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Dtsch Med Wochenschr 2020; 145(15): 1068-1073
DOI: 10.1055/a-1164-4231
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COVID-19 aus Sicht des Nephrologen

COVID-19: The Perspective Of Nephrology
Martin Kann
,
Thomas Benzing
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Abstract

Increasing insight into the clinical phenotype and mechanisms of SARS-CoV-2 infections and COVID-19 has identified damage of the kidneys as a key player in the course of the disease. This manuscript summarizes the current knowledge on direct viral infection of kidney tissue, proteinuria and acute kidney injury in COVID-19, and management of patients on chronic dialysis as well as after kidney transplantation. Direct infection of podocytes and proximal tubular cells by SARS-CoV-2 has been confirmed and results in proteinuria and hematuria at an early stage of COVID-19. In this context, any kidney affection is a predictor of worse outcomes among COVID-19 patients irrespective of the initial presentation and increases the risk of acute kidney injury. Specific therapies for kidney damage and acute kidney injury within COVID-19 that could be generally recommended are currently lacking. Patients on chronic hemodialysis in particular are at risk for contracting SARS-CoV-2 infections as indicated by outbreaks and super-spreading events in hemodialysis facilities. Immunosuppressive therapy after kidney transplantation needs to be adapted upon diagnosis of COVID-19 depending on the severity of the initial presentation.

Auch wenn bei COVID-19 die Pneumonie dominiert, kommt häufig eine Nierenbeteiligung mit Proteinurie und akutem Nierenschaden (ANV) vor – und mittlerweile weiß man auch, dass SARS-CoV-2 Nierenzellen direkt infizieren kann. Die Nierenbeteiligung hat weitreichende Folgen für das Management von an COVID-19 erkrankten Menschen und ist assoziiert mit einer signifikant erhöhten Mortalität. Der Beitrag fasst die aktuellen Erkenntnisse zusammen.

Schlüsselwörter

Nierenbeteiligung - akutes Nierenversagen - Dialysetherapie - Transplantation - SARS-CoV-2

Key words

kidney affection - acute kidney injury - hemodialysis - transplantation - SARS-CoV-2


Publication History

Article published online:
30 July 2020

© Georg Thieme Verlag KG
Stuttgart · New York

 

  • Literatur

  • 1 Pei G, Zhang Z, Peng J. et al Renal Involvement and Early Prognosis in Patients with COVID-19 Pneumonia. J Am Soc Nephrol 2020; 31: 1157-1165 . doi:10.1681/ASN.2020030276
    CrossrefPubMedGoogle Scholar
  • 2 Puelles VG, Lütgehetmann M, Lindenmeyer MT. et al. Multiorgan and Renal Tropism of SARS-CoV-2. N Engl J Med 2020; DOI: 10.1056/NEJMc2011400.
    CrossrefPubMedGoogle Scholar
  • 3 Su H, Yang M, Wan C. Renal histopathological analysis of 26 postmortem findings of patients with COVID-19 in China. Kidney Int 2020; DOI: 10.1016/j.kint.2020.04.003.
    CrossrefPubMedGoogle Scholar
  • 4 Varga Z, Flammer AJ, Steiger P. et al. Endothelial cell infection and endotheliitis in COVID-19. Lancet 2020; 395: 1417-1418
    CrossrefPubMedGoogle Scholar
  • 5 Monteil V, Kwon H, Prado P. et al Inhibition of SARS-CoV-2 Infections in Engineered Human Tissues Using Clinical-Grade Soluble Human ACE2. Cell 2020; 181: 905-913 . doi:10.1016/j.cell.2020.04.004
    CrossrefPubMedGoogle Scholar
  • 6 Wang W, Xu Y, Gao R. et al Detection of SARS-CoV-2 in Different Types of Clinical Specimens. JAMA 2020; 323: 1843-1844 . doi:10.1001/jama.2020.3786
    PubMedGoogle Scholar
  • 7 Sun J, Zhu A, Li H. et al Isolation of Infectious SARS-CoV-2 from Urine of a COVID-19 Patient. Emerg Microbes Infect 2020; 9: 991-993 . doi:10.1080/22221751.2020.1760144
    CrossrefPubMedGoogle Scholar
  • 8 Chen T, Wu D, Chen H. et al. Clinical characteristics of 113 deceased patients with coronavirus disease 2019: retrospective study. BMJ 2020; 368: m1091
    PubMedGoogle Scholar
  • 9 Reynolds HR, Adhikari S, Pulgarin C. et al. Renin-Angiotensin-Aldosterone System Inhibitors and Risk of Covid-19. N Engl J Med 2020; DOI: 10.1056/NEJMoa2008975.
    CrossrefPubMedGoogle Scholar
  • 10 Cheng Y, Luo R, Wang K. et al. Kidney disease is associated with in-hospital death of patients with COVID-19. Kidney Int 2020; 97: 829-838
    CrossrefPubMedGoogle Scholar
  • 11 Richardson S, Hirsch JS, Narasimhan M. et al. Presenting Characteristics, Comorbidities, and Outcomes Among 5700 Patients Hospitalized With COVID-19 in the New York City Area. JAMA 2020; DOI: 10.1001/jama.2020.6775.
    CrossrefPubMedGoogle Scholar
  • 12 Wang D, Yin Y, Hu C. et al. Clinical course and outcome of 107 patients infected with the novel coronavirus, SARS-CoV-2, discharged from two hospitals in Wuhan, China. Crit Care 2020; 24: 188
    CrossrefPubMedGoogle Scholar
  • 13 Yang X, Yu Y, Xu J. et al. Clinical course and outcomes of critically ill patients with SARS-CoV-2 pneumonia in Wuhan, China: a single-centered, retrospective, observational study. Lancet Respir Med 2020; 8: 475-481
    CrossrefPubMedGoogle Scholar
  • 14 Xiong F, Tang H, Liu L. et al. Clinical Characteristics of and Medical Interventions for COVID-19 in Hemodialysis Patients in Wuhan, China. J Am Soc Nephrol 2020; DOI: 10.1681/ASN.2020030354.
    CrossrefPubMedGoogle Scholar
  • 15 Schwierzeck V, König JC, Kühn J. et al. First reported nosocomial outbreak of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in a pediatric dialysis unit. Clin Infect Dis 2020; DOI: 10.1093/cid/ciaa491.
    CrossrefPubMedGoogle Scholar
  • 16 Trujillo H, Caravaca-Fontán F, Sevillano Á. et al SARS-CoV-2 Infection in Hospitalized Patients with Kidney Disease. Kidney Int Rep 2020; 5: 905-909 . doi:10.1016/j.ekir.2020.04.024
    PubMedGoogle Scholar
  • 17 Husain SA, Dube G, Morris H. et al. Early Outcomes of Outpatient Management of Kidney Transplant Recipients with Coronavirus Disease 2019. CJASN 2020; DOI: 10.2215/CJN.05170420.
    CrossrefPubMedGoogle Scholar
  • 18 Boyarsky BJ, Po-Yu ChiangT, Werbel WA. et al. Early impact of COVID-19 on transplant center practices and policies in the United States. Am J Transplant 2020; DOI: 10.1111/ajt.15915.
    CrossrefPubMedGoogle Scholar