Renal Involvement and Outcomes in Patients Hospitalized with COVID-19 Infection in A Tertiary Hospital

Abstract

Background Kidney involvement is seen frequently in COVID-19 patients and is essential to the prognosis. This study is undertaken to describe the clinical presentation of renal involvement in COVID-19 patients concerning acute kidney injury (AKI), chronic kidney disease (CKD), and urinary abnormalities and to correlate with the severity of COVID-19 illness and its outcome. Material and Methods A retrospective cross-sectional study reviewed the medical records of patients admitted with COVID-19 infection who had pre-existing renal conditions or renal manifestations in the form of deranged renal function tests or abnormal urinary findings. All the relevant clinical and laboratory parameters, including the treatment details and outcome, were noted, and statistical analysis was done. Results A total of 72 out of 1,544 patients satisfied the inclusion criteria. Hypertension (72%) and Diabetes (62%) were the commonest co-morbidities noted. CKD was seen in 51 (70%) patients, and 21 patients (29%) were on maintenance dialysis. 39 (76%) patients with CKD were diagnosed with severe COVID-19, 25 (49%) of the patients developed acute worsening of CKD, and 45% had mortality. AKI was seen in 19 patients (26%). Urinary abnormality was seen in 34 (47%) patients, out of which 27 (37%) had proteinuria of more than 1+. Haematuria was seen in 27 (37.5%) patients, of which 12(17%) had gross haematuria. Dialysis was required in 24 patients (33%) additionally. Mechanical ventilation was required in 32(44%) patients, and inotropes in 41(56%). 21 (29%) patients developed acute respiratory distress syndrome, 39 (54%) had sepsis, with six patients developing multiorgan dysfunction syndrome. 62.5% of patients had mortality. The presence of other comorbid conditions, thrombocytopenia, coagulopathy, abnormality in arterial blood gases, and usage of inotropes were found to be significantly associated with adverse outcomes. Conclusions Most cases had severe renal system involvement, with an AKI prevalence rate of 1.2% and a case-specific mortality rate of 62.5%.

Keywords

• COVID 19
• Renal involvement
• Acute kidney injury

References

1. Qian JY, Wang B, Liu BC. Acute kidney injury in the 2019 novel coronavirus disease. Kidney Dis (Basel). 2020 Jun;323:1-6. doi: 10.1159/000509086.
2. Prasad N, Agrawal SK, On behalf of COVID-19 Working Group of Indian Society of Nephrology. COVID 19 and acute kidney injury. Indian J Nephrol. 2020 May-Jun;30(3):161-165. doi: 10.4103/ijn.IJN_120_20. Pei G, Zhang Z, Peng J, Liu L, Zhang C, Yu C, Ma Z, Huang Y, Liu W, Yao Y, Zeng R, Xu G. Renal involvement and early prognosis in patients with COVID-19 pneumonia. J Am Soc Nephrol. 2020 Jun;31(6):1157-65. doi: 10.1681/ASN.2020030276.
3. Patel SK, Singh R, Rana J, Tiwari R, Natesan S, Harapan H, Arteaga-Livias K, Bonilla-Aldana DK, Rodríguez-Morales AJ, Dhama K. The kidney and COVID-19 patients. Important considerations. Travel Med Infect Dis. 2020 Sep-Oct;37:101831. doi: 10.1016/j.tmaid.2020.101831.
4. Gabarre P, Dumas G, Dupont T, Darmon M, Azoulay E, Zafrani L. Acute kidney injury in critically ill patients with COVID-19. Intensive Care Med. 2020 Jul;46(7):1339-48. doi: 10.1007/s00134-020-06153-9.
5. Ronco C, Reis T, Husain-Syed F. Management of acute kidney injury in patients with COVID-19. Lancet Respir Med. 2020 Jul; 8(7):738-42. doi: 10.1016/S2213-2600(20)30229-0.
6. Allemailem KS, Almatroudi A, Khan AA, Rahmani AH, Almarshad IS, Alekezem FS, Hassanein N, El-Kady AM. Manifestations of renal system involvement in hospitalized patients with COVID-19 in Saudi Arabia. PLoS One. 2021 Jul 15;16(7):e0253036. doi: 10.1371/journal.pone.0253036.
7. Leon-Abarca JA, Memon RS, Rehan B, Iftikhar M, Chatterjee A. The impact of COVID-19 in diabetic kidney disease and chronic kidney disease: A population-based study. Acta Biomed. 2020 Nov 10;91(4):e2020161. doi: 10.23750/abm.v91i4.10380.
8. Chen CY, Shao SC, Chen YT, Hsu CK, Hsu HJ, Lee CC, Sun CY, Chen YC, Hung MJ, Wu IW. Incidence and cinical impacts of COVID-19 infection in patients with hemodialysis: Systematic review and meta-analysis of 396,062 hemodialysis patients. Healthcare (Basel). 2021 Jan 5;9(1):47. doi: 10.3390/healthcare9010047.

9. Akalin E, Azzi Y, Bartash R, Seethamraju H, Parides M, Hemmige V, Ross M, Forest S, Goldstein YD, Ajaimy M, Liriano-Ward L, Pynadath C, Loarte-Campos P, Nandigam PB, Graham J, Le M, Rocca J, Kinkhabwala M. COVID-19 and kidneyt. N Engl J Med. 2020 Jun 18;382(25):2475-2477. doi: 10.1056/NEJMc2011117.
10. Vasist P, Yousuff M. Renal manifestations of COVID-19 and its association with severity of disease in a tertiary care hospital of south India- A retrospective study. J Assoc Physicians India. 2022 Apr;70(4):11-12.
11. Ng JH, Hirsch JS, Hazzan A, Wanchoo R, Shah HH, Malieckal DA, Ross DW, Sharma P, Sakhiya V, Fishbane S, Jhaveri KD; Northwell Nephrology COVID-19 Research Consortium. Outcomes among patients hospitalized with COVID-19 and acute kidney injury. Am J Kidney Dis. 2021 Feb; 77(2):204-15.e1. doi: 10.1053/j.ajkd.2020.09.002.
12. Smarz-Widelska I, Grywalska E, Morawska I, Forma A, Michalski A, Mertowski S, Hrynkiewicz R, Niedźwiedzka-Rystwej P, Korona-Glowniak I, Parczewski M, Załuska W. Pathophysiology and clinical manifestations of COVID-19-related acute kidney injury-The current state of knowledge and future perspectives. Int J Mol Sci. 2021 Jun 30;22(13):7082. doi: 10.3390/ijms22137082.
13. Głowacka M, Lipka S, Młynarska E, Franczyk B, Rysz J. Acute kidney injury in COVID-19. Int J Mol Sci. 2021 Jul 28;22(15):8081. doi: 10.3390/ijms22158081.
14. Liu Y, Sun W, Guo Y, Chen L, Zhang L, Zhao S, Long D, Yu L. Association between platelet parameters and mortality in coronavirus disease 2019: Retrospective cohort study. Platelets. 2020 May 18;31(4):490-496. doi: 10.1080/09537104.2020.1754383.
15. Russo E, Esposito P, Taramasso L, Magnasco L, Saio M, Briano F, Russo C, Dettori S, Vena A, Di Biagio A, Garibotto G, Bassetti M, Viazzi F; GECOVID working group. Kidney disease and all-cause mortality in patients with COVID-19 hospitalized in Genoa, Northern Italy. J Nephrol. 2021 Feb;34(1):173-183. doi: 10.1007/s40620-020-00875-1.
16. Alfano G, Fontana F, Mori G, Giaroni F, Ferrari A, Giovanella S, Ligabue G, Ascione E, Cazzato S, Ballestri M, Di Gaetano M, Meschiari M, Menozzi M, Milic J, Andrea B, Franceschini E, Cuomo G, Magistroni R, Mussini C, Cappelli G, Guaraldi G; Modena COVID-19 Working Group (MoCo19). Acid base disorders in patients with COVID-19. Int Urol Nephrol. 2022 Feb;54(2):405-410. doi: 10.1007/s11255-021-02855-1.
17. Sindhu C, Prasad P, Elumalai R, Matcha J. Clinical profile and outcomes of COVID-19 patients with acute kidney injury: a tertiary centre experience from South India. Clin Exp Nephrol. 2022 Jan;26(1):36-44. doi: 10.1007/s10157-021-02123-7.