Infection with the new crown (COVID-19), from asymptomatic infection to life-threatening respiratory failure, the clinical manifestations of different patients vary greatly.
Most symptomatic patients with COVID-19 have mild symptoms: the most common are nasal congestion, sneezing, Cough, sore throat, myalgia, and headache, and others have diarrhea, abnormal smell or taste, and other abnormalities.
Pneumonia is the most common serious manifestation of new crown infection, mainly manifested as fever, cough, difficulty breathing, chest Imaging bilateral infiltration. Some patients will also develop critical illness, acute respiratory distress syndrome, multiple organ damage and even death. [1]
The recent outbreak of the epidemic has caused us kidney friends to worry again: What will happen to the kidneys if you are infected with the new crown? Kidney Online will answer the questions that everyone cares about.
1. Is it more dangerous than the average person to be infected with the new crown?
Yes.
Infected with the new crown, the condition varies from mild to severe. In the first few months of the new crown, data from the Chinese Center for Disease Control and Prevention showed that about 80% of the new crown patients had mild or no symptoms, 20% of the patients were relatively severe or very severe, and the overall case fatality rate was about 2.3%[2]< /span>
Healthy individuals of all ages may have a relatively serious new crown infection, but the new crown is severe The patients are mainly concentrated in the following groups:Older, with underlying diseases and unvaccinated. [1]
Patients with chronic kidney disease infected with the new crown are more dangerous than ordinary people .
People at risk of developing severe disease ▽
and in patients with chronic kidney disease (hormonal immunosuppressive regimens) , cyclophosphamide and other immunosuppressants, rituximab, etc.), renal failure (CKD stage 4, 5), dialysis, kidney transplant patients. These immunocompromised patients are at risk of developing new coronary infection. The probability of severe illness is higher.
COVID-19 critical illness manifests as severe respiratory manifestations, such as dyspnea, severe hypoxia, and severe lung involvement , may also be combined with multiple organ damage, such as acute renal failure, severe intestinal obstruction, encephalopathy, sepsis, shock, multiple organ failure, etc., which means that patients may face admission to the intensive care unit, dialysis, tracheal intubation, mechanical ventilation, even death. [1]
2. Will the new crown cause kidney damage? How likely is it?
Yes, it will. The kidney is one of the target organs attacked by the new crown.
The specific manifestations are:Acute kidney injury< /span> (sudden increase in serum creatinine for a short period of time, some mildly increased by 1-2 times, severe may also increase by more than 2 times), hematuria or proteinuria increased High.
A small number of patients with new coronary infection, new-onset focal segmental glomerulosclerosis (FSGS), IgA nephropathy, ANCA-associated small vessel vasculitis, anti-GBM disease and other glomerular diseases.
In a meta-analysis of more than 13,000 hospitalized patients with COVID-19, The incidence of acute kidney injury caused by the new crown is about 17%, and 5% of patients are severe enough to require dialysis. But note that this is only a rough data, each patient’s condition is different, the probability and severity of kidney damage are very different. [3]
Different studies include different populations, the probability of kidney injury varies from 0.5% to 80%, and the proportion of severe cases requiring dialysis is also very different. For example, in a study that included 50,000 critically ill patients with COVID-19, 21% of COVID-19 patients in the ICU required dialysis. [4]
3. Why does the new crown cause kidney damage? Whether it is because of viral infection-induced hemodynamic changes, cytokine release, or direct nephrotoxicity of the virus, further research is needed.
4. Does the impact of the new crown on the body recover as quickly as a cold? Can kidney damage recover? When will it resume?
Coronavirus recovery is a continuous process. Some patients with mild symptoms of the new crown recovered faster, and recovered within 1 or 2 weeks. But there are also many patients with severe new crown infection that take longer to recover, such as 2 to 3 months to gradually recover. The recovery is usually divided into 2 phases: COVID-19acute infection : lasts 4 weekslong-term COVID-19: refers to the duration of There are various sequelae symptoms, lasting ≥2 months.You may have seen some new crown patients who recovered after passing through the acute phase on social media, reporting their own “sequelae” symptoms. The long-term effects of COVID-19 on the body are more common, usually including easy fatigue, difficulty breathing, chest pain and cough, and headaches, joint pain, dysgeusia, myalgia and diarrhea have also been reported, as well as difficulty concentrating , insomnia, anxiety and depression and other symptoms. The time for the symptoms to subside mainly depends on the age of the patient, the physical condition of the patient before the onset, and the severity of the new crown infection. However, even patients with mild symptoms of the new crown may have long-term sequelae.
For the kidneys, the new crown causes kidney damage, which may recover in the acute phase, or may develop into persistent, long-term, irreversible kidney damage. The degree of damage varies from person to person. different.
For example, in the study below, 32% of hospitalized patients with COVID-19 developed acute Kidney damage, but by the time they were discharged from the hospital, nearly half of them had not returned to their original level of kidney function. [5]
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Another study analyzed the renal sequelae after the acute phase of the new crown, compared with the new crown infection (more than 80,000 people) and renal prognosis of people without COVID-19 (more than 1 million), with a median follow-up period of 164 days (127-268 days).
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It was found that compared with people without the new crown infection, the patients infected with the new crown had subsequent worsening of renal function, uremia The risk is significantly elevated. And the more severe the disease, the greater the kidney risk. Even in patients with COVID-19 who did not have acute kidney injury at the time, their renal function declined faster during the follow-up period than those without COVID-19. [6]
The rate of deterioration of renal function, the average annual glomerular The filtration rate decreased by 3.26ml/min/1.73m2; in hospitalized patients without acute kidney injury, the annual average glomerular filtration rate decreased >5.2ml/min/1.73m2; for patients hospitalized with acute kidney injury, annual average glomerular filtration Rate dropped by 7.69ml/min/1.73m2.
Therefore, patients infected with the new crown need to pay special attention to kidney problems in the follow-up, especially if they have kidney disease before. people.
5. How should kidney patients be protected?
Wash your hands frequently, wear a mask, pay attention to open windows for ventilation and other well-known protective measures Not much to say here.
Here we focus on vaccines. Vaccines can reduce the infection rate of the new crown. Even if the vaccine is still infected, the vaccine can reduce the severe rate, and the same is true for kidney patients.
In addition to being allergic to the vaccine, which is an absolute contraindication to the new crown vaccine and cannot be vaccinated, other patients can Comprehensive judgment of your actual environment and condition, communicate with your doctor, and weigh the pros and cons of vaccinating against COVID-19. Especially for immunocompromised patients such as renal insufficiency and uremia, once infected with the new crown, the severe rate will be higher than that of ordinary people, and vaccination should be encouraged. For details, please refer to the article before the kidney launch: 1) New crown vaccine, can kidney disease patients take it? This article puts an end to your doubts and entanglements; 2) New crown vaccine, which kidney disease patients cannot get it? The article makes it clear; 3) What is the evidence for the advice on vaccination of patients with kidney disease against COVID-19?
Many kidney patients worry that vaccination will aggravate kidney disease. Is there such a situation? Yes! Recurrences of new-onset glomerular disease and relapse of pre-existing glomerular disease have been reported shortly after vaccination against COVID-19. For example, it has been reported that new-onset IgA nephropathy, minimal change disease, ANCA-associated small-vessel vasculitis, etc., shortly after vaccination; and patients with renal disease such as existing IgA nephropathy, minimal change disease, and membranous nephropathy, have relapsed after receiving the new crown vaccine. But overall, this is relatively rare. [7]
Everyone should know a truth, two The right to harm the lesser. For any medical decision, it is not necessary at allIt is more difficult to take risks. If you need to choose between the two options of jumping from the 1st floor and jumping from the 3rd floor, which one do you choose?
Like the following little friend who gave us feedback and our reply to her: She said she regretted getting vaccinated , Vaccine-induced MLD relapsed (Minimal disease itself is more likely to relapse, whether her relapse must be caused by vaccines is a question mark, or it may be a coincidence phenomenon). But in fact, there is nothing to regret if you choose it. If you are in a high-risk infection environment, high-risk infection occupation, and don’t get vaccinated, you will unfortunately be infected with the new crown. Not to mention the recurrence of kidney disease, there may be other more serious consequences. At that time, you will regret why you didn’t Vaccination.