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De Clercq J, Malfait T, Malfait S, Boelens J, Coorevits L, Padalko E, Vandendriessche S, Verhasselt B, Morbée L, Bauters F, Hertegonne K, Stevens D, Vande Weygaerde Y, Vermaelen K, Van Biesen W, Vanommeslaeghe F, Verbeke F, Piers R, Van Den Noortgate N, Desmet T, Vermassen F, Vandekerckhove L, Van Braeckel E. Diagnosing COVID-19; towards a feasible COVID-19 rule-out protocol. Acta Clin Belg 2022; 77:368-376. [PMID: 33586631 PMCID: PMC7885724 DOI: 10.1080/17843286.2021.1883362] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Introduction: We present the results of the COVID-19 rule-out protocol at Ghent University Hospital, a step-wise testing approach which included repeat NFS SARS-CoV-2 rRT-PCR, respiratory multiplex RT-PCR, low-dose chest CT and bronchoscopy with BAL to confirm or rule-out SARS-CoV-2 infection in patients admitted with symptoms suggestive of COVID-19. Results: Between 19 March 2020 and 30 April 2020, 455 non-critically ill patients with symptoms suspect for COVID-19 were admitted. The initial NFS for SARS-CoV-2 rRT-PCR yielded 66.9%, the second NFS 25.4% and bronchoscopy with BAL 5.9% of total COVID-19 diagnoses. In the BAL fluid, other respiratory pathogens were detected in 65% (13/20) of the COVID-19 negative patients and only in 1/7 COVID-19 positive patients. Retrospective antibody testing at the time around BAL sampling showed a positive IgA or IgG in 42.9 % of the COVID-19 positive and 10.5% of the COVID-19 negative group. Follow-up serology showed 100% COVID-19 positivity in the COVID-19 positive group and 100% IgG negativity in the COVID-19 negative group. Conclusion: In our experience, bronchoscopy with BAL can have an added value to rule-in or rule-out COVID-19 in patients with clinical and radiographical high-likelihood of COVID-19 and repeated negative NFS testing. Furthermore, culture and respiratory multiplex PCR on BAL fluid can aid to identify alternative microbial etiological agents in this group. Retrospective analysis of antibody development in this selected group of patients suggests that the implementation of serological assays in the routine testing protocol will decrease the need for invasive procedures like bronchoscopy.
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Affiliation(s)
- J. De Clercq
- Department of Internal Medicine and Paediatrics, Ghent University, Ghent, Belgium
| | - T. Malfait
- Department of Respiratory Medicine, Ghent University Hospital, Ghent, Belgium
| | - S. Malfait
- Strategic Policy Unit, Ghent University Hospital, Ghent, Belgium
| | - J. Boelens
- Department of Medical Microbiology, Ghent University Hospital, Ghent, Belgium
| | - L. Coorevits
- Department of Medical Microbiology, Ghent University Hospital, Ghent, Belgium
| | - E. Padalko
- Department of Medical Microbiology, Ghent University Hospital, Ghent, Belgium
| | - S. Vandendriessche
- Department of Medical Microbiology, Ghent University Hospital, Ghent, Belgium
| | - B. Verhasselt
- Department of Medical Microbiology, Ghent University Hospital, Ghent, Belgium
| | - L. Morbée
- Department of Radiology, Ghent University Hospital, Ghent, Belgium
| | - F. Bauters
- Department of Respiratory Medicine, Ghent University Hospital, Ghent, Belgium
| | - K. Hertegonne
- Department of Internal Medicine and Paediatrics, Ghent University, Ghent, Belgium
- Department of Respiratory Medicine, Ghent University Hospital, Ghent, Belgium
| | - D. Stevens
- Department of Respiratory Medicine, Ghent University Hospital, Ghent, Belgium
| | - Y. Vande Weygaerde
- Department of Respiratory Medicine, Ghent University Hospital, Ghent, Belgium
| | - K. Vermaelen
- Department of Internal Medicine and Paediatrics, Ghent University, Ghent, Belgium
- Department of Respiratory Medicine, Ghent University Hospital, Ghent, Belgium
| | - W. Van Biesen
- Department of Internal Medicine and Paediatrics, Ghent University, Ghent, Belgium
- Department of Nephrology, Ghent University Hospital, Ghent, Belgium
| | | | - F. Verbeke
- Department of Internal Medicine and Paediatrics, Ghent University, Ghent, Belgium
- Department of Nephrology, Ghent University Hospital, Ghent, Belgium
| | - R. Piers
- Department of Internal Medicine and Paediatrics, Ghent University, Ghent, Belgium
- Department of Geriatrics, Ghent University Hospital, Ghent, Belgium
| | - N. Van Den Noortgate
- Department of Internal Medicine and Paediatrics, Ghent University, Ghent, Belgium
- Department of Geriatrics, Ghent University Hospital, Ghent, Belgium
| | - T. Desmet
- Emergency Department, Ghent University Hospital, Ghent, Belgium
| | - F. Vermassen
- Department of Thoracic and Vascular Surgery, Ghent University Hospital, Ghent, Belgium
| | - L. Vandekerckhove
- Department of Internal Medicine and Paediatrics, Ghent University, Ghent, Belgium
- Department of General Internal Medicine, Ghent University Hospital, Ghent, Belgium
| | - E. Van Braeckel
- Department of Internal Medicine and Paediatrics, Ghent University, Ghent, Belgium
- Department of Respiratory Medicine, Ghent University Hospital, Ghent, Belgium
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Fourdinier O, Schepers E, Meuth VML, Glorieux G, Liabeuf S, Verbeke F, Choukroun G, Massy Z, Metzinger L. Expression sérique et intérêt pronostique de miR-126 et miR-223 dans la maladie rénale chronique. Nephrol Ther 2018. [DOI: 10.1016/j.nephro.2018.07.293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Verbeke F, Lindley E, Van Bortel L, Vanholder R, London G, Cochat P, Wiecek A, Fouque D, Van Biesen W. A European Renal Best Practice (ERBP) position statement on the Kidney Disease: Improving Global Outcomes (KDIGO) Clinical Practice Guideline for the Management of Blood Pressure in Non-dialysis-dependent Chronic Kidney Disease: an endorsement with some caveats for real-life application. Nephrol Dial Transplant 2013; 29:490-6. [DOI: 10.1093/ndt/gft321] [Citation(s) in RCA: 69] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Bolignano D, Zanoli L, Rastelli S, Marcantoni C, Coppolino G, Lucisano G, Tamburino C, Battaglia E, Castellino P, Coppolino G, Lucisano G, Presta P, Battaglia E, Pedrelli L, Bolignano D, Rastelli S, Zanoli L, Marcantoni C, Bolignano D, Coppolino G, Battaglia E, Tamburino C, Castellino P, Bolignano D, Zanoli L, Rastelli S, Marcantoni C, Coppolino G, Lucisano G, Battaglia E, Tamburino C, Castellino P, Iiadis F, Ntemka A, Didangelos T, Makedou A, Divani M, Moralidis E, Makedou K, Gotzamani-Psarakou A, Grekas D, Selistre L, Souza V, Domanova O, Cochat P, Ranchin B, Varennes A, Dubourg L, Hadj-Aissa A, Leonardis D, Mallamaci F, Enia G, Postorino M, Tripepi G, Zoccali C, MAURO Working Group, Donadio C, Kanaki A, Caprio F, Donadio E, Tognotti D, Olivieri L, Eloot S, Schepers E, Barreto D, Barreto F, Liabeuf S, Van Biesen W, Verbeke F, Glorieux G, Choukroun G, Massy Z, Vanholder R, Chaaban A, Torab F, Abouchacra S, Bernieh B, Hussein Q, Osman M, Gebran N, Kayyal Y, Al Omary H, Nagelkerke N, Horio M, Imai E, Yasuda Y, Takahara S, Watanabe T, Matsuo S, Fujimi A, Ueda S, Fukami K, Obara N, Okuda S, Pecchini P, Mieth M, Mass R, Tripepi G, Malberti F, Mallamaci F, Quinn R, Zoccali C, Ravani P, Fujii H, Kono K, Nakai K, Goto S, Fukagawa M, Nishi S, Havrda M, Granatova J, Vernerova Z, Vranova J, Hornova L, Zabka J, Rychlik I, Kratka K, De Nicola L, Zamboli P, Mascia S, Calabria M, Grimaldi M, Conte G, Minutolo R, Gluhovschi G, Modilca M, Kaycsa A, Velciov S, Gluhovschi C, Bob F, Petrica L, Bozdog G, Methven S, Traynor J, Deighan C, O'Reilly D, MacGregor M, Szotowska M, Chudek J, Adamczak M, Wiecek A, Dudar I, Shifris I, Loboda O, Yanagisawa N, Ando M, Tsuchiya K, Nitta K, Heguilen R, Liste A, Canteli M, Muguerza G, Cohen L, Ortemberg M, Hermes R, Bernasconi A, Galli D, Miani N, Staffolani E, Nicolais R, Borzacchi MS, Tozzo C, Manca di Villahermosa S, Di Daniele N, Musial K, Zwolinska D, Loriga G, Carru C, Zinellu A, Milia A, Satta AE, Frolova I, Kuryata A, Koppe L, Kalabacher E, Pelletier C, Geloen A, Fouque D, Soulage C, Feriozzi S, Torras J, Cybulla M, Nicholls K, Sunder-Plassmann G, West M. Progression & risk factors CKD 1-5 (1). Clin Kidney J 2011. [DOI: 10.1093/ndtplus/4.s2.30] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Verbeke F, Van Biesen W, Honkanen E, Wikström B, Jensen P, Krzesinski J, Rasmussen M, Vanholder R, Rensma P. 1.1 PROGNOSTIC VALUE OF COMBINED ASSESSMENT OF AORTIC STIFFNESS AND CALCIFICATION IN DIALYSIS PATIENTS: OUTCOME DATA OF THE CALCIFICATION OUTCOME IN RENAL DISEASE (CORD) STUDY. Artery Res 2011. [DOI: 10.1016/j.artres.2011.10.207] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Verbeke F, Haug U, Dhondt A, Beck W, Schnell A, Dietrich R, Deppisch R, Vanholder R. The role of polymer surface degradation and barium sulphate release in the pathogenesis of catheter-related infection. Nephrol Dial Transplant 2009; 25:1207-13. [DOI: 10.1093/ndt/gfp638] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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7
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Van Biesen W, Verbeke F, Vanholder R. We don't need no education ... . (Pink Floyd, The Wall ) Multidisciplinary predialysis education programmes: pass or fail? Nephrol Dial Transplant 2009; 24:3277-9. [DOI: 10.1093/ndt/gfp448] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Van Laecke S, Van Biesen W, Verbeke F, De Bacquer D, Peeters P, Vanholder R. Posttransplantation hypomagnesemia and its relation with immunosuppression as predictors of new-onset diabetes after transplantation. Am J Transplant 2009; 9:2140-9. [PMID: 19624560 DOI: 10.1111/j.1600-6143.2009.02752.x] [Citation(s) in RCA: 94] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
New-onset diabetes after transplantation (NODAT) is a frequent complication and has an impact on patient and graft survival. Hypomagnesemia is common in both renal transplant recipients and in diabetics. This study examines the relationship between hypomagnesemia, NODAT and the type of immunosuppression in renal transplant recipients. We conducted a retrospective single-center analysis (2002-2008) in order to assess NODAT the first year posttransplantation as defined by American Diabetes Association criteria. Serum magnesium (Mg) levels were defined as the median of all Mg levels registered during the first month posttransplantation. Patients with NODAT (N = 75; 29.5%) versus non-NODAT had lower Mg levels (p < 0.001). Patients with an Mg level < versus > or = 1.9 mg/dL showed a faster development of NODAT (log-rank p < 0.001). Mg levels were lower in patients on calcineurin inhibitors (CNI) versus no CNI patients (p < 0.001). Mg levels, albumin, BMI, triglycerides, posttransplantation hyperglycemia, tacrolimus levels and the use of sirolimus were predictors of NODAT in the multivariate analysis. Hypomagnesemia was an independent predictor of NODAT in renal transplant recipients. We confirm that the use of CNI is associated with NODAT, but, to a large extent, this effect seems attributable to the induction of hypomagnesemia. After adjustment for Mg, sirolimus was also associated with NODAT.
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Affiliation(s)
- S Van Laecke
- Renal Division, Department of Internal Medicine, Ghent University Hospital, Ghent, Belgium.
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Glorieux G, Schepers E, Schindler R, Lemke HD, Verbeke F, Dhondt A, Lameire N, Vanholder R. A novel bio-assay increases the detection yield of microbiological impurity of dialysis fluid, in comparison to the LAL-test. Nephrol Dial Transplant 2008; 24:548-54. [DOI: 10.1093/ndt/gfn485] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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10
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Pletinck A, Verbeke F, Van Bortel L, Dequidt C, Vijt D, Van Biesen W, Vanholder R. Acute central haemodynamic effects induced by intraperitoneal glucose instillation. Nephrol Dial Transplant 2008; 23:4029-35. [DOI: 10.1093/ndt/gfn384] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Mahieu D, Rietzschel E, De Buyzere M, Verbeke F, Gillebert T, De Backer G, De Bacquer D, Verdonck P, Van Bortel L, Segers P. 03.05 ESTIMATED CENTRAL BLOOD PRESSURE: IMPORTANCE OF RADIAL ARTERY PRESSURE WAVEFORM CALIBRATION. Artery Res 2008. [DOI: 10.1016/j.artres.2008.08.293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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12
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Van Biesen W, Verbeke F, Vanholder R. Cardiovascular disease in haemodialysis and peritoneal dialysis: arguments pro peritoneal dialysis. Nephrol Dial Transplant 2007. [DOI: 10.1093/ndt/gfm196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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13
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Van Biesen W, Veys N, Verbeke F, Vanholder R. Chronic kidney disease: the cinderella of general medicine. Epidemiology of and screening for CKD in Belgium. Acta Clin Belg 2006; 61:319-25. [PMID: 17323841 DOI: 10.1179/acb.2006.051] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Affiliation(s)
- W Van Biesen
- Renal Division, Dept of Internal Medicine, University Hospital Ghent, Belgium.
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Vanholder R, Van Biesen W, Verbeke F, Lameire N. The epidemic of cardio-vascular disease in renal failure: where does it come from, where do we go? Acta Clin Belg 2006; 61:205-11. [PMID: 17240733 DOI: 10.1179/acb.2006.035] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
Cardio-vascular disease and death are among the most important medical and socio-economic challenges of the 21st century. Renal failure, a major medical problem per se, gives rise to an accelerated and strongly magnified model of atherogenesis and vascular damage. Already with a minor decrease in renal function, coronary and vascular risk are increased and play a role next to classical risk factors such as male gender, diabetes mellitus, hypercholesterolemia or smoking. The impact of renal failure on cardio-vascular risk remains present even after correction for these traditional risk factors. This suggests that factors specifically related to renal failure play a role. Atheromatosis is currently considered as an inflammatory disorder. Renal failure gives rise to enhanced inflammatory parameters. However, the atherogenic factors related to this inflammation remain largely unknown. Hence, the condition of renal failure may be helpful to answer this question. According to recent data from the USA, close to 5% of the general population (11% of those older than 65 without diabetes or hypertension) has a renal function which is decreased by at least 50%, but other analyses come up with even higher figures. Better identification of the factors at play in this population, optimized secondary preventive actions similar to those applied in diabetics, and timely screening and therapy will be helpful to improve quality of life and reduce socio-economic burden in this population.
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Affiliation(s)
- R Vanholder
- Nephrology Section, University Hospital, Gent, Belgium.
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Vanholder R, Massy Z, Argiles A, Spasovski G, Verbeke F, Lameire N. Chronic kidney disease as cause of cardiovascular morbidity and mortality. Nephrol Dial Transplant 2005; 20:1048-56. [PMID: 15814534 DOI: 10.1093/ndt/gfh813] [Citation(s) in RCA: 410] [Impact Index Per Article: 21.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
To make an evidence-based evaluation of the relationship between kidney failure and cardiovascular risk, we reviewed the literature obtained from a PubMed search using pre-defined keywords related to both conditions and covering 18 years (1986 until end 2003). Eighty-five publications, covering 552 258 subjects, are summarized. All but three studies support a link between kidney dysfunction and cardiovascular risk. More importantly, the association is observed very early during the evolution of renal failure: an accelerated cardiovascular risk appears at varying glomerular filtration rate (GFR) cut-off values, which were >/=60 ml/min in at least 20 studies. Many studies lacked a clear definition of cardiovascular disease and/or used a single determination of serum creatinine or GFR as an index of kidney function, which is not necessarily corresponding to well-defined chronic kidney disease. In six studies, however, chronic kidney dysfunction and cardiovascular disease were well defined and the results of these confirm the impact of kidney dysfunction. It is concluded that there is an undeniable link between kidney dysfunction and cardiovascular risk and that the presence of even subtle kidney dysfunction should be considered as one of the conditions necessitating intensive prevention of this cardiovascular risk.
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Affiliation(s)
- R Vanholder
- Nephrology Section, 0K12, University Hospital, De Pintelaan 185, B-9000 Gent, Belgium.
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Boutouyrie P, Azizi M, Agharazii M, Bissery A, Verbeke F, Laurent S, Alhenc-Gelas F, Jeunemaitre X. ARTERIAL PROPERTIES AND ENDOTHELIAL FUNCTION IN SUBJECTS WITH GENETICALLY REDUCED KALLIKREIN ACTIVITY. J Hypertens 2004. [DOI: 10.1097/00004872-200406002-00505] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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