Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Review
. 2020 Dec:60:91-95.
doi: 10.1016/j.jcrc.2020.07.023. Epub 2020 Jul 28.

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

Marlies Ostermann  1 , Nuttha Lumlertgul  2 , Lui G Forni  3 , Eric Hoste  4
Affiliations
Review

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

Marlies Ostermann et al. J Crit Care. 2020 Dec.

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.

PubMed Disclaimer

Conflict of interest statement

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

References

    1. Guan W.J., Ni Z.Y., Hu Y., Liang W.H., Ou C.Q., He J.X., et al. Clinical characteristics of coronavirus disease 2019 in China. N. Engl. J. Med. 2020;382(18):1708–1720. - PMC - PubMed
    1. Arentz M., Yim E., Klaff L., Lokhandwala S., Riedo F.X., Chong M., et al. Characteristics and outcomes of 21 critically ill patients with COVID-19 in Washington State. JAMA. 2020;Mar 19;323(16):1612–1614. - PMC - PubMed
    1. Pei G, Zhang Z, Peng J, Liu L, Zhang C, Yu C, et al. Renal involvement and early prognosis in patients with COVID-19 pneumonia. JASN 2020; (Apr 28) - PMC - PubMed
    1. Wang L., Li X., Chen H., Yan S., Li D., Li Y., et al. Coronavirus Disease 19 Infection does not result in acute kidney injury: an analysis of 116 hospitalized patients from Wuhan, China. Am. J. Nephrol. 2020;51(5):343–348. - PMC - PubMed
    1. Pan X.W., Xu D., Zhang H., Zhou W., Wang L.H., Cui X.G. Identification of a potential mechanism of acute kidney injury during the COVID-19 outbreak: a study based on single-cell transcriptome analysis. Intensive Care Med. 2020;46(6):1114–1116. - PMC - PubMed