Kidney medicine and kidney failure advice.©published 2012.07.04 updated 2024.01.04
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Kidney medicine and kidney failure advice.©published 2012.07.04 updated 2024.01.04

Contents▾

PANDEMICS - as a Chronic Kidney Disease patient, what you ought to do. 

Contents

  1. COVID-19 Vaccines
  2. Atlas of COVID-19
  3. What we know about COVID-19
  4. Coronavirus (COVID-19) guidance for patients with kidney disease
  5. Current management of COVID-19
  6. Artficial Organ suport
  7. References 


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1.  COVID-19 Vaccines

A. Current vaccines: Pfizer-BioNTeck modRNA vaccine, Oxford(AZ)-Sputnik vaccine and Sinovac corona vaccine. 

COVID-19 vaccines
COVID-19 vaccines
Pfizer & Moderna vac: It is an RNA vaccine composed of nucleoside-modified mRNA (modRNA) encoding a mutated form of the spike protein of SARS-CoV-2, which is encapsulated in lipid nanoparticles. The vaccination requires two doses given three weeks apart. The particle fuses with cells and with cellular protein synthesis to produce the spike protein. This spike proteins induces antibody production by T lymphocytes against the corona virus spike protein to provide the immunity.
Pfizer & Moderna vac: It is an RNA vaccine composed of nucleoside-modified mRNA (modRNA) encoding a mutated form of the spike protein of SARS-CoV-2, which is encapsulated in lipid nanoparticles. The vaccination requires two doses given three weeks apart. The particle fuses with cells and with cellular protein synthesis to produce the spike protein. This spike proteins induces antibody production by T lymphocytes against the corona virus spike protein to provide the immunity.
Oxford-Sputnik vac: A diagram showing how the Oxford COVID-19 vaccine works. A chimpanzee adenovirus is used in the ChAdOx1 viral vector, engineered to match the SARS-CoV-2 spike protein. The Oxford vaccine contains the genetic sequence of this surface spike protein. When the vaccine enters cells inside the body, it uses this genetic code to produce the surface spike protein of the coronavirus. This induces an immune response, priming the immune system to attack the coronavirus if it later infects the body.
Oxford-Sputnik vac: A diagram showing how the Oxford COVID-19 vaccine works. A chimpanzee adenovirus is used in the ChAdOx1 viral vector, engineered to match the SARS-CoV-2 spike protein. The Oxford vaccine contains the genetic sequence of this surface spike protein. When the vaccine enters cells inside the body, it uses this genetic code to produce the surface spike protein of the coronavirus. This induces an immune response, priming the immune system to attack the coronavirus if it later infects the body.
Sinovac or CoronaVac: Chinese vaccine is an inactivated vaccine candidate against COVID-19, created from African green monkey kidney cells (Vero cells) that have been inoculated with SARS-CoV-2 (CN02 strain). At the end of the incubation period, the virus was harvested, inactivated with β-propiolactone, concentrated, purified, and finally absorbed onto aluminium hydroxide. The aluminium hydroxide complex was then diluted in a sodium chloride, phosphate-buffered saline, and water solution before being sterilised and filtered ready for injection.
Sinovac or CoronaVac: Chinese vaccine is an inactivated vaccine candidate against COVID-19, created from African green monkey kidney cells (Vero cells) that have been inoculated with SARS-CoV-2 (CN02 strain). At the end of the incubation period, the virus was harvested, inactivated with β-propiolactone, concentrated, purified, and finally absorbed onto aluminium hydroxide. The aluminium hydroxide complex was then diluted in a sodium chloride, phosphate-buffered saline, and water solution before being sterilised and filtered ready for injection.

B. Newer Vaccines NOVAVAX  and Johnson & Johnson vaccine 

Newer vaccines are affective against newer strain of COVID-19 virus.
Newer vaccines are affective against newer strain of COVID-19 virus.
It combines an engineered protein from the virus that causes COVID-19 with a plant-based ingredient to help generate a stronger immune response.

If the body encounters coronavirus in the future, the body is primed to fend it off.
The Novavax vaccine, called NVX-CoV2373, only needs to be stored at fridge temperatures - much like the AstraZeneca and Moderna vaccines.

This means distribution and supply chain management is easier than it is for the Pfizer vaccine, which has to be stored at the much lower temperature of -70C.

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C. Concensus on COVID-19 vaccines by regulatory bodies 


 ____________________________                      2.   Atlas of COVID-19 from literatures

COVID-19 AFFECTS
COVID-19 AFFECTS


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3. What we know about COVID-19  

If we don't, who will..
If we don't, who will..<thank you key workers>
COVID-19 pandemic worldwide
COVID-19 pandemic worldwide
What everyone needs to do to be lucky
What everyone needs to do to be lucky
Corona virus attacks lung cell
Corona virus attacks lung cell
Corona virus precautions
Corona virus precautions
Do not eat wild animals
Do not eat wild animals

   ____________________________                      4.  Coronavirus (COVID-19) guidance for patients with kidney disease   

Coronavirus mutants
Coronavirus mutants

These advices have been produced by the Kidney Care organizations of UK for chronic kidney disease patients during the period of COVID-19 pandemic. 

Please go to the link below to get your desired information. 

https://www.kidneycareuk.org/news-and-campaigns/coronavirus-advice/

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Abridged from the above website.

🛑 A)  If you have either:

* a high temperature (over 37.8 degrees)
or
* a new continuous cough

* Then self-isolate and stay at home for seven days if you live alone;
* if you share a home with other people
 you and your whole household should stay at home for 14 days. 
* Please do not go to your renal unit until you have spoken to them on the telephone, 
* and do not go to your GP or pharmacy.

* Dialysis patients with symptoms of COVID-19 should contact their dialysis unit and the dialysis unit can then ensure that kidney care continues to be provided.  
* Please don't go directly into your unit until you know what arrangements are being made for you.

* If you have had a transplant and believe you have COVID-19 you should let your transplant unit know. You are now being advised to self-isolate for 12 weeks regardless of having symptoms. 
* Do not visit the GP or pharmacy 
* Do not chnge your medications unless advised to do so by your renal unit. 

Self-isolation
* Strictly avoid contact with someone who is displaying symptoms of coronavirus (COVID-19). These symptoms include high temperature and/or new and continuous cough.

* Do not leave your house.
*  Do not attend any gatherings. These include gatherings of friends and families in private spaces for example family homes, weddings and religious services.
* Do not go out for shopping, leisure or travel and, when arranging food or medication deliveries, these should be left at the door to minimise contact.*
* Keep in touch using remote technology such as phone, internet, and social media.

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🛑B)  If you're a contact of a COVID-19 case
Or

If you are in Lock Down area, then stay home.

Stay at Home

* Only go outside for food, health reasons or work (but only if you cannot work from home)
* If you go out, stay 2 metres (6ft) away from other people at all times
* Wash your hands as soon as you get home
* Do not meet others, even friends or family.
* You can spread the virus even if you don’t have symptoms.

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🛑C) People who have had a transplant or take a certain level of immunosuppressive medicines are  advised to start strict self-isolation.

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🛑D)  Other group of patients that need self-isolation

You are at very high risk and will need to self-isolate yourself if you are in at least one of the following groups:

* You have a transplant

* If you over 70 and are on any form of immunosuppression or have been on one in the past

* Your kidney disease is caused by inflammation, a condition of your kidneys (sometimes called an autoimmune condition) AND-

* If you are currently receiving intravenous cyclophosphamide treatment or rituximab treatment or have done so within the last 6 months

* If you are receiving cyclophosphamide treatment as tablets (oral treatment)

* If you have received prednisolone at a dose equal to or above 20mg tablets every day for more than 4 weeks any time within the last 6 months

* If you have received or currently are receiving more than 5mg every day of prednisolone for greater than 4 weeks taken with at least one other immunosuppressive type of medicine within the last 6 months.

* If you suffer with nephrotic syndrome

* For children, who have the above kidney diseases.

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5.   Current management of COVID-19  

Nightingale hospital, London
Nightingale hospital, London

Current management strategies against Corona Virus infection:

🛑 

These are the main strategies with details in the web links

1) IL-6(R) mab: (targeting CRS that happens in SIRS) 

2) Anti-viral Remdesivir (Ebola agent) : 

3) Convalescent plasma (donates plasma of recovered pt): (Blocking antibody) 

4) Autologus stem cell inhalation: (repopulating pneumocytes) 

5) Vaccine: 

6) But everything down to maintaining clean status. http://Go.gov.sg/may2moh

🛑 
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6.  Artificial life support 

COVID-19, as shown in the picture, is a Multisystem disorder culminating in respective organ failure, involving diffuse inflammation with activation of Classic and Alternate Complement Activation resulting in systemic inflammatory response syndrome with release of complement by-products, diffuse intravascular coagulation syndrome, and thromboembolic disorder as a result of endothelial damage by the virus. 


All these pathologies culminate in organ damage and organ failure. Survival needs Artficial Organ support. 


Artficial Organ suport.

A) Acute respiratory failure

Machine ventilation with positive pressure ventilation 

ECMO, Extra Corporeal Machine Oxygenation

B)  Acute Renal Failure

Continuous renal replacement therapy (CRRT) 

Haemodialysis, Acute peritoneal dialysis 

C)  Acute Liver failure 

MARS, Molecular Adsorption recirculation systar. 

D)  Acute Circulatory failure

IABP, Intra Aortic Ballon counter-pulsating pump

E)  Acute Left Ventricular failure 

LVAD, Left ventricr Assisted Device

 F)  DIVC with vascular clotting, 

IVC Filter


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Be smart and be vigilant

Be brave and be confident

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