‫بسم هللا الرحمن الرحيم‬

‫وزاره التعليم العالي والبحث العلمي‬

‫زهراء كريم‬.‫د‬/ ‫اسم استاذ‬
‫ايناس حسام نديم‬/ ‫اسم طالبه‬
‫كليه الشيخ طولي‬/‫اسم جامعه‬
‫تقرير حول الفشل الكلوي وعالقته ب فايروس كورونا‬/‫موضوع‬
‫بايلوجي‬/ ‫اسم ماده‬

Kidney failure

The kidneys filter the blood and excrete wastes and excess fluid into the urine. When the
performance of the kidneys is affected, waste and excess fluid accumulate in the body,
.which can be dangerous

The deterioration in the functioning of the kidneys is slow, as symptoms increase as the
chronic kidney failure worsens. Sometimes any symptoms of the disease are not
.recognized in the early stages, so they are only discovered in later stages
Treatment focuses on slowing the decline in kidney function, generally by treating the
primary cause of the injury. When the disease progresses, it is possible to reach a
.situation where the kidneys are not completely functioning due to the injury

Symptoms of kidney failure

:Symptoms of chronic kidney failure may develop slowly, to include

●Decreased urine output

●Nausea and vomiting

Lack of appetite

●Fatigue and weakness

 ●Difficulty sleeping

●Decreased intensity of thinking

●Muscle contraction

●Edema of the ankles and legs

●Itch

These symptoms are not limited to injury to the functioning of the kidneys. They may also
appear when other diseases are affected. In addition, the kidneys have a high ability to
compensate for the damage. Therefore, the diagnosis of the disease and the permanent
.injury of the kidneys work may be delayed

Causes and risk factors for kidney failure

Kidney injury occurs when a certain disease prevents the kidneys from performing their
work for long periods of time, months or years. The accumulated damage results in
.decreased kidney function and a chronic injury

Diseases and conditions that lead to kidney damage

.Diabetes mellitus type 1

.Diabetes mellitus type 2

.hypertension

.An enlarged prostate gland

.kidney stones

.Urinary bladder cancer

.Kidney cancer

.Kidney infection

.Rheumatic diseases such as lupus (Lupus), scleroderma and vasculitis

.Partial or complete blockage of the kidney artery supplying it with blood

Kidney injury risk factors include: heart disease, smoking, obesity, high levels of cholesterol
in the blood, previous kidney infections within the patient's family and the advanced
.generation

Complications of kidney failure

:There are some complications associated with developing kidney failure, which are

Fluid retention: The kidneys ability to excrete excess fluid is damaged, which leads to the
.development of edema of the limbs or lungs in addition to high blood pressure
 Fatal arrhythmia (Arrhythmia): Potassium secretion is damaged, and blood levels may rise
.rapidly leading to arrhythmia, which can lead to death

Bone fractures: The kidneys balance the levels of phosphorous and calcium in the blood,
which are vital components for building bones. Damage to the concentration of these
.minerals leads to weakening of the bone and the possibility of fractures

Anemia: The kidneys produce an important hormone called Erythropoietin, which has the
function of stimulating the bone marrow to produce red blood cells. When the kidneys are
.damaged, hormone levels decrease and anemia occurs

Central nervous system injury: a buildup of toxic substances in the body causes damage to
functioning, and the patient suffers from difficulty concentrating, personality changes
.leading to seizures. This condition is known as uremia

Additional complications: a decrease in sexual arousal and impotence, a decrease in the

functioning of the immune system, pericarditis (Pericarditis) and complications during
.pregnancy

■■Diagnosis of kidney failure

There are several methods that can be used to diagnose kidney failure, which include

Blood tests: Through blood tests, you can see the level of waste materials such as urea and
creatinine in addition to calcium, potassium phosphorous, sodium and more. These
.indicators reflect the level of college performance

Urine examination: the presence of certain substances, such as proteins, leads to suspicion
of impaired kidney performance, and vice versa, as well, where a very low concentration of
.excreta can indicate an injury

Imaging tests: In some cases, we would like to see the college building and whether there
was a mechanical injury or tumor, so we perform an ultrasound or computerized
.tomography (CT) scan

Biopsy: A needle is inserted and guided by an ultrasound imaging device, and a small piece
of kidney tissue is taken. This tissue can be examined in the laboratory and diagnosed with
.kidney disease
 Treatment of kidney failure

Treatment for chronic kidney failure focuses on the cause of the disease, because no drug
has yet been found that can help restore kidney function. In addition, the prevention of
:continued harm includes

Reducing alcohol consumption to a minimum

Proper nutrition (eat the least amount of protein, potassium and salt)

Balancing the sugar level

Treating blood pressure

 Stop smoking

Maintaining a healthy weight

Rational use of over-the-counter medications that are known to be toxic to the kidney, such
.as NSAIDS

There are other treatments aimed at treating complications of the disease with drugs that
lower blood pressure (mainly angiotensin converting enzyme - ACE) and angiotensin II
receptor blockers - ARB), treatments to lower cholesterol, raise the level of hemoglobin and
treat anemia Blood, strengthening bones, reducing edema and following a low-protein diet,
.which prevents excessive burden on the patient's kidney

Ultimately, when the kidneys are infected and not working, there is a need to filter the

:blood to prevent conditions that endanger life. The existing therapeutic potential for this

:Dialysis

The idea underlying the dialysis basis is to carry out, by medical devices, the activity that the
kidneys perform in the healthy human body. This can be done by Hemodialysis, where the
blood is inserted through a tube for a device that filters the blood and returns it to the body
after filtering. This process takes a few hours and must be done several times a week.
Another possibility is peritoneal dialysis - through which a special liquid solution is
introduced into the abdominal cavity, and then, through the peritoneum, the waste material
is transported from the blood to the solution, after which the solution is pumped out of the
.abdominal space
 :Kidney transplant

A kidney transplant is performed in the patient’s body that was donated by a person who
died or from a living donor. The transplanted kidney works instead of the inactive patient's
.kidneys

Prevention of kidney failure

:The Seven Golden Rules for College Preservation

:Maintaining physical fitness and physical activity

.It reduces blood pressure and has been proven to maintain kidney performance

:Maintaining sugar values

Nearly half of diabetics suffer from kidney damage, which could have been prevented by a
regular examination to discover a disorder in the functioning of the kidney and by helping
.to maintain sugar values in the proper field

:Maintaining proper blood pressure

Everyone knows that high blood pressure damages the functioning of the heart and may
lead to stroke. But high blood pressure is also a common cause of kidney failure, so it
.must be measured regularly and treated according to instructions when it is high

:Healthy food and maintaining a healthy weight

Essential for maintaining the functioning of the heart, blood vessels and preventing
diabetes, which is harmful to the functioning of the kidneys. In addition, it is important to
.keep it low in salt because the salt causes an overload on the kidney

Smoking: In addition to the damage it causes to the respiratory system, smoking also
damages the blood supply to the kidneys, and increases the risk of developing kidney
.cancer by 50%

Refraining from using over-the-counter medications on a consistent basis

Many medications, especially those belonging to the non-steroidal anti-inflammatory :

family (NSAIDS) (such as Nurofen), cause cumulative damage to the kidneys when used in
.large quantities and at high frequency

:Periodic examination

People who face the above risk factors should do a regular blood test, with which it can
.help detect kidney injury at an early stage

Stages of kidney failure

The stages of chronic renal insufficiency are five and are calculated using the patient's
.glomerular filtration rate
 .Stage 1: Kidney function reduced with few symptoms

The second and third phases: The need for care increases to reduce and treat kidney
.dysfunction

Phases IV and V: The patient usually needs treatment and in the fifth stage the disease is
.considered severe and requires dialysis or kidney transplantation if possible

Diagnostic approach

Measuring chronic kidney disease

Stages of college failure

The stages of kidney failure are measured in five stages, and are calculated using the
glomerular filtration rate. Stage 1: Kidney function is impaired slightly with few obvious
symptoms. Second and third stage: You need to increase the levels of supportive care from
medical providers to slow and cure the dysfunction of the kidneys. Patients in the fourth
and fifth stages usually require preparing the patient for effective treatment in order to
survive. Stage 5 is a severe disease and requires some form of nephrostimulation
.(hemodialysis) or kidney transplantation if possible

Glomerular filtration rate

The normal glomerular filtration rate varies according to many factors. Including gender,
age, body size, and race. Kidney professionals rate the glomerular filtration rate the best
comprehensive indicator of kidney function. The National Kidney Foundation offers an easy-
to-use calculator for calculating glomerular filtration rate online for anyone interested in
knowing the glomerular filtration rate. (You will need a blood serum creatinine level, which
.is a simple blood test, to use the calculator)

Use the term uremic

Before advancing in modern medicine, renal failure is often referred to as uremic poisoning.
Uremia was a term for blood contamination with urine. It is an excessive amount of urea in
 the blood. Beginning in 1847, this included a decrease in the amount of urine produced,
which was thought to be due to the mixing of urine with blood rather than being excreted
through the urethra [citation needed]. The term uremia is now used for disease associated
.with kidney failure

Kidney failure is diagnosed from the aforementioned clinical tests with some laboratory
tests such as high urea and creatinine in the blood. Also, creatinine clearance from plasma
.decreases to 30 milliliters out of 120 milliliters

Kidney failure and its relationship to Coronavirus

Doctors have observed an increase in the number of kidney failure cases among patients
with the emerging coronavirus that causes Covid-19 disease, especially those who have
?severe symptoms. How does the Corona virus affect the kidneys

Although the new corona virus affects the human respiratory system, it leaves its effects on
all parts of the infected person's body

To date, there have been no reports of coronavirus causing damage to the kidneys in cases
.where the disease is accompanied by mild or moderate symptoms

For those who develop severe symptoms, doctors found that the virus causes severe
.damage to the kidneys

Almost all of Corona's patients who had pneumonia and had to have a respiratory system "
also had (kidney problems)," says Jan Kristoff Gallah, president of the German Society of
.Nephrology

This damage appears in the results of kidney function tests that reveal a change in some
.proportions, which means that the kidneys cannot fully perform their functions

Blood and protein samples were detected in half of the cases that entered the hospital, "
which is an early indication of damage to the kidneys," Alan Clegger, a kidney disease
.specialist at Yale University School of Medicine told the Washington Post

Severe complications were reported in 14% to 30% of these cases in New York and in
.Wuhan, China, to the extent that these patients needed dialysis, according to Kliger

Kliger added that the number of people with kidney failure due to corona in the intensive
care units has become unusually large, forcing these units in New York to increase the
number of employees and requesting volunteers from other cities to conduct dialysis to
.patients

In the same context, the "New York Times" warned of a crisis in dialysis equipment soon
.due to the rapidly increasing number of cases

?What exactly is happening

In severe cases of corona's disease, the blood clots faster, which may lead to the formation
.of small clots that block the blood vessels

This may also happen in the kidneys, which some experts call "small clots in kidney tissue".
.In addition, there is scientific evidence that the virus may attack the kidneys directly
In the event that corona patients have pneumonia and need respiration, the matter affects
the kidneys in a significant way. The pneumonia caused by corona leads to a large pool of
.water around the lungs

In this case, the doctors give the patient diuretics that help withdraw fluid from the body,
which requires the kidneys to work more than normal, while you suffer from low blood flow
due to small clots, which speeds up the failure of their work

Endless results

It is not yet clear whether these damages are long-term or temporary, and Gallah added

that despite this, "it is too early to judge the effect of corona on the kidneys in the long-
".term

.Scientists also warn against rushing to pass judgment, as more research is needed

According to a Chinese study published in the Kidney International scientific journal,

researchers found that nine out of 29 people who died of corona had signs of kidney failure,
.and that seven had particles of the virus in the kidneys, according to the Washington Post

It shows that it is possible that the cases of kidney injuries that we see are directly related "
to the virus, which is different from what we saw in the SARS epidemic in 2002," says
.Pallowski, a kidney disease specialist at the University of Pittsburgh Medical School

Additional prevention measures for kidney patients

Currently, nephrologist Jan Kristof Gallah is particularly concerned with the kidney failure
patients he treats, and says, "We cannot ask them to stay at home. They need dialysis three
.times a week," which increases their risk of developing a Corona infection
 For this reason, the kidney disease clinic at the Ludenscheid Hospital in western Germany,
which is headed by Gallah, organizes dialysis times so that patients come at consecutive
.times throughout the day

They and the drivers who transmit them must also wear a medical mask. In the event of an
outbreak of Coronavirus infection among these patients, it will be very dangerous for their
lives, as most of them also suffer from other diseases such as diabetes, high blood pressure
.and heart disease

Corona viruses are a large group of viruses that cause illnesses that vary between colds and
more severe diseases, such as Middle East Respiratory Syndrome (MERS-CoV) and Severe
Acute Respiratory Syndrome (SARS-CoV). The emerging corona virus (nCoV) is a new strain
.that has not been previously identified in humans

Corona viruses are an animal source, which means that they are transmitted between
animals and humans. Extensive investigations have found that the Corona virus that causes

severe acute respiratory syndrome (SARS) has moved from the butter hooks to humans,
while the Corona virus that causes respiratory syndrome in the Middle East has moved from
one-humped camels to humans. Many known coronaviruses are spread among animals and
.have not yet infected humans

Common symptoms of infection include respiratory symptoms, fever, cough, shortness of

breath, and breathing difficulties. In more severe cases, the infection may cause pneumonia,
.severe acute respiratory syndrome, kidney failure, and even death

Standard recommendations for preventing infection include: washing hands regularly,

covering the mouth and nose when coughing and sneezing, and cooking meat and eggs
thoroughly. In addition to avoiding contact with anyone with symptoms of respiratory
disease, such as coughing and sneezing

Dr. Essam Al-Maghazy, head of the Association for Combating Smoking and Chest Diseases,
affirmed that the fingerprint system in institutions and banknotes contaminated with "the
Crohna virus" transmits the infection, and he said: Corona virus lives on surfaces, including
banknotes, coins and fingerprint devices for a period of 10 hours, so its use after infected
.persons It transmits infection
 Dr. Essam Al-Maghazy, head of the Association to Combat Smoking and Chest Diseases,
previously undersecretary of the Ministry of Health, explained that the Corona virus
mutated 3 times in the first in 2003 and was known as SARS and the second in 2013 and was
known as the Middle East Respiratory Syndrome and in late 2019 as it was known as the
.new Corona virus

Dr. Issam Al-Moazi added that the golden advice in preventing corona is to clean the hand

and wash it well with soap and water in a sustainable manner while reducing handshaking
and hugs with each other. He continued: There are procedures that must be worked out,
which includes cooking food well, sneezing and coughing in a tissue and getting rid of it in a
. way that combats infection

Covid-19 disease affects the kidneys, heart, nervous system, blood, and digestive system.
Recent studies also indicate that people with kidney disease are more likely to become
infected with the emerging coronavirus

Corona's effect on the kidneys

A study published in the "Kidney International" magazine showed that kidney patients are
more susceptible to Covid-19, and dialysis patients should adhere to strict protocols to
.reduce the risk of infection

The study indicated that among 536 patients with viral infection, 36 patients had severe
kidney impairment within 20 days of infection with the virus despite the presence of a
normal creatinine level in the plasma. The effect of acute renal impairment on various
factors ultimately led to multifaceted failure, which resulted in the death of 33 patients with
severe renal impairment

Advice for kidney patients

The CDC recommends the following steps that must be adhered to by everyone suffering
from kidney disease, if they have kidney failure or have recently had a kidney transplant to
:prevent the risk of coronavirus infection

Wash your hands frequently with soap and water for 20 seconds or use an alcohol-free •
.hand sanitizer

Keep 2 meters away from everyone, especially people who suffer from coughing or
.sneezing

.If you feel sick and have flu-like symptoms, stay home and consult a doctor immediately

Nephrologists advise family members residing with dialysis patients to follow the necessary
precautions and regulations for patients to avoid the risk of infection with the Corona virus
.also