Asunto(s)
Lupus Eritematoso Sistémico , Microangiopatías Trombóticas , Humanos , Inactivadores del Complemento/uso terapéutico , Lupus Eritematoso Sistémico/complicaciones , Lupus Eritematoso Sistémico/tratamiento farmacológico , Microangiopatías Trombóticas/tratamiento farmacológico , Microangiopatías Trombóticas/etiologíaRESUMEN
We sought to characterize the clinical profiles and outcomes of patients with coronavirus disease 2019 and comorbid kidney disease hospitalized at urban, Midwestern tertiary care hospital. Material and Methods: In this single-center observational study, we describe 205 patients with acute kidney injury (n=98), dialysis-dependent chronic kidney disease stage 5 (n=54), or kidney transplant (n=53), admitted during the first surge of the local pandemic from March 19 2020, to July 31 2021. Results: Most patients in the cohort were African American (acute kidney injury, 51%; dialysis-dependent chronic kidney disease stage 5, 82%; kidney transplant, 62%), and obesity was common (acute kidney injury, 53%; dialysis-dependent chronic kidney disease stage 5, 44%; kidney transplant 56%). Mechanical ventilation was required in 50% of the acute kidney injury, 22% of the dialysis-dependent chronic kidney disease stage 5, and 13% of the kidney transplant recipients. Nearly half of the acute kidney injury patients (46%) died and 49% required replacement therapy, while in-hospital mortality was 24% in the dialysis-dependent chronic kidney disease stage 5 patients and 9% in the kidney transplant recipients. Logistic regression analysis identified older age and patient group as leading correlates of mortality, with lower death risk in the kidney transplant (24%; odds ratio (OR), 0.17; 95% CI 0.06-0.47) and dialysis dependent chronic kidney disease stage 5 (9%; OR, 0.36; 95% CI 0.16-0.78) patients compared to acute kidney injury patients (46%). Obesity was associated with 5-fold increased mortality risk in the coronavirus disease 2019 patients with acute kidney injury (OR, 5.32; 95% CI 1.41-20.03) but not in dependent dialysis chronic kidney disease stage 5 and kidney transplant patients. Conclusion: During the first surge of the pandemic, kidney patients hospitalized COVID-19 experienced high mortality, especially those with acute kidney injury, older age and obesity. Identifying those at highest risk for adverse outcomes may direct preventative strategies including counseling on vaccination.
RESUMEN
Infiltration of a surgically placed hemodialysis vascular access is recognized as a major contributor to the high health care costs associated with dialysis-dependent patients. Three-dimensional (3D) modeling is a critical tool for proceduralists in preparation for surgical interventions. No such modeling is currently available for dialysis specialists to avoid the common complication of vascular access infiltration. Ferumoxytol-enhanced magnetic resonance angiography was used to generate 3D image data that could render a 3D resin-based model of a vascular access without exposing the patient to iodinated or gadolinium-based radiologic contrast. The technique required an abbreviated magnetic resonance angiography procedure interfaced with a 3D printer workstation. An interventional radiology suite was not required. In the described case, the brachial artery was clearly delineated from a cephalic vein to basilic vein bypass with a 3D spatial resolution of 1 mm. In conclusion, we demonstrate that this new technology pathway can provide preprocedural guidance that has the potential to significantly reduce the morbidity and cost associated with vascular access infiltration.
RESUMEN
BACKGROUND: Compromise of the transplanted vasculature accompanying a kidney allograft can lead to graft failure if not diagnosed and treated expeditiously. Location of the vascular defect in the transplant renal artery or vein is difficult to anticipate, given the variety of etiologies. However, early diagnosis can anticipate further progression of kidney allograft dysfunction. Ferumoxytol-enhanced magnetic resonance angiography (FeMRA) can precisely localize lesions in both the transplant renal artery and vein and provide a comprehensive survey of the vascular conduits of concern. It avoids complications of kidney injury associated with intravenous iodinated contrast that may amplify a diagnosis of delayed graft function or further impair an allograft already compromised by donor-derived vascular disease. METHODS: We report a case of concomitant and irreversible proximal transplant renal artery and vein stenosis diagnosed by FeMRA and treated with surgical intervention. RESULTS AND CONCLUSIONS: FeMRA offers a rapid, non-invasive approach to simultaneously diagnose compromised blood flow through the transplant artery and or vein in preparation for definitive correction of the defect.