11. NUMBERS OF CONFIRMED COVID CASES PER COUNTRY
Jafar Alsaid,M.B.ChB. MD. FASN. FACP 12 Hemodialysis session. 20/11/2020
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0
10000000
20000000
30000000
40000000
50000000
60000000
Global USA India Brazil KSA UAE Bahrain Kuwait Oman
55943189
11695711
8912907
5911758
353918 152809 85008 137885 120718
12. Percentage of cases and mortality rates
7.10%
3.50%
0.60%
2.70%
1%
1.50%
4.90%
3.20%
2.30%
2.40%
2.10%
1.40%
1.10%
1.60%
0.35% 0.39%
0.61%
1.10%
0.00%
1.00%
2.00%
3.00%
4.00%
5.00%
6.00%
7.00%
8.00%
Global USA India Brazil KSA UAE Bahrain Kuwait Oman
Cases Mortality
13. VIRAL ENTRY TO THE KIDNEY
Jafar Alsaid,M.B.ChB. MD. FASN. FACP 12 Hemodialysis session. 20/11/2020
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14. J. Alsaid. 38th HTN and CV highlight session 22nd Aug. 2020. 15
https://www.nejm.org/doi/pdf/10.1056/NEJMsr2005760?articleTools=true
15. J. Alsaid. 38th HTN and CV highlight session 22nd Aug. 2020.
16
DâArdes D., Boccatonda A., et al. COVID-19 and RAS: Unravelling an Unclear Relationship. Int. J. Mol. Sci. 2020, 21, 3003;
doi:10.3390/ijms21083003
RAAS CASCADE AND TARGET OUTCOME
16. ACE2 & TMPRSS2
DISTRIBUTION
M. Dong et al. ACE2, TMPRSS2 distribution and extrapulmonary organ injury in patients with COVID-19 Biomedicine &
Pharmacotherapy 131 (2020) 110678
Jafar Alsaid,M.B.ChB. MD. FASN. FACP 12 Hemodialysis session. 20/11/2020
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17. ACE2 RECEPTORS IN THE KIDNEY
Jafar Alsaid,M.B.ChB. MD. FASN. FACP 12 Hemodialysis session. 20/11/2020
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18. COVID-19 entrance site in the kidney and
the specific receptors and
Yongqian Cheng1 & Wenling Wang1 & Liang Wu1 & Guangyan Cai, SARS-CoV-2-Related Kidney Injury: Current Concern and Challenges.
Accepted: 17 September 2020 # The Author(s) 2020. SN Comprehensive Clinical Medicine https://doi.org/10.1007/s42399-020-00529-0
â˘Inflammation.
â˘Complement.
â˘Coagulopathy.
â˘Endothelial damage.
â˘Collapsing
Glomerulopathy
Jafar Alsaid,M.B.ChB. MD. FASN. FACP 12 Hemodialysis session. 20/11/2020
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19. ENTRY OF SARS- COVID
INTO THE CELLS
⢠ACE2.
⢠TMPRESS2
Found in Epith, Endoth,
Messangial & Podocyt.
M. Dong et al. ACE2, TMPRSS2 distribution and extrapulmonary organ injury in patients with COVID-19 Biomedicine &
Pharmacotherapy 131 (2020) 110678
Jafar Alsaid,M.B.ChB. MD. FASN. FACP 12 Hemodialysis session. 20/11/2020
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20. KIDNEY INVOLVEMENT WITH COVID-19
⢠Acute Kidney Injury.
⢠CKD patient infection with COVID.
⢠Effect on Hemodialysis and Peritoneal dialysis patients.
⢠COVID-19 in Transplant patients.
Jafar Alsaid,M.B.ChB. MD. FASN. FACP 12 Hemodialysis session. 20/11/2020
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21. AKI IN COVID-19 PATIENTS
Jafar Alsaid,M.B.ChB. MD. FASN. FACP 12 Hemodialysis session. 20/11/2020
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22. ACUTE KIDNEY INJURY
3-9% of early report from China.
Naicker S, Yang C-W, Hwang S-J, Liu B-C, Chen J-H, Jha V. The Novel Coronavirus 2019 epidemic and kidneys. Kidney Int . 2020;97(5):824â828. doi: 10.1016/j.kint.2020.03.001 .
Yang X, Yu Y, Xu J, et al. Clinical course and outcomes of critically ill patients with SARS-CoV-2 pneumonia in Wuhan, China: a single-centered, retrospective, observational study. Lancet
Respir Med . 2020;8(5):475â481. doi: 10. 1016/S2213-260 0(20)30 079-5 .
19% - > 50% of ICU patients.
Arentz M, Yim E, Klaff L, et al. Characteristics and outcomes of 21 critically ILL Patients with COVID-19 in Washington State. JAMA . 2020;323(16):1612. doi: 10.1001/jama.2020.4326 .
Yang, X. et al. Clinical course and outcomes of critically ill patients with SARS- CoV-2 pneumonia in Wuhan, China: a single- centered, retrospective, observational study. Lancet. Respir.
Med. 8, 475â481 (2020).
28- 43% of Hospitalized patients.
Hirsch JS, Ng JH, Ross DW, et al. Acute kidney injury in patients hospitalized with COVID-19. Kidney Int . 2020 Published online MayS0085253820305329. doi: 10.1016/j.kint.2020.05.006 .
61-79% of severely ill patients.
Chan L, Chaudhary K, Saha A, et al. Acute kidney injury in hospitalized patients with COVID-19. Nephrology . 2020. doi: 10.1101/2020.05.04.20090944 .
Mortality among AKI COVID-19 is between 35%-90%.
Cheng, Y. et al. Kidney disease is associated with inhospital death of patients with COVID-19. Kidney Int. 97, 829â838, (2020).
Jafar Alsaid,M.B.ChB. MD. FASN. FACP 12 Hemodialysis session. 20/11/2020
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23. INCIDENCE OF AKI
REPORTED IN
DIFFERENT STUDIES.
Cheng Y, Luo R, Wang K et al (2020) Kidney disease is
associated with in-hospital death of patients with COVID-
19. Kidney Int 97:829â838. https
://doi.org/10.1016/j.kint.2020.03.005.
Arentz M, Yim E, Klaff L et al (2020) Characteristics and
outcomes of 21 critically ill patients with COVID-19 in
Washington State. JAMA 323:1612â1614. https
://doi.org/10.1001/ jama.2020.4326
Hirsch JS, Ng JH, Ross DW et al (2020) Acute kidney injury
in patients hospitalized with COVID-19. Kidney Int. https
://doi. org/10.1016/j.kint.2020.05.006
Mohamed MM, Lukitsch I, Torres-Ortiz AE et al (2020)
Acute kidney injury associated with coronavirus disease
2019 in urban New Orleans. Kidney.
https://doi.org/10.34067 /KID.00026 52020
Pei G, Zhang Z, Peng J et al (2020) Renal involvement and
early prognosis in patients with COVID-19 pneumonia. J
Am Soc Nephrol. https ://doi.org/10.1681/ASN.20200
30276Jafar Alsaid,M.B.ChB. MD. FASN. FACP 12 Hemodialysis session. 20/11/2020 24
24. PRECIPITATING FACTORS FOR AKI:
⢠CKD.
⢠Age.
⢠Male.
⢠Black
⢠DM.
⢠HTN.
⢠Heart Failure.
⢠Obesity.
⢠COPD.
Sargiacomo, C., Sotgia, F. & Lisanti, M. P. COVID-19 and chronological aging: senolytics and other anti-aging drugs for the treatment
or prevention of corona virus infection? Aging 12, 6511â6517. (2020).
Chen, N. et al. Epidemiological and clinical characteristics of 99 cases of 2019 novel coronavirus pneumonia in Wuhan, China: a descriptive study.
Lancet 395, 507â513, (2020).
Arentz, M. et al. Characteristics and outcomes of 21 critically ill patients with COVID-19 in Washington State. JAMA 323, 1612â1614 (2020).
USA
CHINA
EUROPE
AKI prevalence
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25. COVID 19 AND AKI IN 5 LARGE REPORTED SAMPLES
Please cite this article as: D. Patel, T. Truong and N. Shah et al., COVID-19 Extrapulmonary illness - The Impact of COVID-19 on Nephrology care, Disease-a-Month,
https://doi.org/10.1016/j.disamonth.2020.101057
Jafar Alsaid,M.B.ChB. MD. FASN. FACP 12 Hemodialysis session. 20/11/2020 26
26. RATES OF AKI
AND RRT IN
PATIENTS
HOSPITALIZED
WITH COVID-19
Nadim, Mitra et. al. COVID-19- associated
acute kidney injury: consensus report of the
25th. Acute Disease Quality Initiative (ADQI)
Workgroup. Nature Reviews | Nephrology.
https://doi.org/10.1038/s41581-020-00356-5
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27. RENAL REPLACEMENT THERAPY REQUIREMENT IN COVID-19
⢠15-20% of patient with COVID AKI.
⢠34-73% of ICU admission.
Chan L, Chaudhary K, Saha A, et al. Acute kidney injury in hospitalized patients with COVID-19. Nephrology . 2020. doi:
10.1101/2020.05.04.20090944 .
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28. POTENTIAL RISK
FACTORS FOR AKI IN
COVID-19 PATIENTS
Nadim, Mitra et. al. COVID-19- associated
acute kidney injury: consensus report of the
25th. Acute Disease Quality Initiative (ADQI)
Workgroup. Nature Reviews | Nephrology.
https://doi.org/10.1038/s41581-020-00356-5
Jafar Alsaid,M.B.ChB. MD. FASN. FACP 12 Hemodialysis session. 20/11/2020
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Patient
Management
Viral disease
29. MORTALITY AMONG
AKI WITH SARS,
MARS AND COVID
AKI
mortality
Overall
mortality
SARS 86.6% 36%
MERS 68.5% 59%
COVID 78% 32%
Jafar Alsaid,M.B.ChB. MD. FASN. FACP 12 Hemodialysis session. 20/11/2020 30
Chen et al. Mortality rate of acute kidney
injury in SARS, MERS, and COVID-19
infection: a systematic review and meta-
analysis Critical Care. (2020) 24:439
31. PATHOLOGICAL FINDING
Pathological lesion Collapsing Glomerulopathy.
Larsen CP, Bourne TD, Wilson JD, Saqqa O, Sharshir MA. Collapsing glomerulopathy in a patient with
COVID-19. Kidney Int Rep . 2020;5(6):935â939. doi: 10.1016/j.ekir.2020.04.002 .
Mainly in African American with APOL1 genotype.
Wu H, Larsen CP, Hernandez-Arroyo CF, et al. AKI and collapsing glomerulopathy associated with COVID-19
and APOL1 high-risk genotype. J Am Soc Nephrol . 2020;31(6) ASN.2020050558. doi:
10.1681/ASN.2020050558 .
Jafar Alsaid,M.B.ChB. MD. FASN. FACP 12 Hemodialysis session. 20/11/2020
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32. POSTMORTEM & KIDNEY BIOPSY STUDIES
⢠Viral particles in the Podocytes and Tubular cells by EM.
Su, H. et al. Renal histopathological analysis of 26 postmortem findings of patients with COVID-19 in China. Kidney
Int. 98, 219â227 (2020).
⢠Collapsing glomerulopathy. Among African American with APOL1 allele gene.
Peleg, Y. et al. Acute kidney injury due to collapsing glomerulopathy following COVID-19 infection. Kidney
Int. Rep. 5, 940â945 (2020).
⢠Acute tubular injury. Negative for vital particles.
Rossi, G. M. et al. Kidney biopsy findings in a critically ill COVID-19 patient with dialysis- dependent acute
kidney injury: a case against âSARS- CoV-2 nephropathyâ. Kidney Int. Rep. 5, 1100â1105 (2020).
Jafar Alsaid,M.B.ChB. MD. FASN. FACP 12 Hemodialysis session. 20/11/2020
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34. CLINICAL RENAL INVOLVEMENT
⢠Proteinuria 63%.
The Team of Zhong Nanshan Responded that the Isolation of SARS-CoV-2 from Urine Remind Us to Pay More Attention to the
Cleaning of Individuals and Families. Guangzhou Daily. Published February 22, 2020.
⢠Proteinuria and Hematuria. 44%.
⢠Hematuria. 26.6%.
⢠Elevated Creatinine. 19%.
⢠Elevated Urea. 27%
Li, Z., Wu, M., Guo, J. et al. Caution on Kidney Dysfunctions of 2019-nCoV Patients. medRxiv 2020.02.08.20021212.
⢠Hyperkalemia and Acidosis 23%.
Chen, Tao et al. Clinical characteristics of 113 deceased patients with coronavirus disease 2019: retrospective study. BMJ 368,
m1295 (2020).
Jafar Alsaid,M.B.ChB. MD. FASN. FACP 12 Hemodialysis session. 20/11/2020
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35. CAUSES OF AKI IN COVID:
⢠Hemodynamic.
⢠ATN.
⢠Toxic Acute Interstitial Nephritis.
⢠Rhabdomyolysis.
⢠Azotemia.
Mohamed MM, Lukitsch I, Torres-Ortiz AE, et al. Acute kidney injury associated with coronavirus disease 2019 in Urban New Orleans.
Kidney360 . 2020 Published online May 13,. doi: 10.34067/KID.0 0 0265202010.34067/KID.
⢠Clinical picture is variable associated with Proteinuria and Hematuria. Granular and Waxy casts.
Hernandez-Arroyo C.F., Varghese V., Mohamed M.M.B., Velez J.C.Q. Urinary sediment microscopy in acute
kidney injury associated with COVID-19. Kidney360 . Published online June 2, 2020:10.34067/KID.0 0 03352020.
doi:10.34067/KID.0 0 03352020
Jafar Alsaid,M.B.ChB. MD. FASN. FACP 12 Hemodialysis session. 20/11/2020
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36. MECHANISM OF RENAL INJURY IN COVID-19
P. Meena et al. / Current Medicine Research and Practice 10 (2020) 165e168.
Farouk, Samira S. COVID-19 and the kidney: what we think we know so far and what we donât Journal of Nephrology. https://doi.org/10.1007/s40620-020-00789-y
Direct Viral injury
Glomerular Fibrin Thrombi
Collapsing FSGSPigmented tubular casts
Hemodynamic
Thrombotic Microangiopathy
KIDNEY INJURYNephrotoxicity Secondary infections
Sepsis
Jafar Alsaid,M.B.ChB. MD. FASN. FACP 12 Hemodialysis session. 20/11/2020
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38. Positive ventilation pressure, PEEP.
MECHANISM OF RENAL INJURY IN COVID-19
Sympathetic
stimulation
RAAS
stimulation
Venous
congestion
Decreased
GFR
Increased Intrathoracic Pressure
Koyner, J. L. & Murray, P. T. Mechanical ventilation and lung- kidney interactions. Clin. J. Am. Soc. Nephrol. 3, 562â570 (2008).
Dudoignon, E. et al. Activation of the renin- angiotensinaldosterone system is associated with acute kidney injury in COVID-19. Anaesth. Crit. Care Pain Med. 39,
453â455 (2020).
Jafar Alsaid,M.B.ChB. MD. FASN. FACP 12 Hemodialysis session. 20/11/2020 40
39. ORGAN CROSS TALK
DAMP: Damage Associated Molecular Patterns
Cytokines
Vasoactive
substances
Chemokines
Joannidis, M. et al. Lung- kidney interactions in critically ill patients: consensus report of the acute disease quality initiative (ADQI) 21 workgroup. Intensive Care
Med. 46, 654â672 (2020).
Armutcu, F. Organ crosstalk: the potent roles of inflammation and fibrotic changes in the course of organ interactions. Inflamm. Res. 68, 825â839 (2019).
Jafar Alsaid,M.B.ChB. MD. FASN. FACP 12 Hemodialysis session. 20/11/2020
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40. KDIGO
AKIN classification of AKI.
http://www.nephjc.com/news/2015/2/17/kdigo-aki-staging
Jafar Alsaid,M.B.ChB. MD. FASN. FACP 12 Hemodialysis session. 20/11/2020
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AKI staging
41. COMORBIDITIES AMONG COVID-19 PATIENTS
Cheng1, Yongqian. SARS-CoV-2-Related Kidney Injury: Current Concern and ChallengesSN Comprehensive Clinical Medicine.
https://doi.org/10.1007/s42399-020-00529-0
Jafar Alsaid,M.B.ChB. MD. FASN. FACP 12 Hemodialysis session. 20/11/2020 43
42. COMORBIDITIES AMONG COVID PATIENTS
1.3
16.9
8.2
3.7
1.9 1.8 1.5
0
2
4
6
8
10
12
14
16
18
CKD HTN DM CVD Stroke HBV COPD
Guan WJ, Liang WH, Zhao Y, Liang HR, Chen ZS, Li YM, et al. Comorbidity and its impact on 1590 patients with COVID-19 in China: a
nationwide analysis.
Eur Respir J. 2020;55(5):2000547. https://doi.org/10.1183/13993003.00547-2020
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43. INCIDENCE OF COVID IN HEMODIALYSIS POPULATION
D. Patel, T. Truong and N. Shah et al., COVID-19 Extrapulmonary illness - The Impact of COVID-19 on Nephrology care, Disease-a-
Month, https://doi.org/10.1016/j.disamonth.2020.10105
Jafar Alsaid,M.B.ChB. MD. FASN. FACP 12 Hemodialysis session. 20/11/2020
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47. TREATMENT
TRIALS
Jafar Alsaid,M.B.ChB. MD. FASN. FACP 12 Hemodialysis session. 20/11/2020 49
Claudia Benedetti 1, Meryl
Waldman2, Gianluigi Zaza3,
Leonardo V. Riella4 and
Paolo Cravedi 1*COVID-19
and the Kidneys: An Updateâ
REVIEW published: 21 July
2020 doi:
10.3389/fmed.2020.00423
48. COVID POTENTIAL TREATMENT AND DRUG INTERACTIONS
D. Patel, T. Truong and N. Shah et al., COVID-19 Extrapulmonary illness - The Impact of COVID-19 on Nephrology care, Disease-a-
Month, https://doi.org/10.1016/j.disamonth.2020.101057
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49. THERAPEUTIC OPTIONS
⢠Ramdesivir: Adenosine analog. Broad spectrum antiviral.
Wang M, Cao R, Zhang L, Yang X, Liu J, Xu M, et al. Remdesivir and chloroquine effectively inhibit the recently emerged
novel coronavirus (2019-nCoV) in vitro. Cell Res. (2020) 30:269â71. doi: 10.1038/s41422-020-0282-0.
⢠Covalescent Plasma: Induce passive immunity.
Shen C,Wang Z, Zhao F, Yang Y, Li J, Yuan J, et al. Treatment of 5 critically Ill patients with COVID-19 with convalescent
plasma. JAMA. (2020) 323:1582â9. doi: 10.1001/jama.2020.4783.
⢠Steroids: DexamÊthasone.
Stockman LJ, Bellamy R, Garner P. SARS: systematic review of treatment effects. PLoS Med. (2006) 3:e343. doi:
10.1371/journal.pmed.0030343
⢠JAK-STAT. Inh. Bacitinib, Fedatinib & Ruxolitinib.
Cantini F, Niccoli L, Matarrese D, Nicastri E, Stobbione P, Goletti D. Baricitinib therapy in COVID-19: a pilot study on
safety and clinical impact. J Infect. (2020). doi: 10.1016/j.jinf.202 0.04.017. [Epub ahead of print].
Jafar Alsaid,M.B.ChB. MD. FASN. FACP 12 Hemodialysis session. 20/11/2020
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50. ⢠IV Immunoglobuline.
Xie Y, Cao S, Dong H, Li Q, Chen E, Zhang W, et al. Effect of regular intravenous immunoglobulin therapy on prognosis of
severe pneumonia in patients with COVID-19. J Infect. (2020). doi: 10.1016/j.jinf.2020.03.044.
⢠Stem Cell Therapy.
Uccelli A, de Rosbo NK. The immunomodulatory function of mesenchymal stem cells: mode of action and pathways:
mesenchymal stem cells and immunity: an update. Ann N Y Acad Sci. (2015) 1351:114â26. doi: 10.1111/nyas.12815
⢠IL6 inhibitors: Tocilizumab.
Naicker S, Yang CW, Hwang SJ, Liu BC, Chen JH, Jha V. The novel coronavirus 2019 epidemic and kidneys. Kidney Int. (2020)
97:824â 8. doi: 10.1016/j.kint.2020.03.001
⢠Ulinastatin: Serin protein inh. With Anti-inflammatory action.
Ye Q, Wang B, Mao J. The pathogenesis and treatment of the âCytokine Stormâ in COVID-19. J Infect. (2020) 80:607â 13. doi:
10.1016/j.jinf.2020.03.037.
⢠Anakinra: IL1 Antagonist.
Ma Y, Diao B, Lv X, Zhu J, Liang W, Liu L, et al. COVID-19 in hemodialysis (HD) patients: report from one HD center in Wuhan, China. medRxiv. (2020).
doi: 10.1101/2020.02.24.20027201. [Epub ahead of print].
Jafar Alsaid,M.B.ChB. MD. FASN. FACP 12 Hemodialysis session. 20/11/2020
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THERAPEUTIC OPTIONS
52. CONCLUSION
1. The kidney is one of the organs that is affected with COVID-19 virus.
2. Monitoring of the renal function is required among the patients.
3. AKI is the most common type of injury .
4. The cause of the insult is usually Multifactorial.
5. Kidney involvement is one of parameters of the severity.
6. These cases have high mortality.
7. Multiple agent are being under investigation.
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