Acute kidney failure in patients admitted due to COVID-19

Abstract

Background and aim In December 2019, a coronavirus 2019 (COVID-19) outbreak, caused by SARS-CoV-2, took place in Wuhan and was declared a global pandemic in March 2020 by the World Health Organization (WHO). It is a prominently respiratory infection, with potential cardiological, hematological, gastrointestinal and renal complications. Acute kidney injury (AKI) is found in 0.5-25% of hospitalized COVID-19 patients and constitutes a negative prognostic factor. Renal damage mechanisms are not completely clear. We report the clinical evolution of hospitalized COVID-19 patients who presented with AKI requiring attention from the Nephrology team in a tertiary hospital in Madrid, Spain. Methods This is an observational prospective study including all COVID-19 cases that required hospitalization and Nephrology management from March 6 th to May 12 th . We collected clinical and analytical data of baseline characteristics, COVID-19 and AKI evolutions. Results We analyzed 41 patients with a mean age of 66.8 years (SD 2.1), 90.2% males, and with a history of chronic kidney disease (CKD) in 36.6%. 56.1% of patients presented with sever pneumonia or acute respiratory distress syndrome (ARDS), and 31.7% required intensive care. AKI etiology was prerenal in 61%, acute tubular necrosis in the context of sepsis in 24.4%, glomerular in 7.3% and tubular toxicity in 7.3% of the cases. We reported proteinuria in 88.9% and hematuria in 79.4% of patients. 48.8% of patients required renal replacement therapy (RRT). Median length of stay was 12 days (interquartilic range 9-23) and 22% of the population died. Patients who developed AKI during hospital stay presented with higher C-reactive protein, Lactate dehydrogenase-LDH and D-dimer values, more severe pulmonary damage, more frequent intensive care unit-ICU admission, treatment with lopinavir/ritonavir and biological drugs and RRT requirement. Conclusions Hypovolemia and dehydration are a frequent cause of AKI among COVID-19 patients. Those who develop AKI during hospitalization display worse prognostic factors in terms of pulmonary damage, renal damage, and analytical findings. We believe that monitorization of renal markers as well as individualized fluid management can play a key role in AKI prevention.

Acute kidney injury in moderate and severe COVID‑19 patients: Report of two university hospitals

“…Almost two thirds of our patients presented with AKI at the moment of admission, most of them being known with a history of CKD. Numerous studies report that AKI at admission is frequent in COVID-19 (34)(35)(36), but, regarding prevalence of previous CKD, some authors found it higher in AKI at admission (34,37) similar to our study, whereas others in hospital-developed AKI (38). This difference was probably due to the modality of admission in the hospital, availability and extension of ICU departments in different hospitals, type of treatment available and recommended by evolving guidelines in the last year of the pandemic.…”

“…We found no differences between AKI at admission and hospital-acquired AKI regarding age or comorbid burden. Most authors report age and multiple comorbidities as predictive factors for AKI at admission (34,37) and few found advanced age to be associated with hospital-acquired AKI (38).…”

COVID19 Long Term Effects in Patients Treated with Chlorine Dioxide

“…Fatigue, breathlessness (dyspnea), and chest pain were symptoms reported mainly in severe patients and could be due to the pulmonary fibrosis caused by SARS-CoV-2, which increases the risk of pulmonary embolisms and affects pulmonary function (Al-Jahdhami et al 2021). Moreover, new hypertension and renal failure were only presented by patients (n = 2) who had presented severe COVID19; this may be because hypovolemia and dehydration are frequent in severe COVID19 patients and are the leading causes of acute kidney injury in hospitalized patients (Tarragón et al 2021). An increasing number of healthy people who did not require hospitalization continue to have symptoms months after mild and moderate cases of COVID19 (Vink and Vink-Niese 2020).…”

A Unique Presentation of Acute Kidney Injury With COVID-19

“…The incidence of AKI was about 6.7% in the last SARS epidemic [ 4 ]. However, 5%-25% of hospitalized patients with COVID-19 now develop acute kidney injury (AKI) and among them, 5%-15% end up in renal replacement requirement therapy [ 2 , 5 ]. Patients with an elevated baseline of creatinine (baseline creatinine 0.74 to 1.35 mg/dL) are more prone to develop AKI than patients with a normal baseline of creatinine [ 6 ].…”