scholarly journals COVID-19 and kidney

2020 ◽  
pp. 73-79
Author(s):  
M. Kolesnyk
Keyword(s):  
Kidney Disease ◽  
Kidney Injury ◽  
Clinical Situation ◽  
Consensus Conference ◽  
Urinary System ◽  
System Disease ◽  
Monitoring Frequency ◽  
Acute Kidney Disease ◽  
Ckd Stage ◽  
Hospital Patients

At the beginning of COVID-19 pandemic attention of healthcare professionals and scientists were already drawn to the appearance of markers of pathologic changes of the urinary system in SARS-CoV-2-infected patients, signs of acute kidney disease (AKD) (including acute kidney injury (AKI) or development of AKI in patients with chronic kidney disease (CKD). This necessitates verification of pathologic changes markers of the urinary system in SARS-CoV-2-infected patients and clarification of their nosologic relevance. The present study aimed to analyze the present information regarding the capacity of SARS-CoV-2 to cause kidney injury (acute kidney disease, including AKI) in patients without such changes before infecting or in patients with CKD, and to verify these changes according to the classification of urinary system disease and Nomenclature for kidney function and disease: report of Kidney Disease: Improving Global Outcomes (KDIGO) Consensus Conference 2020. The presence of the pathologic changes markers of the urinary system in SARS-CoV-2-infected patients necessitates its verification via the use of tools of diagnostics of urinary system disease. Infecting with SARS-CoV-2 may cause (isolated) asymptomatic proteinuria, isolated erythrocyturia, hemoglobinuria; AKD (including AKI) in patients without preexisting urinary system injuries, AKI in patients with CKD, and may complicate hemodialysis and peritoneal dialysis. The frequency of AKI and mortality rate in patients with COVID-19 and CKD are much higher than without the last one. The AKI frequency is higher in ICU (18 – 37,5%) than in patients with moderate or mild COVID-19 (0,5 – 15%). Patients with all CKD stages with moderate or severe COVID-19 must be admitted to the hospital with further determination by a multidisciplinary team (infectionist, nephrologist, ICU physician, etc, according to the clinical situation) of necessary monitoring and treatment capacity for prevention of AKD progression and life-threatening complications or their adequate therapy. After confirmation of SARS-CoV-2 absence and release from the hospital, patients with AKD or all stages of CKD should be followed up, and monitoring frequency depends on AKD or CKD stage.

Renal C3 Production Drives Acute Kidney Injury and Acute Kidney Disease in Diabetics with Sepsis

Diabetes ◽  
2018 ◽  
Vol 67 (Supplement 1) ◽  
pp. 1737-P
Author(s):  
LYNN M. FRYDRYCH ◽  
GUOWU BIAN ◽  
PETER A. WARD ◽  
MARKUS BITZER ◽  
MATTHEW DELANO
Keyword(s):  
Acute Kidney Injury ◽  
Kidney Disease ◽  
Kidney Injury ◽  
Acute Kidney Disease

scholarly journals Chronic kidney disease predicts poor outcomes of COVID-19 patients

2021 ◽  
Author(s):  
Mahmut Gok ◽  
Hakki Cetinkaya ◽  
Tugba Kandemir ◽  
Erdem Karahan ◽  
İzzet Burak Tuncer ◽  
...  
Keyword(s):  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Kidney Injury ◽  
Multivariate Regression Analysis ◽  
Hospital Data ◽  
Group I ◽  
Ckd Stage ◽  
Comorbid Diseases ◽  
Group Ii ◽  
Poor Outcomes

Abstract Purpose The recent outbreak of COVID-19 rapidly spread worldwide. Comorbid diseases are determinants of the severity of COVID-19 infection and mortality. The aim of this study was to explore the potential association between chronic kidney disease (CKD) and the severity of COVID-19 infection. Methods The study included 609 consecutive adult patients (male: 54.52%, mean age: 59.23 ± 15.55 years) hospitalized with the diagnosis of COVID-19 in a tertiary level hospital. Data were collected from the electronic health records of the hospital. The patients were separated into two groups: Group I included COVID-19-positive patients with CKD stage 1–2, and Group II included COVID-19-positive with CKD stage 3–5. The relationships were examined between CKD stage, laboratory parameters and mortality. Results Significant differences were determined between the groups in respect of the inflammation parameters and the parameters used in prognosis. In Group II, statistically significantly higher rates were determined of comorbid diseases [hypertension (p < 0.001) and diabetes mellitus (p < 0.001), acute kidney injury (AKI), which was found to be associated with mortality (p < 0.001), and mortality (p < 0.001)]. In multivariate regression analysis, CKD stage 3–5, AKI, male gender, hypertension, DM and malignancy were found to be significant independent variables increasing mortality. Conclusion The prevelance of CKD stage 3–5 on admission is associated with a high risk of in-hospital mortality in patients with COVID-19. Close follow-up can be recommended for patients with a reduced glomerular filtration rate (GFR).

scholarly journals Atrial Fibrillation and Chronic Kidney Disease—A Risky Combination for Post-Contrast Acute Kidney Injury

2021 ◽  
Vol 10 (18) ◽  
pp. 4140
Author(s):  
Łukasz Kuźma ◽  
Anna Tomaszuk-Kazberuk ◽  
Anna Kurasz ◽  
Małgorzata Zalewska-Adamiec ◽  
Hanna Bachórzewska-Gajewska ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Chronic Kidney Disease ◽  
Acute Kidney Injury ◽  
Kidney Disease ◽  
Coronary Angiography ◽  
Kidney Injury ◽  
Post Contrast ◽  
Acute Kidney Disease ◽  
Patients At Risk ◽  
Kidney Impairment

Atrial fibrillation (AF) symptoms may mimic coronary artery disease (CAD) which reflects the difficulties in qualifying AF patients for invasive diagnostics. A substantial number of coronary angiographies may be unnecessary or even put patients at risk of post-contrast acute kidney injury (PC-AKI), especially patients with chronic kidney disease (CKD). We aimed to investigate the hypothesis indicating higher prevalence of PC-AKI in patients with AF scheduled for coronary angiography. The study population comprised of 8026 patients referred for elective coronarography including 1621 with AF. In the comparison of prevalence of PC-AKI in distinguished groups we can see that kidney impairment was twice more frequent in patients with AF in both groups with CKD (CKD (+)/AF (+) 6.24% vs. CKD (+)/AF (−) 3.04%) and without CKD (CKD (−)/AF (+) 2.32% vs. CKD (−)/AF (−) 1.22%). In our study, post-contrast acute kidney disease is twice more frequent in patients with AF, especially in subgroup with chronic kidney disease scheduled for coronary angiography. Additionally, having in mind results of previous studies stating that AF is associated with non-obstructive coronary lesions on angiography, patients with AF and CKD may be unnecessarily exposed to contrast agent and possible complications.

New Criterion to Evaluate Acute-on-Chronic Kidney Injury Based on the Creatinine Reference Change

2020 ◽  
Vol 51 (6) ◽  
pp. 453-462
Author(s):  
Xin Xu ◽  
Long Wang ◽  
Mengqi Xiong ◽  
Sheng Nie ◽  
Zhangsuo Liu ◽  
...  
Keyword(s):  
Kidney Disease ◽  
Hospital Mortality ◽  
Kidney Injury ◽  
Adverse Outcomes ◽  
Ckd Progression ◽  
Clinical Prognosis ◽  
Reference Change Value ◽  
Chronic Kidney Injury ◽  
Increased Risk ◽  
Ckd Stage

Background: The lack of consensus criteria of acute on chronic kidney injury (ACKI) affects the judgment for its clinical prognosis. Methods: In this study, we analyzed the data from 711,615 hospitalized adults who had at least 2 serum creatinine (SCr) tests within 30 days. We estimated the reference change value (RCV) of SCr given initial SCr level in adults without known risks of acute kidney injury other than chronic kidney disease (CKD). We proposed a criterion for ACKI based on the RCV of SCr (cROCK), which defined ACKI as a ≥25% increase in SCr in 7 days. We validated cROCK by its association with the risks of in-hospital mortality, death after discharge, and CKD progression in a large cohort of patients with CKD stage 3. Results: In 21,661 patients with CKD stage 3, a total of 3,145 (14.5%), 1,512 (7.0%), and 221 (1.0%) ACKI events were detected by both cROCK and Kidney Disease Improving Global Outcomes (KDIGO), cROCK only, and KDIGO only, respectively. cROCK detected 40% more ACKI events than KDIGO. Compared with patients without ACKI by both definitions, those with cROCK- but not KDIGO-defined ACKI had a significantly increased risk of in-hospital mortality (hazard ratio [HR] 5.53; 95% CI 3.75–8.16), death after discharge (HR 1.51; 95% CI 1.21–1.83), and CKD progression (OR 5.65; 95% CI 3.05–10.48). Conclusions: RCV-based criterion (cROCK) for ACKI is clinically valid in that it has a substantially improved sensitivity in identifying patients with high risk of adverse outcomes.

scholarly journals Biomarkers of acute kidney disease. potential application in practice

2021 ◽  
Vol 23 (1) ◽  
pp. 15-19
Author(s):  
Ekaterina S. Schelkanovtseva ◽  
◽  
Ekaterina S. Schelkanovtseva ◽  
Olga Iu. Mironova ◽  
Viktor V. Fomin ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Clinical Practice ◽  
Kidney Disease ◽  
Serum Creatinine ◽  
Potential Application ◽  
Kidney Injury ◽  
Clinical Syndrome ◽  
Acute Kidney Disease ◽  
Definition Of ◽  
New Biomarkers

Acute kidney injury (AKI) is a common clinical syndrome. Its variety of presentation explains the absence of “kidney troponin”. Many research projects of new biomarkers are ongoing now. The enormous number of biomarkers has been identified already. It makes difficult to choose the correct test and dictates the importance of the fastest and most accurate introduction of AKI biomarkers into clinical practice. The integration of appropriately selected biomarkers in routine clinical practice for high-risk patients of AKI is very important. Currently, serum creatinine (sCr) and urine output are used to define AKI in accordance with the definition of KDIGO (Kidney Disease: Improving Global Outcomes), which have a number of significant limitations for practitioners, including the inability to diagnose AKI before serum creatinine levels increase. Practitioners need systematic information about the latest AKI markers and possible situations, when and for which patient groups they can be used. This is the main goal of our review. Keywords: acute kidney injury, biomarkers, NGAL, TIMP-2, IGFBP7, cystatin C, markers, injury, kidney stress For citation: Schelkanovtseva ES, Mironova OIu, Fomin VV. Biomarkers of acute kidney disease. Potential application in practice. Consilium Medicum. 2021; 23 (1): 15–19. DOI: 10.26442/20751753.2021.1.200729

scholarly journals Acute Kidney Disease and Mortality in Acute Kidney Injury Patients with COVID-19

2021 ◽  
Vol 10 (19) ◽  
pp. 4599
Author(s):  
Filipe Marques ◽  
Joana Gameiro ◽  
João Oliveira ◽  
José Agapito Fonseca ◽  
Inês Duarte ◽  
...  
Keyword(s):  
Risk Factors ◽  
Kidney Disease ◽  
Hospital Mortality ◽  
Significant Risk ◽  
Kidney Injury ◽  
Risk Of Mortality ◽  
Number Of Patients ◽  
Acute Kidney Disease ◽  
Risk Patients ◽  
Stage 1

Background: The incidence of AKI in coronavirus disease 2019 (COVID-19) patients is variable and has been associated with worse prognosis. A significant number of patients develop persistent kidney damage defined as Acute Kidney Disease (AKD). There is a lack of evidence on the real impact of AKD on COVID-19 patients. We aim to identify risk factors for the development of AKD and its impact on mortality in COVID-19 patients. Methods: Retrospective analysis of COVID-19 patients with AKI admitted at the Centro Hospitalar Universitário Lisboa Norte between March and August of 2020. The Kidney Disease Improving Global Outcomes (KDIGO) classification was used to define AKI. AKD was defined by presenting at least KDIGO Stage 1 criteria for >7 days after an AKI initiating event. Results: In 339 COVID-19 patients with AKI, 25.7% patients developed AKD (n = 87). The mean age was 71.7 ± 17.0 years, baseline SCr was 1.03 ± 0.44 mg/dL, and the majority of patients were classified as KDIGO stage 3 AKI (54.3%). The in-hospital mortality was 18.0% (n = 61). Presence of hypertension (p = 0.006), CKD (p < 0.001), lower hemoglobin (p = 0.034) and lower CRP (p = 0.004) at the hospital admission and nephrotoxin exposure (p < 0.001) were independent risk factors for the development of AKD. Older age (p = 0.003), higher serum ferritin at admission (p = 0.008) and development of AKD (p = 0.029) were independent predictors of in-hospital mortality in COVID-19-AKI patients. Conclusions: AKD was significantly associated with in-hospital mortality in this population of COVID-19-AKI patients. Considering the significant risk of mortality in AKI patients, it is of paramount importance to identify the subset of higher risk patients.

P0624INCREASED URINARY BIOMARKERS OF KIDNEY INJURY IN PATIENTS AFTER ALLOGENETICHEMATOPOETIC STEM CELL TRANSPLANTATION REFLECT KIDNEY DAMAGE EVEN IN NORMALN KIDNEY FUNCTION

2020 ◽  
Vol 35 (Supplement_3) ◽  
Author(s):  
Malgorzata Kepska ◽  
Inga Chomicka ◽  
Ewa Karakulska-Prystypiuk ◽  
Agnieszka Tomaszewska ◽  
Grzegorz Basak ◽  
...  
Keyword(s):  
Chronic Kidney Disease ◽  
Acute Kidney Injury ◽  
Stem Cell ◽  
Kidney Disease ◽  
Healthy Volunteers ◽  
Kidney Function ◽  
Kidney Injury ◽  
Allogeneic Hsct ◽  
Ckd Stage ◽  
Nephrotoxic Drugs

Abstract Background and Aims Chronic kidney disease (CKD) and acute kidney injury (AKI) are common complications of hematopoietic stem cell transplantation (HSCT) associated with increased morbidity and mortality. On the other hand, presence of CKD is often used as an exclusion criterion when selecting patients who undergo HSCT, especially when fludarabine in conditioning or GVHD prophylaxis with a calcineurin inhibitor is contemplated. There is also no threshold (CKD stage, level of serum creatinine etc) below which patients should not undergo allogeneic HSCT. Kidney function in patients undergoing HSCT is frequently worsened by previous chemotherapy and exposure to a variety of nephrotoxic drugs. Several biomarkers were widely investigated for early diagnosis of acute kidney injury, including neutrophil gelatinase associated lipocalin (NGAL), urinary liver-type fatty acid-binding protein (uL-FABP) and others, however, in patients undergoing HSCT, the published literature is exceptionally scarce. A few studies with inconclusive results stress the knowledge gap and need for further research. The aim of the study was to assess biomarkers of kidney injury in patients at least 3 months after HSCT (to avoid the effect of calcineurin inhibitors) under ambulatory care of Hematology, Oncology and Internal Medicine Department, University Teaching Hospital. Method We studied 80 prevalent patients after allogeneic HSCT and 32 healthy volunteers to obtained normal ranges for biomarkers. In this cross-sectional study following biomarkers of kidney injury in urine were evaluated: IGFBP-7/TIMP2 (insulin growth factor binding protein-7/, tissue inhibitor of metalloproteinases-2), netrin-1, semaphorin A2 using commercially available assays. Results All the biomarkers studied were significantly higher in patients after HSCT when compared to healthy volunteers (all p&lt;0.001). When we divided patients according to kidney function (below and over 60 ml./min/1.72m2), we found that only concentration of IGFBP-7 was significantly higher in 23 patients with CKD stage 3 (i.e. eGFR below 60ml.min/1.72m2) relative to patients with eGFR over 60 ml.min.1.72m2. All biomarkers in both subgroups of patients with eGFR below and over 60 ml./min/1.72m2 were significantly higher relative to healthy volunteers. In univariate correlations sempahorinA2 was related to netrin 1 (r=0.47, p&lt;0.001), IGFBP7 (r=0.35, p&lt;0.01), TIMP2 (r=0.32, p&lt;0.01), whereas IGFBP7 was positively related to serum creatinine (r=0.38, p&lt;0.001) and inversely to eGFR (r=-0.36, p&lt;0.001). Conclusion Concluding, patients after allogeneic HSCT despite normal or near normal kidney function show evidence of kidney injury, which might be due to comorbidities, previous chemotherapy, conditioning regimen,complement activation, calcineurin therapy after HSCT, other possible nephrotoxic drugs etc. Nephroprotective strategies are to be considered as chronic kidney disease is a risk factor for increased morbidity and mortality in this vulnerable population.

scholarly journals Nomenclature for Kidney Function from KDIGO: Shortcomings of Terminology Oversimplification

2021 ◽  
pp. 1-4
Author(s):  
Alberto Palazzuoli ◽  
Kristen M. Tecson ◽  
Claudio Ronco ◽  
Peter A. McCullough
Keyword(s):  
Kidney Disease ◽  
Management Strategy ◽  
Filtration Rate ◽  
Estimated Glomerular Filtration Rate ◽  
Kidney Injury ◽  
Medical Problem ◽  
Consensus Conference ◽  
Kidney Dysfunction ◽  
Starting Point

The recent Kidney Disease: Improving Global Outcomes (KDIGO) consensus conference proposed a universal nomenclature calling for “Kidney Disease” (KD) to be applied to every form of kidney dysfunction, regardless of etiology. We recognize that the estimated glomerular filtration rate and urine albumin:creatinine ratio are limited in their application to the broad spectrum of KD. However, there are additional in vitro and advanced diagnostic options that can help identify the underlying cause of KD and inform about prognosis and management. While the overarching benefit of generalizing KD as a medical problem lies with screening and detection, the downsides attributable to a nonexact diagnosis (i.e., unclear prognosis and management strategy) are considerable. Finally, the terms “acute kidney injury” and “worsening renal function” are currently used interchangeably by nephrologists and cardiologists alike, and a universal adoption of one term will likely be a sizeable challenge. To be of greater benefit, we propose KD be used as a starting point and that the etiology and other epigenetic determinants of illness continue to be evaluated and characterized.

scholarly journals Outcomes of adults with congenital heart disease that experience acute kidney injury in the intensive care unit

2020 ◽  
pp. 1-5
Author(s):  
Dana Y. Fuhrman ◽  
Lan Nguyen ◽  
Emily L. Joyce ◽  
Priyanka Priyanka ◽  
John A. Kellum
Keyword(s):  
Intensive Care Unit ◽  
Acute Kidney Injury ◽  
Congenital Heart Disease ◽  
Young Adults ◽  
Intensive Care ◽  
Kidney Disease ◽  
Renal Dysfunction ◽  
Congenital Heart ◽  
Kidney Injury ◽  
Acute Kidney Disease

Abstract Background: Young adults with congenital heart disease (CHD) are increasing in number with an increased risk for acute kidney injury. Little is known concerning the impact of non-recovery of kidney function for these patients. Therefore, we sought to explore the rates of acute kidney disease, persistent renal dysfunction, and their associations with adverse outcomes in young adults with CHD. Methods: This is a single-centre retrospective study including all patients at the ages of 18–40 with CHD who were admitted to an intensive care unit between 2010 and 2014. Patients with a creatinine ≥ 1.5 times the baseline at the time of hospital discharge were deemed to have persistent renal dysfunction, while acute kidney disease was defined as a creatinine ≥ 1.5 times the baseline 7–28 days after a diagnosis of acute kidney injury. Outcomes of death at 5 years and length of hospital stay were examined using multivariable logistic regression and negative binomial regression, respectively. Results: Of the (89/195) 45.6% of patients with acute kidney injury, 33.7% had persistent renal dysfunction and 23.6% met the criteria for acute kidney disease. Persistent renal dysfunction [odds ratio (OR), 3.27; 95% confidence interval (CI): 1.15–9.29] and acute kidney disease (OR: 11.79; 95% CI: 3.75–39.09) were independently associated with mortality at 5 years. Persistent renal dysfunction was associated with a longer duration of hospital stay (Incidence Rate Ratio: 1.96; 95% CI: 1.53–2.51). Conclusions: In young adults with CHD, acute kidney injury was common and persistent renal dysfunction, as well as acute kidney disease, were associated with increased mortality and length of hospitalisation.

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