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Nlandu Y, Makulo JR, Essig M, Sumaili E, Lumaka A, Engole Y, Mboliasa MF, Mokoli V, Tshiswaka T, Nkodila A, Bukabau J, Longo A, Kajingulu F, Zinga C, Nseka N. Factors associated with acute kidney injury (AKI) and mortality in COVID-19 patients in a Sub-Saharan African intensive care unit: a single-center prospective study. Ren Fail 2023; 45:2263583. [PMID: 37870858 PMCID: PMC11001370 DOI: 10.1080/0886022x.2023.2263583] [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: 04/30/2023] [Accepted: 09/21/2023] [Indexed: 10/24/2023] Open
Abstract
INTRODUCTION Acute kidney injury (AKI) is a complication of severe coronavirus disease 2019 (COVID-19). Kidney damage associated with COVID-19 could take specific features due to environmental and socio-cultural factors. This study evaluates the incidence of AKI, the associated factors, and mortality in COVID-19 patients in a Sub-Saharan African intensive care unit. METHODS In a prospective cohort study conducted in the intensive care unit (ICU) of the Centre Médical de Kinshasa (CMK), consecutive patients admitted for COVID-19 were screened for the presence of AKI between 27 March, 2020 and 27 January 2022. AKI was defined according to Kidney Disease Improving Global Outcomes (KDIGO) guidelines. The primary outcome was occurrence of AKI. The secondary outcome was 48 days' mortality and recovery of the renal function at intensive care unit (ICU) discharge. Survival (time-to death) curves were built using the Kaplan Meier methods. Multivariate analyses were performed by logistic regression to identify factors associated with AKI and Cox regression to explore the association between AKI and in-hospital mortality. The significance level of the p-value was set at 0.05. RESULTS The median(IQR) sequential organ failure assessment score (SOFA) score and mean age of patients (215) including in our cohort were respectively 3(2-4) and 58.9 ± 14.9 years. The incidence of AKI was 28.4% with stages 1, 2, or 3 AKI accounted for 39.3%, 11.5%, and 49.2%, respectively. Hemodialysis was required in 16 out 215 (7.4%) patients. Dyspnea (adjusted odds ratio (aOR):2.27 [1.1--4.57] p = 0.021), SOFA ≥5 (aOR:3.11[1.29-7.53] p = 0.012), AST/ALT ratio (aOR: 1.53 [1.09-1.79] p = 0.015), N/L ratio (aOR:2.09 [1.09-3.20] p = 0.016), mechanical ventilation (aOR: 3.20 [1.66-10.51] p = 0.005) and Amikacin (aOR: 2.91 [1.37-6.18] p = 0.006) were the main factors associated with AKI. Patients with AKI had a mortality rate of 52.5% and 67.2% of the survivors did not recover kidney function at the end of hospitalization. Adjusted Cox regression analysis revealed that COVID-19-associated AKI was independently associated with in-hospital death (HR:2.96 [1.93-4.65] p = 0.013) compared to non-AKI patients. CONCLUSIONS AKI was present in three out of ten COVID-19 patients. The most significant factors associated with AKI were dyspnea, SOFA ≥ 5, AST/ALT and N/L ratio, mechanical ventilation and Amikacin. AKI has been associated with an almost threefold increase in overall mortality and seven out of ten survivors did not recover kidney function after AKI.
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Affiliation(s)
- Yannick Nlandu
- Nephrology Unit, Kinshasa University Hospital, University of Kinshasa, Kinshasa, Democratic Republic of Congo
- Intensive Care Unit, Centre Médical de Kinshasa, Kinshasa, Democratic Republic of Congo
| | - Jean-Robert Makulo
- Nephrology Unit, Kinshasa University Hospital, University of Kinshasa, Kinshasa, Democratic Republic of Congo
| | - Marie Essig
- Nephrology Department, Ambroise Paré Hospital, AP-HP University Paris-Saclay, Boulogne-Billancourt, France
| | - Ernest Sumaili
- Nephrology Unit, Kinshasa University Hospital, University of Kinshasa, Kinshasa, Democratic Republic of Congo
| | - Aimé Lumaka
- Center for Human Genetics, Department of Pediatrics, University of Kinshasa, Kinshasa, Democratic Republic of Congo
| | - Yannick Engole
- Nephrology Unit, Kinshasa University Hospital, University of Kinshasa, Kinshasa, Democratic Republic of Congo
- Intensive Care Unit, Centre Médical de Kinshasa, Kinshasa, Democratic Republic of Congo
| | - Marie-France Mboliasa
- Nephrology Unit, Kinshasa University Hospital, University of Kinshasa, Kinshasa, Democratic Republic of Congo
- Intensive Care Unit, Centre Médical de Kinshasa, Kinshasa, Democratic Republic of Congo
| | - Vieux Mokoli
- Nephrology Unit, Kinshasa University Hospital, University of Kinshasa, Kinshasa, Democratic Republic of Congo
| | - Trésor Tshiswaka
- Nephrology Unit, Kinshasa University Hospital, University of Kinshasa, Kinshasa, Democratic Republic of Congo
| | - Aliocha Nkodila
- Department of Family Medicine and Primary Care, Protestant University in Congo, Kinshasa, Democratic Republic of Congo
| | - Justine Bukabau
- Nephrology Unit, Kinshasa University Hospital, University of Kinshasa, Kinshasa, Democratic Republic of Congo
- Intensive Care Unit, Centre Médical de Kinshasa, Kinshasa, Democratic Republic of Congo
| | - Augustin Longo
- Nephrology Unit, Kinshasa University Hospital, University of Kinshasa, Kinshasa, Democratic Republic of Congo
| | - François Kajingulu
- Nephrology Unit, Kinshasa University Hospital, University of Kinshasa, Kinshasa, Democratic Republic of Congo
| | - Chantal Zinga
- Nephrology Unit, Kinshasa University Hospital, University of Kinshasa, Kinshasa, Democratic Republic of Congo
| | - Nazaire Nseka
- Nephrology Unit, Kinshasa University Hospital, University of Kinshasa, Kinshasa, Democratic Republic of Congo
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Morello M, Amoroso D, Losacco F, Viscovo M, Pieri M, Bernardini S, Adorno G. Urine Parameters in Patients with COVID-19 Infection. Life (Basel) 2023; 13:1640. [PMID: 37629497 PMCID: PMC10455209 DOI: 10.3390/life13081640] [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: 06/09/2023] [Revised: 07/21/2023] [Accepted: 07/25/2023] [Indexed: 08/27/2023] Open
Abstract
A urine test permits the measure of several urinary markers. This is a non-invasive method for early monitoring of potential kidney damage. In COVID-19 patients, alterations of urinary markers were observed. This review aims to evaluate the utility of urinalysis in predicting the severity of COVID-19. A total of 68 articles obtained from PubMed studies reported that (i) the severity of disease was related to haematuria and proteinuria and that (ii) typical alterations of the urinary sediment were noticed in COVID-19-associated AKI patients. This review emphasizes that urinalysis and microscopic examination support clinicians in diagnosing and predicting COVID-19 severity.
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Affiliation(s)
- Maria Morello
- Clinical Biochemistry Department of Laboratory Medicine, Division of Proteins, University Hospital (PTV), 00133 Rome, Italy; (F.L.); (M.V.); (M.P.); (S.B.)
- Clinical Pathology and Clinical Biochemistry, Graduate School, Faculty of Medicine, University of Tor Vergata, 00133 Rome, Italy;
- Department of Experimental Medicine, Faculty of Medicine, University of Tor Vergata, 00133 Rome, Italy
| | - Dominga Amoroso
- Clinical Biochemistry Department of Laboratory Medicine, Division of Proteins, University Hospital (PTV), 00133 Rome, Italy; (F.L.); (M.V.); (M.P.); (S.B.)
- Clinical Pathology and Clinical Biochemistry, Graduate School, Faculty of Medicine, University of Tor Vergata, 00133 Rome, Italy;
| | - Felicia Losacco
- Clinical Biochemistry Department of Laboratory Medicine, Division of Proteins, University Hospital (PTV), 00133 Rome, Italy; (F.L.); (M.V.); (M.P.); (S.B.)
- Clinical Pathology and Clinical Biochemistry, Graduate School, Faculty of Medicine, University of Tor Vergata, 00133 Rome, Italy;
| | - Marco Viscovo
- Clinical Biochemistry Department of Laboratory Medicine, Division of Proteins, University Hospital (PTV), 00133 Rome, Italy; (F.L.); (M.V.); (M.P.); (S.B.)
- Clinical Pathology and Clinical Biochemistry, Graduate School, Faculty of Medicine, University of Tor Vergata, 00133 Rome, Italy;
| | - Massimo Pieri
- Clinical Biochemistry Department of Laboratory Medicine, Division of Proteins, University Hospital (PTV), 00133 Rome, Italy; (F.L.); (M.V.); (M.P.); (S.B.)
- Clinical Pathology and Clinical Biochemistry, Graduate School, Faculty of Medicine, University of Tor Vergata, 00133 Rome, Italy;
- Department of Experimental Medicine, Faculty of Medicine, University of Tor Vergata, 00133 Rome, Italy
| | - Sergio Bernardini
- Clinical Biochemistry Department of Laboratory Medicine, Division of Proteins, University Hospital (PTV), 00133 Rome, Italy; (F.L.); (M.V.); (M.P.); (S.B.)
- Clinical Pathology and Clinical Biochemistry, Graduate School, Faculty of Medicine, University of Tor Vergata, 00133 Rome, Italy;
- Department of Experimental Medicine, Faculty of Medicine, University of Tor Vergata, 00133 Rome, Italy
| | - Gaspare Adorno
- Clinical Pathology and Clinical Biochemistry, Graduate School, Faculty of Medicine, University of Tor Vergata, 00133 Rome, Italy;
- Department of Biomedicine and Prevention, University of Rome, 00133 Rome, Italy
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Galiero R, Simeon V, Loffredo G, Caturano A, Rinaldi L, Vetrano E, Medicamento G, Alfano M, Beccia D, Brin C, Colantuoni S, Di Salvo J, Epifani R, Nevola R, Marfella R, Sardu C, Coppola C, Scarano F, Maggi P, Calabrese C, De Lucia Sposito P, Rescigno C, Sbreglia C, Fraganza F, Parrella R, Romano A, Calabria G, Polverino B, Pagano A, Numis FG, Bologna C, Nunziata M, Esposito V, Coppola N, Maturo N, Nasti R, Di Micco P, Perrella A, Lettieri M, Adinolfi LE, Chiodini P, Sasso FC. Association between Renal Function at Admission and COVID-19 in-Hospital Mortality in Southern Italy: Findings from the Prospective Multicenter Italian COVOCA Study. J Clin Med 2022; 11:jcm11206121. [PMID: 36294442 PMCID: PMC9604778 DOI: 10.3390/jcm11206121] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Revised: 09/22/2022] [Accepted: 10/14/2022] [Indexed: 11/16/2022] Open
Abstract
Background. Evidence has shown a close association between COVID-19 infection and renal complications in both individuals with previously normal renal function and those with chronic kidney disease (CKD). Methods. The aim of this study is to evaluate the in-hospital mortality of SARS-CoV-2 patients according to their clinical history of CKD or estimated glomerular filtration rate (eGFR). This is a prospective multicenter observational cohort study which involved adult patients (≥18 years old) who tested positive with SARS-CoV-2 infection and completed their hospitalization in the period between November 2020 and June 2021. Results. 1246 patients were included in the study, with a mean age of 64 years (SD 14.6) and a median duration of hospitalization of 15 days (IQR 9−22 days). Cox’s multivariable regression model revealed that mortality risk was strongly associated with the stage of renal impairment and the Kaplan−Meier survival analysis showed a progressive and statistically significant difference (p < 0.0001) in mortality according to the stage of CKD. Conclusion. This study further validates the association between CKD stage at admission and mortality in patients hospitalized for COVID-19. The risk stratification based on eGFR allows clinicians to identify the subjects with the highest risk of intra-hospital mortality despite the duration of hospitalization.
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Affiliation(s)
- Raffaele Galiero
- Department of Advanced Medical and Surgical Sciences, University of Campania “Luigi Vanvitelli”, Piazza L. Miraglia 2, 80138 Naples, Italy
| | - Vittorio Simeon
- Medical Statistics Unit, Department of Physical and Mental Health and Preventive Medicine, University of Campania “Luigi Vanvitelli”, Largo Madonna delle Grazie 1, 80138 Naples, Italy
| | - Giuseppe Loffredo
- Department of Advanced Medical and Surgical Sciences, University of Campania “Luigi Vanvitelli”, Piazza L. Miraglia 2, 80138 Naples, Italy
| | - Alfredo Caturano
- Department of Advanced Medical and Surgical Sciences, University of Campania “Luigi Vanvitelli”, Piazza L. Miraglia 2, 80138 Naples, Italy
| | - Luca Rinaldi
- Department of Advanced Medical and Surgical Sciences, University of Campania “Luigi Vanvitelli”, Piazza L. Miraglia 2, 80138 Naples, Italy
| | - Erica Vetrano
- Department of Advanced Medical and Surgical Sciences, University of Campania “Luigi Vanvitelli”, Piazza L. Miraglia 2, 80138 Naples, Italy
| | - Giulia Medicamento
- Department of Advanced Medical and Surgical Sciences, University of Campania “Luigi Vanvitelli”, Piazza L. Miraglia 2, 80138 Naples, Italy
| | - Maria Alfano
- Department of Advanced Medical and Surgical Sciences, University of Campania “Luigi Vanvitelli”, Piazza L. Miraglia 2, 80138 Naples, Italy
| | - Domenico Beccia
- Department of Advanced Medical and Surgical Sciences, University of Campania “Luigi Vanvitelli”, Piazza L. Miraglia 2, 80138 Naples, Italy
| | - Chiara Brin
- Department of Advanced Medical and Surgical Sciences, University of Campania “Luigi Vanvitelli”, Piazza L. Miraglia 2, 80138 Naples, Italy
| | - Sara Colantuoni
- Department of Advanced Medical and Surgical Sciences, University of Campania “Luigi Vanvitelli”, Piazza L. Miraglia 2, 80138 Naples, Italy
| | - Jessica Di Salvo
- Department of Advanced Medical and Surgical Sciences, University of Campania “Luigi Vanvitelli”, Piazza L. Miraglia 2, 80138 Naples, Italy
| | - Raffaella Epifani
- Department of Advanced Medical and Surgical Sciences, University of Campania “Luigi Vanvitelli”, Piazza L. Miraglia 2, 80138 Naples, Italy
| | - Riccardo Nevola
- Department of Advanced Medical and Surgical Sciences, University of Campania “Luigi Vanvitelli”, Piazza L. Miraglia 2, 80138 Naples, Italy
- Ospedale Evangelico Betania, Via Argine 604, 80147 Naples, Italy
| | - Raffaele Marfella
- Department of Advanced Medical and Surgical Sciences, University of Campania “Luigi Vanvitelli”, Piazza L. Miraglia 2, 80138 Naples, Italy
| | - Celestino Sardu
- Department of Advanced Medical and Surgical Sciences, University of Campania “Luigi Vanvitelli”, Piazza L. Miraglia 2, 80138 Naples, Italy
| | - Carmine Coppola
- Hepatology Unit, Internal Medicine, Area Stabiese Hospital, 80053 Naples, Italy
| | - Ferdinando Scarano
- COVID Center “S. Anna e SS. Madonna della Neve” Hospital, 80042 Boscotrecase, Italy
| | - Paolo Maggi
- U.O.C. Infectious and Tropical Diseases, S. Anna e S. Sebastiano Hospital, 81100 Caserta, Italy
| | - Cecilia Calabrese
- Pneumologia Vanvitelli Department of Translational Medical Sciences, University of Campania ‘Luigi Vanvitelli’, AORN Ospedali dei Colli, Via Leonardo Bianchi, 80131 Naples, Italy
| | | | - Carolina Rescigno
- U.O.C. Infectious Diseases and Neurology, Cotugno Hospital, 80131 Naples, Italy
| | - Costanza Sbreglia
- U.O.C. Infectious Diseases of the Elderly, Cotugno Hospital, 80131 Naples, Italy
| | - Fiorentino Fraganza
- U.O.C. Anestesia and Intensive Care Unit, Cotugno Hospital, 80131 Naples, Italy
| | - Roberto Parrella
- U.O.C. Respiratory Infectious Diseases, Cotugno Hospital, 80131 Naples, Italy
| | | | - Giosuele Calabria
- IXth Division of Infectious Diseases and Interventional Ultrasound, Cotugno Hospital, 80131 Naples, Italy
| | | | - Antonio Pagano
- Emergency and Acceptance Unit, “Santa Maria delle Grazie” Hospital, 80078 Pozzuoli, Italy
| | - Fabio Giuliano Numis
- Emergency and Acceptance Unit, “Santa Maria delle Grazie” Hospital, 80078 Pozzuoli, Italy
| | | | | | - Vincenzo Esposito
- IVth Division of Immunodeficiency and Gender Infectious Diseases, Cotugno Hospital, 80131 Naples, Italy
| | - Nicola Coppola
- Department of Mental Health and Public Medicine, Centro COVID A.O.U. Vanvitelli, 80131 Naples, Italy
| | - Nicola Maturo
- U.O.S.D. Infectious Diseases Emergency and Acceptance, Cotugno Hospital, 80131 Naples, Italy
| | - Rodolfo Nasti
- Emergency Division, A.O.R.N. “Antonio Cardarelli”, Via Antonio Cardarelli 9, 80131 Naples, Italy
| | - Pierpaolo Di Micco
- Department of Internal Medicine, Fatebenefratelli Hospital of Naples, 80123 Naples, Italy
| | | | - Miriam Lettieri
- Division of Cardiovascular Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, 3.31 Core Technology Facility, 46 Grafton Street, Manchester M13 9NT, UK
| | - Luigi Elio Adinolfi
- Department of Advanced Medical and Surgical Sciences, University of Campania “Luigi Vanvitelli”, Piazza L. Miraglia 2, 80138 Naples, Italy
| | - Paolo Chiodini
- Medical Statistics Unit, Department of Physical and Mental Health and Preventive Medicine, University of Campania “Luigi Vanvitelli”, Largo Madonna delle Grazie 1, 80138 Naples, Italy
- Correspondence: (P.C.); (F.C.S.); Tel.: +39-081-566-6021 (P.C.); +39-081-566-5010 (F.C.S.)
| | - Ferdinando Carlo Sasso
- Department of Advanced Medical and Surgical Sciences, University of Campania “Luigi Vanvitelli”, Piazza L. Miraglia 2, 80138 Naples, Italy
- Correspondence: (P.C.); (F.C.S.); Tel.: +39-081-566-6021 (P.C.); +39-081-566-5010 (F.C.S.)
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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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Richardson GM, Su SW, Iragorri S. Case report: Diarrhea-associated hemolytic uremic syndrome in the Era of COVID-19. Front Pediatr 2022; 10:979850. [PMID: 36389381 PMCID: PMC9659847 DOI: 10.3389/fped.2022.979850] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Accepted: 10/11/2022] [Indexed: 12/03/2022] Open
Abstract
Over the past two years, a growing number of SARS-CoV-2 infection-associated clinical pediatric phenotypes have been identified, including a hemolytic uremic syndrome (HUS) form of thrombotic microangiopathy. Oregon's high prevalence of Shiga toxin-producing Escherichia coli (STEC) infections gives it a unique perspective to discuss the impact of COVID-19 and HUS. We seek to highlight SARS-CoV-2 as a potential new infectious etiology of severe diarrhea-associated HUS, based on two cases from Portland, Oregon, occurring in non-COVID-19 immunized children. The first case is a previously healthy ten-year-old who presented with SARS-CoV-2 infection and bloody diarrhea after an appendectomy, followed by full-blown oligo-anuric HUS. Second is a previously healthy six-year-old who presented with short-lived bloody diarrhea, rapidly evolving to HUS, and who tested positive for COVID-19 via polymerase chain reaction and STEC toxins one and two. These two cases highlight two main points. First, SARS-CoV-2 must be included in the differential diagnosis of diarrhea-associated HUS, either as the sole agent or concurrent with a STEC infection. Second, when managing STEC gastroenteritis the recommendation has been to maintain excellent hydration as a strategy to prevent the progression to oligo-anuric acute kidney injury and HUS. This strategy may need to be re-evaluated in a patient with SARS-CoV-2 infection or co-infection.
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Affiliation(s)
- Gina M. Richardson
- Oregon Health & Science University, Portland, OR, United States
- Correspondence: Gina M. Richardson
| | - Sharon W. Su
- Department of Pediatric Nephrology, Randall Children's Hospital at Legacy Emanuel, Portland, OR, United States
| | - Sandra Iragorri
- Oregon Health & Science University, Portland, OR, United States
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