Arrestier Romain, Gendreau Ségolène, Mokrani David, Bastard Jean-Philippe, Fellahi Soraya, Bagate François, Masi Paul, d'Humières Thomas, Razazi Keyvan, Carteaux Guillaume, De Prost Nicolas, Audard Vincent, Mekontso-Dessap Armand
Service de Médecine Intensive Réanimation, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpitaux Universitaires Henri Mondor, 94010 Creteil, France.
GRC CARMAS, Faculté de Médecine de Créteil, Université Paris Est Créteil, 94010 Creteil, France.
J Clin Med. 2022 Apr 5;11(7):2029. doi: 10.3390/jcm11072029.
Purpose: Acute kidney injury (AKI) is common in patients with COVID-19, however, its mechanism is still controversial, particularly in ICU settings. Urinary proteinuria profile could be a non-invasive tool of interest to scrutinize the pathophysiological process underlying AKI in COVID-19 patients. Material and Methods: We conducted a retrospective study between March 2020 and April 2020. All patients with laboratory-confirmed COVID-19 and without end-stage kidney disease requiring renal replacement therapy before ICU admission were included. Our objectives were to assess the incidence and risk factors for AKI and to describe its clinical and biological characteristics, particularly its urinary protein profile. Results: Seventy patients were included; 87% needed mechanical ventilation and 61% needed vasopressor during their ICU stay; 64.3% of patients developed AKI and half of them needed dialysis. Total and tubular proteinuria on day 1 were higher in patients with AKI, whereas glomerular proteinuria was similar in both groups. The main risk factor for AKI was shock at admission (OR = 5.47 (1.74−17.2), p < 0.01). Mortality on day 28 was higher in AKI (23/45, 51.1%) than in no-AKI patients (1/25, 4%), p < 0.001. Risk factors for 28-days mortality were AKI with need for renal replacement therapy, non-renal SOFA score and history of congestive heart failure. Conclusions: AKI is common in COVID-19 patients hospitalized in ICU; it seems to be related to tubular lesions rather than glomerular injury and is related to shock at ICU admission.
急性肾损伤（AKI）在新型冠状病毒肺炎（COVID-19）患者中很常见，但其机制仍存在争议，尤其是在重症监护病房（ICU）环境中。尿蛋白谱可能是一种用于仔细研究COVID-19患者AKI潜在病理生理过程的无创工具。材料与方法：我们在2020年3月至2020年4月期间进行了一项回顾性研究。纳入所有实验室确诊为COVID-19且在入住ICU前无需要肾脏替代治疗的终末期肾病患者。我们的目标是评估AKI的发生率和危险因素，并描述其临床和生物学特征，特别是其尿蛋白谱。结果：纳入70例患者；87%的患者在ICU住院期间需要机械通气，61%的患者需要血管活性药物；64.3%的患者发生了AKI，其中一半需要透析。AKI患者第1天的总蛋白尿和肾小管性蛋白尿较高，而两组的肾小球性蛋白尿相似。AKI的主要危险因素是入院时休克（比值比=5.47（1.74 - 17.2），p<0.01）。AKI患者28天死亡率（23/45，51.1%）高于非AKI患者（1/25，4%），p<0.001。28天死亡率的危险因素是需要肾脏替代治疗的AKI、非肾脏序贯器官衰竭评估（SOFA）评分和充血性心力衰竭病史。结论：AKI在入住ICU的COVID-19患者中很常见；它似乎与肾小管损伤而非肾小球损伤有关，并且与ICU入院时的休克有关。
