A Brief Summary of recent publication on Kidney International Link here : https://doi.org/10.1016/j.kint.2020.03.001
Main Points
- COVID19 Mainly manifests as acute respiratory disease but can involve multiple organs such as the Kidneys, heart , digestive tracts, blood and nervous system
- Most cases are mild 16 -20% have been classified as severe/critical
- Patients with severe illness have high levels of multiple inflammatory markers
- Risk of AKI in earlier reports was around 3-9% , but massive Albuminuria more common even from first day up to 34%
- AKI was an independent risk factor for patients’ in-hospital mortality
- The exact mechanism of kidney involvement is unclear: postulated mechanisms include sepsis leading to cytokine storm syndrome or direct cellular injury due to the virus.
- SARS-CoV-2 has been successfully isolated from the urine sample of an infected patient, suggesting the kidney as the target
- The current treatment of COVID-19 with AKI includes general and supportive management and kidney replacement therapy. There is no effective antiviral therapy available at present.
- Treatments that showed some positive early findings include lopina-vir/ritonavir , redes vir, Chloroquine -phosphate ; all are under further investigations; look for national guidelines for use in your patients
- Use of steroids is controversial and not recommended by the World Health Organization because of potential inhibition of viral clearance and prolongation of the duration of viremia.
- Some centers used convalescent plasma and Monoclonal Antibody against ( IL-6) with some success ; studies are undergoing
- When Renal replacement therapy is needed for severe illness in AKI- , if there is the expertise and also availability of the machine use the continuous Renal replacement therapies as they help decrease personnel contact with the patient and also help decrease the inflammatory mediators especially when used in high flow hemofilters but in our country where this may not be available use regular HD therapies with high flux dialyzers
For patient on Maintenance HD
-Goal is to decrease the risk of transmission to patients and staff.
– Follow Established national Guidelines on COVID 19 prevention but pay particular attention to dialysis staff, Nurses, physicians and techs as they spend significant amount of time with patients in close contact
-A working team consisting of dialysis physicians, nursing staff, and technologists should receive training in updated clinical knowledge of epidemic COVID-19, notification of infection at risk, epidemic
-Group activities, including group rounds, group studies, and case discussions, should be minimized.
-Dialysis machine: equipment that may come into contact with patients or
potentially contaminated material should be disinfected according to stan-
dard protocols.
-The medical waste from confirmed or suspected patients with novel coronavirus
infection should be considered as infectious medical waste and disposed accordingly.
