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J Res Med Sci 2021,  26:64

Gender related of acute kidney injury in COVID-19 patients

Water and Electrolytes Research Center, Isfahan University of Medical Sciences, Isfahan, Iran

Date of Submission31-Aug-2020
Date of Decision08-Sep-2020
Date of Acceptance21-Sep-2020
Date of Web Publication30-Aug-2021

Correspondence Address:
Prof. Mehdi Nematbakhsh
Water and Electrolytes Research Center, Isfahan University of Medical Sciences, Isfahan
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/jrms.JRMS_1034_20

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How to cite this article:
Nematbakhsh M. Gender related of acute kidney injury in COVID-19 patients. J Res Med Sci 2021;26:64

How to cite this URL:
Nematbakhsh M. Gender related of acute kidney injury in COVID-19 patients. J Res Med Sci [serial online] 2021 [cited 2022 Dec 8];26:64. Available from: https://www.jmsjournal.net/text.asp?2021/26/1/64/325057

Dear Editor,

The coronavirus disease 2019 (COVID-19) is well recognized as a global pandemic worldwide. Besides the significant prevalence of pneumonia and acute respiratory distress syndrome (ARDS), acute or chronic kidney diseases are subject of debate in patients with COVID-19. The 0.5%, 4.3%, 4.5%, 7%, 10.5%, 23%, or 34.6% prevalence of acute or chronic kidney diseases among the patients with COVID-19 were reported.[1],[2],[3],[4],[5] The major cause of acute kidney injury (AKI) was related to cytokine damage or organ cross-talk between the pulmonary and renal system and cardio-renal syndrome in COVID-19 patients.[1] Abnormal urine dipstick test or AKI were also detected in 75.4% of 333 patients with COVID-19.[3] The kidney histopathological investigation in 26 patients with COVID-19 showed the existence of proximal tubule injury with loss of brush border.[5] It seems that the cytokine storm induced tubular injury, cytopathic effect of virus, angiotensin-converting enzyme-2 (ACE2) expression effect on podocytes and tubular epithelial cell or viral tropism are the main important factors in the pathophysiology of AKI associated with COVID-19.[6] Generally, there is an association between ARDS and AKI, and the prevalence of AKI compared to ARDS is low. However, the occurrence of AKI in ARDS patients with COVID-19 must be monitored seriously for hospitalized patients to reduce the mortality rate during the COVID-19 crisis. In addition, the use of ACE inhibitors or angiotensin-receptor blockers may worse infection in COVID-19 patients, and the control of ACE2 is suggested.

Now, one question needs to be considered here. Does AKI in patient with COVID-19 occurs gender dependently or not? It is documented that cytokine storm is gender related,[7] and a higher ACE2 expression[8] was detected in old female rats than male and it contributes in SARS attacks. Increased ACE2 activity in male animals compare to females also is existed.[9] Although the existence of an equal prevalence of COVID-19 between males and females, however, the mortality rate in males is higher than females.[10] The activity of renin-angiotensin system (RAS) is gender related, while a lower level of angiotensin II type 2 receptor was detected in male, and the kidney injury also was altered by gender.[11] Collectively, it may be concluded that the AKI in COVID-19 patients is gender related, and the exact mechanisms should be determined. However, the gender dependence of ACE2 expression, RAS activity, and cytokine storm are good early reasons to accept the gender related of COVID-19 as well as AKI in COVID-19 patients.

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Conflicts of interest

There are no conflicts of interest.

  References Top

Ronco C, Reis T. Kidney involvement in COVID-19 and rationale for extracorporeal therapies. Nat Rev Nephrol 2020;16:308-10.  Back to cited text no. 1
Izzedine H, Jhaveri KD, Perazella MA. COVID-19 therapeutic options for patients with kidney disease. Kidney Int 2020;97:1297-8.  Back to cited text no. 2
Pei G, Zhang Z, Peng J, Liu L, Zhang C, Yu C, et al. Renal involvement and early prognosis in patients with COVID-19 pneumonia. J Am Soc Nephrol 2020;31:1157-65.  Back to cited text no. 3
Batlle D, Soler MJ, Sparks MA, Hiremath S, South AM, Welling PA, et al. Acute kidney injury in COVID-19: Emerging evidence of a distinct pathophysiology. J Am Soc Nephrol 2020;31:1380-3.  Back to cited text no. 4
Su H, Yang M, Wan C, Yi LX, Tang F, Zhu HY, et al. Renal histopathological analysis of 26 postmortem findings of patients with COVID-19 in China. Kidney Int 2020;98:219-27.  Back to cited text no. 5
Durvasula R, Wellington T, McNamara E, Watnick S. COVID-19 and Kidney Failure in the Acute Care Setting: Our Experience From Seattle. Am J Kidney Dis 2020;76:4-6.  Back to cited text no. 6
Pellegrini P, Contasta I, Del Beato T, Ciccone F, Berghella AM. Gender-specific cytokine pathways, targets, and biomarkers for the switch from health to adenoma and colorectal cancer. Clin Dev Immunol 2011;2011:819724.  Back to cited text no. 7
Xie X, Chen J, Wang X, Zhang F, Liu Y. Age- and gender-related difference of ACE2 expression in rat lung. Life Sci 2006;78:2166-71.  Back to cited text no. 8
Walter LA, McGregor AJ. Sex- and gender-specific observations and implications for COVID-19. West J Emerg Med 2020;21:507-9.  Back to cited text no. 9
Jin JM, Bai P, He W, Wu F, Liu XF, Han DM, et al. Gender differences in patients with COVID-19: Focus on severity and mortality. Front Public Health 2020;8:152.  Back to cited text no. 10
Harris RC, Zhang MZ. The role of gender disparities in kidney injury. Ann Transl Med 2020;8:514.  Back to cited text no. 11


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