Inflammation and kidney involvement in human viral diseases caused by SARS-CoV-2, HIV, HCV and HBV

Inflammation is closely related to renal diseases. This is particularly true for renal diseases caused by infections as in viral diseases. In this review, we highlight the inflammatory mechanisms that underlie kidney dysfunction in SARS-CoV-2, human immunodeficiency (HIV), hepatitis C (HCV), and hepatitis B (HBV) infections. The pathophysiology of renal involvement in COVID-19 is complex, but kidney damage is frequent, and the prognosis is worse when it happens. Virus-like particles were demonstrated mostly in renal tubular epithelial cells and podocytes, which suggest that SARS-CoV-2 directly affects the kidneys. SARS-CoV-2 uses the angiotensin-converting enzyme 2 receptor, which is found in endothelial cells, to infect the human host cells. Critical patients with SARS-CoV-2-associated acute kidney injury (AKI) show an increase in inflammatory cytokines (IL-1β, IL-8, IFN-γ, TNF-α), known as cytokine storm that favors renal dysfunction by causing intrarenal inflammation, increased vascular permeability, volume depletion, thromboembolic events in microvasculature and persistent local inflammation. Besides AKI, SARS-CoV-2 can also cause glomerular disease, as other viral infections such as in HIV, HBV and HCV. HIV-infected patients present chronic inflammation that can lead to a number of renal diseases. Proinflammatory cytokines and TNF-induced apoptosis are some of the underlying mechanisms that may explain the virus-induced renal diseases that are here reviewed.(AU)

Estudo prospectivo de 2151 pacientes com doença renal crônica em tratamento conservador com abordagem multidisciplinar no Vale do Paraíba, SP / Prospective study of 2151 patients with chronic kidney disease under conservative treatment with multidisciplinary care in the Vale do Paraíba, SP

INTRODUÇÃO: A doença renal crônica (DRC) é uma enfermidade grave, comum e tratável, cuja detecção envolve exames de baixo custo. OBJETIVO: Avaliar o efeito de uma intervenção multidisciplinar (nefrologista, assistente social, enfermeira, nutricionista e psicóloga) em parâmetros clínicos e laboratoriais de pacientes com DRC. MÉTODOS: Estudo prospectivo de 2.151 pacientes atendidos no Centro Estadual de Doenças Renais do Vale do Paraíba, SP, de fevereiro de 2008 a março de 2011. A função renal foi avaliada no início e ao final do seguimento por testes de albuminúria e taxa de filtração glomerular estimada (TFGe) pela fórmula do MDRD. Os desfechos clínicos foram: ocorrência de eventos cardiovasculares (ECV), episódios de hospitalização, necessidade de terapia renal substitutiva (TRS) e óbito. RESULTADOS: A idade média foi 62 anos (variação: 14 a 101), com acompanhamento médio de 546 dias (variação: 90 a 1540), havendo predomínio do estagio três da DRC (59%). Os diagnósticos de base mais comuns foram: hipertensão arterial (41,2%) e diabetes (32,4%). A média da pressão arterial antes e ao final do seguimento foi de 143 ± 26 mmHg x 87 ± 14 mmHg e 123 ± 16 mmHg x 79 ± 9 mmHg, respectivamente (p < 0,001); a TFGe reduziu de 58,5 ± 31 ml/min para 56,3 ± 23 ml/min (p < 0,01). A proteinúria caiu de 1,04 ± 1,44 g/dia para 0,61 ± 1,12 g/dia (p < 0,001); e a glicemia de jejum de 137 ± 73 mg/dl para 116 ± 42 mg/dl. Cento e vinte e dois pacientes (5,7%) apresentaram eventos cardiovasculares, a taxa geral de hospitalizações foi de 6,6% (n = 143 pacientes), foram observados 156 (7,3%) óbitos e 23 (1,1%) pacientes evoluíram para TRS. O risco de ECV, hospitalização e óbito aumentou de forma inversa à TFGe, mas são considerados baixos quando comparados à literatura internacional. CONCLUSÕES: A intervenção multidisciplinar com metas bem definidas é efetiva para preservação da função renal e redução da morbidade e mortalidade de pacientes com DRC.

INTRODUCTION: Chronic Kidney Disease (CKD) is common, severe and treatable. Its detection involves low cost tests. AIM: To evaluate the effect of a multidisciplinary (nephrologist, social worker, nurse, nutritionist, and psychologist) intervention comparing clinical and laboratory parameters in patients with CKD. METHODS: A prospective study with 2,151 patients attended at the State Center for Kidney Diseases of the Vale do Paraiba, São Paulo, from February 2008 to March 2011. The kidney function was measured using albuminuria and estimated glomerular filtration rate (eGRF) using the MDRD formula The clinical outcomes were the occurrence of cardiovascular disease (CAD), hospitalization episodes, need of renal replacement therapy (RRT) and death. RESULTS: Participants had a mean (range) age of 62 years (14-101), a mean follow-up of 546 days (90-1540) and the majority was in the stage 3 of CKD (59%). The most common primary diagnoses were hypertension (41.2%) and diabetes (32.4%). Mean blood pressure values at the beginning and at the end of treatment were 143 ± 26 mmHg x 87 ± 14 mmHg and 123 ± 16 mmHg x 79 ± 9 mmHg, respectively (p < 0.001); the eGRF decreased from 58.5 ± 31 ml/min. to 56.3 ± 23 ml/min (p < 0.01). Mean value of proteinuria decreased from 1.04 ± 1.44 g/day to 0.61 ± 1.12 g/day, p < 0.001, and the fasting glicemia decreased from 137 ± 73 mg/dl to 116 ± 42 mg/dl. One hundred and twenty-two patients (5.7%) had a CAD episode, the hospitalization rate was 6.6% (n = 143 patients), 7.3% patients died (n = 156), and 1.1% (n = 23) patients needed to start RRT. The risk of cardiovascular events, hospitalization, or death was inversely related to eGRF, and the rates of these events were low compared with the international literature. CONCLUSION: The multidisciplinary care with well defined targets is effective for the preservation of renal function and reduction in morbidity and mortality of CKD patients.