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Li Y, Gong Y, Xu G. New insights into kidney disease after COVID-19 infection and vaccination: histopathological and clinical findings. QJM 2024; 117:317-337. [PMID: 37402613 DOI: 10.1093/qjmed/hcad159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Revised: 06/23/2023] [Indexed: 07/06/2023] Open
Abstract
In addition to its pulmonary effects, coronavirus disease 2019 (COVID-19) has also been found to cause acute kidney injury (AKI), which has been linked to high mortality rates. In this review, we collected data from 20 clinical studies on post-COVID-19-related AKI and 97 cases of AKI associated with COVID-19 vaccination. Acute tubular injury was by far the most common finding in the kidneys of patients with COVID-19-related AKI. Among patients hospitalized for COVID-19, 34.0% developed AKI, of which 59.0%, 19.1% and 21.9% were Stages 1, 2 and 3, respectively. Though kidney disease and other adverse effects after COVID-19 vaccination overall appear rare, case reports have accumulated suggesting that COVID-19 vaccination may be associated with a risk of subsequent kidney disease. Among the patients with post-vaccination AKI, the most common pathologic findings include crescentic glomerulonephritis (29.9%), acute tubular injury (23.7%), IgA nephropathy (18.6%), antineutrophil cytoplasmic autoantibody-associated vasculitis (17.5%), minimal change disease (17.5%) and thrombotic microangiopathy (10.3%). It is important to note that crescentic glomerulonephritis appears to be more prevalent in patients who have newly diagnosed renal involvement. The proportions of patients with AKI Stages 1, 2 and 3 after COVID-19 vaccination in case reports were 30.9%, 22.7% and 46.4%, respectively. In general, clinical cases of new-onset and recurrent nephropathy with AKI after COVID-19 vaccination have a positive prognosis. In this article, we also explore the underlying pathophysiological mechanisms of AKI associated with COVID-19 infection and its vaccination by describing key renal morphological and clinical features and prognostic findings.
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Affiliation(s)
- Yebei Li
- Department of Nephrology, The Second Affiliated Hospital of Nanchang University, No. 1, Minde Road, Donghu District, Nanchang 330006, P.R. China
| | - Yan Gong
- Department of Neurosurgery, The Second Affiliated Hospital of Nanchang University, No. 1, Minde Road, Donghu District, Nanchang 330006, P.R. China
| | - Gaosi Xu
- Department of Nephrology, The Second Affiliated Hospital of Nanchang University, No. 1, Minde Road, Donghu District, Nanchang 330006, P.R. China
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Godi I, Pasin L, Ballin A, Martelli G, Bonanno C, Terranova F, Tamburini E, Simoni C, Randon G, Franchetti N, Cattarin L, Nalesso F, Calò L, Tiberio I. Long-term outcome of COVID-19 patients with acute kidney injury requiring kidney replacement therapy. JOURNAL OF ANESTHESIA, ANALGESIA AND CRITICAL CARE 2024; 4:32. [PMID: 38725050 PMCID: PMC11083751 DOI: 10.1186/s44158-024-00163-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/22/2024] [Accepted: 04/15/2024] [Indexed: 05/12/2024]
Abstract
BACKGROUND Limited data existed on the burden of coronavirus disease 2019 (COVID-19) renal complications and the outcomes of the most critical patients who required kidney replacement therapy (KRT) during intensive care unit (ICU) stay. We aimed to describe mortality and renal function at 90 days in patients admitted for COVID-19 and KRT. METHODS A retrospective cohort study of critically ill patients admitted for COVID-19 and requiring KRT from March 2020 to January 2022 was conducted in an Italian ICU from a tertiary care hospital. Primary outcome was mortality at 90 days and secondary outcome was kidney function at 90 days. RESULTS A cohort of 45 patients was analyzed. Mortality was 60% during ICU stay and increased from 64% at the time of hospital discharge to 71% at 90 days. Among 90-day survivors, 31% required dialysis, 38% recovered incompletely, and 31% completely recovered renal function. The probability of being alive and dialysis-free at 3 months was 22%. CONCLUSIONS Critically ill patients with COVID-19 disease requiring KRT during ICU stay had elevated mortality rate at 90 days, with low probability of being alive and dialysis-free at 3 months. However, a non-negligible number of patients completely recovered renal function.
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Affiliation(s)
- Ilaria Godi
- Department of Urgency and Emergency, Anaesthesiology and Intensive Care Unit, University Hospital of Padua, Via Giustiniani 2, Padua, Italy.
| | - Laura Pasin
- Department of Urgency and Emergency, Anaesthesiology and Intensive Care Unit, University Hospital of Padua, Via Giustiniani 2, Padua, Italy
| | - Andrea Ballin
- Department of Urgency and Emergency, Anaesthesiology and Intensive Care Unit, University Hospital of Padua, Via Giustiniani 2, Padua, Italy
| | - Gabriele Martelli
- Department of Urgency and Emergency, Anaesthesiology and Intensive Care Unit, University Hospital of Padua, Via Giustiniani 2, Padua, Italy
| | - Claudio Bonanno
- Department of Urgency and Emergency, Anaesthesiology and Intensive Care Unit, University Hospital of Padua, Via Giustiniani 2, Padua, Italy
| | - Francesco Terranova
- Department of Urgency and Emergency, Anaesthesiology and Intensive Care Unit, University Hospital of Padua, Via Giustiniani 2, Padua, Italy
| | - Enrico Tamburini
- Department of Medicine, Section of Anesthesiology and Critical Care, University of Padua, Padua, Italy
| | - Caterina Simoni
- Department of Medicine, Section of Anesthesiology and Critical Care, University of Padua, Padua, Italy
| | - Ginevra Randon
- Department of Medicine, Section of Anesthesiology and Critical Care, University of Padua, Padua, Italy
| | - Nicola Franchetti
- Department of Medicine, Section of Anesthesiology and Critical Care, University of Padua, Padua, Italy
| | - Leda Cattarin
- Department of Nephrology and Dialysis, University Hospital of Padua, Padua, Italy
| | - Federico Nalesso
- Department of Nephrology and Dialysis, University Hospital of Padua, Padua, Italy
| | - Lorenzo Calò
- Department of Nephrology and Dialysis, University Hospital of Padua, Padua, Italy
| | - Ivo Tiberio
- Department of Urgency and Emergency, Anaesthesiology and Intensive Care Unit, University Hospital of Padua, Via Giustiniani 2, Padua, Italy
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Nogueira GM, Rocha PN, Cruz CMS. Case fatality rate among COVID-19 patients treated with acute kidney replacement therapy. J Bras Nefrol 2024; 46:9-17. [PMID: 37955522 PMCID: PMC10962413 DOI: 10.1590/2175-8239-jbn-2022-0161en] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Accepted: 08/07/2023] [Indexed: 11/14/2023] Open
Abstract
INTRODUCTION Acute kidney injury (AKI) is a frequent complication of severe COVID-19 and is associated with high case fatality rate (CFR). However, there is scarcity of data referring to the CFR of AKI patients that underwent kidney replacement therapy (KRT) in Brazil. The main objective of this study was to describe the CFR of critically ill COVID-19 patients treated with acute kidney replacement therapy (AKRT). METHODS Retrospective descriptive cohort study. We included all patients treated with AKRT at an intensive care unit in a single tertiary hospital over a 15-month period. We excluded patients under the age of 18 years, patients with chronic kidney disease on maintenance dialysis, and cases in which AKI preceded COVID-19 infection. RESULTS A total of 100 out of 1479 (6.7%) hospitalized COVID-19 patients were enrolled in this study. The median age was 74.5 years (IQR 64 - 82) and 59% were male. Hypertension (76%) and diabetes mellitus (56%) were common. At the first KRT prescription, 85% of the patients were on invasive mechanical ventilation and 71% were using vasoactive drugs. Continuous veno-venous hemodiafiltration (CVVHDF) was the preferred KRT modality (82%). CFR was 93% and 81 out of 93 deaths (87%) occurred within the first 10 days of KRT onset. CONCLUSION AKRT in hospitalized COVID-19 patients resulted in a CFR of 93%. Patients treated with AKRT were typically older, critically ill, and most died within 10 days of diagnosis. Better strategies to address this issue are urgently needed.
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Affiliation(s)
| | - Paulo Novis Rocha
- Universidade Federal da Bahia, Faculdade de Medicina da Bahia,
Salvador, BA, Brazil
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Samaan F, Freitas RAP, Viana R, Gâmbaro L, Cunha K, Vieira TD, Feitosa V, Correa EA, Maciel AT, Aranha S, Osawa EA, Pillar R, Flato EMDS, da Silva RC, Carneiro E, Souza FBGDL, Rossi PRG, Abud MB, Konigsfeld HP, da Silva RG, de Souza RBC, Coutinho SM, Goes MÂ, da Silva BAB, Zanetta DMT, Burdmann EA. Critically ill patients with COVID-19-associated acute kidney injury treated with kidney replacement therapy: Comparison between the first and second pandemic waves in São Paulo, Brazil. PLoS One 2023; 18:e0293846. [PMID: 37922282 PMCID: PMC10624321 DOI: 10.1371/journal.pone.0293846] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Accepted: 10/20/2023] [Indexed: 11/05/2023] Open
Abstract
INTRODUCTION This study aimed to compare the characteristics and outcomes of critically ill patients with COVID-19-associated acute kidney injury (AKI) who were treated with kidney replacement therapy (KRT) in the first and second waves of the pandemic in the megalopolis of Sao Paulo, Brazil. METHODS A multicenter retrospective study was conducted in 10 intensive care units (ICUs). Patients aged ≥18 years, and treated with KRT due to COVID-19-associated AKI were included. We compared demographic, laboratory and clinical data, KRT parameters and patient outcomes in the first and second COVID-19 waves. RESULTS We assessed 656 patients (327 in the first wave and 329 in the second one). Second-wave patients were admitted later (7.1±5.0 vs. 5.6±3.9 days after the onset of symptoms, p<0.001), were younger (61.4±13.7 vs. 63.8±13.6 years, p = 0.023), had a lower frequency of diabetes (37.1% vs. 47.1%, p = 0.009) and obesity (29.5% vs. 40.0%, p = 0.007), had a greater need for vasopressors (93.3% vs. 84.6%, p<0.001) and mechanical ventilation (95.7% vs. 87.8%, p<0.001), and had higher lethality (84.8% vs. 72.7%, p<0.001) than first-wave patients. KRT quality markers were independently associated with a reduction in the OR for death in both pandemic waves. CONCLUSIONS In the Sao Paulo megalopolis, the lethality of critically ill patients with COVID-19-associated AKI treated with KRT was higher in the second wave of the pandemic, despite these patients being younger and having fewer comorbidities. Potential factors related to this poor outcome were difficulties in health care access, lack of intra-hospital resources, delay vaccination and virus variants.
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Affiliation(s)
- Farid Samaan
- Grupo Hapvida-NotreDame Intermédica, São Paulo, SP, Brazil
- Instituto Dante Pazzanese de Cardiologia, São Paulo, SP, Brazil
- Secretaria de Estado da Saúde de São Paulo, São Paulo, SP, Brazil
| | | | - Renata Viana
- Instituto Dante Pazzanese de Cardiologia, São Paulo, SP, Brazil
| | - Lívia Gâmbaro
- Instituto Dante Pazzanese de Cardiologia, São Paulo, SP, Brazil
| | - Karlla Cunha
- Grupo Hapvida-NotreDame Intermédica, São Paulo, SP, Brazil
| | | | | | | | | | - Sylvia Aranha
- Imed Research Group, Hospital São Camilo Pompéia, São Paulo, SP, Brazil
| | | | - Roberta Pillar
- Unidade Assistencial Hospital Ipiranga, São Paulo, SP, Brazil
| | | | | | | | | | | | | | | | | | | | | | | | | | | | - Emmanuel Almeida Burdmann
- Laboratório de Investigação Médica (LIM 12), Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
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Samaan F, Aoike D, Pagrion-Neto R, Cesar Pons T, Bracci Lisboa R, Burdmann EA. Medical students’ and health professionals’ knowledge regarding acute kidney injury: a cross-sectional study in the city of São Paulo, Brazil. Ren Fail 2022; 44:1660-1668. [DOI: 10.1080/0886022x.2022.2131575] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Affiliation(s)
- Farid Samaan
- Instituto Dante Pazzanese de Cardiologia, São Paulo, Brazil
- LIM 12, Disciplina de Nefrologia, Universidade de São Paulo, São Paulo, Brazil
| | - Danilo Aoike
- Disciplina de Nefrologia, Universidade Federal de São Paulo, Brazil
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Multistate Modeling of Clinical Trajectories and Outcomes in the ICU: A Proof-of-Concept Evaluation of Acute Kidney Injury Among Critically Ill Patients With COVID-19. Crit Care Explor 2022; 4:e0784. [PMID: 36479445 PMCID: PMC9722556 DOI: 10.1097/cce.0000000000000784] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Multistate models yield high-fidelity analyses of the dynamic state transition and temporal dimensions of a clinical condition's natural history, offering superiority over aggregate modeling techniques for addressing these types of problems. OBJECTIVES To demonstrate the utility of these models in critical care, we examined acute kidney injury (AKI) development, progression, and outcomes in COVID-19 critical illness through multistate analyses. DESIGN SETTING AND PARTICIPANTS Retrospective cohort study at an urban tertiary-care academic hospital in the United States. All patients greater than or equal to 18 years in an ICU with COVID-19 in 2020, excluding patients with preexisting end-stage renal disease. MAIN OUTCOMES AND MEASURES Using electronic health record data, we determined AKI presence/stage in discrete 12-hour time windows and fit multistate models to determine longitudinal transitions and outcomes. RESULTS Of 367 encounters, 241 (66%) experienced AKI (maximal stages: 88 stage-1, 49 stage-2, 104 stage-3 AKI [51 received renal replacement therapy (RRT), 53 did not]). Patients receiving RRT overwhelmingly received invasive mechanical ventilation (IMV) (n = 60, 95%) compared with the AKI-without-RRT (n = 98, 53%) and no-AKI groups (n = 39, 32%; p < 0.001), with similar mortality patterns (RRT: n = 36, 57%; AKI: n = 74, 40%; non-AKI: n = 23, 19%; p < 0.001). After 24 hours in the ICU, almost half the cohort had AKI (44.9%; 95% CI, 41.6-48.2%). At 7 days after stage-1 AKI, 74.0% (63.6-84.4) were AKI-free or discharged. By contrast, fewer patients experiencing stage-3 AKI were recovered (30.0% [24.1-35.8%]) or discharged (7.9% [5.2-10.7%]) after 7 days. Early AKI occurred with similar frequency in patients receiving and not receiving IMV: after 24 hours in the ICU, 20.9% of patients (18.3-23.6%) had AKI and IMV, while 23.4% (20.6-26.2%) had AKI without IMV. CONCLUSIONS AND RELEVANCE In a multistate analysis of critically ill patients with COVID-19, AKI occurred early and heterogeneously in the course of critical illness. Multistate methods are useful and underused in ICU care delivery science as tools for understanding trajectories, prognoses, and resource needs.
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Kang L, Wang Y, Xing S, Li H, Chien CW, Tung TH. Group-based trajectory modeling to identify health beliefs of COVID-19 vaccination and its predictors: A cohort study in China. Hum Vaccin Immunother 2022; 18:2091899. [PMID: 35977916 DOI: 10.1080/21645515.2022.2091899] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVES This study aimed to characterize distinct patterns of change in health beliefs and their dimensions of COVID-19 vaccination and to evaluate the predictors of various trajectory groups. METHODS A total of 1129 participants who completed two doses of COVID-19 vaccines in China were included in this prospective study. Participants' characteristics and health beliefs regarding COVID-19 vaccination were collected before and after the two doses of COVID-19 vaccination. A group-based trajectory model was used to identify the distinct longitudinal patterns of health beliefs and their dimensions. A multinomial logistic regression model was conducted to determine the predictors of different trajectory groups. RESULTS The group-based trajectory model identified two to four distinct patterns of global health beliefs and their domains, namely, very low-stable (16.1%), low-stable (30.2%), medium-stable (45.6%), and high-stable (8.1%) trajectories for global health beliefs. And the five domains of health beliefs showed two or three trajectory stable progression, which were similar to the global health beliefs trajectories. Sex, occupation post, adverse reactions foreboding, and quality of life were associated with the trajectory of global health beliefs or at least one domain of health beliefs. CONCLUSIONS During the study, individuals' health beliefs about COVID-19 vaccination were stable without the interference of external factors. Based on the impact of sex, occupation post, adverse reactions foreboding, and quality of life on individuals' health beliefs, personalized interventions can be developed to improve public health beliefs about COVID-19 vaccination and reduce vaccination hesitancy.
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Affiliation(s)
- Linlin Kang
- Department of Operations Management, Central lab, Shenzhen Bao'an District Traditional Chinese Medicine Hospital, Shenzhen, China.,Institute for Hospital Management, TsingHua University, Shenzhen, China
| | - Yanjiao Wang
- Institute for Hospital Management, TsingHua University, Shenzhen, China
| | - Sizhong Xing
- Department of Operations Management, Central lab, Shenzhen Bao'an District Traditional Chinese Medicine Hospital, Shenzhen, China
| | - Hang Li
- Department of Operations Management, Central lab, Shenzhen Bao'an District Traditional Chinese Medicine Hospital, Shenzhen, China
| | - Ching-Wen Chien
- Institute for Hospital Management, TsingHua University, Shenzhen, China
| | - Tao-Hsin Tung
- Evidence-based Medicine Center, Taizhou Hospital of Zhejiang Province, Affiliated to Wenzhou Medical University, Linhai, China
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Kow CS, Ramachandram DS, Hasan SS. Can Renin-Angiotensin System Inhibitors Protect Against Acute Kidney Injury in Patients With COVID-19? Crit Care Med 2022; 50:e796-e797. [PMID: 36227048 PMCID: PMC9555555 DOI: 10.1097/ccm.0000000000005618] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Affiliation(s)
- Chia Siang Kow
- School of Pharmacy, International Medical University, Kuala Lumpur, Malaysia
| | | | - Syed Shahzad Hasan
- School of Applied Sciences, University of Huddersfield, Huddersfield, United Kingdom
- School of Biomedical Sciences & Pharmacy, University of Newcastle, Callaghan, NSW, Australia
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Anandh U, Noorin A, Kazmi SKS, Bannur S, Shah SSA, Farooq M, Yedlapati G, Amer W, Prasad B, Dasgupta I. Acute kidney injury in critically ill COVID-19 infected patients requiring dialysis: experience from India and Pakistan. BMC Nephrol 2022; 23:308. [PMID: 36076183 PMCID: PMC9452278 DOI: 10.1186/s12882-022-02931-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Accepted: 06/20/2022] [Indexed: 11/12/2022] Open
Abstract
Background Acute kidney injury (AKI) was common in the first two waves of the SARS-COV-2 pandemic in critically ill patients. A high percentage of these patients required renal replacement therapy and died in the hospital. Methods The present study examines the clinical presentation, laboratory parameters and therapeutic interventions in critically ill patients with AKI admitted to the ICU in two centres, one each in India and Pakistan. Patient and outcome details of all critically ill COVID 19 patients admitted to the ICU requiring renal replacement therapy were collected. Data was analysed to detect patient variables associated with mortality. Results A total of 1,714 critically ill patients were admitted to the ICUs of the two centres. Of these 393 (22.9%) had severe acute kidney injury (AKIN stage 3) requiring dialysis. Of them, 60.5% were men and the mean (± SD) age was 58.78 (± 14.4) years. At the time of initiation of dialysis, 346 patients (88%) were oligo-anuric. The most frequent dialysis modality in these patients was intermittent hemodialysis (48.1%) followed by slow low efficiency dialysis (44.5%). Two hundred and six (52.4%) patients died. The mortality was higher among the Indian cohort (68.1%) than the Pakistani cohort (43.4%). Older age (age > 50 years), low serum albumin altered sensorium, need for slower forms of renal replacement therapy and ventilatory support were independently associated with mortality. Conclusion There was a very high mortality in patients with COVID-19 associated AKI undergoing RRT in the ICUs in this cohort from the Indian sub-continent.
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Affiliation(s)
- Urmila Anandh
- Department of Nephrology, Yashoda Hospitals, Secunderabad, India.
| | - Amna Noorin
- Department of Nephrology, Peshawar Institute of Cardiology, Peshawar, Pakistan
| | | | - Sooraj Bannur
- Department of Nephrology, Yashoda Hospitals, Secunderabad, India
| | | | - Mehrin Farooq
- Department of General Medicine, Ghurki Trust Teaching Hospital, Lahore, Pakistan
| | | | - Waseem Amer
- Department of Medicine, Lahore Medical and Dental College and Ghurki Trust Teaching Hospitals, Lahore, Pakistan
| | - Bonthu Prasad
- Department of Statistics, Yashoda Hospitals, Secunderabad, India
| | - Indranil Dasgupta
- University Hospital Birmingham NHS Foundation Trust, Birmingham, UK. .,Warwick Medical School, University of Warwick, Coventry, UK.
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Chávez-Valencia V, Orizaga-de-la-Cruz C, Lagunas-Rangel FA. Acute Kidney Injury in COVID-19 Patients: Pathogenesis, Clinical Characteristics, Therapy, and Mortality. Diseases 2022; 10:diseases10030053. [PMID: 35997358 PMCID: PMC9397016 DOI: 10.3390/diseases10030053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Revised: 08/12/2022] [Accepted: 08/16/2022] [Indexed: 01/08/2023] Open
Abstract
Coronavirus disease 2019 (COVID-19) is a disease caused by infection with the SARS-CoV-2 virus and has represented one of the greatest challenges humanity has faced in recent years. The virus can infect a large number of organs, including the lungs and upper respiratory tract, brain, liver, kidneys, and intestines, among many others. Although the greatest damage occurs in the lungs, the kidneys are not exempt, and acute kidney injury (AKI) can occur in patients with COVID-19. Indeed, AKI is one of the most frequent and serious organic complications of COVID-19. The incidence of COVID-19 AKI varies widely, and the exact mechanisms of how the virus damages the kidney are still unknown. For this reason, the purpose of this review was to assess current findings on the pathogenesis, clinical features, therapy, and mortality of COVID-19 AKI.
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Affiliation(s)
- Venice Chávez-Valencia
- Department of Nephrology, Hospital General Regional Hospital No. 1, Instituto Mexicano del Seguro Social, Bosque de los Olivos No. 101. Av. La Goleta Mpo. Charo, Morelia 61301, Mexico
- Correspondence: (V.C.-V.); (F.A.L.-R.)
| | - Citlalli Orizaga-de-la-Cruz
- Department of Nephrology, Hospital General Regional Hospital No. 1, Instituto Mexicano del Seguro Social, Bosque de los Olivos No. 101. Av. La Goleta Mpo. Charo, Morelia 61301, Mexico
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