ABSTRACT
INTRODUCTION: Renal involvement in COVID-19 is less well characterized in settings with vigilant public health surveillance, including mass screening and early hospitalization. We assessed kidney complications among COVID-19 patients in Hong Kong, including the association with risk factors, length of hospitalization, critical presentation, and mortality. METHODS: Linked electronic records of all patients with confirmed COVID-19 from 5 major designated hospitals were extracted. Duplicated records due to interhospital transferal were removed. Primary outcome was the incidence of in-hospital acute kidney injury (AKI). Secondary outcomes were AKI-associated mortality, incident renal replacement therapy (RRT), intensive care admission, prolonged hospitalization and disease course (defined as >90th percentile of hospitalization duration [35 days] and duration from symptom onset to discharge [43 days], respectively), and change of estimated glomerular filtration rate (GFR). Patients were further stratified into being symptomatic or asymptomatic. RESULTS: Patients were characterized by young age (median: 38.4, IQR: 28.4-55.8 years) and short time (median: 5, IQR: 2-9 days) from symptom onset to admission. Among the 591 patients, 22 (3.72%) developed AKI and 4 (0.68%) required RRT. The median time from symptom onset to in-hospital AKI was 15 days. AKI increased the odds of prolonged hospitalization and disease course by 2.0- and 3.5-folds, respectively. Estimated GFR 24 weeks post-discharge reduced by 7.51 and 1.06 mL/min/1.73 m2 versus baseline (upon admission) in the AKI and non-AKI groups, respectively. The incidence of AKI was comparable between asymptomatic (4.8%, n = 3/62) and symptomatic (3.7%, n = 19/519) patients. CONCLUSION: The overall rate of AKI among COVID-19 patients in Hong Kong is low, which could be attributable to a vigilant screening program and early hospitalization. Among patients who developed in-hospital AKI, the duration of hospitalization is prolonged and kidney function impairment can persist for up to 6 months post-discharge. Mass surveillance for COVID-19 is warranted in identifying asymptomatic subjects for earlier AKI management.
Subject(s)
Acute Kidney Injury/epidemiology , COVID-19 Testing , COVID-19/diagnosis , Mass Screening/organization & administration , Renal Replacement Therapy/statistics & numerical data , Acute Kidney Injury/diagnosis , Acute Kidney Injury/immunology , Acute Kidney Injury/therapy , Adult , Age Factors , Aged , COVID-19/complications , COVID-19/immunology , COVID-19/virology , Critical Care/statistics & numerical data , Early Diagnosis , Female , Glomerular Filtration Rate/immunology , Hong Kong/epidemiology , Hospital Mortality , Humans , Incidence , Length of Stay , Male , Mass Screening/statistics & numerical data , Middle Aged , Patient Discharge , Retrospective Studies , Risk Factors , SARS-CoV-2/immunology , SARS-CoV-2/isolation & purification , Severity of Illness IndexABSTRACT
Clinical outcomes of COVID-19 vary considerably between patients. Little was known about the clinical course and optimal management of immunosuppressed patients infected with SARS-CoV-2. We report a kidney transplant recipient with COVID-19 who presented with pneumonitis and acute kidney injury (AKI). She improved after reduction of immunosuppressive treatment and had two consecutive negative reverse transcription polymerase chain reaction (RT-PCR) tests. Her respiratory tract samples turned positive again afterwards, and she was treated with lopinavir-ritonavir. She had satisfactory virological and clinical response after a prolonged disease course. This case illustrates the risk of relapse or persisting shedding of SARS-CoV-2 in immunosuppressed patients, the important role of viral load monitoring in management, the challenges in balancing the risks of COVID-19 progression and transplant rejection, and the pharmacokinetic interaction between immunosuppressive and antiviral medications.