Augmented renal clearance in COVID-19 critically ill patients

Introduction: Augmented renal clearance (ARC) is a clinical entity characterized by an increase in the renal glomerular filtration rate above normal limits. The objective of this description is to highlight the association between ARC and COVID-19 in critically ill patients. Clinical cases: Two clin...

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Autor principal: Luchitta, Claudina
Formato: Artículo revista
Lenguaje:Español
Publicado: Universidad Nacional de Rosario 2022
Materias:
Riñon hiperfiltrante
COVID-19
pacientes críticos
Augmented Renal Clearance
Critical illness
Acceso en línea:https://fcmcientifica.unr.edu.ar/index.php/revista/article/view/56
Aporte de:
FCM Científica de Universidad Nacional de Rosario
id I15-R235-article-56
record_format ojs
institution Universidad Nacional de Rosario
institution_str I-15
repository_str R-235
container_title_str FCM Científica
language Español
format Artículo revista
topic Riñon hiperfiltrante
COVID-19
pacientes críticos
Augmented Renal Clearance
COVID-19
Critical illness
spellingShingle Riñon hiperfiltrante
COVID-19
pacientes críticos
Augmented Renal Clearance
COVID-19
Critical illness
Luchitta, Claudina
Augmented renal clearance in COVID-19 critically ill patients
topic_facet Riñon hiperfiltrante
COVID-19
pacientes críticos
Augmented Renal Clearance
COVID-19
Critical illness
author Luchitta, Claudina
author_facet Luchitta, Claudina
author_sort Luchitta, Claudina
title Augmented renal clearance in COVID-19 critically ill patients
title_short Augmented renal clearance in COVID-19 critically ill patients
title_full Augmented renal clearance in COVID-19 critically ill patients
title_fullStr Augmented renal clearance in COVID-19 critically ill patients
title_full_unstemmed Augmented renal clearance in COVID-19 critically ill patients
title_sort augmented renal clearance in covid-19 critically ill patients
description Introduction: Augmented renal clearance (ARC) is a clinical entity characterized by an increase in the renal glomerular filtration rate above normal limits. The objective of this description is to highlight the association between ARC and COVID-19 in critically ill patients. Clinical cases: Two clinical cases of young women with acute respiratory failure secondary to COVID-19 pneumonia requiring invasive mechanical ventilation (MV) are described; both presented elevated acute phase reactants and hypoxemia on admission, requiring prone position, deep sedation and neuromuscular blockade. They presented prolonged MV and difficult sedation requiring high doses of sedatives and analgesia. Given the suspicion of ARC, in the first case, on day 6 of hospitalization, a 24-hour urine creatinine clearance of 246 ml / min / 1.73m2 was found, evolving unfavorably, dying on day 23. In the second case, on day 4 of hospitalization, the diagnosis of ARC was made, observing creatinine clearance of 157 ml / min / 1.73m2, after 37 days of hospitalization he evolved favorably. Discussion: The importance of the recognition of ARC lies in the pharmacokinetic changes with which it is associated, particularly with renal excretion drugs, of which it can modify the half-life, plasma concentration and therapeutic levels. This leads to taking into account the possibility of ARC in patients with COVID-19 when it is suspected, since a pharmacological therapeutic failure can occur in them, in addition to the limited literature on this association published so far.
publisher Universidad Nacional de Rosario
publishDate 2022
url https://fcmcientifica.unr.edu.ar/index.php/revista/article/view/56
work_keys_str_mv AT luchittaclaudina augmentedrenalclearanceincovid19criticallyillpatients
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first_indexed 2023-06-26T22:51:01Z
last_indexed 2023-06-26T22:51:01Z
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spelling I15-R235-article-562022-07-08T21:44:15Z Augmented renal clearance in COVID-19 critically ill patients Riñón hiperfiltrante en pacientes críticos con COVID-19 Luchitta, Claudina Riñon hiperfiltrante COVID-19 pacientes críticos Augmented Renal Clearance COVID-19 Critical illness Introduction: Augmented renal clearance (ARC) is a clinical entity characterized by an increase in the renal glomerular filtration rate above normal limits. The objective of this description is to highlight the association between ARC and COVID-19 in critically ill patients. Clinical cases: Two clinical cases of young women with acute respiratory failure secondary to COVID-19 pneumonia requiring invasive mechanical ventilation (MV) are described; both presented elevated acute phase reactants and hypoxemia on admission, requiring prone position, deep sedation and neuromuscular blockade. They presented prolonged MV and difficult sedation requiring high doses of sedatives and analgesia. Given the suspicion of ARC, in the first case, on day 6 of hospitalization, a 24-hour urine creatinine clearance of 246 ml / min / 1.73m2 was found, evolving unfavorably, dying on day 23. In the second case, on day 4 of hospitalization, the diagnosis of ARC was made, observing creatinine clearance of 157 ml / min / 1.73m2, after 37 days of hospitalization he evolved favorably. Discussion: The importance of the recognition of ARC lies in the pharmacokinetic changes with which it is associated, particularly with renal excretion drugs, of which it can modify the half-life, plasma concentration and therapeutic levels. This leads to taking into account the possibility of ARC in patients with COVID-19 when it is suspected, since a pharmacological therapeutic failure can occur in them, in addition to the limited literature on this association published so far. Introducción: El riñón hiperfiltrante (RHF) es una entidad clínica caracterizada por un aumento en la tasa de filtrado glomerular (TFG) renal por encima de límites normales. El objetivo de esta descripción es resaltar la asociación entre el RHF y la COVID-19 en pacientes críticos. Casos clínicos: Se describen dos casos clínicos de mujeres jóvenes con insuficiencia respiratoria aguda secundaria a neumonía por  COVID-19 con requerimiento de ventilación mecánica (VM) invasiva, ambas presentaban al ingreso reactantes de fase aguda elevados e hipoxemia, con necesidad de decúbito prono, sedación profunda y bloqueo neuromuscular. Presentaron VM prolongada y sedación difícil requiriendo dosis elevadas de sedantes y analgesia. Ante la sospecha de RHF, en el primer caso, al día 6 de internación se constata aclaramiento de creatinina en orina de 24 hs de 246 ml/min/1,73m2, evoluciona desfavorablemente, falleciendo al día 23. En el segundo caso, al día 4 de internación se realiza el diagnóstico de RHF, observándose aclaramiento de creatinina de 157 ml/min/1,73m2,  tras 37 días de internación evoluciona favorablemente y pasa a sala. Discusión: La importancia del reconocimiento del RHF radica en los cambios farmacocinéticos con los que se asocia, particularmente a los fármacos de excreción renal, de los que puede modificar la vida media, la concentración plasmática y los niveles terapéuticos. Esto lleva a tener en cuenta la posibilidad de RHF en pacientes con COVID-19 cuando se lo sospeche, ya que puede suceder una falla terapéutica farmacológica en los mismos, sumado a la escasa literatura de esta asociación publicada hasta el momento. Universidad Nacional de Rosario 2022-07-08 info:eu-repo/semantics/article info:eu-repo/semantics/publishedVersion application/pdf https://fcmcientifica.unr.edu.ar/index.php/revista/article/view/56 10.35305/fcm.v2i.56 Revista de la Facultad de Ciencias Médicas. Universidad Nacional de Rosario.; Vol. 2 (2021): Revista de la Facultad de Ciencias Médicas. Universidad Nacional de Rosario.; 75-79 2796-7719 spa https://fcmcientifica.unr.edu.ar/index.php/revista/article/view/56/64 Derechos de autor 2022 Revista de la Facultad de Ciencias Médicas. Universidad Nacional de Rosario. https://creativecommons.org/licenses/by-nc/4.0

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