ABSTRACT
A multiscale approach for the detailed simulation of water droplets dispersed in a turbulent airflow is presented. The multiscale procedure combines a novel representative volume element (RVE) with the Pseudo Direct Numerical Simulation (P-DNS) method. The solution at the coarse-scale relies on a synthetic model, constructed using precomputed offline RVE simulations and an alternating digital tree, to characterize the non-linear dynamic response at the fine-scale. A set of numerical experiments for a wide range of volume fractions, particle distribution sizes, and external shear forces in the RVE are carried out. Quantitative results of the statistically stationary turbulent state are obtained, and the turbulence modulation phenomenon due to the presence of droplets is discussed. The developed synthetic model is then employed to solve global scale simulations of flows with airborne droplets via the P-DNS method. Improved predictions are obtained for flow conditions where turbulence modulation is noticeable.
ABSTRACT
BACKGROUND: Kidney involvement is a feature of COVID-19 and it can be severe in Black patients. Previous research linked increased susceptibility to collapsing glomerulopathy, including in patients with HIV-associated nephropathy, to apo L1 (APOL1) variants that are more common in those of African descent. METHODS: To investigate genetic, histopathologic, and molecular features in six Black patients with COVID-19 presenting with AKI and de novo nephrotic-range proteinuria, we obtained biopsied kidney tissue, which was examined by in situ hybridization for viral detection and by NanoString for COVID-19 and acute tubular injury-associated genes. We also collected peripheral blood for APOL1 genotyping. RESULTS: This case series included six Black patients with COVID-19 (four men, two women), mean age 55 years. At biopsy day, mean serum creatinine was 6.5 mg/dl and mean urine protein-creatinine ratio was 11.5 g. Kidney biopsy specimens showed collapsing glomerulopathy, extensive foot process effacement, and focal/diffuse acute tubular injury. Three patients had endothelial reticular aggregates. We found no evidence of viral particles or SARS-CoV-2 RNA. NanoString showed elevated chemokine gene expression and changes in expression of genes associated with acute tubular injury compared with controls. All six patients had an APOL1 high-risk genotype. Five patients needed dialysis (two of whom died); one partially recovered without dialysis. CONCLUSIONS: Collapsing glomerulopathy in Black patients with COVID-19 was associated with high-risk APOL1 variants. We found no direct viral infection in the kidneys, suggesting a possible alternative mechanism: a "two-hit" combination of genetic predisposition and cytokine-mediated host response to SARS-CoV-2 infection. Given this entity's resemblance with HIV-associated nephropathy, we propose the term COVID-19-associated nephropathy to describe it.