Table 1 Potential mechanisms of kidney damage and treatment strategies in COVID-19
From: Kidney involvement in COVID-19 and rationale for extracorporeal therapies
Pathwaya | Mechanism of kidney damage | Suggested treatment strategy |
|---|---|---|
Cytokine damage | ||
Cytokine release syndrome | Direct cytokine lesion | Cytokine removal using various approaches: direct haemoperfusion using a neutro-macroporous sorbent; plasma adsorption on resin after separation from whole blood; CKRT with hollow fibre filters with adsorptive properties; high-dose CKRT with MCO or HCO membranes |
Increased cytokine generation owing to ECMO, invasive mechanical ventilation and/or CKRT | ||
Haemophagocytic syndrome | ||
Organ crosstalk | ||
Cardiomyopathy and/or viral myocarditis | Cardiorenal syndrome type 1 | LVAD, arteriovenous ECMO |
Alveolar damage | Renal medullary hypoxia | Venovenous ECMO |
High peak airway pressure and intra-abdominal hypertension | Renal compartment syndrome | Venovenous ECMO, extracorporeal CO2 removal, CKRT |
Rhabdomyolysis | Tubular toxicity | CKRT using a HCO or MCO membrane |
Systemic effects | ||
Positive fluid balance | Renal compartment syndrome | Continuous ultrafiltration and diuretics |
Endothelial damage, third-space fluid loss and hypotension | Renal hypoperfusion | Vasopressors and fluid expansion |
Rhabdomyolysis | Tubular toxicity | CKRT using a HCO or MCO membrane |
Endotoxins | Septic AKI | Endotoxin removal using polysterene fibres functionalized with polymyxin-B |
