Influence of SARS-COV-2 on Lungs, Liver & Kidneys

Inﬂuence of SARS-COV-2 on Lungs, Liver & Kidneys Covid-19 has been around for more than 20 months now. We are already aware of the multiple symptoms that show up. Ever wondered what is behind the scenes once the virus enters inside the body? In this blog, we explain how it does. Read on to know more!

What is ACE2?

Angiotensin-Converting Enzyme 2 is an enzyme attached to the membrane of the cells attached to the intestines, kidneys, heart, lungs, etc. It is responsible for lowering blood pressure by catalyzing the hydrolysis of angiotensin II to angiotensin.

Attachment with ACE2 receptor

SARS-COV-2 uses Angiotensin-2 converting enzyme (ACE2) receptor protein to attack the host system. ACE2 receptors are present in abundance on the surface of the lung cells. ACE2 proteins are important in enzymatic function inﬂuencing blood ﬂow to the organs such as lungs, heart, kidneys. The spike protein protruding from the virus attacks ACE2 receptors to get access to the interior of the human cells where it can replicate. When the virus connects to the ACE2 it’s speculated to reduce the enzymatic function of ACE2.

Inﬂuence of COVID-19 on lungs

Once it starts replicating itself, it affects the respiratory system. Here the immune system responds to the pathogens that enter inside the body and activate the inﬂammatory pathway. Cytokines, proteins or glycoproteins secreted by the WBCs in response to stimuli are produced as a response to pathogens. Due to sudden acute increase in circulating levels of different proinﬂammatory cytokinesincl. IL6, a cytokine storm, is produced. This storm causes irreversible tissue damage which is recognized in patients suffering from moderate to severe COVID-19 infection. This may further cause ARDS.

Inﬂuence of COVID-19 on liver

This is generally followed by attacking the liver as studies indicate that the virus gets attached to the ACE2 positive cholangiocytes to exert a cytopathic effect. Cholangiocytes are involved in many aspects of liver physiology, including regeneration and adaptive immune response mechanisms, and the disruption of cholangiocyte function can cause hepatobiliary damage.

This is supported by cholestatic markers, including gamma-glutamyltransferase (GGT) which is the ﬁrst liver enzyme that rises in COVID-19. This is followed by SGOT & SGPT levels that increase upto three times. Elevated levels of Alkaline phosphatase (ALP) and Bilirubin are rarely observed in patients suffering from COVID-19. Hypoalbuminemia was reported in 55% of hospitalized patients with COVID‐19 and was associated with disease severity.

C-Reactive Protein or CRP levels also rise due to COVID-19. Almost all the patients suffering from COVID-19 have been observed having elevated levels of CRP. It is one of the markers that rises early on in COVID-19 and gauges the severity of the infection.

It is used to differentiate COVID-19 from other illnesses. Abnormally high CRP does not necessarily indicate COVID-19 however gradually rising CRP does. The half life of CRP is 4 to 6 hours in which it increases and doubles in every 8 hours. It is found to be at its peak between 36 to 56 hours. That means, it usually takes 2 days to reach 100 mg/l. CRP values in COVID-19 can be interpreted as follows:

Normally CRP values should be < 10 mg/L
Less than 26 mg/L: Moderate Elevation
26 to 100 mg/L: Mild Elevation
> 100 mg/L : Severe Elevation

Inﬂuence of COVID-19 on kidneys

Since ACE2 is also present in the kidneys, COVID-19 affects the kidneys as well. It has been observed that patients with kidney problems are at higher risk of getting infected with COVID-19. This is because people on dialysis have a weakened immune system making it hard to ﬁght the infection. People who have had a kidney transplant are on anti-rejection medicines also known as immunosuppressive medications also can be

Once the virus does affect the kidneys, evidence shows the presence of RNA fragments in the urine of the affected patients that indicate urea and creatinine are the ﬁrst parameters that get elevated. The normal range of creatinine is 0.7 to 1.2 mg/dl but in COVID-19 it can go as high as 2.58 mg/dl. Patients who survived COVID had 90% higher uric acid levels, hence it might be a good speciﬁcity indicator of mortality in COVID-19 patients.

Hospitalized with COVID-19 are twice as likely to develop Acute Kidney Injury (AKI) as compared to non hospitalized patients. This can lead to serious illness, dialysis, and even death.

COVID-19-related effects that contribute to AKI include kidney tubular injury with septic shock, microinﬂammation & increased blood clotting. Most patients with COVID-19-related AKI who recover continue to have low kidney function after discharge from the hospital.

To conclude, a joint guideline published on 22nd April 2021 by ICMR & AIIMS advises monitoring the parameters associated with kidneys and liver regularly. In the case of patients suffering from moderate COVID-19 infection, it’s advised to measure the parameters 24 to 48 hourly and in case of severe patients daily.

Once the patient is discharged from the hospital and recovering from COVID-19 it is important to still monitor the kidney and liver as the steroids can have long-lasting side effects or can cause other complications.

Let Accurex aid you in this ﬁght as it has specially designed a campaign that includes the kidney and liver parameters for COVID-19 monitoring. To know more about it, feel free to contact us!

Accurex- Testing, Monitoring, and Saving Lives! Ref:

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Influence of SARS-COV-2 on Lungs, Liver & Kidneys