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Covid-19 and Acute Kidney Injury

COVID-19 AND ACUTE KIDNEY INJURY

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COVID-19, the disease caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), often causes lasting lung damage. However, coronavirus can also cause severe and lasting harm in other organs, including the heart and kidneys.  People suffering with severe cases of COVID-19 are showing signs of kidney damage, and reports say up to 40% of patients hospitalized with COVID-19 develop moderate or severe kidney injury (1-3).
 
Recent evidence shows that SARS-CoV-2 can directly infect the kidney, most likely through ACE2 receptor-mediated endocytosis, potentially damaging kidney tissues as it replicates.  Acute kidney injury (AKI) can also be caused by low oxygen levels, overproduction of inflammatory cytokines, or blood clots commonly observed in SARS-CoV-2 infections.
 
Signs of kidney problems in patients with COVID-19 include high levels of protein in the urine and elevated serum creatinine (SCr) levels. Though relatively small increases of SCr levels over baseline can indicate AKI, the average SCr levels of COVID-19 patients can increase almost 10-fold. While elevated SCr is a clear marker of acute kidney injury (AKI), there is still no broadly accepted consensus on the degree of elevation required to qualify for the diagnosis of Covid-19-related AKI. However, SCr appears to be a suitable biomarker for acute kidney damage associated with COVID-19, and it is a possible warning sign of a serious, or even fatal, course of the disease.

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Citations:
1. Gabarre, P., et al. (2020). Acute kidney injury in critically ill patients with COVID-19. Intensive Care Medicine, 46(7), 1339–1348.
2. Cheng, Y., et al. (2020). Kidney disease is associated with in-hospital death of patients with COVID-19. Kidney International, 97(5), 829–838.
3. Tian, W., et al. (2020). Predictors of mortality in hospitalized COVID-19 patients: A systematic review and meta-anlysis. Journal of Medical Virology, 92(10), 1875–1883.

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