Mayo Clinic researchers found that COVID-19-related acute kidney damage mimics the kidney damage caused by sepsis. The immune response triggered by the infection plays a key role.
The findings, published in the Mayo Clinic Proceedings, also suggest that mitochondrial dysfunction - the loss of cellular energy-producing properties - is often found in COVID-19-related kidney damage.
According to a study published last year, more than a third of hospitalized COVID-19 patients reported acute renal failure. Sudden kidney failure is one of the causes of hospital mortality.
"These findings suggest that COVID-19 can trigger a strong immune response in patients that contributes to kidney damage, and that supportive kidney therapy should be started early in these patients," said Dr. Mariam Alexander, Mayo kidney pathologist Clinic and lead author of the study. “Our data show that a potential target of therapy should be the problem of mitochondrial damage. Some of these therapies have recently been developed and tested in preclinical models. ”
It is known that severe cases of COVID-19 can be associated with a systemic inflammatory response as well as heart and pneumonia. We have little research available on the immune response in the kidney for this reason, and molecular research into the pathology of the kidneys of COVID-19 patients is limited.
As Dr. Alexander says, "As far as we know, this is the first in-depth study of the molecular and cellular changes seen in cases of COVID-19 that have damaged the kidneys."
A study by the Mayo Clinic evaluated the kidneys of 17 adults who died from COVID-19 and were autopsied between April 2022 and October 2022. Scientists have described the pathological spectrum of COVID-19-related kidney damage and characterized its molecular profile by comparing it with the damage associated with sepsis.
Study shows that the morphological and molecular profile of severe kidney injury from COVID-19 resembles that of sepsis to the point of including microvascular dysfunction, inflammation, and metabolic reprogramming
Acute kidney injurythat observed with COVID-19 is likely secondary to the activation of the immune system seen in sepsis patients. The kidneys of a COVID-19 patient are inflamed and show an increased number of dead cells and significantly more mitochondrial damage compared to non-COVID-19 damaged kidneys.
76% of patients admitted to the ICU for COVID-19 have acute kidney injury. According to data published by the Journal of the American Society of Nephrology, patients hospitalized for secondary acute kidney injury from COVID-19 are at a 50% risk of death. For comparison, it is worth mentioning that in people without kidney damage, the risk is 8%.
17 of the patients in the Mayo Clinic study had a mean age of 78, of whom 15 were male. Most of them were hospitalized for more than five days before they died. 53% reported hypertension, and diabetes and cardiovascular disease were other major comorbidities.
"The complex integrated imaging and molecular tests used in this study pave the way for similar molecular analyzes in various disease states. This is to study immune-mediated kidney injuries both under natural and transplant conditions, ”says Timucin Taner, MD, a Mayo Clinic transplant surgeon, immunologist, and senior author of the study.