AIDED - Acute kIDnEy injury in coviD-19.

The pandemic caused by the Coronavirus (COVID-19) although primarily affecting the lungs and airways, affects other organs in the body. At least a quarter of people who need hospital treatment for COVID-19 also suffer reduced kidney function (known as acute kidney injury, AKI), which can cause complete kidney failure.
As some of the processes that lead to AKI in COVID-19 are specific to the viral infection, it is possible that long term kidney health may be more severely affected. At the moment, we do not know the long-term effects of COVID-19 on the kidneys. Improving our understanding of this is important to allow us to know how best to monitor and support people after their recovery from the initial infection.
To address this, we will perform a unique research study that will bring together scientists at the University of Nottingham, UK and those in Uppsala University, Sweden. The study will collect a number of different Magnetic Resonance Imaging (MRI) datasets in ventilated patients with acute COVID-19 in Uppsala University (UU), Sweden. MRI can show the entire kidney in great detail and there is a range of MRI techniques that can assess different aspects of kidney function. Combining the different MRI techniques into a single scan session is called multiparametric MRI. Multiparametric MRI will assess the changes that may have been caused by COVID-19 in the kidneys, such as changes in blood flow, oxygen levels and the degree of scarring (fibrosis). In addition, changes in other organ function such as the liver and spleen will be measured. Importantly, MRI scans do not use radiation (unlike X-Rays and CT scans). Patients scanned at the acute phase of COVID-19 will have their MRI measures collected again at 3 and 12 months after being in hospital.
The multiparametric MRI measures collected in Sweden will be analysed by experts at UoN and compared to an existing MRI dataset of non-COVID AKI collected at the UoN, prior to the COVID-19 outbreak, and healthy subjects from both the UoN and UU.
These information sources will allow us to understand the long-term effects of COVID-19 on the kidneys. This will inform how COVID-19 is impacting patients' kidney health, and how this should be monitored.

This proposal will support the University of Nottingham (UoN) component of a unique international multi-speciality collaboration that will advance the understanding of the mechanisms of COVID-19 associated Acute Kidney Injury (AKI). AKI occurs in a third of COVID-19 cases in
intensive care units (ICU) and is associated with multi-organ injury. Its causes are unclear. This study will analyse a unique collection of multiparametric Magnetic Resonance Imaging (MRI) data acquired in ventilated patients with acute COVID-19 associated AKI, collected in Uppsala University (UU), Sweden. This multiparametric MRI protocol will inform on microvascular blood flow (potentially affected by small vessel thrombotic processes, large vessel flow/thrombosis), and quantify the degree of inflammation/oedema in the kidney and other abdominal organs (liver and spleen). Furthermore, evaluation of the effect of an intravenous fluid bolus will help assess the degree to which pre-renal factors are contributing to changes in MRI measures. The multiparametric MRI measures collected in Sweden will be analysed by experts at UoN and compared to an existing MRI dataset of non-COVID AKI collected at the UoN, prior to the COVID-19 outbreak, and healthy subjects from UoN and UU. Direct benefits of this research will include:
i) identifying COVID-19 specific mechanisms of AKI in critically ill patients; ii) use of multiparametric MRI for assessment of the acute damage in the kidney and associated interactions with injury in other intra-abdominal organs including the liver and spleen; iii) an evaluation of the effects of standard AKI therapy (fluid resuscitation); (iv) understanding of changes at time of acute illness and follow-up that will inform future studies of recovery.