Sodium status and kidney involvement during COVID-19 infection

• Published in: Virus research 2020-09, Vol.286, p.198034-198034, Article 198034
• Main Authors: Post, Adrian, Dullaart, Robin P.F., Bakker, Stephan J.L.
• Format: Article
• Language: English
• Subjects: ACE2 receptor; Angiotensin-Converting Enzyme 2; Animals; Betacoronavirus - genetics; Betacoronavirus - metabolism; Betacoronavirus - pathogenicity; Coronavirus Infections - genetics; Coronavirus Infections - metabolism; Coronavirus Infections - pathology; Coronavirus Infections - virology; COVID-19; Epithelial Cells - drug effects; Epithelial Cells - metabolism; Epithelial Cells - pathology; Epithelial Cells - virology; Gene Expression Regulation; Host-Pathogen Interactions - genetics; Humans; Hypertension - genetics; Hypertension - metabolism; Hypertension - pathology; Hypertension - virology; Kidney; Kidney - drug effects; Kidney - metabolism; Kidney - pathology; Kidney - virology; Lung - metabolism; Lung - pathology; Lung - virology; Pandemics; Peptidyl-Dipeptidase A - genetics; Peptidyl-Dipeptidase A - metabolism; Pneumonia, Viral - genetics; Pneumonia, Viral - metabolism; Pneumonia, Viral - pathology; Pneumonia, Viral - virology; Protein Binding; Rats; Rats, Inbred SHR; SARS-CoV-2; Severity of Illness Index; Sodium; Sodium, Dietary - metabolism; Sodium, Dietary - pharmacology; Spike Glycoprotein, Coronavirus - genetics; Spike Glycoprotein, Coronavirus - metabolism
• ISSN: 0168-1702; 1872-7492
• DOI: 10.1016/j.virusres.2020.198034

•Low sodium intake or sodium losses upregulate kidney expression of ACE2.•SARS-CoV-2 makes use of ACE2 to interact with target cells.•Low sodium status may increase the risk of kidney involvement during COVID-19. The angiotensin-converting enzyme 2 receptor (ACE2) is expressed in epithelial cells of many tissues including the kidney, and has been identified to interact with human pathogenic coronaviruses, including SARS-CoV-2. Although diffuse alveolar damage and acute respiratory failure are the main features of COVID-19 infection, two recent studies demonstrate that kidney impairment in hospitalized COVID-19 patients is common, and that kidney involvement is associated with high risk of in-hospital death. Interestingly, studies in rats have demonstrated that high dietary sodium intake results in down-regulation of the ACE2 expression in kidney tissue. We hypothesize that low sodium status makes kidney involvement during the course of COVID-19 infection more likely due to upregulation of membrane bound ACE2 in the kidneys. We propose that sodium intake and status should be monitored carefully during severe COVID-19 infections, and that low sodium intake be corrected early in its course, despite a potential conflict regarding common dietary recommendations to restrict dietary sodium intake in patients with hypertension, diabetes, and kidney disease.