COVID-19 and Renal Diseases: An Update

Abstract

Background: 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 substantial influence on the outcomes of the disease. Methods: 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, 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 worse prog-nosis, 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. Conclusion: The kidney and the RAS exert fundamental roles in the SARS-CoV-2 infection and more research is required to have a complete understanding on the repercussions caused by COVID-19 in renal diseases.

COVID-19 Infection: Viral Clearance and Antibody Response in Dialysis Patients and Renal Transplant Recipients

“…The overall mortality of SARS-CoV-2 infection in Italy was 11.6%; a worse outcome is reported in patients with chronic diseases and cardiovascular comorbidity [ 28 ]. Consistent with previous reports [ 24 , 25 ], our population showed an elevated death rate (22.2% in patients with decompensated renal failure, 38.0% in dialysis patients, and 31.2% in transplant recipients), confirming the fragility of chronic nephropathic patients, in spite of the timely therapy against COVID-19 given in most of the cases and the reduction of immunosuppression in transplanted patients. Sadly, the work suffers from the heterogeneity of therapeutic intervention for COVID-19, mainly related to the period in which the study was conducted, the early stages of the pandemic outbreak in Italy, when a reference treatment scheme was not well defined yet.…”

“…SARS-CoV-2 infection is having a tremendous impact on national health systems worldwide. Our data confirm the increased susceptibility to COVID-19 of patients with advanced-stage renal failure [20], under chronic dialysis therapy [21,22] and kidney transplant recipients [23] compared to the general population, as previously reported in Italy and other industrialized countries [8,24,25].…”

The Influence of Helminth Immune Regulation on COVID-19 Clinical Outcomes: Is it Beneficial or Detrimental?

“…42 An exacerbated systemic inflammatory response and the massive release of IL-1, IL-2, IL-7, G-CSF, IP-10, MCP-1, MIP-1A, and TNFα was observed in severe COVID-19 cases. 43 Data coming from the COVID-19 pandemics showed that people with pre-existing conditions such as chronic pulmonary diseases, 44 cardiovascular diseases (CVD), 45 renal diseases, 46 and metabolic syndromes 47,48 are at higher risk of severe disease and mortality when infected. These metabolic diseases are characterized by increased levels of proinflammatory cytokines.…”

Renal involvement in COVID-19: focus on kidney transplant sector

“…Renal transplant patients with COVID-19 age nearly 60, and two-third of them are males. Comorbidities reflect patients' age (diabetes, hypertension, cardiovascular and pulmonary diseases) and are frequently serious being transplanted subjects under immunosuppressive therapy to prevent rejection [50,[62][63][64][82][83][84][85]; this frequently leads COVID-19 toward a severe course [85].…”