Objectives
The Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2) is a newly identified virus that is spreading rapidly throughout the world and results in a severe Coronavirus-associated disease (COVID-19) in a considerable number of individuals affected. In the current pandemic, medical information on COVID-19 in high-risk patients, such as individuals with chronic kidney disease, hemodialysis and kidney transplant patients, is still scarce. Additionally, the impact of SARS-CoV2 infection on the kidney itself leading to acute kidney injury remains unclear. To overcome this lack of knowledge, the website Kidney in COVID-19 was set up using the platform kidneyinfection.org. Kidney in COVID-19 aims to provide the latest research concerning the interaction between kidney disease and the current SARS-CoV-2 pandemic for nephrologists. You are cordially invited to participate and email us latest reseach concerning the kidney in COVID-19 as well as your experiences as experts in the field so we can share expertise and knowledge.

KIDNEY IN COVID-19 REGISTRY​

The novel Kidney in COVID-19 Registry, which facilitates anonymous documentation of nephrology patients of the regional network in Cologne, Germany, and the surrounding area, is online. The Kidney in COVID-19 Registry aims for the anonymous retrospective collection of clinical data of the following nephrology patients groups with COVID-19 infection:

  1. Patients with pre-existing dialysis (Haemodialysis peritoneal dialysis)
  2. Patients with acute kidney injury in the disease course of COVID-19
  3. Patients with pre-existing chronic kidney diseases
  4. Patients with kidney transplants

We suggest documentation of clinical cases 3-4 weeks after the day of diagnosis of COVID-19. Data entry to the Kidney in COVID-19 Registry can be found on the general data protection compliant platform clinicalsurveys.net and is secured by password.
Please mail us your affiliation at kidneyinfection@uk-koeln.de and your personal account for clinicalsurveys.net will be set-up.

Click here for the Kidney in COVID-19 Registry manual.

Click here for the German explanation of the Kidney in COVID-19 Registry / Klicken Sie hier für die deutsche Beschreibung des Kidney in COVID-19 Registers.

During the current SARS-CoV-2 outbreak situation in Cologne, Germany, Kidneyinfection.org provides local health care professionals in nephrology information and recommendations, such as Standard Operating Procedures (SOPs) and daily case numbers of SARS-CoV-2 cases among dialysis patients. Click here for further information.

Latest Research

COVID-19, a disease caused by a novel coronavirus, is a major global human threat that has turned into a pandemic. This novel coronavirus has specifically high morbidity in the elderly and in comorbid populations. Uraemic patients on dialysis combine an intrinsic fragility and a very frequent burden of comorbidities with a specific setting in which many patients are repeatedly treated in the same area (haemodialysis centres). Moreover, if infected, the intensity of dialysis requiring specialized resources and staff is further complicated by requirements for isolation, control and prevention, putting healthcare systems under exceptional additional strain. Therefore, all measures to slow if not to eradicate the pandemic and to control unmanageably high incidence rates must be taken very seriously. The aim of the present review of the European Dialysis (EUDIAL) Working Group of ERA-EDTA is to provide recommendations for the prevention, mitigation and containment in haemodialysis centres of the emerging COVID-19 pandemic. The management of patients on dialysis affected by COVID-19 must be carried out according to strict protocols to minimize the risk for other patients and personnel taking care of these patients. Measures of prevention, protection, screening, isolation and distribution have been shown to be efficient in similar settings. They are essential in the management of the pandemic and should be taken in the early stages of the disease.

Basile C et al. Nephrol Dial Transplant, 2020.  https://doi.org/10.1093/ndt/gfaa069

Here, we review the most recent findings on the effects of SARS-CoV-2 infection on kidney diseases, including acute kidney injury, and examine the potential effects of ARBs on the outcomes of patients with COVID-19. Lastly, we discuss the clinical management of COVID-19 patients with existing chronic renal disorders, particularly those in dialysis and with kidney transplants.

Perico L et al. Nephron, 2020.https://doi.org/10.1159/000507305

Organisation and therapeutical recommendations including the Brescia COVID-19 respiratory severity score facilitating clinical assessment of nephrology patients.

Alberici F et al. on behalf of the Brescia Renal Covid Task Force. https://www.era-edta.org/en/wp-content/uploads/2020/03/COVID_guidelines_finale_eng-GB.pdf

The Renal Association recently published guidlines for the management of immunosuppressive therapy in patients with autoimmune conditions during the COVID-19 pandemic. They give advices on, if and how to continue or adapt treatment plans. Further they created stratified risk profiles as decision support for a prolonged self isolation. For futher information:
https://renal.org/guidance-clinicians-patients-receiving-immunosuppression-treatment-autoimmune-conditions-native-kidneys-covid-19/
https://renal.org/stratified-risk-prolonged-self-isolation-adults-children-receiving-immunosuppression-disease-native-kidneys/

Last week the journal International Urology and Nephrology presented the first results of a meta- analysis including four studies with a total of 1389 COVID-19 patients. They found that out of this 1389 patients, 273 developed a severe disease progression and that there is a significant correlation to patients with chronic kidney diseases. They conclude, physicians should pay extra attention on this vulnerable group of patients.

Henry BM et al. Int Urol Neprhol, 2020. doi: https://doi.org/10.1007/s11255-020-02451-9

 

Overview of the therapeutic options for patients with kidney diseases in the course of COVID-19- infection. This abstract includes a table with potential antiviral or other drugs in off lable use with advice for dose adjustment and possible renal adverse events.

Izzedine et al. Kidney Int, 2020. Doi: https://doi.org/10.1016/j.kint.2020.03.015

In contrast to the findings in other cohorts that renal involvement may be a common complication in COVID-19- infected patients (see for example medRxiv preprints https://doi.org/10.1101/2020.03.07.20032599, https://doi.org/10.1101/2020.02.08.20021212 and https://doi.org/10.1101/2020.02.18.20023242v1), this is the conclusion of a study of 116 COVID-19- patients in Wuhan recently published in the American Journal of Nephrology. None of the studied patients fulfilled official diagnostic criteria for acute kidney injury. It should be mentioned though that only eleven of the 116 patients had to be transferred to intensive care unit, which seems to be an important factor for the development of AKI in this patient group.

Wang et al. Am J Nephrol, 2020. Doi: https://doi.org/10.1159/000507471

The authors present a detailed description of five kidney transplant recipients with COVID- 19- infection. They outline the adaption of the immunosuppressive as well as supportive therapy and the performed diagnostics.

Zhang H et al. Eur Urol, 2020. Doi: https://doi.org/10.1016/j.eururo.2020.03.030

The author, a nephrologist from the Johns Hopkins University, gives an overview about the different aspects and so far gained study results concerning the kidney during the SARS- Cov-2- pandemic. Points raised are for example patients under hemodialytic therapy, kidney transplant recipients, patients with acute kidney injury and more.

Rabb H, J Clin Invest, 2020. Doi: https://doi.org/10.1172/JCI138871

Nephrologists from Brescia, Italy summarize their therapeutic approach to kidney transplant recipients, haemodialysis patients and those with chronic kidney disease with COVID-19. In the supplementary material one can find a detailed treatment protocol based on patient characteristics and disease severity.

Alberici F et al. Kidney International Reports, 2020. Doi: https://doi.org/10.1016/j.ekir.2020.04.001

 

Retrospective study  examining the outcome of patients with end-stage kidney disease hospitalized in 13 New York Hospitals due to COVID-19.

Hg J et al. Kidney Int, 2020. DOI:10.1016/j.kint.2020.07.030

In this autopsy study SARS-CoV-2 renal tropisms identified by viral evidence of SARS-CoV-2 RNA in kidney samples is associated with overall disease severity and development of acute kidney injury.

Braun F et al. Lancet, 2020. DOI:https://doi.org/10.1016/S0140-6736(20)31759-1

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