Renal Division, Department of Medicine, Peking University First Hospital, Beijing, China; Peking University Institute of Nephrology, Beijing, China; Key Laboratory of Renal Disease, Ministry of Health of China, Beijing, China.
Renal Division, Department of Medicine, Peking University First Hospital, Beijing, China; Peking University Institute of Nephrology, Beijing, China; Key Laboratory of Renal Disease, Ministry of Health of China, Beijing, China.
Semin Nephrol. 2020 Sep;40(5):430-442. doi: 10.1016/j.semnephrol.2020.09.001. Epub 2020 Sep 4.
Coronavirus disease 2019 (COVID-19) is spreading rapidly worldwide. Here, we review recently published studies on COVID-19-associated acute kidney injury (AKI) in China. The pooled incidence of AKI in all reported COVID-19 patients was 6.5%, with a much higher rate in patients from the intensive care unit (32.5%). AKI is associated with the severity of COVID-19 and mortality rates, which is similar to other kidney abnormalities including proteinuria and hematuria. The renal tubule is the main site of injury in COVID-19 patients, and the etiology of renal impairment in COVID-19 patients likely is diverse and multifactorial. Apart from direct viral attack via angiotensin-converting enzyme 2 and transmembrane serine proteases 2, hypoxia and hypercoagulability also may contribute to the occurrence of renal injury. To date, there is only randomized controlled trial evidence to support the use of dexamethasone in patients requiring oxygen therapy and remdesivir for shortening the time to recovery, with no specific treatment for COVID-19-associated AKI. Studies researching kidney pathologies or reporting renal outcome and prognosis are in urgent need. Further studies are urgently warranted to identify risk factors, to predict prognosis and renal outcome, to explore the exact mechanisms of renal injury, and to suggest targeted interventions.
新型冠状病毒病 2019（COVID-19）在全球范围内迅速传播。在这里，我们回顾了最近发表的关于中国 COVID-19 相关急性肾损伤（AKI）的研究。所有报告的 COVID-19 患者中 AKI 的总发生率为 6.5%，来自重症监护病房（ICU）的患者发生率更高（32.5%）。AKI 与 COVID-19 的严重程度和死亡率相关，与包括蛋白尿和血尿在内的其他肾脏异常相似。肾小管是 COVID-19 患者损伤的主要部位，COVID-19 患者肾损伤的病因可能是多样的和多因素的。除了通过血管紧张素转换酶 2 和跨膜丝氨酸蛋白酶 2 直接病毒攻击外，缺氧和高凝状态也可能导致肾损伤。迄今为止，只有随机对照试验证据支持在需要氧疗的患者中使用地塞米松和瑞德西韦缩短恢复时间，而 COVID-19 相关性 AKI 没有特定的治疗方法。急需研究肾脏病理或报告肾脏结局和预后的研究。迫切需要进一步的研究来确定危险因素，预测预后和肾脏结局，探讨肾损伤的确切机制，并提出针对性的干预措施。
