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      Fulminant Acute Kidney Injury in a Young Patient with Novel Coronavirus 2019

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          Abstract

          Coronavirus disease 2019 (COVID-19) is a global pandemic affecting more than 200 countries and 180,000 cases in the United States. While the outbreak began in China, the number of cases outside of China exceeded those in China on March 15, 2020 and are currently rising at an exponential rate. The number of fatalities in the United States are expected to exceed more than Italy and China. The disease is characterized predominantly as an acute respiratory illness. However, preliminary data suggests that kidney is a target for the virus and deterioration of renal function was associated with poor outcomes including in-hospital mortality. We pre­sent a report of a patient with COVID-19 who presented with acute onset of symptoms and normal renal function at baseline but rapidly deteriorated resulting in death. The timing of decline in renal function correlated with his worsening clinical status. He was started on continuous veno-venous hemofiltration without signs of clinical benefit. We also present the possible mechanisms for acute kidney injury in these patients. We performed a review of the emerging literature by searching PubMed, Google Scholar, and EMBASE for studies and/or case series published on this topic. Acute kidney injury might help risk stratify critically ill patients on a fatal course of COVID-19.

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          Most cited references 6

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          The deadly coronaviruses: The 2003 SARS pandemic and the 2020 novel coronavirus epidemic in China

          The 2019-nCoV is officially called SARS-CoV-2 and the disease is named COVID-19. This viral epidemic in China has led to the deaths of over 1800 people, mostly elderly or those with an underlying chronic disease or immunosuppressed state. This is the third serious Coronavirus outbreak in less than 20 years, following SARS in 2002–2003 and MERS in 2012. While human strains of Coronavirus are associated with about 15% of cases of the common cold, the SARS-CoV-2 may present with varying degrees of severity, from flu-like symptoms to death. It is currently believed that this deadly Coronavirus strain originated from wild animals at the Huanan market in Wuhan, a city in Hubei province. Bats, snakes and pangolins have been cited as potential carriers based on the sequence homology of CoV isolated from these animals and the viral nucleic acids of the virus isolated from SARS-CoV-2 infected patients. Extreme quarantine measures, including sealing off large cities, closing borders and confining people to their homes, were instituted in January 2020 to prevent spread of the virus, but by that time much of the damage had been done, as human-human transmission became evident. While these quarantine measures are necessary and have prevented a historical disaster along the lines of the Spanish flu, earlier recognition and earlier implementation of quarantine measures may have been even more effective. Lessons learned from SARS resulted in faster determination of the nucleic acid sequence and a more robust quarantine strategy. However, it is clear that finding an effective antiviral and developing a vaccine are still significant challenges. The costs of the epidemic are not limited to medical aspects, as the virus has led to significant sociological, psychological and economic effects globally. Unfortunately, emergence of SARS-CoV-2 has led to numerous reports of Asians being subjected to racist behavior and hate crimes across the world.
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            Caution on Kidney Dysfunctions of 2019-nCoV Patients

             Zhen Li,  Ming Wu,  Jie Guo (2020)
            Until 24:00 of February 7th 2020, 31774 laboratory-confirmed cases of novel coronavirus (2019-nCoV) infection have been reported, including 6101 severe cases in critical conditions and 722 deaths. The critical and urgent need at this moment is to find an effective treatment strategy with available means to prevent these thousands of severe inpatients from worsening and dying. It has been recently known that the 2019-nCoV shares a common cellular mechanism with the severe acute respiratory syndrome-associated coronavirus (SARS-CoV). Thus, we surveyed a previous retrospective case study on SARS which showed that acute renal impairment was uncommon in SARS but carried a formidably high mortality (91.7%, 33 of 36 cases). Here we report an ongoing case study on kidney functions in 59 patients infected by 2019-nCoV (including 28 diagnosed as severe cases and 3 deaths). 63% (32/51) of the patients exhibited proteinuria, indicative of renal impairment. 19% (11/59) and 27% (16/59) of the patients had an elevated level of plasma creatinine and urea nitrogen respectively. The computerized tomography (CT) scan showed radiographic abnormalities of the kidneys in 100% (27/27) of the patients. Together, these multiple lines of evidence point to the idea that renal impairment is common in 2019-nCov patients, which may be one of the major causes of the illness by the virus infection and also may contribute to multi-organ failure and death eventually. Therefore, we strongly suggest exercising a high degree of caution in monitoring the kidney functions of 2019-nCoV patients and, very importantly, that applying potential interventions including continuous renal replacement therapies (CRRT) for protecting kidney functions as early as possible, particular for those with plasma creatinine rising, is key to preventing fatality.
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              Cardiology in the Time of COVID-19

               J Mallidi (2020)
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                Author and article information

                Journal
                Cardiorenal Med
                Cardiorenal Med
                CRM
                Cardiorenal Medicine
                S. Karger AG (Allschwilerstrasse 10, P.O. Box · Postfach · Case postale, CH–4009, Basel, Switzerland · Schweiz · Suisse, Phone: +41 61 306 11 11, Fax: +41 61 306 12 34, karger@karger.com )
                1664-3828
                1664-5502
                6 May 2020
                : 1-6
                Affiliations
                aDepartment of Medicine, The Brooklyn Hospital Center, Brooklyn, New York, USA
                bDepartment of Medicine, Einstein Medical Center, Philadelphia, Pennsylvania, USA
                cBaylor University Medical Center, Baylor Heart and Vascular Hospital, Baylor Heart and Vascular Institute, Dallas, Texas, USA
                dSidney Kimmel College of Thomas Jefferson University, Philadelphia, Pennsylvania, USA
                Author notes
                *Akshaya Gopalakrishnan, PGY1 Internal Medicine Resident Physician, The Brooklyn Hospital Center, 153 Remsen St Apt 3B, Brooklyn, NY 11201 (USA), akshayamd92@ 123456gmail.com
                Article
                crm-0001
                10.1159/000508179
                7251584
                32375150
                Copyright © 2020 by S. Karger AG, Basel

                This article is made available via the PMC Open Access Subset for unrestricted re-use and analyses in any form or by any means with acknowledgement of the original source. These permissions are granted for the duration of the COVID-19 pandemic or until permissions are revoked in writing. Upon expiration of these permissions, PMC is granted a perpetual license to make this article available via PMC and Europe PMC, consistent with existing copyright protections.

                Page count
                Figures: 3, References: 16, Pages: 6
                Categories
                Case Report

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