|
|
| Line 1: |
Line 1: |
| __NOTOC__ | | __NOTOC__ |
| '''For COVID-19 frequently asked inpatient questions, click [[COVID-19 frequently asked inpatient questions|here]]'''<br>
| | {{SI}} |
| '''For COVID-19 frequently asked outpatient questions, click [[COVID-19 frequently asked outpatient questions|here]]'''<br>
| |
| {{COVID-19}} | |
|
| |
|
| {{CMG}}; {{AE}}
| | '''For patient information, click [[Insert page name here (patient information)|Insert page name here]]''' |
| =COVID-19 Infection in Transplant Patients=
| |
|
| |
|
| Risk of COVID-19 in renal transplant patients is higher because of immunosuppression, underlying chronic kidney disease, and other co morbidities such as diabetes and hypertension, which are presently perceived as noteworthy components impacting the results in patients with COVID-19.<ref name="pmid32171076">{{cite journal |vauthors=Zhou F, Yu T, Du R, Fan G, Liu Y, Liu Z, Xiang J, Wang Y, Song B, Gu X, Guan L, Wei Y, Li H, Wu X, Xu J, Tu S, Zhang Y, Chen H, Cao B |title=Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study |journal=Lancet |volume=395 |issue=10229 |pages=1054–1062 |date=March 2020 |pmid=32171076 |pmc=7270627 |doi=10.1016/S0140-6736(20)30566-3 |url=}}</ref>.It is realized that any transplant recipient presented to the infection would result in a high level of cases; however the risk of donor to recipient transmission is unknown. The chances of a donor to recipient infection might be affected by exposure of the donor, infectivity of the the donor during the incubation period and the degree of viremia as well as the viability of virus in specific organ system.In this manner, in spite of the conceivable negative outcomes, temporary interruption of kidney transplantation might be fundamental in regions where the rate of infection is high.<ref name="MichaelsLa Hoz2020">{{cite journal|last1=Michaels|first1=Marian G.|last2=La Hoz|first2=Ricardo M.|last3=Danziger-Isakov|first3=Lara|last4=Blumberg|first4=Emily A.|last5=Kumar|first5=Deepali|last6=Green|first6=Michael|last7=Pruett|first7=Timothy L.|last8=Wolfe|first8=Cameron R.|title=Coronavirus disease 2019: Implications of emerging infections for transplantation|journal=American Journal of Transplantation|year=2020|issn=1600-6135|doi=10.1111/ajt.15832}}</ref>
| | {{CMG}} |
|
| |
|
| = Epidemiology and Demographics =
| | {{SK}} |
| *Epidemiological date indicates that the rate of severe complications of COVID-19 is almost 25%, and kidney is also one of the main organs affected in severe illness.<ref name="YangYu2020">{{cite journal|last1=Yang|first1=Xiaobo|last2=Yu|first2=Yuan|last3=Xu|first3=Jiqian|last4=Shu|first4=Huaqing|last5=Xia|first5=Jia'an|last6=Liu|first6=Hong|last7=Wu|first7=Yongran|last8=Zhang|first8=Lu|last9=Yu|first9=Zhui|last10=Fang|first10=Minghao|last11=Yu|first11=Ting|last12=Wang|first12=Yaxin|last13=Pan|first13=Shangwen|last14=Zou|first14=Xiaojing|last15=Yuan|first15=Shiying|last16=Shang|first16=You|title=Clinical course and outcomes of critically ill patients with SARS-CoV-2 pneumonia in Wuhan, China: a single-centered, retrospective, observational study|journal=The Lancet Respiratory Medicine|volume=8|issue=5|year=2020|pages=475–481|issn=22132600|doi=10.1016/S2213-2600(20)30079-5}}</ref>
| |
| *AKI is seen in 5-15% of the SARS-CoV and MERS-CoV infection, and the mortality rate is reported to be higher than in general population at 60-90% as per the literature. <ref name="NaickerYang2020">{{cite journal|last1=Naicker|first1=Saraladevi|last2=Yang|first2=Chih-Wei|last3=Hwang|first3=Shang-Jyh|last4=Liu|first4=Bi-Cheng|last5=Chen|first5=Jiang-Hua|last6=Jha|first6=Vivekanand|title=The Novel Coronavirus 2019 epidemic and kidneys|journal=Kidney International|volume=97|issue=5|year=2020|pages=824–828|issn=00852538|doi=10.1016/j.kint.2020.03.001}}</ref>
| |
| *.The risk is further increased in patients having chronic kidney disease(CKD), patients on chronic replacement therapies, and patients with kidney transplants.<ref name="NaickerYang2020">{{cite journal|last1=Naicker|first1=Saraladevi|last2=Yang|first2=Chih-Wei|last3=Hwang|first3=Shang-Jyh|last4=Liu|first4=Bi-Cheng|last5=Chen|first5=Jiang-Hua|last6=Jha|first6=Vivekanand|title=The Novel Coronavirus 2019 epidemic and kidneys|journal=Kidney International|volume=97|issue=5|year=2020|pages=824–828|issn=00852538|doi=10.1016/j.kint.2020.03.001}}</ref>
| |
|
| |
|
| | == Overview == |
| | |
| | ==Historical Perspective== |
| | |
| | ==Classification== |
| | |
| | == Pathophysiology== |
| | |
| | === Genetics === |
| | |
| | === Associated Conditions=== |
| | |
| | ===Gross Pathology=== |
| | |
| | ===Microscopic Pathology=== |
| | |
| | ==Causes== |
| | ===Life Threatening Causes=== |
| | Life-threatening causes include conditions which may result in death or permanent disability within 24 hours if left untreated. |
| | |
| | ===Common Causes=== |
| | |
| | ===Causes by Organ System=== |
| | |
| | {|style="width:80%; height:100px" border="1" |
| | |style="height:100px"; style="width:25%" border="1" bgcolor="LightSteelBlue" | '''Cardiovascular''' |
| | |style="height:100px"; style="width:75%" border="1" bgcolor="Beige" | No underlying causes |
| | |- |
| | |-bgcolor="LightSteelBlue" |
| | | '''Chemical / poisoning''' |
| | |bgcolor="Beige"| No underlying causes |
| | |- |
| | |-bgcolor="LightSteelBlue" |
| | | '''Dermatologic''' |
| | |bgcolor="Beige"| No underlying causes |
| | |- |
| | |-bgcolor="LightSteelBlue" |
| | | '''Drug Side Effect''' |
| | |bgcolor="Beige"| No underlying causes |
| | |- |
| | |-bgcolor="LightSteelBlue" |
| | | '''Ear Nose Throat''' |
| | |bgcolor="Beige"| No underlying causes |
| | |- |
| | |-bgcolor="LightSteelBlue" |
| | | '''Endocrine''' |
| | |bgcolor="Beige"| No underlying causes |
| | |- |
| | |-bgcolor="LightSteelBlue" |
| | | '''Environmental''' |
| | |bgcolor="Beige"| No underlying causes |
| | |- |
| | |-bgcolor="LightSteelBlue" |
| | | '''Gastroenterologic''' |
| | |bgcolor="Beige"| No underlying causes |
| | |- |
| | |-bgcolor="LightSteelBlue" |
| | | '''Genetic''' |
| | |bgcolor="Beige"| No underlying causes |
| | |- |
| | |-bgcolor="LightSteelBlue" |
| | | '''Hematologic''' |
| | |bgcolor="Beige"| No underlying causes |
| | |- |
| | |-bgcolor="LightSteelBlue" |
| | | '''Iatrogenic''' |
| | |bgcolor="Beige"| No underlying causes |
| | |- |
| | |-bgcolor="LightSteelBlue" |
| | | '''Infectious Disease''' |
| | |bgcolor="Beige"| No underlying causes |
| | |- |
| | |-bgcolor="LightSteelBlue" |
| | | '''Musculoskeletal / Ortho''' |
| | |bgcolor="Beige"| No underlying causes |
| | |- |
| | |-bgcolor="LightSteelBlue" |
| | | '''Neurologic''' |
| | |bgcolor="Beige"| No underlying causes |
| | |- |
| | |-bgcolor="LightSteelBlue" |
| | | '''Nutritional / Metabolic''' |
| | |bgcolor="Beige"| No underlying causes |
| | |- |
| | |-bgcolor="LightSteelBlue" |
| | | '''Obstetric/Gynecologic''' |
| | |bgcolor="Beige"| No underlying causes |
| | |- |
| | |-bgcolor="LightSteelBlue" |
| | | '''Oncologic''' |
| | |bgcolor="Beige"| No underlying causes |
| | |- |
| | |-bgcolor="LightSteelBlue" |
| | | '''Opthalmologic''' |
| | |bgcolor="Beige"| No underlying causes |
| | |- |
| | |-bgcolor="LightSteelBlue" |
| | | '''Overdose / Toxicity''' |
| | |bgcolor="Beige"| No underlying causes |
| | |- |
| | |-bgcolor="LightSteelBlue" |
| | | '''Psychiatric''' |
| | |bgcolor="Beige"| No underlying causes |
| | |- |
| | |-bgcolor="LightSteelBlue" |
| | | '''Pulmonary''' |
| | |bgcolor="Beige"| No underlying causes |
| | |- |
| | |-bgcolor="LightSteelBlue" |
| | | '''Renal / Electrolyte''' |
| | |bgcolor="Beige"| No underlying causes |
| | |- |
| | |-bgcolor="LightSteelBlue" |
| | | '''Rheum / Immune / Allergy''' |
| | |bgcolor="Beige"| No underlying causes |
| | |- |
| | |-bgcolor="LightSteelBlue" |
| | | '''Sexual''' |
| | |bgcolor="Beige"| No underlying causes |
| | |- |
| | |-bgcolor="LightSteelBlue" |
| | | '''Trauma''' |
| | |bgcolor="Beige"| No underlying causes |
| | |- |
| | |-bgcolor="LightSteelBlue" |
| | | '''Urologic''' |
| | |bgcolor="Beige"| No underlying causes |
| | |- |
| | |-bgcolor="LightSteelBlue" |
| | | '''Dental''' |
| | |bgcolor="Beige"| No underlying causes |
| | |- |
| | |-bgcolor="LightSteelBlue" |
| | | '''Miscellaneous''' |
| | |bgcolor="Beige"| No underlying causes |
| | |- |
| | |} |
| | |
| | ===Causes in Alphabetical Order=== |
| | |
| | *A... |
| | *Z... |
| | |
| | Make sure that each diagnosis is linked to a page. |
| | |
| | ==Differentiating type page name here from other Diseases== |
| | |
| | == Epidemiology and Demographics == |
| ===Age=== | | ===Age=== |
| *Renal transplant patients of all ages are at a higher risk of COVID-19 due to immunosuppression.
| |
| *In general population, COVID-19 associated AKI has higher incidence in elderly.<ref name="PeiZhang2020">{{cite journal|last1=Pei|first1=Guangchang|last2=Zhang|first2=Zhiguo|last3=Peng|first3=Jing|last4=Liu|first4=Liu|last5=Zhang|first5=Chunxiu|last6=Yu|first6=Chong|last7=Ma|first7=Zufu|last8=Huang|first8=Yi|last9=Liu|first9=Wei|last10=Yao|first10=Ying|last11=Zeng|first11=Rui|last12=Xu|first12=Gang|title=Renal Involvement and Early Prognosis in Patients with COVID-19 Pneumonia|journal=Journal of the American Society of Nephrology|volume=31|issue=6|year=2020|pages=1157–1165|issn=1046-6673|doi=10.1681/ASN.2020030276}}</ref>
| |
|
| |
| ===Gender=== | | ===Gender=== |
| *Men are more likely to be affected by COVID_19 than women.<ref name="SharmaVolgman2020">{{cite journal|last1=Sharma|first1=Garima|last2=Volgman|first2=Annabelle Santos|last3=Michos|first3=Erin D.|title=Sex Differences in Mortality From COVID-19 Pandemic|journal=JACC: Case Reports|year=2020|issn=26660849|doi=10.1016/j.jaccas.2020.04.027}}</ref>
| |
| *Women dying from COVID-19 are generally elder than men(median age: 82 vs. 79 years for women vs. men, respectively).<ref name="SharmaVolgman2020">{{cite journal|last1=Sharma|first1=Garima|last2=Volgman|first2=Annabelle Santos|last3=Michos|first3=Erin D.|title=Sex Differences in Mortality From COVID-19 Pandemic|journal=JACC: Case Reports|year=2020|issn=26660849|doi=10.1016/j.jaccas.2020.04.027}}</ref>
| |
| ===Race=== | | ===Race=== |
| *There is no racial predilection for COVID-19 infection in renal transplant patients.
| | ===Developed Countries=== |
| | ===Developing Countries=== |
| | |
| | == Risk Factors == |
| | |
| | == Screening == |
| | |
| | == Natural History, Complications and Prognosis== |
| | |
| | == Diagnosis == |
| | ===Diagnostic Criteria=== |
| | If available, the diagnostic criteria are provided here. |
| | |
| | ===History=== |
| | A directed history should be obtained to ascertain |
| | |
| | === Symptoms === |
| | "Type symptom here" is pathognomonic of the "type disease name here". |
| | |
| | "Type non specific symptoms" may be present. |
| | |
| | ===Past Medical History=== |
| | |
| | ===Family History=== |
| | |
| | ===Social History=== |
| | ====Occupational==== |
| | ====Alcohol==== |
| | The frequency and amount of alcohol consumption should be characterized. |
| | ====Drug Use==== |
| | ====Smoking==== |
| | |
| | ===Allergies=== |
|
| |
|
| =Pathophysiology= | | === Physical Examination === |
|
| |
|
| * Acute Kidney Injury has been reported in patients with COVID-19 infection and presence of proteinuria, hematuria has also been reported. In a case observation, 4 out of 7 patients had AKI which may indicate that renal transplant patients are at higher risk AKI on being infected with COVID-19 whereas only 29% AKI was seen in critically ill patients of general population.<ref name="YangYu2020">{{cite journal|last1=Yang|first1=Xiaobo|last2=Yu|first2=Yuan|last3=Xu|first3=Jiqian|last4=Shu|first4=Huaqing|last5=Xia|first5=Jia'an|last6=Liu|first6=Hong|last7=Wu|first7=Yongran|last8=Zhang|first8=Lu|last9=Yu|first9=Zhui|last10=Fang|first10=Minghao|last11=Yu|first11=Ting|last12=Wang|first12=Yaxin|last13=Pan|first13=Shangwen|last14=Zou|first14=Xiaojing|last15=Yuan|first15=Shiying|last16=Shang|first16=You|title=Clinical course and outcomes of critically ill patients with SARS-CoV-2 pneumonia in Wuhan, China: a single-centered, retrospective, observational study|journal=The Lancet Respiratory Medicine|volume=8|issue=5|year=2020|pages=475–481|issn=22132600|doi=10.1016/S2213-2600(20)30079-5}}</ref>
| | ==== Appearance of the Patient ==== |
| *Acute Kidney Injury seen in COVID-19 infection can be from the cytotropic effect of the viral particles as well as systemic inflammatory response induced by the cytokines. Patients admitted with severe disease, acute respiratory distress syndrome (ARDS) or in patients admitted to ICU have a higher incidence of AKI . <ref name="ZhouYu2020">{{cite journal|last1=Zhou|first1=Fei|last2=Yu|first2=Ting|last3=Du|first3=Ronghui|last4=Fan|first4=Guohui|last5=Liu|first5=Ying|last6=Liu|first6=Zhibo|last7=Xiang|first7=Jie|last8=Wang|first8=Yeming|last9=Song|first9=Bin|last10=Gu|first10=Xiaoying|last11=Guan|first11=Lulu|last12=Wei|first12=Yuan|last13=Li|first13=Hui|last14=Wu|first14=Xudong|last15=Xu|first15=Jiuyang|last16=Tu|first16=Shengjin|last17=Zhang|first17=Yi|last18=Chen|first18=Hua|last19=Cao|first19=Bin|title=Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study|journal=The Lancet|volume=395|issue=10229|year=2020|pages=1054–1062|issn=01406736|doi=10.1016/S0140-6736(20)30566-3}}</ref>. Other possible reasons that can play a role in AKI development, are multi-organ failure resulting in acute tubular necrosis (ATN), volume reduction causing prerenal ATN, high fever, drug toxicity, hemodynamic instability, and contrast exposure. <ref name="Beddhu2004">{{cite journal|last1=Beddhu|first1=Srinivasan|title=Hypothesis: The Body Mass Index Paradox and an Obesity, Inflammation, and Atherosclerosis Syndrome in Chronic Kidney Disease|journal=Seminars in Dialysis|volume=17|issue=3|year=2004|pages=229–232|issn=08940959|doi=10.1111/j.0894-0959.2004.17311.x}}</ref> <ref name="MohamedLukitsch2020">{{cite journal|last1=Mohamed|first1=Muner MB|last2=Lukitsch|first2=Ivo|last3=Torres-Ortiz|first3=Aldo E|last4=Walker|first4=Joseph B|last5=Varghese|first5=Vipin|last6=Hernandez-Arroyo|first6=Cesar F|last7=Alqudsi|first7=Muhannad|last8=LeDoux|first8=Jason R|last9=Velez|first9=Juan Carlos Q|title=Acute Kidney Injury Associated with Coronavirus Disease 2019 in Urban New Orleans|journal=Kidney360|year=2020|pages=10.34067/KID.0002652020|issn=2641-7650|doi=10.34067/KID.0002652020}}</ref>
| |
| *Uptake of SARS-Cov-2 virus into proximal tubule cells is possible explanation for the AKI seen in COVID patients. Angiotensin-converting enzyme 2 and Dipeptidyl peptidase have been implicated in the uptake of SARS-Cov and MERS-CoV. These receptors are found in the proximal tubules of kidney..<ref name="LiMoore2003">{{cite journal|last1=Li|first1=Wenhui|last2=Moore|first2=Michael J.|last3=Vasilieva|first3=Natalya|last4=Sui|first4=Jianhua|last5=Wong|first5=Swee Kee|last6=Berne|first6=Michael A.|last7=Somasundaran|first7=Mohan|last8=Sullivan|first8=John L.|last9=Luzuriaga|first9=Katherine|last10=Greenough|first10=Thomas C.|last11=Choe|first11=Hyeryun|last12=Farzan|first12=Michael|title=Angiotensin-converting enzyme 2 is a functional receptor for the SARS coronavirus|journal=Nature|volume=426|issue=6965|year=2003|pages=450–454|issn=0028-0836|doi=10.1038/nature02145}}</ref><ref name="RajMou2013">{{cite journal|last1=Raj|first1=V. Stalin|last2=Mou|first2=Huihui|last3=Smits|first3=Saskia L.|last4=Dekkers|first4=Dick H. W.|last5=Müller|first5=Marcel A.|last6=Dijkman|first6=Ronald|last7=Muth|first7=Doreen|last8=Demmers|first8=Jeroen A. A.|last9=Zaki|first9=Ali|last10=Fouchier|first10=Ron A. M.|last11=Thiel|first11=Volker|last12=Drosten|first12=Christian|last13=Rottier|first13=Peter J. M.|last14=Osterhaus|first14=Albert D. M. E.|last15=Bosch|first15=Berend Jan|last16=Haagmans|first16=Bart L.|title=Dipeptidyl peptidase 4 is a functional receptor for the emerging human coronavirus-EMC|journal=Nature|volume=495|issue=7440|year=2013|pages=251–254|issn=0028-0836|doi=10.1038/nature12005}}</ref>ACE2: ACE ratio is higher in the kidneys compared to the respiratory system. (1:1 in the kidneys VS 1:20 in the respiratory system)).<ref name="MalhaMueller2020">{{cite journal|last1=Malha|first1=Line|last2=Mueller|first2=Franco B.|last3=Pecker|first3=Mark S.|last4=Mann|first4=Samuel J.|last5=August|first5=Phyllis|last6=Feig|first6=Peter U.|title=COVID-19 and the Renin-Angiotensin System|journal=Kidney International Reports|volume=5|issue=5|year=2020|pages=563–565|issn=24680249|doi=10.1016/j.ekir.2020.03.024}}</ref>SARS-CoV2 spike(S) protein is cleaved and activated by transmembrane serine protease family (TMPRSS) after attaching to angiotensin-converting enzyme 2 (ACE2) receptors. This allows the virus to release fusion peptide that aides in membrane fusion..<ref name="PanXu2020">{{cite journal|last1=Pan|first1=Xiu-wu|last2=Xu|first2=Da|last3=Zhang|first3=Hao|last4=Zhou|first4=Wang|last5=Wang|first5=Lin-hui|last6=Cui|first6=Xin-gang|title=Identification of a potential mechanism of acute kidney injury during the COVID-19 outbreak: a study based on single-cell transcriptome analysis|journal=Intensive Care Medicine|volume=46|issue=6|year=2020|pages=1114–1116|issn=0342-4642|doi=10.1007/s00134-020-06026-1}}</ref>
| |
| *Pro-inflammatory cytokine levels are elevated in the COVID-19 infection and there is activation of T-call response. <ref name="HuangWang2020">{{cite journal|last1=Huang|first1=Chaolin|last2=Wang|first2=Yeming|last3=Li|first3=Xingwang|last4=Ren|first4=Lili|last5=Zhao|first5=Jianping|last6=Hu|first6=Yi|last7=Zhang|first7=Li|last8=Fan|first8=Guohui|last9=Xu|first9=Jiuyang|last10=Gu|first10=Xiaoying|last11=Cheng|first11=Zhenshun|last12=Yu|first12=Ting|last13=Xia|first13=Jiaan|last14=Wei|first14=Yuan|last15=Wu|first15=Wenjuan|last16=Xie|first16=Xuelei|last17=Yin|first17=Wen|last18=Li|first18=Hui|last19=Liu|first19=Min|last20=Xiao|first20=Yan|last21=Gao|first21=Hong|last22=Guo|first22=Li|last23=Xie|first23=Jungang|last24=Wang|first24=Guangfa|last25=Jiang|first25=Rongmeng|last26=Gao|first26=Zhancheng|last27=Jin|first27=Qi|last28=Wang|first28=Jianwei|last29=Cao|first29=Bin|title=Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China|journal=The Lancet|volume=395|issue=10223|year=2020|pages=497–506|issn=01406736|doi=10.1016/S0140-6736(20)30183-5}}</ref>There is higher cytokine levels and there is occurrence of cytokine storm in severe cases. In cytokine storm the, the immune system damages the healthy tissue rather than virus.<ref name="PanXu2020">{{cite journal|last1=Pan|first1=Xiu-wu|last2=Xu|first2=Da|last3=Zhang|first3=Hao|last4=Zhou|first4=Wang|last5=Wang|first5=Lin-hui|last6=Cui|first6=Xin-gang|title=Identification of a potential mechanism of acute kidney injury during the COVID-19 outbreak: a study based on single-cell transcriptome analysis|journal=Intensive Care Medicine|volume=46|issue=6|year=2020|pages=1114–1116|issn=0342-4642|doi=10.1007/s00134-020-06026-1}}</ref> According to an autopsy report of six patients, the light microscopy revealed cluster of differentiation 68 (CD68)+ macrophage infiltration of the tubulointerstitium and severe ATN. The tubules showed complement 5b-9 deposition in all six cases, but deposition in glomeruli and capillaries were seldom seen. Some CD8+ T lymphocyte cells and CD56+ (natural killer) cells were seen in kidney tissue<ref name="DiaoWang2020">{{cite journal|last1=Diao|first1=Bo|last2=Wang|first2=Chenhui|last3=Wang|first3=Rongshuai|last4=Feng|first4=Zeqing|last5=Tan|first5=Yingjun|last6=Wang|first6=Huiming|last7=Wang|first7=Changsong|last8=Liu|first8=Liang|last9=Liu|first9=Ying|last10=Liu|first10=Yueping|last11=Wang|first11=Gang|last12=Yuan|first12=Zilin|last13=Ren|first13=Liang|last14=Wu|first14=Yuzhang|last15=Chen|first15=Yongwen|year=2020|doi=10.1101/2020.03.04.20031120}}</ref>
| |
|
| |
|
| =Lab Findings= | | ====Vital Signs==== |
| Presenting symptoms in renal transplant patients are similar to those of non-renal transplant patients.
| |
| *Respiratory symptons
| |
| **Cough
| |
| **Chest Pain
| |
| **Dysnea
| |
| *Fever
| |
| *Hypoxia
| |
| *Lymphopenia
| |
| *High C-Reactive Protein<ref name="BanerjeePopoola2020">{{cite journal|last1=Banerjee|first1=Debasish|last2=Popoola|first2=Joyce|last3=Shah|first3=Sapna|last4=Ster|first4=Irina Chis|last5=Quan|first5=Virginia|last6=Phanish|first6=Mysore|title=COVID-19 infection in kidney transplant recipients|journal=Kidney International|volume=97|issue=6|year=2020|pages=1076–1082|issn=00852538|doi=10.1016/j.kint.2020.03.018}}</ref>
| |
|
| |
|
| Valuable prognostic blood tests that can be done are
| | ====Skin==== |
| *Lymphocyte count
| |
| **Renal transplant patients generally have a low lymphocyte count due to immunosuppression, hence finding a further drop in the lymphocyte count can be of prognostic value.
| |
| *D-dimer
| |
| *Ferritin
| |
| *Troponin
| |
| **Microvascular thrombosis and disseminated intravascular coagulation( with gut ischemia) can occur later in the course of illness. They are characterized by marked increase in the levels of D-dimer particularly. D dimer, ferritin, and troponin should be measured in all patients with severe COVID-19 infection on admission and in those who fail to show any clinical improvement.<ref name="BanerjeePopoola2020">{{cite journal|last1=Banerjee|first1=Debasish|last2=Popoola|first2=Joyce|last3=Shah|first3=Sapna|last4=Ster|first4=Irina Chis|last5=Quan|first5=Virginia|last6=Phanish|first6=Mysore|title=COVID-19 infection in kidney transplant recipients|journal=Kidney International|volume=97|issue=6|year=2020|pages=1076–1082|issn=00852538|doi=10.1016/j.kint.2020.03.018}}</ref>
| |
|
| |
|
| =Management of immunosuppression in Transplant patients= | | ====Head==== |
| In renal transplant patients, the immune responses are altered, especially the T cell response, due to generalized immunosuppression. Due to recent timeframe of outbreak of COVID-19 and insufficient scientific evidence, there is limited evidence on decreasing or changing the pattern of immunosuppression in renal transplant patients who have been infected with COVID-19. <ref name="ZhuXu2020">{{cite journal|last1=Zhu|first1=Lan|last2=Xu|first2=Xizhen|last3=Ma|first3=Ke|last4=Yang|first4=Junling|last5=Guan|first5=Hanxiong|last6=Chen|first6=Song|last7=Chen|first7=Zhishui|last8=Chen|first8=Gang|title=Successful recovery of COVID‐19 pneumonia in a renal transplant recipient with long‐term immunosuppression|journal=American Journal of Transplantation|year=2020|issn=1600-6135|doi=10.1111/ajt.15869}}</ref>
| |
|
| |
|
| *Clinical presentation of COVID-19 infection in renal transplant patients are like the clinical presentations of infection in general population. <ref name="ZhuXu2020">{{cite journal|last1=Zhu|first1=Lan|last2=Xu|first2=Xizhen|last3=Ma|first3=Ke|last4=Yang|first4=Junling|last5=Guan|first5=Hanxiong|last6=Chen|first6=Song|last7=Chen|first7=Zhishui|last8=Chen|first8=Gang|title=Successful recovery of COVID‐19 pneumonia in a renal transplant recipient with long‐term immunosuppression|journal=American Journal of Transplantation|year=2020|issn=1600-6135|doi=10.1111/ajt.15869}}</ref>.Moreover, renal transplant patients are generally immunocompromised, and this predisposes them to severe infection with COVID-19. Rejection of the graft can occur if immunosuppression is reduced in these patients. Hence given the high rate of mortality in COVID-19 infections, it is suggested that a careful risk vs benefits assessment of whether to continue immunosuppression should be done.<ref name="pmid32354637">{{cite journal |vauthors=Banerjee D, Popoola J, Shah S, Ster IC, Quan V, Phanish M |title=COVID-19 infection in kidney transplant recipients |journal=Kidney Int. |volume=97 |issue=6 |pages=1076–1082 |date=June 2020 |pmid=32354637 |pmc=7142878 |doi=10.1016/j.kint.2020.03.018 |url=}}</ref>
| | ==== Eyes ==== |
| *'''Managing the immunosuppression in renal transplant patients is difficult and should be based on'''<ref name="pmid32354637">{{cite journal |vauthors=Banerjee D, Popoola J, Shah S, Ster IC, Quan V, Phanish M |title=COVID-19 infection in kidney transplant recipients |journal=Kidney Int. |volume=97 |issue=6 |pages=1076–1082 |date=June 2020 |pmid=32354637 |pmc=7142878 |doi=10.1016/j.kint.2020.03.018 |url=}}</ref>
| |
| **Age
| |
| **Severity of COVID-19 infection
| |
| **Presence of Co-Morbidities
| |
| **Time since the transplant
| |
| *''In patients with mild to moderate infection, it has been a practice to continue or decrease the doses of immunosuppressive drugs, however this approach can cause high mortality in patients having COVID-19 infection.''<ref name="pmid32354637">{{cite journal |vauthors=Banerjee D, Popoola J, Shah S, Ster IC, Quan V, Phanish M |title=COVID-19 infection in kidney transplant recipients |journal=Kidney Int. |volume=97 |issue=6 |pages=1076–1082 |date=June 2020 |pmid=32354637 |pmc=7142878 |doi=10.1016/j.kint.2020.03.018 |url=}}</ref>
| |
|
| |
|
| =Treatment= | | ==== Ear ==== |
| ==Immunosuppresant Drugs== | |
| *'''Antiproliferative agents such as MMF and azathioprine '''<ref name="pmid32354637">{{cite journal |vauthors=Banerjee D, Popoola J, Shah S, Ster IC, Quan V, Phanish M |title=COVID-19 infection in kidney transplant recipients |journal=Kidney Int. |volume=97 |issue=6 |pages=1076–1082 |date=June 2020 |pmid=32354637 |pmc=7142878 |doi=10.1016/j.kint.2020.03.018 |url=}}</ref>
| |
| **Should be stopped at the time of admission to hospital
| |
| *'''Prednisolone'''<ref name="pmid32354637">{{cite journal |vauthors=Banerjee D, Popoola J, Shah S, Ster IC, Quan V, Phanish M |title=COVID-19 infection in kidney transplant recipients |journal=Kidney Int. |volume=97 |issue=6 |pages=1076–1082 |date=June 2020 |pmid=32354637 |pmc=7142878 |doi=10.1016/j.kint.2020.03.018 |url=}}</ref>
| |
|
| |
|
| **The dosage can be either increased or left unchanged. These can provide immunological protection to the renal graft.
| | ====Nose==== |
| **Corticosteroids have beneficial effects such as
| |
| ***''Immunomodulation and anti-inflammatory properties''
| |
| ****Inhibition of proinflammatory cytokines
| |
| ****Reduction of white blood cell traffic
| |
| ***''Vascular protective effects''
| |
| ****Maintenance of integrity and permeability of endothelium. <ref name="LansburyRodrigo2020">{{cite journal|last1=Lansbury|first1=Louise E.|last2=Rodrigo|first2=Chamira|last3=Leonardi-Bee|first3=Jo|last4=Nguyen-Van-Tam|first4=Jonathan|last5=Shen Lim|first5=Wei|title=Corticosteroids as Adjunctive Therapy in the Treatment of Influenza|journal=Critical Care Medicine|volume=48|issue=2|year=2020|pages=e98–e106|issn=0090-3493|doi=10.1097/CCM.0000000000004093}}</ref> <ref name="pmid32354637">{{cite journal |vauthors=Banerjee D, Popoola J, Shah S, Ster IC, Quan V, Phanish M |title=COVID-19 infection in kidney transplant recipients |journal=Kidney Int. |volume=97 |issue=6 |pages=1076–1082 |date=June 2020 |pmid=32354637 |pmc=7142878 |doi=10.1016/j.kint.2020.03.018 |url=}}</ref>
| |
| *'''Tacrolimus'''<ref name="pmid32354637">{{cite journal |vauthors=Banerjee D, Popoola J, Shah S, Ster IC, Quan V, Phanish M |title=COVID-19 infection in kidney transplant recipients |journal=Kidney Int. |volume=97 |issue=6 |pages=1076–1082 |date=June 2020 |pmid=32354637 |pmc=7142878 |doi=10.1016/j.kint.2020.03.018 |url=}}</ref>
| |
|
| |
|
| **Low doses of tacrolimus can be given but more evidence is required.<ref name="pmid32354637">{{cite journal |vauthors=Banerjee D, Popoola J, Shah S, Ster IC, Quan V, Phanish M |title=COVID-19 infection in kidney transplant recipients |journal=Kidney Int. |volume=97 |issue=6 |pages=1076–1082 |date=June 2020 |pmid=32354637 |pmc=7142878 |doi=10.1016/j.kint.2020.03.018 |url=}}</ref>
| | ====Mouth==== |
|
| |
|
| **The dose should be reduced to 50%. Target levels for tacrolimus should be 3-5 ng/ml.<ref name="urlwww.massgeneral.org">{{cite web |url=https://www.massgeneral.org/assets/MGH/pdf/news/coronavirus/mass-general-COVID-19-treatment-guidance.pdf |title=www.massgeneral.org |format= |work= |accessdate=}}</ref>
| | ====Throat ==== |
| *'''Tocilizumab'''.<ref name="pmid32354637">{{cite journal |vauthors=Banerjee D, Popoola J, Shah S, Ster IC, Quan V, Phanish M |title=COVID-19 infection in kidney transplant recipients |journal=Kidney Int. |volume=97 |issue=6 |pages=1076–1082 |date=June 2020 |pmid=32354637 |pmc=7142878 |doi=10.1016/j.kint.2020.03.018 |url=}}</ref>
| |
|
| |
|
| **COVID-19 infection has been found to cause cytokine storm and inflammation due to antiviral immune response, hence trials of anti-interleukin 6 monoclonal antibody Tocilizumab and continuing steroids in infected patients has been considered.
| | ==== Heart ==== |
| *'''Cyclosporine'''
| |
| **Cyclosporin A has been shown to have an inhibitory effect on proliferation of corona viruses and hepatitis C virus in vitro, not seen in tacrolimus. Cyclosporin A is thought to inhibit the replication of a diverse array of coronaviruses through its impact on cyclophilin A and B.<ref name="de WildeZevenhoven-Dobbe2011">{{cite journal|last1=de Wilde|first1=Adriaan H.|last2=Zevenhoven-Dobbe|first2=Jessika C.|last3=van der Meer|first3=Yvonne|last4=Thiel|first4=Volker|last5=Narayanan|first5=Krishna|last6=Makino|first6=Shinji|last7=Snijder|first7=Eric J.|last8=van Hemert|first8=Martijn J.|title=Cyclosporin A inhibits the replication of diverse coronaviruses|journal=Journal of General Virology|volume=92|issue=11|year=2011|pages=2542–2548|issn=0022-1317|doi=10.1099/vir.0.034983-0}}</ref><ref name="TanakaSato2013">{{cite journal|last1=Tanaka|first1=Yoshikazu|last2=Sato|first2=Yuka|last3=Sasaki|first3=Takashi|title=Suppression of Coronavirus Replication by Cyclophilin Inhibitors|journal=Viruses|volume=5|issue=5|year=2013|pages=1250–1260|issn=1999-4915|doi=10.3390/v5051250}}</ref>
| |
| **Cyclosporine levels should be targeted at 25-50 ng/ml.<ref name="urlwww.massgeneral.org">{{cite web |url=https://www.massgeneral.org/assets/MGH/pdf/news/coronavirus/mass-general-COVID-19-treatment-guidance.pdf |title=www.massgeneral.org |format= |work= |accessdate=}}</ref>
| |
|
| |
|
| ==Medical Therapy== | | ==== Lungs ==== |
| *With regard to specific antiviral therapies, although a recent trial showed no benefit of lopinavir-ritonavir in hospitalized patients with severe COVID-19, it remains possible that treatment with these drugs as well as hydroxychloroquine will be considered in patients with COVID-19 pneumonia.<ref name="CaoWang2020">{{cite journal|last1=Cao|first1=Bin|last2=Wang|first2=Yeming|last3=Wen|first3=Danning|last4=Liu|first4=Wen|last5=Wang|first5=Jingli|last6=Fan|first6=Guohui|last7=Ruan|first7=Lianguo|last8=Song|first8=Bin|last9=Cai|first9=Yanping|last10=Wei|first10=Ming|last11=Li|first11=Xingwang|last12=Xia|first12=Jiaan|last13=Chen|first13=Nanshan|last14=Xiang|first14=Jie|last15=Yu|first15=Ting|last16=Bai|first16=Tao|last17=Xie|first17=Xuelei|last18=Zhang|first18=Li|last19=Li|first19=Caihong|last20=Yuan|first20=Ye|last21=Chen|first21=Hua|last22=Li|first22=Huadong|last23=Huang|first23=Hanping|last24=Tu|first24=Shengjing|last25=Gong|first25=Fengyun|last26=Liu|first26=Ying|last27=Wei|first27=Yuan|last28=Dong|first28=Chongya|last29=Zhou|first29=Fei|last30=Gu|first30=Xiaoying|last31=Xu|first31=Jiuyang|last32=Liu|first32=Zhibo|last33=Zhang|first33=Yi|last34=Li|first34=Hui|last35=Shang|first35=Lianhan|last36=Wang|first36=Ke|last37=Li|first37=Kunxia|last38=Zhou|first38=Xia|last39=Dong|first39=Xuan|last40=Qu|first40=Zhaohui|last41=Lu|first41=Sixia|last42=Hu|first42=Xujuan|last43=Ruan|first43=Shunan|last44=Luo|first44=Shanshan|last45=Wu|first45=Jing|last46=Peng|first46=Lu|last47=Cheng|first47=Fang|last48=Pan|first48=Lihong|last49=Zou|first49=Jun|last50=Jia|first50=Chunmin|last51=Wang|first51=Juan|last52=Liu|first52=Xia|last53=Wang|first53=Shuzhen|last54=Wu|first54=Xudong|last55=Ge|first55=Qin|last56=He|first56=Jing|last57=Zhan|first57=Haiyan|last58=Qiu|first58=Fang|last59=Guo|first59=Li|last60=Huang|first60=Chaolin|last61=Jaki|first61=Thomas|last62=Hayden|first62=Frederick G.|last63=Horby|first63=Peter W.|last64=Zhang|first64=Dingyu|last65=Wang|first65=Chen|title=A Trial of Lopinavir–Ritonavir in Adults Hospitalized with Severe Covid-19|journal=New England Journal of Medicine|volume=382|issue=19|year=2020|pages=1787–1799|issn=0028-4793|doi=10.1056/NEJMoa2001282}}</ref>
| |
| *Remdesiver inhibits the viral replication by pre mature termination of RNA transcription, and have shown activity in vitro against the viral agent.<ref name="WangCao2020">{{cite journal|last1=Wang|first1=Manli|last2=Cao|first2=Ruiyuan|last3=Zhang|first3=Leike|last4=Yang|first4=Xinglou|last5=Liu|first5=Jia|last6=Xu|first6=Mingyue|last7=Shi|first7=Zhengli|last8=Hu|first8=Zhihong|last9=Zhong|first9=Wu|last10=Xiao|first10=Gengfu|title=Remdesivir and chloroquine effectively inhibit the recently emerged novel coronavirus (2019-nCoV) in vitro|journal=Cell Research|volume=30|issue=3|year=2020|pages=269–271|issn=1001-0602|doi=10.1038/s41422-020-0282-0}}</ref>Food and Drug Administration (FDA) in the USA has authorized its use in patients hospitalized with COVID-19.It is not recommended in patients with lower GFR (GFR < 30 mL/min).<ref name="SandersMonogue2020">{{cite journal|last1=Sanders|first1=James M.|last2=Monogue|first2=Marguerite L.|last3=Jodlowski|first3=Tomasz Z.|last4=Cutrell|first4=James B.|title=Pharmacologic Treatments for Coronavirus Disease 2019 (COVID-19)|journal=JAMA|year=2020|issn=0098-7484|doi=10.1001/jama.2020.6019}}</ref>
| |
| *The choice of calcineurin inhibitor may also be beneficial. For example, cyclosporin A has been shown to have an inhibitory effect on proliferation of corona viruses and hepatitis C virus in vitro, not seen in tacrolimus. Cyclosporin A is thought to inhibit the replication of a diverse array of coronaviruses through its impact on cyclophilin A and B.<ref name="de WildeZevenhoven-Dobbe2011">{{cite journal|last1=de Wilde|first1=Adriaan H.|last2=Zevenhoven-Dobbe|first2=Jessika C.|last3=van der Meer|first3=Yvonne|last4=Thiel|first4=Volker|last5=Narayanan|first5=Krishna|last6=Makino|first6=Shinji|last7=Snijder|first7=Eric J.|last8=van Hemert|first8=Martijn J.|title=Cyclosporin A inhibits the replication of diverse coronaviruses|journal=
| |
| Journal of General Virology
| |
| |volume=92|issue=11|year=2011|pages=2542–2548|issn=0022-1317|doi=10.1099/vir.0.034983-0}}</ref><ref name="TanakaSato2013">{{cite journal|last1=Tanaka|first1=Yoshikazu|last2=Sato|first2=Yuka|last3=Sasaki|first3=Takashi|title=Suppression of Coronavirus Replication by Cyclophilin Inhibitors|journal=Viruses|volume=5|issue=5|year=2013|pages=1250–1260|issn=1999-4915|doi=10.3390/v5051250}}</ref>
| |
|
| |
|
| ==Primary Prevention== | | ==== Abdomen ==== |
| *Currently no vaccine has been developed against the SARS-CoV 2 virus.<ref name="AdapaChenna2020">{{cite journal|last1=Adapa|first1=Sreedhar|last2=Chenna|first2=Avantika|last3=Balla|first3=Mamtha|last4=Merugu|first4=Ganesh Prasad|last5=Koduri|first5=Narayana Murty|last6=Daggubati|first6=Subba Rao|last7=Gayam|first7=Vijay|last8=Naramala|first8=Srikanth|last9=Konala|first9=Venu Madhav|title=COVID-19 Pandemic Causing Acute Kidney Injury and Impact on Patients With Chronic Kidney Disease and Renal Transplantation|journal=Journal of Clinical Medicine Research|volume=12|issue=6|year=2020|pages=352–361|issn=1918-3003|doi=10.14740/jocmr4200}}</ref>
| |
|
| |
|
| ==General Measures for Renal transplant Patients== | | ==== Extremities ==== |
|
| |
|
| *The kidney transplant population must comply with the recommended measures of protection in the general population. Physicians can recommend the use of a mask on an individual basis, especially when the patient goes to health center or other place with agglomeration. People who show symptoms of being infected with SARS-CoV-2 should wear masks to prevent the spread of the disease to others..<ref name="LópezVázquez2020">{{cite journal|last1=López|first1=Verónica|last2=Vázquez|first2=Teresa|last3=Alonso-Titos|first3=Juana|last4=Cabello|first4=Mercedes|last5=Alonso|first5=Angel|last6=Beneyto|first6=Isabel|last7=Crespo|first7=Marta|last8=Díaz-Corte|first8=Carmen|last9=Franco|first9=Antonio|last10=González-Roncero|first10=Francisco|last11=Gutiérrez|first11=Elena|last12=Guirado|first12=Luis|last13=Jiménez|first13=Carlos|last14=Jironda|first14=Cristina|last15=Lauzurica|first15=Ricardo|last16=Llorente|first16=Santiago|last17=Mazuecos|first17=Auxiliadora|last18=Paul|first18=Javier|last19=Rodríguez-Benot|first19=Alberto|last20=Ruiz|first20=Juan Carlos|last21=Sánchez-Fructuoso|first21=Ana|last22=Sola|first22=Eugenia|last23=Torregrosa|first23=Vicente|last24=Zárraga|first24=Sofía|last25=Hernández|first25=Domingo|title=Recommendations on management of the SARS-CoV-2 coronavirus pandemic (Covid-19) in kidney transplant patients|journal=Nefrología (English Edition)|year=2020|issn=20132514|doi=10.1016/j.nefroe.2020.03.017}}</ref>
| | ==== Neurologic ==== |
| *It is prudent to approve a sick leave in patients whose profession involves a high hazard for disease.<ref name="LópezVázquez2020">{{cite journal|last1=López|first1=Verónica|last2=Vázquez|first2=Teresa|last3=Alonso-Titos|first3=Juana|last4=Cabello|first4=Mercedes|last5=Alonso|first5=Angel|last6=Beneyto|first6=Isabel|last7=Crespo|first7=Marta|last8=Díaz-Corte|first8=Carmen|last9=Franco|first9=Antonio|last10=González-Roncero|first10=Francisco|last11=Gutiérrez|first11=Elena|last12=Guirado|first12=Luis|last13=Jiménez|first13=Carlos|last14=Jironda|first14=Cristina|last15=Lauzurica|first15=Ricardo|last16=Llorente|first16=Santiago|last17=Mazuecos|first17=Auxiliadora|last18=Paul|first18=Javier|last19=Rodríguez-Benot|first19=Alberto|last20=Ruiz|first20=Juan Carlos|last21=Sánchez-Fructuoso|first21=Ana|last22=Sola|first22=Eugenia|last23=Torregrosa|first23=Vicente|last24=Zárraga|first24=Sofía|last25=Hernández|first25=Domingo|title=Recommendations on management of the SARS-CoV-2 coronavirus pandemic (Covid-19) in kidney transplant patients|journal=Nefrología (English Edition)|year=2020|issn=20132514|doi=10.1016/j.nefroe.2020.03.017}}</ref>
| |
| *It is recommended to screen kidney transplant patients through teleconsultation so as to decrease the time spent in healthcare centers and decrease the risk of infection <ref name="LópezVázquez2020">{{cite journal|last1=López|first1=Verónica|last2=Vázquez|first2=Teresa|last3=Alonso-Titos|first3=Juana|last4=Cabello|first4=Mercedes|last5=Alonso|first5=Angel|last6=Beneyto|first6=Isabel|last7=Crespo|first7=Marta|last8=Díaz-Corte|first8=Carmen|last9=Franco|first9=Antonio|last10=González-Roncero|first10=Francisco|last11=Gutiérrez|first11=Elena|last12=Guirado|first12=Luis|last13=Jiménez|first13=Carlos|last14=Jironda|first14=Cristina|last15=Lauzurica|first15=Ricardo|last16=Llorente|first16=Santiago|last17=Mazuecos|first17=Auxiliadora|last18=Paul|first18=Javier|last19=Rodríguez-Benot|first19=Alberto|last20=Ruiz|first20=Juan Carlos|last21=Sánchez-Fructuoso|first21=Ana|last22=Sola|first22=Eugenia|last23=Torregrosa|first23=Vicente|last24=Zárraga|first24=Sofía|last25=Hernández|first25=Domingo|title=Recommendations on management of the SARS-CoV-2 coronavirus pandemic (Covid-19) in kidney transplant patients|journal=Nefrología (English Edition)|year=2020|issn=20132514|doi=10.1016/j.nefroe.2020.03.017}}</ref>
| |
| *Maintenance of general hygiene. Washing your hands as often as possible with cleanser and water, or with a alcohol based hand sanitizer (60% alc), particularly: after utilizing the restroom, before eating, in the wake of blowing, coughing or sneezing and after direct contact with patient or their surroundings. Abstain from touching your eyes, nose and mouth before washing your hands.<ref name="LópezVázquez2020">{{cite journal|last1=López|first1=Verónica|last2=Vázquez|first2=Teresa|last3=Alonso-Titos|first3=Juana|last4=Cabello|first4=Mercedes|last5=Alonso|first5=Angel|last6=Beneyto|first6=Isabel|last7=Crespo|first7=Marta|last8=Díaz-Corte|first8=Carmen|last9=Franco|first9=Antonio|last10=González-Roncero|first10=Francisco|last11=Gutiérrez|first11=Elena|last12=Guirado|first12=Luis|last13=Jiménez|first13=Carlos|last14=Jironda|first14=Cristina|last15=Lauzurica|first15=Ricardo|last16=Llorente|first16=Santiago|last17=Mazuecos|first17=Auxiliadora|last18=Paul|first18=Javier|last19=Rodríguez-Benot|first19=Alberto|last20=Ruiz|first20=Juan Carlos|last21=Sánchez-Fructuoso|first21=Ana|last22=Sola|first22=Eugenia|last23=Torregrosa|first23=Vicente|last24=Zárraga|first24=Sofía|last25=Hernández|first25=Domingo|title=Recommendations on management of the SARS-CoV-2 coronavirus pandemic (Covid-19) in kidney transplant patients|journal=Nefrología (English Edition)|year=2020|issn=20132514|doi=10.1016/j.nefroe.2020.03.017}}</ref>
| |
| *Regular cleaning of home with disinfection of objects and surfaces.<ref name="LópezVázquez2020">{{cite journal|last1=López|first1=Verónica|last2=Vázquez|first2=Teresa|last3=Alonso-Titos|first3=Juana|last4=Cabello|first4=Mercedes|last5=Alonso|first5=Angel|last6=Beneyto|first6=Isabel|last7=Crespo|first7=Marta|last8=Díaz-Corte|first8=Carmen|last9=Franco|first9=Antonio|last10=González-Roncero|first10=Francisco|last11=Gutiérrez|first11=Elena|last12=Guirado|first12=Luis|last13=Jiménez|first13=Carlos|last14=Jironda|first14=Cristina|last15=Lauzurica|first15=Ricardo|last16=Llorente|first16=Santiago|last17=Mazuecos|first17=Auxiliadora|last18=Paul|first18=Javier|last19=Rodríguez-Benot|first19=Alberto|last20=Ruiz|first20=Juan Carlos|last21=Sánchez-Fructuoso|first21=Ana|last22=Sola|first22=Eugenia|last23=Torregrosa|first23=Vicente|last24=Zárraga|first24=Sofía|last25=Hernández|first25=Domingo|title=Recommendations on management of the SARS-CoV-2 coronavirus pandemic (Covid-19) in kidney transplant patients|journal=Nefrología (English Edition)|year=2020|issn=20132514|doi=10.1016/j.nefroe.2020.03.017}}</ref>
| |
| *Keep a distance of at least two metres from people with general symptoms such as fever, cough, malaise, sore throat or dyspnea). Abstain from sharing personal belongings.<ref name="LópezVázquez2020">{{cite journal|last1=López|first1=Verónica|last2=Vázquez|first2=Teresa|last3=Alonso-Titos|first3=Juana|last4=Cabello|first4=Mercedes|last5=Alonso|first5=Angel|last6=Beneyto|first6=Isabel|last7=Crespo|first7=Marta|last8=Díaz-Corte|first8=Carmen|last9=Franco|first9=Antonio|last10=González-Roncero|first10=Francisco|last11=Gutiérrez|first11=Elena|last12=Guirado|first12=Luis|last13=Jiménez|first13=Carlos|last14=Jironda|first14=Cristina|last15=Lauzurica|first15=Ricardo|last16=Llorente|first16=Santiago|last17=Mazuecos|first17=Auxiliadora|last18=Paul|first18=Javier|last19=Rodríguez-Benot|first19=Alberto|last20=Ruiz|first20=Juan Carlos|last21=Sánchez-Fructuoso|first21=Ana|last22=Sola|first22=Eugenia|last23=Torregrosa|first23=Vicente|last24=Zárraga|first24=Sofía|last25=Hernández|first25=Domingo|title=Recommendations on management of the SARS-CoV-2 coronavirus pandemic (Covid-19) in kidney transplant patients|journal=Nefrología (English Edition)|year=2020|issn=20132514|doi=10.1016/j.nefroe.2020.03.017}}</ref>
| |
| *During the lockdown circumstance you should stay at home aside from the specified exemptions, as indicated by the standards built up by the political and wellbeing specialists. Telephone the kidney transplant facility at your referral community or the telephone numbers approved by the wellbeing specialists.<ref name="LópezVázquez2020">{{cite journal|last1=López|first1=Verónica|last2=Vázquez|first2=Teresa|last3=Alonso-Titos|first3=Juana|last4=Cabello|first4=Mercedes|last5=Alonso|first5=Angel|last6=Beneyto|first6=Isabel|last7=Crespo|first7=Marta|last8=Díaz-Corte|first8=Carmen|last9=Franco|first9=Antonio|last10=González-Roncero|first10=Francisco|last11=Gutiérrez|first11=Elena|last12=Guirado|first12=Luis|last13=Jiménez|first13=Carlos|last14=Jironda|first14=Cristina|last15=Lauzurica|first15=Ricardo|last16=Llorente|first16=Santiago|last17=Mazuecos|first17=Auxiliadora|last18=Paul|first18=Javier|last19=Rodríguez-Benot|first19=Alberto|last20=Ruiz|first20=Juan Carlos|last21=Sánchez-Fructuoso|first21=Ana|last22=Sola|first22=Eugenia|last23=Torregrosa|first23=Vicente|last24=Zárraga|first24=Sofía|last25=Hernández|first25=Domingo|title=Recommendations on management of the SARS-CoV-2 coronavirus pandemic (Covid-19) in kidney transplant patients|journal=Nefrología (English Edition)|year=2020|issn=20132514|doi=10.1016/j.nefroe.2020.03.017}}</ref>
| |
| *Attempt to follow a right eating routine. Abstain from smoking and liquor. These substances weaken the immune system, and increase the risk of infectious diseases.<ref name="LópezVázquez2020">{{cite journal|last1=López|first1=Verónica|last2=Vázquez|first2=Teresa|last3=Alonso-Titos|first3=Juana|last4=Cabello|first4=Mercedes|last5=Alonso|first5=Angel|last6=Beneyto|first6=Isabel|last7=Crespo|first7=Marta|last8=Díaz-Corte|first8=Carmen|last9=Franco|first9=Antonio|last10=González-Roncero|first10=Francisco|last11=Gutiérrez|first11=Elena|last12=Guirado|first12=Luis|last13=Jiménez|first13=Carlos|last14=Jironda|first14=Cristina|last15=Lauzurica|first15=Ricardo|last16=Llorente|first16=Santiago|last17=Mazuecos|first17=Auxiliadora|last18=Paul|first18=Javier|last19=Rodríguez-Benot|first19=Alberto|last20=Ruiz|first20=Juan Carlos|last21=Sánchez-Fructuoso|first21=Ana|last22=Sola|first22=Eugenia|last23=Torregrosa|first23=Vicente|last24=Zárraga|first24=Sofía|last25=Hernández|first25=Domingo|title=Recommendations on management of the SARS-CoV-2 coronavirus pandemic (Covid-19) in kidney transplant patients|journal=Nefrología (English Edition)|year=2020|issn=20132514|doi=10.1016/j.nefroe.2020.03.017}}</ref>
| |
|
| |
|
| =Specific recommendations for kidney transplant patients suspected of SARS-CoV-2 infection= | | ====Genitals==== |
| All kidney transplant patients with suspected symptoms of COVID-19 are advised to contact their healthcare provider (ideally by phone), to discuss the full course of their treatment and other chronic conditions that they are having. Depending upon the symptoms :-
| |
| *Mild symptoms ie
| |
| **without Dyspnea or Tachypnea
| |
| **Temperature <38°C
| |
| **Kidney receptor with adequate functional reserves
| |
| ***The patient can be asked to remain in contact via teleconsultation to have the diagnostic tests performed, monitor the symptoms and communicate alarming to the transplant team every 24–48h.
| |
| *Moderate/Severe symptoms
| |
| **Temperature >38°C
| |
| **Presence of Dyspnea
| |
| **Presence of Tachypnea
| |
| **Fragile Kidney receptor
| |
| ***Patient can be asked to report to Emergency Department for clinical evaluation..<ref name="LópezVázquez2020">{{cite journal|last1=López|first1=Verónica|last2=Vázquez|first2=Teresa|last3=Alonso-Titos|first3=Juana|last4=Cabello|first4=Mercedes|last5=Alonso|first5=Angel|last6=Beneyto|first6=Isabel|last7=Crespo|first7=Marta|last8=Díaz-Corte|first8=Carmen|last9=Franco|first9=Antonio|last10=González-Roncero|first10=Francisco|last11=Gutiérrez|first11=Elena|last12=Guirado|first12=Luis|last13=Jiménez|first13=Carlos|last14=Jironda|first14=Cristina|last15=Lauzurica|first15=Ricardo|last16=Llorente|first16=Santiago|last17=Mazuecos|first17=Auxiliadora|last18=Paul|first18=Javier|last19=Rodríguez-Benot|first19=Alberto|last20=Ruiz|first20=Juan Carlos|last21=Sánchez-Fructuoso|first21=Ana|last22=Sola|first22=Eugenia|last23=Torregrosa|first23=Vicente|last24=Zárraga|first24=Sofía|last25=Hernández|first25=Domingo|title=Recommendations on management of the SARS-CoV-2 coronavirus pandemic (Covid-19) in kidney transplant patients|journal=Nefrología (English Edition)|year=2020|issn=20132514|doi=10.1016/j.nefroe.2020.03.017}}</ref>
| |
|
| |
|
| | ==== Other ==== |
| | |
| | === Laboratory Findings === |
| | |
| | ==== Electrolyte and Biomarker Studies ==== |
| | |
| | ==== Electrocardiogram ==== |
| | |
| | ==== Chest X Ray ==== |
| | |
| | ====CT ==== |
| | |
| | ==== MRI ==== |
| | |
| | ==== Echocardiography or Ultrasound ==== |
| | |
| | ==== Other Imaging Findings ==== |
| | |
| | === Other Diagnostic Studies === |
| | |
| | == Treatment == |
| | === Pharmacotherapy === |
| | |
| | ==== Acute Pharmacotherapies ==== |
| | |
| | ==== Chronic Pharmacotherapies ==== |
| | |
| | === Surgery and Device Based Therapy === |
| | |
| | ==== Indications for Surgery ==== |
| | |
| | ==== Pre-Operative Assessment ==== |
| | |
| | ==== Post-Operative Management ==== |
| | |
| | ==== Transplantation ==== |
| | |
| | === Primary Prevention === |
| | |
| | === Secondary Prevention === |
| | |
| | === Cost-Effectiveness of Therapy === |
| | |
| | === Future or Investigational Therapies === |
|
| |
|
| ==References== | | ==References== |
| <references />
| | {{Reflist|2}} |
| | |
| | [[Category:Disease]] |