COVID-19 Pandemic Causing Acute Kidney Injury and Impact on Patients With Chronic Kidney Disease and Renal Transplantation

Abstract

Coronavirus disease 2019 (COVID-19) caused by 2019 novel coronavirus (2019-nCoV) has caused significant mortality and has been declared as a global pandemic by the World Health Organization. The infection mainly presents as fever, cough, and breathing difficulty, and few patients develop very severe symptoms. The purpose of this review is to analyze the impact of the virus on the kidney. COVID-19 infection causes acute kidney injury (AKI) and is an independent risk factor for mortality. Angiotensin-converting enzyme 2 (ACE2) receptors, direct viral damage, and immune-mediated damage play important roles in the pathogenesis. AKI in COVID-19 infection could be from the synergistic effect of virus-induced direct cytotropic effect and cytokine-induced systemic inflammatory response. AKI caused in the viral infection has been analyzed from the available epidemiological studies. The proportion of patients developing AKI is significantly higher when they develop severe disease. Continuous renal replacement therapy (CRRT) is the most used blood purification technique when needed. The impact of COVID-19 infection on chronic kidney disease (CKD) and renal transplant patients is also discussed in the manuscript. No vaccine has been developed against the 2019-nCoV virus to date. The critical aspect of management is supportive care. Several investigative drugs have been studied, drugs approved for other indications have been used, and several clinical trials are underway across the globe. Recently remdesivir has received emergency use authorization by the Food and Drug Administration (FDA) in the USA for use in patients hospitalized with COVID-19. Prevention of the infection holds the key to management. The patients with underlying kidney problems and renal transplant patients are vulnerable to developing COVID-19 infection.

A 65-Year-Old Woman with a History of Type 2 Diabetes Mellitus and Hypertension and a 15-Day History of Dry Cough and Fever Who Presented with Acute Renal Failure Due to Infection with SARS-Cov-2

“…The initial treatment of renal failure established in the present case coincides with that recommended in the current literature on acute renal failure in COVID-19 patients [ 7 , 8 ], which consists of renal support and protection measures, as well as early introduction of renal replacement therapies. Interleukin 6 inhibitors were not used in our patient because it was not possible to quantify IL-6 plasma levels, and waiting for the isolation of microorganisms in blood and urine put the patient at risk for developing a serious state of infection.…”

“…Regarding guidelines for treatment of acute kidney injury in COVID-19 disease, Ronco et al proposed that in addition to kidney-protection measures (e.g., avoiding nephrotoxic agents, monitoring of creatinine and urinary output, balance adjustment, and avoiding volume overload or hypovolemia), it is important to consider early continuous replacement therapy for kidney function as the first treatment option if conservative measures fail [ 7 ] (especially in hemodynamically unstable patients), in addition to sequential extracorporeal support of organs (ECOS) [ 8 ]. Guangchang et al also found that adequate management of pneumonia and prevention of barotrauma provided renal protection [ 9 ].…”

A Case Control Study to Evaluate the Impact of Colchicine on Patients Admitted to the Hospital with Moderate to Severe COVID-19 Infection

“…It is likely that the exclusion of the patients with severe AKI or ERSD in the colchicine group contributed towards lesser patients having renal failure in the colchicine group. COVID-19 has been reported to cause AKI, with the proposed pathogenesis of AKI possibly due to a combined direct viral effect through binding of viral proteins to the angiotensin converting enzyme-2 (ACE-2) receptor and a systemic cytokine hyperinflammatory response [ 23 ]. It is possible that the anti-inflammatory effect of colchicine can also play a protective role against the development of renal failure in patients with COVID-19.…”

COVID-19 and obesity in childhood and adolescence: a clinical review

“…90 , 91 In addition, acute tubular necrosis and thrombotic effects secondary to endothelial dysfunction are also observed in COVID-19. 92 …”