Renal Complications and Their Prognosis in Korean Patients with Middle East Respiratory Syndrome-Coronavirus from the Central MERS-CoV Designated Hospital

Abstract

Some cases of Middle East Respiratory Syndrome-Coronavirus (MERS-CoV) infection presented renal function impairment after the first MERS-CoV patient died of progressive respiratory and renal failure. Thus, MERS-CoV may include kidney tropism. However, reports about the natural courses of MERS-CoV infection in terms of renal complications are scarce. We examined 30 MERS-CoV patients admitted to National Medical Center, Korea. We conducted a retrospective analysis of the serum creatinine (SCr), estimated glomerular filtration rate (eGFR), urine dipstick tests, urinary protein quantitation (ACR or PCR), and other clinical parameters in all patients. Two consecutive results of more than trace (or 1+) of albumin and blood on dipstick test occurred in 18 (60%) (12 [40%]) and 22 (73.3%) (19 [63.3%]) patients, respectively. Fifteen (50.0%) patients showed a random urine ACR or PCR more than 100 mg/g Cr. Eight (26.7%) patients showed acute kidney injury (AKI), and the mean and median durations to the occurrence of AKI from symptom onset were 18 and 16 days, respectively. Old age was associated with a higher occurrence of AKI in the univariate analysis (HR [95% CI]: 1.069 [1.013-1.128], P = 0.016) and remained a significant predictor of the occurrence of AKI after adjustment for comorbidities and the application of a mechanical ventilator. Diabetes, AKI, and the application of a continuous renal replacement therapy (CRRT) were risk factors for mortality in the univariate analysis (HR [95% CI]: diabetes; 10.133 [1.692-60.697], AKI; 12.744 [1.418-114.565], CRRT; 10.254 [1.626-64.666], respectively). Here, we report renal complications and their prognosis in 30 Korean patients with MERS-CoV.

MERS-CoV infection in humans is associated with a pro-inflammatory Th1 and Th17 cytokine profile

“…Commonly reported symptoms of MERS-CoV infection included cough, fever, breathing difficulty, sore throat, headache, vomiting and diarrhea [7,26]. Some patients may develop acute respiratory failure and acute kidney injury, which are considered as the major complications of the disease [27,28].…”

MERS coronavirus outbreak: Implications for emerging viral infections

“…The first ever reported case suffered from acute kidney injury (Zaki et al, 2012). Proteinuria, hematuria and acute kidney injury (AKI) were noted in a retrospective study of 30 MERS-CoV cases in South Korea, in which diabetes, AKI, and the application of a continuous renal replacement therapy (CRRT) were observed to be risk factors for MERS-CoV-related mortality (Cha et al, 2015). Seizures, DIC, and rhabdomyolysis were also reported as complications related to MERS-CoV infection in a study of seventy patients in a single centre in KSA (Shalhoub et al, 2015).…”

“…About 75% of confirmed MERS-CoV infections occur in patients with comorbid disease. Frequent comorbid conditions seen in patients with MERS-CoV infection are diabetes mellitus, obesity, chronic kidney disease, cardiac diseases, and hypertension, as well as respiratory diseases including asthma and COPD (Ahmed, 2018;Arabi et al, 2014;Assiri et al, 2013b;Badawi and Ryoo, 2016;Banik et al, 2016;Cha et al, 2015; Korea Centers for Disease Control, and Prevention, 2015; Matsuyama et al, 2016;Park et al, 2018;Saad et al, 2014;Shalhoub et al, 2015). Disease severity and mortality risk is impacted by comorbidities and age.…”

A Middle East respiratory syndrome screening clinic for health care personnel during the 2015 Middle East respiratory syndrome outbreak in South Korea: A single-center experience

“…During the outbreak, 186 patients were confirmed to have MERS, of which 37 died. 1,2 Isolated strains were typed as clade B MERS-coronavirus (CoV) and were closely related to the viruses circulating in the Middle East. 3 The distinct feature of the MERS outbreak in South Korea was that the transmission was hospital-related, with transmission within the hospital and from hospital to hospital, resulting in the exposure of a high number of health care personnel (HCP) to MERS-CoV.…”