H1N1 infection and acute kidney injury in the critically ill

H1N1 infection and acute kidney injury in the critically ill Sir, Acute renal failure due to viral infections rarely occurs. We assessed the development of acute kidney injury in critically compromised patients due to H1N1 influenza virus. All patients with PCR-confirmed diagnosis of H1N1 infection between May and July 2009 were retrospectively studied. Thereafter, the risk factors associated with the development of acute renal injury, the requirements of acute haemodial-ysis and death were analysed. Twenty-two subjects with H1N1 pneumonia were included: age: 52. A vaccination: 9 (41%). All patients received oseltamivir within 48 h of presumed diagnosis. Seventeen patients (77.3%) developed initial fever. Six patients (27.3%) required non-invasive ventilation assistance and 15 (68.2%) received invasive ven-tilatory support. The mean days on mechanical respiratory assistance were 11 ± 10.35. The arterial partial pressure of oxygen/fraction of inspired oxygen ratio was 140.11 ± 83.03 mmHg. Inotropic drugs were administered to 15 patients (68.2%). Fourteen patients (63.6%) developed acute kidney injury. The mean highest creatinine levels were 2.74 ± 2.83 mg/dL. Four patients (18.2%) needed renal replacement therapy with a mean duration of 15 ± 12 days. Six patients (42.9%) recovered renal function. Significant differences between patients with and without acute kidney injury included, respectively, pregnancy, 2 versus 0, lack of recovery of renal function (2 versus 4, P < 0.01). Three out of four (75%) haemodialysed patients died. In summary, in the critically ill due to H1N1 pneumonia, re-nal insufficiency was a frequent complication, demanding renal replacement therapy in 18% of cases. The necessity of haemodialysis was associated with an elevated risk of death. Mortality was mainly associated with multiple organ failure, oligoanuria, acute renal injury and a lack of recovery of renal function. Rhabdomyolysis may play a role in renal dysfunction, regardless of CK levels [1–4]. A infection with rhabdomyolysis and acute renal failure—a potentially fatal complication. Takagi D et al. Acute renal failure due to rhab-domyolysis associated with echovirus 9 infection: a case report and review of literature. Occult hepatitis B virus infection in a Sicilian chronic dialysis population Sir, Occult HBV infection with undetectable HBsAg is a risk factor for hepatic disease development. Among the general population, HBV circulation is a public health concern [1]. The DOPPS II study showed a considerable prevalence of HBV infection in dialysis populations [2]. In an Italian subset of DOPPS II, the prevalence was 6.3% [3].