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Post-COVID nephrology related conditions: MoHFW guideline updates

M3 India Newsdesk Mar 15, 2022

There are several nephrological conditions that are observed as a consequence of COVID infections. Discussed in this part of the series of COVID sequelae are the common nephrological conditions and their recommended management.


Key takeaways

  1. Acute kidney injury (AKI) is an independent predictor of mortality and poor outcomes in COVID-19 patients.
  2. It is important to note that often there are no symptoms/ signs of Post-COVID-19 related nephrological problems and patients are asymptomatic.
  3. If a Post-COVID patient is diagnosed with nephrological sequelae, he should be managed at a health care facility having the support of a Nephrologist and there should be access to dialysis services.

Common nephrological complications associated with post-COVID

The following are the most frequently occurring renal problems associated with COVID:

  • AKI in native kidney or transplant kidney
  • Rapid progression of pre-existing CKD in native kidney or transplant kidney
  • Progression of CKD to End-Stage Kidney Disease (ESKD) in native kidney or transplant
  • kidney
  • New-onset glomerular disease-proteinuria, hematuria and renal dysfunction
  • New-onset hypertension or worsening of hypertension


Prevalence and epidemiological load in terms of incidence

  1. AKI is an independent predictor of mortality and poor outcomes in COVID-19 patients. COVID-19 is known to cause AKI in about 46% of severe COVID-19 requiring ICU admissions. Around 20-30% ICU patients with AKI will need renal replacement therapy.
  2. Approximately 1/3 of the COVID-19 patients with AKI, who survived will not recover kidney function to baseline values within 3 weeks after discharge from the hospital.
  3. COVID-19 linked AKI also leads to a faster decline in pre-existing kidney dysfunction.
  4. The prevalence of CKD among patients with recovered COVID-19 varies from 5% to 20%.
  5. Hematuria and proteinuria are found in 15% to 25% of COVID-19 patients.
  6. Few cases of COVID-19 associated collapsing glomerulopathy has been reported in African patients. More information and data are needed on long term renal outcomes of COVID-19 patients.

Post-COVID AKI sequelae

Patients with incomplete recovery of AKI at discharge needs to be followed. Regularly (every month) for a minimum period of 3 months to document late AKI recovery or diagnosing patients going to CKD. Patients with recovered AKI at discharge also needs to be followed up as up to 14% have been shown to develop kidney dysfunction.


Symptoms and indicators of the presence of post-COVID nephrological complications

Symptoms to suspect Post-COVID nephrological complications:

  • Fatigue and unexplained weakness
  • Nocturia (frequent urination during the night which disturbs sleep)
  • Increased froth in urine
  • Anorexia (loss of appetite)
  • Headache
  • Swelling on leg
  • Increase requirement of anti-hypertensives
  • Breathing difficulty
  • Orthopnea (Breathing difficulty during lying down)

It is important to note that often there are no symptoms of Post-COVID-19 related nephrological problems and patients are asymptomatic.

Signs of Post-COVID related nephrological complications:

  • Tachycardia
  • Tachypnoea
  • New-onset hypertension or worsening hypertension
  • Anaemia, new-onset or worsening from before
  • Facial puffiness
  • Pedal oedema

It is important to note that often there are no signs of Post-COVID related nephrological problems and patients may be asymptomatic.


Most often performed investigations to confirm the diagnosis

  • Complete Blood Count
  • Routine complete urine examination
  • Spot urine protein/creatinine ratio
  • Serum creatinine and blood urea
  • Blood sugar and HbA1c
  • Serum Na and K
  • 24-hour urine protein
  • Ultrasound of Kidneys
  • C-reactive protein
  • Pulse oximetry


Minimum treatment facilities required

If a Post-COVID patient is diagnosed with nephrological sequelae, he should be managed at a health care facility having the support of a Nephrologist and there should be access to dialysis services.


Do's and don'ts for avoiding nephrological problems

Do’s:

  1. Maintain a healthy lifestyle and healthy weight; avoid weight gain.
  2. Drink adequate water.
  3. Restrict salt and fat in the diet.
  4. Follow the advice of a doctor in relation to intake of amount and type of protein.
  5. Start with home-cooked simple food, eat small meals at intervals.
  6. Reduce stress, get good sleep, stay connected with friends and family members.
  7. Proper control of any underlying co-morbidities like diabetes, hypertension.
  8. Practice moderate exercise, yoga and meditation for at least 45 minutes/day and 5 days/week.
  9. Get kidney function tests done.

Don’ts:
• Consume citrus fruits and leafy vegetables
• Self-medicate
• Intake nicotine and alcohol products


The guidelines for post COVID sequel by MoHFW will be discussed in this series pertaining to different organ systems- Cardiovascular, Gastrointestinal, Nephrological, Neurological, and Respiratory. Click here to read the previous parts- Post-COVID cardiovascular sequelae: Latest MoHFW updates , Gastrointestinal symptoms post COVID-19: New MoHFW updates


Click here to see references

 

Disclaimer- The views and opinions expressed in this article are those of the author's and do not necessarily reflect the official policy or position of M3 India.

The author is a practising super specialist from New Delhi.

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