bluuebunny/crossref_metadata_2025_split huggingface dataset:
MO294: Multidisciplinary Management of Obstructive Anuria: Uro-Nephrological Interdependence of the Patient Service
Authors: Afifi Rania , Alafifi M , Zamd Mohammed , Mtioui N , Elkhayat Ss , Medkouri G , Ramdani B , Benghanem M , Dakir M , Debbagh A , Aboutaieb R 
Published: May 2022

Abstract

BACKGROUND AND AIMS
Obstructive anuria is defined as a total cessation of diuresis or a volume of &lt;200 or even 400 mL/24 h due to bilateral or unilateral blockage of a single anatomical or functional kidney. It is rapidly the cause of acute renal failure, endangering the vital prognosis in the short term and requiring emergency treatment in a specialised environment, whatever its aetiology.
It accounts for 10% of all anurias. They are significant conditions that might jeopardise the kidney's functional prognosis.
The goal of our study is to to describe the epidemiological profile, clinical and medical-surgical management performed at the CHU IBN ROCHD CASABLANCA in partnership with various services to manage this pathology, which remains severe.

METHOD
From January 2018 to December 2020, we conducted a 3-year retrospective and descriptive study of patients treated at the CHU IBN ROCHD of Casablanca's nephrology and haemodialysis department and urology department.

RESULTS
There were a total of 217 patients; 92 women and 125 men, i.e. 42.39% and 57.6%, respectively, with an average age of 56.7 years ‘22–79’. The circumstances of discovery were: oligo anuria 69.12%, haematuria 23.04% and AEG 7.83%. Obstruction was neoplastic in 64.51%; lithiasis 26.27%; bladder malformation 0.92% and of undetermined aetiology in 4.6%. The neoplastic origin was cervical cancer, followed by bladder and prostate. The mean creatinine level was 86.86mg/L. The indication for haemodialysis was: threatening hyperkalaemia, uraemic syndrome, acidosis and acute lung oedema in 58%, 25.8%, 8.2% and 8% of cases, respectively.
The total number of haemodialysis sessions was 260 with an average number of 1.198. Obstacle removal was performed by percutaneous nephrostomy in 70.96% of cases, by double J catheterization in 26.26% of cases. The outcome was good in 78.34% of cases, 13.82% progressed to CKD. Mortality was 6.9%. The risk factors for mortality were: age, aetiology of neoplasia.

CONCLUSION
Obstructive anuria is an emergency requiring multidisciplinary management. The aetiologies were dominated by pelvic cancers and lithiasis in our context. Depending on the severity of the obstruction, treatment consists of three steps: treatment of metabolic abnormalities induced by acute renal failure, drainage of the obstructed excretory tract and treatment of the source of the obstruction. Prevention is based on early and adequate management of the various causative conditions.
MO297: Acute Kidney Injury Among COVID-19 Positive Patients is Associated With Higher Mortality: Single Center Experience
Authors: Ashry Ahmed Gheith Osama , Maher Nagib Ayman , Elserwy Nabil , Abbas Ahmad , Elsawi Islam S , Nair Prasad , Khalid Mahmoud , Hammad Mohamed , Fayyad Zohair , Atta Ahmed , Mostafa Ahmed , Deraz Ahmed , Abdelmonem Mohamed , Alotaibi Torki 
Published: May 2022

Abstract

BACKGROUND AND AIMS
Despite the lungs are the major targets of COVID-19, other organs such as the kidneys are also affected. Renal complications of COVID-19 are not yet well studied. We aimed to study the prevalence of acute kidney injury (AKI) among positive COVID-19 cases that were managed in the intensive care unit (ICU) in a single isolation hospital during the pandemic, and to explore its impact on patient outcome.

METHOD
This retrospective study included 616 patients with COVID-19 who were managed in the ICU in a single isolation hospital in Kuwait during the pandemic, from February to December 2020. AKI was defined according to the serum creatinine criteria in the Kidney Disease: Improving Global Outcomes (KDIGO) guidelines. Of the 616 patients, 40.2% developed AKI (group 1, n = 248) and were compared with the patients without AKI (group 2, n = 368).

RESULTS
Most of cases in the two groups were males (73% versus 70.7%), aged (60.8 ± 14 versus 51.7 ± 16 years), respectively. The two groups were comparable regarding chronic kidney disease (2% versus 0.8%) and chronic pulmonary disease. Other factors were significantly predominating among group 1 as diabetes mellitus (63.7 versus 40.5%), hypertension (74.2% versus 40.5%) and ischemic heart disease (26.2% versus 12.5%) (P &lt; .05).
Fever, cough, shortness of breath and dehydration were significantly more frequent presentations among patients of group 1, and had radiological findings that were synchronized with COVID-19 (89.5% versus 50.8%) (P &lt; .05). Moreover, sepsis, volume depletion, shock, arrhythmias and ARDS predominated among the AKI group (P &lt; .05). The number of cases who were managed by therapeutic anticoagulation was significantly higher in AKI patients (89.9% versus 51.9%); also, cases who received supportive vasopressors and convalescent plasma transfusion as well as steroid were significantly higher in the same group (P &lt; .05). Other therapeutic modalities such as antivirals, tocilizumab and hydroxychloroquine were comparable in both groups.
We found that acute respiratory failure requiring mechanical ventilation was significant among the AKI group (66.8% versus 29.4%), and the overall mortality rate was significantly higher in the same group (62.5% versus 32.8%).

CONCLUSION
The prevalence of AKI in patients with COVID-19 was 40.2%, and it was associated with poor prognosis among ICU COVID-19 positive cases.
MO312: Long-Term Kidney Function Outcome After COVID-19 Associated Acute Kidney Injury and Kidney Replacement Therapy in Intensive Care
Authors: Smolander Jessica , Rashid Tony Qureshi Abdul , Bruchfeld Annette 
Published: May 2022

Abstract

BACKGROUND AND AIMS
Acute kidney injury (AKI), frequently with concurrent albuminuria and haematuria, is common and increases mortality in COVID-19 infection. We present the clinical course and long-term outcomes of COVID-19 survivors with AKI and continuous kidney replacement therapy (CKRT) with follow-up of kidney function at 6 and 12 months.

METHOD
A total of 29 non-CKD COVID-19 infected patients with AKI required mechanical ventilation and CKRT at the intensive care unit (ICU). Of those, 15 died (52%) and 14 survived. Written informed consent to collect and publish data was obtained from 13 survivors.
We estimated eGFR with CKD-EPI creatinine in population-based healthy controls (n = 80, median age 62 years) for comparison.

RESULTS
A total of 13 survivors, median age 58 years, 85% male, 15% diabetes and median BMI 30 kg/m2. None had CKD before admission or at admission following rehydration.
The typical scenario was a normal or slightly elevated creatinine level at admission, normalizing after IV fluids, but rising creatinine from day 8 (median) and the start of CKRT on day 10 (median). Urine analysis was available in 7 patients, of which only 1 had no urinary findings, 6 had albuminuria and/or haematuria and/or leukocyturia. Dialysis could be weaned in all 13 survivors after a median time of 16 days in dialysis (range 1–40 days). The median length of stay at the ICU was 41 days (range 10–72 days) and the median weight loss was 16 kg (range 8–27 kg).
The survivors had a median eGFR of 100 mL/min/1.73 m2 (range 66–113) at baseline and a median eGFR of 69 mL/min/1.73 m2 (range 49–97) at 12 months estimated with CKD-EPI creatinine. Population-based control subjects had a median eGFR of 85 mL/min/1.73 m2 estimated CKD-EPI creatinine. Urine analysis was available in 11 patients at 12 months, of which 5 had no urinary findings, 3 had microalbuminuria and 3 had haematuria and/or leukocyturia.
Since the weight loss was accompanied by a decline in creatinine, we used both creatinine-based, and cystatin C-based eGFR to evaluate kidney function at 6 month follow-up. At 6 months, the survivors had a median eGFR of 70 mL/min/1.73 m2 (range 44–111) estimated with CKD-EPI creatinine as compared with 46 mL/min/1.73 m2 (range 36–65) estimated with cystatin C eGFR, suggesting that cystatin C-based formulae are clinically more useful after COVID-19 associated critical illness.

CONCLUSION
The AKI mortality in COVID-19 despite CKRT is high, but a substantial number of patients survive and can be weaned off dialysis. Kidney function at 12 months did improve substantially but did not return to its baseline values and was lower compared with healthy age-matched population-based control subjects. Kidney outcome follow-up after COVID-19 and AKI is likely to be important for assessing long-term CKD prognosis and is proposed to be evaluated with both creatinine and cystatin C as well as urinalysis.
MO317: The Impact of Early Versus Late Initiation of Renal Replacement Therapy in Critically ill Patients With Acute Kidney Injury on Mortality and Clinical Outcomes: A Systematic Review With Meta-Analysis
Authors: Relvas Miguel , Castro Inês , Gameiro Joana , António Lopes José , Monteiro-Soares Matilde , Coentrao Luis 
Published: May 2022

Abstract

BACKGROUND AND AIMS
Renal replacement therapy (RRT) is consensual in the presence of life-threatening complications associated with acute kidney injury (AKI). In the absence of urgent indications, the optimal timing for RRT initiation is still under debate. This systematic review with meta-analysis aims to compare the benefits between early and late RRT initiation strategies in critically ill patients with AKI.

METHOD
Studies were obtained from three databases (MEDLINE, CENTRAL and SCOPUS), searched from inception to May 2021. The selected primary outcome was 28-day mortality. Secondary outcomes included overall mortality, recovery of renal function (RRF) and RRT-associated adverse events. A random-effects model was used for summary measures. Heterogeneity was assessed through Cochrane I2 test statistics. Potential sources of heterogeneity for the primary outcome were sought using sensitivity analyses. Further subgroup analyses were conducted based on the RRT modality.

RESULTS
A total of 13 randomized controlled trials, including 5193 participants, were analyzed. No significant differences were found between early and late RRT initiation regarding 28-day mortality [risk ratio (RR) 1.00, 95% confidence interval (95% CI) 0.89–1.12; I² = 30%], overall mortality (RR 1.00, 95% CI 0.90–1.12; I² = 42%) and RRF (RR 1.02, 95% CI 0.92–1.13; I² = 53%). However, early RRT initiation was associated with a significantly higher incidence of hypotensive (RR 1.34, 95% CI 1.17–1.53; I² = 6%) and infectious events (RR 1.83, 95% CI 1.11–3.02; I² = 0%).

CONCLUSION
Early RRT initiation does not improve the 28-day or overall mortality, nor the likelihood of RRF and increases the risk for RRT-associated adverse events, namely hypotension and infection.
MO319: AKI in Patients With COVID-19 Supported on ECMO: A Single Center Experience in Mexico
Authors: Rizo Topete Lilia , Gomez Rene , Contreras Veronica , Borja Silvia , Sanchez Sergio , Lopez Alicia , Chavarria Uriel 
Published: May 2022

Abstract

BACKGROUND AND AIMS
AKI is a common complication in critically ill patients, during the COVID-19 pandemic, it has been presented directly associated with damage by the virus, due to the severity of the disease and secondary to treatment, that is, secondary to the crosstalk of organs and the crosstalk of support equipment, such as the extracorporeal oxygenation membrane (ECMO), which has been used in patients with severe respiratory failure. According to the international bibliography, the incidence of AKI in ECMO ranges from 26% to 85% depending on the characteristics of the patient, the percentage that requires KRT is around 45%.

OBJECTIVE
Our hospital is a national reference center for ECMO support therapy as for lung transplantation, it is the only center that has an active program, so understanding the epidemiology of AKI associated with ECMO in our population is important, in addition to representing a part of the experience in Latin America.

METHOD
Retrospective and descriptive studies were included all patients 18 years or older connected to ECMO with a diagnosis of severe pneumonia for COVID-19 from June 2020 to August 2021. Data were collected in Excel and using the ECMO Team platform data that is shared in the ELSO. Descriptive data analysis was performed with SPSS V21 and Excel.

RESULTS
A total of 48 patients were connected to ECMO for COVID-19 severe pneumonia in our center, of which 39 were men. Average age 49 years (min 21 year, max 68 year), average weight 93 kg (min 55 kg, max 125 kg) 25 patients (52%) with AKI, 22 (45%) required KRT and 100% CKRT. Of them, 10 patients (20%) have kidney recovery function, all of them get out form ECMO. From all, 45% patients died, these 45% were still in ECMO. In most of the cases, the AKI cause is multifactorial, but the most common cause identified was sepsis, the second nephrotoxicity (antibiotics like vancomycin and colistin) and the third hemolysis (an ECMO membrane complication). About the indication of star KRT: 50% fluid overload, 30% acidosis and uremia and 20% anuria. A total of 100% of patients were in ECMO-VV at time CKRT started, all were connected in parallel in ECMO in post-blood pump and return pre-blood pump, with no coagulation problems as long as they have the ECMO anticoagulation, 93% patients with heparin and 7% with argatroban for HIT suspicious. As data to highlight from our population, there is the first bilateral lung transplant secondary to COVID-19 in Latin America and the longest air transfer in ECMO in the world.

CONCLUSION
In our center, the AKI, KRT and mortality in patients with ECMO are much like other centers reported. In COVID-19, there is not yet very clear evidence and more studies should be done. This is the first study in Mexico about ECMO, AKI and COVID-19.
MO325: Renal Glycosuria in Acute Kidney Injury Predicts the Diagnosis of Acute Interstitial Nephritis
Authors: Landaluce Triska Eugenia , Shabaka Amir , León-Póo Mariana , Maria Fernandez Juarez Gema 
Published: May 2022

Abstract

BACKGROUND AND AIMS
Acute interstitial nephritis (AIN) is one of the most frequent causes of acute kidney injury (AKI). Interstitial inflammation can lead to tubular epithelial infiltration producing tubular dysfunction, which could be clinically detected by glycosuria (with or without Fanconi syndrome), leukocyturia, microscopic haematuria or tubular proteinuria. The aim of this study was to determine the predictive value of renal glycosuria in AKI for the diagnosis of AIN.

METHOD
We conducted a retrospective study of kidney biopsies performed at out centre between May 1998 and December 2021, and included patients whose kidney biopsy was performed while presenting with AKI. We excluded patients with other indications for kidney biopsy, patients with diabetes mellitus and patients who presented a serum glucose level of &gt; 120 mg/dL at presentation. We registered demographic, clinical and laboratory variables at presentation of AKI, and compared patients with a final diagnosis of AIN to patients with other causes of AKI.

RESULTS
The study included 211 patients; 39 patients (18.5%) with a diagnosis of AIN and 172 patients (81.5%) with other diagnoses for AKI. Eight patients with AIN presented with renal glycosuria (20.5%) compared with seven patients with other causes of AKI (4.1%) (P &lt; .001). Patients with AIN presented less frequently haematuria (46.2% versus 86%; P &lt; .001), lower albuminuria [86 (35–151) mg/g versus 694 (136–1414) mg/g; P &lt; .001], proteinuria [0.43 (0.22–0.92) g/24 h versus 1.43 (0.76–2.97) g/24 h; P &lt; .001], serum glucose (89.5 ± 12 versus 94.7 ± 12.5 mg/dL; P = .019) and uric acid (6.5 ± 2.5 versus 7.8 ± 2.3 mg/dL; P = .003), and more frequently metabolic acidosis (68.6% versus 33.3%; P &lt; .001) and eosinophilia (17.9% versus 5.2%; P = .007) than in patients with other causes of AKI. There were no differences in age, sex, extrarenal manifestations, serum creatinine, potassium or phosphorus levels at presentation. The presence of at least traces (≥50 mg/dL) of glycosuria had a specificity of 96.5% (92.6–98.7) for the diagnosis of AIN, with a positive predictive value of 57.1% (32.9–78.3) and a negative predictive value of 84.3% (82%–86.3%). The positive likelihood ratio was 5.9 (2.2–16) and the negative likelihood ratio was 0.82 (0.7–0.97). The presence of &gt; 100 mg/dL of glycosuria had a specificity of 99.4% for the diagnosis of AIN, with a positive predictive value of 75% (24.3–96.6) and a positive likelihood ratio of 13.2 (1.4–123.8).

CONCLUSION
AIN can lead to proximal tubular dysfunction, which can be clinically expressed as renal glycosuria. The presence of renal glycosuria in patients with AKI guides towards the diagnosis of AIN, with an excellent specificity when glycosuria &gt; 100 mg/dL.
MO329: Acute Kidney Injury (AKI) is Associated With Increased in-Hospital Mortality and With Impairment of Renal, Lung, Motor and Immune Function 1 Year After Discharge For COVID-19
Authors: Morosini Umberto , Marengo Marita , Prenna Stefania , Colombatto Andrea , Fornara Laura , Quaglia Marco , Merlotti Guido , Paolo Sainaghi Pier , Bellan Mattia , Cantaluppi Vincenzo 
Published: May 2022

Abstract

BACKGROUND AND AIMS
AKI is the most frequent complication after respiratory failure in COVID-19. AKI increases mortality risk, length of hospital stay and healthcare costs, with possible progression towards CKD. Study aims: (1) evaluation of AKI incidence in 1020 COVID-19 hospitalized patients; (2) comparison of AKI incidence in COVID-19 versus pre-pandemic period; (3) establishment of out-patient follow-up for monitoring kidney, lung, motor and immune function; (4) creation of a biobank for biomarker discovery studies.

METHOD
AKI incidence was calculated matching laboratory and administrative data of 26 214 hospitalized patients in 2018–2019 and in 1020 COVID-19 patients in 2020–2021: KDIGO algorithms were applied for AKI grading. After 12 months from discharge, 232 COVID AKI patients and relative controls matched for age and gender were evaluated for kidney (eGFR, biomarkers of tubular damage NGAL, CCl-14, DKK-3), lung (DLCO, CT scan) and neuro-motor (SPPB, 2-min walking test, post-traumatic stress test-IES) function.

RESULTS
Before the pandemic, in-hospital AKI incidence was 18% (10% KDIGO 1, 5% KDIGO 2, 3% KDIGO 3): median age of AKI patients was 69. In-hospital mortality was 3.5% in non-AKI group versus 15% in AKI group in accordance with KDIGO stages. In COVID patients, AKI incidence increased to 37% (20% KDIGO 1.11% KDIGO 2, 6% KDIGO 3): median age of patients was 54. In-hospital mortality was 31% in the AKI group; AKI is an independent risk factor for death. After 12 months from hospital discharge, COVID AKI patients showed a persistent reduction of respiratory function (severe DLCO impairment &lt; 60%) related to the extent of CT scan abnormalities. AKI patients also presented the motor function impairment and a worse post-traumatic stress response. GFR reduction was 1.8 mL/min in non-AKI patients versus 9.7 mL/min in AKI COVID patients not related to age. Urinary DKK-3 and CCL-14 were also higher in the AKI group. Last, IgG response after SARS-CoV-2 vaccination was significantly lower in the AKI group.

CONCLUSION
AKI incidence was significantly increased during COVID-19 in respect to the pre-pandemic period, with an association with higher mortality in class 2–3 KDIGO. In the post-COVID follow-up, AKI was associated with lung and neuro-motor function impairment, a defective antibody response and a sudden GFR decline concomitant to the persistence of tubular injury biomarkers. These results suggest the importance of nephrological and multidisciplinary follow-up of frail patients who developed AKI during hospitalization for COVID-19.
MO331: Acute Kidney Failure as a Risk Factor for Longer Hospital Stay, Renal Replacement Therapy and Mortality: A Public Health System Analysis
Authors: Portoles Jose' M , Lopez Paula , De Valdenebro Recio Maria , Sanchez Briales Paula , Luisa Serrano Salazar Maria , Ramos-Vegue Arturo , Gil-Casares Casanova Beatriz , Marques Vidas Maria 
Published: May 2022

Abstract

BACKGROUND AND AIMS
Acute kidney failure (AKI) is a well-known risk factor in coronary care unit (CCU) and postoperative patients. We aim to analyse their role in a multicentre database (DB) from a public regional health system (6 million inhabitants).

METHOD
Observational, retrospective study, including all hospital admissions between January 2013 and December 2014 in all referral hospitals in Madrid. We grouped into three categories, admissions due to AKI (ON-AKI), AKI during stay (HOSP-AKI) secondary to other disease and admissions without AKI (no-AKI); ICD-9 code was 584. Admission from patients aged under 16, women to give birth or previous renal replacement therapy (RRT) were excluded. Study was approved by the ethics committee.

RESULTS
Of the 419 851 admissions registered in 2 years, 6.7% had an associated AKI (0.6% on arrival AKI and 6.1% during admission AKI). Patients admitted for AKI are older (ON-AKI: 74.8 years versus HOSP-AKI: 77.9 versus no-AKI: 63.6), with greater comorbidity (Charlson index 2.9 versus 3.1 versus 1.7); patients had more previous CV events (28.5% versus 46.8 versus 21.0), diabetes mellitus (34.1% versus 30.4 versus 17.1) and a higher prevalence of previous chronic kidney disease-CKD (41.3 versus 31.5 versus 4.9%). AKI kidney failure lengthens hospital stay by 3.2 days 95% confidence interval (95% CI) (2.8–3.5) after adjust by age, gender, Charlson index, surgery and major diagnostic categories.
Admissions with AKI are usually unscheduled and have a longer hospital stay (9.6 ON-AKI versus 12.6 HOSP-AKI versus 7.1 days in no-AKI admission). More patient died during hospital stay in AKI group (14.4% ON-AKI; 22.9 HOSP-AKI versus 3.5% No-AKI) and although 4.3% of admission needed dialysis, only 0.5% started a chronic RRT during admission.
Principal risk factor for developing secondary AKI (R2 = 16%) is previous CKD [OR 3.6; (3.48–3.74)], after corrected by age, male, the Charlson index and non-surgical admission.
Mortality risk for patients with an admission for AKI (R2 = 17%), corrected for age, sex, comorbidity, previous CKD, and type of admission is OR: 1.8 95% CI (1.57–2.08); secondary AKI is OR 3.73 (3.59–3.88) than no-AKI admission.

CONCLUSION
AKI is a huge burden for health system and patients, and associates significant longer stay, cost and a higher mortality. Main factor to develop secondary AKI is age and previous CKD.