ACE2 and COVID-19: Elevated creatinine, which shows renal impairment, was identified in a recent review to be associated with an increase in mortality in COVID-19 patients.34 The pathophysiology of poor outcomes in the presence of renal impairment may be related to down-regulation of ACE2 in response to increasing angiotensin II because of acute lung injury with subsequent worsening of acute kidney injury.35