Deutsche medizinische Wochenschrift
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Increasing insight into the clinical phenotype and mechanisms of SARS-CoV-2 infections and COVID-19 has identified damage of the kidneys as a key player in the course of the disease. This manuscript summarizes the current knowledge on direct viral infection of kidney tissue, proteinuria and acute kidney injury in COVID-19, and management of patients on chronic dialysis as well as after kidney transplantation. Direct infection of podocytes and proximal tubular cells by SARS-CoV-2 has been confirmed and results in proteinuria and hematuria at an early stage of COVID-19. ⋯ Specific therapies for kidney damage and acute kidney injury within COVID-19 that could be generally recommended are currently lacking. Patients on chronic hemodialysis in particular are at risk for contracting SARS-CoV-2 infections as indicated by outbreaks and super-spreading events in hemodialysis facilities. Immunosuppressive therapy after kidney transplantation needs to be adapted upon diagnosis of COVID-19 depending on the severity of the initial presentation.
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Dtsch. Med. Wochenschr. · Jul 2020
[Invasive Mechanical Ventilation Therapy in the Dying Process - Step by Step].
Invasive mechanical ventilation can be terminated by immediate (palliative) extubation or by gradual reduction of ventilation with the ventilation access left open (terminal weaning). Both procedures are ethically equivalent and can be performed in everyday life, so that individual patient factors and the experience of the treatment team are decisive. However, the primary goal is to ensure that the patient and relatives do not suffer. This article presents step by step which aspects are relevant: communication, adjust or stop monitoring, selection and implementation of the appropriate procedure, preparatory measures, recognition and treatment of distressing symptoms by means of drug or non-drug therapy options and last but not least accurate documentation.