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Nature Sub-Journal: Coronavirus can directly infect the kidneys and cause acute kidney injury
Coronavirus can directly infect the kidneys and cause acute kidney injury. The COVID-19 epidemic broke out at the end of 2019, and it quickly spread to all parts of the world and caused a global pandemic. Today, it has caused more than 100 million infections and more than 2.3 million deaths.
The typical symptoms of new coronaviruspneumonia include fever, cough, shortness of breath, pneumonia, etc., and in elderly patients and critically ill patients, acute respiratory distress syndrome, acute heart injury, lymphopenia and lymphopenia are also common. It shows that the new coronavirus can affect various organs of the human body.
We already know that the new coronavirus invades the human body through the interaction of the spike protein (S protein) protein on its surface with the ACE2 receptor on the surface of human cells. In fact, ACE2 is widely expressed in organs and tissues such as the heart, blood vessels, intestines, lungs, kidneys, testes, and brain.
Studies have found that some patients with COVID-19 have elevated proteinuria levels, which indicates that COVID-19 virus infections may cause acute kidney injury (AKI). In addition, the new coronavirus can also directly infect human kidney organs through the ACE2 receptor.
However, there is no evidence that the new coronavirus can directly infect human kidneys and cause acute kidney injury (AKI).
On May 4, 2021, Chen Yongwen and Wu Yuzhang of the Third Military Medical University, and Ren Liang of Huazhong University of Science and Technology published a research paper titled: Human kidney is a target for novel severe acute respiratory syndrome coronavirus 2 infection in Nature Communications.
The research team retrospectively analyzed the clinical data of the renal function of 85 patients with new coronavirus disease admitted to the General Hospital of the Central Theater of Wuhan from January 17, 2020 to February 13, 2020. It was found that 27% (23/85) of the patients showed acute kidney injury (AKI).
Histopathological examination of the kidneys of six other patients with COVID-19 who underwent an autopsy revealed that their kidneys had moderate to severe tubular damage.
The study provides direct evidence that the new coronavirus directly infects the kidneys to cause renal tubular lesions and acute kidney injury (AKI).
First, the research team retrospectively analyzed 85 new coronavirus patients with clinical data on renal function, including estimated glomerular filtration rate (eGFR), serum urea nitrogen, creatinine and other clinical indicators, and found that 27% (23/85 ) COVID-19 patients showed acute kidney injury based on eGFR levels.
Based on symptoms and clinical signs, these 85 patients were further divided into three groups (mild/moderate, severe and critical). The eGFR levels of critically ill patients were significantly reduced, indicating that acute kidney injury is relatively common in patients with severe new coronavirus disease.
Previous studies have shown that the receptor ACE2 of the new coronavirus is expressed in human renal tubules. The research team found that their kidney tissue had ACE2 expression through immunohistochemical tests on the kidney tissue of patients who died from COVID-19. Immunofluorescence double staining showed that the N protein and S protein of the new coronavirus were co-localized with the ACE2 protein in the renal tubules. These findings indicate that the new coronavirus directly infects human renal tubules through the ACE2 receptor.
Next, the research team explored the pathological pathways involved in kidney injury, and detected hypoxic injury-related molecules by immunofluorescence staining, including the expression of DP2 and prostaglandin D synthase (PDS) in kidney tissues, both of which are It is highly expressed in the renal tubules of COVID-19 autopsy, and is co-expressed with the COVID-19 virus-specific protein and S antigen. In contrast, membranous nephritis (HBV-MN) caused by hepatitis B virus infection did not show any DP2 or PDS, indicating that the new coronavirus can directly cause hypoxic damage in the infected renal tubules.
In general, this study proves that the new coronavirus can directly infect human renal tubules, leading to renal tubular damage and acute kidney injury. This reminds us that we should pay attention to the risk of acute kidney injury in patients with new coronavirus disease. Patients benefit. Potential interventions such as blocking the combination of new coronavirus and ACE2, immune regulation, continuous renal replacement therapy (CRRT), etc., to protect the renal function of patients with new ccoronavirus disease and prevent the death of severely ill patients
(source:internet, reference only)