慢性肾脏病合并2019冠状病毒病临床诊治专家共识(2023年版草案)

Expert consensus on clinical diagnosis and treatment of chronic kidney disease complicated with coronavirus disease 2019

2019冠状病毒病(coronavirus disease 2019,COVID-19)是指新型冠状病毒(severe acute respiratory syndrome coronavirus 2,SARS-CoV-2)感染导致的包括肺炎在内的全身性疾病。COVID-19除了累及呼吸系统,亦可累及包括泌尿系统、心血管系统、消化系统、神经系统、血液系统、免疫系统在内的全身多个器官系统。肾脏是COVID-19常见的受累脏器之一,SARS-CoV-2可通过直接和间接作用引起肾脏损伤,肾脏受累的临床表现包括:急性肾损伤(acute kidney injury,AKI)、蛋白尿、血尿等。慢性肾脏病(chronic kidney disease,CKD)患者常合并不同程度的免疫缺陷,特别是使用激素/免疫抑制剂的免疫性肾病、肾移植以及接受肾脏替代治疗的终末期肾病(end-stage renal disease,ESRD)患者,这些患者不但对SARS-CoV-2易感,且感染后易转为重症或危重症。CKD患者合并COVID-19后治疗与非CKD患者有所不同,抗病毒药物用于重度肾功能不全患者尚存争议。此外,CKD患者常合并营养不良、高凝状态、慢性炎症、水电解质紊乱等,为COVID-19的成功治疗带来困难。因此,本专家共识致力于加强临床医师对CKD合并COVID-19的认识,规范临床诊治,进一步改善患者预后。

Coronavirus disease 2019(COVID-19)is a systemic disease including pneumonia caused by the severe acute respiratory syndrome coronavirus 2(SARS-CoV-2).The COVID-19 infects several organs and systems besides the respiratory system,including the urinary system,cardiovascular system,gastrointestinal system,nervous system,hematological system and immune system.The kidney,as one of the targeted organs of COVID-19,is damaged by SARS-CoV-2 in both direct and indirect ways.The clinical manifestations of kidney involvements include acute kidney injury(AKI),proteinuria,hematuria,etc.Patients with chronic kidney disease(CKD)are often combined with a variety of immunodeficiency,especially those receiving hormones/immunosuppressants for immune nephropathy,kidney transplantation,undergoing renal replacement therapy for end-stage renal disease(ESRD).Moreover,these patients are not only susceptible to SARS-CoV-2,but also prone to becoming seriously or critically ill after infection.The treatment of CKD patients with COVID-19 is different from that of non-CKD patients,and the use of antiviral drugs in patients with severe renal insufficiency remains controversial.Furthermore,CKD patients are often combined with malnutrition,hypercoagulability,chronic inflammation,and water-electrolyte disorders,which make treatment of COVID-19 difficult.Therefore,this expert consensus was developed to enhance the clinicians'awareness of CKD with COVID-19,standardize the clinical diagnosis and treatment,and further improve the prognosis of patients.