Editorial

ACUTE KIDNEY INJURY IN PATIENTS WITH COVID19: A CHALLENGE FOR NEPHROLOGISTS

PETAR KES orcid.org/0000-0002-4501-4823 ; Academy of Medical Sciences of Croatia and School of Medicine, University of Zagreb, Zagreb, Croatia

Abstract

Acute kidney injury (AKI) is a common fi nding in patients with coronavirus disease 2019 (COVID-CoV-19), and it is associated with long-term hospital treatment, more frequent admission to intensive care units (ICUs), and higher mortality compared with COVID-CoV-19 patients without kidney disease. Moreover, mortality rate is directly proportional to the severity of AKI. The pathophysiology of COVID-19 associated AKI could be related to specifi c and unspecifi c mechanisms. COVID-19 - specific mechanisms are direct cellular injury resulting from viral entry through the ACE-2 receptor, which is highly expressed in the kidney, an imbalanced renin-angiotensin-aldosterone system (RAAS), severe respiratory failure, proinfl ammatory cytokines elicited by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, coagulopathy, microangiopathy, and collapsing glomerulopathy. Nonspecifi c mechanisms include hemodynamic alterations, high levels of positive endexpiratory pressure in patients requiring mechanical ventilation, sepsis, hypovolemia, rhabdomyolysis, and administration of nephrotoxic drugs. Today, we do not know enough about the prevention and management of COVID-19. Treatment of AKI includes general management, pharmacological management of COVID-19, hemodynamic and volume optimization, renal
replacement therapy, and other extracorporeal organ support. As of now, long-term prognosis is unknown. However, it may be safe to speculate that prognosis will be associated to the etiology of AKI. Patients with thromboembolic complications and collapsing glomerulopathy may develop a more severe degree of chronic kidney disease compared to those with other types of renal injury (e.g., acute tubule-interstitial nephritis). Early studies suggest that about one-third of patients who survived AKI caused by COVID-19 will remain dialysis-dependent.

Keywords

acute respiratory distress syndrome; acute kidney injury; angiotensin-converting enzyme 2 receptor; COVID-19; cytokine release syndrome; extracorporeal organ support; renal replacement therapy; SARS-CoV-2

Hrčak ID:

259143

URI

https://hrcak.srce.hr/259143

Publication date:

19.6.2021.

Article data in other languages: croatian

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