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   Table of Contents - Current issue
October-December 2020
Volume 20 | Issue 4
Page Nos. 191-235

Online since Friday, October 16, 2020

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Coronavirus 2019 pandemic and renal diseases: a review of the literature p. 191
Osama Gheith, Ayman Maher, Ahmed Abbas, Mohamed Emam, Medhat A Halim, Soheir M Zain Eldein, Tarek Mahmoud, Nashwa Othman, Prasad Nair, Amal Abd Elazim, Torki Al-Otaibi
Objectives Most people with coronavirus 2019 (COVID-19) develop mild illness, but a minority may require active medical care because of the acute respiratory distress syndrome, sepsis and septic shock, and multiorgan failure, including acute kidney injury (AKI) and cardiac injury. The effect of this infection in those with chronic kidney disease (CKD) including kidney transplant recipients has not been evaluated properly. We aimed to highlight the effect of COVID-19 on patients with CKD and the preventive measures to be taken in addition to possible therapeutic modalities till the end of May 2020. Patients and methods We have reviewed most of the literature concerning COVID-19 and focused on the renal implications. Results Patients with CKD (especially dialysis patients and kidney transplant recipients) are at high risk of death because comorbidities increase the risk of dying owing to COVID-19; moreover, COVID-19 infection exaggerates comorbidities and causes possible drug interactions. Patients with COVID-19-induced AKI should be seen regularly by nephrologists, because the risk of these patients to develop CKD is high. In this review, we evaluated the different studies dealing with such topic. Conclusion Kidney involvement seems to be frequent in patients with COVID-19 infection, and AKI is an independent predictor of mortality. Management of patients on dialysis will need special precautions with strict protocols to minimize the risk to other patients and health care personnel taking care of these patients. Immunocompromised patients, such as transplant recipients and those who are maintained on immunosuppressive medications, will need special care.
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Acute kidney injury in patients with coronavirus disease 2019 – how much do we know? p. 204
Mohamed Abdalbary, Hussein Sheashaa
By the end of 2019, coronavirus severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), a new RNA virus belonging to the β-coronavirus cluster, started spreading in China. A few months later, it was declared a pandemic, and it is spreading all over the world causing millions of patients and hundreds of thousands of deaths. Despite respiratory manifestations being the most common symptoms with coronavirus disease 2019 (COVID-19), kidney affection was noted in many studies. There is noticeable heterogeneity in the available literature about the incidence of acute kidney injury (AKI) in COVID-19-infected patients. However, AKI was associated with higher rates of mortality. SARS-CoV-2 uses angiotensin-converting enzyme 2 receptor to enter target organs. Angiotensin-converting enzyme 2 is highly expressed in kidney tubules, which suggests that tubular injury is the main consequence of SARS-CoV-2. It remains unclear whether AKI in COVID-19-infected patients is a direct viral cytopathic effect or a part of a cytokine storm, hemodynamic instability, or hypercoagulability. It is more likely that the etiology of AKI is multifactorial. The available evidence for treatment of COVID-19 is either from observational studies or small limited controlled trials. Moreover, limited data are suggesting specific strategies for AKI management in COVID-19-infected patients. However, earlier detection and management of renal abnormalities, involving hemodynamic support, avoidance of nephrotoxic medications, and extracorporeal modalities, may help to mitigate the hazardous effect of AKI on COVID-19-infected patients. We tried to highlight the possible mechanism, management options, and magnitude of AKI in patients with COVID-19 infection.
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Preventive strategies and renal replacement therapies for patients with COVID-19 p. 211
Hesham Elsayed
The current pandemic of coronavirus disease 2019 (COVID-19) spotlighted the vulnerability of patients with chronic kidney disease stage 5 on maintenance hemodialysis (HD) to the viral infection, A baseline hyperinflammatory state driven by factors such as the retention of uremic toxins afflicts these patients. Emphasis is placed on preparedness and prevention strategies for infection with this new COVID-19 Virus. Extracorporeal techniques can be helpful in the modulation of an immune dysregulated response, both in the severely ill and in the chronic HD patient. The use of high-flux (HF) dialyzers for HD is the standard of care. However, with HF membranes the effect is augmented when applied in a Hemodiafiltration mode, thanks for its dragging effect, on the other hand the use of superflux or Medium cut off dialyzers MCO are advantageous in removing the larger middle molecules with special respect to the cytokines release as a main cause of deterioration in those patients the use of more prolonged Hemodialysis, namely Continuous Renal Replacement Therapy (CRRT) as well the Prolonged Intermittent Renal Replacement Therapy (PIRRT) are considered best options as per its more prolongated time so compensate for the balance between production and elimination. Important issues are to improve the overall patients conditions on Maintenance Hemodialysis (MHD) in the term of maximizing the HD Dose, Nutritional support, treatment of any comorbidity as well inflammation as first step in preparedness of patients beside the strict and extensively adherent to preventive strategies that may improve the overall outcomes if they get infected with COVID-19.
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COVID-19 and kidney transplantation: how to face the disaster? p. 224
Ahmed Y Elmowafy, Ahmed A.-F Denewar, Mohamed E Mashaly, Mohamed Osama, Ahmed F Donia, Ayman F Refaie, Hussein A Sheashaa
There is no doubt that pandemic of COVID-19 caused by SARS-CoV-2 virus is a real disaster, which has affected all aspects of medical field. Kidney transplantation program has faced many problems during COVID-19 pandemic. The program has been cut down in many centers all over the world. Shortage of medical facilities, which have been directed to COVID-19 care, unavailability of ICU beds, and redirection of medical personnel to combat against COVID-19 are restrictions against continuity of the transplantation program. Transplantation is surrounded by many safety issues, as donor–recipient COVID-19 transmission is not well defined till now. Being immunocomprised, kidney transplant recipients are at high risk for infection. The immune state may alter the presentation and prognosis of disease in that particular population. The challenge is to keep the graft well functioning while the patient recovers rapidly from infection which requires meticulous manipulation of immunosuppressive medications. Herein, we discuss the effect of COVID-19 pandemic on kidney transplantation and the available treatment plans for infected kidney transplant recipients.
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Smoking cessation as a tool for prevention of development and progression of kidney disease p. 232
Mariam E Omar, Mohamed E Elrggal
In the era of COVID-19, smoking has already been incriminated as an imminent risk for patients infected with SARS-COV-2. Patients with kidney disease are more susceptible to poor outcomes especially in the setting of immunosuppression and end stage kidney disease (ESKD). Hence, in our letter, we would like to throw the light on the association of smoking with kidney disease and the crucial role of smoking cessation in prevention of the development and progression of chronic kidney disease.
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‘COVID-19: nephrologists in the battle crosswords’ p. 234
Moatasem Elsayed, Hussein Sheashaa
Coronaviruses are important human and animal pathogens. At the end of 2019, a novel coronavirus (ie, SARS-CoV-2) was identified as the cause of a cluster of pneumonia cases in Wuhan, a city in the Hubei Province of China. By 2020, it rapidly spread until it became a pandemic that has spread throughout the world. SARS-CoV-2 disease (COVID-19) mainly manifests as a respiratory infection ranging from those of a mild upper respiratory symptom to severe pneumonia, acute respiratory distress syndrome, and death. COVID-19 Severely affects patients with pre-existing comorbidities, such as patients with various types of kidney disease, hypertension, diabetes and elderly. All medical professionals, including nephrology clinicians, are tasked with rapidly adjusting their practice to withhold the spread of the virus, while providing the usual medical care to their patients. In this crosswords we hope to provide a basic and essential information in a simple manner describing the relationship between COVID-19 infection and kidney diseases.
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