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Ibrahim R. The effect of pre-hospital use of RAS inhibitors on COVID-19 mortality. J Investig Med 2024:10815589241270417. [PMID: 39075674 DOI: 10.1177/10815589241270417] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/31/2024]
Abstract
The effect of pre-hospital use of renin-angiotensin system (RAS) inhibitors (angiotensin-converting enzyme inhibitors (ACEis)/angiotensin receptor blockers (ARBs)) on clinical outcomes of hypertensive patients with COVID-19 has been questioned due to conflicting reports on this issue. After applying exclusion criteria, 175 COVID-19 hospitalized patients admitted to the Tishreen Hospital from January 1 to July 31, 2021 were retrospectively enrolled in this study. Baseline characteristics and in-hospital mortality rate were assessed between hypertensive (N = 91, 52%) and non-hypertensive (N = 84, 48%) patients, as well as between patients taking ACEis/ARBs and non-ACEis/ARBs within the hypertensive group. A lower mortality rate (51.2 versus 31.9%, p = 0.009) was observed in the hypertensive group (mean age 64.6 years, 64.8% males) compared to the non-hypertensive (mean age 62.6 years, 66.7% males). Patients' mortality in the non-hypertensive group was associated with lower blood oxygen saturation (SPO2 = 75 versus 86%, p = 0.002), increased levels of inflammatory (CRP, white blood cell and neutrophils count), and tissue/renal injury markers (LDH, urea, and creatinine). In the hypertensive group, a lower mortality rate was noted in the ACEis/ARBs group compared to the non-ACEis/ARBs (24.1 versus 45.5%, p = 0.036), and this was associated with a decrease in D-DIMER levels, although not significant (1723 versus 2683 ng/mL, p > 0.05). Death in the non-ACEis/ARBs group was associated with decreased SPO2 and tissue/renal injury markers (LDH, CK, AST, urea, and creatinine). We concluded that hypertension is not a direct cause of poor prognosis in COVID-19 patients and that multi-organ damage is a significant indicator of death from COVID-19. RAS inhibitors could improve the survival of hypertensive COVID-19 patients.
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Affiliation(s)
- Rama Ibrahim
- Department of Biochemistry and Microbiology, Faculty of Pharmacy,Al-Sham Private University (ASPU), Lattakia, Syria
- Department of Biochemistry and Microbiology, Faculty of Pharmacy, Tishreen University, Lattakia, Syria
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2
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Salgueira M, Almenara M, Gutierrez-Pizarraya A, Belmar L, Labrador PJ, Melero R, Serrano M, Portolés JM, Molina A, Poch E, Ramos N, Lloret MJ, Echarri R, Díaz-Mancebo R, González-Lara DM, Sánchez JE, Soler MJ. Characterization of hospitalized patients with acute kidney injury associated with COVID-19 in Spain: renal replacement therapy and mortality. FRA-COVID SEN Registry Data. Nefrologia 2024; 44:527-539. [PMID: 39127584 DOI: 10.1016/j.nefroe.2023.03.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Revised: 03/29/2023] [Accepted: 03/31/2023] [Indexed: 08/12/2024] Open
Abstract
BACKGROUND Acute kidney injury (AKI) is common among hospitalized patients with COVID-19 and associated with worse prognosis. The Spanish Society of Nephrology created the AKI- COVID Registry to characterize the population admitted for COVID-19 that developed AKI in Spanish hospitals. The need of renal replacement therapy (RRT) therapeutic modalities, and mortality in these patients were assessed MATERIAL AND METHOD: In a retrospective study, we analyzed data from the AKI-COVID Registry, which included patients hospitalized in 30 Spanish hospitals from May 2020 to November 2021. Clinical and demographic variables, factors related to the severity of COVID-19 and AKI, and survival data were recorded. A multivariate regression analysis was performed to study factors related to RRT and mortality. RESULTS Data from 730 patients were recorded. A total of 71.9% were men, with a mean age of 70 years (60-78), 70.1% were hypertensive, 32.9% diabetic, 33.3% with cardiovascular disease and 23.9% had some degree of chronic kidney disease (CKD). Pneumonia was diagnosed in 94.6%, requiring ventilatory support in 54.2% and admission to the ICU in 44.1% of cases. The median time from the onset of COVID-19 symptoms to the appearance of AKI (37.1% KDIGO I, 18.3% KDIGO II, 44.6% KDIGO III) was 6 days (4-10). A total of 235 (33.9%) patients required RRT: 155 patients with continuous renal replacement therapy, 89 alternate-day dialysis, 36 daily dialysis, 24 extended hemodialysis and 17 patients with hemodiafiltration. Smoking habit (OR 3.41), ventilatory support (OR 20.2), maximum creatinine value (OR 2.41), and time to AKI onset (OR 1.13) were predictors of the need for RRT; age was a protective factor (0.95). The group without RRT was characterized by older age, less severe AKI, and shorter kidney injury onset and recovery time (p < 0.05). 38.6% of patients died during hospitalization; serious AKI and RRT were more frequent in the death group. In the multivariate analysis, age (OR 1.03), previous chronic kidney disease (OR 2.21), development of pneumonia (OR 2.89), ventilatory support (OR 3.34) and RRT (OR 2.28) were predictors of mortality while chronic treatment with ARBs was identified as a protective factor (OR 0.55). CONCLUSIONS Patients with AKI during hospitalization for COVID-19 had a high mean age, comorbidities and severe infection. We defined two different clinical patterns: an AKI of early onset, in older patients that resolves in a few days without the need for RRT; and another more severe pattern, with greater need for RRT, and late onset, which was related to greater severity of the infectious disease. The severity of the infection, age and the presence of CKD prior to admission were identified as a risk factors for mortality in these patients. In addition chronic treatment with ARBs was identified as a protective factor for mortality.
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Affiliation(s)
- M Salgueira
- Hospital Universitario Virgen Macarena, Sevilla, Spain.
| | - M Almenara
- Hospital Universitario Virgen Macarena, Sevilla, Spain
| | | | - L Belmar
- Hospital Universitario Marqués de Valdecilla, Santander, Spain
| | - P J Labrador
- Complejo Hospitalario Universitario de Cáceres, Spain
| | - R Melero
- Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - M Serrano
- Hospital Universitario Puerta de Hierro Majadahonda, Madrid, Spain
| | - J M Portolés
- Hospital Universitario Puerta de Hierro Majadahonda, Madrid, Spain
| | - A Molina
- Hospital Clinic, Barcelona, Spain
| | - E Poch
- Hospital Clinic, Barcelona, Spain
| | - N Ramos
- Hospital Vall de Hebron, Barcelona, Spain
| | | | - R Echarri
- Hospital Universitario Infanta Sofía, Madrid, Spain
| | | | | | - J E Sánchez
- Hospital Universitario de Cabueñes, Gijón, Spain
| | - M J Soler
- Hospital Vall de Hebron, Barcelona, Spain
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Salgueira M, Almenara M, Gutierrez-Pizarraya A, Belmar L, Labrador PJ, Melero R, Serrano ML, Portolés JM, Molina A, Poch E, Ramos N, Lloret MJ, Echarri R, Díaz Mancebo R, González-Lara DM, Sánchez JE, Soler MJ. [Characterization of hospitalized patients with acute kidney injury associated with COVID-19 in Spain: Renal replacement therapy and mortality. FRA-COVID SEN Registry Data]. Nefrologia 2023; 44:S0211-6995(23)00057-7. [PMID: 37359780 PMCID: PMC10076078 DOI: 10.1016/j.nefro.2023.03.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Accepted: 03/31/2023] [Indexed: 06/28/2023] Open
Abstract
Background and objectives Acute kidney injury (AKI) is common among hospitalized patients with COVID-19 and associated with worse prognosis. The Spanish Society of Nephrology created the AKI-COVID Registry to characterize the population admitted for COVID-19 that developed AKI in Spanish hospitals. The need of renal replacement therapy (RRT) therapeutic modalities, and mortality in these patients were assessed. Material and method In a retrospective study, we analyzed data from the AKI-COVID Registry, which included patients hospitalized in 30 Spanish hospitals from May 2020 to November 2021. Clinical and demographic variables, factors related to the severity of COVID-19 and AKI, and survival data were recorded. A multivariate regression analysis was performed to study factors related to RRT and mortality. Results Data from 730 patients were recorded. A total of 71.9% were men, with a mean age of 70 years (60-78), 70.1% were hypertensive, 32.9% diabetic, 33.3% with cardiovascular disease and 23.9% had some degree of chronic kidney disease (CKD). Pneumonia was diagnosed in 94.6%, requiring ventilatory support in 54.2% and admission to the ICU in 44.1% of cases.The median time from the onset of COVID-19 symptoms to the appearance of AKI (37.1% KDIGO I, 18.3% KDIGO II, 44.6% KDIGO III) was 6 days (4-10). A total of 235 (33.9%) patients required RRT: 155 patients with continuous renal replacement therapy, 89 alternate-day dialysis, 36 daily dialysis, 24 extended hemodialysis and 17 patients with hemodiafiltration. Smoking habit (OR 3.41), ventilatory support (OR 20.2), maximum creatinine value (OR 2.41) and time to AKI onset (OR 1.13) were predictors of the need for RRT; age was a protective factor (0.95). The group without RRT was characterized by older age, less severe AKI, shorter kidney injury onset and recovery time (p < 0.05). 38.6% of patients died during hospitalization; serious AKI and RRT were more frequent in the death group. In the multivariate analysis, age (OR 1.03), previous chronic kidney disease (OR 2.21), development of pneumonia (OR 2.89), ventilatory support (OR 3.34) and RRT (OR 2.28) were predictors of mortality while chronic treatment with ARBs was identified as a protective factor (OR 0.55). Conclusions Patients with AKI during hospitalization for COVID-19 had a high mean age, comorbidities and severe infection. We defined two different clinical patterns: an AKI of early onset, in older patients that resolves in a few days without the need for RRT; and another more severe pattern, with greater need for RRT, and late onset, which was related to greater severity of the infectious disease. The severity of the infection, age and the presence of CKD prior to admission were identified as risk factors for mortality in these patients. In addition chronic treatment with ARBs was identified as a protective factor for mortality.
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Affiliation(s)
- Mercedes Salgueira
- Unidad de Nefrología, Hospital Universitario Virgen Macarena, Sevilla, España
| | - Marina Almenara
- Unidad de Nefrología, Hospital Universitario Virgen Macarena, Sevilla, España
| | | | - Lara Belmar
- Unidad de Nefrología, Hospital Universitario Marqués de Valdecilla, Santander, España
| | - Pedro Jesús Labrador
- Unidad de Nefrología, Complejo Hospitalario Universitario de Cáceres, Cáceres, España
| | - Rosa Melero
- Unidad de Nefrología, Hospital General Universitario Gregorio Marañón, Madrid, España
| | - María Luisa Serrano
- Unidad de Nefrología, Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, España
| | - José María Portolés
- Unidad de Nefrología, Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, España
| | - Alicia Molina
- Unidad de Nefrología, Hospital Clinic, Barcelona, España
| | - Esteban Poch
- Unidad de Nefrología, Hospital Clinic, Barcelona, España
| | - Natalia Ramos
- Unidad de Nefrología, Hospital Vall d'Hebron, Barcelona, España
| | | | - Rocío Echarri
- Unidad de Nefrología, Hospital Universitario Infanta Sofía, Madrid, España
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Teng L, Chang W. The Investigation of Kidney Involvement in 430 Hospitalized Patients with Omicron COVID-19 in Tianjin, China. Blood Purif 2023; 52:437-445. [PMID: 36657422 PMCID: PMC9893007 DOI: 10.1159/000528734] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Accepted: 12/15/2022] [Indexed: 01/20/2023]
Abstract
INTRODUCTION This study evaluated the incidence, clinical characteristics, and risk factors of kidney involvement in patients with the Omicron variant infection in the post-acute treatment phase in Tianjin, China. METHODS Data were collected from 430 patients with Omicron variant infection in Tianjin, China. Demographics, comorbidities, laboratory blood tests, urinalysis, vaccination status, and COVID-19 clinical classification were assessed. Patients were grouped based on kidney involvement, and associated risk factors of kidney involvement were also investigated. RESULTS Asymptomatic, mild, ordinary, and severe patients with Omicron COVID-19 variant comprised 1.5%, 49.1%, 48.9%, and 0.5% of the sample population, respectively, without critical illness or death. The incidences of hematuria, proteinuria, and concurrent hematuria and proteinuria were 14.7%, 14.2%, and 5.1%, respectively. Patients with and without kidney involvement differed in age, body mass index (BMI), comorbidity, creatinine levels, estimated glomerular filtration rate, and C-reactive protein (CRP) levels. Age, hypertension, higher CRP levels, and higher BMI were linked with kidney involvement. CONCLUSION The majority of the patients suffered from mild or ordinary symptoms of Omicron COVID-19 infection. The primary kidney involvement was hematuria and proteinuria. Proteinuria was significantly associated with Omicron variant infection, and patients with hypertensive comorbidity, higher CRP, and higher creatinine levels were at increased risk of proteinuria after Omicron variant infection.
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Affiliation(s)
- Lanbo Teng
- Department of Nephrology, Tianjin First Central Hospital, Tianjin, China
- Key Laboratory of Critical Care Emergency Medicine of National Health Commission, Tianjin, China
| | - Wenxiu Chang
- Department of Nephrology, Tianjin First Central Hospital, Tianjin, China
- Key Laboratory of Critical Care Emergency Medicine of National Health Commission, Tianjin, China
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Silva AVBDA, Campanati JDEAG, Barcelos IDES, Santos ACL, Deus UPDE, Soares TDEJ, Amaral LSDEB. COVID-19 and Acute Kidney Injury - Direct and Indirect Pathophysiological Mechanisms Underlying Lesion Development. AN ACAD BRAS CIENC 2022; 94:e20211501. [PMID: 36477239 DOI: 10.1590/0001-3765202220211501] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Accepted: 03/08/2022] [Indexed: 11/29/2022] Open
Abstract
COVID-19 is a pandemic disease caused by the SARS-CoV-2 (Severe Acute Respiratory Syndrome Coronavirus 2) responsible for millions of deaths worldwide. Although the respiratory system is the main target of COVID-19, the disease can affect other organs, including the kidneys. Acute Kidney Injury (AKI), commonly seen in patients infected with COVID-19, has a multifactorial cause. Several studies associate this injury with the direct involvement of the virus in renal cells and the indirect damage stimulated by the infection. The direct cytopathic effects of SARS-CoV-2 are due to the entry and replication of the virus in renal cells, changing several regulatory pathways, especially the renin-angiotensin-aldosterone system (RAAS), with repercussions on the kallikrein-kinin system (KKS). Furthermore, the virus can deregulate the immune system, leading to an exaggerated response of inflammatory cells, characterizing the state of hypercytokinemia. The such exaggerated inflammatory response is commonly associated with hemodynamic changes, reduced renal perfusion, tissue hypoxia, generation of reactive oxygen species (ROS), endothelial damage, and coagulopathies, which can result in severe damage to the renal parenchyma. Thereby, understanding the molecular mechanisms and pathophysiology of kidney injuries induced by SARS-COV-2 is of fundamental importance to obtaining new therapeutic insights for the prevention and management of AKI.
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Affiliation(s)
- Antônio V B DA Silva
- Universidade Federal da Bahia, Instituto Multidisciplinar em Saúde, 45029-094 Vitória da Conquista, BA, Brazil
| | - João DE A G Campanati
- Universidade Federal da Bahia, Instituto Multidisciplinar em Saúde, 45029-094 Vitória da Conquista, BA, Brazil
| | - Isadora DE S Barcelos
- Universidade Federal da Bahia, Instituto Multidisciplinar em Saúde, 45029-094 Vitória da Conquista, BA, Brazil
| | - Alberto C L Santos
- Universidade Federal da Bahia, Instituto Multidisciplinar em Saúde, 45029-094 Vitória da Conquista, BA, Brazil
| | - Uildson P DE Deus
- Universidade Federal da Bahia, Instituto Multidisciplinar em Saúde, 45029-094 Vitória da Conquista, BA, Brazil
| | - Telma DE J Soares
- Universidade Federal da Bahia, Instituto Multidisciplinar em Saúde, 45029-094 Vitória da Conquista, BA, Brazil
| | - Liliany S DE B Amaral
- Universidade Federal da Bahia, Instituto Multidisciplinar em Saúde, 45029-094 Vitória da Conquista, BA, Brazil
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Aguilar-Andino D, Umaña AN, Alas-Pineda C, Santos FM, Gómez AC, Soto MM, Osorio AL. Clinical features, coagulation and inflammatory biomarkers associated with poor in-hospital outcomes in a Honduran population with RT-PCR confirmed COVID-19. THROMBOSIS UPDATE 2022; 9:100124. [PMID: 38620940 PMCID: PMC9529676 DOI: 10.1016/j.tru.2022.100124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2022] [Revised: 08/14/2022] [Accepted: 10/03/2022] [Indexed: 12/15/2022] Open
Abstract
Background SARS-COV-2, in most cases, only generates a mild acute respiratory disease. However, patients with severe disease show an exaggerated response of the immune system, creating a pro-inflammatory state, which could cause abnormalities in the coagulation system that increases mortality. Latin American countries, specially those with limited resources, have few studies about clinical features, coagulation and inflammatory biomarkers that could be useful at admission to assess poor outcomes. Objective The objective of this study is to describe the clinical features, coagulation, and inflammatory biomarkers, and identify risk factors at admission that are associated poor outcomes in Honduran population. Methods A cohort study was conducted. 210 patients were included, which 105 died during hospitalization due to COVID-19 and 105 were discharged alive, between September 2020 and January 2021. Clinical and laboratorial data was retrospectively collected. Results 57,6% of the population were male. The median age was 58 years. The median time between symptom onset and hospital admission was 6 days. D-dimer median was higher in the dead group compared with the alive group. Poor prognosis factors in the Cox multivariable model were male gender, age, symptom's duration, obesity and an elevated d dimer at admission. Conclusion In low-middle income countries, the assessment of these clinical and laboratory tools, especially in those with risk factors for prothrombotic states, could help clinicians to correctly stratify disease prognosis, establish a baseline to evaluate further evolution, and also predict outcomes, thus improving patient management.
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Affiliation(s)
- David Aguilar-Andino
- Departamento de Epidemiologia, Hospital General Dr. Mario Catarino Rivas, San Pedro Sula, Honduras
- Departamento de Medicina, Universidad Nacional Autónoma de Honduras, San Pedro Sula, Honduras
| | - Andrea N Umaña
- Facultad de Medicina y Cirugía, Universidad Católica de Honduras, Campus San Pedro y San Pablo, Honduras
| | - César Alas-Pineda
- Departamento de Epidemiologia, Hospital General Dr. Mario Catarino Rivas, San Pedro Sula, Honduras
- Facultad de Medicina y Cirugía, Universidad Católica de Honduras, Campus San Pedro y San Pablo, Honduras
| | - Freddy Medina Santos
- Departamento de Medicina Interna, Hospital General Dr. Mario Catarino Rivas, San Pedro Sula, Honduras
| | - Alejandro Cárcamo Gómez
- Departamento de Medicina Interna, Hospital General Dr. Mario Catarino Rivas, San Pedro Sula, Honduras
| | - Marco Molina Soto
- Departamento de Medicina Interna, Hospital General Dr. Mario Catarino Rivas, San Pedro Sula, Honduras
| | - Ana Liliam Osorio
- Departamento de Medicina Interna, Hospital General Dr. Mario Catarino Rivas, San Pedro Sula, Honduras
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Tarragón B, Valdenebro M, Serrano ML, Portoles J. We must evaluate the previous kidney damage in the acute kidney failure due to COVID-19. Nefrologia 2022; 42:615-616. [PMID: 36669951 PMCID: PMC9841070 DOI: 10.1016/j.nefroe.2021.06.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Accepted: 06/20/2021] [Indexed: 06/17/2023] Open
Affiliation(s)
- Blanca Tarragón
- Servicio de Nefrología, Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, Spain
| | - María Valdenebro
- Servicio de Nefrología, Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, Spain
| | - Maria Luisa Serrano
- Servicio de Nefrología, Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, Spain
| | - Jose Portoles
- Servicio de Nefrología, Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, Spain.
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Tarragón B, Valdenebro M, Serrano ML, Portolés J. [We must evaluate the previous kidney damage in the acute kidney failure due to COVID-19]. Nefrologia 2022; 42:615-616. [PMID: 34391610 PMCID: PMC8358131 DOI: 10.1016/j.nefro.2021.06.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Affiliation(s)
- Blanca Tarragón
- Servicio de Nefrología, Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, España
| | - María Valdenebro
- Servicio de Nefrología, Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, España
| | - Maria Luisa Serrano
- Servicio de Nefrología, Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, España
| | - Jose Portolés
- Servicio de Nefrología, Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, España
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Chávez-Valencia V, Orizaga-de-la-Cruz C, Lagunas-Rangel FA. Acute Kidney Injury in COVID-19 Patients: Pathogenesis, Clinical Characteristics, Therapy, and Mortality. Diseases 2022; 10:diseases10030053. [PMID: 35997358 PMCID: PMC9397016 DOI: 10.3390/diseases10030053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Revised: 08/12/2022] [Accepted: 08/16/2022] [Indexed: 01/08/2023] Open
Abstract
Coronavirus disease 2019 (COVID-19) is a disease caused by infection with the SARS-CoV-2 virus and has represented one of the greatest challenges humanity has faced in recent years. The virus can infect a large number of organs, including the lungs and upper respiratory tract, brain, liver, kidneys, and intestines, among many others. Although the greatest damage occurs in the lungs, the kidneys are not exempt, and acute kidney injury (AKI) can occur in patients with COVID-19. Indeed, AKI is one of the most frequent and serious organic complications of COVID-19. The incidence of COVID-19 AKI varies widely, and the exact mechanisms of how the virus damages the kidney are still unknown. For this reason, the purpose of this review was to assess current findings on the pathogenesis, clinical features, therapy, and mortality of COVID-19 AKI.
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Affiliation(s)
- Venice Chávez-Valencia
- Department of Nephrology, Hospital General Regional Hospital No. 1, Instituto Mexicano del Seguro Social, Bosque de los Olivos No. 101. Av. La Goleta Mpo. Charo, Morelia 61301, Mexico
- Correspondence: (V.C.-V.); (F.A.L.-R.)
| | - Citlalli Orizaga-de-la-Cruz
- Department of Nephrology, Hospital General Regional Hospital No. 1, Instituto Mexicano del Seguro Social, Bosque de los Olivos No. 101. Av. La Goleta Mpo. Charo, Morelia 61301, Mexico
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Radulescu D, Tuta LA, David C, Bogeanu C, Onofrei SD, Stepan E, Cuiban E, Ciofalca A, Feier LF, Pana C, Nutu MC, Vacaroiu IA. Acute kidney injury in moderate and severe COVID-19 patients: Report of two university hospitals. Exp Ther Med 2022; 23:37. [PMID: 34849152 PMCID: PMC8613528 DOI: 10.3892/etm.2021.10959] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Accepted: 09/20/2021] [Indexed: 12/15/2022] Open
Abstract
Acute kidney injury (AKI) is one of the most severe complications of SARS-CoV-2 infection. In a retrospective study, we aimed to describe the influence of COVID-19-related factors on the severity, outcome and timing of AKI in 268 patients admitted in two large COVID-19-designated university hospitals over a period of 6 months. In the univariate analysis, there was a significant relationship between KDIGO stage and the extension of COVID-19 pneumonia on computed tomography (CT), need for oxygen supplementation, serum levels of ferritin, interleukin-6, and procalcitonin, but none of these variables had a value for predicting KDIGO stage in multinomial regression. The odds of recovery of renal function were significantly diminished by d-dimer values. Lack of immunomodulatory treatment was found to be correlated with increased need for renal replacement therapy (RRT). Compared with AKI at admission, hospital-acquired AKI was predicted by the severity of lung damage on CT, evolved more frequently with incomplete recovery of renal function, and was significantly associated with antiviral therapy.
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Affiliation(s)
- Daniela Radulescu
- Clinical Department No. 3, ‘Carol Davila’ University of Medicine and Pharmacy, 050474 Bucharest, Romania
- Department of Nephrology and Dialysis, ‘Sf. Ioan’ Emergency Clinical Hospital, 421422 Bucharest, Romania
| | - Liliana-Ana Tuta
- Faculty of Medicine, ‘Ovidius’ University, 900470 Constanta, Romania
- Department of Nephrology, ‘Sf. Apostol Andrei’ Emergency Clinical Hospital, 900591 Constanta, Romania
| | - Cristiana David
- Clinical Department No. 3, ‘Carol Davila’ University of Medicine and Pharmacy, 050474 Bucharest, Romania
- Department of Nephrology and Dialysis, ‘Sf. Ioan’ Emergency Clinical Hospital, 421422 Bucharest, Romania
| | - Carmen Bogeanu
- Clinical Department No. 3, ‘Carol Davila’ University of Medicine and Pharmacy, 050474 Bucharest, Romania
- Department of Nephrology and Dialysis, ‘Sf. Ioan’ Emergency Clinical Hospital, 421422 Bucharest, Romania
| | - Simona Daniela Onofrei
- Clinical Department No. 3, ‘Carol Davila’ University of Medicine and Pharmacy, 050474 Bucharest, Romania
- Department of Nephrology and Dialysis, ‘Sf. Ioan’ Emergency Clinical Hospital, 421422 Bucharest, Romania
| | - Elena Stepan
- Department of Nephrology and Dialysis, ‘Sf. Ioan’ Emergency Clinical Hospital, 421422 Bucharest, Romania
| | - Elena Cuiban
- Department of Nephrology and Dialysis, ‘Sf. Ioan’ Emergency Clinical Hospital, 421422 Bucharest, Romania
| | - Andreea Ciofalca
- Department of Nephrology and Dialysis, ‘Sf. Ioan’ Emergency Clinical Hospital, 421422 Bucharest, Romania
| | - Larisa Florina Feier
- Department of Nephrology and Dialysis, ‘Sf. Ioan’ Emergency Clinical Hospital, 421422 Bucharest, Romania
| | - Camelia Pana
- Faculty of Medicine, ‘Ovidius’ University, 900470 Constanta, Romania
- Department of Nephrology, ‘Sf. Apostol Andrei’ Emergency Clinical Hospital, 900591 Constanta, Romania
| | - Magda-Cristina Nutu
- Faculty of Medicine, ‘Ovidius’ University, 900470 Constanta, Romania
- Department of Nephrology, ‘Sf. Apostol Andrei’ Emergency Clinical Hospital, 900591 Constanta, Romania
| | - Ileana Adela Vacaroiu
- Clinical Department No. 3, ‘Carol Davila’ University of Medicine and Pharmacy, 050474 Bucharest, Romania
- Department of Nephrology and Dialysis, ‘Sf. Ioan’ Emergency Clinical Hospital, 421422 Bucharest, Romania
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Rebaza-Mateo A, Yarasca-Moreno F, Tataje-Lavanda L. Appreciation of acute kidney failure in patients with COVID-19 infection. Nefrologia 2022; 42:616-617. [PMID: 36681518 PMCID: PMC9841076 DOI: 10.1016/j.nefroe.2021.06.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Accepted: 06/06/2021] [Indexed: 01/19/2023] Open
Affiliation(s)
| | | | - Luis Tataje-Lavanda
- Escuela Profesional de Medicina Humana, Universidad Privada San Juan Bautista Lima, Perú-Filial Ica, Ica, Peru.
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12
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Dutta P, Das S, Fershko A. A Unique Presentation of Acute Kidney Injury With COVID-19. Cureus 2021; 13:e19381. [PMID: 34925984 PMCID: PMC8655043 DOI: 10.7759/cureus.19381] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/08/2021] [Indexed: 11/21/2022] Open
Abstract
Although the respiratory system is the primary target of COVID-19 pneumonia, it can also notably affect the other systemic organs such as renal and cardiac. The incidence and prevalence of SARS CoV-2 associated acute renal failure are emerging day by day. While the pathogenesis is not clearly understood, it is considered multifactorial. Initially, the COVID-19-associated renal dysfunction was limited to acute tubular injury. However, over time a wide spectrum of clinical manifestations has been reported. Therefore, prompt investigation and early initiation of supportive treatment can potentially reduce the mortality and morbidity associated with this systemic disease. In this case report, we present a unique presentation of a COVID-19 with acute kidney injury where the patient was admitted to the intensive care unit with clinical features of acute renal failure with concomitant diagnosis of COVID-19, unlike other reported cases where patients were admitted to the intensive unit with respiratory distress and subsequently developed renal failure.
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Affiliation(s)
| | - Sulagna Das
- Internal Medicine, Kettering Medical Center, Kettering, USA
| | - Adam Fershko
- Internal Medicine, Kettering Medical Center, Dayton, USA
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13
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Gameiro J, Fonseca JA, Oliveira J, Marques F, Bernardo J, Costa C, Carreiro C, Braz S, Lopes JA. Acute kidney injury in hospitalized patients with COVID-19: A Portuguese cohort. Nefrologia 2021; 41:689-698. [PMID: 36165158 PMCID: PMC8800378 DOI: 10.1016/j.nefroe.2022.01.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2020] [Accepted: 04/18/2021] [Indexed: 06/16/2023] Open
Abstract
INTRODUCTION The incidence of acute kidney injury (AKI) in coronavirus disease 2019 (COVID-19) patients ranges from 0.5% to 35% and has been associated with worse prognosis. The purpose of this study was to evaluate the incidence, severity, duration, risk factors and prognosis of AKI in hospitalized patients with COVID-19. METHODS We conducted a retrospective single-center analysis of 192 hospitalized COVID-19 patients from March to May of 2020. AKI was diagnosed using the Kidney Disease Improving Global Outcome (KDIGO) classification based on serum creatinine (SCr) criteria. Persistent and transient AKI were defined according to the Acute Disease Quality Initiative (ADQI) workgroup definitions. RESULTS In this cohort of COVID-19 patients, 55.2% developed AKI (n=106). The majority of AKI patients had persistent AKI (n=64, 60.4%). Overall, in-hospital mortality was 18.2% (n=35) and was higher in AKI patients (28.3% vs. 5.9%, p<0.001, unadjusted OR 6.03 (2.22-16.37), p<0.001). In this multivariate analysis, older age (adjusted OR 1.07 (95% CI 1.02-1.11), p=0.004), lower Hb level (adjusted OR 0.78 (95% CI 0.60-0.98), p=0.035), duration of AKI (adjusted OR 7.34 for persistent AKI (95% CI 2.37-22.72), p=0.001) and severity of AKI (adjusted OR 2.65 per increase in KDIGO stage (95% CI 1.32-5.33), p=0.006) were independent predictors of mortality. CONCLUSION AKI was frequent in hospitalized patients with COVID-19. Persistent AKI and higher severity of AKI were independent predictors of in-hospital mortality.
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Affiliation(s)
- Joana Gameiro
- Division of Nephrology and Renal Transplantation, Department of Medicine, Centro Hospitalar Lisboa Norte, EPE, Av. Prof. Egas Moniz, 1649-035 Lisboa, Portugal.
| | - José Agapito Fonseca
- Division of Nephrology and Renal Transplantation, Department of Medicine, Centro Hospitalar Lisboa Norte, EPE, Av. Prof. Egas Moniz, 1649-035 Lisboa, Portugal
| | - João Oliveira
- Division of Nephrology and Renal Transplantation, Department of Medicine, Centro Hospitalar Lisboa Norte, EPE, Av. Prof. Egas Moniz, 1649-035 Lisboa, Portugal
| | - Filipe Marques
- Division of Nephrology and Renal Transplantation, Department of Medicine, Centro Hospitalar Lisboa Norte, EPE, Av. Prof. Egas Moniz, 1649-035 Lisboa, Portugal
| | - João Bernardo
- Division of Nephrology and Renal Transplantation, Department of Medicine, Centro Hospitalar Lisboa Norte, EPE, Av. Prof. Egas Moniz, 1649-035 Lisboa, Portugal
| | - Claudia Costa
- Division of Nephrology and Renal Transplantation, Department of Medicine, Centro Hospitalar Lisboa Norte, EPE, Av. Prof. Egas Moniz, 1649-035 Lisboa, Portugal
| | - Carolina Carreiro
- Department of Medicine, Centro Hospitalar Lisboa Norte, EPE, Av. Prof. Egas Moniz, 1649-035 Lisboa, Portugal
| | - Sandra Braz
- Department of Medicine, Centro Hospitalar Lisboa Norte, EPE, Av. Prof. Egas Moniz, 1649-035 Lisboa, Portugal
| | - José António Lopes
- Division of Nephrology and Renal Transplantation, Department of Medicine, Centro Hospitalar Lisboa Norte, EPE, Av. Prof. Egas Moniz, 1649-035 Lisboa, Portugal
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14
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Genovesi S, Rebora P, Occhino G, Rossi E, Maloberti A, Belli M, Bonfanti P, Giannattasio C, Rossetti C, Epis OM, Ughi N, Valsecchi MG. Atrial Fibrillation and Clinical Outcomes in a Cohort of Hospitalized Patients with Sars-Cov-2 Infection and Chronic Kidney Disease. J Clin Med 2021; 10:4108. [PMID: 34575219 PMCID: PMC8468274 DOI: 10.3390/jcm10184108] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Revised: 08/30/2021] [Accepted: 09/10/2021] [Indexed: 02/01/2023] Open
Abstract
The aim of the study was to investigate the role of chronic kidney disease (CKD) on in-hospital mortality and on incident atrial fibrillation (AF) in patients infected with SARS-CoV-2. The incidence of acute kidney injury (AKI) was also investigated. Multivariable regression models were used to assess the association between renal function groups (estimated Glomerular Filtration Rate, eGFR, >60 mL/min, 30-59 mL/min, <30 mL/min) and in-hospital all-cause mortality and incident AF and AKI. A cohort of 2816 patients admitted in one year for COVID-19 disease in two large hospitals was analyzed. The independent predictors of mortality were severe CKD [HR 1.732 (95%CI 1.264-2.373)], older age [HR 1.054 (95%CI 1.044-1.065)], cerebrovascular disease [HR 1.335 (95%CI (1.016-1.754)], lower platelet count [HR 0.997 (95%CI 0.996-0.999)], higher C-reactive protein [HR 1.047 (95%CI 1.035-1.058)], and higher plasma potassium value 1.374 (95%CI 1.139-1.658). When incident AKI was added to the final survival model, it was associated with higher mortality [HR 2.202 (1.728-2.807)]. Incident AF was more frequent in patients with CKD, but in the multivariable model only older age was significantly related with a higher incidence of AF [OR 1.036 (95%CI 1.022-1.050)]. Incident AF was strongly associated with the onset of AKI [HR 2.619 (95%CI 1.711-4.009)]. In this large population of COVID-19 patients, the presence of severe CKD was an independent predictor of in-hospital mortality. In addition, patients who underwent AKI during hospitalization had a doubled risk of death. Incident AF became more frequent as eGFR decreased and it was significantly associated with the onset of AKI.
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Affiliation(s)
- Simonetta Genovesi
- School of Medicine and Surgery, Milano-Bicocca University, 20126 Milan, Italy; (A.M.); (M.B.); (P.B.)
- Cardiology Unit, Istituto Auxologico Italiano, IRCCS, 20100 Milan, Italy
| | - Paola Rebora
- Bicocca Bioinformatics Biostatistics and Bioimaging Centre—B4, School of Medicine and Surgery, Milano-Bicocca University, 20126 Milan, Italy; (P.R.); (G.O.); (E.R.); (M.G.V.)
| | - Giuseppe Occhino
- Bicocca Bioinformatics Biostatistics and Bioimaging Centre—B4, School of Medicine and Surgery, Milano-Bicocca University, 20126 Milan, Italy; (P.R.); (G.O.); (E.R.); (M.G.V.)
| | - Emanuela Rossi
- Bicocca Bioinformatics Biostatistics and Bioimaging Centre—B4, School of Medicine and Surgery, Milano-Bicocca University, 20126 Milan, Italy; (P.R.); (G.O.); (E.R.); (M.G.V.)
| | - Alessandro Maloberti
- School of Medicine and Surgery, Milano-Bicocca University, 20126 Milan, Italy; (A.M.); (M.B.); (P.B.)
- Cardiology 4, ASST GOM Niguarda Hospital, 20162 Milan, Italy;
| | - Michele Belli
- School of Medicine and Surgery, Milano-Bicocca University, 20126 Milan, Italy; (A.M.); (M.B.); (P.B.)
| | - Paolo Bonfanti
- School of Medicine and Surgery, Milano-Bicocca University, 20126 Milan, Italy; (A.M.); (M.B.); (P.B.)
- Department of Infectious Diseases, San Gerardo Hospital, 20900 Monza, Italy
| | - Cristina Giannattasio
- Cardiology 4, ASST GOM Niguarda Hospital, 20162 Milan, Italy;
- Department of Infectious Diseases, San Gerardo Hospital, 20900 Monza, Italy
| | - Claudio Rossetti
- Nuclear Medicine, ASST GOM Niguarda Ca’ Granda, 20162 Milan, Italy;
| | - Oscar Massimiliano Epis
- Division of Rheumatology, Multispecialist Medical Department, ASTT GOM Niguarda Ca’ Granda, 20162 Milan, Italy; (O.M.E.); (N.U.)
| | - Nicola Ughi
- Division of Rheumatology, Multispecialist Medical Department, ASTT GOM Niguarda Ca’ Granda, 20162 Milan, Italy; (O.M.E.); (N.U.)
| | - Maria Grazia Valsecchi
- Bicocca Bioinformatics Biostatistics and Bioimaging Centre—B4, School of Medicine and Surgery, Milano-Bicocca University, 20126 Milan, Italy; (P.R.); (G.O.); (E.R.); (M.G.V.)
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15
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Rebaza-Mateo A, Yarasca-Moreno F, Tataje-Lavanda L. [Appreciation of acute kidney failure in patients with COVID-19 infection]. Nefrologia 2021; 42:616-617. [PMID: 34177030 PMCID: PMC8220940 DOI: 10.1016/j.nefro.2021.06.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Affiliation(s)
- Alfredo Rebaza-Mateo
- Escuela Profesional de Medicina Humana, Universidad Privada San Juan Bautista Lima, Perú-Filial Ica, Ica, Perú
| | - Fernando Yarasca-Moreno
- Escuela Profesional de Medicina Humana, Universidad Privada San Juan Bautista Lima, Perú-Filial Ica, Ica, Perú
| | - Luis Tataje-Lavanda
- Escuela Profesional de Medicina Humana, Universidad Privada San Juan Bautista Lima, Perú-Filial Ica, Ica, Perú
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16
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Gameiro J, Fonseca JA, Oliveira J, Marques F, Bernardo J, Costa C, Carreiro C, Braz S, Lopes JA. Acute kidney injury in hospitalized patients with COVID-19: A Portuguese cohort. Nefrologia 2021; 41:S0211-6995(21)00097-7. [PMID: 34112531 PMCID: PMC8120482 DOI: 10.1016/j.nefro.2021.04.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2020] [Revised: 04/09/2021] [Accepted: 04/18/2021] [Indexed: 01/08/2023] Open
Abstract
INTRODUCTION The incidence of acute kidney injury (AKI) in coronavirus disease 2019 (COVID-19) patients ranges from 0.5% to 35% and has been associated with worse prognosis. The purpose of this study was to evaluate the incidence, severity, duration, risk factors and prognosis of AKI in hospitalized patients with COVID-19. METHODS We conducted a retrospective single-center analysis of 192 hospitalized COVID-19 patients from March to May of 2020. AKI was diagnosed using the Kidney Disease Improving Global Outcome (KDIGO) classification based on serum creatinine (SCr) criteria. Persistent and transient AKI were defined according to the Acute Disease Quality Initiative (ADQI) workgroup definitions. RESULTS In this cohort of COVID-19 patients, 55.2% developed AKI (n=106). The majority of AKI patients had persistent AKI (n=64, 60.4%). Overall, in-hospital mortality was 18.2% (n=35) and was higher in AKI patients (28.3% vs. 5.9%, p<0.001, unadjusted OR 6.03 (2.22-16.37), p<0.001). In this multivariate analysis, older age (adjusted OR 1.07 (95% CI 1.02-1.11), p=0.004), lower Hb level (adjusted OR 0.78 (95% CI 0.60-0.98), p=0.035), duration of AKI (adjusted OR 7.34 for persistent AKI (95% CI 2.37-22.72), p=0.001) and severity of AKI (adjusted OR 2.65 per increase in KDIGO stage (95% CI 1.32-5.33), p=0.006) were independent predictors of mortality. CONCLUSION AKI was frequent in hospitalized patients with COVID-19. Persistent AKI and higher severity of AKI were independent predictors of in-hospital mortality.
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Affiliation(s)
- Joana Gameiro
- Division of Nephrology and Renal Transplantation, Department of Medicine, Centro Hospitalar Lisboa Norte, EPE, Av. Prof. Egas Moniz, 1649-035 Lisboa, Portugal.
| | - José Agapito Fonseca
- Division of Nephrology and Renal Transplantation, Department of Medicine, Centro Hospitalar Lisboa Norte, EPE, Av. Prof. Egas Moniz, 1649-035 Lisboa, Portugal
| | - João Oliveira
- Division of Nephrology and Renal Transplantation, Department of Medicine, Centro Hospitalar Lisboa Norte, EPE, Av. Prof. Egas Moniz, 1649-035 Lisboa, Portugal
| | - Filipe Marques
- Division of Nephrology and Renal Transplantation, Department of Medicine, Centro Hospitalar Lisboa Norte, EPE, Av. Prof. Egas Moniz, 1649-035 Lisboa, Portugal
| | - João Bernardo
- Division of Nephrology and Renal Transplantation, Department of Medicine, Centro Hospitalar Lisboa Norte, EPE, Av. Prof. Egas Moniz, 1649-035 Lisboa, Portugal
| | - Claudia Costa
- Division of Nephrology and Renal Transplantation, Department of Medicine, Centro Hospitalar Lisboa Norte, EPE, Av. Prof. Egas Moniz, 1649-035 Lisboa, Portugal
| | - Carolina Carreiro
- Department of Medicine, Centro Hospitalar Lisboa Norte, EPE, Av. Prof. Egas Moniz, 1649-035 Lisboa, Portugal
| | - Sandra Braz
- Department of Medicine, Centro Hospitalar Lisboa Norte, EPE, Av. Prof. Egas Moniz, 1649-035 Lisboa, Portugal
| | - José António Lopes
- Division of Nephrology and Renal Transplantation, Department of Medicine, Centro Hospitalar Lisboa Norte, EPE, Av. Prof. Egas Moniz, 1649-035 Lisboa, Portugal
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17
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Haadi A, Almas T, Nabeel AR, Chan JCY, Al-Awaid AH, Niaz MA. Damage to the waterworks: COVID-19 and the kidneys. Ann Med Surg (Lond) 2021; 64:102223. [PMID: 33747504 PMCID: PMC7959695 DOI: 10.1016/j.amsu.2021.102223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Accepted: 03/10/2021] [Indexed: 11/29/2022] Open
Affiliation(s)
- Abdul Haadi
- RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | - Talal Almas
- RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | | | - Josiah CY. Chan
- RCSI University of Medicine and Health Sciences, Dublin, Ireland
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