COVID-19

Aims

The aim of this page is to provide links to reliable sources of information and to our local unit protocols. Given that advice is rapidly-changing, we have linked to original sources rather than replicating advice here.  We have separate patient information about COVID-19

 

Unit Protocols – start here

Almost all of the relevant guidance can be found here (much of it specific for NHS Lothian).

 

What to tell patients

See our page on patient information about COVID-19 and the Kidney Care UK site.  The Renal Association published guidance on shielding measures and are currently revising this in light of new data and a move towards “unshielding”.

 

Treatment of COVID-19

General principles

Early anticipatory care planning is vital for ALL patients.  Complete NHS Lothian proforma.  This should be completed on Trak [EPR > Overview / Progress > Hospital ACP (Cov 19)], but a paper version is also available.

The management of patients with COVID-19 is broadly the same as for any viral pneumonia / pneumonitis.  Follow the usual principles of good supportive care.  Avoid excessive fluid resuscitation.  Avoid nebulisers, steroids and antibiotics unless there is an alternative indication for their use (e.g. asthma or superadded bacterial infection).

 

Evidence base

The only specific therapies with RCT evidence of efficacy in (some patients) with Covid-19 are remdesivir and dexamethasone.  Patients with renal impairment were not analysed as a pre-specified subgroup, but there is no good reason to think that this benefit should not extend to this patient group.  Other therapies are being assessed in the RECOVERY trial.  

There are no high-quality data to suggest that we should be avoiding any particular class of medication.  Most expert guidance advises that patients who currently take an ACEi or ARB continue to do so.  Current UK advice is that there is no strong evidence that NSAIDs are detrimental in this context but that given a degree of uncertainty, paracetamol should be used first-line.

External links

Core guidance

 

Society guidelines

 

Education & further information

 

Acknowledgements:  The author of this page was Rob Hunter. It was first published 17 March 2020. The date it was last modified is shown in the footer.

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