Development Of Kidney Injury In Patients Research Articles

MO321: The Critical Role of Cytokine Dysregulation in Acute Kidney Injury Development in Patients With COVID-19

BACKGROUND AND AIMSOne of the complications described in critically ill patients in intensive care units with severe COVID-19 was acute kidney injury (AKI). The pathophysiology of AKI in patients with COVID-19 is multifactorial. In addition to the direct virulence of SARS-CoV-2 in renal cells, the tissue inflammation and local immune cell infiltration, cytokine storm, secondary infections and nephrotoxicity associated drugs may contribute to AKI [1]. Mounting evidence throughout the pandemic suggests that patients with severe COVID-19 may have a cytokine storm syndrome, one of the possible causes of AKI in these patients [2]. The present prospective cohort study analysed the correlation between circulating cytokine profile and estimated glomerular filtration rate (eGFR) in patients with COVID-19.METHODAfter signing the informed consent, patients positive for SARS-CoV-2 infection (n = 74) had blood samples (n = 139) collected at hospital admission until the day of the outcome. ELISA measured the cytokines IL-10, IL-4, L-6, TNF-α and IFN-γ, and the eGFR was calculated by the CKD-EPI Cystatin C equation. Statistics description: Continuous variables were checked for normality and presented as mean ± standard deviation or median and interquartile range. The association between continuous variables is shown in scatterplots, and a predicted response with 95% confidence interval (95% CI) is plotted using fractional polynomials. For linear correlations, we obtained P-values using Pearson's correlation coefficient.RESULTSThere is a more significant distribution of eGFR below 90 mL/min in the population studied, associated with older patients. Glomerular filtration rates were negatively correlated with age as expected (–0.60; P < 0.0001). Lower eGFR was correlated with levels of proinflammatory cytokines such as IL-6 (–0.33; P < .0007) and TNF- α (–0.21; P < .03); but without positive correlation with IL-10 (0.04; P < 0.68) or IFN-γ (–0.14; P < .16), even though higher IFN-γ levels have been linked to a worse prognosis in patients with severe COVID-19 [3]. Curiously, a positive correlation was observed between lower eGFR and IL-4 levels.CONCLUSIONThese results demonstrate that a shift in the immune response profile, cytokines with a Th2 profile such as IL-4, and cytokines with systemic functions such as IL-6 and TNF-α can be related to renal failure. The elucidation of the potential pathophysiological mechanisms of AKI associated with COVID-19 as well as monitoring of cytokine levels can (a) help to identify patients with severe COVID-19 at risk of loss of renal function, (b) provide information on specific therapeutic strategies.

Effect of del nido cardioplegia use on kidney injury after coronary bypass operations.

After cardiac surgery, acute kidney injury is observed at a rate of 5-30%, and the second most common cause of acute kidney injury in intensive care units is cardiac surgery. In this study, we aimed to investigate the effect of del Nido cardioplegia solution use on postoperative acute kidney injury development in patients who underwent coronary artery bypass grafting operation with cardiopulmonary bypass. Consecutive patients who underwent an elective coronary artery bypass grafting operation with cardiopulmonary bypass in our clinic between March 15, 2019, and March 15, 2020, were included in the study retrospectively. The patients were divided into two groups as those who received del Nido cardioplegia solution (Group 1) and blood cardioplegia (Group 2), and factors affecting the development of renal failure were examined. A total of 350 consecutive patients were included in the study. There were 156 patients in the del Nido cardioplegia group and 194 patients in the blood cardioplegia group. Among the patient group, 74 (21.1%) patients developed acute kidney injury. The total acute kidney injury development rate was significantly higher in Group 2 (p=0.018). In multivariate logistic regression analysis, advanced age (OR 1.128; 95%CI 1.044-1.217; p=0.042), increased blood product use (OR 1.318; 95%CI 1.154-1.998; p=0.019), preoperative creatinine elevation (OR 2.434; 95%CI 1.655-4.639; p=0.005), and increased cardioplegia volume (OR 1.254; 95%CI 1.109-2.980; p=0.009) were independent predictors of acute kidney injury. With this study, we showed that the use of del Nido cardioplegia solution can reduce the incidence of acute kidney injury.

RENAL COMPLICATIONS OF COVID-19 CORONAVIRUS INFECTION: MECHANISMS AND BIOMARKER

The brief review dealing with risks of the development of renal complications in patients with COVID-19, peculiarities of acute kidney injury development in patients with coronavirus. The special attention is given to the mechanisms of the direct infection of kidney by coronavirus SARS-CoV-2 and to the biomarkers for differential diagnostics of glomerular and tubular dysfunction in patients with COVID-19.

Acute Kidney Injury in Patients of Emergency and Surgical Intensive Care Units: Incidence and Risk Factors

Background: Acute kidney injury is an abrupt or rapid decline in renal filtration function. Objective: The study aimed to identify the incidence and analyze the risk factors (age and sex) for acute kidney injury development in patients of emergency and surgical intensive care units. Patients and Methods: This study was carried out at emergency and surgical intensive care units of Zagazig University Hospitals over a period of 6 months. Data collection were1: Peak of serum creatinine level. 2: Peak of decreased urine output. 3: At the peak of AKI: AKIN (Acute Kidney Injury Network) score. Results: Incidence of AKI in patients with normal kidney functions at admission and without history of any previous renal problems equal 7.015% according to AKIN score. Conclusion: our results reported that incidence rate of developing AKI in patients of emergency and postoperative critical care units along the period of 6 months according to the inclusion criteria and AKIN score is 7.015 %. Age and sex weren’t risk factors for AKI.

Pre-, Intra-, and Post-Operative Factors for Kidney Injury of Patients Underwent Cardiac Surgery: A Retrospective Cohort Study.

BackgroundKidney injury is common in patients who have undergone cardiac surgery, and it has high morbidity and mortality. The objective of the study was to identify pre-, intra-, and post-operative risk factors responsible for kidney injury among patients who had undergone cardiac surgery.Material/MethodsPatients (n=1468) who had undergone cardiac surgery were stratified into those with kidney injury (n=488) and those without kidney injury (n=980) using the KDIGO (Kidney Disease: Improving Global Outcomes) criteria. Data of pre-, intra- and post-operative variables were collected and analyzed.ResultsAcute kidney injury occurred in 33.2% of study patients. Patients with post-operative acute kidney injury had older age, comorbidities, higher preoperative serum creatinine, coronary artery bypass grafting, longer operation time, high cardiopulmonary bypass and cross-clamping time, low central venous pressure, and prolonged mechanical ventilation as compared to patients without kidney injury (P<0.05 for all). Age >65 years (OR 1.4), preoperative hypertension (OR 2.0), preoperative anemia (OR 2.3), preoperative low ejection fraction (OR 3.7), Charlson comorbidity index >2 (OR 2.5), longer cardiopulmonary bypass time (OR 4.0), blood transfusions (OR 2.1), postoperative hypotension (OR 5.2), and low central venous pressure (OR 8.1) were responsible for kidney injury. Mortality of patients with kidney injury was significantly higher than those without acute kidney injury (52 versus 1, P<0.001).ConclusionsAppropriate and effective control of pre-, intra-, and post-operative variables can reduce the risk of kidney injury development in patients following cardiac surgeries.

300 - Aortic calcification is the risk factor of severe acute kidney injury development in patients with urological sepsis

300 - Aortic calcification is the risk factor of severe acute kidney injury development in patients with urological sepsis