COVID-19 and Acute Kidney Injury

James Hilton; Naomi Boyer; Mitra K Nadim; Lui G Forni; John A Kellum

doi:10.1016/j.ccc.2022.01.002

COVID-19 and Acute Kidney Injury

Crit Care Clin. 2022 Jul;38(3):473-489. doi: 10.1016/j.ccc.2022.01.002. Epub 2022 Jan 10.

Authors

James Hilton¹, Naomi Boyer¹, Mitra K Nadim², Lui G Forni³, John A Kellum⁴

Affiliations

¹ Department of Critical Care, Royal Surrey Hospital, Egerton Road, Guildford, Surrey GU2 7XX, UK; SPACeR Group (Surrey Peri-Operative, Anaesthesia & Critical Care Collaborative Research Group), Royal Surrey Hospital, Egerton Road, Guildford, Surrey GU2 7XX, UK.
² Division of Nephrology and Hypertension, Department of Medicine, Keck School of Medicine, University of Southern California, 1520 San Pablo Street, Suite 4300, Los Angeles, CA 90033, USA.
³ Department of Critical Care, Royal Surrey Hospital, Egerton Road, Guildford, Surrey GU2 7XX, UK; SPACeR Group (Surrey Peri-Operative, Anaesthesia & Critical Care Collaborative Research Group), Royal Surrey Hospital, Egerton Road, Guildford, Surrey GU2 7XX, UK; Department of Clinical & Experimental Medicine, Faculty of Health Sciences, University of Surrey, Stag Hill, Guildford GU2 7XH, UK. Electronic address: luiforni@nhs.net.
⁴ Center for Critical Care Nephrology, University of Pittsburgh, 3347 Forbes Avenue #220, Pittsburgh, PA 15213, USA.

Abstract

Initial reporting suggested that kidney involvement following COVID-19 infection was uncommon but this is now known not to be the case. Acute kidney injury (AKI) may arise through several mechanisms and complicate up to a quarter of patients hospitalized with COVID-19 infection being associated with an increased risk for both morbidity and death. Mechanisms of injury include direct kidney damage predominantly through tubular injury, although glomerular injury has been reported; the consequences of the treatment of patients with severe hypoxic respiratory failure; secondary infection; and exposure to nephrotoxic drugs. The mainstay of treatment remains the prevention of worsening kidney damage and in some cases they need for renal replacement therapies (RRT). Although the use of other blood purification techniques has been proposed as potential treatments, results to-date have not been definitive.

Keywords: Acute kidney injury; Blood purification techniques; COVID-19; Cytokines; Renal replacement therapy.

Publication types

Review

MeSH terms

Acute Kidney Injury* / etiology
Acute Kidney Injury* / therapy
COVID-19* / complications
COVID-19* / therapy
Humans
Renal Replacement Therapy
SARS-CoV-2