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Belisário AR, Costa JDA, Simões e Silva AC. Natural history of albuminuria in a large cohort of children and adolescents with sickle cell anemia from Brazil. Blood Adv 2024; 8:365-368. [PMID: 38055923 PMCID: PMC10820287 DOI: 10.1182/bloodadvances.2023011765] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2023] [Revised: 11/27/2023] [Accepted: 12/06/2023] [Indexed: 12/08/2023] Open
Affiliation(s)
- André Rolim Belisário
- Centro de Tecidos Biológicos de Minas Gerais, Fundação Centro de Hematologia e Hemoterapia de Minas Gerais, Lagoa Santa, Brazil
- Laboratório Interdisciplinar de Investigação Médica, Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Jéssica de Almeida Costa
- Laboratório Interdisciplinar de Investigação Médica, Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Ana Cristina Simões e Silva
- Laboratório Interdisciplinar de Investigação Médica, Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
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2
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Ndour EHM, Mnika K, Tall FG, Seck M, Ly ID, Nembaware V, Mazandu GK, Sagna Bassène HAT, Dione R, Ndongo AA, Diop JPD, Barry NOK, Djité M, Ndiaye Diallo R, Guèye PM, Diop S, Diagne I, Cissé A, Wonkam A, Lopez Sall P. Biomarkers of sickle cell nephropathy in Senegal. PLoS One 2022; 17:e0273745. [PMID: 36409722 PMCID: PMC9678278 DOI: 10.1371/journal.pone.0273745] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Accepted: 08/15/2022] [Indexed: 11/22/2022] Open
Abstract
Sickle cell anemia (SCA) is caused by a single point variation in the β-globin gene (HBB): c.20A> T (p.Glu7Val), in homozygous state. SCA is characterized by sickling of red blood cells in small blood vessels which leads to a range of multiorgan complications, including kidney dysfunction. This case-control study aims at identifying sickle cell nephropathy biomarkers in a group of patients living with SCA from Senegal. A total of 163 patients living with SCA and 177 ethnic matched controls were investigated. Biological phenotyping included evaluation of glycemia, glucosuria, albuminuria, proteinuria, tubular proteinuria, serum creatinine, urine creatinine, urine specific gravity and glomerular filtration rate. Descriptive statistics of biomarkers were performed using the χ2 -test, with the significance level set at p<0.05. Patients living with SCA had a median age of 20 years (range 4 to 57) with a female sex frequency of 53.21%. The median age of the control participants was 29 years (range: 4-77) with a female sex frequency of 66.09%. The following proportions of abnormal biological indices were observed in SCA patients versus (vs.) controls, as follows: hyposthenuria: 35.3%vs.5.2% (p<0.001); glomerular hyperfiltration: 47.66%vs.19.75% (p<0.001), renal insufficiency: 5.47%vs.3.82% (p = 0.182); microalbuminuria: 42.38%vs.5.78% (p<0.001); proteinuria: 39.33%vs.4.62% (p<0.001); tubular proteinuria: 40.97%vs.4.73% (p<0.001) and microglucosuria: 22.5%vs.5.1% (p<0.001). This study shows a relatively high proportion of SCA nephropathy among patients living with SCA in Senegal. Microglucosuria, proteinuria, tubular proteinuria, microalbuminuria, hyposthenuria and glomerular hyperfiltration are the most prevalent biomarkers of nephropathy in this group of Senegalese patients with SCA.
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Affiliation(s)
- El Hadji Malick Ndour
- Department of Pharmaceutical Biochemistry, Faculty of Medicine, Pharmacy and Dentistry, Cheikh Anta Diop University, Dakar, Senegal
- Albert Royer National University Hospital of Children, Dakar, Senegal
- * E-mail:
| | - Khuthala Mnika
- Division of Human Genetics, Department of Pathology, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
- Division of Human Genetics, National Health Laboratory Service, and School of Pathology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Fatou Guèye Tall
- Department of Pharmaceutical Biochemistry, Faculty of Medicine, Pharmacy and Dentistry, Cheikh Anta Diop University, Dakar, Senegal
- Albert Royer National University Hospital of Children, Dakar, Senegal
| | - Moussa Seck
- National Center of Blood Transfusion, Dakar, Senegal
| | - Indou Dème Ly
- Albert Royer National University Hospital of Children, Dakar, Senegal
| | - Victoria Nembaware
- Division of Human Genetics, Department of Pathology, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Gaston Kuzamunu Mazandu
- Division of Human Genetics, Department of Pathology, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | | | - Rokhaya Dione
- Albert Royer National University Hospital of Children, Dakar, Senegal
| | | | - Jean Pascal Demba Diop
- Department of Human Genetics, Faculty of Medicine, Pharmacy and Dentistry, Cheikh Anta Diop University, Dakar, Senegal
| | - Nènè Oumou Kesso Barry
- Department of Pharmaceutical Biochemistry, Faculty of Medicine, Pharmacy and Dentistry, Cheikh Anta Diop University, Dakar, Senegal
| | - Moustapha Djité
- Department of Pharmaceutical Biochemistry, Faculty of Medicine, Pharmacy and Dentistry, Cheikh Anta Diop University, Dakar, Senegal
| | - Rokhaya Ndiaye Diallo
- Department of Human Genetics, Faculty of Medicine, Pharmacy and Dentistry, Cheikh Anta Diop University, Dakar, Senegal
| | - Papa Madièye Guèye
- Department of Pharmaceutical Biochemistry, Faculty of Medicine, Pharmacy and Dentistry, Cheikh Anta Diop University, Dakar, Senegal
| | - Saliou Diop
- National Center of Blood Transfusion, Dakar, Senegal
| | - Ibrahima Diagne
- Department of Pediatrics, Faculty of Health Sciences, Gaston Berger University, Saint-Louis, Senegal
| | - Aynina Cissé
- Department of Pharmaceutical Biochemistry, Faculty of Medicine, Pharmacy and Dentistry, Cheikh Anta Diop University, Dakar, Senegal
| | - Ambroise Wonkam
- Division of Human Genetics, Department of Pathology, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
- McKusick-Nathans Institute and Department of Genetic Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States of America
| | - Philomène Lopez Sall
- Department of Pharmaceutical Biochemistry, Faculty of Medicine, Pharmacy and Dentistry, Cheikh Anta Diop University, Dakar, Senegal
- Albert Royer National University Hospital of Children, Dakar, Senegal
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3
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Al-Eyadhy A, Al-Jelaify MR. Suboptimal vancomycin levels in critically ill children with sickle cell disease and acute chest syndrome. J Infect Chemother 2022; 28:1304-1309. [DOI: 10.1016/j.jiac.2022.05.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Revised: 05/24/2022] [Accepted: 05/29/2022] [Indexed: 10/18/2022]
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4
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Martins SR, Toledo SLDO, da Silva AJ, Mendes FS, de Oliveira MM, Ferreira LGR, Dusse LMS, Carvalho MDG, Rios DRA, Alpoim PN, Pinheiro MDB. Endothelial dysfunction biomarkers in sickle cell disease: is there a role for ADMA and PAI-1? Ann Hematol 2021; 101:273-280. [PMID: 34665295 DOI: 10.1007/s00277-021-04695-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Accepted: 10/10/2021] [Indexed: 01/26/2023]
Abstract
Within the spectrum of sickle cell disease (SCD) are sickle cell anemia (SCA), presence of hemoglobin SS (HbSS), hemoglobin SC disease (HbSC), and sickle cell β-thalassemia (Sβ-thal). Asymmetric dimethylarginine (ADMA) competitively inhibits the binding of arginine to NOS, reducing NO production. In patients with HbSS, increased levels of ADMA have been reported, as well as changes in many hemostatic biomarkers, including the plasminogen activator inhibitor type 1 (PAI-1). We hypothesized that high levels of ADMA and PAI-1 may be associated with more severe SCD. Thus, ADMA and PAI-1 levels were determined in 78 individuals including 38 adult patients with SCD and 40 control subjects. Higher levels of ADMA were shown in HbSS and Sβ-thal patients compared to controls. Concerning PAI-1, all patients showed high levels of PAI-1 compared to controls. As a role of NO in the pathogenesis of SCD has already been established, we concluded that high levels of ADMA should compromise, at least in part, NO synthesis, resulting in endothelial dysfunction. Elevated plasma levels of PAI-1 in all patients may indicate not only endothelial dysfunction but also a hypofibrinolytic state favoring thrombotic complications. Finally, high levels of ADMA and PAI-1 may be associated with more severe SCD.
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Affiliation(s)
- Suellen Rodrigues Martins
- Department of Clinical and Toxicological Analysis, Faculty of Pharmacy, Federal University of Minas Gerais, Avenida Antonio Carlos, 6627, Pampulha, Belo Horizonte, Minas Gerais, 31270901, Brazil
| | - Sílvia Letícia de Oliveira Toledo
- Federal University of São João del-Rei (UFSJ), Campus Centro-Oeste Dona Lindu, Sebastião Gonçalves Coelho Street, 400, Building: D, Room: 308.1, ChanadourDivinópolis, MG, 35501-296, Brazil
| | - Aislander Junio da Silva
- Department of Clinical and Toxicological Analysis, Faculty of Pharmacy, Federal University of Minas Gerais, Avenida Antonio Carlos, 6627, Pampulha, Belo Horizonte, Minas Gerais, 31270901, Brazil
| | - Fernanda Santos Mendes
- Department of Clinical and Toxicological Analysis, Faculty of Pharmacy, Federal University of Minas Gerais, Avenida Antonio Carlos, 6627, Pampulha, Belo Horizonte, Minas Gerais, 31270901, Brazil
| | - Marina Mendes de Oliveira
- Federal University of São João del-Rei (UFSJ), Campus Centro-Oeste Dona Lindu, Sebastião Gonçalves Coelho Street, 400, Building: D, Room: 308.1, ChanadourDivinópolis, MG, 35501-296, Brazil.,Fundação Centro de Hematologia E Hemoterapia Do Estado de Minas Gerais, (Hemominas), Divinópolis, MG, Brazil
| | - Leticia Gonçalves Resende Ferreira
- Federal University of São João del-Rei (UFSJ), Campus Centro-Oeste Dona Lindu, Sebastião Gonçalves Coelho Street, 400, Building: D, Room: 308.1, ChanadourDivinópolis, MG, 35501-296, Brazil
| | - Luci Maria Sant'Ana Dusse
- Department of Clinical and Toxicological Analysis, Faculty of Pharmacy, Federal University of Minas Gerais, Avenida Antonio Carlos, 6627, Pampulha, Belo Horizonte, Minas Gerais, 31270901, Brazil
| | - Maria das Graças Carvalho
- Department of Clinical and Toxicological Analysis, Faculty of Pharmacy, Federal University of Minas Gerais, Avenida Antonio Carlos, 6627, Pampulha, Belo Horizonte, Minas Gerais, 31270901, Brazil.,Federal University of São João del-Rei (UFSJ), Campus Centro-Oeste Dona Lindu, Sebastião Gonçalves Coelho Street, 400, Building: D, Room: 308.1, ChanadourDivinópolis, MG, 35501-296, Brazil
| | - Danyelle Romana Alves Rios
- Federal University of São João del-Rei (UFSJ), Campus Centro-Oeste Dona Lindu, Sebastião Gonçalves Coelho Street, 400, Building: D, Room: 308.1, ChanadourDivinópolis, MG, 35501-296, Brazil
| | - Patrícia Nessralla Alpoim
- Department of Clinical and Toxicological Analysis, Faculty of Pharmacy, Federal University of Minas Gerais, Avenida Antonio Carlos, 6627, Pampulha, Belo Horizonte, Minas Gerais, 31270901, Brazil.
| | - Melina de Barros Pinheiro
- Federal University of São João del-Rei (UFSJ), Campus Centro-Oeste Dona Lindu, Sebastião Gonçalves Coelho Street, 400, Building: D, Room: 308.1, ChanadourDivinópolis, MG, 35501-296, Brazil.
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Mohamed SOO, Ibrahim OAO, Mohammad DAA, Ali AHM. Correlates of gallbladder stones among patients with sickle cell disease: A meta-analysis. JGH OPEN 2021; 5:997-1003. [PMID: 34584966 PMCID: PMC8454478 DOI: 10.1002/jgh3.12622] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Revised: 07/12/2021] [Accepted: 07/14/2021] [Indexed: 12/16/2022]
Abstract
Sickle cell disorders are the most common hemoglobinopathies worldwide. Clinical variability of sickle cell disease (SCD) and susceptibility to its complications have been attributed to hematologic, genetic, and other influencing factors. This review aimed to provide further summary and analyses of the prevalence and factors associated with cholelithiasis among patients with SCD. A systematic database search was conducted in MEDLINE (PubMed), ScienceDirect, Google Scholar, World Health Organization Virtual Health Library, Cochrane Library databases, and System for Information on Gray Literature in Europe (SIGLE). Pooled prevalence, odds ratio (OR), and standardized mean difference (SMD) with the corresponding 95% confidence interval (CI) were calculated using Comprehensive Meta-Analysis Software version 3.3. A total of 34 studies that fulfilled the eligibility criteria were included in the analyses. The overall prevalence of cholelithiasis among SCD patients was 25.3% (95% CI 19.4-32.3%). The risk of developing cholelithiasis was significantly associated with lower total hemoglobin level (SMD = -0.45; P = 0.002), lower hemoglobin F (HbF) level (SMD = -0.85; P = 0.003), higher total serum bilirubin level (SMD = 1.15; P < 0.001), higher reticulocytes count (SMD = 0.44; P = 0.007), and UDP-glucuronosyltransferase-1A1 enzyme (UGT1A1) promoter polymorphism. This review provides a comprehensive view of the high rate of cholelithiasis and its associated factors in SCD patients.
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Affiliation(s)
- Sagad O O Mohamed
- Department of Paediatrics and Child Health, Faculty of Medicine University of Khartoum Khartoum Sudan
| | - Omer A O Ibrahim
- Department of Internal Medicine University of Khartoum Khartoum Sudan
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6
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Belisário AR, S Filha RD, de Almeida JA, Mendes FG, Rezende PV, Vieira ÉL, E Silva AC. Novel kidney injury biomarkers in a large cohort of children with sickle cell anemia. Biomark Med 2021; 15:999-1009. [PMID: 34289712 DOI: 10.2217/bmm-2020-0769] [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: 11/21/2022] Open
Abstract
Aim: The aim of this study was to compare novel kidney injury biomarkers in sickle cell anemia (SCA) children with and without albuminuria or glomerular hyperfiltration. Materials & methods: A total of 358 Brazilian children with SCA were studied. Fifteen kidney injury biomarkers in urine were measured. Albuminuria was defined as urine albumin/creatinine ratio >100 mg/g. Glomerular hyperfiltration was defined as estimated glomerular filtration rate ≥140 ml/min/1.73 m2. Results: After adjustment for age, sex and modifying therapies in use, EGF and collagen IV urinary levels were associated with albuminuria. Renin and clusterin levels were associated with hyperfiltration. Conclusion: Levels of novel kidney injury biomarkers were associated with albuminuria and hyperfiltration in Brazilian children with SCA, suggesting concomitant structural and functional abnormalities.
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Affiliation(s)
- André R Belisário
- Centro de Tecidos Biológicos de Minas Gerais, Fundação Hemominas, Lagoa Santa, Minas Gerais, 33400000, Brazil.,Laboratório Interdisciplinar de Investigação Médica, Faculdade de Medicina, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, Minas Gerais, 30130100, Brazil.,Faculdade de Medicina/Núcleo de Ações e Pesquisa em Apoio Diagnóstico (NUPAD), UFMG, Belo Horizonte, Minas Gerais, 30130100, Brazil
| | - Roberta da S Filha
- Laboratório Interdisciplinar de Investigação Médica, Faculdade de Medicina, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, Minas Gerais, 30130100, Brazil
| | - Jéssica A de Almeida
- Laboratório Interdisciplinar de Investigação Médica, Faculdade de Medicina, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, Minas Gerais, 30130100, Brazil
| | - Fabíola G Mendes
- Laboratório Interdisciplinar de Investigação Médica, Faculdade de Medicina, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, Minas Gerais, 30130100, Brazil
| | - Paulo V Rezende
- Faculdade de Medicina/Núcleo de Ações e Pesquisa em Apoio Diagnóstico (NUPAD), UFMG, Belo Horizonte, Minas Gerais, 30130100, Brazil.,Ambulatório do Hemocentro de Belo Horizonte, Fundação Hemominas, Belo Horizonte, Minas Gerais, 30130110, Brazil
| | - Érica Lm Vieira
- Laboratório Interdisciplinar de Investigação Médica, Faculdade de Medicina, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, Minas Gerais, 30130100, Brazil
| | - Ana Cs E Silva
- Laboratório Interdisciplinar de Investigação Médica, Faculdade de Medicina, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, Minas Gerais, 30130100, Brazil
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7
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Payán-Pernía S, Ruiz Llobet A, Remacha Sevilla ÁF, Egido J, Ballarín Castán JA, Moreno JA. Sickle cell nephropathy. Clinical manifestations and new mechanisms involved in kidney injury. Nefrologia 2021; 41:373-382. [PMID: 36165106 DOI: 10.1016/j.nefroe.2021.10.001] [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: 08/15/2020] [Accepted: 10/03/2020] [Indexed: 06/16/2023] Open
Abstract
Kidney problems are among the most common complications in sickle cell disease (SCD). They occur early in childhood and are one of the main factors related to mortality in these patients. The main underlying pathogenic mechanisms are vaso-occlusion and haemolysis. The renal medulla has ideal conditions for the sickling of red cells due to its low partial pressure of oxygen, high osmolarity and acidic pH. Initially, sickle-cell formation in the vasa recta of the renal medulla causes hyposthenuria. This is universal and appears in early childhood. Microscopic and macroscopic haematuria also occur, in part related to renal papillary necrosis when the infarcts are extensive. Release of prostaglandins in the renal medulla due to ischaemia leads to an increase in the glomerular filtration rate (GFR). Adaptively, sodium reabsorption in the proximal tubule increases, accompanied by increased creatinine secretion. Therefore, the GFR estimated from creatinine may be overestimated. Focal segmental glomerulosclerosis is the most common glomerular disease. Albuminuria is very common and reduction has been found in 72.8% of subjects treated with ACE inhibitors or ARB. Recent evidence suggests that free haemoglobin has harmful effects on podocytes, and may be a mechanism involved in impaired kidney function in these patients. These effects need to be better studied in SCD, as they could provide a therapeutic alternative in sickle cell nephropathy.
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Affiliation(s)
- Salvador Payán-Pernía
- Unidad de Eritropatología, Unidad de Gestión Clínica de Hematología, Hospital Universitario Virgen del Rocío, Instituto de Biomedicina de Sevilla (IBIS/CSIC), Sevilla, Spain.
| | - Anna Ruiz Llobet
- Servicios y Unidades de Referencia (CSUR) de Eritropatología Hereditaria, Hospital Sant Joan de Déu - Hospital de la Santa Creu i Sant Pau, Barcelona, Spain; Servicio de Hematología Pediátrica, Hospital Sant Joan de Déu, Universitat de Barcelona, Barcelona, Spain; Institut de Recerca, Fundació Sant Joan de Déu, Esplugues de Llobregat, Barcelona, Spain
| | - Ángel Francisco Remacha Sevilla
- Servicios y Unidades de Referencia (CSUR) de Eritropatología Hereditaria, Hospital Sant Joan de Déu - Hospital de la Santa Creu i Sant Pau, Barcelona, Spain; Servicio de Hematología, Hospital de la Santa Creu i Sant Pau, Instituto de Investigación Biomédica Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Jesús Egido
- Laboratorio de Enfermedades Renales, Vasculares y Diabetes, Instituto de Investigación Sanitaria-Fundación Jiménez Díaz, Universidad Autónoma, Madrid, Spain
| | | | - Juan Antonio Moreno
- Departamento de Biología Celular, Fisiología e Inmunología, Universidad de Córdoba, Instituto Maimónides de Investigaciones Biomédicas de Córdoba (IMIBIC), Hospital Universitario Reina Sofía, Córdoba, Spain.
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8
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Abstract
Kidney problems are among the most common complications in sickle cell disease (SCD). They occur early in childhood and are one of the main factors related to mortality in these patients. The main underlying pathogenic mechanisms are vaso-occlusion and haemolysis. The renal medulla has ideal conditions for the sickling of red cells due to its low partial pressure of oxygen, high osmolarity and acidic pH. Initially, sickle-cell formation in the vasa recta of the renal medulla causes hyposthenuria. This is universal and appears in early childhood. Microscopic and macroscopic haematuria also occur, in part related to renal papillary necrosis when the infarcts are extensive. Release of prostaglandins in the renal medulla due to ischaemia leads to an increase in the glomerular filtration rate (GFR). Adaptively, sodium reabsorption in the proximal tubule increases, accompanied by increased creatinine secretion. Therefore, the GFR estimated from creatinine may be overestimated. Focal segmental glomerulosclerosis is the most common glomerular disease. Albuminuria is very common and reduction has been found in 72.8% of subjects treated with ACE inhibitors or ARB. Recent evidence suggests that free haemoglobin has harmful effects on podocytes, and may be a mechanism involved in impaired kidney function in these patients. These effects need to be better studied in SCD, as they could provide a therapeutic alternative in sickle cell nephropathy.
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9
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Simões e Silva AC, Lanza K, Palmeira VA, Costa LB, Flynn JT. 2020 update on the renin-angiotensin-aldosterone system in pediatric kidney disease and its interactions with coronavirus. Pediatr Nephrol 2021; 36:1407-1426. [PMID: 32995920 PMCID: PMC7524035 DOI: 10.1007/s00467-020-04759-1] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Revised: 08/12/2020] [Accepted: 09/03/2020] [Indexed: 12/16/2022]
Abstract
The last decade was crucial for our understanding of the renin-angiotensin-aldosterone system (RAAS) as a two-axis, counter-regulatory system, divided into the classical axis, formed by angiotensin-converting enzyme (ACE), angiotensin II (Ang II), and the angiotensin type 1 receptor (AT1R), and the alternative axis comprising angiotensin-converting enzyme 2 (ACE2), angiotensin-(1-7) (Ang-(1-7)), and the Mas receptor. Breakthrough discoveries also took place, with other RAAS endopeptides being described, including alamandine and angiotensin A. In this review, we characterize the two RAAS axes and the role of their components in pediatric kidney diseases, including childhood hypertension (HTN), pediatric glomerular diseases, congenital abnormalities of the kidney and urinary tract (CAKUT), and chronic kidney disease (CKD). We also present recent findings on potential interactions between the novel coronavirus, SARS-CoV-2, and components of the RAAS, as well as potential implications of coronavirus disease 2019 (COVID-19) for pediatric kidney diseases.
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Affiliation(s)
- Ana Cristina Simões e Silva
- grid.8430.f0000 0001 2181 4888Interdisciplinary Laboratory of Medical Investigation, Faculty of Medicine, Federal University of Minas Gerais (UFMG), Avenida Alfredo Balena, 190, 2nd floor, Room # 281, Belo Horizonte, MG 30130-100 Brazil ,grid.8430.f0000 0001 2181 4888Pediatric Nephrology Unit, Department of Pediatrics, Faculty of Medicine, UFMG, Belo Horizonte, Brazil
| | - Katharina Lanza
- grid.8430.f0000 0001 2181 4888Interdisciplinary Laboratory of Medical Investigation, Faculty of Medicine, Federal University of Minas Gerais (UFMG), Avenida Alfredo Balena, 190, 2nd floor, Room # 281, Belo Horizonte, MG 30130-100 Brazil
| | - Vitória Andrade Palmeira
- grid.8430.f0000 0001 2181 4888Interdisciplinary Laboratory of Medical Investigation, Faculty of Medicine, Federal University of Minas Gerais (UFMG), Avenida Alfredo Balena, 190, 2nd floor, Room # 281, Belo Horizonte, MG 30130-100 Brazil
| | - Larissa Braga Costa
- grid.8430.f0000 0001 2181 4888Interdisciplinary Laboratory of Medical Investigation, Faculty of Medicine, Federal University of Minas Gerais (UFMG), Avenida Alfredo Balena, 190, 2nd floor, Room # 281, Belo Horizonte, MG 30130-100 Brazil
| | - Joseph T. Flynn
- grid.34477.330000000122986657Pediatric Nephrology, Seattle Children’s Hospital, University of Washington School of Medicine, Seattle, WA 98105 USA
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