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 corona viruses, 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 extra corporeal 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 extra corporeal 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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