Background
Acute kidney injury (AKI) is frequent in Coronavirus Infection Disease 2019 (COVID-19) patients. Factors associated with AKI in COVID-19 intensive care unit (ICU) patients and their ...outcomes have not been previously explored.
Methods
Prospective observational study of COVID-19 patients admitted to the ICUs of the Hospital Clínic of Barcelona (Spain), from March 25th to April 21st, 2020, who developed AKI stage 2 or higher (AKIN classification). The primary goal was to describe the characteristics of moderate-severe AKI of COVID-19 patients in an ICU context. As a secondary goal, we aimed to find independent predictors of AKI progression, Renal Replacement Therapy (RRT) requirement and mortality among these patients.
Results
During the study period, 52 out of 237 ICU patients, developed AKIN stage 2 or higher and were included in the study. A Sequential Organ Failure Assessment (SOFA) score at AKI diagnosis of 8 or higher was associated with RRT, OR 5.2, p 0.032. At the time of AKI diagnosis, patients had a worse liver profile and higher inflammation markers than at admission. Fifty per cent of the patients presented AKI progression from AKIN 2 to 3 and 28.85% required RRT. The use of corticosteroids in 69.2% of patients was associated with a reduced requirement of RRT, OR 0.13 (CI 95% 0.02–0.89), p 0.037. AKI was associated with high mortality (50%) and a longer hospital stay, median 35 vs 18 days (p 0.024).
Conclusions
The prevalence of moderate/severe AKI in COVID-19 patients admitted to the ICU is high and has a strong correlation with mortality and length of hospital stay.
Objective To develop performance metrics that objectively define a reference approach to a transurethral resection of bladder tumours (TURBT) procedure, seek consensus on the performance metrics from ...a group of international experts. Methods The characterisation of a reference approach to a TURBT procedure was performed by identifying phases and explicitly defined procedure events (i.e., steps, errors, and critical errors). An international panel of experienced urologists (i.e., Delphi panel) was then assembled to scrutinise the metrics using a modified Delphi process. Based on the panel's feedback, the proposed metrics could be edited, supplemented, or deleted. A voting process was conducted to establish the consensus level on the metrics. Consensus was defined as the panel majority (i.e., >80%) agreeing that the metric definitions were accurate and acceptable. The number of metric units before and after the Delphi meeting were presented. Results A core metrics group (i.e., characterisation group) deconstructed the TURBT procedure. The reference case was identified as an elective TURBT on a male patient, diagnosed after full diagnostic evaluation with three or fewer bladder tumours of ≤3 cm. The characterisation group identified six procedure phases, 60 procedure steps, 43 errors, and 40 critical errors. The metrics were presented to the Delphi panel which included 15 experts from six countries. After the Delphi, six procedure phases, 63 procedure steps, 47 errors, and 41 critical errors were identified. The Delphi panel achieved a 100% consensus. Conclusion Performance metrics to characterise a reference approach to TURBT were developed and an international panel of experts reached 100% consensus on them. This consensus supports their face and content validity. The metrics can now be used for a proficiency‐based progression training curriculum for TURBT.
Pancreas graft status in simultaneous pancreas-kidney transplant (SPKTx) is currently assessed by nonspecific biochemical markers, typically amylase or lipase. Identifying a noninvasive biomarker ...with good sensitivity in detecting early pancreas graft rejection could improve SPKTx management.
Here, we developed a pilot study to explore donor-derived cell-free DNA (dd-cfDNA) performance in predicting biopsy-proven acute rejection (P-BPAR) of the pancreas graft in a cohort of 36 SPKTx recipients with biopsy-matched plasma samples. dd-cfDNA was measured using the Prospera test (Natera, Inc.) and reported both as a fraction of the total cfDNA (fraction; %) and as concentration in the recipient's plasma (quantity; copies/mL).
In the absence of P-BPAR, dd-cfDNA was significantly higher in samples collected within the first 45 d after SPKTx compared with those measured afterward (median, 1.00% versus 0.30%; median, 128.2 versus 35.3 cp/mL, respectively with both; P = 0.001). In samples obtained beyond day 45, P-BPAR samples presented a significantly higher dd-cfDNA fraction (0.83 versus 0.30%; P = 0.006) and quantity (81.3 versus 53.3 cp/mL; P = 0.001) than stable samples. Incorporating dd-cfDNA quantity along with dd-cfDNA fraction outperformed dd-cfDNA fraction alone to detect active rejection. Notably, when using a quantity cutoff of 70 cp/mL, dd-cfDNA detected P-BPAR with a sensitivity of 85.7% and a specificity of 93.7%, which was more accurate than current biomarkers (area under curve of 0.89 for dd-cfDNA (cp/ml) compared with 0.74 of lipase and 0.46 for amylase).
dd-cfDNA measurement through a simple noninvasive blood test could be incorporated into clinical practice to help inform graft management in SPKTx patients.
La hemoglobinuria paroxística nocturna (HPN) es un trastorno secundario a la deficiencia de CD55 y CD59, proteínas de superficie reguladoras del complemento, resultando en hemólisis crónica mediada ...por el complemento1. La afectación renal oscila entre la lesión renal aguda durante las crisis hemolíticas, la disfunción tubular proximal (DTP) y la enfermedad renal crónica (ERC)2. La hemoglobinuria solo ocurre en el 25% de los pacientes3, en series recientes se ha reportado una incidencia del 64% de ERC, con hasta un 20% de ERC estadio 3-54. Se presentan 2 casos de HPN en el que los depósitos de hemosiderina visualizadas por resonancia magnética (IRM) parecen ser los primeros signos de afectación renal.
En este libro se presentan un conjunto de ensayos que discuten varios aspectos centrales a la relación entre pandemia y educación, que se inician en una mirada desde lo macro, examinando la dimensión ...política y la educación.
A series of 99 consecutively operated patients presenting staghorn stones has been reviewed to ascertain the factors implicated in recurrent calculogenesis. 71.7% of the calculi were infection ...stones; 50.7% harbored Proteus species bacteria and 33.8% Escherichia coli. Struvite stones were found in 57.6% followed at long distance (18.2%) by carbonate apatite, calcium oxalate (11.1%) and mixed (9.1%) stones. Postoperative assessment revealed 17% residual stones, which enhanced infection in 46.7% of these cases and regrew to form a new dendritic stone in 33.3%; 80% of these repeat stones were struvite. 31.5% of the patients initially freed of their calculi by the operation, had true recurrences, and 56.5% of them had resistant urinary infection, caused by Proteus or E. coli (50%-50%). Progressive growth of the recurrent lithiasis occurred in 61.5% of the infected cases, while 87.5% of the recurrences occurring in patients with sterile urine remained stabilized. In the group of nonrecurring lithiasis (56.8%) only 16% had urinary infection. These results confirm the preponderant role played by infection in the pathogenesis of staghorn "malignant' lithiasis and move the authors to make a plea in favor of postoperative integrated therapy, including the use of long-term antibacterial agents and urease inhibitors.
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