Covid may accelerate the loss of kidney function in some patients | Mumbai news - Hindustan Times
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Covid may accelerate the loss of kidney function in some patients

ByJyoti Shelar, Mumbai
Oct 03, 2021 01:31 AM IST

Doctors said kidneys have borne the most impact during the pandemic –patients with chronic kidney diseases suffered as dialysis units shut down at the beginning of the pandemic, patients with existing kidney diseases were at higher risk of getting the Covid-19 infection.

A 63-year-old businessman from south Mumbai, who has been suffering from diabetes and kidney disease, had a gradual deterioration in his kidney function over the years. His kidney’s filtration rate, known as the estimated glomerular filtration rate (eGFR), had dropped from 60 in 2017 to 50 in 2020. Last August, the businessman contracted Covid-19 and his two-week-long battle with the infection led to his kidney function dropping speedily to 35. He was eventually put on dialysis two months ago.

Patients with kidney diseases are staged according to their eGFR. When patients reach stage 5, they are put on dialysis and are recommended transplants. (HT FILE)
Patients with kidney diseases are staged according to their eGFR. When patients reach stage 5, they are put on dialysis and are recommended transplants. (HT FILE)

Doctors said kidneys have borne the most impact during the pandemic –patients with chronic kidney diseases suffered as dialysis units shut down at the beginning of the pandemic, patients with existing kidney diseases were at higher risk of getting the Covid-19 infection, and patients like this south Mumbai businessman, who contracted the infection, had kidney functions worsening at a much faster rate.

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“On an average, kidney patients have 3% to 5% loss of kidney function every year,” said Dr Hemal Shah, a nephrologist from Bhatia Hospital, who has been treating the south Mumbai businessman. “When these patients get Covid-19, their kidney function deteriorates much faster, at a double speed,” he added.

Kidneys are two bean-shaped organs that filter the blood in the body by removing waste and extra water to make urine. The filtration function of the kidneys is crucial to remove the toxins and ensure a normal body function. The rate of a kidney’s filtration or eGFR is calculated by measuring the levels of creatinine, which is the waste produced during the normal wear and tear of the body muscles.

Patients with kidney diseases are staged according to their eGFR. An eGFR slightly higher than 90 is considered stage 1; eGFR between 89 and 60 is stage 2; 59 to 30 is stage 3; 29 to 15 is stage 4 and an eGFR less than 15 is considered stage 5. When patients reach stage 5, they are put on dialysis and are recommended transplants. Until then, they are managed with a combination of treatment and a restricted diet, which includes a lower quantity of proteins.

Medical experts say that any kind of severe infection can have an impact on the kidneys. For instance, if someone has severe pneumonia or typhoid, the body typically activates its immune system to fight the disease and it may lead to inflammation.

“In Covid-19, too, as the body attempts to fight the infection, a systemic inflammation may occur,” said nephrologist Dr Bharat Shah from Global Hospital. “Systemic inflammation is a state when the whole body is inflamed. During this, the kidneys are also inflamed and their function gets affected. However, we have seen such reaction only in moderate to severe Covid-19 patients,” he added.

How exactly does the virus impact the kidneys? The kidneys are made of lakhs of filtering units called nephrons. Each nephron consists of a filter called the glomerulus and a small tube known as a tubule.

According to Dr Shah, any organism enters the human body by binding to a receptor – a molecule that receives signals for a cell. “The Sars-CoV-2 is known to bind with the angiotensin-converting enzyme 2 (ACE2) receptor. These receptors are present on the tubules of the kidney, which perhaps makes it easier for the virus to impact the kidneys in an infected patient,” he said.

A study from Brazil, published last month in the peer-reviewed journal Frontiers in Physiology, stated that the “impairment of ACE2’s biological functions can lead to a drop in renal blood flow and a reduced glomerular filtration rate (GFR), altering the capacity of the kidneys to eliminate substances (metabolites) that are toxic in excessive quantities. It can also increase vasoconstriction (narrowing of blood vessels) in the kidneys, leading to renal function deterioration.”

The researchers highlighted that there is no available information on the impact of Covid-19 on long-term kidney function, but Covid-related acute kidney injury seems to contribute to a faster decline in GFR, higher rate of kidney replacement therapy requirement, and slower complete kidney function recovery. They also highlighted the importance of monitoring kidney function in Covid-19 survivors who presented acute kidney injury or kidney abnormalities.

Dr Shah from Bhatia Hospital cited another case of a 43-year-old carpenter who did not have any existing history of kidney disease but was admitted with a very high creatinine level when he contracted Covid-19 last September. At the time of discharge from the hospital, his eGFR had dropped to 20, meaning he was in the stage-3 category of chronic kidney disease. “He somehow pulled off over the past several months, but we had to eventually put him on dialysis last week,” said Dr Shah, adding that the patient is also likely to undergo a kidney transplant soon as one of his close relatives is willing to donate the organ.

A senior doctor from a civic-run hospital in Mumbai said that Covid-19 mortality among kidney patients is likely to be higher. “We need quick, large-scale, detailed studies from all institutions to understand the impact of Covid-19 on kidneys and introduce mitigation measures, mainly in the non-urban pockets where medical services are already compromised,” he said.

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