Renal dysfunction in young adults with severe community-acquired pneumonia

Background: Pneumonia continues to be a serious public health concern in the 21st century because of its high prevalence and significant mortality, especially in adults, where the incidence can be as high as 14 cases per 1000 people. Community-acquired pneumonia is generally mild but can potentially lead to dangerous complications in elderly and immunocompromised patients, requiring hospitalization in up to 50% of cases and with a mortality rate of 0.7 per 1000 people annually. Acute kidney injury is a serious complication, occurring in up to 52.5% of cases of severe community-acquired pneumonia.

The aim of the study was to assess the renal function in young patients (18–44 years) with severe community-acquired pneumonia and without a history of underlying chronic diseases.

Methods: The renal function of 220 patients aged 18–44 years without preexisting chronic comorbidities who received treatment in the intensive care unit (ICU) for severe community-acquired pneumonia (SCAP) between 2011 and 2017 was evaluated.

Results: Severe community-acquired pneumonia in young adults without chronic comorbidities was associated with a diastolic blood pressure below 60 mmHg in 146 patients (66.3%) and bilobar or multilobar lung involvement in 141 patients (64%). Acute kidney injury (AKI) complicated SCAP in 25.4% of cases. In SCAP, AKI was more frequent in viral-bacterial cases (31.91%) than in bacterial cases (20.8%) (p < 0.05). The frequency of AKI increased with SCAP severity, with AKI developing in 85.7% of patients within an average of 2.5 (2–3) days after initiation of mechanical ventilation (p < 0.01). SCAP complicated by AKI was associated with a significant increase in hospital stay, ICU stay, and mortality. The median hospital stay of patients with SCAP was 23 (18–30) days in those without AKI and 28 (20–43) days in those with AKI (p < 0.01). Additionally, the median ICU stay for patients with SCAP was 3 (2–4) days in those without AKI and 4 (3–7) days in those with AKI (p = 0.001). Mortality was significantly higher in SCAP patients with AKI (10.7%) than in those without AKI (0.6%) (p < 0.01). Complete renal function recovery was observed in 99.52% of surviving patients, with normal urine output and serum creatinine levels.

Conclusions: Despite advances in early diagnosis and modern pharmacotherapy, community-acquired pneumonia remains a clinically significant condition. Severe cases are characterized by respiratory failure and dysfunction of multiple organs and systems, including the kidneys. The high incidence of AKI in SCAP indicates the need for heightened awareness and early detection of its potential occurrence.