key: cord-0887706-itq0yxv3 authors: Choy, Kay Weng title: Association of SARS-CoV-2 renal tropism with acute kidney injury date: 2020-12-12 journal: Lancet DOI: 10.1016/s0140-6736(20)32588-5 sha: ef687f435df3d376c0b3a08c38eda749ea23da2f doc_id: 887706 cord_uid: itq0yxv3 nan difficult to elucidate as part of the mechanisms underlying differential progress of male and female researchers is that of invitations to give scientific talks and to chair scientific meetings. Here, the merit of such an invitation is not always transparent or as easy to assess as a publication record. However, these activities are key to a researcher's academic success. 4 Cancellations and reorganisation of scientific meetings during the COVID-19 pandemic present an opportunity to consider the consequences of these decisions. In October, 2020, a scientific congress of cardiology, cardiosurgery, and paediatric cardiology was held under the patronage of the German Society of Cardiology. Due to the second wave of the COVID-19 pandemic, the meeting was held virtually, and for that reason, the organising committee felt that the event needed shortening substantially. Thus, 37 of 82 speakers and chairs were disinvited a few days before the congress. 29 (41%) of 71 male speakers (95% CI 29-53%) were disinvited, whereas eight (73%) of 11 female speakers (39-94%) were disinvited, bringing the female speaker participation down from 13% to 7% of speakers. With CIs overlapping (in part due to how few women were invited), it cannot be said whether the higher proportion of disinvited female speakers was coincidental or not. If there was a difference, it could also well be that unconscious gender bias by the organising committee (consisting of five men and one woman) was not behind the decision, but that the committee considered a range of factors, such as seniority, specialty, or external affiliation of the speaker. Nevertheless, I believe that this example highlights how important it is for organising committees of scientific meetings to apply a gendered perspective to the difficult task of inviting and disinviting researchers to give scientific talks. I would also suggest that data on these kinds of cancellations and reorganisations in academia Several studies have pointed towards the COVID-19 pandemic's potential to negatively affect career paths of women in science. 1,2 Although the impact on manuscript submissions and publications, as one career path mechanism, has been well documented, 3 an area that is often For more on this congress see https://www.freiburger-herzkreislauf-tage.de/ wissenschaftlicheshauptprogramm In their report on the association of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) renal tropism with acute kidney injury, Fabian Braun and colleagues 1 do not appear to have provided evidence for acute kidney injury as defined in the Kidney Disease: Improving Global Outcomes (KDIGO) clinical practice guidelines-that is, an increase in serum creatinine (SCr) by 26·5 µmol/L or more within 48 h; an increase in SCr to 1·5 times or more from baseline, which is known or presumed to have occurred within the previous 7 days; or a urine volume of less than 0·5 ml/kg per h for 6 h. 2 Using case 45 (a woman aged 87 years) as an example, SCr on admission was 103 µmol/L, with an estimated glomerular filtration rate (eGFR) of 43 mL/min per 1·73 m² For the KDIGO guidelines see https://kdigo.org/guidelines/ Although there is no available consensus or guidelines to conclusively define COVID-19-associated acute kidney injury, the high frequency of acute kidney injury among patients with SARS-CoV-2 infection might serve as a catalyser for such discussions. Another important point is the definition of chronic kidney disease. Cases 17 and 48 indeed presented with an estimated glomerular filtration rate (eGFR) above the threshold for chronic kidney disease according to the KDIGO guidelines. 3 However, the possibility of a careful organ examination allowed us to grade structural kidney changes associated with chronic kidney disease (ie, fibrotic parenchymal remodelling, thinned kidney cortex, or decreased organ weight), which clearly indicated abnormalities of kidney structure as per KDIGO guidelines. 3 In contrast, determination of kidney function using a single measurement of eGFR can be limited by multiple causes (eg, case 48 had a measured body-mass index of 17; hence eGFR could be overestimated). Thus, autopsy studies provide a unique opportunity to extend clinical definitions with additional layers of structural information. In summary, although the KDIGO guidelines have provided the framework for reliable and reproducible nomenclature of acute kidney injury and chronic kidney disease, autopsy studies can add further anatomical and pathological information and help to identify renal tropism and COVID-19related acute kidney injury. 1,4,5 The association of SARS-CoV-2 infection and kidney injury opens potential new avenues for early diagnostics, prediction, and prevention of COVID-19-related kidney disease. 6 FB reports grants and personal fees from Amicus Therapeutics; personal fees from Takeda/Shire; and travel support from Sanofi Genzyme and Astellas. It is surprising that two of the 12 patients (cases 17 and 48) with a reported history of chronic kidney disease had eGFR values of 60 mL/min per 1·73 m² or more, which is not consistent with the KDIGO definition of chronic kidney disease, unless there is persistent albuminuria. 3 Acute kidney injury was reported in the other ten patients with chronic kidney disease. 1 In contrast, the seven patients who did not have acute kidney injury were not reported to have chronic kidney disease. 1 Underlying chronic kidney disease is a risk factor for acute kidney injury. 4 In the absence of specific therapeutic options, application of the KDIGO supportive care guidelines (eg, regular monitoring of urinary output and SCr, and avoidance of nephrotoxins) could reduce the incidence and severity of acute kidney injury in COVID-19. 5 I declare no competing interests. The Northern Hospital, Epping, VIC 3076, Australia SARS-CoV-2 renal tropism associates with acute kidney injury Kidney Disease: Improving Global Outcomes Acute Kidney Injury Work Group. KDIGO clinical practice guideline for acute kidney injury Kidney Disease: Improving Global Outcomes Chronic Kidney Disease Work Group. KDIGO 2012 clinical practice guideline for the evaluation and management of chronic kidney disease Acute kidney injury Management of acute kidney injury in patients with COVID-19 We thank Kay Choy for the nterest in our Correspondence, 1 in which we described an association between severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) renal tropism and acute kidney injury in autopsy cases with COVID-19 diagnosis.We analysed data from a large autopsy series of 63 patients. Since an individual's disease course, comorbidities, and complications of severe COVID-19 disease are highly variable, we depicted three different cases as supplemental information exemplifying this variation. 1 The first example had initially stable renal function and presented an abrupt decline before death, shortly after COVID-19 diagnosis (case 50). The second example presented with declining renal function before COVID-19 diagnosis, which aggravated over the following weeks (case 52). The third example had signs of acute kidney injury shortly after admission and later a positive respiratory swab for SARS-CoV-2 (case 45). As we expected, these cases have sparked some interesting discussions.Case 45 was used by Choy as an example that merits clarification regarding the adherence to Kidney Disease: Improving Global Outcomes (KDIGO) guidelines for the acute kidney injury definition. This patient developed an increase in serum creatinine from 102·57 µmol/L at admission to 197·18 µmol/L within 48 h, meeting KDIGO criteria for acute kidney injury. 2 Notably, this patient was not tested for COVID-19 due to respiratory symptoms, but was instead diagnosed following a routine diagnostic procedure on the ward. Given the complex clinical context of COVID-19 and the dynamic nature of indications for testing, establishing the link between acute kidney injury and SARS-CoV-2 infection remains challenging. In this case, we chose to use temporal proximity to COVID-19 diagnosis as a key defining parameter.