Nephrology and Coronavirus Disease 2019
Novel coronavirus disease 2019 (COVID-19) has emerged as a threat to the human population worldwide. Old age and presence of comorbidities are risk factors for severe complications of the disease, as many of these patients are not able to mount effective or have an aberrant antiviral response. Patients with chronic kidney disease are at high risk of COVID-19 and its complications, especially those with end-stage renal disease (ESRD). Patients have repeated exposure to crowding in dialysis units, and face the uncertainties of health care system sustainability during periods of increasing demand and scarce supply. Acute kidney injury (AKI) is a notable complication in patients with COVID-19 with an incidence of up to 25% in specific populations. Patients with AKI have a higher mortality rate. The etiology and pathogenesis of AKI in COVID-19 are multifactorial. Direct viral invasion and cytopathic effects on renal tubular cells and indirect factors like hypovolemia, rhabdomyolysis, renal vein congestion, and hypercoagulable state play a role in causing AKI in these patients. Renal replacement therapy in the form of continuous renal replacement therapy is most widely used worldwide mostly due to hemodynamic instability of critically sick patients with COVID-19. Anticoagulation therapy is critical as most COVID-19 patients have increased clotting tendency and extracorporeal circuit thrombosis is common. ESRD patients in China had mild-to-moderate symptoms commonly. However, the data from Spain and Italy report a higher mortality rate in ESRD patients than the general population. Strict screening and uniform adherence to infection control practices have led to a decreased risk of cross-infection among other patients and dialysis personnel in dialysis units. The association between nephrology and COVID-19 is unique and focus on further research on kidney pathology along with the strengthening of existing dialysis facilities are needed.
KeywordsCOVID-19 - end-stage renal disease - acute kidney injury - continuous renal replacement therapy
23 July 2020 (online)
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