Acute kidney injury due to cytokine storm in patients with COVID-19 infection

Patients with severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) or COVID-19 represents usually a variety range of symptoms related to influenza-like syndrome and respiratory tract infections. Likewise, kidney involvement and acute kidney injury (AKI) were reported in many previous studies. Although a hypovolemic circulation would be the most common reason in patients with AKI, some strong proofs are suggesting a cytokine storm due to immune system exaggeration and inflammation-mediated tubular injury in COVID-19 infections. The inflammatory response in cytokine storm leads to the high release of cytokines mostly including TNFα, IL-1β, IL-6, INFγ, IL-2, IL-7, and endothelial mediators. The main culprits in the AKI and consequent organ failure are resident leukocytes in specific tissues, activated following the cytokine release, and systemic inflammatory response. AKI management and cytokine profile evaluation should be highly emphasized in patients with COVID-19 to prevent the progression of chronic kidney disease or permanent renal failure. Treatment options in COVID-19 regarding no specific drugs should be supportive and based on stabilizing the patients; however, combination therapy with different antiviral have shown promising outcomes. As a result, utilizing the anti-TNFα and anti-IL-1 agents should be noticed if indicated. Additionally, the hematopoietic stem cell transplantation is a curative approach.

Download Full-text

A Combined Cardiorenal Assessment for the Prediction of Acute Kidney Injury in Lower Respiratory Tract Infections

The American Journal of Medicine ◽

10.1016/j.amjmed.2011.07.010 ◽

2012 ◽

Vol 125 (2) ◽

pp. 168-175 ◽

Cited By ~ 14

Author(s):

Tobias Breidthardt ◽

Mirjam Christ-Crain ◽

Daiana Stolz ◽

Roland Bingisser ◽

Beatrice Drexler ◽

...

Keyword(s):

Acute Kidney Injury ◽

Respiratory Tract ◽

Lower Respiratory Tract ◽

Respiratory Tract Infections ◽

Kidney Injury ◽

Lower Respiratory Tract Infections ◽

Tract Infections

Download Full-text

FC 047COMPARISON OF THE CHARACTERISTICS AND MORTALITY OF ACUTE KIDNEY INJURY IN PATIENTS WITH COVID-19 AND OTHER RESPIRATORY INFECTIONS: A PROSPECTIVE COHORT STUDY

Nephrology Dialysis Transplantation ◽

10.1093/ndt/gfab116.003 ◽

2021 ◽

Vol 36 (Supplement_1) ◽

Author(s):

Matthias Diebold ◽

Tobias Zimmermann ◽

Michael Dickenmann ◽

Stefan Schaub ◽

Stefano Bassetti ◽

...

Keyword(s):

Acute Kidney Injury ◽

Tract Infection ◽

Respiratory Tract ◽

Respiratory Tract Infection ◽

Respiratory Tract Infections ◽

Kidney Injury ◽

Renal Recovery ◽

Prognostic Impact ◽

Laboratory Test Results ◽

Tract Infections

Abstract Background and Aims Previous studies have indicated a coherency between coronavirus disease 2019 (COVID-19) and acute kidney injury (AKI), indicating poor outcomes. However, most studies only included patients with COVID-19 and lacked a control group. Therefore, the aim of this study was to investigate the prevalence and prognostic impact of AKI in patients with COVID-19 in comparison with other respiratory tract infections. Method The prospective single-center observational case-control COronaVIrus surviVAl (COVIVA, clinicaltrials.gov NCT04366765) study performed at the University Hospital Basel Switzerland consecutively enrolled patients presenting to the emergency department with symptoms suggestive of COVID-19 between March 23 and May 31, 2020. The final diagnosis that led to the inclusion in the study was adjudicated by physicians after reviewing all available medical data including laboratory test results 30 days after discharge. For this analysis, we compared patients tested positive for SARS-CoV-2 with patients tested negative but with an adjudicated diagnosis of upper or lower respiratory tract infection including pneumonia. Primary outcome measure was death at 30 days, secondary outcomes were AKI incidence, renal recovery and need for renal replacement therapy. AKI was defined according to the serum creatinine criteria of the 2012 KDIGO clinical practice guideline. Results Of the 1086 patients included, 507 had a final adjudicated diagnosis of respiratory tract infection and were eligible for this analysis. Of those, 183 (36%) had a positive PCR swab test for SARS-CoV-2. Baseline characteristics were comparable between patients with and without COVID-19. AKI occurred in 95 patients (19%) with a higher incidence (30%, 95%CI 24-37 versus 12%, 95%CI 9-17, p<0.001) and a higher severity (KDIGO stage 3, 22% versus 10%, p=0.003) in patients with COVID-19 as compared to controls, respectively. Need for intensive care (22% versus 6%, p<0.001) and requirement for RRT were higher in patients with COVID-19 (8 patients (4.4%) versus 2 patients (0.62%); p=0.01). Renal recovery at discharge in survivors was similar in patients with (64%) and without COVID-19 (48%, p=0.175). Survival analysis identified AKI as a predictor of 30-day mortality independent of COVID-19 status (adjusted hazard ratio (aHR) 3.44, 95% confidence interval (CI) 1.55-7.63, p=0.002), but COVID-19 patients with AKI carried the highest risk (aHR 4.24, 95%CI 1,82-9.88, p<0.001). (Figure 1) Conclusion AKI occurs more frequently and more severely in patients with COVID-19 compared to other respiratory tract infections. It is associated with an increased risk for death, with the highest risk observed in COVID-19 patients. This underlines the augmented burden of AKI during the COVID-19 pandemic.

Download Full-text

Acute kidney injury associated with COVID-19: understanding its underlying mechanism

Applied Science and Technology Annals ◽

10.3126/asta.v1i1.30302 ◽

2020 ◽

Vol 1 (1) ◽

pp. 173-175

Author(s):

Samir Singh

Keyword(s):

Acute Kidney Injury ◽

Blood Clotting ◽

Kidney Injury ◽

Underlying Mechanism ◽

Clinical Findings ◽

World Health ◽

Cytokine Storm ◽

Kidney Involvement ◽

Novel Coronavirus ◽

Health Organization

World Health Organization (WHO) has declared coronavirus disease 2019 (COVID-19) outbreak as a global emergency. Kidney involvement is commonly seen in COVID-19 patients with clinical findings ranging from mild proteinuria to acute kidney injury (AKI) in hospitalized patients. In this viewpoint, I would like to discuss about various mechanism contributing to AKI such as, entry of novel coronavirus into host cell, cytokine storm that destroy kidney tissues, increased blood clotting that clogs kidney, and probable direct infection of the kidney.

Download Full-text

Acute kidney injury in hematopoietic stem cell transplantation

Current Opinion in Critical Care ◽

10.1097/mcc.0000000000000657 ◽

2019 ◽

Vol 25 (6) ◽

pp. 531-538 ◽

Cited By ~ 4

Author(s):

Rimda Wanchoo ◽

Brian R. Stotter ◽

Ruthee L. Bayer ◽

Kenar D. Jhaveri

Keyword(s):

Acute Kidney Injury ◽

Stem Cell ◽

Hematopoietic Stem Cell Transplantation ◽

Stem Cell Transplantation ◽

Cell Transplantation ◽

Hematopoietic Stem Cell ◽

Kidney Injury ◽

Hematopoietic Stem

Download Full-text

First Reported Case in Romania of a Successfully Treated Severe COVID-19 in a Kidney Transplant Recipient: A Focus on Acute Kidney Injury

Case Reports in Nephrology and Dialysis ◽

10.1159/000512606 ◽

2020 ◽

Vol 10 (3) ◽

pp. 174-179

Author(s):

Flaviu Tosa ◽

Roxana Manaila ◽

Alina Elec ◽

Tudor Moisoiu ◽

Liviu Ghervan ◽

...

Keyword(s):

Acute Kidney Injury ◽

Transplant Recipient ◽

Kidney Transplant ◽

Kidney Transplant Recipient ◽

Clinical Status ◽

Organ Transplant ◽

Treatment Strategies ◽

Kidney Injury ◽

Kidney Graft ◽

Kidney Involvement

As coronavirus disease 2019 (COVID-19) caused by the novel virus SARS-CoV-2 is expanding worldwide, kidney involvement seems to be part of the spectrum of its effects. Moreover, the prognosis of the disease seems to be worse in immunocompromised patients when compared to the general population, with 4–5 times higher mortality rates. However, the overall impact on long-term function of the kidney graft is unknown. We report on a case of a 46-year-old kidney transplant recipient who was successfully treated for severe COVID-19 pneumonia. The clinical course was complicated by transient acute kidney injury, most likely due to tubulo-interstitial involvement, with return to the baseline of the creatinine level by the time of discharge. We discuss the characteristics and differential diagnosis of acute kidney injury, as well as management of immunosuppression in connection with overall clinical status and evolution of kidney function. The case is illustrative for dilemmas that transplant professionals may face in the absence of evidence-based, efficient COVID-19 therapy. The risk-benefit balance of the yet to be approved treatment strategies may be weighed differently in organ transplant recipients owing to their immunocompromised status and potential drug interactions with immunosuppressive therapy.

Download Full-text

Acute kidney injury and its outcomes in melioidosis

Journal of Nephrology ◽

10.1007/s40620-021-00970-x ◽

2021 ◽

Author(s):

Ravindra Attur Prabhu ◽

Tushar Shaw ◽

Indu Ramachandra Rao ◽

Vandana Kalwaje Eshwara ◽

Shankar Prasad Nagaraju ◽

...

Keyword(s):

Acute Kidney Injury ◽

Kidney Function ◽

Univariate Analysis ◽

Kidney Injury ◽

Function Recovery ◽

Kidney Involvement ◽

Duration Of Hospitalization ◽

Observational Cohort ◽

Stage 1 ◽

Urinary Abnormalities

Abstract Background Melioidosis is a potentially fatal tropical infection caused by Burkholderia pseudomallei. Kidney involvement is possible, but has not been well described. Aim This study aimed to assess the risk of acute kidney injury (AKI) and its outcomes in melioidosis. Methods A retrospective observational cohort study was performed. Case records of consecutive patients with culture-confirmed melioidosis, observed from January 1st, 2012 through December 31st, 2019 were analysed for demographics, presence of comorbidities, including chronic kidney disease (CKD), diabetes mellitus (DM), and presence of bacteraemia, sepsis, shock, AKI, and urinary abnormalities. The outcomes we studied were: mortality, need for hospitalisation in an intensive care unit (ICU), duration of hospitalization. We then compared the outcomes between patients with and without AKI. Results Of 164 patients, AKI was observed in 59 (35.98%), and haemodialysis was required in eight (13.56%). In the univariate analysis, AKI was associated with CKD (OR 5.83; CI 1.140–29.90, P = 0.03), bacteraemia (OR 8.82; CI 3.67–21.22, P < 0.001) and shock (OR 3.75; CI 1.63–8.65, P = 0.04). In the multivariate analysis, CKD (adjusted OR 10.68; 95% CI 1.66–68.77; P = 0.013) and bacteraemia (adjusted OR 8.22; 95% CI 3.15–21.47, P < 0.001) predicted AKI. AKI was associated with a greater need for ICU care (37.3% vs. 13.3%, P = 0.001), and mortality (32.2% vs. 5.7%, P < 0.001). Mortality increased with increasing AKI stage, i.e. stage 1 (OR 3.52, CI 0.9–13.7, P = 0.07), stage 2 (OR 6.79, CI 1.92–24, P = 0.002) and stage 3 (OR 17.8, CI 5.05–62.8, P < 0.001), however kidney function recovered in survivors. Hyponatremia was observed in 138 patients (84.15%) and isolated urinary abnormalities were seen in 31(18.9%). Conclusions AKI is frequent in melioidosis and occurred in 35.9% of our cases. Hyponatremia is likewise common. AKI was predicted by bacteraemia and CKD, and was associated with higher mortality and need for ICU care; however kidney function recovery was observed in survivors. Graphic abstract

Download Full-text

Amelioration of Acute Kidney Injury in Lipopolysaccharide-Induced Systemic Inflammatory Response Syndrome by an Aldose Reductase Inhibitor, Fidarestat

PLoS ONE ◽

10.1371/journal.pone.0030134 ◽

2012 ◽

Vol 7 (1) ◽

pp. e30134 ◽

Cited By ~ 28

Author(s):

Kazunori Takahashi ◽

Hiroki Mizukami ◽

Kosuke Kamata ◽

Wataru Inaba ◽

Noriaki Kato ◽

...

Keyword(s):

Acute Kidney Injury ◽

Systemic Inflammatory Response Syndrome ◽

Inflammatory Response ◽

Aldose Reductase ◽

Reductase Inhibitor ◽

Kidney Injury ◽

Aldose Reductase Inhibitor ◽

Systemic Inflammatory Response

Download Full-text

Survival from paraquat induced renal impairment in a 17 years old male

International Journal of Advances in Medicine ◽

10.18203/2349-3933.ijam20210282 ◽

2021 ◽

Vol 8 (2) ◽

pp. 300

Author(s):

Medo M. Kuotsu ◽

N. Biplab Singh ◽

Nyamnyei Konyak ◽

Vikie-o Khruomo ◽

Senjele Kath ◽

...

Keyword(s):

Acute Kidney Injury ◽

Treatment Options ◽

Fatal Outcome ◽

Radical Scavenging ◽

Case Fatality ◽

Kidney Injury ◽

Organ Damage ◽

Paraquat Poisoning ◽

Adequate Hydration ◽

Life Threatening

N, N’-dimethyl-4, 4’-bipyridinium dichloride (paraquat) is a herbicide commonly used in India that leads to fatal outcome on ingestion. Paraquat interferes in the intracellular electron transfer systems inhibiting the reduction of NADP to NADPH resulting in accumulation of superoxide radical causing lipid cell membranes destruction leading to various organ damage. Life threatening effects such as acute kidney injury as paraquat elimination is mainly by kidney, acute respiratory distress syndrome and multi-organ failure are the causes of mortality in paraquat poisoning. There is no specific antidotes for paraquat poisoning so prevention and aggressive decontamination remains the mainstay of management in case of exposure or ingestion. Paraquat poisoning presentation may vary in cases depending on the amount of paraquat consumed and thus the outcome. Here we report a case of a 17 years old male who presented with acute kidney injury following ingestion of paraquat in a suicidal attempt. In our case, induced vomiting of the stomach content readily after ingestion of the poison, early haemodialysis, use of immunosuppression such as methylprednisolone, cyclophosphamide and antioxidants such as acetylcysteine, Vitamin C and Vitamin E as free radical scavenging agent , supportive measures such as adequate hydration and antibiotics might have helped in the patient’s survival. The case fatality remains very high in paraquat poisoning till date owing to lack of effective treatment options.

Download Full-text

MiR-22-3p suppresses sepsis-induced acute kidney injury by targeting PTEN

Bioscience Reports ◽

10.1042/bsr20200527 ◽

2020 ◽

Vol 40 (6) ◽

Author(s):

Xudong Wang ◽

Yali Wang ◽

Mingjian Kong ◽

Jianping Yang

Keyword(s):

Acute Kidney Injury ◽

Inflammatory Response ◽

Periodic Acid ◽

Kidney Injury ◽

Luciferase Reporter ◽

Tunel Staining ◽

Tnf Α

Abstract Background: Septic acute kidney injury is considered as a severe and frequent complication that occurs during sepsis. The present study was performed to understand the role of miR-22-3p and its underlying mechanism in sepsis-induced acute kidney injury. Methods: Rats were injected with adenovirus carrying miR-22-3p or miR-NC in the caudal vein before cecal ligation. Meanwhile, HK-2 cells were transfected with the above adenovirus following LPS stimulation. We measured the markers of renal injury (blood urea nitrogen (BUN), serum creatinine (SCR)). Histological changes in kidney tissues were examined by hematoxylin and eosin (H&E), Masson staining, periodic acid Schiff staining and TUNEL staining. The levels of IL-1β, IL-6, TNF-α and NO were determined by ELISA assay. Using TargetScan prediction and luciferase reporter assay, we predicted and validated the association between PTEN and miR-22-3p. Results: Our data showed that miR-22-3p was significantly down-regulated in a rat model of sepsis-induced acute kidney injury, in vivo and LPS-induced sepsis model in HK-2 cells, in vitro. Overexpression of miR-22-3p remarkably suppressed the inflammatory response and apoptosis via down-regulating HMGB1, p-p65, TLR4 and pro-inflammatory factors (IL-1β, IL-6, TNF-α and NO), both in vivo and in vitro. Moreover, PTEN was identified as a target of miR-22-3p. Furthermore, PTEN knockdown augmented, while overexpression reversed the suppressive role of miR-22-3p in LPS-induced inflammatory response. Conclusions: Our results showed that miR-22-3p induced protective role in sepsis-induced acute kidney injury may rely on the repression of PTEN.

Download Full-text