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Al-Medhtiy MH, Mohammed MT, M Raouf MMH, Al-Qaaneh AM, Jabbar AAJ, Abdullah FO, Mothana RA, Alanzi AR, Hassan RR, Abdulla MA, Saleh MI, Hasson S. A triterpenoid (corosolic acid) ameliorated AOM-mediated aberrant crypt foci in rats: modulation of Bax/PCNA, antioxidant and inflammatory mechanisms. J Mol Histol 2024:10.1007/s10735-024-10229-x. [PMID: 39122895 DOI: 10.1007/s10735-024-10229-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2024] [Accepted: 07/17/2024] [Indexed: 08/12/2024]
Abstract
Corosolic acid (CA) is a well-known natural pentacyclic triterpene found in numerous therapeutic plants that can exhibit many bioactivities including anti-inflammatory and anti-tumor actions. The current investigation explores the chemoprotective roles of CA against azoxymethane (AOM)-induced colonic aberrant crypt foci (ACF) in rats. Thirty Sprague Dawley rats were grouped in 5 cages; Group A, normal control rats inoculated subcutaneously (sc) with two doses of normal saline and fed orally on 10% tween 20; Groups B-E received two doses (sc) of azoxymethane in two weeks and treated with either 10% tween 20 (group B) or two intraperitoneal injections of 35 mg/kg 5-fluorouracil each week for one month (group C), while group D and E treated with 30 and 60 mg/kg, respectively, for 2 months. The toxicity results showed lack of any behavioral abnormalities or mortality in rats ingested with up-to 500 mg/kg of CA. The present AOM induction caused a significant initiation of ACF characterized by an increased number, larger in size, and well-matured tissue clusters in cancer controls. AOM inoculation created a bizarrely elongated nucleus, and strained cells, and significantly lowered the submucosal glands in colon tissues of cancer controls compared to 5-FU or CA-treated rats. CA treatment led to significant suppression of ACF incidence, which could be mediated by its modulatory effects on the immunohistochemical proteins (pro-apoptotic (Bax) and reduced PCNA protein expressions in colon tissues). Moreover, CA-treated rats had improved oxidative stress-mediated cytotoxicity indicated by increased endogenous antioxidants (SOD and CAT) and reduced lipid peroxidation indicators (MDA). In addition, CA ingestion (30 and 60 mg/kg) suppressed the inflammatory cascades, indicated by decreased serum TNF-α and IL-6 cytokines and increased anti-inflammatory (IL-10) cytokines consequently preventing further tumor development. CA treatment maintained liver and kidney functions in rats exposed to AOM cytotoxicity. CA could be a viable alternative for the treatment of oxidative-related human disorders including ACF.
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Affiliation(s)
- Morteta H Al-Medhtiy
- Department of Anatomy and Histology, Faculty of Veterinary Medicine, University of Kufa, Kufa, Najaf Region, 540011, Iraq
| | - Mohammed T Mohammed
- Department of Microbiology, Faculty of veterinary medicine, University of Kufa, Kufa, Iraq
| | - Mohammed M Hussein M Raouf
- Department of Biomedical Sciences, College of Applied Science, Cihan University-Erbil, Erbil, Kurdistan Region, 44001, Iraq
| | - Ayman M Al-Qaaneh
- Department of Allied Health Sciences, Al-Balqa Applied University (BAU), Al-Salt, 19117, Jordan
| | - Ahmed A J Jabbar
- Department of Medical Laboratory Technology, Erbil Technical Health and Medical College, Erbil Polytechnic University, Erbil, 44001, Iraq.
| | - Fuad Othman Abdullah
- Department of Chemistry, College of Science, Salahaddin University-Erbil, Erbil, Kurdistan Region, Iraq
| | - Ramzi A Mothana
- Department of Pharmacognosy, College of Pharmacy, King Saud University, P.O. Box 2457, Riyadh, 11451, Saudi Arabia
| | - Abdullah R Alanzi
- Department of Pharmacognosy, College of Pharmacy, King Saud University, P.O. Box 2457, Riyadh, 11451, Saudi Arabia
| | - Rawaz Rizgar Hassan
- Department of Medical Laboratory Science, College of Science, Knowledge University, Kirkuk Road, Erbil, 44001, Iraq
| | - Mahmood Ameen Abdulla
- Department of Medical Analysis, Faculty of Applied Science, Tishk International University, Erbil, Iraq
| | - Musher Ismail Saleh
- Department of Chemistry, Faculty of Science and Health, Koya University, Koya KOY45, Kurdistan Region, Erbil, 44001, Iraq
| | - Sidgi Hasson
- School of Pharmacy and Biomolecular Sciences, Liverpool John Moores University, Liverpool, L3 3AF, UK
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Li Y, Gong Y, Xu G. New insights into kidney disease after COVID-19 infection and vaccination: histopathological and clinical findings. QJM 2024; 117:317-337. [PMID: 37402613 DOI: 10.1093/qjmed/hcad159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Revised: 06/23/2023] [Indexed: 07/06/2023] Open
Abstract
In addition to its pulmonary effects, coronavirus disease 2019 (COVID-19) has also been found to cause acute kidney injury (AKI), which has been linked to high mortality rates. In this review, we collected data from 20 clinical studies on post-COVID-19-related AKI and 97 cases of AKI associated with COVID-19 vaccination. Acute tubular injury was by far the most common finding in the kidneys of patients with COVID-19-related AKI. Among patients hospitalized for COVID-19, 34.0% developed AKI, of which 59.0%, 19.1% and 21.9% were Stages 1, 2 and 3, respectively. Though kidney disease and other adverse effects after COVID-19 vaccination overall appear rare, case reports have accumulated suggesting that COVID-19 vaccination may be associated with a risk of subsequent kidney disease. Among the patients with post-vaccination AKI, the most common pathologic findings include crescentic glomerulonephritis (29.9%), acute tubular injury (23.7%), IgA nephropathy (18.6%), antineutrophil cytoplasmic autoantibody-associated vasculitis (17.5%), minimal change disease (17.5%) and thrombotic microangiopathy (10.3%). It is important to note that crescentic glomerulonephritis appears to be more prevalent in patients who have newly diagnosed renal involvement. The proportions of patients with AKI Stages 1, 2 and 3 after COVID-19 vaccination in case reports were 30.9%, 22.7% and 46.4%, respectively. In general, clinical cases of new-onset and recurrent nephropathy with AKI after COVID-19 vaccination have a positive prognosis. In this article, we also explore the underlying pathophysiological mechanisms of AKI associated with COVID-19 infection and its vaccination by describing key renal morphological and clinical features and prognostic findings.
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Affiliation(s)
- Yebei Li
- Department of Nephrology, The Second Affiliated Hospital of Nanchang University, No. 1, Minde Road, Donghu District, Nanchang 330006, P.R. China
| | - Yan Gong
- Department of Neurosurgery, The Second Affiliated Hospital of Nanchang University, No. 1, Minde Road, Donghu District, Nanchang 330006, P.R. China
| | - Gaosi Xu
- Department of Nephrology, The Second Affiliated Hospital of Nanchang University, No. 1, Minde Road, Donghu District, Nanchang 330006, P.R. China
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Ratnayake A, Sarnowski A, Sinclair F, Annear NMP, Banerjee D, Chis Ster I. The dynamics and outcomes of AKI progression during the COVID-19 pandemic. Nephrology (Carlton) 2024; 29:325-337. [PMID: 38549280 DOI: 10.1111/nep.14297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Revised: 02/18/2024] [Accepted: 03/17/2024] [Indexed: 05/19/2024]
Abstract
PURPOSE Acute kidney injury (AKI) associated with COVID-19 is associated with poor prognosis. This study assessed the hitherto uninvestigated impact of COVID-19 on the progression and clinical outcomes of patients with AKI. METHODS Data from 576 patients with AKI admitted between 13/3/20 and 13/5/20 were studied. Increasingly complex analyses, from logistic regressions to competing-risk and multi-state models, have revealed insights into AKI progression dynamics associated with PCR-confirmed COVID-19 acquisition and death. Meta-analyses of case fatality ratios among patients with AKI were also conducted. RESULTS The overall case-fatality ratio was 0.33 [95% CI (0.20-0.36)]; higher in COVID-19 positive (COVID+) patients 0.52 [95% CI (0.46-0.58)] than in their negative (COVID-) counterparts 0.16 [95% CI (0.12-0.20)]. In AKI Stage-3 patients, that was 0.71 [95% CI (0.64-0.79)] among COVID+ patients with 45% dead within 14 days and 0.35 [95% CI (0.25-0.44)] in the COVID- group and 28% died within 14 days. Among patients diagnosed with AKI Stage-1 within 24 h, the probability of progression to AKI Stage-3 on day 7 post admission was 0.22 [95% CI (0.17-0.27)] among COVID+ patients, and 0.06 [95% CI (0.03, 0.09)] among those who tested negative. The probability of discharge by day 7 was 0.71 [95% CI (0.66, 0.75)] in COVID- patients, and 0.27 [95% CI (0.21, 0.32)] in COVID+ patients. By day 14, in AKI Stage-3 COVID+ patients, that was 0.35 [95% CI (0.25, 0.44)] with little change by day 10, that is, 0.38 [95% CI (0.29, 0.47)]. CONCLUSION These results are consistent with either a rapid progression in severity, prolonged hospital care, or high case fatality ratio among AKI Stage-3 patients, significantly exacerbated by COVID-19 infection.
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Affiliation(s)
- Aruni Ratnayake
- Renal & Transplantation Unit, St George's University Hospitals NHS Foundation Trust, London, UK
- Centre of Inflammatory Disease, Department of Immunology and Inflammation, Imperial College London, Hammersmith Campus, London, UK
| | - Alexander Sarnowski
- Renal & Transplantation Unit, St George's University Hospitals NHS Foundation Trust, London, UK
| | - Fiona Sinclair
- Renal & Transplantation Unit, St George's University Hospitals NHS Foundation Trust, London, UK
| | - Nicholas M P Annear
- Renal & Transplantation Unit, St George's University Hospitals NHS Foundation Trust, London, UK
- Molecular and Clinical Sciences Research Institute and Institute of Biomedical Education, St George's University of London, London, UK
| | - Debasish Banerjee
- Renal & Transplantation Unit, St George's University Hospitals NHS Foundation Trust, London, UK
- Molecular and Clinical Sciences Research Institute and Institute of Biomedical Education, St George's University of London, London, UK
| | - Irina Chis Ster
- Institute of Infection and Immunity, St George's University of London, London, UK
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Larcher R, Bargnoux AS, Badiou S, Besnard N, Brunot V, Daubin D, Platon L, Benomar R, Amalric M, Dupuy AM, Klouche K, Cristol JP. Acute kidney injury in critical COVID-19 patients: usefulness of urinary biomarkers and kidney proximal tubulopathy. Ren Fail 2023; 45:2292152. [PMID: 38078385 PMCID: PMC11001358 DOI: 10.1080/0886022x.2023.2292152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Accepted: 12/01/2023] [Indexed: 12/18/2023] Open
Abstract
Tubular injury is the main cause of acute kidney injury (AKI) in critically ill COVID-19 patients. Proximal tubular dysfunction (PTD) and changes in urinary biomarkers, such as NGAL, TIMP-2, and IGFBP7 product ([TIMP-2]•[IGFBP7]), could precede AKI. We conducted a prospective cohort study from 2020/03/09 to 2020/05/03, which consecutively included all COVID-19 patients who had at least one urinalysis, to assess the incidence of PTD and AKI, and the effectiveness of PTD, NGAL, and [TIMP-2]•[IGFBP7] in AKI and persistent AKI prediction using the area under the receiver operating characteristic curves (AUCs), Kaplan-Meier methodology (log-rank tests), and Cox models. Among the 60 patients admitted to the ICU with proven COVID-19 (median age: 63-year-old (interquartile range: IQR, 55-74), 45 males (75%), median simplified acute physiology score (SAPS) II: 34 (IQR, 22-47) and median BMI: 25.7 kg/m2 (IQR, 23.3-30.8)) analyzed, PTD was diagnosed in 29 patients (48%), AKI in 33 (55%) and persistent AKI in 20 (33%). Urinary NGAL had the highest AUC for AKI prediction: 0.635 (95%CI: 0.491-0.779) and persistent AKI prediction: 0.681 (95%CI: 0.535-0.826), as compared to PTD and [TIMP-2]•[IGFBP7] (AUCs <0.6). AKI was independently associated with higher SAPSII (HR = 1.04, 95%CI: 1.01-1.06, p = 0.005) and BMI (HR = 1.07, 95%CI: 1.00-1.14, p = 0.04) and persistent AKI with higher SAPSII (HR = 1.03, 95%CI: 1.00-1.06, p = 0.048) and nephrotoxic drug use (HR = 3.88, 95%CI: 1.20-12.5, p = 0.02). In conclusion, in critically ill COVID-19 patients, the incidence of PTD and AKI was relatively high. NGAL was the best urinary biomarker for predicting AKI, but only clinical severity was independently associated with its occurrence.
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Affiliation(s)
- Romaric Larcher
- Infectious and Tropical Diseases Department, Nimes University Hospital, Nimes, France
- Biochemistry and Hormonology Department, Montpellier University Hospital, Montpellier, France
- Intensive Care Medicine Department, Montpellier University Hospital, Montpellier, France
- PhyMedExp Laboratory, INSERM, CNRS, Montpellier University, Montpellier, France
| | - Anne-Sophie Bargnoux
- Biochemistry and Hormonology Department, Montpellier University Hospital, Montpellier, France
| | - Stephanie Badiou
- Biochemistry and Hormonology Department, Montpellier University Hospital, Montpellier, France
| | - Noemie Besnard
- Intensive Care Medicine Department, Montpellier University Hospital, Montpellier, France
| | - Vincent Brunot
- Intensive Care Medicine Department, Montpellier University Hospital, Montpellier, France
| | - Delphine Daubin
- Intensive Care Medicine Department, Montpellier University Hospital, Montpellier, France
| | - Laura Platon
- Intensive Care Medicine Department, Montpellier University Hospital, Montpellier, France
| | - Racim Benomar
- Intensive Care Medicine Department, Montpellier University Hospital, Montpellier, France
| | - Matthieu Amalric
- Intensive Care Medicine Department, Montpellier University Hospital, Montpellier, France
| | - Anne-Marie Dupuy
- PhyMedExp Laboratory, INSERM, CNRS, Montpellier University, Montpellier, France
| | - Kada Klouche
- Intensive Care Medicine Department, Montpellier University Hospital, Montpellier, France
- PhyMedExp Laboratory, INSERM, CNRS, Montpellier University, Montpellier, France
| | - Jean-Paul Cristol
- Biochemistry and Hormonology Department, Montpellier University Hospital, Montpellier, France
- PhyMedExp Laboratory, INSERM, CNRS, Montpellier University, Montpellier, France
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Ramamoorthy R, Hussain H, Ravelo N, Sriramajayam K, Di Gregorio DM, Paulrasu K, Chen P, Young K, Masciarella AD, Jayakumar AR, Paidas MJ. Kidney Damage in Long COVID: Studies in Experimental Mice. BIOLOGY 2023; 12:1070. [PMID: 37626956 PMCID: PMC10452084 DOI: 10.3390/biology12081070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Revised: 07/25/2023] [Accepted: 07/27/2023] [Indexed: 08/27/2023]
Abstract
Signs and symptoms involving multiple organ systems which persist for weeks or months to years after the initial SARS-CoV-2 infection (also known as PASC or long COVID) are common complications of individuals with COVID-19. We recently reported pathophysiological changes in various organs post-acute infection of mice with mouse hepatitis virus-1 (MHV-1, a coronavirus) (7 days) and after long-term post-infection (12 months). One of the organs severely affected in this animal model is the kidney, which correlated well with human studies showing kidney injury post-SARS-CoV-2 infection. Our long-term post-infection pathological observation in kidneys includes the development of edema and inflammation of the renal parenchyma, severe acute tubular necrosis, and infiltration of macrophages and lymphocytes, in addition to changes observed in both acute and long-term post-infection, which include tubular epithelial cell degenerative changes, peritubular vessel congestion, proximal and distal tubular necrosis, hemorrhage in the interstitial tissue, and vacuolation of renal tubules. These findings strongly suggest the possible development of renal fibrosis, in particular in the long-term post-infection. Accordingly, we investigated whether the signaling system that is known to initiate the above-mentioned changes in kidneys in other conditions is also activated in long-term post-MHV-1 infection. We found increased TGF-β1, FGF23, NGAL, IL-18, HIF1-α, TLR2, YKL-40, and B2M mRNA levels in long-term post-MHV-1 infection, but not EGFR, TNFR1, BCL3, and WFDC2. However, only neutrophil gelatinase-associated lipocalin (NGAL) increased in acute infection (7 days). Immunoblot studies showed an elevation in protein levels of HIF1-α, TLR-2, and EGFR in long-term post-MHV-1 infection, while KIM-1 and MMP-7 protein levels are increased in acute infection. Treatment with a synthetic peptide, SPIKENET (SPK), which inhibits spike protein binding, reduced NGAL mRNA in acute infection, and decreased TGF-β1, BCL3 mRNA, EGFR, HIF1-α, and TLR-2 protein levels long-term post-MHV-1 infection. These findings suggest that fibrotic events may initiate early in SARS-CoV-2 infection, leading to pronounced kidney fibrosis in long COVID. Targeting these factors therapeutically may prevent acute or long-COVID-associated kidney complications.
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Affiliation(s)
- Rajalakshmi Ramamoorthy
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of Miami Miller School of Medicine, Miami, FL 33136, USA; (R.R.); (N.R.)
| | - Hussain Hussain
- Department of Internal Medicine and Infectious Disease, Larkin Community Hospital, Miami, FL 33143, USA;
| | - Natalia Ravelo
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of Miami Miller School of Medicine, Miami, FL 33136, USA; (R.R.); (N.R.)
| | - Kannappan Sriramajayam
- Department of Molecular and Cellular Pharmacology, University of Miami Miller School of Medicine, Miami, FL 33136, USA;
| | - Dibe M. Di Gregorio
- University of Miami College of Arts and Sciences, Coral Gables, FL 33146, USA;
| | - Kodisundaram Paulrasu
- Department of Surgery, University of Miami Miller School of Medicine, Miami, FL 33136, USA;
| | - Pingping Chen
- Department of Pediatrics, University of Miami Miller School of Medicine, Miami, FL 33136, USA; (P.C.); (K.Y.)
| | - Karen Young
- Department of Pediatrics, University of Miami Miller School of Medicine, Miami, FL 33136, USA; (P.C.); (K.Y.)
| | | | - Arumugam R. Jayakumar
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of Miami Miller School of Medicine, Miami, FL 33136, USA; (R.R.); (N.R.)
| | - Michael J. Paidas
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of Miami Miller School of Medicine, Miami, FL 33136, USA; (R.R.); (N.R.)
- Department of Biochemistry and Molecular Biology, University of Miami Miller School of Medicine, Miami, FL 33136, USA
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Shusterman E, Kliuk Ben-Bassat O, Zahler D, Kupershmidt A, Weiss-Meilik A, Kehat O, Ablin JN. Risk factors, clinical characteristics and prognostic value of acute kidney injury in COVID-19 compared with influenza virus and respiratory syncytial virus. J Nephrol 2023; 36:1349-1359. [PMID: 36971979 PMCID: PMC10041485 DOI: 10.1007/s40620-023-01591-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Accepted: 01/29/2023] [Indexed: 03/29/2023]
Abstract
BACKGROUND Acute Kidney Injury (AKI) complicates a substantial part of patients with COVID-19. Direct viral penetration of renal cells through the Angiotensin Converting Enzyme 2 receptor, and indirect damage by the aberrant inflammatory response characteristic of COVID-19 are likely mechanisms. Nevertheless, other common respiratory viruses such as Influenza and Respiratory Syncytial Virus (RSV) are also associated with AKI. METHODS We retrospectively compared the incidence, risk factors and outcomes of AKI among patients who were admitted to a tertiary hospital because of infection with COVID-19, influenza (A + B) or RSV. RESULTS We collected data of 2593 patients hospitalized with COVID-19, 2041 patients with influenza and 429 with RSV. Patients affected by RSV were older, had more comorbidities and presented with higher rates of AKI at admission and within 7 days (11.7% vs. 13.3% vs. 18% for COVID-19, influenza and RSV, respectively p = 0.001). Nevertheless, patients hospitalized with COVID-19 had higher mortality (18% with COVID-19 vs. 8.6% and 13.5% for influenza and RSV, respectively P < 0.001) and higher need of mechanical ventilation (12.4% vs. 6.5% vs.8.2% for COVID-19, influenza and RSV, respectively, P = 0.002). High ferritin levels and low oxygen saturation were independent risk factors for severe AKI only in the COVID-19 group. AKI in the first 48 h of admission and in the first 7 days of hospitalization were strong independent risk factors for adverse outcome in all groups. CONCLUSION Despite many reports of direct kidney injury by SARS-COV-2, AKI was less in patients with COVID-19 compared to influenza and RSV patients. AKI was a prognostic marker for adverse outcome across all viruses.
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Affiliation(s)
- Eden Shusterman
- Internal Medicine H, Sourasky Medical Centre, Tel Aviv, Israel.
| | - Orit Kliuk Ben-Bassat
- Department of Nephrology, Tel Aviv Sourasky Medical Center, affiliated with Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - David Zahler
- Department of Cardiology, Tel-Aviv Sourasky Medical Center affiliated to the Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel
| | | | | | | | - Jacob N Ablin
- Internal Medicine H, Sourasky Medical Centre, Tel Aviv, Israel
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
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Huang J, Ding H, Feng C, Mao D, Tai S. Spontaneous Prostatic Hemorrhage in a COVID-19 Patient: A Case Report. Infect Drug Resist 2023; 16:3035-3040. [PMID: 37215304 PMCID: PMC10199698 DOI: 10.2147/idr.s410962] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2023] [Accepted: 05/09/2023] [Indexed: 05/24/2023] Open
Abstract
Hematuria occurring in patients with acute kidney injury caused by Corona Virus Disease 2019 (COVID-19) infection has been reported. However, cases of macroscopic hematuria in COVID-19 patients leading to a severe decrease in hemoglobin have not been reported heretofore. Herein, we describe the case of a 56-year-old male patient who suffered from spontaneous prostatic hemorrhage caused by thrombocytopenia and coagulation dysfunction associated with COVID-19 infection, which manifested as macroscopic hematuria, bladder blood clot tamponade and severe hemoglobin decline. Prostatic hemorrhage was diagnosed by endoscopy. There was no recurrence of macroscopic hematuria after undergoing transurethral prostate electrocoagulation for hemostasis, infusing plasma to supplement coagulation factors and taking finasteride. One month after the bleeding event, the patient's blood routine reexamination revealed that the platelet count returned to the normal value and coagulation was normal.
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Affiliation(s)
- Jiaguo Huang
- Department of Urology, Affiliated Xiaoshan Hospital, Hangzhou Normal University, Hangzhou, People’s Republic of China
| | - Hongxiang Ding
- Department of Urology, Affiliated Xiaoshan Hospital, Hangzhou Normal University, Hangzhou, People’s Republic of China
| | - Chao Feng
- School of Medicine, Hangzhou Normal University, Hangzhou, People’s Republic of China
| | - Dikai Mao
- Department of Urology, Affiliated Xiaoshan Hospital, Hangzhou Normal University, Hangzhou, People’s Republic of China
| | - Shengcheng Tai
- Department of Urology, Affiliated Xiaoshan Hospital, Hangzhou Normal University, Hangzhou, People’s Republic of China
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8
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Asakawa T, Cai Q, Shen J, Zhang Y, Li Y, Chen P, Luo W, Zhang J, Zhou J, Zeng H, Weng R, Hu F, Feng H, Chen J, Huang J, Zhang X, Zhao Y, Fang L, Yang R, Huang J, Wang F, Liu Y, Lu H. Sequelae of long COVID, known and unknown: A review of updated information. Biosci Trends 2023; 17:85-116. [PMID: 36928222 DOI: 10.5582/bst.2023.01039] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/16/2023]
Abstract
Over three years have passed since the COVID-19 pandemic started. The dangerousness and impact of COVID-19 should definitely not be ignored or underestimated. Other than the symptoms of acute infection, the long-term symptoms associated with SARS-CoV-2 infection, which are referred to here as "sequelae of long COVID (LC)", are also a conspicuous global public health concern. Although such sequelae were well-documented, the understanding of and insights regarding LC-related sequelae remain inadequate due to the limitations of previous studies (the follow-up, methodological flaws, heterogeneity among studies, etc.). Notably, robust evidence regarding diagnosis and treatment of certain LC sequelae remain insufficient and has been a stumbling block to better management of these patients. This awkward situation motivated us to conduct this review. Here, we comprehensively reviewed the updated information, particularly focusing on clinical issues. We attempt to provide the latest information regarding LC-related sequelae by systematically reviewing the involvement of main organ systems. We also propose paths for future exploration based on available knowledge and the authors' clinical experience. We believe that these take-home messages will be helpful to gain insights into LC and ultimately benefit clinical practice in treating LC-related sequelae.
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Affiliation(s)
- Tetsuya Asakawa
- Institute of Neurology, National Clinical Research Center for Infectious Diseases, the Third People's Hospital of Shenzhen, Shenzhen, China
| | - Qingxian Cai
- Department of Hepatology, National Clinical Research Center for Infectious Diseases, the Third People's Hospital of Shenzhen, Shenzhen, China
| | - Jiayin Shen
- Department of Science and Education, National Clinical Research Center for Infectious Diseases, the Third People's Hospital of Shenzhen, Shenzhen, China
| | - Ying Zhang
- Department of Endocrinology, National Clinical Research Center for Infectious Diseases, the Third People's Hospital of Shenzhen, Shenzhen, China
| | - Yongshuang Li
- Department of Dermatology, National Clinical Research Center for Infectious Diseases, the Third People's Hospital of Shenzhen, Shenzhen, China
| | - Peifen Chen
- Department of Respiratory Medicine, National Clinical Research Center for Infectious Diseases, the Third People's Hospital of Shenzhen, Shenzhen, China
| | - Wen Luo
- Department of Respiratory Medicine, National Clinical Research Center for Infectious Diseases, the Third People's Hospital of Shenzhen, Shenzhen, China
| | - Jiangguo Zhang
- Department of Gastroenterology, National Clinical Research Center for Infectious Diseases, the Third People's Hospital of Shenzhen, Shenzhen, China
| | - Jinfeng Zhou
- Department of Gastroenterology, National Clinical Research Center for Infectious Diseases, the Third People's Hospital of Shenzhen, Shenzhen, China
| | - Hui Zeng
- Department of Cardiology, National Clinical Research Center for Infectious Diseases, the Third People's Hospital of Shenzhen, Shenzhen, China
| | - Ruihui Weng
- Department of Neurology, National Clinical Research Center for Infectious Diseases, the Third People's Hospital of Shenzhen, Shenzhen, China
| | - Feng Hu
- Department of Nephrology, National Clinical Research Center for Infectious Diseases, the Third People's Hospital of Shenzhen, Shenzhen, China
| | - Huiquan Feng
- Department of Urology, National Clinical Research Center for Infectious Diseases, the Third People's Hospital of Shenzhen, Shenzhen, China
| | - Jun Chen
- Department of Hepatology, National Clinical Research Center for Infectious Diseases, the Third People's Hospital of Shenzhen, Shenzhen, China
| | - Jie Huang
- Department of Dermatology, National Clinical Research Center for Infectious Diseases, the Third People's Hospital of Shenzhen, Shenzhen, China
| | - Xiaoyin Zhang
- Department of Gastroenterology, National Clinical Research Center for Infectious Diseases, the Third People's Hospital of Shenzhen, Shenzhen, China
| | - Yu Zhao
- Department of Neurology, National Clinical Research Center for Infectious Diseases, the Third People's Hospital of Shenzhen, Shenzhen, China
| | - Liekui Fang
- Department of Urology, National Clinical Research Center for Infectious Diseases, the Third People's Hospital of Shenzhen, Shenzhen, China
| | - Rongqing Yang
- Department of Dermatology, National Clinical Research Center for Infectious Diseases, the Third People's Hospital of Shenzhen, Shenzhen, China
| | - Jia Huang
- Department of Intensive Care Unit, National Clinical Research Center for Infectious Diseases, the Third People's Hospital of Shenzhen, Shenzhen, China
| | - Fuxiang Wang
- Department of Infectious Diseases, National Clinical Research Center for Infectious Diseases, the Third People's Hospital of Shenzhen, Shenzhen, China
| | - Yingxia Liu
- Department of Infectious Diseases, National Clinical Research Center for Infectious Diseases, the Third People's Hospital of Shenzhen, Shenzhen, China
| | - Hongzhou Lu
- Institute of Neurology, National Clinical Research Center for Infectious Diseases, the Third People's Hospital of Shenzhen, Shenzhen, China.,Department of Infectious Diseases, National Clinical Research Center for Infectious Diseases, the Third People's Hospital of Shenzhen, Shenzhen, China
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9
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Okwor CJ, Meka IA, Nto-Ezimah UA, Nto NJ, Nduka NS, Akinwande KS, Edem VF. Association of SARS-CoV-2 viral load with biochemical profile of COVID-19 patients: A nigerian experience. Niger J Clin Pract 2023; 26:109-115. [PMID: 36751832 DOI: 10.4103/njcp.njcp_1828_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Background Kidney involvement in coronavirus disease 2019 (COVID-19) pathology has been supported by high frequency of angiotensin-converting enzyme 2 (ACE2) expression on renal cells and reports of acute kidney injury. However, the association between host viral load and kidney function is not clear. Aim In this study, plasma levels of renal markers (urea nitrogen, creatinine, and estimated glomerular filtration rate (eGFR)) and electrolytes (sodium, potassium, chlorine, and bicarbonate) were assessed in relation to SARS-CoV-2 viral load of COVID-19 patients. Patients and Methods This cross-sectional study involved 144 consenting COVID-19 patients admitted to the Ogun state COVID-19 isolation center between May and December 2020. All participants presented with mild respiratory symptoms and did not require ICU admission or ventilation support. Data included reverse transcriptase polymerase chain reaction (RT-PCR) cycle threshold (CT) value, blood urea nitrogen (BUN), creatinine, sodium, potassium, chlorine, bicarbonate measurements, and glomerular filtration rate. Reference intervals were used as comparators, and multiple linear regression model was fitted. Statistical significance was set at P < 0.05. Results BUN level and creatinine were elevated in 4 (2.8%) and 42 (29.2%) patients, respectively, with lowered eGFR observed in 37 (25.7%) patients. Hyponatremia and hypokalemia were observed in 35 (24.3%) and 21 (14.6%) patients, respectively, while hypochloremia was observed in 21 (14.6%) patients. Lowered bicarbonate was observed in 29 (20.1%) patients. Linear regression showed statistically significant association (R2 = 0.340, P = 0.032) between RT-PCR CT value and eGFR (β = 0.006, P = 0.017) as well as HCO3 (β = -0.262, P = 0.036). Conclusion COVID-19 patients with mild respiratory symptoms exhibited renal abnormalities, electrolytes, and acid-base imbalances which were partly associated with SARS-CoV-2 viral load.
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Affiliation(s)
- C J Okwor
- Department of Chemical Pathology, College of Medicine, University of Nigeria/University of Nigeria Teaching Hospital, Ituku/Ozalla, Nigeria
| | - I A Meka
- Department of Chemical Pathology, College of Medicine, University of Nigeria/University of Nigeria Teaching Hospital, Ituku/Ozalla, Nigeria
| | - U A Nto-Ezimah
- Department of Chemical Pathology, College of Medicine, University of Nigeria/University of Nigeria Teaching Hospital, Ituku/Ozalla, Nigeria
| | - N J Nto
- Department of Anatomy, University of Nigeria, Enugu Campus, Nigeria
| | - N S Nduka
- 54gene Biotechnology, Lagos, Nigeria
| | - K S Akinwande
- Department of Chemical Pathology and Immunology, Federal Medical Center, Abeokuta, Nigeria
| | - V F Edem
- Department of Immunology, University of Ibadan, Ibadan, Nigeria
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10
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Gross Hematuria following SARS-CoV-2 Vaccination. Case Rep Med 2023; 2023:1225510. [PMID: 36911811 PMCID: PMC9995183 DOI: 10.1155/2023/1225510] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Revised: 08/29/2022] [Accepted: 02/08/2023] [Indexed: 03/05/2023] Open
Abstract
In the setting of the rapid development of currently available vaccines for coronavirus disease of 2019 (COVID-19), little is known about their less frequent potential side effects. Raising the awareness of clinicians and front-line healthcare workers about the less well-known potential side effects of vaccination is important. We describe the self-limited occurrence of gross hematuria in two elderly men on a combination of aspirin and another antiplatelet or anticoagulant following their second dose of the Moderna COVID-19 vaccination. While the bleeding seems to be self-limited, the long-term course currently remains elusive.
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11
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Abstract
PURPOSE OF REVIEW While it is now widely established acute kidney injury (AKI) is a common and important complication of coronavirus disease (COVID-19) disease, there is marked variability in its reported incidence and outcomes. This narrative review provides a mid-2022 summary of the latest epidemiological evidence on AKI in COVID-19. RECENT FINDINGS Large observational studies and meta-analyses report an AKI incidence of 28-34% in all inpatients and 46-77% in intensive care unit (ICU). The incidence of more severe AKI requiring renal replacement therapy (RRT) in ICU appears to have declined over time, in data from England and Wales RRT use declined from 26% at the start of the pandemic to 14% in 2022. The majority of survivors apparently recover their kidney function by hospital discharge; however, these individuals appear to remain at increased risk of future AKI, estimated glomerular filtration rate (eGFR) decline and chronic kidney disease. Importantly even in the absence of overt AKI a significant proportion of survivors of COVID-19 hospitalisation had reduced eGFR on follow-up. SUMMARY This review summarises the epidemiology, risk factors, outcomes and treatment of COVID-19-associated AKI across the global pandemic. In particular the long-term impact of COVID-19 disease on kidney health is uncertain and requires further characterisation.
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12
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Khruleva Y, Kobalava Z, Arisheva O, Efremovtseva M, Garmash I, Vatsik-Gorodetskaya M, Al Jarallah M, Brady PA, Al-Zakwani I, Rajan R. Clinical Outcome and Risk Assessment in Hospitalized COVID-19 Patients with Elevated Transaminases and Acute Kidney Injury:
A Single Center Study. Oman Med J 2022; 37:e443. [PMID: 36458236 PMCID: PMC9631120 DOI: 10.5001/omj.2022.98] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Accepted: 05/12/2022] [Indexed: 08/27/2023] Open
Abstract
OBJECTIVES Initial reports indicate a high incidence of abnormal aspartate aminotransferase (AST) and alanine aminotransferase (ALT) levels in patients with COVID-19 and possible association with acute kidney injury (AKI). We aimed to investigate clinical features of elevated transaminases on admission, its association with AKI, and outcomes in patients with COVID-19. METHODS A retrospective analysis of the registered data of hospitalized patients with laboratory-confirmed COVID-19 and assessment of the AST and ALT was performed. Multinomial logistic regression was used to determine factors associated with community-acquired AKI (CA-AKI) and hospital-acquired AKI (HA-AKI). RESULTS The subjects comprised 828 patients (mean age = 65.0±16.0 years; 51.4% male). Hypertension was present in 70.3% of patients, diabetes mellitus in 26.0%, and chronic kidney disease in 8.5%. In-hospital mortality was 21.0%. At admission, only 41.5% of patients had hypertransaminasemia. Patients with elevated transaminases at admission were younger, had higher levels of inflammatory markers and D-dimer, and poorer outcomes. The AKI incidence in the study population was 27.1%. Patients with hypertransaminasemia were more likely to develop AKI (33.5% vs. 23.3%, p = 0.003). Patients with predominantly elevated AST (compared to elevated ALT) were more likely to have adverse outcomes. Multinomial logistic regression found that hypertension, chronic kidney disease, elevated AST, and hematuria were associated with CA-AKI. Meanwhile, age > 65 years, hypertension, malignancy, elevated AST, and hematuria were predictors of HA-AKI. CONCLUSIONS Elevated transaminases on admission were associated with AKI and poor outcomes. Patients with elevated AST were more likely to have adverse outcomes. Elevated AST on admission was associated with CA-AKI and was a predictor of HA-AKI.
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Affiliation(s)
- Yulia Khruleva
- Department of Internal Diseases, Peoples` Friendship University of Russia, Moscow, Russia
| | - Zhanna Kobalava
- Department of Internal Diseases, Peoples` Friendship University of Russia, Moscow, Russia
| | - Olga Arisheva
- Department of Internal Diseases, Peoples` Friendship University of Russia, Moscow, Russia
| | - Marina Efremovtseva
- Department of Internal Diseases, Peoples` Friendship University of Russia, Moscow, Russia
| | - Irina Garmash
- Department of Internal Diseases, Peoples` Friendship University of Russia, Moscow, Russia
| | - Maria Vatsik-Gorodetskaya
- Department of Cardiology, Russian Clinical and Research Center of Gerontology, Pirogov`s Russian National Research Medical University, Moscow, Russia
| | | | - Peter A Brady
- Department of Cardiology, Illinois Masonic Medical Center, Chicago,Illinois, USA
| | - Ibrahim Al-Zakwani
- Department of Pharmacology and Clinical Pharmacy, College of Medicine and Health Sciences, Sultan Qaboos University, Muscat, Oman
- Gulf Health Research, Muscat, Oman
| | - Rajesh Rajan
- Department of Internal Diseases, Peoples` Friendship University of Russia, Moscow, Russia
- Department of Cardiology, Sabah Al Ahmed Cardiac Centre, Kuwait City, Kuwait
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13
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Silva BM, Assis LCSD, Batista MDC, Gonzalez NAP, Anjos SBD, Goes MA. Acute kidney injury outcomes in covid-19 patients: systematic review and meta-analysis. J Bras Nefrol 2022; 44:543-556. [PMID: 35848725 PMCID: PMC9838673 DOI: 10.1590/2175-8239-jbn-2022-0013en] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Accepted: 05/03/2022] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND Acute kidney injury (AKI) is a frequent complication of coronavirus-19 disease (COVID-19). Therefore, we decided to perform a systematic review and meta-analysis with data from the literature to relate the development of COVID-19 associated-AKI with comorbidities, medications, and the impact of mechanical ventilation. METHODS We performed a systematic review using the Newcastle-Ottawa scale and a meta-analysis using the R program. Relevant studies were searched in the PubMed, Medline, and SciELO electronic databases. Search filters were used to include reports after 2020 and cohort studies. RESULTS In total, 1166 articles were identified and 55 English-written articles were included based on the risk of bias. Of all COVID-19-hospitalized patients presenting with AKI (n = 18029) classified as Kidney Disease Improving Global Outcomes stage 1 to 3, approximately 18% required mechanical ventilation and 39.2 % died. Around 11.3% of the patients required kidney replacement therapy (KRT) and of these, 1093 died and 321 required continuous KRT. Death is more frequent in individuals with AKI [OR 6.03, 95%CI: 5.73-6.74; p<0.01]. Finally, mechanical ventilation is an aggravating factor in the clinical conditions studied [OR 11.01, 95%CI: 10.29-11.77; p<0.01]. CONCLUSION Current literature indicates AKI as an important complication in COVID-19. In this context, we observed that comorbidities, such as chronic kidney disease and heart failure, were more related to the development of AKI. In addition, mechanical ventilation was seen as an aggravating factor in this scenario.
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14
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Chávez-Valencia V, Orizaga-de-la-Cruz C, Lagunas-Rangel FA. Acute Kidney Injury in COVID-19 Patients: Pathogenesis, Clinical Characteristics, Therapy, and Mortality. Diseases 2022; 10:diseases10030053. [PMID: 35997358 PMCID: PMC9397016 DOI: 10.3390/diseases10030053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Revised: 08/12/2022] [Accepted: 08/16/2022] [Indexed: 01/08/2023] Open
Abstract
Coronavirus disease 2019 (COVID-19) is a disease caused by infection with the SARS-CoV-2 virus and has represented one of the greatest challenges humanity has faced in recent years. The virus can infect a large number of organs, including the lungs and upper respiratory tract, brain, liver, kidneys, and intestines, among many others. Although the greatest damage occurs in the lungs, the kidneys are not exempt, and acute kidney injury (AKI) can occur in patients with COVID-19. Indeed, AKI is one of the most frequent and serious organic complications of COVID-19. The incidence of COVID-19 AKI varies widely, and the exact mechanisms of how the virus damages the kidney are still unknown. For this reason, the purpose of this review was to assess current findings on the pathogenesis, clinical features, therapy, and mortality of COVID-19 AKI.
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Affiliation(s)
- Venice Chávez-Valencia
- Department of Nephrology, Hospital General Regional Hospital No. 1, Instituto Mexicano del Seguro Social, Bosque de los Olivos No. 101. Av. La Goleta Mpo. Charo, Morelia 61301, Mexico
- Correspondence: (V.C.-V.); (F.A.L.-R.)
| | - Citlalli Orizaga-de-la-Cruz
- Department of Nephrology, Hospital General Regional Hospital No. 1, Instituto Mexicano del Seguro Social, Bosque de los Olivos No. 101. Av. La Goleta Mpo. Charo, Morelia 61301, Mexico
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15
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Silva BM, Assis LCSD, Batista Júnior MDC, Gonzalez NAP, Anjos SBD, Goes MA. Desfechos de lesão renal aguda em pacientes com covid-19: revisão sistemática e metanálise. J Bras Nefrol 2022. [DOI: 10.1590/2175-8239-jbn-2022-0013pt] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Resumo Antecedentes: Lesão renal aguda (LRA) é uma complicação frequente da doença do coronavírus-19 (COVID-19). Desta forma, decidimos realizar uma revisão sistemática e uma metanálise com dados da literatura para relacionar o desenvolvimento de LRA associada à COVID-19 com comorbidades, medicamentos e o impacto da ventilação mecânica. Métodos: Realizamos uma revisão sistemática usando a escala de Newcastle-Ottawa e uma metanálise utilizando o programa R. Estudos relevantes foram pesquisados nos bancos de dados eletrônicos PubMed, Medline e SciELO. Foram utilizados filtros de pesquisa para incluir relatos após 2020 e estudos de coorte. Resultados: No total, foram identificados 1166 artigos, e foram incluídos 55 artigos escritos em língua inglesa com base no risco de viés. De todos os pacientes hospitalizados por COVID-19 apresentando LRA (n = 18029) classificados como Kidney Disease Improving Global Outcomes estágios 1 a 3, aproximadamente 18% necessitaram de ventilação mecânica e 39,2% foram a óbito. Cerca de 11,3% dos pacientes necessitaram de terapia renal substitutiva (TRS) e destes, 1093 foram a óbito e 321 necessitaram de TRS contínua. O óbito é mais frequente em indivíduos com LRA [OR 6,03; IC95%: 5,73-6,74; p<0,01]. Por fim, a ventilação mecânica é um fator agravante nas condições clínicas estudadas [OR 11,01; IC95%: 10,29-11,77; p<0,01]. Conclusão: A literatura atual indica a LRA como uma complicação importante na COVID-19. Neste contexto, observamos que comorbidades, como doença renal crônica e insuficiência cardíaca, estiveram mais relacionadas ao desenvolvimento de LRA. Além disso, a ventilação mecânica foi vista como um fator agravante neste cenário.
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16
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Correia GDS, Takis PG, Sands CJ, Kowalka AM, Tan T, Turtle L, Ho A, Semple MG, Openshaw PJM, Baillie JK, Takáts Z, Lewis MR. 1H NMR Signals from Urine Excreted Protein Are a Source of Bias in Probabilistic Quotient Normalization. Anal Chem 2022; 94:6919-6923. [PMID: 35503092 PMCID: PMC9118196 DOI: 10.1021/acs.analchem.2c00466] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Normalization to account for variation in urinary dilution is crucial for interpretation of urine metabolic profiles. Probabilistic quotient normalization (PQN) is used routinely in metabolomics but is sensitive to systematic variation shared across a large proportion of the spectral profile (>50%). Where 1H nuclear magnetic resonance (NMR) spectroscopy is employed, the presence of urinary protein can elevate the spectral baseline and substantially impact the resulting profile. Using 1H NMR profile measurements of spot urine samples collected from hospitalized COVID-19 patients in the ISARIC 4C study, we determined that PQN coefficients are significantly correlated with observed protein levels (r2 = 0.423, p < 2.2 × 10-16). This correlation was significantly reduced (r2 = 0.163, p < 2.2 × 10-16) when using a computational method for suppression of macromolecular signals known as small molecule enhancement spectroscopy (SMolESY) for proteinic baseline removal prior to PQN. These results highlight proteinuria as a common yet overlooked source of bias in 1H NMR metabolic profiling studies which can be effectively mitigated using SMolESY or other macromolecular signal suppression methods before estimation of normalization coefficients.
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Affiliation(s)
- Gonçalo D. S. Correia
- Section
of Bioanalytical Chemistry, Division of Systems Medicine, Department
of Metabolism, Digestion and Reproduction, Imperial College London, South Kensington Campus, London SW7 2AZ, United Kingdom
- National
Phenome Centre, Imperial College London, Hammersmith Campus, IRDB Building, London W12 0NN, United Kingdom
- G. D. S. Correia.
| | - Panteleimon G. Takis
- Section
of Bioanalytical Chemistry, Division of Systems Medicine, Department
of Metabolism, Digestion and Reproduction, Imperial College London, South Kensington Campus, London SW7 2AZ, United Kingdom
- National
Phenome Centre, Imperial College London, Hammersmith Campus, IRDB Building, London W12 0NN, United Kingdom
- P. G. Takis.
| | - Caroline J. Sands
- Section
of Bioanalytical Chemistry, Division of Systems Medicine, Department
of Metabolism, Digestion and Reproduction, Imperial College London, South Kensington Campus, London SW7 2AZ, United Kingdom
- National
Phenome Centre, Imperial College London, Hammersmith Campus, IRDB Building, London W12 0NN, United Kingdom
| | - Anna M. Kowalka
- Division
of Diabetes, Endocrinology and Metabolism, Department of Metabolism,
Digestion and Reproduction, Imperial College
London, Du Cane Road, London W12 0NN, United Kingdom
- Clinical
Biochemistry, Blood Sciences, North West London Pathology, Charing Cross Hospital, London W6 8RF, United Kingdom
| | - Tricia Tan
- Division
of Diabetes, Endocrinology and Metabolism, Department of Metabolism,
Digestion and Reproduction, Imperial College
London, Du Cane Road, London W12 0NN, United Kingdom
- Clinical
Biochemistry, Blood Sciences, North West London Pathology, Charing Cross Hospital, London W6 8RF, United Kingdom
| | - Lance Turtle
- NIHR
Health Protection Research Unit in Emerging and Zoonotic Infections,
Institute of Infection and Global Health, University of Liverpool, Liverpool L69 7BE, United Kingdom
| | - Antonia Ho
- MRC-University
of Glasgow Centre for Virus Research, University
of Glasgow, Glasgow G61 1QH, United Kingdom
| | - Malcolm G. Semple
- NIHR
Health Protection Research Unit in Emerging and Zoonotic Infections,
Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Liverpool L69 7BE, United Kingdom
- Respiratory
Medicine, Alder Hey Children’s Hospital, Liverpool L12 2AP, United Kingdom
| | - Peter J. M. Openshaw
- Faculty
of Medicine, National Heart and Lung Institute, Imperial College London, London SW3 6LY, United Kingdom
| | - J. Kenneth Baillie
- Roslin
Institute, University of Edinburgh, Edinburgh EH25 9RG, United Kingdom
| | - Zoltán Takáts
- Section
of Bioanalytical Chemistry, Division of Systems Medicine, Department
of Metabolism, Digestion and Reproduction, Imperial College London, South Kensington Campus, London SW7 2AZ, United Kingdom
- National
Phenome Centre, Imperial College London, Hammersmith Campus, IRDB Building, London W12 0NN, United Kingdom
| | - Matthew R. Lewis
- Section
of Bioanalytical Chemistry, Division of Systems Medicine, Department
of Metabolism, Digestion and Reproduction, Imperial College London, South Kensington Campus, London SW7 2AZ, United Kingdom
- National
Phenome Centre, Imperial College London, Hammersmith Campus, IRDB Building, London W12 0NN, United Kingdom
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17
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Long JD, Strohbehn I, Sawtell R, Bhattacharyya R, Sise ME. COVID-19 Survival and its impact on chronic kidney disease. Transl Res 2022; 241:70-82. [PMID: 34774843 PMCID: PMC8579714 DOI: 10.1016/j.trsl.2021.11.003] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Revised: 10/31/2021] [Accepted: 11/03/2021] [Indexed: 12/16/2022]
Abstract
Up to 87% of patients hospitalized with coronavirus disease 2019 (COVID-19) experience chronic sequelae following infection. The long-term impact of COVID-19 infection on kidney function is largely unknown at this point in the COVID-19 pandemic. In this review, we highlight the current understanding of the pathophysiology of COVID-19-associated kidney injury and the impact COVID-19 may have on long-term kidney function. COVID-19-induced acute kidney injury may lead to tubular injury, endothelial injury, and glomerular injury. We highlight histopathologic correlates from large kidney biopsy and autopsy series. By conducting a comprehensive review of published literature to date, we summarize the rates of recovery from COVID-19-associated-AKI. Finally, we discuss how certain genetic differences, including APOL1 risk alleles (a risk factor for collapsing glomerulopathy), coupled with systemic healthcare disparities, may lead to a disproportionate burden of post-COVID-19-kidney function decline among racial and ethnic minority groups. We highlight the need for prospective studies to determine the true incidence of chronic kidney disease burden after COVID-19.
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Key Words
- aki, acute kidney disease
- aor, adjusted odds ratio
- atn, acute tubular necrosis
- covan, covid-19-associated-nephropathy
- covid-19, coronavirus disease 2019
- ckd, chronic kidney disease
- egfr, estimated glomerular filtration rate
- eskd, end-stage kidney disease
- hr, ratio
- tma, thrombotic microangiopathy
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Affiliation(s)
- Joshua D Long
- Massachusetts General Hospital, Department of Medicine, Division of Nephrology, Boston, Massachusetts
| | - Ian Strohbehn
- Massachusetts General Hospital, Department of Medicine, Division of Nephrology, Boston, Massachusetts
| | - Rani Sawtell
- Massachusetts General Hospital, Department of Medicine, Division of Nephrology, Boston, Massachusetts
| | - Roby Bhattacharyya
- Massachusetts General Hospital, Department of Medicine, Division of Infectious Diseases, Boston, Massachusetts
| | - Meghan E Sise
- Massachusetts General Hospital, Department of Medicine, Division of Nephrology, Boston, Massachusetts.
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18
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Sun S, Annadi RR, Chaudhri I, Munir K, Hajagos J, Saltz J, Hoai M, Mallipattu SK, Moffitt R, Koraishy FM. Short- and Long-Term Recovery after Moderate/Severe AKI in Patients with and without COVID-19. KIDNEY360 2022; 3:242-257. [PMID: 35373118 PMCID: PMC8967640 DOI: 10.34067/kid.0005342021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Accepted: 11/24/2021] [Indexed: 01/10/2023]
Abstract
Background Severe AKI is strongly associated with poor outcomes in coronavirus disease 2019 (COVID-19), but data on renal recovery are lacking. Methods We retrospectively analyzed these associations in 3299 hospitalized patients (1338 with COVID-19 and 1961 with acute respiratory illness but who tested negative for COVID-19). Uni- and multivariable analyses were used to study mortality and recovery after Kidney Disease Improving Global Outcomes Stages 2 and 3 AKI (AKI-2/3), and Machine Learning was used to predict AKI and recovery using admission data. Long-term renal function and other outcomes were studied in a subgroup of AKI-2/3 survivors. Results Among the 172 COVID-19-negative patients with AKI-2/3, 74% had partial and 44% complete renal recovery, whereas 12% died. Among 255 COVID-19 positive patients with AKI-2/3, lower recovery and higher mortality were noted (51% partial renal recovery, 25% complete renal recovery, 24% died). On multivariable analysis, intensive care unit admission and acute respiratory distress syndrome were associated with nonrecovery, and recovery was significantly associated with survival in COVID-19-positive patients. With Machine Learning, we were able to predict recovery from COVID-19-associated AKI-2/3 with an average precision of 0.62, and the strongest predictors of recovery were initial arterial partial pressure of oxygen and carbon dioxide, serum creatinine, potassium, lymphocyte count, and creatine phosphokinase. At 12-month follow-up, among 52 survivors with AKI-2/3, 26% COVID-19-positive and 24% COVID-19-negative patients had incident or progressive CKD. Conclusions Recovery from COVID-19-associated moderate/severe AKI can be predicted using admission data and is associated with severity of respiratory disease and in-hospital death. The risk of CKD might be similar between COVID-19-positive and -negative patients.
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Affiliation(s)
- Siao Sun
- Department of Applied Mathematics and Statistics, Stony Brook University, Stony Brook, New York
| | - Raji R. Annadi
- Department of Computer Science, Stony Brook University, Stony Brook, New York
| | - Imran Chaudhri
- Department of Medicine, Stony Brook University, Stony Brook, New York
| | - Kiran Munir
- Department of Medicine, Stony Brook University, Stony Brook, New York
| | - Janos Hajagos
- Department of Biomedical Informatics, Stony Brook University, Stony Brook, New York
| | - Joel Saltz
- Department of Biomedical Informatics, Stony Brook University, Stony Brook, New York
| | - Minh Hoai
- Department of Computer Science, Stony Brook University, Stony Brook, New York
| | - Sandeep K. Mallipattu
- Division of Nephrology and Hypertension, Department of Medicine, Stony Brook University, Stony Brook, New York
| | - Richard Moffitt
- Department of Biomedical Informatics, Stony Brook University, Stony Brook, New York
| | - Farrukh M. Koraishy
- Division of Nephrology and Hypertension, Department of Medicine, Stony Brook University, Stony Brook, New York
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19
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Teixeira JP, Barone S, Zahedi K, Soleimani M. Kidney Injury in COVID-19: Epidemiology, Molecular Mechanisms and Potential Therapeutic Targets. Int J Mol Sci 2022; 23:2242. [PMID: 35216358 PMCID: PMC8877127 DOI: 10.3390/ijms23042242] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Revised: 02/07/2022] [Accepted: 02/08/2022] [Indexed: 01/08/2023] Open
Abstract
As of December 2021, SARS-CoV-2 had caused over 250 million infections and 5 million deaths worldwide. Furthermore, despite the development of highly effective vaccines, novel variants of SARS-CoV-2 continue to sustain the pandemic, and the search for effective therapies for COVID-19 remains as urgent as ever. Though the primary manifestation of COVID-19 is pneumonia, the disease can affect multiple organs, including the kidneys, with acute kidney injury (AKI) being among the most common extrapulmonary manifestations of severe COVID-19. In this article, we start by reflecting on the epidemiology of kidney disease in COVID-19, which overwhelmingly demonstrates that AKI is common in COVID-19 and is strongly associated with poor outcomes. We also present emerging data showing that COVID-19 may result in long-term renal impairment and delve into the ongoing debate about whether AKI in COVID-19 is mediated by direct viral injury. Next, we focus on the molecular pathogenesis of SARS-CoV-2 infection by both reviewing previously published data and presenting some novel data on the mechanisms of cellular viral entry. Finally, we relate these molecular mechanisms to a series of therapies currently under investigation and propose additional novel therapeutic targets for COVID-19.
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Affiliation(s)
- J. Pedro Teixeira
- Department of Internal Medicine, Division of Nephrology, University of New Mexico Health Sciences Center, Albuquerque, NM 87131, USA; (S.B.); (K.Z.)
- Department of Internal Medicine, Division of Pulmonary, Critical Care, and Sleep Medicine, University of New Mexico Health Sciences Center, Albuquerque, NM 87131, USA
| | - Sharon Barone
- Department of Internal Medicine, Division of Nephrology, University of New Mexico Health Sciences Center, Albuquerque, NM 87131, USA; (S.B.); (K.Z.)
- Research/Medicine Services, New Mexico Veterans Healthcare Medical Center, Albuquerque, NM 87108, USA
| | - Kamyar Zahedi
- Department of Internal Medicine, Division of Nephrology, University of New Mexico Health Sciences Center, Albuquerque, NM 87131, USA; (S.B.); (K.Z.)
- Research/Medicine Services, New Mexico Veterans Healthcare Medical Center, Albuquerque, NM 87108, USA
| | - Manoocher Soleimani
- Department of Internal Medicine, Division of Nephrology, University of New Mexico Health Sciences Center, Albuquerque, NM 87131, USA; (S.B.); (K.Z.)
- Research/Medicine Services, New Mexico Veterans Healthcare Medical Center, Albuquerque, NM 87108, USA
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20
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McAdams MC, Li M, Xu P, Gregg LP, Patel J, Willett DL, Velasco F, Lehmann CU, Hedayati SS. Using dipstick urinalysis to predict development of acute kidney injury in patients with COVID-19. BMC Nephrol 2022; 23:50. [PMID: 35105331 PMCID: PMC8805668 DOI: 10.1186/s12882-022-02677-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Accepted: 01/10/2022] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Acute kidney injury (AKI) is a common complication in patients hospitalized with COVID-19 and may require renal replacement therapy (RRT). Dipstick urinalysis is frequently obtained, but data regarding the prognostic value of hematuria and proteinuria for kidney outcomes is scarce. METHODS Patients with positive severe acute respiratory syndrome-coronavirus 2 (SARS-CoV2) PCR, who had a urinalysis obtained on admission to one of 20 hospitals, were included. Nested models with degree of hematuria and proteinuria were used to predict AKI and RRT during admission. Presence of Chronic Kidney Disease (CKD) and baseline serum creatinine were added to test improvement in model fit. RESULTS Of 5,980 individuals, 829 (13.9%) developed an AKI during admission, and 149 (18.0%) of those with AKI received RRT. Proteinuria and hematuria degrees significantly increased with AKI severity (P < 0.001 for both). Any degree of proteinuria and hematuria was associated with an increased risk of AKI and RRT. In predictive models for AKI, presence of CKD improved the area under the curve (AUC) (95% confidence interval) to 0.73 (0.71, 0.75), P < 0.001, and adding baseline creatinine improved the AUC to 0.85 (0.83, 0.86), P < 0.001, when compared to the base model AUC using only proteinuria and hematuria, AUC = 0.64 (0.62, 0.67). In RRT models, CKD status improved the AUC to 0.78 (0.75, 0.82), P < 0.001, and baseline creatinine improved the AUC to 0.84 (0.80, 0.88), P < 0.001, compared to the base model, AUC = 0.72 (0.68, 0.76). There was no significant improvement in model discrimination when both CKD and baseline serum creatinine were included. CONCLUSIONS Proteinuria and hematuria values on dipstick urinalysis can be utilized to predict AKI and RRT in hospitalized patients with COVID-19. We derived formulas using these two readily available values to help prognosticate kidney outcomes in these patients. Furthermore, the incorporation of CKD or baseline creatinine increases the accuracy of these formulas.
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Affiliation(s)
- Meredith C McAdams
- Division of Nephrology, Department of Medicine, University of Texas Southwestern Medical Center, 5939 Harry Hines Blvd, MC 8516, Dallas, TX, 75390, USA
| | - Michael Li
- University of Texas Southwestern College of Medicine, Dallas, TX, USA
| | - Pin Xu
- Division of Nephrology, Department of Medicine, University of Texas Southwestern Medical Center, 5939 Harry Hines Blvd, MC 8516, Dallas, TX, 75390, USA
| | - L Parker Gregg
- Section of Nephrology, Department of Medicine, Selzman Institute for Kidney Health, Baylor College of Medicine, Houston, TX, USA
- Section of Nephrology, Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX, USA
- Development Center for Innovations in Quality, Effectiveness, and Safety, Veterans Affairs Health Services Research, Houston, TX, USA
| | - Jiten Patel
- Division of Nephrology, Department of Medicine, University of Texas Southwestern Medical Center, 5939 Harry Hines Blvd, MC 8516, Dallas, TX, 75390, USA
- Parkland Hospital and Health System, Dallas, TX, USA
| | - Duwayne L Willett
- Division of Cardiology, Department of Medicine, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | | | - Christoph U Lehmann
- Clinical Informatics Center, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - S Susan Hedayati
- Division of Nephrology, Department of Medicine, University of Texas Southwestern Medical Center, 5939 Harry Hines Blvd, MC 8516, Dallas, TX, 75390, USA.
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21
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Özlü SG, Aydın Z, Bozelli BN, Avcı B, İnözü M, Çaycı FŞ, Gülhan B, Sezer S, Bayrakçı US. Can microalbuminuria be an ındicator of renal ınvolvement in pediatric Covid 19 patients? Infection 2022; 50:719-724. [PMID: 35094314 PMCID: PMC8800829 DOI: 10.1007/s15010-021-01745-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Accepted: 12/14/2021] [Indexed: 12/01/2022]
Abstract
Background Proteinuria (both tubular and glomerular in origin) and its implications are well-known features of adult patients with COVID19. However currently studies addressing proteinuria and its role in the outcome of kidney and patients of pediatric COVID 19 is scarce. We aimed to evaluate the presence of microalbuminuria in order to detect early renal involvement in pediatric COVID 19 patients. Methods We prospectively evaluated 100 pediatric patients hospitalized with COVID 19 between April and July 2020. Clinical presentations, laboratory findings and outcomes were investigated. Microalbuminuria was compared with the age, gender, disease severity, and hemoglobin, platelet, leukocyte count and serum CRP levels of the patients. Results Twenty seven out of 100 patients had microalbuminuria. Fourteen patients had mild and fourteen had moderate disease. There was not any significant relation according to age and gender. Microalbuminuria was not related to the severity of the disease. Also the mean microalbuminuria level did not differ according to the disease course. Hemoglobin, platelet, leukocyte counts and serum CRP levels were also were not correlated with microalbuminuria levels. Conclusion Although there was no difference between the groups with different disease course; microalbuminuria is detected in an important ratio of pediatric patients with COVID 19 in this study. In the highlight of our findings we suggest that urinary findings of pediatric COVID patients should be carefully evaluated.
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Affiliation(s)
- Sare Gülfem Özlü
- Faculty of Medicine, Department of Pediatric Nephrology, Ankara Yıldırım Beyazıt University, Ankara City Hospital, Üniversiteler Mahallesi, Bilkent Caddesi No:1, Çankaya, Ankara, Turkey
| | - Zehra Aydın
- Department of Pediatric Nephrology, Ankara City Hospital, Ankara, Turkey
| | - Berrak Naz Bozelli
- Faculty of Medicine, Department of General Pediatrics, Ankara Yıldırım Beyazıt University, Ankara City Hospital, Ankara, Turkey
| | - Begüm Avcı
- Department of Pediatric Nephrology, Ankara City Hospital, Ankara, Turkey
| | - Mihriban İnözü
- Department of Pediatric Nephrology, Ankara City Hospital, Ankara, Turkey
| | - Fatma Şemsa Çaycı
- Department of Pediatric Nephrology, University of Health Sciences, Ankara City Hospital, Ankara, Turkey
| | - Belgin Gülhan
- Department of Pediatric Infectious Diseases, Ankara City Hospital, Ankara, Turkey
| | - Sevilay Sezer
- Department of Biochemistry, Ankara City Hospital, Ankara, Turkey
| | - Umut Selda Bayrakçı
- Faculty of Medicine, Department of Pediatric Nephrology, Ankara Yıldırım Beyazıt University, Ankara City Hospital, Üniversiteler Mahallesi, Bilkent Caddesi No:1, Çankaya, Ankara, Turkey
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22
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Cintron Pregosin N, Bronstein R, Mallipattu SK. Recent Advances in Kidney Bioengineering. Front Pediatr 2021; 9:743301. [PMID: 34900859 PMCID: PMC8655860 DOI: 10.3389/fped.2021.743301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2021] [Accepted: 11/02/2021] [Indexed: 12/03/2022] Open
Abstract
Kidney disease is an epidemic that affects more than 600 million people worldwide. The socioeconomic impacts of the disease disproportionately affect Hispanic and non-Hispanic Black Americans, making the disease an issue of social inequality. The urgency of this situation has only become worse during the COVID-19 pandemic, as those who are hospitalized for COVID-19 have an increased risk of kidney failure. For researchers, the kidney is a complex organ that is difficult to accurately model and understand. Traditional cell culture models are not adequate for studying the functional intricacies of the kidney, but recent experiments have offered improvements for understanding these systems. Recent progress includes organoid modeling, 3D bioprinting, decellularization, and microfluidics. Here, we offer a review of the most recent advances in kidney bioengineering.
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Affiliation(s)
- Nina Cintron Pregosin
- Division of Nephrology, Department of Medicine, Stony Brook University, Stony Brook, NY, United States
- Graduate Program in Molecular and Cellular Pharmacology, Stony Brook University, Stony Brook, NY, United States
| | - Robert Bronstein
- Division of Nephrology, Department of Medicine, Stony Brook University, Stony Brook, NY, United States
| | - Sandeep K. Mallipattu
- Division of Nephrology, Department of Medicine, Stony Brook University, Stony Brook, NY, United States
- Renal Section, Northport VA Medical Center, Northport, NY, United States
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23
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Cau A, Cheng MP, Lee T, Levin A, Lee TC, Vinh DC, Lamontagne F, Singer J, Walley KR, Murthy S, Patrick D, Rewa O, Winston B, Marshall J, Boyd J, Russell JA. Acute Kidney Injury and Renal Replacement Therapy in COVID-19 Versus Other Respiratory Viruses: A Systematic Review and Meta-Analysis. Can J Kidney Health Dis 2021; 8:20543581211052185. [PMID: 34733538 PMCID: PMC8558598 DOI: 10.1177/20543581211052185] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Accepted: 09/04/2021] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Acute kidney injury (AKI) is a potentially fatal complication of Coronavirus Disease-2019 (COVID-19). Binding of the Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2), the virus responsible for COVID-19, to its viral receptor, angiotensin converting enzyme 2 (ACE2), results in viral entry and may cause AKI. OBJECTIVES We performed a systematic review and meta-analysis of the frequencies of AKI and renal replacement therapy (RRT) in critically ill COVID-19 patients and compared those frequencies with patients who were infected by respiratory viruses that bind or downregulate ACE2 (ACE2-associated viruses) and viruses that do not bind nor downregulate ACE2 (non-ACE2-associated viruses). DESIGN Systematic review and meta-analysis. SETTING Observational studies on COVID-19 and other respiratory viral infections reporting AKI and RRT were included. The exclusion criteria were non-English articles, non-peer-reviewed articles, review articles, studies that included patients under the age of 18, studies including fewer than 10 patients, and studies not reporting AKI and RRT rates. PATIENTS Adult COVID-19, Severe Acute Respiratory Syndrome (SARS), Middle East Respiratory Syndrome (MERS), and influenza patients. MEASUREMENTS We extracted the following data from the included studies: author, year, study location, age, sex, race, diabetes mellitus, hypertension, chronic kidney disease, shock, vasopressor use, mortality, intensive care unit (ICU) admission, ICU mortality, AKI, and RRT. METHODS We systematically searched PubMed and EMBASE for articles reporting AKI or RRT. AKI was defined by authors of included studies. Critical illness was defined by ICU admission. We performed a random effects meta-analysis to calculate pooled estimates for the AKI and RRT rate within each virus group using a random intercept logistic regression model. RESULTS Of 23 655 hospitalized, critically ill COVID-19 patients, AKI frequencies were not significantly different between COVID-19 patients (51%, 95% confidence interval [CI]: 44%-57%) and critically ill patients infected with ACE2-associated (56%, 95% CI: 37%-74%, P = .610) or non-ACE2-associated viruses (63%, 95% CI: 43%-79%, P = .255). Pooled RRT rates were also not significantly different between critically ill, hospitalized patients with COVID-19 (20%, 95% CI: 16%-24%) and ACE2-associated viruses (18%, 95% CI: 8%-33%, P = .747). RRT rates for both COVID-19 and ACE2-associated viruses were significantly different (P < .001 for both) from non-ACE2-associated viruses (49%, 95% CI: 44%-54%). After adjusting for shock or vasopressor use, AKI and RRT rates were not significantly different between groups. LIMITATIONS Limitations of this study include the heterogeneity of definitions of AKI that were used across different virus studies. We could not match severity of infection or do propensity matching across studies. Most of the included studies were conducted in retrospective fashion. Last, we did not include non-English publications. CONCLUSIONS Our findings suggest that viral ACE2 association does not significantly alter the rates of AKI and RRT among critically ill patients admitted to the ICU. However, the rate of RRT is lower in patients with COVID-19 or ACE2-associated viruses when compared with patients infected with non-ACE2-binding viruses, which might partly be due to the lower frequencies of shock and use of vasopressors in these two virus groups. Prospective studies are necessary to demonstrate whether modulation of the ACE2 axis with Renin-Angiotensin System inhibitors impacts the rates of AKI and whether they are beneficial or harmful in COVID-19 patients.
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Affiliation(s)
- A. Cau
- The University of British Columbia, Vancouver, BC, Canada
| | - M. P. Cheng
- Department of Medicine, McGill University, Montreal, QC, Canada
| | - Terry Lee
- Centre for Health Evaluation & Outcomes Science, The University of British Columbia, Vancouver, BC, Canada
| | - A. Levin
- Division of Nephrology, St. Paul’s Hospital, Vancouver, BC, Canada
| | - T. C. Lee
- Department of Medicine, McGill University, Montreal, QC, Canada
| | - D. C. Vinh
- Department of Medicine, McGill University, Montreal, QC, Canada
| | | | - J. Singer
- Centre for Health Evaluation & Outcomes Science, The University of British Columbia, Vancouver, BC, Canada
| | - K. R. Walley
- Centre for Heart Lung Innovation, St. Paul’s Hospital and The University of British Columbia, Vancouver, BC, Canada
| | - S. Murthy
- BC Children’s Hospital, The University of British Columbia, Vancouver, BC, Canada
| | - D. Patrick
- British Columbia Centre for Disease Control and The University of British Columbia, Vancouver, BC, Canada
| | - O. Rewa
- University of Alberta, Edmonton, AB, Canada
| | - B. Winston
- University of Calgary, Calgary, AB, Canada
| | - J. Marshall
- St. Michael’s Hospital, University of Toronto, Toronto, ON, Canada
| | - J. Boyd
- Centre for Heart Lung Innovation, St. Paul’s Hospital and The University of British Columbia, Vancouver, BC, Canada
| | - JA Russell
- Centre for Heart Lung Innovation, St. Paul’s Hospital and The University of British Columbia, Vancouver, BC, Canada
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Nlandu YM, Sakaji TJM, Engole YM, Mboliasa PMFI, Bena DM, Abatha JM, Nkumu JRM, Nkodila AN, Van Eckout K, Kalifa G, Ahmed R, Bukabau JB. Frequency and factors associated with proteinuria in COVID-19 patients: a cross-sectional study. Pan Afr Med J 2021; 40:37. [PMID: 34795818 PMCID: PMC8571933 DOI: 10.11604/pamj.2021.40.37.29796] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Accepted: 08/31/2021] [Indexed: 12/30/2022] Open
Abstract
Proteinuria is a marker of severity and poor outcome of patients in intensive care unit (ICU). The objective of this study was to determine the frequency of proteinuria and the risk factors associated with proteinuria in Congolese COVID-19 patients. The present cross sectional study of proteinuria status is a post hoc analysis of data from 80 COVID-19 patients admitted at Kinshasa Medical Center (KMC) from March 10th to July 10th, 2020. The population under study came from all adult inpatients (≥18 years old) with a laboratory diagnosis by polymerase chain reaction (PCR) of COVID-19 were selected and divided into two groups (positive proteinuria and negative proteinuria group). Logistic regression models helped to identify the factors associated with proteinuria. The P value significance level was 0.05. Among 80 patients who tested positive for SARS-CoV-2 RT-PCR, 55% had proteinuria. The mean age was 55.2 ± 12.8 years. Fourty-seven patients (58.8%) had history of hypertension and 26 patients (32.5%) diabetes. Multivariable analysis showed age ≥ 65 years (aOR 5,04; 95% CI: 1.51-16.78), diabetes (aOR 3,15; 95% CI: 1.14-8.72), ASAT >40 UI/L (aOR 7,08; 95% CI: 2.40-20.87), ferritin >300 (aOR 13,47; 95% CI: 1.56-26.25) as factors independently associated with proteinuria in COVID-19 patients. Proteinuria is common in Congolese COVID-19 patients and is associated with age, diabetes, ferritin and aspartate aminotransferase (ASAT).
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Affiliation(s)
- Yannick Mayamba Nlandu
- Intensive Care Unit, Kinshasa Medical Center, Kinshasa, Democratic Republic of the Congo
- Nephrology Unit, Kinshasa University Hospital, Kinshasa, Democratic Republic of the Congo
| | | | - Yannick Mompango Engole
- Intensive Care Unit, Kinshasa Medical Center, Kinshasa, Democratic Republic of the Congo
- Nephrology Unit, Kinshasa University Hospital, Kinshasa, Democratic Republic of the Congo
| | - Pitchouna Marie-France Ingole Mboliasa
- Intensive Care Unit, Kinshasa Medical Center, Kinshasa, Democratic Republic of the Congo
- Nephrology Unit, Kinshasa University Hospital, Kinshasa, Democratic Republic of the Congo
| | - Dauphin Mulumba Bena
- Intensive Care Unit, Kinshasa Medical Center, Kinshasa, Democratic Republic of the Congo
| | | | | | | | - Karel Van Eckout
- Intensive Care Unit, Kinshasa Medical Center, Kinshasa, Democratic Republic of the Congo
| | - Golan Kalifa
- Intensive Care Unit, Kinshasa Medical Center, Kinshasa, Democratic Republic of the Congo
| | - Rodolphe Ahmed
- Intensive Care Unit, Kinshasa Medical Center, Kinshasa, Democratic Republic of the Congo
| | - Justine Busanga Bukabau
- Intensive Care Unit, Kinshasa Medical Center, Kinshasa, Democratic Republic of the Congo
- Nephrology Unit, Kinshasa University Hospital, Kinshasa, Democratic Republic of the Congo
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25
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Patel DM, Phadke M, Dai F, Simonov M, Dahl NK, Kodali R. Association of AKI-D with Urinary Findings and Baseline eGFR in Hospitalized COVID-19 Patients. KIDNEY360 2021; 2:1215-1224. [PMID: 35369662 PMCID: PMC8676386 DOI: 10.34067/kid.0001612021] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Accepted: 05/19/2021] [Indexed: 02/04/2023]
Abstract
Background AKI is common in patients hospitalized with coronavirus disease 2019 (COVID-19). Risk factors for AKI requiring dialysis (AKI-D) are not fully understood. We aimed to identify risk factors associated with AKI-D and AKI not requiring dialysis (AKI-ND). Methods We reviewed electronic health records of 3186 patients aged ≥18 years old who were hospitalized with COVID-19 across six hospitals. Patient characteristics, urinalysis findings, and inflammatory markers were analyzed for association with in-hospital AKI status (AKI-D, AKI-ND, or no AKI), and we subsequently evaluated mortality. Results After adjustment for multiple covariates, higher baseline eGFR was associated with 30% lower odds of AKI-D and 11% lower odds of AKI-ND (for AKI-D, OR, 0.70; 95% CI, 0.64 to 0.77; for AKI-ND, OR, 0.89; 95% CI, 0.85 to 0.92). Patients with obesity and those who were Latino had increased odds of AKI-D, whereas patients with congestive heart failure or diabetes with complications had increased odds of AKI-ND. Females had lower odds of in-hospital AKI (for AKI-D, OR, 0.28; 95% CI, 0.17 to 0.46; for AKI-ND, OR, 0.83; 95% CI, 0.70 to 0.99). After adjustment for covariates and baseline eGFR, 1-4+ protein on initial urinalysis was associated with a nine-fold increase in odds of AKI-D (OR, 9.00; 95% CI, 2.16 to 37.38) and more than two-fold higher odds of AKI-ND (OR, 2.28; 95% CI, 1.66 to 3.13). Findings of 1-3+ blood and trace glucose on initial urinalysis were also associated with increased odds of both AKI-D and AKI-ND. AKI-D and AKI-ND were associated with in-hospital death (for AKI-D, OR, 2.64; 95% CI, 1.13 to 6.17; for AKI-ND, OR, 2.44; 95% CI, 1.77 to 3.35). Conclusions Active urine sediments, even after adjustment for baseline kidney function, and reduced baseline eGFR are significantly associated with increased odds of AKI-D and AKI-ND. In-hospital AKI was associated with in-hospital death. These findings may help prognosticate patients hospitalized with COVID-19.
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Affiliation(s)
- Dipal M. Patel
- Department of Internal Medicine, Section of Nephrology, Yale School of Medicine, New Haven, Connecticut
| | - Manali Phadke
- Yale Center for Analytical Sciences, Yale School of Public Health, New Haven, Connecticut
| | - Feng Dai
- Yale Center for Analytical Sciences, Yale School of Public Health, New Haven, Connecticut
| | - Michael Simonov
- Clinical and Translational Research Accelerator, Yale New Haven Health System, New Haven, Connecticut
| | - Neera K. Dahl
- Department of Internal Medicine, Section of Nephrology, Yale School of Medicine, New Haven, Connecticut
| | - Ravi Kodali
- Department of Internal Medicine, Section of Nephrology, Yale School of Medicine, New Haven, Connecticut
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26
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Azinheira Nobrega Cruz N, Gonçalves de Oliveira LC, Tedesco Silva Junior H, Osmar Medina Pestana J, Casarini DE. Angiotensin-Converting Enzyme 2 in the Pathogenesis of Renal Abnormalities Observed in COVID-19 Patients. Front Physiol 2021; 12:700220. [PMID: 34497535 PMCID: PMC8419418 DOI: 10.3389/fphys.2021.700220] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2021] [Accepted: 08/03/2021] [Indexed: 01/08/2023] Open
Abstract
Coronavirus disease 2019 (COVID-19) was first reported in late December 2019 in Wuhan, China. The etiological agent of this disease is severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), and the high transmissibility of the virus led to its rapid global spread and a major pandemic (ongoing at the time of writing this review). The clinical manifestations of COVID-19 can vary widely from non-evident or minor symptoms to severe acute respiratory syndrome and multi-organ damage, causing death. Acute kidney injury (AKI) has been recognized as a common complication of COVID-19 and in many cases, kidney replacement therapy (KRT) is required. The presence of kidney abnormalities on hospital admission and the development of AKI are related to a more severe presentation of COVID-19 with higher mortality rate. The high transmissibility and the broad spectrum of clinical manifestations of COVID-19 are in part due to the high affinity of SARS-CoV-2 for its receptor, angiotensin (Ang)-converting enzyme 2 (ACE2), which is widely expressed in human organs and is especially abundant in the kidneys. A debate on the role of ACE2 in the infectivity and pathogenesis of COVID-19 has emerged: Does the high expression of ACE2 promotes higher infectivity and more severe clinical manifestations or does the interaction of SARS-CoV-2 with ACE2 reduce the bioavailability of the enzyme, depleting its biological activity, which is closely related to two important physiological systems, the renin-angiotensin system (RAS) and the kallikrein-kinin system (KKS), thereby further contributing to pathogenesis. In this review, we discuss the dual role of ACE2 in the infectivity and pathogenesis of COVID-19, highlighting the effects of COVID-19-induced ACE2 depletion in the renal physiology and how it may lead to kidney injury. The ACE2 downstream regulation of KKS, that usually receives less attention, is discussed. Also, a detailed discussion on how the triad of symptoms (respiratory, inflammatory, and coagulation symptoms) of COVID-19 can indirectly promote renal injury is primary aborded.
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Affiliation(s)
| | | | | | | | - Dulce Elena Casarini
- Nephrology Division, Department of Medicine, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, Brazil
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27
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Rahimzadeh H, Kazemian S, Rahbar M, Farrokhpour H, Montazeri M, Kafan S, Salimzadeh A, Talebpour M, Majidi F, Jannatalipour A, Razeghi E. The Risk Factors and Clinical Outcomes Associated with Acute Kidney Injury in Patients with COVID-19: Data from a Large Cohort in Iran. Kidney Blood Press Res 2021; 46:620-628. [PMID: 34315161 PMCID: PMC8450864 DOI: 10.1159/000517581] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Accepted: 06/02/2021] [Indexed: 01/08/2023] Open
Abstract
INTRODUCTION Kidney involvement, ranging from mild hematuria and proteinuria to acute kidney injury (AKI) in patients with coronavirus disease-2019 (COVID-19), is a recent finding with various incidence rates reported among hospitalized patients with COVID-19. Given the various AKI rates and their associated risk factors, lack of AKI recovery in the majority of patients hospitalized with COVID-19, and limited data regarding AKI in patients with COVID-19 in Iran, we aim to investigate the potential risk factors for AKI development and its incidence in patients hospitalized with COVID-19. METHODS In this retrospective cohort study, we enrolled adult patients referred to the Sina Hospital, Iran, from February 20 to May 14, 2020, with either a positive PCR test or a highly susceptible chest computed tomography features consistent with COVID-19 diagnosis. AKI was defined according to the kidney disease improving global outcomes criteria, and patients were stratified based on their AKI staging. We evaluated the risk indicators associated with AKI during hospitalization besides in-hospital outcomes and recovery rate at the time of discharge. RESULTS We evaluated 516 patients with a mean age of 57.6 ± 16.1 years and a male-to-female ratio of 1.69 who were admitted with the COVID-19 diagnosis. AKI development was observed among 194 (37.6%) patients, comprising 61.9% patients in stage 1, 18.0% in stage 2, and 20.1% in stage 3. Out of all patients, AKI occurred in 58 (11.2%) patients during the hospital course, and 136 (26.3%) patients arrived with AKI upon admission. AKI development was positively associated with all of the in-hospital outcomes, including intensive care unit admissions, need for invasive ventilation, acute respiratory distress syndrome (ARDS), acute cardiac injury, acute liver injury, multiorgan damage, and mortality. Patients with stage 3 AKI showed a significantly higher mortality rate, ARDS, and need for invasive ventilation than other stages. After multivariable analysis, male sex (odds ratio [OR]: 11.27), chronic kidney disease (CKD) (OR: 6.89), history of hypertension (OR: 1.69), disease severity (OR: 2.27), and high urea levels (OR: 1.04) on admission were independent risk indicators of AKI development. Among 117 (28.1%) patients who experienced AKI and survived, only 33 (28.2%) patients made a recovery from the AKI, and 84 (71.8%) patients did not exhibit full recovery at the time of discharge. DISCUSSION/CONCLUSION We found that male sex, history of CKD, hypertension, disease severity, and high serum urea were independent risk factors associated with AKI in patients with COVID-19. Also, higher stages of AKI were associated with increased risk of mortality and in-hospital complications. Our results indicate a necessity for more precise care and monitoring for AKI during hospitalization in patients with COVID-19, and lack of AKI recovery at the time of discharge is a common complication in such patients.
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Affiliation(s)
- Hormat Rahimzadeh
- Department of Nephrology Diseases, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Sina Kazemian
- Students' Scientific Research Center (SSRC), Tehran University of Medical Sciences, Tehran, Iran
| | - Maryam Rahbar
- Department of Nephrology Diseases, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Hossein Farrokhpour
- Students' Scientific Research Center (SSRC), Tehran University of Medical Sciences, Tehran, Iran
| | - Mahnaz Montazeri
- Department of Nephrology Diseases, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran
- Students' Scientific Research Center (SSRC), Tehran University of Medical Sciences, Tehran, Iran
- Department of Infectious Diseases, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran
- Department of Pulmonary Diseases, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran
- Rheumatology Research Center, Sina Hospital, Tehran University of Medical Science, Tehran, Iran
- Department of Surgery, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran
- Research Development Center, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran
- Nephrology Research Center, Center of Excellence in Nephrology, Tehran University of Medical Sciences, Tehran, Iran
| | - Samira Kafan
- Department of Pulmonary Diseases, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Ahmad Salimzadeh
- Rheumatology Research Center, Sina Hospital, Tehran University of Medical Science, Tehran, Iran
| | - Mohammad Talebpour
- Department of Surgery, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Fazeleh Majidi
- Research Development Center, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Atefeh Jannatalipour
- Research Development Center, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Effat Razeghi
- Department of Nephrology Diseases, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran
- Nephrology Research Center, Center of Excellence in Nephrology, Tehran University of Medical Sciences, Tehran, Iran
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28
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Allemailem KS, Almatroudi A, Khan AA, Rahmani AH, Almarshad IS, Alekezem FS, Hassanein N, El-Kady AM. Manifestations of renal system involvement in hospitalized patients with COVID-19 in Saudi Arabia. PLoS One 2021; 16:e0253036. [PMID: 34264954 PMCID: PMC8282026 DOI: 10.1371/journal.pone.0253036] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2021] [Accepted: 05/27/2021] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Although COVID-19 is an acute disease that usually resolves rapidly in most cases, the disease can be fatal and has a mortality rate of about 1% to 56%. Alveolar injury and respiratory failure are the main causes of death in patients with COVID 19. In addition, the effect of the disease on other organs is not fully understood. Renal system affection has been reported in patients with COVID 19 and is associated with a higher rate of diverse outcomes, including mortality. Therefore, in the present work, we reported the clinical characteristics and laboratory data of hospitalized patients with COVID-19 and analyzed the manifestations that indicated renal system involvement and their impact on clinical outcomes. MATERIALS AND METHODS This was an observational retrospective study conducted at King Fahd Specialist Hospital, Buraydah, Saudi Arabia. All patients with COVID-19 who were admitted to this Hospital from April to December 2020 were included in the study. The patients' findings at presentation were recorded. Demographic data and laboratory results (hematuria, proteinuria, urinary sediment cast and pus cell presence, and kidney function tests) were retrieved from electronic patient records. RESULTS One hundred and ninety-three patients with confirmed COVID 19 were included in the study. Dipstick examinations of all urine samples showed proteinuria and hematuria in 53.9% and 22.3% of patients, respectively, whereas microscopic examination revealed the presence of pus and brown muddy granular casts in 33.7% and 12.4% of samples, respectively. Acute kidney injury was reported in 23.3% of patients. A multivariable analysis demonstrated that hematuria was associated with acute kidney injury (AKI) (OR, 2.4; 95% CI, 1.2-4.9; P = 0.001), ICU admission (OR, 3.789; 95% CI, 1.913-7.505; P = 0.003), and mortality (OR, 8.084; 95% CI, 3.756-17.397; P = 0.002). Conversely, proteinuria was less significantly associated with the risk of AKI (OR, 1.56; 95% CI, 1.91-7.50; P = 0.003), ICU admission (OR, 2.493; 95% CI, 1.25-4.72; P = 0.001), and mortality (OR, 2.764; 95% CI, 1.368-5.121; P = 0.003). Patients with AKI had a higher probability for mortality than did those without AKI (OR, 14.208; 95% CI, 6.434-31.375; P = 0.003). CONCLUSION The manifestations of the involvement of the renal system are not uncommon in COVID-19. These manifestations included proteinuria, hematuria, and AKI and were usually associated with a poor prognosis, including high incidences of both ICU admission and mortality.
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Affiliation(s)
- Khaled S. Allemailem
- Department of Medical Laboratories, College of Applied Medical Sciences, Qassim University, Buraydah, Saudi Arabia
| | - Ahmad Almatroudi
- Department of Medical Laboratories, College of Applied Medical Sciences, Qassim University, Buraydah, Saudi Arabia
| | - Amjad Ali Khan
- Department of Basic Health Sciences, College of Applied Medical Sciences, Qassim University, Buraydah, Saudi Arabia
| | - Arshad H. Rahmani
- Department of Medical Laboratories, College of Applied Medical Sciences, Qassim University, Buraydah, Saudi Arabia
| | - Ibrahim S. Almarshad
- Department of Laboratory and Blood Bank, King Fahd Specialist Hospital, Buraydah, Saudi Arabia
| | - Fahad S. Alekezem
- Department of Laboratory and Blood Bank, King Fahd Specialist Hospital, Buraydah, Saudi Arabia
| | - Nagwa Hassanein
- Department of Clinical Pathology, Faculty of Medicine (Girls Branch), Al-Azhar University, Cairo, Egypt
| | - Asmaa M. El-Kady
- Department of Medical Parasitology, Faculty of Medicine, South Valley University, Qena, Egypt
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29
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Shimmel A, Shaikhouni S, Mariani L. Current Understanding of Clinical Manifestations of COVID-19 in Glomerular Disease. GLOMERULAR DISEASES 2021; 1:250-264. [PMID: 36747902 PMCID: PMC8450860 DOI: 10.1159/000518276] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Accepted: 06/26/2021] [Indexed: 12/15/2022]
Abstract
Background The novel coronavirus disease (COVID-19), also known as severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), is an evolving pandemic with significant mortality. Information about the impact of infection on glomerular disease patients in particular has been lacking. Understanding the virus's effect in glomerular disease is constantly changing. This review article summarizes the data published thus far on COVID-19 and its manifestations in pre-existing and de novo glomerular disease. Summary While patients with glomerular disease may be at higher risk of severe COVID-19 due to their immunosuppressed status, some data suggest that a low amount of immunosuppression may be helpful in mitigating the systemic inflammatory response which is associated with high mortality rates in COVID-19. There have been a few case reports on COVID-19 causing glomerular disease relapse in patients. Multiple mechanisms have been proposed for kidney injury, proteinuria, and hematuria in the setting of COVID-19. More commonly, these are caused by direct tubular injury due to hemodynamic instability and hypoxic injury. However, the cytokine storm induced by COVID-19 may trigger common post-viral glomerular disease such as IgA nephropathy, anti-GBM, and ANCA vasculitis that have also been described in COVID-19 patients. Collapsing glomerulopathy, a hallmark of HIV-associated nephropathy, is being reported SARS-CoV-2 cases, particularly in patients with high-risk APOL1 alleles. Direct viral invasion of glomerular structures is hypothesized to cause a podocytopathy due to virus's affinity to ACE2, but evidence for this remains under study. Key Messages Infection with SARS-CoV-2 may cause glomerular disease in certain patients. The mechanism of de novo glomerular disease in the setting of COVID-19 is under study. The management of patients with existing glomerular disease poses unique challenges, especially with regard to immunosuppression management. Further studies are needed to inform clinician decisions about the management of these patients during the COVID-19 pandemic.
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Affiliation(s)
- Allison Shimmel
- College of Medicine and Life Sciences, University of Toledo, Toledo, Ohio, USA
| | - Salma Shaikhouni
- Department of Nephrology, Michigan Medicine, Ann Arbor, Michigan, USA
| | - Laura Mariani
- Department of Nephrology, Michigan Medicine, Ann Arbor, Michigan, USA,*Laura Mariani,
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30
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Smarz-Widelska I, Grywalska E, Morawska I, Forma A, Michalski A, Mertowski S, Hrynkiewicz R, Niedźwiedzka-Rystwej P, Korona-Glowniak I, Parczewski M, Załuska W. Pathophysiology and Clinical Manifestations of COVID-19-Related Acute Kidney Injury-The Current State of Knowledge and Future Perspectives. Int J Mol Sci 2021; 22:7082. [PMID: 34209289 PMCID: PMC8268979 DOI: 10.3390/ijms22137082] [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: 04/19/2021] [Revised: 05/26/2021] [Accepted: 06/28/2021] [Indexed: 01/08/2023] Open
Abstract
The continually evolving severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic has resulted in a vast number of either acute or chronic medical impairments of a pathophysiology that is not yet fully understood. SARS-CoV-2 tropism for the organs is associated with bilateral organ cross-talks as well as targeted dysfunctions, among which acute kidney injury (AKI) seems to be highly prevalent in infected patients. The need for efficient management of COVID-related AKI patients is an aspect that is still being investigated by nephrologists; however, another reason for concern is a disturbingly high proportion of various types of kidney dysfunctions in patients who have recovered from COVID-19. Even though the clinical picture of AKI and COVID-related AKI seems to be quite similar, it must be considered that regarding the latter, little is known about both the optimal management and long-term consequences. These discrepancies raise an urgent need for further research aimed at evaluating the molecular mechanisms associated with SARS-CoV-2-induced kidney damage as well as standardized management of COVID-related AKI patients. The following review presents a comprehensive and most-recent insight into the pathophysiology, clinical manifestations, recommended patient management, treatment strategies, and post-mortem findings in patients with COVID-related AKI.
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Affiliation(s)
- Iwona Smarz-Widelska
- Department of Nephrology, Cardinal Stefan Wyszynski Provincial Hospital in Lublin, 20-718 Lublin, Poland;
| | - Ewelina Grywalska
- Department of Clinical Immunology and Immunotherapy, Medical University of Lublin, 20-093 Lublin, Poland; (I.M.); (A.M.); (S.M.)
| | - Izabela Morawska
- Department of Clinical Immunology and Immunotherapy, Medical University of Lublin, 20-093 Lublin, Poland; (I.M.); (A.M.); (S.M.)
| | - Alicja Forma
- Department of Forensic Medicine, Medical University of Lublin, 20-090 Lublin, Poland;
| | - Adam Michalski
- Department of Clinical Immunology and Immunotherapy, Medical University of Lublin, 20-093 Lublin, Poland; (I.M.); (A.M.); (S.M.)
| | - Sebastian Mertowski
- Department of Clinical Immunology and Immunotherapy, Medical University of Lublin, 20-093 Lublin, Poland; (I.M.); (A.M.); (S.M.)
| | - Rafał Hrynkiewicz
- Institute of Biology, University of Szczecin, 71-412 Szczecin, Poland;
| | | | - Izabela Korona-Glowniak
- Department of Pharmaceutical Microbiology, Medical University of Lublin, Chodźki 1, 20-093 Lublin, Poland;
| | - Miłosz Parczewski
- Department of Infectious, Tropical Diseases and Immune Deficiency, Pomeranian Medical University in Szczecin, 71-455 Szczecin, Poland;
| | - Wojciech Załuska
- Department of Nephrology, Medical University of Lublin, 20-954 Lublin, Poland;
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31
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Rando HM, Bennett TD, Byrd JB, Bramante C, Callahan TJ, Chute CG, Davis HE, Deer R, Gagnier J, Koraishy FM, Liu F, McMurry JA, Moffitt RA, Pfaff ER, Reese JT, Relevo R, Robinson PN, Saltz JH, Solomonides A, Sule A, Topaloglu U, Haendel MA. Challenges in defining Long COVID: Striking differences across literature, Electronic Health Records, and patient-reported information. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2021:2021.03.20.21253896. [PMID: 33791733 PMCID: PMC8010765 DOI: 10.1101/2021.03.20.21253896] [Citation(s) in RCA: 53] [Impact Index Per Article: 17.7] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Since late 2019, the novel coronavirus SARS-CoV-2 has introduced a wide array of health challenges globally. In addition to a complex acute presentation that can affect multiple organ systems, increasing evidence points to long-term sequelae being common and impactful. The worldwide scientific community is forging ahead to characterize a wide range of outcomes associated with SARS-CoV-2 infection; however the underlying assumptions in these studies have varied so widely that the resulting data are difficult to compareFormal definitions are needed in order to design robust and consistent studies of Long COVID that consistently capture variation in long-term outcomes. Even the condition itself goes by three terms, most widely "Long COVID", but also "COVID-19 syndrome (PACS)" or, "post-acute sequelae of SARS-CoV-2 infection (PASC)". In the present study, we investigate the definitions used in the literature published to date and compare them against data available from electronic health records and patient-reported information collected via surveys. Long COVID holds the potential to produce a second public health crisis on the heels of the pandemic itself. Proactive efforts to identify the characteristics of this heterogeneous condition are imperative for a rigorous scientific effort to investigate and mitigate this threat.
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Affiliation(s)
- Halie M. Rando
- Center for Health AI, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
- Department of Biochemistry and Molecular Genetics, University of Colorado School of Medicine, Aurora, CO, USA
| | - Tellen D. Bennett
- Center for Health AI and Section of Informatics and Data Science, Department of Pediatrics, University of Colorado School of Medicine, University of Colorado, Aurora, CO, USA
| | | | | | - Tiffany J. Callahan
- Center for Health AI, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
- Computational Bioscience, University of Colorado Anschutz Medical Campus, Boulder, CO, USA
| | - Christopher G. Chute
- Schools of Medicine, Public Health, and Nursing, Johns Hopkins University, Baltimore, MD, USA
| | | | - Rachel Deer
- The University of Texas Medical Branch at Galveston, Galveston, TX, USA
| | - Joel Gagnier
- Computational Bioscience, University of Colorado Anschutz Medical Campus, Boulder, CO, USA
| | | | - Feifan Liu
- University of Massachusetts Medical School Worcester, Worcester, MA, USA
| | - Julie A. McMurry
- Center for Health AI, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Richard A. Moffitt
- Department of Biomedical Informatics, Stony Brook University, Stony Brook, NY, USA
| | - Emily R. Pfaff
- Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Justin T. Reese
- Environmental Genomics and Systems Biology Division, Lawrence Berkeley National Laboratory, Berkeley, CA, USA
| | - Rose Relevo
- Oregon Health & Science University, Portland, OR, USA
| | - Peter N. Robinson
- The Jackson Laboratory For Genomic Medicine, Farmington, CT, USA
- Institute for Systems Genomics, University of Connecticut, Farmington, CT, USA
| | - Joel H. Saltz
- Department of Biomedical Informatics, Stony Brook University, Stony Brook, NY, USA
| | | | - Anupam Sule
- Saint Joseph Mercy Health System, Ypsilanti, MI, USA
| | - Umit Topaloglu
- School of Medicine, Wake Forest University, Winston Salem, NC, USA
| | - Melissa A. Haendel
- Center for Health AI, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
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32
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Abstract
Upper respiratory and pulmonary diseases are the primary manifestations of coronavirus disease 2019 (COVID-19). However, kidney involvement has also been recognized and extensively described. A large percentage of affected patients present with acute kidney injury (AKI). However, specific phenotypic aspects of AKI or other renal manifestations of COVID-19 remain sparsely characterized. Many reports indicate that proteinuria can be detected in AKI associated with COVID-19 (CoV-AKI) despite CoV-AKI being largely described as a form of acute tubular injury. On the other hand, individuals of African ancestry with the high-risk APOL1 genotype are uniquely at risk of developing collapsing glomerulopathy when they are infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the entity now known as COVID-19-associated nephropathy (COVAN). Patients with COVAN typically present with nephrotic-range proteinuria. The exact incidence of proteinuria in COVID-19 is unclear due to heterogeneity in the frequency with which proteinuria has been assessed in cases of COVID-19, as well as methodological differences in the way proteinuria is measured and/or reported. In this review we discuss the current evidence of proteinuria as a manifestation of COVID-19 and elaborate on potential pathophysiological mechanisms associated with it.
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Affiliation(s)
- Muner M B Mohamed
- Department of Nephrology, Ochsner Health System, New Orleans, LA, USA
| | - Juan Carlos Q Velez
- Department of Nephrology, Ochsner Health System, New Orleans, LA, USA
- Ochsner Clinical School, University of Queensland (Australia), New Orleans, LA, USA
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