Department of Critical Care Medicine, King Saud Medical City, Riyadh, Saudi Arabia.
Department of Nephrology, King Saud Medical City, Riyadh, Saudi Arabia.
Saudi J Kidney Dis Transpl. 2021 May-Jun;32(3):869-874. doi: 10.4103/1319-2442.336786.
The coronavirus disease 2019 (COVID-19) infection associated with multisystemic involvement including renal manifestations has been described in the literature. The recent data show a high mortality rate of 60%-90% once renal function begins to deteriorate. We report on three patients who were admitted to intensive care unit due to severe COVID-19 acute respiratory distress syndrome and developed distal renal tubular acidosis. The three COVID-19 patients had hyperchloremic acidosis which was investigated thoroughly through a biochemical analysis of arterial blood gases and urine test as well as serological tests for autoimmune diseases and chronic infections, in addition to renal ultrasound. Metabolic acidosis was managed through repeated doses of intravenous sodium bicarbonate therapy; however, continuous renal replacement therapy was initiated for two refractory cases. We found that severe COVID-19 infection may be accompanied by hyperchloremic acidosis due to the cytopathic damage of the distal renal tubules, making the buffering system nonefficient and if not managed adequately, it may lead to poor prognosis.
新型冠状病毒病 2019（COVID-19）感染与包括肾脏表现在内的多系统受累有关，这在文献中已有描述。最近的数据表明，一旦肾功能开始恶化，死亡率高达 60%-90%。我们报告了 3 名因严重 COVID-19 急性呼吸窘迫综合征而入住重症监护病房并发生远端肾小管酸中毒的患者。这 3 名 COVID-19 患者均患有高氯性酸中毒，通过动脉血气生化分析和尿液检查以及自身免疫性疾病和慢性感染的血清学检查，以及肾脏超声检查对其进行了全面检查。代谢性酸中毒通过反复静脉滴注碳酸氢钠治疗进行管理；然而，对于 2 例难治性病例，开始进行持续肾脏替代治疗。我们发现，严重的 COVID-19 感染可能伴有高氯性酸中毒，这是由于远端肾小管的细胞病变损伤，使缓冲系统效率降低，如果管理不当，可能导致预后不良。
