Department of Critical Care, Royal Surrey Hospital, Egerton Road, Guildford, Surrey GU2 7XX, UK; SPACeR Group (Surrey Peri-Operative, Anaesthesia & Critical Care Collaborative Research Group), Royal Surrey Hospital, Egerton Road, Guildford, Surrey GU2 7XX, UK.
Division of Nephrology and Hypertension, Department of Medicine, Keck School of Medicine, University of Southern California, 1520 San Pablo Street, Suite 4300, Los Angeles, CA 90033, USA.
Crit Care Clin. 2022 Jul;38(3):473-489. doi: 10.1016/j.ccc.2022.01.002. Epub 2022 Jan 10.
Initial reporting suggested that kidney involvement following COVID-19 infection was uncommon but this is now known not to be the case. Acute kidney injury (AKI) may arise through several mechanisms and complicate up to a quarter of patients hospitalized with COVID-19 infection being associated with an increased risk for both morbidity and death. Mechanisms of injury include direct kidney damage predominantly through tubular injury, although glomerular injury has been reported; the consequences of the treatment of patients with severe hypoxic respiratory failure; secondary infection; and exposure to nephrotoxic drugs. The mainstay of treatment remains the prevention of worsening kidney damage and in some cases they need for renal replacement therapies (RRT). Although the use of other blood purification techniques has been proposed as potential treatments, results to-date have not been definitive.
最初的报告表明，COVID-19 感染后的肾脏受累并不常见，但现在已知并非如此。急性肾损伤（AKI）可能通过多种机制引起，并且 COVID-19 感染住院患者中多达四分之一的患者会出现并发症，这与发病率和死亡率增加有关。损伤机制包括主要通过肾小管损伤引起的直接肾脏损伤，尽管已有报道肾小球损伤；严重低氧性呼吸衰竭患者治疗的后果；继发感染；以及接触肾毒性药物。治疗的主要方法仍然是防止肾脏损伤恶化，在某些情况下，他们需要肾脏替代治疗（RRT）。尽管已经提出了其他血液净化技术的使用作为潜在的治疗方法，但迄今为止的结果还不确定。
