Acute renal impairment in coronavirus-associated severe acute respiratory syndrome

• Published in: Kidney international Vol. 67; no. 2; pp. 698 - 705
• Main Authors: Chu, Kwok Hong, Tsang, Wai Kay, Tang, Colin S., Lam, Man Fai, Lai, Fernand M., To, Ka Fai, Fung, Ka Shun, Tang, Hon Lok, Yan, Wing Wa, Chan, Hilda W.H., Lai, Thomas S.T., Tong, Kwok Lung, Lai, Kar Neng
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 01-02-2005; Nature Publishing; Elsevier Limited; International Society of Nephrology. Published by Elsevier Inc
• Subjects: Acute Kidney Injury - etiology; Acute Kidney Injury - metabolism; Acute Kidney Injury - pathology; acute renal failure; acute respiratory distress syndrome; acute tubular necrosis; Adolescent; Adult; Aged; Aged, 80 and over; Biological and medical sciences; Clinical Nephrology – Epidemiology – Clinical Trial; coronavirus; Creatinine - blood; Female; Humans; Kidney - pathology; Male; Medical sciences; Middle Aged; mortality; Nephrology. Urinary tract diseases; Nephropathies. Renovascular diseases. Renal failure; Pneumology; Renal failure; Respiratory system : syndromes and miscellaneous diseases; Risk Factors; SARS coronavirus; severe acute respiratory syndrome; Severe Acute Respiratory Syndrome - complications; acute respiratory distress syndrome; mortality; coronavirus; acute tubular necrosis; acute renal failure; severe acute respiratory syndrome; Kidney disease; Lung disease; Nephrology; Urinary system disease; Respiratory disease; Acute; Mortality; Severe acute respiratory syndrome; Epidemiology; Urology; Infection; Virus; Acute tubular necrosis; Coronavirus; Nephropathy; Viral disease; Renal failure; Respiratory distress; Coronaviridae; Nidovirales
• ISSN: 0085-2538; 1523-1755
• DOI: 10.1111/j.1523-1755.2005.67130.x

Acute renal impairment in coronavirus-associated severe acute respiratory syndrome.
Severe acute respiratory syndrome (SARS) is a newly emerged infection from a novel coronavirus (SARS-CoV). Apart from fever and respiratory complications, acute renal impairment has been observed in some patients with SARS. Herein, we describe the clinical, pathologic, and laboratory features of the acute renal impairment complicating this new viral infection.
We conducted a retrospective analysis of the plasma creatinine concentration and other clinical parameters of the 536 SARS patients with normal plasma creatinine at first clinical presentation, admitted to two regional hospitals following a major outbreak in Hong Kong in March 2003. Kidney tissues from seven other patients with postmortem examinations were studied by light microscopy and electron microscopy.
Among these 536 patients with SARS, 36 (6.7%) developed acute renal impairment occurring at a median duration of 20 days (range 5–48 days) after the onset of viral infection despite a normal plasma creatinine level at first clinical presentation. The acute renal impairment reflected the different prerenal and renal factors that exerted renal insult occurring in the context of multiorgan failure. Eventually, 33 SARS patients (91.7%) with acute renal impairment died. The mortality rate was significantly higher among patients with SARS and acute renal impairment compared with those with SARS and no renal impairment (91.7% vs. 8.8%) (P < 0.0001). Renal tissues revealed predominantly acute tubular necrosis with no evidence of glomerular pathology. The adjusted relative risk of mortality associated with the development of acute renal impairment was 4.057 (P < 0.001). By multivariate analysis, acute respiratory distress syndrome and age were the most significant independent risk factors predicting the development of acute renal impairment in SARS.
Acute renal impairment is uncommon in SARS but carries a high mortality. The acute renal impairment is likely to be related to multi-organ failure rather than the kidney tropism of the virus. The development of acute renal impairment is an important negative prognostic indicator for survival with SARS.