Renal Involvement During the COVID-19 Pandemic: Experience of the Nephrology Department of CHU Bab El Oued
Abstract
Introduction: During the COVID-19 pandemic, numerous extrapulmonary manifestations were the subject of study and research. The relationship between the kidney and COVID-19 attracted particular interest given the frequency of acute kidney injury observed.
Objectives: To determine the characteristics of SARS-CoV-2 infection in dialysis and kidney transplant populations and to describe the clinical, biological, and histological renal manifestations associated with SARS-CoV-2 infection.
Materials and Methods: This was a retrospective descriptive study conducted in the Nephrology Department of CHU Bab El Oued over a 2-year period, from February 2020 to February 2022. We studied the characteristics of COVID-19-related acute kidney injury in patients requiring hemodialysis, the histological renal manifestations associated with SARSCoV-2 infection, and the incidence and characteristics of COVID-19 infection in dialysis patients (hemodialysis and peritoneal dialysis) as well as in kidney transplant recipients.
Results: Eighty patients with renal failure associated with COVID-19 infection were managed with hemodialysis at our center. Thirty-six patients (45%) were dialyzed for acute kidney injury, while 44 patients (55%) already had chronic kidney disease at the stage of extrarenal replacement therapy. The majority of these patients (40 patients, 62%) were hospitalized in the intensive care unit. Most patients were intubated and ventilated (56 patients, 69%), with a high mortality rate of 76% (60 patients). Five patients underwent renal biopsy for renal involvement concomitant with or following COVID-19 infection. Renal histology revealed three cases of membranous nephropathy, one of which was associated with focal segmental glomerulosclerosis, and two cases of IgA nephropathy, one of which was associated with tubulointerstitial nephritis. Among chronic hemodialysis patients in our department, 10 patients (37%) were infected with SARS-CoV-2, presenting with a mild form in the majority of cases (6 patients, 60%). Four patients (40%) presented with severe respiratory distress syndrome, and 3 patients (30%) died. In peritoneal dialysis, 8 patients (32%) were infected with COVID-19, with 100% mild forms and no hospitalization. In the kidney transplant population, 24 transplant recipients (24%) were infected with COVID-19; 18 patients (75%) had mild forms, and only 6 patients (25%) presented with more or less severe forms with complications such as diabetes and graft function deterioration.
Discussion: Renal failure was associated with severe forms of COVID-19 (the majority of hemodialysis patients were hospitalized in the intensive care unit), with significant mortality. Renal involvement during COVID-19 can affect all compartments (glomerular, tubulointerstitial, and vascular). COVID-19 infection in kidney transplant recipients was not particularly more severe despite the immunosuppressed state.
Conclusion: As a newly emerging disease, the characteristics of renal involvement during COVID-19 infection, like the majority of systemic manifestations (cardiac, cerebral, digestive, etc.), have been derived from various studies and experiences from different centers worldwide but remain far from being well-labeled and codified.
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References
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