The case report discusses the difficulties in the treatment of this patient with acute kidney disease.
Acute kidney injury — ranging from prerenal azotemia to acute tubular necrosis — may develop in patients with Covid-19 because of poor oral intake, sepsis, and cytokine storm. Because angiotensin-converting enzyme 2 (ACE2), a putative receptor for SARS-CoV-2, is expressed in kidneys in humans, the kidneys may be a direct target of the virus. In some studies, the viral RNA has been recovered in urine.
Unfortunately, many patients with severe acute kidney injury are not eligible for clinical trials with remdesivir or are required to discontinue participation because remdesivir is eliminated renally and also because of concern about accumulation of the sulfobutylether-β-cyclodextrin carrier used in the formulation of remdesivir. Thus, there is an urgent need for reporting of outcomes associated with the compassionate use of remdesivir in patients with Covid-19 and acute or chronic kidney disease.
Favipiravir has not been studied in patients with severe renal insufficiency, and these patients are being excluded from current clinical trials of favipiravir.
Hydroxychloroquine can be used in patients with acute kidney injury without dose adjustment; however, the drug concentration in the blood is likely to be increased, given that kidney excretion accounts for 15 to 25% of clearance. Patients with acute kidney injury who receive these drugs should be monitored for QT prolongation, since electrolyte abnormalities that occur in patients with acute kidney injury may increase the risk of cardiac arrhythmia.
Read the whole case report here: https://www.nejm.org/doi/full/10.1056/NEJMcpc2002418