ABSTRACT
Introduction. Hypertension, as a medical problem, is one of the most common disorders in cardiovascular disease. High blood pressure has been identified as one of the most familiar risk factors for the ongoing COVID-19 pandemic. We planned to explore the possible interactions between antihypertensive agents and drugs targeting SARS-CoV-2 with broad investigations in the mechanism of action and adverse effects of these medications. Methods. The electronic databases (PubMed, Scopus, and Google scholar) were searched by two of the coauthors to collect the papers relevant to the subject. The keywords searched were angiotensin converting enzyme inhibitors (ACEI), angiotensin-II receptor blockers (ARBs), sympatholytic drugs (alpha-1 blockers, beta blockers), vasodilators (calcium channel blockers, nitrates, hydralazine), diuretics, chloroquine, hydroxychloroquine, lopinavir/ritonavir, remdesivir, favipiravir, interferons, azithromycin, anti-cytokine agents, glucocorticoids, anticoagulant agents, nitric oxide and epoprostenol. Results. QT prolongation, hypokalemia, arrhythmia and increase the serum level of drugs are the most risky adverse effects of medications in patients with COVID-19 on anti-hypertensive drugs. Conclusion. Interaction of the drugs used for COVID-19 patients with anti-hypertensive drugs is an important issue that this review addresses.
ABSTRACT
Introduction. Acute kidney injury (AKI) is the most common renal complication associated with coronavirus 2019 (COVID-19) disease. In this study we evaluated the frequency of AKI, its predisposing factors, and its impact on patients' outcomes in COVID-19 disease. Methods. A cross-sectional study was conducted on hospitalized SARSCoV- 2 infected patients in a COVID-19-designated hospital in Shiraz, Iran from 20th March 2020 to 20th May 2020. Patients' characteristics and laboratory findings were collected by data gathering sheets. Data were analyzed using SPSS, and P value < 0.05 was considered significant. Results. This study was conducted on 1006 COVID-19 patients (mean age: 51.5 .. 16.3 years and men: 55.0%), of which 31.8% developed AKI during their hospitalization period and 1.3% ended up requiring renal replacement therapy. Based on the Kidney Disease Improving Global Outcomes, stage 3 AKI patients experienced more severe/critical COVID-19 diseases compared to other stages (stage 3:71.0%, stage 2:44.8%, stage 1:6.5%, P < 0.001). The mortality rate was higher in AKI patients than in non-AKI ones (16.0% vs. 1.7%, P < 0.001) with an increasing stepwise pattern in more severe AKI stages (stage 1:80.6%, stage 2:38.0%, stage 1:5.8%, P < 0.001). Conclusion. Hospitalized COVID-19 patients are vulnerable to AKI, especially those who experienced more severe COVID-19 diseases or required mechanical ventilation and it has a considerable impact on patients' mortality. Also, the mortality rate of ESRD patients was higher than AKI patients and non-AKI ones. Routine kidney function, blood and urine screening tests for all COVID-19 patients should be considered.
ABSTRACT
BACKGROUND AND AIMS: Coronavirus disease 2019 (COVID 19) was identified in December 2020 and is still growing in most parts of the world. The wide range of affected organs is likely based on the shared expression of the main severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) entry-receptor angiotensinconverting enzyme 2 (ACE2). Therefore, broad distribution of ACE2 receptors in various tissues play a key role in the multi-organ dysfunction and death due to COVID-19. METHOD: International databases including PubMed, Embase, Web of Science, Scopus, and Cochrane Library Databases were used for search of articles by 30 December 2020. Keywords were nephropathy, COVID-19, coronavirus, renal injury, acute kidney injury, chronic kidney injury, and SARS-CoV-2 or a combination of them in the titles/abstracts. After the collection of related studies, Mendeley software was used to categorize and eliminate the duplicate titles. Then, studies with inappropriate purposes were removed. The selected studies were done on humans and published in English. RESULTS: Due to high prevalence of acute kidney injury (AKI) in patients with COVID-19, we summarize the molecular insights into viral infection mechanisms and implications for AKI. Moreover, mechanisms of the AKI to chronic kidney disease (CKD) transition such as relative contribution of immune cell response, fibroblasts activation, endothelial dysfunction and subsequent hypoxia may contribute to association of AKI with worse outcomes during this virus pandemic. CONCLUSION: We highlight the state of the knowledge on SARS-CoV-2-dependent mechanisms for AKI and list the potential management options for prevention of AKI worsening and the imminent possibility of CKD. Finally, we aim to provide a better understanding of why Coronavirus induce AKI and, subsequently, progression to CKD in the coming years and further discuss the acute as well as long-term renal consequences.