Department of Internal Medicine, University Medical Center Groningen, University of Groningen, Groningen, 9700 RB, The Netherlands.
Virus Res. 2020 Sep;286:198034. doi: 10.1016/j.virusres.2020.198034. Epub 2020 May 21.
The angiotensin-converting enzyme 2 receptor (ACE2) is expressed in epithelial cells of many tissues including the kidney, and has been identified to interact with human pathogenic coronaviruses, including SARS-CoV-2. Although diffuse alveolar damage and acute respiratory failure are the main features of COVID-19 infection, two recent studies demonstrate that kidney impairment in hospitalized COVID-19 patients is common, and that kidney involvement is associated with high risk of in-hospital death. Interestingly, studies in rats have demonstrated that high dietary sodium intake results in down-regulation of the ACE2 expression in kidney tissue. We hypothesize that low sodium status makes kidney involvement during the course of COVID-19 infection more likely due to upregulation of membrane bound ACE2 in the kidneys. We propose that sodium intake and status should be monitored carefully during severe COVID-19 infections, and that low sodium intake be corrected early in its course, despite a potential conflict regarding common dietary recommendations to restrict dietary sodium intake in patients with hypertension, diabetes, and kidney disease.
血管紧张素转化酶 2 受体（ACE2）表达于多种组织的上皮细胞，包括肾脏，并已被鉴定与包括 SARS-CoV-2 在内的人类致病冠状病毒相互作用。尽管弥漫性肺泡损伤和急性呼吸衰竭是 COVID-19 感染的主要特征，但最近两项研究表明，住院 COVID-19 患者的肾脏损伤很常见，并且肾脏受累与住院死亡的高风险相关。有趣的是，大鼠研究表明，高膳食钠摄入导致肾脏组织中 ACE2 表达下调。我们假设，由于肾脏中膜结合 ACE2 的上调，低钠状态使 COVID-19 感染过程中的肾脏受累更有可能发生。我们建议，在严重 COVID-19 感染期间应仔细监测钠摄入量和状态，并在病程早期纠正低钠摄入，尽管在高血压、糖尿病和肾病患者中限制膳食钠摄入的常见饮食建议方面存在潜在冲突。
