The
SARS-Coronavirus-19 disease has emerged as a global health challenge and has
engulfed almost all countries since it was first reported in Wuhan, China. Patients
with CKD have not been spared from the wrath of this pandemic and are bearing
the brunt of it along with the rest of the population. Most of the patients
with CKD have underlying comorbidities like diabetes and hypertension and are
at an increased risk of adverse outcomes. Some of the manifestations of
COVID-19 include proteinuria, hematuria, AKI, and acute CKD, requiring various
forms of renal replacement therapy. Multiple mechanisms proposed for this
damage include direct invasion, cytokine storm, hemodynamic derangements, and
many others that are still undergoing extensive research. Since SARS COV 2 enters
the cells through ACE 2 receptors, there are concerns regarding the use of ACE
inhibitors and ARBs in patients already on these drugs. There are concerns
regarding the use of immunosuppressants in various immune-mediated kidney
diseases (postponing planned doses of methylprednisolone/cyclophosphamide/rituximab).
Hemodialysis patients are exposed to potential sources of coronavirus as they
have to repeatedly report to hospitals for their dialysis sessions. Measures
regarding safeguarding dialysis staff from COVID -19 are contentious issues,
especially in resource-limited settings. Almost all renal transplant patients
are on lifelong immunosuppressive agents, making them more vulnerable to
infections. Therefore, CKD patients have unique issues in the management of
COVID and CKD, which we need to understand to develop protocols for the
management of these problems.
Keywords: ACE2, Acute on CKD, AKI, COVID-19, COVAN, CRRT, Cytokine storm, Extracorporeal therapies, Glomerular diseases, Hematuria, Hemodialysis, Immunosuppressive therapy, Kidney diseases, Kidney transplant, Maintenance, Organ crosstalk, Pandemic, Peritoneal dialysis, Personal, Protective equipment, Proteinuria, Systemic effects, Sytosorb.
