Renal Tubular Acidosis in Pregnant Critically Ill COVID-19 Patients: A Secondary Analysis of a Prospective Cohort

Abstract

Background: Renal tubular acidosis (RTA) is an extremely rare cause of metabolic acidosis (10 in 100,000). RTA has been linked neither to pregnancy nor to severe coronavirus disease 2019 (COVID-19). The purpose of this study was to analyze the prevalence and clinical course of normal anion gap metabolic acidosis in critically ill pregnant COVID-19 patients and to compare them to an age-matched nonpregnant female patient cohort. Methods: Secondary analysis was conducted on a prospective observational cohort of critically ill patients suffering from COVID-19 consecutively admitted to a tertiary intensive care unit (ICU) between February 2020 and April 2021. Results: A total of 321 COVID-19 patients required admission to the ICU; 95 (30%) were female, and 18 (19%) were of childbearing age. Seven of eight (88%) pregnant women (all in the last trimester) required advanced respiratory support due to COVID-19. The estimated glomerular filtration rate was 135 (123–158) mL/min/m2 body surface area, and six pregnant women (86%) were diagnosed with a normal, respiratory compensated, anion gap metabolic acidosis (pHmin 7.3 (7.18–7.31), HCO3−min 14.8 (12.8–18.6) mmol/L, and paCO2 3.4 (3.3–4.5) kPa). Three (43%) acidotic pregnant women fulfilled diagnostic criteria for RTA. All women recovered spontaneously within less 7 days. Conclusions: Metabolic acidosis seems to be very common (85%) in pregnant critically ill COVID-19 patients, and the prevalence of RTA might be higher than normal. It remains to be demonstrated if this observation is an indirect epiphenomenon or due to a direct viral effect on the tubular epithelium.

Acidose tubular renal associada ao novo coronavírus: relato de caso

“…Visto que outras causas de RTA foram excluídas, a exemplo de diarréia, drenos e características da Síndrome de Fanconi e que a COVID-19 atinge múltiplos sistemas, acredita-se que a tempestade de citocinas do novo coronavírus, seja a justificativa deste dano renal, pois, a enzima conversora de angiotensina 2 atua como um receptor e auxilia na entrada do vírus, como o SARS-CoV-2, que se ligam as bordas em escova de células epiteliais tubulares renais, capaz de potencializar e garantir a invasão do SARS-CoV-2 nos rins (Razavi- Amoli et al, 2022). Associado a isso, o vírus consegue macular o endotélio dos vasos, por meio de seu receptor de acesso da enzima conversora de angiotensina 2 (ACE2), sendo descoberto nas células do Research, Society andDevelopment, v. 11, n. 12, e17111234027, 2022 (CC BY 4.0) | ISSN 2525-3409 | DOI: http://dx.doi.org/10.33448/rsd-v11i12.34027 endotélio renal e epitélio tubular (Humbel, et al, 2022). A literatura também demonstra eventos de insuficiência ventricular à direita em decorrência da acidificação do metabolismo humano.…”