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Case Reports
. 2020 May 28;382(22):2147-2156.
doi: 10.1056/NEJMcpc2002418. Epub 2020 May 13.

Case 17-2020: A 68-Year-Old Man with Covid-19 and Acute Kidney Injury

Meghan E Sise  1 , Meridale V Baggett  1 , Jo-Anne O Shepard  1 , Jacob S Stevens  1 , Eugene P Rhee  1
Affiliations
Case Reports

Case 17-2020: A 68-Year-Old Man with Covid-19 and Acute Kidney Injury

Meghan E Sise et al. N Engl J Med. .
No abstract available

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Figures

Figure 1.
Figure 1.. Chest Radiographs.
A chest radiograph obtained on admission (Panel A) shows bilateral multifocal patchy opacities, a finding suggestive of pneumonia. A chest radiograph obtained 1 day before continuous venovenous hemofiltration was initiated (Panel B) shows evidence of an increase in bilateral consolidation and interstitial opacities, a finding suggestive of worsening pulmonary edema, pneumonia, or acute respiratory distress syndrome. Also shown are an endotracheal tube in the trachea, a catheter in the superior vena cava, and a nasogastric tube in place.
Figure 2.
Figure 2.. Considerations for Continuous Venovenous Hemofiltration in Patients with Covid-19.
Shown is a simplified overview of continuous venovenous hemofiltration, a common form of continuous renal replacement therapy. Blood from the patient is filtered through a permeable membrane (the filter) and the filtrate is discarded, resulting in clearance of urea nitrogen, creatinine, potassium, phosphate, and other substances; cells and larger proteins such as albumin are not filtered. Replacement fluid that is isotonic to plasma is provided to replace volume and provide base equivalents, typically in the form of bicarbonate or less commonly citrate. Although it reduces clearance efficiency, replacement fluid is usually provided prefilter rather than postfilter in order to prevent hemoconcentration and subsequent clotting in the filter. Citrate-based replacement fluid can provide additional anticoagulation by chelating calcium in the filter; the patient must have adequate hepatic function to metabolize citrate into bicarbonate. Other common approaches to attenuate filter clotting include increasing the blood flow rate, which can be limited by the quality of vascular access, and infusing an anticoagulant, either prefilter or systemically. Increasing the rate of replacement fluid and filtrate turnover increases the treatment dose and is one approach to maximizing clearance for intermittent therapy, which may be indicated if continuous therapy is precluded by recurrent clotting or because a machine is to be shared among multiple patients.
See this image and copyright information in PMC

References

    1. World Health Organization. Report of the WHO-China Joint Mission on Coronavirus Disease 2019 (COVID-19). February 28, 2020. (https://www.who.int/publications-detail/report-of-the-who-china-joint-mi...).
    1. Zhou F, Yu T, Du R, et al. Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study. Lancet 2020; 395: 1054–62. - PMC - PubMed
    1. Diao B, Wang C, Wang R, et al. Human kidney is a target for novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. medRxiv. 2020. (https://www.medrxiv.org/content/10.1101/2020.03.04.20031120v4) (preprint). - DOI - PMC - PubMed
    1. Cheng Y, Luo R, Wang K, et al. Kidney disease is associated with in-hospital death of patients with COVID-19. Kidney Int 2020; 97: 829–38. - PMC - PubMed
    1. Li Z, Wu M, Yao J, et al. Caution on kidney dysfunctions of Covid-19 patients. medRxiv. 2020. (https://www.medrxiv.org/content/10.1101/2020.02.08.20021212v2) (preprint). - DOI

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