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ESSENTIALS OF DIAGNOSIS
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CLINICAL FINDINGS & TREATMENT
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Nearly 30% of patients hospitalized with COVID-19 and 50% of critically ill patients are affected by 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”) and to states of prolonged hypotension and volume depletion.
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UA may reveal hematuria, reflecting endothelial injury and fibrin thrombi that are commonly observed on biopsy. An emerging entity is COVID-19–associated collapsing glomerulopathy, which is a type of focal segmental glomerulosclerosis that predominantly affects Black patients, due to the increased prevalence of high-risk APOL1 genetic variants (see section on Nephrotic Spectrum Glomerular Diseases below). Collapsing glomerulopathy presents with nephrotic syndrome. Treatment of COVID-19–related AKI is largely supportive; approximately 20% of patients require kidney replacement therapy. Corticosteroids have been used in COVID-19–associated collapsing glomerulopathy with reported success, but there is a lack of trial data or long-term follow-up to date to confirm efficacy.
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Kudose
S
et al. Longitudinal outcomes of COVID-19-associated collapsing glomerulopathy and other podocytopathies. J Am Soc Nephrol. 2021;32:2958.
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et al. A multi-center retrospective cohort study defines the spectrum of kidney pathology in Coronavirus 2019 Disease (COVID-19). Kidney Int. 2021;100:1303.
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et al. Outcomes among patients hospitalized with COVID-19 and acute kidney injury. Am J Kidney Dis. 2021;77:204.
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Palevsky
PM. COVID-19 and AKI: where do we stand? J Am Soc Nephrol. 2021;32;1029.
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C
et al. Management of acute kidney injury in patients with COVID-19. Lancet Respir Med. 2020;8:738.
[PubMed: 32416769]