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COVID-19 patients in intensive care develop predominantly oliguric acute kidney injury.
Luther, Tomas; Bülow-Anderberg, Sara; Larsson, Anders; Rubertsson, Sten; Lipcsey, Miklos; Frithiof, Robert; Hultström, Michael.
  • Luther T; Department of Surgical Sciences, Anaesthesiology and Intensive Care Medicine, Uppsala University, Uppsala, Sweden.
  • Bülow-Anderberg S; Department of Surgical Sciences, Anaesthesiology and Intensive Care Medicine, Uppsala University, Uppsala, Sweden.
  • Larsson A; Department of Medical Sciences, Clinical Chemistry, Uppsala University, Uppsala, Sweden.
  • Rubertsson S; Department of Surgical Sciences, Anaesthesiology and Intensive Care Medicine, Uppsala University, Uppsala, Sweden.
  • Lipcsey M; Department of Surgical Sciences, Anaesthesiology and Intensive Care Medicine, Uppsala University, Uppsala, Sweden.
  • Frithiof R; Hedenstierna laboratory, CIRRUS, Anaesthesiology and Intensive Care Medicine, Department of Surgical Sciences, Uppsala University, Uppsala, Sweden.
  • Hultström M; Department of Surgical Sciences, Anaesthesiology and Intensive Care Medicine, Uppsala University, Uppsala, Sweden.
Acta Anaesthesiol Scand ; 65(3): 364-372, 2021 03.
Article in English | MEDLINE | ID: covidwho-944614
ABSTRACT

BACKGROUND:

Acute kidney injury (AKI) is a syndrome of reduced glomerular filtration rate and/or reduced urine flow associated with mortality in corona virus disease 2019 (COVID-19). AKI is often associated with renal tissue damage, which may lead to chronic kidney disease. Biomarkers of tissue damage may identify patients of particular risk.

METHODS:

In a prospective observational study of 57 patients admitted to intensive care, AKI incidence and characteristics was evaluated according to KDIGO criteria and related to days after admission. Urinary albumin, Neutrophil Gelatinase-Associated Lipocalin (NGAL), Kidney Injury Molecule 1 (KIM-1) and Plasma Tissue Inhibitor of MetalloProteinase 2 (TIMP-2) were analysed in 52 patients at admission. The majority (n = 51, 89%) of patients developed AKI, and 27 (47%) patients had predominantly oliguric AKI where oliguria was more severe than plasma Creatinine increase. Severe oliguria within first 2 days after admission was common (n = 37, 65%), whereas stage 2 and 3 AKI due to Creatinine occurred later than day 2 in 67% (12/18) of cases. Renal replacement therapy was started in 9 (16%) patients, and 30-day mortality was 28%. Urinary biomarkers were increased in a majority of patients, but did not robustly predict KDIGO stage. Most patients had microalbuminuria, and severe albuminuria (albumin Creatinine ratio > 30 mg/mmol) was found in n = 9 (17%) patients.

CONCLUSIONS:

A majority of patients with COVID-19 admitted to the ICU develop AKI. The functional deficit is often low urinary volume, and initial levels of biomarkers are generally increased without clear relation to final AKI stage.
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Full text: Available Collection: International databases Database: MEDLINE Main subject: Oliguria / Critical Care / Acute Kidney Injury / COVID-19 Type of study: Cohort study / Experimental Studies / Observational study / Prognostic study Topics: Long Covid Limits: Female / Humans / Male / Middle aged Language: English Journal: Acta Anaesthesiol Scand Year: 2021 Document Type: Article Affiliation country: Aas.13746

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Full text: Available Collection: International databases Database: MEDLINE Main subject: Oliguria / Critical Care / Acute Kidney Injury / COVID-19 Type of study: Cohort study / Experimental Studies / Observational study / Prognostic study Topics: Long Covid Limits: Female / Humans / Male / Middle aged Language: English Journal: Acta Anaesthesiol Scand Year: 2021 Document Type: Article Affiliation country: Aas.13746