SAT-028 ACUTE KIDNEY INJURY ASSOCIATED WITH MIDDLE EAST RESPIRATORY SYNDROME CORONAVIRUS (MERS-CoV) INFECTION

Middle East Respiratory Syndrome Coronavirus (MERS-CoV) infection is zoonotic infection that was first identified in 2012 with high mortality rate It is linked to camel exposure or human-to-human transmission Clinical presentation of MERS CoV infection ranges from mild disease to septic shock with multi organ failure and death Acute kidney injury (AKI) has been described in cohorts of MERS CoV infected patients with variable degree of severity We studied the clinical characteristics and outcomes of AKI in MERS CoV infected patients Method(s): Ethical approval was obtained to conduct a retrospective multicenter chart review study for MERS CoV confirmed cases in Al Ain City over 7 years period (May 2012 - May 2019) We included patients who developed AKI and studied their outcomes Demographic, clinical and laboratory data were collected and analyzed Result(s): A total of 58 individuals with MERS CoV infection were identified during the study period Ten patients developed AKI and were included in the study The mean age was 54 5 years and majority were males 8 (80%) The comorbid conditions were hypertension (5), chronic kidney disease (4), diabetes mellitus (3), ischemic heart disease (2), nephrotic syndrome (1) and dyslipidemia (2) Risk factors for MERS CoV infection included close contact with infected patient (3), camel exposure (2) and travel history to Oman (2) or Saudi Arabia (1) MERS CoV PCR was detected in nasopharyngeal aspirate (8) and sputum (2) with mean viral shedding of 13 5 days Majority of patients 9 (90%) had severe MERS CoV infection and required critical care AKI episodes were classified as severe stage 3 in 9 patients, and stage 2 in one patient Mild proteinuria and hematuria were noted in urine analysis of some patients Autoimmune workups and hepatitis serology were done for three patients and were negative Provisional diagnosis of acute tubular necrosis due to severe sepsis and shock was considered Imaging renal studies in all patients were negative for hydronephrosis or stones Renal replacement therapy were needed in 7 (70%) patients and duration of range from 3 to 14 days MERS CoV PCR was not done in urine sample Other complications related to severe MERS CoV infection including septic shock 6 (60%), acute respiratory failure required intubation 7 (70%) or non-invasive ventilation 2 (20%), supraventricular tachycardia 2 (20%), Anemia 3 (30%), acute ischemic stroke 1 (10%), and secondary pulmonary infections (Influenza B, Klepseilla pneumonia, Staph aureus) Mortality rate was high 7 (70%) among patient with severe MERS CoV and AKI Two patients recovered from AKI and one patient became hemodialysis dependent as he has advanced CKD at baseline Conclusion(s): AKI is commonly associated with severe MERS CoV infection in old patients with comorbid conditions The mortality is high with severe infection and multi organ failure Copyright © 2020