ABSTRACT
Introduction: Covid-19-associated rhabdomyolysis has not been clearly established;therefore, clinicians might have low clinical suspicion for rhabdomyolysis Case Description: We are presenting five cases where Covid-19 patients became very catabolic and developed rhabdomyolysis associated with acute kidney injury (AKI). Symptoms were shortness of breath, fever, generalized malaise one week before the presentation. At the time of admission all patients had fever, tachycardia, tachypnea and were hypoxemic. One day later they were intubated for tachypnea and worsening oxygen saturation. They were admitted to the intensive care units and were treated with intravenous hydration. All the patients eventually required pressor support. AKI developed 10 days after onset of the symptoms and it was attributed to cytokine storm, ischemic acute tubular necrosis, and rhabdomyolysis. Intravenous furosemide was attempted with poor responses. Renal replacement therapy (RRT) was needed approximately three days after development of AKI. Continues renal replacement therapy (CRRT) was the modality used. After 3 days of interrupted therapy due to clotting, there was not improvement and overall high mortality. Discussion: Rhabdomyolysis has been associated with many infectious diseases, including viral infections. The direct viral invasion and circulating viral toxins may directly destroy muscle cell membranes leading to rhabdomyolysis. However theexcessive immune response and cytokine storms which often seen in COVID-19 can promote to high catabolic state and rhabdomyolysis and therefore it will contribute to rapid worsening on renal function. Early detection and promptly supportive treatment with RRT may help to improve the vital prognosis of COVID-19.
ABSTRACT
Background: Angiotensin converting enzyme (ACE 2) receptor has been implicated as an entry point for severe acute respiratory syndrome coronavirus 2 (SARS-COV-2) causing pandemic coronavirus disease 2019 (COVID-19). Experts have postulated the potential benefits of using ACEI/ARB to reduce the severity of acute lung injury and as the treatment of hypertension in COVID-19. However, there is limited data in showing the renal outcomes after the use of angiotensin converting enzyme inhibitors (ACEIs) and angiotensin II receptor blockers (ARBs) in COVID-19 patients. Methods: This is a retrospective, single center study of 300 patients diagnosed with COVID-19 confirmed by real-time reverse transcription polymerase chain reaction. Four groups were divided based on ACEI/ARB exposure. Group 1 (n=51 patients;17%) were initiated on ACEIs/ARBs during hospitalization, group 2 (n=58 patients;19%) were on ACEIs/ARBS at home and discontinued, group 3 (n=76 patients;25%) were on ACES/ ARBS at home and continued during hospitalization and group 4 (n=116 patients;38%) were never treated with ACEIs/ARBS. The primary end points including the incidence of AKI using KDIGO definition, hyperkalemia, the necessity of dialysis and the secondary end points being the length of total hospital stays, the recovery rate, mortality rate were compared between group 1,2,3 with 4 using adjusted odd ratios (ORs). Results: In group 1, the use of ACEI/ARB has 4 times higher risk of developing AKI than the control group 4 (P= 0.001, 95% CI of 1.70-9.59). and is 4.6 times for stage 2 or above AKI (P= 0.001;95% CI of 1.8-11.5). OR for hyperkalemia is 5.7 (P= 0.001, 95% CI of 2.09-15.5) and for hemodialysis is 3.7 (P= 0.02, 95% CI of 1.2-11.2). Their mortality rate is increased 2.9 times (P=0.026, 95% CI of 1.23-7.44). In group 2, the incidence of AKI is 7.5 times higher (P= <0.001, 95% CI of 3.3-17) and 3.5 times (P=0.001, 95% CI of 1.6-7.7) for stage 2 above AKI. OR for the initiation of hemodialysis and the mortality rate are not statistically significant after adjusted with variables. In group 3, no statistically significant data were found. Conclusions: Our findings suggest that the initiation of ACEI/ARB in COVID 19 patients have increased risk of AKI, hyperkalemia, necessity of dialysis and mortality rate.