CLINICAL AND LABORATORY FEATURES OF KIDNEY INFLAMMATION IN PATIENTS WITH COVID-19

Abstract

Topicality. Coronavirus, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), was first identified in December 2019 as the cause of respiratory disease marked by coronavirus disease in 2019, or COVID-19. Lung damage and respiratory failure have been recognized as the main features of COVID-19, but it is now suggested that damage to other organs, such as the heart, kidneys and nervous system, may occur and affect clinical course and mortality. Given that the kidneys serve as important metabolic organs and are target organs for the attack of SARS-CoV-2. The link between COVID-19 and acute renal failure (ARF) is receiving increasing attention. Retrospective studies in other countries have shown that renal failure is common in patients with COVID-19 and may be a major cause of multiple organ failure and death.

Aim. Our study is to determine the prevalence of kidney disease and the incidence of acute kidney disease in a cohort of adult patients with COVID-19.

Materials and methods. 92 patients with COVID-19 took part in our prospective study, who were hospitalized in the infectious department and in the intensive care unit of the regional clinical hospital. The inclusion criteria were sick patients with a positive test for SARS-CoV-2. Samples were taken on admission. Clinical and epidemiological data and results of laboratory research methods were taken into account in establishing the diagnosis.

Results. The development of ARF is more common in patients with chronic kidney disease. The results of the current study showed that the development of ARF in patients with CKD led to an acceleration of mortality.

In our study, 45 patients (48.9 %) were diagnosed with ARF , all of whom were in the group of critically ill patients. 14 (15.2 %) patients developed ARF, 9 patients had a history of CKD. 37 patients had proteinuria, 32 had 1.0 g/day, 5 – 2.0 g/day had 8 hematuria, and 15 had proteinuria and hematuria.

Due to the small sample size, we were unable to investigate the relationship between ARF and mortality. In addition, the receipt of GFR did not differ significantly between the two groups. Spearman’s correlation analysis showed that the patient’s age, condition, and IL-6 were also positively correlated with ARF; however, lymphocyte counts and GFR levels at admission were negatively associated with ARF. Patients with ARF were older, predominantly male, and had more severe disease than patients without ARF. Meanwhile, patients with ARF were more likely to have comorbidities (47.5 vs. 21.5 %, P <0.001).

Conclusions. Patients with chronic kidney disease should be advised to take additional precautions to minimize the risk of contracting the virus.

The presence of chronic kidney disease should be considered as an important factor in future risk stratification models for COVID-19.

Patients who had an internal kidney injury prior to hospitalization were at risk, but most patients with COVID-19 had no history of kidney disease.

The incidence of renal impairment among patients with COVID-19 can range from 1 to 13 %, and the development of acute renal impairment is a predictor of the risk associated with high hospital mortality.

Cytokines in the levels of IL-2, IL-4, interferon (IFN) -α or IFN-γ do not differ between the two groups, but cytokines in the level of IL-6 can cause intrarenal inflammation and lead to kidney damage.

Patients who have been hospitalized with elevated serum creatinine have had long an increase in white blood cell counts and lower lymphocyte and platelet counts.