The M235T polymorphism in the angiotensinogen gene is not a major risk factor for diabetic nephropathy; a meta-analysis

Introduction: Diabetic nephropathy (DN) is the leading cause of chronic kidney disease in diabetes patients. The angiotensin AGT M235T gene polymorphism, which is linked to the renin-angiotensin-aldosterone system (RAAS), has been extensively studied in DN patients, but the results are still conflicting. The current study’s goal is to conduct a meta-analysis to assess the relationship between AGT M235T gene polymorphism and DN susceptibility. Methods: Fourteen case-control studies related to AGT M235T polymorphism and DN were searched using PubMed, Web of Science and Google Scholar databases. Genotype data from the T2DM and T2DN groups were collected from all papers. The pooled odds ratio (OR) and 95 percent confidence interval (95% CI) were calculated employing a random-effects model to assess the relationship. Results: There were no statistically significant link between AGT M235T and DN risk in dominant (P=0.801, OR: 0.95; 95% CI: 0.66-1.38), allelic (P=0.933, OR: 1.01; 95% CI: 0.75-1.37) and recessive (P=0.374, OR: 1.21; 95% CI: 0.80-1.83) genetic models. Further, the stratified analysis based on ethnicity did not reveal significant link between AGT M235T and DN risk in Asian (Dom OR: 1.07; 95% CI: 0.63-1.82) and the Caucasian populations (Dom OR: 0.77; 95% CI: 0.49-1.21). In all three models, there was a high degree of heterogeneity between studies. Publication bias was not seen. Conclusion: Our findings suggest that the AGT gene M235T polymorphism does not contribute to DN risk. However, validation of this association will require multi-center and large population-based studies.

IL1RN VNTR Polymorphism and kidney damage in sickle cell anemia patients

Introduction: Sickle cell anemia (SCA) is a chronic illness associated with acute and chronic hemolytic anemia, recurrent vaso-occlusion episodes, intense pain, progressive multiple organ damage, and early mortality. Inflammation plays a significant role in the pathophysiology of SCA. Elevated levels of pro-inflammatory cytokines are involved in worsening the degree of kidney damage in SCA patients. Objectives: The present study aimed to assess whether IL1RN VNTR polymorphism is associated with kidney damage in patients with SCA. Patients and Methods: We have investigated 190 SCA patients (104 with Normal kidney function and 86 with kidney damage). Creatinine-based estimated glomerular filtration rate (eGFR) was calculated to assess kidney function. Interleukin-1 receptor antagonist gene (IL1RN) variable number tandem repeats (VNTR) genotypes were analyzed using PCR-electrophoresis. The association between IL1RN-VNTR and kidney damage was evaluated by using χ2 test. Odds ratios (OR) and 95% CI were calculated. The relationship between kidney damage and fetal hemoglobin (HbF) and their interaction with IL1RN-VNTR genotypes, was investigated using a Mantel-Haenszel (M-H) stratified analysis. Results: There were no significant differences in genotype frequencies between SCA patients with or without kidney damage (P=0.107). Furthermore, no significant interactions between IL1RN VNTR and HbF on determining kidney damage were found. Conclusion: These results conflict with the biological plausibility that interleukin levels modulate SCA pathophysiology and may deserve further exploration.

Molecular docking study of Momordica charantia Linn phytoconstituent with caspase 3 and implications for renoprotective actions in diabetes mellitus

Introduction: Caspase 3, an apoptosis executioner, inhibition may be beneficial for diabetes, nephropathies, neurodegenerative disease treatments and in areas of regenerative medicine. Since early traditional medicine, plant extracts comprised the major treatments of many ailments. Phytoconstituents have been a prime source for therapeutics, which are abundantly available resources. Therefore, with the interest to identify potential anti-apoptotic agents in plant extracts, D-galacturonic acid (DGA) was selected for screening anti-caspase 3 activity as it is the major constituent in Momordica charantia (bitter melon) and many other fruits’ pectin composition. Objectives: The present study aimed to evaluate activity of major phytoconstituent of M. charantia extract, DGA against caspase 3. Materials and Methods: The chemical structure of the ligand was from obtained PubChem database, and the protein structure was procured from PDB database. Molecular docking study was performed using AutoDock version 4.2. Results: This study states the interactions of DGA with GLU’124, LYS’137 and ARG’164 amino acids of caspase 3, where GLU’124, LYS’137 amino acid interactions are important for stability of caspase 3 enzyme. Conclusion: The interactions between DGA and caspase 3 revealed in this study may be helpful in characterizing the medicinal property of this phytoconstituent in the bitter melon extract by future studies.

Sodium-glucose co-transporter 2 inhibitors (SGLT2i); as a preventive factor of kidney failure in patients with type 2 diabetes; a meta-analysis of randomized controlled trials

Introduction: Sodium-glucose co-transporter 2 inhibitors (SGLT2i) are a new class of anti-diabetic drugs. SGLT2 inhibitors lower blood glucose levels by decreasing glucose reabsorption in the proximal renal tubule, resulting in increased urinary glucose and sodium excretion. Objective: This study was conducted to investigate the effects of SGLT2i on individual renal outcomes in diabetic patients. Methods: This study was a systematic review and meta-analysis of clinical trials. A comprehensive search of Cochrane Central Register of Controlled Trials was conducted in the Cochrane Library and PubMed, to identify relevant articles focusing on SGLT2i and chronic kidney disease (CKD) in diabetic patients. The most recent article search was conducted on July 12, 2021. Results: Seven randomized controlled trials (RCTs) were included in the meta-analysis. Two trials were comparing dapagliflozin, two comparing empagliflozin, one comparing ertugliflozin, one comparing canagliflozin, and one comparing sotagliflozin. Composite renal outcome and acute kidney injury (AKI) was found in seven and four studies, respectively. Data on end-stage kidney disease (ESKD) and albuminuria or initiation of renal replacement therapy were reported in the two studies. The pooled risk ratio (RR) 95% confidence interval (CI) for the composite renal outcome was 0.54 (0.50–0.59), with 92 % heterogeneity. The pooled RR for AKI was 0.77 (0.66–0.89), with no heterogeneity. A significant lower incidence of albuminuria (RR: 0.69; 95% CI: 0.59–0.81), initiation of renal replacement therapy (RR: 0.71; 95% CI: 0.58–0.87), was observed following the use of SGLT2 inhibitors. Conclusion: Our findings confirm that the SGLT2 inhibitors can reduce the risk of albuminuria, AKI and renal replacement therapy in ESKD patients with T2D (type 2 diabetes). These meta-analyses provide substantial evidence supporting the beneficial effect of SGLT2 inhibitors on reducing CKD events in individuals with T2D.

World Kidney Day 2021 with the theme of living well with kidney disease; a review of current concepts

Since 2006, by considering one dimension of kidney disease, each year, the International Society of Nephrology (ISN) and the International Federation of Kidney Foundations (IFKF) have consistently and unanimously declared a World Kidney Day (WKD) around a specific kidney disease to increase the global awareness about kidney diseases. WKD, which is celebrated in more than 150 countries worldwide, is an international kidney health awareness campaign emphasizing the importance of the kidneys to reduce the global prevalence of kidney diseases and their related health problems by promoting patients and providing education. The present review aims to summarize the themes of previous WKD campaigns and the advocacy of the 2021 WKD campaign theme "Living well with kidney disease". The 2021 WKD Steering Committee advocates for the empowerment of CKD patients, their family members, and care partners, along with both drug and non-drug therapeutic programs to achieve better health outcomes.

Understanding kidney injury in COVID-19; a pressing priority

The 2019 novel coronavirus disease (COVID-19) is a newly defined infectious and highly contagious acute disease caused by the severe acute respiratory syndrome coronavirus 2 ( (SARS-CoV-2). COVID-19 is mainly characterized by an acute respiratory disease however it can also affect multiple other organ systems such as the kidney, gastrointestinal tract, heart, vascular system, and the central nervous system. Kidney involvement is frequent in patients with COVID-19 and this review aims to explore the available data on kidney and COVID-19. In conclusion, COVID-19 infection can affect renal function and may cause acute kidney injury (AKI), due to several mechanisms that need to be fully elucidated. As only supportive management strategies are available for treating AKI in COVID-19, it is necessary to identify and preserve renal function during SARS-CoV-2 infection.

COVID-19 and the kidney; mechanisms of tubular injury by SARS-CoV-2

Coronavirus disease 2019 (COVID-19) is an ongoing pandemic, reported to cause asymptomatic to severe disease and eventually death. Multi-organ failure and death in patients with severe COVID-19 is associated with increased release of pro-inflammatory cytokines into the blood stream. Renal impairment is reported in a significant proportion of COVID-19 patients and is associated with high mortality. Acute kidney injury (AKI) is multifactorial and involving overlapping pathogenic mechanisms. This review updates the reader of recent publications dealing with the mechanisms underlying AKI in patients with COVID-19. A full understanding of all the possible ways in which the system plays its role in AKI is still a matter of research. Further studies are warranted to better understand the causes of AKI in COVID-19 patients.

Interleukin-10 gene promoter variants and susceptibility to diabetic nephropathy; a meta-analysis

Introduction: Diabetic nephropathy (DN) is a leading cause of chronic kidney disease (CKD) in diabetes patients. There is ample evidence that the inflammatory pathways are central to both diabetes and DN. Several studies that examined the link between the interleukin-10 (IL10) polymorphisms and DN risk yielded conflicting results. Objectives: The purpose of this meta-analysis is to evaluate the associations between IL10 promoter polymorphisms and DN risk. Methods: A bibliographic search was carried out on PubMed, Google scholar and Web of Science from the beginning until July 30, 2020. Association between IL10 promoter variants (-1082 A>G, -819 C>T and -592 C>A) and DN risk were assessed by considering diabetes without nephropathy (DWN) as well as healthy controls. Data were retrieved and the pooled odds ratio (OR) with 95% confidence interval (CI) was calculated. Results: For the IL10 -1082 A> G analysis, a total of 4 studies with DWN controls (682 cases and 529 controls) and 5 studies with healthy controls (1025 cases and 1625 controls) were considered. For the IL10 -819 C> T analysis, a total of three studies with DWN controls (9619 cases and 445 controls) and 5 studies with healthy controls (1005 cases and 1537 controls) were considered. For the IL10 -592 C> T analysis, a total of 5 studies with DWN controls (819 cases and 645 controls) and 5 studies with healthy controls (1005 cases and 1537 controls) were considered. In addition, there was no evidence of publication bias for IL10 promoter variants. No substantial association was observed between IL10 promoter variants and DN risk. Conclusion: Our study signifies that polymorphisms of IL10 -1082 A>G, -819 C>T and -592 C>A are not linked with DN risk.

Potential of renin-angiotensin system inhibition to improve metabolic bone disorders

Metabolic bone disorder is an abnormality of bones indicated by reduced bone mass and high risk of fractures. Several lines of evidence have demonstrated that the local bone tissue renin-angiotensin system (RAS) is directly involved in bone metabolism and influences the bone health. This review aimed to assess the role of RAS in bone metabolism and comparative effectiveness of angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin receptor blockers (ARBs) in reducing the bone fractures. In summary, the clinical trials, in vivo studies, and functional - pharmacological experiments suggested that the RAS regulates bone marrow metabolism and influences the bone health. Hence, it warrants further investigation on the role of ACEIs and ARBs in reducing risk fractures.

Metformin induced acute kidney injury; a systematic review

Introduction: Metformin is the best proven first-line treatment for type 2 diabetes (T2DM), based on both national and international guidelines. The present systematic review is aimed to examine the acute kidney injury (AKI) risk associated with metformin. Methods: A systematic literature search was performed in MEDLINE, PubMed and google scholar, to retrieve the literature related to the metformin use. A bibliographic management software (Endnote X9) was used for managing the literature. The following keywords were used: "Acute renal injury OR ARI", "Acute kidney injury OR AKI"," Metformin", " Type 2 diabetes mellitus OR T2DM", "Diabetic patients", "Renal function", "CKD". Results: About 28 relevant articles were found during the electronic and manual search. Finally, a total of four articles that fulfill the inclusion criteria were used for this systematic literature review. There is no evidence to suggest that metformin increases the incidence of AKI and is associated with an increased survival of 28 days following AKI event. Further, there was no difference in the incidence of AKI in patients who continued metformin after arterial contrast exposure compared with the control group. Conclusion: In summary, there is no evidence that metformin increases the incidence of AKI. More clinical trials are needed in this area, to investigate more evidence so that we can better understand the outcome.

Strive for kidney health for everyone during COVID-19; the possible theme for the world kidney day 2021

Increasing awareness regarding CKD and self-care during COVID-19 pandemic has become the most important aspect for the nephrologists. Hence it is appropriate that the theme of the forthcoming World Kidney Day on 11 March 2021 should be "Strive for kidney health for everyone during COVID-19"

Administration of metformin in type 2 diabetes mellitus patients with chronic kidney disease; facts and myths

There are few publications reporting adverse effects of metformin for patients with type 2 diabetes mellitus (T2DM) and chronic kidney disease (CKD). Although some of these reports have made big claims about the adverse effects of metformin in patients with renal failure, the majority of studies showed a superior safety profile for metformin compared with other antidiabetic medications in these patients. Further, metformin use is not contributing to an increased incidence of acute kidney injury (AKI). In conclusion, we suggest that a low dose of metformin is safe to use in patients with or without CKD. Multicenter randomized trials are required to further discover the benefits of the risk of metformin therapy in different stages of CKD and its effect on progression of CKD.

Genetic association of ACE gene I/D polymorphism with the risk of diabetic kidney disease; a meta-analysis

Introduction: Diabetic nephropathy (DN) is a progressive renal disease characterized by persistent albuminuria that leads to end-stage renal disease in both type 1 diabetes (T1DM) and type 2 diabetes (T2DM) patients. The renin-angiotensin-aldosterone system (RAAS) plays a major role in the onset and progression of DN. Objectives: The present meta-analysis is intended to synthesize evidence on the association between ACE gene insertion and deletion (ACE I/D) polymorphism and the risk of DN. Methods: PubMed, Scopus, Google Scholar and Embase were searched to retrieve relevant publications. Odds ratios (ORs) with 95% confidence intervals (CIs) were calculated to evaluate the association between ACE I/D polymorphism and DN risk. The Cochrane Q test and I2 statistic were used to detect heterogeneity. To assess between-study heterogeneity, subgroup analysis and sensitivity analysis were performed. Funnel plots and Egger’s test were used to estimate publication bias. Results: Around 45 articles (47 studies) with 6124 patients of DN and 2492 T2DM patients (controls) were ultimately considered for meta-analysis. Overall, the ACE I/D polymorphism was associated with DN under three different genetic models (allelic model: OR = 1.34; 95% CI: 1.20- 1.49; P<0.001; dominant model: OR= 1.54; 95% CI: 1.31- 1.81; P<0.001; and recessive model: OR= 1.39; 95% CI: 1.19- 1.63; P<0.001). Significant heterogeneity (I2 > 50%) was present in the analysis for all ethnic groups. Further, there is no evidence for publication bias in this meta-analysis. Conclusion: The current meta-analysis provided confirmation that the ACE I/D polymorphism is correlated with an increased risk of DN in patients with T2DM and the D allele of ACE I/D was a susceptible factor.

Lack of association between IRF6 polymorphisms and nonsyndromic oral clefts in South Indian population

Objective: This present study is aimed to investigate the association between interferon regulatory factor 6 (IRF6), single nucleotide polymorphisms (SNPs), and nonsyndromic cleft lip without without cleft palate (NSCLP) in the South Indian population. Subject and Methods: For this study, 190 unrelated NSCLP patients and 189 controls without clefts were genotyped with rs2235371 (V2741) and rs642961 SNPs using PCR-RFLP. The associations between NSCLP groups and IRF6 gene polymorphisms, as well as haplotypes, were analyzed using chi-squared test and 95% confidence interval (95%CI) of the odds ratios were calculated with the control groups as reference. Results: For controls, the minor allele frequencies of both variants, V2741 and rs642961, were 7.1% and 21.1%, respectively. Genotype data for both variants in control and cleft groups follow the Hardy Weinberg Equilibrium. Between cases with NSCLP and controls, the two SNPs showed no differences in frequencies of the genotypes or alleles. The pairwise linkage disequilibrium (LD) values (D’=1 and r2=0.027) between V2741 and rs642961 revealed that these two SNPs are not in strong LD. Haplotype G-T showed a significantly reduced risk for oral clefts (p<0.001) and haplotype A-T increased the risk for oral clefts (p=0.043). Gene-gene interaction showed that the higher risk group contains more GG-CC combination of cases that the controls, but this model was not significantly associated with cleft status (p=0.136) Conclusion: In conclusion, while IRF6 is strongly associated in other populations, this study demonstrated that variants in IRF6 may play a role in NSCLP in a South Indian population, but other genes are expected to play a role in this population as well.

HLA class II SNP interactions and the association with type 1 diabetes mellitus in Bengali speaking patients of Eastern India

BACKGROUND

Several studies have demonstrated a fundamental role for the HLA in the susceptibility of, or protection to, type 1 diabetes mellitus (T1DM). However, this has not been adequately studied in Asian Indian populations. To assess the frequency of HLA class II (DPA1, DPB1, DQA1, DQB1 and DRB1) associated to susceptibility or protection toT1DM in a Bengali population of India with diabetes.

RESULTS

Single nucleotide polymorphism study. The HLA genotyping was performed by a polymerase chain reaction followed by their HLA-DP, DQ, and DRB1 genotypes and haplotypes by sequencing method. The results are studied by Plink software. The χ2 tests were used for the inferential statistics. To our knowledge, this study is the first of a kind which has attempted to check the HLA association with T1DM by SNPs analysis. The study recruited 151 patients with T1DM and same number of ethno-linguistic, sex matched non-diabetic controls. The present study found a significant SNP rs7990 of HLA-DQA1 (p = 0.009) negative correlation, again indicating that risk from HLA is considerably more with T1DM.

CONCLUSIONS

This study demonstrates that the HLA class-II alleles play a major role in genetic basis of T1DM.