AL SHIFA CLINIC KARACHI

Syed Intisar Hussain

Explore the impact of COVID-19 on chronic kidney disease with Meri Sehat. Stay informed for precautions and well-being during the pandemic.

COVID-19: The Chronicles of CKD

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Debunking Myths About COVID-19 & Anti-Malarial Drugs

Introduction

A pandemic is often a cause of panic, and rightly so, as things are often difficult to make sense of at the start or even in the middle. The looming threat of a deadly illness can lead to irrational fears among people. As expected, the <a href="https://www.merisehat.pk/disease/covid-19">COVID-19 pandemic</a> also gave birth to some strange fears across the world. These ranged from thinking 5G networks cause <a href="https://www.merisehat.pk/disease/covid-19">COVID-19</a> to drinking disinfectants as a preventive measure. There has also been a lot of misinformation about coronavirus treatments. While some have touted eating garlic to be lifesaving, others have stuck to drinking camel urine.

According to the World Health Organization (WHO), as of 19th May, the world has reported more than 520 million COVID-19 cases and 6 million deaths<a href="#accordion">[1]</a>. Although the first COVID-19 case emerged in November 2019, Pakistan did not report a case until February 2020<a href="#accordion">[2]</a>. However, the fear of an outbreak had already gripped the country way before the detection of the first case. Soon enough, people were sharing various home remedies and myths about the novel coronavirus. Moreover, the pandemic also led to the prescription and use of unauthorized drugs for the treatment of COVID-19. These included antibiotics and antimalarial drugs, among others.&nbsp;

&nbsp;

Understanding The Dangers Of Unsubstantiated COVID Treatments

At the start of the pandemic, scientists conducted multiple studies in hopes to find a cure for the novel coronavirus. They investigated existing drugs such as ivermectin, anti-viral drugs, and antimalarial medications chloroquine and hydroxychloroquine as experimental therapies for COVID-19. Short on time, many doctors also began prescribing these drugs to COVID patients, without any conclusive scientific evidence of their effectiveness.&nbsp;

To make matters worse, the then U.S President, Donald J. Trump admitted to taking the antimalarial hydroxychloroquine as a preventive strategy. Many of Trump&#39;s advisers and doctors supported his decision. The statement was backed by a French trial that had demonstrated a decrease in viral load after just 6 days of treatment with hydroxychloroquine<a href="#accordion">[3]</a>. However, many experts labeled the results from the small-scale study anecdotal and insufficient.&nbsp;

As a result of the drug demonstrating anti-viral effects in experimental models, the U.S. Food and Drug Administration (FDA) further granted both chloroquine and hydroxychloroquine emergency use authorization early in the pandemic. And researchers around the world began conducting large clinical trials to evaluate the drug&#39;s safety and effectiveness against COVID-19. However, many of the trials had to be stopped in the middle due to the drug&#39;s adverse effects on participants. Moreover, many failed to show a significant benefit compared to a placebo group. In a study done among rheumatoid arthritis patients, researchers found a similar incidence of COVID-19 among both groups: 0.89% in hydroxychloroquine users and 0.62% in non-users<a href="#accordion">[4]</a>. Thus, showing that the antimalarial drug does not provide protection against the novel coronavirus.&nbsp;

As a result of the negative results in multiple trials, the FDA later revoked its emergency use authorization for chloroquine and hydroxychloroquine<a href="#accordion">[5]</a>. According to the regulatory body, the benefits no longer outweighed the risks associated with drug use. Thus, resulting in a reversal of the decision.&nbsp;

Despite the evidence, several countries such as Brazil, Pakistan, and India continued administering the antimalarial. Pakistan even banned exports of the drugs to have more available for the treatment of COVID-19. However, the increased prescription and self-medication of the drug resulted in a shortage for those that truly needed them.

&nbsp;

Both chloroquine and hydroxychloroquine are used for the treatment of malaria. Chloroquine works by preventing the malarial parasite from multiplying within the red blood cells. There was a time when it was hailed as a highly effective drug and was widely used to treat malaria. However, over the years, malaria strains have developed resistance to the drug. Therefore, in areas with chloroquine resistance, doctors usually prescribe other antimalarials such as mefloquine or atovaquone.&nbsp;&nbsp;

Hydroxychloroquine is a safer and more soluble metabolite of chloroquine. Both are used for treating or preventing malaria. However, due to their immunosuppressive effects, they are also FDA-approved for treating autoimmune conditions, such as lupus and rheumatoid arthritis.

The most common side effects of using antimalarial drugs are headache, nausea, diarrhea, itchiness, hives, double vision, anxiety, and hair discoloration. Although both are fairly safe, long-term use of these drugs can lead to retinal toxicity, heart toxicity, and even death. Moreover, in COVID-19 patients, antimalarial drugs have been shown to exert severe cardiac side effects. These include disturbances in the heart&#39;s rhythm and, in certain cases, sudden death.&nbsp;

&nbsp;

Chloroquine and hydroxychloroquine are not the only antimalarial drugs that people have used to treat COVID-19. Many have also experimented with the Artemisia plant in the form of herbal teas or supplements to cure the viral disease.&nbsp;

One of the commonly used antimalarial drugs, artemisinin-based combination therapies (ACTs) are produced from extracts of the Artemisia plant. However, no study has found the drug or the plant to exert a positive effect against COVID-19. The WHO has also found no evidence of the plant&#39;s effectiveness against the novel coronavirus.&nbsp;

One antimalarial drug, atovaquone, has shown anti-viral activity in a lab study. Atovaquone is an effective antimalarial drug used in combination with proguanil. Sold under the brand name Malarone, the medication is highly effective in treating chloroquine-resistant malaria. Moreover, atovaquone is also used to treat toxoplasmosis and mild pneumocystis pneumonia infections. Due to the drug&#39;s anti-viral effects against viruses such as Zika and dengue, scientists conducted a laboratory study investigating its effect on infected human lung cells.

The study not only demonstrated the drug&#39;s ability to prevent coronavirus replication in cells but also its effectiveness against various coronavirus variants<a href="#accordion">[6]</a>. Based on these results, researchers are now conducting clinical trials of atovaquone for COVID-19 treatment.

&nbsp;

Conclusion

The start of the COVID-19 pandemic led to scientists scrambling for a cure or breakthrough in the treatment of the novel coronavirus. Since developing new treatments can take a lot of time, researchers turned to drug repurposing. This involves investigating new uses for existing drugs. The strategy is often employed for its time and cost-effectiveness, especially in times like the pandemic.&nbsp;

During the COVID-19 pandemic, researchers repurposed various drugs such as remdesivir, ivermectin, steroids, antidepressants, vitamin C and D, Zinc, and even immunosuppressants. While this led to several safe and effective coronavirus treatments, it also helped establish which drugs don&#39;t work.&nbsp;

Antimalarial drugs, such as chloroquine and hydroxychloroquine, are among the treatment options that did not show a favorable profile against COVID-19. Although, at the start of the pandemic, many countries adopted the drugs without any validated scientific evidence. Antimalarial use was further exacerbated when the then U.S. President Donald J. Trump reported using hydroxychloroquine as a precautionary step. Despite the lack of evidence, people rushed to get their hands on a prescription for the medicine. Moreover, the increased demand led to pharmaceutical companies putting all their resources into increasing drug production. This diverted attention from the production of important pandemic supplies, like face masks, ventilators, and gowns. Experts have criticized people for hoarding these medications and causing shortages for those suffering from malaria, lupus, or rheumatoid arthritis. Moreover, recent trials and studies have proven hydroxychloroquine and chloroquine as ineffective against COVID-19. Many have also related severe side effects to the drug&#39;s use.&nbsp;

Therefore, the WHO urges people to not self-medicate with these or any drugs that have not been backed by any health regulatory body. Moreover, physicians are advised to refrain from administering such treatments to COVID-19 patients.

In conclusion, prevention is the best strategy against COVID-19. Washing hands, maintaining social distancing, and wearing a mask continue to be the best precautionary steps for preventing COVID-19.

&nbsp;

Key points

<ul></ul><ul><li style="line-height: 1.2; margin-top: 0pt; margin-bottom: 0pt;">The COVID-19 pandemic began in November of 2019 and has infected more than 520 million people across the world.&nbsp;</li><li style="line-height: 1.2; margin-top: 0pt; margin-bottom: 0pt;">The pandemic gave rise to several myths and theories about the spread and treatment of COVID-19. From eating garlic to drinking disinfectants, people have done some rather outlandish things to protect themselves.&nbsp;</li><li style="line-height: 1.2; margin-top: 0pt; margin-bottom: 0pt;">One such myth surrounded the use of antimalarial drugs to treat COVID-19. Early in the pandemic, several scientists also supported the theory, citing successful result from small scale in-vitro studies.&nbsp;</li><li style="line-height: 1.2; margin-top: 0pt; margin-bottom: 0pt;">As the use of chloroquine and hydroxychloroquine increased worldwide, it also led to the development of severe side effects among COVID-19 patients.</li><li style="line-height: 1.2; margin-top: 0pt; margin-bottom: 0pt;">Multiple trials also investigated the effects of these drugs on the novel coronavirus. However, none could demonstrate any benefits. Moreover, many clinical trials ended halfway due to the occurrence of severe cardiac side effects among trial patients taking hydroxychloroquine.</li><li style="line-height: 1.2; margin-top: 0pt; margin-bottom: 0pt;">Other than chloroquine and hydroxychloroquine, people have also explored the Artemisia plant for its anti-viral properties. The plant's extracts are used for making artemisinin-based combination therapies (ACTs) for malaria. However, studies have not found the plant to have anti-COVID activity.</li><li style="line-height: 1.2; margin-top: 0pt; margin-bottom: 0pt;">So far, atovaquone is the only antimalarial that has shown anti-viral properties against COVID-infected lung cells. The laboratory study is now being converted into a clinical trial to help scientists better understand the drug's mechanism of action and safety.&nbsp;</li></ul>

[1] WHO, 2022. WHO Coronavirus (COVID-19) Dashboard. [Online].

[2] Habib, M. & Abbas, M., 2021. Facing the Threat of COVID-19 in Pakistan: A Nation’s Dilemma. Value in Health Regional Issues, Volume 24, pp. 90-95.

[3] Gautret, P. et al., 2020. Hydroxychloroquine and azithromycin as a treatment of COVID-19: results of an open-label non-randomized clinical trial. International Journal of Antimicrobial Agents.

[4] Favalli, E. G. et al., 2020. Role of antimalarials in COVID-19: observational data from a cohort of rheumatic patients. Annals of the Rheumatic Disease, 80(5).

[5] FDA, 2020. Coronavirus (COVID-19) Update: FDA Revokes Emergency Use Authorization for Chloroquine and Hydroxychloroquine. [Online].

[6] Carter-Timofte, E. M. et al., 2021. Antiviral Potential of the Antimicrobial Drug Atovaquone against SARS-CoV-2 and Emerging Variants of Concern. ACS Infectious Diseases, 7(11), pp. 3034-3051.

Nimrah H. Sattar

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Iqra Mazhar

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Debunking Myths Of Kidney Stones

<a href="https://www.merisehat.pk/disease/kidney-stones-66">Kidney stones</a> are notorious for being one of the most painful and difficult ailments an individual can be diagnosed with. And they are becoming more prevalent. Today over half of all urology patients in Pakistan have a kidney stone and 3-5% of the population is at risk of developing a kidney stone at some point in their lives[1]. Diet, an abundance of body weight, and certain ailments and medications are among the leading reasons for kidney stones. From the kidneys to the bladder, any segment of the urinary tract can be hindered by renal stones. 
&nbsp;

Although a common occurrence, there are a ton of myths and misinterpretations surrounding kidney stones, their causes, and ways to prevent their formation. 
&nbsp;

Potential causes include drinking too little water, excessively working out, weight reduction surgery, obesity, or eating salty or sugary food. In certain individuals, diseases and family ancestry may also play a role. Moreover, consuming an excess of fructose (present in table sugar and high fructose corn syrup) corresponds to a growing chance of fostering a kidney stone<a href="#accordion">[2]</a>. 
&nbsp;

There are four main kinds of kidney stones: 
&nbsp;

<ul>
	<li>Calcium Stones: Calcium stones are the most common type of kidney stones<a href="#accordion">[3]</a>.&nbsp;Calcium oxalate stones are formed due to calcium mixing with the oxalate present in urine. Consuming oxalate-rich foods such as spinach, peanuts, and chocolates can increase one&rsquo;s risk of these stones. On the other hand, calcium phosphate stones are less prevalent than oxalate ones. They are typically caused by hyperparathyroidism, renal tubular acidosis, and urinary tract diseases<a href="#accordion">[4]</a>. 
	&nbsp;</li>
	<li>Uric Acid Stones: Uric acid stones are often associated with diabetes, body weight fluctuations, and several metabolic disorders. These stones are formed due to excessively acidic urine<a href="#accordion">[3]</a>. 
	&nbsp;</li>
	<li>Struvite Stones: The most well-known reason for struvite stones is urinary tract infections (UTIs) that lead to urine pH imbalances These stones can be significantly large and cause urinary obstruction<a href="#accordion">[3]</a>. 
	&nbsp;</li>
	<li>Cystine Stones: This is the least common type of kidney stone. It occurs in people with cystinuria, a genetic condition that results in increased levels of the amino acid cystine in the urine.&nbsp; 
	&nbsp;</li>
</ul>

&nbsp;

Understanding kidney stones and some common myths

Have you ever received unsolicited medical advice from a neighbour? A friend? Or maybe an aunt with no blood relation to you?&nbsp; Technically, anyone but a medical practitioner? Then you have stumbled upon the right page. If there is anything desis love more than chai it is reliance on pseudo-helpful home remedies and ancestral healing concoctions. And why should kidney stones be any different? Here, we have listed the top 5 myths about kidney stones, believing which would do you more harm than good: 
&nbsp;

<h5>1. Toss Out Dairy</h5>

It has been misconstrued that you need to opt for non-milk options and adapt to a dairy-free life as research suggests otherwise. The calcium in milk is essential for several bodily functions such as blood clotting, assisting muscular contractions, regulating healthy heart contractions and relaxations, nerve functioning, strong bones and teeth, and, most of all, preventing kidney stones<a href="#accordion">[5]</a>. 
&nbsp;

Many individuals dread calcium since calcium consumption has been linked to the formation of kidney stones, yet the reality of the situation could not be further from such a restrictive diet. If there is a possibility that your calcium intake is excessively low, you are in fact in danger of increasingly absorbing oxalate, a typical compound we eat in numerous food sources. Excessive retention of oxalate can prompt additional oxalate in your urine and that can give rise to calcium oxalate stones. 
&nbsp;

<h5>2. Like A Stomachache</h5>

We trace the origin of this myth to just a lack of knowledge of anatomy, where any region of the abdomen below the chest and above the legs has been coiled under the umbrella term stomach. While you will experience incredible levels of discomfort and sharp pain in your lower abdominal region, it will feel more like a spasm. At the point when you have spasms, your stomach muscles flex with incomparable force and intensity which causes serious pain. As the stone travels through the urinary tract, the pain might differ in levels of intensity. Kidney stones can cause a tightening of muscles, and for certain individuals, the stabbing sensation of pain is like that experienced in menstrual cramps. To rule out the dismissing excuse of a stomachache, keep an eye out for other symptoms of kidney stones, which include nausea, discomfort while urinating, and a pungent smell of urine<a href="#accordion">[5]</a>. 
&nbsp;

<h5>3. Kidney Stone Is Always Painful</h5>

Kidney stones are defined as hard sediments of minerals within the urinary tract that obstructs the path of urine, cause infection, and bring a mammoth of pain. However, they are not always bearers of pain, especially when they are in the initial stages of formation. Other symptoms might indicate the formation of a kidney stone such as blood while urinating, severe nausea, and uncontrollable vomiting. 
&nbsp;

A type of kidney stone termed &lsquo;Silent Stone&rsquo; fails to exhibit characteristic kidney stone symptoms and is diagnosed by an imaging test or a routine checkup. In Pakistan, the results of a study in a urology department found that 3% of all urology patients suffered from silent kidney stones<a href="#reference" target="_blank">1</a>. Therefore, routine visits to a GP are necessary to catch any unprecedented discovery and receive timely treatment before the development of any complications. 
&nbsp;

<h5>4. Cranberry Juice Is The Elixir Of All</h5>

Cranberry juice is a perfectly viable option and beverage for when you have a urinary tract infection or as a preventive measure to forestall one. It thickens and solidifies your urine, which drains the contaminated substances out and wards off the probability of having it again. However, if you have a kidney stone, it exacerbates the issue. Cranberry contains high measures of oxalate, which is a primary mineral found in kidney stones. Therefore, if you want to get rid of kidney stones, skip the cranberry juice. 
&nbsp;

With regards to halting kidney stones, lemon juice is a far better alternative to cranberry juice. Citrus refreshments have been associated with an increment of citrate levels in urine, which can limit and restrict stone development. Nonetheless, research shows the amount you drink has a lot more prominent effect than what you drink. You must hydrate yourself sufficiently with 100 ounces of liquids daily - anything that those liquids might be - to keep the kidneys flushed out and the abundance and prevalence of stone-forming salts lower. 
&nbsp;

<h5>5. Sodas Cause Kidney Stones</h5>

As an organization dedicated to garnering public attention towards medical illnesses, we feel obligated to suggest avoiding sodas and fizzy beverages as their high sugar and preservative concentrations can cause several complications. But, as morally honest fact bearers, we must admit that soft drinks are not the sole contributors to kidney stones. The truth of the matter is phosphoric acid is the main culprit. The ingredient is commonly found in dark-colored soft drinks. The other issue with soda is that it is an infamous diuretic because of the addition of caffeine. This raises the normal concentration of salt in your urine, which advances kidney stones<a href="#accordion">[6]</a>. So, if you choose to consume a soft drink, compensate the ounces with an equivalent measure of water and you will diminish that concentration. Then again, you could stay away from soft drinks through and through and replace them with better options. 
&nbsp;

<h4>"A high Heart rate variability is a an important indicator of good health. Head on over to our <a href="https://www.merisehat.pk/page/sehat-scan/" target="_blank">sehat scan </a>and check your heart rate variability today!" </h4>

The only conclusion that can be drawn from busting several myths is another myth that the internet knows it all. While many verified health blogs and revered medical journals will supply you with an influx of information, it is important to realize that each body is different. For any disease or illness or even kidney stones, always consult a doctor, a urologist, and a certified dietician who can guide you, assist you, and support you with reasonable and sustainable solutions. 
&nbsp;

Tip of the day: Be old school and book that appointment ASAP. 
&nbsp;

Key Points

This article gathered to debunk some of the most common myths surrounding kidney stones that patients have heard from their acquaintances or on the internet. With the intent to inform rather than offend the key takeaways from this article are:

<ul>
	<li>There are four types of kidney stones: calcium stones, uric acid stones, struvite stones, and cystine stones.</li>
	<li>The body should not be deprived of calcium as its deficiency can lead to kidney stones.</li>
	<li>Kidney stones are not always painful and can be silent.</li>
	<li>Kidney stones cause a more severe pain than a stomachache.</li>
	<li>Kidney stones cannot be cured with cranberry juice; opt for lemon juice instead.</li>
	<li>Stay hydrated!&nbsp; 
	&nbsp;</li>
</ul>

[1].Buchholz, N., Abbas, F., Khan, R., Talati, J., Afzal, M., & Rizvi, I. (2003). The Prevalence of Silent Kidney Stones - an Ultrasonographic Screening Study. Journal of the Pakistan Medical Association, Vol 53, 1-5.

[2].National Kidney Foundation. (2022). Kidney Stones. Retrieved from National Kidney Foundation:

[3].U.S. Department of Health and Human Services. (n.d.). Definition & Facts for Kidney Stones. National Institute of Diabetes and Digestive and Kidney Diseases. Retrieved July 28, 2022,

[4].Loughlin, K. R. (2019, May 17). What causes kidney stones (and what to do). Retrieved from Harvard Medical School:

[5].Urology Specialists of Georgia. (2022). Debunking 3 Common Kidney Stone Myths. Retrieved from Urology Specialists of Georgia:

[6].Uribarri, J., Oh, M. S., & Carroll, H. J. (1989). The First Kidney Stone. Annals of internal medicine, 111(12), 1006–1009.

Zarlish Kazmi

This article or video has been recorded by a subject / domain specialists with a proven track record of excellence in their area. 

O’ Sweet Kidney Of Mine!

This is surely not an article on how cannibalism is good. I mean there shouldn’t be any articles on “how cannibalism is good”, right? Rest assured, the information summoned here, is related to the sugary stuff and its effects on your health. So, get ready as you’re in for a treat, no pun intended!

Understanding Diabetic Nephropathy

Nephropathy is the progressive deterioration of the kidney&rsquo;s function. Diabetic nephropathy, then, refers to the deterioration of the kidney as a result of longstanding or complicated<a href="https://merisehat.pk/disease/diabetes-type-1-and-2"> diabetes</a><a href="#accordion">[5]</a>. As the disease progresses and reaches the final stage, it is termed as kidney failure or end-stage renal disease (ESRD)<a href="#accordion">[2]</a>.&nbsp;

According to the CDC reports, diabetes is the most common cause of ESRD. In 2011, there were around 26 million diabetic people in the U.S., and more than 200,000 people with ESRD were either going through chronic renal dialysis or had kidney transplant<a href="#accordion">[2]</a>.&nbsp;

&nbsp;

There are essentially two types of diabetes:&nbsp;

1. Type I (Inherited or Juvenile)&nbsp;

2. Type II (Adapted)

&nbsp;

Type I diabetes is the most likely of the two types of diabetes to progress into ESRD, the fifth and last stage of diabetic nephropathy, while patients who develop type II diabetes mellitus may present with albuminuria (the presence of albumin protein in the urine) at the time of diagnosis.

However, diabetic nephropathy in type I diabetes develops over the course of 15-20 years after the diagnosis. This difference in the timeline is because it&rsquo;s difficult to pinpoint the precise onset of type II diabetes. It&rsquo;s identified only when the kidney&rsquo;s structural and functional changes occur due to diabetes, causing proteinuria and hypertension the hallmarks of diabetic nephropathy<a href="#accordion">[1]</a>. 
&nbsp;

<ul>
	<li>Ethnic Groups: Some groups of the population, such as&nbsp;African Americans, Native Americans, and Mexican Americans, are more at risk than others. Researchers have noted familial clustering (occurrence of the disease within some families in excess of what would be expected from the occurrence in the population) in these cases, which indicates that genetics also play a vital role in developing nephropathy<a href="#accordion">[1]</a>.&nbsp;</li>
	<li>Blood Sugar Level: The high levels of blood sugar associated with diabetes damage the kidney through various pathways. The damage is mostly directed toward&nbsp;the blood vessels that are responsible to filter the blood in order to make urine.</li>
</ul>

&nbsp;

Diabetic nephropathy has a high morbidity and mortality rate&nbsp;mainly because of other issues due to diabetes<a href="#accordion">[1]</a>:

<ul>
	<li>Chronic Kidney Disease (CKD): As of now, diabetic nephropathy is the leading cause of CKD in the United States as well as other Western societies<a href="#accordion">[6]</a>.&nbsp;</li>
	<li>Hypertension: Like CKD, hypertension (commonly known as high blood pressure) is also believed to be both a cause of and a result of the damage that is done by the disease. An individual suffering from uncontrolled hypertension progresses toward&nbsp;stage V diabetic nephropathy faster than those who don&rsquo;t have high blood pressure<a href="#accordion">[2]</a>.&nbsp; 
	&nbsp;</li>
</ul>

On the basis of the clinical presentation, doctors have broken down this kidney disease into 5 stages, depending on the glomerular filtration rate (GFR) which is essentially the rate at which the kidneys filter the blood. GFR is basically a representation of the effectiveness of the kidney function in percentage. The stages are as follows<a href="#accordion">[3]</a>:

Stage 1: The kidney is damaged; however, the kidney function is normal and a GFR of 90% or above is seen.

Stage 2: The kidney faces some degree of damage and a GFR of 60&ndash;89% is observed.

Stage 3: Mild to severe loss of kidney function is recorded with a GFR of 30&ndash;59%.

Stage 4: This stage refers to the severe loss of function and a GFR of 15&ndash;29%.

Stage 5: Kidney failure and a GFR of under 15% defines stage 5. 
&nbsp;

Diabetic nephropathy is always a cause for alarm if the individual has diabetes mellitus as a comorbidity along with a history of the following<a href="#accordion">[1]</a>:

1. Foamy urine

2. An unexplained proteinuria

3. Diabetic retinopathy, i.e., diabetes affecting the visual sense

4. Fatigue and foot edema because of hypoalbuminemia, i.e., decreased levels of albumin protein)

5. Hypertension

6. Coronary artery disease

&nbsp;

Diabetic nephropathy sounds dangerous, and rightfully so! However, there are ways to lower the risk<a href="#accordion">[4]</a>:&nbsp;

<ul>
	<li>Keep up with regular checkups; an annual appointment with a healthcare team helps with diabetes management, hence, helping avoid complications like diabetic nephropathy, retinopathy, and neuropathy.&nbsp;</li>
	<li>Take antidiabetic drugs with utmost efficiency. When it&rsquo;s impossible to resist chocolate cake, tiramisus, or maybe some soft succulent, and sweet gulab jamuns, why hold back on the medicines that actually allow devouring these delicacies in moderation? There is no doubt that medication can be very effective and may even help prevent diabetic nephropathy.&nbsp;</li>
	<li>Manage blood pressure as it increases the risk of kidney disease<a href="#accordion">[3]</a>. Moreover, take care while taking nonprescription pain relievers (e.g., aspirin) and nonsteroidal anti-inflammatory drugs (e.g., naproxen and ibuprofen) as they can lead to kidney damage in case of diabetic nephropathy.&nbsp;</li>
	<li>Also try to maintain a balanced body mass index<a href="#accordion">[3]</a>.&nbsp;</li>
	<li>Another crucial thing to take care of&nbsp;to avoid diabetic nephropathy and its complications is smoking. The solution is pretty simple: don&rsquo;t smoke. Cigarette smoking is responsible for damaging the kidneys and can even make existing kidney damage worse<a href="#accordion">[3]</a>.</li>
</ul>

&nbsp;

A doctor advising medical intervention will discuss the best drug according to the severity of the disease. Therapeutic agents for glycemic (sugar) control in diabetic patients, who have developed kidney disease as well, include<a href="#accordion">[3]</a>:

<ul>
	<li>Dipeptidyl Peptidase Inhibitors, e.g., Sitagliptin</li>
	<li>Alpha-Glucosidase Inhibitors, e.g., Acarbose</li>
	<li>Sodium-Glucose Cotransporter 2 (SGLT2) Inhibitors, e.g., Canagliflozin</li>
	<li>Glucagon-like peptide-1 (GLP-1) Receptor Agonists or Incretin Mimetics, e.g., Dulaglutide&nbsp;</li>
	<li>Amylin Analogs, e.g., Pramlintide</li>
	<li>Nonsteroidal, Selective Mineralocorticoid Receptor (MR) Antagonists, e.g., Finerenone&nbsp; 
	&nbsp;</li>
</ul>

It may take months or years for complications of diabetic nephropathy to develop. Whatever the reason, whether it was non-compliance on your part or whether it was due to the fact that the disease was already in its advanced stages, it is important to know the current status of your condition so that it can be treated accordingly before it develops into the following complications<a href="#accordion">[4]</a>:

1. Fluid Retention: Fluid retention can cause swelling in the arms and legs, hypertension, or even cause pulmonary edema, whereby fluid builds up in the lungs.

2. Hyperkalemia: Hyperkalemia is an increase in potassium levels in the blood and it can lead to abnormal heart rhythms.

3. Cardiovascular Disease: Another major complication is cardiovascular diseases which, in turn, can lead to stroke.

4. Diabetic Retinopathy: Uncontrolled diabetic nephropathy can also damage the blood vessels of the retina, the light-sensitive tissue at the back of the eye, and cause diabetic retinopathy.

5. Blood Loss: It will lead to a reduced number of red blood cells to transport oxygen, a condition known as anemia

6. Bone And Mineral Disorders: Since the kidneys are losing their ability to function properly, it will affect the level of calcium and phosphorus in blood.

7. Miscellaneous Conditions: Some other conditions caused due to diabetic nephropathy are foot sores, erectile dysfunction, diarrhea, damaged nerves and blood vessels, and pregnancy complications. 
&nbsp;

Dialysis or a kidney transplant is used as the last resort, i.e., if the kidneys are damaged beyond repair, then the patient may need dialysis on a regular basis - at least until they can get a transplant - to survive<a href="#accordion">[3]</a>.

&nbsp;

Additionally, the doctor may give some instructions regarding their diet to avoid an unfortunate event<a href="#accordion">[3]</a>:

<ul>
	<li>Water: Water is definitely essential; however, excess fluid can increase the risk of swelling and hypertension.</li>
	<li>Sodium: An excessive intake of sodium can raise blood pressure pathologically.</li>
	<li>Protein: A drawback of kidney disease is the consumption of too much protein can lead to a buildup of waste products in the blood, putting unnecessary pressure on the kidneys</li>
	<li>Phosphorus: Phosphorus is found in high quantities in dairy products. A high level of phosphorus can weaken the bones and again put excessive pressure on the kidneys.</li>
	<li>Potassium: People with kidney disease reportedly have a higher level of potassium than a healthy adult; too much and/or too little&nbsp;potassium is bad for the neurons. 
	&nbsp;</li>
</ul>

Diabetes takes away a person’s integrity slowly and bit by bit. However, with due management and precautionary methods, it can be kept at bay and the patient can live a fairly decent life filled with heavenly desserts (in moderation of course)!

<ul>
	<li>Nephropathy is the progressive deterioration of the kidney&rsquo;s function. Diabetic nephropathy, by extension, is the deterioration of the kidney due to long-standing or complicated diabetes.</li>
	<li>According to the CDC reports, diabetes is the most common cause of ESRD.</li>
	<li>In 2011, there were around 26 million diabetic people in the U.S., and more than 200,000 people with ESRD were either going through chronic renal dialysis or had undergone a kidney transplant.</li>
	<li>There are essentially 5 stages of diabetic nephropathy; ESRD is the fifth and last stage.</li>
	<li>Some groups, such as African Americans, Native Americans, and Mexican Americans are at a high risk of developing diabetic nephropathy.</li>
	<li>Researchers have noted familial clustering, which means that genetics play a vital role in developing nephropathy.</li>
	<li>Diabetic nephropathy is one of the most prominent long-term complications when it comes to morbidity and mortality of a diabetic person.</li>
	<li>Hypertension is an inevitable threat posed by diabetes. It is also a major reason why diabetic nephropathy develops in the first instance.</li>
	<li>The damage is mostly directed towards the blood vessels responsible to filter the blood to make urine.</li>
	<li>If the kidney&rsquo;s structural and functional changes occur due to diabetes, it results in proteinuria and hypertension, which are the hallmarks of diabetic nephropathy.</li>
	<li>Diabetic nephropathy is an alarming condition given the patient also has diabetes mellitus as a comorbidity.</li>
	<li>Do not skip regular checkups. An annual appointment with the healthcare team is necessary since it sheds light on how well the person can manage diabetes, and thereby, avoid complications like diabetic nephropathy, retinopathy, and neuropathy.</li>
	<li>Moreover, take nonprescription pain relievers (e.g., aspirin) and nonsteroidal anti-inflammatory drugs (e.g., naproxen and ibuprofen) as prescribed by the doctor since their side effects often include kidney damage.</li>
	<li>Cigarette smoking is responsible for damaging the kidneys and can even make existing kidney damage worse.</li>
	<li>Kidney disease is categorized into 5 stages, depending on the glomerular filtration rate.</li>
	<li>In Stage 1, the kidney is damaged; however, the kidney function is normal and a GFR of 90% or above is seen.</li>
	<li>In Stage 2, the kidney faces some degree of damage&nbsp;and a GFR of 60&ndash;89% is observed.</li>
	<li>Stage 3 is when there is mild to severe loss of kidney function and a GFR of 30&ndash;59%.</li>
	<li>Stage 4 refers to the severe loss of function and a GFR of 15&ndash;29%.</li>
	<li>Stage 5 is defined by kidney failure and a GFR of under 15%.</li>
	<li>The doctor may suggest a medical intervention to discuss the treatment options according to the severity of the disease.</li>
	<li>Complications of diabetic nephropathy include fluid retention, diabetic retinopathy, and hyperkalemia.</li>
	<li>If a person has diabetic nephropathy, then they need to keep a check on their intake of sodium, phosphorus, and water specifically.</li>
</ul>

[1] Diabetic nephropathy - statpearls - NCBI bookshelf.

[2] Diabetic nephropathy (kidney disease). Diabetic Nephropathy (Kidney Disease) | Johns Hopkins Medicine.

[3] Diabetic nephropathy: Symptoms, stages, causes, and treatment. Medical News Today.

[4] Diabetic nephropathy (kidney disease). Mayo Clinic.

[5] EmmaHook. Diabetic nephropathy (kidney disease). Diabetes UK.

[6] Gross JL, de Azevedo MJ, Silveiro SP, Canani LH, Caramori ML, Zelmanovitz T. Diabetic nephropathy: Diagnosis, prevention, and treatment. American Diabetes Association.

Arbaz Ansari

Ismail Munir

COVID-19: Unmask Your Mental Health

The COVID-19 pandemic has drastically changed people&rsquo;s lifestyles. The new normal is a combination of altered daily routines, uncertainty, social isolation, and financial pressures. People are constantly worried about getting sick, their jobs being affected, and the pandemic never-ending. Moreover, the rumors and overload of misinformation can make individuals feel out of control or unclear about their goals. The pandemic can lead to <a href="https://www.merisehat.pk/article/how-to-manage-anxiety">feelings of anxiety</a>, stress, fear, and loneliness which can all worsen with time

According to surveys, there is an increase in the number of adults who report symptoms of stress, anxiety, insomnia, and <a href="https://www.merisehat.pk/disease/depression">depression</a> during COVID-19 compared to the ones before the pandemic. Some people have also increased their consumption of alcohol and smoking, both of which can trigger depression and anxiety. Moreover, substance abusers, especially those addicted to tobacco or opioids, are at a higher risk of COVID-19 and adverse outcomes such as hospitalizations and death<a href="#accordion">[1]</a>. This is because addictions can harm the function of the lungs, and weaken the immune system. Furthermore, they lead to chronic conditions, like heart and lung diseases, which can increase the risk of serious COVID-19 complications. Therefore, it is important to learn self-care strategies and get the required care.

&nbsp;

Understanding The Impact Of COVID On Mental Health

The high number of cases during the COVID-19 pandemic has placed immense stress on healthcare professionals (HCPs). Long work hours and limited resources further add to their mental distress. Therefore, the mental health of caregivers should be given equal importance.

A cross-sectional study, conducted across multiple hospitals in Karachi, Pakistan, assessed depression and anxiety scores of healthcare professionals posted in the COVID-19 wards. The Depression Anxiety Stress Scale-21 was used to calculate their scores. According to the results, 72.3% of the participants suffered from moderate to extremely severe depression, 85.7% suffered from moderate to extremely severe anxiety, and 90.1% of participants reported moderate to extreme levels of stress<a href="#accordion">[2]</a>.

The presence of psychological ailments such as stress, anxiety, and depression in HCPs points to the need for regular mental health checks. However, that cannot be possible without the intervention of higher authorities.

&nbsp;

The COVID-19 pandemic caused the implementation of social restrictions, leading to an increase in mental health issues among people.&nbsp;

A study conducted in Lahore, Pakistan measured the impact of COVID-19 on anxiety levels and obsessional thinking in clinical and non-clinical populations. The online survey consisted of a demographic profile and two scales: CAS (Coronavirus Anxiety Scale) and OCS (Obsession with COVID-19 Scale). All the participants were aged eighteen and above. A total of 240 people filled out the survey, comprising 20% men and 80% women.

According to the results, there was a positive correlation between anxiety and obsessions related to COVID-19. Overall results of the study depicted that the average adult population of Lahore does not suffer from dysfunctional anxiety or obsessions linked with COVID-19<a href="#accordion">[3]</a>. In contrast, studies conducted in other countries have indicated high levels of anxiety and obsession related to COVID-19 within their population.&nbsp;

&nbsp;

<h4>"Not all COVID infections lower the oxygen saturation. Check out your oxygen levels with our <a href="https://www.merisehat.pk/page/sehat-scan/" target="_blank">sehat scan</a>!" </h4>

The CDC claims that people with specific mental health conditions have a higher risk of COVID-19. They may require hospitalization and ICU admission. Moreover, the severity of the symptoms can also lead to death among these patients.

The mental disorder schizophrenia ranks second to aging as a risk factor for COVID-19<a href="#accordion">[4]</a>. A study published in JAMA Psychiatry demonstrated higher COVID-19 mortality rates among schizophrenics<a href="#accordion">[5]</a>. However, other factors could also play a role, for example, age, race, medical conditions, and sex. Another study reported higher odds of COVID-related death and hospitalizations in people with mood disorders<a href="#accordion">[6]</a>.

Therefore, it is recommended that people who are at a higher risk of severe COVID-19 work in collaboration with their healthcare providers for the management of their condition. Moreover, getting vaccinated and keeping up with booster shots are a must.

&nbsp;

Stress is a normal human response to unforeseen circumstances. Everyone reacts to stress differently and it is completely normal to be stressed during a pandemic. However, multiple challenges, for example, the effects of COVID-19 can push you beyond your coping capabilities. As a result, many people develop mental health concerns like anxiety symptoms and depression during this period. Despite multiple efforts, some of them will feel helpless, sad, and angry, which further hinders their overall quality of life.&nbsp;

If you notice a decline in your mental health, ask for help.

&nbsp;

[1] Volkow, N., 2020. New evidence on substance use disorders and COVID-19 susceptibility. NIDA.

[2] Sandesh, R., Shahid, W., Dev, K., Mandhan, N., Shankar, P., Shaikh, A. and Rizwan, A., 2020. Impact of COVID-19 on the mental health of healthcare professionals in Pakistan. Cureus, 12(7).

[3] Majeed, S., Schwaiger, E.M., Nazim, A. and Samuel, I.S., 2021. The Psychological Impact of COVID-19 Among Pakistani Adults in Lahore. Frontiers in Public Health, 9.

[4] Mohan, M., Perry, B.I., Saravanan, P. and Singh, S.P., 2021. COVID-19 in people with schizophrenia: potential mechanisms linking schizophrenia to poor prognosis. Frontiers in Psychiatry, 12, p.684.

[5] Nemani, K., Li, C., Olfson, M., Blessing, E.M., Razavian, N., Chen, J., Petkova, E. and Goff, D.C., 2021. Association of psychiatric disorders with mortality among patients with COVID-19. JAMA psychiatry, 78(4), pp.380-386.

[6] Ceban, F., Nogo, D., Carvalho, I.P., Lee, Y., Nasri, F., Xiong, J., Lui, L.M., Subramaniapillai, M., Gill, H., Liu, R.N. and Joseph, P., 2021. Association between mood disorders and risk of COVID-19 infection, hospitalization, and death: a systematic review and meta-analysis. JAMA psychiatry, 78(10), pp.1079-1091.

Staff Writer

Studies have shown that <a href="https://www.merisehat.pk/disease/chronic-kidney-disease">chronic kidney disease (CKD)</a> patients are more vulnerable to COVID-19 infection and mortality, than the general population.

In December of 2019, the emergence of <a href="https://www.merisehat.pk/disease/covid-19">COVID-19</a> led to countries and governments implementing several compulsory measures to curb the spread of the virus. These included quarantine measures, restricting mass gatherings and events, closure of schools and businesses, and reducing the frequency of public transport. While these measures have had a great impact on everyone&rsquo;s mental health, the unpredictability of the virus has further exacerbated the psychological distress.

&nbsp;

Understanding The Effect Of COVID On CKD

Throughout the pandemic, researchers have hypothesized that the SARS-CoV-2 virus not only affects the respiratory system but also other organs and systems in the body. So the question arises are the kidneys also at risk of the effects of COVID-19?&nbsp;&nbsp;

People with severe COVID and no underlying kidney problems often show signs of kidney damage such as blood in the urine. Moreover, studies have shown that chronic kidney disease (CKD) patients are more vulnerable to COVID-19 infection and mortality than the general population<a href="#accordion">[1]</a>. The infection can lead to a high frequency of renal abnormalities, including protein and blood in the urine with elevated levels of creatinine and urea in the blood<a href="#accordion">[2]</a>. Additionally, CKD is associated with an increased risk of pneumonia and pneumonia-related deaths in COVID-19 patients<a href="#accordion">[3]</a>. However, despite all this evidence, there is a lack of information on the impact of COVID-19 on various stages of CKD.&nbsp;

Chronic kidney disease (CKD), or chronic kidney failure, results in the loss of kidney function. The organs lose their ability to filter excess fluid and waste products from the blood. As a result, fluids, electrolytes, and waste products build up in the blood leading to kidney damage. The common signs and symptoms of CKD include nausea, vomiting, fatigue, loss of appetite, muscle cramps, swelling of feet and ankles, hypertension, and shortness of breath. CKD eventually results in end-stage kidney failure, which requires frequent dialysis or a kidney transplant.

&nbsp;

<h4>"Infections can lower your heart rate variability. Head on over to the <a href="https://www.merisehat.pk/page/sehat-scan/" target="_blank">sehat scan </a>and get your reading today!" </h4>

Studies have shown that 30% of patients hospitalized with COVID-19 develop kidney injury. Whereas more than 50% in the intensive care unit may require dialysis<a href="#accordion">[4]</a>. However, with improvements in treatment, there has been a significant decrease in the rates of dialysis. The risk of kidney disease is higher in patients with co-existing chronic conditions such as high blood pressure and diabetes.&nbsp;

The impact of the coronavirus on the kidneys is quite complex. Below are some explanations of how COVID-19 may damage the kidneys:&nbsp;

&nbsp;

<h5>1. The Virus May Target The Kidney Cells&nbsp;</h5>

Kidneys have receptors that enable the coronavirus to attach to them and infect the renal cells. The virus invades the cells, replicates, and damages the kidney tissues. Researchers have also found similar receptors on the cells of the lungs and heart, making them vulnerable as well.&nbsp;

&nbsp;

<h5>2. A Lack Of Oxygen Can Cause Kidneys To Malfunction&nbsp;</h5>

In severe COVID, pneumonia can cause critically low levels of oxygen. It is hypothesized that these abnormally low levels can contribute to renal problems in COVID patients.

&nbsp;

<h5>3. Cytokines Can Destroy Kidney Cells&nbsp;</h5>

From what we know so far, the body releases too many cytokines at a much higher rate than normal as a reaction to the coronavirus infection. This is known as a &lsquo;cytokine storm&rsquo;. The immune response to COVID-19 can be quite extreme in some people, causing a sudden influx of cytokines. Cytokines are small proteins that communicate with the immune system and fight off infections. This immune response can cause severe inflammation that can destroy healthy tissue, including tissues of the kidneys.&nbsp;

A cytokine storm is not only a common complication of COVID-19 but also other respiratory diseases such as Severe Acute Respiratory Syndrome (SARS) and Middle East Respiratory Syndrome (MERS).&nbsp;

&nbsp;

<h5>4. COVID-19 Blood Clots Can Clog The Kidneys&nbsp;</h5>

The kidneys&rsquo; function is to filter out waste products, toxins, and extra water. However, COVID-19 can significantly impair renal functioning by forming blood clots within renal vessels. The cytokine storm associated with the viral infection results in the release of clotting factors into the bloodstream. Thus, resulting in clot formation within the blood vessels in the lungs, legs, and kidneys.&nbsp;

&nbsp;

People with chronic kidney disease, or any other chronic medical condition, are at a higher risk of developing severe illness. Additionally, people on dialysis have a weaker immune system which makes it more difficult to fight off infections. Similarly, people with kidney transplants are on anti-rejection medications, also known as immunosuppressive medications, to keep the immune system less active. This makes it more difficult to fight infections. While it is important to keep taking these medications, it is equally important to wash your hands, maintain good hygiene and follow COVID-19 precautions.&nbsp;

Though kidney patients need to continue with their follow-ups and dialysis treatments, it is also essential to take the following precautions:

<ul>
	<li>Limit close contact in public spaces and keep away from those who are sick.</li>
	<li>Wear a mask outdoors and indoors.</li>
	<li>Wash your hands often.</li>
	<li>Avoid crowds.</li>
	<li>During an outbreak, try and stay at home.</li>
</ul>

&nbsp;

<ul><li>During the lockdown period, a lack of personal protective equipment, and limited transport for follow-ups and acquiring drugs caused an increased threat to the health of CKD patients.</li><li>Studies have shown that compared to the general population, chronic kidney disease patients have an increased risk of severe illness.&nbsp;</li><li>COVID-19 can also lead to kidney damage. Thus, kidney patients need to take precautions to prevent the severe consequences of infection.</li></ul>

[1] Okoro, R.N., 2021. COVID-19 pandemic: The role of community pharmacists in chronic kidney disease management supportive care. Research in Social and Administrative Pharmacy, 17(1), pp.1925-1928.

[2] Naicker, S., Yang, C.W., Hwang, S.J., Liu, B.C., Chen, J.H. and Jha, V., 2020. The novel coronavirus 2019 epidemic and kidneys. Kidney International, 97(5), pp.824-828.

[3] Henry, B.M. and Lippi, G., 2020. Chronic kidney disease is associated with severe coronavirus disease 2019 (COVID-19) infection. International urology and nephrology, 52(6), pp.1193-1194.

[4] Hirsch, J.S., Ng, J.H., Ross, D.W., Sharma, P., Shah, H.H., Barnett, R.L., Hazzan, A.D., Fishbane, S., Jhaveri, K.D., Abate, M. and Andrade, H.P., 2020. Acute kidney injury in patients hospitalized with COVID-19. Kidney international, 98(1), pp.209-218.