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Diniz LRL, Souza MTDS, Duarte ABS, de Sousa DP. Mechanistic Aspects and Therapeutic Potential of Quercetin against COVID-19-Associated Acute Kidney Injury. Molecules 2020; 25:molecules25235772. [PMID: 33297540 PMCID: PMC7730372 DOI: 10.3390/molecules25235772] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Revised: 12/01/2020] [Accepted: 12/03/2020] [Indexed: 02/06/2023] Open
Abstract
The inflammatory mediator and oxidant agent storm caused by the SARS-CoV-2 infection has been strongly associated with the failure of vital organs observed in critically ill patients with coronavirus disease 2019 (COVID-19) and the death of thousands of infected people around the world. Acute kidney injury (AKI) is a common renal disorder characterized by a sudden and sustained decrease in renal function with a critical influence on poor prognosis and lethal clinical outcomes of various etiologies, including some viral infection diseases. It is known that oxidative stress and inflammation play key roles in the pathogenesis and development of AKI. Quercetin is a natural substance that has multiple pharmacological properties, such as anti-inflammatory action, and is used as a dietary supplement. There is evidence of the anti-coronavirus activities of this compound, including against the target SARS-CoV-2 3CLpro. The ability to inhibit coronavirus and its inflammatory processes is strongly desired in a new drug for the treatment of COVID-19. Therefore, in this review, the dual effect of quercetin is discussed from a mechanistic perspective in relation to AKI kidney injury and its nephroprotective potential to SARS-CoV-2 patients.
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Affiliation(s)
- Lúcio Ricardo Leite Diniz
- Department of Nursing, College of Nordeste da Bahia, 48590-000 Coronel João Sá, Bahia, Brazil
- Correspondence: ; Tel.: +55-75-3286-2268
| | | | - Allana Brunna Sucupira Duarte
- Department of Pharmaceutical Sciences, Federal University of Paraíba, 58051-970 João Pessoa, PB, Brazil; (A.B.S.D.); (D.P.d.S.)
| | - Damião Pergentino de Sousa
- Department of Pharmaceutical Sciences, Federal University of Paraíba, 58051-970 João Pessoa, PB, Brazil; (A.B.S.D.); (D.P.d.S.)
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Guo H, Liu J, Pu L, Hao J, Yin N, Liu Y, Xiong H, Li A. Continuous renal replacement therapy in patients with HIV/AIDS. BMC Nephrol 2020; 21:95. [PMID: 32160882 PMCID: PMC7066780 DOI: 10.1186/s12882-020-01754-4] [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: 12/17/2019] [Accepted: 02/28/2020] [Indexed: 11/28/2022] Open
Abstract
Background Acute kidney injury (AKI) is a common complication among human immunodeficiency virus (HIV)-infected patients resulting in increased morbidity and mortality. Continuous renal replacement therapy (CRRT) is a useful method and instrument in critically ill patients with fluid overload and metabolic disarray, especially in those who are unable to tolerate the intermittent hemodialysis. However, the epidemiology, influence factors of CRRT and mortality in patients with HIV/AIDS are still unclear in China. This study aims to study the HIV-infected patients admitted in Intensive Care Unit (ICU) and explore the influence factors correlated with CRRT and their prognosis. Methods We performed a retrospective case-control study in the ICU of the Beijing Ditan Hospital Capital Medical University. From June 1, 2005 to May 31, 2017, 225 cases were enrolled in this clinical study. Results 122 (54.2%) patients were diagnosed with AKI during their stay in ICU, the number and percentage of AKI stage 1, 2 and 3 were 38 (31.1%), 21(17.2%) and 63(51.7%), respectively. 26.2% of AKI patients received CRRT during the stay of ICU. 56.25% CRRT patients died in ICU. The 28-day mortality was 62.5%, and the 90-day mortality was 75%. By univariate logistics analysis, it showed that higher likelihood of diagnosis for respiratory failure (OR = 7.333,95% CI 1.467–36.664, p = 0.015), higher likelihood of diagnosis for septic shock (OR = 1.005,95% CI 1.001–1.01, p = 0.018), and higher likelihood to use vasoactive agents (OR = 10.667,95% CI 1.743–65.271, p = 0.001), longer mechanical ventilation duration (OR = 1.011,95% CI 1.002–1.019, p = 0.011), higher likelihood for diagnosis for PCP (OR = 7.50,95% CI 1.288–43.687, p = 0.025), higher SOFA score at ICU admission (OR = 1.183,95% CI 1.012–1.383, p = 0.035), longer duration of CRRT (OR = 1.014,95% CI 1.001–1.028, p = 0.034) contributed to a higher mortality at ICU. The Cox Analysis for the cumulative survival of AKI 3 patients between the CRRT and non-CRRT groups shows no significant differences (p = 0.595). Conclusions There is a high incidence of AKI in HIV-infected patients admitted in our ICU. Patients with severe AKI were more prone to be admitted for CRRT and have a consequent poor prognosis.
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Affiliation(s)
- Hebing Guo
- Department of Critical Care Medicine, Beijing Ditan Hospital, Capital Medical University, No. 8 Jingshundong Street, Beijing, 100015, Chaoyang District, China
| | - Jingyuan Liu
- Department of Critical Care Medicine, Beijing Ditan Hospital, Capital Medical University, No. 8 Jingshundong Street, Beijing, 100015, Chaoyang District, China
| | - Lin Pu
- Department of Critical Care Medicine, Beijing Ditan Hospital, Capital Medical University, No. 8 Jingshundong Street, Beijing, 100015, Chaoyang District, China
| | - Jingjing Hao
- Department of Critical Care Medicine, Beijing Ditan Hospital, Capital Medical University, No. 8 Jingshundong Street, Beijing, 100015, Chaoyang District, China
| | - Ningning Yin
- Department of Critical Care Medicine, Beijing Ditan Hospital, Capital Medical University, No. 8 Jingshundong Street, Beijing, 100015, Chaoyang District, China
| | - Yufeng Liu
- Department of Critical Care Medicine, Beijing Ditan Hospital, Capital Medical University, No. 8 Jingshundong Street, Beijing, 100015, Chaoyang District, China
| | - Haofeng Xiong
- Department of Critical Care Medicine, Beijing Ditan Hospital, Capital Medical University, No. 8 Jingshundong Street, Beijing, 100015, Chaoyang District, China
| | - Ang Li
- Department of Critical Care Medicine, Beijing Ditan Hospital, Capital Medical University, No. 8 Jingshundong Street, Beijing, 100015, Chaoyang District, China.
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Silva Junior GBD, Parente Filho SLA, Soares DDS, Alencar RDND, Peixoto TTT, Nogueira IS, Oliveira Filho AMPD, Menezes FH, Cavalcante MG, Pires Neto RDJ, Daher EDF. Acute kidney injury and other factors associated with mortality in hiv-infected patients. ACTA ACUST UNITED AC 2018; 64:509-517. [PMID: 30304308 DOI: 10.1590/1806-9282.64.06.509] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2017] [Accepted: 11/02/2017] [Indexed: 11/21/2022]
Abstract
OBJECTIVE HIV-related mortality is still high, especially in developed countries. The aim of this study is to investigate factors associated to death in HIV-infected patients. METHODS This is a cross-sectional study with all HIV adult patients admitted to a tertiary infectious diseases hospital in Fortaleza, Northeast Brazil, from January 2013 to December 2014. Patients were divided into two groups: survivors and non-survivors. Demo-graphical, clinical and laboratory data were compared and a logistic regression was performed in order to investigate risk factors for death. P values ≤0.05 were considered statistically significant. RESULTS A total of 200 patients with mean age of 39 years were including in the study, 69.5% males. Fifteen patients (7.5%) died. Non-survivors presented a higher percentage of males (93.3 vs. 67.3%, p = 0.037). Non-survivors presented AKI (73.3 vs. 10.3%, p < 0.001), liver dysfunction (33.3 vs. 11.5, p = 0.031), dyspnea (73.3 vs. 33.0%, p = 0.002) and disorientation (33.3 vs. 12.4%, p = 0.025) more frequently. Non-survivors also had higher levels of urea (73.8 ± 52.7vs. 36.1 ± 29.1 mg/dL, p < 0.001), creatinine (1.98 ± 1.65 vs. 1.05 ± 1.07 mg/dL, p < 0.001), aspartate aminotransferase (130.8 vs. 84.8 U/L, p = 0.03), alanine aminotransferase (115.6 vs. 85.4 U/L, p = 0.045) and lactate dehydrogenase (LDH) (1208 vs. 608 U/L, p = 0.012), as well as lower levels of bicarbonate (18.0 ± 4.7 vs. 21.6 ± 4.6 mEq/L, p = 0.016) and PCO2 (27.8 ± 7.7 vs. 33.0 ± 9.3 mmHg, p = 0.05). In multivariate analysis, disorientation (p = 0.035, OR = 5.523, 95%CI = 1.130 - 26.998), dyspnoea (p = 0.046, OR = 4.064, 95%CI = 1.028 - 16.073), AKI (p < 0.001, OR = 18.045, 95%CI = 4.308 - 75.596) and disseminated histoplasmosis (p = 0.016, OR = 12.696, 95%CI = 1.618 - 99.646) and LDH > 1000 U/L (p = 0.038, OR = 4.854, 95%CI = 1.093 - 21.739) were risk factors for death.]CONCLUSION: AKI and disseminated histoplasmosis (DH) were the main risk factors for death in the studied population. Neurologic and respiratory impairment as well as higher levels of LDH also increased mortality in HIV-infected patients.
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Affiliation(s)
- Geraldo Bezerra da Silva Junior
- School of Medicine, Public Health and Medical Sciences Post-Graduation Programs, Health Sciences Center, University of Fortaleza. Fortaleza, Ceará, Brasil
| | | | - Douglas de Sousa Soares
- Department of Internal Medicine, School of Medicine, Federal University of Ceará.Fortaleza, Ceará, Brasil
| | | | - Tiago Tomaz Teles Peixoto
- Department of Internal Medicine, School of Medicine, Federal University of Ceará.Fortaleza, Ceará, Brasil
| | - Isadora Sales Nogueira
- Department of Internal Medicine, School of Medicine, Federal University of Ceará.Fortaleza, Ceará, Brasil
| | | | - Fernanda Holanda Menezes
- Department of Internal Medicine, School of Medicine, Federal University of Ceará.Fortaleza, Ceará, Brasil
| | - Malena Gadelha Cavalcante
- School of Medicine, Medical Sciences and PharmacologyPost-Graduation Programs, Federal University of Ceará. Fortaleza, Ceará, Brasil
| | - Roberto da Justa Pires Neto
- Department of Community Health, Public Health Post-Graduation Program, School of Medicine, Federal University of Ceará. Fortaleza, Ceará, Brasil
| | - Elizabeth de Francesco Daher
- Department of Internal Medicine, School of Medicine, Federal University of Ceará.Fortaleza, Ceará, Brasil.,School of Medicine, Medical Sciences and PharmacologyPost-Graduation Programs, Federal University of Ceará. Fortaleza, Ceará, Brasil
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Cohen SD, Kopp JB, Kimmel PL. Kidney Diseases Associated with Human Immunodeficiency Virus Infection. N Engl J Med 2017; 377:2363-2374. [PMID: 29236630 DOI: 10.1056/nejmra1508467] [Citation(s) in RCA: 59] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- Scott D Cohen
- From the Division of Renal Diseases and Hypertension, Department of Medicine, George Washington University, Washington, DC (S.D.C., P.L.K.); and the National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD (J.B.K., P.L.K.)
| | - Jeffrey B Kopp
- From the Division of Renal Diseases and Hypertension, Department of Medicine, George Washington University, Washington, DC (S.D.C., P.L.K.); and the National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD (J.B.K., P.L.K.)
| | - Paul L Kimmel
- From the Division of Renal Diseases and Hypertension, Department of Medicine, George Washington University, Washington, DC (S.D.C., P.L.K.); and the National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD (J.B.K., P.L.K.)
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Doi A, Iwata K, Hara S, Imai Y, Hasuike T, Nishioka H. Interstitial nephritis caused by HIV infection by itself: a case report. Int J Gen Med 2016; 9:311-4. [PMID: 27621665 PMCID: PMC5012837 DOI: 10.2147/ijgm.s115393] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
Interstitial nephritis is a common cause of renal dysfunction. It is primarily caused by drugs, infections, or autoimmune disorders. Patients with human immunodeficiency virus (HIV) infection can develop interstitial nephritis, although it typically occurs because of the aforementioned etiologies and not as a direct consequence of HIV infection. Interstitial lesions may occur in patients with HIV-associated nephropathy (HIVAN). However, interstitial nephritis without the glomerular injuries characteristic of HIVAN, and without the risk factors described earlier, is very rare. Here, we describe a rare case of interstitial nephritis that was likely caused directly by HIV infection and not by other etiologies.
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Affiliation(s)
- Asako Doi
- Department of Infectious Diseases; Department of General Internal Medicine, Kobe City Medical Center General Hospital
| | | | - Shigeo Hara
- Department of Diagnostic Pathology, Kobe University Hospital
| | - Yukihiro Imai
- Department of Pathology, Kobe City Medical Center General Hospital, Kobe, Hyogo, Japan
| | - Toshikazu Hasuike
- Department of Infectious Diseases; Department of General Internal Medicine, Kobe City Medical Center General Hospital
| | - Hiroaki Nishioka
- Department of Infectious Diseases; Department of General Internal Medicine, Kobe City Medical Center General Hospital
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Perazzo S, Soler-García ÁA, Hathout Y, Das JR, Ray PE. Urinary biomarkers of kidney diseases in HIV-infected children. Proteomics Clin Appl 2015; 9:490-500. [PMID: 25764519 PMCID: PMC4530778 DOI: 10.1002/prca.201400193] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2014] [Revised: 02/01/2015] [Accepted: 03/09/2015] [Indexed: 01/06/2023]
Abstract
A significant number of children infected with the human immunodeficiency virus 1 (HIV-1) virus all over the world are at risk of developing renal diseases that could have a significant impact on their treatment and quality of life. It is necessary to identify children undergoing the early stages of these renal diseases, as well as the potential renal toxicity that could be caused by antiretroviral drugs, in order to prevent the development of cardiovascular complications and chronic renal failure. This article describes the most common renal diseases seen in HIV-infected children, as well as the value and limitations of the clinical markers that are currently being used to monitor their renal function and histological damage in a noninvasive manner. In addition, we discuss the progress made during the last 10 years in the discovery and validation of new renal biomarkers for HIV-infected children and young adults. Although significant progress has been made during the early phases of the biomarkers discovery, more work remains to be done to validate the new biomarkers in a large number of patients. The future looks promising, however, the new knowledge needs to be integrated and validated in the context of the clinical environment where these children are living.
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Affiliation(s)
| | | | | | | | - Patricio E. Ray
- Center for Genetic Medicine Research and Division of Nephrology, Children’s National Medical Center, and Department of Pediatrics, The George Washington University, Washington DC
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Heung M, Koyner JL. Entanglement of Sepsis, Chronic Kidney Disease, and Other Comorbidities in Patients Who Develop Acute Kidney Injury. Semin Nephrol 2015; 35:23-37. [DOI: 10.1016/j.semnephrol.2015.01.004] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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Daher EDF, Junior Silva GBD, Vieira APF, Souza JBD, Falcão FDS, Costa CRD, Fernandes AACDS, Lima RSA. Acute kidney injury in a tropical country: a cohort study of 253 patients in an infectious diseases intensive care unit. Rev Soc Bras Med Trop 2014; 47:86-9. [PMID: 24603743 DOI: 10.1590/0037-8682-0223-2013] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2013] [Accepted: 01/30/2014] [Indexed: 01/31/2023] Open
Abstract
INTRODUCTION Acute kidney injury (AKI) is a frequent and potentially fatal complication in infectious diseases. The aim of this study was to investigate the clinical aspects of AKI associated with infectious diseases and the factors associated with mortality. METHODS This retrospective study was conducted in patients with AKI who were admitted to the intensive care unit (ICU) of a tertiary infectious diseases hospital from January 2003 to January 2012. The major underlying diseases and clinical and laboratory findings were evaluated. RESULTS A total of 253 cases were included. The mean age was 46±16 years, and 72% of the patients were male. The main diseases were human immunodeficiency virus (HIV) infection, HIV/acquired immunodeficiency syndrome (AIDS) (30%), tuberculosis (12%), leptospirosis (11%) and dengue (4%). Dialysis was performed in 70 cases (27.6%). The patients were classified as risk (4.4%), injury (63.6%) or failure (32%). The time between AKI diagnosis and dialysis was 3.6±4.7 days. Oliguria was observed in 112 cases (45.7%). The Acute Physiology and Chronic Health Evaluation (APACHE) II scores were higher in patients with HIV/AIDS (57±20, p-value=0.01) and dengue (68±11, p-value=0.01). Death occurred in 159 cases (62.8%). Mortality was higher in patients with HIV/AIDS (76.6%, p-value=0.02). A multivariate analysis identified the following independent risk factors for death: oliguria, metabolic acidosis, sepsis, hypovolemia, the need for vasoactive drugs, the need for mechanical ventilation and the APACHE II score. CONCLUSIONS AKI is a common complication in infectious diseases, with high mortality. Mortality was higher in patients with HIV/AIDS, most likely due to the severity of immunosuppression and opportunistic diseases.
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Affiliation(s)
- Elizabeth De Fransceco Daher
- Departamento de Medicina Interna, Faculdade de Medicina, Universidade Federal do Ceará, FortalezaCE, Departamento de Medicina Interna, Faculdade de Medicina, Universidade Federal do Ceará, Fortaleza, CE
| | - Geraldo Bezerra da Junior Silva
- Departamento de Medicina Interna, Faculdade de Medicina, Universidade Federal do Ceará, FortalezaCE, Departamento de Medicina Interna, Faculdade de Medicina, Universidade Federal do Ceará, Fortaleza, CE
| | - Ana Patrícia Freitas Vieira
- Departamento de Medicina Interna, Faculdade de Medicina, Universidade Federal do Ceará, FortalezaCE, Departamento de Medicina Interna, Faculdade de Medicina, Universidade Federal do Ceará, Fortaleza, CE
| | - Juliana Bonfim de Souza
- Departamento de Medicina Interna, Faculdade de Medicina, Universidade Federal do Ceará, FortalezaCE, Departamento de Medicina Interna, Faculdade de Medicina, Universidade Federal do Ceará, Fortaleza, CE
| | - Felipe Dos Santos Falcão
- Departamento de Medicina Interna, Faculdade de Medicina, Universidade Federal do Ceará, FortalezaCE, Departamento de Medicina Interna, Faculdade de Medicina, Universidade Federal do Ceará, Fortaleza, CE
| | - Cristiane Rocha da Costa
- Departamento de Medicina Interna, Faculdade de Medicina, Universidade Federal do Ceará, FortalezaCE, Departamento de Medicina Interna, Faculdade de Medicina, Universidade Federal do Ceará, Fortaleza, CE
| | - Anna Allicy Câmara da Silva Fernandes
- Departamento de Medicina Interna, Faculdade de Medicina, Universidade Federal do Ceará, FortalezaCE, Departamento de Medicina Interna, Faculdade de Medicina, Universidade Federal do Ceará, Fortaleza, CE
| | - Rafael Siqueira Athayde Lima
- Departamento de Medicina Interna, Faculdade de Medicina, Universidade Federal do Ceará, FortalezaCE, Departamento de Medicina Interna, Faculdade de Medicina, Universidade Federal do Ceará, Fortaleza, CE
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Lameire NH, Bagga A, Cruz D, De Maeseneer J, Endre Z, Kellum JA, Liu KD, Mehta RL, Pannu N, Van Biesen W, Vanholder R. Acute kidney injury: an increasing global concern. Lancet 2013; 382:170-9. [PMID: 23727171 DOI: 10.1016/s0140-6736(13)60647-9] [Citation(s) in RCA: 654] [Impact Index Per Article: 59.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Despite an increasing incidence of acute kidney injury in both high-income and low-income countries and growing insight into the causes and mechanisms of disease, few preventive and therapeutic options exist. Even small acute changes in kidney function can result in short-term and long-term complications, including chronic kidney disease, end-stage renal disease, and death. Presence of more than one comorbidity results in high severity of illness scores in all medical settings. Development or progression of chronic kidney disease after one or more episode of acute kidney injury could have striking socioeconomic and public health outcomes for all countries. Concerted international action encompassing many medical disciplines is needed to aid early recognition and management of acute kidney injury.
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Kidney disease in children and adolescents with perinatal HIV-1 infection. J Int AIDS Soc 2013; 16:18596. [PMID: 23782479 PMCID: PMC3687339 DOI: 10.7448/ias.16.1.18596] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2013] [Revised: 04/14/2013] [Accepted: 04/16/2013] [Indexed: 12/20/2022] Open
Abstract
Introduction Involvement of the kidney in children and adolescents with perinatal (HIV-1) infection can occur at any stage during the child's life with diverse diagnoses, ranging from acute kidney injury, childhood urinary tract infections (UTIs), electrolyte imbalances and drug-induced nephrotoxicity, to diseases of the glomerulus. The latter include various immune-mediated chronic kidney diseases (CKD) and HIV-associated nephropathy (HIVAN). Discussion The introduction of highly active anti-retroviral therapy (HAART) has dramatically reduced the incidence of HIVAN, once the commonest form of CKD in children of African descent living with HIV, and also altered its prognosis from eventual progression to end-stage kidney disease to one that is compatible with long-term survival. The impact of HAART on the outcome of other forms of kidney diseases seen in this population has not been as impressive. Increasingly important is nephrotoxicity secondary to the prolonged use of anti-retroviral agents, and the occurrence of co-morbid kidney disease unrelated to HIV infection or its treatment. Improved understanding of the molecular pathogenesis and genetics of kidney diseases associated with HIV will result in better screening, prevention and treatment efforts, as HIV specialists and nephrologists coordinate clinical care of these patients. Both haemodialysis (HD) and peritoneal dialysis (PD) are effective as renal replacement therapy in HIV-infected patients with end-stage kidney disease, with PD being preferred in resource-limited settings. Kidney transplantation, once contraindicated in this population, has now become the most effective renal replacement therapy, provided rigorous criteria are met. Given the attendant morbidity and mortality in HIV-infected children and adolescents with kidney disease, routine screening for kidney disease is recommended where resources permit. Conclusions This review focuses on the pathogenesis and genetics, clinical presentation and management of kidney disease in children and adolescents with perinatal HIV-1 infection.
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Clajus C, Kühn-Velten WN, Schmidt JJ, Lorenzen JM, Pietsch D, Beutel G, Kielstein JT. Cotrimoxazole plasma levels, dialyzer clearance and total removal by extended dialysis in a patient with acute kidney injury: risk of under-dosing using current dosing recommendations. BMC Pharmacol Toxicol 2013; 14:19. [PMID: 23551893 PMCID: PMC3626772 DOI: 10.1186/2050-6511-14-19] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2012] [Accepted: 03/20/2013] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Dosing of antibiotics in critically ill patients is challenging. It becomes even more difficult if renal or hepatic impairment ensue. Modern means of renal replacement therapy are capable of removing antibiotics to a higher rate than decades ago, leaving clinicians with a high degree of uncertainty concerning the dose of antibiotics in this patient population. Cotrimoxazole, a combination of trimethoprim (TMP) and sulfamethoxazole (SMX) is frequently used in the treatment of several infections including Pneumocystis jirovecii pneumonia (PCP). CASE PRESENTATION Here we describe a patient with acute kidney injury in which we investigated the TMP and SMX levels during the course of an ICU stay. Cotrimoxazole was administered every six hours i.v. in a dose of TMP/SMX 15/75 mg/kg/day. Extended dialysis was performed with a high-flux dialyzer. Blood samples, as well as pre- and postdialyzer samples and aliquots of the collected spent dialysate were collected.Observed peak concentrations (Cmax) were 7.51 mg/l for TMP and 80.80 mg/l for SMX. Decline of blood levels during extended dialysis (TMP 64%; SMX 84%) was mainly due to removal by the dialysis procedure, illustrated by the high dialyzer clearances (median of 4 extended dialysis sessions: TMP 94.0 / SMX 51.0 ml/min), as well as by the absolute amount of both substances in the collected spent dialysate (median of 6 extended dialysis sessions: TMP 556 mg / SMX 130 mg). Within the limitation of a case report our data from 4 consecutive extended dialysis sessions suggest that this procedure substantially removes both TMP and SMX. CONCLUSIONS Dose reduction, which is usually advocated in patients with acute kidney injury under renal replacement therapy, might lead to significant under-dosing. Pharmacokinetic studies for TMP/SMX dosing in this patient population are necessary to allow adequate dosing.
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Affiliation(s)
- Christian Clajus
- Department of Nephrology and Hypertension, Medical School Hannover, Hannover, Germany
| | | | - Julius J Schmidt
- Department of Nephrology and Hypertension, Medical School Hannover, Hannover, Germany
| | - Johan M Lorenzen
- Department of Nephrology and Hypertension, Medical School Hannover, Hannover, Germany
| | - Daniel Pietsch
- Institute of Clinical Chemistry, Medical School Hannover, Hannover, Germany
| | - Gernot Beutel
- Department of Hematology, Hemostasis, Oncology, and Stem Cell Transplantation, Medical School Hannover, Hannover, Germany
| | - Jan T Kielstein
- Department of Nephrology and Hypertension, Medical School Hannover, Hannover, Germany
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Ulinski T, Sellier-Leclerc AL, Tudorache E, Bensman A, Aoun B. Acute tubulointerstitial nephritis. Pediatr Nephrol 2012; 27:1051-7. [PMID: 21638156 DOI: 10.1007/s00467-011-1915-9] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2011] [Revised: 04/29/2011] [Accepted: 05/04/2011] [Indexed: 12/27/2022]
Abstract
Acute tubulointerstitial nephritis (TIN) is a frequent cause of acute renal failure, characterised by the presence of inflammatory cell infiltrate in the interstitium of the kidney. Immuno-allergic reaction to certain medications, mainly non-steroidal anti-inflammatory drugs and antibiotics are by far the most important etiology for TIN today, but other situations such as infections, toxins, and vasculitis are known to induce TIN. Incidence of TIN is increasing, probably due to prescription habits and NSAID overuse, representing 3-7% of acute kidney injury in biopsies in children. Avoidance of the causal substance and rapid steroid therapy are hallmarks for patient care, but spontaneous initial recovery is very frequent and the general prognosis seems satisfactory. However, development of chronic TIN, without response to steroid or other immunosuppressive treatment, is possible. As the largest part of TIN is secondary to certain drugs, clear indications in particular for NSAID or antibiotics should be respected to reduce the number of TIN cases.
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Affiliation(s)
- Tim Ulinski
- Department of Pediatric Nephrology, Armand Trousseau Hospital (APHP), University Pierre & Marie Curie, Paris 6, 26, Avenue du Docteur Arnold Netter, 75012, Paris, France.
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Melica G, Matignon M, Desvaux D, Audard V, Copie-Bergman C, Lang P, Levy Y, Grimbert P. Acute Interstitial Nephritis With Predominant Plasmacytic Infiltration in Patients With HIV-1 Infection. Am J Kidney Dis 2012; 59:711-4. [DOI: 10.1053/j.ajkd.2011.12.017] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2011] [Accepted: 12/13/2011] [Indexed: 11/11/2022]
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Arendse C, Okpechi I, Swanepoel C. Acute dialysis in HIV-positive patients in Cape Town, South Africa. Nephrology (Carlton) 2011; 16:39-44. [PMID: 21175975 DOI: 10.1111/j.1440-1797.2010.01358.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
AIM The prognosis for HIV patients needing acute dialysis is uncertain. The aim of this study was to describe the clinical presentation, renal diagnoses and outcomes of HIV patients who underwent acute haemodialysis at Groote Schuur Hospital in the period 2002-2007. METHODS A retrospective review of case records of HIV patients who underwent acute haemodialysis was conducted. RESULTS One hundred and seventeen patients were reviewed (median age 34.0 years (29.0-40.0) 53.8% men, 93.2% black Africans) and 33 had a renal biopsy. Acute tubular necrosis (ATN) was diagnosed in 68 patients. Recovery of renal function occurred in 33.3% of all patients while in 25.7% treatment was withdrawn and 41.0% died in hospital. Suspected ATN was the commonest cause of renal disease in those who recovered renal function (82.1%). A higher CD4 count (odds ratio (OR)=0.994, P=0.007), lower pre-dialysis serum creatinine (<1230 µmol/L) and longer hospitalization (OR=0.93, P=0.006) significantly correlated with survival. CONCLUSION There is a good chance of survival for HIV patients needing acute dialysis when the diagnosis is ATN, and when the CD4 count is more than 200 cells/mm3.
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Affiliation(s)
- Craig Arendse
- Nephrology Division, Department of Medicine, Groote Schuur Hospital and University of Cape Town, Cape Town, South Africa.
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Elewa U, Sandri AM, Rizza SA, Fervenza FC. Treatment of HIV-associated nephropathies. Nephron Clin Pract 2011; 118:c346-54; discussion c354. [PMID: 21293158 DOI: 10.1159/000323666] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
In patients with HIV, the use of highly active antiretroviral therapy has improved life expectancy. At the same time, this increase in life expectancy has been associated with a higher frequency of chronic kidney disease due to factors other than HIV infection. Besides HIV-associated nephropathy, a number of different types of immune complex and non-immune complex-mediated processes have been identified on kidney biopsies, including vascular disease (nephrosclerosis), diabetes, and drug-related renal injury. In this setting, renal biopsy needs to be considered in order to obtain the correct diagnosis in individual patients with HIV and kidney impairment. Many issues regarding the optimal treatment of the different pathological processes affecting the kidneys of these patients have remained unresolved. Further research is needed in order to optimize treatment and renal outcomes in patients with HIV and kidney disease.
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Affiliation(s)
- Usama Elewa
- New Kasr Al-Aini Teaching Hospital, Cairo University, Cairo, Egypt
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Silva Júnior GB, Libório AB, Mota RMS, Abreu KLS, Silva AEB, Araújo SMHA, Daher EF. Acute kidney injury in AIDS: frequency, RIFLE classification and outcome. Braz J Med Biol Res 2010; 43:1102-8. [PMID: 20922270 DOI: 10.1590/s0100-879x2010007500100] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2010] [Accepted: 09/21/2010] [Indexed: 02/07/2023] Open
Abstract
The objective of the present study was to evaluate the characteristics of acute kidney injury (AKI) in AIDS patients and the value of RIFLE classification for predicting outcome. The study was conducted on AIDS patients admitted to an infectious diseases hospital inBrazil. The patients with AKI were classified according to the RIFLE classification: R (risk), I (injury), F (failure), L (loss), and E (end-stage renal disease). Univariate and multivariate analyses were used to evaluate the factors associated with AKI. A total of 532 patients with a mean age of 35 ± 8.5 years were included in this study. AKI was observed in 37% of the cases. Patients were classified as "R" (18%), "I" (7.7%) and "F" (11%). Independent risk factors for AKI were thrombocytopenia (OR = 2.9, 95%CI = 1.5-5.6, P < 0.001) and elevation of aspartate aminotransferase (AST) (OR = 3.5, 95%CI = 1.8-6.6, P < 0.001). General mortality was 25.7% and was higher among patients with AKI (40.2 vs17%, P < 0.001). AKI was associated with death and mortality increased according to RIFLE classification - "R" (OR 2.4), "I" (OR 3.0) and "F" (OR 5.1), P < 0.001. AKI is a frequent complication in AIDS patients, which is associated with increased mortality. RIFLE classification is an important indicator of poor outcome for AIDS patients.
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Affiliation(s)
- G B Silva Júnior
- Divisão de Nefrologia, Hospital Universitário Walter Cantídio, Faculdade de Medicina, Universidade Federal do Ceará, Fortaleza, CE, Brasil.
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[Diffuse infiltrative lymphocytosis syndrome: another cause of acute renal failure in the HIV-infected patient]. Enferm Infecc Microbiol Clin 2010; 28:757-8. [PMID: 20880610 DOI: 10.1016/j.eimc.2010.06.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2010] [Accepted: 06/09/2010] [Indexed: 11/23/2022]
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Rachakonda AK, Kimmel PL. CKD in HIV-infected patients other than HIV-associated nephropathy. Adv Chronic Kidney Dis 2010; 17:83-93. [PMID: 20005492 DOI: 10.1053/j.ackd.2009.09.001] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2009] [Revised: 08/28/2009] [Accepted: 09/01/2009] [Indexed: 12/17/2022]
Abstract
A spectrum of kidney diseases in HIV-infected patients has been reported both before and after the introduction of highly active antiretroviral therapy (HAART). Kidney syndromes affecting HIV-infected patients include CKD as well as proteinuria, nephrotic syndrome, and acute nephritic syndrome. Thrombotic microangiopathy should be considered in patients with kidney disease and typical clinical characteristics. As the HIV-infected population ages, there is increased concern regarding the incidence of vascular and metabolic disease, leading to an increased burden of CKD. Although HIV-associated nephropathy is still the major cause of nephrotic syndrome in HIV-infected patients, immune complex glomerulonephritis (ICGN) still comprises a substantial proportion of the disease burden, especially in people of European origin. Genetic investigations into the underpinnings of the various histologic expressions of HIV-associated kidney disease hold great promise. The single most important diagnostic test to differentiate various forms of kidney disease in HIV-infected patients is a kidney biopsy. The results of treating kidney disease in HIV-infected patients remain unclear, and properly designed randomized controlled trials of the treatment of ICGN with HAART and other approaches are desperately needed.
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Renal biopsy is necessary for the diagnosis of HIV-associated renal diseases. ACTA ACUST UNITED AC 2008; 5:22-3. [PMID: 19015655 DOI: 10.1038/ncpneph0990] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2008] [Accepted: 10/13/2008] [Indexed: 11/08/2022]
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