<abstract xmlns="http://www.w3.org/1999/xhtml">

<p>Acute kidney injury is a common complication of COVID-19, frequently fuelled by a complex interplay of factors. These include tubular injury and three primary drivers of cardiocirculatory instability: heart-lung interaction abnormalities, myocardial damage, and disturbances in fluid balance. Further complicating this dynamic, renal vulnerability to a “second-hit” injury, like a SARS-CoV-2 infection, is heightened by advanced age, chronic kidney disease, cardiovascular diseases, and diabetes mellitus. Moreover, the influence of chronic treatment protocols, which may constrain the compensatory intrarenal hemodynamic mechanisms, warrants equal consideration. COVID-19-associated acute kidney injury not only escalates mortality rates but also significantly affects long-term kidney function recovery, particularly in severe instances. Thus, the imperative lies in developing and applying therapeutic strategies capable of warding off acute kidney injury and decelerating the transition into chronic kidney disease after an acute event. This narrative review aims to proffer a flexible diagnostic and therapeutic strategy that recognizes the multi-faceted nature of COVID-19-associated acute kidney injury in critically ill patients and underlines the crucial role of a tailored, overarching hemodynamic and respiratory framework in managing this complex clinical condition.</p>
</abstract>

Acute kidney injury is a common complication of COVID-19, frequently fuelled by a complex interplay of factors. These include tubular injury and three primary drivers of cardiocirculatory instability: heart-lung interaction abnormalities, myocardial damage, and disturbances in fluid balance. Further complicating this dynamic, renal vulnerability to a “second-hit” injury, like a SARS-CoV-2 infection, is heightened by advanced age, chronic kidney disease, cardiovascular diseases, and diabetes mellitus. Moreover, the influence of chronic treatment protocols, which may constrain the compensatory intrarenal hemodynamic mechanisms, warrants equal consideration. COVID-19-associated acute kidney injury not only escalates mortality rates but also significantly affects long-term kidney function recovery, particularly in severe instances. Thus, the imperative lies in developing and applying therapeutic strategies capable of warding off acute kidney injury and decelerating the transition into chronic kidney disease after an acute event. This narrative review aims to proffer a flexible diagnostic and therapeutic strategy that recognizes the multi-faceted nature of COVID-19-associated acute kidney injury in critically ill patients and underlines the crucial role of a tailored, overarching hemodynamic and respiratory framework in managing this complex clinical condition.

Kidney Injury in Critically Ill Patients with COVID-19 – From Pathophysiological Mechanisms to a Personalized Therapeutic Model

Carol Davila University of Medicine and Pharmacy

The Journal of Critical Care Medicine

This work is licensed under the Creative Commons Attribution 4.0 International License.

Acute kidney injury is a common complication of COVID-19, frequently fuelled by a complex interplay of factors. These include tubular injury and three primary...

Kidney Injury in Critically Ill Patients with COVID-19 – From Pathophysiological Mechanisms to a Personalized Therapeutic Model

Article Category: Review

Published Online: Jul 31, 2023

Page range: 148 - 161

Received: Jul 06, 2023

Accepted: Jul 28, 2023

DOI: https://doi.org/10.2478/jccm-2023-0023

Keywords
acute kidney injury, COVID-19, renal replacement therapy, acute respiratory distress syndrome, personalized cardiocirculatory support

© 2023 Cosmin Balan et al., published by Sciendo

This work is licensed under the Creative Commons Attribution 4.0 International License.

Kidney Injury in Critically Ill Patients with COVID-19 – From Pathophysiological Mechanisms to a Personalized Therapeutic Model

Article Category: Review

Published Online: Jul 31, 2023

Page range: 148 - 161

Received: Jul 06, 2023

Accepted: Jul 28, 2023

DOI: https://doi.org/10.2478/jccm-2023-0023

Keywordsacute kidney injury, COVID-19, renal replacement therapy, acute respiratory distress syndrome, personalized cardiocirculatory support

© 2023 Cosmin Balan et al., published by Sciendo

This work is licensed under the Creative Commons Attribution 4.0 International License.

Keywords
acute kidney injury, COVID-19, renal replacement therapy, acute respiratory distress syndrome, personalized cardiocirculatory support