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Panminerva Medica 2020 May 20

DOI: 10.23736/S0031-0808.20.03965-8

Copyright © 2020 EDIZIONI MINERVA MEDICA

language: English

The kidney in COVID-19: protagonist or figurant?

Maria Francesca STAICO ¹, Marco ZAFFANELLO ² ✉, Giulia DI PIETRO ¹, Vassilios FANOS ^{1, 3, 4}, Maria Antonietta MARCIALIS ⁴

¹ School of Pediatrics, University of Cagliari, Cagliari, Italy; ² Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, University of Verona, Verona, Italy; ³ Department of Surgery, University of Cagliari, Cagliari, Italy; ⁴ Neonatal Intensive Care Unit, AOU Cagliari, Cagliari, Italy

The etiology of injury in COVID-19 patients is diverse and multifactorial. Autopsy and biopsy studies reveal, alongside podocyte and tubular cell anomalies, the presence of virion within the cells. Evidence suggests that, in addition to the direct cytopathic effect of SARS- CoV2 on the glomeruli and renal tubules, there is also the indirect effect of cell-mediated immunity, the cytokines storm and the cross-talk between organs with possible systemic effects of the disease. These mechanisms are interconnected and have profound therapeutic implications involving extracorporeal removal of inflammatory cytokines. Dialysis patients, and children, in particular, should be classified as "at high risk" of contracting the disease. Infections are one of the most frequent causes of death in children with chronic renal failure who undergo dialysis. The reasons for this particular susceptibility are to be found in the compromised immune system, secondary to chronic malnutrition, immunosuppressive therapy, and uremia, frequent contact with healthcare personnel and other patients attending the dialysis unit and in need of the presence of other family members during treatment.

KEY WORDS: Acute kidney injury; Acute renal failure; COVID-19; Inhibitors of angiotensin conversion enzyme; Kidney; Inflammation; Renin angiotensin aldosterone system; SARS-CoV-2