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COVID-19 and Acute Kidney Injury (AKI)


Anna Malkina

, MD, University of California, San Francisco

Last full review/revision Dec 2020| Content last modified Dec 2020

COVID-19, a disease caused by the novel coronavirus SARS-CoV-2, may present with acute kidney injury (AKI), particularly in critically ill patients.

(See also Acute Kidney Injury and COVID-19.)

The presence of AKI increases risk of mortality in patients with COVID-19 (1). While the data are new and evolving, the following have been described as independent risk factors for AKI with COVID-19 (2) thus far:

  • Age
  • Race (higher among blacks)
  • Diabetes
  • Hypertension
  • Cardiovascular disease
  • Mechanical ventilation
  • Shock requiring vasopressors

Early studies suggest that the pathophysiology of AKI may be due to ischemia during sepsis, systemic inflammatory response to the virus, and potentially direct viral toxicity to the kidneys. Presentation of AKI in patients with COVID-19 is similar to that of other infectious etiologies, including elevated creatinine, oliguria or anuria, and in some cases proteinuria (including nephrotic range) and hematuria (1). Treatment is focused on supportive care, including intravascular volume optimization (balanced against the risk of pulmonary edema in patients with respiratory distress), monitoring of electrolytes, and possibly dialysis. Due to the increased risk of dialysis circuit thrombosis, patients requiring hemodialysis are treated with anticoagulation unless contraindicated by bleeding risk. Infection control is of the utmost importance.


  • 1. Pei G, Zhang Z, Peng J, et al: Renal involvement and early prognosis in patients with COVID-19 pneumonia. J Am Soc Nephrol 31(6):1157, 2020. doi: 10.1681/ASN.2020030276. Epub 2020 Apr 28.
  • 2. Hirsch JS, Ng JH, Ross DW, et al: Acute kidney injury in patients hospitalized with COVID-19. Kidney Int 98(1):209, 2020. doi: Epub 2020 May 16.

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