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Newspapers and online media are full of the effects of the coronavirus on airways and olfactory functions and the importance of respiratory physicians (pulmonologists in the USA), ventilators and intensive care teams. However, as per the Intensive Care National Audit and research centre reports on COVID-19, approximately 25-28% of cases will require renal support in some form or other. The common causes of acute kidney injury (AKI) in such settings are: 1) prolonged fever, 2) dehydration, 3) vomiting / abdominal cramps / inability to eat or drink, 4) direct viral invasion of renal tubules and podocytes, 5) cytokine-storm in severe cases, 6) tendency to keep patients on ‘the dry side’ to help lung function. It is now recognised that keeping patients well hydrated reduces the risks of AKI. The need to treat AKI in ICU will involve an extra burden on dialysis machines, plastic disposables and dialyser fluid. NHS organisations throughout the UK will need to continue their efforts with renal teams and manufacturers in the UK and overseas for adequate supplies. The second group of serious COVID-19 cases are outside intensive care units and are in either hospital wards or care homes. Every effort should be made to ensure that these patients do not develop AKI. Some recommendations are: 1) strict fluid balance and body weight, 2) daily blood tests for creatinine, urea, electrolytes and bicarbonate, 3) stopping nephrotoxic drugs / antibiotics, 4) Avoiding contrast-media, NSAIDS, ACE inhibitors, etc. 5) daily review of drug charts and to modify drugs such as metformin, opiates, gabapentin, anti-coagulants, digoxin as necessary. After all, ‘prevention is better than cure’. My personal advice to clinicians and junior doctors would be that, when in doubt, you should refer to the well-written AKI chapter in the British National Formulary (BNF).

Rising dialysis need sparks shortage fears.
Mhase E.
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Arun K Sharma

West Herts NHS Trust (Watford General Hospital)

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