Assessment of Acute Kidney Injury in Critically Ill Sars-Cov-2 Patients: A Narrative Review
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Abstract
Background: The COVID-19 pandemic, caused by the SARS-CoV-2 virus, has highlighted acute kidney injury (AKI) as a significant complication among hospitalized patients, with varying incidences reported globally. The pathophysiology of COVID-19 related AKI encompasses direct viral damage, systemic inflammation, and the activation of the renin-angiotensin-aldosterone system (RAAS), among other factors. This complexity underscores the need for a detailed understanding of its epidemiology, clinical presentation, and management strategies to improve patient outcomes.
Objective: To synthesize current knowledge on the epidemiology, pathophysiology, clinical presentation, and management of AKI in COVID-19 patients, aiming to identify key factors influencing incidence rates, patient prognosis, and effective therapeutic approaches.
Methods: A comprehensive review of literature was conducted, examining studies from various geographical regions that reported on the incidence, risk factors, pathophysiological mechanisms, clinical presentation, and management of AKI in COVID-19 patients. Data on renal replacement therapy needs, mortality rates, and outcomes related to different management strategies were also collated.
Results: The incidence of AKI among COVID-19 patients varies significantly, with higher rates observed in critically ill patients. Key risk factors include older age, pre-existing comorbidities (e.g., hypertension, diabetes mellitus), and severe COVID-19 infection. The clinical presentation of AKI in the context of COVID-19 is characterized by abnormalities in urinary sediment, including albuminuria and hematuria. Management strategies largely align with those for AKI due to other causes, focusing on fluid and hemodynamic management, cautious use of nephrotoxic drugs, and consideration of RAAS inhibitors. The mortality rate among COVID-19 patients with AKI is notably high, particularly in those requiring renal replacement therapy.
Conclusion: AKI is a common and serious complication of COVID-19, associated with high morbidity and mortality rates. A multidisciplinary approach, incorporating current guidelines and tailored management strategies, is essential for the care of these patients. Further research is needed to fully understand the pathophysiology of COVID-19 related AKI and to identify effective treatments.
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