Brigham and Women's Hospital COVID-19 Guidelines: Nephrology

Acute Kidney Injury - Summary points

Investigations and Monitoring in COVID-19 patients:

1. Monitor Creatinine a daily, patients with prexisting CKD will deteriorate more rapidly

2. Urinalysis if BUN and or creatinine increases

3. Patients may present with proteinuria (44%), hematuria (26.9%)

4. Avoid nephrotoxic medications

5. Assess fluid balance

Escalation:

1. Consult Renal/nephrology team early, do not wait for severe AKI and need for renal replacement therapy (RRT)/dialysis
   

Renal Replacement Therapy (RRT)

1. Estimates for RRT range from 1 to 5% of hospitalized patients

2. In critically ill patients, need for CRRT ranges from 5 to 23%

3. Indications for dialysis in COVID-19 patients are the same as the indications for all patients

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Triage of Suspected COVID-19 patients

Source: The Lancet Respiratory Medicine 2020 8e11-e12DOI: (10.1016/S2213-2600(20)30071-0)

Useful Resources:

Brigham and Women's Hospital COVID-19 Guidelines: Nephrology
https://covidprotocols.org/protocols/10-nephrology

MedShr Open Article: COVID-19 At-Risk Group: Haemodialysis Patients

References:

Jinnong Zhang, Luqian Zhou, Yuqiong Yang, Wei Peng, Wenjing Wang, Xuelin Chen, Therapeutic and triage strategies for 2019 novel coronavirus disease in fever clinics , The Lancet Respiratory Medicine , Volume 8 Issue 3 Pages e11-e12 (March 2020), DOI: 10.1016/S2213-2600(20)30071-0