COVID-19 discharge and follow-up recommendations Abdelnabi, Mahmoud; Leelaviwat, Natnicha; Eshak, Nouran ...
Proceedings - Baylor University. Medical Center,
10/2020, Letnik:
34, Številka:
1
Journal Article
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Currently, the world is facing a global pandemic of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), also known as COVID-19. So far, there are no clear recommendations regarding hospital ...discharge and aftercare for COVID-19. Here, we briefly discuss the current understanding of recommendations for discharge criteria, discharge treatment regimens, and follow-up.
Dietary intake can promote good health including blood pressure control from low sodium intake, slow progression of chronic kidney disease (CKD) from low protein diet. Counseling how to control ...amount of diet may be unpractical unless there is objective information of consumed nutrient. A 24-hour urine collection can provide information regarding the amount of intake nutrient. We present a case of healthy women comes for a living kidney donor evaluation and 24-hour urine collection showed high daily sodium and protein intake and lowering sodium and protein intake are advice for the patient.
A 37-year-old Caucasian woman with a past medical history significant for possible gestational diabetes mellitus comes to pre-living kidney donation clinic. She would like to donate her kidney to her friend who has end-stage renal disease from a lupus nephritis. The patient denies history of kidney diseases, dysuria, gross hematuria, difficulty urination, or history of passing kidney stone. Her weight was 49.4 kg, height was 1.47 m, and body mass index was BMI 22.76 kg/m2. Blood pressure was 126/76 mmHg. Serum creatinine was 0.7 mg/dL and blood urea nitrogen was 14 mg/dL. A 24-hour urine collection showed volume of 1.98 L, microalbumin of 0.24 g, creatinine of 0.9 g, urine urea of 10.1 g, and sodium of 174.
Calculations from the 24-hour urine collection include a daily urinary creatinine excretion of 18.22 mg/kg/day indicating adequately collected urine and creatinine clearance of 89.21 ml/min. Since urine sodium was 174 mmol/day, calculated daily sodium intake was 4 g. Daily protein intake of 16% of daily protein excretion was 11.63 g/day; therefore, daily protein intake was 72.7 g/day or 1.47 g/kg/day. She was advice to decrease amount of daily sodium intake to 62% (2.5 g/day) and protein intake to 68% (1 g/kg/day) of her current daily dietary intake.
From the 24-hour urine collection, we can estimate 2 important nutrients that our patient took a day. Calculated daily sodium and protein intake were 4 g/day and 1.47 g/kg/day, respectively. These amounts of sodium and protein intake are higher than recommended daily amount for general population. Particularly, for the person who plan to donate their kidney and will have lower than normal renal function after kidney donation, should have more strict diet control. Therefore, calculated amount of daily nutrient intake from a 24-hour urine collection provide practical care and recommendation to person who need dietary guidance with subjective evidence.
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Overweight and obesity are associated with hypertension (HTN) in renal transplant recipients (RTR). Body weight variability is known to be associated with HTN and poor cardiovascular (CV) outcomes in ...diabetic patients. After successful kidney transplantation (KT), weight change is very common due partly to perioperative and immunological factors. Association between body weight variability and HTN in RTR is unknown. We hypothesize that high body weight variability is associated with post-transplant HTN.
Body weight variability of RTR from a single transplant center was assessed as visit-to-visit body mass index variability (VVBMIV) by using average successive variability (ASV = the average absolute difference between successive values of BMI measured at 4, 12, 24, 36, and 48 weeks after KT). Multi-variable Cox proportional hazard regression analysis was used to examine association between post-transplant VVBMIV and systolic and diastolic HTN (SHTN and DHTN), which are defined as SBP and DBP ≥130 and 80 mmHg, respectively.
Of 104 RTR, mean ± SD age was 54.29 ± 11.65 years and 62% were female. The majority (36%) were obese followed by normal weight (33%), and overweight (31%). Incidence of SBP was 0.041 person-weeks and median time to event was 12.86 weeks; while the incidence of DBP was 0.036 person-weeks with a slightly longer median time-to-event of 13 weeks. Mean ASV of BMI was 1.26 ± 0.82 kg/m2 (0.47 to 2.18). Risk of SHTN is increased 32% for every 1 kg/m2 increase in VVBMIV (HR 1.32, 95%CI 1.04 to 1.68, P 0.022). After adjusted for age, gender, and their interaction terms, very 1 kg/m2 increase in VVBMIV is associated with a 29% greater risk of developing SHTN (HR 1.29, 95% CI 1.01 to 1.65, P 0.043). However, increase in VVBMIV is not associated with an increased risk of DHTN for both univariable (HR 1.15, 95%CI 0.88 to 1.49, P 0.308) and multi-variable Cox regressions models (HR 1.13, 95%CI 0.86 to 1.49, P 0.391).
Post-kidney transplant VVBMIV is independently associated post-transplant SHTN, but not DHTN. Further studies is needed to examine mechanism of body weight variability and blood pressure outcomes in RTR.
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Obesity is associated with worsening kidney allograft function. Since kidney allograft function may rapidly change throughout the course of kidney transplantation, particularly during early ...post-transplant period, we aim to examine association between pre-transplant obesity and development of chronic kidney disease (CKD) over several time points during post-transplant periods.
A single center retrospective cohort study included kidney transplant recipients who received kidney transplantation, between 2012 and 2015. The study population were divided into non-obese and obese groups based on pre-transplant body mass index (BMI) of < 30 and ≥30 kg/m2, respectively. Association between the obesity status and post-transplant CKD defined as estimated glomerular filtration rate (eGFR) < 60 ml/min/1.73 m2 was examined by multivariable Cox proportional hazard regression analysis with a time-dependent effect at 12, 24, 36, and 48 weeks post-kidney transplantation.
Of all 105 patients, mean age ± SD was 54 ± 12 and 61% was female. Non-obese and obese groups were account for 64% and 36%, respectively and their corresponding mean BMI were 24.34 ± 3.54 and 34.27 ± 3.53 kg/m2 (P < 0.001). The risk of developing CKD at 12, 36, and 48 weeks post-kidney transplantation, were not significantly difference. However, at 24-week post- kidney transplantation, obese group had 71% greater the risk for CKD compared to non-obese group (Hazard ratio (HR) 1.71, P 0.049, 95% confidence interval (95%CI) 1.002, 2.908). After adjusted for age, gender, type of kidney transplantation, systolic and diastolic blood pressure at 24 weeks post-kidney transplantation, the obese group remain at higher the risk for CKD (HR 1.74, P 0.044, 95% CI 1.014, 2.985).
Pre-kidney transplant obesity was associated with increased risk of CKD at the early, but not at the immediate or long-term post-transplant periods independent to the baseline characteristics and blood pressure. Pathophysiological changes during different post-transplant periods including immunological or non-immunological factors may contribute to this time-dependent effects of pre-transplant obesity and CKD. Additional studies are warranted to further examine possible mechanism.
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A 19-year-old woman with a history of asthma presented with acute confusion following a near-drowning event 2 weeks prior to admission. She was found to have severe thrombocytopenia and ...microangiopathic hemolytic anemia (MAHA). The treatment for thrombotic thrombocytopenic purpura (TTP) was started on the day of admission due to high clinical suspicion. Subsequent workup confirmed a diagnosis of TTP with no clear etiology except the near-drowning incident. TTP following a near-drowning event has never been reported in the literature. Furthermore, she developed refractory TTP that required reinitiation of therapeutic plasma exchange and rituximab. After discharge, the patient had been doing well over a year of follow-up without remission.
Key Clinical MessagePre-bariatric surgery dietary recommendations should take into account daily protein intake and other risk factors for kidney injury. This is important because a high protein ...intake can potentially lead to kidney injury.AbstractBariatric surgery has been shown to be a highly effective intervention for achieving weight loss and reducing obesity related-comorbidities. Acute kidney injury (AKI) is considered one of the common complications in perioperative and post-bariatric surgery. However, pre-bariatric surgery AKI has never been reported. Several studies demonstrated that pre-bariatric surgery weight loss improved surgical outcomes and decrease postoperative complications. Some diet regimens have been introduced including low-caloric diet (LCD), very-low caloric diet (VLCD), and very-low caloric ketogenic diet (VLCKD). We present a patient who develops AKI after 10 days of having a high-protein diet from a pre-bariatric weight loss strategy.
Central diabetes insipidus (DI) is an uncommon condition caused by reduced or lack of vasopressin secretion from the posterior pituitary gland, typically caused by gland destruction. Several other ...causes for central DI have also been proposed. Here we present a case of transient central DI after discontinuation of vasopressin used for septic shock without evidence of overt pituitary damage in a cystic fibrosis patient. The serum sodium concentration peaked at 137 mmol/L in the setting of polyuria within 3 days of vasopressin discontinuation without other identified alternative etiologies. Sodium levels and urine output trended down dramatically with desmopressin administration.
Eosinophilia with pulmonary involvement is characterized by the presence of peripheral blood eosinophilia, typically >500 cells/mm3, nonspecific pulmonary symptoms, and radiographic evidence of ...pulmonary disease. Clinical, laboratory, and radiologic features can be overlapping in these diseases, thus, it is wise to approach eosinophilia with pulmonary involvement systematically to determine the diagnosis and provide definitive treatment for a better outcome. The authors present a case of idiopathic chronic eosinophilic pneumonia in a patient with a long history of chronic obstructive pulmonary disease (COPD) which was resolved by corticosteroid.
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