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Key Clinical Updates in COVID-19 & The Kidney
Nearly half of patients hospitalized with COVID-19 present with or develop AKI, which is associated with poorer prognosis.
The most common cause of AKI in patients with COVID-19 is acute tubular necrosis related to a high inflammatory state (termed “cytokine storm”).
Treatment of COVID-19–related AKI is largely supportive.
Urinalysis may reveal hematuria, reflecting endothelial injury and fibrin thrombi that are commonly observed on biopsy.
Another emerging entity described is COVID-19–associated collapsing glomerulopathy, which is a type of focal segmental glomerulosclerosis.
The role of corticosteroids in COVID-19–associated collapsing glomerulopathy is under investigation.
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CLINICAL FINDINGS & TREATMENT
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Nearly half of patients hospitalized with COVID-19 present with or develop AKI, which is associated with poorer prognosis. Many causes of AKI are described in patients with COVID-19, but the most common is ATN related to a high inflammatory state (termed “cytokine storm”).
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Urinalysis may reveal hematuria, reflecting endothelial injury and fibrin thrombi that are commonly observed on biopsy. Another emerging entity is COVID-19–associated collapsing glomerulopathy, which is a type of focal segmental glomerulosclerosis (see section on “Nephrotic Spectrum Glomerular Diseases” below). Patients with collapsing glomerulopathy present with nephrotic syndrome and are typically of African ancestry, highlighting a suspected genetic predisposition. Treatment of COVID-19–related AKI is largely supportive; the role of corticosteroids in COVID-19–associated collapsing glomerulopathy is under investigation.
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Chan
L
et al; Mount Sinai COVID Informatics Center (MSCIC). AKI in hospitalized patients with COVID-19. J Am Soc Nephrol. 2021;32:151.
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Nasr
SH
et al. COVID-19-associated collapsing glomerulopathy: an emerging entity. Kidney Int Rep. 2020;5:759.
[PubMed: 32368701]
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Ronco
C
et al. Management of acute kidney injury in patients with COVID-19. Lancet Respir Med. 2020;8:738.
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Shetty
AA
et al. COVID-19-associated glomerular disease. J Am Soc Nephrol. 2021;32:33.
[PubMed: 33214201]