COVID-19 and Acute Kidney Injury: A Systematic Review and Meta-Analysis

Abstract

Background: coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome—coronavirus-2 (SARS-CoV-2)—is an ongoing pandemic with high morbidity and mortality rates. Preliminary evidence suggests that acute kidney injury (AKI) is uncommon in patients with COVID-19 and associated with poor outcomes. Study aims and design: we performed a systematic review of the literature with a meta-analysis of clinical studies to evaluate the frequency of AKI and dialysis requirement in patients who underwent hospitalization due to COVID-19. The incidence of AKI according to the death risk was calculated in these patients. The random-effects model of DerSimonian and Laird was adopted, with heterogeneity and stratified analyses. Results: thirty-nine clinical studies (n = 25,566 unique patients) were retrieved. The pooled incidence of AKI was 0.154 (95% CI, 0.107; 0.201; p < 0.0001) across the studies. Significant heterogeneity was found (p = 0.0001). The overall frequency of COVID-19-positive patients who underwent renal replacement therapy (RRT) was 0.043 (95% CI, 0.031; 0.055; p < 0.0001); no publication bias was found (Egger’s test, p = 0.11). The pooled estimate of AKI incidence in patients with severe COVID-19 was 0.53 (95% CI, 0.427; 0.633) and heterogeneity occurred (Q = 621.08, I2 = 97.26, p = 0.0001). According to our meta-regression, age (p < 0.007) and arterial hypertension (p < 0.001) were associated with AKI occurrence in hospitalized COVID-19 positive patients. The odds ratio (OR) for the incidence of AKI in deceased COVID-19 positive patients was greater than among survivors, 15.4 (95% CI, 20.99; 11.4; p < 0.001). Conclusions: AKI is a common complication in hospitalized COVID-19 positive patients. Additional studies are under way to assess the risk of AKI in COVID-19 patients and to deepen the mechanisms of kidney injury.

COVID-19 imaging: Diagnostic approaches, challenges, and evolving advances

“…The genitourinary system, and in particular, the kidneys, are commonly injured among critically ill COVID-19 patients (20%-40%) as a result of infarction and inflammation[ 99 ]. The use of ultrasound is first line for evaluating suspected renal vascular involvement as allergies to contrast and renal insufficiency preclude the use of CT with contrast[ 100 ]. Other notable extrapulmonary manifestations of COVID-19 that don’t necessarily maintain a role for imaging but are included here for completeness sake include dermatologic pathologies such as COVID toes (frostbite-like toes or “pseudochilbain”) and maculopapular eruptions[ 101 ].…”

Incidence and Outcomes of Acute Kidney Injury in Patients Admitted to Hospital With COVID-19: A Retrospective Cohort Study

“…Our findings of AKI incidence in patients with COVID-19 are consistent with a systematic review conducted which found around 50% frequency of AKI in severe COVID-19 populations, with an incidence of around 15% for AKI in patients with COVID-19 not stratified for severity. 28 It is interesting that AKI was so substantially more common in our cohort, when one considers the biologic rationale for direct kidney injury by the virus, compared to the commonly hypothesized ischemia-reperfusion injury.…”

CD47 as a potential biomarker for the early diagnosis of severe COVID-19

“…Results indicated an ageing-related increase in CD47 expression, which may contribute the increased COVID-19 vulnerability in older patients [Hokello et al, 2020]. Moreover, high CD47 levels are known to be involved in vascular disease, vasoconstriction, and hypertension, which may predispose SARS-CoV-2-infected individuals to various conditions associated with severe COVID-19 related, including pulmonary hypertension, lung fibrosis, myocardial injury, stroke, and acute kidney injury [Soto-Pantoja et al, 2013;Rogers et al, 2017a;Cruz Rodriguez et al, 2020;Fabrizi et al, 2020;Karmouty-Quintana et al, 2020;Scutelnic and Heldner, 2020;Leeming et al, 2021;Sanghvi et al, 2021;Shah et al, 2021].…”