The clinical presentation of AKI complicating COVID-19: Observations from Elmhurst Hospital, New York City

ABSTRACT

Background: Early in March, NYC Hospitals became inundated, especially safety net public hospitals, The physicians at Elmhurst Hospital Center (EHC) encountered countless cases of respiratory failure often accompanied by AKI. Autopsy studies from China described an interstitial nephritis, with macrophage infiltrates and complement deposition along with fibrotic changes. We report our experience with COVID-19 and AKI. Methods: We reviewed the charts of 137 SARS-CoV-2 positive patients (PCR of a nasopharyngeal sample) admitted to EHC 3/7/2020 - 4/7/2020. We categorized patients as having KDIGO defined AKI vs no AKI within the first seven days of admission. Comorbidities, renal associated markers and inflammatory markers were anlayzed. Clinical outcomes were assessed. Exclusion criteria <18 years old, pregnant, ESRD, mortality prior to day 7 of hospitalization. Welch T test and Chi square were used for AKI vs non-AKI Results: Age was similar in both groups as was gender (male 74% vs 79%) and incidence of diabetes. Early AKI developed in 35% of whom 55% needed RRT;85% of the AKI patients required mechanical ventilation vs 11.2% of the non-AKI group. Inflammatory markers (WBC, CRP, LDH);urine protein and urine white cells (but not CPK) were significantly higher in the AKI group. Procalcitonin and D-dimers as maximum levels became significant. We found that 20% of those not with early AKI developed late-onset AKI. Mortality was 76.7% in the AKI and 17.9% in the non-AKI group. Conclusions: Early AKI developing in the first week of hospitalization was associated with overwhelming respiratory failure. The accompanying higher inflammatory markers, elevated urine WBCs and protein could implicate interstitial nephritis as an underlying pathology as described earlier.