What every Intensivist should know about COVID-19 associated acute kidney injury

Marlies Ostermann, Nuttha Lumlertgul, Lui G Forni, Eric Hoste, Marlies Ostermann, Nuttha Lumlertgul, Lui G Forni, Eric Hoste

Abstract

Acute kidney injury (AKI) is a serious complication in critically ill patients with COVID-19 with a reported incidence ranging from <5% to >25%. Proposed aetiologies include hypovolemia, hemodynamic disturbance and inflammation but also specific factors like direct viral invasion, microvascular thrombosis, and altered regulation of the renin-angiotensin-aldosterone system. To date, there are no confirmed specific therapies, and prevention and management of AKI should follow established guidelines. Novel therapies specifically targeting COVID-19 related pathologies are under investigation. The incidence of renal replacement therapy (RRT) is variable, ranging from 0-37%. In a pandemic, RRT practice is likely to be determined by the number of patients, availability of machines, consumables and staff, clinical expertise, and acceptable alternatives. Close collaboration between critical care and renal services is essential. In this article, we describe the epidemiology and pathophysiology of COVID-19 associated AKI, outline current management and suggest strategies to provide RRT during a pandemic when resources may be scarce.

Keywords: Acute kidney injury; COVID-19; Pandemic; Renal replacement therapy.

Conflict of interest statement

Declaration of Competing Interest The authors have no conflict of interest.

Copyright © 2020. Published by Elsevier Inc.

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Source: PubMed

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