Acute Kidney Injury Complications Research Articles

Treatment of Acute Kidney Injury: A Review of Current Approaches and Emerging Innovations.

Acute kidney injury (AKI) is a complex and life-threatening condition with multifactorial etiologies, ranging from ischemic injury to nephrotoxic exposures. Management is founded on treating the underlying cause of AKI, but supportive care-via fluid management, vasopressor therapy, kidney replacement therapy (KRT), and more-is also crucial. Blood pressure targets are often higher in AKI, and these can be achieved with fluids and vasopressors, some of which may be more kidney-protective than others. Initiation of KRT is controversial, and studies have not consistently demonstrated any benefit to early start dialysis. There are no targeted pharmacotherapies for AKI itself, but some do exist for complications of AKI; additionally, medications become a key aspect of AKI management because changes in renal function and dialysis support can lead to issues with both toxicities and underdosing. This review will cover existing literature on these and other aspects of AKI treatment. Additionally, this review aims to identify gaps and challenges and to offer recommendations for future research and clinical practice.

Analysis of the human kidney transcriptome and plasma proteome identifies markers of proximal tubule maladaptation to injury.

Acute kidney injury (AKI) is a major risk factor for long-term adverse outcomes, including chronic kidney disease. In mouse models of AKI, maladaptive repair of the injured proximal tubule (PT) prevents complete tissue recovery. However, evidence for PT maladaptation and its etiological relationship with complications of AKI is lacking in humans. We performed single-nucleus RNA sequencing of 120,985 nuclei in kidneys from 17 participants with AKI and seven healthy controls from the Kidney Precision Medicine Project. Maladaptive PT cells, which exhibited transcriptomic features of dedifferentiation and enrichment in pro-inflammatory and profibrotic pathways, were present in participants with AKI of diverse etiologies. To develop plasma markers of PT maladaptation, we analyzed the plasma proteome in two independent cohorts of patients undergoing cardiac surgery and a cohort of marathon runners, linked it to the transcriptomic signatures associated with maladaptive PT, and identified nine proteins whose genes were specifically up- or down-regulated by maladaptive PT. After cardiac surgery, both cohorts of patients had increased transforming growth factor-β2 (TGFB2), collagen type XXIII-α1 (COL23A1), and X-linked neuroligin 4 (NLGN4X) and had decreased plasminogen (PLG), ectonucleotide pyrophosphatase/phosphodiesterase 6 (ENPP6), and protein C (PROC). Similar changes were observed in marathon runners with exercise-associated kidney injury. Postoperative changes in these markers were associated with AKI progression in adults after cardiac surgery and post-AKI kidney atrophy in mouse models of ischemia-reperfusion injury and toxic injury. Our results demonstrate the feasibility of a multiomics approach to discovering noninvasive markers and associating PT maladaptation with adverse clinical outcomes.

Complications of Acute Kidney Injury in COVID-19 Patients: A Systematic Review

Introduction: Acute Kidney Injury has been associated with a higher mortality rate among hospitalized patients with Coronavirus disease.The present review aimed to evaluate the association of COVID-19 with acute kidney injury. The study also aimed to assess the symptoms, complications, and treatment performed for the successful management of acute kidney injury patients with COVID-19. Methodology: The literature review search was conducted by using PubMed, Medline, and another database of medical journals for identifying, reviewing, and evaluating the published articles with cases of COVID-19 and acute kidney injury complications. Results: The systematic review of 25 studies found that patients with COVID-19 had a high prevalence of acute kidney injury due to risk factors, such as hypertension, diabetes, cardiovascular disease, and the overuse of diuretics. The average age of acute kidney injury occurrence in patients was from 54-70 years of age. From 25 studies, a total of 27922 patients, 29.9%, were detected with acute kidney injury with the pathological cause of acute tubular necrosis and focal segmental glomerulosclerosis. Conclusion: The current systematic review indicates a high prevalence of acute kidney injury among COVID-19 patients with hospitalisation. Patients with COVID-19 pose a risk for the development of acute kidney injury due to chronic infection, high use of corticosteroids, and systemic hemodynamic instability, which results in acute tubular injury in hospitalised COVID-19 patients. A majority of the patients were seen with undiagnosed acute kidney injury. Early detection in such comorbid cases can resolve renal complications and improve the therapeutic outcome in COVID-19 patients.

Morbidity and mortality pattern of leptospirosis in Galle District, Sri Lanka: A descriptive analysis based on disease surveillance

Introduction: Leptospirosis is considered as one of the most common zoonotic diseases in Sri Lanka, which has a high case fatality rate. This study was conducted to assess the morbidity and mortality pattern of leptospirosis in the Galle District.Methods: A descriptive cross-sectional study was conducted based on information on leptospirosis in the Galle district obtained from the disease surveillance system. Data were extracted from the publicly available website of the Epidemiology unit which was collected through the routine disease surveillance system based on H 399, special surveillance forms and death investigation forms available at the Epidemiology unit, Galle district.Results: Data of monthly notified incident cases of leptospirosis had a trend and seasonality. Seasonal peak cannot be limited to a specific time duration. A rapid increment of notified incident cases of leptospirosis was reported in 2020. Elpitiya and Karandeniya medical officer of health (MOH) areas were identified as endemic areas for leptospirosis in Galle district while people involved in cinnamon cultivation were identified as a risk group additional to paddy workers. A total number of 75 deaths was reported for the past six years (2017 to 2022) while 2017 had the highest case fatality rates (4.3%). The majority of deaths(80.8%) occurred with complications of acute kidney injury followed by pulmonary haemorrhages (69.2%) while multi-organ failure was observed in 23.1% of deaths.Conclusion: Disease morbidity and mortality patterns had geographical variations. This should be considered during the implemention of preventive and curative measures in leptospirosis management.

Complications of Acute Kidney Injury in Critically Ill COVID-19 Patients

Complications of Acute Kidney Injury in Critically Ill COVID-19 Patients

#4767 ACUTE CORTICAL NECROSIS IN PREGNANCY IS STILL AN IMPORTANT CAUSE FOR END-STAGE RENAL DISEASE IN DEVELOPING COUNTRIES

Abstract Background and Aims Renal cortical necrosis (RCN) is a serious complication of acute kidney injury (AKI) and pregnancy is a clinical state closely associated with it with poor renal outcomes. The incidence is much higher in obstetrical AKI compared to other causes of RCN. Despite better medical care facilities available, this continues to be an important cause of morbidity and mortality in developing countries. Method This is a retrospective analysis among all pregnant females presenting with AKI from January 2000 to December 2020 at a tertiary care center in the northern part of India. We looked for the incidence of obstetrical-related RCN in our renal biopsies performed in the last 20 years and to evaluate precipitating factors responsible for RCN. Results RCN constituted 8.1 % of pregnancy-related AKI cases in our institution. The overall incidence has been declining which was 9.09% from 2000 to 2008 to 8.7 % from 2009 to 2014 and 8.1% from 2014-2020. The patient's median age was 28.4 ± 4.6 years. The average time to presentation from the day of delivery was 7.8 ±3.0 days. The mortality was observed in 10.4 % of them with sepsis and multiorgan dysfunction present in all of them. The most common etiology for RCN was found to be septic abortion and puerperal sepsis accounting for - 16.2 % each. Postpartum hemorrhage was a cause in 9.67 % of patients. The most important cause of RCN was postpartum thrombotic microangiopathy which was observed in 49.5% of patients. Kidney biopsy was helpful in diagnosis in 36 patients while computed tomography scan abdomen alone helped in diagnosis in five patients. Patchy cortical necrosis in histology was seen in 36.7% of patients and morbidity in terms of prolonged hospitalization was seen in 23.4 % while dialysis dependency in 63.4% of the study population Conclusion Strategies need to be implemented in reducing the preventable causes for RCN which is not only catastrophic in terms of renal outcomes but also for social and psychological perspectives as well.

Clinical Characteristics of Acute Kidney Injury in Covid-19 Patients

Background: Coronavirus Disease 2019 (COVID-19) is one of the infectious diseases that exist in Indonesia. Not only infects the lungs, but this virus can also infect other organs such as the kidneys. In addition, the process of viral infection causes cell hypermetabolism, which can increase the workload of the kidneys in excreting metabolic waste. In the end, the damage caused by the virus can cause Acute Kidney Injury (AKI). It is necessary to know the prevalence and characteristics of this event. Purposes: This study aims to provide an overview of AKI's prevalence and clinical features in COVID-19 patients. Methods: This was a descriptive study that used patient medical records for the period April-September 2021. The univariate analysis data showed a characteristic frequency distribution of age, gender, comorbidity, hospitalization duration, and urea creatinine rate. Results: The incoming samples based on the inclusion and exclusion criteria were 44 samples. In COVID-19 patients, complications of AKI were found in adults, as much as 68.2% of both men and women had a percentage of 50%, the most common comorbid was hypertension 30.8% with a hospitalization duration of 1-10 days 43.2% and an average increase in urea 79.68 mg/dL and creatinine average 2,859 mg/dL. Conclusion: Based on patient characteristics, the results showed that more COVID-19 patients with acute kidney injury complications occurred in adult patients, with no difference in prevalence between males and females, with comorbid hypertension and length of hospitalization less than ten days.

Acute kidney injury in neurocritical patients: a retrospective cohort study.

Acute kidney injury (AKI) is a significant complication in critical care units (CCU). Non-neurological complications such as AKI are an independent predictor of poor clinical outcomes, with an increase in morbidity and mortality, financial costs, and worse functional recovery. This work aims to estimate the incidence of AKI and evaluate the risk factors and complications of AKI in neurocritical patients hospitalized in the CCU. A retrospective cohort study was conducted. Patients admitted to the neurocritical care unit between 2016 and 2018 with a stay longer than 48h were retrospectively analyzed in regard to the incidence, risk factors, and outcomes of AKI. The study population comprised 213 neurocritical patients. The incidence of AKI was 23.5%, with 58% KDIGO 1 and 2% requiring renal replacement therapy. AKI was an independent predictor of prolonged use of mechanical ventilation, cerebral edema, and mortality. Cerebral edema [OR 4.40 (95% CI 1.98-9.75) p < 0.001] and a change in chloride levels greater than 4mmol/L at 48h (OR 2.44 (95% CI 1.10-5.37) p = 0.027) were risk factors for developing AKI in the first 14days of hospitalization. There is a high incidence of AKI in neurocritical patients; it is associated with worse clinical outcomes regardless of the CCU admission etiology or AKI severity.

Efficacy of orally administered montmorillonite in myoglobinuric acute renal failure model in male rats.

Acute kidney injury can be associated with serious consequences and therefore early treatment is critical to decreasing mortality and morbidity rate. We evaluated the effect of montmorillonite, the clay with strong cation exchange capacity, on the AKI model in rats. Glycerol (50% solution, 10 ml/kg) was injected in the rat hind limbs to induce AKI. 24 hr after induction of acute kidney injury, the rats received oral doses of montmorillonite (0.5 g/kg or 1 g/kg), or sodium polystyrene sulfonate (1 g/kg) for three consecutive days. Glycine induced acute kidney injury in rats with high levels of urea (336.60± 28.19 mg/dl), creatinine (4.10± 0.21 mg/dl), potassium (6.15 ± 0.28 mEq/L), and calcium (11.52 ± 0.19 mg/dl). Both doses of montmorillonite (0.5 and 1 g/kg) improved the serum urea (222.66± 10.02 and 170.20±8.06, P<0.05), creatinine (1.86±0.1, 2.05± 0.11, P<0.05), potassium (4.68 ± 0.4, 4.73 ± 0.34, P<0.001) and calcium (11.15 ± 0.17, 10.75 ± 0.25, P<0.01) levels. Treatment with montmorillonite especially at a high dose reduced the kidney pathological findings including, tubular necrosis, amorphous protein aggregation, and cell shedding into the distal and proximal tubule lumen. However, administration of SPS could not significantly decrease the severity of damages. According to the results of this study, as well as the physicochemical properties of montmorillonite, such as high ion exchange capacity and low side effects, montmorillonite can be a low-cost and effective treatment option to reduce and improve the complications of acute kidney injury. However, the efficacy of this compound in human and clinical studies needs to be investigated.

Evaluation of Klotho gene expression and NGAL levels following acute kidney injury during pregnancy hypertensive disorders.

This study examined the relationship between hypertensive disorders and acute kidney injury (AKI) during pregnancy by evaluating Klotho (KL) gene expression and Neutrophil gelatinase-associated lipocalin (NGAL) levels in pregnant women. Pregnant women were divided into 3 groups: (1) Pregnancy related hypertensive disorders with AKI (PR-AKI) (9 cases), (2) hypertensive disorders pregnancy (HDP) (40 cases), and (3) normal pregnancy (30 cases). For each group, Klotho gene transcription levels in the blood, Klotho and NGAL proteins levels, Malondialdehyde (MDA) and superoxide dismutase (SOD) activity levels were measured in serum. Statistical comparisons were made among the three groups. Klotho/β-actin transcript levels and serum KL protein concentrations were significantly decreased in hypertensive disorder pregnancies with AKI complications. Serum NGAL protein levels were significantly increased in the hypertensive disorder pregnancies with AKI complications. Total serum Klotho protein was negatively correlated with creatinine, while serum NGAL was positively correlated with serum creatinine, urea nitrogen, uric acid, systolic blood pressure, diastolic blood pressure and 24h urine protein levels. Serum levels of MDA and SOD were significantly increased in the hypertensive disorder pregnancy with AKI and the overall MDA concentration was negatively correlated with Klotho protein concentration. Klotho protein was found to have a direct effect on creatinine, and a mediating effect of MDA was found. Decreased expression of Klotho protein in correlation with increased levels of oxidative stress are found during of AKI complications in pregnancy hypertensive disorders.

Đặc điểm tổn thương động mạch vành và thay đổi mức lọc cầu thận sau chụp hoặc can thiệp động mạch vành qua da ở bệnh nhân bệnh thận mạn

Introduction: Coronary artery disease is the leading cause of death in patients with chronic kidney disease. Despite many advances in diagnosis and treatment, percutaneous coronary intervention in patients with chronic kidney disease remains challenging.Objectives: (1) Describe clinical, subclinical and coronary artery lesions in patients with chronic kidney disease requiring percutaneous coronary angiography at the Vietnam Heart Institute. (2) Evaluation the changes in clinical, laboratory and glomerular filtration rate after coronary angiography or intervention in thesse patients.Subjects and methods: A descriptive prospective study of 59 chronic kidney disease patients assigned to take percutaneous coronary angiography with or without intervention at the Vietnam Heart Institute from August 2020 to October 2021. The study collected and analyzed information of clinical and laboratory characteristics, percutaneous coronary angiography results and changes in renal function after intervention. Result: The average SYNTAX score was 21,9 ± 13,0. Coronary artery lesions accounted for the majority of branches (84.8%), lesions of 1 branch (11.9%). The most common site of injury was the left anterior descending artery (88.1%) followed by the right coronary artery (71.2%) and the circumflex artery (50.8%). The culprit lesions were often complex, type B2 and type C were the most common types (76.2%), followed by type B1 (14.3%), type A (9.5%). The rate of chronic total occlusion was also quitehigh (25.4%), lesions at the bifurcation (25.4%) were less common in left coronary artery (13.6%). 17,3% of patients had complications of acute kidney injury after the intervention, of which the CKD 3 and CKD 4-5 group were accounted for 12.9% and 23.8% of the patients respectively. Of these, 3 patients had to undergo emergency dialysis after the intervention.Conclusion: Coronary artery lesions in patients with chronic kidney disease was often complicated, often with multiple coronary artery lesions and tended to be more severe with the decline of glomerular filtration rate. Percutaneous coronary intervention in patients with chronic kidney disease had safe results in terms of procedures, however, the rate of complications of acute kidney injury was quite high in patients with CKD.

Risk Factors, Etiology, Pathology, and Diagnostic Methods for Acute Kidney Injury: A Review Study

Background: Acute kidney injury (AKI) is characterized by a rapid decline in kidney function, resulting in significant morbidity and mortality. This review summarizes our knowledge of AKI risk factors, pathogenesis, prediction, diagnosis, and emerging management approaches. Methods: A comprehensive literature search was conducted to summarize current knowledge on AKI. Five electronic databases were searched using various combinations of search terms related to AKI’s risk factors, pathogenesis, prediction, diagnosis, and management approaches. The databases included PubMed, Embase, Web of Science, CINAHL, and Cochrane Central Register of Controlled Trials. Relevant publications were limited to those written in English from 2016 to 2024, but some prior studies were included if highly seminal. Reference lists were also reviewed to find other sources. The full texts of all possibly relevant articles were assessed for inclusion. Data were extracted on study details and findings concerning AKI causes, biomarkers, prediction strategies, diagnostic techniques, treatments, and perspectives to enhance prevention and outcomes. Quality was considered during data extraction, prioritizing well-performed randomized controlled trials, systematic reviews, and large epidemiological studies. Case reports and select editorials were included to summarize specific topics. Extracted data were narratively synthesized to provide an overview of current AKI knowledge and highlight opportunities for mitigating its impact. Through searching multiple databases using applicable index terms, hand searching reference lists, screening and extracting pertinent published literature, this review aims to understand AKI complications and advance solutions from the existing evidence base. Results: This review summarizes current knowledge on AKI risk mechanisms, diagnostic approaches, emerging therapies and implications of personalized medicine leveraging multi-omics for optimizing prediction and precision treatment. Conclusion: Despite progress, AKI has remained challenging. However, integrative approaches leveraging new technologies offer hope for improving AKI prevention and management.

National trends in thoracic aortic aneurysms and dissections in patients with Marfans and Ehlers Danlos syndrome.

Connective tissue disorders predispose patients to earlier aortic dissections and aneurysms. However, there is limited large cohort data given its low incidence. The National Inpatient Samplewas searched for all adults with Marfans (MFS) and Ehlers Danlos (EDS) disease between 2010 and 2017. ICDcodes were used to select those with a type A aortic dissection or aneurysm. There was a total of 19,567 cases, giving the estimated incidence of MFS and EDS of 18 and 22.4 per 100k people, respectively. After inclusion criteria, there were 2553 MF and 180 EDS patients. There was no statistical difference in mortality between the MFS and EDS cohorts (4.6% vs. 2.8%, p = .26). EDS patients were more likely to undergo a TEVAR procedure (2.8% vs. 1.0%, p = .03). MF patients were more likely to have a complication of acute kidney injury (p = .02). EDS patients were more likely older (50 vs. 42, p < .001) and female (47% vs. 33%, p < .001). MFS patients were more likely to have a type A aortic dissection (44% vs. 31%, p < .001). The majority (89%) of patients were treated at urban teaching hospitals. On univariable logistic regression, aortic dissection was a predictor for mortality (odds ratio7.31, p < .001). The type of connective tissue disease was not a significant predictor. National level estimates show low mortality for patients with MF or ED presenting to the hospital with aortic dissection or aneurysm. The differences in age and gender can guide surveillance for these patient populations, leading to more elective admissions and reduced hospital mortality.

Long-short-term memory machine learning of longitudinal clinical data accurately predicts acute kidney injury onset in COVID-19: a two-center study

ObjectivesThis study used the long-short-term memory (LSTM) artificial intelligence method to model multiple time points of clinical laboratory data, along with demographics and comorbidities, to predict hospital-acquired acute kidney injury (AKI) onset in patients with COVID-19.MethodsMontefiore Health System data consisted of 1982 AKI and 2857 non-AKI (NAKI) hospitalized patients with COVID-19, and Stony Brook Hospital validation data consisted of 308 AKI and 721 NAKI hospitalized patients with COVID-19. Demographic, comorbidities, and longitudinal (3 days before AKI onset) laboratory tests were analyzed. LSTM was used to predict AKI with fivefold cross-validation (80%/20% for training/validation).ResultsThe top predictors of AKI onset were glomerular filtration rate, lactate dehydrogenase, alanine aminotransferase, aspartate aminotransferase, and C-reactive protein. Longitudinal data yielded marked improvement in prediction accuracy over individual time points. The inclusion of comorbidities and demographics further improves prediction accuracy. The best model yielded an area under the curve, accuracy, sensitivity, and specificity to be 0.965 ± 0.003, 89.57 ± 1.64%, 0.95 ± 0.03, and 0.84 ± 0.05, respectively, for the Montefiore validation dataset, and 0.86 ± 0.01, 83.66 ± 2.53%, 0.66 ± 0.10, 0.89 ± 0.03, respectively, for the Stony Brook Hospital validation dataset.ConclusionLSTM model of longitudinal clinical data accurately predicted AKI onset in patients with COVID-19. This approach could help heighten awareness of AKI complications and identify patients for early interventions to prevent long-term renal complications.

Fatal cases of hemorrhagic fever with renal syndrome in Udmurtia, Russia, 2010 to 2019.

Hemorrhagic fever with renal syndrome (HFRS) continues to be a cause of death in Europe. Our aim was to describe the clinical and histopathological features of fatal HFRS in the Udmurt Republic (Udmurtia), located in the European part of Russia. This retrospective observational study included all fatal cases of HFRS that occurred in Udmurtia from January 2010 through December 2019. The most relevant clinical and autopsy data of these cases were recorded through a review of the patients’ medical records and autopsy reports. During 2010–2019, Udmurtia had 41 fatal cases of HFRS of a total of 10,312 confirmed cases (case-fatality rate of 0.4%). Twenty-seven patients died in hypotensive and oliguric phases of HFRS due to refractory septic shock and acute respiratory distress syndrome. Fourteen patients died in the polyuric phase of the disease from complications of acute kidney injury or because of hospital-acquired bacterial infections. Multiorgan involvement was noted in all autopsies with variable degrees of generalized venous congestion, interstitial edema, capillary wall thickening, perivascular deposition of plasma proteins, microthrombosis formation, and perivascular hemorrhage. The more prominent histopathological features were seen in kidneys, lungs, and hypophysis.Supplementary InformationThe online version contains supplementary material available at 10.1007/s10096-022-04463-y.

Epidemiology and course features of acute kidney injury in Ukrainian children

Abstract. Epidemiological or clinical study on the pediatric population has not been conducted in Ukraine since the term acute kidney injury (AKI) was defined in the year 2004. Our study aimed to analyze the epidemiology, etiology, and features of the AKI in children over 20 years period.&#x0D; Materials and methods. The study included 242 children aged 6 months to 18 years with AKI who were observed during the years 2002-2020 in the reference center (until the year 2002: n=17; 2002-2012 years: n=105; 2013-2020 years: n=120).&#x0D; Results. The number of patients per 10.000 children ranged from 0.025 to 0.034 from 2013 to 2017, except for the year 2015 (0.008), but it began to decrease in 2018. Patients from the Kyiv region accounted for one-third of all episodes (34-29%), and the quotas of the Central Ukrainian region were also stable (6-5-4%). The quantity of Podolsky region tripled after the year 2012 (from 6 to 19%), and patients from the Black Sea region and Donetsk region appeared in the structure at that time (15-14% and 13-7%, respectively). The part of the Northwest region of Ukraine was reduced significantly (from 24 to 8%), as the Northeast region (from 12 to 5%) and Carpathian region (from 12 to 3%). Boys predominated among patients (145/59.9%), and the average age at disease onset was 4 years (from 3 months to 17 years and 11 months).&#x0D; The main AKI cause in children aged under the 12 months and 1-3 years old was hemolytic-uremic syndrome (with or without intestinal disorders), its quantity decreased in the age from 3 to 10 years (due to the increasing number of patients with hemolytic anemia) and in adolescents (due to glomerulonephritis and toxic factors). Complications such as multiple organ failure syndromes, sepsis, and congenital anomalies of the kidney and urinary tract aggravated the course of AKI.&#x0D; Conclusions. The relative proportion of AKI cases per year decreased in 2018-2019 compared to the 2013-2017 period with the largest part of disease detection in the central regions of Ukraine. Dominant etiological factors, age differences and complications of AKI in children were identified.

The Role of Gut-Derived, Protein-Bound Uremic Toxins in the Cardiovascular Complications of Acute Kidney Injury.

Acute kidney injury (AKI) is a frequent disease encountered in the hospital, with a higher incidence in intensive care units. Despite progress in renal replacement therapy, AKI is still associated with early and late complications, especially cardiovascular events and mortality. The role of gut-derived protein-bound uremic toxins (PBUTs) in vascular and cardiac dysfunction has been extensively studied during chronic kidney disease (CKD), in particular, that of indoxyl sulfate (IS), para-cresyl sulfate (PCS), and indole-3-acetic acid (IAA), resulting in both experimental and clinical evidence. PBUTs, which accumulate when the excretory function of the kidneys is impaired, have a deleterious effect on and cause damage to cardiovascular tissues. However, the link between PBUTs and the cardiovascular complications of AKI and the pathophysiological mechanisms potentially involved are unclear. This review aims to summarize available data concerning the participation of PBUTs in the early and late cardiovascular complications of AKI.

Acute Kidney Injury and Acute Pancreatitis in Patients with Chronic Hypertension and COVID-19: A Case Report

BACKGROUND: Hypertensive patients with Coronavirus Disease 2019 (COVID-19) are facing high morbidity and mortality. These morbidities include acute kidney injury (AKI) and acute pancreatitis, which have an incidence of about 17% each. Severe acute respiratory syndrome-corona virus 2 (SARS-CoV2) virus penetrates cells through the angiotensin-converting enzyme 2 (ACE2) receptor which is widely found in the respiratory tract, gastrointestinal tract, kidneys, pancreas, and other organs. The virus multiplies in the airway and then enters circulation bound to ACE2 receptors in the tissue. CASE REPORT: This case report presents a chronic hypertensive patient with COVID-19 accompanied by complications of AKI and acute pancreatitis. CONCLUSION: AKI is a risk factor for death in COVID-19 patients, where kidney involvement in COVID-19 is thought to be due to direct infection with SARS-CoV2 or through other complicating conditions, where acute pancreatitis occurs due to COVID-19.

Impact of Cirrhotic Cardiomyopathy Diagnosed According to Different Criteria on Patients with Cirrhosis Awaiting Liver Transplantation: A Retrospective Cohort Study.

Recently, the Cirrhotic Cardiomyopathy Consortium (Consortium) proposed criteria to replace the World Congress of Gastroenterology (WGO) criteria for cirrhotic cardiomyopathy (CCM) using contemporary echocardiography parameters. We assessed the impact of substituting WGO by Consortium criteria on the frequency of diagnosis and clinical outcomes in patients with cirrhosis awaiting liver transplantation (LT). Consecutive adults with cirrhosis approved for LT with echocardiography evaluation from January 2014 to December 2016 were screened. Patients with structural heart diseases were excluded. Two primary outcomes were: (1) frequency of CCM; (2) association of CCM with pre-transplant mortality. The secondary outcomes were pre-LT complications of acute kidney injury (AKI) and/or hepatic encephalopathy (HE), and post-LT mortality. Of 386 patients screened, 278 were included. 238 (85.6%) and 208 (74.8%) patients met Consortium and WGO criteria, respectively; 180 (64.7%) patients fulfilled both the criteria, while 12 (4.3%) patients had no evidence of CCM by either criterion. Pre-LT mortality rates in Consortium-CCM group were similar to the other groups (19.3% vs 20.2% vs 25.0%). The patients with advanced diastolic dysfunction (DD) per Consortium-CCM criteria had higher mortality than the other groups. The rates of pre-LT AKI/HE rates and post-LT mortality were similar in Consortium-CCM and WGO-CCM groups. The Consortium criteria do not impact the prevalence of CCM compared to WGO criteria and have similar predictive accuracy. Presence of advanced DD per the Consortium criteria increases the risk of pre-LT mortality and complications of AKI/HE. The patients with advanced DD could benefit from further monitoring and treatment.

POS-957 SURVIVAL ANALYSIS AND RISK FACTOR OF MORTALITY AMONG COVID-19 PATIENTS WITH HEMODIALYSIS IN SANGLAH GENERAL HOSPITAL BALI INDONESIA

Complication for COVID 19 infection not only in lung organ, but can reach far organ such as kidney. Kidney problem can be as complication of COVID 19 infection which is Acute Kidney Injury (AKI), or as comorbid in patient who already has declining of kidney function, Chronic Kidney Disease (CKD). In AKI complication, often patients need renal support when metabolic and fluid problem beyond than kidney ability to handle. CKD patients who in hemodialysis (HD) treatment are population in high risk to infected COVID-19.