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Abstract: PO0668

Hematuria and Elevated Lactate Dehydrogenase Are Associated with AKI in Hospitalized COVID-19 Patients

Session Information

Category: Coronavirus (COVID-19)

  • 000 Coronavirus (COVID-19)

Authors

  • Thomas, George, Cleveland Clinic, Cleveland, Ohio, United States
  • Nakhoul, Georges, Cleveland Clinic, Cleveland, Ohio, United States
  • Taliercio, Jonathan J., Cleveland Clinic, Cleveland, Ohio, United States
  • Vachharajani, Tushar J., Cleveland Clinic, Cleveland, Ohio, United States
  • Demirjian, Sevag, Cleveland Clinic, Cleveland, Ohio, United States
Background

Acute kidney injury (AKI) can be a severe complication of COVID-19, particularly in those who require intensive care. Its relationship to the incidence of proteinuria, hematuria, and elevated inflammatory markers has not been well characterized. Our objective is to describe the incidence of AKI in COVID-19, and its association with inflammatory markers.

Methods

Retrospective cohort study of adult patients hospitalized at the Cleveland Clinic with COVID-19. SARS-CoV-2 infection was confirmed by virus detection in respiratory specimens using RT-PCR. AKI was diagnosed per KDIGO serum creatinine-based classification. We selected stage 2 and higher as our primary endpoint for the study. Baseline creatinine was defined as the most recent pre-admission level available within 3 months of presentation. Acute lung injury was defined by the need for mechanical ventilation.

Results

The incidence of AKI was 14% in 621 hospitalized COVID-19 patients, with half requiring kidney replacement therapy (KRT). The incidence of proteinuria and microscopic hematuria were high in these patients (83% and 77% respectively). Seventy five percent of patients with AKI needed mechanical ventilation, and timing of KRT overlapped with time of mechanical ventilation. Inflammatory markers and acute phase reactants, including LDH, ferritin, and C reactive protein were significantly higher in patients with AKI compared to those with no AKI. On adjusted analysis, hematuria and elevated LDH levels were significantly associated with AKI (Figure).

Conclusion

Elevated lactate dehydrogenase levels and microscopic hematuria on presentation are independently associated with 50% probability of moderate to severe AKI. Our findings suggest a possible pathogenetic mechanism of endothelial cell injury and thrombotic microangiopathy as a cause of AKI in COVID-19 patients. Additional studies are needed to explore this potential mechanism of AKI in COVID-19.

Association of hematuria and LDH with AKI in COVID-19