COVID‐19 patients in intensive care develop predominantly oliguric acute kidney injury

Abstract

Background Acute kidney injury (AKI) is a syndrome of reduced glomerular filtration rate and/or reduced urine flow associated with mortality in corona virus disease 2019 (COVID‐19). AKI is often associated with renal tissue damage, which may lead to chronic kidney disease. Biomarkers of tissue damage may identify patients of particular risk. Methods In a prospective observational study of 57 patients admitted to intensive care, AKI incidence and characteristics was evaluated according to KDIGO criteria and related to days after admission. Urinary albumin, Neutrophil Gelatinase‐Associated Lipocalin (NGAL), Kidney Injury Molecule 1 (KIM‐1) and Plasma Tissue Inhibitor of MetalloProteinase 2 (TIMP‐2) were analysed in 52 patients at admission. The majority (n = 51, 89%) of patients developed AKI, and 27 (47%) patients had predominantly oliguric AKI where oliguria was more severe than plasma Creatinine increase. Severe oliguria within first 2 days after admission was common (n = 37, 65%), whereas stage 2 and 3 AKI due to Creatinine occurred later than day 2 in 67% (12/18) of cases. Renal replacement therapy was started in 9 (16%) patients, and 30‐day mortality was 28%. Urinary biomarkers were increased in a majority of patients, but did not robustly predict KDIGO stage. Most patients had microalbuminuria, and severe albuminuria (albumin Creatinine ratio > 30 mg/mmol) was found in n = 9 (17%) patients. Conclusions A majority of patients with COVID‐19 admitted to the ICU develop AKI. The functional deficit is often low urinary volume, and initial levels of biomarkers are generally increased without clear relation to final AKI stage.

Severe acute kidney injury associated with progression of chronic kidney disease after critical COVID-19

“…Corona virus disease 2019 (COVID-19) is associated with acute kidney injury (AKI) in patients that require critical care [1]. As we have previously reported, the association between clinical AKI and biomarkers was not strong, perhaps indicating less renal tissue damage [2]. Further, the preceding illness with high fever and restrictive fluid treatment in intensive care (ICU) may cause AKI through dehydration [3].…”

“…Author details 1 Anesthesia and Intensive Care Medicine, Department of Surgical Sciences, Uppsala University Hospital, Uppsala University, Entrance 78, etg 4, 75185 Uppsala, Sweden. 2 Integrative Physiology, Department of Medical Cell Biology, Uppsala University, Uppsala, Sweden. 3 Hedenstierna Laboratory, CIRRUS,…”

Evaluation of the relationship between KIM-1 and suPAR level in COVID-19 patients and a different perspective on suPAR

“…The dense presence of the KIM-1 molecule in T cells gave it a different name: T cell/transmembrane, immunoglobulin, and mucin (TIM-1). The interaction of KIM-1/TIM-1 with T cells has played an important role in immune response, allergy, asthma, autoimmune diseases and response to viral infections 5. In the preliminary evaluation of clinical interaction between KIM-1/TIM-1 and COVID-19 patients, the relationship with acute kidney damage was evaluated in the foreground 15 . Kim-1/TIM-1 has been observed to facilitate the entry of the virus into the cell, such as ACE-2 receptors via IgV.…”

Development of a Europium Nanoparticles Lateral Flow Immunoassay for NGAL Detection in Urine and Diagnosis of Acute Kidney Injury

“…The sensitivity europium-based lateral fluorescence immunoassays (EU-NPS-LFIA) for detection of NGAL in human urine and diagnosis of acute kidney injury during the COVID-19 pandemic has been developed in our study. AKI developed in 89% of severe patients with COVID-19, and a majority of patients had predominantly oliguria when appears earlier than plasma Creatinine [27]. Biomarkers increased elevated levels at admission, which associated with increased mortality.…”