Management of acute kidney injury in patients with COVID-19

Abstract

The outbreak of coronavirus disease 2019 (COVID-19) has rapidly evolved into a global pandemic. Most patients with COVID-19 have mild symptoms, but about 5% develop severe symptoms, which can include acute respiratory distress syndrome, septic shock, and multiple organ failure. Kidney involvement is frequent, with clinical presentation ranging from mild proteinuria to progressive acute kidney injury (AKI) necessitating renal replacement therapy (RRT). An understanding of the pathophysiology and mechanisms of kidney damage and AKI in the setting of critical illness and COVID-19 is emerging, although further research is needed to identify patients at risk of AKI and to guide management strategies. As no specific treatment options exist for AKI secondary to COVID-19, intensive care is largely supportive. Current approaches to prevention and management of AKI, and identification of potential indications for use of RRT and sequential extracorporeal therapies, are based mainly on clinical experience, and AKI strategies are adapted empirically to patients with COVID-19. International collaborative and cross-disciplinary research is needed to obtain adequate evidence to support current clinical approaches and to develop new approaches to management.

Clinical Course and Risk Factors for severe Disease and Death of Adult Critically Ill Inpatients with COVID-19 in Toulouse, France: A Retrospective Cohort Study

“…19 . In line with previous reports 18 , we have identi ed that acute kidney injury was observed in approximately one third of critically ill patients from our cohort. An understanding of the pathophysiological and mechanisms that can explain such a high rate of acute kidney injury is emerging.…”

“…20 27 (18)(19)(20)(21)(22)(23)(24)(25)(26)(27)(28)(29)(30)(31)(32)(33)(34)(35)(36)(37) 33 (22) 21 (14) 23 (15,3) 3 ( 2 222 2213 134 45 (5) 28 2822 2213 1311 (11) 3 336 (31-43)…”

“…19 (11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24)(25)(26) 27 (19)(20)(21)(22)(23)(24)(25)(26)(27)(28)(29)(30)(31)(32)(33)(34) 11 (11) 1 (1) 0 (8) In univariable analysis of ICU admission data, odds of unfavorable outcome were higher in patients with most severe ARDS (lower PaO2/FiO2). Platelet count, creatinine and troponin I were also associated with unfavorable outcome.…”

Atrial fibrillation in COVID‐19: A review of possible mechanisms

“…In another retrospective study of 187 patients from Seventh Hospital Wuhan, 27.8% of hospitalized patients had elevated troponin levels, suggesting some underlying myocardial ischemia 7 . Severe COVID‐19 infection may be associated with myocarditis and or cardiogenic shock, significant right heart dysfunction and or renal failure 8‐13 . These serious infectious presentations would be associated with significant tissue inflammation, hypoxia, and electrolyte abnormalities that can all contribute to atrial arrhythmias 14 .…”

Inflammaging: Analysis of a Risk Profile for Gerontocide by COVID-19 in Brazil

“…Currently, these worries have expanded due to the COVID-19 Pandemic. The patients most affected by have shown comorbidities such as hypertension 26 , diabetes 27 , and kidney disease 28 and very high levels of systemic in ammatory biomarkers 29,30 . For this reason, they have more comorbidities and in ammation, and older age presents more risk factors associated with COVID-19 deaths 31,32 .…”