Germany was not hit as hard by the SARS-COV-2 pandemic as many other European countries.
This was due to the late arrival of the wave of infections in Germany, alerted by the situation in Italy and Spain, which ordered an early blockade and conducted extensive testing.
As of 2 June 2020, There were 182,028 cases of COVID-19 in Germany, including 8,522 deaths.
As in other countries, dialysis patients are at high risk because they tend to be older, have more complications and, of course, have compromised immune systems.
A practical problem that increases the risk is that they cannot stop treatment and must go to the dialysis room three times a week, meaning strict home isolation is not possible for these high-risk patients.
Photo credit: NIAID.
Germany has established a registry to investigate the prevalence and clinical outcomes of dialysis patients suffering from SARS-COV-2 infection.
As of the end of May, about 2 percent of patients enrolled in dialysis — about 300 out of 14,000 — had tested positive for SARS-COV-2, and these patients proved to have a poor prognosis: the mortality rate was about 20 percent.
The second phase of the registry will also include patients with acute kidney injury and chronic kidney disease and will investigate their clinical outcomes and prognostic factors.
However, not only do patients with kidney disease have a higher risk of sarS-COV-2 infection, they also have a more severe course of COVID-19 – data also suggest that the kidney may be the target organ for the viral disease.
Early data from CoVID-19 in China include some surprising findings: Kidney involvement often seems to occur in people who test positive for SARS-COV-2 and develop symptoms.
After a major epidemic occurred in Wuhan in 2020, a continuous cohort study was conducted on coVID-19 patients admitted to three branches of a third-grade a teaching hospital in Wuhan. Clinical parameters such as hematuria, proteinuria, serum creatinine concentration, and the incidence of acute kidney injury (AKI) were analyzed.
At admission, 44% of patients had proteinuria and 26.7% had hematuria.
AKI occurred in 5.1% of patients.
After adjusting for confounders, all renal involvement indicators were associated with a higher risk of in-hospital death.
The authors had suggested in February that clinicians should raise awareness of renal involvement in hospitalized COVID-19 patients.
In fact, another study showed a significant increase in the incidence of AKI in hospitalized patients.
Of the 4259 patients who did not require mechanical ventilation, 925 had AKI (any stage) and 9 required renal replacement therapy.
The incidence was significantly higher in aerated patients — 276 (23.2%) of 1,190 patients required dialysis.
The main conclusion of these authors is that AKI occurs frequently in coVID-19 patients.
It occurs early, is associated with respiratory failure over time, and is associated with poor prognosis.
Clearly, COVID-19 can cause kidney damage.
In a postmortem study in Hamburg, Germany, viral load analysis was performed on tissue samples from different organs from 27 postmortem coVID-19 patients.
It was found that while the lungs were most affected by the novel Coronavirus, other organs, especially the kidneys, were also affected.
In addition, samples from seven patients were used to investigate which renal regions were particularly affected, and the results showed that the viral load of renal tubules, especially glomerular cells, was high.
These findings are consistent with clinical observation.
The glomeruli perform the filtering function of the kidneys, and the tubules are responsible for reabsorption.
Many patients have been found to have abnormal urine, especially proteinuria, in the early stages of COVID-19.
The question is how to use these findings.”
A research team from Germany gottingen and from Hamburg (Germany), cologne (Germany) and aachen team closely, is currently studying early sign of kidney involvement, such as proteinuria, hypoalbuminemia and antithrombin Ⅲ lack, whether can be early risk assessment and stratification of patients.
These patients are at higher risk for complications such as pulmonary edema and thromboembolism, such as the dreaded pulmonary embolism.
A recently initiated study is currently under way to investigate the prognostic significance of renal parameters.