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Scientists investigate how infection by SARS-CoV-2 can lead to kidney disorders

A review article published in the journal Frontiers in Physiology by researchers affiliated with the Federal University of São Paulo (UNIFESP) in Brazil discusses the mechanisms whereby SARS-CoV-2 damages the kidneys, potentially serving as a basis…

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A review article published in the journal Frontiers in Physiology by researchers affiliated with the Federal University of São Paulo (UNIFESP) in Brazil discusses the mechanisms whereby SARS-CoV-2 damages the kidneys, potentially serving as a basis for further research in pursuit of treatments to prevent severe renal problems and even chronic kidney disease in COVID-19 patients.

Credit: Holly Fischer/Holly Fischer/Wikimedia Commons
https://commons.wikimedia.org/wiki/File:Kidney_Cross_Section.png

A review article published in the journal Frontiers in Physiology by researchers affiliated with the Federal University of São Paulo (UNIFESP) in Brazil discusses the mechanisms whereby SARS-CoV-2 damages the kidneys, potentially serving as a basis for further research in pursuit of treatments to prevent severe renal problems and even chronic kidney disease in COVID-19 patients.

The study shows that interaction with angiotensin-converting enzyme 2 (ACE2) not only enables the virus to infect and replicate in human cells but can cause a significant imbalance in the renin-angiotensin system, which regulates arterial blood pressure, and the kallikrein-kinin system, which is involved in inflammation, control of blood pressure, and other processes. 

Impairment of ACE2’s biological functions can lead to a drop in renal blood flow and a reduced glomerular filtration rate (GFR), altering the capacity of the kidneys to eliminate substances (metabolites) that are toxic in excessive quantities. It can also increase vasoconstriction in the kidneys, leading to renal function deterioration.

“Studies and systematic reviews have confirmed 20%-40% incidence of acute renal injury in COVID-19 patients. Data now being published shows that recovery is slower in some cases and complications requiring dialysis occur in others,” said Nayara Azinheira Nobrega Cruz, first author of the article.

Conducted at the university’s medical school (EPM-UNIFESP), the study was part of Cruz’s PhD research and was supported by FAPESP via three projects (18/16653-7, 17/17027-0 and 18/23953-7).

Another part of the study, analyzing data on infection by SARS-CoV-2 in pregnant women and the role of ACE2 in placenta, was also published recently in Clinical Science. It showed that pregnant women infected by the virus run a greater risk of developing pre-eclampsia, a disorder characterized by persistent high blood pressure that can cause serious harm to mother and baby (more at: agencia.fapesp.br/36662/). 

The prospect of a rise in the number of cases of severe kidney injury due to the COVID-19 pandemic is a grave concern, according to Professor Dulce Elena Casarini, co-principal investigator for the study alongside José Medina Pestana, who heads EPM-UNIFESP’s Kidney Hospital (HRIM) and is a member of the São Paulo State Government’s Coronavirus Contingency Center.

“If demand for dialysis is rising now, we may see a rise in demand for kidney transplants before long,” Casarini told.

The number of kidney transplants performed in Brazil averaged a little over 5,900 per year between 2017 and 2019, according to data from the Ministry of Health, but the waiting list grew from 28,351 to 29,554 in the period.

Research by an international group of scientists published on September 1, 2021, in the Journal of the American Society of Nephrology, using data from the United States showed that seven out of every 10,000 mild or moderate COVID-19 patients required dialysis or a kidney transplant in the period March 2020 to March 2021. Among non-hospitalized patients, the risk of acute renal injury within six months of infection was 23% higher than among non-infected subjects.

Multiple functions

According to Lilian Caroline Gonçalves de Oliveira, head of UNIFESP’s Kidney and Hormone Laboratory and a co-author of the article, one of the points analyzed was the role of ACE2 in the pathogenesis of COVID-19. “The importance of the ACE2 receptor to cell invasion by SARS-CoV-2 has been known for some time. The interaction between the virus and the receptor prevents ACE2 from performing its protective functions,” Oliveira said.

The article on the study notes that the mechanism of renal involvement in COVID-19 is unknown and may be multifactorial, adding that infection by the virus may indirectly injure the kidneys via systemic inflammation, hypoxemia (low blood oxygen), shock, hypotension, and renin-angiotensin system imbalance.

The renin-angiotensin system comprises a series of reactions that help regulate blood pressure. When blood pressure falls, for example, the kidneys release the enzyme renin into the bloodstream, where it produces angiotensin 1, which is converted by ACE into angiotensin 2, an active hormone that induces vasoconstriction by acting on the wall muscles of the small arteries. Under normal conditions, a harmonious balance between ACE and ACE2 maintains renin-angiotensin system homeostasis.

Furthermore, the virus can infect kidney cells, causing damage directly, compromising the intra-renal renin-angiotensin system, and contributing to acute and long-term diseases. “Our review is a compilation that can serve as a basis for future research and shows the importance of the impact of COVID-19 on other organs besides the respiratory system,” Cruz said.

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About São Paulo Research Foundation (FAPESP)

The São Paulo Research Foundation (FAPESP) is a public institution with the mission of supporting scientific research in all fields of knowledge by awarding scholarships, fellowships and grants to investigators linked with higher education and research institutions in the State of São Paulo, Brazil. FAPESP is aware that the very best research can only be done by working with the best researchers internationally. Therefore, it has established partnerships with funding agencies, higher education, private companies, and research organizations in other countries known for the quality of their research and has been encouraging scientists funded by its grants to further develop their international collaboration. You can learn more about FAPESP at http://www.fapesp.br/en and visit FAPESP news agency at http://www.agencia.fapesp.br/en to keep updated with the latest scientific breakthroughs FAPESP helps achieve through its many programs, awards and research centers. You may also subscribe to FAPESP news agency at http://agencia.fapesp.br/subscribe.

Journal

Frontiers in Physiology

DOI

10.3389/fphys.2021.700220

Article Title

Angiotensin-Converting Enzyme 2 in the Pathogenesis of Renal Abnormalities Observed in COVID-19 Patients

Article Publication Date

23-Aug-2021

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“The Face Of The Digital Censorship Movement”: Matt Taibbi Calls Out Amy Klobuchar

"The Face Of The Digital Censorship Movement": Matt Taibbi Calls Out Amy Klobuchar

Authored by Matt Taibbi via Racket News,

If you read this…

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October 26, 2023

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"The Face Of The Digital Censorship Movement": Matt Taibbi Calls Out Amy Klobuchar

Authored by Matt Taibbi via Racket News,

If you read this morning’s Racket article about Senator Amy Klobuchar’s letter to Jeff Bezos asking for “proactive measures” to suppress sites like Substack or Rumble, you probably gathered I’m in a mood.

I’ve had it.

Whether it’s NewsGuard slapping “anti-US” labels on Joe Lauria and Consortium News, or Drs. Jay Bhattacharya, Aaron Kheriaty, and Martin Kulldorff censored on multiple platforms for being right on Covid, or podcaster Alison Morrow fired from a state job for interviewing Kheriaty, or friend CJ Hopkins in Germany criminally convicted for a book cover, or the FBI asking Twitter to remove Aaron Mate for the Ukrainian Secret Police, or ballooning budget requests of “counter-disinformation” enforcement agencies, or the new jailing even of Owen Shroyer for having “helped create January 6th” with speech, or of course the forever-detention of Julian Assange, and above all the total indifference of legacy media to all of it, it’s over. I’ve lost patience. Time for a more focused approach.

A problem when grappling with the censorship hydra is that it has no public face, no Tipper Gore or Jerry Falwell to personify the topic. Klobuchar, for reasons listed this morning and beyond, is right for this role. She needs to be Red Pencil Amy, Blacklist Amy, Amy “Thought Police” Klobuchar. And longshot or not, removal of her from office in next year’s election or even from Senate leadership positions is a worthwhile goal. The rest of Washington needs to read public sentiment about this issue through a colleague’s public relations dilemma.

I’ve already got a lot on my plate, but I’ll make Klobuchar a personal branding project, even if it takes time. I’ll write up any move she makes in this direction, or not in this direction. Her lesser-known partner in the bid to make Amazon a “verified sources only” zone, congressman Joseph Morelle of the Rochester, New York area, can be thrown in. Think of Morelle as the VP half of the censorship movement’s ticket. It’s nothing personal. At earlier times this person could have been anyone from Rick Stengel to Adam Schiff (especially him) or Mark Warner. Klobuchar and Morelle just picked the wrong time in my personal downward spiral to pull this stunt.

T-shirting, postering, meming ideas very welcome.

Incidentally, I’m still planning town halls on the speech subject, and in fact have one confirmed at my old college in the third week of November. (Details to come). Willing to do more if anyone can help on the venue side. Although perhaps these events would be best held in Minnesota now.

For readers who might be concerned I’m losing my mind, you’re not wrong. What can I say? Even my dog flashes worried looks at me these days. But I was pushed. Pushed I say! And so were many, many others. A la bataille!

Tyler Durden Thu, 10/26/2023 - 19:50

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International

‘I see no happy ending’ − a former national security leader on the Gaza hostage situation

No government wants to have to deal with a hostage crisis. A former US national security official explains that there is no winning without losing in such…

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October 26, 2023

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Israelis whose relatives are being held hostage demonstrate on October 26, 2023 in front of the Defense Ministry building in Tel Aviv, demanding the government to bring back their loved ones. Mostafa Alkharouf/Anadolu via Getty Images

Hamas took more than 200 people hostage during its deadly rampage in Israeli border towns on Oct. 7, 2023. Among the hostages are children and the elderly. While four of them have been released, the fate of the rest is unknown, as Qatar serves as an intermediary in working to free the hostages. In this interview with Naomi Schalit, The Conversation U.S. senior politics and democracy editor, Gregory F. Treverton of USC Dornsife, a former chairman of the National Intelligence Council in the Obama administration, says most hostage-taking has specific goals. This one, says Treverton, “is basically an adjunct of warfare, and that makes it very different” – and very hard to solve.

How do people in your field think about hostage-taking? I would imagine that the feeling is, “Oh, my god, please let nothing like that happen.”

It’s an utter dilemma, because on the one hand you feel for the hostages. And as we’ve seen in the past, the Israelis have been prepared to – and did – release a thousand hostages to get one Israeli back.

On the other hand, when you do a deal to get hostages released, you’re only encouraging more hostage-taking. So you’re damned if you do and damned if you don’t. As a result, every government, including the United States, says, “We never deal with hostage-takers.” But of course, they all do – and they have to.

I think it’s one of the hardest parts of being in the national security business. You want to free the people – but you’re also going to get criticized. Every time President Biden has gotten somebody out of Russia, people have said, “Oh, he’s paid too high a price” or “He’s rewarded hostage-taking,” and to some extent, that’s true. You are basically rewarding the hostage-takers. But we still have to deal with them. We want to get our people out. And at some some point – as the Israelis have shown – they’re prepared to pay almost any price to get them back.

A worried and teary-eyed woman holds a photo of her daughter.
Keren Shem, the mother of hostage Mia Shem, holds a photograph of her daughter as she speaks to the press in Tel Aviv on Oct. 17, 2023. Gil Cohen-MAGEN/AFP via Getty Images

Israel released more than 1,000 prisoners in 2011 in exchange for Israeli soldier Gilad Shalit, whom Hamas captured and held for five years. This is more than 200 times the number of hostages, so how do you even think about that?

At least in my professional experience, this is without precedent. The closest parallel would be the 1976 Entebbe hijacking and hostage-taking by two Germans and two Palestinians on a flight from Tel Aviv to Paris. Hijackers held 103 Israeli hostages, once they released the 148 non-Israeli hostages. Hamas holds twice the number of hostages, and in very, very different circumstances. In Entebbe, the Israeli government knew where they were, they were in a single place – the airplane – which had been forced to land in Entebbe, Uganda, after taking off from Tel Aviv. And that’s where Israeli commandos were able to rescue the hostages.

In Gaza, we don’t know where they are. We know for sure they’re scattered throughout the tunnels, likely in lots of different small groups. Hamas will presumably then use them as shields if fighting begins on the ground. They might think that that would encourage the Israelis not to make a major attack – to keep Hamas from killing all the hostages. We know that Israeli Prime Minister Benjamin Netanyahu isn’t keen on a major ground assault, and this really puts the onus on the Israelis for how the hostage situation ends.

When you think about the history of hostage negotiations, do you see something that has any relevance to what’s going on now?

It seems to me it’s a really different category. Even Entebbe was hostage-taking for some political aim – the hijackers wanted Israel to release a large number of prisoners who were Palestinian. A colleague of mine used to say that the point of terrorism was to do the least amount of violence with the most people watching it. But Entebbe was political theater, basically, and this is not political theater. This is basically an adjunct of warfare, and that makes it very different. It’s not the usual kind of tit for tat, with “How much am I willing to pay?” or “Can I take a hostage to get somebody else out?”

Two buses driving through an arid landscape.
Buses carrying Palestinian prisoners on Oct. 16, 2011, who were being exchanged for Israeli hostage Gilad Shalit, held by Hamas for five years. Jack Guez/AFP via Getty Images

What does Israel’s heavy bombing of Gaza and the beginning of a ground invasion tell you about the government’s approach to the hostage situation?

It suggests either that they have a pretty good fix on where the hostages are located, which seems unlikely given the network of Hamas tunnels, or that they have decided they must proceed in any case and will try their best to safeguard and free hostages as they go. Given the Hamas practice of using civilians as human shields, the outcome is likely to be very ugly.

Where do you see this going?

I see no happy ending. I don’t think there’s a deal that Israel could conceivably make, given its own politics. Or that Hamas would accept. So it does seem to me that at some point there is going to be that ground attack and the hostages are going to be caught in the middle of it. I see almost no alternative, given what Israel has pledged – to destroy Hamas. The Biden administration maintains that Israel doesn’t really have a strategy. They have a desire, which is to destroy Hamas. But that’s not a strategy for dealing with the hostages or for Gaza after the attack.

Gregory F. Treverton does not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.

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International

Hamas Delegation Arrives In Moscow As Russia Blames US For Escalation

Hamas Delegation Arrives In Moscow As Russia Blames US For Escalation

In a somewhat unexpected development, a delegation of Hamas leaders…

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21 hours ago

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October 26, 2023

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Hamas Delegation Arrives In Moscow As Russia Blames US For Escalation

In a somewhat unexpected development, a delegation of Hamas leaders have arrived in Moscow for talks, the Russian Foreign Ministry has confirmed Thursday evening (local time). "I can confirm that representatives of the [Hamas] Palestinian movement are visiting Moscow,” Foreign Ministry spokeswoman Maria Zakharova said in a press briefing, vowing to provide relevant details as the talks unfold.

The visit had not been previously announced by either side, and the Hamas delegation is being led by a senior member of the group, Moussa Abu Marzouk. Hamas is a designated terror organization in the US, European Union, and some other countries; but it has official relations with countries like Iran, Turkey, Syria, and now apparently Russia.

A 2019 meeting involving Hamas, Fatah, and Russian representatives, via Reuters

Russia, however, has said it remains willing to talk to all sides of the conflict in hopes of achieving ceasefire and peace. After the US exit from Afghanistan, Moscow had similarly hosted a Taliban delegation. 

It's as yet unclear whether Russia's top diplomat, Sergei Lavrov, will meet with the Hamas representatives, given he's said to currently be in Minsk. 

RIA Novosti has reported that Hamas has during opening meetings with Russian officials "commended Putin’s position and the efforts of Russia’s diplomacy."

The Kremlin has said it is engaged in crisis diplomacy talks with both the Hamas and Israeli sides, at a moment that over 220 hostages are still being held in Gaza. Four have been released thus far, including two Americans, due in large part to the mediation of Qatar. Will Russia press the delegation to release more captives? Likely this is high on the agenda for Moscow. 

Just days ago Russia blamed the United States for stoking escalation by positioning Navy warships in the Mediterranean near Israel. FM Lavrov said Monday during a meeting in Tehran that "the more a state takes this kind of proactive measures, the greater the risk and the danger of an escalation of the conflict".

He called out Washington as "already among the countries intervening the most" since the October 7 Hamas terror attack. The Biden administration as of course rejected the charge, and blamed Iran for ultimately being behind Hamas and regional terror.

At the UN in New York, Russia and China have also just vetoed US drafted UN Security Council resolution on Gaza. The dueling sides have rejected the proposals of the other given Washington's pro-Israel stance, and the willingness of Moscow and Beijing to heap criticism on Tel Aviv for the humanitarian crisis and soaring death toll among Palestinians.

Turkey has also been a foremost critic of Israel's assault on Gaza, as the death toll surpasses 7,000 - with President Erdogan blasting the West's double standard on the crisis. 

He said in his most recent speech at a Thursday conference, "Is it possible not to react while seeing what happens in Gaza? Nothing justifies such savagery. Unfortunately, so-called 'civilized' countries watch it. We heard that the EU is still hesitating to call for a cease-fire. How many children should die before you decide on a call? Let us know when the cease-fire should be declared. I have been in politics for 40 years, but I never sat idly in the face of such savagery,” Erdoğan said.

Tyler Durden Thu, 10/26/2023 - 12:05

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