COVID-19 and acute kidney injury presentation; stages and prognosis

Introduction: Coronavirus disease 2019 (COVID-19) can present with acute kidney injury (AKI). Although the rate of AKI among these patients is not high, their outcome could be much worse than the other patients. Serum creatinine rise along with other laboratory findings may help as a clinical predictor of COVID-19 disease prognosis. Objectives: We aimed to evaluate the incidence and possible predictors of AKI occurrence and its outcome during the COVID-19 pandemic. Patients and Methods: In a retrospective observational study of 946 hospital-admitted patients with confirmed COVID-19 between March 20, 2020 and May 9, 2020, we described AKI incidence and its stages along with their association with demographic data, comorbidities, habitual and past-medical history, and laboratory findings using STATA version 14. Results: The mean age of participants was 55.6 (±18.7) years of which 60.4% were male. The most and least frequent underlying diseases were hypertension and chronic liver disease, 20.1% and 1.5%, respectively. Among patients with AKI, 45.9% had a higher age mean and female sex was more prevalent. In addition, hypertension, ischemic heart disease, diabetes, and chronic renal disease were more common in patients with AKI compared to patients without AKI. Moreover, AKI patients had lower oxygen saturation and mean levels of lymphocytes and higher mean levels of LDH and CKMB in comparison with no AKI group on admission. Overall, 80% of the patients were discharged (i.e. alive), of which 63.7% were non-severe patients and 19.4% of the patients expired during hospitalization. Conclusion: Comorbidities were more prevalent among AKI groups. Female and older patients were more prone to AKI during COVID-19 progression. The level of CK-MB was also higher in AKI group, suggesting probable cardiac injury. Lymphopenia and leukocytosis may be poor-prognostic factors for both AKI and COVID-19.

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The prevalence of Helicobacter pylori and its effect on prognosis of patients with COVID-19

Medical Science and Discovery ◽

10.36472/msd.v8i4.509 ◽

2021 ◽

Vol 8 (4) ◽

pp. 208-212

Author(s):

Ahmed Bilal Genc ◽

Selcuk Yaylaci ◽

Hamad Dheir ◽

Didar Senocak ◽

Elif Ozozen ◽

...

Keyword(s):

Statistical Difference ◽

Demographic Data ◽

Prognostic Indicators ◽

Laboratory Findings ◽

The Poor ◽

Disease Prognosis ◽

Negative Effect ◽

The Mean ◽

H Pylori ◽

Test Outcomes

Objective: SARS-CoV-2 RNA positivity in stool in COVID-19 infection has been reported at rates varying between 6-83%. The purpose of this study was to determine the prevalence of H.pylori and investigate whether it determines the disease prognosis in COVID-19 patients. Methods: This study was conducted on 117 confirmed COVID-19 patients who were hospitalized due to symptomatic pneumonia and tested for stool H.pylori antigen. Stool H. pylori test outcomes, demographic parameters, laboratory findings, and prognostic predictors of disease were recorded. The effect of the presence of H.pylori in patients with COVID-19 was analyzed. Results: The mean age of 117 included patients was 49.68 ± 14.62 years, 78 (66.7%) had COVID PCR positivity and 32 (27.35%) had H.pylori positivity. There was no statistical difference in demographic data, prognosis, and laboratory parameters between those with and without H.pylori. Conclusion: H.pylori positivity was detected as 27.35% in patients with COVID-19 infection. However, we could not find the positive or negative effect of H.pylori on the prognosis of COVID-19 disease. In conclusion, according to the results of this study, H. pylori positivity or negativity neither determined the severity of the COVID-19 disease nor the poor prognostic indicators of the disease.

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The effect of age on the incidence of COVID-19 complications: a systematic review and meta-analysis

Systematic Reviews ◽

10.1186/s13643-021-01636-2 ◽

2021 ◽

Vol 10 (1) ◽

Author(s):

Sofonyas Abebaw Tiruneh ◽

Zemenu Tadese Tesema ◽

Melkalem Mamuye Azanaw ◽

Dessie Abebaw Angaw

Keyword(s):

Acute Kidney Injury ◽

Acute Respiratory Distress Syndrome ◽

Respiratory Distress Syndrome ◽

Distress Syndrome ◽

Risk Group ◽

Meta Analysis ◽

Cardiac Injury ◽

Kidney Injury ◽

The Mean ◽

Meta Regression

Abstract Background The coronavirus (COVID-19) pandemic was reported from Wuhan, China, on December 31, 2019, and the pandemic was spread to more than 212 countries in the globe. This meta-analysis aimed to assess the pooled incidence of COVID-19 complications and to identify the association between the incidence of complications and age. Methods Comprehensive databases, PubMed, Hinari, and Google Scholar, were used to locate potential articles for this review. Data were extracted using Microsoft Excel and imported to the STATA/MP version 16.0 software for analysis. Heterogeneity between studies was assessed using the Cochrane Q test statistics and I2 test, and small study effect was checked using Egger’s statistical test at 5% significant level. Sensitivity analysis was checked. A random-effects model was conducted to estimate the pooled incidence of COVID-19 complications. Univariate meta-regression was conducted to identify the association between the mean ages with each complication. Results From the total of 1237 studies, 12 studies were included with a total of 3064 COVID-19 patients. The most complications were acute respiratory distress syndrome (30.93%, 95%CI 21.3–40.6%) followed by acute liver injury (22.8%, 95%CI 14–31.5%), shock (10.9%, 95%CI 7.4–14.4%), acute kidney injury (7%, 95%CI 3.8–10.4%), and acute cardiac injury (6.4%, 95%CI 2.8–15.6%). Univariate meta-regression revealed that as the mean age increased by 1 year, the incidence of acute respiratory distress syndrome, acute kidney injury, acute cardiac injury, and shock increased by a factor of 2.9 (β = 2.9, 95%CI 2.4–3.4, adjusted R2 = 88), 0.4 (β = 0.4, 95%CI 0.04–0.72, adjusted R2 = 54), 1.6 (β = 1.6, 95%CI 1.1–2.1, adjusted R2 = 85), and 1.1 (β = 1.1, 95%CI 0.8–1.5, adjusted R2 = 26) times respectively. Conclusion Significant complications of COVID-19 viral infections were reported. Older populations were a high-risk group of developing adverse complications as compared to their counterparts. Health care professionals should give primary attention to those risk group individuals.

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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.

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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.

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Clinical Characteristics and Outcomes of Adults with Nephrotic Syndrome Due to Minimal Change Disease

Journal of Clinical Medicine ◽

10.3390/jcm10163632 ◽

2021 ◽

Vol 10 (16) ◽

pp. 3632

Author(s):

Sophia Lionaki ◽

Evangelos Mantios ◽

Ioanna Tsoumbou ◽

Smaragdi Marinaki ◽

George Makris ◽

...

Keyword(s):

Acute Kidney Injury ◽

Nephrotic Syndrome ◽

Minimal Change Disease ◽

Kidney Injury ◽

Spontaneous Remission ◽

Minimal Change ◽

Adult Onset ◽

Potential Risk Factors ◽

The Mean ◽

End Stage

Purpose: Minimal change disease (MCD) is considered a relatively benign glomerulopathy, as it rarely progresses to end-stage kidney disease. The aim of this study was to describe the characteristics and outcomes of adults with MCD and identify potential risk factors for relapse. Patients & Methods: We retrospectively studied a cohort of adults with biopsy-proven MCD in terms of clinical features and treatment outcomes. Baseline characteristics and outcomes were recorded and predictors of relapse were analyzed using logistic regression multivariate analysis. Results: 59 patients with adult-onset primary MCD with nephrotic syndrome were included. Mean serum creatinine at diagnosis was 0.8 mg/dL (±2.5) and estimated GFR (eGFR) was 87 mL/min/1.73 m2 (±29.5). Mean serum albumin was 2.5 g/dL (±0.8) and 24 h proteinuria 6.8 g (±3.7). Microscopic hematuria was detected in 35 (58.5%) patients. 42 patients received prednisone alone, six patients received prednisone plus cyclophosphamide, five patients received prednisone plus cyclosporine, one patient received prednisone plus rituximab and five patients did not receive immunosuppression at all since they achieved spontaneous remission. During a mean follow up time of 34.7(22.1) months, 46.1% of patients experienced at least one episode of relapse. The mean age of patients who did not experience a relapse was significantly higher than that of patients who relapsed while relapsers had a significantly longer duration of 24 h proteinuria prior to biopsy compared to non-relapsers. Overall, 10% of patients experienced acute kidney injury while the mean eGFR at the end was 82 mL/min/1.73 m2 (±29.1) and one patient ended up in chronic dialysis. Overall, the proportion of non-relapsers, who experienced acute kidney injury (17%) was significantly higher than the one recorded among relapsers (0%).Conclusion: In this series of patients, almost 46% of adult-onset nephrotic MCD patients experienced a relapse, although their renal progression was rare. Younger onset age was an independent risk factor for relapse in adult-onset MCD patients.

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Factors Determining Nephrotoxicity and Mortality in Critical Care Patients Receiving Colistin

The Journal of Infection in Developing Countries ◽

10.3855/jidc.9443 ◽

2018 ◽

Vol 11 (12) ◽

pp. 912-917 ◽

Cited By ~ 1

Author(s):

Ali Ciftci ◽

Seval Izdes ◽

Neriman Defne Altintas

Keyword(s):

Risk Factors ◽

Acute Kidney Injury ◽

Demographic Data ◽

Kidney Injury ◽

Apache Ii ◽

Factors Affecting ◽

Acute Kidney Injury Group ◽

Injury Group ◽

Independent Risk Factors ◽

Critical Patients

Introduction: We aimed to determine risk factors for nephrotoxicity and factors affecting mortality in patients who received colistin. Methodology: Critical patients who received colistin were enrolled. Pregnancy, age < 18 years, basal creatinine level > 2 mg/dL, colistin use for < 48 hours, and previous renal replacement therapy were exclusion criteria. KDIGO stages were determined according to creatinine levels. Patients were grouped as those with no acute kidney injury (Group N0) and those with acute kidney injury (Group N). Their demographic data, APACHE II and SOFA scores, treatments, and laboratory results were recorded. Results: A total of 91 patients were included: 27 in Group N0 and 64 in Group N. Demographic data were similar between groups; however, higher admission APACHE-II scores (OR:1.179, 95% CI:1.033-1.346, p = 0.015) and need for vasopressors (OR:5.486, 95% CI:1.522–19.769, p = 0.009) were found to be independent risk factors for nephrotoxicity. Higher APACHE II scores (OR:1.253, %95 CI:1.093-1.437, p = 0.001), presence of coronary artery disease (OR:7.720, % 95 CI: 1.613-36.956, p = 0.011), need for vasopressors (OR: 4.587, % 95 CI: 1.224 – 17.241, p = 0.024), hypoalbuminemia (OR: 4.721, % 95 CI: 1.088 – 20.469, p = 0.038), and higher direct bilirubin levels (OR: 1.806, % 95 CI: 1.055 – 3.092, p = 0.031) were independent risk factors for mortality. Conclusion: When use of colistin is considered in ICU patients, presence of modifiable risk factors for nephrotoxicity such as hypoalbuminemia, nephrotoxic drug administration, and presence of shock should be determined and managed to prevent nephrotoxicity.

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A CLINICAL STUDY OF ETIOLOGY, OUTCOME AND PROGNOSTIC FACTORS OF ACUTE KIDNEY INJURY AMONG ICU ADMISSIONS IN RURAL TERTIARY CARE HOSPITAL

10.36106/gjra/9815424 ◽

2021 ◽

pp. 201-204

Author(s):

Shashikantha Shashikantha ◽

Sohil Sharda. ◽

Bernice Robert ◽

Gangurde Bhushan Daulatrao

Keyword(s):

Acute Kidney Injury ◽

Prognostic Factors ◽

Renal Disease ◽

Tertiary Care Hospital ◽

Chronic Renal Disease ◽

Tertiary Care ◽

Ventilatory Support ◽

Kidney Injury ◽

Care Hospital ◽

Study Results

INTRODUCTION: Acute kidney injury is a common occurrence in ICU admissions causing increased morbidity and mortality. Present study aimed to determine the causes and prognostic factors of acute kidney injury in intensive care unit. MATERIAL AND METHODS: This Hospital based Cross sectional Study was conducted at a tertiary care Hospital and Research Center, including 100 patients aged >18 years with Acute Kidney Injury admitted in ICU from the period of October 2018 to June 2020. Patients with chronic renal disease, previous renal transplantation, congenital renal disease were excluded from the study. RESULTS: Most of the patients (63%) were aged above 50 years. Diabetes was found in 55% and hypertension in 26% of AKI cases. Most common cause identied were sepsis, CLD, renal, CNS and CVD. Hypotension occurred in 48% patients, while oliguria occurred in 45% patients. Ventilatory support was required by 43% patients, while 31% patients required haemodialysis. Mortality rate in AKI was 51%. Mortality was signicantly associated with advanced age, presence of Diabetes, and RIFLE criteria. Spot urine <40 meq/L, hyperkalemia, serum creatinine >4 mg/dl, blood urea >100 mg/dl and acidosis were associated with higher mortality. CONCLUSION: Continuous monitoring parameters like Spot Fe Na, Serum Potasium and pH especially in patients at risk, like elderly patients with diabetes, those with sepsis, can help in early identication and appropiate management, thus reduce the incidence or severity of AKI.

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Point-of-Care Echocardiography Unveils Misclassification of Acute Kidney Injury as Hepatorenal Syndrome

American Journal of Nephrology ◽

10.1159/000501299 ◽

2019 ◽

Vol 50 (3) ◽

pp. 204-211 ◽

Cited By ~ 3

Author(s):

Juan Carlos Q. Velez ◽

Bradley Petkovich ◽

Nithin Karakala ◽

J. Terrill Huggins

Keyword(s):

Acute Kidney Injury ◽

Kidney Function ◽

Volume Expansion ◽

Hepatorenal Syndrome ◽

Point Of Care ◽

Kidney Injury ◽

Volume Status ◽

Early Improvement ◽

Abdominal Hypertension ◽

The Mean

Introduction: Fulfillment of the diagnostic criteria for hepatorenal syndrome type 1 (HRS-1) requires prior failure of 2 days of intravenous volume expansion and/or diuretic withdrawal. However, no parameter of volume status is used to guide the need for volume expansion in patients with suspected HRS-1. We hypothesized that point-of-care echocardiography (POCE) may better characterize the volume status in patients with acute kidney injury (AKI) and cirrhosis to ascertain or disprove the diagnosis of HRS-1. Methods: A pilot observational study was conducted to determine the clinical utility of POCE-based examination of inferior vena cava diameter (IVCD) and collapsibility index (IVCCI) to assess intravascular volume status in patients with cirrhosis and AKI who had been deemed adequately volume-repleted and thereby assigned a clinical diagnosis of HRS-1. Early improvement in kidney function was defined as ≥20% decrease in serum creatinine (sCr) at 48–72 h. Results: A total of 53 patients were included. The mean sCr at the time of volume assessment was 3.2 ± 1.5 mg/dL, and the mean Model for End-Stage Liver Disease score was 29 ± 8. Fifteen (23%) patients had an IVCD <1.3 cm and IVCCI >40% and were reclassified as fluid-depleted, 11 (21%) had an IVCD >2 cm and IVCCI <40% and were reclassified as fluid-expanded, and 8 (15%) had and IVCD <1.3 cm and IVCCI <40% and were reclassified as having intra-abdominal hypertension (IAH). Twelve (23%) patients exhibited early improvement in kidney function following a POCE-guided therapeutic maneuver, that is, volume expansion, diuresis, or paracentesis for those deemed fluid-depleted, fluid-expanded or having IAH, respectively. Conclusion: POCE-based assessment of volume status in cirrhotic individuals with AKI reveals marked heterogeneity. Unguided volume expansion in these patients may lead to premature or delayed diagnosis of HRS-1.

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Intermittent Hemodialysis For Patients With Acute Kidney Injury (AKI): Outcome In A Tertiary Level Hospital

Medical Journal of Shree Birendra Hospital ◽

10.3126/mjsbh.v17i1.18629 ◽

2018 ◽

Vol 17 (1) ◽

pp. 25-30

Author(s):

Arun Sharma ◽

Binod Karki ◽

Ajay Rajbhandari

Keyword(s):

Acute Kidney Injury ◽

Renal Function ◽

Renal Replacement Therapy ◽

Replacement Therapy ◽

Acute Gastroenteritis ◽

Kidney Injury ◽

Tertiary Level ◽

Intermittent Hemodialysis ◽

The Mean ◽

Level Hospital

INTRODUCTION: Acute kidney injury (AKI) is the sudden loss of renal function with accumulation of nitrogenous waste compounds. In developing countries, community acquired AKI is common than AKI in hospitalized septic patients. With conservative management many patients recover renal function however few require renal support with intermittent Hemodialysis (HD). We conducted a study to find out the etiology and outcome of the patients presenting with AKI who required dialysis.METHODS: This is a descriptive follow up study of the patients who needed renal replacement therapy in the form of HD presenting to our Nephrology unit of the hospital over a period of two years. Patients were followed up for three months post discharge. Data were tabulated and analyzed using SPSS software.RESULTS: Total 50 patients were included in study with 67% male. The commonest etiologies were urinary tract infection (30%) and acute gastroenteritis (24%).The mean creatinine at the time of nephrology consultation, maximum level and at the time of discharge were 6.5(SD± 2.62), 7.3(SD ±2.13) and 2.2(SD ±1.75) respectively. Uremia with anuria was the most common reason for the initiation of HD in 54% cases. The mean number of intermittent HD used was 3.36. Complete recovery was seen in 68%, death in 26% and CKD in 6%.CONCLUSION: UTI followed by acute gastroenteritis are the leading cause of AKI in our tertiary level hospital. Timely initiated renal replacement therapy in the form of intermittent HD could lead to substantial renal recovery in almost three fourth of patients.

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Coronavirus Disease 19 Infection Does Not Result in Acute Kidney Injury: An Analysis of 116 Hospitalized Patients from Wuhan, China

American Journal of Nephrology ◽

10.1159/000507471 ◽

2020 ◽

Vol 51 (5) ◽

pp. 343-348 ◽

Cited By ~ 102

Author(s):

Luwen Wang ◽

Xun Li ◽

Hui Chen ◽

Shaonan Yan ◽

Dong Li ◽

...

Keyword(s):

Acute Kidney Injury ◽

Renal Function ◽

Demographic Data ◽

Pulmonary Inflammation ◽

Stable State ◽

Kidney Injury ◽

Test Results ◽

Reading Frame ◽

Laboratory Test Results ◽

Treatment Measures

Background: Whether the patients with coronavirus disease 19 (COVID-19) infected by severe acute respiratory syndrome (SARS)-CoV-2 would commonly develop acute kidney injury (AKI) is an important issue worthy of clinical attention. This study aimed to explore the effects of SARS-CoV-2 infection on renal function through analyzing the clinical data of 116 hospitalized COVID-19-confirmed patients. Methods: One hundred sixteen COVID-19-confirmed patients enrolled in this study were hospitalized in the Department of Infectious Diseases, Renmin Hospital of Wuhan University from January 14 to February 13, 2020. The recorded information includes demographic data, medical history, contact history, potential comorbidities, symptoms, signs, laboratory test results, chest computer tomography scans, and treatment measures. SARS-CoV-2 RNA in 53 urine sediments of enrolled patients was detected by real-time reverse transcription-polymerase chain reaction. Results: Twelve (10.8%) patients showed mild increase of blood urea nitrogen or creatinine (<26 μmol/L within 48 h), and 8 (7.2%) patients showed trace or 1+ albuminuria in 111 COVID-19-confirmed patients without chronic kidney disease (CKD). All these patients did not meet the diagnostic criteria of AKI. In addition, 5 patients with CKD who were undergone regular continuous renal replacement therapy (CRRT) before admission were confirmed infection of SARS-CoV-2 and diagnosed as COVID-19. In addition to therapy for COVID-19, CRRT was also applied 3 times weekly during hospitalization for these 5 patients with CKD. In the course of treatment, the renal function indicators showed stable state in all 5 patients with CKD, without exacerbation of CKD, and pulmonary inflammation was gradually absorbed. All 5 patients with CKD were survived. Moreover, SARS-CoV-2 RNA in urine sediments was positive only in 3 patients from 48 cases without CKD, and 1 patient had a positive for SARS-CoV-2 open reading frame 1ab from 5 cases with CKD. Conclusion: AKI was uncommon in COVID-19. SARS-CoV-2 infection does not result in AKI, or aggravate CKD in the COVID-19 patients.

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