h heart rate ( β: −0.083) were the only three factors that remained as independent determinants of 24-h PWV (adjusted R 2 = 0.929). These associations were not modified when all 21 risk factors were analysed conjointly or when the model included only variables shown to be significant in univariate comparisons. Conclusion: The present study shows that age together with simultaneously assessed oscillometric BP and heart rate are the major determinants of Mobil-O-Graph-derived PWV, explaining >90% of the total variation of this marker. This age dependence of oscillometric PWV limits the validity of this marker to detect the premature vascular ageing, a unique characteristic of vascular remodelling in ESKD.

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Dietary Intake, Nutritional Status, and Body Composition in Children With End-Stage Kidney Disease on Hemodialysis or Peritoneal Dialysis

Journal of Renal Nutrition ◽

10.1053/j.jrn.2016.12.007 ◽

2017 ◽

Vol 27 (3) ◽

pp. 207-215 ◽

Cited By ~ 6

Author(s):

Consuelo Pontón-Vázquez ◽

Edgar Manuel Vásquez-Garibay ◽

Erika Fabiola Hurtado-López ◽

Adriana de la Torre Serrano ◽

Germán Patiño García ◽

...

Keyword(s):

Body Composition ◽

Peritoneal Dialysis ◽

Kidney Disease ◽

Nutritional Status ◽

Dietary Intake ◽

End Stage Kidney Disease ◽

End Stage

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Elastase, α1-Proteinase Inhibitor, and Interleukin-8 in Children and Young Adults with End-Stage Kidney Disease Undergoing Continuous Ambulatory Peritoneal Dialysis

Archivum Immunologiae et Therapiae Experimentalis ◽

10.1007/s00005-013-0265-7 ◽

2013 ◽

Vol 62 (3) ◽

pp. 239-245 ◽

Cited By ~ 4

Author(s):

Bożena Polańska ◽

Daria Augustyniak ◽

Irena Makulska ◽

Maria Niemczuk ◽

Adam Jankowski ◽

...

Keyword(s):

Young Adults ◽

Peritoneal Dialysis ◽

Kidney Disease ◽

Continuous Ambulatory Peritoneal Dialysis ◽

Proteinase Inhibitor ◽

Interleukin 8 ◽

End Stage Kidney Disease ◽

Children And Young Adults ◽

End Stage

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Peritoneal Dialysis

10.2310/nephro.12057 ◽

2019 ◽

Author(s):

Karlien François ◽

Joanne M. Bargman

Keyword(s):

Renal Failure ◽

Peritoneal Dialysis ◽

Peritoneal Cavity ◽

Fluid Overload ◽

Kidney Injury ◽

Dialysis Fluid ◽

Keywords Peritoneal Dialysis ◽

Stage Renal Disease ◽

End Stage ◽

Developed World

In peritoneal dialysis (PD), the peritoneum serves as a biological dialyzing membrane. The endothelium of the vast capillary network perfusing the peritoneum functions as a semipermeable membrane and allows bidirectional solute and water transfer between the intravascular space and dialysate fluid dwelling in the peritoneal cavity. PD is a renal replacement strategy for patients presenting with end-stage renal disease. It can also be offered for ultrafiltration in patients with diuretic-resistant fluid overload even in those without advanced renal failure. PD can also be used for patients with acute kidney injury, although in the developed world this occurs rarely compared to the use of extracorporeal therapies. This review contains 9 videos, 8 figures, 4 tables, and 73 references. Keywords: peritoneal dialysis, peritoneal cavity, catheter, dialysis fluid, ultrafiltration, tunnel infection, osmotic pressure, renal failure

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Quinine-Induced Thrombotic Microangiopathy (Q-TMA): Frequency, Presenting Features, Outcomes

Blood ◽

10.1182/blood.v128.22.1381.1381 ◽

2016 ◽

Vol 128 (22) ◽

pp. 1381-1381 ◽

Cited By ~ 1

Author(s):

Evaren E Page ◽

Sara K. Vesely ◽

James N. George

Keyword(s):

Chronic Kidney Disease ◽

Kidney Disease ◽

Conflicts Of Interest ◽

Elevated Serum ◽

Kidney Injury ◽

Long Term Outcome ◽

Presenting Symptoms ◽

Immune Mediated ◽

Organ Systems ◽

History Of

Abstract Q-TMA is an acute, severe, immune-mediated, drug-induced disorder. Q-TMA is suspected when symptoms suddenly begin within hours following quinine (Q) exposure. Diagnosis of Q-TMA is established by the history of recurrent acute symptoms following recurrent Q exposures and/or by documentation of Q-dependent antibodies reactive with platelets and/or neutrophils. The Oklahoma TTP-HUS Registry enrolls all patients for whom plasma exchange (PEX) is requested for suspected TTP or HUS. Since 1995, when routine measurement of ADAMTS13 activity began, the Registry has diagnosed 78 patients with acquired TTP (ADAMTS13 <10%). During this time we have also diagnosed 17 patients with Q-TMA; 2 additional patients were diagnosed before 1995. Seventeen of these 19 patients were tested for Q-dependent antibodies; all were positive. Nine patients had a history of recurrent acute symptoms with recurrent Q exposure, including the 2 patients not tested for Q-dependent antibodies. Q exposure was a pill in 18 patients, tonic water in one. Remarkably, 18 patients were women; all 19 patients were white. Common presenting symptoms were fever, chills, nausea and vomiting. No patients had focal neurologic abnormalities. All patients had microangiopathic hemolytic anemia (MAHA), thrombocytopenia, and acute kidney injury. Eight patients had elevated serum alanine aminotransferase (231-1345 U/L). Three patients had neutropenia (absolute neutrophil counts, 184-486). Two patients had coagulation abnormalities suggesting disseminated coagulation (DIC). One patient died from complications of the central venous catheter insertion, performed for PEX and dialysis; all other patients recovered normal platelet counts. Three of the 18 surviving patients had end-stage renal disease (2 had kidney transplants). The median estimated glomerular filtration rate (GFR) for the other 15 patients, at 2.7-19.2 years (median, 10.2) after recovery, was 36 ml/min (range, 19-98). Only two patients had normal GFR (≥90 ml/min). Eleven patients had chronic kidney disease, defined by GFR <60 ml/min. Seven of 18 patients have died 4.1-12.7 years (median, 7.8) following recovery at ages 59-87 years. Conclusion. Quinine can cause severe immune-mediated toxicities involving multiple organ systems (Am J Hematol 2016; 91: 461). Q-TMA is an acute disorder causing severe kidney injury and, in some patients, also liver toxicity, neutropenia, and/or DIC. Q-TMA is not rare. During 20 years, we enrolled 17 Q-TMA patients compared to 78 patients with acquired TTP. Chronic kidney disease is a common long-term outcome. Explicit questions are required to discover the association of systemic symptoms with quinine ingestion. Table Table. Disclosures No relevant conflicts of interest to declare.

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