ABSTRACT
ABSTRACT Covid-19 has been identified as the cause of acute respiratory disease with interstitial and alveolar pneumonia, but it can affect several organs, such as kidneys, heart, blood, nervous system and digestive tract. The disease-causing agent (Sars-CoV-2) has a binding structure to the angiotensin-converting enzyme 2 (ACE2) receptor, enabling entry into cells that express ACE2, such as the pulmonary alveolar epithelial cells. However, studies also indicate the possibility of damage to renal cells, since these cells express high levels of ACE2. Currently, there is no evidence to indicate a specific treatment for covid-19. Several drugs have been used, and some of them may have their excretion process altered in patients with abnormal kidney function. To date, there are no studies that assist health professionals in adjusting the dose of these drugs. Thus, this study aims to review and discuss the topic, taking into account factors associated with kidney injury in covid-19, as well as pharmacokinetic aspects and dose recommendations of the main drugs used for covid-19.
RESUMO A covid-19 foi identificada como a causa de doença respiratória aguda com pneumonia intersticial e alveolar, mas que pode afetar vários órgãos, como rim, coração, sangue, sistema nervoso e trato digestivo. O agente causador da doença (Sars-CoV-2) tem uma estrutura de ligação ao receptor da enzima de conversão da angiotensina 2 (ACE2), permitindo a entrada em células que expressam ACE2, como as células epiteliais alveolares pulmonares. Porém, estudos também indicam a possibilidade de lesão das células renais, uma vez que essas células expressam altos níveis de ACE2. Atualmente, não existem evidências para a indicação de um tratamento específico para a covid-19. Vários medicamentos vêm sendo utilizados, e alguns podem ter o processo de eliminação alterados em pacientes com comprometimento renal. Até o momento, não há estudos que auxiliem os profissionais de saúde no ajuste de dose desses medicamentos. Assim, este estudo tem como objetivo revisar e discutir o tema, levando em consideração os fatores relacionados à lesão renal na covid-19, bem como aspectos farmacocinéticos e recomendações de doses dos principais medicamentos utilizados para covid-19.
Subject(s)
Humans , COVID-19/complications , COVID-19/drug therapy , Kidney/physiopathology , Kidney Diseases/virology , Angiotensin-Converting Enzyme 2Subject(s)
Humans , Postoperative Complications/prevention & control , Kidney Transplantation , Polyomavirus , Polyomavirus Infections/diagnosis , Kidney Diseases/prevention & control , Kidney Diseases/virology , Postoperative Complications/virology , Tumor Virus Infections/diagnosis , Early DiagnosisABSTRACT
Quantitative measurement of BK virus DNA (Q-BKDNA) has been used for the early diagnosis and monitoring of BK virus-associated nephropathy (BKVAN). This study was designed to determine the BKDNA cutoff for the diagnosis of BKVAN. Between June 2005 and February 2007, 64 renal transplant recipients taken renal biopsies due to renal impairment submitted plasma and urine for Q-BKDNA. Eight BKVAN patients (12.5%) had median viral loads of 6.0 log(10) copies/mL in plasma and 7.3 log(10) copies/mL in urine. Among 56 non-BKVAN patients, 45 were negative for Q-BKDNA; 4 were positive in plasma with a median viral load of 4.8 log(10) copies/ mL, and 10 were positive in urine with a median viral load of 4.8 log(10) copies/mL. Receiver operating characteristic curve analysis showed that a cutoff of 4.5 log(10) copies/mL in plasma and a cutoff of 5.9 log(10) copies/mL in urine had a sensitivity of 100% and a specificity of 96.4%, respectively. A combined cutoffs of 4 log(10) copies/ mL in plasma and 6 log(10) copies/mL in urine had better performance with a sensitivity of 100% and a specificity of 98.2% than each cutoff of urine or plasma. QBKDNA with the combined cutoffs could reliably diagnose BKVAN in renal transplant recipients.
Subject(s)
Adolescent , Adult , Female , Humans , Male , Middle Aged , BK Virus/genetics , Biopsy , Calibration , DNA, Viral/genetics , Kidney Diseases/virology , Kidney Transplantation/methods , Polymerase Chain Reaction , Polyomavirus Infections/diagnosis , Treatment OutcomeABSTRACT
Polyoma virus nephropathy occurs in 3% to 4% of renal transplant recipients, causing graft loss in 50% of cases. The objective of the present study was to explore the effects of age, sex, post-transplantation period and plasma creatinine levels on the polyoma virus infection in kidney transplanted patients. Urine samples were collected from 362 patients, centrifuged and microscopic slides prepared using Papaniclaou staining method. The slides then examined and decoy cells were identified in 96 [27%] patients. The prevalence of the infection increased with increased post-transplantation period and the age of the patients. Moreover, patients with positive decoy cells had more abnormal plasma creatinine levels than those with negative for such cells. In conclusion identification of decoy cells might be of value for the diagnosis of nephropathy, especially if the presence of such cells is accompanied with the elevated plasma levels of creatinine
Subject(s)
Humans , Male , Female , Tumor Virus Infections , Kidney Transplantation , Kidney Diseases/virology , Urine/cytologyABSTRACT
Hepatitis C virus [HCV] infection causes both acute and chronic liver disease and is also associated with renal disease in adults. Whether HCV is associated with renal disease in children, as hepatitis B virus is not known. The study described the clinical and virologic features of 46 children with nephrotic syndrome who were followed up in the Pediatric Vapour Nephrology Clinic, Ain-Shams University. Most of the patients had normal kidney and liver functions. Anti-HCV was detected in 6 patients and it was negative in all children in the control group. Patients with anti-HCV were furtherly studied for HCV-RNA, C3 and cryoglobulins. Two patients had HCV-RNA detected in their serum, 2 had hypocomplementemia and cryoglobulins were not detected in all the patients. It is concluded that HCV infection is more common in Egyptian nephrotic children in comparison to healthy children. The exact role of this infection in the etiology or perpetuation of the renal disease is not known. HCV associated glomerulopathy differ in prognosis and management from primary glomerulopathy