key: cord-0862392-02jpx08a authors: Gross, Oliver title: COVID-19 und die Niere – Klinik: Wie die Nephrologie die klinische und intensivmedizinische Versorgung der Patienten fundamental verbessert date: 2020-12-11 journal: Nephrologe DOI: 10.1007/s11560-020-00470-2 sha: 35c06b3bf97ee08e4b823bb8940394f39d50e896 doc_id: 862392 cord_uid: 02jpx08a The aim of this article is to explain the clinical benefits of the growing knowledge about severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). In addition to the lungs, SARS-CoV‑2 can invade multiple cell types in other organs, such as the kidneys and replicate there. Important damaging pathways of the virus, such as vascular endotheliitis, thrombotic events and systemic cytokine release are still incompletely understood. Coronavirus disease 2019 (COVID-19) is a systemic disease that necessitates intensive medical care and in particular, internal medicine involvement and represents a major challenge for all disciplines of internal medicine. Among these, nephrology in particular is involved in the fight against COVID-19 in a variety of ways: urine investigations can provide indications of multiple organ involvement, endotheliitis, microthrombi and microcirculation damage, etc. Experience with low serum albumin levels and antithrombin III activity in nephrotic patients helps to point out the decreasing effects of loop diuretics and heparin to other specialist disciplines. Nephrological knowledge of the complications of hypoalbuminemia and “resistance” to diuretics must lead to an early implementation of renal replacement procedures in order to be able to prevent mechanical ventilation in COVID-19 intensive care patients with increased extracellular lung fluid. The kidneys can be used as a seismograph for severe courses of COVID-19 and nephrological knowledge can be brought to use to optimize the intensive medical care for critically ill patients. Both together have the potential to considerably reduce morbidity and mortality further. Die Coronaviruserkrankung COVID-19 ("coronavirus disease 2019") beginnt mit der Infektion des oberen Respirationstrakts mit SARS-CoV-2 ("severe acute respiratory syndrome coronavirus 2"; [1, 2] ). Auch wenn die Lunge Hauptangriffspunkt des Virus ist, so werden die Schwere des Verlaufs und die Letalität insbesondere vom Multiorganbefall geprägt. Das Virus kann verschiedene Zelltypen in vielen Organen, insbesondere den Nieren, angreifen und sich dort replizieren. In der Niere spielen mutmaßlich Epithelzellen (Podozyten, Tubulus) eine führende Rolle, aber auch die Endothelitis der kleinen Gefäße in den Glomeruli, Mikrothromben und die systemische Freisetzung von Chemokinen [3] [4] [5] [6] [7] [8] [9] . Während die meis-tenPatienteneinenmildenbis moderaten Verlauf haben und ambulant betreut werden können, wird bei einer Untergruppe die Krankenhausaufnahme erforderlich. Von den stationären Patienten wiederum verschlechtern sich einige schnell in Richtung Multiorganversagen, invasiver Beatmung, ECMO("extracorporeal membrane oxygenation")-Therapie und Dialysepflicht sowie einer daraus resultierenden hohen Letalität [10] [11] [12] [13] [14] [15] [16] [17] . Im Frühjahr 2020, während der ersten Erkrankungswelle, suchten die COVID-19-Krisenteams inDeutschland -wie alle anderen Länder -daher nach Mitteln und Wegen, die schweren Krankheitsverläufe früher zu erkennen, um präventive Maßnahmen ergreifen zu können. Der oben beschriebene Zugang zu den "Hauptangriffspunkten" von SARS-CoV-2, auch und gerade an der Niere, hat das Potenzial, sich besser gegen das Virus ver- and antithrombin III activity in nephrotic patients helps to point out the decreasing effects of loop diuretics and heparin to other specialist disciplines. Nephrological knowledge of the complications of hypoalbuminemia and "resistance" to diuretics must lead to an early implementation of renal replacement procedures in order to be able to prevent mechanical ventilation in COVID-19 intensive care patients with increased extracellular lung fluid. The kidneys can be used as a seismograph for severe courses of COVID-19 and nephrological knowledge can be brought to use to optimize the intensive medical care for critically ill patients. Both together have the potential to considerably reduce morbidity and mortality further. 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