ABSTRACT
Background: From March through June 2020, SARS-CoV-2 virus surged through the New York Metropolitan area, killing 43,000 in NY and NJ. The sickest patients had both respiratory failure and severe acute kidney injury (AKI), were intubated and on dialysis. Method(s): Seventy intubated patients with severe covid and severe AKI requiring dialysis were treated in 2 north Jersey hospital ICU during this period. Their records were reviewed, focusing particularly during the period of AKI onset to identify potential renal insults - hypotension and shock, secondary infections, and inflammation markers. Result(s): Following admission, respiratory failure quickly progressed, and intubation occurred 3.3 +/- 3.7 days after admission. AKI became evident 1.5 days later (4.7 +/- 4.8 days after admission), and dialysis was initiated 5.4 +/- 6.6 days after AKI onset. Serum creatinine at the start of dialysis was 6.44 +/- 3.40 mg/dl. Around the onset of AKI (start of dialysis +/- 5 days), hemodynamic and clinical instability were rampant. Hypotension requiring vasopressors occurred in 83%;oliguria developed in 79% and worsened to anuria in 33%. Bacteremia and fungemia complicated this period in 28% and 10%. The inflammatory markers - CRP, d-dimer, ferritin, interleukin-6 and ESR, were extremely elevated. Fifty-two patients (74%) died during the hospitalization, 17.7 +/- 11.8 days from admission. Renal function improved in only 1 of these patients. Eighteen patients (26%) survived, and were discharged 63 +/- 15 days after admission. Fifteen (83%) of them regained renal function after requiring dialysis for 20 +/- 15 days. Their serum creatinine decreased to 1.15 +/- 0.63 mg/dl at discharge. Some went through a polyuric phase. Most of these survivors had severe medical problems. Over the next 3.5 months, 5 of them died. Conclusion(s): The following clinical aspects were highly suggestive of acute tubular injury: - onset of AKI during severe hemodynamic instability, intubation, pressor use, secondary infections and intense inflammation;- the rapid progression to uremia;- oliguria early in AKI;some with polyuric phase that preceded improvement of renal function;- short period of dialysis and marked improvement of renal function 8 weeks after onset in 83% of the survivors.