Interdisciplinary Laboratory of Medical Investigation, Faculty of Medicine, Federal University of Minas Gerais, UFMG, Belo Horizonte, Minas Gerais, Brazil.
Curr Drug Targets. 2021;22(1):52-67. doi: 10.2174/1389450121999201013151300.
It becomes increasingly evident that the SARS-CoV-2 infection is not limited to the respiratory system. In addition to being a target of the virus, the kidney also seems to have a substantial influence on the outcomes of the disease.
Data was obtained by a comprehensive and non-systematic search in the PubMed, Cochrane, Scopus and SciELO databases, using mainly the terms "SARS-CoV-2", "COVID-19", "chronic kidney disease", "renal transplantation", acute kidney injury" and "renal dysfunction" Discussion: The membrane-bound angiotensin-converting enzyme 2 is the receptor for SARS-CoV- -2, and this interaction may lead to an imbalance of the Renin-Angiotensin System (RAS), associated with worse clinical presentations of COVID-19, including acute pulmonary injury, hyperinflammatory state and hematological alterations. In the framework of renal diseases, the development of acute kidney injury is associated mostly with immune alterations and direct cytopathic lesions by the virus, leading to higher mortality. As for chronic kidney disease, the patients at a non-terminal stage have a worse prognosis, while the hemodialysis patients appear to have mild courses of COVID-19, probably due to lower chances of being affected by the cytokine storm. Furthermore, the current scenario is unfavorable to kidney donation and transplantation. The relationship between COVID-19 and immunosuppression in kidney transplantation recipients has been greatly discussed to determine whether it increases mortality and how it interacts with immunosuppressive medications.
The kidney and the RAS exert fundamental roles in the SARS-CoV-2 infection, and more research is required to have a complete understanding of the repercussions caused by COVID-19 in renal diseases.
越来越明显的是，SARS-CoV-2 感染不仅局限于呼吸系统。肾脏不仅是病毒的靶器官，似乎对疾病的结果也有很大的影响。
通过在 PubMed、Cochrane、Scopus 和 SciELO 数据库中进行全面和非系统性检索，主要使用术语“SARS-CoV-2”、“COVID-19”、“慢性肾脏病”、“肾移植”、“急性肾损伤”和“肾功能障碍”来获取数据。
膜结合血管紧张素转换酶 2 是 SARS-CoV-2 的受体，这种相互作用可能导致肾素-血管紧张素系统（RAS）失衡，与 COVID-19 的更严重临床表现相关，包括急性肺损伤、高炎症状态和血液学改变。在肾脏疾病的框架内，急性肾损伤的发生主要与免疫改变和病毒的直接细胞病变有关，导致更高的死亡率。对于慢性肾脏病，非终末期患者的预后更差，而血液透析患者的 COVID-19 病程似乎较轻，可能是因为发生细胞因子风暴的机会较低。此外，目前的情况不利于肾脏捐赠和移植。COVID-19 与肾移植受者免疫抑制之间的关系已被广泛讨论，以确定其是否增加死亡率以及与免疫抑制药物的相互作用如何。
肾脏和 RAS 在 SARS-CoV-2 感染中发挥着重要作用，需要进一步研究以全面了解 COVID-19 在肾脏疾病中的影响。
