Acute Renal Damage Research Articles

The study of clinical profile of acute kidney injury in COVID-19 patients

Aim:All prior studies have demonstrated that acute renal damage in People who have the coronavirus disease of2019 (COVID-19) are often diagnosed and have a dismal prognosis. Acute renal injury in COVID-19 patients hasnot been well reported in developing countries like India. Examining the clinical traits, biochemistry, and prognosisof acute kidney injury (AKI) in COVID-19 patients is the aim of this article. Methods:The Department of Nephrology at the Sri Aurobindo Medical College and Graduate Institute (M.P.) inIndore, India, conducted this study from April 1, 2020, to January 31, 2021. We examined 130 COVID-19 casesof AKI recorded by SAMC and PGI in Indore. Included 18 year-old and older COVID-19 patients verified by real-time reverse polymerase chain reaction (RT-PCR). The term “sepsis” was employed in its conventional sense. TheKidney Disease Improving Global Outcomes (KDIGO) guidelines of AKI were adhered to. Patients under the age of18 undergoing renal replacement therapy for CKD in stages I to IV and ESRD were not eligible. Results:A total of 12,438 COVID patients were admitted to our hospital during this period. The incidence ofAKI was 1.04% (130). The mean age was 51.2 years. The male-to-female ratio was 1.4:1 (76:54). Commonestsymptoms were fever in 71.5% (93) of patients, headache in 62% (81) of patients, and cough in 51.5% (67) ofpatients, followed by breathlessness in 37.5% (49) patients. The typical creatinine values at the time of admissionwere 3.57 mg/dl. AKI stage 1 was seen in 30% (39) cases, stage 2 in 45.5% (59) cases, and stage 3 in 24.5%(32) cases. The most common etiology was sepsis in 65% (84) and drugs in 14% (18). T2DM was the mostcommon comorbidity in 42% (55) of patients, HTN in 41.5% (54) of patients, Coronary Artery Disease (CAD) in9.2% (12) of patients, and malignancy in 5% (7) of patients. Oxygen by nasal mask/nasal prongs was requiredin 59% (77) of patients, BIPAP in 16% (21) of patients, and ventilatory support in 12.5% (16) of patients. Theaverage hospitalization was 12.3 days. Dialysis was required in 16% (21) of patients. Notably, 87% (113) of patientsrecovered completely, and 13% (17) of patients expired. The majority of patients had elevated inflammatorymarkers. Erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) were elevated in 81% (105) of patients,and ferritin was raised in 71% (92) of patients. Conclusion:Hospitalized COVID-19 patients commonly get AKI, which is associated with a poor prognosis andhigh mortality. In COVID-19 patients, increased inflammatory markers, type 2 diabetes, sepsis, older age, and malesex were the main risk factors for developing acute renal injury.

The Study of Clinical Profile of Acute Kidney Injury in COVID-19 Patients

All prior studies have demonstrated that acute renal damage in People who have the coronavirus disease of 2019(COVID-19)areoftendiagnosedandhaveadismalprognosis.AcuterenalinjuryinCOVID-19patientshasnot been well reported in developing countries like India. Examining the clinical traits, biochemistry, and prognosis of acute kidney injury (AKI) in COVID-19 patients is the aim of this article. Methods: The Department of Nephrology at the Sri Aurobindo Medical College and Graduate Institute (M.P.) in Indore, India, conducted this study from April 1, 2020, to January 31, 2021. We examined 130 COVID-19 cases of AKI recorded by SAMC & PGI in Indore. Included 18-year-old and older COVID-19 patients verified by real-time reversepolymerasechainreaction(RT-PCR).Theterm“sepsis”wasemployedinitsconventionalsense.TheKidney Disease Improving Global Outcomes (KDIGO) guidelines of AKI were adhered to. Patients under the age of 18 undergoing renal replacement therapy for CKD in stages I to IV and ESRD were not eligible. Results: A total of 12,438 COVID patients were admitted to our hospital during this period. The incidence of AKI was 1.04% (130). The mean age was 51.2 years. The male-to-female ratio was 1.4:1 (76:54). Commonest symptoms were fever in 71.5% (93) of patients, headache in 62% (81) of patients, and cough in 51.5% (67) of patients, followed bybreathlessnessin37.5%(49)patients.Thetypicalcreatininevaluesatthetimeofadmissionwerewere3.57mg/dl. AKIstage1wasseenin30%(39)cases,stage2in45.5%(59)cases,andstage3in24.5%(32)cases.Themostcommon aetiology was sepsis in 65% (84) and drugs in 14% (18). T2DM was the most common comorbidity in 42% (55) of patients, HTN in 41.5% (54) of patients, Coronary Artery Disease (CAD) in 9.2% (12) of patients, and malignancy in 5% (7) of patients. Oxygen by nasal mask/nasal prongs was required in 59% (77) of patients, BIPAP in 16% (21) of patients, and ventilatory support in 12.5% (16) of patients. The average hospitalization was 12.3 days. Dialysis was required in 16% (21) of patients. Notably, 87% (113) of patients recovered completely, and 13% (17) of patients expired. The majority of patients had elevated inflammatory markers. Erythrocyte sedimentation rate (ESR) and Creactive protein (CRP) were elevated in 81% (105) of patients, and ferritin was raised in 71% (92) of patients. Conclusion: Hospitalized COVID-19 patients commonly get AKI, which is associated with a poor prognosis and high mortality. In COVID-19 patients, increased inflammatory markers, type 2 diabetes, sepsis, older age, and male sex were the main risk factors for developing acute renal injury.

CONTRAST INDUCED ACUTE KIDNEY INJURY IS NOT A SITUATION TO BE AFRAID OF.

Acute kidney injury (AKI), formerly called acute renal failure (ARF), is clinically manifested as a reversible acute increase in nitrogen waste products, as measured by blood urea nitrogen (BUN) and serum creatinine levels. Contrast induced acute kidney injury (CIAKI) is a potentially fatal complication of angiographic procedures caused by the use of contrast media (CM). It is the third most prevalent cause of hospital acquired acute renal damage, accounting for around up to 30% of cases. Contrast induced nephropathy (CIN) is defined as a greater than 25% or 0.5 mg/dl (44 μmol/l) increase in serum creatinine (Scr) from baseline within 3 days. More sensitive indicators of renal damage are sought, hence numerous tubular injury biomarkers are being studied. Multiple risk factors may lead to the development of CIN; these risk factors are classified as patient-related and procedure-related. Treatment of CIN Is primarily symptomatic and consist firstly of careful fluid and electrolyte management, although dialysis may be necessary in some cases. With available treatment options, prevention is the cornerstone of management.

Hyperchloremia in Critically Ill Patients in ICU: Review Article

Chloride (Cl) is required for the regulation of blood pressure, renal function, gastrointestinal homeostasis and decarboxylation/gas transport. "Dyschloremia" or levels of serum Cl beyond the normal range, is a frequent occurrence in intensive care units and seems to be mostly caused by iatrogenic procedures (i.e. intravenous infusion of fluids rich in Cl). Hypochloremia and hyperchloremia seem to be related to high risk of death in specified intensive care unit (ICU) groups, although the data is inconclusive. Hyperchloremia may be associated with higher hemodynamic unstable changes and need for vasopressors, in addition to hyperchloremic metabolic acidosis (e.g., following major surgeries). Nonetheless, the direct or indirect mediation of these effects is still uncertain. Additionally, new research suggests that individuals with advanced hyperchloremia have a higher risk of acute renal damage and require renal replacement treatment. Objective: The purpose of this study was to describe significant chloride-related outcomes in critical illness and to evaluate their relevance for everyday clinical practice and therapeutic alternatives.

Clinical Profile of Scrub Typhus among Paediatric Age Group in a Tertiary Care Center

Introduction: Scrub typhus, a dreaded disease in the pre-antibiotic era, was a serious military disease that killed thousands of people in the Far East during WWII. It is a zoonosis that is common throughout Asia and the Pacific Islands. Scrub typhus is a febrile illness characterized by a wide range of symptoms and indications. This disease has a wide spectrum of clinical symptoms, from subclinical through organ failure to death. The objective of this study was to assess the clinical profile of scrub typhus infection among children in a tertiary care hospital in south India.
 Methodology: This is a retrospective study of the clinical profile of 50 paedriatric children, who were admitted in the Paediatric ward of a tertiary care hospital, during the study period of JAN 2020 to DEC 2020.
 Results: All children presented with fever. Other common symptoms were vomiting (56%), facial swelling (52%), cough (35%), abdominal pain (33%), breathlessness (29%) and decreased urine output (29%). High grade fever (>101 oF) was recorded in 91% of children. Other common signs were hepatomegaly, splenomegaly, edema, tender lymphadenopathy and hypotension, observed in 82%, 59%, 39%, 38% and 36% of cases, respectively. An eschar and a maculopapular rash each were observed in 20% of patients. Within 48 hours of starting an appropriate antibiotic, 90% of the children became afebrile. Overall, there was a 7.5 percent mortality rate. Refractory shock, meningoencephalitis, acute respiratory distress syndrome, bronchopneumonia, acute renal damage, and myocarditis were among the causes of mortality.
 Conclusion: In any febrile child with a maculopapular rash, hepatosplenomegaly, tender lymphadenopathy, thrombocytopenia, or symptoms indicative of capillary leak, paediatricians should have a high index of suspicion for scrub typhus. Pending serological confirmation, empirical therapy with doxycycline or azithromycin should be initiated immediately, since any delay in treatment could lead to life-threatening consequences.

Olanzapine Induced Rhabdomyolysis in A Schizophrenic Adult: Case Report

Rhabdomyolysis is a syndrome characterized by acute necrosis of skeletal muscle and subsequent release of its cellular contents into the circulation. It can occur due to trauma, exercise, infections and some metabolic diseases, as well as secondary to the use of various drugs. A 34-year-old male patient with a diagnosis of schizophrenia for 2 months was brought to our emergency department by his relatives because of the intake of 350 mg of olanzapine for suicide. The patient whose extrapyramidal system findings were present and whose creatine kinase (CK) was found to be 42670 U / L in laboratory tests was hospitalized to our service because of the secondary rhabdomyolysis for the use of olanzapine. During the hospitalization period, only the medical treatment returned normalcy to the CK level, and the kidney and liver dysfunction did not develop, and the patient was discharged by psychiatric outpatient clinic control. Rhabdomyolysis is a rare and potentially serious adverse drug reaction to antipsychotic drugs. The patients should be evaluated for side effects and in terms of rhabdomyolysis facilitating factors. Especially in high doses, patients should be monitored for rhabdomyolysis, which is a serious complication, such as acute renal damage.

Associations of Carbonaceous Compounds and Water-Soluble Inorganic Ions in Ambient PM2.5 with Renal Function in Older Individuals: The China BAPE Study.

Exposure to fine particulate matter (PM2.5) is proven to be associated with a decline in renal function. However, few studies have explored the acute renal damage from carbonaceous compounds and water-soluble inorganic ions (WSIIs), which constitute the bulk of total PM2.5 mass. We examined the acute effect of these constituents of ambient PM2.5 on renal function in older Chinese individuals. Seventy-one healthy people aged 60-69 years from Jinan, China, were enrolled and visited monthly and asked to complete survey questionnaires, undergo physical exams, and provide blood samples. The hourly concentrations of organic carbon, elemental carbon (EC), and WSIIs in ambient PM2.5 were collected from a fixed-site monitoring station. The association between PM2.5 constituents and estimated glomerular filtration rate (eGFR) was evaluated using linear mixed-effects models after controlling for a series of covariates. We observed that ambient carbonaceous compounds and WSIIs were associated with a significant decline in renal function. The interquartile range increased in the 24 h moving average of carbonaceous compounds, and WSIIs in ambient PM2.5 were associated with -13.11% [95% confidence interval (95% CI): -19.49, -6.21%] to -0.81% (95% CI: -4.17, 2.67%) changes in eGFR. We found significant associations between EC, chlorine (Cl-), sodium (Na+), and magnesium (Mg2+) and eGFR in single-pollutant, constituent-PM2.5, and residual-constituent models with a lag period of 0-24 h. This study demonstrated that carbonaceous compounds and WSIIs in PM2.5 were inversely associated with renal function.

Research progress of renal resistive index in the evaluation of acute kidney injury

Acute kidney injury (AKI) is common in critically ill patients and it is directly related to the patient's prognosis and survival. Despite remaining uncertainties regarding the prevalence of AKI in intensive care unit (ICU), the overall incidence of AKI is relatively high, and prompt recognition is necessary to ensure the risk assessment, early diagnosis, clinical outcome, and treatment of critically ill patients. Doppler-based renal resistive index (RRI) mainly reflects vascular bed resistance state, which can be indirect to the extent of the damage of renal parenchyma. It is a relatively objective and quantitative evaluation, and is widely used in clinical prognosis of acute or chronic renal damage evaluation and judgment. This paper reviews the definition of RRI, the measurement methods of RRI, the application and progress of RRI in the field of AKI, the advantages and disadvantages of ultrasonic measurement of RRI, the long-term application of RRI, the effectiveness of RRI in predicting AKI, and the progress in clinical application.

The role of retinoids in acute renal damage associated with acetic acid induced ulcerative colitis in adult male rats: Histological and biochemical study

The role of retinoids in acute renal damage associated with acetic acid induced ulcerative colitis in adult male rats: Histological and biochemical study

The Impact of Intravenous Iron on Renal Injury and Function Markers in Patients With Chronic Kidney Disease and Iron Deficiency Without Anemia

The Impact of Intravenous Iron on Renal Injury and Function Markers in Patients With Chronic Kidney Disease and Iron Deficiency Without Anemia

A knock-in rat model unravels acute and chronic renal toxicity in glutaric aciduria type I

Glutaric aciduria type I (GA-I, OMIM # 231670) is an autosomal recessive inborn error of metabolism caused by deficiency of the mitochondrial enzyme glutaryl-CoA dehydrogenase (GCDH). The principal clinical manifestation in GA-I patients is striatal injury most often triggered by catabolic stress. Early diagnosis by newborn screening programs improved survival and reduced striatal damage in GA-I patients. However, the clinical phenotype is still evolving in the aging patient population. Evaluation of long-term outcome in GA-I patients recently identified glomerular filtration rate (GFR) decline with increasing age.We recently created the first knock-in rat model for GA-I harboring the mutation p.R411W (c.1231 C>T), corresponding to the most frequent GCDH human mutation p.R402W. In this study, we evaluated the effect of an acute metabolic stress in form of high lysine diet (HLD) on young Gcdhki/ki rats. We further studied the chronic effect of GCDH deficiency on kidney function in a longitudinal study on a cohort of Gcdhki/ki rats by repetitive 68Ga-EDTA positron emission tomography (PET) renography, biochemical and histological analyses.In young Gcdhki/ki rats exposed to HLD, we observed a GFR decline and biochemical signs of a tubulopathy. Histological analyses revealed lipophilic vacuoles, thinning of apical brush border membranes and increased numbers of mitochondria in proximal tubular (PT) cells. HLD also altered OXPHOS activities and proteome in kidneys of Gcdhki/ki rats.In the longitudinal cohort, we showed a progressive GFR decline in Gcdhki/ki rats starting at young adult age and a decline of renal clearance. Histopathological analyses in aged Gcdhki/ki rats revealed tubular dilatation, protein accumulation in PT cells and mononuclear infiltrations.These observations confirm that GA-I leads to acute and chronic renal damage. This raises questions on indication for follow-up on kidney function in GA-I patients and possible therapeutic interventions to avoid renal damage.

Effect of Quercetin on Injury to Indomethacin-Treated Human Embryonic Kidney 293 Cells

Nonsteroidal anti-inflammatory drugs (NSAIDs) are used to treat inflammation and pain and even to prevent the progression of cardiovascular disease. They have become widely used because of their effectiveness, especially among athletes performing high-intensity training. Indomethacin is used for pain management in sports medicine and is highly effective and versatile. However, several clinical studies have reported that indomethacin induces acute renal damage. In the present study, we determined that indomethacin reduced human embryonic kidney 293 (HEK293) cell viability in a concentration-dependent manner by triggering apoptosis. In addition, we demonstrated the effect of quercetin on indomethacin-treated HEK293 cells by inactivating the caspase-3 and caspase-9 signals. Furthermore, quercetin reduced ROS production and increased mitochondrial membrane potential (ΔΨm) in indomethacin-treated HEK293 cells. Our results indicate that quercetin can interrupt the activated caspase and mitochondrial pathway induced by indomethacin in HEK293 cells and affect apoptotic mRNA expression. Quercetin can protect against indomethacin-induced HEK293 cell apoptosis by regulating abnormal ΔΨm and apoptotic mRNA expression.

KIDNEY DAMAGE IN CHILDREN WITH COVID-19 (CLINICAL CASE)

Currently, in the study of the SARS-COV-2 (COVID-19) viral infection, the issues of the course and outcome of the disease are becoming increasingly important. Thanks to the implementation of the COVID-19 Diagnostic and Treatment Protocols, it was possible to establish control over the timely diagnosis and optimization of the unfavorable outcome of a new viral infection.The lower prevalence and severity of the disease in children may be associated with both a lower susceptibility to COVID-19 infection and a lower likelihood of symptoms. The role of neutropenia characteristic of childhood cannot be ruled out.However, recent studies indicate an increase in the incidence of COVID-19 among children. Attention is drawn to kidney damage in this syndrome, where the development of acute renal damage with the subsequent development of multiple organ syndrome can affect the outcome of COVID-19.

Обоснование мероприятий интенсивной терапии и экстракорпоральной детоксикации при комбинированных отравлениях метадоном

Актуальность. Острые отравления метадоном в сочетании с другими психоактивными веществами, в частности этанолом, нередко осложняются синдромом компрессии мягких тканей и острым повреждением почек, что требует использования методов экстракорпоральной детоксикации. Цель исследования — изучение эффективности раннего применения гемодиализа с ультрафильтрацией, мембранного плазмафереза и озонирования крови в комплексной терапии острых отравлений метадоном тяжелой степени. Материалы и методы. Проведен анализ результатов лечения 186 пациентов с отравлением метадоном в возрасте от 21 до 43 лет обоих полов, которые составляли три группы исследования. Лечение проводилось на базе отделении интенсивной терапии и экстракорпоральной детоксикации Киевской городской клинической больницы скорой медицинской помощи в 2018–2019 гг. Использованы клинические, биохимические, функциональные, химико-аналитические, статистические методы исследования. Показатели в группах сравнивали с помощью t-критерия Стьюдента для независимых выборок; различия считали статистически значимыми при р ≤ 0,05. Результаты. По результатам проведенного клинического, функционального и лабораторного обследования пациентов с комбинированными отравлениями метадоном выявлена токсическая гепатонефропатия у 34,3 % пациентов, синдром ишемии мягких тканей и олигурия/анурия — у 22,9 %. Причинами развития почечной недостаточности были как преренальные (гиповолемия, низкий сердечный выброс, снижение тонуса почечных сосудов), так и ренальные факторы (токсическое поражение паренхимы почек). Показанием для гемодиализа был симптомокомплекс: олигурия/анурия в течение 24 часов, повышение уровня КФК плазмы крови, увеличение уровня креатинина, мочевины, лактата, АСАТ, АЛАТ, ЛДГ, водно-электролитный дисбаланс, ишемия мягких тканей (≥ 5 % площади тела), отек мозга, угроза сосудистого тромбоза вследствие усиления компрессии в зоне ишемии мягких тканей. Применены вено-венозный гемодиализ и ультрафильтрация (CVVHD) у 86 пациентов с острым повреждением почек. Выводы. Разнообразие нарушений гомеостаза при комбинированном отравлении метадоном, в частности с наличием синдрома ишемии мягких тканей, требует раннего использования (в течение 24–48 часов) методов экстракорпоральной терапии. Среди таких методов эффективными являются пролонгированный вено-венозный гемодиализ с ультрафильтрацией, мембранный плазмаферез и озонотерапия (внутривенное введение физиологического раствора и аутогемотрансфузия озонированной крови).

Changes in the urinary system in children with enterovirus infection

A significant increase in the incidence of enterovirus infections (EVI) with the development of multiple organ damage does not exclude the involvement of the urinary system organs in the pathological process. Materials and methods. 151 EVI children (103 cases with enterovirus meningitis (EVM), 48 children with other forms of EVI without damage of central nervous system) aged from 1 to 18 years. The frequency and nature of changes in urinary sediment and kidney function in patients with various EVI forms were studied. A highly sensitive marker of acute kidney injury - KIM-1 was used as a marker along with standard methods (determination of blood creatinine level with calculation of glomerular filtration rate) in 25 EVM patients. Results. Pathological changes in urinary sediment in EVI are registered in 37.75% of cases (27.1-42.72%, depending on the clinical form), more often in preschool children, are represented by unexpressed proteinuria and abacterial leukocyturia, and are of a short-term transient nature. 40% of EVM children patients showed an increase in the KIM-1 level above the standard values. Conclusion. The detection of KIM-1 in the urine of EVM children patients indicates the possible development of acute transient tubulointerstitial renal damage. At risk there are children with cerebrospinal fluid pleocytosis greater than 200×106/L, abacterial leukocyturia, and decreased glomerular filtration rate.

Surgical treatment of a newborn in critical condition with intrapericardiac teratoma: a case report

This article presents a clinical case of the successful surgical treatment of a newborn with intrapericardial teratoma, which was initially diagnosed in the postnatal period, complicated by multiple organ failure, including severe cardio-respiratory disorders and acute renal damage. The systematized results of clinical, electrophysiological, radiation, and morphological diagnostics during the initial examination and at the stages of supervision of the newborn are reported. On the nineteenth day of life, significant multidisciplinary cooperation was implemented to perform a radical surgical intervention to remove the intrapericardial teratoma in a patient in critical condition due to heart compression and intrathoracic tension syndrome, which determined the needed prosthetics for vital functions. Two months after the operation, the efficiency of the intervention and complex therapy was confirmed by the direct results and data of the infants examination. The organizational aspects provided newborns with emergency multidisciplinary specialized medical care.

MR-Proadrenomedullin as biomarker of renal damage in urinary tract infection in children

BackgroundMidregional-proadrenomedullin (MR-proADM) is a useful prognostic peptide in severe infectious pathologies in the adult population. However, there are no studies that analyze its utility in febrile urinary tract infection (fUTI) in children. An accurate biomarker would provide an early detection of patients with kidney damage, avoiding other invasive tests like renal scintigraphy scans. Our objective is to study the usefulness of MR-proADM as a biomarker of acute and chronic renal parenchymal damage in fUTI within the pediatric population.MethodsA prospective cohort study was conducted in pediatric patients with fUTI between January 2015 and December 2018. Plasma and urine MR-proADM levels were measured at admission in addition to other laboratory parameters. After confirmation of fUTI, renal scintigraphy scans were performed during the acute and follow-up stages. A descriptive study has been carried out and sensitivity, specificity and ROC curves for MR-proADM, C-reactive protein, and procalcitonin were calculated.Results62 pediatric patients (34 female) were enrolled. Scintigraphy showed acute pyelonephritis in 35 patients (56.5%). Of those patients, the median of plasmatic MR-proADM (P-MR-proADM) showed no differences compared to patients without pyelonephritis. 7 patients (11.3%) developed renal scars (RS). Their median P-MR-proADM levels were 1.07 nmol/L (IQR 0.66–1.59), while in patients without RS were 0.48 nmol/L (0.43–0.63) (p < 0.01). The AUC in this case was 0.92 (95% CI 0.77–0.99). We established an optimal cut-off point at 0.66 nmol/L with sensitivity 83.3% and specificity 81.8%.ConclusionMR-ProADM has demonstrated a poor ability to diagnose pyelonephritis in pediatric patients with fUTI. However, P-MR-proADM proved to be a very reliable biomarker for RS prediction.

Cystatin C as a predictor of acute renal damage after radical surgical treatment in patients with muscle-invasive bladder cancer

Purpose of the study. To assess the clinical and prognostic significance of serum and urinary cystatin C (uCys-C and sCys-C) in patients undergoing radical cystectomy (RC) in relation to AKI.Patients and methods. In this prospective study, uCys-C and sCys-C levels were measured during the first week after undergoing RC in a heterogeneous group of patients undergoing RC (n=186), mean age 59.5±11.4 years. The observation period of the patients was 6 months. The diagnosis of AKI that developed within the first week after surgery was based on the KDIGO criteria.Results. Of the 186 examined patients, 43 developed AKI according to generally accepted criteria. During the follow-up period, no patient required renal replacement therapy. AKI patients had a longer hospital stay (22.4±22.9 versus 13.0±4.1). The sCys-C levels were significantly associated with the occurrence of AKI and CKD in the long-term postoperative period and had an area under the ROC curve of 0.76 and 0.81, respectively, for predicting severe outcomes. At an optimal cut-off value of 161.17 ng/ml, sCys-C showed a sensitivity of 65 % and a specificity of 58 % for predicting AKI. The greatest increase in the concentration of sCys-C was detected 6-12 hours after surgery, followed by a decrease in the long-term follow-up.Conclusion. Peak sCys-C levels are associated with AKI and independently predict the development of AKI in patients after RC and the onset of CKD within 6 months.

Statin-induced rhabdomyolysis in a 60-year-old woman with decompensated type 2 diabetes: a case report

Rhabdomyolysis is a very rare and most severe form of statin-induced muscle adverse event characterized by muscle pain, muscle necrosis with myoglobinemia and/or myoglobinuria with a very high risk of acute kidney injury and death. The article presents a case report of developing rhabdomyolysis in a middleaged female patient with hypertension, decompensated type 2 diabetes and albuminuria. A 60-year-old woman was admitted to the hospital for emergency indications with complaints of severe muscle weakness that began in the neck, which spread over several days to the upper and lower extremities, with a symptoms progression up to paresis. According to the appointment of a primary care physician, three months before hospitalization, the patient was switched from therapy with European generic brand-name rosuvastatin 20 mg to the Russian generic unbranded atorvastatin in the same dose (20 mg), which is not comparable in lipid-lowering effect. In a laboratory study, an increase in creatine phosphokinase level by 348 times (50462 U/L) of upper normal limit in combination with severe hypokalemia 1б7 mmol/L in the absence of renal dysfunction was recorded. Cancellation of statin, metformin and empagliflozin, intensive infusion therapy and treating electrolyte imbalance made it possible to prevent the development of acute renal damage, life-threatening arrhythmias and completely stop muscle complaints within a few days. The patient was discharged from the hospital on the 23rd day with reference clinical and laboratory values, including creatine phosphokinase.This case emphasizes the importance of maintaining clinical suspicion regarding rhabdomyolysis in patients receiving statin therapy in the presence of risk factors (in this case, female sex, hyperglycemia, chronic kidney disease, concomitant therapy), as well as the relevance of timely diagnosis and treatment of this condition.

Urine biomarkers for the prediction of mortality in COVID-19 hospitalized patients

Risk factors associated with severity and mortality attributable to COVID-19 have been reported in different cohorts, highlighting the occurrence of acute kidney injury (AKI) in 25% of them. Among other, SARS-CoV-2 targets renal tubular cells and can cause acute renal damage. The aim of the present study was to evaluate the usefulness of urinary parameters in predicting intensive care unit (ICU) admission, mortality and development of AKI in hospitalized patients with COVID-19. Retrospective observational study, in a tertiary care hospital, between March 1st and April 19th, 2020. We recruited adult patients admitted consecutively and positive for SARS-CoV-2. Urinary and serum biomarkers were correlated with clinical outcomes (AKI, ICU admission, hospital discharge and in-hospital mortality) and evaluated using a logistic regression model and ROC curves. A total of 199 COVID-19 hospitalized patients were included. In AKI, the logistic regression model with a highest area under the curve (AUC) was reached by the combination of urine blood and previous chronic kidney disease, with an AUC of 0.676 (95%CI 0.512–0.840; p = 0.023); urine specific weight, sodium and albumin in serum, with an AUC of 0.837 (95% CI 0.766–0.909; p < 0.001) for ICU admission; and age, urine blood and lactate dehydrogenase levels in serum, with an AUC of 0.923 (95%CI 0.866–0.979; p < 0.001) for mortality prediction. For hospitalized patients with COVID-19, renal involvement and early alterations of urinary and serum parameters are useful as prognostic factors of AKI, the need for ICU admission and death.