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Background and objectivesAKI in coronavirus disease 2019 (COVID-19) is associated with higher morbidity and mortality. The objective of this study was to identify the kidney histopathologic characteristics of deceased patients with diagnosis of COVID-19 and evaluate the association between biopsy findings and clinical variables, including AKI severity.Design, setting, participants, & measurementsOur multicenter, observational study of deceased patients with COVID-19 in three third-level centers in Mexico City evaluated postmortem kidney biopsy by light and electron microscopy analysis in all cases. Descriptive and association statistics were performed between the clinical and histologic variables.ResultsA total of 85 patients were included. Median age was 57 (49–66) years, 69% were men, body mass index was 29 (26–35) kg/m2, 51% had history of diabetes, 46% had history of hypertension, 98% received anticoagulation, 66% were on steroids, and 35% received at least one potential nephrotoxic medication. Severe AKI was present in 54% of patients. Biopsy findings included FSGS in 29%, diabetic nephropathy in 27%, and arteriosclerosis in 81%. Acute tubular injury grades 2–3 were observed in 49%. Histopathologic characteristics were not associated with severe AKI; however, pigment casts on the biopsy were associated with significantly lower probability of kidney function recovery (odds ratio, 0.07; 95% confidence interval, 0.01 to 0.77). The use of aminoglycosides/colistin, levels of C-reactive protein and serum albumin, previous use of angiotensin-converting enzyme inhibitors or angiotensin II receptor blockers, antivirals, nonsteroid anti-inflammatory drugs, and anticoagulants were associated with specific histopathologic findings.ConclusionsA high prevalence of chronic comorbidities was found on kidney biopsies. Nonrecovery from severe AKI was associated with the presence of pigmented casts. Inflammatory markers and medications were associated with specific histopathologic findings in patients dying from COVID-19.

Background/Aims: We evaluated the potential preventive effect of Nephrology On-Site (i.e. nephrologists integrated into the postoperative cardiac intensive care unit, ICU, team) versus Nephrology On-Demand (i.e. nephrology consultation depending on intensivist criteria) in the ICU on in-hospital outcomes. Methods: This was a retrospective cohort study comparing outcomes during 2 consecutive time periods: from March 1, 2009 to February 28, 2010 with Nephrology On-Demand, and from March 1, 2010 to February 28, 2011 with Nephrology On-Site. Adult patients admitted to the postoperative cardiac ICU in an academic hospital in Mexico City were eligible. Patients with chronic kidney disease stage 5 or minimally invasive procedures were excluded. Results: We analyzed 1,096 patients, 558 and 538 in the respective periods. The patients were 52.4 ± 16.2 years old, 56.1% were males, 17.2% had diabetes and 37.6% had hypertension. Further, the patients' median Euroscore was 5 (3-5) and their median Thakar score was 3 (2-4). With Nephrology On-Site, we observed a lower incidence of acute kidney injury [AKI; 25.7 vs. 31.9%, p = 0.02; adjusted OR 0.71 (0.53-0.95), p = 0.02], lower in-hospital mortality among patients with severe AKI [34.1 vs. 55.9%, p = 0.06; adjusted OR 0.33 (0.12-0.95), p = 0.04] and higher renal recovery [61.0 vs. 35.3%, p = 0.03; adjusted OR 3.57 (1.27-10.11), p = 0.02]. No differences were found in the length of stay at the ICU and mechanical ventilation. Conclusion: Integrating nephrologists into the postoperative cardiac ICU team was associated with a lower incidence of AKI. Patients who developed severe AKI had lower in-hospital mortality and higher renal recovery.