The severe acute respiratory syndrome coronavirus 2 or SARS-CoV-2, the virus behind the COVID-19 pandemic, is well-known for causing respiratory problems. However, the virus does not only attack the lungs but targets other organs as well.
As UP College of Medicine professor and Philippine Nephrology Society vice president Dr. Elizabeth Montemayor said: “Patients with kidney problems are a very special group of patients who will need very special attention.”
Dr. Montemayor delivered her talk on “COVID-19 and the Kidneys” during the fourth installment of the UP “Stop COVID Deaths: Clinical Management Updates”, which was held on May 15, with replay available on the TVUP YouTube channel.
She discussed four different kinds of patients with kidney disease who are especially vulnerable to COVID-19: patients with Chronic Kidney Disease (CKD); patients who have had kidney transplants; patients who are on hemodialysis; and patients who have developed acute kidney injury (AKI).
According to Dr. Montemayor, patients with Chronic Kidney Disease have a higher risk of developing severe COVID-19. “This should be emphasized, because CKD patients should be advised to take extra precautions to minimize risk of exposure to the virus. Doctors engaged in the care of CKD patients should be really monitoring them for timely detection of disease progression,” she said.
She also discussed the effect of the virus on ACE (angiotensin-converting enzyme) receptors in the kidneys, and the use of ACE inhibitors and angiotensin II receptor blockers, which are used to treat hypertension and to prevent kidney failure in patients with diabetes.
Kidney transplant recipients need to take immunosuppressants to keep their bodies from rejecting the transplanted organ. These significantly reduce their body’s ability to fight off pathogens, including the SARS-CoV-2. As a result, the mortality rate is high for transplant patients who contract COVID-19. Hence, Dr. Montemayor stressed the need to enhance a transplant patient’s protection against contact with the virus. She also reiterated the statement of the Philippine Society of Transplant Surgeons, which recommends that “all living and deceased organ transplant surgical procedures be suspended indefinitely.”
Patients undergoing hemodialysis are another distinct population in the COVID-19 outbreak, given their relatively large number; their mobility as they travel to and from the dialysis facilities, which makes them potential vectors for infection; their close proximity to other patients and medical staff; and their impaired immune systems and comorbidities. In the Philippines, many hemodialysis facilities cannot handle or accept COVID-positive patients, displacing these patients and putting pressure on remaining hemodialysis facilities. “There is a need for designated COVID-19 dialysis units in different parts of the country to cater to the needs of this special group of patients,” Dr. Montemayor noted.
Finally, patients hospitalized for COVID-19 run the risk of developing Acute Kidney Injury (AKI) along with respiratory failure. Dr. Montemayor discussed the findings of various studies showing the association between respiratory failure and AKI, among others. Identifying patients with AKI may lead to a better allocation of hospital resources and better clinical outcomes for the patients.
The UP “Stop COVID Deaths: Clinical Management Updates” webinar series taps into the experiences of clinicians, hospital administrators, and researchers with the goal of protecting the health systems against COVID-19 by bridging the gap between knowledge and practice in the clinical management of cases in the Philippines. This webinar series is produced by the University in partnership with the National Telehealth Center and the Philippine Health Insurance Corporation.
The fifth installment of the webinar series will focus on COVID-19 and how it impacts other infections the Philippines is already battling with, such as tuberculosis, HIV and dengue, focusing on the experience of San Lazaro Hospital. The featured speaker will be Dr. Rontgene M. Solante, head of Adult Infectious Diseases, Tropical Medicine, San Lazaro Hospital.
Register for the UP “Stop COVID Deaths: Clinical Management Updates” webinar no. 5 here.
(This was originally posted on the UP System website on May 21, 2020)