Kidney Injury in COVID-19: an Emerging Concern to the Clinician
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COVID-19
Kidney Injury in COVID-19: an Emerging Concern to the Clinician Nurshad Ali 1
&
Shakil Mahmood 2
Accepted: 21 August 2020 # Springer Nature Switzerland AG 2020
To the Editor, COVID-19 outbreak has created a serious health concern worldwide. Respiratory systems are the main target of SARS-CoV-2 infection; however, it can affect multiple organ systems in the human body [1, 2]. At the beginning of the pandemic, little attention has been paid to the incidence of acute kidney injury (AKI) in COVID-19 patients. However, there is evidence that AKI is prevalent in COVID-19 patients with severe disease courses. Therefore, kidney injury in COVID-19 is an emerging concern to the clinicians. Some recent studies have shown kidney injury in severe COVID-19 patients [3–5]. A recent study reported that patients with elevated baseline serum creatinine were admitted in the ICU and required more mechanical ventilation than patients with normal serum creatinine levels, indicating that pre-existing kidney dysfunction on admission increases the disease severity [3]. Kidney injury was observed in some severe patients, even those who had no pre-existing kidney disease [3]. The authors also observed that kidney injury on admission and the progression of AKI stage 2 during hospitalization were associated with a greater risk of hospital mortality [3]. Few more studies have also reported a significant association between kidney failure and death in COVID-19 patients [4, 5]. A recent review reported AKI in up to 25% of severe COVID-19 patients, especially in those This article is part of the Topical Collection on COVID-19 * Nurshad Ali [email protected]; [email protected] 1
Department of Biochemistry and Molecular Biology, Shahjalal University of Science and Technology, Sylhet 3114, Bangladesh
2
Department of Biochemistry, Gonoshasthaya Samaj Vittik Medical College, Savar, Dhaka 1344, Bangladesh
with pre-existing comorbidities [6]. AKI was associated with higher mortality rates in COVID-19 patients, especially when renal replacement therapy was required [6]. The impact of COVID-19 on the renal system remains unclear and needs to be elucidated. Current knowledge suggests some possible mechanisms that could explain the kidney injury in severe COVID-19 patients. These include direct pathogenic effects of the virus on kidney cells through the angiotensin-converting enzyme 2 (ACE2)–dependent pathway. Recent data showed that ACE2 is more highly expressed in the kidney than in the lungs and heart [6]. Secondly, elevated levels of pro-inflammatory cytokines and pneumoniarelated hypoxia may be associated with renal damage in COVID-19. Thirdly, certain drugs used in the treatment may also have adverse effects on the renal system. Furthermore, COVID-19-related microangiopathy and hemophagocytic macrophage activation may also cause kidney injury in severe disease courses. Up to now, there is no specific treatment for AKI in COVID-19 [7], although several medications are being used in the treatment of COVID-19, and their effects on AKI a
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