Diabetes is the leading cause of end-stage kidney disease (ESKD) worldwide.
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) vaccination is an important method to reduce the spread of Coronavirus disease 2019 (COVID-19). While most recipients experience only mild side effects such as fever, fatigue, and injection site pain, it has been found that SARS-CoV-2 vaccination is associated with a few autoimmune problems, including the development of immune thrombotic thrombocytopenia, autoimmune liver disorders, rheumatoid arthritis, IgA nephropathy (IgAN) and systemic lupus erythematosus (SLE). There have been several reports documenting the occurrence of lupus nephritis (LN) after administration of the SARS-CoV-2 vaccine. Considering the ability to activate the immune system, vaccines carry a series of risk inducing flares or exacerbating disease in patients with glomerulonephritises.
Preterm infants are at risk for acute kidney injury (AKI) for multiple reasons. Reports on the frequency and timeline of iatrogenic renal insults and potential consequences are limited. Our objectives are to estimate the prevalence and timing of exposure to nephrotoxic medications, and assess the association of these nephrotoxic medications with AKI in preterm infants. We performed a retrospective chart review of infants <30 weeks postmenstrual age and/or <1500 g birth weight admitted to the neonatal intensive care units at Cincinnati Children's Hospital Medical Center and University of Cincinnati Medical Center from 2011 to 2014. We queried the electronic health record for exposures to nephrotoxic medications and/or radiologic contrast media and correlated to serum creatinine concentration proximate to the exposure. Using the Kidney Disease Improving Global Outcomes (KDIGO) creatinine criteria, we assessed the AKI rate associated with the exposures. The cohort included 276 preterm infants. 233 (84%) received nephrotoxicity-associated medications. Antibiotics were the most common type (80%). AKI occurred in 9% of infants and was associated with exposure to a nephrotoxic medication. In a forward stepwise logistical regression, birth weight (OR: 0.995 (95% CI: 0.991-0.998), p=0.004) and number of exposures (OR: 1.83 (95% CI: 1.33-2.53), p=0.0002) were predictive of AKI. Nephrotoxic medication exposure increased the odds of AKI in preterm and low birth weight infants. Future prospective surveillance through the electronic health record in addition to routine serum creatinine monitoring may reduce the rate of exposure and subsequent AKI.
