COVID-19 doesn’t only infect Lungs but also Kidneys:
Experts say
25-50% of the people infected with COVID-19 reported
to develop symptoms of Acute Kidney Injury (AKI)
The
unprecedented COVID-19 pandemic has almost opened a pandora’s box. Besides
other challenges, it has been testing the current healthcare systems. Among the
COVID-19 infected people, quite a few have developed kidney abnormalities in otherwise
healthy kidneys. A few patients even developed Acute Kidney Injury (AKI), a
condition known to impact survival of patients. Also, a recent report of the
International Society of Nephrology (ISN) reveals that of the people infected
with COVID-19, 25-50% of them were seen with Kidney abnormalities, which
manifested as a substantial leak of protein and blood in urine, resulting in
the development of AKI in close to 15% patients, hinting that COVID-19 also
attacks the kidney. [1]
“Effect
on the kidney is secondary to hypoxia or cytokines released by the covid19. It
is generally perceived that COVID-19 types of viruses are borne from
respiratory systems — Lungs, but a growing body of evidence shows that COVID-19
also attacks the kidneys either directly or mediated by excessive immune response
seen in severe COVID-19 patients and not just the lungs. As per earlier reports
of SARS and MERS-CoV infections, Acute Kidney Injury (AKI) had developed in 5
to 15 per cent cases, but about 60 to 90 per cent of those cases reported
mortality. While the preliminary reports of COVID-19 patients suggested a lower
incidence (3 to 9 per cent) of AKI, the later reports indicated a higher
frequency of kidney abnormalities. A study of 59 patients with COVID-19 found
that about two-thirds of patients developed a massive leak of protein in urine
during their stay in hospital”, says Dr. Suresh Rao, Intensivist,
MGM, Chennai.
The current treatment of COVID-19
with AKI includes general and supportive management and kidney replacement
therapy. In the absence of effective antiviral therapy with smaller proportion
requiring acute or urgent dialysis, Continuous Renal Replacement Therapy (CRRT)
a term used for a collection of acute dialysis techniques can support these
patients for 24 hours in a day especially to the critically ill patients
suffering with AKI or having overwhelming immune response.
“Previous
studies [2,
3, 4] show that CRRT had been successfully applied in the
treatment of SARS and MERS illnesses related to previously known coronaviruses,
which also manifested as respiratory illnesses. At relatively higher doses, it can help clear
the immune toxins, thus suggesting CRRT may play a role in patients with
COVID-19 with AKI or high immune toxin load”, says, Dr. NGK Gopal
Nephrologist, TNMSC, Chennai.
He further adds, “In
situations where shifts in fluid balance and metabolic fluctuations are poorly
tolerated and in situations where other extracorporeal therapies are required,
CRRT can be used as an integrated system and is preferred over parallel
systems, as was highlighted by a recently published retrospective cohort study.
[5] In
the study, it was found that 36 COVID-19 patients requiring invasive mechanical
ventilation, where CRRT was associated with a reduction in mortality than those
treated without CRRT. However, the potential
role of extracorporeal therapy techniques needs to be evaluated by the treating
physician.”
Experts are unanimous that acute
dialysis techniques such as CRRT may also be effective in treating patients
with COVID-19 and sepsis syndrome irrespective of their kidney function.
Considering the ongoing scenario and the increasing rate of kidney involvement
due to COVID-19, such extra-corporeal
therapies may play an important role in the treatment of severely ill patients.
Right treatment by the experts at the right time can save the lives of the
infected people who are battling between life and death.
References:
[1] ISN Guidelines 2020,
https://www.theisn.org/covid-19. Last accessed on 25th March 2020
[2] Chu KH, Tsang WK, Tang CS et al. Acute
renal impairment in coronavirus associated severe acute respiratory syndrome.
Kidney Int. 2005 Feb; 67(2):698-705.
[3] Arabi YM, Arifi AA, Balkhy HH, et al.
Clinical course and outcomes of critically ill patients with Middle East
respiratory syndrome coronavirus infection. Ann Intern Med. 2014 Mar 18;
160(6):389-97.
[4] Ghani RA, Zainudin S, Ctkong N, et al.
Serum IL-6 and IL-1-ra with sequential organ failure assessment scores in
septic patients receiving high-volume haemofiltration and continuous venovenous
haemofiltration. Nephrology (Carlton).2006 Oct;11(5):386-393.
[5] Yi Yang*, Jia Shi*, Shuwang Ge et al. Effect
of continuous renal replacement therapy on all cause mortality in COVID-19
patients undergoing invasive mechanical ventilation: a retrospective cohort
study. https://doi.org/10.1101/2020.03.16.20036780
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