COVID-19 and the Kidney: A Worrisome Scenario of Acute and Chronic Consequences

Sanchez-Russo, Luis; Billah, Marzuq; Chancay, Jorge; Hindi, Judy; Cravedi, Paolo

doi:10.3390/jcm10050900

Cited by 8 publications

(8 citation statements)

References 106 publications

(164 reference statements)

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“…When considering Covid19 specific therapy, we found LPV/r and dexamethasone to be respectively positively and negatively related to AKI development, in accordance with other groups [33][34][35][36][37]. We also reported well described AKI risk factors, such as diabetes mellitus, use of norepinephrine and baseline eGFR [38,39]. Interestingly, the relation between AKI risk and the baseline eGFR was nonlinear, where higher eGFRs were associated with a reduced probability of AKI up to a threshold beyond which the risk increased.…”

Section: Discussionsupporting

confidence: 89%

“…Patients from clusters 1 and 2 developed more severe AKI than patients from cluster 3 (34% [21-47] versus 7% [0-12] of KDIGO3 AKI, p=0.02) and more frequently received RRT (25% [13-38] versus 4% [0-7], p<0.001). They also showed lower renal function recovery rates (51% [35-68] versus 82% [71-97] of the patients fully recover their renal function while 14% [3-24] versus 0% [0-0] were not weaned from the RRT at ICU discharge p=0.006 and 0.008 respectively, Figure 3a,b ).…”

Section: Resultsmentioning

confidence: 99%

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Unsupervised clustering reveals phenotypes of AKI in ICU Covid19 patients

Sangla

Marchi

Assouline

et al. 2022

Preprint

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Background: Acute Kidney Injury (AKI) is a very frequent condition, occurring in about one in three patients admitted to an intensive care unit (ICU). AKI is a syndrome defined as a sudden decrease in glomerular filtration rate. However, this unified definition does not reflect the various mechanisms involved in AKI pathophysiology, each with its own characteristics and sensitivity to therapy. In this study, we aimed at developing an innovative machine learning based method able to subphenotype AKI according to its pattern of risk factors. Methods: We adopted a three-step pipeline of analyses. Firstly, we looked for factors associated with AKI using a generalized additive model. Secondly, we calculated the importance of each identified AKI related factor in the estimated AKI risk to find the main risk factor for AKI, at the single patient level. Lastly, we clusterized AKI patients according to their profile of risk factors and compared the clinical characteristics and outcome of every cluster. We applied this method to a cohort of severe Covid19 patients hospitalized in the ICU of Geneva University Hospitals. Results: Among the 250 patients analyzed, we found ten factors associated with AKI development. Using the individual expression of these factors, we identified three groups of AKI patients, based on the use of Lopinavir/Ritonavir, a prior history of diabetes mellitus and baseline eGFR and ventilation. The three clusters expressed distinct characteristic in terms of AKI severity and recovery, metabolic patterns and ICU mortality. Conclusion: We propose here a new method to phenotype AKI patients according to their most important individual risk factors for AKI development. When applied to an ICU cohort of Covid19 patients, we were able to differentiate three groups of patients. Each expressed specific AKI characteristics and outcomes, which probably reflects a distinct pathophysiology.

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Section: Discussionsupporting

confidence: 89%

Section: Resultsmentioning

confidence: 99%

Unsupervised clustering reveals phenotypes of AKI in ICU Covid19 patients

Sangla

Marchi

Assouline

et al. 2022

Preprint

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“…We speculate that this difference may be due to the fact that in other research, most patients had intrinsic kidney damage, whereas our patients did not. Several studies have shown that patients with COVID-19 who developed AKI had longer hospitalization durations, were more likely to be admitted to an ICU, and had a higher mortality rate (9). In our study, the fact that the 4 patients who developed AKI were all from the critically ill group and that 3 of them died also supports these findings.…”

Section: Treatmentsupporting

confidence: 87%

“…In our study, we showed that patients with COVID-19 demonstrated elevated levels of D-dimers, fibrinogen, PCT, and IL-6, as well as increased hypoalbuminemia, hypocalcemia, and lymphopenia. Five meta-analyses including more than 20,000 patients indicated the incidence of AKI among patients with COVID-19 to range from 4.5% to 18% (9). Our data showed that the prevalence of AKI in the entire study population and in patients without a CKD history was 4.2% and 3.3%, respectively, which was slightly lower than the incidence reported in existing reports (10).…”

Section: Treatmentcontrasting

confidence: 61%

A survey on acute kidney injury in severely and critically ill COVID-19 patients without chronic kidney disease

Yu¹,

Ge²,

Wang³

et al. 2021

Ann Palliat Med

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Background: Research has shown that acute kidney injury (AKI) has a noticeable incidence in critically ill patients with coronavirus disease 2019 . Patients with prior renal insufficiency are particularly susceptible to severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), due to their immune dysfunction. However, most patients with COVID-19 do not have a history of kidney dysfunction, and few studies have focused on the incidence of AKI among COVID-19 patients without chronic kidney disease (CKD). In this study, we aimed to investigate the occurrence of AKI in severely and critically ill COVID-19 patients, with a particular focus on those without a CKD history.Methods: A single-center retrospective study of 96 patients with COVID-19 in China between February 7 and March 3, 2020 was conducted. All patients were diagnosed by nucleic acid test (NAT) for SARS-CoV-2.Enrolled patients were divided into the severely or critically ill group according to the defined criteria.Patients' epidemiological, clinical, and laboratory characteristics, along with their treatment information, were collected from the medical history system. The occurrence of AKI was compared between the severe and critical patients, and between patients with or without a history of CKD. The diagnostic criteria for AKI included an increase in the serum creatinine level to ≥1.5-fold the level at baseline within 7 days according to the Kidney Disease: Improving Global Outcomes (KDIGO) guidelines. Renal outcomes were defined as AKI or non-AKI.Results: Four patients (4.2%) developed AKI, all of whom were in the critically ill group, and 3 (75%) of whom died. Out of the 90 severely and critically ill COVID-19 patients without CKD, 3 (3.3%) patients developed AKI; out of the 6 patients with CKD, 1 (16.7%) patient developed AKI. Age, disease severity, procalcitonin, C-reactive protein, and interleukin-6 were correlated with AKI onset in severely and critically ill COVID-19 patients, while lymphocyte count and estimated glomerular filtration rate at admission were inversely related to the development of AKI.Conclusions: Only 3.3% of severely and critically ill COVID-19 patients without CKD in our research cohort developed AKI. Critically ill patients may be more susceptible to AKI than severely ill patients.

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“…Almost half the cases (5/11 cases) with AKI clinically demonstrated moderate or severe ATN at autopsy, which is in contrast with the previous study by Santoriello et al who found the severity of ATN to be mild as compared to the extent of rising in creatinine in 71% of their cases [ 13 ]. The occurrence of AKI in COVID-19 infection has been attributed to cytokine storm and the use of mechanical ventilation for acute respiratory distress syndrome (ARDS) in these cases [ 28 ]. However, in the present study, no significant association was established between the days of hospitalization or mechanical ventilation and the stage of AKI.…”

Section: Discussionmentioning

confidence: 99%

Clinical, Virological, and Pathological Profile of Patients Who Died of COVID-19: An Autopsy-Based Study From India

Yadav¹,

Goel²,

Purwar³

et al. 2022

Cureus

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Background and objective Ever since its emergence in December 2019, coronavirus disease 2019 (COVID-19) has affected more than 220 million people worldwide, resulting in more than 45 million deaths. The present autopsy-based study was undertaken to understand the pathophysiology of the disease and correlate the histopathological and virological findings with the antemortem clinical and biochemical determinants. Methods In this prospective observational study, autopsies were carried out on 21 reverse transcription-polymerase chain reaction (RT-PCR)-proven COVID-19 patients who had died of the disease. The histopathological findings of tissue samples from lungs, liver, and kidneys collected during the autopsy were graded based on their presence or absence; if present, they were graded as either focal or diffuse. The findings were correlated with antemortem clinical and biochemical findings. Postmortem tissue RT-PCR analysis was conducted, and findings were compared with postmortem histopathological findings. Results There was multisystem involvement with the COVID-19 cases. The involvement of lungs was observed in most of the cases (90.4%). The presence of viral RNA was observed in all the organs including the liver (57.1%) and kidney (66.6%). An association was observed between antemortem biochemical parameters [aspartate aminotransferase (AST), alanine aminotransferase (ALT)] and the histopathological features in the liver. No correlation between the Sequential Organ Failure Assessment (SOFA) score recorded clinically and lung histopathology was observed; nor was there any correlation between blood urea-creatinine levels and kidney histopathology. Conclusions Our study shows that COVID-19 is a multisystemic disease and the mortality associated with it is likely to be multifactorial. Despite the presence of amplifiable severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in various organs, no association could be established between the clinical and histopathology findings. Neither the duration of hospitalization nor the duration of mechanical ventilation showed any correlation with the severity of histopathological findings in the lungs at autopsy.

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COVID-19 and the Kidney: A Worrisome Scenario of Acute and Chronic Consequences

Cited by 8 publications

References 106 publications

Unsupervised clustering reveals phenotypes of AKI in ICU Covid19 patients

Unsupervised clustering reveals phenotypes of AKI in ICU Covid19 patients

A survey on acute kidney injury in severely and critically ill COVID-19 patients without chronic kidney disease

Clinical, Virological, and Pathological Profile of Patients Who Died of COVID-19: An Autopsy-Based Study From India

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