Peng Xia1, Yubing Wen1, Yaqi Duan2,3, Hua Su4, Wei Cao5, Meng Xiao6, Jie Ma7, Yangzhong Zhou1, Gang Chen1, Wei Jiang8, Huanwen Wu9, Yan Hu7, Sanpeng Xu2, Hanghang Cai2, Zhengyin Liu5, Xiang Zhou10, Bin Du11, Jinglan Wang12, Taisheng Li5, Xiaowei Yan13, Limeng Chen1, Zhiyong Liang14, Shuyang Zhang15, Chun Zhang4, Yan Qin7, Guoping Wang16,3, Xuemei Li1. 1. Department of Nephrology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China. 2. Institute of Pathology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China. 3. Department of Pathology, School of Basic Medical Science, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China. 4. Department of Nephrology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China. 5. Department of Infectious Disease, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China. 6. Department of Laboratory Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China. 7. Department of Nephrology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China qinyanbeijing@126.com wanggp@hust.edu.cn. 8. Department of Medical ICU, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China. 9. Department of Pathology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China qinyanbeijing@126.com wanggp@hust.edu.cn. 10. Department of Intensive Care Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China. 11. Department of Medical ICU, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China qinyanbeijing@126.com wanggp@hust.edu.cn. 12. Department of Pulmonary and Critical Care Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China qinyanbeijing@126.com wanggp@hust.edu.cn. 13. Department of Cardiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China qinyanbeijing@126.com wanggp@hust.edu.cn. 14. Department of Pathology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China. 15. Department of Cardiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China. 16. Institute of Pathology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China qinyanbeijing@126.com wanggp@hust.edu.cn.
Abstract
BACKGROUND: The incidence, severity, and outcomes of AKI in COVID-19 varied in different reports. In patients critically ill with COVID-19, the clinicopathologic characteristics of AKI have not been described in detail. METHODS: This is a retrospective cohort study of 81 patients critically ill with COVID-19 in an intensive care unit. The incidence, etiologies, and outcomes of AKI were analyzed. Pathologic studies were performed in kidney tissues from ten deceased patients with AKI. RESULTS: A total of 41 (50.6%) patients experienced AKI in this study. The median time from illness to AKI was 21.0 (IQR, 9.5-26.0) days. The proportion of Kidney Disease Improving Global Outcomes (KDIGO) stage 1, stage 2, and stage 3 AKI were 26.8%, 31.7%, and 41.5%, respectively. The leading causes of AKI included septic shock (25 of 41, 61.0%), volume insufficiency (eight of 41, 19.5%), and adverse drug effects (five of 41, 12.2%). The risk factors for AKI included age (per 10 years) (HR, 1.83; 95% CI, 1.24 to 2.69; P=0.002) and serum IL-6 level (HR, 1.83; 95% CI, 1.23 to 2.73; P=0.003). KDIGO stage 3 AKI predicted death. Other potential risk factors for death included male sex, elevated D-dimer, serum IL-6 level, and higher Sequential Organ Failure Assessment score. The predominant pathologic finding was acute tubular injury. Nucleic acid tests and immunohistochemistry failed to detect the virus in kidney tissues. CONCLUSIONS: AKI was a common and multifactorial complication in patients critically ill with COVID-19 at the late stage of the disease course. The predominant pathologic finding was acute tubular injury. Older age and higher serum IL-6 level were risk factors of AKI, and KDIGO stage 3 AKI independently predicted death.
BACKGROUND: The incidence, severity, and outcomes of AKI in COVID-19 varied in different reports. In patientscritically ill with COVID-19, the clinicopathologic characteristics of AKI have not been described in detail. METHODS: This is a retrospective cohort study of 81 patientscritically ill with COVID-19 in an intensive care unit. The incidence, etiologies, and outcomes of AKI were analyzed. Pathologic studies were performed in kidney tissues from ten deceased patients with AKI. RESULTS: A total of 41 (50.6%) patients experienced AKI in this study. The median time from illness to AKI was 21.0 (IQR, 9.5-26.0) days. The proportion of Kidney Disease Improving Global Outcomes (KDIGO) stage 1, stage 2, and stage 3 AKI were 26.8%, 31.7%, and 41.5%, respectively. The leading causes of AKI included septic shock (25 of 41, 61.0%), volume insufficiency (eight of 41, 19.5%), and adverse drug effects (five of 41, 12.2%). The risk factors for AKI included age (per 10 years) (HR, 1.83; 95% CI, 1.24 to 2.69; P=0.002) and serum IL-6 level (HR, 1.83; 95% CI, 1.23 to 2.73; P=0.003). KDIGO stage 3 AKI predicted death. Other potential risk factors for death included male sex, elevated D-dimer, serum IL-6 level, and higher Sequential Organ Failure Assessment score. The predominant pathologic finding was acute tubular injury. Nucleic acid tests and immunohistochemistry failed to detect the virus in kidney tissues. CONCLUSIONS: AKI was a common and multifactorial complication in patientscritically ill with COVID-19 at the late stage of the disease course. The predominant pathologic finding was acute tubular injury. Older age and higher serum IL-6 level were risk factors of AKI, and KDIGO stage 3 AKI independently predicted death.
Authors: Victor G Puelles; Marc Lütgehetmann; Maja T Lindenmeyer; Jan P Sperhake; Milagros N Wong; Lena Allweiss; Silvia Chilla; Axel Heinemann; Nicola Wanner; Shuya Liu; Fabian Braun; Shun Lu; Susanne Pfefferle; Ann S Schröder; Carolin Edler; Oliver Gross; Markus Glatzel; Dominic Wichmann; Thorsten Wiech; Stefan Kluge; Klaus Pueschel; Martin Aepfelbacher; Tobias B Huber Journal: N Engl J Med Date: 2020-05-13 Impact factor: 91.245
Authors: Cynthia S Goldsmith; Sara E Miller; Roosecelis B Martines; Hannah A Bullock; Sherif R Zaki Journal: Lancet Date: 2020-05-19 Impact factor: 79.321
Authors: Jamie S Hirsch; Jia H Ng; Daniel W Ross; Purva Sharma; Hitesh H Shah; Richard L Barnett; Azzour D Hazzan; Steven Fishbane; Kenar D Jhaveri Journal: Kidney Int Date: 2020-05-16 Impact factor: 10.612
Authors: Matthew D Cheung; Elise N Erman; Shanrun Liu; Nathaniel B Erdmann; Gelare Ghajar-Rahimi; Kyle H Moore; Jeffrey C Edberg; James F George; Anupam Agarwal Journal: Kidney360 Date: 2021-11-05