COVID-19 doesn’t only infect Lungs but also Kidneys: Experts say

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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. Chirag, Intensivist, Wockhart, Gujarat.
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. Mayur Patil,
Nephrologist, CMIS, Gujarat.
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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