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Acute kidney injury in COVID 19 - an update on pathophysiology and management modalities
Manoj Khokhar1, Purvi Purohit1, Dipayan Roy1
1Department of Biochemistry, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India.
Insights
Severe COVID-19 can cause acute kidney injury (AKI), especially in older, immunocompromised patients. Early diagnosis and management, including renal replacement therapy, are crucial for these high-risk individuals.
Area of Science:
- Nephrology
- Infectious Diseases
- Virology
Background:
- Acute kidney injury (AKI) is common in severe coronavirus disease 2019 (COVID-19), presenting with fluid imbalance.
- Elderly patients with comorbidities are at higher risk for severe COVID-19 and subsequent AKI.
- Early AKI diagnosis and intervention are critical for improving outcomes in COVID-19 patients.
Purpose of the Study:
- To review the development of SARS-CoV-2-induced renal injury.
- To discuss the clinical characteristics and management strategies for AKI in COVID-19.
- To explore the role of renal replacement therapy and cytokine-lowering approaches.
Main Methods:
- Review of histopathological findings in COVID-19 patients with AKI.
- Analysis of clinical characteristics and management strategies.
- Discussion of supportive care, including fluid balance and hemodynamic monitoring.
Main Results:
- Histopathology shows SARS-CoV-2 invasion of renal parenchyma in AKI patients.
- AKI management involves renal replacement therapy and careful monitoring of immunosuppressants and antivirals.
- Cytokine-lowering strategies are emerging as potential treatments.
Conclusions:
- SARS-CoV-2 infection can directly cause AKI through viral invasion.
- Comprehensive management of AKI in COVID-19 requires attention to fluid balance, hemodynamics, and specific therapies.
- Further research is needed on immunosuppressant interactions in transplant patients with COVID-19.
Abstract:
Acute kidney injury (AKI), characterised by fluid imbalance and overload, is prevalent in severe disease phenotypes of coronavirus disease 2019 (COVID-19). The elderly immunocompromised patients with pre-existing comorbidities being more risk-prone to severe COVID-19, the importance of early diagnosis and intervention in AKI is imperative. Histopathological examination of COVID-19 patients with AKI reveals viral invasion of the renal parenchyma and evidence of AKI. The definitive treatment for AKI includes renal replacement therapy and renal transplant. Immunosuppressant regimens and its interactions with COVID-19 have to be further explored to devise effective treatment strategies in COVID-19 transplant patients. Other supportive strategies for AKI patients include hemodynamic monitoring and maintenance of fluid balance. Antiviral drugs should be meticulously monitored in the management of these high-risk patients. We have focussed on the development of renal injury provoked by the SARS-CoV-2, the varying clinical characteristics, and employment of different management strategies, including renal replacement therapy, alongside the emerging cytokine lowering approaches.
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