Acute kidney injury in COVID-19
This article discusses the common and severe renal complications associated with COVID-19 in critically ill patients. Manifestations of acute renal failure may include proteinuria, hematuria, increased serum creatinine, or blood urea nitrogen levels. A meta-analysis shows that more than half of COVID-19 patients develop proteinuria, elevated serum levels of Scr and BUN, as well as CT scan shows renal inflammation and edema. Multiple factors may be associated with renal complications, such as: direct virus infection, cytokine storm, hypoxia, septic shock, hemodynamic instability and rhabdomyolysis, hypertension and diabetes may be associated with acute kidney injury in COVID-19 patients. These complications may be related to age, smoking, cytokine storm, severity of disease, ethnicity, and comorbidities. The article discusses inflammatory mechanisms that may be related to acute kidney injury in COVID patients and states that complete recovery of the kidneys is approximately 30-45% based on recent reports. Therapeutic potentials for COVID-19 associated AKI are also discussed. The authors recommend treatments which target specific molecules and pathways to encourage renal recovery.
Long Covid Symptom and Impact Tools
In this article, authors aim to develop and validate patients-reported instruments based on patient experience to monitor the symptoms and impact of long COVID. The long COVID Symptom and Impact Tools (ST and IT) were developed from answers to a survey with open-ended questions sent to 492 patients with long COVID. Validation of the tools involved patients with suspected or confirmed COVID-19 with symptoms extending over three weeks after onset. Construct validity was assessed by examining relationship between ST and IT scores with health-related quality of life, function, and perceived health. The tools provide the first validated and reliable instruments from monitoring the symptoms and impact of long COVID. The supplementary data may be viewed at this link Development and validation of the long covid symptom and impact tools, a set of patient-reported instruments constructed from patients’ lived experience | Clinical Infectious Diseases | Oxford Academic (oup.com).
COVID-19 and myocardial infarction: Primary results of a nationwide angiographic study
In this multicenter prospective study, patients who were diagnosed with COVID-19 and experienced a myocardial infarction who underwent coronary angiography were evaluated to determine patterns and in-hospital outcomes. A total of 152 patients were included, 142 had COVID-19 infection. The median time between symptom onset and hospital admission was 5 days. A total of 83 patients presented with ST-elevation MI, as well as others having multi-vessel disease, complex lesion, and myocardial blush grades 0/1. Overall in-hospital mortality was 23.7% with ST-segment elevation MI and baseline myocardial blush grades 0 or 1 were independently associated with higher risk for mortality. Patients who have a MI in the context of COVID-19 mostly present complex coronary morphologies, implying a background of prior atherosclerotic disease superimposed on a thrombotic milieu. The in-hospital prognosis is poor with markedly high mortality. Authors encourage further investigation.
Pulmonary fibrosis secondary to COVID-19
In this narrative review, current evidence regarding post-COVID-19 pulmonary fibrosis is discussed. The authors emphasize potential risk factors, histopathology, pathophysiology, functional and tomographic features and potential therapeutic modalities. Expert opinion suggests that pulmonary sequelae may occur secondary to COVID-19 and should be included in the current differential diagnoses for pulmonary fibrosis. POST-COVID-19 pulmonary fibrosis is defined as the presence of persistent and different fibrotic tomographic changes identified upon follow up, combined with impaired pulmonary function testing. Patients with increased risk include those who are older, male, smokers, with comorbidities. Patients with this condition may present with dyspnea, dry cough, and oxygen desaturation. Multiple symptoms and strategies to reduce the progression and severity are further discussed.