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COVID-19 and Acute Kidney Injury (AKI)

By

Anna Malkina

, MD, University of California, San Francisco

Last full review/revision Jan 2022| Content last modified Jan 2022
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COVID-19, a disease caused by the novel coronavirus SARS-CoV-2, may present with acute kidney injury (AKI), particularly in critically ill patients.

  • Age

  • Race (higher among Black people)

  • Diabetes

  • Obesity

  • Hypertension

  • Cardiovascular disease

  • Low baseline kidney function

  • 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. 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 Acute Tubular Necrosis (ATN) (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 Focal Segmental Glomerulosclerosis (FSGS; [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 ). 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.

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