Acute kidney injury in patients with COVID-19 (May 2020)
AKI has been reported among ptns infected with the coronavirus disease 2019 (COVID-19), but the available database on its current incidence and its clinical criteria have been limited owing to the small number of patients. In an observational report conducting 5500 patients who admitted with COVID-19 infection, AKI occurred mostly in %, with % of cases were in need for dialysis (DX). Almost % of the ptns with AKI presents with hematuria and proteinuria syndrome, and about one1/3rd were diagnosed with AKI within 24 hs of hospital admission. AKI has been observed in % of ptns requiring mechanical ventilation and in % of non-ventilated ptns. The current findings raise the postulation that AKI is a common sequela of COVID-19, furthermore, it can be recognized as an important marker of clinical disease severity.
Ptns with an estimated glomerular filtration rate (eGFR) of <30 mL/min/1.73 m2 have a higher risk of acute kidney injury (AKI) following intravenous iodinated contrast used for computed tomography (CT). By contrast, the risk is not appreciably increased among ptns with a higher eGFR, consequently, it is NOT recommended to apply the policy of prophylactic volume expansion in such cohort of ptns. In a trial conducting over 550 ptns with mild/ moderate chronic kidney disease (eGFR ≥30 mL/min/1.73 m2) who underwent CT with IV contrast, post-contrast AKI can be observed at similar rates among cohorts receiving, and not receiving prophylactic volume expansion with . These findings support the recommendation that should be NOT administered to prevent post-contrast AKI in ptns with an eGFR ≥30 mL/min/1.73 m2.
Timal RJ, Kooiman J, Sijpkens YWJ, et al. Effect of No Prehydration vs Sodium Bicarbonate Prehydration Prior to Contrast-Enhanced Computed Tomography in the Prevention of Postcontrast Acute Kidney Injury in Adults With Chronic Kidney Disease: The Kompas Randomized Clinical Trial. JAMA Intern Med 2020; 180:533.