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Gantsova E, Serova O, Vishnyakova P, Deyev I, Elchaninov A, Fatkhudinov T. Mechanisms and physiological relevance of acid-base exchange in functional units of the kidney. PeerJ 2024; 12:e17316. [PMID: 38699185 PMCID: PMC11064853 DOI: 10.7717/peerj.17316] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Accepted: 04/09/2024] [Indexed: 05/05/2024] Open
Abstract
This review discusses the importance of homeostasis with a particular emphasis on the acid-base (AB) balance, a crucial aspect of pH regulation in living systems. Two primary organ systems correct deviations from the standard pH balance: the respiratory system via gas exchange and the kidneys via proton/bicarbonate secretion and reabsorption. Focusing on kidney functions, we describe the complexity of renal architecture and its challenges for experimental research. We address specific roles of different nephron segments (the proximal convoluted tubule, the loop of Henle and the distal convoluted tubule) in pH homeostasis, while explaining the physiological significance of ion exchange processes maintained by the kidneys, particularly the role of bicarbonate ions (HCO3-) as an essential buffer system of the body. The review will be of interest to researchers in the fields of physiology, biochemistry and molecular biology, which builds a strong foundation and critically evaluates existing studies. Our review helps identify the gaps of knowledge by thoroughly understanding the existing literature related to kidney acid-base homeostasis.
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Affiliation(s)
- Elena Gantsova
- Avtsyn Research Institute of Human Morphology of Federal State Budgetary Scientific Institution “Petrovsky National Research Centre of Surgery”, Moscow, Russia
- Research Institute of Molecular and Cellular Medicine, Peoples’ Friendship University of Russia (RUDN University), Moscow, Russia
| | - Oxana Serova
- Shemyakin–Ovchinnikov Institute of Bioorganic Chemistry, Russian Academy of Sciences, Moscow, Russian Federation
| | - Polina Vishnyakova
- Research Institute of Molecular and Cellular Medicine, Peoples’ Friendship University of Russia (RUDN University), Moscow, Russia
- National Medical Research Center for Obstetrics, Gynecology and Perinatology Named after Academician V.I. Kulakov of Ministry of Healthcare of Russian Federation, Moscow, Russian Federation
| | - Igor Deyev
- Shemyakin–Ovchinnikov Institute of Bioorganic Chemistry, Russian Academy of Sciences, Moscow, Russian Federation
| | - Andrey Elchaninov
- Avtsyn Research Institute of Human Morphology of Federal State Budgetary Scientific Institution “Petrovsky National Research Centre of Surgery”, Moscow, Russia
- Research Institute of Molecular and Cellular Medicine, Peoples’ Friendship University of Russia (RUDN University), Moscow, Russia
| | - Timur Fatkhudinov
- Avtsyn Research Institute of Human Morphology of Federal State Budgetary Scientific Institution “Petrovsky National Research Centre of Surgery”, Moscow, Russia
- Research Institute of Molecular and Cellular Medicine, Peoples’ Friendship University of Russia (RUDN University), Moscow, Russia
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Bertilacchi MS, Piccarducci R, Celi A, Germelli L, Romei C, Bartholmai B, Barbieri G, Giacomelli C, Martini C. Blood oxygenation state in COVID-19 patients: Unexplored role of 2,3-bisphosphoglycerate. Biomed J 2024:100723. [PMID: 38583585 DOI: 10.1016/j.bj.2024.100723] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Revised: 03/16/2024] [Accepted: 03/29/2024] [Indexed: 04/09/2024] Open
Abstract
BACKGROUND COVID-19 reduces lung functionality causing a decrease of blood oxygen levels (hypoxemia) often related to a decreased cellular oxygenation (hypoxia). Besides lung injury, other factors are implicated in the regulation of oxygen availability such as pH, partial arterial carbon dioxide tension (PaCO2), temperature, and erythrocytic 2,3-bisphosphoglycerate (2,3-BPG) levels, all factors affecting hemoglobin saturation curve. However, few data are currently available regarding the 2,3-BPG modulation in SARS-CoV-2 affected patients at the hospital admission. MATERIAL AND METHODS Sixty-eight COVID-19 patients were enrolled at hospital admission. The lung involvement was quantified using chest-Computer Tomography (CT) analysed with automatic software (CALIPER). Haemoglobin concentrations, glycemia, and routine analysis were evaluated in the whole blood, while partial arterial oxygen tension (PaO2), PaCO2, pH, and HCO3- were assessed by arterial blood gas analysis. 2,3-BPG levels were assessed by specific immunoenzymatic assays in RBCs. RESULTS A higher percentage of interstitial lung disease (ILD) and vascular pulmonary-related structure (VRS) volume on chest-CT quantified with CALIPER had been found in COVID-19 patients with a worse disease outcome (R = 0.4342; and R = 0.3641, respectively). Furthermore, patients with lower PaO2 showed an imbalanced acid-base equilibrium (pH, p = 0.0208; PaCO2, p = 0.0496) and a higher 2,3-BPG levels (p = 0.0221). The 2,3-BPG levels were also lower in patients with metabolic alkalosis (p = 0.0012 vs. no alkalosis; and p = 0.0383 vs. respiratory alkalosis). CONCLUSIONS Overall, the data reveal a different pattern of activation of blood oxygenation compensatory mechanisms reflecting a different course of the COVID-19 disease specifically focusing on 2,3-BPG modulation.
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Affiliation(s)
| | | | - Alessandro Celi
- Department of Surgical, Medical and Molecular Pathology and Critical Care, University of Pisa, Pisa, 56126, Italy
| | | | - Chiara Romei
- Department of Radiology, Pisa University Hospital, Pisa, Italy.
| | - Brian Bartholmai
- Division of Radiology, Mayo Clinic Rochester, Rochester, MN, USA
| | - Greta Barbieri
- Department of Emergency Medicine Department, Pisa University Hospital, Italy
| | | | - Claudia Martini
- Department of Pharmacy, University of Pisa, 56126, Pisa, Italy
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Sotiropoulou Z, Antonogiannaki EM, Koukaki E, Zaneli S, Bakakos A, Vontetsianos A, Anagnostopoulos N, Rovina N, Loverdos K, Tripolitsioti P, Kyriakopoulou M, Pontikis K, Bakakos P, Georgopoulos D, Papaioannou AI. Evaluation of the Acid-Base Status in Patients Admitted to the ICU Due to Severe COVID-19: Physicochemical versus Traditional Approaches. J Pers Med 2023; 13:1700. [PMID: 38138927 PMCID: PMC10744463 DOI: 10.3390/jpm13121700] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Revised: 12/08/2023] [Accepted: 12/09/2023] [Indexed: 12/24/2023] Open
Abstract
BACKGROUND Stewart's approach is known to have better diagnostic accuracy for the identification of metabolic acid-base disturbances compared to traditional methods based either on plasma bicarbonate concentration ([HCO3-]) and anion gap (AG) or on base excess/deficit (BE). This study aimed to identify metabolic acid-base disorders using either Stewart's or traditional approaches in critically ill COVID-19 patients admitted to the ICU, to recognize potential hidden acid-base metabolic abnormalities and to assess the prognostic value of these abnormalities for patient outcome. METHODS This was a single-center retrospective study, in which we collected data from patients with severe COVID-19 admitted to the ICU. Electronical files were used to retrieve data for arterial blood gases, serum electrolytes, and proteins and to derive [HCO3-], BE, anion gap (AG), AG adjusted for albumin (AGadj), strong ion difference, strong ion gap (SIG), and SIG corrected for water excess/deficit (SIGcorr). The acid-base status was evaluated in each patient using the BE, [HCO3-], and physicochemical approaches. RESULTS We included 185 patients. The physicochemical approach detected more individuals with metabolic acid-base abnormalities than the BE and [HCO3-] approaches (p < 0.001), and at least one acid-base disorder was recognized in most patients. According to the physicochemical method, 170/185 patients (91.4%) had at least one disorder, as opposed to the number of patients identified using the BE 90/186 (48%) and HCO3 62/186 (33%) methods. Regarding the derived acid-base status variables, non-survivors had greater AGadj, (p = 0.013) and SIGcorr (p = 0.035) compared to survivors. CONCLUSIONS The identification of hidden acid-base disturbances may provide a detailed understanding of the underlying conditions in patients and of the possible pathophysiological mechanisms implicated. The association of these acid-base abnormalities with mortality provides the opportunity to recognize patients at increased risk of death and support them accordingly.
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Affiliation(s)
- Zoi Sotiropoulou
- 1st Department of Respiratory Medicine, National and Kapodistrian University of Athens, School of Medicine, Sotiria Chest Hospital, Mesogeion 152, 11527 Athens, Greece; (Z.S.); (E.K.); (S.Z.); (A.B.); (A.V.); (N.A.); (N.R.); (K.L.); (P.T.); (M.K.); (K.P.); (P.B.)
| | | | - Evangelia Koukaki
- 1st Department of Respiratory Medicine, National and Kapodistrian University of Athens, School of Medicine, Sotiria Chest Hospital, Mesogeion 152, 11527 Athens, Greece; (Z.S.); (E.K.); (S.Z.); (A.B.); (A.V.); (N.A.); (N.R.); (K.L.); (P.T.); (M.K.); (K.P.); (P.B.)
| | - Stavroula Zaneli
- 1st Department of Respiratory Medicine, National and Kapodistrian University of Athens, School of Medicine, Sotiria Chest Hospital, Mesogeion 152, 11527 Athens, Greece; (Z.S.); (E.K.); (S.Z.); (A.B.); (A.V.); (N.A.); (N.R.); (K.L.); (P.T.); (M.K.); (K.P.); (P.B.)
| | - Agamemnon Bakakos
- 1st Department of Respiratory Medicine, National and Kapodistrian University of Athens, School of Medicine, Sotiria Chest Hospital, Mesogeion 152, 11527 Athens, Greece; (Z.S.); (E.K.); (S.Z.); (A.B.); (A.V.); (N.A.); (N.R.); (K.L.); (P.T.); (M.K.); (K.P.); (P.B.)
| | - Angelos Vontetsianos
- 1st Department of Respiratory Medicine, National and Kapodistrian University of Athens, School of Medicine, Sotiria Chest Hospital, Mesogeion 152, 11527 Athens, Greece; (Z.S.); (E.K.); (S.Z.); (A.B.); (A.V.); (N.A.); (N.R.); (K.L.); (P.T.); (M.K.); (K.P.); (P.B.)
| | - Nektarios Anagnostopoulos
- 1st Department of Respiratory Medicine, National and Kapodistrian University of Athens, School of Medicine, Sotiria Chest Hospital, Mesogeion 152, 11527 Athens, Greece; (Z.S.); (E.K.); (S.Z.); (A.B.); (A.V.); (N.A.); (N.R.); (K.L.); (P.T.); (M.K.); (K.P.); (P.B.)
| | - Nikoleta Rovina
- 1st Department of Respiratory Medicine, National and Kapodistrian University of Athens, School of Medicine, Sotiria Chest Hospital, Mesogeion 152, 11527 Athens, Greece; (Z.S.); (E.K.); (S.Z.); (A.B.); (A.V.); (N.A.); (N.R.); (K.L.); (P.T.); (M.K.); (K.P.); (P.B.)
| | - Konstantinos Loverdos
- 1st Department of Respiratory Medicine, National and Kapodistrian University of Athens, School of Medicine, Sotiria Chest Hospital, Mesogeion 152, 11527 Athens, Greece; (Z.S.); (E.K.); (S.Z.); (A.B.); (A.V.); (N.A.); (N.R.); (K.L.); (P.T.); (M.K.); (K.P.); (P.B.)
| | - Paraskevi Tripolitsioti
- 1st Department of Respiratory Medicine, National and Kapodistrian University of Athens, School of Medicine, Sotiria Chest Hospital, Mesogeion 152, 11527 Athens, Greece; (Z.S.); (E.K.); (S.Z.); (A.B.); (A.V.); (N.A.); (N.R.); (K.L.); (P.T.); (M.K.); (K.P.); (P.B.)
| | - Magdalini Kyriakopoulou
- 1st Department of Respiratory Medicine, National and Kapodistrian University of Athens, School of Medicine, Sotiria Chest Hospital, Mesogeion 152, 11527 Athens, Greece; (Z.S.); (E.K.); (S.Z.); (A.B.); (A.V.); (N.A.); (N.R.); (K.L.); (P.T.); (M.K.); (K.P.); (P.B.)
| | - Konstantinos Pontikis
- 1st Department of Respiratory Medicine, National and Kapodistrian University of Athens, School of Medicine, Sotiria Chest Hospital, Mesogeion 152, 11527 Athens, Greece; (Z.S.); (E.K.); (S.Z.); (A.B.); (A.V.); (N.A.); (N.R.); (K.L.); (P.T.); (M.K.); (K.P.); (P.B.)
| | - Petros Bakakos
- 1st Department of Respiratory Medicine, National and Kapodistrian University of Athens, School of Medicine, Sotiria Chest Hospital, Mesogeion 152, 11527 Athens, Greece; (Z.S.); (E.K.); (S.Z.); (A.B.); (A.V.); (N.A.); (N.R.); (K.L.); (P.T.); (M.K.); (K.P.); (P.B.)
| | - Dimitrios Georgopoulos
- Intensive Care Medicine Department, University Hospital of Heraklion, Medical School, University of Crete, 71110 Heraklion, Greece;
| | - Andriana I. Papaioannou
- 1st Department of Respiratory Medicine, National and Kapodistrian University of Athens, School of Medicine, Sotiria Chest Hospital, Mesogeion 152, 11527 Athens, Greece; (Z.S.); (E.K.); (S.Z.); (A.B.); (A.V.); (N.A.); (N.R.); (K.L.); (P.T.); (M.K.); (K.P.); (P.B.)
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