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Dehesa-López E, Galindo AE, Santos IMV, Aros-Pérez MA, Rodríguez DMG, Ojeda-Mendoza E, Ide BPA. Clinical characteristics and factors associated with acute kidney injury among patients hospitalized with coronavirus disease: an observational retrospective study. SAO PAULO MED J 2022; 140:566-573. [PMID: 35730863 PMCID: PMC9491477 DOI: 10.1590/1516-3180.2021.0668.r1.121121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2021] [Accepted: 11/12/2021] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Coronavirus disease 19 (COVID-19) is a multisystemic disease with high incidence of acute kidney injury (AKI). OBJECTIVE To describe the clinical characteristics and factors associated with AKI among patients hospitalized with COVID-19. DESIGN AND SETTING Retrospective cohort conducted at Hospital Civil de Culiacan, Mexico. METHODS We included 307 patients hospitalized due to COVID-19. AKI was defined and staged based on serum creatinine levels in accordance with the criteria of the Acute Kidney Injury Network (AKIN). Multivariate logistic regression analysis was used to determine factors associated with AKI. RESULTS The patients' age was 56 ± 15 years (64.5% male). The incidence of AKI was 33.6% (n = 103). Overall, 53.4% of patients had community-acquired AKI, and 46.6% had hospital-acquired AKI. Additionally, 15.5% of them presented AKIN stage 1; 34% had AKIN stage 2; and 50.5% had AKIN stage 3. Hemodialysis was required for 10.7% of the patients. The factors associated with AKI were chronic kidney disease (odds ratio, OR: 10.8; P = 0.04), use of norepinephrine (OR: 7.3; P = 0.002), diabetes mellitus (OR: 2.9; P = 0.03), C-reactive protein level (OR: 1.005; P = 0.01) and COVID-19 severity index based on chest tomography (OR: 1.09; statistical trend, P = 0.07). Hospital stay (11 ± 7 days; P < 0.001) and mortality (83.5 versus 31.4%; P < 0.05) were greater among patients with AKI. CONCLUSION AKI was a frequent and serious complication in our cohort of patients hospitalized with COVID-19, which was associated with high mortality and long hospital stay.
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Affiliation(s)
- Edgar Dehesa-López
- MD, MSc, PhD. Chief of Department of Internal Medicine, Centro de Investigación y Docencia en Ciencias de la Salud (CIDOCS), Culiacán, Mexico
| | - Adolfo Entzana Galindo
- MD. Chief of the Hospital Epidemiological Unit, Hospital Civil de Culiacán, Culiacán, Mexico
| | - Irali María Velasco Santos
- MD. Internal Medicine Resident, Department of Internal Medicine, Centro de Investigación y Docencia en Ciencias de la Salud (CIDOCS), Culiacán, Mexico
| | - Michel Alberto Aros-Pérez
- MD. Internal Medicine Resident, Department of Internal Medicine, Centro de Investigación y Docencia en Ciencias de la Salud (CIDOCS), Culiacán, Mexico
| | - Diego Manuel Gómez Rodríguez
- MD. Internal Medicine Resident, Department of Internal Medicine, Centro de Investigación y Docencia en Ciencias de la Salud (CIDOCS), Culiacán, Mexico
| | - Erick Ojeda-Mendoza
- MD. Internal Medicine Resident, Department of Internal Medicine, Centro de Investigación y Docencia en Ciencias de la Salud (CIDOCS), Culiacán, Mexico
| | - Brenda Paola Aguilar Ide
- MD. House Staff, Department of Internal Medicine, Centro de Investigación y Docencia en Ciencias de la Salud (CIDOCS), Culiacán, Mexico
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Lombardi R, Ferreiro A, Ponce D, Claure-Del Granado R, Aroca G, Venegas Y, Pereira M, Chavez-Iñiguez J, Rojas N, Villa A, Colombo M, Carlino C, Guimarâes C, Younes-Ibrahim M, Rizo LM, Guzmán G, Varela C, Rosa-Diez G, Janiques D, Ayala R, Coronel G, Roessler E, Amor S, Osorio W, Rivas N, Pereira B, de Azevedo C, Flores A, Ubillo J, Raño J, Yu L, Burdmann EA, Rodríguez L, Galagarza-Gutiérrez G, Curitomay-Cruz J. Latin American registry of renal involvement in COVID-19 disease. The relevance of assessing proteinuria throughout the clinical course. PLoS One 2022; 17:e0261764. [PMID: 35085273 PMCID: PMC8794101 DOI: 10.1371/journal.pone.0261764] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Accepted: 12/09/2021] [Indexed: 01/08/2023] Open
Abstract
The Latin American Society of Nephrology and Hypertension conducted a prospective cohort, multinational registry of Latin American patients with kidney impairment associated to COVID-19 infection with the objective to describe the characteristics of acute kidney disease under these circumstances. The study was carried out through open invitation in order to describe the characteristics of the disease in the region. Eight-hundred and seventy patients from 12 countries were included. Median age was 63 years (54-74), most of patients were male (68.4%) and with diverse comorbidities (87.2%). Acute kidney injury (AKI) was hospital-acquired in 64.7% and non-oliguric in 59.9%. Multiorgan dysfunction syndrome (MODS) due to COVID-19 and volume depletion were the main factors contributing to AKI (59.2% and 35.7% respectively). Kidney replacement therapy was started in 46.2%. Non-recovery of renal function was observed in 65.3%. 71.5% of patients were admitted to ICU and 72.2% underwent mechanical ventilation. Proteinuria at admission was present in 62.4% of patients and proteinuria during hospital-stay occurred in 37.5%. Those patients with proteinuria at admission had higher burden of comorbidities, higher baseline sCr, and MODS was severe. On the other hand, patients with de novo proteinuria had lower incidence of comorbidities and near normal sCr at admission, but showed adverse course of disease. COVID-19 MODS was the main cause of AKI in both groups. All-cause mortality of the general population was 57.4%, and it was associated to age, sepsis as cause of AKI, severity of condition at admission, oliguria, mechanical ventilation, non-recovery of renal function, in-hospital complications and hospital stay. In conclusion, our study contributes to a better knowledge of this condition and highlights the relevance of the detection of proteinuria throughout the clinical course.
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Affiliation(s)
- Raúl Lombardi
- Department of Nephrology, Universidad de la República, Montevideo, Uruguay
| | - Alejandro Ferreiro
- Department of Nephrology, Universidad de la República, Montevideo, Uruguay
| | - Daniela Ponce
- Clinical Hospital of Botucatu, School Medicine, HCFMB, University of Sao Paulo State UNESP, Brazil
| | | | | | - Yanissa Venegas
- Hospital Nacional Arzobispo Loayza, Servicio de Nefrología, Lima, Perú
| | | | | | - Nelson Rojas
- Departamento de Nefrología, Hospital General de Agudos Dr Cosme Argerich, Buenos Aires, Argentina
| | - Ana Villa
- Division of Nephrology, Hospital Civil de Guadalajara, Guadalajara, Mexico
| | | | - Cristina Carlino
- Department of Nephrology, Hospital Provincial, Rosario, Argentina
| | - Caio Guimarâes
- Nefrologia, Pontificia Universidade Catolica do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Mauricio Younes-Ibrahim
- Nefrologia, Pontificia Universidade Catolica do Rio de Janeiro, Rio de Janeiro, Brazil
- Internal Medicine, University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Lilia Maria Rizo
- Nephrology Hospital Universitario Dr José Eleuterio González, Monterrey, Mexico
| | - Gisselle Guzmán
- Centros de Diagnóstico y Medicina Avanzada, Santo Domingo, República Dominicana
| | - Carlos Varela
- Servicio de Nefrología, Hospital Italiano, Buenos Aires, Argentina
| | | | - Diego Janiques
- Nefrologia, Pontificia Universidade Catolica do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Roger Ayala
- Departamento de Medicina Interna, Salud Renal MSP, Asunción, Paraguay
| | - Galo Coronel
- Departamento de Nefrología, Hospital General de Agudos Dr Cosme Argerich, Buenos Aires, Argentina
| | - Eric Roessler
- Department of Nephrology, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Serena Amor
- Servicio de Nefrología, Hospital Español, Montevideo, Uruguay
| | - Washington Osorio
- Departamento de Nefrología, Hospital de Especialidades de las Fuerzas Armadas, Quito, Ecuador
| | - Natalia Rivas
- Servicio de Nefrología y Diálisis, Hospital Rojas, Buenos Aires, Argentina
| | | | | | - Adriana Flores
- Departamento de Nefrología, Hospital Regional General Dr Carlos Mac Gregor Sanchez Navarro, DF, Mexico
| | - José Ubillo
- Departamento de Nefrología, Hospital de Pediatría CMN Siglo XXI, DF, Mexico
| | - Julieta Raño
- Departamento de Nefrología, Hospital General de Agudos Dr Cosme Argerich, Buenos Aires, Argentina
| | - Luis Yu
- Department of Nephrology, School of Medicine, University of Sao Paulo, Sao Paulo, Brazil
| | - Emmanuel A. Burdmann
- Department of Nephrology, School of Medicine, University of Sao Paulo, Sao Paulo, Brazil
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Kuno T, Miyamoto Y, Iwagami M, Ishimaru M, So M, Takahashi M, Egorova NN. The association of hemoglobin drop with in-hospital outcomes in COVID-19 patients. QJM 2022; 114:789-794. [PMID: 34597401 PMCID: PMC8500138 DOI: 10.1093/qjmed/hcab251] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Revised: 09/16/2021] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Bleeding events can be critical in hospitalized patients with COVID-19, especially those with aggressive anticoagulation therapy. AIM We aimed to investigate whether hemoglobin drop was associated with increased risk of acute kidney injury (AKI) and in-hospital mortality among patients with COVID-19. DESIGN Retrospective cohort study. METHODS This retrospective study was conducted by review of the medical records of 6683 patients with laboratory-confirmed COVID-19 hospitalized in the Mount Sinai Health system between 1st March 2020 and 30th March 2021. We compared patients with and without hemoglobin drop >3 g/dl during hospitalization within a week after admissions, using inverse probability treatment weighted analysis (IPTW). Outcomes of interest were in-hospital mortality and AKI which was defined as serum creatine change of 0.3 mg/dl increase or 1.5 times baseline. RESULTS Of the 6683 patients admitted due to COVID-19, 750 (11.2%) patients presented with a marked hemoglobin drop. Patients with hemoglobin drop were more likely to receive therapeutic anticoagulation within 2 days after admissions. Patients with hemoglobin drop had higher crude in-hospital mortality (40.8% vs. 20.0%, P < 0.001) as well as AKI (51.4% vs. 23.9%, P < 0.001) compared to those without. IPTW analysis showed that hemoglobin drop was associated with higher in-hospital mortality compared to those without (odds ratio (OR) [95% confidential interval (CI)]: 2.21 [1.54-2.88], P < 0.001) as well as AKI (OR [95% CI]: 2.79 [2.08-3.73], P < 0.001). CONCLUSIONS Hemoglobin drop during COVID-19 related hospitalizations was associated with a higher risk of AKI and in-hospital mortality.
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Affiliation(s)
- Toshiki Kuno
- Division of Cardiology, Montefiore Medical Center, Albert Einstein College of Medicine, NY, USA
- Address for correspondence: Toshiki Kuno, MD, PhD, Division of Cardiology, Montefiore Medical Center, Albert Einsten College of Medicine, 111 East 210th St, Bronx, NY 10467-2401,
| | | | - Masao Iwagami
- Department of Health Services Research, University of Tsukuba, Tsukuba, Japan
| | - Miho Ishimaru
- Department of Health Services Research, University of Tsukuba, Tsukuba, Japan
| | - Matsuo So
- Department of Medicine, Icahn School of Medicine at Mount Sinai, Mount Sinai Beth Israel, NY, USA
| | - Mai Takahashi
- Department of Medicine, Icahn School of Medicine at Mount Sinai, Mount Sinai Beth Israel, NY, USA
| | - Natalia N Egorova
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, NY, USA
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Melchers M, Festen B, den Dekker BM, Mooren ERM, van Binsbergen AL, van Bree SHW, Heusinkveld M, Schellaars R, Buil JB, Verweij PE, van Zanten ARH. A 67-Year-Old Male Patient With COVID-19 With Worsening Respiratory Function and Acute Kidney Failure. Chest 2022; 161:e5-e11. [PMID: 35000717 PMCID: PMC8733290 DOI: 10.1016/j.chest.2021.08.045] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Revised: 07/13/2021] [Accepted: 08/02/2021] [Indexed: 11/11/2022] Open
Abstract
CASE PRESENTATION A 67-year-old obese man (BMI 38.0) with type 2 diabetes mellitus (DM), chronic atrial fibrillation, and chronic lymphocytic leukemia stage II, stable for 8 years after chemotherapy, and a history of smoking presented to the ED with progressive dyspnea and fever due to SARS-CoV-2 infection. He was admitted to a general ward and treated with dexamethasone (6 mg IV once daily) and oxygen. On day 3 of hospital admission, he became progressively hypoxemic and was admitted to the ICU for invasive mechanical ventilation. Dexamethasone treatment was continued, and a single dose of tocilizumab (800 mg) was administered. On day 9 of ICU admission, voriconazole treatment was initiated after tracheal white plaques at bronchoscopy, suggestive of invasive Aspergillus tracheobronchitis, were noticed. However, his medical situation dramatically deteriorated.
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Affiliation(s)
- Max Melchers
- Department of Intensive Care Medicine, Hospital Gelderse Vallei, Ede, The Netherlands
| | - Barbara Festen
- Department of Intensive Care Medicine, Hospital Gelderse Vallei, Ede, The Netherlands
| | - Bianca M den Dekker
- Department of Intensive Care Medicine, Hospital Gelderse Vallei, Ede, The Netherlands
| | - Eline R M Mooren
- Department of Intensive Care Medicine, Hospital Gelderse Vallei, Ede, The Netherlands
| | | | - Sjoerd H W van Bree
- Department of Intensive Care Medicine, Hospital Gelderse Vallei, Ede, The Netherlands
| | - Moniek Heusinkveld
- Department of Medical Microbiology, Hospital Gelderse Vallei, Ede, The Netherlands
| | - Roel Schellaars
- Department of Intensive Care Medicine, Hospital Gelderse Vallei, Ede, The Netherlands
| | - Jochem B Buil
- Department of Medical Microbiology and Radboudumc-CWZ Center of Expertise for Mycology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Paul E Verweij
- Department of Medical Microbiology and Radboudumc-CWZ Center of Expertise for Mycology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Arthur R H van Zanten
- Department of Intensive Care Medicine, Hospital Gelderse Vallei, Ede, The Netherlands; Division of Human Nutrition and Health, Wageningen University & Research, Wageningen, The Netherlands.
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5
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Sindhu C, Prasad P, Elumalai R, Matcha J. Clinical profile and outcomes of COVID-19 patients with acute kidney injury: a tertiary centre experience from South India. Clin Exp Nephrol 2022; 26:36-44. [PMID: 34401969 PMCID: PMC8366740 DOI: 10.1007/s10157-021-02123-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Accepted: 08/10/2021] [Indexed: 12/19/2022]
Abstract
AIM The rates of development of acute kidney injury (AKI) in COVID-19 have been variably reported from across the world. Prevalence and outcomes of AKI in hospitalised COVID-19 patients in India has not been studied well. METHODS This was a retrospective observational study amongst adult hospitalised COVID-19 patients admitted at a tertiary care centre between May 1 and October 31, 2020. We estimated the prevalence of AKI and outcomes including mortality and acute kidney disease (AKD) at the time of discharge. Regression analysis was done to study the factors associated with mortality and AKD. RESULTS Out of 2650 hospitalised patients with COVID-19, 190 (7.2%) patients developed AKI. Mean age of patients with AKI was 62.6 years, 81.6% were male. Comorbidities included diabetes mellitus in 72.1%, hypertension in 66.8%, heart disease in 30% and chronic kidney disease (CKD) in 22.6%. Most patients had stage 1 AKI (71.1%). Overall mortality in patients with AKI was 22.1%, 75% in those requiring dialysis and 74.5% in those requiring ICU. Amongst survivors without pre-existing CKD, 40.9% patients had acute kidney disease at the time of discharge. Higher age, stage 3 AKI and need for mechanical ventilation were associated with higher mortality. On multivariable regression, factors associated with AKD at discharge included pre-existing heart disease and severe albuminuria during hospitalisation. CONCLUSION In our study population, we found a low prevalence of AKI. Mortality was high in AKI patients requiring ICU care and dialysis. Amongst survivors, a significant percentage had AKD at the time of discharge.
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Affiliation(s)
- Chaganti Sindhu
- Department of Nephrology, Sri Ramachandra Institute of Higher Education and Research, Chennai, India
| | - Pallavi Prasad
- Department of Nephrology, Sri Ramachandra Institute of Higher Education and Research, Chennai, India.
- , 37&38, Sri Lakshmi Nagar, 10th Cross Street, Valasarvakkam, Chennai, 600087, India.
| | - Ramprasad Elumalai
- Department of Nephrology, Sri Ramachandra Institute of Higher Education and Research, Chennai, India
| | - Jayakumar Matcha
- Department of Nephrology, Sri Ramachandra Institute of Higher Education and Research, Chennai, India
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Wang W, Chen J, Hu D, Pan P, Liang L, Wu W, Tang Y, Huang XR, Yu X, Wu J, Lan HY. SARS-CoV-2 N Protein Induces Acute Kidney Injury via Smad3-Dependent G1 Cell Cycle Arrest Mechanism. Adv Sci (Weinh) 2022; 9:e2103248. [PMID: 34813685 PMCID: PMC8787402 DOI: 10.1002/advs.202103248] [Citation(s) in RCA: 37] [Impact Index Per Article: 18.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Revised: 10/10/2021] [Indexed: 05/02/2023]
Abstract
COVID-19 is infected by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and can cause severe multiple organ injury and death. Kidney is one of major target organs of COVID-19 and acute kidney injury (AKI) is common in critically ill COVID-19 patients. However, mechanisms through which COVID-19 causes AKI remain largely unknown and treatment remains unspecific and ineffective. Here, the authors report that normal kidney-specifically overexpressing SARS-CoV-2 N develops AKI, which worsens in mice under ischemic condition. Mechanistically, it is uncovered that SARS-CoV-2 N-induced AKI is Smad3-dependent as SARS-CoV-2 N protein can interact with Smad3 and enhance TGF-β/Smad3 signaling to cause tubular epithelial cell death and AKI via the G1 cell cycle arrest mechanism. This is further confirmed in Smad3 knockout mice and cells in which deletion of Smad3 protects against SARS-CoV-2 N protein-induced cell death and AKI in vivo and in vitro. Most significantly, it is also found that targeting Smad3 with a Smad3 pharmacological inhibitor is able to inhibit SARS-CoV-2 N-induced AKI. In conclusion, the authors identify that SARS-CoV-2 N protein is a key mediator for AKI and induces AKI via the Smad3-dependent G1 cell cycle arrest mechanism. Targeting Smad3 may represent as a novel therapy for COVID-19-asscoaited AKI.
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Affiliation(s)
- Wenbiao Wang
- Departments of Medicine and TherapeuticsLi Ka Shing Institute of Health Sciences, and Lui Che Woo Institute of Innovative MedicineThe Chinese University of Hong KongHong Kong999077China
- Guangdong Provincial Key Laboratory of VirologyInstitute of Medical MicrobiologyJinan UniversityGuangzhou510632China
- Guangdong‐Hong Kong Joint Laboratory for Immunological and Genetic Kidney DiseaseGuangdong Academy of Medical ScienceGuangdong Provincial People's HospitalGuangzhou510080China
- The Chinese University of Hong Kong‐Guangdong Academy of Sciences/Guangdong Provincial People's Hospital Joint Research Laboratory on Immunological and Genetic Kidney DiseasesThe Chinese University of Hong KongHong Kong999077China
| | - Junzhe Chen
- Departments of Medicine and TherapeuticsLi Ka Shing Institute of Health Sciences, and Lui Che Woo Institute of Innovative MedicineThe Chinese University of Hong KongHong Kong999077China
- Department of NephrologyThe Third Affiliated HospitalSouthern Medical UniversityGuangzhou510080China
| | - Dingwen Hu
- State Key Laboratory of VirologyCollege of Life SciencesWuhan UniversityWuhan430072China
| | - Pan Pan
- Guangdong Provincial Key Laboratory of VirologyInstitute of Medical MicrobiologyJinan UniversityGuangzhou510632China
| | - Liying Liang
- Departments of Medicine and TherapeuticsLi Ka Shing Institute of Health Sciences, and Lui Che Woo Institute of Innovative MedicineThe Chinese University of Hong KongHong Kong999077China
| | - Wenjing Wu
- Departments of Medicine and TherapeuticsLi Ka Shing Institute of Health Sciences, and Lui Che Woo Institute of Innovative MedicineThe Chinese University of Hong KongHong Kong999077China
- Guangdong‐Hong Kong Joint Laboratory for Immunological and Genetic Kidney DiseaseGuangdong Academy of Medical ScienceGuangdong Provincial People's HospitalGuangzhou510080China
| | - Ying Tang
- Department of NephrologyThe Third Affiliated HospitalSouthern Medical UniversityGuangzhou510080China
| | - Xiao R. Huang
- Departments of Medicine and TherapeuticsLi Ka Shing Institute of Health Sciences, and Lui Che Woo Institute of Innovative MedicineThe Chinese University of Hong KongHong Kong999077China
- Guangdong‐Hong Kong Joint Laboratory for Immunological and Genetic Kidney DiseaseGuangdong Academy of Medical ScienceGuangdong Provincial People's HospitalGuangzhou510080China
| | - Xueqing Yu
- Guangdong‐Hong Kong Joint Laboratory for Immunological and Genetic Kidney DiseaseGuangdong Academy of Medical ScienceGuangdong Provincial People's HospitalGuangzhou510080China
| | - Jianguo Wu
- Guangdong Provincial Key Laboratory of VirologyInstitute of Medical MicrobiologyJinan UniversityGuangzhou510632China
- State Key Laboratory of VirologyCollege of Life SciencesWuhan UniversityWuhan430072China
| | - Hui Y. Lan
- Departments of Medicine and TherapeuticsLi Ka Shing Institute of Health Sciences, and Lui Che Woo Institute of Innovative MedicineThe Chinese University of Hong KongHong Kong999077China
- The Chinese University of Hong Kong‐Guangdong Academy of Sciences/Guangdong Provincial People's Hospital Joint Research Laboratory on Immunological and Genetic Kidney DiseasesThe Chinese University of Hong KongHong Kong999077China
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Toth-Manikowski SM, Caldwell J, Joo M, Chen J, Meza N, Bruinius J, Gupta S, Hannan M, Kagalwalla M, Madrid S, Melamed ML, Pacheco E, Srivastava A, Viamontes C, Lash JP, Leaf DE, Ricardo AC. Sex-related differences in mortality, acute kidney injury, and respiratory failure among critically ill patients with COVID-19. Medicine (Baltimore) 2021; 100:e28302. [PMID: 34918709 PMCID: PMC8677989 DOI: 10.1097/md.0000000000028302] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Accepted: 11/22/2021] [Indexed: 01/05/2023] Open
Abstract
Although the number of deaths due to coronavirus disease 2019 (COVID-19) is higher in men than women, prior studies have provided limited sex-stratified clinical data.We evaluated sex-related differences in clinical outcomes among critically ill adults with COVID-19.Multicenter cohort study of adults with laboratory-confirmed COVID-19 admitted to intensive care units at 67 U.S. hospitals from March 4 to May 9, 2020. Multilevel logistic regression was used to evaluate 28-day in-hospital mortality, severe acute kidney injury (AKI requiring kidney replacement therapy), and respiratory failure occurring within 14 days of intensive care unit admission.A total of 4407 patients were included (median age, 62 years; 2793 [63.4%] men; 1159 [26.3%] non-Hispanic White; 1220 [27.7%] non-Hispanic Black; 994 [22.6%] Hispanic). Compared with women, men were younger (median age, 61 vs 64 years, less likely to be non-Hispanic Black (684 [24.5%] vs 536 [33.2%]), and more likely to smoke (877 [31.4%] vs 422 [26.2%]). During median follow-up of 14 days, 1072 men (38.4%) and 553 women (34.3%) died. Severe AKI occurred in 590 men (21.8%), and 239 women (15.5%), while respiratory failure occurred in 2255 men (80.7%) and 1234 women (76.5%). After adjusting for age, race/ethnicity and clinical variables, compared with women, men had a higher risk of death (OR, 1.50, 95% CI, 1.26-1.77), severe AKI (OR, 1.92; 95% CI 1.57-2.36), and respiratory failure (OR, 1.42; 95% CI, 1.11-1.80).In this multicenter cohort of critically ill adults with COVID-19, men were more likely to have adverse outcomes compared with women.
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Affiliation(s)
| | - Jillian Caldwell
- Department of Medicine, University of Illinois at Chicago, Chicago, IL
| | - Min Joo
- Department of Medicine, University of Illinois at Chicago, Chicago, IL
| | - Jinsong Chen
- Department of Medicine, University of Illinois at Chicago, Chicago, IL
| | - Natalie Meza
- Department of Medicine, University of Illinois at Chicago, Chicago, IL
| | - Jacob Bruinius
- Department of Medicine, University of Illinois at Chicago, Chicago, IL
| | - Shruti Gupta
- Division of Renal Medicine, Brigham and Women's Hospital, Boston, MA
| | - Mary Hannan
- Department of Medicine, University of Illinois at Chicago, Chicago, IL
| | | | - Samantha Madrid
- Department of Medicine, University of Illinois at Chicago, Chicago, IL
| | - Michal L. Melamed
- Division of Nephrology, Department of Medicine, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, NY
| | - Esther Pacheco
- Department of Medicine, University of Illinois at Chicago, Chicago, IL
| | - Anand Srivastava
- Center for Translational Metabolism and Health, Institute for Public Health and Medicine, Division of Nephrology and Hypertension, Northwestern University Feinberg School of Medicine, Chicago, IL
| | | | - James P. Lash
- Department of Medicine, University of Illinois at Chicago, Chicago, IL
| | - David E. Leaf
- Division of Renal Medicine, Brigham and Women's Hospital, Boston, MA
| | - Ana C. Ricardo
- Department of Medicine, University of Illinois at Chicago, Chicago, IL
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8
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Bezerra R, Teles F, Mendonca PB, Damte T, Likaka A, Ferrer-Miranda E, de Albuquerque JO, de Lima Filho JL. Outcomes of critically ill patients with acute kidney injury in COVID-19 infection: an observational study. Ren Fail 2021; 43:911-918. [PMID: 34057014 PMCID: PMC8168780 DOI: 10.1080/0886022x.2021.1933530] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Revised: 04/15/2021] [Accepted: 05/17/2021] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Early reports indicate that AKI is common during COVID-19 infection. Different mortality rates of AKI due to SARS-CoV-2 have been reported, based on the degree of organic dysfunction and varying from public to private hospitals. However, there is a lack of data about AKI among critically ill patients with COVID-19. METHODS We conducted a multicenter cohort study of 424 critically ill adults with severe acute respiratory syndrome (SARS) and AKI, both associated with SARS-CoV-2, admitted to six public ICUs in Brazil. We used multivariable logistic regression to identify risk factors for AKI severity and in-hospital mortality. RESULTS The average age was 66.42 ± 13.79 years, 90.3% were on mechanical ventilation (MV), 76.6% were at KDIGO stage 3, and 79% underwent hemodialysis. The overall mortality was 90.1%. We found a higher frequency of dialysis (82.7% versus 45.2%), MV (95% versus 47.6%), vasopressors (81.2% versus 35.7%) (p < 0.001) and severe AKI (79.3% versus 52.4%; p = 0.002) in nonsurvivors. MV, vasopressors, dialysis, sepsis-associated AKI, and death (p < 0.001) were more frequent in KDIGO 3. Logistic regression for death demonstrated an association with MV (OR = 8.44; CI 3.43-20.74) and vasopressors (OR = 2.93; CI 1.28-6.71; p < 0.001). Severe AKI and dialysis need were not independent risk factors for death. MV (OR = 2.60; CI 1.23-5.45) and vasopressors (OR = 1.95; CI 1.12-3.99) were also independent risk factors for KDIGO 3 (p < 0.001). CONCLUSION Critically ill patients with SARS and AKI due to COVID-19 had high mortality in this cohort. Mortality was largely determined by the need for mechanical ventilation and vasopressors rather than AKI severity.
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Affiliation(s)
- Rodrigo Bezerra
- Keizo Asami Laboratory of Immunopathology, Federal University of Pernambuco, Recife, Brazil
- PROCAPE, University of Pernambuco, Recife, Brazil
| | - Flávio Teles
- Clinical Medicine Department, Federal University of Alagoas, Maceio, Brazil
| | | | | | - Andrew Likaka
- Keizo Asami Laboratory of Immunopathology, Federal University of Pernambuco, Recife, Brazil
| | | | - Jones Oliveira de Albuquerque
- Keizo Asami Laboratory of Immunopathology, Federal University of Pernambuco, Recife, Brazil
- Department of Statistics and Informatics, Federal Rural University of Pernambuco, Recife, Brazil
| | - José Luiz de Lima Filho
- Keizo Asami Laboratory of Immunopathology, Federal University of Pernambuco, Recife, Brazil
- Department of Biochemistry, Federal University of Pernambuco, Recife, Brazil
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9
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Goichberg J, Becker-Cohen R. [PEDIATRIC NEPHROLOGY IN THE TIME OF CORONA]. Harefuah 2021; 160:780-785. [PMID: 34957711] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Symptomatic coronavirus 2019 (COVID-19) infection usually presents with upper airway symptoms, but may lead to complications, such as pneumonia and involvement of other organs, or even death. Children often have a mild clinical course or may be asymptomatic, however, a severe complication of multisystem inflammatory syndrome has been described in rare cases. In severe COVID-19 infection, acute kidney injury may manifest even in children without comorbidities. The aim of this review is to present available data on renal involvement in pediatric COVID-19, and disease manifestations in children with underlying chronic kidney disease (CKD) or children receiving immunosuppressive medications due to kidney transplantation or glomerular disease. Although it could be assumed that children with CKD, including immunosuppressed patients, might be a high risk group for infection and severity of COVID-19 disease, this is not supported by current available data.
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Affiliation(s)
- Jenny Goichberg
- Division of Pediatric Nephrology, Shaare Zedek Medical Center, Jerusalem, Israel
| | - Rachel Becker-Cohen
- Division of Pediatric Nephrology, Shaare Zedek Medical Center, Jerusalem, Israel
- Hebrew University-Hadassah School of Medicine, Jerusalem, Israel
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10
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Abstract
Although respiratory failure and hypoxaemia are the main manifestations of COVID-19, kidney involvement is also common. Available evidence supports a number of potential pathophysiological pathways through which acute kidney injury (AKI) can develop in the context of SARS-CoV-2 infection. Histopathological findings have highlighted both similarities and differences between AKI in patients with COVID-19 and in those with AKI in non-COVID-related sepsis. Acute tubular injury is common, although it is often mild, despite markedly reduced kidney function. Systemic haemodynamic instability very likely contributes to tubular injury. Despite descriptions of COVID-19 as a cytokine storm syndrome, levels of circulating cytokines are often lower in patients with COVID-19 than in patients with acute respiratory distress syndrome with causes other than COVID-19. Tissue inflammation and local immune cell infiltration have been repeatedly observed and might have a critical role in kidney injury, as might endothelial injury and microvascular thrombi. Findings of high viral load in patients who have died with AKI suggest a contribution of viral invasion in the kidneys, although the issue of renal tropism remains controversial. An impaired type I interferon response has also been reported in patients with severe COVID-19. In light of these observations, the potential pathophysiological mechanisms of COVID-19-associated AKI may provide insights into therapeutic strategies.
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Affiliation(s)
- Matthieu Legrand
- Department of Anesthesia and Perioperative Care, Division of Critical Care Medicine, University of California, San Francisco, CA, USA.
- Investigation Network Initiative-Cardiovascular and Renal Clinical Trialists network, Nancy, France.
| | - Samira Bell
- Division of Population Health and Genomics, School of Medicine, University of Dundee, Dundee, UK
| | - Lui Forni
- Intensive Care Unit, Royal Surrey Hospital NHS Foundation Trust, Surrey, UK
- Department of Clinical and Experimental Medicine, Faculty of Health Sciences, University of Surrey, Surrey, UK
| | - Michael Joannidis
- Division of Intensive Care and Emergency Medicine, Medical University of Innsbruck, Innsbruck, Austria
| | - Jay L Koyner
- Divisions of Nephrology, Departments of Medicine, University of Chicago, Chicago, IL, USA
| | - Kathleen Liu
- Divisions of Nephrology and Critical Care Medicine, Departments of Medicine and Anesthesia, University of San Francisco, San Francisco, CA, USA
| | - Vincenzo Cantaluppi
- Nephrology and Kidney Transplantation Unit, Department of Translational Medicine, University of Piemonte Orientale, Novara, Italy
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11
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Ohno M, Sasaki M, Orba Y, Sekiya T, Masum MA, Ichii O, Sawamura T, Kakino A, Suzuki Y, Kida H, Sawa H, Shingai M. Abnormal Blood Coagulation and Kidney Damage in Aged Hamsters Infected with Severe Acute Respiratory Syndrome Coronavirus 2. Viruses 2021; 13:v13112137. [PMID: 34834944 PMCID: PMC8618556 DOI: 10.3390/v13112137] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Revised: 10/14/2021] [Accepted: 10/20/2021] [Indexed: 01/28/2023] Open
Abstract
Systemic symptoms have often been observed in patients with coronavirus disease 2019 (COVID-19) in addition to pneumonia, however, the details are still unclear due to the lack of an appropriate animal model. In this study, we investigated and compared blood coagulation abnormalities and tissue damage between male Syrian hamsters of 9 (young) and over 36 (aged) weeks old after intranasal infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Despite similar levels of viral replication and inflammatory responses in the lungs of both age groups, aged but not young hamsters showed significant prolongation of prothrombin time and prominent acute kidney damage. Moreover, aged hamsters demonstrated increased intravascular coagulation time-dependently in the lungs, suggesting that consumption of coagulation factors causes prothrombin time prolongation. Furthermore, proximal urinary tract damage and mesangial matrix expansion were observed in the kidneys of the aged hamsters at early and later disease stages, respectively. Given that the severity and mortality of COVID-19 are higher in elderly human patients, the effect of aging on pathogenesis needs to be understood and should be considered for the selection of animal models. We, thus, propose that the aged hamster is a good small animal model for COVID-19 research.
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Affiliation(s)
- Marumi Ohno
- Laboratory for Biologics Development, International Institute for Zoonosis Control, Hokkaido University, Sapporo 001-0020, Japan; (M.O.); (H.K.)
| | - Michihito Sasaki
- Division of Molecular Pathobiology, International Institute for Zoonosis Control, Hokkaido University, Sapporo 001-0020, Japan; (M.S.); (Y.O.)
| | - Yasuko Orba
- Division of Molecular Pathobiology, International Institute for Zoonosis Control, Hokkaido University, Sapporo 001-0020, Japan; (M.S.); (Y.O.)
| | - Toshiki Sekiya
- International Collaboration Unit, International Institute for Zoonosis Control, Hokkaido University, Sapporo 001-0020, Japan;
| | - Md. Abdul Masum
- Laboratory of Anatomy, Department of Basic Veterinary Sciences, Faculty of Veterinary Medicine, Hokkaido University, Sapporo 060-0818, Japan; (M.A.M.); (O.I.)
| | - Osamu Ichii
- Laboratory of Anatomy, Department of Basic Veterinary Sciences, Faculty of Veterinary Medicine, Hokkaido University, Sapporo 060-0818, Japan; (M.A.M.); (O.I.)
- Laboratory of Agrobiomedical Science, Faculty of Agriculture, Hokkaido University, Sapporo 060-0818, Japan
| | - Tatsuya Sawamura
- Department of Molecular Pathophysiology, School of Medicine, Shinshu University, Matsumoto 390-8621, Japan; (T.S.); (A.K.)
| | - Akemi Kakino
- Department of Molecular Pathophysiology, School of Medicine, Shinshu University, Matsumoto 390-8621, Japan; (T.S.); (A.K.)
| | - Yasuhiko Suzuki
- Division of Bioresources, International Institute for Zoonosis Control, Hokkaido University, Sapporo 001-0020, Japan;
| | - Hiroshi Kida
- Laboratory for Biologics Development, International Institute for Zoonosis Control, Hokkaido University, Sapporo 001-0020, Japan; (M.O.); (H.K.)
| | - Hirofumi Sawa
- Division of Molecular Pathobiology, International Institute for Zoonosis Control, Hokkaido University, Sapporo 001-0020, Japan; (M.S.); (Y.O.)
- One Health Research Center, Hokkaido University, Sapporo 001-0020, Japan
- Correspondence: (H.S.); (M.S.); Tel.: +81-11-706-5185 (H.S.); +81-11-706-9494 (M.S.)
| | - Masashi Shingai
- Laboratory for Biologics Development, International Institute for Zoonosis Control, Hokkaido University, Sapporo 001-0020, Japan; (M.O.); (H.K.)
- Correspondence: (H.S.); (M.S.); Tel.: +81-11-706-5185 (H.S.); +81-11-706-9494 (M.S.)
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12
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AbdulRahim N, McAdams M, Xu P, Wojciechowski D, La Hoz RM, Lu C, Vazquez MA, Hedayati SS. Association of Inflammatory Biomarkers with Immunosuppression Management and Outcomes in Kidney Transplant Recipients with COVID-19. Transplant Proc 2021; 53:2451-2467. [PMID: 34465422 PMCID: PMC8349691 DOI: 10.1016/j.transproceed.2021.08.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Revised: 07/23/2021] [Accepted: 08/02/2021] [Indexed: 01/31/2023]
Abstract
BACKGROUND Kidney transplant recipients with coronavirus disease 2019 (COVID-19) are at increased risk for adverse outcomes, such as acute kidney injury (AKI), intensive care unit (ICU) admission, and death. The association of inflammatory biomarkers with outcomes and the impact of changes in immunosuppression on biomarker levels are unknown. METHODS We investigated factors associated with a composite of AKI, ICU admission, or death, and whether immunosuppression changes correlated with changes in inflammatory biomarkers and outcomes in kidney transplant recipients with a positive severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) polymerase chain reaction. RESULTS Of 59 patients, 50% had estimated glomerular filtration rate (eGFR) <60 mL/min/1.73 m2. Patients who discontinued calcineurin inhibitors (CNIs) had higher peak high-sensitivity C-reactive protein (hs-CRP) than those who maintained the same dose (median, 344; interquartile range [IQR], 145-374 vs median, 41; IQR, 22-116 mg/L, P = .03). Of the patients, 73% were hospitalized, 22% had admissions to the ICU, and 20% died. Of the 56% with AKI, 35% required dialysis. All patients with AKI but without pulmonary manifestations recovered to 10% of baseline creatinine levels. Factors associated with the composite outcome were eGFR <60 mL/min/1.73 m2 (odds ratio [OR], 5.833; 95% confidence interval [CI], 1.880-18.099; P = .002), hs-CRP (OR, 1.011/unit increase; 95% CI, 1.002-1.021; P = .019), white blood cell count (OR, 1.173/unit increase; 95% CI, 1.006-1.368; P = .041), and decreased or discontinued CNI (OR, 4.286; 95% CI, 1.353-13.572; P = .013). eGFR<60 mL/min/1.73 m2 (OR, 11.176; 95% CI, 1.581-79.001; P = .016), and peak hs-CRP (OR, 1.010/unit increase; 95% CI, 1.000-1.020; P = .049) remained associated with the composite in the multivariable model. CONCLUSIONS Kidney transplant recipients with COVID-19 have high rates of ICU admissions, AKI, and death. Those with eGFR<60 mL/min/1.73 m2 are at highest risk. CNI reduction is associated with higher inflammatory biomarkers, correlating with worse outcomes. More studies are needed to determine if this association should drive clinical management.
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Affiliation(s)
- Nashila AbdulRahim
- Division of Nephrology, Department of Medicine, University of Texas Southwestern Medical Center, Dallas, Texas; Parkland Hospital and Health System, Dallas, Texas
| | - Meredith McAdams
- Division of Nephrology, Department of Medicine, University of Texas Southwestern Medical Center, Dallas, Texas.
| | - Pin Xu
- Division of Nephrology, Department of Medicine, University of Texas Southwestern Medical Center, Dallas, Texas
| | - David Wojciechowski
- Division of Nephrology, Department of Medicine, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Ricardo M La Hoz
- Division of Infectious Diseases and Geographic Medicine, Department of Medicine, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Christopher Lu
- Division of Nephrology, Department of Medicine, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Miguel A Vazquez
- Division of Nephrology, Department of Medicine, University of Texas Southwestern Medical Center, Dallas, Texas; Parkland Hospital and Health System, Dallas, Texas
| | - S Susan Hedayati
- Division of Nephrology, Department of Medicine, University of Texas Southwestern Medical Center, Dallas, Texas
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13
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Caceres PS, Savickas G, Murray SL, Umanath K, Uduman J, Yee J, Liao TD, Bolin S, Levin AM, Khan MN, Sarkar S, Fitzgerald J, Maskey D, Ormsby AH, Sharma Y, Ortiz PA. High SARS-CoV-2 Viral Load in Urine Sediment Correlates with Acute Kidney Injury and Poor COVID-19 Outcome. J Am Soc Nephrol 2021; 32:2517-2528. [PMID: 34088853 PMCID: PMC8722807 DOI: 10.1681/asn.2021010059] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2021] [Accepted: 05/23/2021] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND AKI is a complication of coronavirus disease 2019 (COVID-19) that is associated with high mortality. Despite documented kidney tropism of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), there are no consistent reports of viral detection in urine or correlation with AKI or COVID-19 severity. Here, we hypothesize that quantification of the viral load of SARS-CoV-2 in urine sediment from patients with COVID-19 correlates with occurrence of AKI and mortality. METHODS The viral load of SARS-CoV-2 in urine sediments (U-viral load) was quantified by qRT-PCR in 52 patients with PCR-confirmed COVID-19 diagnosis, who were hospitalized between March 15 and June 8, 2020. Immunolabeling of SARS-CoV-2 proteins Spike and Nucleocapsid was performed in two COVID-19 kidney biopsy specimens and urine sediments. Viral infectivity assays were performed from 32 urine sediments. RESULTS A total of 20 patients with COVID-19 (39%) had detectable SARS-CoV-2 U-viral load, of which 17 (85%) developed AKI with an average U-viral load four-times higher than patients with COVID-19 who did not have AKI. U-viral load was highest (7.7-fold) within 2 weeks after AKI diagnosis. A higher U-viral load correlated with mortality but not with albuminuria or AKI stage. SARS-CoV-2 proteins partially colocalized with the viral receptor ACE2 in kidney biopsy specimens in tubules and parietal cells, and in urine sediment cells. Infective SARS-CoV-2 was not detected in urine sediments. CONCLUSION Our results further support SARS-CoV-2 kidney tropism. A higher SARS-CoV-2 viral load in urine sediments from patients with COVID-19 correlated with increased incidence of AKI and mortality. Urinary viral detection could inform the medical care of patients with COVID-19 and kidney injury to improve prognosis.
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Affiliation(s)
- Paulo S. Caceres
- Hypertension and Vascular Research Division, Department of Internal Medicine, Henry Ford Hospital, Detroit, Michigan
- Department of Physiology, Wayne State University, Detroit, Michigan
| | - Gina Savickas
- Hypertension and Vascular Research Division, Department of Internal Medicine, Henry Ford Hospital, Detroit, Michigan
- Department of Physiology, Wayne State University, Detroit, Michigan
- Translational and Clinical Research Center, Henry Ford Hospital, Detroit, Michigan
| | - Shannon L. Murray
- Translational and Clinical Research Center, Henry Ford Hospital, Detroit, Michigan
| | - Kausik Umanath
- Division of Nephrology and Hypertension, Department of Internal Medicine, Henry Ford Hospital, Detroit, Michigan
- Division of Nephrology and Hypertension, Wayne State University, Detroit, Michigan
| | - Junior Uduman
- Division of Nephrology and Hypertension, Department of Internal Medicine, Henry Ford Hospital, Detroit, Michigan
| | - Jerry Yee
- Division of Nephrology and Hypertension, Department of Internal Medicine, Henry Ford Hospital, Detroit, Michigan
- Division of Nephrology and Hypertension, Wayne State University, Detroit, Michigan
| | - Tang-Dong Liao
- Hypertension and Vascular Research Division, Department of Internal Medicine, Henry Ford Hospital, Detroit, Michigan
| | - Steven Bolin
- Veterinary Diagnostic Laboratory, Michigan State University, Lansing, Michigan
| | - Albert M. Levin
- Division of Biostatistics, Department of Public Health Sciences, Henry Ford Hospital, Detroit, Michigan
- Center for Bioinformatics, Henry Ford Hospital, Detroit, Michigan
| | - Moomal N. Khan
- Translational and Clinical Research Center, Henry Ford Hospital, Detroit, Michigan
| | - Sarah Sarkar
- Translational and Clinical Research Center, Henry Ford Hospital, Detroit, Michigan
| | - Jamie Fitzgerald
- Department of Orthopedic Surgery, Bone and Joint Center, Henry Ford Hospital, Detroit, Michigan
| | - Dipak Maskey
- Hypertension and Vascular Research Division, Department of Internal Medicine, Henry Ford Hospital, Detroit, Michigan
| | - Adrian H. Ormsby
- Department of Pathology and Laboratory Medicine, Henry Ford Hospital, Detroit, Michigan
| | - Yuvraj Sharma
- Division of Nephrology and Hypertension, Department of Internal Medicine, Henry Ford Hospital, Detroit, Michigan
| | - Pablo A. Ortiz
- Hypertension and Vascular Research Division, Department of Internal Medicine, Henry Ford Hospital, Detroit, Michigan
- Department of Physiology, Wayne State University, Detroit, Michigan
- Translational and Clinical Research Center, Henry Ford Hospital, Detroit, Michigan
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14
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Alexander MP, Mangalaparthi KK, Madugundu AK, Moyer AM, Adam BA, Mengel M, Singh S, Herrmann SM, Rule AD, Cheek EH, Herrera Hernandez LP, Graham RP, Aleksandar D, Aubry MC, Roden AC, Hagen CE, Quinton RA, Bois MC, Lin PT, Maleszewski JJ, Cornell LD, Sethi S, Pavelko KD, Charlesworth J, Narasimhan R, Larsen CP, Rizza SA, Nasr SH, Grande JP, McKee TD, Badley AD, Pandey A, Taner T. Acute Kidney Injury in Severe COVID-19 Has Similarities to Sepsis-Associated Kidney Injury: A Multi-Omics Study. Mayo Clin Proc 2021; 96:2561-2575. [PMID: 34425963 PMCID: PMC8279954 DOI: 10.1016/j.mayocp.2021.07.001] [Citation(s) in RCA: 37] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Accepted: 07/02/2021] [Indexed: 01/20/2023]
Abstract
OBJECTIVE To compare coronavirus disease 2019 (COVID-19) acute kidney injury (AKI) to sepsis-AKI (S-AKI). The morphology and transcriptomic and proteomic characteristics of autopsy kidneys were analyzed. PATIENTS AND METHODS Individuals 18 years of age and older who died from COVID-19 and had an autopsy performed at Mayo Clinic between April 2020 to October 2020 were included. Morphological evaluation of the kidneys of 17 individuals with COVID-19 was performed. In a subset of seven COVID-19 cases with postmortem interval of less than or equal to 20 hours, ultrastructural and molecular characteristics (targeted transcriptome and proteomics analyses of tubulointerstitium) were evaluated. Molecular characteristics were compared with archived cases of S-AKI and nonsepsis causes of AKI. RESULTS The spectrum of COVID-19 renal pathology included macrophage-dominant microvascular inflammation (glomerulitis and peritubular capillaritis), vascular dysfunction (peritubular capillary congestion and endothelial injury), and tubular injury with ultrastructural evidence of mitochondrial damage. Investigation of the spatial architecture using a novel imaging mass cytometry revealed enrichment of CD3+CD4+ T cells in close proximity to antigen-presenting cells, and macrophage-enriched glomerular and interstitial infiltrates, suggesting an innate and adaptive immune tissue response. Coronavirus disease 2019 AKI and S-AKI, as compared to nonseptic AKI, had an enrichment of transcriptional pathways involved in inflammation (apoptosis, autophagy, major histocompatibility complex class I and II, and type 1 T helper cell differentiation). Proteomic pathway analysis showed that COVID-19 AKI and to a lesser extent S-AKI were enriched in necroptosis and sirtuin-signaling pathways, both involved in regulatory response to inflammation. Upregulation of the ceramide-signaling pathway and downregulation of oxidative phosphorylation in COVID-19 AKI were noted. CONCLUSION This data highlights the similarities between S-AKI and COVID-19 AKI and suggests that mitochondrial dysfunction may play a pivotal role in COVID-19 AKI. This data may allow the development of novel diagnostic and therapeutic targets.
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Affiliation(s)
- Mariam P Alexander
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA.
| | - Kiran K Mangalaparthi
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA; Institute of Bioinformatics, International Technology Park, Karnataka, India; Amrita School of Biotechnology, Kerala, India
| | - Anil K Madugundu
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA; Institute of Bioinformatics, International Technology Park, Karnataka, India; Manipal Academy of Higher Education, Manipal, Karnataka, India; Center for Molecular Medicine, National Institute of Mental Health and Neurosciences, Karnataka, India
| | - Ann M Moyer
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
| | - Benjamin A Adam
- Department of Laboratory Medicine and Pathology, University of Alberta, Edmonton, Alberta, Canada
| | - Michael Mengel
- Department of Laboratory Medicine and Pathology, University of Alberta, Edmonton, Alberta, Canada
| | - Smrita Singh
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA; Institute of Bioinformatics, International Technology Park, Karnataka, India; Manipal Academy of Higher Education, Manipal, Karnataka, India; Center for Molecular Medicine, National Institute of Mental Health and Neurosciences, Karnataka, India
| | - Sandra M Herrmann
- Division of Nephrology and Hypertension, Mayo Clinic, Rochester, MN, USA
| | - Andrew D Rule
- Division of Nephrology and Hypertension, Mayo Clinic, Rochester, MN, USA
| | - E Heidi Cheek
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
| | | | - Rondell P Graham
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
| | - Denic Aleksandar
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA; Division of Nephrology and Hypertension, Mayo Clinic, Rochester, MN, USA
| | | | - Anja C Roden
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
| | - Catherine E Hagen
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
| | - Reade A Quinton
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
| | - Melanie C Bois
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
| | - Peter T Lin
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
| | - Joseph J Maleszewski
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
| | - Lynn D Cornell
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
| | - Sanjeev Sethi
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
| | | | - Jon Charlesworth
- Microscopy and Cell Analysis Core, Mayo Clinic, Rochester, MN, USA
| | | | | | - Stacey A Rizza
- Division of Infectious Diseases, Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA
| | - Samih H Nasr
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
| | - Joseph P Grande
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
| | - Trevor D McKee
- STTARR Innovation Core Facility, University Health Network, Toronto, Ontario, Canada
| | - Andrew D Badley
- Division of Infectious Diseases, Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA; Department of Molecular Medicine, Mayo Clinic, Rochester, MN, USA
| | - Akhilesh Pandey
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA; Center for Individualized Medicine, Mayo Clinic, Rochester, MN, USA; Center for Molecular Medicine, National Institute of Mental Health and Neurosciences, Karnataka, India
| | - Timucin Taner
- Department of Surgery (T.T.), Mayo Clinic, Rochester, MN, USA; Department of Immunology (T.T.), Mayo Clinic, Rochester, MN, USA
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15
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Friedman AN, Guirguis J, Kapoor R, Gupta S, Leaf DE, Timsina LR. Obesity, inflammatory and thrombotic markers, and major clinical outcomes in critically ill patients with COVID-19 in the US. Obesity (Silver Spring) 2021; 29:1719-1730. [PMID: 34109768 DOI: 10.1002/oby.23245] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Revised: 05/10/2021] [Accepted: 06/04/2021] [Indexed: 12/15/2022]
Abstract
OBJECTIVE This study aimed to determine whether obesity is independently associated with major adverse clinical outcomes and inflammatory and thrombotic markers in critically ill patients with COVID-19. METHODS The primary outcome was in-hospital mortality in adults with COVID-19 admitted to intensive care units across the US. Secondary outcomes were acute respiratory distress syndrome (ARDS), acute kidney injury requiring renal replacement therapy (AKI-RRT), thrombotic events, and seven blood markers of inflammation and thrombosis. Unadjusted and multivariable-adjusted models were used. RESULTS Among the 4,908 study patients, mean (SD) age was 60.9 (14.7) years, 3,095 (62.8%) were male, and 2,552 (52.0%) had obesity. In multivariable models, BMI was not associated with mortality. Higher BMI beginning at 25 kg/m2 was associated with a greater risk of ARDS and AKI-RRT but not thrombosis. There was no clinically significant association between BMI and inflammatory or thrombotic markers. CONCLUSIONS In critically ill patients with COVID-19, higher BMI was not associated with death or thrombotic events but was associated with a greater risk of ARDS and AKI-RRT. The lack of an association between BMI and circulating biomarkers calls into question the paradigm that obesity contributes to poor outcomes in critically ill patients with COVID-19 by upregulating systemic inflammatory and prothrombotic pathways.
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Affiliation(s)
- Allon N Friedman
- Division of Nephrology, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - John Guirguis
- Division of Nephrology, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Rajat Kapoor
- Division of Pulmonary and Critical Care Medicine, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Shruti Gupta
- Division of Renal Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - David E Leaf
- Division of Renal Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Lava R Timsina
- Department of Surgery, Indiana University School of Medicine, Indianapolis, Indiana, USA
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16
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Omer D, Pleniceanu O, Gnatek Y, Namestnikov M, Cohen-Zontag O, Goldberg S, Friedman YE, Friedman N, Mandelboim M, Vitner EB, Achdout H, Avraham R, Zahavy E, Israely T, Mayan H, Dekel B. Human Kidney Spheroids and Monolayers Provide Insights into SARS-CoV-2 Renal Interactions. J Am Soc Nephrol 2021; 32:2242-2254. [PMID: 34112705 PMCID: PMC8729846 DOI: 10.1681/asn.2020111546] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2020] [Accepted: 04/22/2021] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND Although coronavirus disease 2019 (COVID-19) causes significan t morbidity, mainly from pulmonary involvement, extrapulmonary symptoms are also major componen ts of the disease. Kidney disease, usually presenting as AKI, is particularly severe among patients with COVID-19. It is unknown, however, whether such injury results from direct kidney infection with COVID-19's causative virus, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), or from indirect mechanisms. METHODS Using ex vivo cell models, we sought to analyze SARS-CoV-2 interactions with kidney tubular cells and assess direct tubular injury. These models comprised primary human kidney epithelial cells (derived from nephrectomies) and grown as either proliferating monolayers or quiescent three-dimensional kidney spheroids. RESULTS We demonstrated that viral entry molecules and high baseline levels of type 1 IFN-related molecules were present in monolayers and kidney spheroids. Although both models support viral infection and replication, they did not exhibit a cytopathic effect and cell death, outcomes that were strongly present in SARS-CoV-2-infected controls (African green monkey kidney clone E6 [Vero E6] cultures). A comparison of monolayer and spheroid cultures demonstrated higher infectivity and replication of SARS-CoV-2 in actively proliferating monolayers, although the spheroid cultures exhibited high er levels of ACE2. Monolayers exhibited elevation of some tubular injury molecules-including molecules related to fibrosis (COL1A1 and STAT6) and dedifferentiation (SNAI2)-and a loss of cell identity, evident by reduction in megalin (LRP2). The three-dimensional spheroids were less prone to such injury. CONCLUSIONS SARS-CoV-2 can infect kidney cells without a cytopathic effect. AKI-induced cellular proliferation may potentially intensify infectivity and tubular damage by SARS-CoV-2, suggesting that early intervention in AKI is warranted to help minimize kidney infection.
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Affiliation(s)
- Dorit Omer
- Pediatric Stem Cell Research Institute, Edmond and Lily Sara Children’s Hospital, Sheba Medical Center, Ramat-Gan, Israel
- Pediatric Research Center for Genetics, Development and Environment, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Oren Pleniceanu
- Pediatric Stem Cell Research Institute, Edmond and Lily Sara Children’s Hospital, Sheba Medical Center, Ramat-Gan, Israel
- Pediatric Research Center for Genetics, Development and Environment, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yehudit Gnatek
- Pediatric Stem Cell Research Institute, Edmond and Lily Sara Children’s Hospital, Sheba Medical Center, Ramat-Gan, Israel
- Pediatric Research Center for Genetics, Development and Environment, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Michael Namestnikov
- Pediatric Stem Cell Research Institute, Edmond and Lily Sara Children’s Hospital, Sheba Medical Center, Ramat-Gan, Israel
- Pediatric Research Center for Genetics, Development and Environment, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
- The Kidney Research Laboratory, The Institute of Nephrology and Hypertension, Sheba Medical Center, Ramat-Gan, Israel
| | - Osnat Cohen-Zontag
- Pediatric Stem Cell Research Institute, Edmond and Lily Sara Children’s Hospital, Sheba Medical Center, Ramat-Gan, Israel
- Pediatric Research Center for Genetics, Development and Environment, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Sanja Goldberg
- Pediatric Stem Cell Research Institute, Edmond and Lily Sara Children’s Hospital, Sheba Medical Center, Ramat-Gan, Israel
- Pediatric Research Center for Genetics, Development and Environment, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | | | - Nehemya Friedman
- Central Virology Laboratory, Ministry of Health, Sheba Medical Center, Ramat-Gan, Israel
| | - Michal Mandelboim
- Central Virology Laboratory, Ministry of Health, Sheba Medical Center, Ramat-Gan, Israel
| | - Einat B. Vitner
- Department of Infectious Diseases, Israel Institute for Biological Research, Ness Ziona, Israel
| | - Hagit Achdout
- Department of Infectious Diseases, Israel Institute for Biological Research, Ness Ziona, Israel
| | - Roy Avraham
- Department of Infectious Diseases, Israel Institute for Biological Research, Ness Ziona, Israel
| | - Eran Zahavy
- Department of Biochemistry and Molecular Genetics, Israel Institute for Biological Research, Ness Ziona, Israel
| | - Tomer Israely
- Department of Infectious Diseases, Israel Institute for Biological Research, Ness Ziona, Israel
| | - Haim Mayan
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
- Department of Medicine E, Sheba Medical Center, Ramat-Gan, Israel
| | - Benjamin Dekel
- Pediatric Stem Cell Research Institute, Edmond and Lily Sara Children’s Hospital, Sheba Medical Center, Ramat-Gan, Israel
- Pediatric Research Center for Genetics, Development and Environment, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
- Division of Pediatric Nephrology, Safra Children’s Hospital, Sheba Medical Center, Ramat-Gan, Israel
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17
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Orieux A, Khan P, Prevel R, Gruson D, Rubin S, Boyer A. Impact of dexamethasone use to prevent from severe COVID-19-induced acute kidney injury. Crit Care 2021; 25:249. [PMID: 34271956 PMCID: PMC8283744 DOI: 10.1186/s13054-021-03666-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2021] [Accepted: 07/03/2021] [Indexed: 12/15/2022] Open
Affiliation(s)
- Arthur Orieux
- Service de Médecine Intensive Réanimation, Hôpital Pellegrin, Place Amélie Raba Léon, CHU de Bordeaux, 33000, Bordeaux, France.
| | - Pierre Khan
- Service de Médecine Intensive Réanimation, Hôpital Pellegrin, Place Amélie Raba Léon, CHU de Bordeaux, 33000, Bordeaux, France
| | - Renaud Prevel
- Service de Médecine Intensive Réanimation, Hôpital Pellegrin, Place Amélie Raba Léon, CHU de Bordeaux, 33000, Bordeaux, France
| | - Didier Gruson
- Service de Médecine Intensive Réanimation, Hôpital Pellegrin, Place Amélie Raba Léon, CHU de Bordeaux, 33000, Bordeaux, France
- Unité INSERM U1045, Université de Bordeaux, Bordeaux, France
| | - Sébastien Rubin
- Service de Néphrologie, Transplantation, Dialyse, Aphérèses, Hôpital Pellegrin, CHU de Bordeaux, Bordeaux, France
- Unité INSERM U1034, Université de Bordeaux, Bordeaux, France
| | - Alexandre Boyer
- Service de Médecine Intensive Réanimation, Hôpital Pellegrin, Place Amélie Raba Léon, CHU de Bordeaux, 33000, Bordeaux, France
- Unité INSERM U1045, Université de Bordeaux, Bordeaux, France
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18
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Karimi Z, Masjedi F, Malekmakan L, Doostkam A, Roozbeh J, Ghahramani N. Potential Mechanisms of the SARS-CoV-2-induced AKI Progression to CKD: A Forward-Looking Perspective. Iran J Kidney Dis 2021; 15:243-255. [PMID: 34278995] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Received: 01/30/2021] [Revised: 05/30/2021] [Accepted: 05/30/2021] [Indexed: 06/13/2023]
Abstract
Coronavirus disease 2019 (COVID‑19) was identified in December 2019 and is still expanding in most parts of the world. The wide variety of affected organs is likely based upon the shared expression of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) important entry-receptor angiotensin-converting enzyme 2 (ACE2). For this reason, the broad distribution of ACE2 receptors in different tissues plays a crucial role in the multi-organ dysfunction and fatality due to COVID-19. Because of the high prevalence of acute kidney injury (AKI) in patients with COVID-19, we review the molecular understanding into viral infection mechanisms and implications for AKI. Furthermore, mechanisms of the AKI to chronic kidney disease (CKD) progression, such as the relative contribution of immune cell reaction, fibroblasts activation, endothelial dysfunction, and subsequent hypoxia may contribute to the association of AKI with worse outcomes during this virus pandemic. We highlight the state of the knowledge on SARS-CoV-2-dependent mechanisms for AKI and list the potential management choices for the prevention of AKI aggravation and the impending possibility of CKD. Finally, we intend to provide a much better understanding of why Coronavirus induces AKI and its subsequent progression to CKD in the coming years and further discuss the acute and long-term renal consequences.
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Affiliation(s)
| | | | | | | | - Jamshid Roozbeh
- Shiraz Nephro-Urology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran.
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19
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Mousavi Movahed SM, Akhavizadegan H, Dolatkhani F, Nejadghaderi SA, Aghajani F, Faghir Gangi M, Ghazi Z, Ghasemi H. Different incidences of acute kidney injury (AKI) and outcomes in COVID-19 patients with and without non-azithromycin antibiotics: A retrospective study. J Med Virol 2021; 93:4411-4419. [PMID: 33792956 PMCID: PMC8251081 DOI: 10.1002/jmv.26992] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Revised: 03/17/2021] [Accepted: 03/30/2021] [Indexed: 01/08/2023]
Abstract
In late December 2019, an outbreak of a novel coronavirus which caused coronavirus disease 2019 (COVID-19) was initiated. Acute kidney injury (AKI) was associated with higher severity and mortality of COVID-19. We aimed to evaluate the effects of comorbidities and medications in addition to determining the association between AKI, antibiotics against coinfections (AAC) and outcomes of patients. We conducted a retrospective study on adult patients hospitalized with COVID-19 in a tertiary center. Our primary outcomes were the incidence rate of AKI based on comorbidities and medications. The secondary outcome was to determine mortality, intensive care unit (ICU) admission, and prolonged hospitalization by AKI and AAC. Univariable and multivariable logistic regression method was used to explore predictive effects of AKI and AAC on outcomes. Out of 854 included participants, 118 patients developed AKI in whom, 57 used AAC and 61 did not. Hypertension and diabetes were the most common comorbidities in patients developed AKI. AAC, lopinavir/ritonavir, ribavirin, angiotensin-converting enzyme inhibitors and angiotensin II receptor blockers, and corticosteroids had significant higher rate of administration in patients developed AKI. AAC were associated with higher deaths (odds ratio [OR] = 5.13; 95% confidence interval (CI): 3-8.78) and ICU admission (OR = 5.87; 95%CI: 2.81-12.27), while AKI had higher OR for prolonged hospitalization (3.37; 95%CI: 1.76-6.45). Both AKI and AAC are associated with poor prognosis of COVID-19. Defining strict criteria regarding indications and types of antibiotics would help overcoming concomitant infections and minimizing related adverse events.
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Affiliation(s)
| | - Hamed Akhavizadegan
- Department of Urology, Baharloo HospitalTehran University of Medical SciencesTehranIran
| | - Fatemeh Dolatkhani
- Department of Nephrology, Baharloo HospitalTehran University of Medical SciencesTehranIran
| | - Seyed Aria Nejadghaderi
- School of MedicineShahid Beheshti University of Medical SciencesTehranIran
- Systematic Review and Meta‐analysis Expert Group (SRMEG)Universal Scientific Education and Research Network (USERN)TehranIran
| | - Faezeh Aghajani
- School of MedicineTehran University of Medical SciencesTehranIran
| | - Monireh Faghir Gangi
- Department of Epidemiology and Biostatistics, School of Public HealthTehran University of Medical SciencesTehranIran
| | - Zahra Ghazi
- Baharloo HospitalTehran University of Medical SciencesTehranIran
| | - Hoomaan Ghasemi
- School of MedicineTehran University of Medical SciencesTehranIran
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20
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Gómez-Escobar LG, Hoffman KL, Choi JJ, Borczuk A, Salvatore S, Alvarez-Mulett SL, Galvan MD, Zhao Z, Racine-Brzostek SE, Yang HS, Stout-Delgado HW, Choi ME, Choi AMK, Cho SJ, Schenck EJ. Cytokine signatures of end organ injury in COVID-19. Sci Rep 2021; 11:12606. [PMID: 34131192 PMCID: PMC8206105 DOI: 10.1038/s41598-021-91859-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Accepted: 05/26/2021] [Indexed: 02/08/2023] Open
Abstract
Increasing evidence has shown that Coronavirus disease 19 (COVID-19) severity is driven by a dysregulated immunologic response. We aimed to assess the differences in inflammatory cytokines in COVID-19 patients compared to contemporaneously hospitalized controls and then analyze the relationship between these cytokines and the development of Acute Respiratory Distress Syndrome (ARDS), Acute Kidney Injury (AKI) and mortality. In this cohort study of hospitalized patients, done between March third, 2020 and April first, 2020 at a quaternary referral center in New York City we included adult hospitalized patients with COVID-19 and negative controls. Serum specimens were obtained on the first, second, and third hospital day and cytokines were measured by Luminex. Autopsies of nine cohort patients were examined. We identified 90 COVID-19 patients and 51 controls. Analysis of 48 inflammatory cytokines revealed upregulation of macrophage induced chemokines, T-cell related interleukines and stromal cell producing cytokines in COVID-19 patients compared to the controls. Moreover, distinctive cytokine signatures predicted the development of ARDS, AKI and mortality in COVID-19 patients. Specifically, macrophage-associated cytokines predicted ARDS, T cell immunity related cytokines predicted AKI and mortality was associated with cytokines of activated immune pathways, of which IL-13 was universally correlated with ARDS, AKI and mortality. Histopathological examination of the autopsies showed diffuse alveolar damage with significant mononuclear inflammatory cell infiltration. Additionally, the kidneys demonstrated glomerular sclerosis, tubulointerstitial lymphocyte infiltration and cortical and medullary atrophy. These patterns of cytokine expression offer insight into the pathogenesis of COVID-19 disease, its severity, and subsequent lung and kidney injury suggesting more targeted treatment strategies.
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Affiliation(s)
- Luis G Gómez-Escobar
- Division of Pulmonary and Critical Care Medicine, Weill Department of Medicine, Weill Cornell Medicine, New York, NY, USA
| | - Katherine L Hoffman
- Division of Biostatistics, Department of Population Health Sciences, Weill Cornell Medicine, New York, NY, USA
| | - Justin J Choi
- Division of General Internal Medicine, Weill Department of Medicine, Weill Cornell Medicine, New York, NY, USA
- Department of Medicine, NewYork-Presbyterian Hospital/Weill Cornell Medicine, New York, NY, USA
| | - Alain Borczuk
- Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, New York, NY, USA
- Department of Medicine, NewYork-Presbyterian Hospital/Weill Cornell Medicine, New York, NY, USA
| | - Steven Salvatore
- Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, New York, NY, USA
- Department of Medicine, NewYork-Presbyterian Hospital/Weill Cornell Medicine, New York, NY, USA
| | - Sergio L Alvarez-Mulett
- Division of Pulmonary and Critical Care Medicine, Weill Department of Medicine, Weill Cornell Medicine, New York, NY, USA
| | - Manuel D Galvan
- Advanced Diagnostics Complement Laboratory, National Jewish Health, Denver, CO, USA
| | - Zhen Zhao
- Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, New York, NY, USA
- Department of Medicine, NewYork-Presbyterian Hospital/Weill Cornell Medicine, New York, NY, USA
| | - Sabrina E Racine-Brzostek
- Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, New York, NY, USA
- Department of Medicine, NewYork-Presbyterian Hospital/Weill Cornell Medicine, New York, NY, USA
| | - He S Yang
- Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, New York, NY, USA
- Department of Medicine, NewYork-Presbyterian Hospital/Weill Cornell Medicine, New York, NY, USA
| | - Heather W Stout-Delgado
- Division of Pulmonary and Critical Care Medicine, Weill Department of Medicine, Weill Cornell Medicine, New York, NY, USA
| | - Mary E Choi
- Division of Nephrology and Hypertension, Weill Department of Medicine, Weill Cornell Medicine, New York, NY, USA
- Department of Medicine, NewYork-Presbyterian Hospital/Weill Cornell Medicine, New York, NY, USA
| | - Augustine M K Choi
- Division of Pulmonary and Critical Care Medicine, Weill Department of Medicine, Weill Cornell Medicine, New York, NY, USA
- Department of Medicine, NewYork-Presbyterian Hospital/Weill Cornell Medicine, New York, NY, USA
| | - Soo Jung Cho
- Division of Pulmonary and Critical Care Medicine, Weill Department of Medicine, Weill Cornell Medicine, New York, NY, USA.
- Department of Medicine, NewYork-Presbyterian Hospital/Weill Cornell Medicine, New York, NY, USA.
| | - Edward J Schenck
- Division of Pulmonary and Critical Care Medicine, Weill Department of Medicine, Weill Cornell Medicine, New York, NY, USA.
- Department of Medicine, NewYork-Presbyterian Hospital/Weill Cornell Medicine, New York, NY, USA.
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21
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Buqaileh R, Saternos H, Ley S, Aranda A, Forero K, AbouAlaiwi WA. Can cilia provide an entry gateway for SARS-CoV-2 to human ciliated cells? Physiol Genomics 2021; 53:249-258. [PMID: 33855870 PMCID: PMC8213509 DOI: 10.1152/physiolgenomics.00015.2021] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Revised: 04/12/2021] [Accepted: 04/12/2021] [Indexed: 12/30/2022] Open
Abstract
A worldwide coronavirus pandemic is in full swing and, at the time of writing, there are only few treatments that have been successful in clinical trials, but no effective antiviral treatment has been approved. Because of its lethality, it is important to understand the current strain's effects and mechanisms not only in the respiratory system but also in other affected organ systems as well. Past coronavirus outbreaks caused by SARS-CoV and MERS-CoV inflicted life-threatening acute kidney injuries (AKI) on their hosts leading to significant mortality rates, which went somewhat overlooked in the face of the severe respiratory effects. Recent evidence has emphasized renal involvement in SARS-CoV-2, stressing that kidneys are damaged in patients with COVID-19. The mechanism by which this virus inflicts AKI is still unclear, but evidence from other coronavirus strains may hold some clues. Two theories exist for the proposed mechanism of AKI: 1) the AKI is a secondary effect to reduced blood and oxygen levels causing hyperinflammation and 2) the AKI is due to cytotoxic effects. Kidneys express angiotensin-converting enzyme-2 (ACE2), the confirmed SARS-CoV-2 target receptor as well as collectrin, an ACE2 homologue that localizes to the primary cilium, an organelle historically targeted by coronaviruses. Although the available literature suggests that kidney damage is leading to higher mortality rates in patients with COVID-19, especially in those with preexisting kidney and cardiovascular diseases, the pathogenesis of COVID-19 is still being investigated. Here, we present brief literature review supporting our proposed hypothesis of a possible link between SARS-CoV-2 cellular infection and cilia.
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Affiliation(s)
- Raghad Buqaileh
- Department of Pharmacology and Experimental Therapeutics, College of Pharmacy and Pharmaceutical Sciences, University of Toledo, Toledo, Ohio
| | - Hannah Saternos
- Department of Pharmacology and Experimental Therapeutics, College of Pharmacy and Pharmaceutical Sciences, University of Toledo, Toledo, Ohio
| | - Sidney Ley
- Department of Pharmacology and Experimental Therapeutics, College of Pharmacy and Pharmaceutical Sciences, University of Toledo, Toledo, Ohio
| | - Arianna Aranda
- Department of Pharmacology and Experimental Therapeutics, College of Pharmacy and Pharmaceutical Sciences, University of Toledo, Toledo, Ohio
| | - Kathleen Forero
- Department of Pharmacology and Experimental Therapeutics, College of Pharmacy and Pharmaceutical Sciences, University of Toledo, Toledo, Ohio
| | - Wissam A AbouAlaiwi
- Department of Pharmacology and Experimental Therapeutics, College of Pharmacy and Pharmaceutical Sciences, University of Toledo, Toledo, Ohio
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22
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Bamgboye EL, Omiye JA, Afolaranmi OJ, Davids MR, Tannor EK, Wadee S, Niang A, Were A, Naicker S. COVID-19 Pandemic: Is Africa Different? J Natl Med Assoc 2021; 113:324-335. [PMID: 33153755 PMCID: PMC7607238 DOI: 10.1016/j.jnma.2020.10.001] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Revised: 09/24/2020] [Accepted: 10/05/2020] [Indexed: 12/29/2022]
Abstract
COVID-19 has now spread to all the continents of the world with the possible exception of Antarctica. However, Africa appears different when compared with all the other continents. The absence of exponential growth and the low mortality rates contrary to that experienced in other continents, and contrary to the projections for Africa by various agencies, including the World Health Organization (WHO) has been a puzzle to many. Although Africa is the second most populous continent with an estimated 17.2% of the world's population, the continent accounts for only 5% of the total cases and 3% of the mortality. Mortality for the whole of Africa remains at a reported 19,726 as at August 01, 2020. The onset of the pandemic was later, the rate of rise has been slower and the severity of illness and case fatality rates have been lower in comparison to other continents. In addition, contrary to what had been documented in other continents, the occurrence of the renal complications in these patients also appeared to be much lower. This report documents the striking differences between the continents and within the continent of Africa itself and then attempts to explain the reasons for these differences. It is hoped that information presented in this review will help policymakers in the fight to contain the pandemic, particularly within Africa with its resource-constrained health care systems.
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Affiliation(s)
| | | | | | - Mogamat Razeen Davids
- Division of Nephrology, Stellenbosch University and Tygerberg Hospital, Cape Town, South Africa
| | | | - Shoyab Wadee
- Wits Donald Gordon Medical Centre, University of the Witwatersrand, Johannesburg, South Africa
| | - Abdou Niang
- Dalal Jamm Hospital, Dakar Cheikh A. Diop University, Senegal
| | - Anthony Were
- Department of Medicine, East African Kidney Institute, College of Health Sciences, University of Nairobi, Kenya
| | - Saraladevi Naicker
- Department of Internal Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
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23
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Diao B, Wang C, Wang R, Feng Z, Zhang J, Yang H, Tan Y, Wang H, Wang C, Liu L, Liu Y, Liu Y, Wang G, Yuan Z, Hou X, Ren L, Wu Y, Chen Y. Human kidney is a target for novel severe acute respiratory syndrome coronavirus 2 infection. Nat Commun 2021; 12:2506. [PMID: 33947851 DOI: 10.1101/2020.03.04.20031120] [Citation(s) in RCA: 192] [Impact Index Per Article: 64.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2020] [Accepted: 03/23/2021] [Indexed: 05/20/2023] Open
Abstract
It is unclear whether severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) can directly infect human kidney, thus leading to acute kidney injury (AKI). Here, we perform a retrospective analysis of clinical parameters from 85 patients with laboratory-confirmed coronavirus disease 2019 (COVID-19); moreover, kidney histopathology from six additional COVID-19 patients with post-mortem examinations was performed. We find that 27% (23/85) of patients exhibited AKI. The elderly patients and cases with comorbidities (hypertension and heart failure) are more prone to develop AKI. Haematoxylin & eosin staining shows that the kidneys from COVID-19 autopsies have moderate to severe tubular damage. In situ hybridization assays illustrate that viral RNA accumulates in tubules. Immunohistochemistry shows nucleocapsid and spike protein deposits in the tubules, and immunofluorescence double staining shows that both antigens are restricted to the angiotensin converting enzyme-II-positive tubules. SARS-CoV-2 infection triggers the expression of hypoxic damage-associated molecules, including DP2 and prostaglandin D synthase in infected tubules. Moreover, it enhances CD68+ macrophages infiltration into the tubulointerstitium, and complement C5b-9 deposition on tubules is also observed. These results suggest that SARS-CoV-2 directly infects human kidney to mediate tubular pathogenesis and AKI.
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Affiliation(s)
- Bo Diao
- Institute of Immunology, PLA, Third Military Medical University, Chongqing, P. R. China
- Department of Medical Laboratory Center, General Hospital of Central Theater Command, Wuhan, Hubei Province, P. R. China
- Hubei Key Laboratory of Central Nervous System Tumor and Intervention, Wuhan, Hubei Province, P. R. China
| | - Chenhui Wang
- Institute of Immunology, PLA, Third Military Medical University, Chongqing, P. R. China
| | - Rongshuai Wang
- Department of Forensic Medicine, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei Province, P. R. China
| | - Zeqing Feng
- Institute of Immunology, PLA, Third Military Medical University, Chongqing, P. R. China
| | - Ji Zhang
- Institute of Immunology, PLA, Third Military Medical University, Chongqing, P. R. China
| | - Han Yang
- Institute of Immunology, PLA, Third Military Medical University, Chongqing, P. R. China
| | - Yingjun Tan
- Department of Medical Laboratory Center, General Hospital of Central Theater Command, Wuhan, Hubei Province, P. R. China
| | - Huiming Wang
- Department of Nephrology, Renmin Hospital of Wuhan University, Wuhan, Hubei Province, P. R. China
| | - Changsong Wang
- Department of Pathology, 989th Hospital of PLA, Luoyang, Henan Province, P. R. China
| | - Liang Liu
- Hubei Chongxin Judicial Expertise Center, Wuhan, Hubei Province, P. R. China
| | - Ying Liu
- Department of Medical Laboratory Center, General Hospital of Central Theater Command, Wuhan, Hubei Province, P. R. China
| | - Yueping Liu
- Department of Medical Laboratory Center, General Hospital of Central Theater Command, Wuhan, Hubei Province, P. R. China
| | - Gang Wang
- Department of Medical Laboratory Center, General Hospital of Central Theater Command, Wuhan, Hubei Province, P. R. China
| | - Zilin Yuan
- Department of Medical Laboratory Center, General Hospital of Central Theater Command, Wuhan, Hubei Province, P. R. China
| | - Xiaotao Hou
- Guangzhou KingMed Center for Clinical Laboratory Co., Ltd., Guangzhou, Guangdong Province, P. R. China
| | - Liang Ren
- Department of Forensic Medicine, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei Province, P. R. China.
| | - Yuzhang Wu
- Institute of Immunology, PLA, Third Military Medical University, Chongqing, P. R. China.
| | - Yongwen Chen
- Institute of Immunology, PLA, Third Military Medical University, Chongqing, P. R. China.
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24
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Ahmadian E, Hosseiniyan Khatibi SM, Razi Soofiyani S, Abediazar S, Shoja MM, Ardalan M, Zununi Vahed S. Covid-19 and kidney injury: Pathophysiology and molecular mechanisms. Rev Med Virol 2021; 31:e2176. [PMID: 33022818 PMCID: PMC7646060 DOI: 10.1002/rmv.2176] [Citation(s) in RCA: 164] [Impact Index Per Article: 54.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2020] [Revised: 09/16/2020] [Accepted: 09/17/2020] [Indexed: 12/15/2022]
Abstract
The novel coronavirus (SARS-CoV-2) has turned into a life-threatening pandemic disease (Covid-19). About 5% of patients with Covid-19 have severe symptoms including septic shock, acute respiratory distress syndrome, and the failure of several organs, while most of them have mild symptoms. Frequently, the kidneys are involved through direct or indirect mechanisms. Kidney involvement mainly manifests itself as proteinuria and acute kidney injury (AKI). The SARS-CoV-2-induced kidney damage is expected to be multifactorial; directly it can infect the kidney podocytes and proximal tubular cells and based on an angiotensin-converting enzyme 2 (ACE2) pathway it can lead to acute tubular necrosis, protein leakage in Bowman's capsule, collapsing glomerulopathy and mitochondrial impairment. The SARS-CoV-2-driven dysregulation of the immune responses including cytokine storm, macrophage activation syndrome, and lymphopenia can be other causes of the AKI. Organ interactions, endothelial dysfunction, hypercoagulability, rhabdomyolysis, and sepsis are other potential mechanisms of AKI. Moreover, lower oxygen delivery to kidney may cause an ischaemic injury. Understanding the fundamental molecular pathways and pathophysiology of kidney injury and AKI in Covid-19 is necessary to develop management strategies and design effective therapies.
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Affiliation(s)
- Elham Ahmadian
- Kidney Research CenterTabriz University of Medical SciencesTabrizIran
| | | | - Saiedeh Razi Soofiyani
- Clinical Research Development UnitSina Educational, Research and Treatment CenterTabriz University of Medical SciencesTabrizIran
| | - Sima Abediazar
- Kidney Research CenterTabriz University of Medical SciencesTabrizIran
| | - Mohammadali M. Shoja
- Department of SurgeryUniversity of Illinois at Chicago‐Metropolitan Group Hospitals (UIC‐MGH)ChicagoIllinoisUSA
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Alser O, Mokhtari A, Naar L, Langeveld K, Breen KA, El Moheb M, Kapoen C, Gaitanidis A, Christensen MA, Maurer LR, Mashbari H, Bankhead-Kendall B, Parks J, Fawley J, Saillant N, Mendoza A, Paranjape C, Fagenholz P, King D, Lee J, Farhat MR, Velmahos GC, Kaafarani HMA. Multisystem outcomes and predictors of mortality in critically ill patients with COVID-19: Demographics and disease acuity matter more than comorbidities or treatment modalities. J Trauma Acute Care Surg 2021; 90:880-890. [PMID: 33891572 DOI: 10.1097/ta.0000000000003085] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND We sought to describe characteristics, multisystem outcomes, and predictors of mortality of the critically ill COVID-19 patients in the largest hospital in Massachusetts. METHODS This is a prospective cohort study. All patients admitted to the intensive care unit (ICU) with reverse-transcriptase-polymerase chain reaction-confirmed severe acute respiratory syndrome coronavirus 2 infection between March 14, 2020, and April 28, 2020, were included; hospital and multisystem outcomes were evaluated. Data were collected from electronic records. Acute respiratory distress syndrome (ARDS) was defined as PaO2/FiO2 ratio of ≤300 during admission and bilateral radiographic pulmonary opacities. Multivariable logistic regression analyses adjusting for available confounders were performed to identify predictors of mortality. RESULTS A total of 235 patients were included. The median (interquartile range [IQR]) Sequential Organ Failure Assessment score was 5 (3-8), and the median (IQR) PaO2/FiO2 was 208 (146-300) with 86.4% of patients meeting criteria for ARDS. The median (IQR) follow-up was 92 (86-99) days, and the median ICU length of stay was 16 (8-25) days; 62.1% of patients were proned, 49.8% required neuromuscular blockade, and 3.4% required extracorporeal membrane oxygenation. The most common complications were shock (88.9%), acute kidney injury (AKI) (69.8%), secondary bacterial pneumonia (70.6%), and pressure ulcers (51.1%). As of July 8, 2020, 175 patients (74.5%) were discharged alive (61.7% to skilled nursing or rehabilitation facility), 58 (24.7%) died in the hospital, and only 2 patients were still hospitalized, but out of the ICU. Age (odds ratio [OR], 1.08; 95% confidence interval [CI], 1.04-1.12), higher median Sequential Organ Failure Assessment score at ICU admission (OR, 1.24; 95% CI, 1.06-1.43), elevated creatine kinase of ≥1,000 U/L at hospital admission (OR, 6.64; 95% CI, 1.51-29.17), and severe ARDS (OR, 5.24; 95% CI, 1.18-23.29) independently predicted hospital mortality.Comorbidities, steroids, and hydroxychloroquine treatment did not predict mortality. CONCLUSION We present here the outcomes of critically ill patients with COVID-19. Age, acuity of disease, and severe ARDS predicted mortality rather than comorbidities. LEVEL OF EVIDENCE Prognostic, level III.
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Affiliation(s)
- Osaid Alser
- From the Division of Trauma, Emergency Surgery and Surgical Critical Care (O.A., A.M., L.N., K.L., K.A.B., M.E.M., C.K., A.G., M.A.C., L.R.M., H.M., B.B.-K., J.P., J.F., N.S., A.M., C.P., P.F., D.K., J.L., G.C.V., H.M.A.K.), and Division of Pulmonary Critical Care (M.R.F.), Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
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Casas-Aparicio GA, León-Rodríguez I, Alvarado-de la Barrera C, González-Navarro M, Peralta-Prado AB, Luna-Villalobos Y, Velasco-Morales A, Calderón-Dávila N, Ormsby CE, Ávila-Ríos S. Acute kidney injury in patients with severe COVID-19 in Mexico. PLoS One 2021; 16:e0246595. [PMID: 33556150 PMCID: PMC7870064 DOI: 10.1371/journal.pone.0246595] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Accepted: 01/21/2021] [Indexed: 01/08/2023] Open
Abstract
Introduction Some patients with COVID-19 pneumonia present systemic disease involving multiple systems. There is limited information about the clinical characteristics and events leading to acute kidney injury (AKI). We described the factors associated with the development of AKI and explored the relation of AKI and mortality in Mexican population with severe COVID-19. Methods We retrospectively reviewed the medical records of individuals with severe pneumonia caused by SARS-CoV-2 hospitalized at the largest third-level reference institution for COVID-19 care in Mexico between March and April 2020. Demographic information, comorbidities, clinical and laboratory data, dates of invasive mechanical ventilation (IMV) and hospitalization, mechanical-ventilator settings and use of vasoactive drugs were recorded. Results Of 99 patients studied, 58 developed AKI (58.6%). The risk factors for AKI were older age (OR = 1.07, 95% CI = 1.01–1.13, p = 0.024); obesity (OR = 6.58, 95% CI = 1.8–24.05, p = 0.040); and the need for IMV (OR = 6.18, CI = 1.29–29.58, p = 0.023). The risk factors for mortality were obesity (OR = 5.57, 95% CI = 1.48–20.93, p = 0.011); requirement of vasoactive drugs on admission (OR = 5.35, 95% CI = 1.16–24.61, p = 0.031); and AKI (OR = 8.61, 95% CI = 2.24–33.1, p = 0.002). In-hospital mortality was significantly higher in patients with AKI stage 3 (79.3%) and AKI stage 2 (68.7%) compared with those with AKI stage 1 (25%; p = 0.004). Fifty-three patients underwent the furosemide stress test (FST) to predict progression to AKI stage 3. Of those, 12 progressed to AKI stage 3 (22%). The ROC curve for the FST had an AUC of 0.681 (p = 0.009); a sensitivity of 81.6% and a specificity of 54.5%. Conclusions AKI was common in our cohort of patients with severe pneumonia caused by SARS-CoV-2 infection. The risk factors for AKI were older age, obesity and the need for of IMV on admission. The risk factors for mortality were obesity, requirement of vasoactive drugs on admission and AKI. Mortality was more frequent in patients with AKI stages 2–3. The FST had an acceptable predictive capacity to identify patients progressing to AKI stage 3.
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Affiliation(s)
- Gustavo A. Casas-Aparicio
- Centro de Investigación en Enfermedades Infecciosas, Instituto Nacional de Enfermedades Respiratorias Ismael Cosío Villegas, Mexico City, Mexico
- * E-mail:
| | - Isabel León-Rodríguez
- Centro de Investigación en Enfermedades Infecciosas, Instituto Nacional de Enfermedades Respiratorias Ismael Cosío Villegas, Mexico City, Mexico
| | - Claudia Alvarado-de la Barrera
- Centro de Investigación en Enfermedades Infecciosas, Instituto Nacional de Enfermedades Respiratorias Ismael Cosío Villegas, Mexico City, Mexico
| | - Mauricio González-Navarro
- Centro de Investigación en Enfermedades Infecciosas, Instituto Nacional de Enfermedades Respiratorias Ismael Cosío Villegas, Mexico City, Mexico
| | - Amy B. Peralta-Prado
- Centro de Investigación en Enfermedades Infecciosas, Instituto Nacional de Enfermedades Respiratorias Ismael Cosío Villegas, Mexico City, Mexico
| | - Yara Luna-Villalobos
- Centro de Investigación en Enfermedades Infecciosas, Instituto Nacional de Enfermedades Respiratorias Ismael Cosío Villegas, Mexico City, Mexico
| | - Alejandro Velasco-Morales
- Resident Doctor at Instituto Nacional de Enfermedades Respiratorias Ismael Cosío Villegas, Mexico City, Mexico
| | - Natalia Calderón-Dávila
- Resident Doctor at Instituto Nacional de Enfermedades Respiratorias Ismael Cosío Villegas, Mexico City, Mexico
| | - Christopher E. Ormsby
- Centro de Investigación en Enfermedades Infecciosas, Instituto Nacional de Enfermedades Respiratorias Ismael Cosío Villegas, Mexico City, Mexico
| | - Santiago Ávila-Ríos
- Centro de Investigación en Enfermedades Infecciosas, Instituto Nacional de Enfermedades Respiratorias Ismael Cosío Villegas, Mexico City, Mexico
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Russo E, Esposito P, Taramasso L, Magnasco L, Saio M, Briano F, Russo C, Dettori S, Vena A, Di Biagio A, Garibotto G, Bassetti M, Viazzi F. Kidney disease and all-cause mortality in patients with COVID-19 hospitalized in Genoa, Northern Italy. J Nephrol 2021; 34:173-183. [PMID: 33025516 PMCID: PMC7538179 DOI: 10.1007/s40620-020-00875-1] [Citation(s) in RCA: 40] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Accepted: 09/23/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND The prevalence of kidney involvement during SARS-CoV-2 infection has been reported to be high. Nevertheless, data are lacking about the determinants of acute kidney injury (AKI) and the combined effect of chronic kidney disease (CKD) and AKI in COVID-19 patients. METHODS We collected data on patient demographics, comorbidities, chronic medications, vital signs, baseline laboratory test results and in-hospital treatment in patients with COVID-19 consecutively admitted to our Institution. Chronic kidney disease was defined as eGFR < 60 mL/min per 1.73 m2 or proteinuria at urinalysis within 180 days prior to hospital admission. AKI was defined according to KDIGO criteria. The primary and secondary outcomes were the development of AKI and death. RESULTS Of 777 patients eligible for the study, acute kidney injury developed in 176 (22.6%). Of these, 79 (45%) showed an acute worsening of a preexisting CKD, and 21 (12%) required kidney replacement therapy. Independent associates of AKI were chronic kidney disease, C-reactive protein (CRP) and ventilation support. Among patients with acute kidney injury, 111 died (63%) and its occurrence increased the risk of death by 60% (HR 1.60 [95% IC 1.21-2.49] p = 0.002) independently of potential confounding factors including hypertension, preexisting kidney damage, and comorbidities. Patients with AKI showed a significantly higher rate of deaths attributed to bleeding compared to CKD and the whole population (7.5 vs 1.5 vs 3.5%, respectively). CONCLUSION Awareness of kidney function, both preexisting CKD and development of acute kidney injury, may help to identify those patients at increased risk of death.
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Affiliation(s)
- Elisa Russo
- Department of Internal Medicine, Clinica Nefrologica Dialisi e Trapianto, University of Genoa, Hospital Policlinico San Martino, IRCCS, Viale Benedetto XV, 16132, Genoa, Italy
| | - Pasquale Esposito
- Department of Internal Medicine, Clinica Nefrologica Dialisi e Trapianto, University of Genoa, Hospital Policlinico San Martino, IRCCS, Viale Benedetto XV, 16132, Genoa, Italy
| | - Lucia Taramasso
- Department of Health Sciences, Infectious Diseases Clinic, University of Genoa, Hospital Policlinico San Martino-IRCCS, Genoa, Italy
| | - Laura Magnasco
- Department of Health Sciences, Infectious Diseases Clinic, University of Genoa, Hospital Policlinico San Martino-IRCCS, Genoa, Italy
| | - Michela Saio
- Department of Internal Medicine, Clinica Nefrologica Dialisi e Trapianto, University of Genoa, Hospital Policlinico San Martino, IRCCS, Viale Benedetto XV, 16132, Genoa, Italy
| | - Federica Briano
- Department of Health Sciences, Infectious Diseases Clinic, University of Genoa, Hospital Policlinico San Martino-IRCCS, Genoa, Italy
| | - Chiara Russo
- Department of Health Sciences, Infectious Diseases Clinic, University of Genoa, Hospital Policlinico San Martino-IRCCS, Genoa, Italy
| | - Silvia Dettori
- Department of Health Sciences, Infectious Diseases Clinic, University of Genoa, Hospital Policlinico San Martino-IRCCS, Genoa, Italy
| | - Antonio Vena
- Department of Health Sciences, Infectious Diseases Clinic, University of Genoa, Hospital Policlinico San Martino-IRCCS, Genoa, Italy
| | - Antonio Di Biagio
- Department of Health Sciences, Infectious Diseases Clinic, University of Genoa, Hospital Policlinico San Martino-IRCCS, Genoa, Italy
| | - Giacomo Garibotto
- Department of Internal Medicine, Clinica Nefrologica Dialisi e Trapianto, University of Genoa, Hospital Policlinico San Martino, IRCCS, Viale Benedetto XV, 16132, Genoa, Italy
| | - Matteo Bassetti
- Department of Health Sciences, Infectious Diseases Clinic, University of Genoa, Hospital Policlinico San Martino-IRCCS, Genoa, Italy
| | - Francesca Viazzi
- Department of Internal Medicine, Clinica Nefrologica Dialisi e Trapianto, University of Genoa, Hospital Policlinico San Martino, IRCCS, Viale Benedetto XV, 16132, Genoa, Italy.
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Gu YY, Zhang M, Cen H, Wu YF, Lu Z, Lu F, Liu XS, Lan HY. Quercetin as a potential treatment for COVID-19-induced acute kidney injury: Based on network pharmacology and molecular docking study. PLoS One 2021; 16:e0245209. [PMID: 33444408 PMCID: PMC7808608 DOI: 10.1371/journal.pone.0245209] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Accepted: 12/23/2020] [Indexed: 02/08/2023] Open
Abstract
Kidneys are one of the targets for SARS-CoV-2, it is reported that up to 36% of patients with SARS-CoV-2 infection would develop into acute kidney injury (AKI). AKI is associated with high mortality in the clinical setting and contributes to the transition of AKI to chronic kidney disease (CKD). Up to date, the underlying mechanisms are obscure and there is no effective and specific treatment for COVID-19-induced AKI. In the present study, we investigated the mechanisms and interactions between Quercetin and SARS-CoV-2 targets proteins by using network pharmacology and molecular docking. The renal protective effects of Quercetin on COVID-19-induced AKI may be associated with the blockade of the activation of inflammatory, cell apoptosis-related signaling pathways. Quercetin may also serve as SARS-CoV-2 inhibitor by binding with the active sites of SARS-CoV-2 main protease 3CL and ACE2, therefore suppressing the functions of the proteins to cut the viral life cycle. In conclusion, Quercetin may be a novel therapeutic agent for COVID-19-induced AKI. Inhibition of inflammatory, cell apoptosis-related signaling pathways may be the critical mechanisms by which Quercetin protects kidney from SARS-CoV-2 injury.
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Affiliation(s)
- Yue-Yu Gu
- Department of Nephrology, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, China
| | - Min Zhang
- Department of Nephrology, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, China
| | - Huan Cen
- Department of Ultrasound, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, China
| | - Yi-Fan Wu
- Department of Nephrology, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, China
| | - Zhaoyu Lu
- Department of Nephrology, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, China
| | - Fuhua Lu
- Department of Nephrology, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, China
| | - Xu-Sheng Liu
- Department of Nephrology, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, China
- * E-mail: (HYL); (XSL)
| | - Hui-Yao Lan
- Department of Medicine and Therapeutics, Li Ka Shing Institute of Health Sciences, The Chinese University of Hong Kong, Hong Kong, China
- * E-mail: (HYL); (XSL)
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29
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Affiliation(s)
- Anna Burgner
- Division of Nephrology and Hypertension, Vanderbilt University Medical Center, Nashville, Tennessee
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30
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Gupta S, Coca SG, Chan L, Melamed ML, Brenner SK, Hayek SS, Sutherland A, Puri S, Srivastava A, Leonberg-Yoo A, Shehata AM, Flythe JE, Rashidi A, Schenck EJ, Goyal N, Hedayati SS, Dy R, Bansal A, Athavale A, Nguyen HB, Vijayan A, Charytan DM, Schulze CE, Joo MJ, Friedman AN, Zhang J, Sosa MA, Judd E, Velez JCQ, Mallappallil M, Redfern RE, Bansal AD, Neyra JA, Liu KD, Renaghan AD, Christov M, Molnar MZ, Sharma S, Kamal O, Boateng JO, Short SA, Admon AJ, Sise ME, Wang W, Parikh CR, Leaf DE. AKI Treated with Renal Replacement Therapy in Critically Ill Patients with COVID-19. J Am Soc Nephrol 2021; 32:161-176. [PMID: 33067383 PMCID: PMC7894677 DOI: 10.1681/asn.2020060897] [Citation(s) in RCA: 173] [Impact Index Per Article: 57.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Accepted: 08/27/2020] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND AKI is a common sequela of coronavirus disease 2019 (COVID-19). However, few studies have focused on AKI treated with RRT (AKI-RRT). METHODS We conducted a multicenter cohort study of 3099 critically ill adults with COVID-19 admitted to intensive care units (ICUs) at 67 hospitals across the United States. We used multivariable logistic regression to identify patient-and hospital-level risk factors for AKI-RRT and to examine risk factors for 28-day mortality among such patients. RESULTS A total of 637 of 3099 patients (20.6%) developed AKI-RRT within 14 days of ICU admission, 350 of whom (54.9%) died within 28 days of ICU admission. Patient-level risk factors for AKI-RRT included CKD, men, non-White race, hypertension, diabetes mellitus, higher body mass index, higher d-dimer, and greater severity of hypoxemia on ICU admission. Predictors of 28-day mortality in patients with AKI-RRT were older age, severe oliguria, and admission to a hospital with fewer ICU beds or one with greater regional density of COVID-19. At the end of a median follow-up of 17 days (range, 1-123 days), 403 of the 637 patients (63.3%) with AKI-RRT had died, 216 (33.9%) were discharged, and 18 (2.8%) remained hospitalized. Of the 216 patients discharged, 73 (33.8%) remained RRT dependent at discharge, and 39 (18.1%) remained RRT dependent 60 days after ICU admission. CONCLUSIONS AKI-RRT is common among critically ill patients with COVID-19 and is associated with a hospital mortality rate of >60%. Among those who survive to discharge, one in three still depends on RRT at discharge, and one in six remains RRT dependent 60 days after ICU admission.
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Affiliation(s)
- Shruti Gupta
- Division of Renal Medicine, Brigham and Women’s Hospital, Boston, Massachusetts
| | - Steven G. Coca
- Division of Nephrology, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Lili Chan
- Division of Nephrology, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Michal L. Melamed
- Department of Medicine, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, New York
| | - Samantha K. Brenner
- Department of Internal Medicine, Hackensack Meridian School of Medicine, Seton Hall, Nutley, New Jersey
- Department of Internal Medicine, Heart and Vascular Hospital, Hackensack Meridian Health Hackensack University Medical Center, Hackensack, New Jersey
| | - Salim S. Hayek
- Division of Cardiology, University of Michigan Medical Center, Ann Arbor, Michigan
| | - Anne Sutherland
- Division of Pulmonary and Critical Care Medicine, Rutgers New Jersey Medical School, Newark, New Jersey
| | - Sonika Puri
- Division of Nephrology, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey
| | - Anand Srivastava
- Division of Nephrology and Hypertension, Center for Translational Metabolism and Health, Institute for Public Health and Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Amanda Leonberg-Yoo
- Renal-Electrolyte and Hypertension Division, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Alexandre M. Shehata
- Department of Medicine, Hackensack Meridian Health Mountainside Medical Center, Glen Ridge, New Jersey
| | - Jennifer E. Flythe
- Division of Nephrology and Hypertension, Department of Medicine, University of North Carolina Kidney Center, University of North Carolina School of Medicine, Chapel Hill, North Carolina
- Cecil G. Sheps Center for Health Services Research, University of North Carolina, Chapel Hill, North Carolina
| | - Arash Rashidi
- Division of Nephrology and Hypertension, University Hospitals Cleveland Medical Center, Cleveland, Ohio
| | - Edward J. Schenck
- Divison of Pulmonary and Critical Care Medicine, Department of Medicine Weill Cornell Medicine, New York, New York
| | - Nitender Goyal
- Division of Nephrology, Tufts Medical Center, Boston, Massachusetts
| | - S. Susan Hedayati
- Division of Nephrology, Department of Medicine, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Rajany Dy
- Division of Pulmonary and Critical Care Medicine, University Medical Center, University of Nevada, Las Vegas, Nevada
| | - Anip Bansal
- Division of Renal Diseases and Hypertension, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | | | - H. Bryant Nguyen
- Division of Pulmonary, Critical Care, Hyperbaric, Allergy, and Sleep Medicine, Loma Linda University Health, Loma Linda, California
| | - Anitha Vijayan
- Division of Nephrology, Washington University, St. Louis, Missouri
| | - David M. Charytan
- Division of Nephrology, New York University Grossman School of Medicine, New York, New York
| | - Carl E. Schulze
- Division of Nephrology, Department of Medicine, University of California, Los Angeles, California
| | - Min J. Joo
- Department of Medicine, Section of Pulmonary, Critical Care, Sleep, and Allergy, University of Illinois, Chicago, Illinois
| | - Allon N. Friedman
- Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana
| | - Jingjing Zhang
- Division of Nephrology, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
| | - Marie Anne Sosa
- Division of Nephrology, Department of Medicine, University of Miami Miller School of Medicine and Jackson Memorial Hospital, Miami, Florida
| | - Eric Judd
- Division of Nephrology, University of Alabama at Birmingham, Birmingham, Alabama
| | - Juan Carlos Q. Velez
- Department of Nephrology, Ochsner Health System, New Orleans, Louisiana
- Ochsner Clinical School, The University of Queensland, Brisbane, Queensland, Australia
| | - Mary Mallappallil
- Division of Nephrology, Kings County Hospital Center, New York City Health and Hospital Corporation, Brooklyn, New York
| | - Roberta E. Redfern
- Research Department, ProMedica Research, ProMedica Toledo Hospital, Toledo, Ohio
| | - Amar D. Bansal
- Renal and Electrolyte Division, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Javier A. Neyra
- Division of Nephrology, Department of Internal Medicine, Bone and Mineral Metabolism, University of Kentucky, Lexington, Kentucky
| | - Kathleen D. Liu
- Division of Nephrology and Critical Care Medicine, University of California, San Francisco, California
| | - Amanda D. Renaghan
- Division of Nephrology, University of Virginia Health System, Charlottesville, Virginia
| | - Marta Christov
- Department of Medicine-Nephrology, Westchester Medical Center, New York Medical College, New York, New York
| | - Miklos Z. Molnar
- Department of Surgery, University of Tennessee Health Science Center, Memphis, Tennessee
| | - Shreyak Sharma
- Division of Renal Medicine, Brigham and Women’s Hospital, Boston, Massachusetts
| | - Omer Kamal
- Division of Renal Medicine, Brigham and Women’s Hospital, Boston, Massachusetts
| | - Jeffery Owusu Boateng
- Department of Epidemiology, Boston University School of Public Health, Boston, Massachusetts
| | - Samuel A.P. Short
- University of Vermont Larner College of Medicine, Burlington, Vermont
| | - Andrew J. Admon
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan
| | - Meghan E. Sise
- Division of Nephrology, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts
| | - Wei Wang
- Department of Medicine, Brigham and Women’s Hospital, Boston, Massachusetts
- Department of Neurology, Brigham and Women’s Hospital, Boston, Massachusetts
| | - Chirag R. Parikh
- Division of Nephrology, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - David E. Leaf
- Division of Renal Medicine, Brigham and Women’s Hospital, Boston, Massachusetts
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31
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Ştefan MF, Magda ŞL, Vinereanu D. COVID-19 presented as acute kidney injury with secondary myocardial damage. J Infect Public Health 2020; 14:371-373. [PMID: 33647554 PMCID: PMC7833619 DOI: 10.1016/j.jiph.2020.12.031] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Accepted: 12/23/2020] [Indexed: 01/06/2023] Open
Abstract
The most common manifestations of the 2019 novel coronavirus disease (COVID-19) include fever, cough, dyspnea. Nevertheless, many atypical forms of presentation might be present, delaying a correct diagnosis. Acute kidney injury (AKI) is one of the important complications of COVID-19, occurring in 0.5-7% of cases and in 2.9-23% of ICU patients. The exact mechanisms by which COVID-19 induces AKI in different clinical settings is still a matter of debate. We present the case of a 53-year old woman, without any prior renal pathology, admitted to a Cardiology Department for atypical thoracic pain and oligo-anuria, without respiratory symptoms, who was diagnosed with SARS-CoV-2 infection. The patient had a significant rise in high-sensitivity cardiac troponin (from 304 ng/L to 889 ng/L in one hour) and mild systolic dysfunction (LVEF 45%), which led to the initial misdiagnosis of an acute myocardial infarction. Blood tests confirmed the diagnosis of acute kidney injury (creatinine 8.8 mg/dL in two different samples). She received hydro-electrolytic rebalancing treatment, with good clinical and biological evolution. To our knowledge this is one of the first reports, that highlights the existence of myocardial injury secondary to acute kidney injury caused by SARS-CoV-2 infection, in a patient without respiratory symptoms.
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Affiliation(s)
| | - Ştefania L Magda
- University and Emergency Hospital, Bucharest, Romania; "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania.
| | - Dragoş Vinereanu
- University and Emergency Hospital, Bucharest, Romania; "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania
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Stevens JS, King KL, Robbins-Juarez SY, Khairallah P, Toma K, Alvarado Verduzco H, Daniel E, Douglas D, Moses AA, Peleg Y, Starakiewicz P, Li MT, Kim DW, Yu K, Qian L, Shah VH, O'Donnell MR, Cummings MJ, Zucker J, Natarajan K, Perotte A, Tsapepas D, Krzysztof K, Dube G, Siddall E, Shirazian S, Nickolas TL, Rao MK, Barasch JM, Valeri AM, Radhakrishnan J, Gharavi AG, Husain SA, Mohan S. High rate of renal recovery in survivors of COVID-19 associated acute renal failure requiring renal replacement therapy. PLoS One 2020; 15:e0244131. [PMID: 33370368 PMCID: PMC7769434 DOI: 10.1371/journal.pone.0244131] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2020] [Accepted: 12/03/2020] [Indexed: 01/08/2023] Open
Abstract
INTRODUCTION A large proportion of patients with COVID-19 develop acute kidney injury (AKI). While the most severe of these cases require renal replacement therapy (RRT), little is known about their clinical course. METHODS We describe the clinical characteristics of COVID-19 patients in the ICU with AKI requiring RRT at an academic medical center in New York City and followed patients for outcomes of death and renal recovery using time-to-event analyses. RESULTS Our cohort of 115 patients represented 23% of all ICU admissions at our center, with a peak prevalence of 29%. Patients were followed for a median of 29 days (2542 total patient-RRT-days; median 54 days for survivors). Mechanical ventilation and vasopressor use were common (99% and 84%, respectively), and the median Sequential Organ Function Assessment (SOFA) score was 14. By the end of follow-up 51% died, 41% recovered kidney function (84% of survivors), and 8% still needed RRT (survival probability at 60 days: 0.46 [95% CI: 0.36-0.56])). In an adjusted Cox model, coronary artery disease and chronic obstructive pulmonary disease were associated with increased mortality (HRs: 3.99 [95% CI 1.46-10.90] and 3.10 [95% CI 1.25-7.66]) as were angiotensin-converting-enzyme inhibitors (HR 2.33 [95% CI 1.21-4.47]) and a SOFA score >15 (HR 3.46 [95% CI 1.65-7.25). CONCLUSIONS AND RELEVANCE Our analysis demonstrates the high prevalence of AKI requiring RRT among critically ill patients with COVID-19 and is associated with a high mortality, however, the rate of renal recovery is high among survivors and should inform shared-decision making.
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Affiliation(s)
- Jacob S. Stevens
- Division of Nephrology, Department of Medicine, Columbia University Irving Medical Center, New York, NY, United States of America
- Columbia University Renal Epidemiology Group, New York, NY, United States of America
- Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, United States of America
- * E-mail:
| | - Kristen L. King
- Division of Nephrology, Department of Medicine, Columbia University Irving Medical Center, New York, NY, United States of America
- Columbia University Renal Epidemiology Group, New York, NY, United States of America
| | - Shelief Y. Robbins-Juarez
- Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, United States of America
| | - Pascale Khairallah
- Division of Nephrology, Department of Medicine, Columbia University Irving Medical Center, New York, NY, United States of America
| | - Katherine Toma
- Division of Nephrology, Department of Medicine, Columbia University Irving Medical Center, New York, NY, United States of America
| | - Hector Alvarado Verduzco
- Division of Nephrology, Department of Medicine, Columbia University Irving Medical Center, New York, NY, United States of America
| | - Emily Daniel
- Division of Nephrology, Department of Medicine, Columbia University Irving Medical Center, New York, NY, United States of America
| | - Denzil Douglas
- Division of Nephrology, Department of Medicine, Columbia University Irving Medical Center, New York, NY, United States of America
| | - Andrew A. Moses
- Division of Nephrology, Department of Medicine, Columbia University Irving Medical Center, New York, NY, United States of America
| | - Yonatan Peleg
- Division of Nephrology, Department of Medicine, Columbia University Irving Medical Center, New York, NY, United States of America
| | - Piotr Starakiewicz
- Division of Nephrology, Department of Medicine, Columbia University Irving Medical Center, New York, NY, United States of America
| | - Miah T. Li
- Division of Nephrology, Department of Medicine, Columbia University Irving Medical Center, New York, NY, United States of America
- Columbia University Renal Epidemiology Group, New York, NY, United States of America
| | - Daniel W. Kim
- Division of Nephrology, Department of Medicine, Columbia University Irving Medical Center, New York, NY, United States of America
- Columbia University Renal Epidemiology Group, New York, NY, United States of America
| | - Kathleen Yu
- Columbia University Renal Epidemiology Group, New York, NY, United States of America
- Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, United States of America
| | - Long Qian
- Columbia University Renal Epidemiology Group, New York, NY, United States of America
- Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, United States of America
| | - Vaqar H. Shah
- Division of Nephrology, Department of Medicine, Columbia University Irving Medical Center, New York, NY, United States of America
| | - Max R. O'Donnell
- Division of Pulmonary, Allergy & Critical Care Medicine, Department of Medicine, Columbia University Irving Medical Center, New York, NY, United States of America
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, United States of America
| | - Matthew J. Cummings
- Division of Pulmonary, Allergy & Critical Care Medicine, Department of Medicine, Columbia University Irving Medical Center, New York, NY, United States of America
| | - Jason Zucker
- Division of Infectious Diseases, Department of Medicine, Columbia University Irving Medical Center, New York, NY, United States of America
| | - Karthik Natarajan
- Department of Biomedical Informatics, Columbia University, New York, NY, United States of America
| | - Adler Perotte
- Department of Biomedical Informatics, Columbia University, New York, NY, United States of America
| | - Demetra Tsapepas
- Department of Pharmacy, New-York Presbyterian Hospital, New York, NY, United States of America
- Department of Quality, New-York Presbyterian Hospital, New York, NY, United States of America
| | - Kiryluk Krzysztof
- Division of Nephrology, Department of Medicine, Columbia University Irving Medical Center, New York, NY, United States of America
- Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, United States of America
| | - Geoffrey Dube
- Division of Nephrology, Department of Medicine, Columbia University Irving Medical Center, New York, NY, United States of America
- Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, United States of America
| | - Eric Siddall
- Division of Nephrology, Department of Medicine, Columbia University Irving Medical Center, New York, NY, United States of America
- Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, United States of America
| | - Shayan Shirazian
- Division of Nephrology, Department of Medicine, Columbia University Irving Medical Center, New York, NY, United States of America
- Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, United States of America
| | - Thomas L. Nickolas
- Division of Nephrology, Department of Medicine, Columbia University Irving Medical Center, New York, NY, United States of America
- Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, United States of America
| | - Maya K. Rao
- Division of Nephrology, Department of Medicine, Columbia University Irving Medical Center, New York, NY, United States of America
- Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, United States of America
| | - Jonathan M. Barasch
- Division of Nephrology, Department of Medicine, Columbia University Irving Medical Center, New York, NY, United States of America
- Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, United States of America
| | - Anthony M. Valeri
- Division of Nephrology, Department of Medicine, Columbia University Irving Medical Center, New York, NY, United States of America
- Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, United States of America
| | - Jai Radhakrishnan
- Division of Nephrology, Department of Medicine, Columbia University Irving Medical Center, New York, NY, United States of America
- Columbia University Renal Epidemiology Group, New York, NY, United States of America
- Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, United States of America
| | - Ali G. Gharavi
- Division of Nephrology, Department of Medicine, Columbia University Irving Medical Center, New York, NY, United States of America
- Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, United States of America
| | - S. Ali Husain
- Division of Nephrology, Department of Medicine, Columbia University Irving Medical Center, New York, NY, United States of America
- Columbia University Renal Epidemiology Group, New York, NY, United States of America
- Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, United States of America
| | - Sumit Mohan
- Division of Nephrology, Department of Medicine, Columbia University Irving Medical Center, New York, NY, United States of America
- Columbia University Renal Epidemiology Group, New York, NY, United States of America
- Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, United States of America
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Affiliation(s)
- Daniil Shimonov
- Division of Nephrology and Hypertension, Weill Cornell Medicine, New York, New York
- The Rogosin Institute, New York, New York
| | - Vesh Srivatana
- Division of Nephrology and Hypertension, Weill Cornell Medicine, New York, New York
- The Rogosin Institute, New York, New York
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Kutluhan MA, Taş A, Şahin A, Ürkmez A, Topaktas R, Ataç Ö, Verit A. Assessment of clinical features and renal functions in Coronavirus disease-19: A retrospective analysis of 96 patients. Int J Clin Pract 2020; 74:e13636. [PMID: 32894811 DOI: 10.1111/ijcp.13636] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Revised: 06/25/2020] [Accepted: 07/28/2020] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND The most common extra pulmonary organ dysfunction in acute respiratory distress syndrome is acute kidney injury. Current data so far indicate low incidence of AKI in Covid-19 disease. OBJECTIVE In this retrospective study, we analysed the clinical features of patients diagnosed with Covid-19 and investigated the effect of Covid-19 on kidney function. METHODS Ninety-six patients diagnosed with Covid-19 were included in our study. Demographic features (Age, gender, co-morbidities), symptoms, thorax CT findings, Covid-19 PCR results and laboratory findings were recorded. The clinical features of the patients were analysed and kidney function values before Covid-19 diagnosis were compared with kidney function values after Covid-19 diagnosis. RESULTS Most presenting symptom was fever (51%). Most accompanying co-morbidity was hypertension (56%). According to laboratory findings; ferritin, D-dimer and C-reactive protein levels were statistically significantly higher in ARDS group than severe pneumonia and pneumonia group (P = .002, P = .001 and P < .001, respectively). Also lymphocyte levels were statistically significantly lower in ARDS group than severe pneumonia and pneumonia group (P = .042). According to KDIGO criteria 3 (3.1%) patients had AKI during the hospital stay. For all patients, there was statistically significant difference between basal, 1st, 5th and 10th day BUN and SCr levels (P = .024 and P = .018, respectively). For severe pneumonia group there was statistically significant difference between basal, 1st, 5th and 10th day SCr levels (P = .045). CONCLUSION Our study demonstrated that Covid-19 can cause renal impairment both with pneumonia and ARDS. A large-scale prospective randomised studies are needed to reach final judgement about this topic.
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Affiliation(s)
- Musab Ali Kutluhan
- Department of Urology, Fatih Sultan Mehmet Training and Research Hospital, Istanbul, Turkey
| | - Ahmet Taş
- Department of Urology, Fatih Sultan Mehmet Training and Research Hospital, Istanbul, Turkey
| | - Aytaç Şahin
- Department of Urology, Fatih Sultan Mehmet Training and Research Hospital, Istanbul, Turkey
| | - Ahmet Ürkmez
- Department of Urology, Fatih Sultan Mehmet Training and Research Hospital, Istanbul, Turkey
| | - Ramazan Topaktas
- Department of Urology, Haydarpasa Numune Training and Research Hospital, Istanbul, Turkey
| | - Ömer Ataç
- Department of Public Health, School of Medicine, Medipol University, Istanbul, Turkey
| | - Ayhan Verit
- Department of Urology, Fatih Sultan Mehmet Training and Research Hospital, Istanbul, Turkey
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Nadim MK, Forni LG, Mehta RL, Connor MJ, Liu KD, Ostermann M, Rimmelé T, Zarbock A, Bell S, Bihorac A, Cantaluppi V, Hoste E, Husain-Syed F, Germain MJ, Goldstein SL, Gupta S, Joannidis M, Kashani K, Koyner JL, Legrand M, Lumlertgul N, Mohan S, Pannu N, Peng Z, Perez-Fernandez XL, Pickkers P, Prowle J, Reis T, Srisawat N, Tolwani A, Vijayan A, Villa G, Yang L, Ronco C, Kellum JA. COVID-19-associated acute kidney injury: consensus report of the 25th Acute Disease Quality Initiative (ADQI) Workgroup. Nat Rev Nephrol 2020; 16:747-764. [PMID: 33060844 PMCID: PMC7561246 DOI: 10.1038/s41581-020-00356-5] [Citation(s) in RCA: 362] [Impact Index Per Article: 90.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/09/2020] [Indexed: 01/08/2023]
Abstract
Kidney involvement in patients with coronavirus disease 2019 (COVID-19) is common, and can range from the presence of proteinuria and haematuria to acute kidney injury (AKI) requiring renal replacement therapy (RRT; also known as kidney replacement therapy). COVID-19-associated AKI (COVID-19 AKI) is associated with high mortality and serves as an independent risk factor for all-cause in-hospital death in patients with COVID-19. The pathophysiology and mechanisms of AKI in patients with COVID-19 have not been fully elucidated and seem to be multifactorial, in keeping with the pathophysiology of AKI in other patients who are critically ill. Little is known about the prevention and management of COVID-19 AKI. The emergence of regional 'surges' in COVID-19 cases can limit hospital resources, including dialysis availability and supplies; thus, careful daily assessment of available resources is needed. In this Consensus Statement, the Acute Disease Quality Initiative provides recommendations for the diagnosis, prevention and management of COVID-19 AKI based on current literature. We also make recommendations for areas of future research, which are aimed at improving understanding of the underlying processes and improving outcomes for patients with COVID-19 AKI.
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Affiliation(s)
- Mitra K Nadim
- Division of Nephrology and Hypertension, Department of Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Lui G Forni
- Department of Clinical and Experimental Medicine, Faculty of Health Sciences, University of Surrey, Guildford, UK
- Intensive Care Unit, Royal Surrey County Hospital NHS Foundation Trust, Guildford, UK
| | - Ravindra L Mehta
- Division of Nephrology, Department of Medicine, University of California, San Diego, CA, USA
| | - Michael J Connor
- Divisions of Pulmonary, Allergy, Critical Care, & Sleep Medicine, Division of Renal Medicine, Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA
| | - Kathleen D Liu
- Divisions of Nephrology and Critical Care Medicine, Departments of Medicine and Anesthesia, University of California, San Francisco, CA, USA
| | - Marlies Ostermann
- Department of Intensive Care, Guy's & St Thomas' NHS Foundation Hospital, London, UK
| | - Thomas Rimmelé
- Department of Anesthesiology and Intensive Care Medicine, Edouard Herriot Hospital, Hospices Civils de Lyon, Lyon, France
| | - Alexander Zarbock
- Department of Anesthesiology, Intensive Care and Pain Medicine, University Hospital Münster, Münster, Germany
| | - Samira Bell
- Division of Population Health and Genomics, School of Medicine, University of Dundee, Dundee, UK
| | - Azra Bihorac
- Department of Medicine, University of Florida, Gainesville, FL, USA
| | - Vincenzo Cantaluppi
- Nephrology and Kidney Transplantation Unit, Department of Translational Medicine, University of Piemonte Orientale, Novara, Italy
| | - Eric Hoste
- Intensive Care Unit, Ghent University Hospital, Ghent University, Ghent, Belgium
| | - Faeq Husain-Syed
- Division of Nephrology, Pulmonology and Critical Care Medicine, Department of Medicine II, University Hospital Giessen and Marburg, Giessen, Germany
| | - Michael J Germain
- Division of Nephrology, Renal Transplant Associates of New England, Baystate Medical Center U Mass Medical School, Springfield, MA, USA
| | - Stuart L Goldstein
- Division of Nephrology and Hypertension, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Shruti Gupta
- Division of Renal Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Michael Joannidis
- Division of Intensive Care and Emergency Medicine, Department of Medicine, Medical University of Innsbruck, Innsbruck, Austria
| | - Kianoush Kashani
- Division of Nephrology and Hypertension, Division of Pulmonary and Critical Care Medicine, Department of Medicine, Mayo Clinic, Rochester, MN, USA
| | - Jay L Koyner
- Division of Nephrology, Department of Medicine, University of Chicago, Chicago, IL, USA
| | - Matthieu Legrand
- Department of Anesthesiology and Perioperative Care, University of California San Francisco, San Francisco, CA, USA
| | - Nuttha Lumlertgul
- Department of Intensive Care, Guy's & St Thomas' NHS Foundation Hospital, London, UK
- Division of Nephrology, Excellence Center for Critical Care Nephrology, Critical Care Nephrology Research Unit, King Chulalongkorn Memorial Hospital, Chulalongkorn University, Bangkok, Thailand
| | - Sumit Mohan
- Department of Medicine, Division of Nephrology, Columbia University College of Physicians & Surgeons and New York Presbyterian Hospital, New York, NY, USA
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Neesh Pannu
- Division of Critical Care Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Zhiyong Peng
- Division of Critical Care Medicine, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Xose L Perez-Fernandez
- Servei de Medicina Intensiva, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Peter Pickkers
- Department of Intensive Care Medicine, Radboudumc, Nijmegen, The Netherlands
| | - John Prowle
- Critical Care and Peri-operative Medicine Research Group, William Harvey Research Institute, Queen Mary University of London, London, UK
| | - Thiago Reis
- Department of Nephrology, Dialysis and Transplantation, San Bortolo Hospital, International Renal Research Institute of Vicenza, Vicenza, Italy
- Department of Nephrology, Clínica de Doenças Renais de Brasília, Brasília, Brazil
| | - Nattachai Srisawat
- Division of Nephrology, Excellence Center for Critical Care Nephrology, Critical Care Nephrology Research Unit, King Chulalongkorn Memorial Hospital, Chulalongkorn University, Bangkok, Thailand
- Academy of Science, Royal Society of Thailand, Bangkok, Thailand
| | - Ashita Tolwani
- Division of Nephrology, Department of Medicine, University of Alabama, Birmingham, AL, USA
| | - Anitha Vijayan
- Division of Nephrology, Washington University School of Medicine, St. Louis, MO, USA
| | - Gianluca Villa
- Section of Anaesthesiology and Intensive Care, Department of Health Science, University of Florence, Florence, Italy
| | - Li Yang
- Renal Division, Peking University First Hospital, Beijing, China
| | - Claudio Ronco
- Department of Nephrology, Dialysis and Transplantation, San Bortolo Hospital, International Renal Research Institute of Vicenza, Vicenza, Italy
- Department of Medicine, University of Padova, Padova, Italy
| | - John A Kellum
- Department of Critical Care Medicine, Center for Critical Care Nephrology, University of Pittsburgh, Pittsburgh, PA, USA.
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Cavagnaro Sm F, Scheu Goncalves C. [Acute kidney injury in COVID-19]. Rev Chil Pediatr 2020; 91:997-998. [PMID: 33861841 DOI: 10.32641/rchped.vi91i6.3338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Affiliation(s)
- Felipe Cavagnaro Sm
- Clínica Alemana, Facultad de Medicina, Universidad del Desarrollo, Santiago, Chile
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Sang L, Chen S, Zheng X, Guan W, Zhang Z, Liang W, Zhong M, Jiang L, Pan C, Zhang W, Xia J, Chen N, Wu W, Wu H, Xu Y, Liu X, Liu X, He J, Li S, Zhang D, Zhong N, Li Y. The incidence, risk factors and prognosis of acute kidney injury in severe and critically ill patients with COVID-19 in mainland China: a retrospective study. BMC Pulm Med 2020; 20:290. [PMID: 33167955 PMCID: PMC7649893 DOI: 10.1186/s12890-020-01305-5] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Accepted: 10/01/2020] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND The clinical correlates, prognosis and determinants of acute kidney injury (AKI) in patients with coronavirus disease 2019 (Covid-19) remain largely unclear. METHODS We retrospectively reviewed medical records of all adult patients with laboratory-confirmed Covid-19 who were admitted to the intensive care unit (ICU) between January 23rd 2020 and April 6th 2020 at Wuhan JinYinTan Hospital and The First Affiliated Hospital of Guangzhou Medical University. RESULTS Among 210 patients, 131 were males (62.4%). The median Age was 64 years (IQR: 56-71). Of 92 (43.8%) patients who developed AKI during hospitalization, 13 (14.1%), 15 (16.3%) and 64 (69.6%) were classified as being at stage 1, 2 and 3, respectively. 54 patients (58.7%) received continuous renal replacement therapy. Age, sepsis, nephrotoxic drug, invasive mechanical ventilation and elevated baseline serum creatinine levels were associated with the occurrence of AKI. Renal recovery during hospitalization was identified among 16 patients with AKI (17.4%), who had a significantly shorter time from admission to AKI diagnosis, lower incidence of right heart failure and higher ratio of partial pressure of oxygen to the fraction of inspired oxygen. Of 210 patients, 93 deceased within 28 days of ICU admission. AKI stage 3, critical disease, greater Age and the lowest ratio of partial pressure of oxygen to the fraction of inspired oxygen being < 150 mmHg were independently associated with death. CONCLUSIONS Among patients with Covid-19, the incidence of AKI was high. Our findings of the risk factors of the development of AKI and factors associated with renal function recovery may inform clinical management of patients with critical illness of Covid-19.
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Affiliation(s)
- Ling Sang
- Department of Pulmonary and Critical Care Medicine, State Key Laboratory of Respiratory Diseases, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Sibei Chen
- Department of Pulmonary and Critical Care Medicine, State Key Laboratory of Respiratory Diseases, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Xia Zheng
- Department of Critical Care Medicine, The First Affiliated Hospital of Zhejiang University, Zhejiang, Hangzhou, China
| | - Weijie Guan
- Department of Pulmonary and Critical Care Medicine, State Key Laboratory of Respiratory Diseases, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Zhihui Zhang
- Department of Pulmonary and Critical Care Medicine, State Key Laboratory of Respiratory Diseases, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Wenhua Liang
- Department of Thorax Surgery, State Key Laboratory of Respiratory Diseases, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Ming Zhong
- Department of Critical Care Medicine, Zhongshan Hospital Fudan University, Shanghai, China
| | - Li Jiang
- Department of Critical Care Medicine, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Chun Pan
- Department of Critical Care Medicine, Zhongda Hospital, Southeast University, Nanjing, China
| | - Wei Zhang
- Emergency Department, the 900th Hospital of Joint Service Corps of Chinese PLA, FuZhou, China
| | - Jiaan Xia
- Department of tuberculosis, Wuhan Jinyintan Hospital, Wuhan, China
| | - Nanshan Chen
- Department of Respiratory and Critical Care Medicine, Wuhan Jinyintan Hospital, Wuhan, China
| | - Wenjuan Wu
- Department of Critical Care Medicine, Wuhan Jinyintan Hospital, Wuhan, China
| | - Hongkai Wu
- State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou Medical University, Guangzhou, China
| | - Yonghao Xu
- Department of Pulmonary and Critical Care Medicine, State Key Laboratory of Respiratory Diseases, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Xuesong Liu
- Department of Pulmonary and Critical Care Medicine, State Key Laboratory of Respiratory Diseases, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Xiaoqing Liu
- Department of Pulmonary and Critical Care Medicine, State Key Laboratory of Respiratory Diseases, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Jianxing He
- Department of Thorax Surgery, State Key Laboratory of Respiratory Diseases, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Shiyue Li
- Department of Pulmonary and Critical Care Medicine, State Key Laboratory of Respiratory Diseases, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Dingyu Zhang
- Research Center for Translational Medicine, Wuhan Jinyintan Hospital, Wuhan, China
- Joint Laboratory of Infectious Diseases and Health, Wuhan Institute of Virology and Wuhan Jinyintan Hospital, Chinese Academy of Sciences, Wuhan, China
| | - Nanshan Zhong
- Department of Pulmonary and Critical Care Medicine, State Key Laboratory of Respiratory Diseases, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Yimin Li
- Department of Pulmonary and Critical Care Medicine, State Key Laboratory of Respiratory Diseases, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China.
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Zhou S, Xu J, Xue C, Yang B, Mao Z, Ong ACM. Coronavirus-associated kidney outcomes in COVID-19, SARS, and MERS: a meta-analysis and systematic review. Ren Fail 2020; 43:1-15. [PMID: 33256491 PMCID: PMC7717867 DOI: 10.1080/0886022x.2020.1847724] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Revised: 11/02/2020] [Accepted: 11/03/2020] [Indexed: 01/08/2023] Open
Abstract
OBJECTIVES A meta-analysis and systematic review was conducted on kidney-related outcomes of three recent pandemics: SARS, MERS, and COVID-19, which were associated with potentially fatal acute respiratory distress syndrome (ARDS). METHODS A search of all published studies until 16 June 2020 was performed. The incidence/prevalence and mortality risk of acute and chronic renal events were evaluated, virus prevalence, and mortality in preexisting hemodialysis patients was investigated. RESULTS A total of 58 eligible studies involving 13452 hospitalized patients with three types of coronavirus infection were included. The reported incidence of new-onset acute kidney injury (AKI) was 12.5% (95% CI: 7.6%-18.3%). AKI significantly increased the mortality risk (OR = 5.75, 95% CI 3.75-8.77, p < 0.00001) in patients with coronavirus infection. The overall rate of urgent-start kidney replacement therapy (urgent-start KRT) use was 8.9% (95% CI: 5.0%-13.8%) and those who received urgent-start KRT had a higher risk of mortality (OR = 3.43, 95% CI 2.02-5.85, p < 0.00001). Patients with known chronic kidney disease (CKD) had a higher mortality than those without CKD (OR = 1.97, 95% CI 1.56-2.49, p < 0.00001). The incidence of coronavirus infection was 7.7% (95% CI: 4.9%-11.1%) in prevalent hemodialysis patients with an overall mortality rate of 26.2% (95% CI: 20.6%-32.6%). CONCLUSIONS Primary kidney involvement is common with coronavirus infection and is associated with significantly increased mortality. The recognition of AKI, CKD, and urgent-start KRT as major risk factors for mortality in coronavirus-infected patients are important steps in reducing future mortality and long-term morbidity in hospitalized patients with coronavirus infection.
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Affiliation(s)
- Shoulian Zhou
- Division of Nephrology, Changzheng Hospital, Second Military Medical University, Shanghai, People’s Republic of China
| | - Jing Xu
- Division of Nephrology, Changzheng Hospital, Second Military Medical University, Shanghai, People’s Republic of China
| | - Cheng Xue
- Division of Nephrology, Changzheng Hospital, Second Military Medical University, Shanghai, People’s Republic of China
| | - Bo Yang
- Internal Medicine III (Nephrology & Endocrinology), Naval Medical Center of PLA, Second Military Medical University, Shanghai, People’s Republic of China
| | - Zhiguo Mao
- Division of Nephrology, Changzheng Hospital, Second Military Medical University, Shanghai, People’s Republic of China
| | - Albert C. M. Ong
- Academic Nephrology Unit, Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, UK
- Sheffield Teaching Hospitals NHS Trust, Sheffield Kidney Institute, Sheffield, UK
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Hamilton P, Hanumapura P, Castelino L, Henney R, Parker K, Kumar M, Murphy M, Al-Sayed T, Pinnington S, Felton T, Challiner R, Ebah L. Characteristics and outcomes of hospitalised patients with acute kidney injury and COVID-19. PLoS One 2020; 15:e0241544. [PMID: 33141867 PMCID: PMC7608889 DOI: 10.1371/journal.pone.0241544] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Accepted: 10/16/2020] [Indexed: 01/08/2023] Open
Abstract
INTRODUCTION COVID-19 has spread globally to now be considered a pandemic by the World Health Organisation. Initially patients appeared to have a respiratory limited disease but there are now increasing reports of multiple organ involvement including renal disease in association with COVID-19. We studied the development and outcomes of acute kidney injury (AKI) in patients with COVID-19, in a large multicultural city hospital trust in the UK, to better understand the role renal disease has in the disease process. METHODS This was a retrospective review using electronic records and laboratory data of adult patients admitted to the four Manchester University Foundation Trust Hospitals between March 10 and April 30 2020 with a diagnosis of COVID-19. Records were reviewed for baseline characteristics, medications, comorbidities, social deprivation index, observations, biochemistry and outcomes including mortality, admission to critical care, mechanical ventilation and the need for renal replacement therapy. RESULTS There were 1032 patients included in the study of whom 210 (20.3%) had AKI in association with the diagnosis of COVID-19. The overall mortality with AKI was considerably higher at 52.4% compared to 26.3% without AKI (p-value <0.001). More patients with AKI required escalation to critical care (34.8% vs 11.2%, p-value <0.001). Following admission to critical care those with AKI were more likely to die (54.8% vs 25.0%, p-value <0.001) and more likely to require mechanical ventilation (86.3% vs 66.3%, p-value 0.006). DISCUSSION We have shown that the development of AKI is associated with dramatically worse outcomes for patients, in both mortality and the requirement for critical care. Patients with COVID-19 presenting with, or at risk of AKI should be closely monitored and appropriately managed to prevent any decline in renal function, given the significant risk of deterioration and death.
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Affiliation(s)
- Patrick Hamilton
- Manchester Institute of Nephrology and Transplantation, Manchester University NHS Foundation Trust, Manchester, United Kingdom
- Manchester Academic Health Sciences Centre (MAHSC), Manchester, United Kingdom
- Division of Cell Matrix Biology and Regenerative Medicine, Wellcome Centre for Cell-Matrix Research, School of Biological Sciences, Faculty of Biology Medicine and Health, The University of Manchester, Manchester, United Kingdom
| | - Prasanna Hanumapura
- Manchester Institute of Nephrology and Transplantation, Manchester University NHS Foundation Trust, Manchester, United Kingdom
- Manchester Academic Health Sciences Centre (MAHSC), Manchester, United Kingdom
| | - Laveena Castelino
- Manchester Institute of Nephrology and Transplantation, Manchester University NHS Foundation Trust, Manchester, United Kingdom
| | - Robert Henney
- Manchester Institute of Nephrology and Transplantation, Manchester University NHS Foundation Trust, Manchester, United Kingdom
- Manchester Academic Health Sciences Centre (MAHSC), Manchester, United Kingdom
| | - Kathrine Parker
- Manchester Institute of Nephrology and Transplantation, Manchester University NHS Foundation Trust, Manchester, United Kingdom
- Manchester Academic Health Sciences Centre (MAHSC), Manchester, United Kingdom
| | - Mukesh Kumar
- Manchester Institute of Nephrology and Transplantation, Manchester University NHS Foundation Trust, Manchester, United Kingdom
| | - Michelle Murphy
- Manchester Institute of Nephrology and Transplantation, Manchester University NHS Foundation Trust, Manchester, United Kingdom
| | - Tamer Al-Sayed
- Manchester Institute of Nephrology and Transplantation, Manchester University NHS Foundation Trust, Manchester, United Kingdom
| | - Sarah Pinnington
- Manchester Institute of Nephrology and Transplantation, Manchester University NHS Foundation Trust, Manchester, United Kingdom
| | - Tim Felton
- Division of Infection, Immunity and Respiratory Medicine, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, United Kingdom
- Intensive Care Unit, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester, United Kingdom
- NIHR Manchester Biomedical Research Centre, Manchester, United Kingdom
| | - Rachael Challiner
- Manchester Institute of Nephrology and Transplantation, Manchester University NHS Foundation Trust, Manchester, United Kingdom
- Manchester Academic Health Sciences Centre (MAHSC), Manchester, United Kingdom
| | - Leonard Ebah
- Manchester Institute of Nephrology and Transplantation, Manchester University NHS Foundation Trust, Manchester, United Kingdom
- Manchester Academic Health Sciences Centre (MAHSC), Manchester, United Kingdom
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40
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Zhang Z, Zhang L, Zha D, Hu C, Wu X. Clinical characteristics and risks of Chinàs 2019 novel coronavirus patients with AKI: a systematic review and meta-analysis. Ren Fail 2020; 42:926-931. [PMID: 32875936 PMCID: PMC7946000 DOI: 10.1080/0886022x.2020.1812401] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Revised: 08/10/2020] [Accepted: 08/11/2020] [Indexed: 01/14/2023] Open
Affiliation(s)
- Zhiqin Zhang
- Nephrology Department, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Lian Zhang
- Nephrology Department, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Dongqing Zha
- Nephrology Department, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Chun Hu
- Nephrology Department, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Xiaoyan Wu
- Nephrology Department, Zhongnan Hospital of Wuhan University, Wuhan, China
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41
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Affiliation(s)
- Michael R Rudnick
- Nephrology Division, Perelman School of Medicine of the University of Pennsylvania, Philadelphia, Pennsylvania, USA,
| | - Rachel Hilburg
- Nephrology Division, Perelman School of Medicine of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
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42
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Zahid U, Ramachandran P, Spitalewitz S, Alasadi L, Chakraborti A, Azhar M, Mikhalina G, Sherazi A, Narh JT, Khattar P, Bedi P. Acute Kidney Injury in COVID-19 Patients: An Inner City Hospital Experience and Policy Implications. Am J Nephrol 2020; 51:786-796. [PMID: 33011717 PMCID: PMC7573899 DOI: 10.1159/000511160] [Citation(s) in RCA: 60] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Accepted: 08/24/2020] [Indexed: 12/29/2022]
Abstract
BACKGROUND Although diffuse alveolar damage and respiratory failure are the key features of coronavirus disease 2019 (COVID-19), the involvement of other organs such as the kidney has also been reported. The reports of the incidence of acute kidney injury (AKI) in COVID-19 patients vary widely. In this study, we report our unique experience with AKI in COVID-19 patients in a low socioeconomic and predominantly ethnic minority group and provide its incidence, risk factors, and prognosis to expand the current understanding of this complication. METHODS In this single-center, retrospective cohort study, we analyzed the data of 469 COVID-19 patients admitted to the Brookdale University Hospital in Brooklyn, NY, from March 18 through April 23, 2020. Information regarding demographics, comorbidities, medications, clinical and laboratory data, and outcomes was collected from the electronic medical records. Both univariate and multivariate analyses were performed to determine the association of AKI with in-hospital mortality. RESULTS The median age was 66 years (interquartile range [IQR] 25-75; range 19-101 years), and 268 (57.14%) patients were male. Estimated glomerular filtration rate (eGFR) as determined by the Modification of Diet in Renal Disease Study Equation was low (<60 mL/min/1.73 m2) in 207 (44.1%) patients. During hospitalization, 128 (27.3%) patients developed AKI, and the incidence was significantly higher in those patients presenting with a low eGFR (N = 81, 39.1%; p < 0.001). Male sex, hypertension, the use of angiotensin-converting enzyme inhibitors and non-steroidal anti-inflammatories, hemodynamic instability, mechanical ventilation, acute respiratory distress syndrome, and admission elevated ferritin, creatinine kinase, brain natriuretic peptide, and troponin 1 were identified as the risk factors for in-hospital AKI. Ninety-seven (28.45%) patients died in the non-AKI group versus 91 (71.1%) in the AKI group (p < 0.001). The Cox proportional hazard model after adjusting for age, gender, comorbidities, hemodynamic status, and PF ratio (arterial oxygen partial pressure [PaO2]/fractional inspired oxygen [FiO2]) determined that on admission, an elevated blood urea nitrogen (hazard ratio [HR]: 1.75; 95% confidence interval [CI] 1.23-2.48), a low eGFR (HR 1.43; CI 1.1-2.03), AKI stage 1 (HR 1.14; CI 0.64-2.03), AKI stage 2 (HR 1.86; CI 1.03-3.56), and AKI stage 3 (HR 2.1; CI 1.3-2.81) were independent risk factors for in-hospital mortality. Renal replacement therapy (RRT) did not improve survival in stage III AKI. CONCLUSION AKI in our hospitalized COVID-19 patients was common and carried a high mortality, especially in patients with AKI stage 3. RRT did not improve survival. Policy changes and planning for this high incidence of AKI in COVID-19 patients and its associated high mortality are necessary at the local and national levels.
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Affiliation(s)
- Umar Zahid
- Division of Nephrology, Brookdale University Hospital and Medical Center, Brooklyn, New York, USA
| | - Preethi Ramachandran
- Division of Hematology/Oncology, Brookdale University Hospital and Medical Center, Brooklyn, New York, USA
| | - Samuel Spitalewitz
- Division of Nephrology, Brookdale University Hospital and Medical Center, Brooklyn, New York, USA
| | - Lutfi Alasadi
- Division of Nephrology, Brookdale University Hospital and Medical Center, Brooklyn, New York, USA
| | - Abhishek Chakraborti
- Department of Internal Medicine, Brookdale University Hospital and Medical Center, Brooklyn, New York, USA
| | - Muhammad Azhar
- Division of Nephrology, Brookdale University Hospital and Medical Center, Brooklyn, New York, USA
| | - Galina Mikhalina
- Division of Nephrology, Brookdale University Hospital and Medical Center, Brooklyn, New York, USA
| | - Andleeb Sherazi
- Division of Nephrology, Brookdale University Hospital and Medical Center, Brooklyn, New York, USA
| | - Joshua Tetteh Narh
- Department of Internal Medicine, Brookdale University Hospital and Medical Center, Brooklyn, New York, USA
| | - Pallavi Khattar
- Department of Pathology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Puneet Bedi
- Division of Nephrology, Brookdale University Hospital and Medical Center, Brooklyn, New York, USA,
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Laurence J, Mulvey JJ, Seshadri M, Racanelli A, Harp J, Schenck EJ, Zappetti D, Horn EM, Magro CM. Anti-complement C5 therapy with eculizumab in three cases of critical COVID-19. Clin Immunol 2020; 219:108555. [PMID: 32771488 PMCID: PMC7410014 DOI: 10.1016/j.clim.2020.108555] [Citation(s) in RCA: 83] [Impact Index Per Article: 20.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Revised: 07/29/2020] [Accepted: 08/03/2020] [Indexed: 01/01/2023]
Abstract
Respiratory failure and acute kidney injury (AKI) are associated with high mortality in SARS-CoV-2-associated Coronavirus disease 2019 (COVID-19). These manifestations are linked to a hypercoaguable, pro-inflammatory state with persistent, systemic complement activation. Three critical COVID-19 patients recalcitrant to multiple interventions had skin biopsies documenting deposition of the terminal complement component C5b-9, the lectin complement pathway enzyme MASP2, and C4d in microvascular endothelium. Administration of anti-C5 monoclonal antibody eculizumab led to a marked decline in D-dimers and neutrophil counts in all three cases, and normalization of liver functions and creatinine in two. One patient with severe heart failure and AKI had a complete remission. The other two individuals had partial remissions, one with resolution of his AKI but ultimately succumbing to respiratory failure, and another with a significant decline in FiO2 requirements, but persistent renal failure. In conclusion, anti-complement therapy may be beneficial in at least some patients with critical COVID-19.
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Affiliation(s)
- Jeffrey Laurence
- Department of Medicine, Division of Hematology and Medical Oncology, Weill Cornell Medicine, New York, NY, USA.
| | - J Justin Mulvey
- Department of Laboratory Medicine, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
| | - Madhav Seshadri
- Department of Medicine, Division of Hematology and Medical Oncology, Weill Cornell Medicine, New York, NY, USA
| | - Alexandra Racanelli
- Department of Medicine, Division of Pulmonary and Critical Care Medicine, Weill Cornell Medicine, New York, NY, USA
| | - Joanna Harp
- Department of Dermatology, Weill Cornell Medicine, New York, NY, USA
| | - Edward J Schenck
- Department of Medicine, Division of Pulmonary and Critical Care Medicine, Weill Cornell Medicine, New York, NY, USA
| | - Dana Zappetti
- Department of Medicine, Division of Pulmonary and Critical Care Medicine, Weill Cornell Medicine, New York, NY, USA
| | - Evelyn M Horn
- Department of Medicine, Division of Cardiology, Weill Cornell Medicine, New York, NY, USA
| | - Cynthia M Magro
- Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, New York, NY, USA
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44
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Li Q, Cheng Q, Zhao Z, Dai N, Zeng L, Zhu L, Guo W, Li C, Wang J, Li S, Shen N, Ge Q. Novel coronavirus infection and acute kidney injury in two renal transplant recipients: a case report. J Int Med Res 2020; 48:300060520964009. [PMID: 33100064 PMCID: PMC7588709 DOI: 10.1177/0300060520964009] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Accepted: 09/04/2020] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND The causative virus of coronavirus disease 2019 (COVID-19) may cause severe fatal pneumonia. The clinical presentation includes asymptomatic infection, severe pneumonia, and acute respiratory failure. Data pertaining to acute renal injury due to COVID-19 in patients who have undergone renal transplantation are scarce. We herein report two cases of COVID-19 along with acute kidney injury following kidney transplantation.Case presentation: Two patients with COVID-19 underwent renal transplantation and were subsequently diagnosed with acute kidney injury. The first patient presented with progressive respiratory symptoms and acute renal injury. He was treated with diuretics and suspension of immunosuppressive therapy; however, the patient died. The second patient presented with respiratory tract symptoms, hypoxemia, and progressive deterioration of renal function followed by improvement. Her mycophenolate mofetil was stopped after admission, and tacrolimus was discontinued 10 days later. Moxifloxacin and methylprednisolone were continued in combination with albumin and gamma globulin infusion. A diuretic was administered, and prednisone was gradually reduced along with tacrolimus. The patient exhibited a satisfactory clinical recovery. CONCLUSION Patients who develop COVID-19 after kidney transplantation are at risk of acute kidney injury, and their prednisone, immunosuppressant, and gamma globulin treatment must be adjusted according to their condition.
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Affiliation(s)
- Qiuyu Li
- Department of Respiratory and Critical Care Medicine, Peking University Third Hospital, Beijing, PR China
| | - Qin Cheng
- Department of Respiratory and Critical Care Medicine, Peking University Third Hospital, Beijing, PR China
| | - Zhiling Zhao
- Department of Critical Care Medicine, Peking University Third Hospital, Beijing, PR China
| | - Nini Dai
- Department of Respiratory and Critical Care Medicine, Peking University Third Hospital, Beijing, PR China
| | - Lin Zeng
- Research Center of Clinical Epidemiology, Peking University Third Hospital, Beijing, PR China
| | - Lan Zhu
- Institute of Organ Transplantation, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, PR China
| | - Wei Guo
- Department of Radiology, Peking University Third Hospital, Beijing, PR China
| | - Chao Li
- Department of Critical Care Medicine, Peking University Third Hospital, Beijing, PR China
| | - Junhong Wang
- Department of Emergency, Peking University Third Hospital, Beijing, PR China
| | - Shu Li
- Department of Emergency, Peking University Third Hospital, Beijing, PR China
| | - Ning Shen
- Department of Respiratory and Critical Care Medicine, Peking University Third Hospital, Beijing, PR China
| | - Qinggang Ge
- Department of Critical Care Medicine, Peking University Third Hospital, Beijing, PR China
- Qinggang Ge, Department of Critical Care Medicine, Peking University Third Hospital, No. 49 Huayuanbeilu Road, Haidian District, Beijing 100191, P.R. China.
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45
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Hansrivijit P, Qian C, Boonpheng B, Thongprayoon C, Vallabhajosyula S, Cheungpasitporn W, Ghahramani N. Incidence of acute kidney injury and its association with mortality in patients with COVID-19: a meta-analysis. J Investig Med 2020; 68:1261-1270. [PMID: 32655013 PMCID: PMC7371487 DOI: 10.1136/jim-2020-001407] [Citation(s) in RCA: 57] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/23/2020] [Indexed: 12/15/2022]
Abstract
Acute kidney injury (AKI) is a complication of COVID-19. However, the incidence of AKI in COVID-19 varies among studies. Thus, we aimed to evaluate the pooled incidence of AKI and its association with mortality in patients with COVID-19 using a meta-analysis. We search Ovid MEDLINE, EMBASE, and the Cochrane Library for eligible publications reporting the clinical characteristics of patients with COVID-19 without language restriction. Incidence of AKI and mortality were reported. Meta-regression was used to describe the association between outcomes. From 26 studies (n=5497), the pooled incidence of AKI in patients with COVID-19 was 8.4% (95% CI 6.0% to 11.7%) with a pooled incidence of renal replacement therapy of 3.6% (95% CI 1.8% to 7.1%). The incidence of AKI was higher in critically ill patients (19.9%) compared with hospitalized patients (7.3%). The pooled estimated odds ratio for mortality from AKI was 13.33 (95% CI 4.05 to 43.91). No potential publication bias was detected. By using meta-regression analyses, the incidence of AKI was positively associated with mortality after adjusted for age and sex (Q=26.18; p=0.02). Moreover, age (p<0.01), diabetes (p=0.02), hypertension (p<0.01) and baseline serum creatinine levels (p=0.04) were positively associated with AKI incidence in adjusted models. In conclusion, AKI is present in 8.3% of overall patients with COVID-19 and in 19.9% of critically ill patients with COVID-19. Presence of AKI is associated with 13-fold increased risk of mortality. Age, diabetes, hypertension, and baseline serum creatinine levels are associated with increased AKI incidence.
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Affiliation(s)
- Panupong Hansrivijit
- Department of Internal Medicine, UPMC Pinnacle Harrisburg, Harrisburg, Pennsylvania, USA
| | - Chenchen Qian
- Department of Internal Medicine, UPMC Pinnacle Harrisburg, Harrisburg, Pennsylvania, USA
| | - Boonphiphop Boonpheng
- Division of Nephrology, University of California Los Angeles David Geffen School of Medicine, Los Angeles, California, USA
| | | | | | - Wisit Cheungpasitporn
- Division of Nephrology, University of Mississippi Medical Center, Jackson, Mississippi, USA
| | - Nasrollah Ghahramani
- Division of Nephrology, Pennsylvania State University College of Medicine, Hershey, Pennsylvania, USA
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46
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Lynch MR, Tang J. COVID-19 and Kidney Injury. R I Med J (2013) 2020; 103:24-28. [PMID: 32900008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Acute kidney injury (AKI) has been reported as a complication of COVID-19. However, the epidemiology, management, and associated outcomes have varied greatly between studies. The pathophysiology remains unclear. Summary: The etiology of AKI in the setting of COVID-19 appears multifactorial. Systemic effects of sepsis, inflammation, and vascular injury likely play some role. Furthermore, SARS-CoV-2 binds to the angiotensin-converting enzyme 2 receptor, highly expressed in the kidney, providing a route for direct infection. Older age, baseline comorbidities, and respiratory failure are strong risk factors for the development of AKI. Regardless of etiology, AKI carries a significantly increased risk for in-hospital mortality, especially in those with critical illness. Currently, management of AKI in patients with COVID-19 remains supportive. Key Messages: AKI is common in patients with COVID-19. Future studies are needed to examine the response to anti-viral treatment as well as long-term renal outcomes in patients with AKI.
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Affiliation(s)
- Matthew R Lynch
- Division of Kidney Diseases and Hypertension, Department of Medicine, Alpert Medical School of Brown University, Providence, RI
| | - Jie Tang
- Division of Kidney Diseases and Hypertension, Department of Medicine, Alpert Medical School of Brown University, Providence, RI
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47
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Abstract
Coronavirus disease 2019 (COVID-19) is spreading rapidly worldwide. Here, we review recently published studies on COVID-19-associated acute kidney injury (AKI) in China. The pooled incidence of AKI in all reported COVID-19 patients was 6.5%, with a much higher rate in patients from the intensive care unit (32.5%). AKI is associated with the severity of COVID-19 and mortality rates, which is similar to other kidney abnormalities including proteinuria and hematuria. The renal tubule is the main site of injury in COVID-19 patients, and the etiology of renal impairment in COVID-19 patients likely is diverse and multifactorial. Apart from direct viral attack via angiotensin-converting enzyme 2 and transmembrane serine proteases 2, hypoxia and hypercoagulability also may contribute to the occurrence of renal injury. To date, there is only randomized controlled trial evidence to support the use of dexamethasone in patients requiring oxygen therapy and remdesivir for shortening the time to recovery, with no specific treatment for COVID-19-associated AKI. Studies researching kidney pathologies or reporting renal outcome and prognosis are in urgent need. Further studies are urgently warranted to identify risk factors, to predict prognosis and renal outcome, to explore the exact mechanisms of renal injury, and to suggest targeted interventions.
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Affiliation(s)
- Xizi Zheng
- Renal Division, Department of Medicine, Peking University First Hospital, Beijing, China; Peking University Institute of Nephrology, Beijing, China; Key Laboratory of Renal Disease, Ministry of Health of China, Beijing, China
| | - Youlu Zhao
- Renal Division, Department of Medicine, Peking University First Hospital, Beijing, China; Peking University Institute of Nephrology, Beijing, China; Key Laboratory of Renal Disease, Ministry of Health of China, Beijing, China
| | - Li Yang
- Renal Division, Department of Medicine, Peking University First Hospital, Beijing, China; Peking University Institute of Nephrology, Beijing, China; Key Laboratory of Renal Disease, Ministry of Health of China, Beijing, China.
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48
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Braun F, Lütgehetmann M, Pfefferle S, Wong MN, Carsten A, Lindenmeyer MT, Nörz D, Heinrich F, Meißner K, Wichmann D, Kluge S, Gross O, Pueschel K, Schröder AS, Edler C, Aepfelbacher M, Puelles VG, Huber TB. SARS-CoV-2 renal tropism associates with acute kidney injury. Lancet 2020; 396:597-598. [PMID: 32818439 PMCID: PMC7431179 DOI: 10.1016/s0140-6736(20)31759-1] [Citation(s) in RCA: 218] [Impact Index Per Article: 54.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Revised: 07/28/2020] [Accepted: 07/29/2020] [Indexed: 12/24/2022]
Affiliation(s)
- Fabian Braun
- Department of Medicine, University Medical Center Hamburg-Eppendorf, Hamburg 20246, Germany
| | - Marc Lütgehetmann
- Institute of Medical Microbiology, Virology and Hygiene, University Medical Center Hamburg-Eppendorf, Hamburg 20246, Germany
| | - Susanne Pfefferle
- Institute of Medical Microbiology, Virology and Hygiene, University Medical Center Hamburg-Eppendorf, Hamburg 20246, Germany
| | - Milagros N Wong
- Department of Medicine, University Medical Center Hamburg-Eppendorf, Hamburg 20246, Germany
| | - Alexander Carsten
- Institute of Medical Microbiology, Virology and Hygiene, University Medical Center Hamburg-Eppendorf, Hamburg 20246, Germany
| | - Maja T Lindenmeyer
- Department of Medicine, University Medical Center Hamburg-Eppendorf, Hamburg 20246, Germany
| | - Dominik Nörz
- Institute of Medical Microbiology, Virology and Hygiene, University Medical Center Hamburg-Eppendorf, Hamburg 20246, Germany
| | - Fabian Heinrich
- Department of Legal Medicine, University Medical Center Hamburg-Eppendorf, Hamburg 20246, Germany
| | - Kira Meißner
- Department of Legal Medicine, University Medical Center Hamburg-Eppendorf, Hamburg 20246, Germany
| | - Dominic Wichmann
- Department of Intensive Care Medicine, University Medical Center Hamburg-Eppendorf, Hamburg 20246, Germany
| | - Stefan Kluge
- Department of Intensive Care Medicine, University Medical Center Hamburg-Eppendorf, Hamburg 20246, Germany
| | - Oliver Gross
- Clinic of Nephrology and Rheumatology, University of Gottingen, Gottingen, Germany
| | - Klaus Pueschel
- Department of Legal Medicine, University Medical Center Hamburg-Eppendorf, Hamburg 20246, Germany
| | - Ann S Schröder
- Department of Legal Medicine, University Medical Center Hamburg-Eppendorf, Hamburg 20246, Germany
| | - Carolin Edler
- Department of Legal Medicine, University Medical Center Hamburg-Eppendorf, Hamburg 20246, Germany
| | - Martin Aepfelbacher
- Institute of Medical Microbiology, Virology and Hygiene, University Medical Center Hamburg-Eppendorf, Hamburg 20246, Germany
| | - Victor G Puelles
- Department of Medicine, University Medical Center Hamburg-Eppendorf, Hamburg 20246, Germany
| | - Tobias B Huber
- Department of Medicine, University Medical Center Hamburg-Eppendorf, Hamburg 20246, Germany.
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Na KR, Kim HR, Ham Y, Choi DE, Lee KW, Moon JY, Kim YS, Cheon S, Sohn KM, Kim J, Kim S, Jeong H, Jeon JW. Acute Kidney Injury and Kidney Damage in COVID-19 Patients. J Korean Med Sci 2020; 35:e257. [PMID: 32686373 PMCID: PMC7371456 DOI: 10.3346/jkms.2020.35.e257] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Accepted: 06/30/2020] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Coronavirus disease 2019 (COVID-19) is caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. This disease, which is quickly spreading worldwide, has high potential for infection and causes rapid progression of lung lesions, resulting in a high mortality rate. This study aimed to investigate the effects of SARS-CoV-2 infection on renal function in patients with COVID-19. METHODS From February 21 to April 24, 2020, 66 patients diagnosed with COVID-19 at Chungnam National University Hospital were analyzed; all patients underwent routine urinalysis and were tested for serum creatinine, urine protein to creatinine ratio (PCR), and urine albumin to creatinine ratio (ACR). RESULTS Acute kidney injury (AKI) occurred in 3 (4.5%) of the 66 patients, and 1 patient with AKI stage 3 underwent hemodialysis. Upon follow-up, all 3 patients recovered normal renal function. Compared with patients with mild COVID-19, AKI (n = 3) occurred in patients with severe COVID-19, of whom both urine PCR and ACR were markedly increased. CONCLUSION The incidence of AKI was not high in COVID-19 patients. The lower mortality rate in SARS-CoV-2 infection compared with previous Middle East respiratory syndrome and SARS-CoV infections is thought to be associated with a low incidence of dysfunction in organs other than the lungs.
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Affiliation(s)
- Ki Ryang Na
- Department of Internal Medicine, Chungnam National University School of Medicine, Daejeon, Korea
- Department of Nephrology, Chungnam National University Hospital, Daejeon, Korea
| | - Hae Ri Kim
- Department of Nephrology, Chungnam National University Sejong Hospital, Sejong, Korea
| | - Youngrok Ham
- Department of Internal Medicine, Chungnam National University School of Medicine, Daejeon, Korea
- Department of Nephrology, Chungnam National University Hospital, Daejeon, Korea
| | - Dae Eun Choi
- Department of Internal Medicine, Chungnam National University School of Medicine, Daejeon, Korea
- Department of Nephrology, Chungnam National University Hospital, Daejeon, Korea
| | - Kang Wook Lee
- Department of Internal Medicine, Chungnam National University School of Medicine, Daejeon, Korea
- Department of Nephrology, Chungnam National University Hospital, Daejeon, Korea
| | - Jae Young Moon
- Department of Internal Medicine, Chungnam National University School of Medicine, Daejeon, Korea
- Department of Pulmonary and Critical Care Medicine, Chungnam National University Sejong Hospital, Sejong, Korea
| | - Yeon Sook Kim
- Department of Internal Medicine, Chungnam National University School of Medicine, Daejeon, Korea
- Department of Infectious Disease, Chungnam National University Hospital, Daejeon, Korea
| | - Shinhye Cheon
- Department of Internal Medicine, Chungnam National University School of Medicine, Daejeon, Korea
- Department of Infectious Disease, Chungnam National University Hospital, Daejeon, Korea
| | - Kyung Mok Sohn
- Department of Internal Medicine, Chungnam National University School of Medicine, Daejeon, Korea
- Department of Infectious Disease, Chungnam National University Hospital, Daejeon, Korea
| | - Jungok Kim
- Department of Internal Medicine, Chungnam National University School of Medicine, Daejeon, Korea
- Department of Infectious Disease, Chungnam National University Sejong Hospital, Sejong, Korea
| | - Sungmin Kim
- Department of Internal Medicine, Chungnam National University School of Medicine, Daejeon, Korea
- Department of Infectious Disease, Chungnam National University Sejong Hospital, Sejong, Korea
| | - Hyeongseok Jeong
- Department of Infectious Disease, Chungnam National University Hospital, Daejeon, Korea
| | - Jae Wan Jeon
- Department of Internal Medicine, Chungnam National University School of Medicine, Daejeon, Korea
- Department of Nephrology, Chungnam National University Sejong Hospital, Sejong, Korea.
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50
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Smolander J, Bruchfeld A. [COVID-19 and kidney disease]. Lakartidningen 2020; 117:20110. [PMID: 32658300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Acute kidney injury (AKI), albuminuria and hematuria are common in Covid-19 and have been shown to increase mortality. Assessment with a urinary dipstick and creatinine at admission should be completed with a urinary sediment and quantification of albuminuria if positive. SARS-Cov-2 seems to enter and infect the endothelium and kidney cells, and contributes to damage in addition to hypercoagulability, multi organ failure and hyperinflammation. Underhydration and rhabdomyolysis can contribute to acute tubular necrosis. Anti-inflammatory treatment may be considered and discussed with a nephrologist. Treatment with ACEi/ARBs should be continued if possible.
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Affiliation(s)
| | - Annette Bruchfeld
- professor, överläkare, Linköpings universitet; njurmedicin, Universitetssjukhuset i Linköping; Karolinska universitetssjukhuset, Stockholm
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