Coronavirus is an infection that affects not only the human immune and respiratory systems. COVID-19 has similar symptoms to that of acute respiratory infections and influenza, with complications of a new coronavirus infection affecting the heart, kidneys and other internal organs. Patients with chronic kidney disease (CKD) belong to the group of particularly high risk of COVID-19 infection and high lethality in the development of the disease. This is due to the fact that the cause of CKD is the main population diseases (diabetes mellitus, hypertension, obesity, atherosclerosis), as well as old age, which themselves contribute to high morbidity and mortality from COVID-19.
OBJECTIVE
To evaluate the frequency of development of renal function disorders and their semiotics in patients with COVID-19, complicated by pneumonia, who were hospitalized in the Moscow multidisciplinary hospital for diagnosis and treatment, as well as their pre-morbid background, the frequency of chronic pathology of the urinary system and disorders of carbohydrate metabolism and diabetes.
MATERIAL AND METHODS
The data were analyzed from 206 patients (82 men and 124 women) aged 26 to 97 years (average age 56.8±6.1 years) undergoing treatment in the 3rd department of Clinical Hospital No. 15 named after O.M. Filatov. 197 patients were discharged from the hospital, 6 patients died. CKD classifications were used from 2006 and 2013 years for division of patients into groups. There were 2 groups of patients of different ages: the 1st group — 78 patients (31 men, 47 women) aged 26—60 years (average age 48.6 years); the 2nd group — 128 patients (51 men, 77 women) aged 61—97 years (average age 74.2 years). The kidney ultrasound was performed on a Lojik-400 ultrasound scanner («General Electric», USA). In total, kidney ultrasound was carried out on 26 patients. The glomerular filtration rate (GFR) was calculated using the Cockroft-Golt formula, taking into account the level of creatinine concentration in blood serum, age and sex of the patient. The concentration of creatinine in the blood serum was determined by the method of O. Shyuk with sodium picrate on a spectrophotometer Getpremier (USA).
RESULTS
GFR was on average 23.7% higher (p<0.05, the difference was significant) in patients of group 1. When analyzing normal and pathological GFR values, it was found that GFR values classified in stage III—IV CKD (below 60 ml/min) were 4 times more likely to be detected in younger patients with COVID-19 and pneumonia (16.6% versus 67.2% in group 2). In 48 (23%) patients, diagnostically significant dynamics of creatinine concentration and GFR level (by 11—36 ml/min) was observed during the period of inpatient treatment. In all such patients, leukocyte and erythrocyturia, proteinuria (0.3—1 g/l) were detected in the urinary sediment, a history of arterial hypertension was found, and only 17 (8.2%) had bacteriuria. The urea concentration according to the mean values was higher in the 2nd group, in older patients, by 25.2% (p<0.03, significant). Increased values of the indicator were observed more often in the 2nd group — by 16.6%, (p>0.1, unreliable). The frequency of detection of urinary syndrome by the level of proteinuria, leukocyte, erythrocyte, cylindruria and the sign of bacteriuria in both groups of patients with COVID-19 and pneumonia was high — within 37—44%.
RESULTS
1. Possible signs of acute renal injury and pathological urinary syndrome were identified in more than 20% of patients. 2. The average level of urea concentration in the blood serum in patients with COVID-19 in the age group over 60 years old significantly and reliably exceeded the values in the group of younger patients, which may be a sign of the development of an inflammatory process in the lungs with more pronounced intoxication, including due to more severe impairment of renal function of nitrogen excretion. 3. The incidence of stage III—IV CKD in the group of older patients with COVID-19 exceeds this indicator in the group of younger patients by 4 times. The most significant reason for the development of stage III—IV CKD, apparently, is arterial hypertension, 2.7 times more often diagnosed in patients over the age of 60 years.
