COVID-19 and kidney

At the beginning of COVID-19 pandemic attention of healthcare professionals and scientists were already drawn to the appearance of markers of pathologic changes of the urinary system in SARS-CoV-2-infected patients, signs of acute kidney disease (AKD) (including acute kidney injury (AKI) or development of AKI in patients with chronic kidney disease (CKD). This necessitates verification of pathologic changes markers of the urinary system in SARS-CoV-2-infected patients and clarification of their nosologic relevance. The present study aimed to analyze the present information regarding the capacity of SARS-CoV-2 to cause kidney injury (acute kidney disease, including AKI) in patients without such changes before infecting or in patients with CKD, and to verify these changes according to the classification of urinary system disease and Nomenclature for kidney function and disease: report of Kidney Disease: Improving Global Outcomes (KDIGO) Consensus Conference 2020. The presence of the pathologic changes markers of the urinary system in SARS-CoV-2-infected patients necessitates its verification via the use of tools of diagnostics of urinary system disease. Infecting with SARS-CoV-2 may cause (isolated) asymptomatic proteinuria, isolated erythrocyturia, hemoglobinuria; AKD (including AKI) in patients without preexisting urinary system injuries, AKI in patients with CKD, and may complicate hemodialysis and peritoneal dialysis. The frequency of AKI and mortality rate in patients with COVID-19 and CKD are much higher than without the last one. The AKI frequency is higher in ICU (18 – 37,5%) than in patients with moderate or mild COVID-19 (0,5 – 15%). Patients with all CKD stages with moderate or severe COVID-19 must be admitted to the hospital with further determination by a multidisciplinary team (infectionist, nephrologist, ICU physician, etc, according to the clinical situation) of necessary monitoring and treatment capacity for prevention of AKD progression and life-threatening complications or their adequate therapy. After confirmation of SARS-CoV-2 absence and release from the hospital, patients with AKD or all stages of CKD should be followed up, and monitoring frequency depends on AKD or CKD stage.