Review articles published in journals Physiology frontier Researchers at the Federal University of Sao Paulo (UNIFESP) in Brazil discuss the mechanism by which SARS-CoV-2 damages the kidneys and provide treatments to prevent severe kidney problems and chronic kidney disease. It may serve as the basis for further research to pursue. In COVID-19 patients.
The study found that interaction with angiotensin converting enzyme 2 (ACE2) not only allows the virus to infect and replicate human cells, but also to the renin-angiotensin system and kallikrein-kinin, which regulate arterial blood pressure. Systems involved in inflammation, blood pressure control, and other processes that have shown to be able to cause significant imbalances.
Impaired biological function of ACE2 can lead to decreased renal blood flow and reduced glomerular filtration rate (GFR), which can alter the kidney’s ability to eliminate excessive amounts of toxic substances (metabolites). I have. It can also increase renal vasoconstriction and cause a decline in renal function.
“Studies and systematic reviews have confirmed that patients with COVID-19 have an incidence of acute kidney injury of 20% to 40%. Currently published data show that recovery may be slow in some cases. , There may be complications that require dialysis, “says Nayara Azinheira Nobrega Cruz. The first author of the article.
Another part of the study, analysis of data on SARS-CoV-2 infection Pregnant woman The role of ACE2 in the placenta was also recently announced in Clinical Science. Pregnant women infected with the virus have been shown to be at increased risk of developing preeclampsia, which is characterized by persistent hypertension, which can cause serious harm to mothers and babies.
Expected increase in the number of severe cases liver Injuries from the COVID-19 pandemic are a serious concern, according to Professor Dulce Elena Casarini, who heads the Kidney Hospital (HRIM) at EPM-UNIFESP and is a co-principal researcher in the study with Jose Medina Pestana, a member of São Paulo. .. State Government Coronavirus Emergency Center.
“If the demand for dialysis is currently increasing, the demand for kidney transplants may eventually increase,” said Casalini.
According to data from the Ministry of Health, the number of kidney transplants performed in Brazil averaged slightly above 5,900 per year between 2017 and 2019, but the waiting list increased from 28,351 to 29,554 during this period.
A study by an international group of scientists published on September 1, 2021 Journal of the American Society of Nephrology US data show that 7 out of 10,000 patients with mild or moderate COVID-19 required dialysis or kidney transplantation between March 2020 and March 2021. rice field. Up to 6 patients at risk of acute kidney injury are not hospitalized. The number of months of infection was 23% higher than that of uninfected subjects.
According to Lillian Caroline Gonzalves de Oliveira, head of the UNIFESP Kidney and Hormone Institute and co-author of the article, one of the points analyzed is the role of ACE2 in the pathogenesis of COVID-19. was. “The importance of the ACE2 receptor to cell infiltration by SARS-CoV-2 has long been known. The interaction between the virus and the receptor prevents ACE2 from performing its protective function,” Oliveira said. Said.
Articles on this study point out that the mechanism of renal involvement in COVID-19 is unknown and may be multifactorial, and viral infections are systemic inflammation, hypoxemia (hypotension). Oxygen), shock, hypotension, and renin-angiotensin system imbalance.
The renin-angiotensin system consists of a series of reactions that help regulate blood pressure. For example, when blood pressure drops, the kidneys release the enzyme renin into the bloodstream, where it produces angiotensin 1. Angiotensin 1 is converted by ACE to angiotensin 2. It is an active hormone that acts on the muscles of the walls of arterioles to induce vasoconstriction. Under normal conditions, the harmonious balance of ACE and ACE2 maintains the homeostasis of the renin-angiotensin system.
In addition, the virus infects kidney cells, causing direct damage, endangering the renin-angiotensin system in the kidney, and can contribute to acute and long-term illness. “Our review is an compilation that can serve as a basis for future research and demonstrates the importance of the effects of COVID-19 on other organs besides the respiratory system,” Cruz said. ..
For more information:
Nayara Azinheira Nobrega Cruz et al, Angiotensin converting enzyme in the pathogenesis of renal abnormalities observed in patients with COVID-19 2, Physiology frontier (2021). DOI: 10.3389 / fphys.2021.700220