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Corona Virus Disease 2019 (COVID-19) and Its Effect on Renal System, A Systematic Review and Meta-analysis
Mehrbod Vakhshoori, Sayed Ali Emami, Maryam Heidarpour
1Heart Failure Research Center, Isfahan Cardiovascular Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran. d.shafie87@gmail.com.
Insights
COVID-19 (Coronavirus disease 2019) rarely causes severe kidney problems. Acute kidney injury (AKI) was infrequent, particularly in non-severe cases, suggesting limited renal involvement in most patients.
Area of Science:
- Nephrology
- Infectious Diseases
- Internal Medicine
Background:
- Coronavirus disease 2019 (COVID-19) primarily affects the respiratory system but can involve other organs.
- Acute kidney injury (AKI) is a reported complication of COVID-19, with variable reported frequencies.
- Renal biomarkers such as blood urea nitrogen (BUN) and serum creatinine (Cr) are used to assess kidney function.
Purpose of the Study:
- To determine the frequency of AKI in COVID-19 patients.
- To evaluate BUN and serum Cr levels in individuals with COVID-19 infection.
- To compare renal involvement across different clinical statuses (severe, non-severe, death).
Main Methods:
- A systematic literature review was conducted across Medline/PubMed, Scopus, and Google Scholar until April 16, 2020.
- Included peer-reviewed studies on COVID-19 patients, with no language restrictions.
- Patients were categorized into severe, non-severe, and death groups for comparative analysis.
Main Results:
- 18 records involving 4528 individuals were analyzed. The mean age was 52.5 years (55.6% male).
- Overall AKI prevalence was 4% (95% CI: 2% to 8%), significantly lower in non-severe (1%) versus deceased (31%) patients.
- Mean BUN was 5.14 mmol/L and mean serum Cr was 71.60 mmol/L, with lower BUN levels observed in non-severe cases compared to severe or deceased patients.
Conclusions:
- COVID-19 appears to have limited extensive involvement of the renal system.
- AKI incidence is low, especially in non-severe COVID-19 cases.
- Further research into potential underlying mechanisms of renal involvement is warranted.
Abstract:
Coronavirus disease 2019 (COVID-19) has been recently emerged with various manifestations, mainly on respiratory system. However, other organs might also be involved. Acute kidney injury has been reported as a complication with high variability and controversial results. We aimed to define the frequency of AKI as well as two specific renal biomarkers including BUN and serum Cr among individuals suffering from COVID-19 infection. We investigated Medline/PubMed, Scopus, and Google Scholar databases until 16th April 2020 and included all relevant peer-reviewed published studies without any language limitations. We further categorized patients according to their clinical status into severe, non-severe, and death groups. 18 records on 4528 individuals were assessed. The mean age of individuals were 52.5 ± 24.4 years (males: 55.6%). Prevalence of AKI was 4% (95% CI: 2% to 8%) and was significantly lower among non-severe patients in comparison to deceased ones (1%, 95% CI: 0% to 4%, vs. 31%, 95% CI: 19% to 47%). BUN mean was 5.14 mmol/L (95% CI: 4.60 to 5.69). Non-severe patients had remarkably lower means of BUN compared to deceased or those with severe infection (4.25 mmol/L, 95% Cl: 3.70 to 4.79, vs. 8.9 mmol/L, 95% CI: 7.94 to 9.86, vs. 6.63 mmol/L, 95% Cl: 5.62 to 7.65; respectively). The mean serum Cr was 71.60 mmol/L (95% Cl: 67.56 to 75.64). Our findings suggest that COVID-19 does not seem to involve renal system extensively and other possible mechanisms might be further investigated in this regard.
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