Background. There is lack of data on feasibility and safety of kidney transplants from living donors who recovered from COVID-19. Methods. Here, we present a retrospective cohort study of 31 kidney transplant recipients (KTR) from living donors who recovered from polymerase chain reaction confirmed COVID-19 across 19 transplant centers in India from July 3, 2020, to December 5, 2020. We detailed demographics, clinical manifestations, immunosuppression regimen, treatment, and outcomes. Donors with a previous diagnosis of COVID-19 were accepted after documenting 2 negative polymerase chain reaction tests with complete symptom resolution for at least 28 days and significant social distancing for 14 days before surgery. Results. COVID-19 clinical severity in donors ranged from completely asymptomatic (71%, n = 22) to mild infection (29%, n = 9). None progressed to moderate or severe stages of the disease in the entire clinical course of home treatment. Patient and graft survival was 100%, respectively, with acute cellular rejection being reported in 6.4% (n = 2) recipient. All recipients and donors were asymptomatic with normal creatinine at median follow-up of 44 days after surgery without any complications relating to surgery and COVID-19. Conclusions. Our data support safety of proceeding with living donation for asymptomatic individuals with comprehensive donor, recipients screening before surgery, using a combination of clinical, radiologic, and laboratory criteria. It could provide new insights into the management of KTR from living donors who have recovered from COVID-19 in India. To the best of our knowledge, this remains the largest cohort of KTR from living donors who recovered from COVID-19.

Plasmodium vivax is causing increasingly more cases of severe malaria worldwide. Among 25 cases in India during 2010–2011, associated conditions were renal failure, thrombocytopenia, jaundice, severe anemia, acute respiratory distress syndrome, shock, cerebral malaria, hypoglycemia, and death. Further studies are needed to determine why P. vivax malaria is becoming more severe.

Severe and complicated malaria is usually caused by Plasmodium falciparum malaria (PF) but it has been increasingly observed that Plasmodium vivax malaria (PV), which was otherwise considered to be benign malaria, with a low case-fatality ratio, can also occasionally result in severe disease as with PF malaria. There is an urgent need to re-examine the clinical spectrum and burden of PV so that adequate control measures can be implemented against this emerging but neglected disease. We report a case of severe PV malaria with multi-organ dysfunction. Patients exhibited acute kidney injury, severe anemia/thrombocytopenia, jaundice, hypoglycemia, hyponatremia, and pulmonary edema. Peripheral blood microscopy by trained and expert pathologist and rapid diagnostic test showed the presence of PV and absence of PF. The patient recovered completely with anti-malarial drugs, supportive measures, and hemodialysis.Recent microrheologic research that analyzed malaria severity in PV clearly demonstrated enhanced aggregation, erythrocyte clumping, and reduced deformability affecting microcirculation. Our case report highlights the fact that PV malaria is benign by name but not always by nature. PV can lead to unusual and potentially life-threatening complications. Further large-scale multi-centric studies are needed to define this less known entity.

The outcome of chronic kidney disease (CKD) patients admitted to the Intensive Care Unit (ICU) is difficult to predict. This study assessed the outcome of CKD patients admitted to the ICU and evaluated prediction of 30-day mortality using the Acute Physiology and Chronic Health Evaluation (APACHE II), Simplified Acute Physiology Score (SAPS II), and Sequential Organ Failure Assessment (SOFA) score. One hundred consecutive CKD patients admitted to the ICU at a tertiary care hospital, Ahmedabad between 2011 and 2013 were included prospectively. Data on demographics, indication for admission, cause of CKD, use of vasoactive drugs and mechanical ventilation (MV), mode of renal replacement therapy (RRT), and 30-day mortality were recorded. The APACHE II, SAPS II, and SOFA scores were calculated based on the admission characteristics. The mean APACHE II, SAPS II, and SOFA scores were 28.22 ± 7.53, 43.04 ± 16.40, and 10.39 ± 5.20, respectively, and area under receiver operating characteristics curve in predicting 30-day mortality were 0.961, 0.994, and 0.950, respectively. The scores were significantly higher in 30-day nonsurvivors as compared to survivors (P = 0.001). During the ICU stay, MV and vasoactive drugs were required in 57% and 67% of the patients, respectively, and the requirement was significantly greater in nonsurvivors as compared to survivors (P = 0.001). About 85% of patients were on intermittent hemodialysis and 15% of patients were on continuous venovenous hemodiafiltration. Sepsis was the main reason for hospital admission, and the mean length of stay in the ICU was 7.74 ± 5.34 days. The study indicates that all three scores (APACHE II, SAPS II, and SOFA) perform equally well and have equal diagnostic utility in predicting 30-day mortality.

Plasmodium vivax is causing increasingly more cases of severe malaria worldwide. There is an urgent need to reexamine the clinical spectrum and burden of P. vivax so that adequate control measures can be implemented against this emerging but neglected disease. Herein, we report a case of renal acute cortical necrosis and acute kidney injury (AKI) associated with P. vivax monoinfection. Her initial serum creatinine was 7.3 mg/dL on admission. Modification of Diet in Renal Disease (MDRD) Study glomerular filtration rate (GFR) value was 7 mL/min/1.73 m(2) (normal kidney function-GFR above 90 mL/min/1.73 m(2) and no proteinuria). On follow-up, 5 months later, her SCr. was 2.43 mg/dl with no proteinuria. MDRD GFR value was 24 mL/min/1.73 m(2) suggesting severe chronic kidney disease (CKD; GFR less than 60 or kidney damage for at least 3 months), stage 4. Our case report highlights the fact that P. vivax malaria is benign by name but not always by nature. AKI associated with P. vivax malaria can lead to CKD. Further studies are needed to determine why P. vivax infections are becoming more severe.

How to cite this article: Patel MP, Kute VB, Goswami J, Balwani MR. Hospitals may Become “Disease Hotspots” for COVID-19 amid Shortage of Personal Protective Equipment. Indian J Crit Care Med 2020;24(11):1145–1146.

Introduction: There is a wide discrepancy between demand for and availability of donor organs for organ transplantation. There is no study on awareness about organ donation in chronic kidney disease (CKD) patients in India. Objectives: To study the awareness and beliefs towards organ donation in CKD patients on hemodialysis in western India. Patients and Methods: Authors conducted a cross sectional study among 85 CKD patients to evaluate knowledge about and attitude towards organ donation at a tertiary hospital. Results: Age of respondents ranged from 15 to 75 years. All were aware of term organ donation and cadaver donation. About 47% of people heard about organ donation through hospital or from doctor. Strikingly, radio was not the source of information to any of the respondents, despite radio being one of the most common medium of mass communication. Almost one third of patients were unaware about any legislation regarding organ donation. All respondents felt that organs should go to the needy irrespective of their religion. About 70% feel that medical colleges should make decisions about organ donation in case of unclaimed dead bodies. About 31.76% believe that there is a danger that donated organs could be misused, abused or misappropriated. Conclusion: Our study shows about 31.76% of our participants believe that there is a danger that donated organs could be misused, abused or misappropriated. There seems to be paucity of information and awareness regarding organ donation among CKD patients. Mass media, religious and political leaders may be involved to maximize awareness about organ donation.

BK virus (BKV) is a common opportunistic pathogen in kidney transplant recipients and one of the most challenging causes of allograft dysfunction and loss. Although over-immunosuppression remains the primary risk factor for BKV infection after transplantation, male gender, older recipient age, prior rejection episodes, degree of human leukocyte antigen mismatching, prolonged cold ischemia time, BK virus serostatus and ureteral stent placement have all been implicated as risk factors. Routine screening post-renal transplant is important to prevent allograft loss in patients with BK viruria or viremia. Reduction of immunosuppression remains the mainstay of BKV nephropathy treatment and is the most studied intervention. In this review, we are going to discuss the epidemiology of BK virus infection, screening strategies, treatment options and new studies or evidence in the future.