I’m getting a lot of calls and emails nowadays from my patients and the general public asking me whether coronavirus affects the kidneys. The answer is yes, it does. Experience from China and South Korea has shown that it can cause protein leakage in urine in about 30-40 percent patients and Acute Kidney Injury (AKI) in 15-20 percent patients. AKI is due to multiple factors like dehydration, sepsis and also the concomitant use of painkillers indiscriminately for reducing fever.
Kidney damage has been seen in advanced stage of the disease when the patient has multi-organ failure. At that stage, treatment is usually supportive in the form of dialysis and, if the general condition of the patient improves, the kidney functions of these patients will get better. It remains to be seen how many patients will progress to develop chronic irreversible kidney damage called CKD.
Kidney disease is a non-communicable disease and currently affects around 850 million people worldwide. One in 10 adults has Chronic Kidney Disease (CKD). A bigger concern, however, is that patients with CKD are prone to contract coronavirus infection and worsen kidney damage. This is because they have poor immunity. This also applies to kidney transplant patients as well as those who are on immunosuppression.
10 Commandments
The following should be adhered to by kidney patients to minimise the risk of contracting a coronavirus infection:
1. Wash your hands frequently or use an alcohol-based sanitiser.
2. Stop smoking and avoid alcohol intake as this weakens your immune system and increases the chances of a fulminant infection if you acquire a Covid-19.
3. Control your blood sugar.
4. Practice social distancing.
5. Keep yourself physically active. Breathing exercises help bolster immunity of the lung.
6. Eat a healthy diet rich in antioxidants (in consultation with your nephrologist and nutritionist). We should use natural foods rich in probiotics and antioxidants like yoghurt, ginger, turmeric and cabbage.
7. Drink plenty of water, preferably warm. If you sip water, you may swallow the viruses into your gut and prevent them from getting into your lungs. The human stomach has acidic ph which destroys viruses.
8. Make sure you are vaccinated against Pneumococcal infections as this will help minimise the chances of secondary infection.
9. Do not miss your dialysis treatments for fear of coronavirus.
10. Maintain a reserve of medications. If the same brand is not available, it is better to go for any generic brand rather than stopping it.
Family Members and Caregivers
1) All family members living with patients on dialysis must follow all the precautions, which includes body temperature check, maintaining personal hygiene, and promptly reporting a potentially sick person.
2) Patients on dialysis who have a family member or caregiver subject to basic quarantine can have dialysis as usual during the 14-day period.
So, kidney involvement seems to be frequent in this infection, and AKI is an independent predictor of mortality. The impact of this infection in those with CKD has not been studied but these patients are at high risk of severe infections. The management of patients on dialysis who are suspected to have been in contact with Covid-19 should be carried out according to strict protocols to minimise risk to other patients and healthcare personnel taking care of these patients.
The author is Director, Nephrology and Kidney Transplant, Fortis Group of Hospitals, NCR