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[COVID-19 and kidney disease].
Jessica Smolander1, Annette Bruchfeld2
1bitr överläkare, njurmedicin, Danderyds sjukhus, Stockholm.
Lakartidningen
|July 14, 2020
Summary
Acute kidney injury (AKI), albuminuria, and hematuria are common in COVID-19 patients and increase mortality risk. Early urinary assessment and kidney-protective treatments are crucial for managing these conditions.
Area of Science:
- Nephrology
- Infectious Diseases
- Critical Care Medicine
Background:
- COVID-19 frequently presents with acute kidney injury (AKI), albuminuria, and hematuria, all linked to increased mortality.
- SARS-CoV-2 infection targets vascular endothelium and kidney cells, exacerbating kidney damage.
- Hyperinflammation, hypercoagulability, and multi-organ failure are key pathophysiological mechanisms in severe COVID-19.
Purpose of the Study:
- To highlight the significance of early renal assessment in COVID-19 patients.
- To outline diagnostic approaches for kidney injury in COVID-19.
- To discuss potential management strategies for renal complications.
Main Methods:
- Initial assessment includes urinary dipstick and creatinine levels.
- Positive findings warrant further investigation with urinary sediment analysis and albuminuria quantification.
- Review of pathophysiological mechanisms linking SARS-CoV-2 to kidney damage.
Main Results:
- AKI, albuminuria, and hematuria are prevalent in COVID-19.
- These urinary abnormalities are associated with higher mortality rates.
- Underhydration and rhabdomyolysis can precipitate acute tubular necrosis.
Conclusions:
- Prompt and thorough urinary assessment is vital for COVID-19 patients.
- Consideration of anti-inflammatory treatments in consultation with a nephrologist is advised.
- Continuation of ACE inhibitors/ARBs is recommended when feasible to protect kidney function.
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