Characterization of regulatory T cells in SARS-CoV-2 infected hemodialysis patients: relation to clinical and radiological severity

BACKGROUND

Disordered Treg counts and function have been observed in patients with SARS-Cov-2 and are thought to contribute to disease severity. In hemodialysis patients, scarce data are available on the Treg response to SARS-CoV-2 or its relation to the clinical presentation.

METHODS

A cross-sectional study included one hundred patients divided into three groups, thirty SARS-CoV-2-infected hemodialysis patients (COV-HD), and thirty confirmed SARSCoV-2 infected patients (COV), and forty non-infected hemodialysis patients (HD). Flow cytometric analysis of CD4, CD25, FoxP3, and CD39+ Tregs was done for all patients and tested for correlation to in-hospital mortality, clinical, radiological severity indices.

RESULTS

COV-HD and COV patients had significantly lower Treg cell count than HD patients (Median value of 0.016 cell/ μl vs 0.28 cell/ μl, respectively- P: 0.001). COV-HD patients had higher CD39+ Tregs (median value of 0.006 cell/ μl vs 0.002 cell/ μl, respectively- P: 0.04). COV-HD patients had significantly lower hospital stay (median value of 3 vs 13 days, P:0.001), ICU admission rates (26.5% vs 46.7%, P:0.005) and in-hospital mortality (20.7% versus 43.3%, P:0.003) than COV patients. Treg and CD39 expressing Treg counts were not correlated to severity indices in both groups. A high neutrophil to lymphocyte ratio is strongly correlated to disease severity in COV-HD patients.

CONCLUSIONS

This study provides evidence of T-cell, particularly T-regulatory cell decline in SARS-CoV-2 and suggests that hemodialysis per se does not distinctively impact the T-cell response. COV-HD patients exhibited a higher CD39+ Treg count and a better clinical profile, however, larger studies are needed to extrapolate on these findings.

Is Adynamic Bone Always a Disease? Lessons from Patients with Chronic Kidney Disease

Renal osteodystrophy (ROD) is a common complication of end-stage kidney disease that often starts early with loss of kidney function, and it is considered an integral part in management of patients with chronic kidney disease (CKD). Adynamic bone (ADB) is characterized by suppressed bone formation, low cellularity, and thin osteoid seams. There is accumulating evidence supporting increasing prevalence of ADB, particularly in early CKD. Contemporarily, it is not very clear whether it represents a true disease, an adaptive mechanism to prevent bone resorption, or just a transitional stage. Several co-players are incriminated in its pathogenesis, such as age, diabetes mellitus, malnutrition, uremic milieu, and iatrogenic factors. In the present review, we will discuss the up-to-date knowledge of the ADB and focus on its impact on bone health, fracture risk, vascular calcification, and long-term survival. Moreover, we will emphasize the proper preventive and management strategies of ADB that are pivotal issues in managing patients with CKD. It is still unclear whether ADB is always a pathologic condition or whether it can represent an adaptive process to suppress bone resorption and further bone loss. In this article, we tried to discuss this hard topic based on the available limited information in patients with CKD. More studies are needed to be able to clearly address this frequent ROD finding.

The diagnostic and prognostic utility of Serum Cystatin C and Angiopoietin 2 in patients with liver cirrhosis complicated by acute kidney injury

BACKGROUND

Acute kidney injury (AKI) frequently affects patients with liver cirrhosis, diagnosed by changes in serum creatinine and urine output. This study aimed to evaluate the diagnostic and prognostic utility of serum Cystatin C (Cys C) and Angiopoietin 2 (Ang 2) in patients with liver cirrhosis complicated by AKI.

METHODS

Eighty-one cirrhotic patients with AKI were included. AKI was diagnosed according to KDIGO criteria. All patients were assessed clinically and biochemically. Baseline serum Cys C and Ang 2 were assessed, and patients were prospectively followed-up to assess patients' and renal survival.

RESULTS

Cys C significantly predicted AKI (P <0.001). Ang 2 (≤ 179.7 pg/ml) was an independent predictor of mortality in multivariate analysis. Marked ascites and PCO₂ ≤29 were significant predictors of non-renal recovery.

CONCLUSION

Cys C showed validity AKI diagnosis in cirrrhotic patients while Ang 2 was an independent predictor of mortality. This article is protected by copyright. All rights reserved.