Acute Renal Failure in Critically Ill COVID-19 Patients With a Focus on the Role of Renal Replacement Therapy: A Review of What We Know So Far.

Ahmad Raza,Adrian Estepa,Vincent Chan,Munnam S Jafar

doi:10.7759/cureus.8429

Abstract

Acute renal failure remains a significant concern in all patients with the coronavirus disease 2019 (COVID-19) infection. Management is particularly challenging in critically ill patients requiring intensive care unit (ICU) level of care. Supportive care in the form of accurate volume correction and avoiding nephrotoxic agents are the chief cornerstone of the management of these patients. The pathophysiology of acute renal failure in COVID-19 is multifactorial, with significant contributions from excessive cytokine release. Gaining a better insight into the pathophysiology of renal failure will hopefully help develop more directed treatment options. A considerable number of these patients deteriorate despite adequate supportive care owing to the complexity of the disease and multi-organ involvement. Renal replacement therapy is used for a long time in critically ill septic patients who develop progressive renal failure despite adequate conservative support. Timing and choice of renal replacement therapy in critically ill COVID-19 patients remains an area of future research that may help decrease mortality in this patient population.

Highlights

BackgroundThe global pandemic of novel coronavirus disease 2019 (COVID-19) caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) began in Wuhan, China in December 2019 and has since spread worldwide [1]
We review the pathogenesis of acute renal failure in COVID-19 patients and discuss the role of renal replacement therapy in the management of these critically ill patients
Virus infection was confirmed by immunofluorescence (IF) staining using an antibody targeting SARS-CoV nucleoprotein shared between β-coronaviruses. These findings indicate that the SARS-CoV-2 virus can directly infect the renal tubular epithelium and podocytes, which was associated with acute kidney injury (AKI) and proteinuria in these patients with COVID-19

Summary

Introduction

The global pandemic of novel coronavirus disease 2019 (COVID-19) caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) began in Wuhan, China in December 2019 and has since spread worldwide [1]. The Early Versus Late Initiation of Renal Replacement Therapy in Critically Ill Patients with Acute Kidney Injury (ELAIN) trial was published in 2016, which had different results from that of the AKIKI trial [24]. In 2018, another multicentered, randomized, controlled trial was published studying septic shock patients with severe acute kidney injury [28]. Similar to the AKIKI trial, this study concluded that among patients with septic shock who had severe acute kidney injury, there was no significant difference in the overall 90-day mortality rate in early initiation compared to delayed initiation. While the mainstay of management of COVID-19 infection is supportive with the leading cause of mortality resulting from acute respiratory distress syndrome (ARDS), multi-organ failure in these patients is possibly associated with a hyperinflammatory syndrome characterized by hypercytokinemia.

Conclusions

Disclosures

Findings

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