Characteristic and management of Sars-Cov-2 pneumonia without Remdesivir in patient with chronic kidney diseases and sarcomatous endothelial carcinoma

The SARS-CoV-2 pandemic has already infected more than 98 million people worldwide and resulted in 2.1 million deaths. Though originally described as a respiratory virus, SARS-CoV-2 has now been shown to have multiorgan involvement. Chronic kidney disease (CKD) has emerged as a risk factor for adverse outcomes. The virus can cause renal involvement, and severe renal dysfunction is more common among patients with chronic comorbid conditions, especially patients with chronic kidney disease. Angiotensin-converting enzyme 2 (ACE2) has been proven to be the major receptor of SARS-CoV-2 in kidneys, suggesting that ACE2-related changes may be involved in renal injury during the infection. For patients with SARS-CoV-2 infection, renal injury by either direct infection or systemic effects, including host immune clearance and immune tolerance disorders, endothelium-mediated vasculitis, thrombus formation, glucose and lipid metabolism disorder, increased serum creatinine, variable degrees of proteinuria, hematuria, and radiographic abnormalities of the kidneys and hypoxia. Here, we report an Italian patient with Chronic kidney diseases, hypertension and sarcomatous endothelial carcinoma responding to alternative therapy with regression of pneumonia caused by Sars-Cov-2 without Remdesivir for nefrotoxicity.