Experts say up to 15% Covid-19 patients may also suffer kidney damage

Several patients infected with the novel coronavirus have developed symptoms of acute kidney injury or AKI, say experts.

A recent report of the International Society of Nephrology (ISN) reveals that of those infected with Covid-19, some 25-50 per cent 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 per cent patients. The finding suggests that Covid-19 also attacks the kidney.

“It is generally perceived that Covid-19 types of viruses are borne from respiratory systems — the 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, AKI had developed in 5 to 15 per cent cases, but about 60 to 90 per cent of those cases reported mortality,"  said Tushar Parmar, Intensivist, Apollo Hospital, Mumbai.

He added that 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, Parmar claimed.

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.

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.

"Previous studies  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 A S Ansari, Intensivist, Nanavati Hospital, Mumbai.