Use of medicines for covid-19 treatment in patients with loss of kidney function: a narrative review

ABSTRACT Covid-19 has been identified as the cause of acute respiratory disease with interstitial and alveolar pneumonia, but it can affect several organs, such as kidneys, heart, blood, nervous system and digestive tract. The disease-causing agent (Sars-CoV-2) has a binding structure to the angiotensin-converting enzyme 2 (ACE2) receptor, enabling entry into cells that express ACE2, such as the pulmonary alveolar epithelial cells. However, studies also indicate the possibility of damage to renal cells, since these cells express high levels of ACE2. Currently, there is no evidence to indicate a specific treatment for covid-19. Several drugs have been used, and some of them may have their excretion process altered in patients with abnormal kidney function. To date, there are no studies that assist health professionals in adjusting the dose of these drugs. Thus, this study aims to review and discuss the topic, taking into account factors associated with kidney injury in covid-19, as well as pharmacokinetic aspects and dose recommendations of the main drugs used for covid-19.摘要：新型冠状病毒肺炎（COVID-19）已被明确为引发伴间质性与肺泡性肺炎的急性呼吸道疾病的病因，但其可累及肾脏、心脏、血液系统、神经系统及消化道等多个器官。该疾病的致病病原体严重急性呼吸综合征冠状病毒2（SARS-CoV-2）具备与血管紧张素转换酶2（ACE2）受体结合的结构，借此可侵入表达ACE2的细胞，如肺泡上皮细胞。然而，相关研究亦提示肾细胞存在受损风险，因此类细胞高表达ACE2。目前尚无针对新型冠状病毒肺炎的特效治疗方案，临床已使用多种治疗药物，其中部分药物的排泄过程可能在肾功能异常患者体内发生改变。截至目前，尚无相关研究可帮助临床医护人员调整此类药物的给药剂量。有鉴于此，本研究旨在回顾并探讨该主题，综合考量新型冠状病毒肺炎相关肾损伤的关联因素，以及用于治疗该疾病的主要药物的药代动力学特征与剂量推荐方案。