Critically Ill COVID-19 Patients With Acute Kidney Injury Have Reduced Renal Blood Flow and Perfusion Despite Preserved Cardiac Function: A Case-Control Study Using Contrast-Enhanced Ultrasound.
Shock
; 55(4): 479-487, 2021 04 01.
Article
de En
| MEDLINE
| ID: mdl-32890313
ABSTRACT
BACKGROUND:
Acute kidney injury (AKI) is a common complication of COVID-19 critical illness but the pathophysiology is uncertain. Some evidence has indicated that a vascular aetiology may be implicated. We used contrast-enhanced ultrasound (CEUS) and echocardiography to study renal perfusion and global blood flow and compared our findings with measurements taken in a group of septic shock patients and healthy volunteers.METHODS:
Prospective case-control study. Renal perfusion variables were assessed with CEUS; macrovascular blood flow was assessed using Doppler analysis of large renal vessels; echocardiography was used to assess right and left heart function and cardiac output.RESULTS:
CEUS-derived parameters were reduced in COVID-19 associated AKI compared with healthy controls (perfusion index 3,415 vs. 548 a.u., Pâ=â0·001; renal blood volume 7,794 vs. 3,338 a.u., Pâ=â0·04). Renal arterial flow quantified using time averaged peak velocity was also reduced compared with healthy controls (36·6 cm/s vs. 20·9âcm/s, Pâ=â0.004) despite cardiac index being similar between groups (2.8 L/min/m2 vs. 3.7âL/min/m2, Pâ=â0.07). There were no differences in CEUS-derived or cardiac parameters between COVID-19 and septic shock patients but patients with septic shock had more heterogeneous perfusion variables.CONCLUSION:
Both large and small vessel blood flow is reduced in patients with COVID-19 associated AKI compared with healthy controls, which does not appear to be a consequence of right or left heart dysfunction. A reno-vascular pathogenesis of COVID-19 AKI seems likely.
Texte intégral:
1
Collection:
01-internacional
Base de données:
MEDLINE
Sujet principal:
Circulation rénale
/
Échographie
/
Maladie grave
/
Atteinte rénale aigüe
/
COVID-19
/
Tests de la fonction cardiaque
Type d'étude:
Diagnostic_studies
/
Observational_studies
/
Risk_factors_studies
Limites:
Aged
/
Female
/
Humans
/
Male
/
Middle aged
Langue:
En
Journal:
Shock
Sujet du journal:
ANGIOLOGIA
/
CARDIOLOGIA
Année:
2021
Type de document:
Article
Pays d'affiliation:
Royaume-Uni