(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 a novel coronavirus SARS-CoV-2. COVID-19 was first reported in late 2019 in Wuhan, China and has since spread extensively... read more .)
The presence of AKI increases risk of mortality in patients with COVID-19 (1 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 (2 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:
Age
Race (higher among blacks)
Diabetes
Hypertension
Cardiovascular disease
Mechanical ventilation
Shock requiring vasopressors
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. 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 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.
References
1. Pei G, Zhang Z, Peng J, et al: Renal involvement and early prognosis in patients with COVID-19 pneumonia. J Am Soc Nephrol 31(6):1157, 2020. doi: 10.1681/ASN.2020030276. Epub 2020 Apr 28.
2. Hirsch JS, Ng JH, Ross DW, et al: Acute kidney injury in patients hospitalized with COVID-19. Kidney Int 98(1):209, 2020. doi:https://doi.org/10.1016/j.kint.2020.05.006. Epub 2020 May 16.
