Theofilis Panagiotis, Vordoni Aikaterini, Kalaitzidis Rigas G
Department of Nephrology, General Hospital of Nikaia-Piraeus "Agios Panteleimon", Piraeus, Nikaia 18454, Greece.
Curr Vasc Pharmacol. 2022;20(4):321-325. doi: 10.2174/1570161120666220513103007.
Coronavirus disease-19 (COVID-19), caused by severe acute respiratory syndrome Coronavirus- 2 (SARS-CoV-2), has caused a global pandemic with high morbidity and mortality. The presence of several comorbidities has been associated with a worse prognosis, with chronic kidney disease being a critical risk factor. Regarding COVID-19 complications, other than classical pneumonia and thromboembolism, acute kidney injury (AKI) is highly prevalent and represents a poor prognostic indicator linked to increased disease severity and mortality. Its pathophysiology is multifactorial, revolving around inflammation, endothelial dysfunction, and activation of coagulation, while the direct viral insult of the kidney remains a matter of controversy. Indirectly, COVID-19 AKI may stem from sepsis, volume depletion, and administration of nephrotoxic agents, among others. Several markers have been proposed for the early detection of COVID-19 AKI, including blood and urinary inflammatory and kidney injury biomarkers, while urinary SARS-CoV-2 load may also be an early prognostic sign. Concerning renal replacement therapy (RRT), general principles apply to COVID-19 AKI, but sudden RRT surges may mandate adjustments in resources. Following an episode of COVID-19 AKI, there is a gradual recovery of kidney function, with pre-existing renal impairment and high serum creatinine at discharge being associated with kidney disease progression and long-term dialysis dependence. Finally, kidney transplant recipients represent a special patient category with increased susceptibility to COVID- 19 and subsequent high risk of severe disease progression. Rates of mortality, AKI, and graft rejection are significantly elevated in the presence of COVID-19, highlighting the need for prevention and careful management of the disease in this subgroup.
新型冠状病毒肺炎（COVID-19）由严重急性呼吸综合征冠状病毒2（SARS-CoV-2）引起，已造成全球大流行，发病率和死亡率很高。多种合并症的存在与预后较差相关，慢性肾脏病是一个关键危险因素。关于COVID-19并发症，除了典型的肺炎和血栓栓塞外，急性肾损伤（AKI）非常普遍，是与疾病严重程度增加和死亡率上升相关的不良预后指标。其病理生理学是多因素的，围绕炎症、内皮功能障碍和凝血激活，而病毒对肾脏的直接损害仍存在争议。间接而言，COVID-19相关性急性肾损伤可能源于脓毒症、容量耗竭和使用肾毒性药物等。已经提出了几种用于早期检测COVID-19相关性急性肾损伤的标志物，包括血液和尿液中的炎症及肾损伤生物标志物，而尿液中的SARS-CoV-2载量也可能是早期预后指标。关于肾脏替代治疗（RRT），一般原则适用于COVID-19相关性急性肾损伤，但RRT需求的突然增加可能需要对资源进行调整。在发生COVID-19相关性急性肾损伤后，肾功能会逐渐恢复，出院时存在既往肾功能损害和高血清肌酐与肾病进展及长期透析依赖相关。最后，肾移植受者是一类特殊患者群体，对COVID-19易感性增加，随后发生严重疾病进展的风险很高。在存在COVID-19的情况下，死亡率、急性肾损伤和移植排斥率显著升高，突出了在这一亚组中预防和谨慎管理该疾病的必要性。
