Kidney in the net of acute and long-haul coronavirus disease 2019: a potential role for lipid mediators in causing renal injury and fibrosis

Chiang, Kate Chander; Imig, John D.; Kalantar-Zadeh, Kamyar; Gupta, Ajay

doi:10.1097/mnh.0000000000000750

Cited by 14 publications

(11 citation statements)

References 149 publications

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“…Second, it can be attributed to the direct infection of renal cells by SARS‐Cov‐2, which promotes tubulointerstitial fibrosis at the molecular level 25,26 . In addition, lipid mediators storm, which plays a potential role in causing renal injury and fibrosis, increases the possibility of acute kidney disease to CKD 27 . Last but not least, SARS‐CoV‐2 produces cellular damage by alterations of the ACE2 pathway, various inflammatory cytokines, mitochondrial dysfunction, pro‐coagulation, and other immune aberrations, 16,17 of which the imbalance of anti‐inflammatory/pro‐inflammatory cytokines play a very important role.…”

Section: Discussionmentioning

confidence: 99%

The pattern of cytokines expression and dynamic changes of renal function at 6 months in patients with Omicron COVID‐19

Teng

Song

Zhang

et al. 2023

Journal of Medical Virology

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To analyze the dynamic changes of renal function longitudinally and investigate the cytokine profiles at 6 months in patients with Omicron COVID‐19. Forty‐seven patients with a proven diagnosis of Omicron COVID‐19 from January to February 2022 attended a 6‐month follow‐up after discharge at Tianjin First Central Hospital. The demographic parameters, clinical features, and laboratory indexes were collected during hospitalization and 6 months after discharge. The serum cytokine levels at 6 months were also assessed. Patients were grouped according to with or without kidney involvement at admission. The levels of serum creatinine and estimated glomerular filtration rate (eGFR) were all normal both in the hospital and at follow‐up. Whereas, compared with renal function in the hospital, serum creatinine levels at 6 months increased remarkably; meanwhile, eGFR decreased significantly in all patients. The serum levels of interleukin (IL)‐2, IL‐4, IL‐5, IL‐6, IL‐10, and TNF‐α and IFN‐γ significantly decreased and TGF‐β remarkably increased in the kidney involvement group. The serum levels of IL‐2 and IL‐5 were positively correlated with age; contrarily, TGF‐β showed a negative correlation with aging. The younger was an independent risk factor of the higher TGF‐β levels. Omicron patients showed a decline in renal function at follow‐up, reflecting the trend of CKD. Serum cytokine profiles were characterized with the majority of cytokines decreased and TGF‐β increased in the kidney involvement group; the latter may be used as a sign of CKD. The tendency of CKD is one of the manifestations of long COVID and deserves attention.

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Section: Discussionmentioning

confidence: 99%

The pattern of cytokines expression and dynamic changes of renal function at 6 months in patients with Omicron COVID‐19

Teng

Song

Zhang

et al. 2023

Journal of Medical Virology

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“…Even in patients with mild symptoms, there is an increased risk of long-term renal damage [ 29 ]. The direct infection of renal cells and lipid mediator storm caused by SARS-Cov-2 can promote tubulointerstitial fibrosis at the molecular level, which increases the possibility of acute kidney involvement and CKD [ 30 , 31 ]. Although the incidence of hematuria and albuminuria is not high in this study, the kidney involvement represented by hematuria and albuminuria is likely to be the starting point of adverse renal outcomes in long-term follow-up.…”

Section: Discussionmentioning

confidence: 99%

The Investigation of Kidney Involvement in 430 Hospitalized Patients with Omicron COVID-19 in Tianjin, China

Teng

Chang

2023

Blood Purif

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Introduction: This study evaluated the incidence, clinical characteristics, and risk factors of kidney involvement in patients with the Omicron variant infection in the post-acute treatment phase in Tianjin, China. Methods: Data were collected from 430 patients with Omicron variant infection in Tianjin, China. Demographics, comorbidities, laboratory blood tests, urinalysis, vaccination status, and COVID-19 clinical classification were assessed. Patients were grouped based on kidney involvement, and associated risk factors of kidney involvement were also investigated. Results: Asymptomatic, mild, ordinary, and severe patients with Omicron COVID-19 variant comprised 1.5%, 49.1%, 48.9%, and 0.5% of the sample population, respectively, without critical illness or death. The incidences of hematuria, proteinuria, and concurrent hematuria and proteinuria were 14.7%, 14.2%, and 5.1%, respectively. Patients with and without kidney involvement differed in age, body mass index (BMI), comorbidity, creatinine levels, estimated glomerular filtration rate, and C-reactive protein (CRP) levels. Age, hypertension, higher CRP levels, and higher BMI were linked with kidney involvement. Conclusion: The majority of the patients suffered from mild or ordinary symptoms of Omicron COVID-19 infection. The primary kidney involvement was hematuria and proteinuria. Proteinuria was significantly associated with Omicron variant infection, and patients with hypertensive comorbidity, higher CRP, and higher creatinine levels were at increased risk of proteinuria after Omicron variant infection.

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“…In line with these organ-specific findings, SARS-CoV-2 antigen has been recovered from multiple body sites including the gastrointestinal tract, hepatic tissues, the brain, lymphoid tissues, and in circulation up to 7-month post-infection 34,40,207,208 Some groups proposed that, much like other chronic infections, persistent antigen exposure leads to chronic immune activation and subsequent systemic and compartmentalized inflammation, contributing to the wide array of clinical manifestations seen in long COVID. 105,165,177,178,181,183,189–193,209–212…”

Section: Long Covidmentioning

confidence: 99%

The role of immune activation and antigen persistence in acute and long COVID

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Fram

et al. 2023

Journal of Investigative Medicine

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In late 2019, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) triggered the global coronavirus disease 2019 (COVID-19) pandemic. Although most infections cause a self-limited syndrome comparable to other upper respiratory viral pathogens, a portion of individuals develop severe illness leading to substantial morbidity and mortality. Furthermore, an estimated 10%–20% of SARS-CoV-2 infections are followed by post-acute sequelae of COVID-19 (PASC), or long COVID. Long COVID is associated with a wide variety of clinical manifestations including cardiopulmonary complications, persistent fatigue, and neurocognitive dysfunction. Severe acute COVID-19 is associated with hyperactivation and increased inflammation, which may be an underlying cause of long COVID in a subset of individuals. However, the immunologic mechanisms driving long COVID development are still under investigation. Early in the pandemic, our group and others observed immune dysregulation persisted into convalescence after acute COVID-19. We subsequently observed persistent immune dysregulation in a cohort of individuals experiencing long COVID. We demonstrated increased SARS-CoV-2-specific CD4+ and CD8+ T-cell responses and antibody affinity in patients experiencing long COVID symptoms. These data suggest a portion of long COVID symptoms may be due to chronic immune activation and the presence of persistent SARS-CoV-2 antigen. This review summarizes the COVID-19 literature to date detailing acute COVID-19 and convalescence and how these observations relate to the development of long COVID. In addition, we discuss recent findings in support of persistent antigen and the evidence that this phenomenon contributes to local and systemic inflammation and the heterogeneous nature of clinical manifestations seen in long COVID.

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Kidney in the net of acute and long-haul coronavirus disease 2019: a potential role for lipid mediators in causing renal injury and fibrosis

Cited by 14 publications

References 149 publications

The pattern of cytokines expression and dynamic changes of renal function at 6 months in patients with Omicron COVID‐19

The pattern of cytokines expression and dynamic changes of renal function at 6 months in patients with Omicron COVID‐19

The Investigation of Kidney Involvement in 430 Hospitalized Patients with Omicron COVID-19 in Tianjin, China

The role of immune activation and antigen persistence in acute and long COVID

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