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{{SK}} [[Acute Kidney Injury]], [[Acute Renal Failure]], [[AKI]], [[ARF]]
{{SK}} [[Acute Kidney Injury]], [[Acute Renal Failure]], [[AKI]], [[ARF]]


==[[Xyz overview|Overview]]==
==[[AKI overview|Overview]]==


=[[Xyz historical perspective|Historical Perspective]]=
=[[AKI historical perspective|Historical Perspective]]=








=[[Xyz classification|Classification]]=
=[[AKI classification|Classification]]=


=[[Xyz pathophysiology|Pathophysiology]]=
=[[AKI pathophysiology|Pathophysiology]]=


*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>
Line 26: Line 26:




=[[Xyz causes|Causes]]=
=[[AKI causes|Causes]]=
*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>
*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]]
**[[Sepsis]]
**Hypotension
**Hypotension
=[[Xyz differential diagnosis|Differentiating Xyz from other Diseases]]=
=[[AKI differential diagnosis]]=


=[[Xyz epidemiology and demographics|Epidemiology and Demographics]]=
=[[AKI epidemiology and demographics|Epidemiology and Demographics]]=
*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  mild [[BUN]] or creatinine rise [10.8%] and mild proteinuria [7.2%] 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>
*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  mild [[BUN]] or creatinine rise [10.8%] and mild proteinuria [7.2%] 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> But, these findings are not significantly different with other critical diseases.
*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> But, these findings are not significantly different from other critical diseases.
 
=[[AKI risk factors|Risk Factors]]=


=[[Xyz risk factors|Risk Factors]]=
*Severe [[COVID-19]] pneumonia and [[severe acute respiratory distress syndrome]] are associated with developing [[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>  
*Severe [[COVID-19]] pneumonia and [[severe acute respiratory distress syndrome]] are associated with developing [[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 screening|Screening]]=
=[[AKIscreening|Screening]]=


=[[Xyz natural history, complications and prognosis|Natural History, Complications and Prognosis]]=
=[[AKI natural history, complications and prognosis|Natural History, Complications and Prognosis]]=
*Approximately half of the new AKI following COVID-19 is mild with good short-term prognosis.
*Approximately half of the new AKI following COVID-19 is mild with good short-term prognosis.
*If no improvement occurs during follow-up, it is contributed to higher mortality.<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>  
*If no improvement occurs during follow-up, it is contributed to higher mortality.<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>  
=Diagnosis=
=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]]
 
*Patients in the early stages of kidney failure may be asymptomatic. If left untreated, patients may progress to develop [[Azotemia]] and [[Uremia]], which occur due to the buildup of waste materials in the blood.
'''History and Symptoms'''
*Symptoms of kidney injury include<ref name=Skorecki>{{cite book |vauthors=Skorecki K, Green J, Brenner BM |veditors=Kasper DL, Braunwald E, Fauci AS |title=Harrison's Principles of Internal Medicine|url=https://archive.org/details/harrisonsprincip00kasp |url-access=limited |edition=16th |year=2005 |publisher=McGraw-Hill |location=New York, NY |isbn=978-0-07-139140-5 |pages=[https://archive.org/details/harrisonsprincip00kasp/page/n1681 1653]–63 |chapter=Chronic renal failure|display-editors=etal}}</ref>:
**Nausea and Vomiting
**Weakness
**Fatigue
**Confusion
**Weight loss
**Loss of appetite
**[[Oliguria]] or [[Anuria]]
**Fluid retention, leading [[edema]] and swelling of face, extremities
**Electrolyte imbalance; High level of [[Potassium]] which leads to [[cardiac arrhythmia]]
 
'''Physical Examination'''
 
'''Laboratory Findings'''
 
'''Electrocardiogram'''
 
'''Ultrasound Finding'''
 
'''Other Diagnostic Studies'''


=Treatment=
=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]]
 
'''AKI Medical Therapy'''
 
'''AKI Prevention'''

Revision as of 11:36, 17 June 2020


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

Acute Kidney Injury in COVID-19

For patient information, click here


Synonyms and keywords: Acute Kidney Injury, Acute Renal Failure, AKI, ARF

Overview

Historical Perspective

Classification

Pathophysiology

  • 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.[1]
  • 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)[1]


Causes

  • It is thought that AKI following COVID-19 is the result of[1]

AKI differential diagnosis

Epidemiology and Demographics

  • 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 mild BUN or creatinine rise [10.8%] and mild proteinuria [7.2%] occurred. [2]
  • However, recent study found 75.4% of hospitalized patients with COVID-19 pneumonia developed hematuria, proteinuria, and AKI. [3] But, these findings are not significantly different from other critical diseases.

Risk Factors

Screening

Natural History, Complications and Prognosis

  • Approximately half of the new AKI following COVID-19 is mild with good short-term prognosis.
  • If no improvement occurs during follow-up, it is contributed to higher mortality.[3]

Diagnosis

  • Patients in the early stages of kidney failure may be asymptomatic. If left untreated, patients may progress to develop Azotemia and Uremia, which occur due to the buildup of waste materials in the blood.

History and Symptoms

  • Symptoms of kidney injury include[4]:
    • Nausea and Vomiting
    • Weakness
    • Fatigue
    • Confusion
    • Weight loss
    • Loss of appetite
    • Oliguria or Anuria
    • Fluid retention, leading edema and swelling of face, extremities
    • Electrolyte imbalance; High level of Potassium which leads to cardiac arrhythmia

Physical Examination

Laboratory Findings

Electrocardiogram

Ultrasound Finding

Other Diagnostic Studies

Treatment

AKI Medical Therapy

AKI Prevention

  1. ↑ 1.0 1.1 1.2 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.
  2. ↑ 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.
  3. ↑ 3.0 3.1 3.2 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.
  4. ↑ 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.
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