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Although the novel coronavirus is known for causing respiratory symptoms, there are new questions about its impact on other parts of the body. COVID-19 may be linked in some patients with increases in inflammation of the heart as well as injury to other organs and tissues. William Brangham talks to Yale University's Dr. Alan Kliger about one of the concerning trends: serious kidney damage.
Even as we learn more about this coronavirus, there are new questions we didn't expect about what else it may be doing to the body.
In addition to the respiratory distress it causes, COVID-19 seems to be linked with increases for some patients in inflammation of the heart and other organ and tissue damage. None of these connections are conclusive.
But William Brangham explores one of those connections that has a number of doctors concerned.
One of the many things that we're learning about this novel coronavirus is the impact that it is having on the kidneys.
And, for that, I'm joined now by Dr. Alan Kliger. He's at the Yale University School of Medicine, and he co-chairs the COVID-19 Response Team for the American Society of Nephrology.
Dr. Kliger, thank you very much for being here.
Could you tell me when you first started to learn that what we think of as a respiratory virus is also damaging kidneys?
Well, some of the earliest reports out of China showed that, among COVID-positive patients admitted to the hospital, as many as 40 or even 50 percent had evidence of some damage in the kidney.
They had protein in their urine or blood in their urine. And 10 percent of them even had some decrease in kidney function. So, we knew early on that the kidney was one of the targets.
And do we know why the virus impacts the kidneys?
It's not so clear, but there's been a lot of speculation about that.
We know, for example, that the virus can attach to kidney cells through a specific receptor in the kidney. These same receptors are in other organs as well, and can damage the kidney directly.
We also know that, in patients who are very sick, who need to be on ventilators and are in intensive care units, that the combined illness in the lung and other organs can sometimes cause a huge inflammatory reaction. And the body releases these things called cytokines. And they can, in turn, damage the kidney.
So, what are the practical implications?
If I am someone who is infected with the coronavirus, and I'm getting quite sick, and it starts to damage my kidneys, what are — what does that mean for me as a patient?
Well, first of all, most people who are sick with this disease never get sick enough to be in the hospital and never get sick enough to have many organs damaged that way.
But if you look specifically at patients sick enough to be in the intensive care unit from COVID-19, it looks, in centers like New York that have a lot of disease, that 30 percent or 40 percent of those patients may have evidence of kidney failure.
There are even some places that they're as high as 50 percent of those intensive care unit patients who have kidney failure.
We know that's obviously a huge complication for the individual, but it's also got to put some stress on the ICU that is caring for them, because dialysis, that kidney care, is not something that is easily procured, right?
Well, it's true.
In centers like New York or other cities like Detroit or Chicago, first of all, many more intensive care units have had to be created to take care of patients who are so sick. And in those units, the provision of care, like dialysis or like continuous replacement therapy, different kinds of dialysis treatments that treat kidney failure, are very intensive of both equipment and personnel.
So, obviously, that means ICU staff have to be beefed up, the amount of equipment have to be beefed up.
Is it your sense that there are enough of those individuals and equipment to handle projected surge of cases?
Well, we know that best from the experience in New York, where, last week, many hospitals started running short of equipment and be concerned about those staff.
You know, many people taking care of patients with kidney — with COVID-19 themselves have been infected. And so, often, staff are out and ill. And so what we started hearing from New York was that the need for equipment and dialysis was four or five times usual, while staff available was sometimes 70 percent or 80 percent of what usually is used.
So that combination has made it really critical in some places to bring in more staff and to bring in more equipment.
And, long-term, do we know what this virus does to the kidneys over the long term, meaning, do people heal from this and can they restore traditional normal kidney function?
It's a good question. And this is early yet, and we don't have all the answers to that.
What we do know is that there have been patients who have had acute kidney injury from this illness that they have recovered from and where the kidneys have been able to go on and do what they have needed to without dialysis.
But we also know there are some patients who still have evidence of kidney failure and need dialysis even after they have been released from the hospital.
Another one of these long-term impacts of this virus we're going to be living with for a very, very long time.
Dr. Alan Kliger at the Yale University School of Medicine, thank you very much for your time.
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