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261, 435, 768 COVID-19 infections were detected worldwide, of them 5, 207, 634 deaths were registered. Identifying markers of the patient severity early in the course of the disease can facilitate the assessment of the risk of adverse outcome. The objective: To compare values of laboratory parameters and their changes during treatment of patients with a complicated course of COVID-19 infection. Subjects and Methods. 56 patients were included in the study, all of them were hospitalized to COVID Hospital of the Clinic of Bashkir State Medical University, Russian Ministry of Health, from September 30, 2021 to November 15, 2021, and their complicated course of the disease necessitated transfer to the intensive care unit (ICU). The laboratory evaluation included the following: a general blood and urine counts, blood chemistry including urea and creatinine, liver transaminases, and blood coagulogram (prothrombin time (PTT), prothrombin index (PTI), thrombin time, fibrinogen, and blood clotting time). Results. In the group of patients with a fatal outcome on the day of transfer to ICU, lymphocytopenia, eosinopenia, elevated values of creatinine, total bilirubin, transaminases, C-reactive protein, D-dimer, and ferritin were noted. Also on this day, microscopic hematuria, proteinuria and cylindruria were detected in the urine tests of most patients in this group during treatment. Conclusion. Critical deviations in the results of hematological and biochemical tests were revealed. Particular attention should be paid to such parameters as the level of erythrocytes, lymphocytes, eosinophils, glucose, urea, creatinine, total bilirubin, aspartate aminotransferase, alanine aminotransferase, creatine kinase, C-reactive protein, D-dimer, and ferritin. © 2022 The authors.
ABSTRACT
INTRODUCTION AND OBJECTIVE: Acute kidney injury (AKI) in coronavirus infection (COVID-19) caused by the SARS-CoV-2 virus is much more common than previously thought and is associated with severe disease and high mortality. Despite the fact that the respiratory and immune systems are the main targets of the COVID- 19 virus, AKI is also observed, identified by the occurrence of proteinuria or hematuria, an increase in serum urea and creatinine levels. The aim of the study is to assess the pathomorphological changes in the kidneys in 100 cases of autopsy of patients with COVID-19 using light microscopy and immunohistochemical diagnostic methods in order to clarify the possible mechanism of AKI. METHODS: The study was carried out using samples obtained from 100 patients, the time interval of the onset of the disease corresponded to the 4th wave of the peak of the incidence in Russia (from June 2021). The age of patients varied from 37 to 94 years 72 (s =12.5), men - 34, women - 66. Patients with chronic kidney disease, diabetes mellitus and cancer were not included in the analysis. The cause of death in all cases was acute respiratory failure, histologically defined as diffuse alveolar injury. AKI in accordance with the KDIGO criteria was detected in 34 patients. RESULTS: On light microscopy, diffuse massive damage to the proximal tubules with loss of the brush border, degeneration of vacuoles was detected in 46 patients, massive necrosis of the tubules in 11 patients. In 65 patients, an extremely pronounced congestion of paretic dilated vessels with widespread paravasal hemorrhages was revealed. Paravasal lymphoid infiltration of the vascular endothelium was detected in 27 patients. Severe sludge syndrome in small and medium-sized vessels in 46 patients. In almost all cases, hemosiderin granules and hyaline casts were found. The quantitative and qualitative composition of tissue macrophages corresponded to the population data, without visible correlations with the disease. CONCLUSIONS: According to the study, the factors contributing to AKI include systemic hypoxia, abnormal coagulation, increased catabolism due to fever, drug-related rhabdomyolysis or hyperventilation with increased serum degradation products. Thus, our research provides evidence for AKI during the progression of COVID-10. These results contribute to a better understanding of the course and progression of SARS-CoV-2 virus infection.
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Introduction & Objective: Coronavirus Disease 2019 (COVID- 19) is a newly emerging respiratory infection with frequent acute kidney injury (AKI). However, dynamic changes in kidney function and its relationship to predicting COVID-19 outcomes are not sufficiently defined to apply preventive measures in patient management strategies. , especially in patients with concomitant diseases or undergoing surgery. Methods: This single-center retrospective cohort study analyzed the clinical characteristics, medical history, laboratory and instrumental studies and treatment data of 160 patients with COVID-19, among whom at the time of hospitalization there were no clinical signs of AKI according to the criteria, there were 40 people who analyzed the data of the marker panel. AKI: urine NGAL, serum CisC, urine IL-18, the sensitivity, specificity and threshold values of which were determined from the ROC analysis of 236 patients with initially diagnosed AKI during hospitalization. Renal function was assessed using the calculated GFR equation (CKD-EPI 2009) based on serum creatinine levels. Results: AKI at hospitalization was detected in 16 patients, Distribution by stages: 8.13%, 12.6% and 24.5% according to the KDIGO criteria. The ROC analysis determined the threshold value of the Marker Panel in patients with AKI at hospitalization, which was 156.87 ng / ml NGAL, 79.42 ± 13.69 for IL-18, and 175.0 ± 16.63 for SCysC. The sensitivity of the method was 80% and the specificity was 73.7%. Based on the panel of markers, a subclinical form of AKI was identified, the outcomes of which were assessed within 3 months. In 14 patients of this group, a decrease in the GFR level was recorded within 30 days after hospitalization, associated with a lethal outcome. Mortality within 30 days from common causes was 8.3% Conclusions: The increased risk of death from all causes was associated with increased levels of the AKI and Scr panel markers in the control group. Dynamic changes in the three markers of kidney function have been associated with varying degrees of severity and poor prognosis in COVID-19 patients. The AKI marker panel has demonstrated high potential for predicting adverse outcomes in COVID-19 patients for severity stratification and patient strategy. (Table Presented).
ABSTRACT
COVID-19 is an acute respiratory viral disease that primarily affects the lungs, but can also affect other organs, including the kidneys. Damage to the kidneys can be caused by direct effects arising from the invasion of the virus into kidney cells, or it occurs secondarily due to immunological, hemocoagulation and ischemic disorders. Given the importance of preserving kidney function during illness and after recovery, this review aims to investigate the impact of novel coronavirus infection on the kidney and its role in the development of acute kidney injury.