Manifestations of renal system involvement in hospitalized patients with COVID-19 in Saudi Arabia

Abstract

Background Although COVID-19 is an acute disease that usually resolves rapidly in most cases, the disease can be fatal and has a mortality rate of about 1% to 56%. Alveolar injury and respiratory failure are the main causes of death in patients with COVID 19. In addition, the effect of the disease on other organs is not fully understood. Renal system affection has been reported in patients with COVID 19 and is associated with a higher rate of diverse outcomes, including mortality. Therefore, in the present work, we reported the clinical characteristics and laboratory data of hospitalized patients with COVID-19 and analyzed the manifestations that indicated renal system involvement and their impact on clinical outcomes. Materials and methods This was an observational retrospective study conducted at King Fahd Specialist Hospital, Buraydah, Saudi Arabia. All patients with COVID-19 who were admitted to this Hospital from April to December 2020 were included in the study. The patients’ findings at presentation were recorded. Demographic data and laboratory results (hematuria, proteinuria, urinary sediment cast and pus cell presence, and kidney function tests) were retrieved from electronic patient records. Results One hundred and ninety-three patients with confirmed COVID 19 were included in the study. Dipstick examinations of all urine samples showed proteinuria and hematuria in 53.9% and 22.3% of patients, respectively, whereas microscopic examination revealed the presence of pus and brown muddy granular casts in 33.7% and 12.4% of samples, respectively. Acute kidney injury was reported in 23.3% of patients. A multivariable analysis demonstrated that hematuria was associated with acute kidney injury (AKI) (OR, 2.4; 95% CI, 1.2–4.9; P = 0.001), ICU admission (OR, 3.789; 95% CI, 1.913–7.505; P = 0.003), and mortality (OR, 8.084; 95% CI, 3.756–17.397; P = 0.002). Conversely, proteinuria was less significantly associated with the risk of AKI (OR, 1.56; 95% CI, 1.91–7.50; P = 0.003), ICU admission (OR, 2.493; 95% CI, 1.25–4.72; P = 0.001), and mortality (OR, 2.764; 95% CI, 1.368–5.121; P = 0.003). Patients with AKI had a higher probability for mortality than did those without AKI (OR, 14.208; 95% CI, 6.434–31.375; P = 0.003). Conclusion The manifestations of the involvement of the renal system are not uncommon in COVID-19. These manifestations included proteinuria, hematuria, and AKI and were usually associated with a poor prognosis, including high incidences of both ICU admission and mortality.

The value of urinalysis in predicting acute kidney injury and mortality in COVID-19 patients

“…In a recent meta-analysis, COVID-19 patients with AKI had a significantly increased risk of death compared to patients without AKI (OR 30.46, 95% CI 9.29-15.19) [26]. We also found that proteinuria on admission was independently associated with in-hospital mortality and had a 2.7 times higher risk of death similar to previous reports [11,12,37]. Pei ity in the patients with renal involvement, including hematuria, proteinuria, and AKI, compared with that of patients without renal involvement (11.2% vs 1.2%, P=0.006) [3].…”

A Rare Cause of Transient Proximal Tubule Dysfunction: COVID-19

“…In a study conducted in Saudi Arabia, it was revealed that the course of COVID-19 cases with at least one of the indicators of renal involvement, including hematuria, proteinuria, tubulopathy, and acute kidney injury, was more severe. 14 Therefore, it may be suggested that there is a linear relationship between the duration of intensive care follow-up of our patient and the course of tubulopathy.…”

COVID-19 and renal involvement: a prospective cohort study assessing the impact of mild SARS-CoV-2 infection on the kidney function of young healthy males

“…Previous literature reported renal protein leakage and albuminuria with severe COVID-19 [ 39 – 42 ]. We found significantly lower serum albumin in patients with mild COVID-19 pneumonia.…”