Supplementary Files
How to Cite
Abstract
Objective: The purpose of this research was to determine the incidence of Acute Kidney Injury (AKI) in COVID-19-affected patients
Methods: This retrospective cohort study was conducted at Ziauddin Hospital Clifton Campus from June to December 2020. Adult patients with AKI or acute-on-chronic kidney disease (ACKD) were included in a retrospective study. Patients infected with SARS-CoV2 and renal involvement were directed towards the ICU/Nephrology departments which have the expertise to perform laboratory analysis, radiography and institution of treatment. Supplemental oxygen use was documented. The research also assessed information about therapy (antivirals, immunomodulators, RRT) and results (renal function recovery or death).
Results: After excluding patients with obstructive AKI, a total of 180 (mean age 50.1 years) of 104 males and 76 females were included in the research. 120 patients were found to have prerenal, and 60 had intrinsic AKI with significant differences between mild, moderate, and severe cases (p=0.004). Acute kidney injury (AKI) survivors had a complete recovery rate of 70%, a partial recovery rate of 22%, and a hemodialysis dependency rate of 8%.
Conclusion: Patients with severe COVID-19 infection often develop more severe AKI, and those in the severe or critical stages often exhibit proteinuria and dipstick hematuria. Long-term follow-up for COVID-19 patients should be done to evaluate its influence on renal outcome, and larger samples are required to elucidate the association between COVID-19 and renal damage.
Keywords: Coronavirus Disease, Renal Replacement Therapy, proteinuria, dipstick hematuria
References
Onyeaka H, Anumudu CK, Al-Sharify ZT, Egele-Godswill E, Mbaegbu P. COVID-19 pandemic: A review of the global lockdown and its far-reaching effects. Sci Prog. 2021 Apr-Jun;104(2):368504211019854. doi: 10.1177/00368504211019854.
Sohrabi C, Alsafi Z, O'neill N, Khan M, Kerwan A, Al-Jabir A, et al. World Health Organization declares global emergency: A review of the 2019 novel coronavirus (COVID-19). International journal of surgery. 2020;76:71-6. doi: 10.1016/j.ijsu.2020.02.034
García LF. Immune response, inflammation, and the clinical spectrum of COVID-19. Frontiers in immunology. 2020;11:1441. doi: 10.3389/fimmu.2020.01441.
Gabarre P, Dumas G, Dupont T, Darmon M, Azoulay E, Zafrani L. Acute kidney injury in critically ill patients with COVID-19. Intensive care medicine. 2020;46:1339-48. doi: 10.1007/s00134-020-06153-9.
Fu EL, Janse RJ, de Jong Y, van der Endt VH, Milders J, van der Willik EM, et al. Acute kidney injury and kidney replacement therapy in COVID-19: a systematic review and meta-analysis. Clinical kidney journal. 2020;13(4):550-63. doi: 10.1093/ckj/sfaa160.
Shao M, Li X, Liu F, Tian T, Luo J, Yang Y. Acute kidney injury is associated with severe infection and fatality in patients with COVID-19: A systematic review and meta-analysis of 40 studies and 24,527 patients. Pharmacological research. 2020;161:105107. doi: 10.1016/j.phrs.2020.105107.
Nadim MK, Forni LG, Mehta RL, Connor Jr MJ, Liu KD, Ostermann M, et al. COVID-19-associated acute kidney injury: consensus report of the 25th Acute Disease Quality Initiative (ADQI) Workgroup. Nature reviews Nephrology. 2020;16(12):747-64. doi: 10.1038/s41581-020-00356-5.u6u
Post-COVID-19 global health strategies: the need for an interdisciplinary approach. Ageing clinical and experimental research. 2020;32(8):1613-20. doi: 10.1007/s40520-020-01616-x
Tan BW, Tan BW, Tan AL, Schriver ER, Gutiérrez-Sacristán A, Das P, et al. Long-term kidney function recovery and mortality after COVID-19-associated acute kidney injury: An international multi-centre observational cohort study. Eclinicalmedicine. 2023;55:101724. doi: 10.1016/j.eclinm.2022.101724.
Wainstein M, MacDonald S, Fryer D, Young K, Balan V, Begum H, et al. Use of an extended KDIGO definition to diagnose acute kidney injury in patients with COVID-19: A multinational study using the ISARIC–WHO clinical characterisation protocol. PLoS medicine. 2022;19(4):e1003969. https://doi.org/10.1371/journal.pmed.1003969
Silver SA, Beaubien-Souligny W, Shah PS, Harel S, Blum D, Kishibe T, et al. The prevalence of acute kidney injury in patients hospitalized with COVID-19 infection: a systematic review and meta-analysis. Kidney medicine. 2021;3(1):83-98. e1. doi: 10.1016/j.xkme.2020.11.008.
Long JD, Strohbehn I, Sawtell R, Bhattacharyya R, Sise ME. COVID-19 Survival and its impact on chronic kidney disease. Translational Research. 2022;241:70-82. doi: 10.1016/j.trsl.2021.11.003.
Lumlertgul N, Pirondini L, Cooney E, Kok W, Gregson J, Camporota L, et al. Acute kidney injury prevalence, progression and long-term outcomes in critically ill patients with COVID-19: a cohort study. Annals of intensive care. 2021;11(1):1-11. doi: 10.1186/s13613-021-00914-5.
Palvesky P, Radhakrishnan J, Townsend RR. COVID-19: Issues related to acute kidney injury, glomerular disease, and hypertension. UpToDate; 2020.
Zhang W, Liu L, Xiao X, Zhou H, Peng Z, Wang W, et al. Identification of common molecular signatures of SARS-CoV-2 infection and its influence on acute kidney injury and chronic kidney disease. Frontiers in Immunology. 2023;14. https://doi.org/10.3389/fimmu.2023.961642
Bhatraju PK, Ghassemieh BJ, Nichols M, Kim R, Jerome KR, Nalla AK, et al. Covid-19 in critically ill patients in the Seattle region—case series. New England Journal of Medicine. 2020;382(21):2012-22. doi: 10.1056/NEJMoa2004500
Robbins-Juarez SY, Qian L, King KL, Stevens JS, Husain SA, Radhakrishnan J, Mohan S. Outcomes for Patients With COVID-19 and Acute Kidney Injury: A Systematic Review and Meta-Analysis. Kidney Int Rep. 2020 Jun 25;5(8):1149-1160. doi: 10.1016/j.ekir.2020.06.013.
Chaudhri I, Moffitt R, Taub E, Annadi RR, Hoai M, Bolotova O, et al. Association of proteinuria and hematuria with acute kidney injury and mortality in hospitalized patients with COVID-19. Kidney and Blood Pressure Research. 2020;45(6):1018-32. doi: 10.1159/000511946.
Xu H, Garcia-Ptacek S, Annetorp M, Bruchfeld A, Cederholm T, Johnson P, et al. Acute kidney injury and mortality risk in older adults with COVID-19. Journal of nephrology. 2021;34:295-304. doi: 10.1007/s40620-021-01022-0.
Huang C, Soleimani J, Herasevich S, Pinevich Y, Pennington KM, Dong Y, et al., editors. Clinical characteristics, treatment, and outcomes of critically ill patients with COVID-19: a scoping review. Mayo Clin Proc. 2021 Jan;96(1):183-202. doi: 10.1016/j.mayocp.2020.10.022.
Graidis S, Papavramidis TS, Papaioannou M. Vitamin D and Acute Kidney Injury: A Two-Way Causality Relation and a Predictive, Prognostic, and Therapeutic Role of Vitamin D. Front Nutr. 2021 Mar 4;7:630951. doi: 10.3389/fnut.2020.630951.
Legrand M, Bell S, Forni L, Joannidis M, Koyner JL, Liu K, et al. Pathophysiology of COVID-19-associated acute kidney injury. Nature Reviews Nephrology. 2021;17(11):751-64. https://doi.org/10.1038/s41581-021-00452-0
Farouk SS, Fiaccadori E, Cravedi P, Campbell KN. COVID-19 and the kidney: what we think we know so far and what we don’t. Journal of nephrology. 2020;33:1213-8. doi: 10.1007/s40620-020-00789-y.
Bruchfeld A. The COVID-19 pandemic: consequences for nephrology. Nature Reviews Nephrology. 2021;17(2):81-2. doi: 10.1038/s41581-020-00381-4.
Birkelo BC, Parr SK, Perkins AM, Greevy Jr RA, Hung AM, Shah SC, et al. Comparison of COVID-19 versus influenza on the incidence, features, and recovery from acute kidney injury in hospitalized United States Veterans. Kidney International. 2021;100(4):894-905. doi: 10.1016/j.kint.2021.05.029
Batlle D, Soler MJ, Sparks MA, Hiremath S, South AM, Welling PA, et al. Acute kidney injury in COVID-19: emerging evidence of a distinct pathophysiology. Journal of the American Society of Nephrology. 2020;31(7):1380-3. doi: 10.1681/ASN.2020040419.
Serafinelli J, Mastrangelo A, Morello W, Cerioni VF, Salim A, Nebuloni M, et al. Kidney involvement and histological findings in two pediatric COVID-19 patients. Pediatric Nephrology. 2021;36(11):3789-93. DOI: 10.1007/s00467-021-05212-7.
Bullock, HA, Goldsmith CS, Zaki SR, Martines RB, Miller SE. Difficulties in differentiating coronaviruses from Subcellular Structures in Human Tissues by Electron Microscopy. Emerging Infectious Diseases . 2021 Ap ;27(4), 1023-1031. DOI:10.3201/eid2704.204337.
Hopfer H, Herzig MC, Gosert R, Menter T, Hench J, Tzankov A, Hirsch HH, Miller SE. Hunting coronavirus by transmission electron microscopy–a guide to SARS‐CoV‐2‐associated ultrastructural pathology in COVID‐19 tissues. Histopathology. 2021 Feb;78(3):358-70.
Zaki N, Alashwal H, Ibrahim S. Association of hypertension, diabetes, stroke, cancer, kidney disease, and high-cholesterol with COVID-19 disease severity and fatality: A systematic review. Diabetes & Metabolic Syndrome: Clinical Research & Reviews. 2020;14(5):1133-42. DOI: 10.1016/j.dsx.2020.07.005.
Li Q, Zhang T, Li F, Mao Z, Kang H, Tao L, et al. Acute kidney injury can predict in-hospital mortality in elderly patients with COVID-19 in the ICU: a single-center study. Clinical interventions in aging. 2020:2095-107. DOI: 10.2147/CIA.S273720
Liang W, Liang H, Ou L, Chen B, Chen A, Li C, Li Y, Guan W, Sang L, Lu J, Xu Y. Development and validation of a clinical risk score to predict the occurrence of critical illness in hospitalized patients with COVID-19. JAMA internal medicine. 2020 Aug 1;180(8):1081-9. DOI:10.1001/jamainternmed.2020.2033
Zhuang MW, Cheng Y, Zhang J, Jiang XM, Wang L, Deng J, et al. Increasing host cellular receptor—angiotensin‐converting enzyme 2 expression by coronavirus may facilitate 2019‐nCoV (or SARS‐CoV‐2) infection. Journal of medical virology. 2020;92(11):2693-701. DOI: 10.1002/jmv.26139
Douangboupha V. Applied Epidemiology of Infectious Diseases in Lao People's Democratic Republic (Lao PDR): The Australian National University (Australia); 2022.
Khismatullin RR, Ponomareva AA, Nagaswami C, Ivaeva RA, Montone KT, Weisel JW, Litvinov RI. Pathology of lung‐specific thrombosis and inflammation in COVID‐19. Journal of Thrombosis and Haemostasis. 2021 Dec 1;19(12):3062-72.DOI: 10.1111/jth.15532.
National Health Commission & National Administration of Traditional Chinese Medicine. Diagnosis and treatment protocol for novel coronavirus pneumonia (Trial Version 7). Chinese Medical Journal. 2020 May 1;133(09):1087-95. DOI: 10.1097/CM9.0000000000000819.
Pei G, Zhang Z, Peng J, Liu L, Zhang C, Yu C, et al. Renal involvement and early prognosis in patients with COVID-19 pneumonia. Journal of the American Society of Nephrology. 2020;31(6):1157-65.
Jafar TH, Chaturvedi N, Gul A, Khan AQ, Schmid CH, Levey AS. Ethnic differences and determinants of proteinuria among South Asian subgroups in Pakistan. Kidney international. 2003 Oct 1;64(4):1437-44. DOI: 10.1046/j.1523-1755.2003.00212.
This work is licensed under a Creative Commons Attribution-ShareAlike 4.0 International License.
Copyright (c) 2023 Mahvesh Mahmud, Ashok Kumar, Khurram Baqai