Renal failure at Covid-19 is on the rise and has four possible causes

Renal failure at Covid-19 is on the rise and has four possible causes
Renal failure at Covid-19 is on the rise and has four possible causes

Kidney injuries have caused up to half of patients with Covid-19 who have developed severe conditions and were intubated to have kidney failure and need dialysis, according to the Brazilian Society of Nephrology (SBN).

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“When the condition is very severe, the patient may have kidney damage and need hemodialysis, because the kidney stops working”, says Osvaldo Merege, president of SBN. Who will need dialysis is the one who is intubated. It is known that 5% of patients have severe forms and that they need to intubate.

According to Merege, the need for hemodialysis affects up to half of critically ill patients. “In percentage, of the 5% that are intubated, 2.5% are in need. We have cases of hospitals undergoing dialysis in 30%, 40% and even half of the intubated patients.”

Possible causes

Organ damage can be caused by a serious event that affects some people with Covid-19, the storm of cytokines, an exacerbated reaction of the immune system that can affect the functioning of vital organs and lead to death. Sepsis and the action of the virus on the organ can also be linked to the cases.

At the end of March last year, the intensive care pediatrician Nelson Horigoshi, 65, had Covid-19 after going to a family meeting. “One person was infected. Six people got it and I was the only one hospitalized. And I was in a serious condition. I was intubated for 10 days and had to do some hemodialysis sessions. When my kidney started to respond, I managed to get rid of it. In all, they were 20 days in the ICU and 20 days in the bedroom. ”

In addition to the kidney problem, Horigoshi had cardiac and pulmonary involvement. “The cardiac part was the one that reversed the fastest. The lung took three months to normalize, but I still have a little fatigue to this day. I have insomnia and the kidney took a long time to improve. This month was the first that I had the kidney exam with result normal. It’s a terrible disease. “

It can become chronic

Many patients recover from this damage, but there are cases of people who end up progressing to chronic kidney disease, says the president of SBN. However, there is still no record of overload in the service because of the arrival of people who overcame Covid-19 and had kidney damage.

“It has no impact on the chronic ones, because they are machines used for acute cases. In chronic kidney patients, dialysis is programmed. But the number of acute cases has increased a lot in this new variant and with severe cases even among the youngest.”

Merege says that there are currently 144,500 chronic kidney patients on dialysis and that Covid-19 is dangerous for this group. “In the general population, mortality by Covid is 2.3%. In the population on dialysis, 30% of those who get it end up dying. Therefore, it would be important to prioritize the vaccine for these patients.”

HCor Nephrology medical leader, Leda Lotaif, says that the hospital increased the number of equipment already last year because she noticed that there were cases of kidney failure reported by other countries.

There were eight pieces of equipment, went to ten, reached 15 and should receive four more in the next few days. With the P1 variant, there is a perception that cases started to occur more frequently.

“We have not sequenced these patients, but in P1, apparently it is a more serious disease, which evolves quickly and gives more kidney failure. We had an increase in patients in need of dialysis and there are more young patients, in their 30s and 50s. It is definitely a more serious strain. ” At the hospital, according to Leda, between 35% and 40% of patients in the ICU need to do the procedure.

“We have patients who have already been discharged and patients who have had sequelae in the kidney and will have to follow up with a nephrologist. The kidneys are vital organs and people are not so aware until the moment when someone in the family starts to have kidney failure. They maintain fluid balance, are important for bone health and produce hormones that stimulate the bone marrow to produce red blood cells. People should spare themselves from having a disease like that. “

How does Covid-19 affect the kidneys?

  • Inflammatory storm: kidney damage may be caused by the cytokine storm, according to Leda Lotaif, HCor’s nephrology medical leader. “That is, inflammatory mediators released in great concentration in the blood circulation causing renal inflammation, as well as causing pulmonary, cardiac and other organs inflammation;
  • Organ Crosstalk: “It is a” cross line “of the lung-kidney axis, in which the acute respiratory syndrome caused by Covid causes kidney damage”, explains Leda;
  • Generalized infection: systemic effects caused by sepsis, a serious infection that can affect the functioning of organs and lead to death;
  • Direct toxic effect: cases of direct damage to kidney cells by the new coronavirus.

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