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McAdams MC, Li M, Xu P, Gregg LP, Patel J, Willett DL, Velasco F, Lehmann CU, Hedayati SS. Using dipstick urinalysis to predict development of acute kidney injury in patients with COVID-19. BMC Nephrol 2022; 23:50. [PMID: 35105331 PMCID: PMC8805668 DOI: 10.1186/s12882-022-02677-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Accepted: 01/10/2022] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Acute kidney injury (AKI) is a common complication in patients hospitalized with COVID-19 and may require renal replacement therapy (RRT). Dipstick urinalysis is frequently obtained, but data regarding the prognostic value of hematuria and proteinuria for kidney outcomes is scarce. METHODS Patients with positive severe acute respiratory syndrome-coronavirus 2 (SARS-CoV2) PCR, who had a urinalysis obtained on admission to one of 20 hospitals, were included. Nested models with degree of hematuria and proteinuria were used to predict AKI and RRT during admission. Presence of Chronic Kidney Disease (CKD) and baseline serum creatinine were added to test improvement in model fit. RESULTS Of 5,980 individuals, 829 (13.9%) developed an AKI during admission, and 149 (18.0%) of those with AKI received RRT. Proteinuria and hematuria degrees significantly increased with AKI severity (P < 0.001 for both). Any degree of proteinuria and hematuria was associated with an increased risk of AKI and RRT. In predictive models for AKI, presence of CKD improved the area under the curve (AUC) (95% confidence interval) to 0.73 (0.71, 0.75), P < 0.001, and adding baseline creatinine improved the AUC to 0.85 (0.83, 0.86), P < 0.001, when compared to the base model AUC using only proteinuria and hematuria, AUC = 0.64 (0.62, 0.67). In RRT models, CKD status improved the AUC to 0.78 (0.75, 0.82), P < 0.001, and baseline creatinine improved the AUC to 0.84 (0.80, 0.88), P < 0.001, compared to the base model, AUC = 0.72 (0.68, 0.76). There was no significant improvement in model discrimination when both CKD and baseline serum creatinine were included. CONCLUSIONS Proteinuria and hematuria values on dipstick urinalysis can be utilized to predict AKI and RRT in hospitalized patients with COVID-19. We derived formulas using these two readily available values to help prognosticate kidney outcomes in these patients. Furthermore, the incorporation of CKD or baseline creatinine increases the accuracy of these formulas.
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Affiliation(s)
- Meredith C McAdams
- Division of Nephrology, Department of Medicine, University of Texas Southwestern Medical Center, 5939 Harry Hines Blvd, MC 8516, Dallas, TX, 75390, USA
| | - Michael Li
- University of Texas Southwestern College of Medicine, Dallas, TX, USA
| | - Pin Xu
- Division of Nephrology, Department of Medicine, University of Texas Southwestern Medical Center, 5939 Harry Hines Blvd, MC 8516, Dallas, TX, 75390, USA
| | - L Parker Gregg
- Section of Nephrology, Department of Medicine, Selzman Institute for Kidney Health, Baylor College of Medicine, Houston, TX, USA
- Section of Nephrology, Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX, USA
- Development Center for Innovations in Quality, Effectiveness, and Safety, Veterans Affairs Health Services Research, Houston, TX, USA
| | - Jiten Patel
- Division of Nephrology, Department of Medicine, University of Texas Southwestern Medical Center, 5939 Harry Hines Blvd, MC 8516, Dallas, TX, 75390, USA
- Parkland Hospital and Health System, Dallas, TX, USA
| | - Duwayne L Willett
- Division of Cardiology, Department of Medicine, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | | | - Christoph U Lehmann
- Clinical Informatics Center, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - S Susan Hedayati
- Division of Nephrology, Department of Medicine, University of Texas Southwestern Medical Center, 5939 Harry Hines Blvd, MC 8516, Dallas, TX, 75390, USA.
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Nlandu YM, Sakaji TJM, Engole YM, Mboliasa PMFI, Bena DM, Abatha JM, Nkumu JRM, Nkodila AN, Van Eckout K, Kalifa G, Ahmed R, Bukabau JB. Frequency and factors associated with proteinuria in COVID-19 patients: a cross-sectional study. Pan Afr Med J 2021; 40:37. [PMID: 34795818 PMCID: PMC8571933 DOI: 10.11604/pamj.2021.40.37.29796] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Accepted: 08/31/2021] [Indexed: 12/30/2022] Open
Abstract
Proteinuria is a marker of severity and poor outcome of patients in intensive care unit (ICU). The objective of this study was to determine the frequency of proteinuria and the risk factors associated with proteinuria in Congolese COVID-19 patients. The present cross sectional study of proteinuria status is a post hoc analysis of data from 80 COVID-19 patients admitted at Kinshasa Medical Center (KMC) from March 10th to July 10th, 2020. The population under study came from all adult inpatients (≥18 years old) with a laboratory diagnosis by polymerase chain reaction (PCR) of COVID-19 were selected and divided into two groups (positive proteinuria and negative proteinuria group). Logistic regression models helped to identify the factors associated with proteinuria. The P value significance level was 0.05. Among 80 patients who tested positive for SARS-CoV-2 RT-PCR, 55% had proteinuria. The mean age was 55.2 ± 12.8 years. Fourty-seven patients (58.8%) had history of hypertension and 26 patients (32.5%) diabetes. Multivariable analysis showed age ≥ 65 years (aOR 5,04; 95% CI: 1.51-16.78), diabetes (aOR 3,15; 95% CI: 1.14-8.72), ASAT >40 UI/L (aOR 7,08; 95% CI: 2.40-20.87), ferritin >300 (aOR 13,47; 95% CI: 1.56-26.25) as factors independently associated with proteinuria in COVID-19 patients. Proteinuria is common in Congolese COVID-19 patients and is associated with age, diabetes, ferritin and aspartate aminotransferase (ASAT).
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Affiliation(s)
- Yannick Mayamba Nlandu
- Intensive Care Unit, Kinshasa Medical Center, Kinshasa, Democratic Republic of the Congo
- Nephrology Unit, Kinshasa University Hospital, Kinshasa, Democratic Republic of the Congo
| | | | - Yannick Mompango Engole
- Intensive Care Unit, Kinshasa Medical Center, Kinshasa, Democratic Republic of the Congo
- Nephrology Unit, Kinshasa University Hospital, Kinshasa, Democratic Republic of the Congo
| | - Pitchouna Marie-France Ingole Mboliasa
- Intensive Care Unit, Kinshasa Medical Center, Kinshasa, Democratic Republic of the Congo
- Nephrology Unit, Kinshasa University Hospital, Kinshasa, Democratic Republic of the Congo
| | - Dauphin Mulumba Bena
- Intensive Care Unit, Kinshasa Medical Center, Kinshasa, Democratic Republic of the Congo
| | | | | | | | - Karel Van Eckout
- Intensive Care Unit, Kinshasa Medical Center, Kinshasa, Democratic Republic of the Congo
| | - Golan Kalifa
- Intensive Care Unit, Kinshasa Medical Center, Kinshasa, Democratic Republic of the Congo
| | - Rodolphe Ahmed
- Intensive Care Unit, Kinshasa Medical Center, Kinshasa, Democratic Republic of the Congo
| | - Justine Busanga Bukabau
- Intensive Care Unit, Kinshasa Medical Center, Kinshasa, Democratic Republic of the Congo
- Nephrology Unit, Kinshasa University Hospital, Kinshasa, Democratic Republic of the Congo
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Ouahmi H, Courjon J, Morand L, François J, Bruckert V, Lombardi R, Esnault V, Seitz-Polski B, Demonchy E, Dellamonica J, Boyer-Suavet S. Proteinuria as a Biomarker for COVID-19 Severity. Front Physiol 2021; 12:611772. [PMID: 33767630 PMCID: PMC7985082 DOI: 10.3389/fphys.2021.611772] [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: 09/29/2020] [Accepted: 02/08/2021] [Indexed: 12/24/2022] Open
Abstract
Background Renal involvement in syndrome coronavirus 2 (SARS-CoV-2) infection has been retrospectively described, especially acute kidney injury (AKI). However, quantitative proteinuria assessment and its implication in coronavirus disease 2019 (COVID-19) remain unknown. Methods In this prospective, multicenter study in France, we collected clinical and biological data including urinary protein to creatine ratio (UPCR) in patients presenting with moderate to severe COVID-19. Clinical outcome was analyzed according to the level of UPCR. Results 42/45 patients (93.3%) had renal involvement (abnormal urinary sediment and/or AKI). Significant proteinuria occurred in 60% of patients. Urine protein electrophoresis showed tubular protein excretion in 83.8% of patients with proteinuria. Inflammatory parametersand D-dimer concentrations correlated with proteinuria level. Patients who required intensive care unit (ICU) admission had higher proteinuria (p = 0.008). On multivariate analysis, proteinuria greater than 0.3 g/g was related to a higher prevalence of ICU admission [OR = 4.72, IC95 (1.16–23.21), p = 0.03], acute respiratory distress syndrome (ARDS) [OR = 6.89, IC95 (1.41–53.01, p = 0.02)], nosocomial infections [OR = 3.75, IC95 (1.11–13.55), p = 0.03], longer inpatient hospital stay (p = 0.003). Conclusion Renal involvement is common in moderate to severe SARS-CoV-2 infection. Proteinuria at baseline is an independent risk factor for increased hospitalization duration and ICU admission in patients with COVID-19.
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Affiliation(s)
- Hajar Ouahmi
- Service de Médecine Intensive Réanimation, CHU de Nice, Université Côte d'Azur, Nice, France.,Service de Néphrologie-Dialyse-Transplantation, CHU de Nice, Université Côte d'Azur, Nice, France
| | - Johan Courjon
- Service d'Infectiologie, CHU de Nice, Université Côte d'Azur, Nice, France.,Université Côte d'Azur, Centre Méditerranéen de Médecine Moléculaire (C3M), CHU de Nice, INSERM U1065, Nice, France
| | - Lucas Morand
- Service de Médecine Intensive Réanimation, CHU de Nice, Université Côte d'Azur, Nice, France
| | | | - Vincent Bruckert
- Département de réanimation médico-chirugicale et transplantation d'organe, hôpital L'Archet 2, CHU de Nice, Université Côte d'Azur, Nice, France
| | - Romain Lombardi
- Service de Médecine Intensive Réanimation, CHU de Nice, Université Côte d'Azur, Nice, France
| | - Vincent Esnault
- Service de Néphrologie-Dialyse-Transplantation, CHU de Nice, Université Côte d'Azur, Nice, France
| | - Barbara Seitz-Polski
- Service de Néphrologie-Dialyse-Transplantation, CHU de Nice, Université Côte d'Azur, Nice, France.,Laboratoire d'Immunologie, CHU de Nice, Université Côte d'Azur, Nice, France.,Centre de référence Maladies rares Syndrome néphrotique idiopathique, CHU de Nice, Université Côte d'Azur, Nice, France.,Unité de Recherche Clinique de la Côte d'Azur (UR2CA), Université Côte d'Azur, Nice, France
| | - Elisa Demonchy
- Service d'Infectiologie, CHU de Nice, Université Côte d'Azur, Nice, France
| | - Jean Dellamonica
- Service de Médecine Intensive Réanimation, CHU de Nice, Université Côte d'Azur, Nice, France.,Unité de Recherche Clinique de la Côte d'Azur (UR2CA), Université Côte d'Azur, Nice, France
| | - Sonia Boyer-Suavet
- Centre de référence Maladies rares Syndrome néphrotique idiopathique, CHU de Nice, Université Côte d'Azur, Nice, France.,Unité de Recherche Clinique de la Côte d'Azur (UR2CA), Université Côte d'Azur, Nice, France
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Pan HC, Chen YJ, Lin JP, Tsai MJ, Jenq CC, Lee WC, Tsai MH, Fan PC, Chang CH, Chang MY, Tian YC, Hung CC, Fang JT, Yang CW, Chen YC. Proteinuria can predict prognosis after liver transplantation. BMC Surg 2016; 16:63. [PMID: 27628850 PMCID: PMC5024482 DOI: 10.1186/s12893-016-0176-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2015] [Accepted: 08/24/2016] [Indexed: 12/28/2022] Open
Abstract
Background Proteinuria is a manifestation of renal dysfunction and it has been demonstrated to be a significant prognostic factor in various clinical situations. The study was designed to analyze prognosis of patients receiving liver transplantation as well as to determine predictive performance of perioperative proteinuria. Methods We retrospectively reviewed data of patients who had received a liver transplant in a medical center between 2002 and 2010. Demographic information and clinical characteristic parameters were recorded on the day of intensive care unit admission before operation and on postoperative days 1, 7, and 14. Results Among a total of 323 patients, in-hospital mortality and 90-day mortality rates were 13.0 % (42/323) and 14.2 % (46/323), respectively. Patients with proteinuria on admission had higher rates of acute kidney injury (26.8 % vs. 8.8 %, p < 0.001), severe infection episodes (48.8 % vs. 30.7 %, p = 0.023), hospital death (31.1 % vs. 10.1 %, p < 0.001), and 90-day mortality (37.7 % vs. 10.9 %, p < 0.001). Multivariate analysis showed that proteinuria on admission and Sequential Organ Failure Assessment (SOFA) score were independent predictors of in-hospital mortality. The discriminatory ability of proteinuria plus SOFA was even better than that of SOFA alone, especially on postoperative day 1. Conclusions The presence of proteinuria before liver transplantation is supposed to be recognized as a negative predictor for in-hospital survival. Moreover, the presence of proteinuria after liver transplantation can assist in the early prediction of poor short-term prognosis for patients receiving liver transplantation.
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Affiliation(s)
- Heng-Chih Pan
- Department of Nephrology, Chang Gung Memorial Hospital, Keelung, Taiwan
| | - Ying-Jen Chen
- Division of General Internal Medicine and Geriatrics Medicine, Chang Gung Memorial Hospital, Taipei, Taiwan
| | - Jhe-Ping Lin
- Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Ming-Jung Tsai
- Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Chang-Chyi Jenq
- Chang Gung University College of Medicine, Taoyuan, Taiwan.,Kidney Research Center, Department of Nephrology, Chang Gung Memorial Hospital, Taipei, Taiwan
| | - Wei-Chen Lee
- Chang Gung University College of Medicine, Taoyuan, Taiwan. .,Laboratory of Immunology, Department of General Surgery, Chang Gung Memorial Hospital, Taipei, Taiwan.
| | - Ming-Hung Tsai
- Chang Gung University College of Medicine, Taoyuan, Taiwan.,Division of Gastroenterology, Chang Gung Memorial Hospital, Taipei, Taiwan
| | - Pei-Chun Fan
- Kidney Research Center, Department of Nephrology, Chang Gung Memorial Hospital, Taipei, Taiwan
| | - Chih-Hsiang Chang
- Kidney Research Center, Department of Nephrology, Chang Gung Memorial Hospital, Taipei, Taiwan
| | - Ming-Yang Chang
- Chang Gung University College of Medicine, Taoyuan, Taiwan.,Kidney Research Center, Department of Nephrology, Chang Gung Memorial Hospital, Taipei, Taiwan
| | - Ya-Chung Tian
- Chang Gung University College of Medicine, Taoyuan, Taiwan.,Kidney Research Center, Department of Nephrology, Chang Gung Memorial Hospital, Taipei, Taiwan
| | - Cheng-Chieh Hung
- Chang Gung University College of Medicine, Taoyuan, Taiwan.,Kidney Research Center, Department of Nephrology, Chang Gung Memorial Hospital, Taipei, Taiwan
| | - Ji-Tseng Fang
- Chang Gung University College of Medicine, Taoyuan, Taiwan.,Kidney Research Center, Department of Nephrology, Chang Gung Memorial Hospital, Taipei, Taiwan
| | - Chih-Wei Yang
- Chang Gung University College of Medicine, Taoyuan, Taiwan.,Kidney Research Center, Department of Nephrology, Chang Gung Memorial Hospital, Taipei, Taiwan
| | - Yung-Chang Chen
- Chang Gung University College of Medicine, Taoyuan, Taiwan. .,Kidney Research Center, Department of Nephrology, Chang Gung Memorial Hospital, Taipei, Taiwan.
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