Kidney damage in Covid-19: clinical and morphological manifestations of renal pathology in 220 patients died from Covid-19

The mini-review presents modern data on the epidemiology, clinical and morphological aspects of kidney damage in COVID-19. Potential mechanisms of kidney involvement in the clinical picture of the disease may include cytokine damage, cross-organ damage, and systemic effects that determine the treatment strategy. These mechanisms are closely interrelated and are especially important for individuals undergoing extracorporeal therapy and kidney transplants. Autopsy data provide evidence of SARS-CoV-2 virus invasion into kidney tissue with damage to tubular epithelial cells and podocytes, and erythrocyte aggregation in persons with severe COVID-19. By including people with chronic kidney disease in planned COVID-19 research protocols, an evidence base for effective and safe treatments can be generated.

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“…According to the study by Stolyarevich et al morphological signs of kidney damage in patients who died from COVID-19 are diverse (28).…”

Section: Daminov B Et Almentioning

confidence: 99%

Epidemiological, clinical and morphological aspects of kidney damage in COVID-19

et al. 2021

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“…В зарубежных исследованиях была продемонстрирована высокая частота острого повреждения почек (ОПП) у госпитализированных пациентов с COVID-19 (17-43%) [1], а у пациентов в критическом состоянии частота ОПП составляла >50% [1]. По данным исследований из Российской Федерации, частота ОПП составляет от 17,6 до 29% среди госпитализированных пациентов с COVID-19, среди умерших пациентов -от 20,6 до 61% [2][3][4][5][6]. Ауто псийные исследования пациентов с COVID-19 показали, что большинство из них имеют признаки ОПП [7], а в некоторых исследованиях показана роль острой почечной недостаточности как основной причины смерти во время COVID-19 [8].…”

Section: Introductionunclassified

Short- and long-term outcomes of patients with COVID-19 and acute kidney injury

Khruleva

Efremovtseva

Timofeeva

et al. 2023

Cardiovasc Ther Prev

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Aim. To evaluate the impact of acute kidney injury (AKI) on in-hospital (death) and long-term outcomes (rehospitalization or death within 30 days; death within 180 days) in hospitalized patients with coronavirus disease 2019 (COVID-19).Material and methods. The registry of patients with COVID-19 was analyzed to identify risk factors (RFs) for mortality. Discharged patients were included in a prospective study. Outcomes were assessed by telephone contacts.Results. The study included 1000 patients. The mortality rate was 20,8%, while AKI was registered in 29,6% of patients. According to multivariate analysis, AKI, regardless of other risk factors, increased the risk of death (hazard ratio (HR), 1,62, 95% confidence interval (CI): 1,08-2,44, p=0,02). The prospective part included 691 patients. We revealed that 10% were rehospitalized or died within 30 days, while independent risk factors were age >65 years (HR, 2,72, 95% CI: 1,47-5,01, p=0,001) and AKI in the acute phase of COVID-19 (HR, 1,67, 95% CI: 1,00-2,80, p=0,05). In addition, 6% of patients died within 180 days, while AKI was the risk factor for death according to univariate analysis; the only independent predictor was age >65 years (HR, 5,96, 95% CI: 2,26-15,72, p<0,001).Conclusion. AKI during the acute period of COVID-19, independently of other risk factors, more than 1,5 times increases the risk of mortality and the risk of adverse outcome within 30 days after discharge.

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A clinical case of SARS-CoV-2 infection complicated by nephrogenic pulmonary edema and COVID-associated pneumonitis, alveolitis

Воробьева

Gimaldinova

Romanova

2023

Russian Journal of Infection and Immunity

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COVID-19 is a highly transmissible disease with severe course especially in patients with nephrogenic hypertensive disease and chronic kidney disease due to a higher incidence of all-type infections than in the general population. The aim of the study is to describe a clinical case of SARS-CoV-2 infection complicated by nephrogenic pulmonary edema and COVID-associated pneumonitis, alveolitis. Description of the case. Patient K.S., born in 1975, was hospitalized 24 hours after symptom onset at emergency hospital due to complaints of increased blood pressure up to 180200/110120 mm Hg, temperature up to 38.7C, dry cough, feeling of heaviness in the chest, change in urine color. PCR smear for SARS-CoV-2 was positive. Computed tomography revealed a pattern of bilateral COVID-associated pneumonitis, alveolitis, with 75% involvement. The electrocardiogram revealed signs of left ventricular myocardial hypertrophy. Ultrasound examination showed numerous cysts in the kidneys. Urinalysis at admission: leukocytes 499, erythrocytes 386. Glomerular filtration rate (CKD-EPI: 29 ml/min/1.73 m2) and corresponds to stage IV of chronic kidney disease. Coagulogram: fibrinogen: 32.3 (1.64.0) g/l, D-dimer: 663 (0250). Despite the treatment, the patients condition worsened, the phenomena of cardiopulmonary and renal insufficiency increased, which led to a fatal outcome. During a virological study of sectional material: SARS-CoV-2 coronavirus RNA was found in the lung and kidneys. Signs of bilateral COVID-associated pneumonitis, alveolitis with diffuse cellular infiltrates in combination with changes in the alveolar apparatus, signs of pulmonary edema were revealed. Heart-related signs swelling of the interstitium, fragmented muscle fibers, some of them hypertrophied, a wave-like deformation of cardiomyocytes, blurring of the transverse striation. Arteries with thickened sclerosed walls. In the kidneys diffuse damage to the proximal tubules of the nephron with areas of cortical and proximal necronephrosis, areas of fibrinoid swelling. Conclusion. The cause of death of a 45-year-old patient was a severe course of bilateral COVID-associated pneumonitis, alveolitis, which contributed to the development of renal medullary hypoxia and type 1 cardiorenal syndrome, which led to early nephrogenic pulmonary edema.

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Kidney damage in Covid-19: clinical and morphological manifestations of renal pathology in 220 patients died from Covid-19

Cited by 7 publications

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Epidemiological, clinical and morphological aspects of kidney damage in COVID-19

Epidemiological, clinical and morphological aspects of kidney damage in COVID-19

Short- and long-term outcomes of patients with COVID-19 and acute kidney injury

A clinical case of SARS-CoV-2 infection complicated by nephrogenic pulmonary edema and COVID-associated pneumonitis, alveolitis

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