COVID-19 and the impact on the Kidneys
More updates are emerging about Kidneys and COVID-19
As more emerges about the impact of Covid-19 (Sars-CoV2) we are beginning to unearth and understand more about the disease and the impact it has on the body’s organs. It has long been understood that the virus causes damage to the lungs and respiratory system, but we are also learning more about the severe and lasting damage to other organs, such as the Kidneys.
As commented by Christopher. John Sperati Director, Nephrology Fellowship Training Program AND Associate Professor of Medicine – John Hopkins Medicine:
“Some people suffering with severe cases of COVID-19 are showing signs of kidney damage, even those who had no underlying kidney problems before they were infected with the coronavirus. Early reports say that up to 30% of patients hospitalized with COVID-19 in China and New York developed moderate or severe kidney injury. Reports from doctors in New York are saying the percentage could be higher.’’ In some cases, it is severe enough for dialysis.
Some patients with severe COVID-19 have pre-existing conditions such as high blood pressure and diabetes, and these conditions increase the risk of kidney disease; however, it does not explain why some who had no previous kidney damage or conditions are seen to be displaying kidney issues.
Doctors and researchers are looking at the possibilities as to why the kidneys are affected by the virus - whether it is the body’s reaction, or whether the infection is causing blood clots that are clogging the kidneys.
Kidney function affects the other organs of the body, including the heart and lungs, which can also be negatively impacted by COVID. If doctors note the kidneys are showing damage through urine or blood work, it can be an indicator that a patient is showing a severe course of the illness.
Nice, The National Institute for Health and Care Excellence, has published a guideline on acute kidney injury which aims to assist non-healthcare professionals who are not kidney specialists to prevent, detect and manage AKI (Acute Kidney Injury) in patients in hospitals with suspected or confirmed COVID-19. It comes as further confirmation that there is emerging evidence to support that coronavirus directly harms the kidneys. AKI may be common in COVID-19 patients and correct management can impact the outcomes of the patients. It is important for patients to be screened for AKI and managed appropriately with fluid levels as this is critical to the outcome.
According to the Lancet , Kidney involvement is frequent in COVID-19; >40% of cases have abnormal proteinuria at hospital admission.
Acute kidney injury is common among critically ill patients with COVID-19, affecting approximately 20–40% of patients admitted to intensive care, according to experience in Europe and the USA. It is also considered a marker of disease severity and a negative prognostic factor for survival
Furthermore, the article comments that “the overall burden of AKI in COVID-19 might be underestimated, as creatinine values at admission might not reflect true preadmission baseline kidney function, and previous serum creatinine values might not be readily available.
“Around 20% of patients admitted to an intensive care unit (ICU) with COVID-19 require renal replacement therapy (RRT) at a median of 15 days from illness onset. Early recognition of kidney involvement in COVID-19 and use of preventive and therapeutic measures to limit subsequent AKI or progression to more severe stages are crucial to reduce morbidity and mortality.”
Such research points to the fact that patients need to be screened for potential issues as soon as admitted to the hospital and as an ongoing measure.
Are there products that can assist in identifying the impact on kidneys?
Sterilab Services has a range of products that can assist healthcare professionals monitor patient’s kidney function swiftly and identify any possible issues at Point of Care and hospital admission.
• The Urilyzer test strip reader is an intuitive connected system that will identify proteinuria in 60 seconds and flag abnormal results in red so that they are not missed. CombiScreen test strips are used in conjunction with the Urilyzer and can also be used for Visually read urine tests and have a clear parallel reading scale with easy detectable colour changes.
• Sterilab’s MALB Crea test strips also offer healthcare professionals an insight into possible kidney indications, by identifying the albumin creatinine ratio in the urine which is a detection method for early nephrology. With a low detection limit of 20 mg/l the strips enable a reliable screening method of at-risk patients. Read in just 60 seconds with no 24-hour sample collection required. These strips will soon be automatically detected and read in the Urilyzer (update in October)
• The Hemolyzer 5 NG is a compact 5-part WBC diff analyzer for Point of Care, Emergency Rooms and Central Laboratory use. The Hemolyzer 5 NG supports in the early screening of critical illness, diagnosis and treatment of COVID-19 by calculation of the neutrophil lymphocyte-ratio (NLR), which is provided with the new software version.
The importance of the NLR parameter
As described in a Chinese medical publication: Neutrophil-to-Lymphocyte Ratio Predicts Severe Illness Patients with 2019 Novel Coronavirus in the Early Stage , the data of 61 patients with 2019-nCoV pneumonia were analyzed. The study concludes that the age of the patient and the NLR value can be an early indication on the severity progress of the disease. Other manufacturers also issued a press release recommending the use of the NLR parameter to monitor, assess, and verify the severity course of COVID-19.
Whilst the NRL parameter alone CANNOT be used to give diagnosis and/or treatment and cannot by itself provide a basis for assessing or deciding on a patient's condition it can provide a foresight and a decision point for doctors at the front line of the epidemic. If someone is proven to be infected and has symptoms, he or she is under care and the patient's immune system is fighting the virus. Based on the patient's age and the measured NLR, the severity of the disease course can be estimated and preparations can be made in advance.
The NLR value can change drastically from day to day during the course of the disease. According to the article, the results showed that NLR was the most significant factor affecting the severe illness incidence, and it had significant predictive value.
For more information, contact Sterilab Services diagnostic specialists with over 20 years Healthcare experience.