Acute Kidney Injury in Critically-Ill COVID-19 Patients

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

doi:10.3390/jcm11072029

Open AccessArticle

Acute Kidney Injury in Critically-Ill COVID-19 Patients

by

Romain Arrestier

^1,2,*

,

Ségolène Gendreau

^1,2

,

David Mokrani

¹,

Jean-Philippe Bastard

^3,4,

Soraya Fellahi

^3,5,

François Bagate

^1,2,

Paul Masi

^1,2,

Thomas d’Humières

⁶,

Keyvan Razazi

^1,2,

Guillaume Carteaux

^1,2,4,

Nicolas De Prost

^1,2

,

Vincent Audard

^4,7,†

and

Armand Mekontso-Dessap

^1,2,4,†

¹

Service de Médecine Intensive Réanimation, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpitaux Universitaires Henri Mondor, 94010 Creteil, France

²

GRC CARMAS, Faculté de Médecine de Créteil, Université Paris Est Créteil, 94010 Creteil, France

³

Département de Biochimie-Pharmacologie-Biologie Moléculaire-Génétique Médicale, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpitaux Universitaires Henri Mondor, 94010 Creteil, France

⁴

Institut National de la Santé et de la Recherche Médicale (INSERM) U955, Institut Mondor de Recherche Biomédicale (IMRB), Université Paris Est Créteil, 94010 Creteil, France

⁵

Centre de Recherche Saint-Antoine, Institut Hospitalo-Universitaire de Cardio-Métabolisme et Nutrition (ICAN), Institut National de la Santé et de la Recherche Médicale (INSERM) UMR S938, Sorbonne Université, 75006 Paris, France

⁶

Service de Physiologie Explorations Fonctionnelles, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpitaux Universitaires Henri Mondor, 94010 Creteil, France

⁷

Service de Néphrologie et Transplantation, Centre de Référence Maladie Rare Syndrome Néphrotique Idiopathique, Assistance Publique-Hôpitaux de Paris (AP-HP), Fédération Hospitalo-Universitaire Innovative Therapy for Immune Disorders, Hôpitaux Universitaires Henri Mondor, 94010 Creteil, France

^*

Author to whom correspondence should be addressed.

^†

These authors contributed equally to this work.

J. Clin. Med. 2022, 11(7), 2029; https://doi.org/10.3390/jcm11072029

Submission received: 3 February 2022 / Revised: 25 March 2022 / Accepted: 31 March 2022 / Published: 5 April 2022

(This article belongs to the Special Issue Challenges in the Management of Renal Patients in the COVID-19 Era)

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Abstract

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.

Keywords: acute kidney injury; tubular necrosis; COVID; SARS-CoV2; dialysis; proteinuria

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MDPI and ACS Style

Arrestier, R.; Gendreau, S.; Mokrani, D.; Bastard, J.-P.; Fellahi, S.; Bagate, F.; Masi, P.; d’Humières, T.; Razazi, K.; Carteaux, G.; et al. Acute Kidney Injury in Critically-Ill COVID-19 Patients. J. Clin. Med. 2022, 11, 2029. https://doi.org/10.3390/jcm11072029

AMA Style

Arrestier R, Gendreau S, Mokrani D, Bastard J-P, Fellahi S, Bagate F, Masi P, d’Humières T, Razazi K, Carteaux G, et al. Acute Kidney Injury in Critically-Ill COVID-19 Patients. Journal of Clinical Medicine. 2022; 11(7):2029. https://doi.org/10.3390/jcm11072029

Chicago/Turabian Style

Arrestier, Romain, Ségolène Gendreau, David Mokrani, Jean-Philippe Bastard, Soraya Fellahi, François Bagate, Paul Masi, Thomas d’Humières, Keyvan Razazi, Guillaume Carteaux, and et al. 2022. "Acute Kidney Injury in Critically-Ill COVID-19 Patients" Journal of Clinical Medicine 11, no. 7: 2029. https://doi.org/10.3390/jcm11072029

APA Style

Arrestier, R., Gendreau, S., Mokrani, D., Bastard, J.-P., Fellahi, S., Bagate, F., Masi, P., d’Humières, T., Razazi, K., Carteaux, G., De Prost, N., Audard, V., & Mekontso-Dessap, A. (2022). Acute Kidney Injury in Critically-Ill COVID-19 Patients. Journal of Clinical Medicine, 11(7), 2029. https://doi.org/10.3390/jcm11072029

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