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 renal 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.

中文翻译：

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COVID-19感染期间的钠状态和肾脏受累情况。

血管紧张素转换酶2受体（ACE2）在包括肾脏在内的许多组织的上皮细胞中表达，并且已被确定与人类致病性冠状病毒，包括SARS-CoV-2相互作用。尽管弥漫性肺泡损伤和急性呼吸衰竭是COVID-19感染的主要特征，但两项最新研究表明，住院的COVID-19患者的肾脏功能损害很常见，而且肾脏受累与院内死亡的高风险相关。有趣的是，在大鼠中的研究表明，高钠饮食会导致肾脏组织中ACE2表达的下调。我们假设低钠状态使COVID-19感染过程中肾脏受累的可能性更大，这是由于肾脏中与膜结合的ACE2上调所致。