SARS-CoV-2-Related Kidney Injury: Current Concern and Challenges
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COVID-19
SARS-CoV-2-Related Kidney Injury: Current Concern and Challenges Yongqian Cheng 1 & Wenling Wang 1 & Liang Wu 1 & Guangyan Cai 1,2 Accepted: 17 September 2020 # The Author(s) 2020
Abstract Coronavirus disease 2019 (COVID-19) not only causes pulmonary inflammation but also causes multiple organ damages, including the kidney. ACE2, as one of the receptors for SARS-CoV-2 intrusion, is widely distributed in kidney tissues. Currently, the diagnosis and treatment of SARS-CoV-2 infection in patients with chronic kidney disease (CKD) are still unclear. Here, we review the recent findings of characteristics of COVID-19 in CKD patients and highlight the possible mechanisms of kidney injury caused by SARS-CoV-2 infection. We then discuss the emerging therapeutic approaches aimed at reducing kidney damage and protecting kidney function including virus removal, immunotherapy, supporting treatment, special blood purification therapy, etc. Problems unresolved and challenges ahead are also discussed. Keywords Coronavirus disease 2019 . Chronic kidney disease . Kidney injury . Pathogenesis . Treatment
Introduction Coronavirus disease 2019 (COVID-19) is the first confirmed pandemic sparked by a coronavirus in the twenty-first century. As COVID-19 continues to spread globally, inevitably, it may trigger new challenges and issue to patients with confounding chronic diseases. Many studies have confirmed that comorbidities are important risk factors for the severity and outcome of SARSCoV-2 infection [1]. Chronic kidney disease (CKD) [2] is not uncommon and represents one of the chronic diseases witnessed during COVID-19 ranging from 8.5 to 9.8% so far reported [3]. In this article, we reviewed the impact of SARS-CoV-2 infection in disease progression and outcome in CKD patients and relevant interests or topics.
Yongqian Cheng and Wenling Wang contributed equally to this work. This article is part of the Topical Collection on COVID-19 * Guangyan Cai [email protected] 1
Department of Geriatrics, The Fifth Medical Center of Chinese PLA General Hospital, Beijing 100039, China
2
Department of Nephrology, The First Medical Center of Chinese PLA General Hospital, National Clinical Research Center for Kidney Diseases, State Key Laboratory of Kidney Diseases, Beijing Key Laboratory of Kidney Disease Research, Chinese PLA Institute of Nephrology, Beijing 100853, China
Does CKD Aggravate the Condition of Patients with COVID-19? It was reported that 20–51% of hospitalized patients have one or more comorbidities. The most prevailing ones are diabetes mellitus (8.2–20%), hypertension (9.5–31.2%), and other cardiovascular and cerebrovascular diseases (5.6–40%) [1, 4–7]. The prevalence of CKD was 0–5.6%, which represents a minor proportion in COVID-19 patients [6, 8–14] (Table 1). A national wide analysis demonstrated that 25.1% (399/ 1590) of COVID-19-infected patients may be confounded by at least one comorbidity, which significantly differed from patients without any, in risk of worse clinical outcomes. The hazard ratio (HR) amo
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