Journal of nephropathology
Volume:12 Issue: 1, Jan 2023

Spironolactone is a first-generation and non-selective mineralocorticoid receptor antagonist (MRA). It is extensively well-studied and recommended due to increased accessibility for patients. Unfortunately, it is often discontinued in several cases due to its association with hyperkalemia. The apparent benefit of eplerenone over spironolactone is its mineralocorticoid receptor (MR) selectivity. However, it is also characterized by low-potency and higher cost compared to spironolactone. The high adverse-effect profile of spironolactone and eplerenone has led to the innovation of novel medications such as non-steroidal MRAs. Among these medications, finerenone is the most advanced agent. Finerenone is associated with decreased proteinuria, reduced risk of hyperkalemia and increased preservation of renal function with comparable benefit in heart failure compared to selective and nonselective MRAs. The nonsteroidal structure of finerenone affects mineralocorticoid receptor binding, lipophilicity and polarity which have potent effects on distribution, the degree of attachment to blood proteins, transportation, and tissue diffusion.

 The emergence of a novel coronavirus (COVID-19) in late December 2019 and its rapid global spread has led World Health Organization (WHO) to introduce it as a very dangerous pandemic. People with underlying disease and a history of organ transplantation are at higher risk for COVID-19 disease compared with healthy people.

 In the present study, clinical and laboratory manifestations in the patients with COVID-19 with a history of kidney transplantation has been investigated.

 This study conducted on 103 COVID-19-positive kidney transplant patients as a descriptive epidemiological study. Clinical and laboratory symptoms of hospitalized renal transplanted patients have been assessed. Statistical analysis of the collected data conducted using SPSS (Statistical Package for Social Sciences, version 22).

 This study consisted of 103 COVID-19 patients with a history of kidney transplant, of which 64 males (62.1%) and 39 females (37.9%) with an average age of 48.5 ± 13.1 years. The most common clinical manifestations were headache (67%) and shortness of breath (66%). Elevated lactate dehydrogenase (LDH) levels, erythrocyte sedimentation rate (ESR), and C-reactive protein (CRP) has been observed in 100%, 98.1% and 93.2% of patients, respectively. In 12.6% and 41.7% of patients, the degree of lung involvement was above 75% and 50%-75%, respectively. Moreover, 79.6% of patients has been discharged after improved, while 20.4% of patients died.

 We found, kidney transplantation may increase COVID-19-related mortality when compared to COVID-19-related mortality in the general population.

In patients with coronavirus disease 2019 (COVID-19), the prevalence of hyponatremia has been reported with varying outcomes.

The aim of this study was to evaluate the prevalence of hyponatremia in hospitalized patients with COVID-19.

 Patients and Methods:

In this multicenter cross-sectional study, information about hospitalized patients with COVID-19 admitted between March 2020 and September 2020, including age, gender, and serum levels of sodium, creatinine, and potassium, as well as blood urea nitrogen (BUN), was analyzed, while P value level less than 0.05 was considered significant.

A total of 667 hospitalized patients with COVID-19 were enrolled in the study, of which 54.4% were male. The median age of patients was 63 years old. About 39.4% of patients had hyponatremia on admission day. More than 80% of patients had mild hyponatremia. The median age of the hyponatremia group was significantly higher than that of eunatremia group.

Our data showed that hyponatremia is observed in hospitalized patients with COVID-19 and is often mild.

 Acute kidney injury (AKI) is prevalent in the coronavirus disease-2019 (COVID-19). There are little data on the relationship between renal dysfunction and COVID-19 prognosis.

 The aim of this research was to investigate the effects of AKI in COVID-19 patients hospitalized to the Golestan and Razi hospitals in Ahvaz, Iran.

 In this retrospective cohort study, a total of 194 COVID-19 patients were included, consisting of 79 patients with AKI and 115 patients without AKI. Primary and secondary outcomes were compared between the two groups.

 According to the findings, mortality was significantly different between the two groups, and mortality was higher in the AKI group (P< 0.001). The mean length of hospital stay was statistically significantly higher in the AKI group (P=0.024). Moreover, there was a significant correlation between intensive care unit (ICU) admission and the study group (P<0.001). Staging of AKI group were seen as; stage I (49.37%), stage II (36.71%), and stage III (13.92%). No significant correlation was observed between outcome and the stages of AKI (P=0.496). Furthermore, 14 patients (17.72%) needed renal replacement therapy (RRT) in the AKI group.

 Although AKI is a common finding in COVID-19 patients, most patients were in stage I disease, which returned to normal after COVID-19 treatment. According to our research, COVID-19 rarely leads to serious and persistent kidney injury. However, the risk of death is increased in COVID-19 patients with AKI. Therefore, it is necessary to evaluate the renal function tests during the course of disease.

Implication for health policy/practice/research/medical education:

this article reports a persistent dehydrated case with mild proteiunuria due to tubulointerstitial involvement that suddenly failed his renal function and underwent peritoneal dialysis.

Please cite this paper as:

 Jahangiri D, Ardalan M, Mubarak M, Alimohammadi S, Jahantigh HR, Saeifar S, Ragati Haghi Y. Chronic dehydration-related nephropathy; an under-recognized cause of renal failure in tropics. J Nephropathol. 2023;12(1):e18391. DOI: 10.34172/jnp.2022.18391.

A 27-year-old man underwent a deceased kidney transplant. Three days after transplantation, COVID-19 was diagnosed for our patient. Immunosuppressants were reduced and a renal biopsy was conducted, which showed acute T cell-mediated rejection. We intened to share a case to help clinicians to understand the risks that kidney transplant recipients face.

MYH9-related diseases (MYH9-RD) are clinically represented by thrombocytopenia, large platelets, proteinuria and various degrees of renal dysfunction. We present a 25-year-old male with thrombocytopenia, large platelets, renal dysfunction and proteinuria. Gene sequencing of whole exons of MYH9 gene confirmed the diagnosis of MYH9-related disorder and revealed single nucleotide polymorphisms (SNPs) in the introns 13 (rs3752462) and 14 (rs2413396) and a mutation in exon 26 of MYH9 gene. Our result supported the possibility of non-coding SNPs involvement in the pathogenicity of the MYH9-RD disease and successful renal transplant in this patient.