COVID-19-associated acute kidney injury

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Nasrin Nikravangolsefid, MD-MPH [2],Sogand Goudarzi, MD [3]

Synonyms and Keywords: COVID-19-associated AKI

Overview

COVID-19 infection can affect many organs and lead to organ failure. Kidneys are vital organs that can be affected by coronavirus. Acute kidney injury (AKI), a sudden deficit in kidney function, is a complication of COVID-19 and associated with a higher risk of mortality. AKI is frequently seen in critically ill patients with pre-existing conditions. Identifying high-risk patients for AKI and regular monitoring of kidney function tests in these patients play a major role in preventing AKI.

Historical Perspective


Classification

Pathophysiology

INTERLEUKIN-6-AKI.PNG


AKI PATHOPHYSIOLOGY-COVID19.PNG

Causes

Differentiating COVID-19-associated acute kidney injury from other Diseases

To review the differential diagnosis of AKI, click here.

Epidemiology and Demographics

  • The prevalence of AKI among patients with COVID-19 hospitalized in ICU is approximately 0.6-29% in China [11] and 22.2% in the USA.[12]
  • Approximately 43% of critically ill patients with COVID-19 developed AKI during the admission period. [4]
  • In a cohort study on 99 patients with severe COVID-19, AKI was reported in 42 patients (42.9%) and among them 32 (74.4%) patients had severe AKI (stage III based on KDIGO definition). [13]
  • The actual incidence of AKI in critcally ill patients with COVID-19 is uncertain but estimated between 27-85%. "Acute Kidney Injury in COVID-19 Patients | COVID-19".
  • Differences of AKI prevalence among studies could be related to several factors, including:[13]
  • AKI commonly affects elderly. The incidence of AKI increases with age; the mean age at diagnosis is 57.1 years. [4]
  • There is no racial predilection to COVID-19 associated AKI.


Risk Factors

Screening

  • Serial monitoring of kidney function tests should be considered in high risk patients.[16]

Natural History, Complications, and Prognosis

Natural History

  • If no improvement occurs during follow-up, it is contributed to higher mortality.[3]

Diagnosis

Diagnostic Study of Choice

  • The diagnosis of AKI is based on the KDIGO criteria, which includes:[18]
    • Elevated serum Creatinine by ≥0.3 mg/dl (≥26.5 μmol/l) within 48 hours; or
    • Elevated serum Creatinine to ≥1.5 times baseline within the previous 7 days; or
    • Urine volume < 0.5 ml/kg/h for >6 hours

Symptoms

Physical Examination

Laboratory Findings

Electrocardiogram

X-ray

Echocardiography or Ultrasound

CT scan

  • There are no CT scan findings associated with AKI.
  • To view the CT scan findings on COVID-19, click here.

MRI

  • There are no MRI findings associated with AKI.
  • To view the MRI findings on COVID-19, click here.

Other Imaging Findings

Other Diagnostic Studies

  • There are no other diagnostic studies associated with AKI.
  • To view other diagnostic studies for COVID-19, click here.

Treatment

Medical Therapy

Interventions

Surgery

Surgical intervention is not recommended for the management of COVID-19 associated AKI.

Primary Prevention

Secondary Prevention

  • Effective measures for the secondary prevention of AKI is using biomarkers for early diagnosis and treatment of AKI in early stages before it causes significant complications.[29][21]


References

  1. Hui DS, I Azhar E, Madani TA, Ntoumi F, Kock R, Dar O, et al. (February 2020). "The continuing 2019-nCoV epidemic threat of novel coronaviruses to global health—The latest 2019 novel coronavirus outbreak in Wuhan, China". International Journal of Infectious Diseases. 91: 264–266. doi:10.1016/j.ijid.2020.01.009. PMC 7128332 Check |pmc= value (help). PMID 31953166.
  2. Wang, Luwen; Li, Xun; Chen, Hui; Yan, Shaonan; Li, Dong; Li, Yan; Gong, Zuojiong (2020). "Coronavirus Disease 19 Infection Does Not Result in Acute Kidney Injury: An Analysis of 116 Hospitalized Patients from Wuhan, China". American Journal of Nephrology. 51 (5): 343–348. doi:10.1159/000507471. ISSN 0250-8095.
  3. 3.0 3.1 3.2 Pei, Guangchang; Zhang, Zhiguo; Peng, Jing; Liu, Liu; Zhang, Chunxiu; Yu, Chong; Ma, Zufu; Huang, Yi; Liu, Wei; Yao, Ying; Zeng, Rui; Xu, Gang (2020). "Renal Involvement and Early Prognosis in Patients with COVID-19 Pneumonia". Journal of the American Society of Nephrology. 31 (6): 1157–1165. doi:10.1681/ASN.2020030276. ISSN 1046-6673.
  4. 4.0 4.1 4.2 4.3 Pei G, Zhang Z, Peng J, Liu L, Zhang C, Yu C; et al. (2020). "Renal Involvement and Early Prognosis in Patients with COVID-19 Pneumonia". J Am Soc Nephrol. 31 (6): 1157–1165. doi:10.1681/ASN.2020030276. PMC 7269350 Check |pmc= value (help). PMID 32345702 Check |pmid= value (help).
  5. 5.0 5.1 5.2 5.3 Malha, Line; Mueller, Franco B.; Pecker, Mark S.; Mann, Samuel J.; August, Phyllis; Feig, Peter U. (2020). "COVID-19 and the Renin-Angiotensin System". Kidney International Reports. 5 (5): 563–565. doi:10.1016/j.ekir.2020.03.024. ISSN 2468-0249.
  6. 6.0 6.1 6.2 Ronco C, Reis T (2020). "Kidney involvement in COVID-19 and rationale for extracorporeal therapies". Nat Rev Nephrol. 16 (6): 308–310. doi:10.1038/s41581-020-0284-7. PMC 7144544 Check |pmc= value (help). PMID 32273593 Check |pmid= value (help).
  7. Husain-Syed F, Slutsky AS, Ronco C (2016). "Lung-Kidney Cross-Talk in the Critically Ill Patient". Am J Respir Crit Care Med. 194 (4): 402–14. doi:10.1164/rccm.201602-0420CP. PMID 27337068.
  8. https://www.medrxiv.org/content/10.1101/2020.03.04.20031120v4. Missing or empty |title= (help)
  9. Ye M, Wysocki J, William J, Soler MJ, Cokic I, Batlle D (2006). "Glomerular localization and expression of Angiotensin-converting enzyme 2 and Angiotensin-converting enzyme: implications for albuminuria in diabetes". J Am Soc Nephrol. 17 (11): 3067–75. doi:10.1681/ASN.2006050423. PMID 17021266.
  10. Perico L, Benigni A, Remuzzi G (2020). "Should COVID-19 Concern Nephrologists? Why and to What Extent? The Emerging Impasse of Angiotensin Blockade". Nephron. 144 (5): 213–221. doi:10.1159/000507305. PMC 7179544 Check |pmc= value (help). PMID 32203970 Check |pmid= value (help).
  11. "Acute Kidney Injury in COVID-19 Patients | COVID-19".
  12. Richardson S, Hirsch JS, Narasimhan M, Crawford JM, McGinn T, Davidson KW; et al. (2020). "Presenting Characteristics, Comorbidities, and Outcomes Among 5700 Patients Hospitalized With COVID-19 in the New York City Area". JAMA. doi:10.1001/jama.2020.6775. PMC 7177629 Check |pmc= value (help). PMID 32320003 Check |pmid= value (help).
  13. 13.0 13.1 13.2 Gabarre P, Dumas G, Dupont T, Darmon M, Azoulay E, Zafrani L (2020). "Acute kidney injury in critically ill patients with COVID-19". Intensive Care Med. 46 (7): 1339–1348. doi:10.1007/s00134-020-06153-9. PMC 7290076 Check |pmc= value (help). PMID 32533197 Check |pmid= value (help).
  14. Sharma G, Volgman AS, Michos ED (2020). "Sex Differences in Mortality from COVID-19 Pandemic: Are Men Vulnerable and Women Protected?". JACC Case Rep. doi:10.1016/j.jaccas.2020.04.027. PMC 7198137 Check |pmc= value (help). PMID 32373791 Check |pmid= value (help).
  15. Rabb H (2020). "Kidney diseases in the time of COVID-19: major challenges to patient care". J Clin Invest. 130 (6): 2749–2751. doi:10.1172/JCI138871. PMC 7259985 Check |pmc= value (help). PMID 32250968 Check |pmid= value (help).
  16. 16.0 16.1 16.2 16.3 16.4 16.5 Selby NM, Forni LG, Laing CM, Horne KL, Evans RD, Lucas BJ; et al. (2020). "Covid-19 and acute kidney injury in hospital: summary of NICE guidelines". BMJ. 369: m1963. doi:10.1136/bmj.m1963. PMID 32457068 Check |pmid= value (help).
  17. 17.0 17.1 17.2 17.3 17.4 Ronco C, Reis T, Husain-Syed F (2020). "Management of acute kidney injury in patients with COVID-19". Lancet Respir Med. doi:10.1016/S2213-2600(20)30229-0. PMC 7255232 Check |pmc= value (help). PMID 32416769 Check |pmid= value (help).
  18. 18.0 18.1 18.2 Khwaja A (2012). "KDIGO clinical practice guidelines for acute kidney injury". Nephron Clin Pract. 120 (4): c179–84. doi:10.1159/000339789. PMID 22890468.
  19. 19.0 19.1 Skorecki K, Green J, Brenner BM (2005). "Chronic renal failure". In Kasper DL, Braunwald E, Fauci AS, et al. Harrison's Principles of Internal Medicine (16th ed.). New York, NY: McGraw-Hill. pp. 1653–63. ISBN 978-0-07-139140-5.
  20. Ostermann, Marlies; Joannidis, Michael (2016). "Acute kidney injury 2016: diagnosis and diagnostic workup". Critical Care. 20 (1). doi:10.1186/s13054-016-1478-z. ISSN 1364-8535.
  21. 21.0 21.1 Kashani K, Cheungpasitporn W, Ronco C (2017). "Biomarkers of acute kidney injury: the pathway from discovery to clinical adoption". Clin Chem Lab Med. 55 (8): 1074–1089. doi:10.1515/cclm-2016-0973. PMID 28076311.
  22. Schrezenmeier EV, Barasch J, Budde K, Westhoff T, Schmidt-Ott KM (2017). "Biomarkers in acute kidney injury - pathophysiological basis and clinical performance". Acta Physiol (Oxf). 219 (3): 554–572. doi:10.1111/apha.12764. PMC 5575831. PMID 27474473.
  23. Oh DJ (2020). "A long journey for acute kidney injury biomarkers". Ren Fail. 42 (1): 154–165. doi:10.1080/0886022X.2020.1721300. PMC 7034110 Check |pmc= value (help). PMID 32050834 Check |pmid= value (help).
  24. 24.0 24.1 Kalantarinia K (2009). "Novel imaging techniques in acute kidney injury". Curr Drug Targets. 10 (12): 1184–9. doi:10.2174/138945009789753246. PMC 2891573. PMID 19715540.
  25. Grein J, Ohmagari N, Shin D, Diaz G, Asperges E, Castagna A; et al. (2020). "Compassionate Use of Remdesivir for Patients with Severe Covid-19". N Engl J Med. 382 (24): 2327–2336. doi:10.1056/NEJMoa2007016. PMC 7169476 Check |pmc= value (help). PMID 32275812 Check |pmid= value (help).
  26. National Kidney Foundation (2015). "KDOQI Clinical Practice Guideline for Hemodialysis Adequacy: 2015 update". Am J Kidney Dis. 66 (5): 884–930. doi:10.1053/j.ajkd.2015.07.015. PMID 26498416.
  27. Kellum, John A; Leblanc, Martine; Gibney, R T. Noel; Tumlin, James; Lieberthal, Wilfred; Ronco, Claudio (2006). "Primary prevention of acute renal failure in the critically ill". Current Opinion in Internal Medicine. 5 (1): 74–78. doi:10.1097/01.ccx.0000179934.76152.02. ISSN 1535-5942.
  28. Lameire, N.; Van Biesen, W.; Hoste, E.; Vanholder, R. (2008). "The prevention of acute kidney injury: an in-depth narrative review Part 1: volume resuscitation and avoidance of drug- and nephrotoxin-induced AKI". Clinical Kidney Journal. 1 (6): 392–402. doi:10.1093/ndtplus/sfn162. ISSN 2048-8505.
  29. Pickering JW, Endre ZH (2009). "Secondary prevention of acute kidney injury". Curr Opin Crit Care. 15 (6): 488–97. doi:10.1097/MCC.0b013e328332f66f. PMID 19823082.