Coronavirus & Kidney Disease
Covid-19 is a type (strain) of coronavirus. A virus is a very tiny germ that can cause an infection and can only replicate in a living host (humans or animals). When we say tiny, this new coronavirus is 80-140 nanometre in diameter. A normal ball pen tip is about 1mm in diameter. About 1.7crore to 3.9 crores of this virus can be comfortably accommodated on the tip of it. Coronaviruses are a group (or family) of viruses that cause different illnesses. These illnesses can range from the common cold to more severe diseases, such as Severe Acute Respiratory Syndrome (SARS).
The disease caused by this virus has different names, one of them being Covid-19 – Coronavirus Disease 2019 for the year in which it first appeared globally. Covid-19 is also known as “novel coronavirus,” meaning a new type of coronavirus not previously discovered or identified. Covid-19 is also called SARS-Cov-2 for severe acute respiratory syndrome coronavirus 2.
Covid -19 is a new virus to which no one has immunity. Its average mortality is about 3.4%, which is lesser than other corona viral diseases like SARS and MERS. However, it is highly contagious and spreads through contact and /or even air, as per recent studies. Persons who are in contact with Covid -19 patients/asymptomatic carriers are more prone to get infections
Which is the population at risk?
The following groups are more at risk for Covid-19:
- •Older adults
- •Any person with the following medical conditions
- •heart disease
- •HIV or weakened immune system
- •chronic kidney disease requiring dialysis
- •Pregnant women
Individuals with a kidney transplant and taking immunosuppressant medicines may also be at a higher risk.
Coronavirus and Acute kidney damage
Detecting proteins and/or blood in urine is an early sign of kidney involvement in people with confirmed Covid-19. Approximately 3% to 9% of patients with confirmed Covid-19 develop acute kidney failure, with many requiring dialysis treatment. Regardless of age, people with AKI (acute kidney injury) have poor outcome. It has been recommended that recovered Covid-19 patients who had an AKI should be seen regularly by a kidney doctor because their risk of developing chronic kidney disease is higher than others. Covid-19 patients who did not develop an AKI, but who had blood and/or protein in their urine should be monitored since they are at increased risk of developing chronic kidney disease.
- General Recommendations
- a) Strictly avoid contact with someone who is displaying symptoms of coronavirus (Covid-19).These symptoms include high temperature and/or new and continuous cough.
- b) Do not leave your house or attend any gatherings
- c) Do not go out for shopping, leisure or travel
- d) Do not shake hands, hug or kiss anyone, including children / parents / grandparents
- e) In case you receive deliveries, these should be left at the door to minimise contact
- f) Keep in touch using remote technology such as phone, internet, and social media
- g) Always wear a face mask when outside your house
- h) Practice sneeze and cough hygiene. Avoid touching your eyes, nose, and mouth with unwashed hands
- i) Wash hands well periodically with soap and water for 20 seconds/ use sanitiser with at least 60% alcohol
- j) Clean and disinfect frequently touched surfaces daily. This includes tables, doorknobs, light switches, countertops, handles, desks, phones, keyboards, toilets, faucets and sinks.
- k) Practise regular deep breathing exercises for increasing lung capacity
2) For patients with kidney disease
Isolation has to be complete (i.e. no face to face contact or physical proximity with anyone, including members of the family inside the house) and prolonged (12 weeks or more) in case one belongs to any of the groups mentioned below:
- a) dialysis – hemodialysis or peritoneal dialysis
- b) kidney transplant
- c) on immunosuppressive therapy like steroids, Tacrolimus, MMF, Rituximab, Cyclophosphamide etc for the treatment of various renal diseases like nephrotic syndrome, glomerulonephritis, vasculitis etc
I] Precautions for patients with chronic kidney disease
COVID-19 is a new virus and therefore research on it has only just begun. Leading health organisations such as the World Health Organization (WHO) and the Centre for Disease Control and Prevention (CDC) have not recommended that patients stop any particular drug in order to decrease the chance of getting COVID-19 or to make it less severe.
Blood pressure medications called angiotensin converting enzyme inhibitors (ACEs) and angiotensin receptor blockers (ARBs) should NOT be stopped, unless recommended by a healthcare professional. These are key drugs in controlling blood pressure in patients with kidney disease. Stopping them could lead to a heart attack, stroke or decreased kidney function.
Patients with kidney transplants should not stop taking their immunosuppressants or lower their dose, unless their healthcare team tells them to. Stopping the immunosuppressants will most likely lead to loss of the donated kidney. The transplant team should be contacted for any questions or concerns.
Patients with kidney disease are usually told to avoid non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen. In general, kidney experts recommend acetaminophen for pain relief and reducing fever. The healthcare team should be consulted before making any changes in the drugs being regularly taken.
II] Recommendations for patients on hemodialysis
- a) Travel to the dialysis unit as safely as possible. Do not use public transport for the same
- b) If in a taxi or autorickshaw ensure minimum contact with co passengers. Sit in the front seat of the car and keep the windows open. Avoid use of air conditioning while travelling with co passengers in a car. Make sure all other people in the vehicle are wearing masks and maintaining a safe distance. Carry an alcohol based sanitiser and disinfect hands periodically
- c) Inform the dialysis staff on telephone if you begin to suffer any symptoms like fever and cough with sore throat or breathlessness, which could indicate a possible COVID 19 infection
- d) Maintain strict social distancing and wear face mask at all times while in the dialysis unit and hospital
- e) Intimate the dialysis staff in case any other patient in the unit has a cough or sore throat
- f) Avoid eating any meals while undergoing dialysis. In case essential, carry candy or chocolate to avoid low sugars during dialysis
- g) Keep at least 12 weeks of medication supplies stocked at home.
- h) Strictly do not miss the dialysis schedule as this might turn into an emergency and further exposure to hospitals surroundings and ICU admissions
- i) Drink regulated liquids / fruits and eat heathy. Strict dietary and medicine compliance is advised in this period to avoid hyperkalemia and uncontrolled blood pressure issues. Drink warm water and avoid cold water / drinks and ice
- j) Avoid regular visits to your doctor and discuss small issues on media / email / telemedicine
Is there any treatment for covid 19?
Presently there is no definitive treatment available for this virus. There are few antimicrobials with potential activity against SARS-CoV-2 such as Hydroxychloroquin, Chloroquin, Lopinavir, Remdisivir and Faviperavir. Some compounds are adjunctive or for supportive care such as Azithromycin, Immunomodulating agents, COVID-19 convalescent plasma, Anticoagulation, and interleukins like Tocilizumab, & Sarilumab. Apart from this, detailed research is ongoing rapidly in several countries in developing a successful vaccine. Plasma therapy and stem cell work are also being followed extensively.
In conclusion, coronavirus is a novel virus which spreads very rapidly in the community with 3-5% mortality and presently we do not have any definite treatment or vaccine. Mortality goes upto 15-20% in elderly population, patients with poor immunity due to underlying illness like kidney, disease. Since there is no way to fight this deadly virus, the only option is to maintain social distancing, self-hygiene and educating one and all around.