Renal involvement is frequent in COVID-19 (4–37%). This study evaluated the incidence and risk factors of acute kidney injury (AKI) in hospitalized patients with COVID-19.Methodology: This study represents a prospective cohort in a public and tertiary university hospital in São Paulo, Brazil, during the first 90 days of the COVID-19 pandemic, with patients followed up until the clinical outcome (discharge or death).Results: There were 101 patients hospitalized with COVID-19, of which 51.9% were admitted to the intensive care unit (ICU). The overall AKI incidence was 50%; 36.8% had hematuria or proteinuria (66.6% of those with AKI), 10.2% had rhabdomyolysis, and mortality was 36.6%. Of the ICU patients, AKI occurred in 77.3% and the mortality was 65.4%. The mean time for the AKI diagnosis was 6 ± 2 days, and Kidney Disease Improving Global Outcomes (KDIGO) stage 3 AKI was the most frequent (58.9%). Acute renal replacement therapy was indicated in 61.5% of patients. The factors associated with AKI were obesity [odds ratio (OR) 1.98, 95% confidence interval (CI) 1.04–2.76, p < 0.05] and the APACHE II score (OR 1.97, 95% CI 1.08–2.64, p < 0.05). Mortality was higher in the elderly (OR 1.03, 95% CI 1.01–1.66, p < 0.05), in those with the highest APACHE II score (OR 1.08, 95% CI 1.02–1.98, p < 0.05), and in the presence of KDIGO stage 3 AKI (OR 1.11, 95% CI 1.05–2.57, p < 0.05).Conclusion: AKI associated with severe COVID-19 in this Brazilian cohort was more frequent than Chinese, European, and North American data, and the risk factors associated with its development were obesity and higher APACHE II scores. Mortality was high, mainly in elderly patients, in those with a more severe disease manifestation, and in those who developed KDIGO stage 3 AKI.

RESUMOEste trabalho teve como objetivo quantificar os danos causados pela ferrugem-asiática em três cultivares de soja, semeadas em diferentes épocas, na região Oeste da Bahia. Os experimentos foram instalados no município de São Desidério, BA, nas safras 2007/2008 e 2008/2009. O delineamento experimental foi em blocos casualizados com quatro repetições, no esquema de parcelas subdivididas no espaço. A parcela foi representada pelos tratamentos de controle da ferrugem (com ou sem aplicação de fungicida) e as subparcelas foram representadas pelas cultivares (Monsoy 8411, BRS Corisco e BRS Barreiras). Avaliou-se a severidade da ferrugem para o cálculo da área abaixo da curva de progresso da doença padronizada (AACPDp), o número de folhas ao longo do ciclo e a produtividade de grãos. O modelo logístico foi o que melhor se ajustou aos dados da severidade. A variação temporal do número de folhas foi ajustada pela função polinomial exponencial Ln (y) = a + bx 1,5 + cx 0,5 . As médias da AACPDp e a da produtividade foram comparadas pelo teste de Tukey a 5% de probabilidade. Os danos causados pela ferrugem-asiática da soja na região foram potencializados na época de semeadura tardia, ocorrendo desfolha antecipada e redução na produtividade de grãos. Palavras-chave: Glycine max, Phakopsora pachyrhizi, produtividade. ABSTRACT Yield loss caused by rust in soybean cultivars sown in different periods in the western region of Bahia, BrazilThe objective of this work was to quantify the yield loss caused by Asian soybean rust in three cultivars sown in different periods in the western region of Bahia. The experiments were installed in São Desidério, BA, in the growing seasons 2007/2008 and 2008/2009. The experimental design was carried out in random blocks with four replicates and subdivided plot scheme in time. The plot was represented by the rust control treatments (with and without chemical control) and the subplots represented by cultivars (Monsoy 8411, BRS Corisco and BRS Barreiras). The severity, number of leaves throughout the cycle and yield were evaluated. The logistic model was the one that better fitted the severity data whereas the polynominal exponential function Ln (y) = a + bx 1, 5 + cx 0,5 fitted the temporal variation of number of leaves better. The means of the area under the disease progress curve and yield were compared by Tukey test. Yield loss increased during later sowing periods due to greater inoculum pressure hindering disease control and decreasing grain yield.

IntroductionElderly patients with COVID-19 are at a higher risk of severity and death as not only several comorbidities but also aging itself has been considered a relevant risk factor. Acute kidney injury (AKI), one of the worst complications of SARS-CoV-2 infection, is associated with worse outcomes. Studies on AKI with COVID-19 in Latin-American patients of older age remain scarce.ObjectivesTo determine AKI incidence and the risk factors associated with its development, as well as to compare outcome of elderly patients with or without AKI associated with SARS-CoV-2 infectionMethodsThis retrospective cohort study evaluated patients with SARS-CoV2 infection admitted to a Public Tertiary Referral Hospital from 03/01/2020 to 12/31/2020, from admission to resolution (hospital discharge or death). Demographic, clinical, and laboratory data were collected from patients during hospitalization. Daily kidney function assessment was performed by measuring serum creatinine and urine output. AKI was diagnosed according to KDIGO 2012 criteria.ResultsOf the 347 patients with COVID-19 admitted to our hospital during the study period, 52.16% were elderly, with a median age of 72 years (65- 80 years). In this age group, most patients were males (56.91%), hypertensive (73.48%), and required ICU care (55.25%). AKI overall incidence in the elderly was 56.9%, with higher frequency in ICU patients (p < 0.001). There was a predominance of KDIGO 3 (50.48%), and acute kidney replacement therapy (AKRT) was required by 47.57% of the patients. The risk factors associated with AKI development were higher baseline creatinine level (OR 10.54, CI 1.22 -90.61, p = 0.032) and need for mechanical ventilation (OR 9.26, CI 1.08-79.26, p = 0.042). Mortality was also more frequent among patients with AKI (46.41%vs24.7%, p < 0.0001), with death being associated with CPK level (OR 1.009, CI 1.001-1.017, p = 0.042), need for mechanical ventilation (OR 17.71, CI 1.13-277.62, p = 0.002) and KDIGO 3 (OR 2.017 CI 1.039 -3.917, p = 0.038).ConclusionAKI was frequent among the elderly hospitalized with COVID-19 and its risk factors were higher baseline creatinine and need for mechanical ventilation. AKI was independently associated with a higher risk of death.

No abstract

Cytokine storm syndrome (CSS) has been documented in coronavirus disease 2019 (COVID-19) since the first reports of this disease. In the absence of vaccines or direct therapy for COVID-19, extracorporeal blood treatment (EBT) could represent an option for the removal of cytokines and may be beneficial to improve the clinical outcome of critically ill patients. Intermittent haemodialysis (IHD), using high flux (HF) or high cut-off membranes, and continuous renal replacement therapy (CRRT) could be used for blood purification in COVID-19 patients with CSS. To the best of our knowledge, cytokine kinetics during and after different types of EBT on COVID-19 patients have never been studied. In this study, we describe cytokine variation and removal during and after IHD and CRRT in COVID-19 patients with acute kidney injury (AKI). Methods: Patients with COVID-19-related AKI according to Kidney Disease Improving Global Outcomes (KDIGO) criteria and admitted at Intensive Care Unit (ICU) were studied. Blood samples were collected at the start and end of both IHD using HF membranes (10 patients) and continuous venovenous haemodiafiltration (CVVHDF: 10 patients) in two sessions for measuring 13 different plasma interleukins and calculating the cytokine removal rate. Results: We evaluated cytokine removal in patients with COVID-19-related AKI undergoing either prolonged IHD (10 patients) or CRRT (CVVHDF: 10 patients). There was no difference between the IHD and CVVHDF groups regarding mechanical ventilation, vasoactive drug use, age or prognostic scores. Patients treated by CRRT presented higher levels of IL-2 and IL-8 than patients treated by prolonged IHD at the start of dialysis. Cytokine removal ranged from 9–78%. Patients treated by CRRT presented higher cytokine removal rates than those treated by prolonged IHD for IL-2, IL-6 IL-8, IP-10 and TNF. The removal rates of IL-4, IL-10, IL-1β, IL-17A, IFN, MCP-1 and free active TGF-B1 were similar in the two groups. After one session of CVVHDF (24 h) the IL-2 and IL-1β levels did not vary significantly, whereas IL-4, IL-6, IL-8, IL-10, IL-17A, TNF, IFN, IP-10, MCP-1, IL-12p70 and free active TGF-B1 decreased by 33.8–76%, and this decrease was maintained over the next 24 h. In the prolonged IHD groups, IL-2, IL-6, TNF, IP-10 and IL-1β levels did not decrease significantly whereas IL-4, IL-8, IL-10, IL-17A, IFN, MCP-1, IL-12p70 and free active TGF-B1 decreased by 21.8–72%. However, all cytokine levels returned to their initial values after 24 h, despite their removal. Conclusions: Cytokine removal is lower using prolonged IHD with HF membranes than by using CVVHDF, and IHD allows a transient and selective decrease in cytokines that can be correlated with mortality during CSS-related COVID-19.