Division of Nephrology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
J Am Soc Nephrol. 2020 Jun;31(6):1157-1165. doi: 10.1681/ASN.2020030276. Epub 2020 Apr 28.
Some patients with COVID-19 pneumonia also present with kidney injury, and autopsy findings of patients who died from the illness sometimes show renal damage. However, little is known about the clinical characteristics of kidney-related complications, including hematuria, proteinuria, and AKI.
In this retrospective, single-center study in China, we analyzed data from electronic medical records of 333 hospitalized patients with COVID-19 pneumonia, including information about clinical, laboratory, radiologic, and other characteristics, as well as information about renal outcomes.
We found that 251 of the 333 patients (75.4%) had abnormal urine dipstick tests or AKI. Of 198 patients with renal involvement for the median duration of 12 days, 118 (59.6%) experienced remission of pneumonia during this period, and 111 of 162 (68.5%) patients experienced remission of proteinuria. Among 35 patients who developed AKI (with AKI identified by criteria expanded somewhat beyond the 2012 Kidney Disease: Improving Global Outcomes definition), 16 (45.7%) experienced complete recovery of kidney function. We suspect that most AKI cases were intrinsic AKI. Patients with renal involvement had higher overall mortality compared with those without renal involvement (28 of 251 [11.2%] versus one of 82 [1.2%], respectively). Stepwise multivariate binary logistic regression analyses showed that severity of pneumonia was the risk factor most commonly associated with lower odds of proteinuric or hematuric remission and recovery from AKI.
Renal abnormalities occurred in the majority of patients with COVID-19 pneumonia. Although proteinuria, hematuria, and AKI often resolved in such patients within 3 weeks after the onset of symptoms, renal complications in COVID-19 were associated with higher mortality.
一些 COVID-19 肺炎患者还伴有肾脏损伤，死于该病的患者的尸检结果有时显示肾脏损害。然而，人们对包括血尿、蛋白尿和 AKI 在内的肾脏相关并发症的临床特征知之甚少。
本研究在中国的一家回顾性单中心研究中，分析了 333 例 COVID-19 肺炎住院患者的电子病历数据，包括临床、实验室、影像学和其他特征以及肾脏结局信息。
我们发现 333 例患者中有 251 例（75.4%）尿液干化学检测异常或 AKI。在中位持续时间为 12 天的 198 例有肾脏受累的患者中，在此期间 118 例（59.6%）肺炎缓解，162 例中的 111 例（68.5%）蛋白尿缓解。在 35 例 AKI 患者中（AKI 的定义根据标准略有扩大，超出了 2012 年改善全球肾脏病预后组织的定义），16 例（45.7%）肾功能完全恢复。我们怀疑大多数 AKI 病例为特发性 AKI。与无肾脏受累的患者相比，有肾脏受累的患者总死亡率更高（251 例中的 28 例[11.2%]与 82 例中的 1 例[1.2%]）。逐步多元二项逻辑回归分析表明，肺炎严重程度是与蛋白尿或血尿缓解及 AKI 恢复的几率降低最相关的危险因素。
COVID-19 肺炎患者大多数存在肾脏异常。虽然此类患者的蛋白尿、血尿和 AKI 通常在症状出现后 3 周内缓解，但 COVID-19 中的肾脏并发症与更高的死亡率相关。
