A Prospective Study on Risk Factors for Acute Kidney Injury and All-Cause Mortality in Hospitalized COVID-19 Patients From Tehran (Iran)

Background: Several reports suggested that acute kidney injury (AKI) is a relatively common occurrence in hospitalized COVID-19 patients, but its prevalence is inconsistently reported across different populations. Moreover, it is unknown whether AKI results from a direct infection of the kidney by SARS-CoV-2 or it is a consequence of the physiologic disturbances and therapies used to treat COVID-19. We aimed to estimate the prevalence of AKI since it varies by geographical settings, time periods, and populations studied and to investigate whether clinical information and laboratory findings collected at hospital admission might influence AKI incidence (and mortality) in a particular point in time during hospitalization for COVID-19. Methods: Herein we conducted a prospective longitudinal study investigating the prevalence of AKI and associated factors in 997 COVID-19 patients admitted to the Baqiyatallah general hospital of Tehran (Iran), collecting both clinical information and several dates (of: birth; hospital admission; AKI onset; ICU admission; hospital discharge; death). In order to examine how the clinical factors influenced AKI incidence and all-cause mortality during hospitalization, survival analysis using the Cox proportional-hazard models was adopted. Two separate multiple Cox regression models were fitted for each outcome (AKI and death). Results: In this group of hospitalized COVID-19 patients, the prevalence of AKI was 28.5% and the mortality rate was 19.3%. AKI incidence was significantly enhanced by diabetes, hyperkalemia, higher levels of WBC count, and blood urea nitrogen (BUN). COVID-19 patients more likely to die over the course of their hospitalization were those presenting a joint association between ICU admission with either severe COVID-19 or even mild/moderate COVID-19, hypokalemia, and higher levels of BUN, WBC, and LDH measured at hospital admission. Diabetes and comorbidities did not increase the mortality risk among these hospitalized COVID-19 patients. Conclusions: Since the majority of patients developed AKI after ICU referral and 40% of them were admitted to ICU within 2 days since hospital admission, these patients may have been already in critical clinical conditions at admission, despite being affected by a mild/moderate form of COVID-19, suggesting the need of early monitoring of these patients for the onset of eventual systemic complications

Delayed Graft Function

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The study of relationship between serum levels of soluble fms-like tyrosine kinase-1 and soluble fibrinogen-like protein 2 with delayed graft function after kidney transplantation

Delayed graft function (DGF) is a transplant complication which means a need to dialysis throughout the first week after transplantation. This study aimed to ascertain the relationship between the two immunomodulatory factors of soluble fms-like tyrosine kinase-1 (sFlt-1) and soluble fibrinogen-like protein 2 (sFGL-2) with DGF after transplantation. This case-control study was done in 2 groups of 58 kidney transplant patients with and without DGF. The control group included the patients who didn't show DGF symptoms. Then, serum levels of sFlt-1and sFGL-2 in all blood samples were measured by ELISA. Serum sFlt-1 and sFGL-2 levels were significantly higher in the DGF group compared to those in the control group (p�0.001). sFlt-1 and sFGL-2 serum levels significantly affect DGF (p<0.001) in such a way that they may be diagnostic factors of DGF. This study showed a significant relationship between sFlt-1 as well as sFGL-2 and DGF. Therefore, plasma levels of sFlt-1 and sFGL-2 may be used as diagnostic tools to determine the risk of DGF. © August 2019, Iran J Allergy Asthma Immunol

Prevalence of Transfusion-transmitted Virus (TTV) infection and its association with renal posttransplantation complications in iran

Background: Transfusion-transmitted virus (TTV) is a single-stranded DNA virus. Renal transplant patients have a higher risk of TTV infection. Objective: To evaluate the prevalence of TTV and its correlation with post-renal transplantation complications in a population of Iranian patients. Methods: A cross-sectional study was performed on 120 renal transplant recipients. TTV infection in the peripheral blood samples was detected by semi-nested polymerase chain reaction (semi-nested PCR). Then, the relationship between TTV and renal post-transplant complications was examined. Results: 34.2 renal transplant recipients were positive for TTV. There was a significant correlation between the presence of TTV and diabetes, acute transplant rejection, and urinary tract infection. We did not find any direct correlation between the presence of TTV infection and hypertension, hyperlipidemia, respiratory tract infection, and cytomegalovirus infection. Conclusion: We found an increased rate of TTV infection in renal transplant recipients associated with post-transplantation complications. TTV may be an important risk factor for some post-renal transplantation complications. © 2018, Iranian Society for Organ Transplantation

Preliminary report of a nationwide case-control study for identifying risk factors of tuberculosis following renal transplantation

Background. Tuberculosis (TB) is an important infection encountered posttransplantation, especially among patients in developing countries, where there are high incidences of morbidity and mortality. Materials and Methods. One hundred and twenty subjects (1) from 15 major kidney transplantation centers in Iran from 1984 to 2003 were compared with 440 controls who were matched for operative time, treatment center, and surgical team. Results. Mean ages of research subjects and controls were 38.6 and 36.6 years (P = .04), respectively. The mean duration of pretransplantation hemodialysis was 29 months (range, 2 to 192 months) in research subjects and 20 months (range, 1 to 180 months) in controls (P = .003). Positive past history of tuberculosis was detected in 4 (3.3) research subjects and in 7 (1.5) controls (P = .2). Fifty-two research subjects (43.3) and 241 controls (54.8) had pretransplantation purified protein derivative of tuberculin less than 5 mm (P = .02). Mean dosages of initial and maintenance immunosuppressive drugs in research subjects and in controls were not significantly different. Sixty research subjects (50) and 152 controls (34.5) had rejection prior to diagnosis of TB (P = .03). Conclusion. To our knowledge, this is the first study that demonstrates an increased risk of posttransplant TB by prolonged duration of pretransplant hemodialysis and number of posttransplant rejection episodes. Further study is needed to clarify these findings specifically with respect to various immunosuppressive regimens. © 2005 by Elsevier Inc. All rights reserved

Prevalence and risk factors of hyperuricemia among kidney transplant recipients

Hyperuricemia is common in renal transplant patients (RTRs), especially those on cyclosporine (CsA)-based therapy. We conducted a retrospective study to determine the prevalence of hyperuricemia and its risk factors among RTRs. A total of 17,686 blood samples were obtained from 4,217 RTRs between April 2008 and January 2011. Hyperuricemia was defined as an uric acid level of ≥7.0 mg/dl in men and of ≥6 mg/dl in women that persisted for at least two consecutive tests. Majority (68.2%) of RTRs were normouricemic. Hyperuricemia was more frequent in younger and female RTRs. On multivariate logistic regression, we found high trough level of cyclosporine to be a risk factor for hyperuricemia. In addition, female gender, impaired renal function, and dyslipidemia (hypercholesterolemia, hypertriglyceridemia, and elevated LDL) were also associated with higher probability of hyperuricemia. Hyperuricemia is a common complication after renal transplantation. Risk factors implicated in post-transplant hyperuricemia include high trough level of cyclosporine, female gender, renal allograft dysfunction, and dyslipidemia

Hyperuricemia after renal transplantation

Background: Hyperuricemia is a common complication after kidney transplantation, and may adversely affect graft survival. Objective: To assess the prevalence of and predictors for development of hyperuricemia after renal transplantation. Materials and Methods: Hyperuricemia was defined as a serum uric acid concentration of at least 7.0 mg/dL in men and 6.0 mg/dL in women. From March 2008 to May 2010, uric acid concentration was measured in 12,767 blood samples from 2961 adult renal transplant recipients (64 male and 36 female patients). Results: Hyperuricemia was observed in 1553 patients (52.4). The disorder frequently occurred in women (P = .003) and in patients with impaired renal graft function (P = .00). After adjustment for sex, serum creatinine concentration, diabetes mellitus, cyclosporine concentration, and dyslipidemia, only female sex (P = .03) and renal allograft dysfunction (P = .05) were associated with hyperuricemia after kidney transplantation. Conclusion: Hyperuricemia is a common complication after kidney transplantation, and renal allograft insufficiency predisposes to higher uric acid concentration. © 2011 by Elsevier Inc. All rights reserved

Anemia after kidney transplantation in adult recipients: Prevalence and risk factors

Objective: To evaluate the prevalence of anemia and appraise its risk factors at 6 months after renal transplantation. Materials and Methods: This retrospective study was performed between 2008 and 2010 in 2713 adult kidney transplant recipients to determine the prevalence of posttransplantation anemia. Anemia was defined as hemoglobin concentration of 12 g/dL or less in women and 13 g/dL or less in men. Results: The prevalence of posttransplantation anemia was 52.7, with severe anemia (hemoglobin â¤11 g/dL) detected in 24.4 of patients. Impaired renal function was the only risk factor associated with anemia (odds ratio, 3.6; P = .047). However, severe anemia after kidney transplantation was correlated with female sex (P = .001), renal allograft dysfunction (P = .00), and cytomegalovirus infection (P = .002). Conclusion: The present study demonstrated a quite high prevalence of posttransplantation anemia, in particular associated with impaired renal allograft function. Severe anemia was correlated with female sex, degree of kidney graft dysfunction, and cytomegalovirus infection. © 2011 by Elsevier Inc. All rights reserved