JUDY WOODRUFF: Even as we learn more about this coronavirus, there are new questions
we didn't expect about what else it may be doing to the body.
In addition to the respiratory distress it causes, COVID-19 seems to be linked with increases
for some patients in inflammation of the heart and other organ and tissue damage. None of
these connections are conclusive.
But William Brangham explores one of those connections that has a number of doctors concerned.
WILLIAM BRANGHAM: That's right.
One of the many things that we're learning about this novel coronavirus is the impact
that it is having on the kidneys.
And, for that, I'm joined now by Dr. Alan Kliger. He's at the Yale University School
of Medicine, and he co-chairs the COVID-19 Response Team for the American Society of
Nephrology.
Dr. Kliger, thank you very much for being here.
DR. ALAN KLIGER, Yale University School of Medicine: Thank you.
WILLIAM BRANGHAM: Could you tell me when you first started to learn that what we think
of as a respiratory virus is also damaging kidneys?
DR. ALAN KLIGER: Well, some of the earliest reports out of China showed that, among COVID-positive
patients admitted to the hospital, as many as 40 or even 50 percent had evidence of some
damage in the kidney.
They had protein in their urine or blood in their urine. And 10 percent of them even had
some decrease in kidney function. So, we knew early on that the kidney was one of the targets.
WILLIAM BRANGHAM: And do we know why the virus impacts the kidneys?
DR. ALAN KLIGER: It's not so clear, but there's been a lot of speculation about that.
We know, for example, that the virus can attach to kidney cells through a specific receptor
in the kidney. These same receptors are in other organs as well, and can damage the kidney
directly.
We also know that, in patients who are very sick, who need to be on ventilators and are
in intensive care units, that the combined illness in the lung and other organs can sometimes
cause a huge inflammatory reaction. And the body releases these things called cytokines.
And they can, in turn, damage the kidney.
WILLIAM BRANGHAM: So, what are the practical implications?
If I am someone who is infected with the coronavirus, and I'm getting quite sick, and it starts
to damage my kidneys, what are -- what does that mean for me as a patient?
DR. ALAN KLIGER: Yes.
Well, first of all, most people who are sick with this disease never get sick enough to
be in the hospital and never get sick enough to have many organs damaged that way.
But if you look specifically at patients sick enough to be in the intensive care unit from
COVID-19, it looks, in centers like New York that have a lot of disease, that 30 percent
or 40 percent of those patients may have evidence of kidney failure.
There are even some places that they're as high as 50 percent of those intensive care
unit patients who have kidney failure.
WILLIAM BRANGHAM: We know that's obviously a huge complication for the individual, but
it's also got to put some stress on the ICU that is caring for them, because dialysis,
that kidney care, is not something that is easily procured, right?
DR. ALAN KLIGER: Well, it's true.
In centers like New York or other cities like Detroit or Chicago, first of all, many more
intensive care units have had to be created to take care of patients who are so sick.
And in those units, the provision of care, like dialysis or like continuous replacement
therapy, different kinds of dialysis treatments that treat kidney failure, are very intensive
of both equipment and personnel.
WILLIAM BRANGHAM: So, obviously, that means ICU staff have to be beefed up, the amount
of equipment have to be beefed up.
Is it your sense that there are enough of those individuals and equipment to handle
projected surge of cases?
DR. ALAN KLIGER: Well, we know that best from the experience in New York, where, last week,
many hospitals started running short of equipment and be concerned about those staff.
You know, many people taking care of patients with kidney -- with COVID-19 themselves have
been infected. And so, often, staff are out and ill. And so what we started hearing from
New York was that the need for equipment and dialysis was four or five times usual, while
staff available was sometimes 70 percent or 80 percent of what usually is used.
So that combination has made it really critical in some places to bring in more staff and
to bring in more equipment.
WILLIAM BRANGHAM: And, long-term, do we know what this virus does to the kidneys over the
long term, meaning, do people heal from this and can they restore traditional normal kidney
function?
DR. ALAN KLIGER: It's a good question. And this is early yet, and we don't have all the
answers to that.
What we do know is that there have been patients who have had acute kidney injury from this
illness that they have recovered from and where the kidneys have been able to go on
and do what they have needed to without dialysis.
But we also know there are some patients who still have evidence of kidney failure and
need dialysis even after they have been released from the hospital.
WILLIAM BRANGHAM: Another one of these long-term impacts of this virus we're going to be living
with for a very, very long time.
DR. ALAN KLIGER: Yes.
WILLIAM BRANGHAM: Dr. Alan Kliger at the Yale University School of Medicine, thank you very
much for your time.
DR. ALAN KLIGER: Thank you.