Covid-19 and acute kidney injury in hospital: summary of NICE guidelines
Authors: Nicholas M Selby, Lui G Forni, Christopher M Laing, Kerry L Horne, Rhys DR Evans, Bethany J Lucas, Richard J Fluck
Journal: BMJ (2020)

What you need to know• Acute kidney injury (AKI) may be common in patients with covid-19 and is associated with an increased risk of dying• AKI associated with covid-19 may be caused by volume depletion, multi-organ failure, viral infection leading directly to kidney tubular injury, thrombotic vascular processes, glomerulonephritis, or rhabdomyolysis• Maintaining optimal fluid status (euvolaemia) is critical in reducing the incidence of AKI • Regular assessments of fluid status and fluid management plans are necessary, and in those who need intravenous fluids the choice of replacement fluid should be based on patients' biochemistry and fluid status • An increased risk of coagulopathy may cause problems with clotting of the extracorporeal circuit during renal replacement therapy Acute kidney injury (AKI), a sudden reduction in kidney function, is seen in some people with covid-19 infection.A subset of patients develop severe AKI and require renal replacement therapy (RRT).As in many settings, the development of AKI is associated with an increased risk of mortality. 1 2Although our understanding is incomplete, a picture is emerging from case reports and autopsy series of covid-19 specific causes of AKI.Intrinsic renal pathology including thrombotic vascular processes, viral mediated tubular cell injury, and glomerulonephritis have been reported, as well as AKI resulting from extrinsic factors such as fluid depletion, multi-organ failure, and rhabdomyolysis. 3-7Anecdotal reports have emerged of proximal tubular injury with Fanconi syndrome that manifests as hypokalaemia, hypophosphataemia, normal anion gap metabolic acidosis, and hypovolaemia from salt wasting.Importantly, AKI can occur at all stages of covid-19 infection, so clinical vigilance and consideration of risk factors for AKI alongside early detection and diagnosis are essential components of general supportive care.Fluid management is central to this.This article summarises key points from the National Institute for Health and Care Excellence (NICE) covid-19 rapid guideline on AKI in hospital. 8Recommendations Communicating with patients • Communicate effectively with patients, their families, and carers, and support their mental wellbeing to help alleviate any anxiety they may have about covid-19.Signpost to charities and UK government guidance on the mental health and wellbeing aspects of covid-19. 9Minimising risk for patients and healthcare workers • All healthcare workers involved in receiving, assessing, and caring for patients who have known or suspected covid-19 should follow UK government guidance for infection prevention and control. 10• If covid-19 is later diagnosed in a patient not isolated from admission or presentation, follow UK government guidance on management of exposed healthcare workers and patients in hospital settings. 11Planning treatment and care• Discuss the risks, benefits, and likely outcomes of treatment options with patients with covid-19, and their families and carers.This will help them make informed decisions about