The pathogenesis, diagnosis and treatment progress of coronavirus disease 2019 complicated by renal injury_West China Medical Journal

Authors：

ZHU Min ^1,2 , WANG Wanting ^1,2 ,  CAO Yu ^1,2

1. Department of Emergency Medicine / Emergency Medicine Laboratory, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, P. R. China;
2. Disaster Medical Center, Sichuan University, Chengdu, Sichuan 610041, P. R. China;

Corresponding author：

CAO Yu, Email: yuyuer@126.com

Keywords：

Coronavirus disease 2019; Kidney injury; Pathogenesis; Diagnosis and Treatment

DOI：

10.7507/1002-0179.202003186

Video：

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Abstract Full text Figures/Tables Video References Cited by

With the in-depth understanding of the severe acute respiratory syndrome coronavirus 2, it has been found that the virus not only causes serious damage to the human respiratory system, but also damages the kidney system, which can be manifested as acute kidney injury, and in severe cases, renal failure can occur. Patients with coronavirus disease 2019 and chronic kidney disease are at higher risk of worsening their condition and even death. Therefore, early recognition and intervention of renal injury is particularly important for prognosis. In this paper, the clinical data of renal injury in patients with coronavirus disease 2019 were reviewed, and the possible pathogenesis, incidence, clinical features, diagnosis and treatment were proposed for reference in clinical decision-making.

Citation： ZHU Min, WANG Wanting, CAO Yu. The pathogenesis, diagnosis and treatment progress of coronavirus disease 2019 complicated by renal injury. West China Medical Journal, 2020, 35(11): 1294-1298. doi: 10.7507/1002-0179.202003186 Copy

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2.	Li Q, Guan X, Wu P, et al. Early transmission dynamics in Wuhan, China, of novel coronavirus-infected pneumonia. N Engl J Med, 2020, 382(13): 1199-1207.
3.	Zhu N, Zhang D, Wang W, et al. A novel coronavirus from patients with pneumonia in China, 2019. N Engl J Med, 2020, 382(8): 727-733.
4.	Su S, Wong G, Shi W, et al. Epidemiology, genetic recombination, and pathogenesis of coronaviruses. Trends Microbiol, 2016, 24(6): 490-502.
5.	World Health Organization. Clinical management of severe acute respiratory infection when novel coronavirus (‎‎‎‎‎‎2019-nCoV)‎‎‎‎‎‎ infection is suspected: interim guidance, 28 January 2020. (2020-01-28)[2020-03-11]. https://apps.who.int/iris/handle/10665/330893.
6.	Guan WJ, Ni ZY, Hu Y, et al. Clinical characteristics of coronavirus disease 2019 in China. N Engl J Med, 2020, 382(18): 1708-1720.
7.	刘茜, 王荣帅, 屈国强, 等. 新型冠状病毒肺炎死亡尸体系统解剖大体观察报告. 法医学杂志, 2020, 36(1): 21-23.
8.	Weiss SR, Leibowitz JL. Coronavirus pathogenesis. Adv Virus Res, 2011, 81: 85-164.
9.	Perlman S. Another decade, another coronavirus. N Engl J Med, 2020, 382(8): 760-762.
10.	Wrapp D, Wang N, Corbett KS, et al. Cryo-EM structure of the 2019-nCoV spike in the prefusion conformation. Science, 2020, 367(6483): 1260-1263.
11.	Lu R, Zhao X, Li J, et al. Genomic characterisation and epidemiology of 2019 novel coronavirus: implications for virus origins and receptor binding. Lancet, 2020, 395(10224): 565-574.
12.	Zou X, Chen K, Zou J, et al. Single-cell RNA-seq data analysis on the receptor ACE2 expression reveals the potential risk of different human organs vulnerable to 2019-nCoV infection. Front Med, 2020, 14(2): 185-192.
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15.	Munster VJ, Koopmans M, van Doremalen N, et al. A novel coronavirus emerging in China - key questions for impact assessment. N Engl J Med, 2020, 382(8): 692-694.
16.	Patel VB, Zhong JC, Grant MB, et al. Role of the ACE2/angiotensin 1-7 axis of the renin-angiotensin system in heart failure. Circ Res, 2016, 118(8): 1313-1326.
17.	Santos RAS, Sampaio WO, Alzamora AC, et al. The ACE2/angiotensin-(1-7)/MAS axis of the renin-angiotensin system: focus on angiotensin-(1-7). Physiol Rev, 2018, 98(1): 505-553.
18.	Jiang Y, Xu J, Zhou C, et al. Characterization of cytokine/chemokine profiles of severe acute respiratory syndrome. AmJ Respir Crit Care Med, 2005, 171(8): 850-857.
19.	Xu Z, Shi L, Wang Y, et al. Pathological findings of COVID-19 associated with acute respiratory distress syndrome. Lancet Respir Med, 2020, 8(4): 420-422.
20.	Chen N, Zhou M, Dong X, et al. Epidemiological and clinical characteristics of 99 cases of 2019 novel coronavirus pneumonia in Wuhan, China: a descriptive study. Lancet, 2020, 395(10223): 507-513.
21.	王翔宇, 马云波. 肾脏缺血再灌注损伤机制及其影响因素的研究进展. 生理学研究, 2016, 4(3): 19-29.
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23.	Salvadori M, Rosso G, Bertoni E. Update on ischemia-reperfusion injury in kidney transplantation: Pathogenesis and treatment. World J Transplant, 2015, 5(2): 52-67.
24.	Usui J, Yamagata K, Imai E, et al. Clinical practice guideline for drug-induced kidney injury in Japan 2016: digest version. Clin Exp Nephrol, 2016, 20(6): 827-831.
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26.	中华医学会临床药学分会《雾化吸入疗法合理用药专家共识》编写组. 雾化吸入疗法合理用药专家共识(2019年版). 医药导报, 2019, 38(2): 135-146.
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28.	Boriskin YS, Pécheur EI, Polyak SJ. Arbidol: a broad-spectrum antiviral that inhibits acute and chronic HCV infection. Virol J, 2006, 3: 56.
29.	Shi L, Xiong H, He J, et al. Antiviral activity of arbidol against influenza A virus, respiratory syncytial virus, rhinovirus, coxsackie virus and adenovirus in vitro and in vivo. Arch Virol, 2007, 152(8): 1447-1455.
30.	Pécheur EI, Borisevich V, Halfmann P, et al. The synthetic antiviral drug arbidol inhibits globally prevalent pathogenic viruses. J Virol, 2016, 90(6): 3086-3092.
31.	蔡晧东. 新型冠状病毒肺炎抗病毒药物的安全应用. 药物不良反应杂志, 2020, 22(2): 95-102.
32.	广东省科技厅及广东省卫生健康委磷酸氯喹治疗新冠状病毒肺炎多中心协作组. 磷酸氯喹治疗新型冠状病毒肺炎的专家共识. 中华结核和呼吸杂志, 2020, 43(3): 185-188.
33.	Best BM, Capparelli EV, Diep H, et al. Pharmacokinetics of lopinavir/ritonavir crushed versus whole tablets in children. J Acquir Immune Defic Syndr, 2011, 58(4): 385-391.
34.	陈军, 凌云, 席秀红, 等. 洛匹那韦利托那韦和阿比多尔用于治疗新型冠状病毒肺炎的有效性研究. 中华传染病杂志, 2020, 38(2): 86-89.
35.	Wang M, Cao R, Zhang L, et al. Remdesivir and chloroquine effectively inhibit the recently emerged novel coronavirus (2019-nCoV) in vitro. Cell Res, 2020, 30(3): 269-271.
36.	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(5): 829-838.
37.	Wang D, Hu B, Hu C, et al. Clinical characteristics of 138 hospitalized patients with 2019 novel coronavirus-infected pneumonia in Wuhan, China. JAMA, 2020, 323(11): 1061-1069.
38.	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(5): 475-481.
39.	Huang C, Wang Y, Li X, et al. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet, 2020, 395(10223): 497-506.
40.	Guan WJ, Liang WH, Zhao Y, et al. Comorbidity and its impact on 1590 patients with COVID-19 in China: a nationwide analysis. Eur Respir J, 2020, 55(5): 2000547.
41.	Wu F, Zhao S, Yu B, et al. A new coronavirus associated with human respiratory disease in China. Nature, 2020, 579(7798): 265-269.
42.	Shi H, Han X, Jiang N, et al. Radiological findings from 81 patients with COVID-19 pneumonia in Wuhan, China: a descriptive study. Lancet Infect Dis, 2020, 20(4): 425-434.
43.	Wang L, Li X, Chen H, et al. Coronavirus disease 19 infection does not result in acute kidney injury: an analysis of 116 hospitalized patients from Wuhan, China. Am J Nephrol, 2020, 51(5): 343-348.
44.	国家卫生健康委办公厅, 国家中医药管理局办公室. 关于印发新型冠状病毒肺炎诊疗方案(试行第六版)的通知. (2020-01-20)[2020-03-11]. http://www.gov.cn/zhengce/zhengceku/2020-02/19/content_5480948.htm.
45.	中华医学会肾脏病学分会专家组. 新型冠状病毒感染合并急性肾损伤诊治专家共识. 中华肾脏病杂志, 2020(3): 242-246.
46.	国家卫生健康委办公厅, 国家中医药管理局办公室. 关于印发新型冠状病毒肺炎诊疗方案(试行第七版)的通知. (2020-03-04)[2020-03-11]. http://www.nhc.gov.cn/yzygj/s7653p/202003/46c9294a7dfe4cef80dc7f5912eb1989.shtml.
47.	Andrassy KM. Comments on “KDIGO 2012 Clinical Practice Guideline for the evaluation and management of chronic kidney disease”. Kidney Int, 2013, 84(3): 622-623.
48.	中华医学会肾脏病学分会, 中国研究型医院学会肾脏病学专业委员会. 特殊血液净化技术应用于重症新型冠状病毒肺炎的专家共识. 中华内科杂志, 2020, 59(11): 847-853.
49.	李德新, 张爱东, 胡长春, 等. SARS并发肾脏损害特点及临床转归. 医学研究通讯, 2003, 32(10): 35-37.
50.	徐远达, 黎毅敏, 萧正伦, 等. 连续性血液净化对重症肺炎合并多器官功能衰竭的回顾性分析. 中国危重病急救医学, 2005, 17(12): 747-751.
51.	国家肾病专业医疗质量管理与控制中心, 中国医促会血液净化治疗与工程技术分会, 全军血液净化治疗学专业委员会. 新型冠状病毒肺炎救治中CRRT应用的专家意见. (2020-02-06)[2020-03-11]. http://www.cnrds.net/Static/file/新型冠状病毒肺炎救治中CRRT应用的专家意见%2020200206.pdf.
52.	陈蕾, 魏萌, 党喜龙, 等. 连续性肾脏替代治疗在新型冠状病毒肺炎危重患者中的治疗建议. 临床医学研究与实践, 2020, 5(S1): 20-23.
53.	中华医学会肾脏病学分会关于血液净化中心(室)新型冠状病毒感染的防控建议. 中华肾脏病杂志, 2020, 36(2): 82-84.
54.	基层血液净化中心(室)新型冠状病毒感染防控建议. 中华全科医师杂志, 2020(3): 193-197.
55.	梁伟, 石明, 王惠明. 新型冠状病毒疫情下肾脏替代治疗策略. 临床肾脏病杂志, 2020, 20(3): 181-183.
56.	Braun F, Lütgehetmann M, Pfefferle S, et al. SARS-CoV-2 renal tropism associates with acute kidney injury. Lancet, 2020, 396(10251): 597-598.

1. Wang C, Horby PW, Hayden FG, et al. A novel coronavirus outbreak of global health concern. Lancet, 2020, 395(10223): 470-473.
2. Li Q, Guan X, Wu P, et al. Early transmission dynamics in Wuhan, China, of novel coronavirus-infected pneumonia. N Engl J Med, 2020, 382(13): 1199-1207.
3. Zhu N, Zhang D, Wang W, et al. A novel coronavirus from patients with pneumonia in China, 2019. N Engl J Med, 2020, 382(8): 727-733.
4. Su S, Wong G, Shi W, et al. Epidemiology, genetic recombination, and pathogenesis of coronaviruses. Trends Microbiol, 2016, 24(6): 490-502.
5. World Health Organization. Clinical management of severe acute respiratory infection when novel coronavirus (‎‎‎‎‎‎2019-nCoV)‎‎‎‎‎‎ infection is suspected: interim guidance, 28 January 2020. (2020-01-28)[2020-03-11]. https://apps.who.int/iris/handle/10665/330893.
6. Guan WJ, Ni ZY, Hu Y, et al. Clinical characteristics of coronavirus disease 2019 in China. N Engl J Med, 2020, 382(18): 1708-1720.
7. 刘茜, 王荣帅, 屈国强, 等. 新型冠状病毒肺炎死亡尸体系统解剖大体观察报告. 法医学杂志, 2020, 36(1): 21-23.
8. Weiss SR, Leibowitz JL. Coronavirus pathogenesis. Adv Virus Res, 2011, 81: 85-164.
9. Perlman S. Another decade, another coronavirus. N Engl J Med, 2020, 382(8): 760-762.
10. Wrapp D, Wang N, Corbett KS, et al. Cryo-EM structure of the 2019-nCoV spike in the prefusion conformation. Science, 2020, 367(6483): 1260-1263.
11. Lu R, Zhao X, Li J, et al. Genomic characterisation and epidemiology of 2019 novel coronavirus: implications for virus origins and receptor binding. Lancet, 2020, 395(10224): 565-574.
12. Zou X, Chen K, Zou J, et al. Single-cell RNA-seq data analysis on the receptor ACE2 expression reveals the potential risk of different human organs vulnerable to 2019-nCoV infection. Front Med, 2020, 14(2): 185-192.
13. Fan C, Li K, Ding Y, et al. ACE2 expression in kidney and testis may cause kidney and testis damage after 2019-nCoV infection. (2020-02-13)[2020-03-11]. https://doi.org/10.1101/2020.02.12.20022418.
14. Anti-2019-nCoV Volunteers, Li Z, Wu M, et al. Caution on kidney dysfunctions of COVID-19 patients. (2020-03-27)[2020-10-31]. https://doi.org/10.1101/2020.02.08.20021212.
15. Munster VJ, Koopmans M, van Doremalen N, et al. A novel coronavirus emerging in China - key questions for impact assessment. N Engl J Med, 2020, 382(8): 692-694.
16. Patel VB, Zhong JC, Grant MB, et al. Role of the ACE2/angiotensin 1-7 axis of the renin-angiotensin system in heart failure. Circ Res, 2016, 118(8): 1313-1326.
17. Santos RAS, Sampaio WO, Alzamora AC, et al. The ACE2/angiotensin-(1-7)/MAS axis of the renin-angiotensin system: focus on angiotensin-(1-7). Physiol Rev, 2018, 98(1): 505-553.
18. Jiang Y, Xu J, Zhou C, et al. Characterization of cytokine/chemokine profiles of severe acute respiratory syndrome. AmJ Respir Crit Care Med, 2005, 171(8): 850-857.
19. Xu Z, Shi L, Wang Y, et al. Pathological findings of COVID-19 associated with acute respiratory distress syndrome. Lancet Respir Med, 2020, 8(4): 420-422.
20. Chen N, Zhou M, Dong X, et al. Epidemiological and clinical characteristics of 99 cases of 2019 novel coronavirus pneumonia in Wuhan, China: a descriptive study. Lancet, 2020, 395(10223): 507-513.
21. 王翔宇, 马云波. 肾脏缺血再灌注损伤机制及其影响因素的研究进展. 生理学研究, 2016, 4(3): 19-29.
22. Malek M, Nematbakhsh M. Renal ischemia/reperfusion injury; from pathophysiology to treatment. J Renal Inj Prev, 2015, 4(2): 20-27.
23. Salvadori M, Rosso G, Bertoni E. Update on ischemia-reperfusion injury in kidney transplantation: Pathogenesis and treatment. World J Transplant, 2015, 5(2): 52-67.
24. Usui J, Yamagata K, Imai E, et al. Clinical practice guideline for drug-induced kidney injury in Japan 2016: digest version. Clin Exp Nephrol, 2016, 20(6): 827-831.
25. 中华人民共和国国家卫生健康委员会. 中华人民共和国国家卫生健康委员会公告2020年第1号. (2020-01-20)[2020-03-11]. http://www.gov.cn/zhengce/zhengceku/2020-01/21/content_5471164.htm.
26. 中华医学会临床药学分会《雾化吸入疗法合理用药专家共识》编写组. 雾化吸入疗法合理用药专家共识(2019年版). 医药导报, 2019, 38(2): 135-146.
27. Loutfy MR, Blatt LM, Siminovitch KA, et al. Interferon alfacon-1 plus corticosteroids in severe acute respiratory syndrome:a preliminary study. JAMA, 2003, 290(24): 3222-3228.
28. Boriskin YS, Pécheur EI, Polyak SJ. Arbidol: a broad-spectrum antiviral that inhibits acute and chronic HCV infection. Virol J, 2006, 3: 56.
29. Shi L, Xiong H, He J, et al. Antiviral activity of arbidol against influenza A virus, respiratory syncytial virus, rhinovirus, coxsackie virus and adenovirus in vitro and in vivo. Arch Virol, 2007, 152(8): 1447-1455.
30. Pécheur EI, Borisevich V, Halfmann P, et al. The synthetic antiviral drug arbidol inhibits globally prevalent pathogenic viruses. J Virol, 2016, 90(6): 3086-3092.
31. 蔡晧东. 新型冠状病毒肺炎抗病毒药物的安全应用. 药物不良反应杂志, 2020, 22(2): 95-102.
32. 广东省科技厅及广东省卫生健康委磷酸氯喹治疗新冠状病毒肺炎多中心协作组. 磷酸氯喹治疗新型冠状病毒肺炎的专家共识. 中华结核和呼吸杂志, 2020, 43(3): 185-188.
33. Best BM, Capparelli EV, Diep H, et al. Pharmacokinetics of lopinavir/ritonavir crushed versus whole tablets in children. J Acquir Immune Defic Syndr, 2011, 58(4): 385-391.
34. 陈军, 凌云, 席秀红, 等. 洛匹那韦利托那韦和阿比多尔用于治疗新型冠状病毒肺炎的有效性研究. 中华传染病杂志, 2020, 38(2): 86-89.
35. Wang M, Cao R, Zhang L, et al. Remdesivir and chloroquine effectively inhibit the recently emerged novel coronavirus (2019-nCoV) in vitro. Cell Res, 2020, 30(3): 269-271.
36. 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(5): 829-838.
37. Wang D, Hu B, Hu C, et al. Clinical characteristics of 138 hospitalized patients with 2019 novel coronavirus-infected pneumonia in Wuhan, China. JAMA, 2020, 323(11): 1061-1069.
38. 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(5): 475-481.
39. Huang C, Wang Y, Li X, et al. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet, 2020, 395(10223): 497-506.
40. Guan WJ, Liang WH, Zhao Y, et al. Comorbidity and its impact on 1590 patients with COVID-19 in China: a nationwide analysis. Eur Respir J, 2020, 55(5): 2000547.
41. Wu F, Zhao S, Yu B, et al. A new coronavirus associated with human respiratory disease in China. Nature, 2020, 579(7798): 265-269.
42. Shi H, Han X, Jiang N, et al. Radiological findings from 81 patients with COVID-19 pneumonia in Wuhan, China: a descriptive study. Lancet Infect Dis, 2020, 20(4): 425-434.
43. Wang L, Li X, Chen H, et al. Coronavirus disease 19 infection does not result in acute kidney injury: an analysis of 116 hospitalized patients from Wuhan, China. Am J Nephrol, 2020, 51(5): 343-348.
44. 国家卫生健康委办公厅, 国家中医药管理局办公室. 关于印发新型冠状病毒肺炎诊疗方案(试行第六版)的通知. (2020-01-20)[2020-03-11]. http://www.gov.cn/zhengce/zhengceku/2020-02/19/content_5480948.htm.
45. 中华医学会肾脏病学分会专家组. 新型冠状病毒感染合并急性肾损伤诊治专家共识. 中华肾脏病杂志, 2020(3): 242-246.
46. 国家卫生健康委办公厅, 国家中医药管理局办公室. 关于印发新型冠状病毒肺炎诊疗方案(试行第七版)的通知. (2020-03-04)[2020-03-11]. http://www.nhc.gov.cn/yzygj/s7653p/202003/46c9294a7dfe4cef80dc7f5912eb1989.shtml.
47. Andrassy KM. Comments on “KDIGO 2012 Clinical Practice Guideline for the evaluation and management of chronic kidney disease”. Kidney Int, 2013, 84(3): 622-623.
48. 中华医学会肾脏病学分会, 中国研究型医院学会肾脏病学专业委员会. 特殊血液净化技术应用于重症新型冠状病毒肺炎的专家共识. 中华内科杂志, 2020, 59(11): 847-853.
49. 李德新, 张爱东, 胡长春, 等. SARS并发肾脏损害特点及临床转归. 医学研究通讯, 2003, 32(10): 35-37.
50. 徐远达, 黎毅敏, 萧正伦, 等. 连续性血液净化对重症肺炎合并多器官功能衰竭的回顾性分析. 中国危重病急救医学, 2005, 17(12): 747-751.
51. 国家肾病专业医疗质量管理与控制中心, 中国医促会血液净化治疗与工程技术分会, 全军血液净化治疗学专业委员会. 新型冠状病毒肺炎救治中CRRT应用的专家意见. (2020-02-06)[2020-03-11]. http://www.cnrds.net/Static/file/新型冠状病毒肺炎救治中CRRT应用的专家意见%2020200206.pdf.
52. 陈蕾, 魏萌, 党喜龙, 等. 连续性肾脏替代治疗在新型冠状病毒肺炎危重患者中的治疗建议. 临床医学研究与实践, 2020, 5(S1): 20-23.
53. 中华医学会肾脏病学分会关于血液净化中心(室)新型冠状病毒感染的防控建议. 中华肾脏病杂志, 2020, 36(2): 82-84.
54. 基层血液净化中心(室)新型冠状病毒感染防控建议. 中华全科医师杂志, 2020(3): 193-197.
55. 梁伟, 石明, 王惠明. 新型冠状病毒疫情下肾脏替代治疗策略. 临床肾脏病杂志, 2020, 20(3): 181-183.
56. Braun F, Lütgehetmann M, Pfefferle S, et al. SARS-CoV-2 renal tropism associates with acute kidney injury. Lancet, 2020, 396(10251): 597-598.

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West China Medical Journal

The pathogenesis, diagnosis and treatment progress of coronavirus disease 2019 complicated by renal injury

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