2019年重症冠状病毒病危重症患者急性肾损伤的特征
Characterization of acute kidney injury in critically ill patients with severe coronavirus disease 2019.
作者信息
Rubin Sébastien, Orieux Arthur, Prevel Renaud, Garric Antoine, Bats Marie-Lise, Dabernat Sandrine, Camou Fabrice, Guisset Olivier, Issa Nahema, Mourissoux Gaelle, Dewitte Antoine, Joannes-Boyau Olivier, Fleureau Catherine, Rozé Hadrien, Carrié Cédric, Petit Laurent, Clouzeau Benjamin, Sazio Charline, Bui Hoang-Nam, Pillet Odile, Rigothier Claire, Vargas Frederic, Combe Christian, Gruson Didier, Boyer Alexandre
机构信息
Service de Néphrologie, Transplantation, Dialyse et Aphérèses, Hôpital Pellegrin, CHU de Bordeaux, Bordeaux, France.
Unité INSERM U1034, Université de Bordeaux, Bordeaux, France.
出版信息
Clin Kidney J. 2020 Jun 6;13(3):354-361. doi: 10.1093/ckj/sfaa099. eCollection 2020 Jun.
BACKGROUND
Coronavirus disease 2019 (COVID-19)-associated acute kidney injury (AKI) frequency, severity and characterization in critically ill patients has not been reported.
METHODS
Single-centre cohort performed from 3 March 2020 to 14 April 2020 in four intensive care units in Bordeaux University Hospital, France. All patients with COVID-19 and pulmonary severity criteria were included. AKI was defined using Kidney Disease: Improving Global Outcomes (KDIGO) criteria. A systematic urinary analysis was performed. The incidence, severity, clinical presentation, biological characterization (transient versus persistent AKI; proteinuria, haematuria and glycosuria) and short-term outcomes were evaluated.
RESULTS
Seventy-one patients were included, with basal serum creatinine (SCr) of 69 ± 21 µmol/L. At admission, AKI was present in 8/71 (11%) patients. Median [interquartile range (IQR)] follow-up was 17 (12-23) days. AKI developed in a total of 57/71 (80%) patients, with 35% Stage 1, 35% Stage 2 and 30% Stage 3 AKI; 10/57 (18%) required renal replacement therapy (RRT). Transient AKI was present in only 4/55 (7%) patients and persistent AKI was observed in 51/55 (93%). Patients with persistent AKI developed a median (IQR) urine protein/creatinine of 82 (54-140) (mg/mmol) with an albuminuria/proteinuria ratio of 0.23 ± 20, indicating predominant tubulointerstitial injury. Only two (4%) patients had glycosuria. At Day 7 after onset of AKI, six (11%) patients remained dependent on RRT, nine (16%) had SCr >200 µmol/L and four (7%) had died. Day 7 and Day 14 renal recovery occurred in 28% and 52%, respectively.
CONCLUSION
Severe COVID-19-associated AKI is frequent, persistent, severe and characterized by an almost exclusive tubulointerstitial injury without glycosuria.
背景
2019年冠状病毒病（COVID-19）相关的急性肾损伤（AKI）在危重症患者中的发生率、严重程度和特征尚未见报道。
方法
于2020年3月3日至2020年4月14日在法国波尔多大学医院的四个重症监护病房进行单中心队列研究。纳入所有符合COVID-19及肺部严重程度标准的患者。使用改善全球肾脏病预后组织（KDIGO）标准定义AKI。进行系统的尿液分析。评估其发生率、严重程度、临床表现、生物学特征（一过性与持续性AKI；蛋白尿、血尿和糖尿）及短期预后。
结果
共纳入71例患者，基础血清肌酐（SCr）为69±21µmol/L。入院时，8/71（11%）的患者存在AKI。中位随访时间[四分位间距（IQR）]为17（12 - 23）天。共有57/71（80%）的患者发生AKI，其中35%为1期，35%为2期，30%为3期AKI；10/57（18%）的患者需要肾脏替代治疗（RRT）。仅4/55（7%）的患者为一过性AKI，51/55（93%）的患者为持续性AKI。持续性AKI患者的尿蛋白/肌酐中位数（IQR）为82（54 - 140）（mg/mmol），白蛋白尿/蛋白尿比值为0.23±20，提示主要为肾小管间质损伤。仅2例（4%）患者出现糖尿。在AKI发病后第7天，6例（11%）患者仍依赖RRT，9例（16%）患者的SCr>200µmol/L，4例（7%）患者死亡。第7天和第14天肾脏恢复的患者分别为28%和52%。
结论
严重的COVID-19相关AKI很常见，呈持续性、严重，且几乎仅以肾小管间质损伤为特征，无糖尿。
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