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Targeting acute kidney injury in COVID-19.
Nephrol Dial Transplant. 2020 10 01; 35(10):1652-1662.ND

Abstract

As of 15 August 2020, Coronavirus disease 2019 (COVID-19) has been reported in >21 million people world-wide and is responsible for more than 750,000 deaths. The occurrence of acute kidney injury (AKI) in patients hospitalized with COVID-19 has been reported to be as high as 43%. This is comparable to AKI in other forms of pneumonia requiring hospitalization, as well as in non-infectious conditions like cardiac surgery. The impact of AKI on COVID-19 outcomes is difficult to assess at present but, similar to other forms of sepsis, AKI is strongly associated with hospital mortality. Indeed, mortality is reported to be very low in COVID-19 patients without AKI. Given that AKI contributes to fluid and acid-base imbalances, compromises immune response and may impair resolution of inflammation, it seems likely that AKI contributes to mortality in these patients. The pathophysiologic mechanisms of AKI in COVID-19 are thought to be multifactorial including systemic immune and inflammatory responses induced by viral infection, systemic tissue hypoxia, reduced renal perfusion, endothelial damage and direct epithelial infection with Severe Acute Respiratory Syndrome Coronavirus 2. Mitochondria play a central role in the metabolic deregulation in the adaptive response to the systemic inflammation and are also found to be vital in response to both direct viral damage and tissue reperfusion. These stress conditions are associated with increased glycolysis and reduced fatty acid oxidation. Thus, there is a strong rationale to target AKI for therapy in COVID-19. Furthermore, many approaches that have been developed for other etiologies of AKI such as sepsis, inflammation and ischemia-reperfusion, have relevance in the treatment of COVID-19 AKI and could be rapidly pivoted to this new disease.

Authors+Show Affiliations

Department of Critical Care Medicine, The Center for Critical Care Nephology, University of Pittsburgh School of Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA, USA.Medical and Development, Astellas Pharma Inc., Tokyo, Japan.Mitobridge, An Astellas Company, Cambridge, MA, USA.

Pub Type(s)

Journal Article
Review

Language

eng

PubMed ID

33022712

Citation

Kellum, John A., et al. "Targeting Acute Kidney Injury in COVID-19." Nephrology, Dialysis, Transplantation : Official Publication of the European Dialysis and Transplant Association - European Renal Association, vol. 35, no. 10, 2020, pp. 1652-1662.
Kellum JA, van Till JWO, Mulligan G. Targeting acute kidney injury in COVID-19. Nephrol Dial Transplant. 2020;35(10):1652-1662.
Kellum, J. A., van Till, J. W. O., & Mulligan, G. (2020). Targeting acute kidney injury in COVID-19. Nephrology, Dialysis, Transplantation : Official Publication of the European Dialysis and Transplant Association - European Renal Association, 35(10), 1652-1662. https://doi.org/10.1093/ndt/gfaa231
Kellum JA, van Till JWO, Mulligan G. Targeting Acute Kidney Injury in COVID-19. Nephrol Dial Transplant. 2020 10 1;35(10):1652-1662. PubMed PMID: 33022712.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Targeting acute kidney injury in COVID-19. AU - Kellum,John A, AU - van Till,J W Olivier, AU - Mulligan,George, PY - 2020/07/08/received PY - 2020/08/04/accepted PY - 2020/10/6/entrez PY - 2020/10/7/pubmed PY - 2020/10/21/medline KW - AKI KW - COVID-19 KW - mitochondria KW - mortality KW - sepsis SP - 1652 EP - 1662 JF - Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association JO - Nephrol Dial Transplant VL - 35 IS - 10 N2 - As of 15 August 2020, Coronavirus disease 2019 (COVID-19) has been reported in >21 million people world-wide and is responsible for more than 750,000 deaths. The occurrence of acute kidney injury (AKI) in patients hospitalized with COVID-19 has been reported to be as high as 43%. This is comparable to AKI in other forms of pneumonia requiring hospitalization, as well as in non-infectious conditions like cardiac surgery. The impact of AKI on COVID-19 outcomes is difficult to assess at present but, similar to other forms of sepsis, AKI is strongly associated with hospital mortality. Indeed, mortality is reported to be very low in COVID-19 patients without AKI. Given that AKI contributes to fluid and acid-base imbalances, compromises immune response and may impair resolution of inflammation, it seems likely that AKI contributes to mortality in these patients. The pathophysiologic mechanisms of AKI in COVID-19 are thought to be multifactorial including systemic immune and inflammatory responses induced by viral infection, systemic tissue hypoxia, reduced renal perfusion, endothelial damage and direct epithelial infection with Severe Acute Respiratory Syndrome Coronavirus 2. Mitochondria play a central role in the metabolic deregulation in the adaptive response to the systemic inflammation and are also found to be vital in response to both direct viral damage and tissue reperfusion. These stress conditions are associated with increased glycolysis and reduced fatty acid oxidation. Thus, there is a strong rationale to target AKI for therapy in COVID-19. Furthermore, many approaches that have been developed for other etiologies of AKI such as sepsis, inflammation and ischemia-reperfusion, have relevance in the treatment of COVID-19 AKI and could be rapidly pivoted to this new disease. SN - 1460-2385 UR - https://www.unboundmedicine.com/medline/citation/33022712/Targeting_acute_kidney_injury_in_COVID_19_ L2 - https://academic.oup.com/ndt/article-lookup/doi/10.1093/ndt/gfaa231 DB - PRIME DP - Unbound Medicine ER -