Mortality Rate in Covid-19 Positive Patients with Acute Kidney Injury Requiring Hemodialysis

Introduction: According to statistics till April, 2020 1,995,983 cases and 131,037 deaths have been reported globally with COVID-19 being a global threat posing great challenges to the healthcare system. Clinical data reviews and researchers have revealed that COVID-19 affects multiple organ especially liver, kidney and heart with primary damage to the respiratory system. Acute kidney injury and COVID-19 infection has been found to be linked to each other but the etiology remains unclear still. Method: This is an observational retrospective study conducted in nephrology department of Patel Hospital, Karachi. Data was collected retrospectively from medical records of patients. The study was carried out during the time period of March, 2020 till May 2021 for duration of 15 months. Patients with positive COVID-19 PCR and having AKI requiring hemodialysis were included in the study. Data was collected by complete evaluation of COVID-19 patient records and their symptoms, clinical status and final outcome during their hospital stay was noted. Results: The frequency of acute kidney injury requiring hemodialysis in our tertiary care setup was found to be 12.2% (n=41). Amongst these there were 53.7% males (n=22) and 46.3% females (n=19) and the mean age of patients was found to be 64.82+ 11.2 years. The mean level of lymphocyte count was found to be 11.3 + 4.8 *109/L. The in hospital mortality of COVID-19 positive patients having AKI was documented to be 73.2% (n=30) as shown in table-4. The other group of patients included 11 patients who recovered from acute kidney injury after hemodialysis sessions and were discharged from the hospital. Conclusion: Since COVID-19 infection became pandemic in 2020 there still needs to be a lot of research done in different populations. Hospitalized patients with COVID-19 infection should be Screen for kidney impairment and provided proper treatment. There has been found a very close association between the severity of acute kidney injury and mortality among the critically ill patients.

Download Full-text

Acute kidney injury following supine mini-PNL versus retrograde intrarenal surgery in patients with renal stones < 3 cm: a prospective comparative study

African Journal of Urology ◽

10.1186/s12301-020-00052-7 ◽

2020 ◽

Vol 26 (1) ◽

Author(s):

Metin Yığman ◽

Semih Tangal ◽

Tuba Candar ◽

Mehmet İlker Gökçe

Keyword(s):

Acute Kidney Injury ◽

Kidney Injury ◽

Renal Stones ◽

Primary Treatment ◽

Study Data ◽

Complication Rates ◽

Duration Of Hospitalization ◽

Prospective Comparative Study ◽

The Mean ◽

The Difference

Abstract Background The purpose of the current study was to prospectively compare mini-PNL and RIRS for development of acute kidney injury (AKI), success, and complication rates in a cohort of patients with kidney stones less than 3 cm. Methods In this prospective study, data of 60 consecutive patients underwent mini-PNL (n = 31) or RIRS (n = 29) was investigated. Urinary NGAL levels were measured preoperatively and at postoperative 6th hour to evaluate AKI. Success and complication rates were also compared. Results The mean stone size was significantly higher in the mini-PNL group (24.6 mm vs. 18.2 mm, p = 0.02). The mean postoperative NGAL levels were 45.6 ± 12.4 and 48.1 ± 13.6 for the mini-PNL and RIRS groups, respectively. The increase was statistically significant for both groups (p: 0.01). The difference between the two groups for mean postoperative NGAL measurements was not statistically significant (p = 0.47). The SFR was significantly higher in the mini-PNL group (96.7% vs. 79.3%, p = 0.04). The complication rates were similar for the two groups (p = 0.99). The mean duration of operation was 48.2 ± 22.5 min in the mini-PNL group and 62.6 ± 18.1 min in the RIRS group (p = 0.03). The median duration of hospitalization was 1 day for both groups. Conclusions In patients with renal stones < 3 cm in diameter, mini-PNL in supine position provides higher SFR and shorter operative times with similar rates of complications and AKI when compared with RIRS. Mini-PNL should be considered as the primary treatment option together with RIRS for renal stones and should not be ruled out for being a more invasive option.

Download Full-text

Pattern of acute kidney injury and its outcome in a tertiary care centre

International Journal of Research in Medical Sciences ◽

10.18203/2320-6012.ijrms20200245 ◽

2020 ◽

Vol 8 (2) ◽

pp. 618

Author(s):

Jennie Santhanam ◽

Meenakshi Sundari Subramaniyan Natarajan ◽

Annam Lakshmanan ◽

Rajeswari K. Balakrishnan

Keyword(s):

Acute Kidney Injury ◽

Kidney Disease ◽

Serum Creatinine ◽

Tertiary Care ◽

Kidney Injury ◽

Risk Category ◽

Care Hospital ◽

Tertiary Care Centre ◽

Disease Category ◽

The Mean

Background: Acute kidney injury is a multiplex disease with severe morbidity and mortality. The trends of acute kidney injury vary according to the regions and the population under study. The aim of this study is to evaluate the trends of acute kidney injury and its outcome in a tertiary care hospital.Methods: The study was a prospective observational study conducted at a tertiary care hospital in a metropolitan city. A total of 102 patients of acute kidney injury were selected based on the Kidney Disease Improving Global Outcomes guidelines of acute kidney injury. The main trends of acute kidney injury presentation and its outcome were assessed.Results: Of 102 patients admitted, 42 had a sepsis related diagnosis (42.41%), 17 patients (17.16%) had cardiovascular disease related acute kidney injury and 12 patients (12.12%) had developed acute kidney injury due to drugs and poisons. According to RIFLE (risk of renal failure, injury to kidney, failure and loss of function and end-stage kidney disease) category, 43.96% of patients belonged to the risk category and 30.77% to the injury category. Of 34 patients in failure category, 23 recovered and 11 did not recover. Authors compared the trends of acute kidney injury in patients who recovered and who deteriorated. The mean serum creatinine values were 3.42 mg/dl in patients who didn’t recover from acute kidney injury and 2.05 mg/dl in patients who recovered. In patients of the recovered group, the mean urine output value is 783 ml/day; in deterioration group, 445 ml/day.Conclusions: Most common etiologies of acute kidney injury in this study include sepsis, drugs and poisons, cardiovascular diseases and diarrheal diseases in order of occurrence. High serum creatinine at admission and oliguria were the most common factors that contributed to deterioration in acute kidney injury.

Download Full-text

First Reported Case in Romania of a Successfully Treated Severe COVID-19 in a Kidney Transplant Recipient: A Focus on Acute Kidney Injury

Case Reports in Nephrology and Dialysis ◽

10.1159/000512606 ◽

2020 ◽

Vol 10 (3) ◽

pp. 174-179

Author(s):

Flaviu Tosa ◽

Roxana Manaila ◽

Alina Elec ◽

Tudor Moisoiu ◽

Liviu Ghervan ◽

...

Keyword(s):

Acute Kidney Injury ◽

Transplant Recipient ◽

Kidney Transplant ◽

Kidney Transplant Recipient ◽

Clinical Status ◽

Organ Transplant ◽

Treatment Strategies ◽

Kidney Injury ◽

Kidney Graft ◽

Kidney Involvement

As coronavirus disease 2019 (COVID-19) caused by the novel virus SARS-CoV-2 is expanding worldwide, kidney involvement seems to be part of the spectrum of its effects. Moreover, the prognosis of the disease seems to be worse in immunocompromised patients when compared to the general population, with 4–5 times higher mortality rates. However, the overall impact on long-term function of the kidney graft is unknown. We report on a case of a 46-year-old kidney transplant recipient who was successfully treated for severe COVID-19 pneumonia. The clinical course was complicated by transient acute kidney injury, most likely due to tubulo-interstitial involvement, with return to the baseline of the creatinine level by the time of discharge. We discuss the characteristics and differential diagnosis of acute kidney injury, as well as management of immunosuppression in connection with overall clinical status and evolution of kidney function. The case is illustrative for dilemmas that transplant professionals may face in the absence of evidence-based, efficient COVID-19 therapy. The risk-benefit balance of the yet to be approved treatment strategies may be weighed differently in organ transplant recipients owing to their immunocompromised status and potential drug interactions with immunosuppressive therapy.

Download Full-text

Snake envenomation-induced acute kidney injury: prognosis and long-term renal outcomes

Postgraduate Medical Journal ◽

10.1136/postgradmedj-2020-139021 ◽

2021 ◽

pp. postgradmedj-2020-139021

Author(s):

Manoj Kumar ◽

Maasila Arcot Thanjan ◽

Natarajan Gopalakrishnan ◽

Dhanapriya Jeyachandran ◽

Dineshkumar Thanigachalam ◽

...

Keyword(s):

Acute Kidney Injury ◽

Kidney Injury ◽

Long Term Outcomes ◽

Urine Protein ◽

Renal Outcomes ◽

Snake Envenomation ◽

The Mean ◽

New Onset

BackgroundSnake bite continues to be a significant cause of acute kidney injury (AKI) in India. There is paucity of data regarding long-term outcomes of such patients. In this study, we aim to assess the prognosis and long-term renal outcomes of such patients.MethodsWe analysed the hospital records of snake envenomation-induced AKI from January 2015 to December 2018. Predictors of in-hospital mortality were assessed. Survivors were advised to visit follow-up clinic to assess their kidney function.ResultsThere were 769 patients with evidence of envenomation and of them, 159 (20.7%) had AKI. There were 112 (70.4%) males. Mortality occurred in 9.4% of patients. Logistic regression analysis identified shock (OR 51.949, 95% CI 4.297 to 628.072) and thrombocytopenia (OR 27.248, 95% CI 3.276 to 226.609) as predictors of mortality. Forty-three patients attended the follow-up. The mean follow-up duration was 30.4±15.23 months. Adverse renal outcomes (eGFR <60 mL/min/1.73 m2 or new-onset hypertension (HTN) or pre-HTN or urine protein creatinine ratio >0.3) occurred in 48.8% of patients. Older age (mean age (years) 53.3 vs 42.8, p=0.004) and longer duration on dialysis (median duration (days) 11.5 vs 5, p=0.024) were significantly associated with adverse renal outcomes.ConclusionsThe incidence of AKI in snake envenomation was 20.7%. The presence of shock and thrombocytopenia were associated with mortality. Adverse renal outcomes occurred in 48.8% of patients in the long term.

Download Full-text

Complement C5 inhibition protects against hemolytic anemia and acute kidney injury in anthrax peptidoglycan-induced sepsis in baboons

Proceedings of the National Academy of Sciences ◽

10.1073/pnas.2104347118 ◽

2021 ◽

Vol 118 (37) ◽

pp. e2104347118

Author(s):

Ravi Shankar Keshari ◽

Narcis Ioan Popescu ◽

Robert Silasi ◽

Girija Regmi ◽

Cristina Lupu ◽

...

Keyword(s):

Acute Kidney Injury ◽

Hemolytic Anemia ◽

Complement Activation ◽

Inflammatory Responses ◽

Atypical Hemolytic Uremic Syndrome ◽

Kidney Injury ◽

Multiple Organ ◽

Immune Recognition ◽

Gram Positive ◽

Terminal Complement

Late-stage anthrax infections are characterized by dysregulated immune responses and hematogenous spread of Bacillus anthracis, leading to extreme bacteremia, sepsis, multiple organ failure, and, ultimately, death. Despite the bacterium being nonhemolytic, some fulminant anthrax patients develop a secondary atypical hemolytic uremic syndrome (aHUS) through unknown mechanisms. We recapitulated the pathology in baboons challenged with cell wall peptidoglycan (PGN), a polymeric, pathogen-associated molecular pattern responsible for the hemostatic dysregulation in anthrax sepsis. Similar to aHUS anthrax patients, PGN induces an initial hematocrit elevation followed by progressive hemolytic anemia and associated renal failure. Etiologically, PGN induces erythrolysis through direct excessive activation of all three complement pathways. Blunting terminal complement activation with a C5 neutralizing peptide prevented the progressive deposition of membrane attack complexes on red blood cells (RBC) and subsequent intravascular hemolysis, heme cytotoxicity, and acute kidney injury. Importantly, C5 neutralization did not prevent immune recognition of PGN and shifted the systemic inflammatory responses, consistent with improved survival in sepsis. Whereas PGN-induced hemostatic dysregulation was unchanged, C5 inhibition augmented fibrinolysis and improved the thromboischemic resolution. Overall, our study identifies PGN-driven complement activation as the pathologic mechanism underlying hemolytic anemia in anthrax and likely other gram-positive infections in which PGN is abundantly represented. Neutralization of terminal complement reactions reduces the hemolytic uremic pathology induced by PGN and could alleviate heme cytotoxicity and its associated kidney failure in gram-positive infections.

Download Full-text

Preoperative Albuminuria and Intraoperative Chloride Load: Predictors of Acute Kidney Injury Following Major Abdominal Surgery

Journal of Clinical Medicine ◽

10.3390/jcm7110431 ◽

2018 ◽

Vol 7 (11) ◽

pp. 431 ◽

Cited By ~ 5

Author(s):

Diamantina Marouli ◽

Kostas Stylianou ◽

Eleftherios Papadakis ◽

Nikolaos Kroustalakis ◽

Stavroula Kolyvaki ◽

...

Keyword(s):

Risk Factors ◽

Acute Kidney Injury ◽

Abdominal Surgery ◽

Care Center ◽

Chronic Kidney Disease Stage ◽

Tertiary Care ◽

Kidney Injury ◽

Major Abdominal Surgery ◽

Disease Stage ◽

Postoperative Aki

Background: Postoperative Acute Kidney Injury (AKI) is a common and serious complication associated with significant morbidity and mortality. While several pre- and intra-operative risk factors for AKI have been recognized in cardiac surgery patients, relatively few data are available regarding the incidence and risk factors for perioperative AKI in other surgical operations. The aim of the present study was to determine the risk factors for perioperative AKI in patients undergoing major abdominal surgery. Methods: This was a prospective, observational study of patients undergoing major abdominal surgery in a tertiary care center. Postoperative AKI was diagnosed according to the Acute Kidney Injury Network criteria within 48 h after surgery. Patients with chronic kidney disease stage IV or V were excluded. Logistic regression analysis was used to evaluate the association between perioperative factors and the risk of developing postoperative AKI. Results: Eleven out of 61 patients developed postoperative AKI. Four intra-operative variables were identified as predictors of AKI: intra-operative blood loss (p = 0.002), transfusion of fresh frozen plasma (p = 0.004) and red blood cells (p = 0.038), as well as high chloride load (p = 0.033, cut-off value > 500 mEq). Multivariate analysis demonstrated an independent association between AKI development and preoperative albuminuria, defined as a urinary Albumin to Creatinine ratio ≥ 30 mg·g−1 (OR = 6.88, 95% CI: 1.43–33.04, p = 0.016) as well as perioperative chloride load > 500 mEq (OR = 6.87, 95% CI: 1.46–32.4, p = 0.015). Conclusion: Preoperative albuminuria, as well as a high intraoperative chloride load, were identified as predictors of postoperative AKI in patients undergoing major abdominal surgery.

Download Full-text

Acute Kidney Injury in Pediatric Acute Respiratory Distress Syndrome

Journal of Intensive Care Medicine ◽

10.1177/0885066620944042 ◽

2020 ◽

pp. 088506662094404

Author(s):

Shubhi Kaushik ◽

Sindy Villacres ◽

Ruth Eisenberg ◽

Shivanand S. Medar

Keyword(s):

Acute Kidney Injury ◽

Acute Respiratory Distress Syndrome ◽

Respiratory Distress Syndrome ◽

Respiratory Distress ◽

Distress Syndrome ◽

Invasive Mechanical Ventilation ◽

Tertiary Care ◽

Kidney Injury ◽

Oxygenation Index ◽

Significant Difference

Objectives: To describe the incidence of and risk factors for acute kidney injury (AKI) in children with acute respiratory distress syndrome (ARDS) and study the effect of AKI on patient outcomes. Design: A single-center retrospective study. Setting: A tertiary care children’s hospital. Patients: All patients less than 18 years of age who received invasive mechanical ventilation (MV) and developed ARDS between July 2010 and July 2013 were included. Acute kidney injury was defined using p-RIFLE (risk, injury, failure, loss, and end-stage renal disease) criteria. Interventions: None. Measurements and Main Results: One hundred fifteen children met the criteria and were included in the study. Seventy-four children (74/115, 64%) developed AKI. The severity of AKI was risk in 34 (46%) of 74, injury in 19 (26%) of 74, and failure in 21 (28%) of 74. The presence of AKI was associated with lower Pao 2 to Fio 2 (P/F) ratio ( P = .007), need for inotropes ( P = .003), need for diuretics ( P = .004), higher oxygenation index ( P = .03), higher positive end-expiratory pressure (PEEP; P = .01), higher mean airway pressure ( P = .008), and higher Fio 2 requirement ( P = .03). Only PEEP and P/F ratios were significantly associated with AKI in the unadjusted logistic regression model. Patients with AKI had a significantly longer duration of hospital stay, although there was no significant difference in the intensive care unit stay, duration of MV, and mortality. Recovery of AKI occurred in 68% of the patients. A multivariable model including PEEP, P/F ratio, weight, need for inotropes, and need for diuretics had a better receiver operating characteristic (ROC) curve with an AUC of 0.75 compared to the ROC curves for PEEP only and P/F ratio only for the prediction of AKI. Conclusions: Patients with ARDS have high rates of AKI, and its presence is associated with increased morbidity and mortality.

Download Full-text

Neutrophil gelatinase associated lipocalin, an early biomarker for diagnosis of acute kidney injury after percutaneous coronary intervention

Turkish Journal of Biochemistry ◽

10.1515/tjb-2017-0004 ◽

2017 ◽

Vol 43 (1) ◽

pp. 15-21 ◽

Cited By ~ 1

Author(s):

Nakhshab Choudhry ◽

Amna Ihsan ◽

Sadia Mahmood ◽

Fahim Ul Haq ◽

Aamir Jamal Gondal

Keyword(s):

Acute Kidney Injury ◽

Percutaneous Coronary Intervention ◽

Serum Creatinine ◽

Kidney Injury ◽

Coronary Intervention ◽

Diagnostic Biomarker ◽

Elective Percutaneous Coronary Intervention ◽

Percutaneous Coronary ◽

Significant Difference ◽

The Mean

AbstractObjectives:This study was designed to find the reliability of serum NGAL as an early and better diagnostic biomarker than that of serum creatinine for acute kidney injury after percutaneous coronary intervention in Pakistani population.Materials and methods:One hundred and fifty-one patients undergoing elective percutaneous coronary intervention were included and demographic data were recorded. Blood was drawn by venipuncture in clot activator vacutainers and serum was separated and stored at 4°C. Sample was drawn before the percutaneous procedure and subsequently sampling was done serially for 5 days.Results:The mean±SD serum NGAL pre-PCI (39.92± 10.35 μg/L) and 4 h post-PCI (100.42±26.07 μg/L) showed highly significant difference (p<0.001). The mean±SD serum creatinine pre-PCI (70.1±11.8 μmol/L) and post-PCI (71.2±11.6 μmol/L) showed significant difference (p=0.005) on day 2 onwards but mean microalbumin showed insignificant results (p=0.533). The serum NGAL predicted CI-AKI with sensitivity of 95.8% and specificity of 97.6% for a cut off value of 118 μg/L.Conclusion:Our results suggest that NGAL is an excellent early diagnostic biomarker for acute kidney injury in patients undergoing elective percutaneous coronary intervention.

Download Full-text

Acute Kidney Injury and Acute Liver Failure in Leptospira Infection and Weil’s Syndrome

Journal of Renal and Hepatic Disorders ◽

10.15586/jrenhep.2020.75 ◽

2020 ◽

Vol 4 (2) ◽

pp. 21-28

Author(s):

Jonathan S Chávez-Iñiguez ◽

Jose Said Cabrera-Aguilar ◽

Guillermo Garcia-Garcia ◽

Juan Armendáriz-Borunda

Keyword(s):

Acute Kidney Injury ◽

Clinical Presentation ◽

Clinical Signs ◽

Kidney Injury ◽

Organ Damage ◽

Multiple Organ ◽

Serological Tests ◽

Microbiological Criteria ◽

Sanitary Conditions ◽

The Impact

Leptospirosis is considered a zoonosis acquired predominantly from contaminated surfaces and water, more commonly in emerging countries with limited sanitary conditions. Leptospira in the host unleashes an immune response that explains the symptoms and clinical signs; once it reaches the kidney and liver tissue, it can manifest with alterations that lead to acute and chronic diseases in both organs. Weil’s syndrome is the best known clinical manifestation with jaundice and acute kidney injury that could lead to multiple organ failure and death. For its diagnosis, there are simplified scores such as the SPiRO score, the microbiological criteria by microscopy or serological tests; the treatment focuses on antibiotics and, if necessary, provides organic support until the infection is curtailed. The purpose of this review was to address the impact of Lep-tospira infection on the kidney and liver, the mechanisms of organ damage, the clinical presentation, and diagnosis and management of this disease.

Download Full-text