Liver, Kidney, Brain and Other Organ damage in COVID-19

As of today, USA has over 1 million positive cases, that is 1/3^rd of the total 3 million cases reported worldwide. The rise in the number of cases has also brought about a surge in COVID-19 related medical literature. The shared experience of the worldwide medical community has started to be published in the medical journals. What we are learning is that whereas respiratory system takes the brunt of the viral attack, the other organs of the body are not immune.

Before reviewing the impact of COVID-19 on other organs of the body, one must recognize that the data being published has been put together in a haste. Most of the published articles include the clinical information that we know so far. This includes data on presenting symptoms, what organs were affected, the laboratory test abnormalities, and the x-rays and CT scans findings.  Since China is ahead of others, most case reports are coming from there. Many are anecdotal and small case studies. These are often from single institution. For the sake of urgency and expediency, most published data is not peer reviewed, and of course, none are based on randomized, planned and thoroughly thought thru clinical trials.

Nonetheless, that is all that is available so far. What we have, tells us that the novel coronavirus is also causing heart attacks, kidney failure, liver injury, blood clots and strokes. Here is some of what we have learnt.

Common Injuries:

The virus enters the body through the nose and mouth. It attaches its spikes to the cell surface receptors like a key fits a lock. The receptors open the door (in the biological sense) and allow the virus to enter the cell nucleus. The genetic material of the virus commandeers the cell to make millions of copies of the coronavirus (replication process). The cell bursts and dies, releasing millions of viral particles. This process is repeated over and over again, leading to the death of many cells ending up with severe tissue damage. The organs with greater number of ACE2 receptors are the ones most affected. The liver and heart cell damage is manifested by increase in certain blood enzymes. Kidney function deterioration requires dialysis. Confusion and seizures have been reported as the virus effects the brain cells.   

Heightened Inflammatory Response (Cytokine Storm)

The natural and physiological response of the body to the viral invasion is “inflammation”. This inflammatory response is in the form of fever, increase in the white blood and the immune cells and increased production of special proteins called cytokines. The purpose is to mobilize the immune protective mechanisms. It has been observed that in some patients, the immune response (cytokine) has been overzealous and has attacked body’s own organs.  This “cytokine storm” has caused circulatory collapse (drop in blood pressure), stiff lung (respiratory failure) and acute liver and kidney failure.

Pregnancy

Small case studies have shown that the virus does not affect the fetus, and the newborn of COVID-19 patients are born healthy. There has been no evidence of the virus is present in mother’s breast milk. However, the studied population (pregnant women) has been very small to draw solid conclusions.

Blood Clots and Strokes

A common complication in acutely ill patients who end up in the ICU, is the increased incidence of bleeding and clotting. The virus induced cell and tissue damage triggers clotting of the blood, medically referred to as disseminated intravascular coagulation (DIC). Such widespread blood clots can cut off blood supply to parts of the brain and lungs causing stroke and pulmonary embolism, respectively. There are many other unusual changes (such as recently describe antiphospholipid antibody syndrome) in the coagulation system that leads to unexpected bleeding or clotting.

Kidney Failure

Along with the shortage of ventilators, we have heard of the shortages of kidney dialysis machines during this pandemic. These dialyzers are as essential as ventilators to keep the systems working till the acute phase of the infection is over. The kidney dialysis machines are large and take up lot of floor space. It has been a challenge to fit all such lifesaving equipment in the ICU rooms.

Long Term Effects

With aggressive supportive care, the organ function can be maintained throughout the course of the COVID-19 illness. Whether their will be lasting damage to the organ function, is not known at this time. It is quite likely that those individuals who had pre-existing kidney, live or heart disease, had diabetes or other ailments, may have some lingering effects once they fully recover from the coronavirus.

Future

No doubt, we will learn more about the short-term and long-term effects of the COVID-19 illness on the human health. In the coming days and months, more will be written about this. I will be looking out for such reports in the medical journals and sharing it with the readers in my future blogs.