Should COVID-19 Concern Nephrologists? Why and to What Extent? The Emerging Impasse of Angiotensin Blockade

Abstract

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.

Keywords: Angiotensin receptor blockers; Angiotensin-converting enzyme inhibitors; COVID-19; Renal and cardiac side effects; SARS-CoV-2; Severe acute respiratory syndrome coronavirus.

Fig. 1

The zoonotic origins of coronaviruses. In nature, several animal species act as natural host reservoirs for viruses. Coronaviruses are commonly found in different bat species. However, intermediate hosts are thought to be necessary for coronaviruses to move from the primary reservoir species into humans. Coronaviruses inducing the outbreak of Severe Acute Respiratory Syndrome (SARS-CoV) and Middle East Respiratory Syndrome (MERS-CoV) were originally bat viruses that spread to an intermediate animal (civet cat and camel, respectively), which then exposed humans to the viruses. Genetic analysis of the coronavirus causing the novel COVID-19 outbreak (SARS-CoV-2) recently showed that their closest genetic relatives appear to be bat coronaviruses, with the role of intermediate species possibly played by the pangolin, although with some conflicting results. Recent studies shown that some bat coronaviruses can infect human cells without passing through an intermediate host. Total number of COVID-19 cases and deaths are relative to the available data on March 15, 2020.