ABSTRACT
PurposeThe coronavirus strain first reported in December 2019 (COVID-19) has spread rapidly worldwide, posing a seriously risk to human health. However, the relationship between acute kidney injury (AKI) and the COVID-19 infection is limited. There is ongoing controversy about AKI in COVID-19, some studies have argued the presence of AKI as being very common and a characteristic side-effect of the virus, while others pointed that AKI remains a rare incident among COVID-19 infections. This meta-analysis aims to shed much-needed light on the relationship between COVID-19 and AKI, and provide a stronger evidence base to support both further research and clinical application. MethodsTwo authors independently performed a literature search using PubMed, Web of Science, Embase, and Cochrane Library. Literature published up until May 04, 2020 (inclusive). Then the incidence of AKI, incidence of RRT required, the mortality rate with AKI and the risk of death with AKI during a COVID-19 infection were statistically analyzed using Open Meta-Analyst software, from which conclusions are derived. ResultsWe found that the incidence of AKI in hospitalized patients with the COVID-19 infection remains low, only about 3.8%; the in-hospital mortality rate with AKI in COVID-19 infected patients reaches up to 86.8%; the odds of death with AKI in COVID-19 infected patients is about 24.2 times higher than those without AKI. ConclusionsThe occurrence of AKI during a COVID-19 infection should be paid greater attention, and should be considered a strong red flag with regards to the patients risk of death. Additional studies are still required to support the conclusions derived herein and to explore the AKI mechanism during a COVID-19 infection. Take-home messageThis meta-analysis was based on the inclusion of 5,448 in-hospital COVID-19 infected patients, and first time indicated that although the incidence of AKI observed during a COVID-19 infection is lower, but it is a strong signal of patient deterioration, to critical illness and even death.
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Objective To investigate the efficacy of leflunomide combined with prednisone in the induction therapy of proliferative lupus nephritis (LN).Methods A prospective,multicenter,randomized controlled clinical trial was conducted in patients with biopsy-proved proliferative lupus nephritis recruited from 15 renal centers from 2013 to 2015.Patients were randomized to two groups.Oral leflunomide or intravenous cyclophosphamide was given to patients in each group.Both groups received a tapering course of oral prednisone therapy.All patients were followed up for 24 weeks.The blood biochemistry,urine index,clinical curative effect and adverse reaction were recorded and analyzed statistically.Results A total of 100 patients were enrolled in this clinical trial,including 48 patients in leflunomide group and 52 patients in cyclophosphamide group.After 24 weeks,the overall response rate was 79％ (95％ CI 67％-90％) in the leflunomide group and 69％ (95％ CI 56％-82％) in the cyclophosphamide group.23％ (95％CI 11％-35％) of patients in leflunomide group showed complete remission compared with 27％ (95％CI 24％-30％) in cyclophosphamide group (P=0.35).The levels of 24-hr urine protein excretion,SLEDAI and anti-dsDNA antibody titers were decreased in patients treated with leflunomide group after 24-weeks treatment.And the levels of serum albumin and complement 3 after treatment were significantly higher compared with these before treatment.There was also no significant difference in changes of 24-hr urine protein excretion,SLEDAI score,anti-dsDNA antibody titers,serum albumin and complement C3 levels after treatment between two groups.Incidence of adverse events did not differ between the leflunomide and cyclophosphamide group.Conclusions Leflunomide combined with prednisone showed same efficacy compared with cyclophosphamide as induction therapy for lupus nephritis.Leflunomide might be an useful medicine in the induction therapy of lupus nephritis.
ABSTRACT
HK-2 cells cultured in vitro were divided into three groups: normal glucose group ( NG ), high glucose group( HG), and mannitol group(MG). The expression of angiotensin-converting enzyme( ACE ) and ACE2 mRNA in HK-2 cells was detected. The concentration of angiotensin Ⅱ ( Ang Ⅱ ) in the culture medium was detected. The mRNA and protein expression of ACE and ACE2 existed in normal cultured HK-2 ( NG group ). In comparison with NG group, the mRNA and protein expressions of ACE in HG group increased significantly ( P＜0. 01 ), and the expression of ACE2 mRNA decreased significantly( P＜0. 01 ). The level of Ang Ⅱ in HG group was significantly higher than in NG group( P＜0. 05 ). The result show that high glucose may induce ACE expression and inhibit ACE2 expression, then promote synthesis of Ang Ⅱ in proximal tubular cells.
