ABSTRACT
Resumen Objetivo: Resumir la evidencia científica sobre las alteraciones renales asociadas con la infección por SARS-CoV-2. Material y métodos: Se realizó una revisión rápida con la metodología Cochrane. Resultados: La enfermedad renal crónica (ERC) preexistente en pacientes con SARS-CoV-2 varió de 1 a 38% y la lesión renal aguda (LRA), de 2.9 a 86.4%. El pronóstico de la infección fue peor en pacientes con ERC y en aquellos con reserva renal remanente (RRR) intacta que desarrollaron LRA. El riesgo de muerte fue mayor (riesgo relativo combinado = 1.49; IC95%: 1.09-2.04) en pacientes infectados por SARS-CoV-2 con ERC preexistente. Los marcadores de RRR mostraron alteraciones en pacientes con SARS-CoV-2 graves y fatales; el marcador más utilizado fue la creatinina sérica. Conclusiones: La evidencia científica muestra la relevancia de la evaluación y monitoreo permanente de la RRR en pacientes hospitalizados por SARS-CoV-2 para mejorar el pronóstico de aquellos con ERC preexistente, así como de aquellos sin ERC que desarrollan LRA.
Abstract: Objective: To summarize the scientific literature on kidney abnormalities associated with SARS-CoV-2 infection. Materials and methods: It was conducted a rapid review using the Cochrane methodology. Results: Pre-existing chronic kidney disease (CKD) in SARS-CoV-2 infected patients ranged from 1-38% and acute kidney injury (AKI) ranged from 2.9-86.4%. The prognosis of patients with SARS-CoV-2 infection was worse among those with CKD and those with normal remnant kidney function (RKF) that developed AKI. The risk of death was higher (pooled risk ratio =1.49; 95%CI: 1.09-2.04) among SARS-CoV-2 infected patients with pre-existing CKD. The RKF markers showed alterations among severe and non-surviving SARS-CoV-2 patients; the most common marker was serum creatinine. Conclusions: The scientific evidence shows the relevance of the evaluation and permanent monitoring of the RKF in SARS-CoV-2 hospitalized patients to improve the prognosis of those with pre-existing CKD as well as the prognosis of those without CKD who develop AKI.
ABSTRACT
Drug-induced nephrotoxicity is an extremely common condition and is responsible for a variety of pathological effects on the kidneys. Drug-induced acute renal failure (ARF) accounted for 20% of all ARF cases. Drugs showed to cause nephrotoxicity exert their toxic effects by one or more common pathogenic mechanisms. Although it is impossible to present all the drugs causing the nephrotoxicity, this article will summarize the mechanism of injury associated with particular common medications, discuss clinical presentations, renal markers, and evaluate strategies that prevent or minimize renal injury. Drug-induced nephrotoxicity tends to be more common among certain patients and in specific clinical situations. Therefore, successful prevention requires knowledge of pathogenic mechanisms of renal injury, patient-related risk factors, drug-related risk factors, and preemptive measures, coupled with vigilance and early intervention. General preventive measures include using alternative nonnephrotoxic drugs whenever possible; correcting risk factors, if possible; assessing baseline renal function before initiation of therapy, followed by adjusting the dosage; monitoring renal function and vital signs during therapy, and avoiding nephrotoxic drug combinations. Surprisingly, little information is available to guide us with respect to avoiding complications in critical illness; therefore, it is necessary to follow the guidelines.