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World J Virol. Sep 25, 2022; 11(5): 283-292
Published online Sep 25, 2022. doi: 10.5501/wjv.v11.i5.283
Acute kidney injury and electrolyte disorders in COVID-19
Gabriel Martins Nogueira, Noel Lucas Oliveira Rodrigues Silva, Ana Flávia Moura, Marcelo Augusto Duarte Silveira, José A Moura-Neto
Gabriel Martins Nogueira, Noel Lucas Oliveira Rodrigues Silva, Ana Flávia Moura, José A Moura-Neto, Department of Medicine, Bahiana School of Medicine and Public Health, Salvador 40290-000, Bahia, Brazil
Marcelo Augusto Duarte Silveira, Department of Nephrology, D’Or Institute for Research and Education, Hospital São Rafael, Salvador 41253900, Bahia, Brazil
Author contributions: Nogueira GM and Silva NLOR collected and read the literature; Nogueira GM wrote the section on acute kidney injury; Silva NLOR wrote the section on electrolyte disorders; Moura AF, Silveira MAD, and Moura-Neto JA reviewed the article.
Conflict-of-interest statement: All authors declare no conflicts of interest for this article.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: José A Moura-Neto, MD, FASN Professor, Department of Medicine, Bahiana School of Medicine and Public Health, Av. Dom Joao VI, Salvador 40290-000, Bahia, Brazil. jamouraneto@hotmail.com
Received: March 31, 2022
Peer-review started: March 31, 2022
First decision: June 16, 2022
Revised: June 30, 2022
Accepted: August 22, 2022
Article in press: August 22, 2022
Published online: September 25, 2022
Processing time: 177 Days and 10.2 Hours
Abstract

Acute kidney injury (AKI) and electrolyte disorders are important complications of hospitalized coronavirus disease 2019 (COVID-19) patients. AKI is thought to occur due to multiple pathophysiological mechanisms, such as multiple organ dysfunction (mainly cardiac and respiratory), direct viral entry in the renal tubules, and cytokine release syndrome. AKI is present in approximately one in every ten hospitalized COVID-19 patients. The incidence rates of AKI increase in patients who are admitted to the intensive care unit (ICU), with levels higher than 50%. Additionally, renal replacement therapy (RRT) is used in 7% of all AKI cases, but in nearly 20% of patients admitted to an ICU. COVID-19 patients with AKI are considered moderate-to-severe cases and are managed with multiple interdisciplinary conducts. AKI acts as a risk factor for mortality in severe acute respiratory syndrome coronavirus 2 infection, especially when RRT is needed. Electrolyte disorders are also common manifestations in hospitalized COVID-19 patients, mainly hyponatremia, hypokalemia, and hypocalcemia. Hyponatremia occurs due to a combination of syndrome of inappropriate secretion of antidiuretic hormone and gastrointestinal fluid loss from vomiting and diarrhea. When it comes to hypokalemia, its mechanism is not fully understood but may derive from hyperaldosteronism due to renin angiotensin aldosterone system overstimulation and gastrointestinal fluid loss as well. The clinical features of hypokalemia in COVID-19 are similar to those in other conditions. Hypocalcemia is the most common electrolyte disorder in COVID-19 and seems to occur because of vitamin D deficiency and parathyroid imbalance. It is also highly associated with longer hospital and ICU stay.

Keywords: COVID-19; SARS-CoV-2; Acute kidney injury; Electrolyte disorders; Renal dialysis

Core Tip: Acute kidney injury and electrolyte disorders are frequent clinical complications in hospitalized patients with coronavirus disease 2019, being directly related to the severity of the disease and increasing the mortality.