The patient is being dialyzed at Mount Sinai Hospital in New York City.
Sonia Toure remembers the moment when her life changed forever. She had a zoom call with her workmates in mid-March when she coughed. It was a deep, strange-sounding cough that frightened everyone. Later that night, she developed 103-degree fever and pain all over her body.
"It wasn't a body ache," she recalls. "My body hurt so much that I felt like I was being hit by a group of people. I could hardly go to the bathroom or catch my breath."
Toure, a 54-year-old project coordinator from the CUNY Research Foundation in New York, was sick 12 days before her hospital stay. By then she had lost her taste and smell, and nausea and vomiting had started. She had called the city's emergency number, but was asked to stay home and ride her out. On the twelfth day, she felt extremely sick and called an Uber to drive her to Mount Sinai Hospital. She was taken in with pneumonia, acute kidney failure and drifted into and out of reality for two weeks.
"Fortunately, I didn't need a ventilator," Toure recalls, "but in three days I needed kidney dialysis in an emergency. My creatinine level rose to 14 within a week before my kidneys finally failed."
Toure used to be a strong and healthy woman with no underlying health problems. After a four-week hospital stay, Toure struck Covid-19, but the disease has affected her kidneys and long-term health outlook. She lives with severe edema and now drives to the dialysis center three to four times a week. She is planning a live donor kidney transplant in the coming months. Her 21-year-old son plans to donate his kidney to keep her alive.
Toure's story shows a harsh reality. Severe coronavirus patients often need dialysis machines as well as ventilators. Many of those recovering from Covid-19 have some form of residual kidney damage that can last for months, years, or even permanently.
A study by Mount Sinai Hospital Systems in New York is a microcosm of the trend. 46 percent of patients hospitalized with Covid-19 since the pandemic started had some form of acute kidney injury; Of these, 17% needed urgent dialysis.
Surprisingly, 82% of patients with acute kidney injury had no history of kidney problems. 18% did it. More than a third of the surviving patients did not restore the kidney function they had before contracting the virus.
The study, which ran from February 24 to May 30, tracked a population of nearly 4,000 patients with an average age of 64 years. Mount Sinai used an AI tool developed in collaboration with RenalytixAI, KidneyIntelX, that assesses a person's likelihood of kidney disease.
Unfortunately, this is a phenomenon that can be observed in the United States and around the world, says Dr. Alan Kliger, co-chair of the American Society of Nephrology's Covid-19 response team. He has been working with the CDC since late February to share trends about how the virus affects the kidneys of patients in hospitals across the country. "We have observed that approximately 10% to 50% of patients with severe Covid-19 who go to the intensive care unit have kidney failure that requires some form of dialysis."
There are several ways that this viral disease can lead to kidney failure, notes Dr. Kliger. Some evidence shows that the immune system is in full swing and producing inflammatory cytokines known as cytokine storms that can injure the kidneys and other organs. In other cases, biopsies have shown that the virus attacks the kidney directly by entering the corona virus via ACE-2 receptors and then infecting itself with cells. In other cases, patients develop Covid-19 so severely that it can trigger sepsis, which can cause multiple organs to fail. Finally, there is also evidence that ventilators in patients with severe lung disease due to Covid-19 can reduce blood flow through the kidney and that this in turn can injure the organ.
Another epidemic is emerging
This is yet another public health crisis that will conquer the nation, experts predict. Before the pandemic, the United States spent approximately $ 100 billion annually to treat the nearly 40 million Americans who suffer from chronic kidney disease and need dialysis and organ transplants. According to the Centers for Disease Control and Prevention, it was the ninth leading cause of death in the nation with the increase in obesity and type 2 diabetes. In response, President Donald Trump launched the Advancing America Kidney Health Initiative last year.
Now kidney disease is increasing, which is compounded by the increase in Covid 19 cases across the country.
"The next epidemic will be chronic kidney disease in the US that has recovered from the coronavirus," says Dr. Steven Coca, Associate Professor of Nephrology at Mount Sinai Health System and co-founder of RenalytixAI. "Since the onset of the coronavirus pandemic, we have seen the highest rate of kidney failure in our lives. This is a long-term health burden for patients, the medical community – and the US economy."
The next epidemic will be chronic kidney disease in the US that has recovered from the coronavirus.
Dr. Steven Coca
Associate professor of nephrology at Mount Sinai Health System and co-founder of RenalytixAI
In response, medical experts are using AI technology to identify biomarkers in Covid patients – including multiple plasma biomarkers, as well as urine proteomics and RNA sequences – with the highest risk of kidney injury. "This will help us do some predictive analysis. We hope that RNA sequencing can give us some pointers," says Dr. Coca.
Using KidneyIntelX – an FDA-approved diagnosis that uses machine learning algorithms to evaluate the combination of blood-based biomarkers, electronic health record information, and other genomic information to identify progressive kidney disease in patients – the Mount Sinai Health System is conducting a multicentre study with others by leading medical centers in the United States to assess kidney complications in recovered Covid 19 patients. The aim is to get a broader overview of the trend.
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Research teams to participate in the study include experts from Mount Sinai, Yale, the University of Michigan, Johns Hopkins, and Rutgers.
The first research results are expected to be published at the end of 2020.
In addition, Mount Sinai Health System's high-performance SARS-CoV-2 serology tests are used to quantitatively determine a patient's antibody levels against COVID-19 over time and to provide valuable insight into the interaction between immune response and kidney-related complications.
"The goal is to assess the risk of kidney disease and failure," said Tom McLain, President and Chief Tk Officer, RenalytixAI.
Fortunately, not all severe Covid 19 patients suffer permanent kidney damage. Steve Lazos is a typical example. He had a severe case of the coronavirus in mid-March and was hospitalized at the height of the New York City crisis at Northshore Hospital with pneumonia. "My kidneys got a blow," he recalls, "but luckily they recovered and returned to normal. It was a slow recovery."
Studying this health problem is now critical. According to Neville Sanjana, PhD., Biology professor at NYU and scientist at Genome Center at NYU Langone, who is working on the Crispr gene editing tool on Covid-19 research. In his laboratory, he found that the coronavirus virus has mutated and is now more contagious than the original strain and can affect all types of human cells and organs.
People who already have kidney problems, including dialysis patients, are currently among the most at risk during this pandemic. According to Dr. Kliger, "This is a group that is more likely to contract the virus, have complications, or die. While government officials are discussing how tests can be used nationwide, this population must be a priority."