Apart from ventilators, another kind of machinery that is in shortage amid the coronavirus pandemic is dialysis machines. Different research reports are now suggesting that a significant proportion of Covid-19 patients are experiencing kidney failure or kidney damage. In the past few weeks, several reports signal that hospitals around the world are looking at shortages of vital equipment other than ventilators and personal protective equipment (PPE) including dialysis machines in their critical care wards. Does the virus attack the kidneys? According to Science, kidney damage is common in severe cases of Covid-19, making death more likely. However, it is not yet clear if the virus directly attacks the kidneys, or if kidney failure or damage is a part of multiple-organ failure. One possible reason that the virus may directly attack the kidneys could be the abundant presence of Angiotensin-converting enzyme 2 (ACE2) receptors on the kidneys. ACE2 is an enzyme found on the outer surface of the kidney. It can be an entry point into cells for some coronaviruses. 📣 Express Explained is now on Telegram. Click here to join our channel (@ieexplained) and stay updated with the latest One study of 85 hospitalised patients in Wuhan published on the pre-print server medRxiv suggests that over 27 per cent experienced kidney failure. Research in the American Journal of Kidney Diseases (AJKD) says that while initial reports from Wuhan suggested that the burden of Acute Kidney Injury (AKI) with Covid-19 was relatively low (3-9 per cent), subsequent analyses demonstrated that the incidence rates of AKI were as high as 15 per cent. Further, AKI is more common among more severe patients who are admitted in intensive case units. Another analysis published in the journal Nature, however, notes that the prevalence of AKI among patients with Covid-19 seems to be low. In a Chinese cohort of 1,099 patients with the disease, 93.6 per cent were hospitalised, 91.1 per cent had pneumonia, 5.3 per cent were admitted to the ICU, 3.4 per cent had acute respiratory distress syndrome (ARDS) and 0.5 per cent had AKI. Possible ways that the virus may harm the kidneys Broadly, there could be two possible ways in which SARS-CoV-2 may affect the kidneys, one way is when the body's inefficient immune system response induces what is known as a "cytokine storm". In case of a cytokine storm, an overstimulated immune system response can trigger an excessive release of white blood cells, which, instead of repairing damaged tissues, start attacking the healthy tissue as well. A cytokine storm can lead to sepsis, multiple organ failure and potentially death. Therefore, it is possible that a Covid-19 patient may suffer kidney failure or damage as a result of facing multiple-organ failure. Another possible pathway is when the virus directly attacks the kidneys, possibly because of the abundant presence of ACE2 receptors on the kidney cells. How are kidney failures and damages dealt with? As per the AJKD research, in case of kidney damage or injury, some patients may need dialysis, the need for which arises usually in the second week of infection and it affects close to five per cent of the ICU patients. These patterns are consistent with estimates from the SARS and MERS outbreaks. Therefore, as healthcare systems across the world are stretched out on both material and human resources, it also poses a risk for patients with kidney failure not having access to dialysis care. Dialysis is a process by which unwanted substances and fluids are filtered out from the blood when kidneys themselves are not able to perform this function. Don't miss from Explained | Coronavirus numbers still small, but Bihar signalling a surge
