Why Does COVID-19 Affect Those With Chronic Kidney Disease?

The topic of COVID-19 is all around us at the moment (and with good reason!) and you’ve likely heard that people with pre-existing health conditions like kidney disease are at risk of more serious complications. So, today I thought I’d unpack how COVID-19 affects the kidney and why people with kidney disease are at a higher risk of more severe infection.

First, though, we need to start at the beginning….

What is COVID-19?

At first, COVID-19 was known as ‘novel coronavirus’, which just means a new strain of coronavirus. Coronaviruses form a large family of viruses that can cause a range of illnesses from the common cold to more serious diseases like SARS (severe acute respiratory syndrome) and MERS (Middle East Respiratory Syndrome). After scientists discovered what this strain of coronavirus was and how to identify it in tests, they gave it the name: SARS-CoV-2 (Severe acute respiratory syndrome coronavirus 2). When someone gets sick with this virus, the illness is called COVID-19.

CO = Corona

VI = Virus

D = Disease

19 = Originating in 2019.

How does it infect the body?

For a virus to infect the body, it first has to gain entry into a cell. SARS-CoV-2 has spike-like protein on its surface that binds to ACE2 (angiotensin-converting enzyme 2) receptors- like a key being inserted into a lock- so ACE2 acts like a doorway for the virus to enter the body. 

ACE2 is a protein found on the surface of many cell types and tissues in the body including the lungs, heart, blood vessels, kidneys, liver and gastrointestinal tract. Given the number of organs that have ACE2 receptors, it starts to make sense that COVID-19 causes more than just lung problems. 

But how does COVID-19 cause kidney damage?

Now, it’s not yet fully understood how COVID-19 damages the kidneys but here are some possibilities that doctors and researchers are exploring:

1. COVID-19 directly attacks the kidneys (virus-mediated cell injury): as I already mentioned, the virus attaches to ACE2 receptors which are found in high concentrations in the kidney, this allows coronavirus to attach to kidney cells, invade cells and make copies of itself resulting in damage to the kidneys. 

2. Inflammation (immune hyperactivation)- they body’s reaction to the infection may also be responsible. The immune response to COVID-19 can be extreme in some people leading to what is called a cytokine storm which is overactivity of the immune system causing severe inflammation that can destroy healthy tissue, including that of the kidneys. 

3. Too little oxygen- another possibility is that kidney problems in patients with COVID-19 are due to abnormally low levels of oxygen in the blood, a result of pneumonia commonly seen in severe cases of the disease.

4. Lack of blood flow and blood clots- COVID-19 also appears to be associated with blood clots in the blood vessels that are important for the transfer of oxygen to organs. These blood clots can disturb normal blood flow and the ability of the blood to deliver oxygen to the kidneys.

5. Pre-existing conditions: many patients with severe COVID-19 have co-existing, chronic conditions, including high blood pressure and diabetes. Both of these increase the risk of kidney disease.

https://jasn.asnjournals.org/content/31/7/1380

Why does COVID affect those with CKD?

The first thing I want to point out is that COVID-19 can affect anybody however what we know is that people with CKD are at a higher risk of having a more severe disease. The research on why this occurs is still evolving but here is what we know so far.

• The incidence of Acute kidney impairment (AKI) is higher in patients with established CKD and the presence of AKI contributes to more severe disease and symptoms. 
• People with CKD are more likely to have cardiovascular disease, including high blood pressure and increased susceptibility to heart attacks and strokes. Cardiovascular disease is linked to more severe infections. 
• People with kidney disease are also more likely to be diabetic. Diabetes can cause severe cardiovascular issues and has been found to put people at risk of developing complications from COVID-19. Some studies are showing that COVID-19 could also induce new-onset diabetes.
• People with CKD have lowered immune function and are more likely to be taking immune-suppressing medication so have more difficulty in fighting off infections.
• People with CKD have higher levels of inflammation in the body, inflammation helps COVID-19 get into the body, bind to cell receptors and wreak havoc.

What role do ACE inhibitors and ARBs play?

You may have heard some discussion about ACE inhibitors and Angiotensin receptor blockers (ARBs) and whether their use increases infection severity. 

Angiotensin-converting enzyme (ACE, aka ACE1) is another protein, also found in tissues such as the lungs, heart and kidneys, where ACE2 is present. Drugs that inhibit the actions of ACE1 are called ACE inhibitors and are used to treat high blood pressure, heart failure and kidney disease. Examples of these drugs are ramipril, lisinopril and enalapril. 

Another commonly prescribed class of drugs, angiotensin receptor blockers (ARBs, eg. losartan, valsartan) have similar actions to ACE inhibitors. 

Some concerns have been raised that ACE inhibitors and angiotensin receptor blockers (ARBs) increase the susceptibility and likelihood of severe COVID-19 illness. On the other hand, there is some evidence that ACE inhibitors and ARBs could actually be protective and may be useful in treating COVID-19. 

At this time, there is insufficient clinical evidence that ACE inhibitors, ARBs or other inhibitors of the renin-angiotensin system are either harmful or beneficial when it comes to COVID-19 infection and its consequences.

https://www.nature.com/articles/s41581-020-0279-4.pdf

What are the long-term consequences of COVID-19?

The long-term consequences of COVID-19 infection still remain to be seen however potential consequences following severe disease are proposed to include lung damage, heart damage, neurological problems and kidney damage. 

The moral of the story?

Having a chronic health condition at a time when a global pandemic is going on may cause a lot of fear and uncertainty so the best thing to do is control the things you can control like managing your health and treating any underlying conditions. 

If you want a quick and easy guide to boost your immune system head to our home page and download our free 7 Immune Boosting Natural Remedies For Kidney Disease.

It is NEVER too late to take your health into your own hands. So if you have kidney disease or suspect you have kidney disease, do not be concerned, there is a growing encyclopaedia of tried and tested natural techniques here on this blog to help you recover from kidney disease, and of course, there is my complete kidney healing program available too, for those of you who like extra support and a step-by-step program.

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