Kidney manifestations of mild, moderate and severe coronavirus disease 2019: a retrospective cohort study

Abstract

Background Coronavirus disease 2019 (COVID-19) is a pandemic that has affected more than 3 million patients globally. Previous data from Wuhan city showed that acute kidney injury (AKI), proteinuria and hematuria occurred frequently in patients with severe COVID-19. However, the prevalence of kidney injury in milder cases remains unclear. Methods This retrospective study included two major consecutive cohorts of COVID-19 patients in Sichuan Province. Baseline characteristics, laboratory data including renal function, proteinuria and dipstick hematuria, and other laboratory parameters were collected. A subgroup of patients was followed up for 2–4 weeks to evaluate the short-term outcome of renal impairment. Results Overall, 168 COVID-19-positive patients were included in the study. The majority of patients (79.7%) were diagnosed with mild or moderate disease. Half of patients presented with fever; however, in The Tibetan cohort, fever only occurred in 13.4% of patients. On hospital admission, proteinuria and dipstick hematuria were noted in 18.4% and 17.4% of patients, respectively, while AKI only occurred in one patient. Further analysis showed that severe or critical COVID-19 was associated with higher risk of proteinuria [relative risk (RR) 7.37, 95% confidence interval (CI) 2.45–22.18, P = 3.8 × 10−4] and dipstick hematuria (RR 8.30, 95% CI 2.69–25.56, P = 2.3 × 10−4). Proteinuria, dipstick hematuria, or the combination of proteinuria and hematuria could significantly predict severe or critical severe COVID-19. Conclusions Proteinuria and dipstick hematuria are not uncommon in patients with COVID-19 infection, especially in severe or critical cases.

Kidney disease and electrolytes in COVID-19: more than meets the eye

“…(1) Both COVID-19 patients in the general population and those with prior CKD may develop COVID-19-associated kidney injury, which may adopt different forms. Thus tubular injury may initially only reflect proximal tubular injury (Fanconi syndrome) [ 17 ] but frequently evolves to AKI with a mainly tubulointerstitial pattern of injury [ 19 , 20 ]. AKI may fail to resolve, leading to acute kidney disease and, potentially, to post-COVID-19 CKD, a possibility that requires prospective follow-up.…”

Acute Kidney Injury in COVID-19: The Chinese Experience

“…We performed a meta-analyses using the “meta” package in R software version 3.6.3 (the R Foundation for Statistical Computing, Vienna, Austria). The pooled incidence of AKI in all reported COVID-19 patients from these 26 studies was 6.5% (95% CI 4.1-10.2), with a much higher rate in patients from the ICU (32.5%, 95% CI 21.2-46.3) 8 , 14 , 19 than in patients from mixed departments (5.1%, 95% CI 3.3-7.8) 2 , 3 , 4 , 5 , 6 , 10 , 11 , 12 , 13 , 15 , 16 , 17 , 18 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 ( Figure 1 a) . Studies from Wuhan showed a higher AKI incidence (9.7%, 95% CI 6.2-14.9) than studies from outside Wuhan (2.8%, 95% CI 1.2-6.6%) ( Figure 1 b) .…”

A Telemedicine Approach to Covid-19 Assessment and Triage

“…Covid-19 severity levels can be categorized as mild, moderate, severe, and critical conditions ( Figure 1 ) [ 28 , 29 ]. Mild disease is defined as patients without dyspnea, without clinical evidence of respiratory distress, no pneumonia on imaging, and blood oxygen saturation maintained above 93% under resting conditions [ 30 , 31 ].…”