Kidney involvement in COVID-19

Abstract

Since March 11, 2019, SARS-CoV-2 started to spread worldwide and made significant death and global problems. Although it is an acute respiratory infection, it can lead to acute kidney injury (AKI), especially in critically ill patients, and worsen their prognosis. This paper aimed to review prevalence, mortality, mechanism, electrolyte and urinary changes and, laboratory test and imaging findings in AKI. Additionally, investigate the relationship between CKD and COVID-19. Keywords like COVID-19, SARS-CoV-2, acute kidney injury and chronic kidney injury were used to find related articles from PubMed, Google Scholar, and Scopus. Due to studies, the mortality rate of COVID-19 patients with AKI was three times more than other COVID-19 patients. Mechanism of damage includes direct damage, cytokine storm, rhabdomyolysis, volume reduction, and organ crosstalk. Hyponatremia, hypokalemia, hypocalcemia, and hypochloremia were the most prevalent electrolyte changes. Due to activation of the renin-angiotensin system (RAS) system after the entrance of SARS-CoV-2 via angiotensin-converting enzyme (ACE2) inhibitor, blood urea nitrogen (BUN) can increase. In addition, the BUN level and BUN/creatinine ratio were higher in severe cases and can predict survival rates. Researches on AKI due to its high prevalence and mortality was required. Accordingly, it seems that most of these factors reviewed were related to AKI incidence and COVID-19 patients’ mortality.

Keywords: Angiotensin-converting enzyme, Coronavirus, Kidney injury, SARS-CoV-2