ABSTRACT
The presentation of kidney damage in Coronavirus disease 2019 (COVlD-19) varies significantly. According to recent studies. the development of acute kidney injury (AKI) in severe cases of COVID-l9 infection significantly worsens the prognosis of these patients. The pathological changes in kidneys might be caused directly by the cytopathic effect mediated by local replication of the severe acute respiratory syndrome coronavirus-Z (SARS-CoV-Z) or indirectly because of systemic immune response or by- percoagulation, so-called immunothrombosis. Other causes. such as hypovolemia and hypoxia. may also contribute to AKI. Acute kidney disease often develops in elderly patients with underlying comorbidities or in critically ill patients with severe respiratory failure. It is known that AKJ is a risk factor for mortality in C OVID-l9 patients.
ABSTRACT
AIM: To determine the incidence and risk factors of acute kidney injury (AKI) in Russian cohort of patients with COVID-19. MATERIALS AND METHODS: We included 315 patients, who were hospitalized with COVID-19 from October 2020 till February 2021. The diagnosis was established on the basis of the positive SARS-CoV-2 swab test and/or typical radiologic findings on CT scans. RESULTS: AKI complicated the clinical course in 92 (29.21%) cases. The independent risk factors of AKI were female sex, underline chronic kidney disease and the highest level of C-reactive protein during hospitalization. In the general group of patients were 41 (13%) lethal cases, in the group with AKI 32 (34.8%). Compared with those without AKI, patients with AKI had 4.065 (95% confidence interval 2.154 to 7.671) times the odds of death. Respiratory support, the highest serum creatinine and glucose levels appeared to be the risk factors of death among patients with AKI in the multivariable Cox regression. CONCLUSION: The clinical course of COVID-19 was complicated by AKI in 29% cases. The independent risk factors of AKI in patients with COVID-19 are underline chronic kidney disease, circulatory disorder and the highest level of C-reactive protein during hospitalization.
Subject(s)
Acute Kidney Injury , COVID-19 , Renal Insufficiency, Chronic , Humans , Female , Male , COVID-19/complications , COVID-19/epidemiology , SARS-CoV-2 , Creatinine , C-Reactive Protein , Retrospective Studies , Risk Factors , Acute Kidney Injury/diagnosis , Acute Kidney Injury/epidemiology , Acute Kidney Injury/etiology , Kidney , Renal Insufficiency, Chronic/diagnosis , Renal Insufficiency, Chronic/epidemiology , Renal Insufficiency, Chronic/etiology , Glucose , Hospital MortalityABSTRACT
The presented clinical observation reflects the difficulties of differential diagnosis of progressive kidney damage in a patient with sarcoidosis who has undergone a new coronavirus infection. The differential circle included interstitial nephritis as an exacerbation of the underlying disease, acute drug-induced kidney injury, acute glomerulonephritis. Nephrobiopsy confirmed the diagnosis of acute sarcoid tubulointerstitial nephritis with acute tubular necrosis. Timely administration of corticosteroids led to the control of the sarcoidosis process, restoration of kidney function.
Subject(s)
COVID-19 , Nephritis, Interstitial , Sarcoidosis , Humans , COVID-19/diagnosis , Nephritis, Interstitial/diagnosis , Nephritis, Interstitial/drug therapy , Nephritis, Interstitial/etiology , Sarcoidosis/complications , Sarcoidosis/diagnosis , Sarcoidosis/drug therapy , Adrenal Cortex Hormones/therapeutic use , Kidney/pathologyABSTRACT
BACKGROUND AND AIMS: The development of acute kidney injury in COVID-19 patients is associated with a high risk of death. Published data demonstrate the possibility of severe kidney injury in patients suffering from COVID-19;however, these data are still controversial. METHOD: A total of 1,280 patients with a proven diagnosis of COVID-19 were included in our study. COVID-19 disease was confirmed by RT-PCR through a nasopharyngeal swab and typical images from a computed tomography scan in all patients. Demographic data, underlying comorbidities, and laboratory blood tests were assessed. We finally assessed the acute kidney injury (AKI) incidence and mortality defined by the survival status at discharge. RESULTS: In 648 (50.6%) of the patients with COVID-19, proteinuria was evidenced. Haematuria was detected in 77 (6%) patients, and leukocyturia was detected in 282 (22%) hospitalized patients. AKI was determined in 371 (29%) patients, and 10 (2.7%) of them required dialysis. Independent AKI risk factors were age >65 years, augmentation of CRP, ferritin and increase in aPTT values as a result of consumption coagulopathy. A total of 162 (12.7%) of the 1,280 hospitalized patients and 111 (30%) of the 371 patients with AKI did not survive. The hazard ratio for mortality 3.96 [CI 95% 2.828 - 5.542] for patients with AKI vs. No-AKI. CONCLUSION: AKI was determined in 29% patients, in 2.7% of them severe kidney injury required dialysis. Risk factors for AKI in COVID-19 patients are old age, the inflammatory response, the severity of lung involvement and DIC. The same factors and arterial hypertension were found to increase risk of mortality.
ABSTRACT
Background - Acute kidney injury (AKI) reaches 29% in the intensive care unit (ICU). Our study aimed to determine the prevalence, features, and the main AKI factors in critically ill patients with coronavirus disease 2019 (COVID-19). Material and Methods - The study included 37 patients with COVID-19. We analyzed the total blood count test results, biochemical profile panel, coagulation tests, and urine samples. We finally estimated the markers of kidney damage and mortality. Result - All patients in ICU had proteinuria, and 80.5% of patients had hematuria. AKI was observed in 45.9% of patients. Independent risk factors were age more than 60 years, increased C-reactive protein (CRP) level, and decreased platelet count. Conclusion - Kidney damage was observed in most critically ill patients with COVID-19. The independent risk factors for AKI in critically ill patients were elderly age, a cytokine response with a high CRP level.