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'''Acute Kidney Injury in COVID-19'''<br><br>
'''For patient information, click [[Xyz (patient information)|here]]'''
{{SK}} [[Acute Kidney Injury]], [[Acute Renal Failure]], [[AKI]], [[ARF]]
==[[Xyz overview|Overview]]==
=[[Xyz historical perspective|Historical Perspective]]=
*Early reports from china revealed that COVID-19 rarely involves the kidneys, as [[Acute Renal Failure]] was not seen among COVID-19 hospitalized patients and just mild increase [[BUN]] or creatinine rise occurred. <ref name="WangLi2020">{{cite journal|last1=Wang|first1=Luwen|last2=Li|first2=Xun|last3=Chen|first3=Hui|last4=Yan|first4=Shaonan|last5=Li|first5=Dong|last6=Li|first6=Yan|last7=Gong|first7=Zuojiong|title=Coronavirus Disease 19 Infection Does Not Result in Acute Kidney Injury: An Analysis of 116 Hospitalized Patients from Wuhan, China|journal=American Journal of Nephrology|volume=51|issue=5|year=2020|pages=343–348|issn=0250-8095|doi=10.1159/000507471}}</ref>
*However, recent study found 75.4% of hospitalized patients with COVID-19 pneumonia developed [[hematuria]], [[proteinuria]], and [[AKI]]. <ref name="PeiZhang2020">{{cite journal|last1=Pei|first1=Guangchang|last2=Zhang|first2=Zhiguo|last3=Peng|first3=Jing|last4=Liu|first4=Liu|last5=Zhang|first5=Chunxiu|last6=Yu|first6=Chong|last7=Ma|first7=Zufu|last8=Huang|first8=Yi|last9=Liu|first9=Wei|last10=Yao|first10=Ying|last11=Zeng|first11=Rui|last12=Xu|first12=Gang|title=Renal Involvement and Early Prognosis in Patients with COVID-19 Pneumonia|journal=Journal of the American Society of Nephrology|volume=31|issue=6|year=2020|pages=1157–1165|issn=1046-6673|doi=10.1681/ASN.2020030276}}</ref>




=[[Xyz classification|Classification]]=


=[[Xyz pathophysiology|Pathophysiology]]=
{{familytree/start}}{{familytree | | | | | | | | | A01 | | | | | |A01=  [[COVID-19]]  }}
{{familytree | | |,|-|-|-|-|-|-|^|-|-|-|-|-|-|.| }}
{{familytree | |  C01  | | | | | | | | | | | | C02 |C01=  '''30-40%'''  <br> [[Asymptomatic]]|C02=  '''60-70%''' <br> [[Symptomatic]]}}
{{familytree | | |!| | | | | | | | | |,|-|-|-|+|-|-|-|-|.|}}
{{familytree | | E01 | | | | | | | | E02 | | E03 | | | E04 |E01=[[Asymptomatic carrier]]|E02='''80%''' <br> Mild symtoms|E03='''14%''' <br> Severe symptoms|E04='''6%''' <br> Critically ill}}
{{familytree | | | | | | | | | | | | |!| | | |!| | | | |!| | }}
{{familytree | | | | | | | | | | | | F01 | | F02 | | | F03 |F01=[[Fever]]<br> [[Chills]]<br> [[Cough]]<br> [[Headache]]<br> [[Sore throat]]<br> [[Nasal congestion]] or secretion <br> [[Fatigue]]<br> [[Body aches]]<br> [[loss of taste]] or [[smell]]
<br> [[Nausea]] or [[vomiting]] <br> [[Diarrhea]]<br> |F02=Severe [[Dyspnea]]<br> [[Chest pain]]<br> Severe [[weakness]] <br> new [[Confusion]]<br> Central [[Cyanosis]]
|F03=Death}}
{{familytree/end}}


*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.
*Despite kidney injury following [[COVID-19]] infection is less frequent than severe lung injury, [[ACE2]]: [[ACE]] ratio is higher in the kidneys compared to the respiratory system. (1:1 in the kidneys VS 1:20 in the respiratory system)
*It is thought that [AKI] following COVID-19 is the result of<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>
**[[Sepsis]]
**Hypotension


=[[Xyz causes|Causes]]=


=[[Xyz differential diagnosis|Differentiating Xyz from other Diseases]]=
{| class="wikitable"
! colspan=4 style="background: #4479BA; color: #FFFFFF; " align="center"|CT manifestations of COVID-19
|-
!style="background: #4479BA; color: #FFFFFF; " align="center" |CT findings
!style="background: #4479BA; color: #FFFFFF; " align="center" |Definition
!style="background: #4479BA; color: #FFFFFF; " align="center" |CT picture
|-
|style="background: #DCDCDC; |'''[[Ground glass opacity]]'''
|
*Hazy opacity in the lungs with well defined bronchial and vascular margins 
*the most common imaging finding
*due to infection, chronic interstitial lung disease, and acute lung injury


=[[Xyz epidemiology and demographics|Epidemiology and Demographics]]=
|[[File:Covid-19-pneumonia-26.jpg|200px|thumb|center]]
|-
|style="background: #DCDCDC; |'''[[Consolidation]]'''
|
*a parenchymal density with ill-defined bronchial and vascular margins
*filling with infectious material [fluid, cells, tissue]
* due to cellular exudates in alveoli
|[[file
|-
|style="background: #DCDCDC; |''' [[Crazy paving pattern]] '''
|
* Septal thickening of inter and intra-lobar regions
* with the background of the Ground glass opacity
* Similar to paving stones
* Due to alveolar edema and acute inflammation of the lung
* Sign of progression
|[[File:Covid-19-pneumonia-122.jpg|200px|thumb|center]]


=[[Xyz risk factors|Risk Factors]]=


=[[Xyz screening|Screening]]=
|-
|style="background: #DCDCDC; |''' [[Reticuldar]] pattern '''
|
*Linear opacities in the lungs
*Due to Interstitial thickening of inter and intralobular septa


=[[Xyz natural history, complications and prognosis|Natural History, Complications and Prognosis]]=
|[[file


=Diagnosis=
|-
[[Xyz diagnostic study of choice|Diagnostic study of choice]] | [[Xyz history and symptoms|History and Symptoms]] | [[Xyz physical examination|Physical Examination]] | [[Xyz laboratory findings|Laboratory Findings]] | [[Xyz electrocardiogram|Electrocardiogram]] | [[Xyz x ray|X-Ray Findings]] | [[Xyz echocardiography and ultrasound|Echocardiography and Ultrasound]] | [[Xyz CT scan|CT-Scan Findings]] | [[Xyz MRI|MRI Findings]] | [[Xyz other imaging findings|Other Imaging Findings]] | [[Xyz other diagnostic studies|Other Diagnostic Studies]]
|style="background: #DCDCDC; |'''[[Air bronchogram]] '''
|
* Air-filled bronchi
*Low attenuated areas in the lung
|[[file


=Treatment=
|-
[[Xyz medical therapy|Medical Therapy]] | [[Xyz interventions|Interventions]] | [[Xyz surgery|Surgery]] | [[Xyz primary prevention|Primary Prevention]] | [[Xyz secondary prevention|Secondary Prevention]] | [[Xyz cost-effectiveness of therapy|Cost-Effectiveness of Therapy]] | [[Xyz future or investigational therapies|Future or Investigational Therapies]]
|style="background: #DCDCDC; |''' [[Bronchiectasis]] '''
|
*irreversible dilatation of the lung airways
* Bronchus diameter more than 1.5 cm
*due to inflammation, obstruction and impaired clearance
|[[file
|}

Latest revision as of 13:33, 15 July 2020



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



 
 
 
 
 
 
 
 
COVID-19
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
30-40%
Asymptomatic
 
 
 
 
 
 
 
 
 
 
 
60-70%
Symptomatic
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Asymptomatic carrier
 
 
 
 
 
 
 
80%
Mild symtoms
 
14%
Severe symptoms
 
 
6%
Critically ill
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Fever
Chills
Cough
Headache
Sore throat
Nasal congestion or secretion
Fatigue
Body aches
loss of taste or smell
Nausea or vomiting
Diarrhea
 
Severe Dyspnea
Chest pain
Severe weakness
new Confusion
Central Cyanosis
 
 
Death


CT manifestations of COVID-19
CT findings Definition CT picture
Ground glass opacity
  • Hazy opacity in the lungs with well defined bronchial and vascular margins
  • the most common imaging finding
  • due to infection, chronic interstitial lung disease, and acute lung injury
Consolidation
  • a parenchymal density with ill-defined bronchial and vascular margins
  • filling with infectious material [fluid, cells, tissue]
  • due to cellular exudates in alveoli
 [[file
Crazy paving pattern
  • Septal thickening of inter and intra-lobar regions
  • with the background of the Ground glass opacity
  • Similar to paving stones
  • Due to alveolar edema and acute inflammation of the lung
  • Sign of progression


Reticuldar pattern
  • Linear opacities in the lungs
  • Due to Interstitial thickening of inter and intralobular septa
 [[file
Air bronchogram
  • Air-filled bronchi
  • Low attenuated areas in the lung
 [[file
Bronchiectasis
  • irreversible dilatation of the lung airways
  • Bronchus diameter more than 1.5 cm
  • due to inflammation, obstruction and impaired clearance
 [[file
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