COVID-19-associated acute kidney injury: Difference between revisions

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** [[Angiotensin-converting enzyme 2]] ([[ACE2]]), which is a primary [[receptor]] for [[SARS-CoV-2]] entry into cells, mostly presents in [[Kidneys]] as well as [[lungs]] and [[heart]].<ref name="MalhaMueller2020">{{cite journal|last1=Malha|first1=Line|last2=Mueller|first2=Franco B.|last3=Pecker|first3=Mark S.|last4=Mann|first4=Samuel J.|last5=August|first5=Phyllis|last6=Feig|first6=Peter U.|title=COVID-19 and the Renin-Angiotensin System|journal=Kidney International Reports|volume=5|issue=5|year=2020|pages=563–565|issn=24680249|doi=10.1016/j.ekir.2020.03.024}}</ref>
** [[Angiotensin-converting enzyme 2]] ([[ACE2]]), which is a primary [[receptor]] for [[SARS-CoV-2]] entry into cells, mostly presents in [[Kidneys]] as well as [[lungs]] and [[heart]].<ref name="MalhaMueller2020">{{cite journal|last1=Malha|first1=Line|last2=Mueller|first2=Franco B.|last3=Pecker|first3=Mark S.|last4=Mann|first4=Samuel J.|last5=August|first5=Phyllis|last6=Feig|first6=Peter U.|title=COVID-19 and the Renin-Angiotensin System|journal=Kidney International Reports|volume=5|issue=5|year=2020|pages=563–565|issn=24680249|doi=10.1016/j.ekir.2020.03.024}}</ref>
*** High expression of [[ACE2]] was found in the [[renal]] proximal [[tubular]] cells and rarely in [[podocytes]]. <ref name="pmid17021266">{{cite journal| author=Ye M, Wysocki J, William J, Soler MJ, Cokic I, Batlle D| title=Glomerular localization and expression of Angiotensin-converting enzyme 2 and Angiotensin-converting enzyme: implications for albuminuria in diabetes. | journal=J Am Soc Nephrol | year= 2006 | volume= 17 | issue= 11 | pages= 3067-75 | pmid=17021266 | doi=10.1681/ASN.2006050423 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17021266  }} </ref> <ref name="pmid32203970">{{cite journal| author=Perico L, Benigni A, Remuzzi G| title=Should COVID-19 Concern Nephrologists? Why and to What Extent? The Emerging Impasse of Angiotensin Blockade. | journal=Nephron | year= 2020 | volume= 144 | issue= 5 | pages= 213-221 | pmid=32203970 | doi=10.1159/000507305 | pmc=7179544 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=32203970  }} </ref>
*** High expression of [[ACE2]] was found in the [[renal]] proximal [[tubular]] cells and rarely in [[podocytes]]. <ref name="pmid17021266">{{cite journal| author=Ye M, Wysocki J, William J, Soler MJ, Cokic I, Batlle D| title=Glomerular localization and expression of Angiotensin-converting enzyme 2 and Angiotensin-converting enzyme: implications for albuminuria in diabetes. | journal=J Am Soc Nephrol | year= 2006 | volume= 17 | issue= 11 | pages= 3067-75 | pmid=17021266 | doi=10.1681/ASN.2006050423 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17021266  }} </ref> <ref name="pmid32203970">{{cite journal| author=Perico L, Benigni A, Remuzzi G| title=Should COVID-19 Concern Nephrologists? Why and to What Extent? The Emerging Impasse of Angiotensin Blockade. | journal=Nephron | year= 2020 | volume= 144 | issue= 5 | pages= 213-221 | pmid=32203970 | doi=10.1159/000507305 | pmc=7179544 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=32203970  }} </ref>
== Differentiating COVID-19-associated acute kidney injury from other Diseases ==
* [[COVID-19]]-associated [[AKI]] must be differentiated from other diseases that cause [[AKI]], such as [[congestive heart failure]], [[hemorrhage]], [[dehydration]], [[liver failure]], [[urinary tract obstruction]], [[Interstitial nephritis]], [[glomerulonephritis]] and [[nephrotoxic]] [[medications]].
To review the differential diagnosis of [[AKI]], click [[Acute kidney injury differential diagnosis#Acute kidney injury differential diagnosis|here]].


== Epidemiology and Demographics ==
== Epidemiology and Demographics ==

Revision as of 05:19, 16 July 2020

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Nasrin Nikravangolsefid, MD-MPH [2],Sogand Goudarzi, MD [3]

Synonyms and keywords: COVID-19-associated AKI

Overview

COVID-19 can involve many organs leading to organ failure, one of which is kidneys that manifest with mild proteinuria to advanced acute kidney injury (AKI).

Historical Perspective

Classification

Pathophysiology

Causes

  • SARS-CoV-2 may have a Kidney tropism. As a recent study found SARS-CoV-2 antigens in renal tubules which suggests the direct damage of SARS-CoV-2 on the kidneys. https://www.medrxiv.org/content/10.1101/2020.03.04.20031120v4. Missing or empty |title= (help)

Differentiating COVID-19-associated acute kidney injury from other Diseases

To review the differential diagnosis of AKI, click here.

Epidemiology and Demographics

Age

  • AKI is more commonly observed among elderly patients.(Mean age: 57.1) [3]

Gender

Race

  • There is no racial predilection for COVID-19 associated AKI.


Risk Factors

Screening

  • Serial monitoring of kidney function tests should be considered in high risk patients.[13]

Natural History, Complications, and Prognosis

Natural History

  • If no improvement occurs during follow-up, it is contributed to higher mortality.[2]

Diagnosis

Diagnostic Study of Choice

  • The diagnosis of AKI is based on the KDIGO criteria, which includes[15]:
    • Elevated serum Creatinine by ≥0.3 mg/dl (≥26.5 μmol/l) within 48 hours; or
    • Elevated serum Creatinine to ≥1.5 times baseline within the previous 7 days; or
    • Urine volume < 0.5 ml/kg/h for >6 hours

Symptoms

Physical Examination

Laboratory Findings

Electrocardiogram

X-ray

Echocardiography or Ultrasound

CT scan

  • There are no CT scan findings associated with AKI.

MRI

  • There are no MRI findings associated with AKI.

Other Imaging Findings

Other Diagnostic Studies

  • There are no other diagnostic studies associated with AKI.

Treatment

Medical Therapy

Interventions

Prevention


References

  1. Wang, Luwen; Li, Xun; Chen, Hui; Yan, Shaonan; Li, Dong; Li, Yan; Gong, Zuojiong (2020). "Coronavirus Disease 19 Infection Does Not Result in Acute Kidney Injury: An Analysis of 116 Hospitalized Patients from Wuhan, China". American Journal of Nephrology. 51 (5): 343–348. doi:10.1159/000507471. ISSN 0250-8095.
  2. 2.0 2.1 2.2 Pei, Guangchang; Zhang, Zhiguo; Peng, Jing; Liu, Liu; Zhang, Chunxiu; Yu, Chong; Ma, Zufu; Huang, Yi; Liu, Wei; Yao, Ying; Zeng, Rui; Xu, Gang (2020). "Renal Involvement and Early Prognosis in Patients with COVID-19 Pneumonia". Journal of the American Society of Nephrology. 31 (6): 1157–1165. doi:10.1681/ASN.2020030276. ISSN 1046-6673.
  3. 3.0 3.1 3.2 3.3 Pei G, Zhang Z, Peng J, Liu L, Zhang C, Yu C; et al. (2020). "Renal Involvement and Early Prognosis in Patients with COVID-19 Pneumonia". J Am Soc Nephrol. 31 (6): 1157–1165. doi:10.1681/ASN.2020030276. PMC 7269350 Check |pmc= value (help). PMID 32345702 Check |pmid= value (help).
  4. 4.0 4.1 4.2 4.3 Malha, Line; Mueller, Franco B.; Pecker, Mark S.; Mann, Samuel J.; August, Phyllis; Feig, Peter U. (2020). "COVID-19 and the Renin-Angiotensin System". Kidney International Reports. 5 (5): 563–565. doi:10.1016/j.ekir.2020.03.024. ISSN 2468-0249.
  5. 5.0 5.1 5.2 Ronco C, Reis T (2020). "Kidney involvement in COVID-19 and rationale for extracorporeal therapies". Nat Rev Nephrol. 16 (6): 308–310. doi:10.1038/s41581-020-0284-7. PMC 7144544 Check |pmc= value (help). PMID 32273593 Check |pmid= value (help).
  6. Husain-Syed F, Slutsky AS, Ronco C (2016). "Lung-Kidney Cross-Talk in the Critically Ill Patient". Am J Respir Crit Care Med. 194 (4): 402–14. doi:10.1164/rccm.201602-0420CP. PMID 27337068.
  7. Ye M, Wysocki J, William J, Soler MJ, Cokic I, Batlle D (2006). "Glomerular localization and expression of Angiotensin-converting enzyme 2 and Angiotensin-converting enzyme: implications for albuminuria in diabetes". J Am Soc Nephrol. 17 (11): 3067–75. doi:10.1681/ASN.2006050423. PMID 17021266.
  8. Perico L, Benigni A, Remuzzi G (2020). "Should COVID-19 Concern Nephrologists? Why and to What Extent? The Emerging Impasse of Angiotensin Blockade". Nephron. 144 (5): 213–221. doi:10.1159/000507305. PMC 7179544 Check |pmc= value (help). PMID 32203970 Check |pmid= value (help).
  9. Richardson S, Hirsch JS, Narasimhan M, Crawford JM, McGinn T, Davidson KW; et al. (2020). "Presenting Characteristics, Comorbidities, and Outcomes Among 5700 Patients Hospitalized With COVID-19 in the New York City Area". JAMA. doi:10.1001/jama.2020.6775. PMC 7177629 Check |pmc= value (help). PMID 32320003 Check |pmid= value (help).
  10. 10.0 10.1 10.2 Gabarre P, Dumas G, Dupont T, Darmon M, Azoulay E, Zafrani L (2020). "Acute kidney injury in critically ill patients with COVID-19". Intensive Care Med. 46 (7): 1339–1348. doi:10.1007/s00134-020-06153-9. PMC 7290076 Check |pmc= value (help). PMID 32533197 Check |pmid= value (help).
  11. Sharma G, Volgman AS, Michos ED (2020). "Sex Differences in Mortality from COVID-19 Pandemic: Are Men Vulnerable and Women Protected?". JACC Case Rep. doi:10.1016/j.jaccas.2020.04.027. PMC 7198137 Check |pmc= value (help). PMID 32373791 Check |pmid= value (help).
  12. Rabb H (2020). "Kidney diseases in the time of COVID-19: major challenges to patient care". J Clin Invest. 130 (6): 2749–2751. doi:10.1172/JCI138871. PMC 7259985 Check |pmc= value (help). PMID 32250968 Check |pmid= value (help).
  13. 13.0 13.1 13.2 13.3 13.4 13.5 Selby NM, Forni LG, Laing CM, Horne KL, Evans RD, Lucas BJ; et al. (2020). "Covid-19 and acute kidney injury in hospital: summary of NICE guidelines". BMJ. 369: m1963. doi:10.1136/bmj.m1963. PMID 32457068 Check |pmid= value (help).
  14. 14.0 14.1 14.2 Ronco C, Reis T, Husain-Syed F (2020). "Management of acute kidney injury in patients with COVID-19". Lancet Respir Med. doi:10.1016/S2213-2600(20)30229-0. PMC 7255232 Check |pmc= value (help). PMID 32416769 Check |pmid= value (help).
  15. 15.0 15.1 15.2 Khwaja A (2012). "KDIGO clinical practice guidelines for acute kidney injury". Nephron Clin Pract. 120 (4): c179–84. doi:10.1159/000339789. PMID 22890468.
  16. Skorecki K, Green J, Brenner BM (2005). "Chronic renal failure". In Kasper DL, Braunwald E, Fauci AS, et al. Harrison's Principles of Internal Medicine (16th ed.). New York, NY: McGraw-Hill. pp. 1653–63. ISBN 978-0-07-139140-5.
  17. Kashani K, Cheungpasitporn W, Ronco C (2017). "Biomarkers of acute kidney injury: the pathway from discovery to clinical adoption". Clin Chem Lab Med. 55 (8): 1074–1089. doi:10.1515/cclm-2016-0973. PMID 28076311.
  18. Schrezenmeier EV, Barasch J, Budde K, Westhoff T, Schmidt-Ott KM (2017). "Biomarkers in acute kidney injury - pathophysiological basis and clinical performance". Acta Physiol (Oxf). 219 (3): 554–572. doi:10.1111/apha.12764. PMC 5575831. PMID 27474473.
  19. Oh DJ (2020). "A long journey for acute kidney injury biomarkers". Ren Fail. 42 (1): 154–165. doi:10.1080/0886022X.2020.1721300. PMC 7034110 Check |pmc= value (help). PMID 32050834 Check |pmid= value (help).
  20. Grein J, Ohmagari N, Shin D, Diaz G, Asperges E, Castagna A; et al. (2020). "Compassionate Use of Remdesivir for Patients with Severe Covid-19". N Engl J Med. 382 (24): 2327–2336. doi:10.1056/NEJMoa2007016. PMC 7169476 Check |pmc= value (help). PMID 32275812 Check |pmid= value (help).


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