[Occupymendocino] COVID-19 often experience kidney problem

[Richard Karch]

COVID-19 often experience kidney problem

By Pam Belluck

The New York Times
Sept. 1, 2021

Since the beginning of the pandemic, doctors have found that people who 
become very ill with COVID-19 often experience kidney problems, not just 
the lung impairments that arethe hallmark of the illness.

Now, a large study suggests that kidney issues can last for months after 
patients recover from the initial infection and may lead to a serious 
lifelong reduction of kidney function in some patients.

The study, published Wednesdayin the Journal of the AmericanSociety of 
Nephrology, found that the sicker COVID-19 patients were initially, the 
more likely they were to experience lingering kidney damage.

But even people with less severeinitial infections could bevulnerable.

“ You see really, across the board, a higher risk of a bunch of 
important kidney-associated events,” said Dr. F. Perry Wilson,a 
nephrologist and associate professor of medicine atYale, who was not 
involved in the study. “And what was particularly striking to me was 
that these persisted.”


Kidneys play a vital role in the body, clearing toxins and excess fluid 
from the blood, helping maintain a healthy blood pressure, and keeping a 
balance of electrolytes and other important substances. When the kidneys 
are not working properly or efficiently, fluids build up, lead-

nths after becoming infected, COVID-19 survivors were about 35% more 
likely than non-COVID-19 patients to have kidney damage or substantial 
declines in kidney function, said Dr. Ziyad Al-Aly, chief of the 
research and development service at the VA St. Louis Health Care System 
and senior author of the study.

"People who have survived the first 30 days of COVID are at risk of 
developing kidney disease," saidAl-Aly, a nephrologist and assistant 
professor of medicine at Washington University School of Medicine.

Because many people with reduced kidney function do not experience pain 
or other symptoms, "what's really important is that people realize that 
the risk is there and that physicians caring for post-COVID patients 
really pay attention to kidney function and disease," he said.

The two sets of patients in the study differed, in that members of one 
group had all been infected with COVID-19 and members of the other group 
may have had a variety of other health conditions. Experts cautioned 
that there were limitations to the comparisons.

The researchers tried to minimize the differences with detailed analyses 
that adjusted for a long list of demographic characteristics, 
preexisting health conditions, medication usage and whether people were 
in nursing homes.

Another limitation is that patients in the VA study were largely male 
and White, with a median age of 68, so it is unclear how generalizable 
the results are.

One strength of the research, experts said, is that it involves more 
than 1.7 million patients with detailedelectronic medical records, 
making it the largest study so far on COVID-19-related kidney problems.

While the results most likely would not apply to all COVID-19 patients, 
they show that for those in the study, "there's a pretty notable impact 
on kidney health in survivors of COVID-19 over the long term, 
particularly those who were very sick during their acute illness," said 
Dr. C. John Sperati, a nephrologist and associate professor of medicine 
at Johns Hopkins, who was not involved in the study.

Other researchers have found similar patterns, "so this is not the only 
study suggesting that these events are transpiring after COVID-19 
infection," he said.

He and other experts said that if even a small percentage of the 
millions of COVID-19 survivors in the U.S. developed lasting kidney 
problems, the impact on health care would be great.

To assess kidney function, the research team evaluated levels of 
creatinine, a waste product that kidneys are supposed to clear from the 
body, as well as a measure of how well the kidneys filter the blood 
called the estimated glomerular filtration rate.

Healthy adults gradually lose kidney function over time, about 1% or 
less a year, starting in their 30s or 40s, Wilson said. Serious 
illnesses and infections can cause more profound or permanent loss of 
function that may lead to chronic kidney disease or end-stage kidney 
disease.

The new study found that 4,757 COVID-19 survivors had lost at least 30% 
of kidney function in the year after their infection, Al-Aly said.

That is equivalent to roughly "30 years of kidney function decline," 
Wilson said.

COVID-19 patients were 25% more likely to reach that level of decline 
than people who had not had the illness, the study found.

Smaller numbers of COVID-19 survivors had steeper declines. But COVID-19 
patients were 44% more likely than non-COVID-19 patients to lose at 
least 40% of kidney function and 62% more likely to lose at least 50%.

Doctors are unsure why COVID-19 can cause kidney damage. Kidneys might 
be especially sensitive to surges of inflammation or immune system 
activation, or blood-clotting problems often seen in COVID-19 patients 
may disturb kidney function, experts said.