Angel-Korman Avital, Brosh Tal, Glick Karina, Leiba Adi
Nephrology and Hypertension Institute, Samson Assuta University Hospital, Ashdod, Israel.
Infectious Disease Unit, Samson Assuta University Hospital, Ashdod, Israel.
Harefuah. 2020 Apr;159(4):231-234.
COVID-19, is a new corona virus of the Beta Coronavirus genus which originated in bats. The virus first emerged in China in December 2019 and has rapidly spread since to other areas worldwide. The World Health Organization (WHO) has therefore recently declared it as the source of a pandemic. The disease caused by the virus manifests in most cases as a lower respiratory tract infection leading to fever, cough and dyspnea, while more severe cases can led to respiratory failure and/or multi organ failure. COVID-19 enters the human cell using the ACE2, an enzyme abundant in renal tubular epithelial cells. Theoretically, this may be significant in several ways: acute kidney injury (AKI) as well as proteinuria and/or microhematuria could be associated with the penetration of COVID-19 into the cells. Moreover, medications based on RAAS inhibition, such and ACE inhibitors and ARBs, upregulate the enzyme ACE2 and could therefore hypothetically explain the high prevalence of hypertension and diabetes reported as previous diagnoses in severe cases. In the setting of chronic kidney disease, the risk of infection with COVID-19 is not clear at this time. However, hemodialysis patients represent a unique group of patients, mostly elderly and immunocompromised, for whom dialysis is a life-saving treatment which cannot be stopped. Hence, the COVID-19 pandemic has presented a complex medical and logistic challenge for the medical staff in hospital and community based dialysis units.
新型冠状病毒肺炎（COVID-19）是一种源自蝙蝠的β冠状病毒属新型冠状病毒。该病毒于2019年12月在中国首次出现，此后迅速传播至全球其他地区。因此，世界卫生组织（WHO）最近宣布其为大流行病的源头。该病毒引起的疾病在大多数情况下表现为下呼吸道感染，导致发热、咳嗽和呼吸困难，而更严重的病例可导致呼吸衰竭和/或多器官衰竭。COVID-19利用血管紧张素转换酶2（ACE2）进入人体细胞，ACE2是一种在肾小管上皮细胞中大量存在的酶。从理论上讲，这可能在几个方面具有重要意义：急性肾损伤（AKI）以及蛋白尿和/或微量血尿可能与COVID-19侵入细胞有关。此外，基于肾素-血管紧张素-醛固酮系统（RAAS）抑制的药物，如血管紧张素转换酶（ACE）抑制剂和血管紧张素Ⅱ受体阻滞剂（ARBs），会上调ACE2酶，因此可以假设解释重症病例中既往诊断为高血压和糖尿病的高患病率。在慢性肾脏病的情况下，目前尚不清楚感染COVID-19的风险。然而，血液透析患者是一组特殊的患者群体，大多为老年人且免疫功能低下，透析是他们赖以生存的治疗方法，不能中断。因此，COVID-19大流行给医院和社区血液透析单位的医务人员带来了复杂的医疗和后勤挑战。
