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Article: Acute renal impairment in coronavirus-associated severe acute respiratory syndrome

TitleAcute renal impairment in coronavirus-associated severe acute respiratory syndrome
Authors
KeywordsAcute renal failure
Acute respiratory distress syndrome
Acute tubular necrosis
Coronavirus
Mortality
Severe acute respiratory syndrome
Issue Date2005
PublisherNature Publishing Group. The Journal's web site is located at http://www.nature.com/ki/index.html
Citation
Kidney International, 2005, v. 67 n. 2, p. 698-705 How to Cite?
AbstractBackground. Severe acute respiratory syndrome (SARS) is a newly emerged infection from a novel coronavirus (SARS-CoV). Apart from fever and respiratory complications, acute renal impairment has been observed in some patients with SARS. Herein, we describe the clinical, pathologic, and laboratory features of the acute renal impairment complicating this new viral infection. Methods. We conducted a retrospective analysis of the plasma creatinine concentration and other clinical parameters of the 536 SARS patients with normal plasma creatinine at first clinical presentation, admitted to two regional hospitals following a major outbreak in Hong Kong in March 2003. Kidney tissues from seven other patients with postmortem examinations were studied by light microscopy and electron microscopy. Results. Among these 536 patients with SARS, 36 (6.7%) developed acute renal impairment occurring at a median duration of 20 days (range 5-48 days) after the onset of viral infection despite a normal plasma creatinine level at first clinical presentation. The acute renal impairment reflected the different prerenal and renal factors that exerted renal insult occurring in the context of multiorgan failure. Eventually, 33 SARS patients (91.7%) with acute renal impairment died. The mortality rate was significantly higher among patients with SARS and acute renal impairment compared with those with SARS and no renal impairment (91.7% vs. 8.8%) (P < 0.0001). Renal tissues revealed predominantly acute tubular necrosis with no evidence of glomerular pathology. The adjusted relative risk of mortality associated with the development of acute renal impairment was 4.057 (P < 0.001). By multivariate analysis, acute respiratory distress syndrome and age were the most significant independent risk factors predicting the development of acute renal impairment in SARS. Conclusion. Acute renal impairment is uncommon in SARS but carries a high mortality. The acute renal impairment is likely to be related to multi-organ failure rather than the kidney tropism of the virus. The development of acute renal impairment is an important negative prognostic indicator for survival with SARS.
Persistent Identifierhttp://hdl.handle.net/10722/77525
ISSN
2015 Impact Factor: 7.683
2015 SCImago Journal Rankings: 3.181
ISI Accession Number ID
References

 

DC FieldValueLanguage
dc.contributor.authorChu, KHen_HK
dc.contributor.authorTsang, WKen_HK
dc.contributor.authorTang, CSen_HK
dc.contributor.authorLam, MFen_HK
dc.contributor.authorLai, FMen_HK
dc.contributor.authorTo, KFen_HK
dc.contributor.authorFung, KSen_HK
dc.contributor.authorTang, HLen_HK
dc.contributor.authorYan, WWen_HK
dc.contributor.authorChan, HWHen_HK
dc.contributor.authorLai, TSTen_HK
dc.contributor.authorTong, KLen_HK
dc.contributor.authorLai, KNen_HK
dc.date.accessioned2010-09-06T07:32:51Z-
dc.date.available2010-09-06T07:32:51Z-
dc.date.issued2005en_HK
dc.identifier.citationKidney International, 2005, v. 67 n. 2, p. 698-705en_HK
dc.identifier.issn0085-2538en_HK
dc.identifier.urihttp://hdl.handle.net/10722/77525-
dc.description.abstractBackground. Severe acute respiratory syndrome (SARS) is a newly emerged infection from a novel coronavirus (SARS-CoV). Apart from fever and respiratory complications, acute renal impairment has been observed in some patients with SARS. Herein, we describe the clinical, pathologic, and laboratory features of the acute renal impairment complicating this new viral infection. Methods. We conducted a retrospective analysis of the plasma creatinine concentration and other clinical parameters of the 536 SARS patients with normal plasma creatinine at first clinical presentation, admitted to two regional hospitals following a major outbreak in Hong Kong in March 2003. Kidney tissues from seven other patients with postmortem examinations were studied by light microscopy and electron microscopy. Results. Among these 536 patients with SARS, 36 (6.7%) developed acute renal impairment occurring at a median duration of 20 days (range 5-48 days) after the onset of viral infection despite a normal plasma creatinine level at first clinical presentation. The acute renal impairment reflected the different prerenal and renal factors that exerted renal insult occurring in the context of multiorgan failure. Eventually, 33 SARS patients (91.7%) with acute renal impairment died. The mortality rate was significantly higher among patients with SARS and acute renal impairment compared with those with SARS and no renal impairment (91.7% vs. 8.8%) (P < 0.0001). Renal tissues revealed predominantly acute tubular necrosis with no evidence of glomerular pathology. The adjusted relative risk of mortality associated with the development of acute renal impairment was 4.057 (P < 0.001). By multivariate analysis, acute respiratory distress syndrome and age were the most significant independent risk factors predicting the development of acute renal impairment in SARS. Conclusion. Acute renal impairment is uncommon in SARS but carries a high mortality. The acute renal impairment is likely to be related to multi-organ failure rather than the kidney tropism of the virus. The development of acute renal impairment is an important negative prognostic indicator for survival with SARS.en_HK
dc.languageengen_HK
dc.publisherNature Publishing Group. The Journal's web site is located at http://www.nature.com/ki/index.htmlen_HK
dc.relation.ispartofKidney Internationalen_HK
dc.subjectAcute renal failureen_HK
dc.subjectAcute respiratory distress syndromeen_HK
dc.subjectAcute tubular necrosisen_HK
dc.subjectCoronavirusen_HK
dc.subjectMortalityen_HK
dc.subjectSevere acute respiratory syndromeen_HK
dc.titleAcute renal impairment in coronavirus-associated severe acute respiratory syndromeen_HK
dc.typeArticleen_HK
dc.identifier.openurlhttp://library.hku.hk:4550/resserv?sid=HKU:IR&issn=0085-2538&volume=67&spage=698&epage=705&date=2005&atitle=Acute+renal+impairment+in+coronavirus-associated+severe+acute+respiratory+syndromeen_HK
dc.identifier.emailLai, KN: knlai@hku.hken_HK
dc.identifier.authorityLai, KN=rp00324en_HK
dc.description.naturelink_to_subscribed_fulltext-
dc.identifier.doi10.1111/j.1523-1755.2005.67130.xen_HK
dc.identifier.pmid15673319-
dc.identifier.scopuseid_2-s2.0-19944431145en_HK
dc.identifier.hkuros99279en_HK
dc.relation.referenceshttp://www.scopus.com/mlt/select.url?eid=2-s2.0-19944431145&selection=ref&src=s&origin=recordpageen_HK
dc.identifier.volume67en_HK
dc.identifier.issue2en_HK
dc.identifier.spage698en_HK
dc.identifier.epage705en_HK
dc.identifier.isiWOS:000226420600033-
dc.publisher.placeUnited Kingdomen_HK
dc.identifier.scopusauthoridChu, KH=7402452789en_HK
dc.identifier.scopusauthoridTsang, WK=7201558610en_HK
dc.identifier.scopusauthoridTang, CS=8681865300en_HK
dc.identifier.scopusauthoridLam, MF=7202630163en_HK
dc.identifier.scopusauthoridLai, FM=7202559720en_HK
dc.identifier.scopusauthoridTo, KF=36785812800en_HK
dc.identifier.scopusauthoridFung, KS=7202934791en_HK
dc.identifier.scopusauthoridTang, HL=7403124702en_HK
dc.identifier.scopusauthoridYan, WW=7402221587en_HK
dc.identifier.scopusauthoridChan, HWH=7403402445en_HK
dc.identifier.scopusauthoridLai, TST=35559048100en_HK
dc.identifier.scopusauthoridTong, KL=16640748100en_HK
dc.identifier.scopusauthoridLai, KN=7402135706en_HK
dc.identifier.citeulike72462-

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