Managing kidney disease in COVID-19 positive cases becoming a challenge

Managing those with kidney disease among the COVID-19 positive cases is emerging as an additional challenge to doctors battling the pandemic.

On April 23, a 70-year-old man died of COVID-19 at the Rajiv Gandhi Government General Hospital here after he tested positive. Hospital authorities said he had diabetes, hypertension and chronic kidney disease and was on dialysis.

Recently, an elderly woman who was admitted for kidney problems at the same hospital tested positive for coronavirus after she was suspected to have contracted the virus from a doctor who was treating her.

The doctor, in turn, is suspected to have got the infection from a patient he was treating.

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"Effect on the kidney is secondary to hypoxia or cytokines released by the COVID-19. It is generally perceived that COVID-19 types of viruses are borne from respiratory systems lungs - but a growing body of evidence shows that the virus also attacks the kidneys either directly or mediated by excessive immune response seen in severe COVID-19 patients and not just the lungs," said Dr Suresh Rao, Intensivist with the city-based MGM Health Care.

Citing the reports of SARS and MERS-CoV infections, he says 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.

"The preliminary reports of COVID-19 patients suggested a lower incidence (3 to 9 per cent) of AKI, but later reports indicated a higher frequency of abnormalities. A study of 59 patients with COVID-19 revealed that about two- thirds of patients developed a massive leak of protein in urine during their stay in hospital," he said.

A senior state Health official said "chronic kidney disease stage-5 patients on dialysis are also vulnerable group because of their existing co-morbidities, repeated unavoidable exposure to hospital environment and immunosuppressed state."

"Due to their health conditions, they also develop severe diseases as compared to general population," the official said.

Prior to reporting coronavirus cases in Tamil Nadu, the state health department identified the vulnerable groups including those who require dialysis and ensured their treatment was not affected.