Decreased renal perfusion during acute kidney injury in critical COVID-19 assessed by magnetic resonance imaging: a prospective case control study

Tomas Luther, Per Eckerbom, Eleanor Cox, Miklos Lipcsey, Sara Bülow, Michael Hultström, Francisco Martinez Torrente, Jan Weis, Fredrik Palm, Susan Francis, Robert Frithiof, Per Liss, Tomas Luther, Per Eckerbom, Eleanor Cox, Miklos Lipcsey, Sara Bülow, Michael Hultström, Francisco Martinez Torrente, Jan Weis, Fredrik Palm, Susan Francis, Robert Frithiof, Per Liss

Abstract

Background: Renal hypoperfusion has been suggested to contribute to the development of acute kidney injury (AKI) in critical COVID-19. However, limited data exist to support this. We aim to investigate the differences in renal perfusion, oxygenation and water diffusion using multiparametric magnetic resonance imaging in critically ill COVID-19 patients with and without AKI.

Methods: A prospective case-control study where patients without prior kidney disease treated in intensive care for respiratory failure due to COVID-19 were examined. Kidney Disease: Improving Global Outcomes Creatinine criteria were used for group allocation. Main comparisons were tested using Mann-Whitney U test.

Results: Nineteen patients were examined, ten with AKI and nine without AKI. Patients with AKI were examined in median 1 [0-2] day after criteria fulfillment. Age and baseline Plasma-Creatinine were similar in both groups. Total renal blood flow was lower in patients with AKI compared with patients without (median 645 quartile range [423-753] vs. 859 [746-920] ml/min, p = 0.037). Regional perfusion was reduced in both cortex (76 [51-112] vs. 146 [123-169] ml/100 g/min, p = 0.015) and medulla (28 [18-47] vs. 47 [38-73] ml/100 g/min, p = 0.03). Renal venous saturation was similar in both groups (72% [64-75] vs. 72% [63-84], ns.), as was regional oxygenation (R2*) in cortex (17 [16-19] vs. 17 [16-18] 1/s, ns.) and medulla (29 [24-39] vs. 27 [23-29] 1/s, ns.).

Conclusions: In critically ill COVID-19 patients with AKI, the total, cortical and medullary renal blood flows were reduced compared with similar patients without AKI, whereas no differences in renal oxygenation were demonstrable in this setting. Trial registration ClinicalTrials ID: NCT02765191 , registered May 6 2014 and updated May 7 2020.

Conflict of interest statement

Institutional funding is accounted for separately. MH and FP are active in the American Physiological Society. The authors declare that they have no relevant competing interests.

© 2022. The Author(s).

Figures

Fig. 1
Fig. 1
Main results of renal multiparametric MRI. Box- and scatterplots of renal multiparametric MRI in 19 patients treated in ICU for respiratory failure due to COVID-19 with AKI and NO AKI, along with 12 healthy volunteers of similar age. Valid numbers of MRI examinations are specified for each parameter and group. p values from Kruskal–Wallis ANOVA. *, **, *** signifies p < 0.05, 0.01 and 0.001 in Mann–Whitney U test. TRUST is short for T2 Relaxation Under Spin Tagging
Fig. 2
Fig. 2
Example of imaging data. Representative regional perfusion using arterial spin labeling with perfusion maps colorized voxelwise showing representative AKI and NO AKI scans from the group of 19 patients with COVID-19 with and without AKI treated in ICU due to respiratory failure. Individual mean cortex perfusion across both kidneys are provided below each image after voxelwise Gaussian fit in each kidney to the histogram of cortical values
Fig. 3
Fig. 3
Post hoc correlation matrix. Post hoc correlation matrix for combined patient groups of clinical factors (MAP, eFF and eGFR) and multiparametric MRI measures showing absolute correlation (R) and the associated significance (P). eFF calculated as eGFRCreatinine/(TRBFPhase Contrast × (1 − Hematocrit)). Selected significant correlations of clinical factors and multiparametric MRI measures are shown in Additional file 1. MAP mean arterial pressure, PEEP positive end-expiratory pressure, eFF estimated filtration fraction, eGFR estimated glomerular filtration rate, R2* BOLD relaxation rate, ADC apparent diffusion coefficient, T2 transverse relaxation time, T1 longitudinal relaxation time, TRBF total renal blood flow

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