favipiravir and Renal-Insufficiency--Chronic

To date the severe acute respiratory syndrome coronavirus 2 (SARS- CoV-2), known as COVID-19, is for clinicians the most difficult global therapeutic problem. In this landscape, the management of patients with chronic kidney disease, acute kidney injury or patients undergoing immunosuppressant therapies for kidney transplant or glomerular diseases, represent a clinical challenge for nephrologists, especially in patients with severe acute lung involvement. Therefore in this setting, due to the lack of anti-COVID treatment schedules, tailored management is mandatory to reduce the side effects, as consequence of impaired renal function and drugs interactions. We report the main treatment actually used against SARS-CoV-2, underlining its possible use in the nephropatic patients and the central role of nephrologists to improve the clinical outcome.

Topics: Adenosine Monophosphate; Adrenal Cortex Hormones; Alanine; Amides; Antibodies, Monoclonal; Cobicistat; Coronavirus Infections; COVID-19; Darunavir; Drug Combinations; Humans; Kidney; Lopinavir; Pandemics; Pneumonia, Viral; Pyrazines; Renal Insufficiency, Chronic; Renal Replacement Therapy; Ritonavir

Coronavirus disease 2019, the disease caused by the severe acute respiratory syndrome coronavirus 2 virus, was first identified in the Hubei Province of China in late 2019. Currently, the only role for therapy is treatment of the disease, as opposed to postexposure prophylaxis, however multiple clinical trials are currently ongoing for both treatment and prophylaxis. Treating coronavirus disease 2019 relies on two components; the first is inhibition of the viral entrance and replication within the body and the second is inhibition of an exacerbated immune response which can be seen in patients with severe disease. Many drugs have shown in vitro antiviral activity; however, clinical trials have not been as promising. This review summarizes the current data for the most commonly used drugs for coronavirus disease 2019 and will cover the unique factors that may affect the dosing of these medications in patients with CKD. While clinical trials are ongoing, most are in patients with normal kidney function. During a pandemic, when patients with CKD are at higher risk of both infection and death, it is imperative to include patients these patients in the clinical trials.

Topics: Adenosine Monophosphate; Alanine; Amides; Anti-Inflammatory Agents; Antibodies, Monoclonal, Humanized; Antiviral Agents; Chloroquine; COVID-19; COVID-19 Drug Treatment; COVID-19 Serotherapy; COVID-19 Vaccines; Creatinine; Cytidine; Dexamethasone; Drug Combinations; Drug Interactions; Humans; Hydroxychloroquine; Hydroxylamines; Immunization, Passive; Interferons; Janus Kinase Inhibitors; Lopinavir; Pyrazines; Renal Elimination; Renal Insufficiency, Chronic; Renal Replacement Therapy; Ribavirin; Ritonavir; SARS-CoV-2