key: cord-0744200-q8w04uky
authors: Orieux, Arthur; Rubin, Sébastien; Prevel, Renaud; Garric, Antoine; Gruson, Didier; Boyer, Alexandre
title: Severe COVID-19 induced AKI: a 3-month follow-up
date: 2021-02-02
journal: Clin Kidney J
DOI: 10.1093/ckj/sfab028
sha: 2d42afc0384ed359c18e01a2d28990f4e34fad59
doc_id: 744200
cord_uid: q8w04uky

nan

Since November 2019 and the emergence in China of a novel coronavirus named SARS-CoV 2, the whole world has been facing a global pandemic 1 

(Coronavirus Disease 2019) is mainly responsible for pneumonia with severe respiratory damages like acute respiratory distress syndrome (ARDS) could require prolonged invasive mechanical ventilation in the intensive care unit (ICU) 2 . Other organ injuries, probably underestimated, were reported like acute kidney injury (AKI) 3 . We reported an incidence of AKI of 80% in severe-COVID-19 patients in a study that included the whole ICU that had received COVID-19 patients (n=4) at the University Hospital of Bordeaux. 4 . Most of AKI-patients suffered from persistent AKI (93%) with likely a tubular involvement (urine protein/creatinine ratio of 82 [54-140] mg/mmol). To date, no data are reported concerning renal outcome after COVID-19-induced AKI.

We carried out a three-month follow-up study of patients admitted to the medical ICU of the University Hospital of Bordeaux. Basal serum creatinine (SCr) was systematically recorded using previous laboratory analysis for each patient. A standardized blood and urine laboratory test to be performed at 3 months were provided to the patient upon discharge from ICU.

From 5 th mars 2020 to 2 nd May 2020, 57 patients were admitted for severe COVID-19 in our ICU. Among them, 8 died during the hospitalization, 7 patients were lost to follow-up and 2 patients with previous CKD before admission were excluded.

CKD was defined as an estimated glomerular filtration rate (eGFR) of < 60mL/min/1.73m 2 . Among the 40 patients analyzed, 27 (68%) suffered from AKI during their stay in ICU. The mean age was 61 ± 11, the mean SAPSII score was 37 ± 17. Nineteen patients out of 27 (70%) and 20/27 (74%) required respectively vasopressor and mechanical ventilation. Basal SCr was 66 ± 14 μmol/L; basal eGFR was 98 ± 12 mL/min/1.73m 2 ( Table 1) .

Using KDIGO classification, nine out 27 patients (33%) had an AKI stage I; 9/27 (33%) an AKI stage II and 9/27 patients (33%) AKI stage 3. Among them, 4/9 (44%) required renal replacement therapy (RRT).

At 3 months of follow-up, SCr was 80 ± 28 μmol/L and eGFR was

Renal recovery was defined as a return of SCr to within 125% of baseline without dialysis 5 . Twenty out of 27 AKI patients (74%) had an early recovery (in the first 7 days) and 7/27 (26%) had AKD. Three of AKD patients (43%) recovered within the 3 months follow-up (Figure 1) . Renal recovery at D90 was presented by 23 patients out of 27 (85%). This report is the first of our knowledge to estimate the short outcome of kidney injury in severe-COVID-19. Because of the specificity of COVID-19 induced AKI associated with a highly inflammatory state 4 , a higher incidence of CKD at 3 months could be expected. However, this report seems to be reassuring and the low proteinuria is in line. Nevertheless, prolonged and careful follow-up is necessary with larger multicenter studies. Renal Recovery Renal recovery was defined as a return of SCr to within 125% of baseline without dialysis5. Twenty out of 27 AKI patients (74%) had an early recovery (in the first 7 days) and 7/27 (26%) had AKD. Three of AKD patients (43%) recovered within the 3 months follow-up ( Figure  1 ). Renal recovery at D90 was presented by 23 patients out of 27 (85%).

Chronic Kidney Disease at 3 Months Four out of 27 patients (15%) suffered from new onset CKD. Among these 4 patients, 3 patients required RRT during their stay in ICU. All these new CKD patients suffered from acute kidney disease (AKD) after AKI and prior to CKD. No patient needed RRT at 90 days of follow-up. 

A Novel Coronavirus from Patients with Pneumonia in China

Baseline Characteristics and Outcomes of 1591 Patients Infected With SARS-CoV-2 Admitted to ICUs of the Lombardy Region

Acute kidney injury in critically ill patients with COVID-19

Characterization of acute kidney injury in critically ill patients with severe coronavirus disease 2019

& for the Alberta Kidney Disease Network. Association between AKI, Recovery of Renal Function, and Long-Term Outcomes after Hospital Discharge

Clinical Trial Endpoints in Acute Kidney Injury