AKI Biomarkers in Coronavirus(COVID)-19

COVID-19 is a rapidly evolving pandemic with approximately 5% of all patients requiring
admission to an intensive care unit. In critically ill patients with COVID-19, acute
respiratory disease and acute kidney injury (AKI) are very common. Patients with AKI have an
increased risk of mortality, especially renal replacement therapy (RRT) is required. The
latest Intensive Care National Audit & Research Centre (ICNARC) report shows a 77% ICU
mortality in patients with COVID-19 who require mechanical ventilation and RRT.

COVID-19 associated AKI is still poorly understood. The exact underlying pathophysiology
remains unknown. Furthermore, there are no specific strategies to prevent or treat AKI.
Management is supportive consisting of fluid and haemodynamic optimization, discontinuation
of nephrotoxic drugs and prevention of nephrotoxic exposures. Ideally, AKI needs to be
recognized as early as possible for these supportive measures to be effective.

Early prediction of AKI may be valuable to optimize management and improve outcomes. In
critically ill patients without COVID-19, the two cell-cycle arrest markers, tissue inhibitor
of metalloproteinases-2 (TIMP-2) and insulin-like growth-factor binding protein 7 (IGFBP7),
have been shown to predict the development of AKI. Whether these new biomarkers also predict
the development of AKI in critically ill patients with COVID-19 is unknown.

The aim of this project is to explore whether urinary cell cycle arrest markers and other
renal biomarkers have a role in predicting AKI in critically ill patients with COVID-19 and
acute respiratory disease. The results will advance the understanding of this disease and
serve to develop strategies for individualized management of this high-risk group.