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Cistanche yog qhov zoo rau lub raum. Nyem qhov no kom tau txais cov ntaub ntawv ntxiv

Hematuria thiab proteinuria

Nyob rau hauv tag nrho pawg. Hauv cov lus piav qhia tsis hnyav, hematuria 2 ntxiv lossis siab dua ntawm cov zis tso zis tshwm sim hauv 16 feem pua ​​​​ntawmCov neeg mob uas muaj COVID-19 thiab 11 feem pua ​​​​ntawm cov neeg mob khaub thuas (Table Ntxiv S2A). New-pib hematuria, txhais tau tias yog 1 ntxiv lossis siab dua ntawm cov zis tso zis thiab qhov tsis zoo lossis cov ntshav nyob ntawm cov zis tso zis ua ntej, tau pom nyob rau hauv 29 feem pua ​​​​ntawm cov neeg mob COVID-19 thiab 18 feem pua ​​​​ntawm cov neeg mob khaub thuas. Kev mob hnyav ntawm cov hematuria ua ntej tau pom nyob rau hauv 22 feem pua ​​​​ntawm cov neeg mob nrog COVID-19 thiab 18 feem pua ​​​​ntawm cov neeg mob khaub thuas. Proteinuria 2 ntxiv lossis siab dua tau tshwm sim hauv 27 feem pua ​​​​ntawm cov neeg mob uas muaj COVID-19 thiab 15 feem pua ​​​​ntawm tus mob khaub thuas. New-inset proteinuria, txhais tau tias yog 1 ntxiv lossis siab dua ntawm cov zis tso zis thiab qhov tsis zoo lossis cov kab mob tsis zoo ntawm cov zis tso zis ua ntej, tau pom nyob rau hauv 44 feem pua ​​​​ntawm cov neeg mob uas muaj COVID-19 thiab 26 feem pua ​​​​ntawm cov neeg mob khaub thuas. Cov proteinuria hnyav dua piv nrog cov txheej txheem preadmission tau pom nyob rau hauv 29 feem pua ​​​​ntawm cov neeg mob nrog COVID-19 thiab 17 feem pua ​​​​ntawm cov neeg mob khaub thuas.

Table 3|Cov yam ntxwv ntawm tus neeg mob hauv lub cev hnyav

COVD-19, kab mob coronavirus 2019; NSAID, nonsteroidal tshuaj tiv thaiv kab mob; W, tus lej ntawm tus neeg mob hnyav; WBC, qe ntshav dawb. tus denominator ntawm cov neeg mob uas tsis muaj preexisting proteinuria (hematuria). bDenominator ntawm cov neeg mob uas muaj preexisting proteinuria (hematuria).

Tus nqi tuaj yeem xav tias yog tus naj npawb zoo ntawm cov neeg mob hauv cov pab pawg hnyav uas tsim los ntawm cov khoom hnyav. Tag nrho pawg ntawm 7082 (2500 nrogmob hnyavraumraug mob[AK]) cov neeg mob tau siv nrog cov neeg mob tau txais qhov hnyav dua 0 thiab tsawg dua lossis sib npaug rau 1, muab cov txiaj ntsig ntawm qhov hnyav sib npaug li 4480 (1485 nrog AK).

Hauv kev sib piv hnyav (Table 3), proteinuria muaj ntau dua nyob rau hauv cov neeg mob nrog COVID-19 piv nrog mob npaws. Proteinuria 2 ntxiv lossis siab dua tau pom nyob rau hauv 25 feem pua ​​​​ntawm cov pab pawg COVID-19 piv nrog 17 feem pua ​​​​ntawm pab pawg mob npaws (P<0.001). hematuria="" 2+="" or="" higher="" occurred="" in="" 14%of="" patients="" with="" covid-19="" and="" 12%="" of="" patients="" with="" influenza(p="0.066)." among="" those="" with="" prehospitalization="" data="" available,="" new-onset="" hematuria="" and="" proteinuria="" were="" both="" more="" common="" in="" covid-19(hematuria,28%=""><0.001];and proteinuria,42%="" vs.=""><0.001]).worsening of="" baseline="" hematuria="" was="" more="" common="" in="" covid-19;="" however,="" this="" difference="" was="" not="" statistically="" significant="" (23%="" vs.20%;p="0.347)." worsening="" of="" baseline="" proteinuria="" was="" more="" common="" in="" covid-19(29%=""><>

Ntawm cov neeg mob AKI. Hauv cov lus piav qhia tsis hnyav ntawm cov neeg mob AKI, hematuria 2 ntxiv lossis siab dua ntawm cov zis tso zis tshwm sim hauv 25 feem pua ​​​​ntawm cov neeg mob uas muaj COVID-19 thiab 18 feem pua ​​​​ntawm cov kab mob npaws (Table Ntxiv S2B). Proteinuria 2 ntxiv lossis siab dua tau tshwm sim hauv 40 feem pua ​​​​ntawm cov neeg mob uas muaj COVID-19 thiab 24 feem pua ​​​​ntawm tus mob khaub thuas. Tom qab qhov hnyav, ntawm cov neeg mob AKI(Table 5), hematuria 2 ntxiv lossis siab dua tau tshwm sim ntau dua hauv cov neeg mob pw hauv tsev kho mob nrog COVID-19 piv nrog mob npaws (24 feem pua ​​​​vs.19 feem pua ​​;P=0.001) . Proteinuria 2 plus los yog siab dua yog ntau dua nyob rau hauv cov neeg mob nrog COVID-19 piv nrog cov neeg mob khaub thuas (39 feem pua ​​​​vs.26 feem pua ​​;P<>

Cov txiaj ntsig ntawm AKI

Hauv tsev kho mob thiab 90-hnub tuag. Hauv cov lus piav qhia tsis hnyav ntawm cov neeg mob AKI, kev tuag hauv tsev kho mob yog 32 feem pua.

Table 4|Lub raum thiab lwm yam tshwm sim ntawm cov neeg mob AKI, hnyav pawg

AKl,mob hnyavraumraug mob; COVID-19, kab mob coronavirus 2019; W, sum ntawm tus neeg mob hnyav.Lub raumKab mob: Txhim Kho Ntiaj Teb Cov Tau Txais (KDIGO)-hloov cov qauv. Txhais tau tias tau txais kev lim ntshav hauv 48 teev tom qab tso tawm.

Cov neeg tuag tau stratified los ntawm AKI theem thiab COVID-19 tiv thaiv kab mob khaub thuas.

Tus nqi tuaj yeem xav tias yog tus naj npawb zoo ntawm cov neeg mob hauv cov pab pawg hnyav uas tsim los ntawm cov khoom hnyav. Tag nrho pawg ntawm 2500 cov neeg mob nrog AKI tau siv nrog cov neeg mob uas tau txais qhov hnyav dua 0 thiab tsawg dua lossis sib npaug rau 1, muab cov txiaj ntsig ntawm qhov hnyav sib npaug rau 1485.

rau cov neeg mob uas muaj COVID-19 thiab 4 feem pua ​​​​rau cov neeg mob khaub thuas (Cov Lus Ntxiv S3). Kev tuag hauv tsev kho mob los ntawm AKI theem hauv pab pawg COVID-19 yog 18 feem pua, 36 feem pua, thiab 62 feem pua ​​​​rau theem 1, 2, thiab 3, feem. Kev tuag hauv tsev kho mob hauv pawg neeg mob khaub thuas yog 2 feem pua, 8 feem pua, thiab 24 feem pua ​​​​rau theem 1,2, thiab 3, raws li. Kev tuag ntawm 90 hnub tom qab cov ntshav siab tshaj plaws creatinine yog 38 feem pua ​​​​hauv pab pawg COVID-19 thiab 10 feem pua ​​​​hauv pab pawg neeg mob khaub thuas. Kev tuag ntawm 90 hnub los ntawm AKI theem hauv pawg COVID-19 yog 25 feem pua, 40 feem pua, thiab 65 feem pua ​​​​rau theem 1,2, thiab 3, raws li. Kev tuag ntawm 90 hnub los ntawm AKI theem hauv pawg kab mob khaub thuas yog 8 feem pua, 16 feem pua, thiab 32 feem pua ​​​​rau theem 1,2, thiab 3, raws li.

Qhov sib piv hnyav (Table 4) tau qhia tias kev tuag hauv tsev kho mob ntawm cov neeg uas muaj AKI yog siab dua hauv cov pab pawg COVID-19 (30 feem pua ​​​​vs. 3 feem pua ​​; P < 0.001).="" kev="" tuag="" hauv="" tsev="" kho="" mob="" siab="" dua="" tau="" pom="" nrog="" cov="" theem="" hnyav="" dua="" ntawm="" aki="" hauv="" ob="" pawg,="" uas="" tau="" tshaj="" tawm="" hauv="" cov="" neeg="" mob="" covid-19="" tiv="" thaiv="" kab="" mob="" khaub="" thuas="" (17="" feem="" pua="" ​​,35="" feem="" pua="" ​​,="" thiab="" 60="" feem="" pua="" ​​​​vs.2="" feem="" pua="" ​​,8="" feem="" pua="" ​​,="" thiab="" 21="" feem="" pua="" ​​kev="" tuag="" rau="" theem="" 1,2,="" thiab="" 3,="" raws="" li;="" tag="" nrho="" cov="" kev="" sib="" piv,=""><0.001). similarly,="" mortality="" at="" 90="" days="" after="" peak="" serum="" creatinine="" was="" higher="" in="" the="" covid-19="" group="" (35%=""><0.001). increasing="" mortality="" with="" aki="" stage="" was="" observed="" in="" both="" groups,="" with="" 90-day="" mortality="" frequencies="" of="" 23%,38%,="" and="" 63%(covid-19="" group)versus="" 7%,14%,="" and="" 27%(influenza="" group)for="" stages="" 1,2,="" and="" 3,="" respectively="" (all="" comparisons,=""><>

Lub raum rov qab

Kev tshuaj xyuas lub raum rov qab tau txwv rau cov neeg mob uas muaj lub hauv paus hauv tsev kho mob creatinine, nrog rau cov ntshav siab creatinine tshwm sim tsawg kawg 90 hnub ua ntej qhov kawg ntawm kev tau txais cov ntaub ntawv, thiab cov uas tsis xav tau.raumhloovkev kho mob thaum mus pw hauv tsev kho mob. Muaj 3 tus neeg mob hauv pab pawg COVID-19 uas nws cov ntshav siab tshaj plaws creatinine tshwm sim<90 days="" before="" the="" end="" of="" data="" acquisition="" and="" was="" excluded="" from="" recovery="">

Hauv cov lus piav qhia tsis hnyav ntawm cov neeg uas muaj AKI, qhov feem pua ​​​​ntawm cov neeg mob uas tseem nyob hauv kev lim ntshav thaum lub sijhawm tso tawm yog 7 feem pua ​​​​ntawm cov neeg mob uas muaj COVID-19 thiab 1 feem pua ​​​​ntawm cov neeg mob khaub thuas (Sab Ntxiv Table S3). Cov feem cuam tshuam ntawm cov neeg mob uas rov zoo li qub nyob rau hauv 20 feem pua ​​​​ntawm cov hauv paus ntshav creatinine ntawm 90 hnub tom qab cov ntshav siab tshaj plaws creatinine yog 57 feem pua ​​​​ntawm cov pab pawg COVID-19 thiab 82 feem pua ​​​​ntawm cov kab mob khaub thuas (Table Ntxiv S4A). Ntawm cov neeg muaj txoj sia nyob ntawm 90 hnub, kev rov qab los ntawm AKI tau pom nyob rau hauv 91 feem pua ​​​​hauv cov pab pawg COVID-19 thiab 91 feem pua ​​​​hauv pab pawg neeg mob khaub thuas (Supplemental Table S4B).

Hauv kev sib piv hnyav ntawm cov neeg mob nrog AKI (Table 4, 6, thiab 7, Daim duab 3, thiab Daim Duab Ntxiv S1), cov neeg mob uas muaj COVID-19 tau qis dua ntawm kev rov qab los ntawm AKI ntawm 90 hnub tom qab cov ntshav siab creatinine piv nrog cov neeg mob ua npaws (60 feem pua ​​vs.82 feem pua ​​; P<0.001). among="" those="" who="" survived="" to="" 90="" days="" following="" peak="" serum="" creatinine,="" the="" rates="" of="" recovery="" from="" aki="" were="" similar(91%in="" the="" covid-19="" group="" and="" 90%="" in="" the="" influenza="" group;="" p="0.494)." patients="" with="" covid-19="" more="" frequently="" remained="" on="" dialysis="" at="" discharge="" than="" patients="" with="" influenza="" (8%="" vs.1%;=""><>

Kev tsom xam rhiab heev

Txhawm rau tswj kom muaj peev xwm nyob rau lub caij nyoog, lub sijhawm, lossis qhov tshwm sim tshwm sim thaum muaj tus kabmob kis loj, peb tau ua qhov kev soj ntsuam rhiab heev uas tau hloov kho rau hnub nkag raws li qhov hloov pauv tsis tu ncua nrog 5-knot spline hauv qhov kev xav tau qhov hnyav. Tag nrho covariates, suav nrog hnub nkag, tau sib npaug (txhua tus qauv txhais tau tias sib txawv,<0.1). this="" sensitivity="">

Table 5|Cov yam ntxwv ntawm tus neeg mob hauv cov neeg mob nrog AKI, hnyav pawg

AKI,mob hnyavraumraug mob; COVD-19, kab mob coronavirus 2019; NSAID, nonsteroidal tshuaj tiv thaiv kab mob; W, tus lej ntawm tus neeg mob hnyav; WBC, qe ntshav dawb. aDenominator ntawm cov neeg mob uas tsis muaj preexisting proteinuria (hematuria). bDenominator ntawm cov neeg mob uas muaj preexisting proteinuria (hematuria).

Tus nqi tuaj yeem xav tias yog tus naj npawb zoo ntawm cov neeg mob hauv cov pab pawg hnyav uas tsim los ntawm cov khoom hnyav. Tag nrho pawg ntawm 7082 (2500 nrog AKI cov neeg mob tau siv nrog cov neeg mob tau txais qhov hnyav dua 0 thiab tsawg dua lossis sib npaug rau 1, muab cov txiaj ntsig ntawm qhov hnyav sib npaug rau 4480 (1485 nrog AKI).

tau ua raws li qhov kev txheeb xyuas thawj zaug, ua kom pom kev muaj zog rau lub cev. Cov txiaj ntsig tau los ntawm qhov kev tshuaj ntsuam no tau piav qhia hauv Cov Lus Qhia Ntxiv S5.

Kev sib tham

Hauv txoj kev tshawb no, peb tau pom qhov tshwm sim ntau dua thiab qhov hnyav ntawm AKI hauv tsev kho mob cov qub tub rog nrog COVID-19 piv nrog cov neeg mob khaub thuas, txawm tias tom qab hloov kho rau cov pej xeem hauv paus thiab comorbidities. Peb kuj pom tias kev tuag hauv tsev kho mob tau siab dua thiabraumKev rov zoo tau qis dua ntawm cov neeg mob pw hauv tsev kho mob nrog COVID-19 piv nrog tus mob khaub thuas tab sis zoo ib yam ntawm cov muaj sia nyob. Ntxiv rau, peb pom tias proteinuria thiab hematuria tau tshwm sim ntau zaus hauv COVID-19 tab sis tau tshwm sim hauv ob pawg.

Cov kev tshawb fawb ua ntej tau muab piv rau cov txiaj ntsig ntawm lub raum hauv COVID-19 nrog rau lwm cov neeg mob. Fisher et al. tshuaj xyuas

Table 6|Renal rov qab nyob rau hauv lub cev hnyav

AKI,mob hnyavraum iniury; COVID-19, kab mob coronavirus 2019; W, sum ntawm tus neeg mob hnyav.

* Txwv rau cov neeg mob uas muaj preadmission baseline serum creatinine, cov neeg mob uas muaj ntshav siab creatinine tshwm sim tsawg kawg yog 90 hnub ua ntej qhov kawg ntawm kev tau txais cov ntaub ntawv, thiab cov neeg mob uas tsis tas yuav lim ntshav. bRecovery rates stratified by AKI stage and COVID-19 vs influenza diagnosis.

Tus nqi W tuaj yeem xav tias yog tus naj npawb zoo ntawm cov neeg mob nyob rau hauv lub cev hnyav uas tsim los ntawm qhov hnyav sib xws. Tag nrho pawg ntawm 2500 cov neeg mob nrog AKI tau siv nrog cov neeg mob uas tau txais qhov hnyav dua 0 thiab tsawg dua lossis sib npaug rau 1, muab cov txiaj ntsig ntawm qhov hnyav sib npaug rau 1485.

Table 7|Lub raum rov qab los ntawm cov neeg muaj sia nyob ntawm 90 hnub tom qab cov ntshav siab tshaj plaws creatinine (qhov hnyav hnyav)

AKI,mob hnyavraumraug mob; COVID-19, kab mob coronavirus 2019; W, sum ntawm tus neeg mob hnyav.

"Tshwj xeeb rau cov neeg mob uas muaj sia nyob 90 hnub tom qab lub siab tshaj plaws creatinine, cov neeg mob uas muaj preadmission baseline serum creatinine, cov neeg mob uas muaj ntshav siab creatinine tshwm sim tsawg kawg 90 hnub ua ntej qhov kawg ntawm cov ntaub ntawv tau, thiab cov neeg mob uas tsis xav tau kev lim ntshav. Precovery rates are stratified by AKI theem thiab COVID-19 tiv thaiv kab mob khaub thuas.

Tus nqi W tuaj yeem xav tias yog tus naj npawb zoo ntawm cov neeg mob nyob rau hauv lub cev hnyav uas tsim los ntawm qhov hnyav sib xws. Tag nrho pawg ntawm 1824 cov neeg mob nrog AKI uas muaj sia nyob 90 hnub tom qab cov ntshav siab tshaj plaws creatinine tau siv nrog cov neeg mob uas tau txais qhov hnyav dua 0 thiab tsawg dua lossis sib npaug rau 1, muab cov txiaj ntsig ntawm qhov hnyav sib npaug rau 1169.

AKI hauv cov neeg mob nrog COVID-19 piv nrog cov neeg mob nyob hauv tsev kho mob tib lub tsev kho mob 1 xyoo dhau los. Lawv tau txheeb xyuas cov kev pheej hmoo sib koom ntawm cov pab pawg tab sis kuj pom tias AKI muaj ntau dua thiab hnyav nrog COVID-19.30 Peb txoj kev tshawb fawb txuas ntxiv rau txoj haujlwm no los ntawm kev tsom mus rau pawg tswj hwm tshwj xeeb los qhia tias qhov xwm txheej thiab qhov hnyav ntawm AKI hauv COVID-19 txawv ntawm cov neeg mob uas muaj lwm cov kab mob ua pa hnyav, txawm tias tom qab hloov kho rau cov pej xeem thiab kab mob ua ntej. Peb pom tias AKI tshwm sim ntau zaus thiab hnyav dua ntawm cov neeg muaj COVID-19. Qhov sib txawv ntawm AKI qhov xwm txheej tshwm sim txawm tias tom qab hloov kho cov yam ntxwv hauv paus, qhia tias tus nqi siab dua ntawm AKI hauv COVID-19 tsis tau piav qhia los ntawm cov xwm txheej sib txawv. Peb kuj tau pom tias cov neeg mob uas muaj tus kab mob COVID-19 feem ntau yuav xav tau cov tshuab ua pa thiab vasopressors thiab muaj kev tuag hauv tsev kho mob ntau dua li cov neeg mob khaub thuas, qhia tias qhov mob hnyav dua yuav yog qhov tseem ceeb rau qhov sib txawv no. Cov kev tshawb pom no zoo ib yam nrog kev tshawb fawb me me tsis ntev los no uas pom muaj tus nqi zoo sib xws ntawm AKI hauv COVID-19 thiab mob khaub thuas ntawm cov neeg mob hnyav uas muaj mob zoo sib xws.] Nws tseem muaj peev xwm hais tias cov txheej txheem ntawm tubular raug mob hauv COVID{{10} } tej zaum yuav muaj ntau yam sib txawv thiab hnyav, qhia txog kev mob hnyav dua, kev ua haujlwm ntawm endothelial, thrombotic microangiopathy, thiab kev cuam tshuam tus kab mob ncaj qha, txawm hais tias tom kawg tseem muaj teeb meem. Ntau qhov sib txawv ntawm cov kab mob glomerular kuj tau tshaj tawm hauv COVID-19 piv nrog tus mob npaws.'Xim, qhov kev nthuav qhia hnyav dua tuaj yeem ua rau muaj qhov tshwm sim ntxiv uas nce ntxiv.kev pheej hmoo rau AKI. Peb tau pom tias cov neeg mob COVID-19 tau txais tshuaj tua kab mob ntau dua li cov neeg mob khaub thuas, muaj ze li ib feem peb tau txais vancomycin.

Daim duab 3|Rov qab los ntawmmob hnyavraumraug mob(AKI) ntawm cov neeg muaj txoj sia nyob nrog (a) kab mob coronavirus 2019(COVID-19) thiab (b) mob npaws. Qhov feem pua ​​​​ntawm cov neeg mob tau rov qab los ntawm AKI ntawm txhua theem (tsis suav nrog cov neeg mob uas tau txais kev lim ntshav siab lossis tsis muaj lub hauv paus hauv tsev kho mob creatinine) ntawm 4, 10, 30, thiab 90 hnub tom qab hnub ntawm cov ntshav siab creatinine. Cov naj npawb hauv txhua kab qhia tias muaj pes tsawg tus neeg muaj sia nyob (cov lej ntawm tus neeg mob qhov hnyav hauv pawg hnyav) ntawm txhua lub sijhawm taw qhia hauv cov neeg zoo (tsaus grey) thiab tsis zoo (lub teeb grey). Lub Square nyob rau hauv txhua kem qhia txog cov neeg tuag. Nco ntsoov cov neeg tuag ntau dua hauv cov pab pawg COVID-19 thiab zoo sib xws ntawm cov neeg muaj sia nyob.

Direct viral ntxeem tau ntawm lublub raumtau raug suav hais tias yog ib qho txheej txheem ntawm AKI hauv COVID-19, nrog cov zaus ntawm cov proteinuria thiab microscopic hematuria, 'tus kab mob RNA, cov kab mob kis kab mob, thiab cov kab mob nyob tau kuaj pom hauv nrog rau kev sib tsoo glomerulopathy.raumcov ntaub so ntswg, 19, 32, 33 thiab lwm yam kab mob tau tshaj tawm.632, 34-36 Tsis tas li ntawd, txoj kev tshawb fawb txog kev tuag tsis ntev los no tau cuam tshuam txog qhov muaj tus kab mob RNA hauvraumnrog cov txiaj ntsig kho mob, suav nrog AKI. Cov qib uas tom kawg suav rau AKI hauv cov neeg nyob hauv tsev kho mob nrog COVID-19 tsis meej. Peb tau pom tias hematuria thiab proteinuria kuj tshwm sim hauv tus mob khaub thuas. Cov etiology ntawm cov kev tshawb pom no tej zaum yuav muaj ntau yam, suav nrog cov zis ntau dhau ntawm cov neeg nyob hauv VA comorbid thiab tuaj yeem cuam tshuam ntawm kev ntsuas (xws li, foley catheter insertion) thaum muaj mob. Txawm hais tias cov kev tshawb pom no qhia tias hematuria thiab proteinuria yuav tsis yog qhov tshwj xeeb rau COVID-19, nws tseem muaj peev xwm hais tias tus nqi siab dua tuaj yeem cuam tshuam ncaj qha rau kev raug mob vim tus kab mob SARS-CoV-2. Kev tshawb fawb tsis ntev los no hauv cov neeg mob pw hauv tsev kho mob nrog COVID-19 tau pom cov pov thawj ntawm kev ua haujlwm tsis zoo ntawm tubular, suav nrog tubular proteinuria. Xwb, tus nqi siab dua ntawm hematuria thiab proteinuria pom hauv COVID-19 tuaj yeem qhia txog cov txheej txheem zoo sib xws ntawm AKI hauv tus mob khaub thuas, nrog rau cov kab mob pathophysiological hnyav dua hauv COVID-19. Cov kev tshawb fawb ntawm cov proteinuria tom qab AKI tau pom muaj kev sib raug zoo ntawm koob tshuaj tiv thaiv ntawm AKI qhov hnyav thiab cov proteinuria tom qab.38,39

Thaum kawg, peb pom muaj tsawg dua rov qab los ntawm AKI ntawm cov neeg uas muaj COVID-19 piv nrog tus mob khaub thuas, qhov sib txawv yuav tshwm sim los ntawm cov neeg tuag ntau dua hauv COVID-19. Txawm hais tias qhov kev tshawb pom no qhia txog cov neeg tuag coob uas cuam tshuam nrog AKI hauv COVID-19, nws kuj tseem muab qee qhov kev cia siab rau kev rov qab los ntawm cov neeg uas muaj sia nyob tus kab mob, raws li kwv yees li 90 feem pua ​​​​ntawm cov neeg muaj sia nyob ntawm cov tsis tau lim ntshav-yuav tsum tau AKI zoo.

Peb qhov kev tshawb pom muaj qhov cuam tshuam tseem ceeb ntawm cov khoom siv. Peb tau pom muaj qhov tshwm sim ntau ntawm AKI hauv tus mob khaub thuas, nrog rau ib feem peb ntawm cov neeg mob uas muaj AKI thaum mus pw hauv tsev kho mob. Nws tseem yuav pom tias qhov cuam tshuam ntawm kev hnav lub npog ntsej muag thiab kev nyob sib nrug deb yuav muaj li cas rau qhov tshwm sim ntawm tus mob khaub thuas nyob rau lub caij khaub thuas tam sim no thiab yav tom ntej. Txawm li cas los xij, qhov muaj peev xwm ntxiv lub nra ntawm AKI ntsig txog tus mob khaub thuas ntxiv rau AKI thaum mus pw hauv tsev kho mob nrog COVID-19 tuaj yeem muaj kev cuam tshuam qis rau kev siv peev txheej. Goldfarb et al. tau piav qhia txog lawv qhov kev paub dhau los hauv COVID-19 qhov tseem ceeb nyob rau lub hlis ntxov ntawm tus kabmob kis thoob ntiaj teb, suav nrog kev xav tau ntau ntxiv rau kev kho lub raum thiab txo lub peev xwm los muab nws, nrog rau COVID-19 cuam tshuam rau lawv cov neeg ua haujlwm (xws li cov kws saib xyuas mob ntshav qab zib ) thiab cov khoom siv lim ntshav. Muab qhov kev nyuaj siab ntawm kev noj qab haus huv vim yog COVID-19, tag nrho lub nra hnyav ntxivraumkab mobthiab nws txoj kev faib nyiaj txiag vim muaj cov mob no yuav yog qhov tseem ceeb rau txoj haujlwm. Qhov feem pua ​​​​ntawm cov neeg mob AKI uas nyob twj ywm rau kev lim ntshav-nyob ntawm qhov tso tawm hauv peb txoj kev tshawb fawb qhia tias qhov no yog qhov pheej hmoo rau AKI. Peb tau pom tias cov neeg mob COVID-19 tau txais tshuaj tua kab mob ntau dua li cov neeg mob khaub thuas, nrog ze li ib feem peb tau txais vancomycin.

Cov kab mob kis ncaj qha ntawm lub raum tau raug kwv yees tias yog ib txoj hauv kev ntawm AKI hauv COVID-19, nrog rau cov proteinuria thiab microscopic hematuria, 'tus kab mob RNA, cov kab mob kis kab mob, thiab cov kab mob muaj sia nyob tau kuaj pom hauv

nrog rau kev sib tsoo glomerupathiesraumcov ntaub so ntswg, 19, 32, 33, thiab lwm yam kab mob tau raug tshaj tawm.632, 34-36 Tsis tas li ntawd, kev tshawb nrhiav kev txiav txim siab tsis ntev los no cuam tshuam txog qhov muaj tus kab mob RNA hauvraumnrog cov txiaj ntsig kho mob, suav nrog AKI. Cov qib uas tom kawg suav rau AKI hauv cov neeg nyob hauv tsev kho mob nrog COVID-19 tsis meej. Peb tau pom tias hematuria thiab proteinuria kuj tshwm sim hauv tus mob khaub thuas. Cov etiology ntawm cov kev tshawb pom no tej zaum yuav muaj ntau yam, suav nrog cov zis ntau dhau ntawm cov neeg nyob hauv VA comorbid thiab tuaj yeem cuam tshuam ntawm kev ntsuas (xws li, foley catheter insertion) thaum muaj mob. Txawm hais tias cov kev tshawb pom no qhia tias hematuria thiab proteinuria yuav tsis yog qhov tshwj xeeb rau COVID-19, nws tseem muaj peev xwm hais tias tus nqi siab dua tuaj yeem cuam tshuam ncaj qha rau kev raug mob vim tus kab mob SARS-CoV-2. Kev tshawb fawb tsis ntev los no hauv cov neeg mob pw hauv tsev kho mob nrog COVID-19 tau pom cov pov thawj ntawm kev ua haujlwm tsis zoo ntawm tubular, suav nrog tubular proteinuria. Xwb, tus nqi siab dua ntawm hematuria thiab proteinuria pom hauv COVID-19 tuaj yeem qhia txog cov txheej txheem zoo sib xws ntawm AKI hauv tus mob khaub thuas, nrog rau cov kab mob pathophysiological hnyav dua hauv COVID-19. Cov kev tshawb fawb ntawm cov proteinuria tom qab AKI tau pom muaj kev sib raug zoo ntawm koob tshuaj tiv thaiv ntawm AKI qhov hnyav thiab cov proteinuria tom qab.38,39

Thaum kawg, peb pom muaj tsawg dua rov qab los ntawm AKI ntawm cov neeg uas muaj COVID-19 piv nrog tus mob khaub thuas, qhov sib txawv yuav tshwm sim los ntawm cov neeg tuag ntau dua hauv COVID-19. Txawm hais tias qhov kev tshawb pom no qhia txog cov neeg tuag coob uas cuam tshuam nrog AKI hauv COVID-19, nws kuj tseem muab qee qhov kev cia siab rau kev rov qab los ntawm cov neeg uas muaj sia nyob tus kab mob, raws li kwv yees li 90 feem pua ​​​​ntawm cov neeg muaj sia nyob ntawm cov tsis tau lim ntshav-yuav tsum tau AKI zoo.

Peb qhov kev tshawb pom muaj qhov cuam tshuam tseem ceeb ntawm cov khoom siv. Peb tau pom muaj qhov tshwm sim ntau ntawm AKI hauv tus mob khaub thuas, nrog rau ib feem peb ntawm cov neeg mob uas muaj AKI thaum mus pw hauv tsev kho mob. Nws tseem yuav pom tias qhov cuam tshuam ntawm kev hnav lub npog ntsej muag thiab kev nyob sib nrug deb yuav muaj li cas rau qhov tshwm sim ntawm tus mob khaub thuas nyob rau lub caij khaub thuas tam sim no thiab yav tom ntej. Txawm li cas los xij, qhov muaj peev xwm ntxiv lub nra ntawm AKI ntsig txog tus mob khaub thuas ntxiv rau AKI thaum mus pw hauv tsev kho mob nrog COVID-19 tuaj yeem muaj kev cuam tshuam qis rau kev siv peev txheej. Goldfarb et al. tau piav qhia txog lawv qhov kev paub dhau los hauv COVID-19 qhov tseem ceeb nyob rau lub hlis ntxov ntawm tus kabmob kis thoob ntiaj teb, suav nrog kev xav tau ntau ntxiv rau kev kho lub raum thiab txo lub peev xwm los muab nws, nrog rau COVID-19 cuam tshuam rau lawv cov neeg ua haujlwm (xws li cov kws saib xyuas mob ntshav qab zib ) thiab cov khoom siv lim ntshav. Muab qhov kev nyuaj siab ntawm kev noj qab haus huv vim yog COVID-19, tag nrho lub nra hnyav ntxivraumkab mobthiab nws txoj kev faib nyiaj txiag vim muaj cov mob no yuav yog qhov tseem ceeb rau txoj haujlwm. Qhov feem pua ​​​​ntawm cov neeg mob AKI uas nyob twj ywm rau kev lim ntshav-nyob ntawm qhov tso tawm hauv peb txoj kev tshawb fawb qhia tias qhov kev nyuaj siab ntawm cov peev txheej no tuaj yeem txuas mus rau cov chaw kho mob sab nraud. Lwm qhov kev txiav txim siab yog qhov muaj peev xwm ntawm coinfection nrog COVID-19 thiab mob khaub thuas. Cov ntaub ntawv los ntawm cov theem pib ntawm kev sib kis thoob plaws hauv Suav teb tau pom tias tus nqi npib nyiaj ntawm COVID-19 nrog rau lwm cov kab mob ua pa tau siab li 25 feem pua ​​.41

Lub zog ntawm peb txoj kev tshawb fawb suav nrog kev siv cov ntaub ntawv hauv tebchaws, creatinine-raws li cov ntsiab lus ntawm AKI, thiab kev sim ua kom zoo rau cov xwm txheej hauv paus uas yuav cuam tshuam rau AKI. Cov kev txwv suav nrog kev txo qis rau cov poj niam, tsis muaj cov ntaub ntawv histologic, tsis muaj peev xwm los sib piv qee qhov kev ntsuas hauv chav kuaj, xws li ferritin lossis lactate dehydrogenase, uas tsis tshua muaj kev ntsuas hauv pawg kab mob khaub thuas, thiab muaj peev xwm ntawm qhov tsis sib haum xeeb. Lub semiquantitative xwm ntawm cov zis dipstick ntsuas nrog rau qhov sib txawv ntawm qhov tseeb thiab tsis muaj cov ntaub ntawv txhim khu kev qha ntawm kev siv cov txheeb ze thiab sij hawm ntawm foley catheter tso ntawm cov pab pawg kuj yuav tsum tau xav txog hauv kev txhais cov kev tshawb pom ntawm cov zis. Kev soj ntsuam ntawm kev rov qab tuaj yeem raug cuam tshuam los ntawm kev tsis txaus ntseeg; Txawm li cas los xij, peb yuav xav tias qhov ntev ntawm kev nyob ntev dua thiab feem ntau ua rau muaj qhov tshwm sim tsis zoo ntawm COVID-19 cov neeg mob kom paub tseeb hauv pab pawg no thiab muaj feem cuam tshuam rau peb cov txiaj ntsig mus rau qhov tsis muaj. Thaum kawg, peb tsis paub txog qhov cuam tshuam uas hloov kho kev kho mob ntawm COVID-19 lossis kev nkag mus rau qhov pib yuav muaj ntawm AKI tus nqi. Ib tsab xov xwm tsis ntev los no tau tshuaj xyuas cov xwm txheej hauv ntiaj teb ntawm AKI hauv COVID-19 thiab pom tias muaj qhov tshwm sim ntawm AKI tsawg dua lub sijhawm, txawm hais tias nws pom tias AKI hnyav thiab qhov xav tau rau kev lim ntshav tseem muaj ntau.42

Hauv kev xaus, peb tau pom qhov tshwm sim ntau dua thiab qhov hnyav ntawm AKI thiab kev tuag ntau dua hauv cov qub tub rog nyob hauv tsev kho mob nrog COVID-19 piv nrog tus mob khaub thuas. Cov kev tshawb pom no yuav raug tsav, yam tsawg kawg ntawm ib feem, los ntawm qhov mob hnyav. Cov kev tshawb fawb ntxiv los txiav txim siab seb AKI hauv COVID-19 puas yog vim qhov txawv ntawm pathophysiology xav tau. Tsis tas li ntawd, ntawm cov neeg uas muaj sia nyob mus txog 90 hnub, kev rov qab los ntawm AKI tau zoo sib xws ntawm cov neeg mob uas muaj mob. Qhov xwm txheej tseem ceeb ntawm AKI nyob rau hauv ob qho tib si mob muab cov ntaub ntawv tseem ceeb ntawm kev cia siab rau lub nra ntawm lubraumnoj qab haus huvntawm cov qub tub rog, cov neeg mob zoo sib xws, thiab lawv cov kws kho mob.

Qhia tawm

EDS tshaj tawm kev sab laj rau Akebia Therapeutics, Inc., thaum lub Plaub Hlis 2019; Honorarium rau kev caw kev kawm tham ntawm DaVita Txhua Xyoo Tus Kws Kho Mob Thawj Coj Rooj Sib Tham hauv Lub Ob Hlis 2019; royalties ua tus sau rau UptoDate, Inc; thiab ua haujlwm rau ntawm pawg thawj coj saib xyuas rau Clinical Journal of the American Society of Nephrology. Tag nrho lwm tus kws sau ntawv tshaj tawm tsis muaj kev sib tw nyiam.

TXOJ CAI

Txoj haujlwm no tau txais kev txhawb nqa los ntawm Veterans Affairs Health Services Research and Development (HSR&D) COVID-19 Rapid Response Project C19 20-214.BCBis txhawb nqa los ntawm T32DK007569-32. Ib feem ntawm txoj haujlwm tshuaj ntsuam xyuas tau txais kev txhawb nqa los ntawm Million Veteran Program grant SDR 18-194.EDS kuj tau txais kev txhawb nqa los ntawm Vanderbilt O'Brien Kidney Center P30-DK114809 Clinical and Translational Research Core.

AUTHOR CONTRIBUTIONS

EDS. MEM. SKP, AMP, RAG, AMH, SCS, JPA, thiab BCB tsim qhov kev kawm; SKP, JD, AV, thiab MEM sau cov ntaub ntawv; AMP, RAG, EDS, MEM, SKP, AMH, SCS, JPA, thiab BCB txheeb xyuas cov ntaub ntawv; AMP thiab AUV ua cov fiqures; BCB, EDS, AMP, RAG, SKP, MEM, thiab SCS tau sau cov ntawv sau thawj zaug, uas tau muab kho dua los ntawm txhua tus kws sau ntawv. Txhua tus kws sau ntawv pom zoo rau qhov kawg ntawm cov ntawv sau.

SUPPLEMENTARY MATERIAL Supplementary File (PDF)

Tab S1. Cov ntsiab lus ntxiv.

Tab S2A. Cov yam ntxwv ntawm tus neeg mob hauv lub cev, lub cev tsis muaj zog.

Tab S2B. Cov yam ntxwv ntawm tus neeg mob hauv cov neeg mob nrog AKI, tsis muaj qhov hnyav.

Table S3.Renal thiab lwm yam tshwm sim ntawm cov neeg mob uas muaj AKI, unweighted cohort.

Tab S4A. Lub raum rov qab tag nrho, unweighted cohort.

Tab S4B. Lub raum rov qab ntawm cov neeg muaj txoj sia nyob (cov neeg tsis muaj zog). Tab S5. Kev soj ntsuam rhiab heev ntawm AK qhov xwm txheej thiab qhov hnyav tau hloov kho rau hnub nkag.

Daim duab S1. Rov qab los ntawm theem 2 lossis 3 AK.

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