ABSTRACT
Robotic kidney transplantation is a safe, reproducible, and less morbid technique in high body mass index and end-stage renal disease. Polycystic kidney disease is a relative contraindication to robotic-assisted kidney transplantation because of the mass effect of the native kidneys on the patient's pelvis that prevents ideal exposure. We report the first 2 cases of robotic-assisted simultaneous bilateral nephrectomy and kidney transplantation for patients with obesity and adult polycystic kidney disease. The recipients were 2 males, 50 and 53 years old, with a body mass index of 35.1 41.6 kg/m2 and 41.6 kg/m2, respectively. Both recipients had suitable living donors. The average operating time was 395 minutes and the estimated blood loss was on average 250 mL. The postoperative course was uneventful and the patients were discharged home on days 4 and 5. Performing robotic nephrectomies simultaneously with kidney transplantation can be done safely, allowing patients with obesity and polycystic kidney disease needing bilateral nephrectomy, to take full advantage of minimally invasive kidney transplantation.
Subject(s)
Kidney Transplantation , Polycystic Kidney Diseases , Polycystic Kidney, Autosomal Dominant , Robotic Surgical Procedures , Adult , Male , Humans , Middle Aged , Polycystic Kidney, Autosomal Dominant/complications , Polycystic Kidney, Autosomal Dominant/surgery , Kidney Transplantation/adverse effects , Kidney Transplantation/methods , Body Mass Index , Retrospective Studies , Nephrectomy/methods , Polycystic Kidney Diseases/complications , Polycystic Kidney Diseases/surgery , Obesity/complications , Obesity/surgeryABSTRACT
Kidneys are critical target organs of COVID-19, but susceptibility and responses to infection remain poorly understood. Here, we combine SARS-CoV-2 variants with genome-edited kidney organoids and clinical data to investigate tropism, mechanism, and therapeutics. SARS-CoV-2 specifically infects organoid proximal tubules among diverse cell types. Infections produce replicating virus, apoptosis, and disrupted cell morphology, features of which are revealed in the context of polycystic kidney disease. Cross-validation of gene expression patterns in organoids reflects proteomic signatures of COVID-19 in the urine of critically ill patients indicating interferon pathway upregulation. SARS-CoV-2 viral variants alpha, beta, gamma, kappa, and delta exhibit comparable levels of infection in organoids. Infection is ameliorated in ACE2-/- organoids and blocked via treatment with de novo-designed spike binder peptides. Collectively, these studies clarify the impact of kidney infection in COVID-19 as reflected in organoids and clinical populations, enabling assessment of viral fitness and emerging therapies.
Subject(s)
Acute Kidney Injury/urine , COVID-19/urine , Kidney Tubules, Proximal/virology , Kidney/virology , Organoids/virology , SARS-CoV-2/pathogenicity , Acute Kidney Injury/etiology , Adult , Aged , Angiotensin-Converting Enzyme 2/genetics , Animals , Apoptosis , Bowman Capsule/cytology , Bowman Capsule/virology , COVID-19/complications , Chlorocebus aethiops , Female , Gene Knockout Techniques , Hospital Mortality , Hospitalization , Humans , Kidney/metabolism , Kidney/pathology , Kidney Tubules, Proximal/metabolism , Kidney Tubules, Proximal/pathology , Male , Middle Aged , Organoids/metabolism , Podocytes/virology , Polycystic Kidney Diseases , Protein Kinase D2/genetics , Proteome , Receptors, Coronavirus/genetics , Reproducibility of Results , Transcriptome , Vero Cells , Viral Tropism , Virus ReplicationSubject(s)
Cilia/metabolism , Eye Diseases/metabolism , Flagella/metabolism , Heart Diseases/metabolism , Lung Diseases/metabolism , Polycystic Kidney Diseases/metabolism , Centrosome/metabolism , Centrosome/ultrastructure , Cilia/ultrastructure , Epithelial Cells/metabolism , Epithelial Cells/ultrastructure , Eye Diseases/genetics , Eye Diseases/pathology , Flagella/ultrastructure , Gene Expression Regulation , Heart Diseases/genetics , Heart Diseases/pathology , Hedgehog Proteins/genetics , Hedgehog Proteins/metabolism , Humans , Lung Diseases/genetics , Lung Diseases/pathology , Polycystic Kidney Diseases/genetics , Polycystic Kidney Diseases/pathology , Wnt Signaling PathwayABSTRACT
Background: Little is known about the impact of SARS-CoV-2 on fetal anomalies. Case presentation: We described a case report of fetal anomalies during second-trimester (25+3 weeks) pregnancy. The fetal autopsy was found with abnormal heart anatomy (including ventricular septal defect, oval hole valve missing, and pericardial effusion), polycystic kidney, and acute chorioamnionitis. Conclusions: SARS-CoV-2 infection in second-trimester pregnancy not the direct factor resulted in congenital defects, and multiple risk factors contribute to these changes.