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. 2020 Sep:286:198034.
doi: 10.1016/j.virusres.2020.198034. Epub 2020 May 21.

Sodium status and kidney involvement during COVID-19 infection

Adrian Post  1 , Robin P F Dullaart  2 , Stephan J L Bakker  3
Affiliations

Sodium status and kidney involvement during COVID-19 infection

Adrian Post et al. Virus Res. 2020 Sep.

Abstract

The angiotensin-converting enzyme 2 receptor (ACE2) is expressed in epithelial cells of many tissues including the kidney, and has been identified to interact with human pathogenic coronaviruses, including SARS-CoV-2. Although diffuse alveolar damage and acute respiratory failure are the main features of COVID-19 infection, two recent studies demonstrate that kidney impairment in hospitalized COVID-19 patients is common, and that kidney involvement is associated with high risk of in-hospital death. Interestingly, studies in rats have demonstrated that high dietary sodium intake results in down-regulation of the ACE2 expression in kidney tissue. We hypothesize that low sodium status makes kidney involvement during the course of COVID-19 infection more likely due to upregulation of membrane bound ACE2 in the kidneys. We propose that sodium intake and status should be monitored carefully during severe COVID-19 infections, and that low sodium intake be corrected early in its course, despite a potential conflict regarding common dietary recommendations to restrict dietary sodium intake in patients with hypertension, diabetes, and kidney disease.

Keywords: ACE2 receptor; COVID-19; Kidney; SARS-CoV-2; Sodium.

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Conflict of interest statement

None.

Figures

Fig. 1
Fig. 1
A schematic overview of the hypothesized interaction between sodium balance, the ACE2 receptor expression, SARS-CoV-2 and the kidney.
See this image and copyright information in PMC

References

    1. Berger R.C., Vassallo P.F., Crajoinas Rde O. Renal effects and underlying molecular mechanisms of long-term salt content diets in spontaneously hypertensive rats. PLoS One. 2015;10(10) - PMC - PubMed
    1. Cao G., Della Penna S.L., Kouyoumdzian N.M. Immunohistochemical expression of intrarenal renin angiotensin system components in response to tempol in rats fed a high salt diet. World J. Nephrol. 2017;6(1):29–40. - PMC - PubMed
    1. Cheng Y., Luo R., Wang K. Kidney impairment is associated with in-hospital death of COVID-19 patients. Kidney Int. 2020;97(5):829–838. - PMC - PubMed
    1. Fagerberg L., Hallstrom B.M., Oksvold P. Analysis of the human tissue-specific expression by genome-wide integration of transcriptomics and antibody-based proteomics. Mol. Cell Proteomics. 2014;13(2):397–406. - PMC - PubMed
    1. Larouche-Lebel E., Loughran K.A., Oyama M.A. Plasma and tissue angiotensin-converting enzyme 2 activity and plasma equilibrium concentrations of angiotensin peptides in dogs with heart disease. J. Vet. Intern. Med. 2019;33(4):1571–1584. - PMC - PubMed

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