By now we all are aware of novel coronavirus diseases (COVID-19) which is a highly contagious disease caused by the severe acute respiratory syndrome (SARS)-coronavirus (CoV)-2. The disease is mainly manifested as a respiratory illness with interstitial and alveolar pneumonia, but it can affect multiple organs such as the kidney, heart, digestive tract, blood, and nervous system.

The kidney involvement

As per recent reports, a higher frequency of renal abnormalities has been observed. In a study involving 59 patients with COVID 19 reported that 34% of patients developed massive albuminuria on the first day of hospitalization, and 63% developed proteinuria during their hospital stay.

In another study, 44% had proteinuria and haematuria and 26.7% had haematuria on admission among a total of 710 consecutive COVID 19 patients.

Kidney involvements include sepsis leading to cytokine storm syndrome or direct cellular injury due to the virus. In the earlier SARSCoV and Mers-CoV, the viral binding occurred at the angiotensin-converting enzyme and dipeptidyl peptidase-4 on renal tubular cells, respectively. The novel coronavirus has also been isolated from the urine sample of an infected patient indicative of the fact that kidney may be target of the novel coronavirus.

Patients on dialysis

COVID-19 poses special challenge to patients on dialysis, especially, those in in-centre haemodialysis. Patients suffering with uraemia are especially susceptible to infection and may show larger variations in clinical symptoms and infectivity.

Patients undergoing in-centre haemodialysis significantly raises the risk of transmission of infections, including to medical staff and facility workers, patients themselves, care givers, family members and all others involved.

Immunosuppressed transplant patients

Immunosuppressed transplant patients are at an increased risk for serious illness if they come in direct contact with the coronavirus that causes COVID-19. Since coronavirus can easily spread from person-to-person and can be spread by asymptomatic individuals, anyone with a compromised immune system including transplant patients who take immunosuppressive drugs at an increased risk of becoming infected.

Newly transplanted patients are particularly susceptible during their recovery period following transplant surgery.

It has also been mandated that hospitals have to test deceased donors for the coronavirus. Transplanting an organ from a coronavirus -positive patient would pose a grave threat of infection to the recipient.

Resources:

1. Naicker S, Yang CW, Hwang SJ, Liu BC, et al. The novel coronavirus 2019 epidemic and kidneys. 2020; 97:824-28.
2. Internet source. Spigler M. 3 Reasons the coronavirus pandemic is affecting kidney transplants. KidneyToday. Accessed on April 4, 2020. Accessed from: https://www.kidneyfund.org/kidney-today/3-reasons-the-coronavirus-pandemic-is-affecting-kidney-transplants.html
3. Chu KW, Tsang WK, Tang CS, Lam MF, et al. Acute renal impairment in coronavirus-associated severe acute respiratory syndrome. Kidney Int. 2005; 67:698-705.