scholarly journals Risk Factors, Clinical Characteristics, and Prognosis of Acute Kidney Injury in Hospitalized COVID-19 Patients: A Retrospective Cohort Study

Medicines ◽  
2021 ◽  
Vol 8 (1) ◽  
pp. 4
Author(s):  
Panupong Hansrivijit ◽  
Kinjal P. Gadhiya ◽  
Mounika Gangireddy ◽  
John D. Goldman
Keyword(s):  
Risk Factors ◽  
Acute Kidney Injury ◽  
Troponin I ◽  
Urine Analysis ◽  
Kidney Injury ◽  
Fractional Excretion ◽  
Positive Pressure ◽  
St Segment ◽  
Fractional Excretion Of Sodium ◽  
Wave Change

Background: Acute kidney injury (AKI) is a serious complication of COVID-19. Methods: Records of hospitalized adult patients with confirmed SARS-CoV-2 infection from 1 March to 31 May 2020 were retrospectively reviewed. Results: Of 283 patients, AKI occurred in 40.6%. From multivariate analyses, the risk factors of AKI in COVID-19 can be divided into: (1) demographics/co-morbidities (male, increasing age, diabetes, chronic kidney disease); (2) other organ involvements (transaminitis, elevated troponin I, ST segment/T wave change on electrocardiography); (3) elevated biomarkers (ferritin, lactate dehydrogenase); (4) possible bacterial co-infection (leukocytosis, elevated procalcitonin); (5) need for advanced oxygen delivery (non-invasive positive pressure ventilation, mechanical ventilation); and (6) other critical features (ICU admission, need for vasopressors, acute respiratory distress syndrome). Most AKIs were due to pre-renal (70.4%) and intrinsic (34.8%) causes. Renal replacement therapy was more common in intrinsic AKI. Both pre-renal (HR 3.2; 95% CI 1.7–5.9) and intrinsic AKI (HR 7.7; 95% CI 3.6–16.3) were associated with higher mortality. Male, stage 3 AKI, higher baseline and peak serum creatinine and blood urea nitrogen were prevalent in intrinsic AKI. Urine analysis and the fractional excretion of sodium and urea were not helpful in distinguishing intrinsic AKI from other causes. Conclusions: AKI is very common in COVID-19 and is associated with higher mortality. Characterization of AKI is warranted due to its diverse nature and clinical outcome.

Fractional excretion of sodium or urea as prognostic indicators for acute kidney injury in the emergency department

2021 ◽  
Vol 29 (1) ◽  
pp. 82-84
Author(s):  
Gregor Lindner ◽  
Adrian Wolfensberger ◽  
Aristomenis K. Exadaktylos ◽  
Christoph Schwarz ◽  
Georg-Christian Funk ◽  
...  
Keyword(s):  
Emergency Department ◽  
Acute Kidney Injury ◽  
Kidney Injury ◽  
Fractional Excretion ◽  
Prognostic Indicators ◽  
Fractional Excretion Of Sodium

Clinical approach to the patient with acute kidney injury

2018 ◽  
Author(s):  
Norbert Lameire ◽  
Raymond Vanholder ◽  
Wim Van Biesen
Keyword(s):  
Acute Kidney Injury ◽  
Renal Function ◽  
Urinary Tract ◽  
Physical Examination ◽  
Kidney Injury ◽  
Fractional Excretion ◽  
Clinical Approach ◽  
Volume Depletion ◽  
Number Of Patients ◽  
Fractional Excretion Of Sodium

The prognosis of acute kidney injury (AKI) depends on early diagnosis and therapy. A multitude of causes are classified according to their origin as prerenal, intrinsic (intrarenal), and post-renal.Prerenal AKI means a loss of renal function despite intact nephrons, for example, because of volume depletion and/or hypotension.There is a broad spectrum of intrinsic causes of AKI including acute tubular necrosis (ATN), interstitial nephritis, glomerulonephritis, and vasculitis. Evaluation includes careful review of the patient’s history, physical examination, urinalysis, selected urine chemistries, imaging of the urinary tree, and eventual kidney biopsy. The history should focus on the tempo of loss of function (if known), associated systemic diseases, and symptoms related to the urinary tract (especially those that suggest obstruction). In addition, a review of the medications looking for potentially nephrotoxic drugs is essential. The physical examination is directed towards the identification of findings of a systemic disease and a detailed assessment of the patient’s haemodynamic status. This latter goal may require invasive monitoring, especially in the oliguric patient with conflicting clinical findings, where the physical examination has limited accuracy.Excluding urinary tract obstruction is necessary in all cases and may be established easily by renal ultrasound.Distinction between the two most common causes of AKI (prerenal AKI and ATN) is sometimes difficult, especially because the clinical examination is often misleading in the setting of mild volume depletion or overload. Urinary chemistries, like calculation of the fractional excretion of sodium (FENa), may be used to help in this distinction. In contrast to FENa, the fractional excretion of urea has the advantage of being rather independent of diuretic therapy. Response to fluid repletion is still regarded as the gold standard in the differentiation between prerenal and intrinsic AKI. Return of renal function to baseline or resuming of diuresis within 24 to 72 hours is considered to indicate ‘transient, mostly prerenal AKI’, whereas persistent renal failure usually indicates intrinsic disease. Transient AKI may, however, also occur in short-lived ATN. Furthermore, rapid fluid application is contraindicated in a substantial number of patients, such as those with congestive heart failure.‘Muddy brown’ casts and/or tubular epithelial cell casts in the urine sediment are typically seen in patients with ATN. Their presence is an important tool in the distinction between ATN and prerenal AKI, which is characterized by a normal sediment, or by occasional hyaline casts. There is a possible role for new serum and/or urinary biomarkers in the diagnosis and prognosis of the patient with AKI, including the differential diagnosis between pre-renal AKI and ATN. Further studies are needed before their routine determination can be recommended.When a diagnosis cannot be made with reasonable certainty through this evaluation, renal biopsy should be considered; when intrarenal causes such as crescentic glomerulonephritis or vasculitis are suspected, immediate biopsy to avoid delay in the initiation of therapy is mandatory.

scholarly journals Assessment of Urinary Kidney Injury Molecule-1 as an Indicator of Early Renal Insult in Children with Cystic Fibrosis

2020 ◽  
Vol 8 (B) ◽  
pp. 262-267
Author(s):  
Walaa Shahin ◽  
Ahmed Bader ◽  
Rawdah Ahmed ◽  
Mona Alattar ◽  
Mona Alfalaki ◽  
...  
Keyword(s):  
Cystic Fibrosis ◽  
Urine Analysis ◽  
Kidney Injury ◽  
Fractional Excretion ◽  
Control Group ◽  
Renal Ultrasound ◽  
Fractional Excretion Of Sodium ◽  
Beta 2 ◽  
Renal Tubular ◽  
Kidney Injury Molecule 1

BACKGROUND: The risk of acute kidney injury in cystic fibrosis (CF) patients is due to renal tubular affection by CFTR gene. AIM: Our study aimed at early detection of renal impairment in CF patients, to enable careful monitoring and adjustment of nephrotoxic medications. METHODS: Fifty patients with CF were enrolled in our study; they were age- and sex-matched to 40 healthy control children. All subjects were screened by urine analysis, measurements of kidney function tests, fractional excretion of sodium, β2-microglobulin (beta-2-M) excretion, and renal ultrasound examination. Urinary kidney injury molecule-1 (KIM-1) was assayed using ELISA technique. RESULTS: Both urinary beta-2-M and KIM-1 concentrations were significantly higher in CF patients compared to the control group (p < 0.001). The duration of the disease was significantly positively correlated with the urinary beta-2-M and KIM-1 levels (r = 0.6 and 0.7, respectively; p < 0.01). CONCLUSIONS: Our results showed that urinary KIM-1 can be considered as a sensitive early indicator of acute renal injury.

Comparative Study between Fractional Excretion of Sodium and Fractional Excretion of Urea in Differentiating Prerenal From Renal Acute Kidney Injury in ICU Patients with Circulatory Shock

QJM ◽  
2020 ◽  
Vol 113 (Supplement_1) ◽  
Author(s):  
S W N Sargious ◽  
M H M Hassan ◽  
S A R Mostafa ◽  
G S R Saad
Keyword(s):  
Acute Kidney Injury ◽  
Kidney Injury ◽  
Fractional Excretion ◽  
Multiple Organ ◽  
Circulatory Shock ◽  
University Hospital ◽  
Shock State ◽  
Mild Renal Impairment ◽  
Fractional Excretion Of Sodium ◽  
Point Calculation

Abstract Background The incidence of acute renal injury (AKI) in ICU is 5%. The mortality rate increases up to 50% if AKI is a part of multiple organ dysfunction syndrome. Aim of the Work Comparison between FENa and FEurea in differentiating renal from prerenal acute kidney injury in circulatory shock, and the effect of diuretics on their handling. Patients and Methods This retrospective study was conducted on 45 Egyptian patients with AKI complicating circulatory shock admitted to the ICUs of AIN SHAMS University Hospital, from August 2018 to February 2019. Consents were taken from all of them according to the local ethics committee approval. Results The cutoff points of both FENa and FEurea as a predictor of mortality were not statistically justified. This is explained as all our patients had circulatory shock, and so patients with mild renal impairment may die from their severe shock state, and patients with severe renal affection may survive if their shock could be rapidly corrected. This cutoff point calculation is recommended only in patients with AKI without other organ affections or shock that may affect the mortality. Conclusion Although both fractional excretion of urea (FEurea) and fractional excretion of sodium (FENa) are feasible, reproducible, and inexpensive markers used in differentiating renal from prerenal azotemia, in our study FEurea showed higher sensitivity and specificity than FENa, not only in differentiating renal from prerenal azotemia in critically ill patients complicating circulatory shock, but also its values were not affected by the use of diuretics like FENa in the same group of patients.

scholarly journals Urinary output and fractional excretion of sodium and urea as indicators of transient versus intrinsic acute kidney injury during early sepsis

Critical Care ◽  
2013 ◽  
Vol 17 (5) ◽  
pp. R234 ◽  
Author(s):  
Jill Vanmassenhove ◽  
Griet Glorieux ◽  
Eric Hoste ◽  
Annemieke Dhondt ◽  
Raymond Vanholder ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Kidney Injury ◽  
Fractional Excretion ◽  
Urinary Output ◽  
Fractional Excretion Of Sodium ◽  
Early Sepsis

scholarly journals Risk factors, predictions, and progression of acute kidney injury in hospitalized COVID-19 patients: An observational retrospective cohort study

PLoS ONE ◽  
2021 ◽  
Vol 16 (9) ◽  
pp. e0257253
Author(s):  
Maryam N. Naser ◽  
Rana Al-Ghatam ◽  
Abdulla H. Darwish ◽  
Manaf M. Alqahtani ◽  
Hajar A. Alahmadi ◽  
...  
Keyword(s):  
Risk Factors ◽  
Acute Kidney Injury ◽  
Cohort Study ◽  
Serum Albumin ◽  
Troponin I ◽  
Cardiac Injury ◽  
Kidney Injury ◽  
Multivariate Regression Analysis ◽  
Observational Cohort

Objectives Studies have shown that acute kidney injury (AKI) occurrence post SARS-CoV-2 infection is complex and has a poor prognosis. Therefore, more studies are needed to understand the rate and the predications of AKI involvement among hospitalized COVID-19 patients and AKI’s impact on prognosis while under different types of medications. Patients and methods This study is a retrospective observational cohort study conducted at Bahrain Defence Force (BDF) Royal Medical Services. Medical records of COVID-19 patients admitted to BDF hospital, treated, and followed up from April 2020 to October 2020 were retrieved. Data were analyzed using univariate and multivariate logistic regression with covariate adjustment, and the odds ratio (OR) and 95% confidence (95% CI) interval were reported. Results Among 353 patients admitted with COVID-19, 47.6% developed AKI. Overall, 51.8% of patients with AKI died compared to 2.2% of patients who did not develop AKI (p< 0.001 with OR 48.6 and 95% CI 17.2–136.9). Besides, deaths in patients classified with AKI staging were positively correlated and multivariate regression analysis revealed that moderate to severe hypoalbuminemia (<32 g/L) was independently correlated to death in AKI patients with an OR of 10.99 (CI 95% 4.1–29.3, p<0.001). In addition, 78.2% of the dead patients were on mechanical ventilation. Besides age as a predictor of AKI development, diabetes and hypertension were the major risk factors of AKI development (OR 2.04, p<0.01, and 0.05 for diabetes and hypertension, respectively). Also, two or more comorbidities substantially increased the risk of AKI development in COVID-19 patients. Furthermore, high levels upon hospital admission of D-Dimer, Troponin I, and ProBNP and low serum albumin were associated with AKI development. Lastly, patients taking ACEI/ARBs had less chance to develop AKI stage II/III with OR of 0.19–0.27 (p<0.05–0.01). Conclusions The incidence of AKI in hospitalized COVID-19 patients and the mortality rate among AKI patients were high and correlated with AKI staging. Furthermore, laboratory testing for serum albumin, hypercoagulability and cardiac injury markers maybe indicative for AKI development. Therefore, clinicians should be mandated to perform such tests on admission and follow-up in hospitalized patients.

scholarly journals Anticoagulant Related Nephropathy Induced by Dabigatran

2018 ◽  
Vol 2018 ◽  
pp. 1-7 ◽  
Author(s):  
Nazia Sharfuddin ◽  
Mahra Nourbakhsh ◽  
Alan Box ◽  
Hallgrimur Benediktsson ◽  
Daniel A. Muruve
Keyword(s):  
Acute Kidney Injury ◽  
Iga Nephropathy ◽  
Kidney Injury ◽  
Volume Overload ◽  
Fractional Excretion ◽  
Bleeding Risk ◽  
Renal Ultrasound ◽  
Nonvalvular Atrial Fibrillation ◽  
Fractional Excretion Of Sodium ◽  
Ultrasound Findings

We describe a case of biopsy-proven dabigatran related nephropathy in a patient without underlying IgA nephropathy. To date, dabigatran related nephropathy was only reported in patients with concurrent or undiagnosed IgA nephropathy, suggesting that it may predispose patients to dabigatran associated injury. The patient is an 81-year-old woman with multiple medical comorbidities, including nonvalvular atrial fibrillation, who was anticoagulated with dabigatran. She presented to hospital with acute kidney injury in the setting of volume overload. Her estimated glomerular filtration rate decreased from a baseline of 57 mL/min/1.73 m2 to 4 mL/min/1.73 m2, necessitating hemodialysis. Renal ultrasound findings, fractional excretion of sodium, and urinalysis suggested acute kidney injury. Renal biopsy showed acute tubular injury, tubular red blood cell casts, and an absence of active glomerulonephritis, similar to the pathological findings of warfarin related nephropathy. A diagnosis of anticoagulant related nephropathy secondary to dabigatran was therefore established. This case demonstrates that dabigatran, like warfarin, may increase tubular bleeding risk in patients, irrespective of underlying kidney or glomerular disease.

scholarly journals Volume Management in the Critically Ill Patient with Acute Kidney Injury

2013 ◽  
Vol 2013 ◽  
pp. 1-6 ◽  
Author(s):  
Mary Labib ◽  
Raeesa Khalid ◽  
Akram Khan ◽  
Supriya Khan
Keyword(s):  
Acute Kidney Injury ◽  
Fluid Management ◽  
Kidney Injury ◽  
Volume Overload ◽  
Fractional Excretion ◽  
Current Evidence ◽  
Critically Ill Patient ◽  
Negative Effects ◽  
Volume Depletion ◽  
Fractional Excretion Of Sodium

Acute kidney injury (AKI) frequently occurs in the setting of critical illness and its management poses a challenge for the intensivist. Optimal management of volume status is critical in the setting of AKI in the ICU patient. The use of urine sodium, the fractional excretion of sodium (FeNa), and the fractional excretion of urea (FeUrea) are common clinical tools used to help guide fluid management especially further volume expansion but should be used in the context of the patient’s overall clinical scenario as they are not completely sensitive or specific for the finding of volume depletion and can be misleading. In the case of oliguric or anuric AKI, diuretics are often utilized to increase the urine output although current evidence suggests that they are best reserved for the treatment of volume overload and hyperkalemia in patients who are likely to respond to them. Management of volume overload in ICU patients with AKI is especially important as volume overload has several negative effects on organ function and overall morbidity and mortality.

scholarly journals Nontraumatic Exertional Rhabdomyolysis Leading to Acute Kidney Injury in a Sickle Trait Positive Individual on Renal Biopsy

2018 ◽  
Vol 2018 ◽  
pp. 1-5
Author(s):  
Kalyana C. Janga ◽  
Sheldon Greenberg ◽  
Phone Oo ◽  
Kavita Sharma ◽  
Umair Ahmed
Keyword(s):  
Acute Kidney Injury ◽  
Abdominal Pain ◽  
Sickle Cell ◽  
Sickle Cell Trait ◽  
Kidney Injury ◽  
Fractional Excretion ◽  
Microscopic Hematuria ◽  
Medical Decision ◽  
Exertional Rhabdomyolysis ◽  
Fractional Excretion Of Sodium

A 26-year-old African American male with a history of congenital cerebral palsy, sickle cell trait, and intellectual disability presented with abdominal pain that started four hours prior to the hospital visit. The patient denied fever, chills, diarrhea, or any localized trauma. The patient was at a party at his community center last evening and danced for 2 hours, physically exerting himself more than usual. Labs revealed blood urea nitrogen (BUN) level of 41 mg/dL and creatinine (Cr) of 2.8 mg/dL which later increased to 4.2 mg/dL while still in the emergency room. Urinalysis revealed hematuria with RBC > 50 on high power field. Imaging of the abdomen revealed no acute findings for abdominal pain. With fractional excretion of sodium (FeNa) > 3%, findings suggested nonoliguric acute tubular necrosis. Over the next couple of days, symptoms of dyspepsia resolved; however, BUN/Cr continued to rise to a maximum of 122/14 mg/dL. With these findings, along with stable electrolytes, urine output matching the intake, and prior use of proton pump inhibitors, medical decision was altered for the possibility of acute interstitial nephritis. Steroids were subsequently started and biopsy was taken. Biopsy revealed heavy deposits of myoglobin. Creatinine phosphokinase (CPK) levels drawn ten days later after the admission were found to be elevated at 334 U/dl, presuming the levels would have been much higher during admission. This favored a diagnosis of acute kidney injury (AKI) secondary to exertional rhabdomyolysis. We here describe a case of nontraumatic exertional rhabdomyolysis in a sickle cell trait (SCT) individual that was missed due to findings of microscopic hematuria masking underlying myoglobinuria and fractional excretion of sodium > 3%. As opposed to other causes of ATN, rhabdomyolysis often causes FeNa < 1%. The elevated fractional excretion of sodium in this patient was possibly due to the underlying inability of SCT positive individuals to reabsorb sodium/water and concentrate their urine. Additionally, because of their inability to concentrate urine, SCT positive individuals are prone to intravascular depletion leading to renal failure as seen in this patient. Disease was managed with continuing hydration and tapering steroids. Kidney function improved and the patient was discharged with a creatinine of 3 mg/dL. A month later, renal indices were completely normal with persistence of microscopic hematuria from SCT.

Sign in / Sign up

Export Citation Format

Share Document