Coronavirus Disease 19 Infection Does Not Result in Acute Kidney Injury: An Analysis of 116 Hospitalized Patients from Wuhan, China

Wang, Gaofeng; Li, Xun; Chen, Hui; Yan, Shaonan; Li, Dong; Li, Yan; Gong, Zhengliang

doi:10.1159/000507471

Cited by 388 publications

(422 citation statements)

References 18 publications

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“…Based on the RNA sequence data from normal tissues in multiple databases (HPA, GTEx, FANTOM5, TCGA, and GEO), ACE2 and TMPRSS2 were highly expressed in kidney and testis. Meanwhile, positive SARS-CoV-2 RNA has been found in the urine sediments from some severely ill patients with urinary tract-related complications 34 . It is tempting to speculate that such complications might be mediated by the entry of SARS-CoV-2 into the kidney via ACE2 and TMPRSS2.…”

Section: Discussionmentioning

confidence: 99%

Multiple expression assessments of ACE2 and TMPRSS2 SARS-CoV-2 entry molecules in the urinary tract and their associations with clinical manifestations of COVID-19

Ren

Wei

et al. 2020

Preprint

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Background: Since December 2019, the novel coronavirus, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), first spread quickly in Wuhan, China, then globally. From previously published evidence, ACE2 and TMPRSS2, are both pivotal entry molecules that enable cellular infection by SARS-CoV-2. Meanwhile, increased expression of pro-inflammatory cytokines, or a "cytokine storm," is associated with multiple organ dysfunction syndrome that is often observed in critically ill patients. Methods: We investigated the expression pattern of ACE2 and TMPRSS2 in major organs in the human body, especially under specific disease conditions. Multiple sequence alignment of ACE2 in different species was used to explain animal susceptibility. Moreover, the cell-specific expression patterns of ACE2 and cytokine receptors in the urinary tract were assessed using single-cell RNA sequencing (scRNA-seq). Additional biological relevance was determined through Gene Set Enrichment Analysis (GSEA) using an ACE2 specific signature. Results: Our results revealed that ACE2 and TMPRSS2 were highly expressed in genitourinary organs. ACE2 was highly and significantly expressed in the kidney among individuals with chronic kidney diseases or diabetic nephropathy. In single cells, ACE2 was primarily enriched in gametocytes in the testis, and renal proximal tubules. The receptors for pro-inflammatory cytokines, especially IL6ST, were remarkably concentrated in endothelial cells, macrophages, and spermatogonial stem cells in the testis, and renal endothelial cells, which suggested the occurrence of alternative damaging mechanisms via autoimmune attacks. Conclusions: This study provided new insights into the pathogenicity mechanisms of SARS-CoV-2 that underlie the clinical manifestations observed in the human testis and kidney. These observations might substantially facilitate the development of effective treatments for this rapidly spreading disease.

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Section: Discussionmentioning

confidence: 99%

Multiple expression assessments of ACE2 and TMPRSS2 SARS-CoV-2 entry molecules in the urinary tract and their associations with clinical manifestations of COVID-19

Ren

Wei

et al. 2020

Preprint

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“…It is currently unclear to what extend COVID-19 itself is an important cause of acute kidney injury. 15 We here describe different modalities of respiratory support, with an emphasis on those feasible in resource-limited settings. Ventilatory support is essential for survival in patients with severe COVID-19, defined according to the WHO as the presence of oxygen saturation on air less than 93% by pulse oximetry, a respiratory rate above 30 per minute, or rapid progression of lung infiltrates on the chest X-ray, or critically ill COVID-19 patients with respiratory failure.…”

Section: Introductionmentioning

confidence: 99%

Respiratory Support in COVID-19 Patients, with a Focus on Resource-Limited Settings

Dondorp

Hayat

Aryal³

et al. 2020

The American Journal of Tropical Medicine and Hygiene

181

163

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The ongoing novel coronavirus disease pandemic is threatening the global human population, including in countries with resource-limited health facilities. Severe bilateral pneumonia is the main feature of severe COVID-19, and adequate ventilatory support is crucial for patient survival. Although our knowledge of the disease is still rapidly increasing, this review summarizes current guidance on the best provision of ventilatory support, with a focus on resource-limited settings. Key messages include that supplemental oxygen is a first essential step for the treatment of severe COVID-19 patients with hypoxemia and should be a primary focus in resource-limited settings where capacity for invasive ventilation is limited. Oxygen delivery can be increased by using a non-rebreathing mask and prone positioning.The presence of only hypoxemia should in general not trigger intubation because hypoxemia is often remarkably well tolerated. Patients with fatigue and at risk for exhaustion, because of respiratory distress, will require invasive ventilation. In these patients, lung protective ventilation is essential. Severe pneumonia in COVID-19 differs in some important aspects from other causes of severe pneumonia or acute respiratory distress syndrome, and limiting the positive endexpiratory pressure level on the ventilator may be important. This ventilation strategy might reduce the currently very high case fatality rate of more than 50% in invasively ventilated COVID-19 patients.

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“…As a ribonucleic acid (RNA) virus it has a vast potential of mutating and generating sub-species or variants [4]. The SARS-CoV-2 virus was confirmed by real-time reverse transcription polymerase chain reaction (rRT-PCR) in sputum, saliva, nasal, pharyngeal and tracheal swabs, broncho-alveolar lavage, pleural effusion fluid, blood, feces, and occasionally in urine, and even semen [5][6][7][8][9][10][11][12][13][14]. According to World Health Organization (WHO), the detection of a single RNA sequence of coronavirus by rRT-PCR is uniform with the confirmation of the disease.…”

Section: The Sars-cov-2 Virus Its Transmission and Entry Pointsmentioning

confidence: 99%

“…Up to 30% of patients with COVID-19 admitted to an ICU presented with symptoms of acute kidney injury (AKI), advanced to stage 3, according to the 2012 Kidney Disease: Improving Global Outcomes (KDIGO) [93,94]. Wang et al [12] denies AKI being caused directly by the SARS-CoV-2 virus. However, renal podocytes and proximal tubule cells express both of the viral receptors -ACE2 and TMPRSS2, serving as a target for it [12,23].…”

Section: Acute Kidney Injury In Covid-19mentioning

confidence: 99%

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COVID-19 — Toward a comprehensive understanding of the disease

et al. 2020

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The evidence on the pathophysiology of the novel coronavirus SARS-CoV-2 infection is rapidly growing. Elucidating why some patients suffering from COVID-19 are getting so sick, while others are not, has become an informal imperative for researchers and clinicians around the globe. The answer to this question would allow rationalizing the fear surrounding this pandemic. Understanding of the pathophysiology of COVID-19 relies on unraveling of interplaying mechanisms, including SARS-CoV-2 virulence, human immune response, and complex inflammatory reactions with coagulation playing a major role. An interplay with bacterial co-infections, as well as the vascular system and microcirculation affected throughout the body should also be examined. More importantly, a comprehensive understanding of pathological mechanisms of COVID-19 will increase the efficacy of therapy and decrease mortality. Herewith, the authors present a combined viewpoint based on the current state of knowledge on COVID-19: beginning from the virus, its transmission, and mechanisms of entry into the human body, through the pathological effects on the cellular level, up to immunological reaction, systemic and organ presentation. Last but not least, currently available and possible future therapeutic and diagnostic options are briefly commented on. (Cardiol J 2020; 27, 2: 99-114)

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Coronavirus Disease 19 Infection Does Not Result in Acute Kidney Injury: An Analysis of 116 Hospitalized Patients from Wuhan, China

Cited by 388 publications

References 18 publications

Multiple expression assessments of ACE2 and TMPRSS2 SARS-CoV-2 entry molecules in the urinary tract and their associations with clinical manifestations of COVID-19

Multiple expression assessments of ACE2 and TMPRSS2 SARS-CoV-2 entry molecules in the urinary tract and their associations with clinical manifestations of COVID-19

Respiratory Support in COVID-19 Patients, with a Focus on Resource-Limited Settings

COVID-19 — Toward a comprehensive understanding of the disease

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