Department of General Medicine, Jawaharlal Nehru Medical College, Belgaum, Karnataka, India.
Nephrology Unit, GNRC Institute of Medical Sciences, Silagrant, Amingaon, Guwahati, India.
Saudi J Kidney Dis Transpl. 2021 Nov-Dec;32(6):1543-1551. doi: 10.4103/1319-2442.352414.
Initial reports early on in the pandemic in 2020 indicate a high incidence of acute kidney injury (AKI) in coronavirus disease 2019 (COVID-19). There is a need to better understand risk factors for AKI in patients with COVID-19. It is also unclear if AKI in patients with COVID-19 differs from AKI due to other causes. More data are required to clarify if COVID-19 is an independent risk factor for AKI and how COVID-19-associated AKI may differ from AKI due to other causes. We, therefore, sought to review the published evidence about the reported relationship between COVID-19, AKI, and outcomes. We performed a systematic search via PubMed and EMBASE using key words "COVID-19" and "AKI" to identify relevant observational studies, case series, and cohort studies published between March 2020 and April 2021. We also manually examined the reference lists of included studies and reviewed the AKI reports published in general medicine journals such as BMJ, Lancet, NEJM, and JAMA. The prevalence of AKI in hospitalized patients with COVID-19 differed across various regions of the world. Initial reports from China where cases of COVID-19 began initially have shown a much lower prevalence compared to those from Europe and North America, especially in critically ill patients in the intensive care unit with acute respiratory distress syndrome. The various components of severe acute respiratory syndrome-associated AKI appear in large parts to be similar to sepsis-induced AKI. However, affinity of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) specifically to the angiotensin-converting enzyme 2 receptors located on podocytes and endothelial cells of the kidney also points toward the direct cytotoxic effects of the virus on the kidney. Numerous mechanisms likely occur simultaneously and hence more treatment approaches need to be streamlined based on pathophysiology. Although data from published literature regarding previous SARS coronaviruses can give some useful insights, we will know more going forward about the nature of kidney injury associated with COVID-19 virus as well as optimum-specific therapeutic management.
2020 年大流行早期的初步报告表明，2019 年冠状病毒病（COVID-19）患者中急性肾损伤（AKI）的发病率很高。需要更好地了解 COVID-19 患者发生 AKI 的危险因素。也不清楚 COVID-19 引起的 AKI 是否与其他原因引起的 AKI 不同。需要更多的数据来阐明 COVID-19 是否是 AKI 的独立危险因素，以及 COVID-19 相关 AKI 是否与其他原因引起的 AKI 不同。因此，我们试图回顾关于 COVID-19、AKI 和结局之间报告关系的已发表证据。我们通过 PubMed 和 EMBASE 进行了系统搜索，使用关键词“COVID-19”和“AKI”来识别 2020 年 3 月至 2021 年 4 月期间发表的相关观察性研究、病例系列和队列研究。我们还手动检查了纳入研究的参考文献列表，并审查了 BMJ、柳叶刀、新英格兰医学杂志和美国医学会杂志等普通医学期刊上发表的 AKI 报告。COVID-19 住院患者 AKI 的患病率在世界不同地区有所不同。最初的报告来自 COVID-19 最初发生的中国，与欧洲和北美相比，其发病率要低得多，尤其是在重症监护病房患有急性呼吸窘迫综合征的危重症患者中。严重急性呼吸综合征相关 AKI 的各个组成部分在很大程度上类似于败血症引起的 AKI。然而，严重急性呼吸综合征冠状病毒 2（SARS-CoV-2）对位于肾脏足细胞和内皮细胞上的血管紧张素转换酶 2 受体的亲和力也表明病毒对肾脏有直接的细胞毒性作用。许多机制可能同时发生，因此需要根据病理生理学更有效地简化治疗方法。虽然来自已发表文献的关于以前的 SARS 冠状病毒的数据可以提供一些有用的见解，但随着时间的推移，我们将更清楚地了解与 COVID-19 病毒相关的肾脏损伤的性质以及最佳的特定治疗管理。
