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COVID-19 and Kidney Disease

Published:October 30, 2020DOI:https://doi.org/10.1053/j.ackd.2020.10.002
      William Osler has frequently been described as the Father of Modern Medicine and one of the “greatest diagnosticians ever to wield a stethoscope.” The art of medicine and being a physician includes two critical skills: diagnosis and prognosis. Since we are all generally aware of the natural history of a disease process, these skills may seem routine to our generation. Hence, very infrequently we are pushed in a completely uncharted territory when it comes to applying our medical knowledge and implementing these skills. The current pandemic has been an important lesson to appreciate the pioneers of medicine in that it has literally taken the entire globe back to the drawing board.
      As of mid-October, in there are over 8 million confirmed cases of coronavirus disease 2019 (COVID-19) and over 224,000 deaths directly attributed to COVID-19 in the United States. The disease is caused by one of the highly pathogenic human coronaviruses (severe acute respiratory syndrome coronavirus [SARS-CoV-2]). SARS-CoV-2 bind to their target cells through a trans-membrane receptor, angiotensin converting enzyme 2 (ACE2), to gain cellular entry, leading to its downstream inflammatory consequences. A combination of pathogen-related and host responses leads to multi-organ involvement and tissue injury. Kidneys are among the most important organs that play a role in regulation of the renin-angiotensin and aldosterone system; hence, they are vulnerable both directly and indirectly to the effects of the viral infection. In addition, kidney disease is also considered one of the major predisposing factors associated with severity of this infection.
      The impact of COVID-19 on our specialty is from both biological consequences and processes of care. Unlike other disciplines, nephrology has been uniquely impacted by COVID-19 in both acute care settings and ambulatory dialysis settings, as well as in organ transplantation. In the current issue of Advances in Chronic Kidney Disease, Dr Silvi Shah and Dr Matthew Sparks have done a masterful job of inviting key experts to provide a scientific update on various aspects of kidney disease in COVID-19.
      • Shah S.
      • Sparks M.A.
      COVID-19 and the kidney community: coalescing in crisis.
      The natural history and science associated with this disease is unfolding in front of us, so we need to be humble about what we know until now and be open-minded about what we will continue to learn along the way. As a special issue, this also represents significant efforts on the part of the individual authors who have devoted their time to inform others during a busy and stressful time for themselves. These efforts are greatly appreciated, and we hope the readers find these works to be both rigorous and comprehensive. Finally, the tireless efforts of the editorial board and administrative staff, including our reviewers and publishers, need to be recognized in order to bring this special issue to fruition. As we enter the fall season, we hope that we are better prepared now than earlier in the spring to deliver care to our patients with kidney disease in a safe and effective manner.

      Reference

        • Shah S.
        • Sparks M.A.
        COVID-19 and the kidney community: coalescing in crisis.
        Adv Chronic Kid Dis. 2020; 27: 362-364