We present the case of a male patient with severe SARS-CoV-2 pneumonia, with simultaneous onset of p-ANCA positive rapidly progressive glomerulonephritis. We discuss the different therapeutic ...possibilities, emphasising the appropriateness of their administration according to the time in the course of the infection.
Presentamos el caso de un varón afecto por neumonía SARS-CoV-2 grave, que a la vez comienza con una glomerulonefritis rápidamente progresiva p-ANCA positiva. Se comentan las distintas posibilidades terapéuticas haciendo hincapié en la idoneidad de su administración según el momento evolutivo de la infección.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UILJ, UL, UM, UPCLJ, UPUK, ZAGLJ, ZRSKP
Abstract
Background and Aims
The vascular access of choice for hemodialysis patients is the arteriovenous fistula (AVF). There is a high rate of early primary failure and loss of primary AVF patency. ...Monitoring of vascular access is essential for early diagnosis of complications and prolonging survival. Models based on Artificial Intelligence (AI) and Machine Learning (ML) can be used for this.
Method
Retrospective descriptive study of the Vascular Doppler Ultrasound (VDU) in adults carried out since January 2019 to January 2022 in our AVF follow-up nephrology clinic. We analyze the results and create AI-based AVF underdevelopment prediction models. We included clinical, demographic and ultrasound variables. Patients were undergoing AVF post-surgery follow-up (VDU by protocol at 3-4 weeks after AVF surgery) or were referred to the clinic with signs of AVF dysfunction. The insufficient development of the vascular access is established as an objective variable. SPSS 20 Statistical Package. Automated Learning Analysis (ML) with Orange ML and BigML.
Results
243 VDU were performed. Of the total, 139 (57%) were follow-up post-surgical VDU per protocol and 104 (43%) were AVF dysfunction VDU. Using supervised ML Analysis techniques with random sampling of 80% of the instances for Training and 20% for Test, we obtain prediction models for the underdevelopment (UD) attribute of FAV: Decision tree algorithm, Area under the curve (AUC) 89%, Classification accuracy (CA) 90%, Precision 90%. Random Forest Algorithm (RF) (AUC) 95%, (CA) 86%, Accuracy 81%. Near Neighbor Algorithm (K-NN) (AUC) 88%, CA 82%, Accuracy 78%. Convolutional Neural Networks (NNC) (AUC) 82%, CA 74%, Accuracy 60%. Algorithm with unsupervised technique of clustering in k-Means 3 clusters are obtained. The variables that best correlate with the objective variable are access flow, vein diameter, resistance index (RI) proximal, (RI) distal, and diameter of the anastomosis.
Conclusion
The vascular ultrasound systematized by the nephrologist facilitates the early diagnosis of complications that lead to early intervention. Analysis of the data with techniques (ML) can facilitate early diagnosis AVF poor development requiring close monitoring or intervention. The development of a nephrology clinic for monitoring vascular access could avoid invasive and unnecessary procedures for the patient.
Abstract
Background and Aims
Dyslipidemia is frequent in patients with chronic kidney disease (CKD), it constitutes a factor of progression of both cardiovascular risk (CVR) and CKD itself. It has ...its own characteristics, which are modified with the ERC stadium. The subgroup of patients with Polycystic Kidney Disease (PKD) presents its own characteristics. The aim of the study was to analyze the lipid profile in the renal population and the differences in the PKD group.
Method
Retrospective observational study, includes population under follow-up in nephrology consultations in a health area, during 2018–2021. We analyzed lipid profile, renal function and whether they received statins. IBM SPSS Statistics V24 was used.
Results
3301 prevalent patients with kidney disease were collected, excluding those on renal replacement therapy (RRT), with glomerular filtration rate (GFR), glomerular filtration rate (GFR) <10ml/min/1.73m² and proteinuria greater than 1.5g. Of these, 112 (3.4%) patients had PKD. 51% of the total CKD patients were under treatment with statins. The average number of Total Cholesterol (TC) was 170.4+/-43mg/dl, LDL 92.3+/-37mg/dl, HDL 50.3+/-15mg/dl and triglycerides (TG) 147.3+/-92mg/dl. In 37% of CKD patients, LDL was >100mg/dl and only 35% had LDL<75mg/dl. In the CKD group with a GFR <60ml/min/1.73m² (N = 2337; 71%), there was a high prevalence of patients with LDL values >100mg/dl (N = 784; 33.5%). In the case of GFR <30ml/min/1.73m² (N = 981; 29.7%), the presence of LDL>100mg/dl 30% (N = 297) was also frequent. In the subanalysis of patients with PKD, the mean TC was 182+/-40mg/dl, LDL 101.2+/-33mg/dl, HDL 56.4+/-17mg/dl, and TG 123.7+/-59mg/dl. 76% of the PKD had GFR <60ml/min/1.73m² (N = 73), of which 43% presented LDL>100mg/dl (N = 32). In PKD patients with GFR > 60ml/min/1.73m² (N = 39), half (N = 22; 56.4%) also had LDL >100mg/dl. In addition, 51% were taking a statin, despite this they had a mean TC 183mg/dl+/-46, LDL 102.7+/-39, HDL 53+/-15, and TG 142+/-69mg/dl.
Conclusion
The presence of elevated LDL was frequent in CKD, especially in the group with GFR < 60ml/min/1.73m² without statin and in a quarter of patients with the same GFR with statin. It is notable in the PKD group, probably due to less awareness of strict CVR control.
Abstract Background and Aims The study of kidney disease (KD), including genetics, may involve a significant change in the management, treatment, and prognosis of the patient. Method Retrospective ...study assessing the impact of genetic studies (GS) requested by the nephrology department at Virgen Macarena Hospital over 43 months (June/2019 to December/2022). We analyze diagnoses before and after GS, as well as their impact. The sequencing platforms used include Illumina HiSeq-MiSeq-NovaSeq and Ion Torrent. Common databases consulted include ClinVar, RefSeq, Ensembl, NCBI, ExAC, aHUS, and BIER. Results A total of 118 patients with genetic studies (GS) were analyzed. The mean age was 45.2 ± 16, with 51% being male and 49% female. 78% had first and/or second-degree relatives with kidney disease, and in 43 cases (36%), no family history was known. The mean creatinine (Cr) was 1.9±2 mg/dl, glomerular filtration rate (GFR) was 67 ± 40 ml/min, and urine albumin/creatinine ratio (UAC) was 770 ± 1700 mg/g, with hematuria present in 57.6% of patients. A renal biopsy (RB) was performed in 32 patients (27%). The indications for genetic testing were as follows: extension of studies in biopsied nephropathy (20%), cystic kidney disease (29%), non-biopsiable or chronic kidney disease (21%), family history (33%), and for research or trial purposes (1%). In 22%, a study of a known familial mutation was conducted, while the remaining cases involved gene panel analysis. The pre-genetic diagnoses were as follows: 39% glomerular disease, 22% other conditions (suspected Alport and Fabry), 16% autosomal dominant polycystic kidney disease (ADPKD), 8% complement-associated pathology (CAP), 5% other cystic diseases, 4% tubulointerstitial nephropathies (TIN), 3% nephropathy of unknown origin, 2% diabetic nephropathy, and 2% nephroangiosclerosis. GS was positive in 76 patients (N = 76; 64%). Variants were detected in 76 patients, with 14 patients exhibiting two concurrent variants in the same or different genes, and 4 patients having up to 3 variants. The most frequent variants were identified in the genes: COL4A, PKD1, C3, MCP, and CFH. Of these, 37% were pathogenic mutations, 26.6% were likely pathogenic, 33% were variants of uncertain significance (VUS) possibly related to the pathology, and 3.2% were unrelated VUS. In cases with negative GS results (42; 35%), we considered that the pre-genetic diagnosis was excluded in 17% of the overall patient cohort. Post-GS diagnoses included Alport (30; 25%), ADPKD (16, 14%), CAP (13; 11%), focal segmental glomerulosclerosis (6; 5%), TIN (4; 3%), autosomal recessive polycystic kidney disease (ARPKD) (1; 1%), congenital anomalies of the kidney and urinary tract (CAKUT) (1; 1%), and other conditions (5; 4%). The concordance between the pre-genetic diagnosis and GS result was 52% (N = 61). It led to a change in diagnosis in 48% of patients (N = 56); both positive and exclusionary results had an impact on clinical management in 83% (N = 98), and it resulted in a change in treatment in 20% (N = 24). Conclusion Genetic studies allow us to trace the origin of the kidney disease, providing a fundamental diagnostic tool. According to the literature, the most frequently diagnosed variants were those related to Alport syndrome, renal polycystic disease (with PKD1 being the most common), and mutations associated with complement pathway pathology. The implications and diagnostic changes brought about by genetic studies justify their implementation. In some cases, they also reclassify the kidney disease in our patients, enabling access to specific treatments.
Abstract
BACKGROUND AND AIMS
The incidence of acute renal failure (ARF) is frequent and has an implication in the morbidity and mortality of SARS-CoV-2 infection.
METHOD
A retrospective descriptive ...study of patients admitted for SARS-CoV-2 infection during the first (G1) and second (G2) waves who presented with ARF. They correspond to the period from March to May 2020 (G1) and from August to December 2020 (G2). We compare populations, outcomes and treatments.
RESULTS
A total of 73 patients in the first wave (G1), with a cumulative incidence (CI) of 28.3% (G1), compared with 58 patients in the second wave (G2), with a CI of 8% (G2). The mean age was higher in G2 65.8 ± 15 years (G1); 75.3 ± 14 (G2); P <.05, with no difference regarding sex 63% (G1); 54% (G2). In G2, there was a higher proportion of patients with cardiovascular disease 23% (G1); 57% (G2), hypertension 56% (G1); 83% (G2). The baseline glomerular filtration rate (GFR) being similar for both groups (CKD EPI: 69 mL/min/1.73² (G1); P = .27). In the first wave, the mean days from admission to ARF was 3.1 days ± 4.2, and 42% of the patients were diagnosed at admission (31 patients). In the second, it was 2.9 days ± 5.7, of which 60% at admission (35 patients). The most prevalent cause was prerenal in both. Higher proportion in G1 of KDIGO stage 3 (G1: 30% versus G2: 17%) and renal replacement therapy (RRT) (G1: 9 versusG2: 2 patients). Only 3 patients remained in RRT in G1 and 1 patient in G2. In G1, 64% recovered their GFR mean time (MT): 7.5 ± 8 days, and the percentage of deaths was 34%. In G2, 72% recovered GFR (MT: 16 ± 25 days), and 19% of patients died.
CONCLUSION
Despite a lower age and comorbidity of the first wave patients, the severity and lethality was higher. There were no differences in the proportion of patients who recovered their baseline renal function, although the recovery time was longer in the second wave.
Dialysis patients are a risk group for SARS-CoV-2 infection and possibly further complications, but we have little information. The aim of this paper is to describe the experience of the first month ...of the SARS-CoV-2 pandemic in a hospital haemodialysis (HD) unit serving the district of Madrid with the second highest incidence of COVID-19 (almost 1,000 patients in 100,000h). In the form of a diary, we present the actions undertaken, the incidence of COVID-19 in patients and health staff, some clinical characteristics and the results of screening all the patients in the unit. We started with 90 patients on HD: 37 (41.1%) had COVID-19, of whom 17 (45.9%) were diagnosed through symptoms detected in triage or during the session, and 15 (40.5%) through subsequent screening of those who, until that time, had not undergone SARS-CoV-2 PCR testing. Fever was the most frequent symptom, 50% had lymphopenia and 18.4% <95% O
saturation. Sixteen (43.2%) patients required hospital admission and 6 (16.2%) died. We found a cluster of infection per shift and also among those using public transport. In terms of staff, of the 44 people involved, 15 (34%) had compatible symptoms, 4 (9%) were confirmed as SARS-CoV-2 PCR cases by occupational health, 9 (20%) required some period of sick leave, temporary disability to work (ILT), and 5 were considered likely cases. CONCLUSIONS: We detected a high prevalence of COVID-19 with a high percentage detected by screening; hence the need for proactive diagnosis to stop the pandemic. Most cases are managed as outpatients, however severe symptoms are also appearing and mortality to date is 16.2%. In terms of staff, 20% have required sick leave in relation to COVID-19.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UILJ, UL, UM, UPCLJ, UPUK, ZAGLJ, ZRSKP
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