Novel coronavirus disease 2019 (COVID-19) is caused by severe acute respiratory distress syndrome (SARS) – coronavirus 2 (cov-2) (corona meaning a crown). This virus has an origin from animals (bats) and after transmission to humans is spreading among humans. The virus has been seen to be shed in respiratory secretions and in stools with maximum viral secretion noted by second week. Hence the human-to-human transmission occurs by droplet transmission of virus (respiratory secretions), direct contact or through fecal route. The human to human transmission of this disease has spread to such extents to become a pandemic causing about one lakh deaths and counting still!
SARS-cov2 disease affects people of all ages including children and presents mainly with influenza – like illness with fever, cough, malaise, myalgia, loose stools and shivering. Cold or running nose is an uncommon presentation. 80% cases have mild illness which is self-limiting, 15% have severe infection and only 5% critical illness – progressing to breathlessness requiring hospitalization and intensive care support.
This disease mainly affects the lungs in the form of pneumonia or leading to a condition called acute respiratory distress syndrome (when requirement for oxygen and further ventilator support is noted). The coronavirus also affects other organs like kidneys, heart, digestive tract, blood and nervous system.
This disease is more common and can be severe among the pregnant women, new born, the elderly, and people with co-morbidities (diabetes mellitus, hypertension, ischemic heart disease, chronic respiratory diseases, chronic liver disease, cancers and chronic kidney disease). It has also negative impacts on those undergoing renal treatment.
Kidney involvement in this disease is noted in 25% to 50% of the individuals and can present as protein leak in urine (proteinuria) and red blood cells in urine (microscopic hematuria). About 15% do have acute renal failure and some of them require renal replacement therapy (in the form of hemodialysis for kidney failure, continuous renal replacement therapy or sustained low efficiency dialysis). Renal dysfunction can also occur as part of multiple organ involvement requiring care in the intensive care unit.
In individuals who already have chronic kidney disease can have worsening of the renal parameters. These individuals as mentioned earlier are more prone for this disease and may present with severe forms of COVID-19.The presentation of the disease is however no different from the others. Luckily, not many cases have been reported so far among the chronic kidney disease population and/or those undergoing renal treatment.
Dialysis population are more at risk for this disease due to the need for frequent travels to dialysis units or dialysis hospitals. Hence it is imperative they are cautious and follow steps to prevent the disease.
Renal transplant recipients are at risk to develop COVID-19 as they are on immunosuppression medications and hence cannot mount a good response against this disease. They are also more prone to develop severe disease and may require intensive care. However, not many cases are reported so far. In view of this higher risk for the COVID-19, no new renal transplantations/renal replacement therapy will be performed until the pandemic is controlled or dies down.
Renal donors (living related renal donors) have not been documented to have any additional risk for COVID-19 as compared to the general population.
Management of the disease basically involves supportive care, oxygen support, intravenous fluids, antipyretics and though antiviral drugs, and drugs with antiviral properties are being tried, specific therapy is yet to be identified.
As in all cases, prevention is better than cure!
Steps to prevent COVID-19:
- Frequent handwash with soap and water or alcohol-based hand sanitizers (containing more than 60% content of alcohol)
- Social distancing
- Use of masks (even the homemade ones) especially during visits to hospitals (more so for dialysis population)
- Cough etiquette – cough into the tissue or into the bent elbow – discard tissue appropriately in a dust bin
- If any fever – report at once to the doctor, inform about any travel history (other countries or locally where disease is more common), contact with any positive cases or suspected cases or the contacts of such people
- Individuals on haemodialysis for kidney failure are requesting to stay at home on non-dialysis days strictly and to venture outside only for the dialysis sessions to the dialysis hospital – with appropriate face mask worn.