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Sharma R, Gonzalez M, Chaudhary V, Villanueva D, Newman C, Danforth J, Amin MS. Collapsing Glomerulopathy Leading To Rapidly Progressive Allograft Failure From Cytomegalovirus and SARS-CoV-2 Infection With Concomitant BK Virus Nephropathy. EXP CLIN TRANSPLANT 2024; 22:392-395. [PMID: 38970283 DOI: 10.6002/ect.2024.0029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/08/2024]
Abstract
We present a challenging clinical case of a 68-year-old female kidney transplant recipient who had a complicated posttransplant course marked by borderline T-cell-mediated rejection and BK virus nephropathy. The treatment for borderline rejection with steroids resulted in overimmunosuppression, and the patient acquired cytomegalovirus infection manifesting as colitis and SARS-CoV-2 infection. This progressed rapidly to collapsing glomerulopathy and allograft failure. This study also highlights the challenges in surveillance with donor-derived cell-free DNA in the setting of allograft injury by multiple viral infections.
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Affiliation(s)
- Rajeev Sharma
- >From the Division of Transplant Surgery, West Virginia University Hospitals, , Morgantown, West Virginia, USA
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2
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Wei S, Xiaqin W, Liwei L, Fasu Z, Ying P, Pingping T, Furong Y. Analysis of Risk Factors for Death in the Coronavirus Disease 2019 (COVID-19) Population: Data Analysis from a Large General Hospital in Anhui, China. Cureus 2024; 16:e60069. [PMID: 38741698 PMCID: PMC11089484 DOI: 10.7759/cureus.60069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/10/2024] [Indexed: 05/16/2024] Open
Abstract
During the coronavirus disease 2019 (COVID-19) pandemic, clinical prevention, early diagnosis, and hematological monitoring were challenging areas. This study aims to compare risk factors and hematological and biochemical data in non-survivor group patients with COVID-19 versus survivor group patients. A total of 204 patients with COVID-19 were selected as research subjects from December 2022 to January 2023. We analyzed the age, sex, time from onset to admission, and laboratory test indicators upon admission. The differences between surviving and deceased patients and mortality-related risk factors were examined. Among the 204 patients, 168 survived, whereas 36 died during hospitalization. Significant differences were observed between the two groups with COVID-19 across various factors, including age (p < 0.0001), WBC count (p < 0.0001), RBC count (p < 0.05), neutrophils (p < 0.0001), lymphocytes (p < 0.05), mean corpuscular hemoglobin concentration (MCHC) (p < 0.0001), RBC distribution width-standard deviation (RDW-SD) (p < 0.0001), RBC distribution width coefficient of variation (RDW-CV) (p < 0.0001), aspartate aminotransferase (AST) (p < 0.05), albumin (ALB) (p < 0.0001), creatinine (CR) (p < 0.0001), uric acid (UA) (p < 0.0001), blood urea nitrogen (BUN) (p < 0.0001), plasma thrombin time (TT) (p < 0.05), prothrombin time (PT) (p < 0.0001), and D-dimer (p < 0.0001). Multivariate logistic analysis revealed that older age, CR, UA, and ALB were independent factors associated with death (p < 0.05). Elderly patients with underlying diseases, abnormal routine blood test indices, and abnormal renal function and coagulation indices are at an increased worse prognosis and should be identified early. Age, UA, CR, and ALB can be used as predictors to assess the worse prognosis in the hospital.
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Affiliation(s)
- Shi Wei
- Medical Laboratory Science, Anhui Medical College, Hefei, CHN
| | - Wu Xiaqin
- Medical Laboratory, Anqing Center, Anhui Medical University, Anqing, CHN
| | - Liu Liwei
- Immunology, Anhui Medical College, Hefei, CHN
| | - Zhang Fasu
- Medical Laboratory Science, Anhui Medical College, Hefei, CHN
| | - Pan Ying
- Medical Laboratory Science, Anhui Medical College, Hefei, CHN
| | - Tian Pingping
- Medical Laboratory Science, Anhui Medical College, Hefei, CHN
| | - Yu Furong
- Medical Laboratory Science, Anhui Medical College, Hefei, CHN
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Ooi SH, Ng KP, Sthaneshwar P, Lim SK, Khor PY, Lim JY, Siow WS, Lim KW, Azlan M. A study of hospitalized COVID-19 patients with AKI in a setting of multiracial developing country. BMC Nephrol 2024; 25:122. [PMID: 38580977 PMCID: PMC10998399 DOI: 10.1186/s12882-024-03498-x] [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: 04/23/2023] [Accepted: 02/12/2024] [Indexed: 04/07/2024] Open
Abstract
BACKGROUND The commonest indication for hospitalization in COVID-19 patients is hypoxemia or severe respiratory symptoms. However, COVID-19 disease may result in extrapulmonary complications including kidney-related pathology. The reported incidence of renal involvement related to COVID infection varies based on geographical location. OBJECTIVE This study aimed to assess the incidence rate of AKI in hospitalized COVID-19 patients and identify risk factors and prognostic predictors. METHOD In this retrospective study, we recruited hospitalized COVID-19 patients from January 2021 until June 2021 at the University Malaya Medical Center. The inclusion criteria were hospitalized for ≥ 48 h with confirmed COVID-19 infection and at least 18 years old. Patient demographic and clinical data were collected from electronic medical records. The staging of AKI was based on criteria as per KDIGO guidelines. RESULTS One thousand five hundred twenty-nine COVID patients fulfilled the inclusion criteria with a male-to-female ratio of 759 (49.6%) to 770 (50.3%). The median age was 55 (IQR: 36-66). 500 patients (32.7%) had diabetes, 621 (40.6%) had hypertension, and 5.6% (n = 85) had pre-existing chronic kidney disease (CKD). The incidence rate of AKI was 21.1% (n = 323). The percentage of COVID patients in different AKI stages of 1,2 and 3 were 16.3%, 2.1%, and 2.7%, respectively. Fifteen hospitalized patients (0.98%) required renal replacement therapy. 58.8% (n = 190) of AKI group had complete recovery of kidney function. Demographic factors included age (p < 0.001), diabetes (p < 0.001), hypertension (p < 0.012), CKD (p < 0.001), and vaccination status (p = 0.042) were associated with an increased risk of developing AKI. We found that the AKI cohort had statistically significant lower platelet counts and higher ferritin levels than the non-AKI cohort. AKI is a risk predictor of prolonged hospitalization (p < 0.001) and higher mortality rates (P < 0.001). CONCLUSION AKI is a common clinical complication among hospitalized COVID-19 patients. The etiology of AKI is multifactorial and may have an adverse impact on patient morbidity and mortality.
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Affiliation(s)
- S H Ooi
- Internal Medicine Department, University Malaya Medical Center, Kuala Lumpur, Malaysia
| | - K P Ng
- Internal Medicine Department, University Malaya Medical Center, Kuala Lumpur, Malaysia.
| | | | - S K Lim
- Internal Medicine Department, University Malaya Medical Center, Kuala Lumpur, Malaysia
| | - P Y Khor
- Internal Medicine Department, University Malaya Medical Center, Kuala Lumpur, Malaysia
| | - J Y Lim
- Internal Medicine Department, University Malaya Medical Center, Kuala Lumpur, Malaysia
| | - W S Siow
- Internal Medicine Department, University Malaya Medical Center, Kuala Lumpur, Malaysia
| | - K W Lim
- Internal Medicine Department, University Malaya Medical Center, Kuala Lumpur, Malaysia
| | - Muhummad Azlan
- Internal Medicine Department, University Malaya Medical Center, Kuala Lumpur, Malaysia
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Anandakrishnan N, Yi Z, Sun Z, Liu T, Haydak J, Eddy S, Jayaraman P, DeFronzo S, Saha A, Sun Q, Yang D, Mendoza A, Mosoyan G, Wen HH, Schaub JA, Fu J, Kehrer T, Menon R, Otto EA, Godfrey B, Suarez-Farinas M, Leffters S, Twumasi A, Meliambro K, Charney AW, García-Sastre A, Campbell KN, Gusella GL, He JC, Miorin L, Nadkarni GN, Wisnivesky J, Li H, Kretzler M, Coca SG, Chan L, Zhang W, Azeloglu EU. Integrated multiomics implicates dysregulation of ECM and cell adhesion pathways as drivers of severe COVID-associated kidney injury. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2024:2024.03.18.24304401. [PMID: 38562892 PMCID: PMC10984064 DOI: 10.1101/2024.03.18.24304401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/04/2024]
Abstract
COVID-19 has been a significant public health concern for the last four years; however, little is known about the mechanisms that lead to severe COVID-associated kidney injury. In this multicenter study, we combined quantitative deep urinary proteomics and machine learning to predict severe acute outcomes in hospitalized COVID-19 patients. Using a 10-fold cross-validated random forest algorithm, we identified a set of urinary proteins that demonstrated predictive power for both discovery and validation set with 87% and 79% accuracy, respectively. These predictive urinary biomarkers were recapitulated in non-COVID acute kidney injury revealing overlapping injury mechanisms. We further combined orthogonal multiomics datasets to understand the mechanisms that drive severe COVID-associated kidney injury. Functional overlap and network analysis of urinary proteomics, plasma proteomics and urine sediment single-cell RNA sequencing showed that extracellular matrix and autophagy-associated pathways were uniquely impacted in severe COVID-19. Differentially abundant proteins associated with these pathways exhibited high expression in cells in the juxtamedullary nephron, endothelial cells, and podocytes, indicating that these kidney cell types could be potential targets. Further, single-cell transcriptomic analysis of kidney organoids infected with SARS-CoV-2 revealed dysregulation of extracellular matrix organization in multiple nephron segments, recapitulating the clinically observed fibrotic response across multiomics datasets. Ligand-receptor interaction analysis of the podocyte and tubule organoid clusters showed significant reduction and loss of interaction between integrins and basement membrane receptors in the infected kidney organoids. Collectively, these data suggest that extracellular matrix degradation and adhesion-associated mechanisms could be a main driver of COVID-associated kidney injury and severe outcomes.
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Cianfarini C, Hassler L, Wysocki J, Hassan A, Nicolaescu V, Elli D, Gula H, Ibrahim AM, Randall G, Henkin J, Batlle D. Soluble Angiotensin-Converting Enzyme 2 Protein Improves Survival and Lowers Viral Titers in Lethal Mouse Model of Severe Acute Respiratory Syndrome Coronavirus Type 2 Infection with the Delta Variant. Cells 2024; 13:203. [PMID: 38334597 PMCID: PMC10854654 DOI: 10.3390/cells13030203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Revised: 01/19/2024] [Accepted: 01/20/2024] [Indexed: 02/10/2024] Open
Abstract
Severe acute respiratory syndrome coronavirus type 2 (SARS-CoV-2) utilizes angiotensin-converting enzyme 2 (ACE2) as its main receptor for cell entry. We bioengineered a soluble ACE2 protein termed ACE2 618-DDC-ABD that has increased binding to SARS-CoV-2 and prolonged duration of action. Here, we investigated the protective effect of this protein when administered intranasally to k18-hACE2 mice infected with the aggressive SARS-CoV-2 Delta variant. k18-hACE2 mice were infected with the SARS-CoV-2 Delta variant by inoculation of a lethal dose (2 × 104 PFU). ACE2 618-DDC-ABD (10 mg/kg) or PBS was administered intranasally six hours prior and 24 and 48 h post-viral inoculation. All animals in the PBS control group succumbed to the disease on day seven post-infection (0% survival), whereas, in contrast, there was only one casualty in the group that received ACE2 618-DDC-ABD (90% survival). Mice in the ACE2 618-DDC-ABD group had minimal disease as assessed using a clinical score and stable weight, and both brain and lung viral titers were markedly reduced. These findings demonstrate the efficacy of a bioengineered soluble ACE2 decoy with an extended duration of action in protecting against the aggressive Delta SARS-CoV-2 variant. Together with previous work, these findings underline the universal protective potential against current and future emerging SARS-CoV-2 variants.
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Affiliation(s)
- Cosimo Cianfarini
- Division of Nephrology/Hypertension, Department of Medicine, Feinberg School of Medicine, Northwestern University, 710 North Fairbanks Court, Chicago, IL 60611, USA
- Charité Universitätsmedizin Berlin, 10117 Berlin, Germany
| | - Luise Hassler
- Division of Nephrology/Hypertension, Department of Medicine, Feinberg School of Medicine, Northwestern University, 710 North Fairbanks Court, Chicago, IL 60611, USA
| | - Jan Wysocki
- Division of Nephrology/Hypertension, Department of Medicine, Feinberg School of Medicine, Northwestern University, 710 North Fairbanks Court, Chicago, IL 60611, USA
| | - Abdelsabour Hassan
- Division of Nephrology/Hypertension, Department of Medicine, Feinberg School of Medicine, Northwestern University, 710 North Fairbanks Court, Chicago, IL 60611, USA
| | - Vlad Nicolaescu
- Howard Taylor Ricketts Laboratory, Department of Microbiology, The University of Chicago, Lemont, IL 60637, USA
| | - Derek Elli
- Howard Taylor Ricketts Laboratory, Department of Microbiology, The University of Chicago, Lemont, IL 60637, USA
| | - Haley Gula
- Howard Taylor Ricketts Laboratory, Department of Microbiology, The University of Chicago, Lemont, IL 60637, USA
| | - Amany M. Ibrahim
- Howard Taylor Ricketts Laboratory, Department of Microbiology, The University of Chicago, Lemont, IL 60637, USA
| | - Glenn Randall
- Howard Taylor Ricketts Laboratory, Department of Microbiology, The University of Chicago, Lemont, IL 60637, USA
| | - Jack Henkin
- Center for Developmental Therapeutics, Northwestern University, Evanston, IL 60208, USA
| | - Daniel Batlle
- Division of Nephrology/Hypertension, Department of Medicine, Feinberg School of Medicine, Northwestern University, 710 North Fairbanks Court, Chicago, IL 60611, USA
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Obrișcă B, Mocanu V, Vornicu A, Jurubiță R, Sorohan B, Dimofte G, Achim C, Andronesi A, Micu G, Bobeică R, Caceaune N, Procop A, Herlea V, Gherghiceanu M, Ismail G. The impact of SARS-CoV-2 infection on renal function in patients with biopsy-proven kidney diseases. PLoS One 2023; 18:e0296168. [PMID: 38134019 PMCID: PMC10745175 DOI: 10.1371/journal.pone.0296168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Accepted: 12/06/2023] [Indexed: 12/24/2023] Open
Abstract
BACKGROUND We sought to evaluate the long-term effects of COVID-19 on renal function in patients with biopsy-proven kidney diseases. METHODS A total of 451 patients with biopsy-proven kidney disease and at least 12 months of follow-up subsequent to COVID-19 pandemic onset were included in the study. The primary study endpoint was a composite of a persistent decline of more than 30% in eGFR or ESRD. RESULTS 23.1% of patients had COVID-19 during a follow-up period of 2.5 y (0.8-2.6), while 17.6% of patients reached the composite endpoint. Those with COVID-19 were more likely to reach the composite endpoint [26.7% vs. 14.8%; OR, 2.1 (95%CI, 1.23-3.58), p = 0.006). There was a significant eGFR change in the first year of follow-up between the two study groups [-2.24 (95%CI,-4.86; 0.37) vs. +2.31 (95%CI, 0.78; 3.85) ml/min, p = 0.004], with an adjusted mean difference of -4.68 ml/min (95%CI,-7.7; -1.59)(p = 0.03). The trend for worse renal outcomes remained consistent in patients with IgAN, MN and FSGS, but not in those with LN. After multivariate adjustment, the independent predictors of the composite endpoint were baseline eGFR (HR, 0.94; 95%CI, 0.92-0.95), COVID-19 (HR, 1.91; 1.16-3.12) and male gender (HR, 1.64; 95%CI, 1.01-2.66). In multivariate linear regression analysis, COVID-19 independently determined a reduction of eGFR at 12 months by 4.62 ml/min/1.73m2 (β coefficient, -4.62; 95%CI, -7.74 to -1.5, p = 0.004). CONCLUSIONS There is a significant impact of COVID-19 on long-term renal function in patients with biopsy-proven kidney diseases, leading to a greater decline of eGFR and a worse renal survival.
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Affiliation(s)
- Bogdan Obrișcă
- “Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania
- Department of Nephrology, Fundeni Clinical Institute, Bucharest, Romania
| | - Valentin Mocanu
- Department of Nephrology, Fundeni Clinical Institute, Bucharest, Romania
| | - Alexandra Vornicu
- “Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania
- Department of Nephrology, Fundeni Clinical Institute, Bucharest, Romania
| | - Roxana Jurubiță
- “Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania
- Department of Nephrology, Fundeni Clinical Institute, Bucharest, Romania
| | - Bogdan Sorohan
- “Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania
- Department of Nephrology, Fundeni Clinical Institute, Bucharest, Romania
| | - George Dimofte
- Department of Nephrology, Fundeni Clinical Institute, Bucharest, Romania
| | - Camelia Achim
- “Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania
- Department of Nephrology, Fundeni Clinical Institute, Bucharest, Romania
| | - Andreea Andronesi
- “Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania
- Department of Nephrology, Fundeni Clinical Institute, Bucharest, Romania
| | - Georgia Micu
- Department of Nephrology, Fundeni Clinical Institute, Bucharest, Romania
| | - Raluca Bobeică
- Department of Nephrology, Fundeni Clinical Institute, Bucharest, Romania
| | - Nicu Caceaune
- Department of Internal Medicine, Fundeni Clinical Institute, Bucharest, Romania
| | - Alexandru Procop
- Department of Pathology, Fundeni Clinical Institute, Bucharest, Romania
| | - Vlad Herlea
- “Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania
- Department of Pathology, Fundeni Clinical Institute, Bucharest, Romania
| | - Mihaela Gherghiceanu
- “Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania
- 5”Victor Babes” National Institute of Pathology, Bucharest, Romania
| | - Gener Ismail
- “Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania
- Department of Nephrology, Fundeni Clinical Institute, Bucharest, Romania
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Nguyen JK, Wu Z, Agudelo J, Herlitz LC, Miller AW, Bruggeman LA. Local Inflammation But Not Kidney Cell Infection Associated with High APOL1 Expression in COVID-Associated Nephropathy. KIDNEY360 2023; 4:1757-1762. [PMID: 37927001 PMCID: PMC10758510 DOI: 10.34067/kid.0000000000000290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Accepted: 10/19/2023] [Indexed: 11/07/2023]
Abstract
In coronavirus disease-19 biopsies, detection of severe acute respiratory syndrome coronavirus 2 was rare with no evidence of viral replication, whereas autopsy tissue failed quality control. In patients with FSGS, apolipoprotein L1 expression differed by degree of immune cell infiltrates, with some podocytes exhibiting up to 18-fold higher expression. In COVAN, the predicted high induction of apolipoprotein L1 expression occurs in a pattern consistent with the stochastic nature of FSGS pathology.
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Affiliation(s)
- Jane K. Nguyen
- Robert J. Tomsich Pathology and Laboratory Medicine Institute, Cleveland Clinic, Cleveland, Ohio
| | - Zhenzhen Wu
- Department of Inflammation and Immunity, Cleveland Clinic, Cleveland, Ohio
| | - Jose Agudelo
- Department of Cardiovascular and Metabolic Sciences, Cleveland Clinic, Cleveland, Ohio
| | - Leal C. Herlitz
- Robert J. Tomsich Pathology and Laboratory Medicine Institute, Cleveland Clinic, Cleveland, Ohio
| | - Aaron W. Miller
- Department of Cardiovascular and Metabolic Sciences, Cleveland Clinic, Cleveland, Ohio
- Department of Urology, Cleveland Clinic, Cleveland, Ohio
| | - Leslie A. Bruggeman
- Department of Inflammation and Immunity, Cleveland Clinic, Cleveland, Ohio
- Department of Kidney Medicine, Cleveland Clinic, Cleveland, Ohio
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Zaa CA, Espitia C, Reyes-Barrera KL, An Z, Velasco-Velázquez MA. Neuroprotective Agents with Therapeutic Potential for COVID-19. Biomolecules 2023; 13:1585. [PMID: 38002267 PMCID: PMC10669388 DOI: 10.3390/biom13111585] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Revised: 10/19/2023] [Accepted: 10/20/2023] [Indexed: 11/26/2023] Open
Abstract
COVID-19 patients can exhibit a wide range of clinical manifestations affecting various organs and systems. Neurological symptoms have been reported in COVID-19 patients, both during the acute phase of the illness and in cases of long-term COVID. Moderate symptoms include ageusia, anosmia, altered mental status, and cognitive impairment, and in more severe cases can manifest as ischemic cerebrovascular disease and encephalitis. In this narrative review, we delve into the reported neurological symptoms associated with COVID-19, as well as the underlying mechanisms contributing to them. These mechanisms include direct damage to neurons, inflammation, oxidative stress, and protein misfolding. We further investigate the potential of small molecules from natural products to offer neuroprotection in models of neurodegenerative diseases. Through our analysis, we discovered that flavonoids, alkaloids, terpenoids, and other natural compounds exhibit neuroprotective effects by modulating signaling pathways known to be impacted by COVID-19. Some of these compounds also directly target SARS-CoV-2 viral replication. Therefore, molecules of natural origin show promise as potential agents to prevent or mitigate nervous system damage in COVID-19 patients. Further research and the evaluation of different stages of the disease are warranted to explore their potential benefits.
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Affiliation(s)
- César A. Zaa
- School of Biological Sciences, Universidad Nacional Mayor de San Marcos (UNMSM), Lima 15081, Peru;
| | - Clara Espitia
- Department of Immunology, Institute of Biomedical Research, Universidad Nacional Autónoma de México (UNAM), Mexico City 04510, Mexico; (C.E.); (K.L.R.-B.)
| | - Karen L. Reyes-Barrera
- Department of Immunology, Institute of Biomedical Research, Universidad Nacional Autónoma de México (UNAM), Mexico City 04510, Mexico; (C.E.); (K.L.R.-B.)
| | - Zhiqiang An
- Texas Therapeutics Institute, Brown Foundation Institute of Molecular Medicine, University of Texas Health Science Center, Houston, TX 77030, USA;
| | - Marco A. Velasco-Velázquez
- Texas Therapeutics Institute, Brown Foundation Institute of Molecular Medicine, University of Texas Health Science Center, Houston, TX 77030, USA;
- School of Medicine, Universidad Nacional Autónoma de México (UNAM), Mexico City 04510, Mexico
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9
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Sivri F, Türköz I, Şencan M, İçen YK, Aksoy F, Ceyhan BÖ. Does COVID-19 Cause Non-Dıpper Hypertension? Angiology 2023:33197231209584. [PMID: 37864346 DOI: 10.1177/00033197231209584] [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: 10/22/2023]
Abstract
Coronavirus disease 2019 (COVID-19) remains a health problem worldwide. The present study aimed to investigate the effect of blood pressure (BP) on the circadian pattern and prevalence of new-onset non-dipper hypertension in the post-COVID period in patients with known hypertension. This prospective single-center study included 722 patients hospitalized for COVID-19 infection. Ambulatory BP (ABP) data were collected during their initial hospitalization. The ABP data were reassessed 1 month after the patients were discharged. The results were compared with a healthy control group with known hypertension but without COVID-19 infection. After exclusion criteria were applied, the study included 187 patients with COVID-19 and 136 healthy hypertensive controls. Post-COVID ABP showed that patients with COVID-19 had significantly higher mean 24-h systolic and diastolic BP, mean nighttime systolic and diastolic BP, and mean daytime diastolic BP than the control group. In addition, new-onset non-dipper hypertension was significantly higher in patients with COVID-19. This study demonstrated for the first time that the circadian pattern is disturbed and a non-dipper pattern develops in individuals with known hypertension during the post-COVID period.
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Affiliation(s)
- Fatih Sivri
- Aydin Nazilli State Hospital, Nazilli, Turkey
| | - Ismail Türköz
- Department of Infectious Diseases, Dortyol State Hospital, Hatay, Turkey
| | - Mehtap Şencan
- Department of Infectious Diseases, Dortyol State Hospital, Hatay, Turkey
| | - Yahya Kemal İçen
- Department of Cardiology, Adana Health Practice and Research, Adana, Turkey
| | - Fatih Aksoy
- Department of Cardiology, Süleyman Demirel University, Isparta, Turkey
| | - Banu Öztürk Ceyhan
- Department Of Endocrine Diseases, Adnan Menderes University, Aydın, Turkey
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10
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Meneghel A, Masenello V, Alfier F, Giampetruzzi S, Sembenini C, Martini G, Tirelli F, Meneghesso D, Zulian F. Renal Involvement in Multisystem Inflammatory Syndrome in Children: Not Only Acute Kidney Injury. CHILDREN (BASEL, SWITZERLAND) 2023; 10:1661. [PMID: 37892324 PMCID: PMC10605058 DOI: 10.3390/children10101661] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Revised: 09/15/2023] [Accepted: 10/06/2023] [Indexed: 10/29/2023]
Abstract
Kidney involvement has been poorly investigated in SARS-CoV-2 Multisystem Inflammatory Syndrome in Children (MIS-C). To analyze the spectrum of renal involvement in MIS-C, we performed a single-center retrospective observational study including all MIS-C patients diagnosed at our Pediatric Department between April 2020 and May 2022. Demographic, clinical, pediatric intensive care unit (PICU) admission's need and laboratory data were collected at onset and after 6 months. Among 55 MIS-C patients enrolled in the study, kidney involvement was present in 20 (36.4%): 13 with acute kidney injury (AKI) and 7 with isolated tubular dysfunction (TD). In eight patients, concomitant AKI and TD was present (AKI-TD). AKI patients needed higher levels of intensive care (PICU: 61.5%, p < 0.001; inotropes: 46.2%, p = 0.002; second-line immuno-therapy: 53.8%, p < 0.001) and showed lower levels of HCO3- (p = 0.012), higher inflammatory markers [neutrophils (p = 0.092), PCT (p = 0.04), IL-6 (p = 0.007)] as compared to no-AKI. TD markers showed that isolated TD presented higher levels of HCO3- and lower inflammatory markers than AKI-TD. Our results indicate a combination of both pre-renal and inflammatory damage in the pathogenesis of kidney injury in MIS-C syndrome. We highlight, for the first time, the presence of tubular involvement in MIS-C, providing new insights in the evaluation of kidney involvement and its management in this condition.
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Affiliation(s)
- Alessandra Meneghel
- Pediatric Rheumatology Unit, Department for Woman and Child’s Health, University of Padua, 35128 Padua, Italy
| | - Valentina Masenello
- Pediatric Rheumatology Unit, Department for Woman and Child’s Health, University of Padua, 35128 Padua, Italy
| | - Fiorenza Alfier
- Pediatric Rheumatology Unit, Department for Woman and Child’s Health, University of Padua, 35128 Padua, Italy
| | - Stefania Giampetruzzi
- Pediatric Rheumatology Unit, Department for Woman and Child’s Health, University of Padua, 35128 Padua, Italy
| | - Camilla Sembenini
- Pediatric Rheumatology Unit, Department for Woman and Child’s Health, University of Padua, 35128 Padua, Italy
| | - Giorgia Martini
- Pediatric Rheumatology Unit, Department for Woman and Child’s Health, University of Padua, 35128 Padua, Italy
| | - Francesca Tirelli
- Pediatric Rheumatology Unit, Department for Woman and Child’s Health, University of Padua, 35128 Padua, Italy
| | - Davide Meneghesso
- Pediatric Nephrology Unit, Department for Woman and Child’s Health, University of Padua, 35128 Padua, Italy
| | - Francesco Zulian
- Pediatric Rheumatology Unit, Department for Woman and Child’s Health, University of Padua, 35128 Padua, Italy
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11
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Kervancioglu Demirci E, Dursun M, Seviç E, Ergül RB, Önel M, Ağaçfidan A, Kadıoğlu A. Evidence for residual SARS-CoV-2 in corpus cavernosum of patients who recovered from COVID-19 infection. Andrology 2023; 11:1016-1022. [PMID: 36426580 DOI: 10.1111/andr.13351] [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: 09/27/2022] [Revised: 11/19/2022] [Accepted: 11/20/2022] [Indexed: 11/26/2022]
Abstract
BACKGROUND The COVID-19 is an ongoing health problem with millions of cases and deaths worldwide. Although the virus is transmitted with droplets through the respiratory system, the involvement of different organs has been reported. OBJECTIVES The pandemic caused urological procedures to be postponed when patient is infected with SARS-CoV-2. However, the reliability of 1 month postpone period and long-term complications of the virus, such as a possible erectile dysfunction (ED) is not clarified. We aimed to compare the corpus cavernosum of patients 1 and 7 months after COVID-19 infection with control patients who had not COVID-19 and search for SARS-CoV-2 in tissues using immunohistochemistry and electron microscopy. MATERIALS AND METHODS Three groups of subjects underwent penile prosthesis implantation and Nesbit procedure for Peyronie's disease 1 and 7 months after COVID-19 infection and control group without previous COVID-19 infection. We searched for SARS-CoV-2 in penile tissue using RT-PCR, electron microscopy and immunohistochemistry. RESULTS Electron microscopy and immunohistochemical staining showed SARS CoV-2 virus in the penile corpus cavernosum of patients 1 month after COVID-19 recovery. Immunohistochemical staining intensity correlated with the severity of previous infection. Transmission electron microscopy revealed intracellular virtual particles of about 80 nm with a typical morphology of prominent spikes and electron-dense dots of nucleocapsid in addition to vesicles filled with virus-like particles. Cells showed increased membrane trafficking. The 1 month after COVID-19 group showed an increased number of fibroblasts. The 7 months after COVID-19 group had similar morphology and immunoreactivity as control group. DISCUSSION This is the first study of late post-COVID examination of penis and the second study of early post-COVID examination of corpus cavernosum. For 1 month post-COVID patients, the aetiology of ED could be the viral infection that is also affecting corpora cavernosa. We hypothesize that viral infection affects the endocytic and exocytic pathways, hence the metabolic activity of cells that can be the reason of altered functions in some post-COVID patients. CONCLUSION This study is important because it did not detect any virus residue in the tissue samples at the seventh month. In addition, we can say that the penile surgeries should be postponed more than 1 month after the COVID infection according to this study. But, there is a need for new studies with large series and high levels of evidence that can show how long the virus remains in the corpus cavernosum. Patients should be followed in this respect.
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Affiliation(s)
- Elif Kervancioglu Demirci
- Department of Histology and Embryology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Murat Dursun
- Department of Urology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Erva Seviç
- Department of Histology and Embryology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Rıfat Burak Ergül
- Department of Urology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Mustafa Önel
- Department of Microbiology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Ali Ağaçfidan
- Department of Microbiology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Ateş Kadıoğlu
- Department of Urology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
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12
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Volbeda M, Jou-Valencia D, van den Heuvel MC, Zijlstra JG, Franssen CFM, van der Voort PHJ, Moser J, van Meurs M. Acute and chronic histopathological findings in renal biopsies in COVID-19. Clin Exp Med 2023; 23:1003-1014. [PMID: 36396750 PMCID: PMC9672628 DOI: 10.1007/s10238-022-00941-x] [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: 03/23/2022] [Accepted: 11/03/2022] [Indexed: 11/19/2022]
Abstract
The dominant ICU admission diagnosis of COVID-19 patients is respiratory insufficiency, but 32-57% of hospitalized COVID-19 patients develop acute kidney injury (COVID-AKI). The renal histopathological changes accompanying COVID-AKI are not yet fully described. To obtain a detailed insight into renal histopathological features of COVID-19, we conducted a review including all studies reporting histopathological findings of diagnostic and postmortem kidney biopsies from patients with COVID-19 published between January 1, 2020, and January 31, 2021. A total of 89 diagnostic and 194 postmortem renal biopsies from individual patients in 39 published studies were investigated and were included in the analysis. In the diagnostic biopsy group, mean age was 56 years and AKI incidence was 96%. In the postmortem biopsy group, mean age was 69 years and AKI incidence was 80%. In the diagnostic biopsy group, the prevalence of acute glomerular diseases was 74%. The most common glomerular lesions were collapsing focal segmental glomerulosclerosis (c-FSGS) in 54% and thrombotic microangiopathy (TMA) in 9% of patients. TMA was also found in 10% of patients in the postmortem biopsy group. The most common acute tubular lesions was acute tubular necrosis (ATN) which was present in 87% of patients in the diagnostic and in 77% of patients in the postmortem biopsy group. Additionally, we observed a high prevalence of preexisting chronic lesions in both groups such as atherosclerosis and glomerulosclerosis. Histopathological changes in renal biopsies of COVID-19 patients show a heterogeneous picture with acute glomerular lesions, predominantly c-FSGS and TMA, and acute tubular lesions, predominantly ATN. In many patients, these lesions were present on a background of chronic renal injury.
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Affiliation(s)
- Meint Volbeda
- Department of Critical Care, University of Groningen, University Medical Center Groningen, Hanzeplein 1, 9713 GZ, Groningen, The Netherlands.
| | - Daniela Jou-Valencia
- Department of Critical Care, University of Groningen, University Medical Center Groningen, Hanzeplein 1, 9713 GZ, Groningen, The Netherlands
| | - Marius C van den Heuvel
- Department of Pathology and Medical Biology, Pathology Section, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Jan G Zijlstra
- Department of Critical Care, University of Groningen, University Medical Center Groningen, Hanzeplein 1, 9713 GZ, Groningen, The Netherlands
| | - Casper F M Franssen
- Department of Nephrology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Peter H J van der Voort
- Department of Critical Care, University of Groningen, University Medical Center Groningen, Hanzeplein 1, 9713 GZ, Groningen, The Netherlands
| | - Jill Moser
- Department of Critical Care, University of Groningen, University Medical Center Groningen, Hanzeplein 1, 9713 GZ, Groningen, The Netherlands
- Department of Pathology and Medical Biology, Medical Biology Section, Laboratory for Endothelial Biomedicine and Vascular Drug Targeting Research, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Matijs van Meurs
- Department of Critical Care, University of Groningen, University Medical Center Groningen, Hanzeplein 1, 9713 GZ, Groningen, The Netherlands
- Department of Pathology and Medical Biology, Medical Biology Section, Laboratory for Endothelial Biomedicine and Vascular Drug Targeting Research, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
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13
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Wei C, Datta PK, Siegerist F, Li J, Yashwanth S, Koh KH, Kriho NW, Ismail A, Luo S, Fischer T, Amber KT, Cimbaluk D, Landay A, Endlich N, Rappaport J, Hayek SS, Reiser J. SuPAR mediates viral response proteinuria by rapidly changing podocyte function. Nat Commun 2023; 14:4414. [PMID: 37479685 PMCID: PMC10362037 DOI: 10.1038/s41467-023-40165-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Accepted: 07/14/2023] [Indexed: 07/23/2023] Open
Abstract
Elevation in soluble urokinase receptor (suPAR) and proteinuria are common signs in patients with moderate to severe coronavirus disease 2019 (COVID-19). Here we characterize a new type of proteinuria originating as part of a viral response. Inoculation of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) causes increased suPAR levels and glomerulopathy in African green monkeys. Using an engineered mouse model with high suPAR expression, inhaled variants of SARS-CoV-2 spike S1 protein elicite proteinuria that could be blocked by either suPAR antibody or SARS-CoV-2 vaccination. In a cohort of 1991 COVID-19 patients, suPAR levels exhibit a stepwise association with proteinuria in non-Omicron, but not in Omicron infections, supporting our findings of biophysical and functional differences between variants of SARS-CoV-2 spike S1 protein and their binding to podocyte integrins. These insights are not limited to SARS-CoV-2 and define viral response proteinuria (VRP) as an innate immune mechanism and co-activation of podocyte integrins.
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Affiliation(s)
- Changli Wei
- Department of Medicine, Rush University Medical Center, Chicago, IL, USA.
| | - Prasun K Datta
- Tulane National Primate Research Center, Covington, LA, 70433, USA
| | - Florian Siegerist
- Department of Anatomy and Cell Biology, University Medicine Greifswald, 17487, Greifswald, Germany
- NIPOKA GmbH, 17489, Greifswald, Germany
| | - Jing Li
- Department of Medicine, Rush University Medical Center, Chicago, IL, USA
| | - Sudhini Yashwanth
- Department of Medicine, Rush University Medical Center, Chicago, IL, USA
| | - Kwi Hye Koh
- Morphic Therapeutic, Waltham, MA, 02451, USA
| | - Nicholas W Kriho
- Department of Pathology, Rush University Medical Center, Chicago, IL, USA
| | - Anis Ismail
- Division of Cardiology, Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Shengyuan Luo
- Department of Medicine, Rush University Medical Center, Chicago, IL, USA
| | - Tracy Fischer
- Tulane National Primate Research Center, Covington, LA, 70433, USA
| | - Kyle T Amber
- Department of Medicine, Rush University Medical Center, Chicago, IL, USA
- Department of Dermatology, Rush University Medical Center, Chicago, IL, USA
| | - David Cimbaluk
- Department of Pathology, Rush University Medical Center, Chicago, IL, USA
| | - Alan Landay
- Department of Medicine, Rush University Medical Center, Chicago, IL, USA
| | - Nicole Endlich
- Department of Anatomy and Cell Biology, University Medicine Greifswald, 17487, Greifswald, Germany
- NIPOKA GmbH, 17489, Greifswald, Germany
| | - Jay Rappaport
- Tulane National Primate Research Center, Covington, LA, 70433, USA
| | - Salim S Hayek
- Division of Cardiology, Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA.
| | - Jochen Reiser
- Department of Medicine, Rush University Medical Center, Chicago, IL, USA.
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14
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Medina E, Rueda C, Batlle D. FSGS and COVID-19 in Non-African American Patients. KIDNEY360 2023; 4:687-699. [PMID: 37229730 PMCID: PMC10371264 DOI: 10.34067/kid.0000000000000104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Accepted: 02/10/2023] [Indexed: 05/27/2023]
Abstract
Collapsing Focal Segmental Glomerulosclerosis (FSGS) has been reported relatively frequently in African American (AA) patients with coronavirus disease 2019 (COVID-19), and it is associated almost always with Apolipoprotein L gen 1 (APOL1) high-risk variants. We reviewed the published literature from April 2020 to November 2022 searching for non-African American (non-AA) patients with FSGS associated with COVID-19 (eight White patients, six Hispanic patients, three Asian patients, one Indian patient, and one Asian Indian patient). The following histologic patterns were found: collapsing (n=11), not otherwise specified (n=5), tip (n=2), and perihilar (n=1). Fifteen of the 19 patients had AKI. The APOL1 genotype was reported in only six of the 19 non-AA patients. Three of them (two Hispanic patients and one White patient) with collapsing FSGS had high-risk APOL1 variants. The other three patients (two White patients and one Hispanic patient with the collapsing variant, tip variant, and not otherwise specified) had low-risk APOL1 variants. Among 53 African American patients with collapsing FSGS associated with COVID-19, 48 had high-risk APOL1 variants and five had low-risk APOL1 variants. We conclude that in non-AA patients, FSGS is a rare complication of COVID-19. FSGS associated with COVID-19 can occur rarely with low-risk APOL1 variants in non-AA and AA patients. Non-AA patients reported to be associated with high-risk APOL1 variants possibly reflect inaccuracy of self-reported race with AA admixture because of unknown ancestry. Given the importance of APOL1 in the pathogenesis of FSGS associated with viral infection and to avoid racial bias, it seems appropriate that APOL1 testing be considered in patients with FSGS associated with COVID-19, regardless of self-reported race.
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Affiliation(s)
- Elba Medina
- Division of Nephrology, General Hospital of México, Eduardo Liceaga, México City, México
- Master's and PhD Program in Dental and Health Medical Sciences, Universidad Nacional Autónoma de México, México City, México
| | - Carlos Rueda
- Division of Nephrology/Hypertension, Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Daniel Batlle
- Division of Nephrology/Hypertension, Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
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15
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Isnard P, Vergnaud P, Garbay S, Jamme M, Eloudzeri M, Karras A, Anglicheau D, Galantine V, Jalal Eddine A, Gosset C, Pourcine F, Zarhrate M, Gibier JB, Rensen E, Pietropaoli S, Barba-Spaeth G, Duong-Van-Huyen JP, Molina TJ, Mueller F, Zimmer C, Pontoglio M, Terzi F, Rabant M. A specific molecular signature in SARS-CoV-2-infected kidney biopsies. JCI Insight 2023; 8:165192. [PMID: 36749641 PMCID: PMC10077488 DOI: 10.1172/jci.insight.165192] [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] [Received: 09/07/2022] [Accepted: 01/25/2023] [Indexed: 02/08/2023] Open
Abstract
Acute kidney injury is one of the most important complications in patients with COVID-19 and is considered a negative prognostic factor with respect to patient survival. The occurrence of direct infection of the kidney by SARS-CoV-2, and its contribution to the renal deterioration process, remain controversial issues. By studying 32 renal biopsies from patients with COVID-19, we verified that the major pathological feature of COVID-19 is acute tubular injury (ATI). Using single-molecule fluorescence in situ hybridization, we showed that SARS-CoV-2 infected living renal cells and that infection, which paralleled renal angiotensin-converting enzyme 2 expression levels, was associated with increased death. Mechanistically, a transcriptomic analysis uncovered specific molecular signatures in SARS-CoV-2-infected kidneys as compared with healthy kidneys and non-COVID-19 ATI kidneys. On the other hand, we demonstrated that SARS-CoV-2 and hantavirus, 2 RNA viruses, activated different genetic networks despite triggering the same pathological lesions. Finally, we identified X-linked inhibitor of apoptosis-associated factor 1 as a critical target of SARS-CoV-2 infection. In conclusion, this study demonstrated that SARS-CoV-2 can directly infect living renal cells and identified specific druggable molecular targets that can potentially aid in the design of novel therapeutic strategies to preserve renal function in patients with COVID-19.
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Affiliation(s)
- Pierre Isnard
- University of Paris Cité, INSERM U1151, CNRS UMR 8253, Institut Necker-Enfants Malades, Département Croissance et Signalisation, Paris, France.,Department of Pathology, Centre Hospitalier Universitaire Necker-Enfants Malades, Assistance Publique - Hopitaux de Paris (AP-HP), Paris, France
| | - Paul Vergnaud
- University of Paris Cité, INSERM U1151, CNRS UMR 8253, Institut Necker-Enfants Malades, Département Croissance et Signalisation, Paris, France
| | - Serge Garbay
- University of Paris Cité, INSERM U1151, CNRS UMR 8253, Institut Necker-Enfants Malades, Département Croissance et Signalisation, Paris, France
| | - Matthieu Jamme
- Department of Intensive Care Medicine, Centre Hospitalier Intercommunal de Poissy, Poissy, France
| | - Maeva Eloudzeri
- University of Paris Cité, INSERM U1151, CNRS UMR 8253, Institut Necker-Enfants Malades, Département Croissance et Signalisation, Paris, France
| | - Alexandre Karras
- Department of Nephrology, Centre Hospitalier Universitaire Européen Georges Pompidou, Paris, France
| | - Dany Anglicheau
- University of Paris Cité, INSERM U1151, CNRS UMR 8253, Institut Necker-Enfants Malades, Département Croissance et Signalisation, Paris, France.,Department of Transplantation, Centre Hospitalier Universitaire Necker-Enfants Malades, Paris, France
| | - Valérie Galantine
- Department of Nephrology, Centre Hospitalier Universitaire de la Guadeloupe, Pointe-à-Pitre, France
| | | | - Clément Gosset
- Department of Nephrology, Centre Hospitalier Universitaire de La Réunion, Saint Denis de La Réunion, France
| | - Franck Pourcine
- Department of Nephrology, Centre Hospitalier de Melun, Melun, France
| | - Mohammed Zarhrate
- Genomics Core Facility, Structure Fédérative de Recherche Necker, University of Paris, Paris, France
| | - Jean-Baptiste Gibier
- Department of Pathology, Centre Hospitalier Universitaire (CHU) Lille, Lille, France
| | | | | | | | - Jean-Paul Duong-Van-Huyen
- Department of Pathology, Centre Hospitalier Universitaire Necker-Enfants Malades, Assistance Publique - Hopitaux de Paris (AP-HP), Paris, France
| | - Thierry J Molina
- Department of Pathology, Centre Hospitalier Universitaire Necker-Enfants Malades, Assistance Publique - Hopitaux de Paris (AP-HP), Paris, France
| | | | | | - Marco Pontoglio
- University of Paris Cité, INSERM U1151, CNRS UMR 8253, Institut Necker-Enfants Malades, Département Croissance et Signalisation, Paris, France
| | - Fabiola Terzi
- University of Paris Cité, INSERM U1151, CNRS UMR 8253, Institut Necker-Enfants Malades, Département Croissance et Signalisation, Paris, France
| | - Marion Rabant
- University of Paris Cité, INSERM U1151, CNRS UMR 8253, Institut Necker-Enfants Malades, Département Croissance et Signalisation, Paris, France.,Department of Pathology, Centre Hospitalier Universitaire Necker-Enfants Malades, Assistance Publique - Hopitaux de Paris (AP-HP), Paris, France
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16
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Valyaeva AA, Zharikova AA, Sheval EV. SARS-CoV-2 cellular tropism and direct multiorgan failure in COVID-19 patients: Bioinformatic predictions, experimental observations, and open questions. Cell Biol Int 2023; 47:308-326. [PMID: 36229927 PMCID: PMC9874490 DOI: 10.1002/cbin.11928] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Revised: 08/24/2022] [Accepted: 09/25/2022] [Indexed: 02/06/2023]
Abstract
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the virus that causes coronavirus disease 2019 (COVID-19), has led to an unprecedented public health emergency worldwide. While common cold symptoms are observed in mild cases, COVID-19 is accompanied by multiorgan failure in severe patients. Organ damage in COVID-19 patients is partially associated with the indirect effects of SARS-CoV-2 infection (e.g., systemic inflammation, hypoxic-ischemic damage, coagulopathy), but early processes in COVID-19 patients that trigger a chain of indirect effects are connected with the direct infection of cells by the virus. To understand the virus transmission routes and the reasons for the wide-spectrum of complications and severe outcomes of COVID-19, it is important to identify the cells targeted by SARS-CoV-2. This review summarizes the major steps of investigation and the most recent findings regarding SARS-CoV-2 cellular tropism and the possible connection between the early stages of infection and multiorgan failure in COVID-19. The SARS-CoV-2 pandemic is the first epidemic in which data extracted from single-cell RNA-seq (scRNA-seq) gene expression data sets have been widely used to predict cellular tropism. The analysis presented here indicates that the SARS-CoV-2 cellular tropism predictions are accurate enough for estimating the potential susceptibility of different cells to SARS-CoV-2 infection; however, it appears that not all susceptible cells may be infected in patients with COVID-19.
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Affiliation(s)
- Anna A. Valyaeva
- School of Bioengineering and BioinformaticsLomonosov Moscow State UniversityMoscowRussia,Belozersky Institute of Physico‐Chemical BiologyLomonosov Moscow State UniversityMoscowRussia
| | - Anastasia A. Zharikova
- School of Bioengineering and BioinformaticsLomonosov Moscow State UniversityMoscowRussia,Belozersky Institute of Physico‐Chemical BiologyLomonosov Moscow State UniversityMoscowRussia
| | - Eugene V. Sheval
- School of Bioengineering and BioinformaticsLomonosov Moscow State UniversityMoscowRussia,Belozersky Institute of Physico‐Chemical BiologyLomonosov Moscow State UniversityMoscowRussia,Department of Cell Biology and Histology, School of BiologyLomonosov Moscow State UniversityMoscowRussia
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17
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Abstract
COVID-19 can cause acute kidney injury and may cause or exacerbate chronic kidney diseases, including glomerular diseases. SARS-CoV-2 infection of kidney cells has been reported, but it remains unclear if viral infection of kidney cells causes disease. The most important causes of kidney injury in patients with COVID-19 include impaired renal perfusion and immune dysregulation. Chronic kidney disease, especially kidney failure with kidney replacement therapy and kidney transplant, is associated with markedly increased COVID-19 mortality. Persons with severe kidney disease have been excluded from most clinical trials of COVID-19 therapies, so therapeutic approaches must be extrapolated from studies of patients without kidney disease. Some medications used to treat COVID-19 should be avoided or used at reduced dosages in patients with severe kidney disease and in kidney transplant recipients. Additional research is needed to determine the optimal strategies to prevent and treat COVID-19 in patients with kidney disease.
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Affiliation(s)
- Maureen Brogan
- Division of Nephrology, Department of Medicine, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, New York, USA;
| | - Michael J Ross
- Division of Nephrology, Department of Medicine, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, New York, USA; .,Department of Developmental and Molecular Biology, Albert Einstein College of Medicine, Bronx, New York, USA
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18
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McNicholas BA, Rezoagli E, Simpkin AJ, Khanna S, Suen JY, Yeung P, Brodie D, Li Bassi G, Pham T, Bellani G, Fraser JF, Laffey J. Epidemiology and outcomes of early-onset AKI in COVID-19-related ARDS in comparison with non-COVID-19-related ARDS: insights from two prospective global cohort studies. Crit Care 2023; 27:3. [PMID: 36604753 PMCID: PMC9814373 DOI: 10.1186/s13054-022-04294-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Accepted: 12/25/2022] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Acute kidney injury (AKI) is a frequent and severe complication of both COVID-19-related acute respiratory distress syndrome (ARDS) and non-COVID-19-related ARDS. The COVID-19 Critical Care Consortium (CCCC) has generated a global data set on the demographics, management and outcomes of critically ill COVID-19 patients. The LUNG-SAFE study was an international prospective cohort study of patients with severe respiratory failure, including ARDS, which pre-dated the pandemic. METHODS The incidence, demographic profile, management and outcomes of early AKI in patients undergoing invasive mechanical ventilation for COVID-19-related ARDS were described and compared with AKI in a non-COVID-19-related ARDS cohort. RESULTS Of 18,964 patients in the CCCC data set, 1699 patients with COVID-19-related ARDS required invasive ventilation and had relevant outcome data. Of these, 110 (6.5%) had stage 1, 94 (5.5%) had stage 2, 151 (8.9%) had stage 3 AKI, while 1214 (79.1%) had no AKI within 48 h of initiating invasive mechanical ventilation. Patients developing AKI were older and more likely to have hypertension or chronic cardiac disease. There were geo-economic differences in the incidence of AKI, with lower incidence of stage 3 AKI in European high-income countries and a higher incidence in patients from middle-income countries. Both 28-day and 90-day mortality risk was increased for patients with stage 2 (HR 2.00, p < 0.001) and stage 3 AKI (HR 1.95, p < 0.001). Compared to non-COVID-19 ARDS, the incidence of shock was reduced with lower cardiovascular SOFA score across all patient groups, while hospital mortality was worse in all groups [no AKI (30 vs 50%), Stage 1 (38 vs 58%), Stage 2 (56 vs 74%), and Stage 3 (52 vs 72%), p < 0.001]. The time profile of onset of AKI also differed, with 56% of all AKI occurring in the first 48 h in patients with COVID-19 ARDS compared to 89% in the non-COVID-19 ARDS population. CONCLUSION AKI is a common and serious complication of COVID-19, with a high mortality rate, which differs by geo-economic location. Important differences exist in the profile of AKI in COVID-19 versus non-COVID-19 ARDS in terms of their haemodynamic profile, time of onset and clinical outcomes.
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Affiliation(s)
- Bairbre A. McNicholas
- grid.412440.70000 0004 0617 9371Department of Anaesthesia and Intensive Care Medicine, School of Medicine, Clinical Sciences Institute, University of Galway, Galway University Hospital, Saolta Hospital Group, Galway, H91 YR71 Ireland ,School of Medicine, University of Galway, Galway, Ireland
| | - Emanuele Rezoagli
- grid.7563.70000 0001 2174 1754School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy ,grid.415025.70000 0004 1756 8604Department of Emergency and Intensive Care, San Gerardo University Hospital, Monza, Italy
| | | | - Sankalp Khanna
- grid.1024.70000000089150953Queensland University of Technology, Brisbane, Australia ,grid.467740.60000 0004 0466 9684CSIRO Australian e-Health Research Centre AU, Herston, Australia
| | - Jacky Y. Suen
- grid.1024.70000000089150953Queensland University of Technology, Brisbane, Australia ,grid.1003.20000 0000 9320 7537University of Queensland, Brisbane, Australia
| | - Pauline Yeung
- grid.194645.b0000000121742757Department of Medicine, The University of Hong Kong and Queen Mary Hospital, Hong Kong, Hong Kong China
| | - Daniel Brodie
- grid.413734.60000 0000 8499 1112Department of Medicine, Columbia College of Physicians and Surgeons, and Center for Acute Respiratory Failure, New-York-Presbyterian Hospital, New York, NY USA
| | - Gianluigi Li Bassi
- grid.1024.70000000089150953Queensland University of Technology, Brisbane, Australia ,grid.1003.20000 0000 9320 7537University of Queensland, Brisbane, Australia
| | - Tai Pham
- grid.413784.d0000 0001 2181 7253Service de Médecine Intensive-Réanimation, AP-HP, Hôpital de Bicêtre, Hôpitaux Universitaires Paris-Saclay, Le Kremlin-Bicêtre, France ,grid.460789.40000 0004 4910 6535UVSQ, Inserm U1018, Equipe d’Epidémiologie Respiratoire Intégrative, Université Paris-Saclay, Villejuif, France
| | - Giacomo Bellani
- grid.7563.70000 0001 2174 1754School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy ,grid.415025.70000 0004 1756 8604Department of Emergency and Intensive Care, San Gerardo University Hospital, Monza, Italy
| | - John F. Fraser
- grid.1024.70000000089150953Queensland University of Technology, Brisbane, Australia ,grid.1003.20000 0000 9320 7537University of Queensland, Brisbane, Australia
| | - John Laffey
- grid.412440.70000 0004 0617 9371Department of Anaesthesia and Intensive Care Medicine, School of Medicine, Clinical Sciences Institute, University of Galway, Galway University Hospital, Saolta Hospital Group, Galway, H91 YR71 Ireland ,School of Medicine, University of Galway, Galway, Ireland
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19
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Lin L, Deng J, Tan W, Li J, Wu Z, Zheng L, Yang J. Pathogenesis and histological changes of nephropathy associated with COVID-19. J Med Virol 2023; 95:e28311. [PMID: 36377540 DOI: 10.1002/jmv.28311] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Revised: 11/01/2022] [Accepted: 11/10/2022] [Indexed: 11/16/2022]
Abstract
Coronavirus disease 2019 (COVID-19) can cause damage to multiple organ, not only to the lungs, but also to the kidneys. Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) can cause acute and chronic kidney disease through direct viral infection, indirect injury, and vaccination-related injury. Like lung injury, kidney injury is also an important aspect affecting the severity and prognosis of SARS-CoV-2. This article summarizes the pathogenesis, pathological manifestations, and clinical features of SARS-CoV-2 direct or indirect renal injury. Including direct injury, indirect injury, special comorbidities (receiving kidney transplantation and chronic kidney disease), and vaccine-related renal injury, and exploring the possible therapeutic effect of anti-SARS-CoV-2 therapy on renal injury. The purpose is to provide reference for understanding COVID-19-related renal injury, guiding clinical and pathological diagnosis and treatment, and evaluating prognosis.
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Affiliation(s)
- Lirong Lin
- Department of Nephrology, The Third Affiliated Hospital of Chongqing Medical University (Gener Hospital), Chongqing, China
| | - Junhui Deng
- Department of Nephrology, The Third Affiliated Hospital of Chongqing Medical University (Gener Hospital), Chongqing, China
| | - Wei Tan
- Department of Nephrology, The Third Affiliated Hospital of Chongqing Medical University (Gener Hospital), Chongqing, China
| | - Jie Li
- Department of Nephrology, Yongchuan People's Hospital of Chongqing, Chongqing, China
| | - Zhifeng Wu
- Department of Nephrology, The Third Affiliated Hospital of Chongqing Medical University (Gener Hospital), Chongqing, China
| | - Luquan Zheng
- Department of Nephrology, The Third Affiliated Hospital of Chongqing Medical University (Gener Hospital), Chongqing, China
| | - Jurong Yang
- Department of Nephrology, The Third Affiliated Hospital of Chongqing Medical University (Gener Hospital), Chongqing, China
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20
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Zheng Z, Li X, Nie K, Wang X, Liang W, Yang F, Zheng K, Zheng Y. Identification of berberine as a potential therapeutic strategy for kidney clear cell carcinoma and COVID-19 based on analysis of large-scale datasets. Front Immunol 2023; 14:1038651. [PMID: 37033923 PMCID: PMC10076552 DOI: 10.3389/fimmu.2023.1038651] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Accepted: 03/14/2023] [Indexed: 04/11/2023] Open
Abstract
Background Regarding the global coronavirus disease 2019 (COVID)-19 pandemic, kidney clear cell carcinoma (KIRC) has acquired a higher infection probability and may induce fatal complications and death following COVID-19 infection. However, effective treatment strategies remain unavailable. Berberine exhibits significant antiviral and antitumour effects. Thus, this study aimed to provide a promising and reliable therapeutic strategy for clinical decision-making by exploring the therapeutic mechanism of berberine against KIRC/COVID-19. Methods Based on large-scale data analysis, the target genes, clinical risk, and immune and pharmacological mechanisms of berberine against KIRC/COVID-19 were systematically investigated. Results In total, 1,038 and 12,992 differentially expressed genes (DEGs) of COVID-19 and KIRC, respectively, were verified from Gene Expression Omnibus and The Cancer Genome Atlas databases, respectively, and 489 berberine target genes were obtained from official websites. After intersecting, 26 genes were considered potential berberine therapeutic targets for KIRC/COVID-19. Berberine mechanism of action against KIRC/COVID-19 was revealed by protein-protein interaction, gene ontology, and Kyoto Encyclopedia of Genes and Genomes with terms including protein interaction, cell proliferation, viral carcinogenesis, and the PI3K/Akt signalling pathway. In COVID-19 patients, ACOX1, LRRK2, MMP8, SLC1A3, CPT1A, H2AC11, H4C8, and SLC1A3 were closely related to disease severity, and the general survival of KIRC patients was closely related to ACOX1, APP, CPT1A, PLK1, and TYMS. Additionally, the risk signature accurately and sensitively depicted the overall survival and patient survival status for KIRC. Numerous neutrophils were enriched in the immune system of COVID-19 patients, and the lives of KIRC patients were endangered due to significant immune cell infiltration. Molecular docking studies indicated that berberine binds strongly to target proteins. Conclusion This study demonstrated berberine as a potential treatment option in pharmacological, immunological, and clinical practice. Moreover, its therapeutic effects may provide potential and reliable treatment options for patients with KIRC/COVID-19.
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Affiliation(s)
- Zhihua Zheng
- Department of Nephrology, Shenzhen Traditional Chinese Medicine Hospital, The Fourth Clinical Medical College of Guangzhou University of Chinese Medicine, Shenzhen, Guangdong, China
| | - Xiushen Li
- Shenzhen Key Laboratory, Shenzhen University General Hospital, Shenzhen, Guangdong, China
| | - Kechao Nie
- Department of Gastroenterology, The Second Xiangya Hospital of Central South University, Changsha, Hunan, China
| | - Xiaoyu Wang
- Department of Nephrology, Health College of Guangdong Pharmaceutical University, Guangzhou, Guangdong, China
| | - Wencong Liang
- Department of Nephrology, Shenzhen Traditional Chinese Medicine Hospital, The Fourth Clinical Medical College of Guangzhou University of Chinese Medicine, Shenzhen, Guangdong, China
| | - Fuxia Yang
- Department of Nephrology, Shenzhen Traditional Chinese Medicine Hospital, The Fourth Clinical Medical College of Guangzhou University of Chinese Medicine, Shenzhen, Guangdong, China
| | - Kairi Zheng
- Traditional Chinese Medicine Department, Peking University Shenzhen Hospital, Shenzhen, Guangdong, China
- *Correspondence: Kairi Zheng, ; Yihou Zheng,
| | - Yihou Zheng
- Department of Nephrology, Shenzhen Traditional Chinese Medicine Hospital, The Fourth Clinical Medical College of Guangzhou University of Chinese Medicine, Shenzhen, Guangdong, China
- *Correspondence: Kairi Zheng, ; Yihou Zheng,
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21
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Kim GH, Jun JB. Altered Serum Uric Acid Levels in Kidney Disorders. LIFE (BASEL, SWITZERLAND) 2022; 12:life12111891. [PMID: 36431026 PMCID: PMC9692609 DOI: 10.3390/life12111891] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Revised: 11/07/2022] [Accepted: 11/13/2022] [Indexed: 11/17/2022]
Abstract
Serum uric acid levels are altered by kidney disorders because the kidneys play a dominant role in uric acid excretion. Here, major kidney disorders which accompany hyperuricemia or hypouricemia, including their pathophysiology, are discussed. Chronic kidney disease (CKD) and hyperuricemia are frequently associated, but recent clinical trials have not supported the pathogenic roles of hyperuricemia in CKD incidence and progression. Diabetes mellitus (DM) is often associated with hyperuricemia, and hyperuricemia may be associated with an increased risk of diabetic kidney disease in patients with type 2 DM. Sodium-glucose cotransporter 2 inhibitors have a uricosuric effect and can relieve hyperuricemia in DM. Autosomal dominant tubulointerstitial kidney disease (ADTKD) is an important hereditary kidney disease, mainly caused by mutations of uromodulin (UMOD) or mucin-1 (MUC-1). Hyperuricemia and gout are the major clinical manifestations of ADTKD-UMOD and ADTKD-MUC1. Renal hypouricemia is caused by URAT1 or GLUT9 loss-of-function mutations and renders patients susceptible to exercise-induced acute kidney injury, probably because of excessive urinary uric acid excretion. Hypouricemia derived from renal uric acid wasting is a component of Fanconi syndrome, which can be hereditary or acquired. During treatment for human immunodeficiency virus, hepatitis B or cytomegalovirus, tenofovir, adefovir, and cidofovir may cause drug-induced renal Fanconi syndrome. In coronavirus disease 2019, hypouricemia due to proximal tubular injury is related to disease severity, including respiratory failure. Finally, serum uric acid and the fractional excretion of uric acid are indicative of plasma volume status; hyperuricemia caused by the enhanced uric acid reabsorption can be induced by volume depletion, and hypouricemia caused by an increased fractional excretion of uric acid is the characteristic finding in syndromes of inappropriate anti-diuresis, cerebral/renal salt wasting, and thiazide-induced hyponatremia. Molecular mechanisms by which uric acid transport is dysregulated in volume or water balance disorders need to be investigated.
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Affiliation(s)
- Gheun-Ho Kim
- Department of Internal Medicine, Hanyang University College of Medicine, Seoul 04763, Republic of Korea
- Correspondence: ; Tel.: +82-2-2290-8318
| | - Jae-Bum Jun
- Department of Rheumatology, Hanyang University Hospital for Rheumatic Diseases, Seoul 04763, Republic of Korea
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22
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Medeiros T, Alves LS, Cabral-Castro MJ, Silva ARO, Xavier AR, Burger D, Almeida JR, Silva AA. Exploring Urinary Extracellular Vesicles and Immune Mediators as Biomarkers of Kidney Injury in COVID-19 Hospitalized Patients. Diagnostics (Basel) 2022; 12:diagnostics12112600. [PMID: 36359444 PMCID: PMC9689919 DOI: 10.3390/diagnostics12112600] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Revised: 10/11/2022] [Accepted: 10/20/2022] [Indexed: 11/16/2022] Open
Abstract
Kidney injury is an important outcome associated with COVID-19 severity. In this regard, alterations in urinary extracellular vesicles (uEVs) could be detected in the early phases of renal injury and may be reflective of the inflammatory process. This is an observational study performed with a case series of COVID-19 hospitalized patients presenting mild-to-critical disease. Total and podocyte-derived uEVs were identified by nanoscale flow cytometry, and urinary immune mediators were assessed by a multiplex assay. We studied 36 patients, where 24 (66.7%) were considered as mild/moderate and 12 (33.3%) as severe/critical. Increased levels of total uEVs were observed (p = 0.0001). Importantly, total uEVs were significantly higher in severe/critical patients who underwent hemodialysis (p = 0.03) and were able to predict this clinical outcome (AUC 0.93, p = 0.02). Severe/critical patients also presented elevated urinary levels (p < 0.05) of IL-1β, IL-4, IL-6, IL-7, IL-16, IL-17A, LIF, CCL-2, CCL-3, CCL-11, CXCL-10, FGFb, M-CSF, and CTAcK. Lastly, we observed that total uEVs were associated with urinary immune mediators. In conclusion, our results show that early alterations in urinary EVs could identify patients at higher risk of developing renal dysfunction in COVID-19. This could also be relevant in different scenarios of systemic and/or infectious disease.
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Affiliation(s)
- Thalia Medeiros
- Multiuser Laboratory for Research Support in Nephrology and Medical Sciences (LAMAP), Faculty of Medicine, Universidade Federal Fluminense, Niterói 24033-900, Rio de Janeiro, Brazil
- Department of Pathology, Faculty of Medicine, Universidade Federal Fluminense, Niterói 24033-900, Rio de Janeiro, Brazil
- Correspondence: (T.M.); (A.A.S.); Tel.: +55-21-3674-7282 (A.A.S.)
| | - Lilian Santos Alves
- Multiuser Laboratory for Research Support in Nephrology and Medical Sciences (LAMAP), Faculty of Medicine, Universidade Federal Fluminense, Niterói 24033-900, Rio de Janeiro, Brazil
| | - Mauro Jorge Cabral-Castro
- Multiuser Laboratory for Research Support in Nephrology and Medical Sciences (LAMAP), Faculty of Medicine, Universidade Federal Fluminense, Niterói 24033-900, Rio de Janeiro, Brazil
- Instituto de Microbiologia Paulo de Góes, Universidade Federal do Rio de Janeiro, Rio de Janeiro 21941-901, Rio de Janeiro, Brazil
| | - Alice Ramos Oliveira Silva
- Multiuser Laboratory for Research Support in Nephrology and Medical Sciences (LAMAP), Faculty of Medicine, Universidade Federal Fluminense, Niterói 24033-900, Rio de Janeiro, Brazil
| | - Analúcia Rampazzo Xavier
- Multiuser Laboratory for Research Support in Nephrology and Medical Sciences (LAMAP), Faculty of Medicine, Universidade Federal Fluminense, Niterói 24033-900, Rio de Janeiro, Brazil
- Department of Pathology, Faculty of Medicine, Universidade Federal Fluminense, Niterói 24033-900, Rio de Janeiro, Brazil
| | - Dylan Burger
- Kidney Research Centre, Department of Cellular and Molecular Medicine, The Ottawa Hospital Research Institute, University of Ottawa, Ottawa, ON K1H 8M5, Canada
| | - Jorge Reis Almeida
- Multiuser Laboratory for Research Support in Nephrology and Medical Sciences (LAMAP), Faculty of Medicine, Universidade Federal Fluminense, Niterói 24033-900, Rio de Janeiro, Brazil
- Department of Clinical Medicine; Faculty of Medicine, Universidade Federal Fluminense, Niterói 24033-900, Rio de Janeiro, Brazil
| | - Andrea Alice Silva
- Multiuser Laboratory for Research Support in Nephrology and Medical Sciences (LAMAP), Faculty of Medicine, Universidade Federal Fluminense, Niterói 24033-900, Rio de Janeiro, Brazil
- Department of Pathology, Faculty of Medicine, Universidade Federal Fluminense, Niterói 24033-900, Rio de Janeiro, Brazil
- Correspondence: (T.M.); (A.A.S.); Tel.: +55-21-3674-7282 (A.A.S.)
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23
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Virus-Associated Nephropathies: A Narrative Review. Int J Mol Sci 2022; 23:ijms231912014. [PMID: 36233315 PMCID: PMC9569621 DOI: 10.3390/ijms231912014] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Revised: 09/23/2022] [Accepted: 10/06/2022] [Indexed: 12/13/2022] Open
Abstract
While most viral infections cause mild symptoms and a spontaneous favorable resolution, some can lead to severe or protracted manifestations, specifically in immunocompromised hosts. Kidney injuries related to viral infections may have multiple causes related to the infection severity, drug toxicity or direct or indirect viral-associated nephropathy. We review here the described virus-associated nephropathies in order to guide diagnosis strategies and treatments in cases of acute kidney injury (AKI) occurring concomitantly with a viral infection. The occurrence of virus-associated nephropathy depends on multiple factors: the local epidemiology of the virus, its ability to infect renal cells and the patient's underlying immune response, which varies with the state of immunosuppression. Clear comprehension of pathophysiological mechanisms associated with a summary of described direct and indirect injuries should help physicians to diagnose and treat viral associated nephropathies.
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24
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Frere JJ, Serafini RA, Pryce KD, Zazhytska M, Oishi K, Golynker I, Panis M, Zimering J, Horiuchi S, Hoagland DA, Møller R, Ruiz A, Kodra A, Overdevest JB, Canoll PD, Borczuk AC, Chandar V, Bram Y, Schwartz R, Lomvardas S, Zachariou V, tenOever BR. SARS-CoV-2 infection in hamsters and humans results in lasting and unique systemic perturbations after recovery. Sci Transl Med 2022; 14:eabq3059. [PMID: 35857629 PMCID: PMC9210449 DOI: 10.1126/scitranslmed.abq3059] [Citation(s) in RCA: 114] [Impact Index Per Article: 57.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Accepted: 05/27/2022] [Indexed: 12/14/2022]
Abstract
The host response to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection can result in prolonged pathologies collectively referred to as post-acute sequalae of COVID-19 (PASC) or long COVID. To better understand the mechanism underlying long COVID biology, we compared the short- and long-term systemic responses in the golden hamster after either SARS-CoV-2 or influenza A virus (IAV) infection. Results demonstrated that SARS-CoV-2 exceeded IAV in its capacity to cause permanent injury to the lung and kidney and uniquely affected the olfactory bulb (OB) and olfactory epithelium (OE). Despite a lack of detectable infectious virus, the OB and OE demonstrated myeloid and T cell activation, proinflammatory cytokine production, and an interferon response that correlated with behavioral changes extending a month after viral clearance. These sustained transcriptional changes could also be corroborated from tissue isolated from individuals who recovered from COVID-19. These data highlight a molecular mechanism for persistent COVID-19 symptomology and provide a small animal model to explore future therapeutics.
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Affiliation(s)
- Justin J. Frere
- Department of Microbiology, Icahn School of Medicine at Mount Sinai, New York, NY 10029
- Department of Microbiology, New York University, Grossman School of Medicine, New York, NY 10016
| | - Randal A. Serafini
- Department of Neuroscience, Icahn School of Medicine at Mount Sinai, New York, NY 10029
| | - Kerri D. Pryce
- Department of Neuroscience, Icahn School of Medicine at Mount Sinai, New York, NY 10029
| | - Marianna Zazhytska
- Mortimer B. Zuckerman Mind, Brain and Behavior Institute, Columbia University, New York, NY 10027
| | - Kohei Oishi
- Department of Microbiology, New York University, Grossman School of Medicine, New York, NY 10016
| | - Ilona Golynker
- Department of Microbiology, New York University, Grossman School of Medicine, New York, NY 10016
| | - Maryline Panis
- Department of Microbiology, New York University, Grossman School of Medicine, New York, NY 10016
| | - Jeffrey Zimering
- Department of Neuroscience, Icahn School of Medicine at Mount Sinai, New York, NY 10029
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, NY 10029
| | - Shu Horiuchi
- Department of Microbiology, New York University, Grossman School of Medicine, New York, NY 10016
| | | | - Rasmus Møller
- Department of Microbiology, New York University, Grossman School of Medicine, New York, NY 10016
| | - Anne Ruiz
- Department of Neuroscience, Icahn School of Medicine at Mount Sinai, New York, NY 10029
| | - Albana Kodra
- Mortimer B. Zuckerman Mind, Brain and Behavior Institute, Columbia University, New York, NY 10027
| | - Jonathan B. Overdevest
- Department of Otolaryngology- Head and Neck Surgery, Columbia University Irving Medical Center, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY 10032
| | - Peter D. Canoll
- Department of Pathology and Cell Biology, Columbia University Irving Medical Center, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY 10032
| | - Alain C. Borczuk
- Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, New York, NY 10021
| | - Vasuretha Chandar
- Department of Physiology, Biophysics, and Systems Biology, Weill Cornell Medicine, New York, NY 10021
| | - Yaron Bram
- Department of Physiology, Biophysics, and Systems Biology, Weill Cornell Medicine, New York, NY 10021
| | - Robert Schwartz
- Department of Physiology, Biophysics, and Systems Biology, Weill Cornell Medicine, New York, NY 10021
- Division of Gastroenterology and Hepatology, Department of Medicine, Weill Cornell Medicine, New York, NY 10021
| | - Stavros Lomvardas
- Mortimer B. Zuckerman Mind, Brain and Behavior Institute, Columbia University, New York, NY 10027
| | - Venetia Zachariou
- Department of Neuroscience, Icahn School of Medicine at Mount Sinai, New York, NY 10029
| | - Benjamin R. tenOever
- Department of Microbiology, New York University, Grossman School of Medicine, New York, NY 10016
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25
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Vergara A, Wang K, Colombo D, Gheblawi M, Rasmuson J, Mandal R, Del Nonno F, Chiu B, Scholey JW, Soler MJ, Wishart DS, Oudit GY. Urinary angiotensin-converting enzyme 2 and metabolomics in COVID-19-mediated kidney injury. Clin Kidney J 2022; 16:272-284. [PMID: 36751625 PMCID: PMC9494506 DOI: 10.1093/ckj/sfac215] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2022] [Indexed: 11/13/2022] Open
Abstract
Background Angiotensin-converting enzyme 2 (ACE2), the receptor for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), is highly expressed in the kidneys. Beyond serving as a crucial endogenous regulator of the renin-angiotensin system, ACE2 also possess a unique function to facilitate amino acid absorption. Our observational study sought to explore the relationship between urine ACE2 (uACE2) and renal outcomes in coronavirus disease 2019 (COVID-19). Methods In a cohort of 104 patients with COVID-19 without acute kidney injury (AKI), 43 patients with COVID-19-mediated AKI and 36 non-COVID-19 controls, we measured uACE2, urine tumour necrosis factor receptors I and II (uTNF-RI and uTNF-RII) and neutrophil gelatinase-associated lipocalin (uNGAL). We also assessed ACE2 staining in autopsy kidney samples and generated a propensity score-matched subgroup of patients to perform a targeted urine metabolomic study to describe the characteristic signature of COVID-19. Results uACE2 is increased in patients with COVID-19 and further increased in those that developed AKI. After adjusting uACE2 levels for age, sex and previous comorbidities, increased uACE2 was independently associated with a >3-fold higher risk of developing AKI [odds ratio 3.05 (95% confidence interval 1.23‒7.58), P = .017]. Increased uACE2 corresponded to a tubular loss of ACE2 in kidney sections and strongly correlated with uTNF-RI and uTNF-RII. Urine quantitative metabolome analysis revealed an increased excretion of essential amino acids in patients with COVID-19, including leucine, isoleucine, tryptophan and phenylalanine. Additionally, a strong correlation was observed between urine amino acids and uACE2. Conclusions Elevated uACE2 is related to AKI in patients with COVID-19. The loss of tubular ACE2 during SARS-CoV-2 infection demonstrates a potential link between aminoaciduria and proximal tubular injury.
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Affiliation(s)
- Ander Vergara
- Department of Medicine, Division of Cardiology, University of Alberta, Edmonton, Alberta, Canada,Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, Alberta, Canada
| | - Kaiming Wang
- Department of Medicine, Division of Cardiology, University of Alberta, Edmonton, Alberta, Canada,Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, Alberta, Canada
| | - Daniele Colombo
- Department of Pathology, National Institute for Infectious Diseases “Lazzaro Spallanzani,” IRCCS, Rome, Italy
| | - Mahmoud Gheblawi
- Department of Medicine, Division of Cardiology, University of Alberta, Edmonton, Alberta, Canada,Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, Alberta, Canada
| | - Jaslyn Rasmuson
- Department of Medicine, Division of Cardiology, University of Alberta, Edmonton, Alberta, Canada,Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, Alberta, Canada
| | - Rupasri Mandal
- Metabolomics Innovation Center, University of Alberta, Edmonton, Alberta, Canada
| | - Franca Del Nonno
- Department of Pathology, National Institute for Infectious Diseases “Lazzaro Spallanzani,” IRCCS, Rome, Italy
| | - Brian Chiu
- Department of Laboratory Medicine and Pathology, University of Alberta Hospital, Edmonton, Alberta, Canada
| | - James W Scholey
- Department of Medicine, Division of Nephrology, University Health Network, Toronto, Ontario, Canada
| | - María José Soler
- Department of Nephrology, Vall d’Hebron University Hospital, Barcelona, Spain,Nephrology and Transplantation Research Group, Vall d’Hebron Research Institute, Barcelona, Spain
| | - David S Wishart
- Metabolomics Innovation Center, University of Alberta, Edmonton, Alberta, Canada
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26
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Gnanenthiran SR, Borghi C, Burger D, Caramelli B, Charchar F, Chirinos JA, Cohen JB, Cremer A, Di Tanna GL, Duvignaud A, Freilich D, Gommans DHF, Gracia-Ramos AE, Murray TA, Pelorosso F, Poulter NR, Puskarich MA, Rizas KD, Rothlin R, Schlaich MP, Schreinlecher M, Steckelings UM, Sharma A, Stergiou GS, Tignanelli CJ, Tomaszewski M, Unger T, van Kimmenade RRJ, Wainford RD, Williams B, Rodgers A, Schutte AE. Renin-Angiotensin System Inhibitors in Patients With COVID-19: A Meta-Analysis of Randomized Controlled Trials Led by the International Society of Hypertension. J Am Heart Assoc 2022; 11:e026143. [PMID: 36000426 PMCID: PMC9496439 DOI: 10.1161/jaha.122.026143] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Background Published randomized controlled trials are underpowered for binary clinical end points to assess the safety and efficacy of renin‐angiotensin system inhibitors (RASi) in adults with COVID‐19. We therefore performed a meta‐analysis to assess the safety and efficacy of RASi in adults with COVID‐19. Methods and Results MEDLINE, EMBASE, ClinicalTrials.gov, and the Cochrane Controlled Trial Register were searched for randomized controlled trials that randomly assigned patients with COVID‐19 to RASi continuation/commencement versus no RASi therapy. The primary outcome was all‐cause mortality at ≤30 days. A total of 14 randomized controlled trials met the inclusion criteria and enrolled 1838 participants (aged 59 years, 58% men, mean follow‐up 26 days). Of the trials, 11 contributed data. We found no effect of RASi versus control on all‐cause mortality (7.2% versus 7.5%; relative risk [RR], 0.95; [95% CI, 0.69–1.30]) either overall or in subgroups defined by COVID‐19 severity or trial type. Network meta‐analysis identified no difference between angiotensin‐converting enzyme inhibitors versus angiotensin II receptor blockers. RASi users had a nonsignificant reduction in acute myocardial infarction (2.1% versus 3.6%; RR, 0.59; [95% CI, 0.33–1.06]), but increased risk of acute kidney injury (7.0% versus 3.6%; RR, 1.82; [95% CI, 1.05–3.16]), in trials that initiated and continued RASi. There was no increase in need for dialysis or differences in congestive cardiac failure, cerebrovascular events, venous thromboembolism, hospitalization, intensive care admission, inotropes, or mechanical ventilation. Conclusions This meta‐analysis of randomized controlled trials evaluating angiotensin‐converting enzyme inhibitors/angiotensin II receptor blockers versus control in patients with COVID‐19 found no difference in all‐cause mortality, a borderline decrease in myocardial infarction, and an increased risk of acute kidney injury with RASi. Our findings provide strong evidence that RASi can be used safely in patients with COVID‐19.
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Affiliation(s)
- Sonali R Gnanenthiran
- The George Institute for Global Health University of New South Wales Sydney NSW Australia
| | - Claudio Borghi
- Department of Medical and Surgical Sciences University of Bologna Italy
| | - Dylan Burger
- Department of Cellular and Molecular Medicine, Kidney Research Centre, Ottawa Hospital Research Institute University of Ottawa Canada
| | - Bruno Caramelli
- Interdisciplinary Medicine in Cardiology Unit, InCor University of Sao Paulo Brazil
| | - Fadi Charchar
- School of Health and Life Sciences Federation University Australia Ballarat VIC Australia
| | - Julio A Chirinos
- Division of Cardiovascular Medicine University of Pennsylvania Perelman School of Medicine Philadelphia PA
| | - Jordana B Cohen
- Renal-Electrolyte and Hypertension Division and Department of Biostatistics, Epidemiology, and Informatics University of Pennsylvania Perelman School of Medicine Philadelphia PA
| | - Antoine Cremer
- Department of Cardiology and Hypertension, Hypertension Excellence Center Hôpital Saint André, Centre Hospitalier Universitaire de Bordeaux & University Bordeaux Bordeaux France
| | - Gian Luca Di Tanna
- The George Institute for Global Health University of New South Wales Sydney NSW Australia
| | - Alexandre Duvignaud
- Department of Infectious Diseases and Tropical Medicine, Division of Tropical Medicine and Clinical International Health Hôpital Pellegrin, Centre Hospitalier Universitaire de Bordeaux & University Bordeaux Bordeaux France
| | | | - D H Frank Gommans
- Department of Cardiology Radboud University Medical Center Nijmegen The Netherlands.,Netherlands Heart Institute Utrecht The Netherlands
| | - Abraham E Gracia-Ramos
- Departamento de Medicina Interna, Hospital General, Centro Médico Nacional "La Raza" Instituto Mexicano del Seguro Social Mexico City Mexico.,Departamento de Medicina Interna Hospital Regional de Alta Especialidad de Zumpango Estado de Mexico Mexico
| | - Thomas A Murray
- Division of Biostatistics, School of Public Health University of Minnesota Minneapolis MN
| | - Facundo Pelorosso
- Asociacion Argentina de Medicamentos Ciudad Autonoma de Buenos Aires Argentina.,Servicio de Anatomía Patologica, Hospital de Alta Complejidad El Calafate SAMIC Santa Cruz Argentina
| | - Neil R Poulter
- Imperial Clinical Trials Unit Imperial College London London UK
| | - Michael A Puskarich
- Department of Emergency Medicine Hennepin County Medical Center University of Minnesota Minneapolis MN
| | - Konstantinos D Rizas
- Medizinische Klinik und Poliklinik I Ludwig Maximilian University Hospital Munich Munich Germany
| | - Rodolfo Rothlin
- Asociacion Argentina de Medicamentos Ciudad Autonoma de Buenos Aires Argentina.,Sociedad Argentina de Farmacología Clínica, Asociacion Medica Argentina Buenos Aires Argentina
| | - Markus P Schlaich
- Dobney Hypertension Centre, Medical School, Royal Perth Hospital Unit-Royal Perth Hospital Medical Research Foundation University of Western Australia Perth Australia
| | - Michael Schreinlecher
- Department of Internal Medicine III, Cardiology and Angiology Medical University of Innsbruck Innsbruck Austria
| | | | - Abhinav Sharma
- Division of Cardiology McGill University Health Centre Montreal Quebec Canada
| | - George S Stergiou
- Hypertension Center STRIDE-7, School of Medicine, Third Department of Medicine, Sotiria Hospital National and Kapodistrian University of Athens Athens Greece
| | | | - Maciej Tomaszewski
- Division of Cardiovascular Sciences, Faculty of Medicine, Biology and Health University of Manchester Manchester UK.,Manchester Academic Health Science Centre Manchester University National Health Service Foundation Trust Manchester Manchester UK
| | - Thomas Unger
- Cardiovascular Research Institute Maastricht-School for Cardiovascular Diseases Maastricht University Maastricht The Netherlands
| | - Roland R J van Kimmenade
- Department of Cardiology Radboud University Medical Center Nijmegen The Netherlands.,Netherlands Heart Institute Utrecht The Netherlands
| | - Richard D Wainford
- Department of Pharmacology and Experimental Therapeutics and the Whitaker Cardiovascular Institute Boston University School of Medicine Boston MA
| | - Bryan Williams
- Institute of Cardiovascular Science University College London and National Institute for Health Research University College London Hospitals Biomedical Research Centre London UK
| | - Anthony Rodgers
- The George Institute for Global Health University of New South Wales Sydney NSW Australia
| | - Aletta E Schutte
- The George Institute for Global Health University of New South Wales Sydney NSW Australia
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27
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Chen Z, Chen C, Chen F, Lan R, Lin G, Xu Y. Bioinformatics analysis of potential pathogenesis and risk genes of immunoinflammation-promoted renal injury in severe COVID-19. Front Immunol 2022; 13:950076. [PMID: 36052061 PMCID: PMC9424635 DOI: 10.3389/fimmu.2022.950076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2022] [Accepted: 07/22/2022] [Indexed: 12/02/2022] Open
Abstract
Renal injury secondary to COVID-19 is an important factor for the poor prognosis of COVID-19 patients. The pathogenesis of renal injury caused by aberrant immune inflammatory of COVID-19 remains unclear. In this study, a total of 166 samples from 4 peripheral blood transcriptomic datasets of COVID-19 patients were integrated. By using the weighted gene co-expression network (WGCNA) algorithm, we identified key genes for mild, moderate, and severe COVID-19. Subsequently, taking these genes as input genes, we performed Short Time-series Expression Miner (STEM) analysis in a time consecutive ischemia-reperfusion injury (IRI) -kidney dataset to identify genes associated with renal injury in COVID-19. The results showed that only in severe COVID-19 there exist a small group of genes associated with the progression of renal injury. Gene enrichment analysis revealed that these genes are involved in extensive immune inflammation and cell death-related pathways. A further protein-protein interaction (PPI) network analysis screened 15 PPI-hub genes: ALOX5, CD38, GSF3R, LGR, RPR1, HCK, ITGAX, LYN, MAPK3, NCF4, SELP, SPI1, WAS, TLR2 and TLR4. Single-cell sequencing analysis indicated that PPI-hub genes were mainly distributed in neutrophils, macrophages, and dendritic cells. Intercellular ligand-receptor analysis characterized the activated ligand-receptors between these immune cells and parenchyma cells in depth. And KEGG enrichment analysis revealed that viral protein interaction with cytokine and cytokine receptor, necroptosis, and Toll-like receptor signaling pathway may be potentially essential for immune cell infiltration leading to COVID-19 renal injury. Finally, we validated the expression pattern of PPI-hub genes in an independent data set by random forest. In addition, we found that the high expression of these genes was correlated with a low glomerular filtration rate. Including them as risk genes in lasso regression, we constructed a Nomogram model for predicting severe COVID-19. In conclusion, our study explores the pathogenesis of renal injury promoted by immunoinflammatory in severe COVID-19 and extends the clinical utility of its key genes.
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Affiliation(s)
- Zhimin Chen
- Department of Nephrology, Blood Purification Research Center, The First Affiliated Hospital, Fujian Medical University, Fuzhou, China
- Research Center for Metabolic Chronic Kidney Disease, The First Affiliated Hospital, Fujian Medical University, Fuzhou, China
| | - Caiming Chen
- Department of Nephrology, Blood Purification Research Center, The First Affiliated Hospital, Fujian Medical University, Fuzhou, China
- Research Center for Metabolic Chronic Kidney Disease, The First Affiliated Hospital, Fujian Medical University, Fuzhou, China
| | - Fengbin Chen
- Department of Traditional Chinese Medicine, The First Affiliated Hospital, Fujian Medical University, Fuzhou, China
| | - Ruilong Lan
- Central Laboratory, The First Affiliated Hospital, Fujian Medical University, Fuzhou, China
| | - Guo Lin
- Department of Intensive Care Unit, The First Affiliated Hospital, Fujian Medical University, Fuzhou, China
| | - Yanfang Xu
- Department of Nephrology, Blood Purification Research Center, The First Affiliated Hospital, Fujian Medical University, Fuzhou, China
- Research Center for Metabolic Chronic Kidney Disease, The First Affiliated Hospital, Fujian Medical University, Fuzhou, China
- Central Laboratory, The First Affiliated Hospital, Fujian Medical University, Fuzhou, China
- *Correspondence: Yanfang Xu,
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28
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Lin L, Tian E, Ren J, Wu Z, Deng J, Yang J. Traditional Chinese Medicine in Treating Primary Podocytosis: From Fundamental Science to Clinical Research. Front Pharmacol 2022; 13:932739. [PMID: 36003509 PMCID: PMC9393213 DOI: 10.3389/fphar.2022.932739] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2022] [Accepted: 06/23/2022] [Indexed: 11/30/2022] Open
Abstract
Podocytes form a key component of the glomerular filtration barrier. Damage to podocytes is referred to as “podocyte disease.” There are many causes of podocyte injury, including primary injury, secondary injury, and gene mutations. Primary podocytosis mostly manifests as nephrotic syndrome. At present, first-line treatment is based on glucocorticoid administration combined with immunosuppressive therapy, but some patients still progress to end-stage renal disease. In Asia, especially in China, traditional Chinese medicine (TCM) still plays an important role in the treatment of kidney diseases. This study summarizes the potential mechanism of TCM and its active components in protecting podocytes, such as repairing podocyte injury, inhibiting podocyte proliferation, reducing podocyte apoptosis and excretion, maintaining podocyte skeleton structure, and upregulating podocyte-related protein expression. At the same time, the clinical efficacy of TCM in the treatment of primary podocytosis (including idiopathic membranous nephropathy, minimal change disease, and focal segmental glomerulosclerosis) is summarized to support the development of new treatment strategies for primary podocytosis.
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Affiliation(s)
- Lirong Lin
- Department of Nephrology, The Third Affiliated Hospital of Chongqing Medical University (General Hospital), Chongqing, China
| | - En Tian
- Department of Nephrology, The Third Affiliated Hospital of Chongqing Medical University (General Hospital), Chongqing, China
| | - Jiangwen Ren
- Department of Nephrology, Rheumatism and Immunology, Jiulongpo District People’s Hospital of Chongqing, Chongqing, China
| | - Zhifeng Wu
- Department of Nephrology, The Third Affiliated Hospital of Chongqing Medical University (General Hospital), Chongqing, China
| | | | - Jurong Yang
- Department of Nephrology, The Third Affiliated Hospital of Chongqing Medical University (General Hospital), Chongqing, China
- *Correspondence: Jurong Yang,
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29
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Medeiros T, Guimarães GMC, Carvalho FR, Alves LS, Faustino R, Campi-Azevedo AC, Peruhype-Magalhães V, Teixeira-Carvalho A, de Souza Gomes M, Rodrigues do Amaral L, Martins-Filho OA, Lugon JR, Almeida JR, Silva AA. Acute kidney injury associated to COVID-19 leads to a strong unbalance of circulant immune mediators. Cytokine 2022; 157:155974. [PMID: 35907365 PMCID: PMC9309102 DOI: 10.1016/j.cyto.2022.155974] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Revised: 05/02/2022] [Accepted: 07/19/2022] [Indexed: 12/23/2022]
Abstract
BACKGROUND Severe cases of coronavirus disease 2019 (COVID-19) have increased risk for acute kidney injury (AKI). The exacerbation of the immune response seems to contribute to AKI development, but the immunopathological process is not completely understood. OBJECTIVES To analyze levels of circulant immune mediators in COVID-19 patients evolving with or without AKI. We have also investigated possible associations of these mediators with viral load and clinical outcomes. METHODS This is a longitudinal study performed with hospitalized patients with moderate to severe COVID-19. Serum levels of 27 immune mediators were measured by a multiplex immunoassay. Data were analyzed at two timepoints during the follow-up: within the first 13 days of the disease onset (early sample) and from the 14th day to death or hospital discharge (follow-up sample). RESULTS We studied 82 COVID-19 patients (59.5 ± 17.5 years, 54.9% male). Of these, 34 (41.5%) developed AKI. These patients presented higher SARS-CoV-2 viral load (P = 0.03), higher frequency of diabetes (P = 0.01) and death (P = 0.0004). Overall, AKI patients presented significantly higher and sustained levels (P < 0.05) of CCL-2, CCL-3, CCL-4, CXCL-8, CXCL-10, IFN-γ, IL-2, IL-6, TNF-α, IL-1Ra, IL-10 and VEGF. Importantly, higher levels of CCL-2, CXCL-10, IL-2, TNF-α, IL-10, FGFb, and VEGF were observed in AKI patients independently of death. ROC curves demonstrated that early alterations in CCL-2, CXCL-8, CXCL-10, IFN-γ, IL-6, IL-1Ra and IL-10 show a good predictive value regarding AKI development. Lastly, immune mediators were significantly associated with each other and with SARS-CoV-2 viral load in AKI patients. CONCLUSIONS COVID-19 associated AKI is accompanied by substantial alterations in circulant levels of immune mediators, which could significantly contribute to the establishment of kidney injury.
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Affiliation(s)
- Thalia Medeiros
- Multiuser Laboratory for Research Support in Nephrology and Medical Sciences (LAMAP), Hospital Universitario Antonio Pedro, Faculty of Medicine, Universidade Federal Fluminense, Niteroi, Rio de Janeiro, Brazil; Department of Pathology, Faculty of Medicine, Universidade Federal Fluminense, Niterói, Rio de Janeiro, Brazil.
| | - Gabriel Macedo Costa Guimarães
- Multiuser Laboratory for Research Support in Nephrology and Medical Sciences (LAMAP), Hospital Universitario Antonio Pedro, Faculty of Medicine, Universidade Federal Fluminense, Niteroi, Rio de Janeiro, Brazil
| | - Fabiana Rabe Carvalho
- Multiuser Laboratory for Research Support in Nephrology and Medical Sciences (LAMAP), Hospital Universitario Antonio Pedro, Faculty of Medicine, Universidade Federal Fluminense, Niteroi, Rio de Janeiro, Brazil
| | - Lilian Santos Alves
- Multiuser Laboratory for Research Support in Nephrology and Medical Sciences (LAMAP), Hospital Universitario Antonio Pedro, Faculty of Medicine, Universidade Federal Fluminense, Niteroi, Rio de Janeiro, Brazil
| | - Renan Faustino
- Multiuser Laboratory for Research Support in Nephrology and Medical Sciences (LAMAP), Hospital Universitario Antonio Pedro, Faculty of Medicine, Universidade Federal Fluminense, Niteroi, Rio de Janeiro, Brazil
| | | | | | | | - Matheus de Souza Gomes
- Laboratory of Bioinformatics and Molecular Analysis (LBAM), Federal University of Uberlandia, Patos de Minas, Minas Gerais, Brazil
| | - Laurence Rodrigues do Amaral
- Laboratory of Bioinformatics and Molecular Analysis (LBAM), Federal University of Uberlandia, Patos de Minas, Minas Gerais, Brazil
| | | | - Jocemir Ronaldo Lugon
- Multiuser Laboratory for Research Support in Nephrology and Medical Sciences (LAMAP), Hospital Universitario Antonio Pedro, Faculty of Medicine, Universidade Federal Fluminense, Niteroi, Rio de Janeiro, Brazil; Department of Clinical Medicine - Nephrology, Faculty of Medicine, Universidade Federal Fluminense, Niteroi, Rio de Janeiro, Brazil
| | - Jorge Reis Almeida
- Multiuser Laboratory for Research Support in Nephrology and Medical Sciences (LAMAP), Hospital Universitario Antonio Pedro, Faculty of Medicine, Universidade Federal Fluminense, Niteroi, Rio de Janeiro, Brazil; Department of Clinical Medicine - Nephrology, Faculty of Medicine, Universidade Federal Fluminense, Niteroi, Rio de Janeiro, Brazil
| | - Andrea Alice Silva
- Multiuser Laboratory for Research Support in Nephrology and Medical Sciences (LAMAP), Hospital Universitario Antonio Pedro, Faculty of Medicine, Universidade Federal Fluminense, Niteroi, Rio de Janeiro, Brazil; Department of Pathology, Faculty of Medicine, Universidade Federal Fluminense, Niterói, Rio de Janeiro, Brazil.
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30
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Killian JT, Houp JA, Burkholder GA, Roman Soto SA, Killian AC, Ong SC, Erdmann NB, Goepfert PA, Hauptfeld-Dolejsek V, Leal SM, Zumaquero E, Nellore A, Agarwal G, Kew CE, Orandi BJ, Locke JE, Porrett PM, Levitan EB, Kumar V, Lund FE. COVID-19 Vaccination and Remdesivir are Associated With Protection From New or Increased Levels of Donor-Specific Antibodies Among Kidney Transplant Recipients Hospitalized With COVID-19. Transpl Int 2022; 35:10626. [PMID: 35928347 PMCID: PMC9343962 DOI: 10.3389/ti.2022.10626] [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: 05/08/2022] [Accepted: 06/20/2022] [Indexed: 02/05/2023]
Abstract
Alloimmune responses in kidney transplant (KT) patients previously hospitalized with COVID-19 are understudied. We analyzed a cohort of 112 kidney transplant recipients who were hospitalized following a positive SARS-CoV-2 test result during the first 20 months of the COVID-19 pandemic. We found a cumulative incidence of 17% for the development of new donor-specific antibodies (DSA) or increased levels of pre-existing DSA in hospitalized SARS-CoV-2-infected KT patients. This risk extended 8 months post-infection. These changes in DSA status were associated with late allograft dysfunction. Risk factors for new or increased DSA responses in this KT patient cohort included the presence of circulating DSA pre-COVID-19 diagnosis and time post-transplantation. COVID-19 vaccination prior to infection and remdesivir administration during infection were each associated with decreased likelihood of developing a new or increased DSA response. These data show that new or enhanced DSA responses frequently occur among KT patients requiring admission with COVID-19 and suggest that surveillance, vaccination, and antiviral therapies may be important tools to prevent alloimmunity in these individuals.
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Affiliation(s)
- John T. Killian
- Department of Surgery, Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Julie A. Houp
- Department of Surgery, Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Greer A. Burkholder
- Department of Medicine, Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Salomon A. Roman Soto
- Department of Surgery, Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, AL, United States
| | - A. Cozette Killian
- Department of Surgery, Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Song C. Ong
- Department of Medicine, Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Nathaniel B. Erdmann
- Department of Medicine, Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Paul A. Goepfert
- Department of Medicine, Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Vera Hauptfeld-Dolejsek
- Department of Surgery, Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Sixto M. Leal
- Department of Pathology, Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Esther Zumaquero
- Department of Microbiology, Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Anoma Nellore
- Department of Medicine, Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Gaurav Agarwal
- Department of Medicine, Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Clifton E. Kew
- Department of Medicine, Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Babak J. Orandi
- Department of Surgery, Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Jayme E. Locke
- Department of Surgery, Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Paige M. Porrett
- Department of Surgery, Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Emily B. Levitan
- School of Public Health, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Vineeta Kumar
- Department of Medicine, Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Frances E. Lund
- Department of Microbiology, Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, AL, United States,*Correspondence: Frances E. Lund,
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31
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Robertson JL, Senger RS, Talty J, Du P, Sayed-Issa A, Avellar ML, Ngo LT, Gomez De La Espriella M, Fazili TN, Jackson-Akers JY, Guruli G, Orlando G. Alterations in the molecular composition of COVID-19 patient urine, detected using Raman spectroscopic/computational analysis. PLoS One 2022; 17:e0270914. [PMID: 35849572 PMCID: PMC9292080 DOI: 10.1371/journal.pone.0270914] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Accepted: 06/17/2022] [Indexed: 11/30/2022] Open
Abstract
We developed and tested a method to detect COVID-19 disease, using urine specimens. The technology is based on Raman spectroscopy and computational analysis. It does not detect SARS-CoV-2 virus or viral components, but rather a urine ‘molecular fingerprint’, representing systemic metabolic, inflammatory, and immunologic reactions to infection. We analyzed voided urine specimens from 46 symptomatic COVID-19 patients with positive real time-polymerase chain reaction (RT-PCR) tests for infection or household contact with test-positive patients. We compared their urine Raman spectra with urine Raman spectra from healthy individuals (n = 185), peritoneal dialysis patients (n = 20), and patients with active bladder cancer (n = 17), collected between 2016–2018 (i.e., pre-COVID-19). We also compared all urine Raman spectra with urine specimens collected from healthy, fully vaccinated volunteers (n = 19) from July to September 2021. Disease severity (primarily respiratory) ranged among mild (n = 25), moderate (n = 14), and severe (n = 7). Seventy percent of patients sought evaluation within 14 days of onset. One severely affected patient was hospitalized, the remainder being managed with home/ambulatory care. Twenty patients had clinical pathology profiling. Seven of 20 patients had mildly elevated serum creatinine values (>0.9 mg/dl; range 0.9–1.34 mg/dl) and 6/7 of these patients also had estimated glomerular filtration rates (eGFR) <90 mL/min/1.73m2 (range 59–84 mL/min/1.73m2). We could not determine if any of these patients had antecedent clinical pathology abnormalities. Our technology (Raman Chemometric Urinalysis—Rametrix®) had an overall prediction accuracy of 97.6% for detecting complex, multimolecular fingerprints in urine associated with COVID-19 disease. The sensitivity of this model for detecting COVID-19 was 90.9%. The specificity was 98.8%, the positive predictive value was 93.0%, and the negative predictive value was 98.4%. In assessing severity, the method showed to be accurate in identifying symptoms as mild, moderate, or severe (random chance = 33%) based on the urine multimolecular fingerprint. Finally, a fingerprint of ‘Long COVID-19’ symptoms (defined as lasting longer than 30 days) was located in urine. Our methods were able to locate the presence of this fingerprint with 70.0% sensitivity and 98.7% specificity in leave-one-out cross-validation analysis. Further validation testing will include sampling more patients, examining correlations of disease severity and/or duration, and employing metabolomic analysis (Gas Chromatography–Mass Spectrometry [GC-MS], High Performance Liquid Chromatography [HPLC]) to identify individual components contributing to COVID-19 molecular fingerprints.
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Affiliation(s)
- John L. Robertson
- Department of Biomedical Engineering and Mechanics, College of Engineering, Virginia Tech, Blacksburg, Virginia, United States of America
- Section of Nephrology, Wake Forest University School of Medicine, Winston-Salem, North Carolina, United States of America
- DialySensors Incorporated, Blacksburg, Virginia, United States of America
- * E-mail:
| | - Ryan S. Senger
- DialySensors Incorporated, Blacksburg, Virginia, United States of America
- Department of Biological Systems Engineering, College of Life Sciences and Agriculture, Virginia Tech, Blacksburg, Virginia, United States of America
- Department of Chemical Engineering, College of Engineering, Virginia Tech, Blacksburg, Virginia, United States of America
| | - Janine Talty
- Clinical Biomechanics and Orthopedic Medicine, Roanoke, Virginia, United States of America
| | - Pang Du
- DialySensors Incorporated, Blacksburg, Virginia, United States of America
- Department of Statistics, College of Science, Virginia Tech, Blacksburg, Virginia, United States of America
| | - Amr Sayed-Issa
- DialySensors Incorporated, Blacksburg, Virginia, United States of America
| | - Maggie L. Avellar
- DialySensors Incorporated, Blacksburg, Virginia, United States of America
- Department of Biological Systems Engineering, College of Life Sciences and Agriculture, Virginia Tech, Blacksburg, Virginia, United States of America
| | - Lacey T. Ngo
- DialySensors Incorporated, Blacksburg, Virginia, United States of America
| | | | - Tasaduq N. Fazili
- Internal Medicine/Infectious Disease, Carilion Clinic, Roanoke, Virginia, United States of America
| | - Jasmine Y. Jackson-Akers
- Internal Medicine/Infectious Disease, Carilion Clinic, Roanoke, Virginia, United States of America
| | - Georgi Guruli
- Division of Surgical Urology/Urologic Oncology, Department of Surgery, Virginia Commonwealth University, Richmond, Virginia, United States of America
| | - Giuseppe Orlando
- Department of Surgery, Wake Forest University School of Medicine, Winston-Salem, North Carolina, United States of America
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32
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Abstract
Initial reporting suggested that kidney involvement following COVID-19 infection was uncommon but this is now known not to be the case. Acute kidney injury (AKI) may arise through several mechanisms and complicate up to a quarter of patients hospitalized with COVID-19 infection being associated with an increased risk for both morbidity and death. Mechanisms of injury include direct kidney damage predominantly through tubular injury, although glomerular injury has been reported; the consequences of the treatment of patients with severe hypoxic respiratory failure; secondary infection; and exposure to nephrotoxic drugs. The mainstay of treatment remains the prevention of worsening kidney damage and in some cases they need for renal replacement therapies (RRT). Although the use of other blood purification techniques has been proposed as potential treatments, results to-date have not been definitive.
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Affiliation(s)
- James Hilton
- Department of Critical Care, Royal Surrey Hospital, Egerton Road, Guildford, Surrey GU2 7XX, UK; SPACeR Group (Surrey Peri-Operative, Anaesthesia & Critical Care Collaborative Research Group), Royal Surrey Hospital, Egerton Road, Guildford, Surrey GU2 7XX, UK
| | - Naomi Boyer
- Department of Critical Care, Royal Surrey Hospital, Egerton Road, Guildford, Surrey GU2 7XX, UK; SPACeR Group (Surrey Peri-Operative, Anaesthesia & Critical Care Collaborative Research Group), Royal Surrey Hospital, Egerton Road, Guildford, Surrey GU2 7XX, UK
| | - Mitra K Nadim
- Division of Nephrology and Hypertension, Department of Medicine, Keck School of Medicine, University of Southern California, 1520 San Pablo Street, Suite 4300, Los Angeles, CA 90033, USA
| | - Lui G Forni
- Department of Critical Care, Royal Surrey Hospital, Egerton Road, Guildford, Surrey GU2 7XX, UK; SPACeR Group (Surrey Peri-Operative, Anaesthesia & Critical Care Collaborative Research Group), Royal Surrey Hospital, Egerton Road, Guildford, Surrey GU2 7XX, UK; Department of Clinical & Experimental Medicine, Faculty of Health Sciences, University of Surrey, Stag Hill, Guildford GU2 7XH, UK.
| | - John A Kellum
- Center for Critical Care Nephrology, University of Pittsburgh, 3347 Forbes Avenue #220, Pittsburgh, PA 15213, USA
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33
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Gómez Preciado F, De Carvalho Ovalles RA, Codina S, Donadeu L, Favà A, Martinez Valenzuela L, Sandoval D, Fernández-Cidón B, Bestard O, Alia-Ramos P, Gomà M, Melilli E, Cruzado JM. Collapsing Glomerulonephritis in a Kidney Transplant Recipient after mRNA SARS-CoV-2 Vaccination. J Clin Med 2022; 11:jcm11133651. [PMID: 35806939 PMCID: PMC9267596 DOI: 10.3390/jcm11133651] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Revised: 06/20/2022] [Accepted: 06/23/2022] [Indexed: 11/16/2022] Open
Abstract
With the vaccination against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), studies are describing cases of glomerulonephritis arising after vaccination. We present the first case of a kidney transplant patient who, after mRNA vaccination against SARS-CoV-2, developed nephrotic proteinuria and renal dysfunction, with a biopsy diagnostic of collapsing glomerulonephritis. No other triggers for this glomerulonephritis were identified. Antibodies against the spike protein were negative, but the patient developed a specific T-cell response. The close time between vaccination and the proteinuria suggests a possible determinant role of vaccination. We should be aware of nephropathies appearing after COVID-19 vaccination in kidney transplant recipients also.
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Affiliation(s)
- Francisco Gómez Preciado
- Department of Nephrology, Hospital Universitari de Bellvitge (HUB), 08907 Barcelona, Spain; (F.G.P.); (S.C.); (A.F.); (L.M.V.); (D.S.)
| | | | - Sergi Codina
- Department of Nephrology, Hospital Universitari de Bellvitge (HUB), 08907 Barcelona, Spain; (F.G.P.); (S.C.); (A.F.); (L.M.V.); (D.S.)
| | - Laura Donadeu
- Laboratory of Nephrology and Transplantation, Vall d’Hebron Institut de Recerca (VHIR), Vall d’Hebron Barcelona Hospital Campus, Universitat Autònoma de Barcelona, 08035 Barcelona, Spain;
| | - Alexandre Favà
- Department of Nephrology, Hospital Universitari de Bellvitge (HUB), 08907 Barcelona, Spain; (F.G.P.); (S.C.); (A.F.); (L.M.V.); (D.S.)
| | - Laura Martinez Valenzuela
- Department of Nephrology, Hospital Universitari de Bellvitge (HUB), 08907 Barcelona, Spain; (F.G.P.); (S.C.); (A.F.); (L.M.V.); (D.S.)
| | - Diego Sandoval
- Department of Nephrology, Hospital Universitari de Bellvitge (HUB), 08907 Barcelona, Spain; (F.G.P.); (S.C.); (A.F.); (L.M.V.); (D.S.)
| | - Bárbara Fernández-Cidón
- Clinical Laboratory, IDIBELL-Hospital Universitari de Bellvitge, L’Hospitalet de Llobregat, 08908 Barcelona, Spain; (B.F.-C.); (P.A.-R.)
| | - Oriol Bestard
- Kidney Transplant Unit, Nephrology Department, Vall d’Hebron Hospital Universitari, 08035 Barcelona, Spain;
| | - Pedro Alia-Ramos
- Clinical Laboratory, IDIBELL-Hospital Universitari de Bellvitge, L’Hospitalet de Llobregat, 08908 Barcelona, Spain; (B.F.-C.); (P.A.-R.)
| | - Montserrat Gomà
- Pathology Department, Hospital Universitari de Bellvitge (HUB), 08907 Barcelona, Spain; (R.A.D.C.O.); (M.G.)
| | - Edoardo Melilli
- Department of Nephrology, Hospital Universitari de Bellvitge (HUB), 08907 Barcelona, Spain; (F.G.P.); (S.C.); (A.F.); (L.M.V.); (D.S.)
- Biomedical Research Institute (IDIBELL), Hospital Duran i Reynals, L’Hospitalet de Llobregat, 08907 Barcelona, Spain
- Correspondence: (E.M.); (J.M.C.)
| | - Josep M Cruzado
- Department of Nephrology, Hospital Universitari de Bellvitge (HUB), 08907 Barcelona, Spain; (F.G.P.); (S.C.); (A.F.); (L.M.V.); (D.S.)
- Biomedical Research Institute (IDIBELL), Hospital Duran i Reynals, L’Hospitalet de Llobregat, 08907 Barcelona, Spain
- School of Medicine and Health Sciencies, University of Barcelona, L’Hospitalet de Llobregat, 08907, Barcelona, Spain
- Correspondence: (E.M.); (J.M.C.)
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34
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McAdams MC, Xu P, Saleh SN, Li M, Ostrosky-Frid M, Gregg LP, Willett DL, Velasco F, Lehmann CU, Hedayati SS. Risk Prediction for Acute Kidney Injury in Patients Hospitalized With COVID-19. Kidney Med 2022; 4:100463. [PMID: 35434597 PMCID: PMC8990440 DOI: 10.1016/j.xkme.2022.100463] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Abstract
Rationale & Objective Acute kidney injury (AKI) is common in patients hospitalized with COVID-19, but validated, predictive models for AKI are lacking. We aimed to develop the best predictive model for AKI in hospitalized patients with coronavirus disease 2019 and assess its performance over time with the emergence of vaccines and the Delta variant. Study Design Longitudinal cohort study. Setting & Participants Hospitalized patients with a positive severe acute respiratory syndrome coronavirus 2 polymerase chain reaction result between March 1, 2020, and August 20, 2021 at 19 hospitals in Texas. Exposures Comorbid conditions, baseline laboratory data, inflammatory biomarkers. Outcomes AKI defined by KDIGO (Kidney Disease: Improving Global Outcomes) creatinine criteria. Analytical Approach Three nested models for AKI were built in a development cohort and validated in 2 out-of-time cohorts. Model discrimination and calibration measures were compared among cohorts to assess performance over time. Results Of 10,034 patients, 5,676, 2,917, and 1,441 were in the development, validation 1, and validation 2 cohorts, respectively, of whom 776 (13.7%), 368 (12.6%), and 179 (12.4%) developed AKI, respectively (P = 0.26). Patients in the validation cohort 2 had fewer comorbid conditions and were younger than those in the development cohort or validation cohort 1 (mean age, 54 ± 16.8 years vs 61.4 ± 17.5 and 61.7 ± 17.3 years, respectively, P < 0.001). The validation cohort 2 had higher median high-sensitivity C-reactive protein level (81.7 mg/L) versus the development cohort (74.5 mg/L; P < 0.01) and higher median ferritin level (696 ng/mL) versus both the development cohort (444 ng/mL) and validation cohort 1 (496 ng/mL; P < 0.001). The final model, which added high-sensitivity C-reactive protein, ferritin, and D-dimer levels, had an area under the curve of 0.781 (95% CI, 0.763-0.799). Compared with the development cohort, discrimination by area under the curve (validation 1: 0.785 [0.760-0.810], P = 0.79, and validation 2: 0.754 [0.716-0.795], P = 0.53) and calibration by estimated calibration index (validation 1: 0.116 [0.041-0.281], P = 0.11, and validation 2: 0.081 [0.045-0.295], P = 0.11) showed stable performance over time. Limitations Potential billing and coding bias. Conclusions We developed and externally validated a model to accurately predict AKI in patients with coronavirus disease 2019. The performance of the model withstood changes in practice patterns and virus variants.
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Affiliation(s)
- Meredith C. McAdams
- Division of Nephrology, Department of Medicine, University of Texas Southwestern Medical Center, Dallas, TX
| | - Pin Xu
- Division of Nephrology, Department of Medicine, University of Texas Southwestern Medical Center, Dallas, TX
| | - Sameh N. Saleh
- Clinical Informatics Center, University of Texas Southwestern Medical Center, Dallas, TX
| | - Michael Li
- University of Texas Southwestern College of Medicine, Dallas, TX
| | - Mauricio Ostrosky-Frid
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX
| | - L. Parker Gregg
- Selzman Institute for Kidney Health, Section of Nephrology, Department of Medicine, Baylor College of Medicine, Houston, TX
- Section of Nephrology, Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX
- Veterans Affairs Health Services Research and Development Center for Innovations in Quality, Effectiveness, and Safety, Houston, TX
| | - Duwayne L. Willett
- Division of Cardiology, Department of Medicine, University of Texas Southwestern Medical Center, Dallas, TX
| | | | - Christoph U. Lehmann
- Clinical Informatics Center, University of Texas Southwestern Medical Center, Dallas, TX
| | - S. Susan Hedayati
- Division of Nephrology, Department of Medicine, University of Texas Southwestern Medical Center, Dallas, TX
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Savedchuk S, Raslan R, Nystrom S, Sparks MA. Emerging Viral Infections and the Potential Impact on Hypertension, Cardiovascular Disease, and Kidney Disease. Circ Res 2022; 130:1618-1641. [PMID: 35549373 DOI: 10.1161/circresaha.122.320873] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Viruses are ubiquitous in the environment and continue to have a profound impact on human health and disease. The COVID-19 pandemic has highlighted this with impressive morbidity and mortality affecting the world's population. Importantly, the link between viruses and hypertension, cardiovascular disease, and kidney disease has resulted in a renewed focus and attention on this potential relationship. The virus responsible for COVID-19, SARS-CoV-2, has a direct link to one of the major enzymatic regulatory systems connected to blood pressure control and hypertension pathogenesis, the renin-angiotensin system. This is because the entry point for SARS-CoV-2 is the ACE2 (angiotensin-converting enzyme 2) protein. ACE2 is one of the main enzymes responsible for dampening the primary effector peptide Ang II (angiotensin II), metabolizing it to Ang-(1-7). A myriad of clinical questions has since emerged and are covered in this review. Several other viruses have been linked to hypertension, cardiovascular disease, and kidney health. Importantly, patients with high-risk apolipoprotein L1 (APOL1) alleles are at risk for developing the kidney lesion of collapsing glomerulopathy after viral infection. This review will highlight several emerging viruses and their potential unique tropisms for the kidney and cardiovascular system. We focus on SARS-CoV-2 as this body of literature in regards to cardiovascular disease has advanced significantly since the COVID-19 pandemic.
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Affiliation(s)
- Solomiia Savedchuk
- Division of Nephrology, Department of Medicine, Duke University School of Medicine, Durham, NC (S.S., S.N., M.A.S.)
| | - Rasha Raslan
- Internal Medicine, Virginia Commonwealth University, Richmond (R.R.)
| | - Sarah Nystrom
- Division of Nephrology, Department of Medicine, Duke University School of Medicine, Durham, NC (S.S., S.N., M.A.S.)
| | - Matthew A Sparks
- Division of Nephrology, Department of Medicine, Duke University School of Medicine, Durham, NC (S.S., S.N., M.A.S.)
- Renal Section, Durham VA Health Care System, NC (M.A.S.)
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Menez S, Parikh CR. COVID-19 and the Kidney: Recent Advances and Controversies. Semin Nephrol 2022; 42:151279. [PMID: 36435682 PMCID: PMC9579187 DOI: 10.1016/j.semnephrol.2022.10.005] [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] [Indexed: 01/27/2023]
Abstract
Kidney involvement is common in coronavirus disease-2019 (COVID-19), and our understanding of the effects of COVID-19 on short- and long-term kidney outcomes has evolved over the course of the pandemic. Initial key questions centered on the spectrum and degree of acute kidney injury (AKI) in patients hospitalized with severe COVID-19. Investigators worldwide have explored the association between COVID-19-associated AKI and short-term outcomes, including inpatient mortality and disease severity. Even as treatments evolved, vaccinations were developed, and newer viral variants arose, subsets of patients were identified as at continued high risk for major adverse kidney outcomes. In this review, we explore key topics of continued relevance including the following: (1) a comparison of COVID-19-associated AKI with AKI developing in other clinical settings; (2) the ongoing controversy over kidney tropism in the setting of COVID-19 and the potential for competitive binding of the severe acute respiratory syndrome coronavirus 2 virus with angiotensin converting enzyme-2 to prevent viral cell entry; and (3) the identification of high-risk patients for adverse outcomes to inform long-term outpatient management. Patients at particularly high risk for adverse kidney outcomes include those with APOL1 high-risk genotype status. Biomarkers of injury, inflammation, tubular health, and repair measured in both the blood and urine may hold prognostic significance.
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Affiliation(s)
| | - Chirag R. Parikh
- Address reprint requests to Chirag R. Parikh, MD, PhD, Division of Nephrology, Johns Hopkins University School of Medicine, 1830 E Monument St, Suite 416, Baltimore, MD 21287
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[Acute kidney injury and COVID-19: lung-kidney crosstalk during severe inflammation]. Med Klin Intensivmed Notfmed 2022; 117:342-348. [PMID: 35476144 PMCID: PMC9044389 DOI: 10.1007/s00063-022-00919-3] [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: 03/30/2022] [Accepted: 03/31/2022] [Indexed: 12/15/2022]
Abstract
Eine mit der Coronaviruserkrankung 2019 (COVID-19) assoziierte Nierenschädigung ist vor allem bei Intensivpatient:innen ein häufiges Phänomen. Das Virus selbst dürfte im Sinne eines direkten Befalls der Niere nur in geringem Ausmaß eine Rolle spielen, die mit einer schweren COVID-19-Erkrankungen assoziierte pathologische Entzündungsreaktion dagegen sehr wohl. Einen wesentlichen Einfluss haben die Folgen der invasiven Beatmung und das durch COVID-19 verursachte Acute Respiratory Distress Syndrome (ARDS). Hohe Beatmungsdrücke wirken sich negativ auf die Nierenperfusion aus und können so zur Entstehung einer AKI beitragen. Die durch das ARDS verursachte Entzündungsreaktion sowie die für COVID-19 typische endotheliale Dysfunktion in Kombination mit einer Hyperkoagulabilität sind weitere Faktoren, die die Nierenfunktion negativ beeinflussen können.
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Nystrom SE, Li G, Datta S, Soldano K, Silas D, Weins A, Hall G, Thomas DB, Olabisi OA. JAK inhibitor blocks COVID-19-cytokine-induced JAK-STAT-APOL1 signaling in glomerular cells and podocytopathy in human kidney organoids. JCI Insight 2022; 7:157432. [PMID: 35472001 PMCID: PMC9220952 DOI: 10.1172/jci.insight.157432] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Accepted: 04/20/2022] [Indexed: 11/17/2022] Open
Abstract
COVID-19 infection causes collapse of glomerular capillaries and loss of podocytes, culminating in a severe kidney disease called COVID-19–associated nephropathy (COVAN). The underlying mechanism of COVAN is unknown. We hypothesized that cytokines induced by COVID-19 trigger expression of pathogenic APOL1 via JAK/STAT signaling, resulting in podocyte loss and COVAN phenotype. Here, based on 9 biopsy-proven COVAN cases, we demonstrated for the first time, to the best of our knowledge, that APOL1 protein was abundantly expressed in podocytes and glomerular endothelial cells (GECs) of COVAN kidneys but not in controls. Moreover, a majority of patients with COVAN carried 2 APOL1 risk alleles. We show that recombinant cytokines induced by SARS-CoV-2 acted synergistically to drive APOL1 expression through the JAK/STAT pathway in primary human podocytes, GECs, and kidney micro-organoids derived from a carrier of 2 APOL1 risk alleles, but expression was blocked by a JAK1/2 inhibitor, baricitinib. We demonstrate that cytokine-induced JAK/STAT/APOL1 signaling reduced the viability of kidney organoid podocytes but was rescued by baricitinib. Together, our results support the conclusion that COVID-19–induced cytokines are sufficient to drive COVAN-associated podocytopathy via JAK/STAT/APOL1 signaling and that JAK inhibitors could block this pathogenic process. These findings suggest JAK inhibitors may have therapeutic benefits for managing cytokine-induced, APOL1-mediated podocytopathy.
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Affiliation(s)
- Sarah E Nystrom
- Division of Nephrology, Duke University School of Medicine, Durham, United States of America
| | - Guojie Li
- Division of Nephrology, Duke University School of Medicine, Durham, United States of America
| | - Somenath Datta
- Division of Nephrology, Duke University School of Medicine, Durham, United States of America
| | - Karen Soldano
- Division of Nephrology, Duke University School of Medicine, Durham, United States of America
| | - Daniel Silas
- Division of Nephrology, Duke University School of Medicine, Durham, United States of America
| | - Astrid Weins
- Department of Pathology, Brigham and Women's Hospital, Harvard Medical School, Boston, United States of America
| | - Gentzon Hall
- Division of Nephrology, Duke University School of Medicine, Durham, United States of America
| | - David B Thomas
- Department of Pathology, Nephrocor, Memphis, United States of America
| | - Opeyemi A Olabisi
- Division of Nephrology, Duke University School of Medicine, Durham, United States of America
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Shazley O, Shazley A, Alshazley M. Acute Bacterial Hemorrhagic Pyelonephritis in a COVID-19 Patient With a History of Hypothyroidism: A Case Report. Cureus 2022; 14:e21730. [PMID: 35251803 PMCID: PMC8887623 DOI: 10.7759/cureus.21730] [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] [Accepted: 01/30/2022] [Indexed: 11/20/2022] Open
Abstract
Since its initial reporting in December 2019, the novel coronavirus SARS-CoV-2 has emerged as a global health problem after its official declaration as a pandemic by the World Health Organization, with an estimated 346 million cases and over 5.9 million fatalities as of January 22, 2022. Studies on the prevalence of COVID-19 among severe cases have shown that comorbidities and risk factors such as obesity, increased aging, and chronic cardiovascular and respiratory diseases play a role in the severity of SARS-CoV-2 infections. The interactions between such factors and their involvement with the progression of infection and mortality remain unclear. While it is known that SARS-CoV-2 damages the lungs, various morbidities such as acute kidney disease and thyroid dysregulation have recently emerged in symptomatic COVID-19 patients. Conditions that alter thyroid hormones, which play a critical role in regulating metabolic pathways, have a role in the level of infectivity of the SARS-CoV-2. The capability of the SARS-CoV-2 to invade and affect any organ system is dependent on its access to the angiotensin-converting enzyme II (ACE2) commonly expressed among various host cells. This binding puts any system at high risk of direct viral injury, inevitably creating an excessively high concentration of anti-inflammatory mediators and cytokines to predispose COVID-19 patients to a state of severe immunosuppression. This case report describes a 62-year-old female who tested positive for COVID-19, with a medical history of hypothyroidism, who presented with a unique combination of acute bacterial hemorrhagic pyelonephritis and ureteral obstruction. She experienced intermittent dysuria, urinary urgency, and hematuria over the past five days. She developed chills, diaphoresis, nausea, and vomiting after administering acetaminophen for her headache. Ageusia and anosmia accompanied her respiratory illnesses despite receiving the Pfizer double dose vaccine six months before her arrival. A computerized tomography (CT) scan revealed severe to moderate inflammation surrounding the enlarged kidney with a 1 mm ureteral stone. Blood and urine cultures showed the growth of Escherichia coli gram-negative bacilli. Chest X-rays displayed a patchy appearance in the right infrahilar airspace, reflecting atelectasis in part for the diagnosis of COVID-19 with additional laboratory findings of profoundly elevated C-reactive protein, fibrinogen, and d-dimer levels. Abdominal CT scans revealed a hemorrhagic ureteral obstruction and massive swelling of the renal parenchyma persistent to pyelonephritis and hydronephrosis.
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Affiliation(s)
- Omar Shazley
- Basic Sciences, Saint James School of Medicine, Park Ridge, USA
| | - Ameer Shazley
- Basic Sciences, Saint James School of Medicine, Park Ridge, USA
| | - Moudar Alshazley
- Emergency Medicine, Internal Medicine, Santa Rosa Medical Center, Pensacola, USA
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Hassler L, Wysocki J, Gelarden I, Sharma I, Tomatsidou A, Ye M, Gula H, Nicolaescu V, Randall G, Pshenychnyi S, Khurram N, Kanwar Y, Missiakas D, Henkin J, Yeldandi A, Batlle D. A Novel Soluble ACE2 Protein Provides Lung and Kidney Protection in Mice Susceptible to Lethal SARS-CoV-2 Infection. J Am Soc Nephrol 2022; 33:1293-1307. [PMID: 35236774 PMCID: PMC9257820 DOI: 10.1681/asn.2021091209] [Citation(s) in RCA: 30] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Accepted: 02/06/2022] [Indexed: 11/03/2022] Open
Abstract
Background: Severe acute respiratory syndrome coronavirus type 2 (SARS-CoV-2) uses full-length angiotensin converting enzyme 2 (ACE2) as a main receptor to enter target cells. The goal of this study was to demonstrate the preclinical efficacy of a novel soluble ACE2 protein with increased duration of action and binding capacity in a lethal mouse model of COVID-19. Methods: A human soluble ACE2 variant fused with an albumin binding domain (ABD) was linked via a dimerization motif hinge-like 4-cysteine dodecapeptide (DDC) to improve binding capacity to SARS-CoV-2. This novel soluble ACE2 protein (ACE2 1-618-DDC-ABD) was then administered intranasally and intraperitoneally to mice prior to intranasal inoculation of SARS-CoV-2 and then for two additional days post viral inoculation. Results: Untreated animals became severely ill and all had to be humanely euthanized by day 6/7 and had pulmonary alveolar hemorrhage with mononuclear infiltrates. In contrast, all but one mouse infected with a lethal dose of SARS-CoV-2 that received ACE2-1-618-DDC-ABD survived. In the animals inoculated with SARS-CoV-2 that were untreated, viral titers were high in the lungs and brain but virus was absent in the kidneys. However, some untreated animals had variable degrees of kidney proximal tubular injury with increased NGAL and TUNEL staining indicating attenuation of the proximal tubular brush border. In contrast, viral titers in the lung and brain were reduced or non-detectable in mice that received ACE2 1-618 DDCABD, and the animals developed only moderate disease as assessed by a near-normal clinical score, minimal weight loss, and improved lung and kidney injury Conclusions: This study demonstrates the preclinical efficacy of a novel soluble ACE2 protein, termed ACE2 1- 618-DDC-ABD, in a lethal mouse model of SARS-CoV-2 infection that causes severe lung injury as well as variable degrees of moderate proximal tubular injury.
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Affiliation(s)
- Luise Hassler
- L Hassler, Division of Nephrology/Hypertension, Department of Medicine and the Department of Pathology, Northwestern University Feinberg School of Medicine, Chicago, United States
| | - Jan Wysocki
- J Wysocki, Division of Nephrology/Hypertension, Department of Medicine and the Department of Pathology, Northwestern University Feinberg School of Medicine, Chicago, United States
| | - Ian Gelarden
- I Gelarden, Division of Nephrology/Hypertension, Department of Medicine and the Department of Pathology, Northwestern University Feinberg School of Medicine, Chicago, United States
| | - Isha Sharma
- I Sharma, Division of Nephrology/Hypertension, Department of Medicine and the Department of Pathology, Northwestern University Feinberg School of Medicine, Chicago, United States
| | - Anastasia Tomatsidou
- A Tomatsidou, Department of Microbiology, The University of Chicago, Chicago, United States
| | - Minghao Ye
- M Ye, Division of Nephrology/Hypertension, Department of Medicine and the Department of Pathology, Northwestern University Feinberg School of Medicine, Chicago, United States
| | - Haley Gula
- H Gula, Department of Microbiology, The University of Chicago, Chicago, United States
| | - Vlad Nicolaescu
- V Nicolaescu, Department of Microbiology, The University of Chicago, Chicago, United States
| | - Glenn Randall
- G Randall, Department of Microbiology, The University of Chicago, Chicago, United States
| | - Sergii Pshenychnyi
- S Pshenychnyi, Recombinant Protein Production Core, Northwestern University, Evanston, United States
| | - Nigar Khurram
- N Khurram, Division of Nephrology/Hypertension, Department of Medicine and the Department of Pathology, Northwestern University Feinberg School of Medicine, Chicago, United States
| | - Yashpal Kanwar
- Y Kanwar, Division of Nephrology/Hypertension, Department of Medicine and the Department of Pathology, Northwestern University Feinberg School of Medicine, Chicago, United States
| | - Dominique Missiakas
- D Missiakas, Department of Microbiology, The University of Chicago, Chicago, United States
| | - Jack Henkin
- J Henkin, Center for Developmental Therapeutics, Northwestern University, Evanston, United States
| | - Anjana Yeldandi
- A Yeldandi, Division of Nephrology/Hypertension, Department of Medicine and the Department of Pathology, Northwestern University Feinberg School of Medicine, Chicago, United States
| | - Daniel Batlle
- D Batlle, Division of Nephrology/Hypertension, Department of Medicine and the Department of Pathology, Northwestern University Feinberg School of Medicine, Chicago, United States
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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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Kidney Injury in COVID-19: Epidemiology, Molecular Mechanisms, and Potential Therapeutic Targets. Int J Mol Sci 2022; 23:ijms23042242. [PMID: 35216358 PMCID: PMC8877127 DOI: 10.3390/ijms23042242] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [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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Gambella A, Barreca A, Biancone L, Roccatello D, Peruzzi L, Besso L, Licata C, Attanasio A, Papotti M, Cassoni P. Spectrum of Kidney Injury Following COVID-19 Disease: Renal Biopsy Findings in a Single Italian Pathology Service. Biomolecules 2022; 12:biom12020298. [PMID: 35204798 PMCID: PMC8961620 DOI: 10.3390/biom12020298] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Revised: 02/09/2022] [Accepted: 02/10/2022] [Indexed: 02/04/2023] Open
Abstract
The onset of coronavirus disease (COVID-19) as a pandemic infection, has led to increasing insights on its pathophysiology and clinical features being revealed, such as a noticeable kidney involvement. In this study, we describe the histopathological, immunofluorescence, and ultrastructural features of biopsy-proven kidney injury observed in a series of SARS-CoV-2 positive cases in our institution from April 2020 to November 2021. We retrieved and retrospectively reviewed nine cases (two pediatric and seven adults) that experienced nephrotic syndrome (six cases), acute kidney injury (two cases), and a clinically silent microhematuria and leukocyturia. Kidney biopsies were investigated by means of light microscopy, direct immunofluorescence, and electron microscopy. The primary diagnoses were minimal change disease (four cases), acute tubular necrosis (two cases), collapsing glomerulopathy (two cases), and C3 glomerulopathy (one case). None of the cases showed viral or viral-like particles on ultrastructural analysis. Novel and specific histologic features on kidney biopsy related to SARS-CoV-2 infection have been gradually disclosed and reported, harboring relevant clinical and therapeutic implications. Recognizing and properly diagnosing renal involvement in patients experiencing COVID-19 could be challenging (due to the lack of direct proof of viral infection, e.g., viral particles) and requires a proper integration of clinical and pathological data.
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Affiliation(s)
- Alessandro Gambella
- Pathology Unit, Department of Medical Sciences, University of Turin, Via Santena 7, 10126 Turin, Italy; (A.G.); (A.A.)
| | - Antonella Barreca
- Pathology Unit, “Città della Salute e della Scienza di Torino” University Hospital, Via Santena 7, 10126 Turin, Italy;
| | - Luigi Biancone
- Division of Nephrology Dialysis and Transplantation, AOU Città della Salute e della Scienza di Torino, Department of Medical Sciences, University of Turin, 10126 Turin, Italy;
| | - Dario Roccatello
- CMID, Coordinating Center of the Network for Rare Diseases of Piedmont and Aosta Valley, Nephrology and Dialysis Unit (ERK-Net Member), San Giovanni Bosco Hub Hospital, University of Turin, 10144 Turin, Italy;
| | - Licia Peruzzi
- Pediatric Nephrology Unit, Regina Margherita Department, AOU Città della Salute e della Scienza di Torino, 10126 Turin, Italy;
| | - Luca Besso
- Division of Nephrology and Dialysis, AO S. Croce e Carle di Cuneo, 12100 Cuneo, Italy;
| | - Carolina Licata
- Division of Nephrology and Dialysis, ASL TO4, 10073 Ciriè, Italy;
| | - Angelo Attanasio
- Pathology Unit, Department of Medical Sciences, University of Turin, Via Santena 7, 10126 Turin, Italy; (A.G.); (A.A.)
| | - Mauro Papotti
- Pathology Unit, Department of Oncology, University of Turin, Via Santena 7, 10126 Turin, Italy;
| | - Paola Cassoni
- Pathology Unit, Department of Medical Sciences, University of Turin, Via Santena 7, 10126 Turin, Italy; (A.G.); (A.A.)
- Correspondence:
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Hebert SA. Renal Consequences of COVID-19. Methodist Debakey Cardiovasc J 2022; 17:91-93. [PMID: 34992728 PMCID: PMC8680200 DOI: 10.14797/mdcvj.1058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Accepted: 11/03/2021] [Indexed: 11/16/2022] Open
Abstract
The column in this issue is provided by Sean A. Hebert, MD, assistant professor of Clinical Medicine at the Houston Methodist Academic Institute. Dr. Hebert specializes in transplant nephrology at Houston Methodist.
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Affiliation(s)
- Sean A Hebert
- Division of Nephrology, Department of Medicine, Houston Methodist, Houston, Texas, US
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León-Román J, Agraz I, Vergara A, Ramos N, Toapanta N, García-Carro C, Gabaldón A, Bury R, Bermejo S, Bestard O, Soler MJ. OUP accepted manuscript. Clin Kidney J 2022; 15:1698-1704. [PMID: 35999963 PMCID: PMC8992323 DOI: 10.1093/ckj/sfac079] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Indexed: 11/25/2022] Open
Abstract
Novel coronavirus disease infection (coronavirus disease 2019, COVID-19) was declared a global pandemic in March 2020 and since then has become a major public health problem. The prevalence of COVID-19 infection and acute kidney injury (AKI) is variable depending on several factors such as race/ethnicity and severity of illness. The pathophysiology of renal involvement in COVID-19 infection is not entirely clear, but it could be in part explained by the viral tropism in the kidney parenchyma. AKI in COVID-19 infection can be either by direct invasion of the virus or as a consequence of immunologic response. Diverse studies have focused on the effect of COVID-19 on glomerulonephritis (GN) patients or the ‘novo’ GN; however, the effect of COVID-19 in acute tubulointerstitial nephritis (ATIN) has been scarcely studied. In this article, we present five cases with different spectrums of COVID-19 infection and ATIN that may suggest that recent diagnosis of ATIN is accompanied by a worse clinical prognosis in comparison with long-term diagnosed ATIN.
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Affiliation(s)
- Juan León-Román
- Vall d'Hebron University Hospital, Department of Nephrology, Barcelona, Spain
| | - Irene Agraz
- Vall d'Hebron University Hospital, Department of Nephrology, Barcelona, Spain
| | - Ander Vergara
- Vall d'Hebron University Hospital, Department of Nephrology, Barcelona, Spain
| | - Natalia Ramos
- Vall d'Hebron University Hospital, Department of Nephrology, Barcelona, Spain
| | - Nestor Toapanta
- Vall d'Hebron University Hospital, Department of Nephrology, Barcelona, Spain
| | - Clara García-Carro
- Clinico San Carlos University Hospital, Department of Nephrology, Madrid, Spain
| | - Alejandra Gabaldón
- Vall d'Hebron University Hospital, Department of Pathology, Barcelona, Spain
| | - Roxana Bury
- Vall d'Hebron University Hospital, Department of Nephrology, Barcelona, Spain
| | - Sheila Bermejo
- Vall d'Hebron University Hospital, Department of Nephrology, Barcelona, Spain
| | - Oriol Bestard
- Vall d'Hebron University Hospital, Department of Nephrology, Barcelona, Spain
- Nephrology Research Group, Vall d'Hebron Research Institute (VHIR), Nephrology
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Azukaitis K, Besusparis J, Laurinavicius A, Jankauskiene A. Case Report: SARS-CoV-2 Associated Acute Interstitial Nephritis in an Adolescent. Front Pediatr 2022; 10:861539. [PMID: 35498789 PMCID: PMC9047909 DOI: 10.3389/fped.2022.861539] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Accepted: 03/18/2022] [Indexed: 12/03/2022] Open
Abstract
Acute interstitial nephritis (AIN) has been recently recognized as one of the infrequent kidney involvement phenotypes among adult patients with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. Although SARS-CoV-2 associated intrinsic kidney disease has been scarcely reported in children, only one case of AIN temporally associated with the infection has been described in the pediatric population so far. We presented a case of a 12-year old boy who presented with fatigue, anorexia, and polydipsia following an RT-PCR that confirmed SARS-CoV-2 infection seven weeks prior to admission. Initial workup revealed increased serum creatinine (235 μmol/L), glucosuria, low-molecular-weight proteinuria, mild leukocyturia, and microhematuria with hyaline and granular casts on microscopy. Antibodies against the SARS-CoV-2 S protein receptor-binding domain confirmed prior infection with high titers. Kidney biopsy showed diffuse active interstitial nephritis with negative immunofluorescence and positive immunohistochemistry for SARS-CoV-2 in the inflammatory cells within the interstitium. Electron microscopy revealed several SARS-CoV-2-like particles. Kidney function continued to deteriorate despite several days of supportive therapy only (peak serum creatinine 272 μmol/L); thus, treatment with methylprednisolone pulse-dose therapy was initiated and was followed by oral prednisolone with gradual tapering. Kidney function completely recovered after 3 weeks post-discharge and remained normal after 11 weeks of follow-up (last estimated glomerular filtration rate 106 ml/min/1.73 m2) with only residual microhematuria. Our case adds to the emerging evidence of SARS-CoV-2 as a potential etiological agent of AIN in children and also suggests that interstitial kidney injury may result from secondary inflammatory damage. Epidemiological history, serologic testing, and SARS-CoV-2 detection in biopsy should be considered in the work-up of children with AIN of unknown etiology.
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Affiliation(s)
- Karolis Azukaitis
- Clinic of Pediatrics, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
| | - Justinas Besusparis
- Institute of Biomedical Sciences, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
| | - Arvydas Laurinavicius
- Institute of Biomedical Sciences, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
| | - Augustina Jankauskiene
- Clinic of Pediatrics, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
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Hsu CM, Gupta S, Tighiouart H, Goyal N, Faugno AJ, Tariq A, Raichoudhury R, Sharma JH, Meyer L, Kshirsagar RK, Jose A, Leaf DE, Weiner DE. Kidney Recovery and Death in Critically Ill Patients With COVID-19-Associated Acute Kidney Injury Treated With Dialysis: The STOP-COVID Cohort Study. Am J Kidney Dis 2021; 79:404-416.e1. [PMID: 34871701 PMCID: PMC8641974 DOI: 10.1053/j.ajkd.2021.11.004] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Accepted: 11/22/2021] [Indexed: 12/27/2022]
Abstract
Rationale & Objective Acute kidney injury treated with kidney replacement therapy (AKI-KRT) occurs frequently in critically ill patients with coronavirus disease 2019 (COVID-19). We examined the clinical factors that determine kidney recovery in this population. Study Design Multicenter cohort study. Setting & Participants 4,221 adults not receiving KRT who were admitted to intensive care units at 68 US hospitals with COVID-19 from March 1 to June 22, 2020 (the “ICU cohort”). Among these, 876 developed AKI-KRT after admission to the ICU (the “AKI-KRT subcohort”). Exposure The ICU cohort was analyzed using AKI severity as the exposure. For the AKI-KRT subcohort, exposures included demographics, comorbidities, initial mode of KRT, and markers of illness severity at the time of KRT initiation. Outcome The outcome for the ICU cohort was estimated glomerular filtration rate (eGFR) at hospital discharge. A 3-level outcome (death, kidney nonrecovery, and kidney recovery at discharge) was analyzed for the AKI-KRT subcohort. Analytical Approach The ICU cohort was characterized using descriptive analyses. The AKI-KRT subcohort was characterized with both descriptive analyses and multinomial logistic regression to assess factors associated with kidney nonrecovery while accounting for death. Results Among a total of 4,221 patients in the ICU cohort, 2,361 (56%) developed AKI, including 876 (21%) who received KRT. More severe AKI was associated with higher mortality. Among survivors, more severe AKI was associated with an increased rate of kidney nonrecovery and lower kidney function at discharge. Among the 876 patients with AKI-KRT, 588 (67%) died, 95 (11%) had kidney nonrecovery, and 193 (22%) had kidney recovery by the time of discharge. The odds of kidney nonrecovery was greater for lower baseline eGFR, with ORs of 2.09 (95% CI, 1.09-4.04), 4.27 (95% CI, 1.99-9.17), and 8.69 (95% CI, 3.07-24.55) for baseline eGFR 31-60, 16-30, ≤15 mL/min/1.73 m2, respectively, compared with eGFR > 60 mL/min/1.73 m2. Oliguria at the time of KRT initiation was also associated with nonrecovery (ORs of 2.10 [95% CI, 1.14-3.88] and 4.02 [95% CI, 1.72-9.39] for patients with 50-499 and <50 mL/d of urine, respectively, compared to ≥500 mL/d of urine). Limitations Later recovery events may not have been captured due to lack of postdischarge follow-up. Conclusions Lower baseline eGFR and reduced urine output at the time of KRT initiation are each strongly and independently associated with kidney nonrecovery among critically ill patients with COVID-19.
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Affiliation(s)
| | | | | | | | | | - Asma Tariq
- Tufts Medical Center / Tufts University, Boston, MA
| | | | - Jill H Sharma
- University Medical Center / Kirk Kerkorian School of Medicine at University of Nevada, Las Vegas, NV
| | - Leah Meyer
- Tufts Medical Center / Tufts University, Boston, MA
| | | | - Aju Jose
- St. Elizabeth's Medical Center / Boston University School of Medicine, Boston, MA
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Gadegbeku CA, Sedor JR. APOL1 Kidney Risk Variants and Acute Kidney Injury in Those with COVID-19: True Association or Red Herring? Clin J Am Soc Nephrol 2021; 16:1779-1780. [PMID: 36630404 PMCID: PMC8729482 DOI: 10.2215/cjn.13571021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Affiliation(s)
- Crystal A. Gadegbeku
- Department of Nephrology and Hypertension, Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio
| | - John R. Sedor
- Department of Nephrology and Hypertension, Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio
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Lin H, Ma X, Xiao F, Su H, Shi Y, Liu Y, Song L, Zhang Z, Zhang C, Peng H. Identification of a special cell type as a determinant of the kidney tropism of SARS-CoV-2. FEBS J 2021; 288:5163-5178. [PMID: 34228902 PMCID: PMC8420455 DOI: 10.1111/febs.16114] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Revised: 06/09/2021] [Accepted: 07/06/2021] [Indexed: 12/01/2022]
Abstract
The kidney tropism of severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) has been well‐validated clinically and often leads to various forms of renal damage in coronavirus disease‐2019 (COVID‐19) patients. However, the underlying mechanisms and diagnostic approaches remain to be determined. We interrogated the expression of virus‐related host factors in single‐cell RNA sequencing (scRNA‐seq) datasets of normal human kidneys and kidneys with pre‐existing diseases and validated the results with urinary proteomics of COVID‐19 patients and healthy individuals. We also assessed the effects of genetic variants on kidney susceptibility using expression quantitative trait loci (eQTLs) databases. We identified a subtype of tubular cells, which we named PT‐3 cells, as being vulnerable to SARS‐CoV‐2 infections in the kidneys. PT‐3 cells were enriched in viral entry factors and replication and assembly machinery but lacked antiviral restriction factors. Immunohistochemistry confirmed positive staining of PT‐3 cell marker SCL36A2 on kidney sections from COVID‐19 patients. Urinary proteomic analyses of COVID‐19 patients revealed that markers of PT‐3 cells were significantly increased, along with elevated viral receptor angiotensin‐converting enzyme 2. We further found that the proportion of PT‐3 cells increased in diabetic nephropathy but decreased in kidney allografts and lupus nephropathy, suggesting that kidney susceptibility varied among these diseases. We finally identified several eQTLs that regulate the expression of host factors in kidney cells. PT‐3 cells may represent a key determinant for the kidney tropism of SARS‐CoV‐2, and detection of PT‐3 cells may be used to assess the risk of renal infection during COVID‐19.
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Affiliation(s)
- Hongchun Lin
- Nephrology Division, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Xinxin Ma
- Nephrology Division, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Fang Xiao
- Department of Cadres Medical Care and Geriatrics, The Second Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Hua Su
- Department of Nephrology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yaling Shi
- Guangzhou Eighth People's Hospital, Guangzhou Medical University, Guangzhou, China
| | - Yuntao Liu
- Department of Emergency, the Second Affiliated Hospital of Guangzhou University of Chinese Medicine, China.,Guangdong Provincial Key Laboratory of Research on Emergency in TCM, Guangzhou, China
| | - Lan Song
- State Key Laboratory of Proteomics, Beijing Proteome Research Center, National Center for Protein Sciences (Beijing), Beijing Institute of LifeOmics, China
| | - Zhongde Zhang
- Department of Emergency, the Second Affiliated Hospital of Guangzhou University of Chinese Medicine, China.,Guangdong Provincial Key Laboratory of Research on Emergency in TCM, Guangzhou, China
| | - Chun Zhang
- Department of Nephrology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Hui Peng
- Nephrology Division, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
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