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. 2020 Jun 6;13(3):354-361.
doi: 10.1093/ckj/sfaa099. eCollection 2020 Jun.

Characterization of acute kidney injury in critically ill patients with severe coronavirus disease 2019

Sébastien Rubin  1   2 , Arthur Orieux  3 , Renaud Prevel  3 , Antoine Garric  1 , Marie-Lise Bats  4   2 , Sandrine Dabernat  4 , Fabrice Camou  3 , Olivier Guisset  3 , Nahema Issa  3 , Gaelle Mourissoux  3 , Antoine Dewitte  5 , Olivier Joannes-Boyau  5 , Catherine Fleureau  5 , Hadrien Rozé  5 , Cédric Carrié  6 , Laurent Petit  6 , Benjamin Clouzeau  3 , Charline Sazio  3 , Hoang-Nam Bui  3 , Odile Pillet  3 , Claire Rigothier  1 , Frederic Vargas  3 , Christian Combe  1 , Didier Gruson  3 , Alexandre Boyer  3
Affiliations

Characterization of acute kidney injury in critically ill patients with severe coronavirus disease 2019

Sébastien Rubin et al. Clin Kidney J. .

Abstract

Background: Coronavirus disease 2019 (COVID-19)-associated acute kidney injury (AKI) frequency, severity and characterization in critically ill patients has not been reported.

Methods: Single-centre cohort performed from 3 March 2020 to 14 April 2020 in four intensive care units in Bordeaux University Hospital, France. All patients with COVID-19 and pulmonary severity criteria were included. AKI was defined using Kidney Disease: Improving Global Outcomes (KDIGO) criteria. A systematic urinary analysis was performed. The incidence, severity, clinical presentation, biological characterization (transient versus persistent AKI; proteinuria, haematuria and glycosuria) and short-term outcomes were evaluated.

Results: Seventy-one patients were included, with basal serum creatinine (SCr) of 69 ± 21 µmol/L. At admission, AKI was present in 8/71 (11%) patients. Median [interquartile range (IQR)] follow-up was 17 (12-23) days. AKI developed in a total of 57/71 (80%) patients, with 35% Stage 1, 35% Stage 2 and 30% Stage 3 AKI; 10/57 (18%) required renal replacement therapy (RRT). Transient AKI was present in only 4/55 (7%) patients and persistent AKI was observed in 51/55 (93%). Patients with persistent AKI developed a median (IQR) urine protein/creatinine of 82 (54-140) (mg/mmol) with an albuminuria/proteinuria ratio of 0.23 ± 20, indicating predominant tubulointerstitial injury. Only two (4%) patients had glycosuria. At Day 7 after onset of AKI, six (11%) patients remained dependent on RRT, nine (16%) had SCr >200 µmol/L and four (7%) had died. Day 7 and Day 14 renal recovery occurred in 28% and 52%, respectively.

Conclusion: Severe COVID-19-associated AKI is frequent, persistent, severe and characterized by an almost exclusive tubulointerstitial injury without glycosuria.

Keywords: COVID-19; acute interstitial nephritis; acute kidney injury; acute tubular injury; critically ill patients; renal replacement therapy.

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Figures

FIGURE 1
FIGURE 1
Flow diagram. Patients admitted from 3 March 2020 to 14 April 2020 were taken into consideration.
FIGURE 2
FIGURE 2
(A) Incidence of AKI during the ICU stay censored with death with 95% confidence interval. (B) Renal recovery during hospitalization censored with death with 95% confidence interval.
See this image and copyright information in PMC

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