Introduction. Chronic kidney disease (CKD) is associated with high mortality rates, mainly as a result of cardiovascular complications. Meanwhile, recent studies have suggested a role of a homodimer protein called activin A in chronic kidney disease-mineral and bone disorder (CKD-MBD) conditions that may exist in the vascular calcification and osteolytic process. Ultrasound examination of the carotid intima-media thickness (cIMT) is a noninvasive method to assess vascular calcification. This study aimed to analyze the relationship between the activin A serum level and cIMT in patients with CKD at Mohammad Hoesin Hospital, Palembang, Indonesia. Methods. We conducted a hospital-based, cross-sectional study of consecutive CKD patients at the Department of Internal Medicine, Mohammad Hoesin Hospital, from July to November 2019. The level of activin A was measured by enzyme-linked immunosorbent assay. Meanwhile, cIMT measurements were collected by B-mode ultrasound imaging. Results. A total of 55 patients with CKD were included in this investigation. The median serum activin A level in these patients was 236.17 (116.33–283) pg/mL, while the median cIMT was 0.8 (0.6–1.45) mm. A relationship between the serum activin A level and cIMT (r  =  0.449; p = 0.001 ) was observed. During multivariate analysis with linear regression, triglyceride p = 0.049 , phosphate p = 0.005 , and activin A p = 0.020 serum levels were factors associated with cIMT. Conclusion. In this study, a relationship between the activin A serum level and cIMT in patients with CKD was identified. Vascular calcification should be screened for in all CKD patients by the measurement of cIMT.

Kidney disease affects 800 million children and adults worldwide, and the numbers keep increasing. A better understanding of the pathogenesis in kidney diseases, especially on a biomolecular level, is much needed to identify novel biomarkers and therapeutic targets for kidney diseases. The glomerular filtration barrier comprises endothelial cells, the glomerular basement membrane, and podocytes. The podocyte has a central role in part of the glomerular filtration barrier. The normal functioning of podocytes is particularly important in preventing the heavy proteinuria seen in nephrotic syndrome or diabetic nephropathy, or in the disease process of focal segmental glomerulosclerosis. The podocyte is injured by circulating factors, which finally results in deranged podocyte motility. Soluble urokinase-type plasminogen activator receptor (suPAR) is a circulating form of glycosyl-phosphatidylinositol uPAR domain membrane protein and is known to play a role in the pathogenesis in kidney diseases, specifically focal segmental glomerulosclerosis and diabetic nephropathy. suPAR binds to αvβ3 integrin on podocyte foot processes and causes podocyte structure disorganization leading to glomerular filtration disruption and hence proteinuria. suPAR is also a potential biomarker to predict the incidence of CKD.

The pandemic of coronavirus disease 2019 (COVID-19) caused by the severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2). The clinical manifestation of COVID-19 is broad, ranging from an asymptomatic carrier state to severe disease leading to the death penalty. There is also emerging evidence that kidneys are affected early in COVID-19. Proteinuria and haematuria have been reported in 44% and 26.7% on admission, respectively.   This literature review shows clinical manifestations of acute kidney injury (AKI) in a patient with COVID-19 infection. Literature reviews are carried out on various sources found on Google Scholar and Pubmed to search for articles, journal research, case reports, systematic reviews, meta-analyses, and textbooks. Various studies demonstrate the possibility of coronavirus infecting the kidney with several mechanisms such as cytokine storm syndrome (CSS), direct viral infection, and imbalance of renin-angiotensin-aldosterone (RAAS). Haematuria and proteinuria are associated with higher mortality and may signify aggressive disease early. Thus all patients should have a baseline urinalysis. There is a number of different causes of AKI in COVID-19, and some mechanisms by which COVID-19 affects kidneys remain unclear.

Included were consenting patients over the age of 18 who had been on chronic hemodialysis for more than 3 months and no history of hospitalization in the last month. Without modifying the clinically established dry weight, we measured weight and total body water by using Tanita's bathroom scale (SF-BIA technology) before and after hemodialysis session for 6 successive sessions. These measures were compared with results from clinical measures. Comparison of the repeated measurements was performed using a Student's t-test on paired samples and the agreement was evaluated by linear regression and Brand-Altman analysis. Results: 264 measurements were performed in 22 patients. The average age was 46.6AE13.1 years, with 54.5% of men and an average duration of dialysis of 92.3 AE 46.8 months. During the hemodialysis session, there was a significant reduction in weight (65AE17.1 kg pre-dialysis compared with 62.9AE17.0 kg post-dialysis, p <0.0001) and total body water (TBW) measured by BIA (TBW BIA ¼ 36.3AE7.1 L pre-dialysis versus 33.0AE6.8 L post-dialysis, p <0.0001) or calculated by the Watson equation (TBW Watson ¼ 35.8AE6.9 L pre-dialysis against 35.2AE6.8 L post-dialysis, p <0.0001). This finding was expected and we guessed that the impedance in our patients was higher at the end than at the beginning of the session since the electrical conduction decreases when there is less water. We found a strong linear correlation and a concordance between the two TBW measurements in predialysis. This correlation remained high in non-concordance postdialysis with a mean of-2.2 differences, a very wide agreement limit (-5.9 and +1.5), and a significant difference in measurements.

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