Renal Complications and Their Prognosis in Korean Patients with Middle East Respiratory Syndrome-Coronavirus from the Central MERS-CoV Designated Hospital

Abstract

Some cases of Middle East Respiratory Syndrome-Coronavirus (MERS-CoV) infection presented renal function impairment after the first MERS-CoV patient died of progressive respiratory and renal failure. Thus, MERS-CoV may include kidney tropism. However, reports about the natural courses of MERS-CoV infection in terms of renal complications are scarce. We examined 30 MERS-CoV patients admitted to National Medical Center, Korea. We conducted a retrospective analysis of the serum creatinine (SCr), estimated glomerular filtration rate (eGFR), urine dipstick tests, urinary protein quantitation (ACR or PCR), and other clinical parameters in all patients. Two consecutive results of more than trace (or 1+) of albumin and blood on dipstick test occurred in 18 (60%) (12 [40%]) and 22 (73.3%) (19 [63.3%]) patients, respectively. Fifteen (50.0%) patients showed a random urine ACR or PCR more than 100 mg/g Cr. Eight (26.7%) patients showed acute kidney injury (AKI), and the mean and median durations to the occurrence of AKI from symptom onset were 18 and 16 days, respectively. Old age was associated with a higher occurrence of AKI in the univariate analysis (HR [95% CI]: 1.069 [1.013-1.128], P = 0.016) and remained a significant predictor of the occurrence of AKI after adjustment for comorbidities and the application of a mechanical ventilator. Diabetes, AKI, and the application of a continuous renal replacement therapy (CRRT) were risk factors for mortality in the univariate analysis (HR [95% CI]: diabetes; 10.133 [1.692-60.697], AKI; 12.744 [1.418-114.565], CRRT; 10.254 [1.626-64.666], respectively). Here, we report renal complications and their prognosis in 30 Korean patients with MERS-CoV.

Keywords: East Respiratory Syndrome-Coronavirus; Middle; Prognosis; Renal Complication.

Fig. 1. The progression of random urine albumin to creatinine ratio, protein to creatinine ratio, serum creatinine, and estimated GFR. (A) Mean random urine albumin to creatinine ratio. (B) Mean random urine protein to creatinine ratio. (C) Mean IDMS traceable serum creatinine. (D) Mean estimated glomerular filtration rate (eGFR) calculated by IDMS-MDRD equation throughout the observation period. Each point stands for the mean (least square) and standard error (error bar). Gray dot line indicates day 52 from symptom onset and data after that day are from one patient.

Fig. 2. The comparison of IDMS traceable serum creatinine and estimated GFR according to the occurrence of AKI and mortality. (A, B) Mean IDMS traceable serum creatinine (SCr) and IDMS-MDRD estimated glomerular filtration rate (eGFR) between the AKI and no AKI group. (C, D) Mean IDMS traceable SCr and IDMS-MDRD eGFR according to the application of CRRT. (E, F) Mean IDMS traceable SCr and IDMS-MDRD eGFR between dead and alive patients. (G, H) Mean IDMS traceable SCr and IDMS-MDRD eGFR between dead and alive patients in the AKI group.