Page 59 - GTM-3-3

Global Translational Medicine COVID-19 and acute kidney injury

Table 4. Incidence of AKI in SARS‑CoV‑2‑positive patient
SL# Study AKI (n) Total death (n) Non‑AKI (n) Death without AKI (n) Total Prevalence (%) Weight (%) Risk ratio
1 Lim et al. 5 17 30 134 13 164 10.37 12.42 6.6
2 Shao et al. 6 7 18 137 11 155 4.52 11.74 5.1
3 Cheng et al. 2 36 113 588 77 701 13.08 8.11 15.0
4 Wang et al. 7 14 19 88 5 107 5.14 53.11 2.6
5 Li et al. 8 32 55 138 23 170 28.50 14.62 4.3
Total 106 235 1,085 129 1,320 8 100 4.1
Abbreviations: AKI: Acute kidney injury; SARS-CoV-2: Severe acute respiratory syndrome coronavirus 2.

Table 5. Mortality in acute kidney injury (AKI) patients who who developed AKI was 18.0%, indicating a significant
were SARS‑CoV‑2 infected association between AKI and mortality. 11

SL# Study Death AKI (n) Prevalence Weight 3.4.5. Inflammation in AKI and acute respiratory
(n) (%) (%) distress syndrome (ARDS)
1 Lim et al. 5 17 30 56.67 18.99 Wang et al. provided insights into the systemic
7
2 Shao et al. 6 7 18 38.89 11.39 inflammation observed in non-survivors of COVID-19,
3 Cheng et al. 2 6 36 16.67 22.78 linking it to multiorgan dysfunction syndromes and ARDS.
4 Wang et al. 7 14 19 73.68 12.03 The study highlighted the significance of inflammatory
5 Li et al. 8 32 55 58.18 34.81 cytokines, such as interleukin (IL)-6 and tumor necrosis
Abbreviations: AKI: Acute kidney injury; SARS-CoV-2: Severe acute factor (TNF)-α, in the development of AKI among patients
respiratory syndrome coronavirus 2. with COVID-19-associated ARDS. It was observed that
ARDS patients with AKI had significantly higher levels of
incubation period generally ranges from 2 to 14 days after IL-6 and TNF-α compared to those without AKI, although
exposure. Most symptomatic individuals show symptoms IL-8 levels were not significantly different between the
by day 12, and the majority become ill by day 14. In two groups. These findings suggest that IL-6 and TNF-α
rare cases, symptoms may appear after 14 days, affecting play specific roles in the development of AKI among these
about one out of every 100 people. Some individuals patients. 7
may have COVID-19 without ever showing symptoms The study also noted that ARDS patients had higher
or their symptoms may be very mild, which suggests that serum levels of all four inflammatory cytokines compared
the COVID-19 incubation period could differ for these to controls, with these levels increasing steadily after
individuals and that current studies might not capture the admission. IL-6 and TNF-α levels correlated with the
mildest cases. 10
levels of creatinine and urea nitrogen, indicating their
3.4.4. Fatality time involvement in kidney function. In addition, IL-6, IL-8,
and TNF-α positively correlated with the acute physiology
Two studies provide critical insights into the progression and chronic health evaluation-II score, suggesting their
of COVID-19 and its association with AKI, particularly role in the severity of the condition. 7
focusing on the critical stages of the disease and factors
2,6
influencing in-hospital mortality. These studies highlight 3.4.6. Biochemical parameters
the importance of monitoring kidney function and the The studies by Shao et al., Cheng et al., Wang et al., and
2
7
6
development of AKI in COVID-19 patients, as these Li et al. consistently observed elevated levels of serum
8
conditions are associated with increased mortality rates. creatinine, blood urea nitrogen, D-dimer, proteinuria, and
A retrospective analysis conducted at the Centro hematuria among COVID-19 patients with AKI. These
Hospitalar Universitário Lisboa Norte between March and findings underscore the critical role of kidney function
August 2020 included 544 SARS-CoV-2-infected patients markers in the diagnosis and management of AKI in
admitted to a dedicated COVID-19 unit. The study found COVID-19 patients.
that 62.3% of these patients developed AKI during their
hospital stay, with older patients and those with pre-existing 3.4.7. Serum creatinine and blood urea nitrogen
comorbidities being more likely to develop AKI. Notably, the Elevated levels of serum creatinine and blood urea
in-hospital mortality rate among these COVID-19 patients nitrogen are common indicators of kidney dysfunction.

Volume 3 Issue 3 (2024) 6 doi: 10.36922/gtm.2798