COVID-19 aus Sicht des Nephrologen

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

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