Adapa Sreedhar, Aeddula Narothama Reddy, Konala Venu Madhav, Chenna Avantika, Naramala Srikanth, Madhira Bhaskar Reddy, Gayam Vijay, Balla Mamtha, Muppidi Vijayadershan, Bose Subhasish
Division of Nephrology, Department of Internal Medicine, Adventist Medical Center, Hanford, CA 93230, USA.
Division of Nephrology, Department of Internal Medicine, Deaconess Health System Inc, Evansville, IN, USA.
J Clin Med Res. 2020 May;12(5):276-285. doi: 10.14740/jocmr4160. Epub 2020 May 8.
Coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), first officially reported in December 2019 in Wuhan City, Hubei province, China, and has since lead to a pandemic. Most cases result in minor symptoms such as cough, fever, sore throat, myalgia, fatigue, nausea, diarrhea, loss of smell, and abdominal pain. As of April 8, 2020, more than 1,485,000 cases of COVID-19 have been reported in more than 200 countries and territories, resulting in over 90,000 deaths. Outcomes are worse in elderly patients, particularly males, and those with comorbidities, but can affect any age group. The incidence of acute kidney injury in patients with COVID-19 infection is about 3-15%; and in patients with severe infection requiring care in the intensive care unit, the rates of acute kidney injury increased significantly from 15% to 50%. Acute kidney injury is an independent risk factor for mortality in COVID-19 patients. The nephrologists, as well as intensivists, are facing immense daily challenges while providing care for these patients in the inpatient setting as well as end-stage renal disease patients on chronic dialysis in both inpatient and outpatient settings. In the current review article, we discussed the epidemiology and etiology of acute kidney injury, management of acute kidney injury including renal replacement therapy options (both hemodialysis and peritoneal dialysis) for inpatient floor, as well as intensive care unit settings. We also discussed the challenges faced by the outpatient dialysis units with COVID-19 infection. We discussed measures required to limit the spread of infection, as well as summarized the guidance as per the Centers for Disease Control and Prevention (CDC), American Society of Nephrology (ASN), American Society of Diagnostic and Interventional Nephrology (ASDIN) and the Vascular Access Society of the Americas (VASA).
2019冠状病毒病（COVID-19）由严重急性呼吸综合征冠状病毒2（SARS-CoV-2）引起，于2019年12月在中国湖北省武汉市首次正式报告，此后引发了一场大流行。大多数病例表现为轻微症状，如咳嗽、发热、咽痛、肌痛、疲劳、恶心、腹泻、嗅觉丧失和腹痛。截至2020年4月8日，200多个国家和地区报告了超过148.5万例COVID-19病例，导致超过9万例死亡。老年患者，尤其是男性以及患有合并症的患者预后较差，但可影响任何年龄组。COVID-19感染患者中急性肾损伤的发生率约为3%-15%；在需要在重症监护病房接受治疗的重症感染患者中，急性肾损伤的发生率从15%显著增加到50%。急性肾损伤是COVID-19患者死亡的独立危险因素。肾病学家以及重症监护医生在为住院患者以及住院和门诊环境中接受慢性透析的终末期肾病患者提供护理时，每天都面临着巨大的挑战。在当前这篇综述文章中，我们讨论了急性肾损伤的流行病学和病因、急性肾损伤的管理，包括住院病房以及重症监护病房环境下的肾脏替代治疗选择（血液透析和腹膜透析）。我们还讨论了门诊透析单位面临的COVID-19感染挑战。我们讨论了限制感染传播所需的措施，并总结了美国疾病控制与预防中心（CDC）、美国肾脏病学会（ASN）、美国诊断与介入肾脏病学会（ASDIN）以及美洲血管通路学会（VASA）的相关指南。
