Alberici Federico, Delbarba Elisa, Manenti Chiara, Econimo Laura, Valerio Francesca, Pola Alessandra, Maffei Camilla, Possenti Stefano, Piva Simone, Latronico Nicola, Focà Emanuele, Castelli Francesco, Gaggia Paola, Movilli Ezio, Bove Sergio, Malberti Fabio, Farina Marco, Bracchi Martina, Costantino Ester Maria, Bossini Nicola, Gaggiotti Mario, Scolari Francesco
Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy.
Nephrology Unit, Spedali Civili Hospital, ASST Spedali Civili di Brescia, Brescia, Italy.
Kidney Int Rep. 2020 Apr 4;5(5):580-585. doi: 10.1016/j.ekir.2020.04.001. eCollection 2020 May.
The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), also known as coronavirus disease (COVID-19), is a major pandemic challenging health care systems around the world. The optimal management of patients infected with COVID-19 is still unclear, although the consensus is moving toward the need of a biphasic approach. During the first phase of the disease (from onset of the symptoms up to 7-10 days) viral-induced effects are prominent, with the opportunity to institute antiviral therapy. In the second inflammatory phase of the disease, immunosuppressive strategies (for example with glucocorticoids or anticytokine drugs) may be considered. This latter stage is characterized by the development of progressive lung involvement with increasing oxygen requirements and occasionally signs of the hemophagocytic syndrome. The management of the disease in patients with kidney disease is even more challenging, especially in those who are immunosuppressed or with severe comorbidities. Here we present the therapeutic approach used in Brescia (Italy) for managing patients infected with COVID-19 who underwent kidney transplantation and are receiving hemodialysis. Furthermore, we provide some clinical and physiopathological background, as well as preliminary outcome data of our cohort, to better clarify the pathogenesis of the disease and clinical management.
严重急性呼吸综合征冠状病毒2（SARS-CoV-2），也称为冠状病毒病（COVID-19），是一场挑战全球医疗保健系统的重大疫情。尽管目前的共识倾向于采用双相治疗方法，但对于COVID-19感染患者的最佳管理方案仍不明确。在疾病的第一阶段（从症状出现到7-10天），病毒诱导的效应较为突出，此时有机会开展抗病毒治疗。在疾病的第二个炎症阶段，可以考虑采用免疫抑制策略（例如使用糖皮质激素或抗细胞因子药物）。后一阶段的特征是肺部病变逐渐进展，氧需求增加，偶尔出现噬血细胞综合征的迹象。肾病患者的疾病管理更具挑战性，尤其是那些免疫抑制或伴有严重合并症的患者。在此，我们介绍意大利布雷西亚用于管理接受肾移植并正在接受血液透析的COVID-19感染患者的治疗方法。此外，我们提供了一些临床和生理病理学背景以及我们队列的初步结果数据，以更好地阐明该疾病的发病机制和临床管理。
