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Rao A, Ranka S, Ayers C, Hendren N, Rosenblatt A, Alger HM, Rutan C, Omar W, Khera R, Gupta K, Mody P, DeFilippi C, Das SR, Hedayati SS, de Lemos JA. Association of Kidney Disease With Outcomes in COVID-19: Results From the American Heart Association COVID-19 Cardiovascular Disease Registry. J Am Heart Assoc 2021; 10:e020910. [PMID: 34107743 PMCID: PMC8477855 DOI: 10.1161/jaha.121.020910] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Background Emerging evidence links acute kidney injury (AKI) in patients with COVID‐19 with higher mortality and respiratory morbidity, but the relationship of AKI with cardiovascular disease outcomes has not been reported in this population. We sought to evaluate associations between chronic kidney disease (CKD), AKI, and mortality and cardiovascular outcomes in patients hospitalized with COVID‐19. Methods and Results In a large multicenter registry including 8574 patients with COVID‐19 from 88 US hospitals, data were collected on baseline characteristics and serial laboratory data during index hospitalization. Primary exposure variables were CKD (categorized as no CKD, CKD, and end‐stage kidney disease) and AKI (classified into no AKI or stages 1, 2, or 3 using a modification of the Kidney Disease Improving Global Outcomes guideline definition). The primary outcome was all‐cause mortality. The key secondary outcome was major adverse cardiac events, defined as cardiovascular death, nonfatal stroke, nonfatal myocardial infarction, new‐onset nonfatal heart failure, and nonfatal cardiogenic shock. CKD and end‐stage kidney disease were not associated with mortality or major adverse cardiac events after multivariate adjustment. In contrast, AKI was significantly associated with mortality (stage 1 hazard ratio [HR], 1.72 [95% CI, 1.46–2.03]; stage 2 HR, 1.83 [95% CI, 1.52–2.20]; stage 3 HR, 1.69 [95% CI, 1.44–1.98]; versus no AKI) and major adverse cardiac events (stage 1 HR, 2.17 [95% CI, 1.74–2.71]; stage 2 HR, 2.70 [95% CI, 2.07–3.51]; stage 3 HR, 3.06 [95% CI, 2.52–3.72]; versus no AKI). Conclusions This large study demonstrates a significant association between AKI and all‐cause mortality and, for the first time, major adverse cardiovascular events in patients hospitalized with COVID‐19.
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Affiliation(s)
- Anjali Rao
- Department of Internal Medicine University of Texas Southwestern Medical Center Dallas TX.,Parkland Health and Hospital System Dallas TX
| | - Sagar Ranka
- Department of Cardiovascular Medicine University of Kansas Kansas City KS
| | - Colby Ayers
- Department of Internal Medicine University of Texas Southwestern Medical Center Dallas TX
| | - Nicholas Hendren
- Department of Internal Medicine University of Texas Southwestern Medical Center Dallas TX.,Parkland Health and Hospital System Dallas TX
| | - Anna Rosenblatt
- Department of Internal Medicine University of Texas Southwestern Medical Center Dallas TX.,Parkland Health and Hospital System Dallas TX
| | | | | | - Wally Omar
- Department of Internal Medicine Beth Israel Deaconess Medical Center Boston MA
| | - Rohan Khera
- Department of Internal Medicine Yale School of Medicine New Haven CT
| | - Kamal Gupta
- Department of Cardiovascular Medicine University of Kansas Kansas City KS
| | - Purav Mody
- Department of Internal Medicine University of Texas Southwestern Medical Center Dallas TX
| | | | - Sandeep R Das
- Department of Internal Medicine University of Texas Southwestern Medical Center Dallas TX.,Parkland Health and Hospital System Dallas TX
| | - S Susan Hedayati
- Department of Internal Medicine University of Texas Southwestern Medical Center Dallas TX
| | - James A de Lemos
- Department of Internal Medicine University of Texas Southwestern Medical Center Dallas TX.,Parkland Health and Hospital System Dallas TX
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102
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Neves PDMDM, Sato VAH, Mohrbacher S, Ferreira BMC, Oliveira ÉS, Pereira LVB, Bales AM, Nardotto LL, Ferreira JN, Machado DJ, Bassi E, Silva-Júnior A, Chocair PR, Cuvello-Neto AL. Acute Kidney Injury Due to COVID-19 in Intensive Care Unit: An Analysis From a Latin-American Center. Front Med (Lausanne) 2021; 8:620050. [PMID: 34150790 PMCID: PMC8211765 DOI: 10.3389/fmed.2021.620050] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Accepted: 04/16/2021] [Indexed: 12/13/2022] Open
Abstract
Introduction: The kidney may be affected by coronavirus (COVID-19) in the setting of acute kidney injury (AKI). Data about AKI in intensive care unit (ICU) patients in Latin America are scarce. We aimed to evaluate the risk of AKI, dialysis (HD), and death in ICU COVID-19 patients in a Brazilian center. Methods: Analysis from medical records of COVID-19 patients in a Brazilian center. Results: A total of 95 patients were analyzed. There was male predominance (64.2%), median age: 64.9 years, and previous history of hypertension and diabetes in 51.6 and 27.4%, respectively. AKI was diagnosed in 54 (56.8%) patients, and 32 (59.2%) of them required HD. Mortality rate was 17.9%. AKI patients when compared with no-AKI were more frequently hypertensive/diabetic and more often needed organ support therapies. Workups depicted more anemia, lymphopenia, and higher levels of inflammatory markers and higher mortality. Comparing patients who had undergone death to survivors, they were older, more frequently diabetic, and had worse SAPS3 and SOFA scores and need for organ support therapies, AKI, and HD. Multinomial logistic regression revealed that hypertension (p = 0.018) and mechanical ventilation (p = 0.002) were associated with AKI; hypertension (p = 0.002), mechanical ventilation (p = 0.008), and use of vasopressor (p = 0.027) to HD patients; and age >65 years (p = 0.03) and AKI (p = 0.04) were risk factors for death. Conclusions: AKI was a common complication of ICU COVID-19 patients, and it was more frequent in patients with hypertension and need of organ support therapies. As well as age >65 years, AKI was an independent risk factor for death.
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Affiliation(s)
- Precil Diego Miranda de Menezes Neves
- Nephrology and Dialysis Center, Oswaldo Cruz German Hospital, São Paulo, Brazil
- Nephrology Division, University of São Paulo School of Medicine, São Paulo, Brazil
| | | | - Sara Mohrbacher
- Nephrology and Dialysis Center, Oswaldo Cruz German Hospital, São Paulo, Brazil
| | | | | | | | | | | | | | - David José Machado
- Nephrology Division, University of São Paulo School of Medicine, São Paulo, Brazil
- Intensive Care Unit, Oswaldo Cruz German Hospital, São Paulo, Brazil
| | - Estêvão Bassi
- Intensive Care Unit, Oswaldo Cruz German Hospital, São Paulo, Brazil
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103
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Pramod S, Kheetan M, Ogu I, Alsanani A, Khitan Z. Viral Nephropathies, Adding SARS-CoV-2 to the List. Int J Nephrol Renovasc Dis 2021; 14:157-164. [PMID: 34113150 PMCID: PMC8184250 DOI: 10.2147/ijnrd.s303080] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Accepted: 05/07/2021] [Indexed: 12/13/2022] Open
Abstract
Viral infections in the immunocompetent host can cause both acute and chronic kidney disease either as a direct damage to the infected kidney cells or as a consequence of systemic immune responses that impact kidney function. Since identifying these entities in the 1970s and 80s, major breakthroughs in the understanding of the viral mechanisms have occurred. Viruses have evolved mechanisms to hijack signaling pathways of infected cells to evade antiviral immune responses by the host. Over time, the clinical presentations and management of these diseases have evolved along with our in-depth understanding of the various pathophysiological mechanisms causing these conditions. Similarly, both at the cellular and systemic levels, the host has evolved mechanisms to counter viral subversion strategies for mutual survival. Since the start of the current COVID-19 pandemic, numerous cases of acute kidney injury have been reported in the literature with various possible pathophysiological mechanisms. In this review, we summarize lessons learned from prior viral pandemics related to viral mechanisms utilized in the pathogenesis of numerous renal manifestations to attempt to utilize this knowledge in predicting post-COVID-19 kidney disease.
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Affiliation(s)
- Sheena Pramod
- Division of Nephrology, Department of Internal Medicine, Joan C Edwards Marshall University School of Medicine, Huntington, WV, USA
| | - Murad Kheetan
- Division of Nephrology, Department of Internal Medicine, Joan C Edwards Marshall University School of Medicine, Huntington, WV, USA
| | - Iheanyichukwu Ogu
- Division of Nephrology, Department of Internal Medicine, Joan C Edwards Marshall University School of Medicine, Huntington, WV, USA
| | - Ahlim Alsanani
- Division of Nephrology, Department of Internal Medicine, Joan C Edwards Marshall University School of Medicine, Huntington, WV, USA
| | - Zeid Khitan
- Division of Nephrology, Department of Internal Medicine, Joan C Edwards Marshall University School of Medicine, Huntington, WV, USA
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Abstract
PURPOSE OF REVIEW In this paper, we seek to review coronavirus disease 2019 (COVID-19) associated kidney injury with a focus on what is known about pathophysiology. RECENT FINDINGS Kidney injury is a common complication of SARS-CoV-2 infection and is associated with increased morbidity and mortality. Acute tubular necrosis and glomerular injury are two common findings. Direct viral effect, endothelial dysfunction, and podocyte and tubular epithelial injury have been described. COVID-19-related glomerular injury may also be associated with high-risk APOL1 genotype. SUMMARY Data on COVID-19 renal involvement have suggested novel mechanisms of kidney injury that need to be further elucidated. More data are needed on renal involvement in milder disease, renal-specific therapeutic interventions, and long-term sequelae.
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105
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Chebotareva N, Berns S, Berns A, Androsova T, Lebedeva M, Moiseev S. Acute kidney injury and mortality in coronavirus disease 2019: results from a cohort study of 1,280 patients. Kidney Res Clin Pract 2021; 40:241-249. [PMID: 34078024 PMCID: PMC8237114 DOI: 10.23876/j.krcp.20.128] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2020] [Revised: 02/01/2021] [Accepted: 02/02/2021] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND The development of acute kidney injury (AKI) in patients with coronavirus disease 2019 (COVID-19) is associated with a high risk of death. Published data demonstrate the possibility of severe kidney injury in patients suffering from COVID-19. However, these data are still controversial. METHODS A total of 1,280 patients with a proven diagnosis of COVID-19 were included in our study. COVID-19 was confirmed in all patients using reverse transcriptase polymerase chain reaction test of a nasopharyngeal swab, and based on the typical computed tomography findings. Demographic data, underlying comorbidities, and laboratory blood tests were assessed. We assessed the incidence of AKI and its associated mortality defined by survival status at discharge. RESULTS Proteinuria was identified with 648 patients (50.6%) with COVID-19. AKI was identified in 371 patients (29.0%). Ten of these patients (2.7%) required dialysis. The risk factors for AKI included age of > 65 years, augmentation of C-reactive protein, ferritin and an increase in values of activated partial thromboplastin time. Overall, 162 of the 1,280 hospitalized patients (12.7%) and 111 of the 371 patients (29.9%) with AKI did not survive. The hazard ratio (HR) for mortality was 3.96 (95% confidence interval, 2.83-5.54) for patients with AKI vs. no AKI. CONCLUSION AKI was a relatively common finding among patients with COVID-19. The risk factors for AKI in COVID-19 included old age, the inflammatory response, the severity of lung involvement, and disseminated intravascular coagulation. These same factors, in addition to arterial hypertension, were found to increase the risk of mortality.
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Affiliation(s)
- Natalia Chebotareva
- Tareev Clinic of Internal Diseases, Sechenov First Moscow State Medical University, Moscow, Russia
| | - Svetlana Berns
- Moscow State Budgetary Healthcare Institution, Zhadkevich City Clinical Hospital, Moscow, Russia
| | - Angelina Berns
- Tareev Clinic of Internal Diseases, Sechenov First Moscow State Medical University, Moscow, Russia
| | - Tatyana Androsova
- Tareev Clinic of Internal Diseases, Sechenov First Moscow State Medical University, Moscow, Russia
| | - Marina Lebedeva
- Tareev Clinic of Internal Diseases, Sechenov First Moscow State Medical University, Moscow, Russia
| | - Sergey Moiseev
- Tareev Clinic of Internal Diseases, Sechenov First Moscow State Medical University, Moscow, Russia
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Levenson E, Shepherd TN, Aviles D, Craver R, Ehlayel A, Love GL, Simms K, Straatmann C, Ashoor IF. De novo collapsing glomerulopathy in a pediatric kidney transplant recipient with COVID-19 infection. Pediatr Transplant 2021; 25:e14013. [PMID: 33773007 DOI: 10.1111/petr.14013] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Revised: 02/17/2021] [Accepted: 03/09/2021] [Indexed: 12/24/2022]
Abstract
The negative impact of COVID-19 on adults with underlying chronic kidney disease, including kidney transplant recipients, has been well documented. Children have a less severe presentation and better prognosis compared to adults. However, little is known regarding the spectrum of COVID-19 infection in children and adolescents with underlying autoimmune disorders necessitating solid organ transplant and long-term immunosuppressive therapy. Case Report. An adolescent male developed end-stage kidney disease secondary to microscopic polyangiitis requiring a living-donor kidney transplant. Six years later, he developed antibody-mediated rejection of his kidney transplant. During his rejection treatment course, he contracted SARS-CoV-2 and developed new-onset nephrotic syndrome with severe acute kidney injury. Kidney transplant biopsy revealed de novo collapsing focal segmental glomerulosclerosis on a background of chronic active antibody mediated rejection. Immunostaining for SARS-CoV-2 on the biopsy specimen demonstrated positive staining of the proximal tubular epithelium consistent with intra-renal viral infection. Pulse corticosteroids, intravenous immunoglobulin, and temporary reduction of anti-metabolite therapy resulted in successful recovery with return of graft function back to pre-infection baseline. This case highlights the clinical conundrum of treating kidney transplant recipients with active rejection in the midst of the COVID-19 pandemic. Pediatric kidney transplant recipients can develop severe COVID-19-related kidney complications. Judicious immunosuppression modulation is necessary to balance infection and rejection risk.
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Affiliation(s)
- Emma Levenson
- Department of Pediatrics, LSU Health New Orleans, New Orleans, LA, USA
| | - Tara N Shepherd
- Department of Pediatrics, Tulane University School of Medicine, New Orleans, LA, USA
| | - Diego Aviles
- Division of Nephrology, Department of Pediatrics, LSU Health New Orleans, New Orleans, LA, USA
| | - Randall Craver
- Department of Pathology, LSU Health Science Center, New Orleans, LA, USA
| | - Abdulla Ehlayel
- Division of Nephrology, Department of Pediatrics, Children's Hospital, New Orleans, LA, USA
| | - Gordon L Love
- Department of Pathology, LSU Health Science Center, New Orleans, LA, USA
| | - K'Joy Simms
- Division of Nephrology, Department of Pediatrics, Children's Hospital, New Orleans, LA, USA
| | - Caroline Straatmann
- Division of Nephrology, Department of Pediatrics, LSU Health New Orleans, New Orleans, LA, USA
| | - Isa F Ashoor
- Division of Nephrology, Department of Pediatrics, LSU Health New Orleans, New Orleans, LA, USA
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Yildirim Z, Sahin OS, Yazar S, Bozok Cetintas V. Genetic and epigenetic factors associated with increased severity of Covid-19. Cell Biol Int 2021; 45:1158-1174. [PMID: 33590936 PMCID: PMC8014716 DOI: 10.1002/cbin.11572] [Citation(s) in RCA: 38] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2021] [Accepted: 02/14/2021] [Indexed: 01/07/2023]
Abstract
Since December 2019, a new form of severe acute respiratory syndrome (SARS) from a novel strain of coronavirus (SARS coronavirus 2 [SARS-CoV-2]) has been spreading worldwide. The disease caused by SARS-CoV-2 was named Covid-19 and declared as a pandemic by the World Health Organization in March 2020. Clinical symptoms of Covid-19 range from common cold to more severe disease defined as pneumonia, hypoxia, and severe respiratory distress. In the next stage, disease can become more critical with respiratory failure, sepsis, septic shock, and/or multiorgan failure. Outcomes of Covid-19 indicate large gaps between the male-female and the young-elder groups. Several theories have been proposed to explain variations, such as gender, age, comorbidity, and genetic factors. It is likely that mixture of genetic and nongenetic factors interplays between virus and host genetics and determines the severity of disease outcome. In this review, we aimed to summarize current literature in terms of potential host genetic and epigenetic factors that associated with increased severity of Covid-19. Several studies indicated that the genetic variants of the SARS-CoV-2 entry mechanism-related (angiotensin-converting enzymes, transmembrane serine protease-2, furin) and host innate immune response-related genes (interferons [IFNs], interleukins, toll-like receptors), and human leukocyte antigen, ABO, 3p21.31, and 9q34.2 loci are critical host determinants related to Covid-19 severity. Epigenetic mechanisms also affect Covid-19 outcomes by regulating IFN signaling, angiotensin-converting enzyme-2, and immunity-related genes that particularly escape from X chromosome inactivation. Enhanced understanding of host genetic and epigenetic factors and viral interactions of SARS-CoV-2 is critical for improved prognostic tools and innovative therapeutics.
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Affiliation(s)
- Zafer Yildirim
- Department of Medical Biology, Faculty of MedicineEge UniversityIzmirTurkey
| | - Oyku Semahat Sahin
- Department of Medical Biology, Faculty of MedicineEge UniversityIzmirTurkey
| | - Seyhan Yazar
- Garvan‐Weizmann Centre for Cellular GenomicsGarvan Institute of Medical ResearchSydneyNew South WalesAustralia
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Geri G, Darmon M, Zafrani L, Fartoukh M, Voiriot G, Le Marec J, Nemlaghi S, Vieillard-Baron A, Azoulay E. Acute kidney injury in SARS-CoV2-related pneumonia ICU patients: a retrospective multicenter study. Ann Intensive Care 2021; 11:86. [PMID: 34057648 PMCID: PMC8165682 DOI: 10.1186/s13613-021-00875-9] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Accepted: 05/13/2021] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND While acute kidney injury (AKI) is frequent in severe SARS-CoV2-related pneumonia ICU patients, few data are still available about its risk factors. METHODS Retrospective observational study performed in four university affiliated hospitals in Paris. AKI was defined according to the KIDGO guidelines. Factors associated with AKI were picked up using multivariable mixed-effects logistic regression. Independent risk factors of day 28 mortality were assessed using Cox model. RESULTS 379 patients (median age 62 [53,69], 77% of male) were included. Half of the patients had AKI (n = 195, 52%) including 58 patients (15%) with AKI stage 1, 44 patients (12%) with AKI stage 2, and 93 patients (25% with AKI stage 3). Chronic kidney disease (OR 7.41; 95% CI 2.98-18.4), need for invasive mechanical ventilation at day 1 (OR 4.83; 95% CI 2.26-10.3), need for vasopressors at day 1 (OR 2.1; 95% CI 1.05-4.21) were associated with increased risk of AKI. Day 28 mortality in the cohort was 26.4% and was higher in patients with AKI (37.4 vs. 14.7%, P < 0.001). Neither AKI (HR 1.35; 95% CI 0.78-2.32) nor AKI stage were associated with mortality (HR [95% CI] for stage 1, 2 and 3 when compared to no AKI of, respectively, 1.02 [0.49-2.10], 1.73 [0.81-3.68] and 1.42 [0.78-2.58]). CONCLUSION In this large cohort of SARS-CoV2-related pneumonia patients admitted to the ICU, AKI was frequent, mostly driven by preexisting chronic kidney disease and life sustaining therapies, with unclear adjusted relationship with day 28 outcome.
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Affiliation(s)
- Guillaume Geri
- Medical Intensive Care Unit, Ambroise Paré Hospital, AP-HP, 9 avenue Charles de Gaulle, 92100, Boulogne-Billancourt, France.
- Paris Saclay University, Gif-sur-Yvette, France.
- INSERM UMR 1018, CESP, Villejuif, France.
- FHU SEPSIS, Saclay, France.
| | - Michael Darmon
- Medical Intensive Care Unit, Saint Louis Hospital, AP-HP, Paris, France
- Paris University, Paris, France
- INSERM U1153, Centre of Research in Epidemiology and Statistics, Paris, France
| | - Lara Zafrani
- Medical Intensive Care Unit, Saint Louis Hospital, AP-HP, Paris, France
- Paris University, Paris, France
- INSERM U976, Immunologie Humaine, Pathophysiologie et immunothérapie, Paris, France
| | - Muriel Fartoukh
- Medical Intensive Care Unit, Tenon Hospital, AP-HP, Paris, France
- Paris Sorbonne University, Paris, France
| | - Guillaume Voiriot
- Medical Intensive Care Unit, Tenon Hospital, AP-HP, Paris, France
- Paris Sorbonne University, Paris, France
- INSERM U955 (IMRB), Equipe GEIC2O, 94000, Créteil, France
| | - Julien Le Marec
- Paris Sorbonne University, Paris, France
- Medical Intensive Care Unit, Pitié-Salpétrière Hospital, AP-HP, Paris, France
- INSERM, UMRS1158 Neurophysiologie Respiratoire Expérimentale et Clinique, Paris, France
| | - Saafa Nemlaghi
- Paris Sorbonne University, Paris, France
- Medical Intensive Care Unit, Pitié-Salpétrière Hospital, AP-HP, Paris, France
- INSERM, UMRS1158 Neurophysiologie Respiratoire Expérimentale et Clinique, Paris, France
| | - Antoine Vieillard-Baron
- Medical Intensive Care Unit, Ambroise Paré Hospital, AP-HP, 9 avenue Charles de Gaulle, 92100, Boulogne-Billancourt, France
- Paris Saclay University, Gif-sur-Yvette, France
- INSERM UMR 1018, CESP, Villejuif, France
- FHU SEPSIS, Saclay, France
| | - Elie Azoulay
- Medical Intensive Care Unit, Saint Louis Hospital, AP-HP, Paris, France
- Paris University, Paris, France
- INSERM U1153, Centre of Research in Epidemiology and Statistics, Paris, France
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Pecly IMD, Azevedo RB, Muxfeldt ES, Botelho BG, Albuquerque GG, Diniz PHP, Silva R, Rodrigues CIS. A review of Covid-19 and acute kidney injury: from pathophysiology to clinical results. ACTA ACUST UNITED AC 2021; 43:551-571. [PMID: 34057983 PMCID: PMC8940122 DOI: 10.1590/2175-8239-jbn-2020-0204] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Accepted: 03/16/2021] [Indexed: 01/08/2023]
Abstract
Acute kidney injury (AKI) in hospitalized patients with COVID-19 is associated with higher mortality and a worse prognosis. Nevertheless, most patients with COVID-19 have mild symptoms, and about 5% can develop more severe symptoms and involve hypovolemia and multiple organ dysfunction syndrome. In a pathophysiological perspective, severe SARS-CoV-2 infection is characterized by numerous dependent pathways triggered by hypercytokinemia, especially IL-6 and TNF-alpha, leading to systemic inflammation, hypercoagulability, and multiple organ dysfunction. Systemic endotheliitis and direct viral tropism to proximal renal tubular cells and podocytes are important pathophysiological mechanisms leading to kidney injury in patients with more critical infection, with a clinical presentation ranging from proteinuria and/or glomerular hematuria to fulminant AKI requiring renal replacement therapies. Glomerulonephritis, rhabdomyolysis, and nephrotoxic drugs are also associated with kidney damage in patients with COVID-19. Thus, AKI and proteinuria are independent risk factors for mortality in patients with SARS-CoV-2 infection. We provide a comprehensive review of the literature emphasizing the impact of acute kidney involvement in the evolutive prognosis and mortality of patients with COVID-19.
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Affiliation(s)
- Inah Maria D Pecly
- Universidade Estácio de Sá, Curso de Medicina, Rio de Janeiro, RJ, Brasil
| | - Rafael B Azevedo
- Universidade Estácio de Sá, Curso de Medicina, Rio de Janeiro, RJ, Brasil
| | - Elizabeth S Muxfeldt
- Universidade Estácio de Sá, Curso de Medicina, Rio de Janeiro, RJ, Brasil.,Universidade Federal do Rio de Janeiro, Hospital Universitário Clementino Fraga Filho, Rio de Janeiro, RJ, Brasil
| | - Bruna G Botelho
- Universidade Estácio de Sá, Curso de Medicina, Rio de Janeiro, RJ, Brasil
| | | | | | - Rodrigo Silva
- Universidade Estácio de Sá, Curso de Medicina, Rio de Janeiro, RJ, Brasil
| | - Cibele I S Rodrigues
- Pontifícia Universidade Católica de São Paulo, Faculdade de Ciências Médicas e da Saúde, São Paulo, SP, Brasil
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Fakhri S, Nouri Z, Moradi SZ, Akkol EK, Piri S, Sobarzo-Sánchez E, Farzaei MH, Echeverría J. Targeting Multiple Signal Transduction Pathways of SARS-CoV-2: Approaches to COVID-19 Therapeutic Candidates. Molecules 2021; 26:2917. [PMID: 34068970 PMCID: PMC8156180 DOI: 10.3390/molecules26102917] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Revised: 04/30/2021] [Accepted: 05/11/2021] [Indexed: 02/06/2023] Open
Abstract
Due to the complicated pathogenic pathways of coronavirus disease 2019 (COVID-19), related medicinal therapies have remained a clinical challenge. COVID-19 highlights the urgent need to develop mechanistic pathogenic pathways and effective agents for preventing/treating future epidemics. As a result, the destructive pathways of COVID-19 are in the line with clinical symptoms induced by severe acute coronary syndrome (SARS), including lung failure and pneumonia. Accordingly, revealing the exact signaling pathways, including inflammation, oxidative stress, apoptosis, and autophagy, as well as relative representative mediators such as tumor necrosis factor-α (TNF-α), nuclear factor erythroid 2-related factor 2 (Nrf2), Bax/caspases, and Beclin/LC3, respectively, will pave the road for combating COVID-19. Prevailing host factors and multiple steps of SARS-CoV-2 attachment/entry, replication, and assembly/release would be hopeful strategies against COVID-19. This is a comprehensive review of the destructive signaling pathways and host-pathogen interaction of SARS-CoV-2, as well as related therapeutic targets and treatment strategies, including potential natural products-based candidates.
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Affiliation(s)
- Sajad Fakhri
- Pharmaceutical Sciences Research Center, Health Institute, Kermanshah University of Medical Sciences, Kermanshah 6734667149, Iran; (S.F.); (S.Z.M.); (S.P.)
| | - Zeinab Nouri
- Student Research Committee, Kermanshah University of Medical Sciences, Kermanshah 6714415153, Iran;
| | - Seyed Zachariah Moradi
- Pharmaceutical Sciences Research Center, Health Institute, Kermanshah University of Medical Sciences, Kermanshah 6734667149, Iran; (S.F.); (S.Z.M.); (S.P.)
- Medical Biology Research Center, Health Technology Institute, Kermanshah University of Medical Sciences, Kermanshah 6734667149, Iran
| | - Esra Küpeli Akkol
- Department of Pharmacognosy, Faculty of Pharmacy, Gazi University, Etiler, Ankara 06330, Turkey;
| | - Sana Piri
- Pharmaceutical Sciences Research Center, Health Institute, Kermanshah University of Medical Sciences, Kermanshah 6734667149, Iran; (S.F.); (S.Z.M.); (S.P.)
| | - Eduardo Sobarzo-Sánchez
- Instituto de Investigación y Postgrado, Facultad de Ciencias de la Salud, Universidad Central de Chile, Santiago 8330507, Chile
- Department of Organic Chemistry, Faculty of Pharmacy, University of Santiago de Compostela, 15782 Santiago de Compostela, Spain
| | - Mohammad Hosein Farzaei
- Medical Technology Research Center, Health Technology Institute, Kermanshah University of Medical Sciences, Kermanshah 6734667149, Iran
| | - Javier Echeverría
- Departamento de Ciencias del Ambiente, Facultad de Química y Biología, Universidad de Santiago de Chile, Santiago 9170022, Chile
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Rivero J, Merino-López M, Olmedo R, Garrido-Roldan R, Moguel B, Rojas G, Chavez-Morales A, Alvarez-Maldonado P, Duarte-Molina P, Castaño-Guerra R, Ruiz-Lopez IK, Soria-Castro E, Luna C, Bonilla-Méndez A, Baranda F, Zabal C, Madero M, Valdez-Ortiz R, Soto-Abraham MV, Vazquez-Rangel A. Association between Postmortem Kidney Biopsy Findings and Acute Kidney Injury from Patients with SARS-CoV-2 (COVID-19). Clin J Am Soc Nephrol 2021; 16:685-693. [PMID: 33782033 PMCID: PMC8259494 DOI: 10.2215/cjn.16281020] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Accepted: 02/22/2021] [Indexed: 02/04/2023]
Abstract
BACKGROUND AND OBJECTIVES AKI in coronavirus disease 2019 (COVID-19) is associated with higher morbidity and mortality. The objective of this study was to identify the kidney histopathologic characteristics of deceased patients with diagnosis of COVID-19 and evaluate the association between biopsy findings and clinical variables, including AKI severity. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS Our multicenter, observational study of deceased patients with COVID-19 in three third-level centers in Mexico City evaluated postmortem kidney biopsy by light and electron microscopy analysis in all cases. Descriptive and association statistics were performed between the clinical and histologic variables. RESULTS A total of 85 patients were included. Median age was 57 (49-66) years, 69% were men, body mass index was 29 (26-35) kg/m2, 51% had history of diabetes, 46% had history of hypertension, 98% received anticoagulation, 66% were on steroids, and 35% received at least one potential nephrotoxic medication. Severe AKI was present in 54% of patients. Biopsy findings included FSGS in 29%, diabetic nephropathy in 27%, and arteriosclerosis in 81%. Acute tubular injury grades 2-3 were observed in 49%. Histopathologic characteristics were not associated with severe AKI; however, pigment casts on the biopsy were associated with significantly lower probability of kidney function recovery (odds ratio, 0.07; 95% confidence interval, 0.01 to 0.77). The use of aminoglycosides/colistin, levels of C-reactive protein and serum albumin, previous use of angiotensin-converting enzyme inhibitors or angiotensin II receptor blockers, antivirals, nonsteroid anti-inflammatory drugs, and anticoagulants were associated with specific histopathologic findings. CONCLUSIONS A high prevalence of chronic comorbidities was found on kidney biopsies. Nonrecovery from severe AKI was associated with the presence of pigmented casts. Inflammatory markers and medications were associated with specific histopathologic findings in patients dying from COVID-19.
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Affiliation(s)
- Jesús Rivero
- Nephrology Division, National Institute of Respiratory Diseases, Ismael Cosío Villegas, Mexico City, Mexico
| | - Maribel Merino-López
- Nephrology Division, General Hospital of Mexico, Eduardo Liceaga, Mexico City, Mexico
| | - Rossana Olmedo
- Nephrology Division, National Institute of Respiratory Diseases, Ismael Cosío Villegas, Mexico City, Mexico
| | - Rubén Garrido-Roldan
- Nephrology Division, General Hospital of Mexico, Eduardo Liceaga, Mexico City, Mexico
| | - Bernardo Moguel
- Nephrology Division, National Institute of Cardiology Ignacio Chávez, Mexico City, Mexico
| | - Gustavo Rojas
- Intensive Care Unit, National Institute of Cardiology Ignacio Chávez, Mexico City, Mexico
| | | | | | - Pablo Duarte-Molina
- Intensive Care Unit, General Hospital of Mexico, Eduardo Liceaga, Mexico City, Mexico
| | | | | | - Elizabeth Soria-Castro
- Cardiovascular Biomedicine Department, National Institute of Cardiology Ignacio Chávez, Mexico City, Mexico
| | - Cesar Luna
- Pathology Department, National Institute of Respiratory Diseases, Ismael Cosío Villegas, Mexico City, Mexico
| | | | - Francisco Baranda
- Intensive Care Unit, National Institute of Cardiology Ignacio Chávez, Mexico City, Mexico
| | - Carlos Zabal
- Intensive Care Unit, National Institute of Cardiology Ignacio Chávez, Mexico City, Mexico
| | - Magdalena Madero
- Nephrology Division, National Institute of Cardiology Ignacio Chávez, Mexico City, Mexico
| | - Rafael Valdez-Ortiz
- Nephrology Division, General Hospital of Mexico, Eduardo Liceaga, Mexico City, Mexico
| | - Ma. Virgilia Soto-Abraham
- Pathology Department, General Hospital of Mexico, Eduardo Liceaga, Mexico City, Mexico,Pathology Department, National Institute of Cardiology Ignacio Chávez, Mexico City, Mexico
| | - Armando Vazquez-Rangel
- Nephrology Division, National Institute of Cardiology Ignacio Chávez, Mexico City, Mexico
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Bruggeman LA, Sedor JR, O'Toole JF. Apolipoprotein L1 and mechanisms of kidney disease susceptibility. Curr Opin Nephrol Hypertens 2021; 30:317-323. [PMID: 33767059 PMCID: PMC8211384 DOI: 10.1097/mnh.0000000000000704] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
PURPOSE OF REVIEW Allelic variants in the gene for apolipoprotein L1 (APOL1), found only in individuals of African ancestry, explain a majority of the excess risk of kidney disease in African Americans. However, a clear understanding how the disease-associated APOL1 variants cause kidney injury and the identity of environmental stressors that trigger the injury process have not been determined. RECENT FINDINGS Basic mechanistic studies of APOL1 biochemistry and cell biology, bolstered by new antibody reagents and inducible pluripotent stem cell-derived cell systems, have focused on the cytotoxic effect of the risk variants when APOL1 gene expression is induced. Since the APOL1 variants evolved to alter a key protein-protein interaction with the trypanosome serum resistance-associated protein, additional studies have begun to address differences in APOL1 interactions with other proteins expressed in podocytes, including new observations that APOL1 variants may alter podocyte cytoskeleton dynamics. SUMMARY A unified mechanism of pathogenesis for the various APOL1 nephropathies still remains unclear and controversial. As ongoing studies have consistently implicated the pathogenic gain-of-function effects of the variant proteins, novel therapeutic development inhibiting the synthesis or function of APOL1 proteins is moving toward clinical trials.
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Affiliation(s)
| | - John R Sedor
- Departments of Nephrology and Inflammation & Immunity, Cleveland Clinic
- Department of Physiology & Biophysics, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
| | - John F O'Toole
- Departments of Nephrology and Inflammation & Immunity, Cleveland Clinic
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Hirsch JS, Ikizler TA, Sharma S, Mohammed A. Acute Kidney Injury and Advanced Kidney Disease in the COVID-19 Pandemic: Proceedings From a National Kidney Foundation Symposium. Kidney Med 2021; 3:426-432. [PMID: 33898966 PMCID: PMC8052503 DOI: 10.1016/j.xkme.2021.03.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
The coronavirus disease 2019 (COVID-19) pandemic is an unprecedented and historic public health crisis that continues to expand and evolve. The National Kidney Foundation held a 2-part continuing medical education live virtual symposium on July 16 and July 24, 2020, to address the multiple challenges of COVID-19 in the context of advanced chronic kidney disease. Faculty addressed the pathophysiology, impact, risks, and management of COVID-19 as it relates to advanced kidney disease. Testing, risk mitigation, and inpatient and outpatient management were also addressed. This concise review addresses major findings of the symposium along with certain updates regarding vaccinations since then. These findings include: (1) severe COVID-19 infection has been associated with acute kidney injury, (2) it is essential to prevent and actively manage acute kidney injury to decrease mortality in these critically ill patients, (3) management of patients with advanced kidney disease should be geared toward minimizing their risk for exposure while making sure they are receiving adequate treatments, and (4) patients with kidney disease, especially ones in advanced stages, should be prioritized for vaccination.
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Affiliation(s)
- Jamie S. Hirsch
- Division of Kidney Diseases and Hypertension, Zucker School of Medicine at Hofstra/Northwell, Great Neck, NY
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114
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Alharthy A, Faqihi F, Memish ZA, Balhamar A, Nasim N, Shahzad A, Tamim H, Alqahtani SA, Brindley PG, Karakitsos D. Continuous renal replacement therapy with the addition of CytoSorb cartridge in critically ill patients with COVID-19 plus acute kidney injury: A case-series. Artif Organs 2021; 45:E101-E112. [PMID: 33190288 PMCID: PMC7753655 DOI: 10.1111/aor.13864] [Citation(s) in RCA: 45] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Revised: 10/10/2020] [Accepted: 11/08/2020] [Indexed: 01/08/2023]
Abstract
Our aim was to investigate continuous renal replacement therapy (CRRT) with CytoSorb cartridge for patients with life-threatening COVID-19 plus acute kidney injury (AKI), sepsis, acute respiratory distress syndrome (ARDS), and cytokine release syndrome (CRS). Of 492 COVID-19 patients admitted to our intensive care unit (ICU), 50 had AKI necessitating CRRT (10.16%) and were enrolled in the study. Upon ICU admission, all had AKI, ARDS, septic shock, and CRS. In addition to CRRT with CytoSorb, all received ARDS-net ventilation, prone positioning, plus empiric ribavirin, interferon beta-1b, antibiotics, hydrocortisone, and prophylactic anticoagulation. We retrospectively analyzed inflammatory biomarkers, oxygenation, organ function, duration of mechanical ventilation, ICU length-of-stay, and mortality on day-28 post-ICU admission. Patients were 49.64 ± 8.90 years old (78% male) with body mass index of 26.70 ± 2.76 kg/m2 . On ICU admission, mean Acute Physiology and Chronic Health Evaluation (APACHE) II was 22.52 ± 1.1. Sequential Organ Function Assessment (SOFA) score was 9.36 ± 2.068 and the ratio of partial arterial pressure of oxygen to fractional inspired concentration of oxygen (PaO2 /FiO2 ) was 117.46 ± 36.92. Duration of mechanical ventilation was 17.38 ± 7.39 days, ICU length-of-stay was 20.70 ± 8.83 days, and mortality 28 days post-ICU admission was 30%. Nonsurvivors had higher levels of inflammatory biomarkers, and more unresolved shock, ARDS, AKI, and pulmonary emboli (8% vs. 4%, P < .05) compared to survivors. After 2 ± 1 CRRT sessions with CytoSorb, survivors had decreased SOFA scores, lactate dehydrogenase, ferritin, D-dimers, C-reactive protein, and interleukin-6; and increased PaO2 /FiO2 ratios, and lymphocyte counts (all P < .05). Receiver-operator-curve analysis showed that posttherapy values of interleukin-6 (cutoff point >620 pg/mL) predicted in-hospital mortality for critically ill COVID-19 patients (area-under-the-curve: 0.87, 95% CI: 0.81-0.93; P = .001). No side effects of therapy were recorded. In this retrospective case-series, CRRT with the CytoSorb cartridge provided a safe rescue therapy in life-threatening COVID-19 with associated AKI, ARDS, sepsis, and hyperinflammation.
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Affiliation(s)
| | - Fahad Faqihi
- Critical Care DepartmentKing Saud Medical CityRiyadhSaudi Arabia
| | - Ziad A. Memish
- Research and Innovation CenterKing Saud Medical CityRiyadhSaudi Arabia
| | | | - Nasir Nasim
- Critical Care DepartmentKing Saud Medical CityRiyadhSaudi Arabia
| | - Ahmad Shahzad
- Critical Care DepartmentKing Saud Medical CityRiyadhSaudi Arabia
| | - Hani Tamim
- Biostatistics UnitClinical Research InstituteAmerican University of Beirut Medical CenterBeirutLebanon
| | - Saleh A. Alqahtani
- Department of MedicineThe Johns Hopkins University HospitalBaltimoreMDUSA
| | - Peter G. Brindley
- Department of Critical CareFaculty of Medicine and DentistryThe University of AlbertaAlbertaCanada
| | - Dimitrios Karakitsos
- Critical Care DepartmentKing Saud Medical CityRiyadhSaudi Arabia
- Critical Care DepartmentKeck School of MedicineUSCLos AngelesCAUSA
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Severe Acute Respiratory Syndrome Coronavirus-2-Associated Acute Kidney Injury: A Narrative Review Focused Upon Pathophysiology. Crit Care Med 2021; 49:e533-e540. [PMID: 33405411 DOI: 10.1097/ccm.0000000000004889] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
OBJECTIVE Severe acute respiratory syndrome coronavirus-2 acute kidney injury is a condition that in many ways resembles classical acute kidney injury. The pathophysiology appears to be multifactorial, and accordingly, our main objective was to review possible components of this form of acute kidney injury. DATA SOURCES Literature review. DATA SYNTHESIS Our principal observation was that the various components of severe acute respiratory syndrome coronavirus-2 acute kidney injury appear to be relatively similar to the classical forms. Temporality of injury is an important factor but is not specific to severe acute respiratory syndrome coronavirus-2 acute kidney injury. Several insults hit the kidney at different moments in the course of disease, some occurring prior to hospital admission, whereas others take place at various stages during hospitalization. CONCLUSIONS AND RELEVANCE Treatment of severe acute respiratory syndrome coronavirus-2 acute kidney injury cannot be approached in a "one-size-fits-all" manner. The numerous mechanisms involved do not occur simultaneously, leading to a multiple hit model that may contribute to the prevalence and severity of acute kidney injury. A personalized approach to each patient with acute kidney injury based on the timing and severity of disease is necessary in order to provide appropriate treatment. Although data from the literature regarding the previous coronavirus infections can give some insights, more studies are needed to explore the different mechanisms of acute kidney injury occurring as a result of severe acute respiratory syndrome coronavirus-2.
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116
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Kanimozhi G, Pradhapsingh B, Singh Pawar C, Khan HA, Alrokayan SH, Prasad NR. SARS-CoV-2: Pathogenesis, Molecular Targets and Experimental Models. Front Pharmacol 2021; 12:638334. [PMID: 33967772 PMCID: PMC8100521 DOI: 10.3389/fphar.2021.638334] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2020] [Accepted: 03/26/2021] [Indexed: 02/05/2023] Open
Abstract
The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is a recent pandemic outbreak threatening human beings worldwide. This novel coronavirus disease-19 (COVID-19) infection causes severe morbidity and mortality and rapidly spreading across the countries. Therefore, there is an urgent need for basic fundamental research to understand the pathogenesis and druggable molecular targets of SARS-CoV-2. Recent sequencing data of the viral genome and X-ray crystallographic data of the viral proteins illustrate potential molecular targets that need to be investigated for structure-based drug design. Further, the SARS-CoV-2 viral pathogen isolated from clinical samples needs to be cultivated and titrated. All of these scenarios demand suitable laboratory experimental models. The experimental models should mimic the viral life cycle as it happens in the human lung epithelial cells. Recently, researchers employing primary human lung epithelial cells, intestinal epithelial cells, experimental cell lines like Vero cells, CaCo-2 cells, HEK-293, H1299, Calu-3 for understanding viral titer values. The human iPSC-derived lung organoids, small intestinal organoids, and blood vessel organoids increase interest among researchers to understand SARS-CoV-2 biology and treatment outcome. The SARS-CoV-2 enters the human lung epithelial cells using viral Spike (S1) protein and human angiotensin-converting enzyme 2 (ACE-2) receptor. The laboratory mouse show poor ACE-2 expression and thereby inefficient SARS-CoV-2 infection. Therefore, there was an urgent need to develop transgenic hACE-2 mouse models to understand antiviral agents' therapeutic outcomes. This review highlighted the viral pathogenesis, potential druggable molecular targets, and suitable experimental models for basic fundamental research.
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Affiliation(s)
- G. Kanimozhi
- Department of Biochemistry, Dharmapuram Gnanambigai Government Arts College for Women, Mayiladuthurai, India
| | - B. Pradhapsingh
- Department of Biochemistry and Biotechnology, Annamalai University, Annamalainagar, India
| | - Charan Singh Pawar
- Department of Biochemistry and Biotechnology, Annamalai University, Annamalainagar, India
| | - Haseeb A. Khan
- Department of Biochemistry, College of Science, King Saud University, Riyadh, Saudi Arabia
| | - Salman H. Alrokayan
- Department of Biochemistry, College of Science, King Saud University, Riyadh, Saudi Arabia
| | - N. Rajendra Prasad
- Department of Biochemistry and Biotechnology, Annamalai University, Annamalainagar, India
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LeónRomán J, Vergara A, Agraz I, García-Carro C, Bermejo S, Gabaldón A, Soler MJ. Focal and segmental glomerulosclerosis associated with COVID-19 infection. Nefrologia 2021; 41:S0211-6995(21)00058-8. [PMID: 33888348 PMCID: PMC8054222 DOI: 10.1016/j.nefro.2021.03.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Revised: 02/20/2021] [Accepted: 03/05/2021] [Indexed: 11/24/2022] Open
Affiliation(s)
- Juan LeónRomán
- Nefrología. Hospital Universitario de Vall d́Hebrón, Barcelona, España
| | - Ander Vergara
- Nefrología. Hospital Universitario de Vall d́Hebrón, Barcelona, España
| | - Irene Agraz
- Nefrología. Hospital Universitario de Vall d́Hebrón, Barcelona, España
| | | | - Sheila Bermejo
- Nefrología. Hospital Universitario de Vall d́Hebrón, Barcelona, España
| | | | - María José Soler
- Nefrología. Hospital Universitario de Vall d́Hebrón, Barcelona, España.
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Abstract
PURPOSE OF REVIEW The current review summarizes the pathologic findings in kidneys from severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)-infected patients who have had autopsies or undergone biopsy, and the pathogenic mechanisms implicated in coronavirus disease 2019 (COVID-19)-associated kidney diseases. RECENT FINDINGS Direct infection of the kidney by SARS-CoV-2 is not common, and convincing morphologic evidence of substantive kidney infection by SARS-CoV-2 is lacking. Severe COVID-19-associated acute kidney injury is likely multifactorial and results from the physiologic disturbances and therapies used to treat this illness. COVID-19-associated collapsing glomerulopathy (COVAN) is seen almost exclusively in patients with apolipoprotein L1 high-risk genotypes with no evidence of direct infection of the kidney by SARS-CoV-2. SUMMARY The prevailing evidence does not support substantive or persistent infection of kidneys in COVID-19 and indirect means of tissue injury are favored, although a 'hit and run' model cannot be excluded. COVAN frequently occurs in patients with mild respiratory systems, suggesting that innate and adaptive immune responses to SARS-CoV-2 infection may provide the second hit needed for the development of collapsing glomerulopathy in susceptible individuals.
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119
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Teoh JYC, Yip TCF, Lui GCY, Wong VWS, Chow VCY, Ho THY, Li TCM, Tse YK, Chiu PKF, Ng CF, Hui DSC, Chan HLY, Szeto CC, Wong GLH. Risks of AKI and Major Adverse Clinical Outcomes in Patients with Severe Acute Respiratory Syndrome or Coronavirus Disease 2019. J Am Soc Nephrol 2021; 32:961-971. [PMID: 33483314 PMCID: PMC8017544 DOI: 10.1681/asn.2020071097] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Accepted: 12/10/2020] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND Severe acute respiratory syndrome (SARS) and coronavirus disease 2019 (COVID-19) are closely related. The effect of AKI on the clinical outcomes of these two conditions is unclear. METHODS This retrospective, territory-wide cohort study used an electronic public healthcare database in Hong Kong to identify patients with SARS or COVID-19 by diagnosis codes, virologic results, or both. The primary endpoint was a composite of intensive care unit admission, use of invasive mechanical ventilation, and/or death. RESULTS We identified 1670 patients with SARS and 1040 patients with COVID-19 (median ages, 41 versus 35 years, respectively). Among patients with SARS, 26% met the primary endpoint versus 5.3% of those with COVID-19. Diabetes mellitus, abnormal liver function, and AKI were factors significantly associated with the primary endpoint among patients with either SARS or COVID-19. Among patients with SARS, 7.9%, 2.1%, and 3.7% developed stage 1, stage 2, and stage 3 AKI, respectively; among those with COVID-19, 6.6%, 0.4%, and 1.1% developed stage 1, stage 2, and stage 3 AKI, respectively. In both groups, factors significantly associated with AKI included diabetes mellitus and hypertension. Among patients with AKI, those with COVID-19 had a lower rate of major adverse clinical outcomes versus patients with SARS. Renal function recovery usually occurred within 30 days after an initial AKI event. CONCLUSIONS AKI rates were higher among patients with SARS than those with COVID-19. AKI was associated with major adverse clinical outcomes for both diseases. Patients with diabetes mellitus and abnormal liver function were also at risk of developing severe consequences after SARS and COVID-19 infection.
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Affiliation(s)
- Jeremy Yuen-Chun Teoh
- Department of Surgery, SH Ho Urology Centre, The Chinese University of Hong Kong, Hong Kong, China
| | - Terry Cheuk-Fung Yip
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, China,Medical Data Analytic Centre, The Chinese University of Hong Kong, Hong Kong, China
| | - Grace Chung-Yan Lui
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, China,Medical Data Analytic Centre, The Chinese University of Hong Kong, Hong Kong, China,Stanley Ho Centre for Emerging Infectious Diseases, Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, China
| | - Vincent Wai-Sun Wong
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, China,Medical Data Analytic Centre, The Chinese University of Hong Kong, Hong Kong, China
| | - Viola Chi-Ying Chow
- Department of Microbiology, The Chinese University of Hong Kong, Hong Kong, China
| | - Tracy Hang-Yee Ho
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, China
| | - Timothy Chun-Man Li
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, China
| | - Yee-Kit Tse
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, China,Medical Data Analytic Centre, The Chinese University of Hong Kong, Hong Kong, China
| | - Peter Ka-Fung Chiu
- Department of Surgery, SH Ho Urology Centre, The Chinese University of Hong Kong, Hong Kong, China
| | - Chi-Fai Ng
- Department of Surgery, SH Ho Urology Centre, The Chinese University of Hong Kong, Hong Kong, China
| | - David Shu-Cheong Hui
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, China,Medical Data Analytic Centre, The Chinese University of Hong Kong, Hong Kong, China,Stanley Ho Centre for Emerging Infectious Diseases, Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, China
| | - Henry Lik-Yuen Chan
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, China,Medical Data Analytic Centre, The Chinese University of Hong Kong, Hong Kong, China
| | - Cheuk-Chun Szeto
- Department of Medicine and Therapeutics, Carol and Richard Yu Peritoneal Dialysis Research Centre, The Chinese University of Hong Kong, Hong Kong, China
| | - Grace Lai-Hung Wong
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, China,Medical Data Analytic Centre, The Chinese University of Hong Kong, Hong Kong, China
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Bullock HA, Goldsmith CS, Miller SE. Best practices for correctly identifying coronavirus by transmission electron microscopy. Kidney Int 2021; 99:824-827. [PMID: 33493525 PMCID: PMC7825881 DOI: 10.1016/j.kint.2021.01.004] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Revised: 01/04/2021] [Accepted: 01/13/2021] [Indexed: 12/12/2022]
Abstract
This guidance provides clear, concise strategies for identifying coronaviruses by transmission electron microscopy of ultrathin sections of tissues or infected tissue cultures. These include a description of virus morphology as well as cell organelles that can resemble viruses. Biochemical testing and caveats are discussed. Numerous references provide information for documentation and further study.
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Affiliation(s)
| | - Cynthia S Goldsmith
- Infectious Diseases Pathology Branch, Centers for Disease Control and Prevention (CDC), Atlanta, Georgia, USA
| | - Sara E Miller
- Department of Pathology, Duke Medical Center, Durham, North Carolina, USA.
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Pérez A, Torregrosa I, D’Marco L, Juan I, Terradez L, Solís MÁ, Moncho F, Carda-Batalla C, Forner MJ, Gorriz JL. IgA-Dominant Infection-Associated Glomerulonephritis Following SARS-CoV-2 Infection. Viruses 2021; 13:587. [PMID: 33807151 PMCID: PMC8066364 DOI: 10.3390/v13040587] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2021] [Revised: 03/29/2021] [Accepted: 03/30/2021] [Indexed: 12/13/2022] Open
Abstract
The renal involvement of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has been reported. The etiology of kidney injury appears to be tubular, mainly due to the expression of angiotensin-converting enzyme 2, the key joint receptor for SARS-CoV-2; however, cases with glomerular implication have also been documented. The multifactorial origin of this renal involvement could include virus-mediated injury, cytokine storm, angiotensin II pathway activation, complement dysregulation, hyper-coagulation, and microangiopathy. We present the renal histological findings from a patient who developed acute kidney injury and de novo nephrotic syndrome, highly suggestive of acute IgA-dominant infection-associated glomerulonephritis (IgA-DIAGN) after SARS-CoV-2 infection, as evidenced by the presence of this virus detected in the renal tissue of the patient via immunohistochemistry assay. In summary, we document the first case of IgA-DIAGN associated to SARS-CoV-2. Thus, SARS-CoV-2 S may act as a super antigen driving the development of multisystem inflammatory syndrome as well as cytokine storm in patients affected by COVID-19, reaching the glomerulus and leading to the development of this novel IgA-DIAGN.
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Affiliation(s)
- Aurora Pérez
- Nephrology Department, Hospital Clínico Universitario, INCLIVA, Universidad de Valencia, 46010 Valencia, Spain; (A.P.); (I.T.); (L.D.); (I.J.); (M.Á.S.); (F.M.)
| | - Isidro Torregrosa
- Nephrology Department, Hospital Clínico Universitario, INCLIVA, Universidad de Valencia, 46010 Valencia, Spain; (A.P.); (I.T.); (L.D.); (I.J.); (M.Á.S.); (F.M.)
| | - Luis D’Marco
- Nephrology Department, Hospital Clínico Universitario, INCLIVA, Universidad de Valencia, 46010 Valencia, Spain; (A.P.); (I.T.); (L.D.); (I.J.); (M.Á.S.); (F.M.)
| | - Isabel Juan
- Nephrology Department, Hospital Clínico Universitario, INCLIVA, Universidad de Valencia, 46010 Valencia, Spain; (A.P.); (I.T.); (L.D.); (I.J.); (M.Á.S.); (F.M.)
| | - Liria Terradez
- Pathology Department, Hospital Clínico Universitario, INCLIVA, Universidad de Valencia, 46010 Valencia, Spain; (L.T.); (C.C.-B.)
| | - Miguel Ángel Solís
- Nephrology Department, Hospital Clínico Universitario, INCLIVA, Universidad de Valencia, 46010 Valencia, Spain; (A.P.); (I.T.); (L.D.); (I.J.); (M.Á.S.); (F.M.)
| | - Francesc Moncho
- Nephrology Department, Hospital Clínico Universitario, INCLIVA, Universidad de Valencia, 46010 Valencia, Spain; (A.P.); (I.T.); (L.D.); (I.J.); (M.Á.S.); (F.M.)
| | - Carmen Carda-Batalla
- Pathology Department, Hospital Clínico Universitario, INCLIVA, Universidad de Valencia, 46010 Valencia, Spain; (L.T.); (C.C.-B.)
| | - María J. Forner
- Internal Medicine Department, Hospital Clínico Universitario, INCLIVA, Universidad de Valencia, 46010 Valencia, Spain;
| | - Jose Luis Gorriz
- Nephrology Department, Hospital Clínico Universitario, INCLIVA, Universidad de Valencia, 46010 Valencia, Spain; (A.P.); (I.T.); (L.D.); (I.J.); (M.Á.S.); (F.M.)
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Armaly Z, Kinaneh S, Skorecki K. Renal Manifestations of Covid-19: Physiology and Pathophysiology. J Clin Med 2021; 10:1216. [PMID: 33804075 PMCID: PMC8000200 DOI: 10.3390/jcm10061216] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Revised: 03/09/2021] [Accepted: 03/11/2021] [Indexed: 02/07/2023] Open
Abstract
Corona virus disease 2019 (COVID-19) imposes a serious public health pandemic affecting the whole world, as it is spreading exponentially. Besides its high infectivity, SARS-CoV-2 causes multiple serious derangements, where the most prominent is severe acute respiratory syndrome as well as multiple organ dysfunction including heart and kidney injury. While the deleterious impact of SARS-CoV-2 on pulmonary and cardiac systems have attracted remarkable attention, the adverse effects of this virus on the renal system is still underestimated. Kidney susceptibility to SARS-CoV-2 infection is determined by the presence of angiotensin-converting enzyme 2 (ACE2) receptor which is used as port of the viral entry into targeted cells, tissue tropism, pathogenicity and subsequent viral replication. The SARS-CoV-2 cellular entry receptor, ACE2, is widely expressed in proximal epithelial cells, vascular endothelial and smooth muscle cells and podocytes, where it supports kidney integrity and function via the enzymatic production of Angiotensin 1-7 (Ang 1-7), which exerts vasodilatory, anti-inflammatory, antifibrotic and diuretic/natriuretic actions via activation of the Mas receptor axis. Loss of this activity constitutes the potential basis for the renal damage that occurs in COVID-19 patients. Indeed, several studies in a small sample of COVID-19 patients revealed relatively high incidence of acute kidney injury (AKI) among them. Although SARS-CoV-1 -induced AKI was attributed to multiorgan failure and cytokine release syndrome, as the virus was not detectable in the renal tissue of infected patients, SARS-CoV-2 antigens were detected in kidney tubules, suggesting that SARS-CoV-2 infects the human kidney directly, and eventually induces AKI characterized with high morbidity and mortality. The mechanisms underlying this phenomenon are largely unknown. However, the fact that ACE2 plays a crucial role against renal injury, the deprivation of the kidney of this advantageous enzyme, along with local viral replication, probably plays a central role. The current review focuses on the critical role of ACE2 in renal physiology, its involvement in the development of kidney injury during SARS-CoV-2 infection, renal manifestations and therapeutic options. The latter includes exogenous administration of Ang (1-7) as an appealing option, given the high incidence of AKI in this ACE2-depleted disorder, and the benefits of ACE2/Ang1-7 including vasodilation, diuresis, natriuresis, attenuation of inflammation, oxidative stress, cell proliferation, apoptosis and coagulation.
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Affiliation(s)
- Zaher Armaly
- Department of Nephrology, Nazareth Hospital, EMMS, Nazareth 16100, Israel;
- The Bar-Ilan University Azrieli Faculty of Medicine, Safed 1311502, Israel;
| | - Safa Kinaneh
- Department of Nephrology, Nazareth Hospital, EMMS, Nazareth 16100, Israel;
| | - Karl Skorecki
- The Bar-Ilan University Azrieli Faculty of Medicine, Safed 1311502, Israel;
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123
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Tang KT, Hsu BC, Chen DY. Autoimmune and Rheumatic Manifestations Associated With COVID-19 in Adults: An Updated Systematic Review. Front Immunol 2021; 12:645013. [PMID: 33777042 PMCID: PMC7994612 DOI: 10.3389/fimmu.2021.645013] [Citation(s) in RCA: 64] [Impact Index Per Article: 21.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Accepted: 02/17/2021] [Indexed: 12/18/2022] Open
Abstract
Background: Numerous cases of the coronavirus disease 2019 (COVID-19) with autoimmune and rheumatic manifestations have been reported. Despite the available reviews that summarized its autoimmune/rheumatic manifestations, a systematic approach is still lacking. Therefore, we conducted a comprehensive systematic review in order to give an overview upon these rare but clinically significant manifestations. Methods: We performed a literature search of PubMed and EMBASE as of October 9, 2020. All articles relevant to either systemic or organ-specific autoimmune and rheumatic manifestations potentially associated with COVID-19 were collected. The reviewed literature were limited to adults ≥18 years. Results: Although most of the existing evidence was based on case reports or case series without a long-term follow-up, a variety of autoimmune/rheumatic manifestations were associated with COVID-19. The manifestations that have a consistent association with COVID-19 include autoimmune cytopenia, cutaneous vasculitis, encephalitis, and Guillain-Barre syndrome. Such association is conflicting as regards to antiphospholipid syndrome, hemophagocytic lymphohistiocytosis, and myasthenia gravis. Conclusion: Our systematic review indicated the potential of the COVID-19 virus to trigger a myriad of autoimmune and rheumatic manifestations, which should be considered amid global efforts to combat COVID-19.
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Affiliation(s)
- Kuo-Tung Tang
- Division of Allergy, Immunology, and Rheumatology, Taichung Veterans General Hospital, Taichung, Taiwan.,Faculty of Medicine, National Yang-Ming University, Taipei, Taiwan.,Ph.D. Program in Translational Medicine and Rong Hsing Research Center for Translational Medicine, National Chung Hsing University, Taichung, Taiwan
| | - Bo-Chueh Hsu
- Division of Allergy, Immunology and Rheumatology, Taichung Veterans General Hospital Puli Branch, Nantou, Taiwan
| | - Der-Yuan Chen
- Translational Medicine Laboratory, China Medical University Hospital, Taichung, Taiwan.,Rheumatology and Immunology Center, China Medical University Hospital, Taichung, Taiwan.,College of Medicine, China Medical University, Taichung, Taiwan
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124
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de Oliveira P, Cunha K, Neves P, Muniz M, Gatto G, Salgado Filho N, Guedes F, Silva G. Renal Morphology in Coronavirus Disease: A Literature Review. MEDICINA (KAUNAS, LITHUANIA) 2021; 57:258. [PMID: 33799854 PMCID: PMC7998438 DOI: 10.3390/medicina57030258] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Revised: 03/05/2021] [Accepted: 03/07/2021] [Indexed: 12/28/2022]
Abstract
Renal biopsy is useful to better understand the histological pattern of a lesion (glomerular, tubulointerstitial, and vascular) and the pathogenesis that leads to kidney failure. The potential impact of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) on the kidneys is still undetermined, and a variety of lesions are seen in the kidney tissue of coronavirus disease patients. This review is based on the morphological findings of patients described in case reports and a series of published cases. A search was conducted on MEDLINE and PubMed of case reports and case series of lesions in the presence of non-critical infection by SARS-CoV-2 published until 15/09/2020. We highlight the potential of the virus directly influencing the damage or the innate and adaptive immune response activating cytokine and procoagulant cascades, in addition to the genetic component triggering glomerular diseases, mainly collapsing focal segmental glomerulosclerosis, tubulointerstitial, and even vascular diseases. Kidney lesions caused by SARS-CoV-2 are frequent and have an impact on morbidity and mortality; thus, studies are needed to assess the morphological kidney changes and their mechanisms and may help define their spectrum and immediate or long-term impact.
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Affiliation(s)
- Patrick de Oliveira
- Nephrology Service, Onofre Lopes University Hospital, Federal University of Rio Grande do Norte, Natal 59066-230, RN, Brazil; (P.d.O.); (F.G.)
| | - Kaile Cunha
- University Hospital of Federal University of Maranhão, São Luis 65020-070, MA, Brazil; (K.C.); (M.M.); (N.S.F.)
| | - Precil Neves
- Nephrology Division, University of São Paulo Medical School, São Paulo 05403-000, SP, Brazil;
| | - Monique Muniz
- University Hospital of Federal University of Maranhão, São Luis 65020-070, MA, Brazil; (K.C.); (M.M.); (N.S.F.)
| | - Giuseppe Gatto
- Nephrology Service, University Hospital of Brasília, Brasília 70840-901, DF, Brazil;
| | - Natalino Salgado Filho
- University Hospital of Federal University of Maranhão, São Luis 65020-070, MA, Brazil; (K.C.); (M.M.); (N.S.F.)
| | - Felipe Guedes
- Nephrology Service, Onofre Lopes University Hospital, Federal University of Rio Grande do Norte, Natal 59066-230, RN, Brazil; (P.d.O.); (F.G.)
| | - Gyl Silva
- Patology Department, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto 14049-900, SP, Brazil
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125
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COVID-19 and Vulnerable Populations in Sub-Saharan Africa. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2021. [PMID: 33656721 DOI: 10.1007/978-3-030-59261-5_13] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/22/2023]
Abstract
The novel corona virus 2019 (COVID-19) outbreak which started in Hubei province in China has now spread to every corner of the earth. While the pandemic started later in Africa, it is now found in all African countries to varying degrees. It is thought that the prevalence and severity of disease is influenced by a number of non-communicable diseases (NCDs) which are all becoming increasingly prevalent in sub-Saharan Africa (SSA). In addition, SSA bears the major burden of human immunodeficiency virus (HIV) and tuberculosis (TB) infections. While data from Europe and the United States show that children are spared severe disease, it is uncertain if the same holds true in SSA where children suffer from sickle cell disease and malnutrition in addition to other infectious diseases. There is limited data from Africa on the effects of these conditions on COVID-19. In this review, we discuss the epidemiology of some of these conditions in Africa and the possible pathogenesis for the interactions of these with COVID-19.
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126
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Sharma P, Ng JH, Bijol V, Jhaveri KD, Wanchoo R. Pathology of COVID-19-associated acute kidney injury. Clin Kidney J 2021; 14:i30-i39. [PMID: 33796284 PMCID: PMC7929005 DOI: 10.1093/ckj/sfab003] [Citation(s) in RCA: 42] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Accepted: 01/08/2021] [Indexed: 01/08/2023] Open
Abstract
Acute kidney injury (AKI) is common among hospitalized patients with coronavirus disease 2019 (COVID-19), with the occurrence of AKI ranging from 0.5% to 80%. An improved knowledge of the pathology of AKI in COVID-19 is crucial to mitigate and manage AKI and to improve the survival of patients who develop AKI during COVID-19. In this review, we summarize the published cases and case series of various kidney pathologies seen with COVID-19. Both live kidney biopsies and autopsy series suggest acute tubular injury as the most commonly encountered pathology. Collapsing glomerulopathy and thrombotic microangiopathy are other encountered pathologies noted in both live and autopsy tissues. Other rare findings such as anti-neutrophil cytoplasmic antibody vasculitis, anti-glomerular basement membrane disease and podocytopathies have been reported. Although direct viral infection of the kidney is possible, it is certainly not a common or even widespread finding reported at the time of this writing (November 2020).
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Affiliation(s)
- Purva Sharma
- Division of Kidney Diseases and Hypertension, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Northwell Health, New Hyde Park, NY, USA
- Glomerular Center at Northwell Health, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Northwell Health, New Hyde Park, NY, USA
| | - Jia H Ng
- Division of Kidney Diseases and Hypertension, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Northwell Health, New Hyde Park, NY, USA
| | - Vanesa Bijol
- Glomerular Center at Northwell Health, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Northwell Health, New Hyde Park, NY, USA
- Department of Pathology, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Northwell Health, New Hyde Park, NY, USA
| | - Kenar D Jhaveri
- Division of Kidney Diseases and Hypertension, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Northwell Health, New Hyde Park, NY, USA
- Glomerular Center at Northwell Health, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Northwell Health, New Hyde Park, NY, USA
| | - Rimda Wanchoo
- Division of Kidney Diseases and Hypertension, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Northwell Health, New Hyde Park, NY, USA
- Glomerular Center at Northwell Health, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Northwell Health, New Hyde Park, NY, USA
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127
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Chong WH, Saha BK. Relationship Between Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) and the Etiology of Acute Kidney Injury (AKI). Am J Med Sci 2021; 361:287-296. [PMID: 33358501 PMCID: PMC7590839 DOI: 10.1016/j.amjms.2020.10.025] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Accepted: 10/23/2020] [Indexed: 01/08/2023]
Abstract
Coronavirus disease 2019 (COVID-19) is caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Since it was first recognized in December 2019, it has resulted in the ongoing worldwide pandemic. Although acute hypoxic respiratory failure (AHRF) and acute respiratory distress syndrome (ARDS) are the main features of the disease, the involvement of other organs needs to be explored. There has been a growing concern regarding the association between acute kidney injury (AKI) and poor outcomes in SARS-CoV-2 patients. Based on current observational data, AKI is the 2nd most common cause of morbidity and mortality behind ARDS in SARS-CoV-2 patients. Angiotensin-converting enzyme 2 (ACE2) receptor has been shown to be the cornerstone of SARS-CoV-2 infection and possibly plays a significant role in the occurrence of renal injury. The pathogenesis of AKI is likely multifactorial that involves not only direct viral invasion but also dysregulated immune response in the form of cytokine storm, ischemia to kidneys, hypercoagulable state, and rhabdomyolysis, among others. We performed a literature search of the Pubmed and Google Scholar database from 1996 to 2020 using the following keywords: severe acute respiratory syndrome coronavirus 2, coronavirus disease 2019, angiotensin-converting enzyme 2 receptor, and acute kidney injury to find the most pertinent and highest-quality of evidence. Any cited references were reviewed to identify relevant literature. The purpose of this review is to discuss, explore, and summarize the relationship between AKI in SARS-CoV-2 patients, with a focus on its epidemiology, association with ACE2 receptors, and pathophysiology of AKI.
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Affiliation(s)
- Woon H Chong
- Department of Pulmonary and Critical Care Medicine; Albany Medical Center, Albany, New York, USA.
| | - Biplab K Saha
- Department of Pulmonary and Critical Care; Ozarks Medical Center, West Plains, Missouri, USA
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128
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Toapanta N, Torres IB, Sellarés J, Chamoun B, Serón D, Moreso F. Kidney transplantation and COVID-19 renal and patient prognosis. Clin Kidney J 2021; 14:i21-i29. [PMID: 33815780 PMCID: PMC7995521 DOI: 10.1093/ckj/sfab030] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Accepted: 01/27/2021] [Indexed: 02/07/2023] Open
Abstract
Coronavirus disease 2019 (COVD-19) emerged as a pandemic in December 2019. Infection has spread quickly and renal transplant recipients receiving chronic immunosuppression have been considered a population at high risk of infection, complications and infection-related death. During this year a large amount of information from nationwide registries, multicentre and single-centre studies have been reported. The number of renal transplant patients diagnosed with COVID-19 was higher than in the general population, but the lower threshold for testing may have contributed to its better identification. Major complications such as acute kidney injury and acute respiratory distress syndrome were very frequent in renal transplant patients, with a high comorbidity burden, but further studies are needed to support that organ transplant recipients receiving chronic immunosuppression are more prone to develop these complications than the general population. Kidney transplant recipients experience a high mortality rate compared with the general population, especially during the very early post-transplant period. Despite the fact that some studies report more favourable outcomes in patients with a kidney transplant than in patients on the kidney waiting list, the higher mortality described in the very early post-transplant period would advise against performing a kidney transplant in areas where the spread of infection is high, especially in recipients >60 years of age. Management of transplant recipients has been challenging for clinicians and strategies such as less use of lymphocyte-depleting agents for new transplants or anti-metabolite withdrawal and calcineurin inhibitor reduction for transplant patients with COVID-19 are not based on high-quality evidence.
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Affiliation(s)
- Néstor Toapanta
- Department of Nephrology, Hospital Universitari Vall d’Hebron, Barcelona, Spain
- Department of Medicine, Autonomous University of Barcelona, Barcelona, Spain
| | - Irina B Torres
- Department of Nephrology, Hospital Universitari Vall d’Hebron, Barcelona, Spain
- Department of Medicine, Autonomous University of Barcelona, Barcelona, Spain
| | - Joana Sellarés
- Department of Nephrology, Hospital Universitari Vall d’Hebron, Barcelona, Spain
- Department of Medicine, Autonomous University of Barcelona, Barcelona, Spain
| | - Betty Chamoun
- Department of Nephrology, Hospital Universitari Vall d’Hebron, Barcelona, Spain
- Department of Medicine, Autonomous University of Barcelona, Barcelona, Spain
| | - Daniel Serón
- Department of Nephrology, Hospital Universitari Vall d’Hebron, Barcelona, Spain
- Department of Medicine, Autonomous University of Barcelona, Barcelona, Spain
| | - Francesc Moreso
- Department of Nephrology, Hospital Universitari Vall d’Hebron, Barcelona, Spain
- Department of Medicine, Autonomous University of Barcelona, Barcelona, Spain
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129
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Miao J, Fidler ME, Nasr SH, Larsen CP, Zoghby ZM. Membranous nephropathy in a patient with coronavirus disease 2019 (COVID-19): A case report. Clin Nephrol Case Stud 2021; 9:11-18. [PMID: 33633925 PMCID: PMC7901357 DOI: 10.5414/cncs110379] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Accepted: 11/10/2020] [Indexed: 01/08/2023] Open
Abstract
INTRODUCTION Though respiratory, immune, and coagulation systems are major targets of coronavirus disease 2019 (COVID-19), kidney dysfunction, presenting with acute kidney injury (AKI), is also common. Most AKI cases in COVID-19 manifest as acute tubular injury (ATI) in conjunction with multiorgan failure. While initial renal pathological findings were limited to acute tubular necrosis and collapsing glomerulopathy, a recent case series reported a larger spectrum of findings. CASE REPORT Here, we report a case of membranous nephropathy (MN) in an 81-year-old Hispanic man with underlying chronic kidney disease (CKD) stage 3 who developed ATI in the setting of COVID-19. The patient was hospitalized for hypoxic respiratory failure in the setting of AKI stage 3 with serum creatinine 7.1 mg/dL 6 days after a positive-SARS-CoV-2 screening. He was found to have nephrotic range proteinuria, glycosuria (with normal serum glucose), anemia, and hypoalbuminemia. Kidney biopsy showed ATI and early MN. Workup for primary and secondary MN was unrevealing, and serum PLA2R antibody was negative. No viral particles were observed in podocytes. CONCLUSION Although the MN could be incidental, this observation raises the question of whether SARS-CoV-2 infection can trigger or worsen an underlying MN from an exaggerated immune response associated with COVID-19.
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Affiliation(s)
- Jing Miao
- Division of Nephrology and Hypertension
| | - Mary E. Fidler
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, and
| | - Samih H. Nasr
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, and
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130
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Bullock HA, Goldsmith CS, Zaki SR, Martines RB, Miller SE. Difficulties in Differentiating Coronaviruses from Subcellular Structures in Human Tissues by Electron Microscopy. Emerg Infect Dis 2021; 27:1023-1031. [PMID: 33600302 PMCID: PMC8007326 DOI: 10.3201/eid2704.204337] [Citation(s) in RCA: 36] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Efforts to combat the coronavirus disease (COVID-19) pandemic caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) have placed a renewed focus on the use of transmission electron microscopy for identifying coronavirus in tissues. In attempts to attribute pathology of COVID-19 patients directly to tissue damage caused by SARS-CoV-2, investigators have inaccurately reported subcellular structures, including coated vesicles, multivesicular bodies, and vesiculating rough endoplasmic reticulum, as coronavirus particles. We describe morphologic features of coronavirus that distinguish it from subcellular structures, including particle size range (60–140 nm), intracellular particle location within membrane-bound vacuoles, and a nucleocapsid appearing in cross section as dense dots (6–12 nm) within the particles. In addition, although the characteristic spikes of coronaviruses may be visible on the virus surface, especially on extracellular particles, they are less evident in thin sections than in negative stain preparations.
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131
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Singh A, Zaheer S, Kumar N, Singla T, Ranga S. Covid19, beyond just the lungs: A review of multisystemic involvement by Covid19. Pathol Res Pract 2021; 224:153384. [PMID: 34153654 PMCID: PMC7885700 DOI: 10.1016/j.prp.2021.153384] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2021] [Revised: 02/11/2021] [Accepted: 02/12/2021] [Indexed: 02/07/2023]
Abstract
With the commencement of the COVID19 pandemic, following its 1st case reported in Wuhan in China, the knowledge about the virus as well as the symptoms produced by the disease have drastically increased to this day. The manifestations of COVID19 is now known to affect multiple organ systems of the body, which have shown to have acute as well as chronic complications. Histopathological analysis of the biopsies from the affected organs have implied a direct cytopathic effect of the virus but at the same time not ruling out other causes like hypoxia metabolic changes etc., occurring during the course of the disease. In this review article, we have highlighted the histopathological changes in various organs as reported by various studies throughout the world for a better understanding of the etiopathogenesis of COVID19.
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Affiliation(s)
- Anam Singh
- Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India.
| | - Sufian Zaheer
- Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India.
| | - Naveen Kumar
- Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India.
| | - Tanisha Singla
- Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India.
| | - Sunil Ranga
- Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India.
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Ferlicot S, Jamme M, Gaillard F, Oniszczuk J, Couturier A, May O, Grünenwald A, Sannier A, Moktefi A, Le Monnier O, Petit-Hoang C, Maroun N, Brodin-Sartorius A, Michon A, Dobosziewicz H, Andreelli F, Guillet M, Izzedine H, Richard C, Dekeyser M, Arrestier R, Sthelé T, Lefèvre E, Mathian A, Legendre C, Mussini C, Verpont MC, Pallet N, Amoura Z, Essig M, Snanoudj R, Brocheriou-Spelle I, François H, Belenfant X, Geri G, Daugas E, Audard V, Buob D, Massy ZA, Zaidan M. The spectrum of kidney biopsies in hospitalized patients with COVID-19, acute kidney injury, and/or proteinuria. Nephrol Dial Transplant 2021; 36:gfab042. [PMID: 33576823 PMCID: PMC7928708 DOI: 10.1093/ndt/gfab042] [Citation(s) in RCA: 41] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Revised: 01/27/2021] [Indexed: 01/08/2023] Open
Abstract
We report a multicentric retrospective case series of patients with COVID-19 who developed acute kidney injury and/or proteinuria and underwent a kidney biopsy in the Paris and its metropolitan area. Forty-seven patients (80.9% men) with COVID-19 who underwent a kidney biopsy between March 08 and May 19, 2020 were included. Median age was 63 years IQR [52-69]. Comorbidities included hypertension (66.0%), diabetes mellitus (27.7%), obesity (27.7%), history of chronic kidney (25.5%), cardiac (38.6%) and respiratory (27.3%) diseases. Initial symptoms were fever (85.1%), cough (63.8%), shortness of breath (55.3%), and diarrhea (23.4%). Almost all patients developed acute kidney injury (97.9%) and 63.8% required renal replacement therapy. Kidney biopsy showed two main histopathological patterns, including acute tubular injury in 20 (42.6%) patients, and glomerular injury consisting of collapsing glomerulopathy and focal segmental glomerulosclerosis in 17 (36.2%) patients. Two (4.3%) patients had acute vascular nephropathy, while eight (17%) had alternative diagnosis most likely unrelated to COVID-19. Acute tubular injury occurred almost invariably in the setting of severe forms of COVID-19, whereas patients with glomerular injury had various profiles of COVID-19 severity and collapsing glomerulopathy was only observed in patients harboring a combination of APOL1 risk variants. At last follow-up, 16 of the 30 patients who initially required dialysis were still on dialysis, and 9 died. The present study describes the spectrum of kidney lesions in patients with COVID-19. While acute tubular injury is correlated with COVID-19 severity, the pattern of glomerular injury is intimately associated with the expression of APOL1 risk variants.
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Affiliation(s)
- Sophie Ferlicot
- Service d’Anatomie Pathologique, Assistance Publique-Hôpitaux de Paris (APHP) Université Paris Saclay, Hôpital Bicêtre, Le Kremlin-Bicêtre, France
- Université Paris Saclay, Université Paris-Sud, UVSQ, Villejuif, France
- Club Francophone de Pathologie Rénale (CFPR) group
| | - Matthieu Jamme
- Service de Réanimation polyvalente, CH Intercommunal de Poissy Saint Germain en Laye, Poissy, France
- INSERM U1018, Equipe 5, CESP (Centre de Recherche en Épidémiologie et Santé des Populations), Université Paris Saclay et Université Versailles Saint Quentin en Yvelines), Villejuif, France
| | - François Gaillard
- Service de Néphrologie, Hôpital Bichat, Assistance Publique-Hôpitaux de Paris (APHP), Université de Paris, INSERM U1149, Paris, France
| | - Julie Oniszczuk
- Service de Néphrologie et Transplantation, Centre de Référence Maladies Rares « Syndrome Néphrotique Idiopathique », Assistance Publique-Hôpitaux de Paris (APHP), Hôpitaux Universitaires Henri-Mondor, Univ Paris Est Créteil, Institut National de la Santé et de la Recherche Médicale (INSERM) U955, Créteil, France
| | - Aymeric Couturier
- INSERM U1018, Equipe 5, CESP (Centre de Recherche en Épidémiologie et Santé des Populations), Université Paris Saclay et Université Versailles Saint Quentin en Yvelines), Villejuif, France
- Service de Néphrologie et Dialyse, Assistance Publique-Hôpitaux de Paris (APHP), Hôpital Universitaire Ambroise Paré, Boulogne Billancourt, France
| | - Olivia May
- Service de néphrologie-dialyse, GHT Grand Paris Nord Est, Hôpital André Grégoire, Montreuil sous Bois
| | - Anne Grünenwald
- Service de médecine intensive-réanimation, Assistance Publique-Hôpitaux de Paris (APHP), Hôpital Bicêtre, Assistance Publique-Hôpitaux de Paris (APHP), 94270 Le Kremlin-Bicêtre, France
- Service de Néphrologie, Dialyse et Transplantation, Hôpital Bicêtre, Assistance Publique-Hôpitaux de Paris (APHP), 94270 Le Kremlin-Bicêtre, France
- Centre de Recherche des Cordeliers, INSERM, Sorbonne Université, Université de Paris, Paris, France
| | - Aurélie Sannier
- Club Francophone de Pathologie Rénale (CFPR) group
- Université de Paris, Assistance Publique-Hôpitaux de Paris (APHP), Service d’Anatomie et Cytologie Pathologiques, Hôpital Bichat, F-75018, Paris, France
| | - Anissa Moktefi
- Club Francophone de Pathologie Rénale (CFPR) group
- Service d’Anatomie Pathologique, Assistance Publique-Hôpitaux de Paris (APHP), Hôpitaux Universitaires Henri-Mondor, Univ Paris Est Créteil, Institut National de la Santé et de la Recherche Médicale (INSERM) U955, Créteil, France
| | - Ophélie Le Monnier
- Sorbonne Université, Assistance Publique–Hôpitaux de Paris, Groupement Hospitalier Pitié–Salpêtrière, French National Referral Center for Systemic Lupus Erythematosus, Antiphospholipid Antibody Syndrome and Other Autoimmune Disorders, Service de Médecine Interne 2, Institut E3M, Inserm UMRS, Centre d’Immunologie et des Maladies Infectieuses (CIMI-Paris), Paris, France
| | - Camille Petit-Hoang
- Service UNTR, Assistance Publique-Hôpitaux de Paris (APHP), INSERM 1155, Sorbonne Université, Hôpital Tenon, Paris, France
| | - Nadine Maroun
- Service de Néphrologie et Dialyse, CH Intercommunal de Poissy Saint-Germain-en-Laye, Poissy, France
| | | | - Arthur Michon
- Service de Néphrologie, Dialyse et Transplantation, Hôpital Bicêtre, Assistance Publique-Hôpitaux de Paris (APHP), 94270 Le Kremlin-Bicêtre, France
| | - Hélène Dobosziewicz
- Service de Néphrologie, Dialyse et Transplantation, Hôpital Bicêtre, Assistance Publique-Hôpitaux de Paris (APHP), 94270 Le Kremlin-Bicêtre, France
| | - Fabrizio Andreelli
- Service de Diabétologie-Métabolismes, Assistance Publique-Hôpitaux de Paris (APHP), CHU Pitié-Salpêtrière, Sorbonne Université, Paris, France
| | - Matthieu Guillet
- Service de Néphrologie, Dialyse et Transplantation, Hôpital Bicêtre, Assistance Publique-Hôpitaux de Paris (APHP), 94270 Le Kremlin-Bicêtre, France
| | - Hassane Izzedine
- Service de Néphrologie, Hôpital Privé des Peupliers, Ramsay Générale de Santé, Paris, France
| | - Christian Richard
- Service de médecine intensive-réanimation, Assistance Publique-Hôpitaux de Paris (APHP), Hôpital Bicêtre, Assistance Publique-Hôpitaux de Paris (APHP), 94270 Le Kremlin-Bicêtre, France
| | - Manon Dekeyser
- Service de Néphrologie, Dialyse et Transplantation, Hôpital Bicêtre, Assistance Publique-Hôpitaux de Paris (APHP), 94270 Le Kremlin-Bicêtre, France
| | - Romain Arrestier
- Service de Médecine Intensive Réanimation, Hôpitaux Universitaires Henri-Mondor, Assistance Publique-Hôpitaux de Paris (APHP), Univ Paris Est Créteil, Créteil, France
| | - Thomas Sthelé
- Service de Néphrologie et Transplantation, Centre de Référence Maladies Rares « Syndrome Néphrotique Idiopathique », Assistance Publique-Hôpitaux de Paris (APHP), Hôpitaux Universitaires Henri-Mondor, Univ Paris Est Créteil, Institut National de la Santé et de la Recherche Médicale (INSERM) U955, Créteil, France
| | - Edouard Lefèvre
- Service de Néphrologie, Dialyse et Transplantation, Hôpital Bicêtre, Assistance Publique-Hôpitaux de Paris (APHP), 94270 Le Kremlin-Bicêtre, France
| | - Alexis Mathian
- Sorbonne Université, Assistance Publique–Hôpitaux de Paris, Groupement Hospitalier Pitié–Salpêtrière, French National Referral Center for Systemic Lupus Erythematosus, Antiphospholipid Antibody Syndrome and Other Autoimmune Disorders, Service de Médecine Interne 2, Institut E3M, Inserm UMRS, Centre d’Immunologie et des Maladies Infectieuses (CIMI-Paris), Paris, France
| | - Christophe Legendre
- Service de Néphrologie, Dialyse et Transplantation, Hôpital Bicêtre, Assistance Publique-Hôpitaux de Paris (APHP), 94270 Le Kremlin-Bicêtre, France
| | - Charlotte Mussini
- Service d’Anatomie Pathologique, Assistance Publique-Hôpitaux de Paris (APHP) Université Paris Saclay, Hôpital Bicêtre, Le Kremlin-Bicêtre, France
- Club Francophone de Pathologie Rénale (CFPR) group
| | - Marie-Christine Verpont
- Sorbonne Université, Université Pierre et Marie Curie Paris 06, and Institut National de la Santé et de la Recherche Médicale, Unité Mixte de Recherche S1155, plate-forme d'Imagerie et de Cytométrie de Tenon, F-75020, Paris, France
| | - Nicolas Pallet
- Service de Biochimie, Assistance Publique-Hôpitaux de Paris (APHP), Hôpital Européen Georges Pompidou, Paris, France
| | - Zahir Amoura
- Sorbonne Université, Assistance Publique–Hôpitaux de Paris, Groupement Hospitalier Pitié–Salpêtrière, French National Referral Center for Systemic Lupus Erythematosus, Antiphospholipid Antibody Syndrome and Other Autoimmune Disorders, Service de Médecine Interne 2, Institut E3M, Inserm UMRS, Centre d’Immunologie et des Maladies Infectieuses (CIMI-Paris), Paris, France
| | - Marie Essig
- INSERM U1018, Equipe 5, CESP (Centre de Recherche en Épidémiologie et Santé des Populations), Université Paris Saclay et Université Versailles Saint Quentin en Yvelines), Villejuif, France
- Service de Néphrologie et Dialyse, Assistance Publique-Hôpitaux de Paris (APHP), Hôpital Universitaire Ambroise Paré, Boulogne Billancourt, France
| | - Renaud Snanoudj
- Service de Néphrologie-Dialyse-Transplantation, Hôpital Foch, Suresnes, France
| | - Isabelle Brocheriou-Spelle
- Club Francophone de Pathologie Rénale (CFPR) group
- Sorbonne Universités, UPMC Univ Paris 06, UMR_S 1155, Assistance Publique-Hôpitaux de Paris, Pathology department, Hôpital de la Pitié-Salpêtrière
| | - Hélène François
- Service UNTR, Assistance Publique-Hôpitaux de Paris (APHP), INSERM 1155, Sorbonne Université, Hôpital Tenon, Paris, France
| | - Xavier Belenfant
- Service de néphrologie-dialyse, GHT Grand Paris Nord Est, Hôpital André Grégoire, Montreuil sous Bois
| | - Guillaume Geri
- INSERM U1018, Equipe 5, CESP (Centre de Recherche en Épidémiologie et Santé des Populations), Université Paris Saclay et Université Versailles Saint Quentin en Yvelines), Villejuif, France
- Service de Médecine Intensive Réanimation, Assistance Publique-Hôpitaux de Paris (APHP), Hôpital Universitaire Ambroise Paré, Boulogne Billancourt, France
| | - Eric Daugas
- Service de Néphrologie, Hôpital Bichat, Assistance Publique-Hôpitaux de Paris (APHP), Université de Paris, INSERM U1149, Paris, France
| | - Vincent Audard
- Service de Néphrologie et Transplantation, Centre de Référence Maladies Rares « Syndrome Néphrotique Idiopathique », Assistance Publique-Hôpitaux de Paris (APHP), Hôpitaux Universitaires Henri-Mondor, Univ Paris Est Créteil, Institut National de la Santé et de la Recherche Médicale (INSERM) U955, Créteil, France
| | - David Buob
- Club Francophone de Pathologie Rénale (CFPR) group
- Sorbonne Université, Assistance Publique-Hôpitaux de Paris (APHP), Service d’Anatomie et Cytologie Pathologiques, Hôpital Tenon, F-75020, Paris, France
| | - Ziad A Massy
- INSERM U1018, Equipe 5, CESP (Centre de Recherche en Épidémiologie et Santé des Populations), Université Paris Saclay et Université Versailles Saint Quentin en Yvelines), Villejuif, France
- Service de Néphrologie et Dialyse, Assistance Publique-Hôpitaux de Paris (APHP), Hôpital Universitaire Ambroise Paré, Boulogne Billancourt, France
| | - Mohamad Zaidan
- Université Paris Saclay, Université Paris-Sud, UVSQ, Villejuif, France
- Service de Néphrologie, Dialyse et Transplantation, Hôpital Bicêtre, Assistance Publique-Hôpitaux de Paris (APHP), 94270 Le Kremlin-Bicêtre, France
- INSERM U1163, Institut IMAGINE, Hôpital Necker-Enfants malades, 75005 Paris, France
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Laboux T, Gibier JB, Pottier N, Glowacki F, Hamroun A. COVID-19-related collapsing glomerulopathy revealing a rare risk variant of APOL1: lessons for the clinical nephrologist. J Nephrol 2021; 34:373-378. [PMID: 33548053 PMCID: PMC7865108 DOI: 10.1007/s40620-020-00935-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Accepted: 11/20/2020] [Indexed: 12/14/2022]
Affiliation(s)
- Timothée Laboux
- Kidney Transplantation and Dialysis Department, University of Lille, CHU Lille, 59037, Lille, France.
- RID-AGE, INSERM U1167, 59000, Lille, France.
| | - Jean-Baptiste Gibier
- Department of Pathology, Pathology Institute, Lille University, Regional and University Hospital Center of Lille, Lille, France
- INSERM UMR-S1172 Lille, JPARC-Jean-Pierre Aubert Research Center, Team Mucins, Epithelial Differentiation and Carcinogenesis, 59037, Lille, France
| | - Nicolas Pottier
- Toxicology and Genopathy Department, CHU Lille, 59000, Lille, France
- INSERM U1190, Translational Research for Diabetes, Lille, France
| | - François Glowacki
- Kidney Transplantation and Dialysis Department, University of Lille, CHU Lille, 59037, Lille, France
- CNRS, INSERM, Lille University, UMR9020- UMR-S 1277, F-59000, Lille, France
| | - Aghilès Hamroun
- Kidney Transplantation and Dialysis Department, University of Lille, CHU Lille, 59037, Lille, France
- Clinical Epidemiology Team, Center for Research in Epidemiology and Population Health, INSERM, Paris-Saclay University, Versailles Saint-Quentin University, CESP, 94807, Villejuif, France
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134
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Müller JA, Groß R, Conzelmann C, Krüger J, Merle U, Steinhart J, Weil T, Koepke L, Bozzo CP, Read C, Fois G, Eiseler T, Gehrmann J, van Vuuren J, Wessbecher IM, Frick M, Costa IG, Breunig M, Grüner B, Peters L, Schuster M, Liebau S, Seufferlein T, Stenger S, Stenzinger A, MacDonald PE, Kirchhoff F, Sparrer KMJ, Walther P, Lickert H, Barth TFE, Wagner M, Münch J, Heller S, Kleger A. SARS-CoV-2 infects and replicates in cells of the human endocrine and exocrine pancreas. Nat Metab 2021; 3:149-165. [PMID: 33536639 DOI: 10.1038/s42255-021-00347-1] [Citation(s) in RCA: 326] [Impact Index Per Article: 108.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Accepted: 01/14/2021] [Indexed: 02/07/2023]
Abstract
Infection-related diabetes can arise as a result of virus-associated β-cell destruction. Clinical data suggest that the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), causing the coronavirus disease 2019 (COVID-19), impairs glucose homoeostasis, but experimental evidence that SARS-CoV-2 can infect pancreatic tissue has been lacking. In the present study, we show that SARS-CoV-2 infects cells of the human exocrine and endocrine pancreas ex vivo and in vivo. We demonstrate that human β-cells express viral entry proteins, and SARS-CoV-2 infects and replicates in cultured human islets. Infection is associated with morphological, transcriptional and functional changes, including reduced numbers of insulin-secretory granules in β-cells and impaired glucose-stimulated insulin secretion. In COVID-19 full-body postmortem examinations, we detected SARS-CoV-2 nucleocapsid protein in pancreatic exocrine cells, and in cells that stain positive for the β-cell marker NKX6.1 and are in close proximity to the islets of Langerhans in all four patients investigated. Our data identify the human pancreas as a target of SARS-CoV-2 infection and suggest that β-cell infection could contribute to the metabolic dysregulation observed in patients with COVID-19.
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Affiliation(s)
- Janis A Müller
- Institute of Molecular Virology, Ulm University Medical Center, Ulm, Germany
| | - Rüdiger Groß
- Institute of Molecular Virology, Ulm University Medical Center, Ulm, Germany
| | - Carina Conzelmann
- Institute of Molecular Virology, Ulm University Medical Center, Ulm, Germany
| | - Jana Krüger
- Department of Internal Medicine 1, Ulm University Hospital, Ulm, Germany
| | - Uta Merle
- Department of Internal Medicine 4, University of Heidelberg, Heidelberg, Germany
| | | | - Tatjana Weil
- Institute of Molecular Virology, Ulm University Medical Center, Ulm, Germany
| | - Lennart Koepke
- Institute of Molecular Virology, Ulm University Medical Center, Ulm, Germany
| | | | - Clarissa Read
- Central Facility for Electron Microscopy, Ulm University, Ulm, Germany
- Institute of Virology, Ulm University Medical Center, Ulm, Germany
| | - Giorgio Fois
- Institute of General Physiology, Ulm University, Ulm, Germany
| | - Tim Eiseler
- Department of Internal Medicine 1, Ulm University Hospital, Ulm, Germany
| | - Julia Gehrmann
- Institute for Computational Genomics, RWTH Aachen University, Aachen, Germany
| | - Joanne van Vuuren
- Institute of Diabetes and Regeneration Research, Helmholtz Zentrum München, Neuherberg, Germany
- Institute of Stem Cell Research, Helmholtz Zentrum München, Neuherberg, Germany
- German Center for Diabetes Research (DZD), Neuherberg, Germany
- School of Medicine, Technical University of Munich, Munich, Germany
| | - Isabel M Wessbecher
- Tissue Bank of the German Center for Infection Research, Institute of Pathology, Heidelberg University Hospital, Heidelberg, Germany
| | - Manfred Frick
- Institute of General Physiology, Ulm University, Ulm, Germany
| | - Ivan G Costa
- Institute for Computational Genomics, RWTH Aachen University, Aachen, Germany
| | - Markus Breunig
- Department of Internal Medicine 1, Ulm University Hospital, Ulm, Germany
| | - Beate Grüner
- Department of Internal Medicine 3, Ulm University Hospital, Ulm, Germany
| | - Lynn Peters
- Department of Internal Medicine 3, Ulm University Hospital, Ulm, Germany
| | - Michael Schuster
- CeMM Research Center for Molecular Medicine of the Austrian Academy of Sciences, Vienna, Austria
| | - Stefan Liebau
- Institute of Neuroanatomy & Developmental Biology, Eberhard Karls University Tübingen, Tübingen, Germany
| | - Thomas Seufferlein
- Department of Internal Medicine 1, Ulm University Hospital, Ulm, Germany
| | - Steffen Stenger
- Institute for Microbiology and Hygiene, Ulm University Medical Center, Ulm, Germany
| | | | - Patrick E MacDonald
- Alberta Diabetes Institute and Department of Pharmacology, University of Alberta, Edmonton, Canada
| | - Frank Kirchhoff
- Institute of Molecular Virology, Ulm University Medical Center, Ulm, Germany
| | | | - Paul Walther
- Central Facility for Electron Microscopy, Ulm University, Ulm, Germany
| | - Heiko Lickert
- Institute of Diabetes and Regeneration Research, Helmholtz Zentrum München, Neuherberg, Germany
- Institute of Stem Cell Research, Helmholtz Zentrum München, Neuherberg, Germany
- German Center for Diabetes Research (DZD), Neuherberg, Germany
- School of Medicine, Technical University of Munich, Munich, Germany
| | | | - Martin Wagner
- Department of Internal Medicine 1, Ulm University Hospital, Ulm, Germany.
| | - Jan Münch
- Institute of Molecular Virology, Ulm University Medical Center, Ulm, Germany.
| | - Sandra Heller
- Department of Internal Medicine 1, Ulm University Hospital, Ulm, Germany.
| | - Alexander Kleger
- Department of Internal Medicine 1, Ulm University Hospital, Ulm, Germany.
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135
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Shabaka A, Rovirosa-Bigot S, Guerrero Márquez C, Alonso Riaño M, Fernández-Juárez G. Acute kidney injury and nephrotic syndrome secondary to COVID-19-associated focal segmental glomerulosclerosis. Nefrologia 2021; 42:S0211-6995(21)00007-2. [PMID: 33610371 DOI: 10.1016/j.nefro.2020.10.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Accepted: 10/29/2020] [Indexed: 12/28/2022] Open
Affiliation(s)
- Amir Shabaka
- Servicio de Nefrología. Hospital Universitario Fundación Alcorcón, Madrid, España.
| | - Sofía Rovirosa-Bigot
- Servicio de Medicina Intensiva. Hospital Universitario Fundación Alcorcón, Madrid, España
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136
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Izzedine H, Brocheriou I, Arzouk N, Seilhean D, Couvert P, Cluzel P, Pha M, Le Monnier O, Varnous S, Andreelli F, Amoura Z, Mathian A. COVID-19-associated collapsing glomerulopathy: a report of two cases and literature review. Intern Med J 2021; 50:1551-1558. [PMID: 33354883 DOI: 10.1111/imj.15041] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Revised: 07/13/2020] [Accepted: 08/16/2020] [Indexed: 12/14/2022]
Abstract
Nephrotic range proteinuria has been reported during the course of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and coronavirus disease (COVID-19). However, the pathological mechanisms underlying this manifestation are unknown. In this article, we present two cases of collapsing glomerulopathy (CG) associated with acute tubular necrosis during the course of COVID-19, and review the literature for similar reports. In our two cases, as in the 14 cases reported so far, the patients were of African ancestry. The 14 patients assessed had an APOL1 high-risk genotype. At the end of the reported period, two patients had died and five patients were still requiring dialysis. The 16 cases detailed in the present report strongly argue in favour of a causal link between SARS-CoV-2 infection and the occurrence of CG in patients homozygous for APOL1 high-risk genotype for which the term COVID-associated nephropathy (COVIDAN) can be put forward.
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Affiliation(s)
- Hassan Izzedine
- Department of Nephrology, Peupliers Private Hospital, Ramsay Générale de Santé, Paris, France
| | - Isabelle Brocheriou
- Department of Pathology, Sorbonne University, Assistance Publique-Hôpitaux de Paris, Groupement Hospitalier Pitié-Salpêtrière, Paris, France
| | - Nadia Arzouk
- Department of Kidney Transplantation, Assistance Publique-Hôpitaux de Paris, Groupement Hospitalier Pitié-Salpêtrière, Paris, France
| | - Danielle Seilhean
- Department of Neuropathology, Sorbonne University, Assistance Publique-Hôpitaux de Paris, Groupement Hospitalier Pitié-Salpêtrière, Paris, France
| | - Philippe Couvert
- Department of Endocrine & Oncology, Sorbonne University, Assistance Publique-Hôpitaux de Paris, Groupement Hospitalier Pitié-Salpêtrière, UMR-S1166, Paris, France.,Service de Biochimie endocrinienne et oncologique, Sorbonne Université, Assistance publique-Hôpitaux de Paris, Groupement hospitalier Pitié-Salpêtrière, Paris, France
| | - Philippe Cluzel
- Department of Interventional Cardiovascular Radiology, Sorbonne Université, Assistance Publique-Hôpitaux de Paris, Groupement Hospitalier Pitié-Salpêtrière, Paris, France
| | - Micheline Pha
- Service de Medecine Interne 2, Institut E3M, Sorbonne University, Assistance Publique-Hôpitaux de Paris, Groupement Hospitalier Pitié-Salpêtrière, Paris, France
| | - Ophelie Le Monnier
- Service de Medecine Interne 2, Institut E3M, Sorbonne University, Assistance Publique-Hôpitaux de Paris, Groupement Hospitalier Pitié-Salpêtrière, Paris, France
| | - Shadia Varnous
- Department of Cardiothoracic Surgery, Sorbonne University, Assistance Publique-Hôpitaux de Paris, Groupement Hospitalier Pitié-Salpêtrière, Paris, France
| | - Fabrizio Andreelli
- Department of Diabetology & Metabolism, Institut E3M, ICAN, Sorbonne University, Assistance Publique-Hôpitaux de Paris, Groupement Hospitalier Pitié-Salpêtrière, Paris, France
| | - Zahir Amoura
- Service de Medecine Interne 2, Institut E3M, Sorbonne University, Assistance Publique-Hôpitaux de Paris, Groupement Hospitalier Pitié-Salpêtrière, Paris, France
| | - Alexis Mathian
- Service de Medecine Interne 2, Institut E3M, Sorbonne University, Assistance Publique-Hôpitaux de Paris, Groupement Hospitalier Pitié-Salpêtrière, Paris, France
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137
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Perlin DV, Dymkov IN, Terentiev AV, Perlina AV. Is Kidney Transplantation From a COVID-19-Positive Deceased Donor Safe for the Recipient? Transplant Proc 2021; 53:1138-1142. [PMID: 33589232 PMCID: PMC8043770 DOI: 10.1016/j.transproceed.2021.01.025] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2020] [Revised: 01/03/2021] [Accepted: 01/11/2021] [Indexed: 12/18/2022]
Abstract
Introduction In recent months, the number of kidney transplants from deceased donors has declined significantly. One of the reasons is the possibility of infection of the recipient with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Determining the risk of transmission of coronavirus disease 2019 (COVID-19) with a donor organ is very important for developing a kidney transplantation policy during a pandemic. Materials and method We present cases of kidney transplantation from COVID-19–positive deceased donors to 2 dialysis patients 49 and 45 years old. One of them was on hemodialysis for 28 months; the other received continuous ambulatory peritoneal dialysis (CAPD). Both patients received only basic immunosuppression, including tacrolimus, methylprednisolone, and mycophenolic acid. No antilymphocyte agents were used for induction therapy. Results Cold ischemia time was 22 and 21 hours, respectively. One recipient had delayed graft function with increasing of urine output on day 8; another had immediate function. Both patients had no febrile and no other symptoms of acute respiratory disease during their hospital stay. No abnormalities on the chest x-ray were seen. No serum anti-SARS-CoV-2 IgM and IgG were detected before and during 6 weeks after surgery. Repeated nasopharyngeal swabs real-time reverse transcription polymerase chain reaction (rRT-PCR) were negative during the period. Both recipients were discharged 5 weeks after surgery with serum creatinine levels of 122 and 91 mcmol/L, respectively. Conclusion Today we have no evidence of the possibility of transmission of COVID-19 from a SARS-CoV-2 positive donor to a kidney recipient. We also have no reason to suspect kidney damage by COVID-19 in a deceased donor at normal serum creatinine level.
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Affiliation(s)
- D V Perlin
- Volgograd Regional Center of Urology and Nephrology, Volzhsky, Russia.
| | - I N Dymkov
- Volgograd Regional Center of Urology and Nephrology, Volzhsky, Russia
| | - A V Terentiev
- Volgograd Regional Center of Urology and Nephrology, Volzhsky, Russia
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138
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Zhang PL, Liu ML. Extracellular vesicles mediate cellular interactions in renal diseases-Novel views of intercellular communications in the kidney. J Cell Physiol 2021; 236:5482-5494. [PMID: 33432614 DOI: 10.1002/jcp.30268] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Revised: 12/23/2020] [Accepted: 12/26/2020] [Indexed: 12/28/2022]
Abstract
The kidney is a complicated and important internal organ receiving approximately 20% of the cardiac output and mediates numerous pathophysiologic actions. These include selectively filtering macromolecules of the blood, exquisite reclaimation of electrolyctes, urine concentration via an elegant osmotic mechanism, and excretion of an acid load. In addition, the renal tubules carry out secretory functions and produce hormones and cytokines. The kidney receives innervation and hormonal regulation. Therefore, dysfunction of the kidney leads to retention of metabolic waste products, and/or significant proteinuria and hematuria. In the past several decades, the role of extracellular vesicles (EVs) in intercellular communications, and the uptake of EVs by recipient cells through phagocytosis and endocytosis have been elucidated. The new knowledge on EVs expands over the classical mechanisms of cellular interaction, and may change our way of thinking of renal pathophysiology in the subcellular scale. Based on some ultrastructural discoveries in the kidney, this review will focus on the role of EVs in intercellular communications, their internalization by recipient cells, and their relationship to renal pathology.
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Affiliation(s)
- Ping L Zhang
- Division of Anatomic Pathology, Beaumont Laboratories, Beaumont Health, Royal Oak, Michigan, USA
| | - Ming-Lin Liu
- Department of Dermatology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA.,Corporal Michael J. Crescenz VA Medical Center, Philadelphia, Pennsylvania, USA
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139
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De Novo Focal and Segmental Glomerulosclerosis After COVID-19 in a Patient With a Transplanted Kidney From a Donor With a High-risk APOL1 Variant. Transplantation 2021; 105:206-211. [PMID: 32852403 DOI: 10.1097/tp.0000000000003432] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND There is compelling evidence that renal complications in a native kidney are a major concern in patients infected with severe acute respiratory syndrome coronavirus 2, the causal agent of coronavirus disease 2019 (COVID-19). The spectrum of renal lesions observed on renal grafts in this context remains to be determined. METHODS We report the case of a renal transplant recipient with non-severe COVID-19, who subsequently developed nephrotic syndrome associated with acute renal injury. RESULTS Renal biopsy demonstrated focal and segmental glomerulosclerosis lesions classified as not otherwise specified histological variant. Genotyping for 2 risk alleles of the apolipoprotein L1 gene demonstrated that the donor was homozygous for the G2/G2 genotype. CONCLUSIONS In renal transplant patients receiving kidneys from donors with high-risk apolipoprotein L1 variants, COVID-19 may promote acute glomerular injury in the form of focal and segmental glomerulosclerosis.
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140
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Parmar MS. Acute kidney injury associated with COVID-19-Cumulative evidence and rationale supporting against direct kidney injury (infection). Nephrology (Carlton) 2021; 26:239-247. [PMID: 33150674 DOI: 10.1111/nep.13814] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2020] [Revised: 10/14/2020] [Accepted: 11/02/2020] [Indexed: 12/13/2022]
Abstract
Acute kidney injury (AKI) is a common complication, affecting up to 37% of hospitalized patients with SARS-CoV-2 infection and is proportional to its severity and portends poor prognosis. Diverse mechanisms have been proposed and studies reported conflicting results. Moreover, renal tropism of SARS-CoV-2 does not equate to its renal pathogenicity. For a virus to be pathogenic, in addition to its affinity (tropism) for specific tissue(s), host cells must allow viral entry, and discuss the important role played by transmembrane protease, serine 2 (TMPRSS2) and coexpression of both ACE2 and TMPRSS2 in the same cells is important to cause damage. Lack of coexpression of ACE2 and TMPRSS2 in the same cells of the kidneys is the limiting factor of SARS-CoV-2 direct effects in the kidney. We present the rationale and cumulative evidence supporting that AKI is secondary to hemodynamic and immunologic effects of SARS-CoV-2 infection than the direct injury or infection.
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Affiliation(s)
- Malvinder S Parmar
- Northern Ontario School of Medicine, Sudbury & Thunder Bay, Ontario, Canada
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141
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Abstract
Evolutionary processes, including mutation, migration and natural selection, have influenced the prevalence and distribution of various disorders in humans. However, despite a few well-known examples, such as the APOL1 variants - which have undergone positive genetic selection for their ability to confer resistance to Trypanosoma brucei infection but confer a higher risk of chronic kidney disease - little is known about the effects of evolutionary processes that have shaped genetic variation on kidney disease. An understanding of basic concepts in evolutionary genetics provides an opportunity to consider how findings from ancient and archaic genomes could inform our knowledge of evolution and provide insights into how population migration and genetic admixture have shaped the current distribution and landscape of human kidney-associated diseases. Differences in exposures to infectious agents, environmental toxins, dietary components and climate also have the potential to influence the evolutionary genetics of kidneys. Of note, selective pressure on loci associated with kidney disease is often from non-kidney diseases, and thus it is important to understand how the link between genome-wide selected loci and kidney disease occurs in relation to secondary nephropathies.
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Cheng QL, Liu Y, Wang CC, Ao QG, Hou JB, Wei L, Qi FY, He W, Zhao JH, Ma Q, Wang XH, Yang G. Clinical analysis of kidney injury in elderly patients with COVID-19. INTEGRATIVE MEDICINE IN NEPHROLOGY AND ANDROLOGY 2021. [PMCID: PMC9106142 DOI: 10.4103/imna.imna_13_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Objective: The aim of the study was to analyze the clinical features of elderly patients with coronavirus disease 2019 (COVID-19) and to explore the relationship between COVID-19 patients and kidney injury. Methods: A total of 188 elderly patients with confirmed COVID-19 enrolled in this study were hospitalized for at least 1 week in the Central Theater Command General Hospital of Chinese People's Liberation Army from January 3, 2020 to March 14, 2020. The recorded information included clinical data and results of kidney-related laboratory tests. Retrospective analysis was performed. Results: The median age of the patients was 69 years (interquartile range 65–78, range: 60–97 years); 31.4% were 60–74 years old, and 68.6% were over 75 years old. A total of 12.8% and 18.6% of the patients were in critical and severe stages of COVID-19, respectively. The proportions of patients using mechanical ventilators and deaths were 9.5% and 8.5%, respectively. A total of 26.1% and 8.5% of the patients showed mild elevation of blood urea nitrogen (BUN) and serum creatinine (SCr) levels at admission. A total of 18.6% and 5.9% of the patients had elevated BUN and SCr 1 week after admission, respectively. A total of 3.1% of the patients were diagnosed with acute kidney injury, and 75% of those patients had chronic kidney disease before admission. Compared with the patients aged 60–74 years, those over 75 years exhibited significantly increased proportions of elevated BUN levels, critical illness, use of mechanical ventilated, and death. Multivariate logistic regression analysis revealed that an elevated BUN level at admission and 1 week after admission were independent risk factors for death in the elderly patients with COVID-19. Conclusion: There were more critical cases and a high mortality in elderly patients with COVID-19. An increased BUN level was an independent risk factor for death in elderly patients with COVID-19.
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143
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Ilonzo N, Kumar S, Borazan N, Hansen T, Rao A, Lantis J, Faries P, Ting W. Endotheliitis in Coronavirus Disease 2019-Positive Patients After Extremity Amputation for Acute Thrombotic Events. Ann Vasc Surg 2020; 72:209-215. [PMID: 33387621 PMCID: PMC7773317 DOI: 10.1016/j.avsg.2020.12.004] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2020] [Revised: 12/08/2020] [Accepted: 12/19/2020] [Indexed: 12/11/2022]
Abstract
BACKGROUND Both arterial and venous thrombotic events of the extremities occur in coronavirus disease 2019 (COVID-19) infection, but the etiology of these events remains unclear. This study sought to evaluate pathology specimens of COVID-19-positive patients postamputation, who were found to have Rutherford 3 acute limb ischemia requiring amputation. METHODS A retrospective review was performed of all vascular surgery emergency room and inpatient consultations in patients who presented to the Mount Sinai Health System from March 26, 2020, to May 10, 2020. Pathology specimens were examined using hematoxylin and eosin stain. The specimens were assessed for the following: inflammatory cells associated with endothelium/apoptotic bodies, mononuclear cells, small vessel congestion, and lymphocytic endotheliitis. Of the specimens evaluated, 2 patients with a known history of peripheral vascular disease were excluded. RESULTS Inflammatory cells associated with endothelium/apoptotic bodies were seen in all 4 patients and in 4 of 5 specimens. Mononuclear cells were found in 2 of 4 patients. Small vessel congestion was seen in all patients. Lymphocytic endotheliitis was seen in 1 of 4 patients. CONCLUSIONS This study shows endotheliitis in amputation specimens of four patients with COVID-19 disease and Rutherford Class 3 acute limb ischemia. The findings in these patients is more likely an infectious angiitis because of COVID-19.
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Affiliation(s)
- Nicole Ilonzo
- Division of Vascular Surgery, Department of Surgery, The Icahn School of Medicine at Mount Sinai, New York, NY.
| | - Shivani Kumar
- Division of Vascular Surgery, Department of Surgery, The Icahn School of Medicine at Mount Sinai, New York, NY
| | - Nabeel Borazan
- Division of Vascular Surgery, Department of Surgery, The Icahn School of Medicine at Mount Sinai, New York, NY
| | - Thomas Hansen
- Division of Vascular Surgery, Department of Surgery, The Icahn School of Medicine at Mount Sinai, New York, NY
| | - Ajit Rao
- Division of Vascular Surgery, Department of Surgery, The Icahn School of Medicine at Mount Sinai, New York, NY
| | - John Lantis
- Division of Vascular Surgery, Department of Surgery, The Icahn School of Medicine at Mount Sinai, New York, NY
| | - Peter Faries
- Division of Vascular Surgery, Department of Surgery, The Icahn School of Medicine at Mount Sinai, New York, NY
| | - Windsor Ting
- Division of Vascular Surgery, Department of Surgery, The Icahn School of Medicine at Mount Sinai, New York, NY
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144
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Ştefan MF, Magda ŞL, Vinereanu D. COVID-19 presented as acute kidney injury with secondary myocardial damage. J Infect Public Health 2020; 14:371-373. [PMID: 33647554 PMCID: PMC7833619 DOI: 10.1016/j.jiph.2020.12.031] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Accepted: 12/23/2020] [Indexed: 01/06/2023] Open
Abstract
The most common manifestations of the 2019 novel coronavirus disease (COVID-19) include fever, cough, dyspnea. Nevertheless, many atypical forms of presentation might be present, delaying a correct diagnosis. Acute kidney injury (AKI) is one of the important complications of COVID-19, occurring in 0.5-7% of cases and in 2.9-23% of ICU patients. The exact mechanisms by which COVID-19 induces AKI in different clinical settings is still a matter of debate. We present the case of a 53-year old woman, without any prior renal pathology, admitted to a Cardiology Department for atypical thoracic pain and oligo-anuria, without respiratory symptoms, who was diagnosed with SARS-CoV-2 infection. The patient had a significant rise in high-sensitivity cardiac troponin (from 304 ng/L to 889 ng/L in one hour) and mild systolic dysfunction (LVEF 45%), which led to the initial misdiagnosis of an acute myocardial infarction. Blood tests confirmed the diagnosis of acute kidney injury (creatinine 8.8 mg/dL in two different samples). She received hydro-electrolytic rebalancing treatment, with good clinical and biological evolution. To our knowledge this is one of the first reports, that highlights the existence of myocardial injury secondary to acute kidney injury caused by SARS-CoV-2 infection, in a patient without respiratory symptoms.
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Affiliation(s)
| | - Ştefania L Magda
- University and Emergency Hospital, Bucharest, Romania; "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania.
| | - Dragoş Vinereanu
- University and Emergency Hospital, Bucharest, Romania; "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania
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145
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Gougeon F, Singh HK, Nickeleit V. Renal comorbidities in collapsing variant focal segmental glomerulosclerosis: more than a coincidence? Nephrol Dial Transplant 2020; 37:311-317. [PMID: 33370435 DOI: 10.1093/ndt/gfaa327] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Collapsing focal segmental glomerulosclerosis (FSGS) has various underlying etiologies and often leads to renal failure. The impact of biopsy-proven renal comorbidities in promoting collapsing glomerulopathy (CG) has not been systematically evaluated in large comparative studies. Those data are reported here. METHODS Biopsies with the initial diagnosis of CG in native (n = 321) or transplant kidneys (n = 30) were identified in the University of North Carolina nephropathology database (1 January 2011 to 1 January 2016). Two cohorts were defined: 'sole' CG without and 'accompanied' CG with significant morphologic renal comorbidities. Tip-variant FSGS (T-FSGS) and time-matched biopsies served as control cohorts for comparative analyses. RESULTS CG was significantly more common in native (4.4%) and transplant biopsies (4.1%) compared with T-FSGS (0.7 and <0.1%, respectively, difference versus CG P < 0.01). 'Associated' disease was significantly more common in CG (native: 151/321; 47.0%, transplant: 21/30; 70%, P < 0.05) versus T-FSGS (native: 14/51; 27.5%, transplant: exceptional; all differences versus CG P < 0.05). In native biopsies with 'accompanied' CG but not in control groups, stenosing vasculopathies including thrombotic microangiopathies were significantly more prevalent (P < 0.01). In transplants, the high incidence of 'accompanied' CG was linked to de novo diseases, mainly rejection and vascular injury. In native kidneys, membranous glomerulopathies were prevalent in 'accompanied' T-FSGS (36%) and CG (14%) (difference versus time-matched controls P < 0.01 and P < 0.05, respectively); they were uncommon in transplants. CONCLUSIONS CG but not T-FSGS shows a high rate of comorbidities, with prominent vasculopathies presumably driving 'ischemic' CG-specific glomerular injury and also the disease course. These findings facilitate future studies into therapy, prognosis and reversibility of 'accompanied' CG.
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Affiliation(s)
- Francois Gougeon
- Department of Pathology and Laboratory Medicine, Division of Nephropathology, University of North Carolina,hapel Hill, NC, USA
| | - Harsharan K Singh
- Department of Pathology and Laboratory Medicine, Division of Nephropathology, University of North Carolina,hapel Hill, NC, USA
| | - Volker Nickeleit
- Department of Pathology and Laboratory Medicine, Division of Nephropathology, University of North Carolina,hapel Hill, NC, USA
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146
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Bernard I, Limonta D, Mahal LK, Hobman TC. Endothelium Infection and Dysregulation by SARS-CoV-2: Evidence and Caveats in COVID-19. Viruses 2020; 13:E29. [PMID: 33375371 PMCID: PMC7823949 DOI: 10.3390/v13010029] [Citation(s) in RCA: 103] [Impact Index Per Article: 25.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2020] [Revised: 12/16/2020] [Accepted: 12/25/2020] [Indexed: 02/06/2023] Open
Abstract
The ongoing pandemic of coronavirus disease 2019 (COVID-19) caused by the acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) poses a persistent threat to global public health. Although primarily a respiratory illness, extrapulmonary manifestations of COVID-19 include gastrointestinal, cardiovascular, renal and neurological diseases. Recent studies suggest that dysfunction of the endothelium during COVID-19 may exacerbate these deleterious events by inciting inflammatory and microvascular thrombotic processes. Although controversial, there is evidence that SARS-CoV-2 may infect endothelial cells by binding to the angiotensin-converting enzyme 2 (ACE2) cellular receptor using the viral Spike protein. In this review, we explore current insights into the relationship between SARS-CoV-2 infection, endothelial dysfunction due to ACE2 downregulation, and deleterious pulmonary and extra-pulmonary immunothrombotic complications in severe COVID-19. We also discuss preclinical and clinical development of therapeutic agents targeting SARS-CoV-2-mediated endothelial dysfunction. Finally, we present evidence of SARS-CoV-2 replication in primary human lung and cardiac microvascular endothelial cells. Accordingly, in striving to understand the parameters that lead to severe disease in COVID-19 patients, it is important to consider how direct infection of endothelial cells by SARS-CoV-2 may contribute to this process.
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Affiliation(s)
- Isabelle Bernard
- Department of Medical Microbiology & Immunology, University of Alberta, Edmonton, AB T6G 2E1, Canada;
| | - Daniel Limonta
- Department of Cell Biology, University of Alberta, Edmonton, AB T6G 2H7, Canada;
- Li Ka Shing Institute of Virology, University of Alberta, Edmonton, AB T6G 2E1, Canada
| | - Lara K. Mahal
- Department of Chemistry, University of Alberta, Edmonton, AB T6G 2G2, Canada;
| | - Tom C. Hobman
- Department of Medical Microbiology & Immunology, University of Alberta, Edmonton, AB T6G 2E1, Canada;
- Department of Cell Biology, University of Alberta, Edmonton, AB T6G 2H7, Canada;
- Li Ka Shing Institute of Virology, University of Alberta, Edmonton, AB T6G 2E1, Canada
- Women & Children’s Health Research Institute, University of Alberta, Edmonton, AB T6G 1C9, Canada
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147
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Khokhar M, Purohit P, Roy D, Tomo S, Gadwal A, Modi A, Banerjee M, Sharma P. Acute kidney injury in COVID 19 - an update on pathophysiology and management modalities. Arch Physiol Biochem 2020; 129:626-639. [PMID: 33320717 DOI: 10.1080/13813455.2020.1856141] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Acute kidney injury (AKI), characterised by fluid imbalance and overload, is prevalent in severe disease phenotypes of coronavirus disease 2019 (COVID-19). The elderly immunocompromised patients with pre-existing comorbidities being more risk-prone to severe COVID-19, the importance of early diagnosis and intervention in AKI is imperative. Histopathological examination of COVID-19 patients with AKI reveals viral invasion of the renal parenchyma and evidence of AKI. The definitive treatment for AKI includes renal replacement therapy and renal transplant. Immunosuppressant regimens and its interactions with COVID-19 have to be further explored to devise effective treatment strategies in COVID-19 transplant patients. Other supportive strategies for AKI patients include hemodynamic monitoring and maintenance of fluid balance. Antiviral drugs should be meticulously monitored in the management of these high-risk patients. We have focussed on the development of renal injury provoked by the SARS-CoV-2, the varying clinical characteristics, and employment of different management strategies, including renal replacement therapy, alongside the emerging cytokine lowering approaches.
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Affiliation(s)
- Manoj Khokhar
- Department of Biochemistry, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Purvi Purohit
- Department of Biochemistry, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Dipayan Roy
- Department of Biochemistry, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Sojit Tomo
- Department of Biochemistry, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Ashita Gadwal
- Department of Biochemistry, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Anupama Modi
- Department of Biochemistry, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Mithu Banerjee
- Department of Biochemistry, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Praveen Sharma
- Department of Biochemistry, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
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148
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Minami T, Iwata Y, Wada T. Renal complications in coronavirus disease 2019: a systematic review. Inflamm Regen 2020; 40:31. [PMID: 33317643 PMCID: PMC7735801 DOI: 10.1186/s41232-020-00140-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Accepted: 08/26/2020] [Indexed: 01/08/2023] Open
Abstract
The world today is facing a pandemic caused by severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), which mainly causes a respiratory disease known as coronavirus disease 2019 (COVID-19). Therefore, its pathogenesis and complications should be identified and understood. SARS-CoV-2 infects the host using the angiotensin-converting enzyme 2 (ACE2) as its receptor, which is expressed in several organs including the lungs, heart, kidneys, and intestines. Kidney complications are relatively common, and acute kidney injury (AKI) is a life-threatening complication in patients with COVID-19. In this review, the renal histological patterns of COVID-19 are described in detail, and its potential mechanisms associated with AKI are discussed.
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Affiliation(s)
- Taichiro Minami
- Renal Division, Department of Medicine, Brigham and Women's Hospital, 4 Blackfan Street, Boston, MA, USA.
- Department of Nephrology and Laboratory Medicine, Kanazawa University, Kanazawa, Ishikawa, Japan.
| | - Yasunori Iwata
- Department of Nephrology and Laboratory Medicine, Kanazawa University, Kanazawa, Ishikawa, Japan
| | - Takashi Wada
- Department of Nephrology and Laboratory Medicine, Kanazawa University, Kanazawa, Ishikawa, Japan
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149
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Kooman JP, van der Sande FM. COVID-19 in ESRD and Acute Kidney Injury. Blood Purif 2020; 50:610-620. [PMID: 33321496 PMCID: PMC7802200 DOI: 10.1159/000513214] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Accepted: 11/09/2020] [Indexed: 12/15/2022]
Abstract
The COVID-19 pandemic has greatly affected nephrology. Firstly, dialysis patients appear to be at increased risk for infection due to viral transmission next to an enhanced risk for mortality as compared to the general population, even in the face of an often apparently mild clinical presentation. Derangements in the innate and adaptive immune systems may be responsible for a reduced antiviral response, whereas chronic activation of the innate immune system and endothelial dysfunction provide a background for a more severe course. The presence of severe comorbidity, older age, and a reduction of organ reserve may lead to a rapid deterioration of the clinical situation of the patients in case of severe infection. Secondly, patients with COVID-19 are at increased risk of acute kidney injury (AKI), which is related to the severity of the clinical disease. The presence of AKI, and especially the need for renal replacement therapy (RRT), is associated with an increased risk of mortality. AKI in COVID-19 has a multifactorial origin, in which direct viral invasion of kidney cells, activation of the renin-angiotensin aldosterone system, a hyperinflammatory response, hypercoagulability, and nonspecific factors such as hypotension and hypoxemia may be involved. Apart from logistic challenges and the need for strict hygiene within units, treatment of patients with ESRD and COVID-19 is not different from that of the general population. Extracorporeal treatment of patients with AKI with RRT can be complicated by frequent filter clotting due to the hypercoagulable state, for which regional citrate coagulation provides a reasonable solution. Also, acute peritoneal dialysis may be a reasonable option in these patients. Whether adjuncts to extracorporeal therapies, such as hemoadsorption, provide additional benefits in the case of severely ill COVID-19 patients needs to be addressed in controlled studies.
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Affiliation(s)
- Jeroen P Kooman
- Division of Nephrology, Department of Internal Medicine, Maastricht University Medical Centre, Maastricht, The Netherlands,
| | - Frank M van der Sande
- Division of Nephrology, Department of Internal Medicine, Maastricht University Medical Centre, Maastricht, The Netherlands
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150
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Peng S, Wang HY, Sun X, Li P, Ye Z, Li Q, Wang J, Shi X, Liu L, Yao Y, Zeng R, He F, Li J, Ge S, Ke X, Zhou Z, Dong E, Wang H, Xu G, Zhang L, Zhao MH. Early versus late acute kidney injury among patients with COVID-19-a multicenter study from Wuhan, China. Nephrol Dial Transplant 2020; 35:2095-2102. [PMID: 33275762 PMCID: PMC7798799 DOI: 10.1093/ndt/gfaa288] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2020] [Accepted: 10/15/2020] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Acute kidney injury (AKI) is an important complication of coronavirus disease 2019 (COVID-19), which could be caused by both systematic responses from multi-organ dysfunction and direct virus infection. While advanced evidence is needed regarding its clinical features and mechanisms. We aimed to describe two phenotypes of AKI as well as their risk factors and the association with mortality. METHODS Consecutive hospitalized patients with COVID-19 in tertiary hospitals in Wuhan, China from 1 January 2020 to 23 March 2020 were included. Patients with AKI were classified as AKI-early and AKI-late according to the sequence of organ dysfunction (kidney as the first dysfunctional organ or not). Demographic and clinical features were compared between two AKI groups. Their risk factors and the associations with in-hospital mortality were analyzed. RESULTS A total of 4020 cases with laboratory-confirmed COVID-19 were included and 285 (7.09%) of them were identified as AKI. Compared with patients with AKI-early, patients with AKI-late had significantly higher levels of systemic inflammatory markers. Both AKIs were associated with an increased risk of in-hospital mortality, with similar fully adjusted hazard ratios of 2.46 [95% confidence interval (CI) 1.35-4.49] for AKI-early and 3.09 (95% CI 2.17-4.40) for AKI-late. Only hypertension was independently associated with the risk of AKI-early. While age, history of chronic kidney disease and the levels of inflammatory biomarkers were associated with the risk of AKI-late. CONCLUSIONS AKI among patients with COVID-19 has two clinical phenotypes, which could be due to different mechanisms. Considering the increased risk for mortality for both phenotypes, monitoring for AKI should be emphasized during COVID-19.
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Affiliation(s)
- Suyuan Peng
- National Institute of Health Data Science, Peking University, Beijing, China
- School of Public Health, Peking University, Beijing, China
| | - Huai-Yu Wang
- National Institute of Health Data Science, Peking University, Beijing, China
- School of Public Health, Peking University, Beijing, China
| | - Xiaoyu Sun
- National Institute of Health Data Science, Peking University, Beijing, China
| | - Pengfei Li
- Advanced Institute of Information Technology, Peking University, Hangzhou, China
| | - Zhanghui Ye
- Advanced Institute of Information Technology, Peking University, Hangzhou, China
| | - Qing Li
- Advanced Institute of Information Technology, Peking University, Hangzhou, China
| | - Jinwei Wang
- Department of Medicine, Renal Division, Peking University First Hospital, Peking University Institute of Nephrology, Beijing, China
| | - Xuanyu Shi
- National Institute of Health Data Science, Peking University, Beijing, China
| | - Liu Liu
- Department of Nephrology, Tongji Hospital Affiliated to Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Ying Yao
- Department of Nephrology, Tongji Hospital Affiliated to Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Department of Clinical Nutrition, Tongji Hospital Affiliated to Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Rui Zeng
- Department of Nephrology, Tongji Hospital Affiliated to Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Fan He
- Department of Nephrology, Tongji Hospital Affiliated to Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Junhua Li
- Department of Nephrology, Tongji Hospital Affiliated to Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Shuwang Ge
- Department of Nephrology, Tongji Hospital Affiliated to Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Xianjun Ke
- Taikang Tongji (Wuhan) Hospital, Wuhan, China
| | - Zhibin Zhou
- Taikang Tongji (Wuhan) Hospital, Wuhan, China
| | - Erdan Dong
- Department of Cardiology and Institute of Vascular Medicine, Peking University Third Hospital, Beijing, China
- Key Laboratory of Cardiovascular Molecular Biology and Regulatory Peptides, Ministry of Health, Beijing, China
- Key Laboratory of Molecular Cardiovascular Sciences, Ministry of Education, Beijing, China
- Beijing Key Laboratory of Cardiovascular Receptors Research, Beijing, China
| | - Haibo Wang
- Clinical Trials Unit, First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Gang Xu
- Department of Nephrology, Tongji Hospital Affiliated to Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Luxia Zhang
- National Institute of Health Data Science, Peking University, Beijing, China
- Advanced Institute of Information Technology, Peking University, Hangzhou, China
- Department of Medicine, Renal Division, Peking University First Hospital, Peking University Institute of Nephrology, Beijing, China
| | - Ming-Hui Zhao
- Department of Medicine, Renal Division, Peking University First Hospital, Peking University Institute of Nephrology, Beijing, China
- Peking-Tsinghua Center for Life Sciences, Beijing, China
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