Pope Francis in critical condition with early kidney failure but remains alert as prayers pour in

ROME (AP) — Pope Francis remained in critical condition Sunday and blood tests showed early kidney failure but he remains alert, responsive and attended Mass, the Vatican said, as the 88-year-old pontiff battles pneumonia and a complex lung infection.

In a late update, the Vatican said Francis hadn’t had any more respiratory crises since Saturday night but was still receiving high flows of supplemental oxygen.

Some blood tests showed “initial, mild, kidney failure,” but doctors said it was under control.

“The complexity of the clinical picture, and the necessary wait for drug therapies to provide some feedback, dictate that the prognosis remains guarded,” Francis' doctors concluded.

Prayers for Francis, meanwhile, poured in from around the world, from his native Argentina to the seat of Sunni Islam in Cairo to schoolchildren in Rome.

In New York, Cardinal Timothy Dolan admitted what church leaders in Rome weren't saying publicly: that the Catholic faithful were united “at the bedside of a dying father.”

“As our Holy Father Pope Francis is in very, very fragile health, and probably close to death,” Dolan said in his homily from the pulpit of St. Patrick's Cathedral, though he later told reporters he hoped and prayed that Francis would “bounce back.”

Doctors have said Francis' condition is touch-and-go, given his age, fragility and pre-existing lung disease. His condition has revived speculation about what might happen if he becomes unconscious or otherwise incapacitated, and whether he might resign.

Prayers for pope at Vatican

Francis was supposed to celebrate Mass on Sunday morning in St. Peter's Basilica and ordain deacons as part of the Vatican's yearlong Holy Year commemoration.

The organizer of the Holy Year, Archbishop Rino Fisichella, celebrated the Mass in his place and offered a special prayer for Francis from the altar before delivering the homily the pope had prepared.

“Even though he is in a hospital bed, we feel Pope Francis close to us. We feel him present among us,” Fisichella told the hundreds of white-robed deacons.

A pre-written message that had been prepared for Francis to read Sunday, but he did not deliver, said he was “confidently continuing my hospitalization at the Gemelli Hospital, carrying on with the necessary treatment; and rest is also part of the therapy!” The message asked for prayers for him — as he always asks — and noted the upcoming anniversary of Russia’s invasion of Ukraine, “a painful and shameful occasion for the whole of humanity.”

Meanwhile in Francis' native Argentina, Catholics prayed for the pope at the Buenos Aires cathedral and the city's iconic obelisk was lit up “Francis, the city prays for you.”

In Cairo, the grand imam of Al-Azhar, the seat of Sunni learning who forged a close bond with Francis, wished him well.

“I pray to Allah to grant my dear brother, Pope Francis, a swift recovery and to bless him with good health and well-being so that he may continue his journey in serving humanity,” Sheikh Ahmed al-Tayeb wrote in a Facebook post.

The American Jewish Committee also offered prayers. “We stand together with our Catholic brothers and sisters during this challenging time,” the group wrote on X.

And school children from around Rome deluged the Gemelli hospital with get-well cards, while Italian bishops led rosary prayers and celebrated special Masses across Italy.

The main threat facing the pope is sepsis

Doctors have warned that the main threat facing Francis is sepsis, a serious infection of the blood that can occur as a complication of pneumonia. To date there has been no reference to any onset of sepsis in the medical updates provided by the Vatican, including on Sunday.

On Saturday, Francis developed a low platelet count, which remained low but stable Sunday. Platelets are cell-like fragments that circulate in the blood that help form blood clots to stop bleeding or help wounds heal. Low platelet counts can be caused by a number of things, including side effects from medicines or infections.

Francis also developed anemia and, during blood transfusions Saturday, was given hematin, a treatment designed to increase the level of hemoglobin in his his blood, which in turn helps the blood carry more oxygen. Doctors reported Sunday that the therapy had been beneficial.

Francis, who has chronic lung disease and is prone to bronchitis in winter, was admitted to Gemelli hospital on Feb. 14 after a weeklong bout of bronchitis worsened.

Doctors first diagnosed the complex viral, bacterial and fungal respiratory tract infection and then the onset of pneumonia in both lungs. They prescribed "absolute rest" and a combination of cortisone and antibiotics, along with supplemental oxygen when he needs it.

Francis’ recent reforms suggest he knew he was getting older and more fragile

Francis has taken several recent decisions that suggest he was well aware that he was getting old and frail.

Last year, he revised the funeral rites that will be used after he dies, simplifying the rituals to emphasize his role as a mere bishop and allowing for burial outside the Vatican in keeping with his wishes. But the core elements of the rites remain, including the three key moments that must be observed between the death of a pope and his funeral: In his home, in St. Peter's Basilica and in the place of burial.

In December, Francis created 21 new cardinals. All but one were under age 80 and thus eligible to vote in a conclave to elect his successor. Their additions brought the overall number of voting-age cardinals to 140, well over the 120 limit set by St. John Paul II. But several of the current electors are turning 80 this year, bringing the number down.

Earlier this month, once he was already sick, Francis decided to extend the five-year term of the current dean of the College of Cardinals, Cardinal Giovanni Battista Re, 91, rather than make way for someone new. As depicted in the film "Conclave," the dean of the College of Cardinals plays an important role in the life of the Catholic hierarchy, and is a crucial figure during the transition between one papacy and the next.

Francis also decided to extend the term of the vice-dean, Argentine Cardinal Leonardo Sandri, 81.

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