COVID-19 and Acute Kidney Injury (AKI)

(See also Acute Kidney Injury Acute Kidney Injury (AKI) Acute kidney injury is a rapid decrease in renal function over days to weeks, causing an accumulation of nitrogenous products in the blood (azotemia) with or without reduction in amount of urine... read more and COVID-19 COVID-19 COVID-19 is an acute, sometimes severe, respiratory illness caused by the novel coronavirus SARS-CoV-2. Prevention is by vaccination and infection control precautions (eg, face masks, handwashing... read more .)

The presence of AKI increases risk of mortality in patients with COVID-19 (1 General references COVID-19, a disease caused by the novel coronavirus SARS-CoV-2, may present with acute kidney injury (AKI), particularly in critically ill patients. (See also Acute Kidney Injury and COVID-19... read more ). In a recent systematic review and meta-analysis, the incidence of AKI was 17%, although it varied from 0.5 to 80% among individual studies depending on geographic location and number of critically ill patients. In this meta-analysis, the overall mortality was 11% and AKI increased the risk of death; utilization of renal replacement therapy was 5% overall (2 General references COVID-19, a disease caused by the novel coronavirus SARS-CoV-2, may present with acute kidney injury (AKI), particularly in critically ill patients. (See also Acute Kidney Injury and COVID-19... read more ).

While the data are new and evolving, the following have been described as independent risk factors for AKI with COVID-19 (3 General references COVID-19, a disease caused by the novel coronavirus SARS-CoV-2, may present with acute kidney injury (AKI), particularly in critically ill patients. (See also Acute Kidney Injury and COVID-19... read more ) thus far:

Early studies suggest that the pathophysiology of AKI may be due to ischemia during sepsis Sepsis and Septic Shock Sepsis is a clinical syndrome of life-threatening organ dysfunction caused by a dysregulated response to infection. In septic shock, there is critical reduction in tissue perfusion; acute failure... read more , systemic inflammatory response to the virus, and potentially direct viral toxicity to the kidneys. Kidney histopathology most commonly shows acute tubular necrosis Acute Tubular Necrosis (ATN) Acute tubular necrosis (ATN) is kidney injury characterized by acute tubular cell injury and dysfunction. Common causes are hypotension or sepsis that causes renal hypoperfusion and nephrotoxic... read more (ATN) and, less commonly, collapsing focal segmental glomerulosclerosis Focal Segmental Glomerulosclerosis Focal segmental glomerulosclerosis is scattered (segmental) mesangial sclerosis that begins in some but not all (focal) glomeruli and eventually involves all glomeruli. It is most often idiopathic... read more (FSGS ; [4] General references COVID-19, a disease caused by the novel coronavirus SARS-CoV-2, may present with acute kidney injury (AKI), particularly in critically ill patients. (See also Acute Kidney Injury and COVID-19... read more ) or renal infarction.

Presentation of AKI in patients with COVID-19 is similar to that of other infectious etiologies, including elevated creatinine, oliguria or anuria, and in some cases proteinuria (including nephrotic range) and hematuria (1 General references COVID-19, a disease caused by the novel coronavirus SARS-CoV-2, may present with acute kidney injury (AKI), particularly in critically ill patients. (See also Acute Kidney Injury and COVID-19... read more ). Treatment is focused on supportive care, including intravascular volume optimization (balanced against the risk of pulmonary edema in patients with respiratory distress), monitoring of electrolytes, and possibly dialysis Overview of Renal Replacement Therapy Renal replacement therapy (RRT) replaces nonendocrine kidney function in patients with renal failure and is occasionally used for some forms of poisoning. Techniques include continuous hemofiltration... read more . Due to the increased risk of dialysis circuit thrombosis, patients requiring hemodialysis are treated with anticoagulation unless contraindicated by bleeding risk. Infection control is of the utmost importance.