Sound Science before Quick Judgement Regarding RAS Blockade in COVID-19

How COVID-19 Has Changed the Management of Glomerular Diseases

“…As we reduce our glomerular disease patients' exposure to immunosuppression, we often need to adjust our conservative therapies, particularly renin-angiotensin-aldosterone system blocking agents and diuretics. Despite recent controversies regarding the possible impact of angiotensinconverting enzyme inhibitors and angiotensin receptor blockers on COVID-19 transmission, we adhere to the recommendations made by experts across various disciplines (cardiology, nephrology, and hypertension) not to discontinue these drugs (5)(6)(7). Therefore, we keep our patients on these agents and, if proteinuria is heavy in patients being weaned off immunosuppression, consider either increasing the dose of angiotensin-converting enzyme inhibitor or angiotensin receptor blockers or, alternatively, keeping the dose unchanged but adding a mineralocorticoid receptor blocker (e.g., eplerenone).…”

Rigor before speculation in COVID-19 therapy

“…As we have discussed before (10) and opposite of the conclusions reached by Abassi et al, there is no COVID-19related evidence supporting abandonment of RAAS inhibitors for patients who are prescribed these medications for indicated conditions. This is consistent with all of the professional societies who have examined and posted their recommendations on the question.…”

Outpatient Management of the Kidney Transplant Recipient during the SARS-CoV-2 Virus Pandemic

“…The SARS-CoV-2 virus uses angiotensin-converting enzyme 2 (ACE2) to gain entry to cells (10,11), similar to SARS-CoV-1 (12), leading to suggestions that ACE inhibitors and/or angiotensin receptor blockers may increase risk of COVID-19, potentially via altered expression of ACE2. However, there are no clear clinical data supporting or refuting this hypothesis, and changing the dosing of ACE inhibitors or angiotensin receptor blockers for treating SARS-CoV-2 virus infection is not recommended (13).…”