The coronavirus and your kidneys 

The whole world is now virtually at a standstill. The rate of speed of the virus is astronomical and the death toll from the coronavirus is increasing by the hour. There are as much as 793 people dying within 24 hours in Italy as a result of COVID-19. As I write this piece, there are 382,644 documented infections with 16,587 deaths and 101,898 fully recovered as at March 24, 2020, 09:27 GMT according to John Hopkins University. In Ghana, there are currently 27 confirmed cases with two recorded deaths.

The coronavirus is in every conversation irrespective of the socioeconomic status, gender, political affiliation or religious group. There is fear and panic and multiple control measures by the World Health Organization (WHO), the Center for Disease Control and Prevention, etc to help prevent the spread with valuable information via all social media platforms to sensitize the public. It the light of all these valuable information, some are also spewing out fake news to feel relevant. Do not accept and share any information without verification especially that which spreads falsehood and panic.

Whoever thought the outbreak in Wuhan in the Hubei Province in China reported in December 2019 will lead to a declaration of a pandemic by the WHO by March 11, 2020 with such high infectivity and death rates. The world is indeed a global village and we need to be each other’s keeper.

COVID-19, caused by the coronavirus affects the respiratory system (airways) of humans. It is associated with fever, cough, sneezing, general weakness and difficulty in breathing. It eventually leads to the inability to breathe properly and the decrease in oxygen in your body is the main cause of death. It is spread by droplets that are released by the airways when one coughs out or sneezes.  When ones’ airways come into contact with the droplet containing the virus, they can get infected and can also pass it on. This happens very fast and spreads quickly especially in crowded areas. Again when one coughs into the hands or the droplet falls on a surface, and this surface is touched by another person, this person will get infected if the person touches the nose, mouth and eyes. Fortunately, majority (over 80 per cent) of the infections are mild and will not even require hospitalization but those with severe diseases can easily die.

The complications resulting from COVID-19 are respiratory failure, pneumonia and kidney disease. Kidney disease has been described in up to 9 per cent of COVID-19 patients but up to 15 per cent has been described in coronaviruses generally. A broad spectrum of the kidneys involvement has been described. There is evidence to show that people who are infected by COVID-19 can have their kidneys directly affected also. Some studies have shown that 34 per cent of patients have heavy amounts of proteins in their urine on admission which increases to 63 per cent during admission. Almost 30 per cent have blood detected in their urine on admission.  There is reduction in the kidney function in 15.5 per cent of patients. It is also know that when you have COVID-19 and develop kidney disease, your risk of dying in hospital increases remarkably. Some other studies have shown that the kidney function is reduced in about a third of patients and in two-thirds of patients who died. Unfortunately, we have no records of the effect of the virus on the kidneys yet in Ghana as most clinicians focus only on the respiratory symptoms only.

COVID-19, caused by the coronavirus affects the respiratory system (airways) of humans. It is associated with fever, cough, sneezing, general weakness and difficulty in breathing. It eventually leads to the inability to breathe properly and the decrease in oxygen in your body is the main cause of death.

It is not yet clear how kidney disease occurs but there is evidence that the virus can get into and may cause damage to the kidneys directly and hence the proteins and blood seen in the urine. It is also believed that the infection can lead to general malaise, inability to eat and drink and hence less amount of fluids in the body and hence kidney damage. There is also evidence to show that patients who are taking some particular class of blood pressure controlling medications are also at risk of death as compared to those not taking the medications. Hence should be switched to other classes when one gets the infection

There is no specific cure for COVID-19 patients with kidney disease. Supportive care is key to improve outcomes in such patients. The supportive care of such patients include bed rest, adequate nutrition which includes lots of fruits and vegetables to improve one’s immunity, adequate fluid intake to ensure the blood pressure of the patients are optimum, give oxygen to those with very low oxygen saturation and look out for complications and treat them appropriately and also look out for infections that can occur as a result of the COVID-19 infection for treatment. It has been established that people who are older are more susceptible to getting COVID-19 infections and more likely to die from the disease. This is because of their reduced immunity and patients with chronic kidney disease, kidney failure, on dialysis and patients who have undergone transplantation also have reduced immunity.  This increases risk of the infection and risk of dying in kidney disease patients.

There is no specific cure for COVID-19 patients with kidney disease. Supportive care is key to improve outcomes in such patients.

Patients who are on dialysis are expected to follow strictly all the necessary hygiene protocols to prevent contracting the disease. They are also at increased risk as they are supposed to travel to the dialysis unit three times a week and share the unit with other patients. They are even more at risk if they use public transport and the dialysis machines are too close to each other.

Prevention is key as the coronavirus increases risk of kidney disease and patients with kidney disease are more at risk of infection and death. Patients with kidney disease as well as their families should observe the following.

1. Wash your hands as frequently as possible: Regularly and thoroughly washing your hands with soap and water for at least 20 seconds is very important to prevent spread. You can hum the ‘happy birthday’ song twice to ensure you are spending enough time with the hand washing. If not available, you can use a hand sanitizer that contains about 70 per cent alcohol.
2. Avoid touching your eyes, nose and mouth: Your hands touch many surfaces and can pick up viruses without your knowledge. Once contaminated, hands can transfer the virus to your eyes, nose or mouth as most are in the habit of touching their faces frequently involuntarily.
3. Social distancing: this can be practiced by keeping a safe space between yourself and others: Maintaining a distance of about two meters between yourself and anyone who is coughing or sneezing has been shown to be very effective as droplet cannot travel beyond one meter as it’s not yet shown to be airborne. Maintaining healthy social distancing is key to preventing infections.
4. Practice respiratory hygiene: This means covering your mouth and nose with your bent elbow or tissue when you cough or sneeze. Please dispose of the used tissue immediately you are done.
5. Clean and disinfect your home: Practice routine cleaning of frequently touched surfaces like tables, doorknobs, handles, desks, taps, switches and mobile phones) using a regular household cleaning spray or wipe with antiseptics as the virus can stay on surfaces for hours to days and cause spread.
6. Avoid crowds as much as possible: you are cautioned to avoid social gatherings like churches, mosques, funerals and parties to reduce transmission and do not shake hands.
7. Stay at home: It’s a simple way to further reduce your risk of being exposed and spread if you have the virus. Call the approved numbers to report how you are faring as most may not need admission and hence do not need to be managed in hospitals except in severe cases.

As more data is collected in other to know more about this pandemic, remember to stay safe, and do not become a statistic. As the numbers come in, we hope to record and will be in a better position to report the effects of COVID-19 on the kidneys of patients seen in Ghana.

By Elliot Koranteng Tannor

Senior Specialist Physician/Nephrologist Komfo Anokye Teaching Hospital
Copyright ©2020 by Creative Imaginations Publicity
All rights reserved. This article or any portion thereof may not be reproduced or used in any manner whatsoever without the express written permission of the publisher except for the use of brief quotations in reviews.