German Study Warns That SARS-CoV-2 Infections Are Causing Acute Kidney Injury And Kidney Damage!

COVID-19 News: The emergence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in late 2019 sparked a global pandemic, leading to millions of infections and significant morbidity and mortality worldwide. What initially appeared as primarily a respiratory virus soon revealed its capacity to affect multiple organ systems, including the kidneys. This COVID-19 News report aims to delve deeper into the renal implications of SARS-CoV-2 infections, exploring viral tropism, pathogenic mechanisms, clinical outcomes, treatment strategies, and long-term effects on kidney health based on a recent study by researchers from University Medical Centre Hamburg-Eppendorf (UKE)-Germany, Bernhard Nocht Institute for Tropical Medicine (BNITM)-Germany and the German Centre for Infection Research (DZIF), Partner site Hamburg-Lübeck-Borstel-Riems-Germany.


SARS-CoV-2 Infections Are Causing Acute Kidney Injury And Kidney Damage
 
Thailand Medical News had covered extensively the issue of SARS-CoV-2 virus being able to cause kidney injuries and damage but sadly many people are still not aware of the threat that this novel virus poses to their renal health and worryingly, the incidence of kidney injury and kidney failure is rising in the last two years.
 
https://www.thailandmedical.news/news/covid-19-induced-kidney-damage-caused-by-sars-cov-2-using-receptors-such-as-tlr-4-kim-1-tim-1-and-cd147
 
https://www.thailandmedical.news/news/covid-19-news-insights-into-the-mechanism-behind-covid-19-induced-acute-kidney-injury-and-the-potential-therapeutic-role-of-quercetin
 
https://www.thailandmedical.news/news/covid-19-news-german-study-finds-that-urinary-n-terminal-pro-brain-natriuretic-peptide-predicts-acute-kidney-injury-and-severe-disease-in-covid-19
 
https://www.thailandmedical.news/news/japanese-study-finds-that-sars-cov-2-mediated-kidney-injury-can-be-prevented-by-inhibition-of-toll-like-receptor-4-and-interleukin-1-receptor
 
https://www.thailandmedical.news/news/breaking-news-fibrotic-events-in -kidneys-may-initiate-early-in-sars-cov-2-infection,-leading-to-pronounced-kidney-fibrosis-in-long-covid
 
https://www.thailandmedical.news/news/thailand-medical-news-warns-that-covid-19-infections-and-vaccinations-are-driving-exponential-incidences-of-acute-kidney-injury
 
https://www.thailandmedical.news/news/study-shockingly-shows-that-many-exposed-to-the-sars-cov-2-omicron-variant-exhibit-hematuria-and-proteinuria-early-signs-of-possible-kidney-damage
 
https://www.thailandmedical.news/news/covid-19-news-study-finds-that-non-omicron-variants-more-likely-to-cause-damage-to-the-kidney-s-filtration-system-than-omicron-sublineages
 
https://www.thailandmedical.news/news/breaking-covid-19-news-french-researchers-warn-that-post-covid-children-and-teenagers-are-at-risk-of-developing-kidney-disease
 
https://www.thailandmedical.news/news/breaking-covid-19-news-sars-cov-2-orf3a-protein-damages-renal-tubules-via-trim59-induced-stat3-activation-causing-acute-kidney-injury
 
https://www.thailandmedical.news/news/breaking-are-certain-newer-sars-cov-2-variants-causing-a-rise-in-chronic-kidney-disease-and-kidney-failure-in-countries-like-singapore-and-thailand
 
https://www.thailandmedical.news/news/breaking-u-s-cdc-reports-high-incidences-of-kidney-failure,-clots,-diabetes-and-heart-issues-in-post-covid-children-and-teenagers
 
https://www.thailandmedical.news/news/university-of-queensland-study-warns-that-millions-of-sars-cov-2-infected-individuals-are-not-aware-that-they-may-have-undiagnosed-acute-kidney-injury
 
https://www.thailandmedical.news/news/dutch-and-german-study-shows-that-sars-cov-2-directly-infects-the-kidneys-and-causes-tissue-scarring-which-ultimately-leads-to-kidney-damage-and-failu
 
https://www.thailandmedical.news/news/university-of-washington-study-confirms-that-sars-cov-2-can-directly-invade-human-kidney-cells-causing-a-range-of-kidney-issues-including-acute-kidney
 
https://www.thailandmedical.news/news/more-great-news-even-those-that-initially-had-mild-covid-19-symptoms-can-develop-kidney-disease-as-part-of-many-manifestations-of-long-covid
 
https://www.thailandmedical.news/news/good-news-study-finds-that-most-recovered-covid-19-patients-even-with-mild-infections-will-ultimately-develop-virus-induced-kidney-damage
 
https://www.thailandmedical.news/news/study-finds-that-covid-19-induced-acute-kidney-injury-similar-to-sepsis-caused-kidney-injury-and-that-mitochondrial-dysfunction-may-play-a-key-role
 
https://www.thailandmedical.news/news/covid-19-diagnostics-researchers-uncover-new-protein-biomarker-supar-to-identify-covid-19-patients-at-risk-of-acute-kidney-injury-aki
 
https://www.thailandmedical.news/news/warning-covid-19-latest-researchers-warn-of-epidemic-of-post-covid-19-kidney-disease-and-study-shows-many-will-die-or-never-recover-from-aki
 
https://www.thailandmedical.news/news/sars-cov-2-attacks-kidney-proximal-tubular-cells-causing-acute-fanconi-syndrome-according-to-french-study
 
https://www.thailandmedical.news/news/acute-kidney-injury-study-shows-that-acute-kidney-injury-(aki)-predominant-among-covid-19-patients
 
https://www.thailandmedical.news/news/covid-19-clinical-care-kidney-failure-emerging-as-a-common-occurrence-from-covid-19-infections
 
https://www.thailandmedical.news/news/breaking-more-emerging-chinese-research-studies-shows-that-the-sars-cov-2-coronavirus-also-attacks-the-kidneys,-pancreas-and-liver
 
https://www.thailandmedical.news/news/more-than-one-third-of-children-who-had-post-covid-19-multisystem-inflammatory-syndrome-developed-acute-kidney-injury
 
https://www.thailandmedical.news/news/covid-19-news-study-finds-that-sars-cov-2-nucleocapsid-protein-accumulates-in-renal-tubular-epithelium-of-post-covid-19-patients,-possibility-causing-
 
It should ne noted that the current COVID-19 mRNA vaccines can also cause kidney injuries and damage.
https://www.thailandmedical.news/news/covid-19-mrna-jabs-can-cause-new-onset-of-acute-interstitial-nephritis
 
https://www.thailandmedical.news/news/breaking-news-gene-study-reveals-how-covid-19-mrna-vaccine-leads-to-high-risk-of-iga-nephropathy-eventual-kidney-failure-and-possible-cancers
 
Understanding Viral Tropism in Renal Cells
Viral tropism refers to the ability of a virus to infect specific cell types within an organism. In the case of SARS-CoV-2, its infectivity in renal cells is influenced by several factors, most notably the presence of key receptors such as angiotensin-I-converting enzyme 2 (ACE2), transmembrane serine protease 2 (TMPRSS2), cathepsin L (CTSL), and dipeptidyl peptidase-4 (DPP4). These receptors are not only found in the respiratory system but also in various tissues throughout the body, including the kidneys.
 
Studies have demonstrated that ACE2, the primary receptor for SARS-CoV-2 entry into cells, is ubiquitously expressed in different renal cell types, including podocytes, mesangial cells, and proximal tubular cells. The presence of ACE2 in the kidney is of particular significance as it plays a crucial role in regulating the renin-angiotensin-aldosterone system (RAAS) and maintaining kidney function.
 
TMPRSS2, another key protein involved in SARS-CoV-2 entry, is also detectable in kidney tissue, further enhancing the virus's ability to infect renal cells.

In vitro experiments have shown that SARS-CoV-2 can infect kidney-derived cell lines, primary human and primate renal epithelial cells, and kidney organoids. This infectivity leads to productive viral replication and the potential for tissue-specific damage. Additionally, the virus has been found to drive fibrosis in kidney organoids, highlighting its ability to induce pathological changes in renal tissue.
 
Pathogenic Mechanisms and Renal Manifestations
The pathogenic mechanisms underlying SARS-CoV-2-induced kidney injury are multifaceted and involve both direct viral effects and indirect immune-mediated responses. Autopsy studies have revealed the presence of SARS-CoV-2 RNA and proteins in kidney tissues, with a predilection for glomerular cells. This direct infection of renal cells, including tubular epithelial cells and podocytes, can lead to acute kidney injury (AKI) and other renal manifestations.
 
Moreover, the systemic inflammatory response triggered by SARS-CoV-2, often characterized by a cytokine storm, can have detrimental effects on renal function.

Pro-inflammatory cytokines such as interleukin-6 (IL-6), interleukin-1β (IL-1β), and tumor necrosis factor-α (TNF-α) contribute to endothelial dysfunction, oxidative stress, and apoptosis in renal cells. The resulting endothelial injury and microvascular thrombosis further exacerbate renal damage, contributing to conditions like acute tubular necrosis (ATN) and glomerular injury.
 
In severe cases of COVID-19, patients may develop collapsing glomerulopathy, a distinct form of glomerular injury characterized by podocyte hypertrophy and hyperplasia, along with tubulointerstitial inflammation. These renal manifestations not only contribute to acute morbidity but can also have long-term consequences, including progression to chronic kidney disease (CKD) in some patients.
 
Treatment Approaches for Renal Injury in COVID-19 Patients
As of now, there are no specific antiviral therapies or targeted treatments for SARS-CoV-2-induced kidney injury. Management primarily focuses on supportive care and addressing complications such as AKI and electrolyte imbalances. Early recognition and monitoring of renal function are crucial in COVID-19 patients, especially those with pre-existing kidney disease or risk factors for renal complications.
 
Treatment strategies for renal injury in COVID-19 patients include personalized fluid management, optimization of hemodynamics, and avoiding nephrotoxic agents whenever possible. In severe cases requiring renal replacement therapy (RRT), such as continuous renal replacement therapy (CRRT) or hemodialysis, close monitoring and careful management are essential to prevent further deterioration of kidney function.
 
Recent studies have also explored potential therapeutic targets and agents that may mitigate renal injury in COVID-19. For instance, Quercetin, a natural flavonoid with anti-inflammatory properties, has shown promise in reducing tubular cell injury associated with SARS-CoV-2 infection. However, further research is needed to validate its efficacy and safety in clinical settings.
 
Long-term Kidney Involvement Post COVID-19
A growing concern is the long-term impact of COVID-19 on kidney health, particularly in patients who experience AKI or other renal complications during their illness. Post-COVID-19 syndrome, also known as "Long COVID," encompasses a range of persistent symptoms and complications that can extend beyond the acute phase of infection. Among COVID-19 survivors, those with a history of AKI are at increased risk of developing CKD and experiencing adverse cardiovascular and renal outcomes.
 
Longitudinal studies are needed to assess the prevalence and severity of CKD post-COVID-19 and to identify optimal strategies for monitoring and managing kidney health in recovering patients. Early detection of CKD and timely interventions, including lifestyle modifications and pharmacological therapies, may help mitigate long-term renal sequelae in this population.
 
Conclusion: Addressing the Complexity of Renal Complications
The renal implications of SARS-CoV-2 infections are multifaceted, involving a complex interplay of viral tropism, immune responses, and host factors. While significant progress has been made in understanding the pathogenesis of SARS-CoV-2-induced kidney injury, many questions remain unanswered, particularly regarding long-term outcomes and optimal management strategies.
 
Continued research efforts are essential to elucidate the mechanisms of renal injury in COVID-19, identify biomarkers for early detection and risk stratification, and develop targeted therapies to preserve kidney function and improve outcomes in affected individuals. Collaborative initiatives involving clinicians, researchers, and public health agencies are crucial in addressing the evolving challenges posed by SARS-CoV-2 on renal health and advancing patient care in the post-pandemic era.
 
The study findings were published in the peer reviewed journal: Current Opinion in Microbiology.
https://www.sciencedirect.com/science/article/pii/S1369527424000511
 
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