Mucormycosis and acute kidney injury

Primary renal mucormycosis in a type 2 diabetic patient: A case report from Syria

Mucormycosis is an opportunistic fungal infection that primarily affects immunocompromised individuals and rarely presents as renal mucormycosis (RM). Diagnosis can be challenging for many physicians. We report a rare case of primary, unilateral RM which triggered diabetic ketoacidosis in a type 2 diabetic patient. The case was later complicated by a bronchopleural fistula and a meropenem-resistant Klebsiella infection. The patient was ultimately treated with surgical intervention, liposomal amphotericin B, and polymyxine E. Early diagnosis and timely treatment of this life-threatening disease and its complications are significant in reducing mortality.

An old confusion: Entomophthoromycosis versus mucormycosis and their main differences

Fungal diseases were underestimated for many years. And the global burden of fungal infections is substantial and has increased in recent years. Invasive fungal infections have been linked to several risk factors in humans which basically depend on the individual homeostasis of the patients. However, many fungi can infect even apparently healthy people. Knowledge of these pathogens is critical in reducing or stopping morbidity and/or mortality statistics due to fungal pathogens. Successful therapeutic strategies rely on rapid diagnosis of the causative fungal agent and the underlying disease. However, the terminology of the diseases was updated to existing phylogenetic classifications and led to confusion in the definition of mucormycosis, conidiobolomycosis, and basidiobolomycosis, which were previously grouped under the now-uncommon term zygomycosis. Therefore, the ecological, taxonomic, clinical, and diagnostic differences are addressed to optimize the understanding and definition of these diseases. The term "coenocytic hyphomycosis" is proposed to summarize all fungal infections caused by Mucorales and species of Basidiobolus and Conidiobolus.

Renal Mucormycosis: Post-COVID-19 Infection Presenting as Unilateral Hydronephrosis in a Young Immunocompetent Male

Mucormycosis is a rare invasive fungal infection with a high mortality rate caused by members of the family Mucoraceae. It mainly affects immunocompromised hosts such as poorly controlled diabetes mellitus, previous solid organ transplant, high-dose steroids, and hematologic malignancy. The most common sites of the disease are rhinocerebral, the skin, the lungs, and the gastrointestinal tract. In this era of COVID-19 infection, there has been a significant rise in invasive mucormycosis predominantly reported from southeast. We present a case of isolated renal mucormycosis in an apparently healthy individual with post-COVID-19 infection presenting as unilateral hydronephrosis. Timely identifying at-risk populations and having a high degree of suspicion with involvement of multidisciplinary teams are of utmost importance to diagnose and treat a rare and fatal infection. Even if there is a long history, antifungal drugs and removal of the source can result in a good outcome.

Behçet's Disease with Bilateral Renal Infarction Due to Mucormycosis

We herein report a case of Behçet's disease with renal infarction due to mucormycosis. A 76-year-old man with entero-Behçet's disease had been treated with glucocorticoid and tumor necrosis factor (TNF) inhibitors. His entero-Behçet's disease was refractory to these treatments, and ileocecal resection was performed. After the operation, renal infarction that was unresponsive to anticoagulation therapy developed. He ultimately died of renal failure due to renal infarction. At the autopsy, histopathology of abundant hyphae in the renal vessel wall revealed mucormycosis. Renal mucormycosis is an important cause of renal failure with renal infarction in immunocompromised patients.

A case of isolated unilateral renal mucormycosis post COVID-19 pneumonia with fatal outcome

Mucormycosis is a rare disease. It is typically seen in immunocompromised patients. Isolated renal mucormycosis is an extremely rare disease. We here report a case of isolated renal mucormycosis who had recently recovered from COVID-19 pneumonia. The patient was a known case of diabetes mellitus and had already developed acute kidney injury when he reported to us. Despite aggressive medical and surgical management, the patient succumbed to the disease.

Dietary intakes of total polyphenol and its subclasses in association with the incidence of chronic kidney diseases: a prospective population-based cohort study

Background

As chronic kidney disease (CKD) is amongst the current global health challenges, this study is aiming to evaluate the long-term intake of total polyphenol and its subclasses in association with CKD incidence.

Methods

For the purpose of this study, a sample of 3021 Iranian adults (47 % men, aged 20–79 years) with no CKD diagnosis at baseline, were selected from the Tehran Lipid and Glucose Study population. The total intake of polyphenol and its major subclasses were assessed by a validated food frequency questionnaire and categorized as flavonoids, phenolic acids, stilbenes, and lignans. Although the morphological abnormalities of the kidneys or 3-month persistent urinalysis can distinctively define CKD, the glomerular filtration rate (eGFR) reduction is accepted as a more precise index of renal function. Therefore, eGFR < 60 mL/min/1.73m² was the exclusive index of CKD diagnosis in the current study. The eGFR was calculated by the Modification of Diet in Renal Disease Study equation. Cox-regression analysis was used to assess the hazard ratio and 95 % confidence intervals of CKD in quartiles of the total polyphenols.

Results

In this study, 355 CKD cases over 11,058.464 person-years was reported. The median (IQR) age of participants was 36 years (27–46) at baseline. Moderate intake of lignans (≤ 6.8 mg) was negatively associated with the incidence of CKD in the adjusted model. No significant associations were detected between higher amounts of lignin and total polyphenols (HR: 0.97, 95 % CI 0.67–1.40) and CKD incidence.

Conclusions

Based on the current findings, moderate intake of lignin possess CKD-protective properties by approximately 32 %. No independent associations were observed between higher amounts of lignins and CKD incidence.

Community-Acquired AKI in Asia: An Update

Community-acquired acute kidney injury (CA-AKI) is the dominant form of AKI encountered in developing countries in Asia. Economic disparities, variations in access to health care services, geographic conditions, environmental risk factors, and sociocultural circumstances shape the causes and outcomes of CA-AKI. Infections, drugs, plant and chemical toxins, envenomations, and obstetric complications are common causes of CA-AKI. Previously healthy young individuals who often work outdoors in fields or farms are exposed to a wide variety of work-related or environmental risk factors for CA-AKI. Improving disease definitions, better data, and evolving host-pathogen interactions have changed disease descriptions and presentations over the past 20 years. Among infections, although the incidence of malaria has decreased, the number of cases with dengue and scrub typhus have increased sharply. The recognition of AKI in relation to Plasmodium knowlesi, Plasmodium vivax, scrub typhus, and leptospirosis in areas not traditionally considered at risk, association of infections with the future development of chronic kidney disease, and the role of complement dysregulation in infection-associated AKI are important new findings. Snake-bite-related toxic envenomation continues to be an important cause of AKI in some counties and is a neglected public health problem. On the other hand, significant decreases in the incidence of AKI related to acute diarrheal illness or obstetric causes are signs of hope. Coordinated efforts between administrative stakeholders, society, and health care delivery services at all levels have the potential to propel research and improve outcomes in CA-AKI.

Effect of serum albumin on the prognosis of elderly patients with stage 3-4 chronic kidney disease

OBJECTIVE

To investigate the influence of serum albumin on the prognosis of elderly patients with stage 3-4 chronic kidney disease (CKD).

METHODS

From July 2013 to November 2015, elderly CKD patients (≥60 years), with eGFR ≥15 mL/min/1.73 m² and <60 mL/min/1.73 m², with CKD stage 3-4 in the geriatric nephrology clinic were enrolled. General information and underlying diseases were recorded. Laboratory indices were evaluated. Composite endpoint events (CEE) including renal endpoint events, cardiocerebral vascular endpoint events, and death were elucidated. Based on the ROC curves, the patients were divided into lower and higher serum albumin groups (<42.5 and ≥42.5 g/L).

RESULTS

The occurrence of CEEs was significantly higher in lower serum albumin group than those in the higher group. Also, the patients in the higher group were significantly younger with lower urinary protein, blood urea, brain natriuretic peptide, and cystatin C than those in the lower serum albumin group. Contrastingly, hemoglobin, total serum protein, serum calcium, and superoxide dismutase were remarkably higher. The composite endpoints of multifactor logistic regression analysis indicated that as the serum albumin is increased by every 1 g/L, the probability of CEEs would reduce 14.8%, and the risk occurrence rate of the lower serum albumin group was 4.739 fold than the higher group.

CONCLUSION

The results suggest that patients with higher serum albumin had a better prognosis than those with lower serum albumin. The low level was an independent risk factor influencing the prognosis of elderly patients in stage 3-4 CKD.

CKD and Infectious Diseases in Asia Pacific: Challenges and Opportunities

The exact number of patients with chronic kidney disease (CKD) in Asia Pacific is uncertain. In numeric terms, the region is home to the largest population of patients with untreated chronic kidney failure. The climatic, geographic, social, cultural, economic, and environmental diversity within this region is higher than in any other part of the world. Large parts of the region face a climate-related burden of infectious diseases. Infections contribute to the development and progression of CKD and complicate the course of patients with pre-existing CKD (especially those on dialysis therapy or who are immunosuppressed), increase the cost of CKD care, and contribute to mortality and morbidity. Kidney involvement is a feature of several infectious diseases prevalent in Asia Pacific. Examples include malaria, leptospirosis, scrub typhus, tuberculosis, hepatitis B and C virus, dengue hemorrhagic fever, and Hantaan virus infections. The contribution of infection-associated acute kidney injury to the overall burden of CKD has not been evaluated systematically. Research is needed to quantify the impact of infections on kidney health by undertaking prospective studies. Nephrologists need to work with infectious disease research groups and government infection surveillance and control programs.