Skip to content
Research Article Open access CC BY 4.0

Evaluation of the Impact of Local Protocol of King Salman Specialized Hospital-KSA of Management of Renal Disease patients requiring Immunosuppressive Therapy Afflicted by Acute COVID 19 Infection – an Observational Study

Abir Farouk Megahed, Dina Abouelkheir Abdalla Mohamed, Ghada El-Said, Omar Ahmad Al Nafel, Nagy Sayed-Ahmed

Asian Journal of Medicine and Health · pp. 212–234 · Published 7 Nov 2022

10.9734/ajmah/2022/v20i11761

Abstract

Aims: We aimed to observe the effect of modification of the immunosuppressive regimen in response to the severity of COVID-19 infection on the outcome of renal disease patients and to study factors affecting their mortality. Methods and Materials: The study was conducted on 18 patients (13 males and 5 females) admitted to the King Salman Specialized hospital (KSSH), a COVID-19 isolation center, in Hail city in KSA; of them, 16 had kidney transplantation maintained on immunosuppression protocols, while 2 had immune-mediated nephritis maintained on immunosuppression. Locally agreed immunosuppressive protocol, the antivirals used as well as the used anticoagulant were followed without interference. Demographic data, associated comorbidities, baseline x-ray, routine laboratory data, and patients’ outcomes were recorded. Results: The ages of the studied patients ranged from 23 - 60 years. Nine patients were treated in the ward (group 1) and the other 9 patients needed admission to the ICU (group 2). Compared to group 1, group 2 patients had higher mortality, higher levels of TLC, CRP, and serum phosphorus as well as admission LDH and D-dimer. Furthermore, group 2 patients had lower serum albumin, and lower blood platelet and lymphocyte counts. All patients continued on corticosteroids and calcineurin inhibitors in case they had been maintained on them before the infection. Antiproliferative drugs (MMF or Azathioprine) were discontinued in all patients; 15 of them stopped it on the first admission day and 3 were reluctant to stop the drugs till a few days later when they were admitted to the ICU. Of the total observed patients 4 died; 3 of them were those who did not stop these drugs early in the course of the disease. Conclusions: Appropriately early discontinuation of antiproliferative drugs in renal immunosuppressed patients and the use of higher doses of systemic steroids were associated with better prognosis of COVID-19 infection patients and did not cause deterioration of kidney function.

COVID 19 infection kidney transplant patients immunosuppressed patients antiproliferative drugs isolated gastrointestinal symptoms

References (20)

  1. 1 A new coronavirus associated with human respiratory disease in China [DOI]
  2. 2 Genomic characterisation and epidemiology of 2019 novel coronavirus: implications for virus origins and receptor binding [DOI]
  3. 3 First Case of 2019 Novel Coronavirus in the United States [DOI]
  4. 4 Remdesivir in adults with severe COVID-19: a randomised, double-blind, placebo-controlled, multicentre trial [DOI]
  5. 5 Unique epidemiological and clinical features of the emerging 2019 novel coronavirus pneumonia (COVID‐19) implicate special control measures [DOI]
  6. 6 Mechanisms of Action of Mycophenolate Mofetil in Preventing Acute and Chronic Allograft Rejection [DOI]
  7. 7 The efficacy and safety of Favipiravir in treatment of COVID-19: a systematic review and meta-analysis of clinical trials [DOI]
  8. 8 Mycophenolate mofetil: effects on cellular immune subsets, infectious complications, and antimicrobial activity [DOI]
  9. 9 Intensity of mycophenolate mofetil treatment is associated with an impaired immune response to SARS-CoV-2 vaccination in kidney transplant recipients [DOI]
  10. 10 How should I manage immunosuppression in a kidney transplant patient with COVID-19? An ERA-EDTA DESCARTES expert opinion [DOI]
  11. 11 Gastrointestinal Manifestations of COVID-19: A Review of What We Know [DOI]
  12. 12 Clinical characteristics and predictors of mortality in African‐Americans with COVID‐19 from an inner‐city community teaching hospital in New York [DOI]
  13. 13 Modeling Combined Immunosuppressive and Anti-inflammatory Effects of Dexamethasone and Naproxen in Rats Predicts the Steroid-Sparing Potential of Naproxen [DOI]
  14. 14 Systematic review of immunosuppressant guidelines in the COVID-19 pandemic [DOI]
  15. 15 COVID-19 Disease Outcomes: Does Gastrointestinal Burden Play a Role? [DOI]
  16. 16 A cross-sectional study of gastrointestinal manifestations in COVID-19 Egyptian patients [DOI]
  17. 17 Increased incidence of infections following the late introduction of mycophenolate mofetil in renal transplant recipients [DOI]
  18. 18 Indicators of Critical Illness and Predictors of Mortality in COVID-19 Patients
  19. 19 Severe COVID-19 infection in a kidney transplant recipient treated with lopinavir/ritonavir, hydroxychloroquine and dexamethasone [DOI]
  20. 20 Clinical Features of 2019 Novel Coronavirus Pneumonia Presented Gastrointestinal Symptoms But Without Fever Onset [DOI]

Cited by 0

No indexed citations yet.

Related research

Article metrics

Real usage data collected on this platform.

35

Page views

0

PDF downloads

9

Outbound clicks

0

Citations

Views over time

Views by country

Approximate, from request IP at view time — not citizenship or institution. Countries with fewer than 5 views are grouped as "Other".

Traffic sources

Referring site, by host.

Views and downloads exclude known bots/crawlers. Citations combines this platform's own DOI-resolved index with each external source's own reported total — see Cited by above for individually listed citing works. Last refreshed 0 seconds ago.