Explained: how the coronavirus can affect the kidneys

A patient undergoes dialysis treatment at a dialysis center, in the midst of the outbreak of coronavirus disease (COVID-19), in Guayaquil, Ecuador. (Reuters photo: Santiago Arcos)

In addition to ventilators, another type of machinery that is in short supply amid the coronavirus pandemic is dialysis machines. Different research reports now suggest that a significant proportion of Covid-19 patients experience kidney failure or kidney damage.

In recent weeks, several reports note that hospitals around the world are examining the shortage of vital equipment other than ventilators and personal protective equipment (PPE), including dialysis machines in their critical care rooms.

Does the virus attack the kidneys?

According to ScienceKidney damage is common in severe cases of Covid-19, increasing the probability of death. However, it remains unclear if the virus directly attacks the kidneys, or if kidney failure or damage is part of multiple organ failure. One possible reason why the virus can directly attack the kidneys could be the abundant presence of angiotensin-converting enzyme 2 (ACE2) receptors in the kidneys.

ACE2 is an enzyme found on the outer surface of the kidney. It can be an entry point to cells for some coronaviruses.

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A study of 85 hospitalized patients in Wuhan published on the prepress server medRxiv suggests that more than 27 percent experienced kidney failure. Research in the American Journal of Kidney Diseases (AJKD) says that while initial reports from Wuhan suggested that the burden of acute kidney injury (ARI) with Covid-19 was relatively low (3-9 percent), subsequent analyzes showed that ARI incidence rates they were as high as 15 percent. In addition, ARF is more common among more severe patients admitted to intensive case units.

Another analysis published in the magazine. NatureHowever, it points out that the prevalence of ARF among patients with Covid-19 seems to be low. In a Chinese cohort of 1,099 patients with the disease, 93.6 percent were hospitalized, 91.1 percent had pneumonia, 5.3 percent were admitted to the ICU, 3.4 percent had acute respiratory distress syndrome (ARDS), and 0.5 percent had an IRA.

Possible ways the virus can harm the kidneys

Generally speaking, there could be two possible ways that SARS-CoV-2 can affect the kidneys, one is when the inefficient response of the body’s immune system induces what is known as a “cytokine storm”. In the case of a cytokine storm, an overstimulated response from the immune system can trigger an excessive release of white blood cells, which, instead of repairing damaged tissues, also begin to attack healthy tissue. A cytokine storm can cause sepsis, multiple organ failure, and potentially death. Therefore, a Covid-19 patient may experience kidney failure or damage as a result of facing multiple organ failure.

Another possible route is when the virus directly attacks the kidneys, possibly due to the abundant presence of ACE2 receptors in kidney cells.

How are kidney failure and damage treated?

According to AJKD research, in case of kidney damage or injury, some patients may need dialysis, the need that generally arises in the second week of infection and affects about five percent of ICU patients. These patterns are consistent with estimates of SARS and MERS outbreaks.

Therefore, as health care systems around the world stretch both in material and human resources, it also represents a risk for kidney failure patients who do not have access to dialysis care. Dialysis is a process by which unwanted substances and fluids are filtered from the blood when the kidneys cannot perform this function.

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