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01-07-2020 | Acute Kidney Injury | Narrative Review

Acute kidney injury in critically ill patients with COVID-19

Authors: Paul Gabarre, Guillaume Dumas, Thibault Dupont, Michael Darmon, Elie Azoulay, Lara Zafrani

Published in: Intensive Care Medicine | Issue 7/2020

Abstract

Acute kidney injury (AKI) has been reported in up to 25% of critically-ill patients with SARS-CoV-2 infection, especially in those with underlying comorbidities. AKI is associated with high mortality rates in this setting, especially when renal replacement therapy is required. Several studies have highlighted changes in urinary sediment, including proteinuria and hematuria, and evidence of urinary SARS-CoV-2 excretion, suggesting the presence of a renal reservoir for the virus. The pathophysiology of COVID-19 associated AKI could be related to unspecific mechanisms but also to COVID-specific mechanisms such as direct cellular injury resulting from viral entry through the receptor (ACE2) which is highly expressed in the kidney, an imbalanced renin–angotensin–aldosteron system, pro-inflammatory cytokines elicited by the viral infection and thrombotic events. Non-specific mechanisms include haemodynamic alterations, right heart failure, high levels of PEEP in patients requiring mechanical ventilation, hypovolemia, administration of nephrotoxic drugs and nosocomial sepsis. To date, there is no specific treatment for COVID-19 induced AKI. A number of investigational agents are being explored for antiviral/immunomodulatory treatment of COVID-19 and their impact on AKI is still unknown. Indications, timing and modalities of renal replacement therapy currently rely on non-specific data focusing on patients with sepsis. Further studies focusing on AKI in COVID-19 patients are urgently warranted in order to predict the risk of AKI, to identify the exact mechanisms of renal injury and to suggest targeted interventions.

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Title: Acute kidney injury in critically ill patients with COVID-19
Authors: Paul Gabarre
Guillaume Dumas
Thibault Dupont
Michael Darmon
Elie Azoulay
Lara Zafrani
Publication date: 01-07-2020
Publisher: Springer Berlin Heidelberg
Keywords: Acute Kidney Injury
SARS-CoV-2
COVID-19
Cytokines
Acute Kidney Injury
Published in: Intensive Care Medicine / Issue 7/2020
Print ISSN: 0342-4642
Electronic ISSN: 1432-1238
DOI: https://doi.org/10.1007/s00134-020-06153-9

At a glance: The STEP trials

Springer Medicine

Acute kidney injury in critically ill patients with COVID-19

Abstract

At a glance: The STEP trials

Springer Medicine

Abstract

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