Cleveland Clinic journal of medicine
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We briefly summarize the complement system and its functions in immunity and disease. We present data supporting the requirement of complement to resolve COVID-19, and discuss how complement overactivation later in severe disease could drive multiorgan damage characteristic of fatal COVID-19.
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Interleukin 6 (IL-6) took center stage as a therapeutic target, given its role in the cytokine storm phase of COVID-19. While IL-6 inhibitors have been widely used to treat a variety of immune-mediated disease states, they have not been used often in the intensive care setting, and new data question their efficacy. This brief review provides practical information on their administration and safety.
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Drugs targeting RNA respiratory viruses have resulted in few effective therapies, highlighting challenges for antivirals to treat COVID-19. Several antivirals are being investigated for symptomatic COVID-19 but no definitive data support their clinical use. Remdesivir appears to result in favorable outcomes with shortened time to recovery and a modest decrease in mortality for hospitalized patients in compassionate use series and some randomized controlled trials. ⋯ A randomized controlled trial of lopinavir/ritonavir demonstrated no apparent clinical or virologic benefit and drug-drug interactions and side effects further limit its utility. Antivirals to treat influenza (oseltamivir) have limited activity against SARS-CoV-2, but favipiravir and umifenovir, two influenza antivirals available internationally, may have distinct viral targets and require further investigation. Antivirals with evidence of clinical activity must be studied as treatment and prophylaxis for those at high risk for severe COVID-19.
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COVID-19 is primarily considered a respiratory illness, but the kidney may be one of the targets of SARS-CoV-2 infection, since the virus enters cells through the angiotensin-converting enzyme 2 receptor, which is found in abundance in the kidney. Information on kidney involvement in COVID-19 is limited but is evolving rapidly. This article discusses the pathogenesis of acute kidney injury (AKI) in COVID-19, its optimal management, and the impact of COVID-19 on patients with chronic kidney disease, patients with end-stage kidney disease on dialysis, and kidney transplant recipients.