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Role of Fluid Management on Renal Failure in Hospitalized COVID-19 Patients

Open Journal of Nephrology 2021年第2期11卷 230-241页

作者： Angelie Santos Hillary Grainer Joseph Scarano majed samarneh Department of Internal Medicine St. John’s Riverside Hospital New York USA

Introduction: The reported incidence of AKI with COVID-19 varies from 0.5% to 22%. Several mechanisms were postulated as a cause of AKI in patients infected with COVID-19. The appropriate management of AKI in patients with COVID-19 remains unclear at this time. One point of absolute importance, is the consideration of volume status. Given the paucity of knowledge with regards to the role of different strategies for fluid management during an episode of AKI in patients with COVID-19, this retrospective study aims to compare renal outcome and overall prognosis in patients who received conservative versus liberal fluid management. Methods: This is a single-center retrospective observational cohort study at a community hospital in Westchester County, NY. All adult patients who tested positive for the COVID-19 infection by PCR testing of a nasopharyngeal swab and were hospitalized from March 22, 2020 to May 25, 2020 are eligible. Among those identified with AKI, patients were divided into two groups: conservative fluid administration versus liberal fluid administration. Results: Of the 136 patients, 84 (61.76%) were admitted to the ICU, with 60% of patients under the conservative fluid strategy and 40% receiving liberal fluid management. On the other hand, 52 (38.23%) patients were admitted on the medical floors, with more patients (67.31%) receiving liberal fluid management. Discussion: In our cohort of 136 patients with COVID-19 respiratory illness and AKI, there was a significant difference in renal outcome, in terms of improvement of renal function in patients receiving liberal fluid management (55.07%) versus conservative fluid management (16.41%, p ≤ 0.001), with more patients in the liberal group having lower peak creatinine before levels improved. This, as well, was associated with improvement in oxygenation, characterized by improvement in respiratory status, facilitating weaning of oxygen suppl

关键词： Acute Kidney Injury COVID-19 Fluid Management

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An Atypical Cause of Abdominal Pain in an Elderly Patient

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Open Journal of Nephrology 2021年第3期11卷 370-378页

作者： Yaroslav Andrew Jakymec Cara Sherman Michelle Annabi-Rabadi majed samarneh Hanady Zainah Lake Erie College of Osteopathic Medicine Erie Pennsylvania USA Department of Medicine St. John’s Riverside Hospital Yonkers New York USA

Background: Henoch-Schonlein Purpura (HSP), or IgA vasculitis, is the most common vasculitis in children and is characterized by four symptoms: palpable purpura with no concurrent thrombocytopenia or coagulopathy, arthritis/ arthralgias, abdominal pain, and renal disease. HSP does occur in older patients at a much lower frequency. Objective: To discuss the atypical presentation of HSP in an elderly adult and the increased nephrogenic risks that are involved in this patient group. Case Presentation: We present the history, physical findings, laboratory results, and the clinical course of a 74-year-old Caucasian male with an atypical presentation of HSP. Our patient presented with severe gastrointestinal and cutaneous symptoms which occurred after the onset of abdominal pain. Biopsies demonstrated leukocytoclastic vasculitis in the skin and acute inflammation and hemorrhage in the gastrointestinal tract. The diagnosis was confirmed as IgA vasculitis following the renal biopsy. The patient’s symptoms improved with the administration of methylprednisolone. Conclusion: In adults with HSP there is greater concern regarding renal involvement and a greater risk of developing end-stage renal disease compared to children. The importance of recognizing HSP in the elderly is imperative for early diagnosis and appropriate treatment to limit renal damage.

关键词： Henoch-Schonlein Purpura IgA Vasculitis Leukocytoclastic Vasculitis

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Remission of Relapsing Immunotactoid Glomerulonephritis with Fludarabine

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Open Journal of Nephrology 2013年第1期3卷 41-43页

作者： Suchita J. Mehta majed M. samarneh Militza K. Kiroycheva Michael B. Stokes John M. Pepe Department of Medicine Staten Island University Hospital New York USA. Division of Nephrology Staten Island University Hospital New York USA. Division of Renal Pathology Department of Pathology and Cell Biology Columbia University Medical Center New York Presbyterian Hospital New York USA

Immunotactoid gloemrulonephritis is a glomerular disease characterized by organized microtubular deposits of monoclonal immunoglobulin. These deposits are Congo red-negative, have hollow centers, measure > 30 nm, and are arranged in stacked or parallel arrays. Treatment of immunotactoid glomerulonephritis is not well-defined, with poor outcomes seen in native kidneys. In fewer than 10% of the cases, trials with steroids alone or cytotoxic agents with steroids or plasmapheresis with steroids has been associated with clinical remission of proteinuria. 50% of patients with renal impairment progress to end stage renal disease (ESRD) in two to four years. There are three case reports of recurrent ITG in renal allograft;one was treated with pulse steroids plus cyclophosphamide, pulse steroids in second case and use of rituximab in the third case. Recurrence of ITG has been described in the renal allograft but there is no literature on relapse of ITG in the native kidneys. Here, we have a case of ITG that relapsed in the native kidneys eight years after being in remission. Renal function improved with fludarabine both times and the patient had stable renal function at last follow-up.

关键词： Glomerulonephritis Fludarabine ITGN

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