NAVIGATING RENAL RISKS: SYSTEMIC AUTOIMMUNE DISORDERS AND CORONAVIRUS DISEASE 2019 - OBSERVATIONAL INSIGHTS FROM NORTH INDIA

7 Feb 2025 12 a.m. 12 a.m.
WCN25-AB-1911, Poster Board= FRI-202

Introduction:

Systemic autoimmune diseases are recognized to have significant impact on renal function, with varying degrees of severity that can affect the overall health of patients. The emergence of Coronavirus Disease-2019 (COVID-19) has further complicated this patient subgroup. The objective of this study is to evaluate the effect of COVID-19 on the outcomes associated with the spectrum of systemic autoimmune diseases and their renal involvement.

Methods:

This observational study was conducted from November 1, 2020, to October 31, 2021. The aim of this study is to evaluate renal outcomes in patients with systemic autoimmune disorders and COVID-19 (Figure 1).

Figure1: Study flow. COVID-19: Coronavirus Disease 2019; RTPCR: Reverse transcription polymerase chain reaction

Results:

51 patients with renal involvement were included in the study. Of those, 18 patients were COVID-19 RT-PCR positive. Most common systemic autoimmune disorder was Systemic Lupus Nephritis (35.3%) followed by rheumatoid arthritis (19.6%) (Figure 2). Figure 2: Diagrammatic Representation of Systemic Autoimmune Disorders in Patients under study Most common renal manifestation observed was drug induced kidney injury (37.3%), followed by lupus nephritis (29.4%), thrombotic microangiopathy (7.8%) and renal artery stenosis (7.8%) (Figure 3).Figure 3: Diagrammatic Representation of Renal Involvement in Patients under study 

Compared to patients who tested negative for COVID-19, those with COVID-19 had a longer hospital stay (p<0.01), more patients had peripheral saturation oxygen levels below 94% at presentation (p<0.01), were admitted to the Intensive Care Unit (p<0.01), required hemodialysis (p=0.01), and experienced a higher mortality rate (p<0.01) (Table 1).

Table-1: Association between parameters and Coronavirus Disease 2019 (COVID-19)

Parameters

Total (n=51) (%)

COVID-19 RT-PCR Positive (n=18) (%)

COVID-19 RT-PCR Negative (n=33) (%)

OR (95% CI)

p

Age (years), Mean ± SD

38.7 ± 14.7

36.2 ± 14.1

40.03 ± 14.7

-

0.89

Male

9 (17.6)

2 (11.1)

7 (21.2)

2.1 (0.39 - 11.67)

0.36

Female

42 (82.3)

16 (88.9)

26 (78.8)

-

-

Length of Hospital Stay (days), median (IQR)

8 (7 – 11)

11 (8 - 14)

8 (7 - 9)

-

<0.01

ICU Admission

19 (37.2)

12 (66.7)

7 (21.2)

7.42 (2.05 - 26.91)

<0.01

Mean Arterial Pressure (mmHg),  median (IQR)

98 (89 - 106)

98 (88 - 105)

98 (90 - 107)

-

0.2

SPO2 <94% at presentation

17 (33.3)

12 (66.6)

5 (15.1)

11.2 (2.85 - 43.9)

<0.01

Serum LDH >2 times ULN

29 (56.9)

13 (72.2)

16 (48.5)

2.76 (0.8 - 9.51)

0.10

Hemolytic Anemia

25 (49.0)

10 (55.5)

15 (45.4)

0.3 (0.13 - 3.37)

0.77

Active Urinary Sediments on Urine Microscopy

29 (56.8)

14 (77.8)

15 (45.4)

4.2 (1.13 - 15.49)

0.02

GFR^1 (ml/min), median (IQR)

31.1 (20.3 - 50.0)

25.07 (17.2 - 52.2)

34.0 (23.4 - 53.4)

-

0.22

KDIGO AKI Stages^2

          

Stage 1

12 (23.5)

4 (22.2)

8 (24.2)

.89 (0.22 - 3.5)

0.87

Stage 2

17 (33.3)

4 (22.2)

13 (39.3)

.44 (0.12 - 1.63)

0.21

Stage 3

22 (43.1)

10 (55.6)

12 (36.4)

2.1 (0.68 – 7.04)

0.18

Required Hemodialysis

17 (33.3)

10 (55.6)

7 (21.1)

4.64 (1.33 – 16.19)

0.01

Discharged

39 (76.5)

10 (55.6)

29 (87.8)

5.8 (1.4 - 23.49)

<0.01

Expired

12 (23.5)

8 (44.4)

4 (12.1)

-

-

Data represented as: number and percentage for qualitative data; mean or median for quantitative data. AKI: Acute Kidney Injury; GFR: Glomerular Filtration Rate; ICU: Intensive Care Unit; IQR: Interquartile Range; KDIGO: Kidney Disease: Improving Global Outcomes; LDH: Lactate Dehydrogenase; SD: Standard Deviation; SPO2: Oxygen saturation; ULN: Upper limit of normal. 1: Calculated from CKD-EPI formula; 2: Based on KDIGO Acute Kidney Injury Guidelines (2012)

Conclusions:

This study emphasizes the spectrum of renal involvement in systemic autoimmune disorders when associated with COVID-19 and underscores the necessity for additional research and targeted management strategies.

I have no potential conflict of interest to disclose.

I did not use generative AI and AI-assisted technologies in the writing process.