Infections that cause kidney damage

In these times of the COVID-19 pandemic, several realizations came to the fore. One of them was how unaware, a big chunk of our society is, on how several infections irrespective of where they initially start, can cause kidney damage. Something that resulted in the death of many patients with COVID-19 – a respiratory illness.

So we at Team ATK decided to get to work and compile a comprehensive list of all infectious diseases which can potentially cause kidney damage, even if the initial infection starts elsewhere.

This article first looks at a very brief overview of how exactly do infections “access” kidneys to damage them and how. Following this, we present the list of kidney-damaging infectious diseases.

How do infections cause kidney damage?

Unlike “exposed” organs like our skin or mucus membranes, kidneys are “internal, visceral organs”, right?

So, how exactly do microbes end up damaging your kidneys?

Well, this can happen both directly and indirectly. Whatever be the mode of kidney damage, the range of impact is diverse, as explained below:

1. DIRECT KIDNEY DAMAGE

Microbes / germs can directly travel to kidneys either from a Urine infection or can spread from other infected body parts via bloodstream. This is possible especially because all blood in our body circulates through kidneys to get cleansed & balanced. While passing throughfind a “fertile piece of territory” within the kidneys, they may “settle down” and cause direct kidney damage.

1️⃣ The most common kidney cell types where direct infection occurs are the cells that make up the filtration zones (Glomerulus).

2️⃣ The germs can even go beyond to lodge & infect the tiny, delicate urine forming tubes (Tubules) of kidney filters..

2. INDIRECT KIDNEY DAMAGE

Sometimes, there could be indirect kidney damage as a result of infection in any other part of the body.

What happens is, once germs enter our body, our immune system immediately kicks-in to fight it off. Such immune response can result in production of toxins from killing the infecting germ.

These toxins are carried via bloodstream to be let out of the body via Urine. This means, that they get a chance to “interact” with delicate kidney filters in the process. This is when, kidney damage is inevitable.

Kidney Damage due to infectious diseases: Mechanisms

1️⃣ Scar the tiny blood vessels that enter kidneys.

This can cause the overall blood supply for nourishing the kidney tissue to fall short.

2️⃣ Cause inflammation & scarring of the Glomerulus i.e. the sophisticated filtration zones present at the entrance of nephrons (kidney filters).

This can cause you to leak plasma proteins & blood in urine. In most cases, this type of damage will slowly decline kidney function over the years. A segment of these cases can progress to kidney failure.

3️⃣ Bring about literal rotting & sloughing (necrosis) of cells that make up the delicate urine forming tubes (Tubules) of nephrons.

In such cases, cells can come-off & pass out in your urine. This demolishes entire kidney filtration units & shows up as an acute disturbance in kidney function in your lab reports.

4️⃣ Lead to patches of inflammation across the kidney tissue (Nephritis).

Such damage typically affects the supporting cells present alongside the kidney filters, that are technically called the Interstitial tissue.
Depending on the infecting germ, such inflammation could develop “acutely” over a short time frame or cause a “chronic”, gradual buildup over months to years.

5️⃣ Block the urine outflow tract (Ureters) from kidneys.

This can cause urine to buildup and cause a push back on your kidney filters ultimately damaging them, if left untreated. The technical name for this condition is “Hydronephrosis”.

Here’s an illustration listing various infection-induced kidney conditions categorized according to the part of kidneys that gets impacted:

List of kidney-harming infections & how you could contract them

Be it viruses, bacteria, fungi or parasites, all categories of microbes / germs that infect humans can potentially harm your kidneys. We present below, a list of all such microbes & how you could possibly contract them.

MICROBE	MODE OF TRANSMISSION
VIRUSES
COVID-19	Droplet infection
Dengue	Infected Aedes mosquito bite
Hantavirus HFRS	Taking food/drink contaminated with urine, droppings, saliva of infected rodents or exposure to dust from their nests; exposure of bloodstream (through open skin wound) to material from infected rodents ; Infected rodent bite
Varicella Zoster (Chicken Pox)	1. Droplet inhalation from cough/sneeze of infected chickenpox patient; 2. Touching blisters/sores directly
Parvovirus B19 (Fifth Disease)	1. Droplet infection (saliva, sputum, nasal mucus) 2. Blood transfusion 3. Vertical transmission
Hepatitis A	1. Contaminated food/drink 2. Close personal contact with infected person (feco-oral route)
Hepatitis C	1. Infected needles 2. Infected blood transfusions 3. Transmission from pregnant mother to unborn baby 4. Intercourse with infected person
HIV (AIDS virus)	1. Infected needles 2. Infected blood transfusions 3. Transmission from pregnant mother to unborn baby 4. Intercourse with infected person
Cytomegalovirus (CMV)	Direct contact with saliva or urine, especially from babies and young children Through sexual contact with infected person Via breast milk: breastfeeding by infected mother Organs transplanted from infected donors Blood donated by infected person (always check if blood products are properly screened or not)
Hepatitis B	1. Infected needles 2. Infected blood transfusions 3. Transmission from pregnant mother to unborn baby 4. Intercourse with infected person
Epstein-Barr Virus (EBV)	Saliva of infected person (sharing drinks or food with and/or kissing an infected person)
Ebola	1. Exposure to food contaminated with saliva of or direct contact with infected fruit bat/ primate 2. Handling clothes or personal items of infected patient 3. Intercourse with males (exposure to semen) who have recovered from Ebola infection, no such evidence for females with past ebola infection.
BACTERIA
Streptococcus pyogenes	1. Inhaling infected droplets from cough / sneeze of a patient 2. Direct transmission into bloodstream via open skin wound
Staphylococcus aureus	Inhaling infected droplets (nasal discharge) from cough or sneeze of a patient
Staphylococcus epidermidis	Resident skin microbe, mostly hospital-acquired infections via indwelling catheters. Kidney infections from long term urinary catheter, skin infections in immunocompromised patients.
Salmonella typhi (Typhoid / Stomach Flu) & Salmonella paratyphi (Paratyphoid fever)	1. Feco-oral route (consuming food, water, milk infected with typhoid / paratyphoid bacteria (or spores) 2. Handling personal items that could be soiled with faeces or urine of infected patients.
Leptospira	Contact with urine (or other body fluids lie saliva) of infected dogs, sheep, cattle, rodents. 2. Consuming food/water or handling soil contaminated with urine of infected animals. Could emerge in flood hit areas where people are exposed to possibly contaminated water for days at a stretch.
Legionella species (Pneumonia)	By inhaling water droplets infected with bacteria, such as those from faucets, showers, ventilation systems of large buildings, fountains, centralized air-conditioners in convention centers.
Escherichia coli (E. coli)	Multiple! 1. Inhaling infected droplets could cause Pneumonia 2. Feco-oral route (Taking contaminated food/drink) could cause food poisoning 3. Urinary tract infections, Meningitis, Heart valve infections & Sepsis (blood infections) could occur in patients with indwelling catheters
Corynebacterium diphtheriae (Diphtheria)	1. Inhaling infected droplets 2. Touching infected sores/open wounds
Mycobacterium tuberculosis (TB)	Inhaling infected droplets (nasal discharge) from cough of a patient
Mycobacterium lepre (Leprosy /Hansen Disease)	1. Inhaling infected droplets from the cough/ sneeze of a Leprosy patient. 2. Many months of personal close contact with “untreated" leprosy patient (patients stop transmitting the infection as soon as treatment starts).
Yersinia enterocolitica (Yersiniosis / Food poisoning)	1. Consuming contaminated food (raw or undercooked pork) 2. Coming in contact with babies / children after handling contaminated food.
Brucella species	1. Eating raw/undercooked meat or unpasteurized dairy/dairy products from infected animals (usually sheep, goat, cattle, pigs, dogs) 2. Veterinarians in close contact with infected animals and workers in slaughterhouse or meat-packaging industries can get infected by inhaling bacteria from raw meat or getting bacteria in their blood through any skin cuts or open wounds.
Campylobacter jejuni (Gut infection)	1. Eating raw or undercooked poultry or eating something that touched it. 2. They can also get it from eating other foods, including seafood, meat, and produce, by contact with infected animals 3. By drinking untreated water.
FUNGUS
Candida	Candida normally resides in healthy skin/mucous membranes. But there can be overgrowth if: 1. Vaginal acidity reduces 2. If patients have poor Immunity due to a medical condition or immunosuppressive medication. If it gets into bloodstream, can infect kidneys.
Mucor	1. Inhaling fungal mould spores 2. Directly to bloodstream via cuts/scratches, open wounds.
Aspergillus	1. By inhaling infective fungal spores (common in environment) 2. Can spread to bloodstream from lungs & turn life threatening.
Penicillium (a.k a. Talaromyces)	1. By inhaling air-borne fungal spores 2. Patients with weakened immune systems are at greater risk
Histoplasma	By handling soil contaminated with droppings of birds or bats infected with histoplasma fungus. Patients with poor Immunity (Diabetics, HIV positive, Transplant recipients, Cancer patients, Patients on immunosuppressive medication)
Blastomyces	Inhaling air-borne fungal spores
Coccidiomyces (Valley Fever)	By inhaling dust from soil contaminated with fungal spores.
PARASITES
Plasmodium species (Malaria)	Mosquito bite (infected Anopheles)
Filariae	Mosquito bite (infected Anopheles)
Leishmania donovani (Kala Azar)	Infected Sandfly bite
Schistosoma (Schistosomiasis)	By coming in contact with freshwater (ponds / streams / lakes) contaminated with the infective form of the parasite that enters through the skin.

Reference

Infections linked to kidney damage irrespective of site of initial infection — NCBI

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