MO874COVID-19 IN HEMODIALYSIS PATIENTS: CLINICAL PARTICULARITIES AND OUTCOMES

Background and Aims Coronavirus disease 2019 (COVID-19) has affected the care and outcomes of patients treated with dialysis worldwide. Patients on hemodialysis (HD) are at extremely high risk to develop COVID-19 because of their multiple co-morbidities and immunosuppression. We report throw this work the experience of our unit of HD with the covid-19 infection and its outcomes on our patients. Method We conducted a prospective study since the beginning of the pandemic. We have collected 26 HD patients reached of COVID 19 disease. Results The sex ratio of our population was equal to 1,36 with female predominance. The mean age of our patients was 61, 31 ±14,17 years. The co-morbidities noted among these patients were respectively hypertension, diabetes, heart diseases and obesity in 19, 17, 10 and 10 cases. The causal nephropathy was respectively diabetic, undetermined, glomerular and interstitial nephropathy in 13, 9, 2 and 2 cases. The major symptoms associated to the COVID 19 were respectively dyspnea, cough, asthenia, fever and chills, digestive manifestations, chest pain in 22, 19, 19, 15, 10, and 6 cases. 7 patients have been exposed to covid-19 infested person. Symptoms appeared within an average of 4,3 ± 2 days. Oxygen saturation was less than 92% in 65% of the cases during hospitalization. 84% of the patients are hospitalized including one among them who required the stay in a resuscitation unit and intubation. The scannographic lesions of covid were estimated to more than 50% in 8 cases and less than 50% in 4 cases. A biological inflammatory syndrome has been noted in all of the patients with a mean CRP at 117+/-127 mg/l and the mean leucocytes count at 10248±6592 elt/mm3. Lymphopenia was noted in 14 cases with lymphocytes count less than 1500 elt/mm3. The ratio of neutrophils / lymphocytes was more than 2,5 in 12 cases. The treatment was based on oxygen, corticosteroids, antibiotics, vitamins and anticoagulation for hospitalized patients (22 patients). The mean number of HD sessions realized per patient during hospitalization was 4 ± 2,3 HD sessions. The perdialytic complications noted were alteration of the state of consciousness in 3 cases and heart failure in 5 cases. The outcomes of our patients were marked by death in 38% and a recovery in 62% of the patients. Thus, the forms observed in our series are respectively moderate, severe, pauci-symptomatic and asymptomatic in 12, 10, 2 and 2 cases. Conclusion We highlight throw this study the severe consequences of COVID-19 on HD patients in whom mortality reached 38%. Until the pandemic is controlled and a vaccine or a treatment are valid, we highlight the importance of the compliance with confinement and develop home dialysis among our population.

Prevalence, risk factors and predicted risk of cardiac events in chronic kidney disease of uncertain aetiology in Sri Lanka: A tubular interstitial nephropathy

Cardiovascular disease (CVD) is the leading cause of morbidity and mortality in patients with ‘traditional’ chronic kidney disease (CKD). However, chronic kidney disease of uncertain aetiology (CKDu), a tubular interstitial nephropathy is typically minimally proteinuric without high rates of associated hypertension or vascular disease and it is unknown if the rates of CVD are similar. This study aimed to identify the prevalence and the risk of CVD in patients with CKDu. This cross-sectional study included patients with confirmed CKDu who were attending two renal clinics in CKDu endemic-area. A detailed medical history, blood pressure, electrocardiogram (resting and six minutes vigorous walking), echocardiograms, appropriate laboratory parameters and medical record reviews were used to collect data at baseline. The WHO/Pan American Health Organization, cardiovascular risk calculator was employed to determine the future risk of CVD. The clinics had recorded 132 number of patients with CKDu, of these 119 consented to participation in the study. The mean age was 52 (± 9.5) years and mean eGFR was 51.1 (± 27.61); a majority (81.5% (n = 97)) were males. Thirty-four patients (28.6%) had evidence of ischaemic heart disease (IHD). Troponin-I (p = 0.02), Age >50 years (p = 0.01) and hyperuricemia (p = 0.01) were significantly associated with IHD in CKDu. Left ventricular hypertrophy was reported in 20.2% (n = 24). According to the risk calculator, 97% of the enrolled patients were at low risk (<10%) for experiencing a cardiovascular event within the next 10 years. Patients with CKDu have low prevalence and risk for CVD, implying that a majority are likely to survive to reach end-stage kidney disease. Our findings highlight the need for developing strategies to minimize the progression of CKDu to end-stage renal disease.

Naturally Acquired Mouse Kidney Parvovirus Infection Produces a Persistent Interstitial Nephritis in Immunocompetent Laboratory Mice

Mouse kidney parvovirus (MKPV), also known as murine chapparvovirus (MuCPV), is an emerging, highly infectious agent that has been isolated from laboratory and wild mouse populations. In immunocompromised mice, MKPV produces severe chronic interstitial nephropathy and renal failure within 4 to 5 months of infection. However, the course of disease, severity of histologic lesions, and viral shedding are uncertain for immunocompetent mice. We evaluated MKPV infections in CD-1 and Swiss Webster mice, 2 immunocompetent stocks of mice. MKPV-positive CD-1 mice ( n = 30) were identified at approximately 8 weeks of age by fecal PCR (polymerase chain reaction) and were subsequently housed individually for clinical observation and diagnostic sampling. Cage swabs, fecal pellets, urine, and blood were evaluated by PCR at 100 and 128 days following the initial positive test, which identified that 28 of 30 were persistently infected and 24 of these were viremic at 100 days. Histologic lesions associated with MKPV in CD-1 ( n = 31) and Swiss mice ( n = 11) included lymphoplasmacytic tubulointerstitial nephritis with tubular degeneration. Inclusion bodies were rare; however, intralesional MKPV mRNA was consistently detected via in situ hybridization within tubular epithelial cells of the renal cortex and within collecting duct lumina. In immunocompetent CD-1 mice, MKPV infection resulted in persistent shedding of virus for up to 10 months and a mild tubulointerstitial nephritis, raising concerns that this virus could produce study variations in immunocompetent models. Intranuclear inclusions were not a consistent feature of MKPV infection in immunocompetent mice.