Amit, Vincent Luther John M.

BSN UV – MARTINSEN A October 31, 2021

Acute Renal Failure in Critically Ill COVID-19 Patients with a Focus on the Role of Renal
Replacement Therapy: A Review of What We Know So Far

A serious illness with acute renal failure is very challenging to manage in patients with
COVID-19 infection. The management of COVID-19 patients is complex and involves the use of
various strategies. These include accurate volume correction, avoiding nephrotoxic agents, and
keeping patients on a low dose of drugs. Through this study, investigators will be able to gain a
deeper understanding of the pathophysiology of renal failure, which can help develop targeted
treatment options for these patients.

The emergence of SARS-CoV-2 as a novel pathogen causing severe acute respiratory

distress syndrome and COVID-19 has had global impact. Although the seriousness of these
infections was widely recognized, the prognosis for these patients remained unclear. During the
outbreak of COVID-19, New York City became the epicenter of the epidemic. It presented
unique challenges in terms of resource planning and patient care. This study describes the
detailed clinical phenotype of critically ill patients with SARS-CoV-2 infection. It shows that
these patients exhibited a high mortality rate and a low kidney recovery. The journalsits
retrospectively identified all individuals with positive test results for SARS-Cov-2 from an
oropharyngeal or nasopharyngeal swab PCR. These individuals were admitted to an intensive
care unit (ICU) and received RRT for acute kidney injury (AKI).

Renal replacement therapy is commonly used in critically ill septic patients with
progressive kidney failure. The global outbreak of COVID-19, which began in December 2019,
has now reached more than 2.5 million cases. It has killed over 169,000 people globally.
SARSCoV2 is a respiratory illness caused by the beta coronavirus. It is considered the world's
most urgent public health issue. SARS-CoV-2 is a respiratory illness that can affect multiple
organs. It primarily affects the respiratory tract. Kidneys are often the first organs to be affected
by COVID-19 infection. They are also difficult to manage in critically ill patients. Acute kidney
injury is a type of infection that can cause sudden death. It is usually caused by SARS and
MERS-CoV infections. Early detection of AKI has been a major step in preventing the onset of
systemic kidney injury. The concept of pathophysiologic mechanisms has also been refined. The
cornerstone of acute renal failure is the use of renal replacement therapy. In COVID-19 patients,
this therapy has been shown to be the most effective method of treating acute kidney failure.

The emergence of new infectious diseases has always threatened global stability and
human health. The SARS-CoV-2 virus is a new type of coronavirus that emerged in 2003. It has
been nicknamed COVID-19. Currently, there is no agreed treatment strategy for COVID-19. The
metallopeptidase 2 enzyme 2 is a functional enzyme that is known to convert erythrocyte into
human kidney. It is a major target organ of SARS-CoV-2. Computerized tomography scans of
the kidneys revealed that COVID-19 patients had elevated levels of urine and edema. Pre-
existing kidney disease is associated with a significantly increased risk of developing acute
kidney injury and severe COVID-19 infection. The pathogenesis of COVID-19 kidney
involvement is not fully understood, but it is widely believed that it is multi-factorial, with
systemic hemodynamic alterations and viral infection as contributing factors. SARS-CoV-2
infection causes acute kidney injuries. The virus enters the cells through the ACE-2 receptors. It
then activates the nephrogenic enzymes and causes cell death. The SARS-CoV-2 virus has broad
Amit, Vincent Luther John M. BSN UV – MARTINSEN A October 31, 2021

organotropism. It was found in different tissues such as the liver, brain, and kidneys. The virus
enters the cells through a viral protein known as the structural spike. The TMPRSS2 protein co-
expressed with ACE-2 activates the viral envelope's natural defenses against cellular membranes.
As a result, the viral envelope is able to infiltrate the cellular membranes. Since the kidneys
receive a significant portion of the cardiac output, hypoxia could contribute to the kidney
damage. In addition, evidence of endothelial injury has been presented. Observational studies
revealed that people with acute kidney injury (AKI) experience chronic kidney failure (CRF)
during the follow-up periods after hospitalization. This condition is considered a risk factor for
developing acute tubular necrosis (ATN).

Infection with SARS-CoV-2 can lead to chronic and acute kidney tissue damage, which
is usually triggered by an acute tubular necrosis. The severity of COVID-19 is also known to
increase the risk of AKI. It has been hypothesized that patients with COVID-19-related acute
kidney infection might develop progressive CKD after a successful recovery. It is very important
that COVID-19 survivors are evaluated for their kidney function once they have appeared to
have recovery. This is also a strategy to improve the outcome of these patients and to control the
cost of advanced kidney disease treatment.

The journal identified 115 critically ill patients who required RRT after developing
severe AKI. Although half of them died, the majority of those who survived had adequate
recovery of kidney function. This study provides important new information for patients with
COVID-19. In our study, the majority of COVID-19 patients admitted to the ICU were required
to have invasive mechanical ventilation and/or pressor support. These scores were significantly
higher than those of other large cohort studies. Although the mechanisms of kidney injury are
still unknown, there are concerns about AKI due to hemodynamic instability or volume depletion
in patients with COV-19-induced acute kidney injury. Understanding the complexity of this issue
and the various factors that may affect the management of this condition is challenging. As
expected, increasing age was linked to increased mortality. they also noted that the presence of
comorbid conditions such as diabetes and COPD was associated with increased risk of death.
Although over half of the participants were obese, this cohort did not show an increased
mortality risk. The markers of inflammation during admission were not linked to mortality. The
exact role of renin-angiotensin sin-aldosterone systems agents in terms of mortality and infection
rates remains controversial. Prior cohorts revealed that mortality rates for patients with COVID-
19 were higher than those with other conditions. The reasons for these differences are unclear.

The study shows a high incidence of severe AKI requiring RRT among critically ill patients in the
US. This finding highlights the importance of this resource during disaster planning. It also shows a high
rate of kidney function recovery among COVID-19 survivors. Understanding the pathophysiology of
COVID-19 acute renal failure is an area of ongoing research. It is exciting to see if different dialysis
techniques can be used to manage this condition. Currently, there is no data available to compare
different techniques. There has been debate regarding the superiority of different dialysis techniques in
the treatment of COVID-19 patients. Currently, no data are available to support this claim.
Amit, Vincent Luther John M. BSN UV – MARTINSEN A October 31, 2021

REFERENCES

Khoshdel-Rad, N., Zahmatkesh, E., Shpichka, A. et al. (2020) Outbreak of chronic renal failure: will this be
a delayed heritage of COVID-19? J Nephrol 34, 3–5 https://doi.org/10.1007/s40620-020-00851-9

Raza A, Estepa A, Chan V, et al. (June 03, 2020) Acute Renal Failure in Critically Ill COVID-19 Patients
with a Focus on the Role of Renal Replacement Therapy: A Review of What We Know So Far.
Cureus 12(6): e8429. doi:10.7759/cureus.8429

Stevens JS, King KL, Robbins-Juarez SY, Khairallah P, Toma K, Alvarado Verduzco H, et al. (2020) High rate
of renal recovery in survivors of COVID-19 associated acute renal failure requiring renal
replacement therapy. PLoS ONE 15(12): e0244131.
https://doi.org/10.1371/journal.pone.0244131