Acute Kidney Injury in Patients with the New Coronavirus Infection
https://doi.org/10.21292/2078-5658-2021-18-3-7-14
Abstract
Estimations of the frequency of acute kidney injury in SARS-CoV-2 (COVID-19) coronavirus disease are very diverse. The literature data is highly inconsistent and shows AKI ranging from 0.5 to 80%.
The objective: to analyze the incidence of renal dysfunction in COVID-19 patients and assess the significance of systemic inflammation for its development.
Subjects and methods: The analysis was performed basing on data of 3,806 patients with COVID-19 treated at the Pavlov State Medical University, 395 of them were admitted to the intensive care units (ICU). The criterion for establishing renal dysfunction (RD) is the increase in blood creatinine level above the upper limit of reference values (0.115 mmol/l). Patients with end-stage chronic kidney disease who needed to continue routine long-term dialysis were not included in the study. We analyzed the incidence of renal dysfunction, changes in blood levels of creatinine, urea, and electrolytes during 8 days. In addition, glomerular filtration rate, diuresis volume, levels of hematocrit, hemoglobin, LDH, CRP, ferritin, and procalcitonin were evaluated.
Results. The frequency of RD among all patients was 19.0%, among patients in the ICU – 41.0%. In 79% and 81%, respectively, it was detected on the first day of hospitalization. The increase in the number of patients with RD and the aggravation of the existing dysfunction occurred after 6 days. At the initial stage of the disease, the manifestations of RD in most cases were not expressed even in those with an unfavorable course of the disease but the level of creatinine showed a weak but significant (p < 0.5) correlation with changes in CRP (r = 0.110), ferritin (r = 0.137), and procalcitonin (PCT, r = 0.418). The difference in the level of creatinine in patients with PСT level above and below 0.5 ng/ml was observed on the first day only; the value of this parameter returned to normal faster in the subgroup of patients whose procalcitonin level did not exceed 0.5 ng/ml.
Conclusion. In case of the signs indicative of RD, it is advisable to distinguish between primary and secondary injury. In the first case, it is primarily due to systemic inflammation, in the second case it is caused by additional impact of other aggressive factors. This will make it possible to clarify the renal and non-renal indications for renal replacement therapy (RRT) in patients with COVID-19, and to evaluate the results adequately since the effectiveness of RRT at different stages of the disease cannot be the same.
About the Authors
Yu. S. Polushin
Pavlov First Saint Petersburg State Medical University
Russian Federation
Russian Federation
Yury S. Polushin, Academician of RAS, Professor, Head of Anesthesiology and Intensive Care Department, Head of Research Clinical Center of Anesthesiology and Intensive Care
6-8, Lva Tolstogo St., St. Petersburg, 197022
R. V. Аkmalova
Pavlov First Saint Petersburg State Medical University
Russian Federation
Russian Federation
Regina V. Akmalova, Researcher of Efferent Hemocorrection Group, Anesthesiologist and Emergency Physician of Research Clinical Center of Anesthesiology and Intensive Care
6-8, Lva Tolstogo St., St. Petersburg, 197022
I. V. Bovkun
Pavlov First Saint Petersburg State Medical University
Russian Federation
Russian Federation
Igor V. Bovkun, Head of Intensive Care Unit no. 4 for Emergency Detoxification of Research Clinical Center of Anesthesiology and Intensive Care, Head of Intensive Care Unit for Emergency Detoxication of Coronavirus Infection Treatment Center
6-8, Lva Tolstogo St., St. Petersburg, 197022
D. V. Sokolov
Pavlov First Saint Petersburg State Medical University
Russian Federation
Russian Federation
Dmitry V. Sokolov, Researcher of Efferent Hemocorrection Group of Research Clinical Center of Anesthesiology and Intensive Care
6-8, Lva Tolstogo St., St. Petersburg, 197022
I. V. Shlyk
Pavlov First Saint Petersburg State Medical University
Russian Federation
Russian Federation
Irina V. Shlyk, Doctor of Medical Sciences, Professor of Anesthesiology and Intensive Care Department, Deputy Head of Research Clinical Center of Anesthesiology and Intensive Care, Deputy Head Physician of University Clinic in Anesthesiology and Intensive Care
6-8, Lva Tolstogo St., St. Petersburg, 197022
E. G. Gavrilova
Pavlov First Saint Petersburg State Medical University
Russian Federation
Russian Federation
Elena G. Gavrilova, Candidate of Medical Sciences, Associate Professor of Anesthesiology and Intensive Care Department, Head of Anesthesiology and Intensive Care Department no. 2 of Research Clinical Center of Anesthesiology and Intensive Care
6-8, Lva Tolstogo St., St. Petersburg, 197022
E. V. Parshin
Pavlov First Saint Petersburg State Medical University
Russian Federation
Russian Federation
Evgeniy V. Parshin, Doctor of Medical Sciences, Professor of Anesthesiology and Intensive Care Department, Head of Research Group for Extracorporeal Hemocorrection
6-8, Lva Tolstogo St., St. Petersburg, 197022
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Review
For citations:
Polushin Yu.S., Аkmalova R.V., Bovkun I.V., Sokolov D.V., Shlyk I.V., Gavrilova E.G., Parshin E.V. Acute Kidney Injury in Patients with the New Coronavirus Infection. Messenger of ANESTHESIOLOGY AND RESUSCITATION. 2021;18(3):7-14. (In Russ.) https://doi.org/10.21292/2078-5658-2021-18-3-7-14
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