COVID-19 Extrapulmonary illness - The Impact of COVID-19 on Nephrology care

Patel, Dhwanil; Truong, Tiffany; Shah, Nikhil; Colbert, Gates B.; Thomas, Beje; Lerma, Edgar V.; Hiremath, Swapnil

doi:10.1016/j.disamonth.2020.101057

Cited by 5 publications

(4 citation statements)

References 43 publications

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“…In our study we retrospectively evaluated BMI in 381 of a total of 946 patients which more than 45% of our patients were categorized as overweight this may be either due to demographic features of admitted patients or due to more susceptibility to COVID-19 in this group of people but it has been shown that overweight patients have 1.84-fold odds of developing severe COVID-19 compared with normal-weight patients (22). Among different studies various incidence rates of AKI are reported through the globe and in our study group the incidence of AKI was estimated as 45.9%, this was consistent with the global trend toward the increased rate of AKI in COVID-19 patients compared with early reports (23,24). We demonstrated that those with AKI, compared to the non-AKI group, had a significantly higher mean of age (62 versus 50.2 years, P < 0.001), and a higher proportion of females (34.9% versus 44.9%, P = 0.002); the first one is commonly due to impaired immune system in older patients and probably due to increased baseline inflammation with aging which also may be a contributing factor resulting in AKI (25).…”

Section: Discussionsupporting

confidence: 90%

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

et al. 2021

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

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Section: Discussionsupporting

confidence: 90%

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

et al. 2021

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“…17,18 In high income countries, delays are reported in accessing urgent treatment for myocardial ischaemia 19–24 and stroke care, 25–29 and there are impacts predicted for other vulnerable groups. 30–33…”

Section: Discussionmentioning

confidence: 99%

“…17,18 In high income countries, delays are reported in accessing urgent treatment for myocardial ischaemia [19][20][21][22][23][24] and stroke care, [25][26][27][28][29] and there are impacts predicted for other vulnerable groups. [30][31][32][33] Recent data detailed a 220% increase in residential aged care deaths during the pandemic in England and Wales, with 14,520 'additional' deaths, 3 (i.e. neither expected nor caused by COVID-19 infection).…”

Section: What This Study Adds?mentioning

confidence: 99%

Increased number of deaths within 24 h of admission during a period of social restriction related to the COVID-19 pandemic: A retrospective service evaluation in a metropolitan palliative care unit

et al. 2021

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Background: COVID-19 has led to implementation of wide-ranging social restriction measures with consequent impact on health care utilisation in many domains. There is little published data on the experience of palliative care services catering to a population with low case numbers of COVID-19. Aim: This study aimed to consider the impact of COVID-19 on utilisation of inpatient palliative care in the context of low community transmission, and low numbers of cases in hospital. Design: A retrospective service evaluation examining differences in number of admissions, diagnoses, number of deaths and time from admission to death, across three discrete 8-week time periods spanning the early COVID-19 pandemic. Setting/participants: All admissions ( n = 194) to a metropolitan tertiary hospital inpatient palliative care unit in Melbourne during the study period. Results: An initial 16.9% fall in admissions was followed by a return to baseline admission numbers, with a 46.7% increase in number of deaths compared to baseline. The number of deaths within 24 h rose from 10.8% to 37.3% ( p < 0.01). The number of patients with non-malignant diagnoses increased from 32.4% to 52%, and those with non-malignant diagnoses were more likely to die rapidly ( p < 0.01). There were no patients with COVID-19 infection. Conclusion: Increased numbers of deaths within 24 h of admission occurred on the palliative care unit despite low COVID-19 case numbers in the wider community, and in the setting of widespread social restriction measures. More research is needed examining the health-related consequences of such restrictions for individuals not infected with COVID-19.

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“…Evaluating urinary biomarkers such as B2M may help to identify COVID-19 patients with active CRS who are likely to become critically ill [17]. Acute kidney injury is largely associated with hemodynamic instability [25]. B2M is freely filtered by the glomerulus and completely reabsorbed by proximal tubular cells.…”

Section: Discussionmentioning

confidence: 99%

Successful Treatment of a COVID-19 Case with Pneumonia and Renal Injury Using Tocilizumab

Ashino

Chagan-Yasutan

Hatta

et al. 2020

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A 49-year-old male Japanese patient was admitted to our hospital under the diagnosis of COVID-19 pneumonia. For 5 days before admission, he had experienced various symptoms, including high fever, watery diarrhea, dyspnea, and cough, and he tested positive for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) nucleic acid. The patient is a smoker who was on medication for hypertension. A chest computed tomography scan showed bilateral multiple patchy ground-glass opacities. Despite being treated with several therapeutic agents, he still exhibited dyspnea (oxygen saturation [SpO2] in ambient air: 88%), a high fever (axillary temperature: 39 °C), and high blood pressure (148/98 mmHg). Because laboratory data revealed high levels of C-reactive protein (CRP; 2.10 mg/dL) and urinary β2-microglobulin (B2M; 33,683 µg/mL), the anti-interleukin-6 receptor antibody tocilizumab (TCZ; 400 mg) was administered intravenously. One day after injection, he was afebrile. Four days after the TCZ injection, his CRP level dropped to 0.27 mg/dL, B2M level decreased to 3817 µg/mL, and viral load became low. No adverse drug reaction due to TCZ was observed. The patient was discharged 15 days after admission. The early administration of TCZ in this patient prevented the pneumonia and kidney injury caused by COVID-19 from progressing to hyperinflammation syndrome.

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COVID-19 Extrapulmonary illness - The Impact of COVID-19 on Nephrology care

Cited by 5 publications

References 43 publications

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

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

Increased number of deaths within 24 h of admission during a period of social restriction related to the COVID-19 pandemic: A retrospective service evaluation in a metropolitan palliative care unit

Successful Treatment of a COVID-19 Case with Pneumonia and Renal Injury Using Tocilizumab

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