Strong immune response underlies acute kidney injury related
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Mayo Clinic researchers have found that acute kidney injury associated with COVID-19 resembles sepsis-caused kidney injury, and the immune response triggered by the infection plays a pivotal role. The findings, also suggest that mitochondrial dysfunction is commonly found in kidney injury related to COVID-19.

"These findings suggest that COVID-19 can induce a robust immune response in patients that contributes to the kidney injury, and kidney-supportive treatments should be initiated early for these patients," says Mariam Alexander, M.D., a renal pathologist at Mayo Clinic and the study's lead author. "Our data point to mitochondrial injury as a potential target for therapies, some of which recently have been developed and tested in preclinical models."

Severe COVID-19 disease is known to be associated with a systemic inflammatory response, as well as inflammation in the heart and lungs. Little research is available about immune response in the kidneys, and molecular studies on the renal pathology of COVID-19 patients have been limited. "To our knowledge, this is the first in-depth study investigating the molecular and cellular changes seen in COVID-19-related kidney injury," says Dr. Alexander.

The Mayo Clinic study evaluated the kidneys of 17 adults who died from COVID-19 and had an autopsy performed between April 2020 and October 2020. Researchers described the pathological spectrum of the kidney injury related to COVID-19 and characterized its molecular profile, compared with sepsis-associated injury. The morphological and molecular profile of severe COVID-19 renal injury resembles sepsis renal injury, including microvascular dysfunction, inflammation and metabolic reprogramming, the study finds.

The 17 patients in the Mayo Clinic study had a median age of 78 years, and 15 were male. Most had been hospitalized more than five days before death, and 53% reported hypertension as a comorbidity. Other leading comorbidities included diabetes and cardiovascular disease.

"The complex integrated imaging and molecular tests used in this study pave the way to perform similar molecular analyses in different disease conditions to study immune-mediated renal injuries in both native and transplant settings," says Timucin Taner, M.D., Ph.D., a Mayo Clinic transplant surgeon, immunologist and senior author.

Source:
https://www.mayoclinicproceedings.org/article/S0025-6196(21)00510-3/fulltext
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