The Acute Renal Failure (ARF) — one of complications at the patients hospitalized with COVID-19 which can lead to a lethal outcome. Treat the reasons of OPN caused by COVID-19: dehydration, multiorgan insufficiency, a viral infection as a result of which arise injury of renal tubules, trombotichesky defeats of vessels gloumerulonefrit or rabdomioliz. Maintenance of optimum volume of liquid in an organism (euvolemiya) is one of the main ways helping to reduce risk of emergence of OPN. Regular measurements of a water balance in an organism are for this purpose taken and the course of infusional therapy is appointed, and the choice of the substituting liquid for the patients needing intravenous infusion is caused by results of biochemical analysis of blood and level of content of liquid in an organism.
In hard cases the replacement renal therapy (RRT) is necessary for patients. When performing replacement renal therapy the risk of development of a coagulopathy increases that leads to formation of blood clots during extracorporal blood circulation. In most cases development of OPN leads to a lethal outcome. Specialists cannot find to it an explanation yet, but statistical data are based on a case history of patients and detailed studying of the diseases complicated by a koronavirusny infection and leading to OPN. Congenital anomalies of kidneys, including trombotichesky processes in vessels, the mediated damage of cells of renal tubules as a result of a viral infection, a glomerulonephritis and also OPN which is a consequence of influence of external factors, such as hypovolemia, multiorgan insufficiency and rabdomioliz belong to such diseases. Damages of proximal department of renal tubules with emergence of signs of a syndrome of Fankoni which is shown by a hypopotassemia, a hypophosphatemia, a metabolic acidosis with a normal anion interval and a hypovolemia because of salt loss are in some cases possible.
It should be noted that OPN can develop on any of stages of a koronavirusny infection therefore it has to is aware therapy special attention to be paid to clinical observation of patients, accounting of risk factors of OPN along with early detection of a disease and statement of the correct diagnosis. The central place is aware of treatment infusional therapy borrows.
It is necessary to be convinced that the drugs appointed on a course of treatment will not cause OPN or other accompanying complications; otherwise it is necessary to stop use of these drugs if it is possible. For the correct selection and definition of a dosage of medicines, including the anticoagulants which are used at treatment and prevention of OPN there can be a need for consultation of the clinical pharmacologist. Patients with OPN have to be round the clock under observation of medical personnel. It is also important to fix and exercise daily control of the level of content of liquid in an organism by carrying out clinical inspections and regulation of hydrobalance. It is necessary to take measurements of level of urea, creatinine and electrolytes (sodium, potassium, bicarbonates) in blood serum each 48 hours or is more often if it is necessary patients (for example, to patients who have an increased risk of development of OPN, to the patients who transferred OPN, to patients with disturbances of level of electrolytes to blood).
For identification of OPN one of the following criteria is used:
increase in level of content of creatinine in blood serum of more than 26 µmol/l within 48 hours;
the established or expected increase in level of creatinine in blood serum more than for 50% for the last 7 days;
reduction of a diuresis to level less than 0.5 ml/kg an hour within six hours and more.
To define OPN reason, the analysis of urine on the maintenance of erythrocytes, proteins and glucose is necessary. In case the received results have aberrations, it is necessary to take a number of measures. At suspicion the patient should appoint radiological survey to obstruction of urinary tract.
It is necessary to remember that patients with suspicion on COVID-19 or with the confirmed diagnosis enter into risk group of development of a hyperpotassemia and have to is under observation according to the offered instructions. For rendering the emergency medical care at a hyperpotassemia along with traditionally applied medical means are used potassium - the connecting drugs.
So far remains not clear what frequency of occurrence of OPN at the patients who are on hospital treatment with the diagnosis of COVID-19 including at patients in intensive care unit and also as COVID-19 influences functioning of kidneys in the long term, including at patients with a renal failure in the last stage who for rehabilitation need continuous replacement renal therapy.