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.
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.