Diabetic Kidney Disease and COVID-19

Chronic kidney disease is common among patients with diabetes, occurring in 20–40% of the diabetic population. Both diabetes and chronic kidney disease increase morbidity and mortality in patients with coronavirus disease 2019 (COVID-19), while COVID-19 affects glucose homeostasis and can result in kidney injury through various pathways. Medications such as angiotensin-converting enzyme inhibitors (ACEI), angiotensin receptor blockers (ARBs), and sodium-glucose cotransporter-2 inhibitors (SGLT-2 inhibitors) are commonly used for the treatment of diabetic nephropathy. Their role in diabetic kidney disease (DKD) during COVID-19 is unclear. In addition, DKD is a common cause of end-stage kidney disease (ESKD) leading to kidney transplantation. Due to underlying risk factors and immunosuppression, these patients have an increased risk for severe COVID-19. This chapter will review the complex interplay between COVID-19 and the kidney, with a focus on patients with DKD and kidney transplantation.