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.

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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

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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.

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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.

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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.

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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

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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

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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

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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.