Management of acute kidney injury in patients with COVID-19
Management of acute kidney injury in patients with COVID-19
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DOI：
10.1016/s2213-2600(20)30229-0
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发表时间：
2020-07-01
影响因子：
76.2
通讯作者：
Husain-Syed, Faeq
中科院分区：
文献类型：
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作者：
Ronco, Claudio;Reis, Thiago;Husain-Syed, Faeq
2019冠状病毒病（COVID-19）的爆发已迅速演变为全球大流行。大多数COVID-19患者症状轻微，但约5%的患者出现严重症状，包括急性呼吸窘迫综合征、感染性休克和多器官衰竭。肾脏经常受累，临床表现从轻度蛋白尿到进行性急性肾损伤（AKI），需要肾脏替代治疗（RRT）。对危重疾病和COVID-19背景下肾损伤和AKI的病理生理和机制的理解正在出现，尽管需要进一步的研究来识别有AKI风险的患者并指导管理策略。由于COVID-19继发AKI没有特定的治疗方案，重症监护在很大程度上是支持性的。目前预防和管理AKI的方法，以及确定使用RRT和序贯体外治疗的潜在适应症，主要基于临床经验，AKI策略根据COVID-19患者的经验进行调整。需要国际合作和跨学科研究来获得足够的证据来支持当前的临床方法并开发新的管理方法。
The outbreak of coronavirus disease 2019 (COVID-19) has rapidly evolved into a global pandemic. Most patients with COVID-19 have mild symptoms, but about 5% develop severe symptoms, which can include acute respiratory distress syndrome, septic shock, and multiple organ failure. Kidney involvement is frequent, with clinical presentation ranging from mild proteinuria to progressive acute kidney injury (AKI) necessitating renal replacement therapy (RRT). An understanding of the pathophysiology and mechanisms of kidney damage and AKI in the setting of critical illness and COVID-19 is emerging, although further research is needed to identify patients at risk of AKI and to guide management strategies. As no specific treatment options exist for AKI secondary to COVID-19, intensive care is largely supportive. Current approaches to prevention and management of AKI, and identification of potential indications for use of RRT and sequential extracorporeal therapies, are based mainly on clinical experience, and AKI strategies are adapted empirically to patients with COVID-19. International collaborative and cross-disciplinary research is needed to obtain adequate evidence to support current clinical approaches and to develop new approaches to management.