The overlooked crisis of post-Covid kidney disease
Covid-19 syndrome is characterised by persistent symptoms or delayed, long-term complications that extend beyond four weeks from the onset of symptoms.
What you need to know:
- Globally, by the year 2021, around 144.7 million people (3.7 per cent) had developed long Covid, and that estimate has since doubled.
The 16th-century French philosopher Voltaire wrote, “We owe respect to the living; to the dead we owe only truth.” Today, a growing population of long Covid survivors demands both our respect and the truth about their suffering—a truth that the world’s governments have yet to fully acknowledge or address.
While the international community looks to the future with the newly adopted Pandemic Accord—a crucial agreement for pandemic prevention, preparedness, and response—millions are still grappling with the insufferable aftermath of the last one. They are known as “long-haulers,” and they have been largely left to their own devices.
Also read: Covid-19 vaccines averted millions of deaths, with older adults benefiting the most, study shows
Many people on our streets today are not familiar with the term "long Covid" or "long haulers." Let alone the average person, even some scholars are genuinely oblivious to long Covid, also referred to as post-acute Covid-19 syndrome. This condition is characterised by persistent symptoms or delayed, long-term complications that extend beyond four weeks from the onset of symptoms. If a person does not succumb after four weeks but their symptoms persist, they have long Covid. Among the international research community, this phenomenon should be expanded to include the aggravation or exacerbation of pre-existing medical conditions.
Globally, by the year 2021, around 144.7 million people (3.7 per cent) had developed long Covid, and that estimate has since doubled. We must recognise that long Covid-19 is a multi-organ disease with a broad spectrum of manifestations. If these symptoms persist, you are a long hauler: body fatigue, dyspnea, cognitive disturbance, chest pains, thromboembolism, chronic kidney disease, and hair loss, among others. Studies have found the following organs to sustain injury: lungs, brain, heart, veins, kidneys, and the skin.
Collapsed
Perhaps you know a friend or relative who had no history of kidney disease, cardiovascular disease, dementia, or diabetes but is now struggling with these conditions. It could be a seemingly healthy individual who suddenly collapsed at the airport, in their living room, or at a bus stop, leaving their next of kin perplexed. Is it that strokes are appearing to occur so frequently these days?
Among the multi-organ injuries caused by long Covid, the kidney seems to be a peculiar and deeply frustrating case. Let’s summarise kidney disease and long Covid infection.
Sometimes it is called post-acute kidney injury (AKI). It has been noted that some patients who had acute kidney injury may not fully recover kidney function—a condition that can lead to chronic kidney disease or reduced kidney reserve. It is also linked to persistent kidney inflammation and immune dysregulation. Studies show that Covid-19 can trigger long-lasting inflammation that damages the small blood vessels in the kidneys. Long Covid may also cause proteinuria (protein in urine) or hematuria (blood in urine) even months later.
It has been postulated that kidney injury features disproportionately among men, presenting with microvascular and clotting issues linked to microclots and endothelial injury, which may reduce kidney perfusion and filtration. Lastly, SARS-CoV-2 can infect kidney cells (tubular cells and podocytes), leading to scarring or fibrosis over time.
In terms of long Covid, kidney disease is a worrying matter. One study shows that among hospitalised individuals, approximately 28 per cent develop AKI, with nine per cent requiring renal replacement therapy. A large multinational study found AKI occurred in about 50.5 per cent of hospitalised patients, and of these, 39.2 per cent did not fully recover kidney function. The post-Covid burden of kidney disease on families and individuals is overwhelming.
Like everywhere else on the globe, studies in Kenya have documented the incidence of AKI among Covid-19 patients, pointing to a long-term kidney disease burden. For instance, recent retrospective cohort studies found an AKI incidence of 21.6 per cent among hospitalised Covid patients.
As of today, neither governments nor the Pandemic Accord—a proposed international agreement crafted under the auspices of the World Health Organization (WHO)—contains any specific references to, or provisions concerning long Covid.
The proposed Accord is designed to strengthen global preparedness and response to future pandemics through legally binding commitments. What are governments doing today about the post-Covid burden of kidney disease?
In Kenya, it is estimated that no less than 21 per cent of patients hospitalised with Covid (2020-2023) present with kidney disease. Unfortunately, kidney dialysis is currently a booming business.
It is a mark of humanity to acknowledge that we owe respect, truth, and commitment to long haulers, especially those with kidney disease.
Prof Otoi is an infectious disease modelling expert, Daystar University
