Augmented renal clearance in COVID-19 critically ill patients

Abstract

Introduction: Augmented renal clearance (ARC) is a clinical entity characterized by an increase in the renal glomerular filtration rate above normal limits. The objective of this description is to highlight the association between ARC and COVID-19 in critically ill patients. Clinical cases: Two clinical cases of young women with acute respiratory failure secondary to COVID-19 pneumonia requiring invasive mechanical ventilation (MV) are described; both presented elevated acute phase reactants and hypoxemia on admission, requiring prone position, deep sedation and neuromuscular blockade. They presented prolonged MV and difficult sedation requiring high doses of sedatives and analgesia. Given the suspicion of ARC, in the first case, on day 6 of hospitalization, a 24-hour urine creatinine clearance of 246 ml / min / 1.73m² was found, evolving unfavorably, dying on day 23. In the second case, on day 4 of hospitalization, the diagnosis of ARC was made, observing creatinine clearance of 157 ml / min / 1.73m², after 37 days of hospitalization he evolved favorably. Discussion: The importance of the recognition of ARC lies in the pharmacokinetic changes with which it is associated, particularly with renal excretion drugs, of which it can modify the half-life, plasma concentration and therapeutic levels. This leads to taking into account the possibility of ARC in patients with COVID-19 when it is suspected, since a pharmacological therapeutic failure can occur in them, in addition to the limited literature on this association published so far.