Kidney Infarction in Patients With COVID-19
Kidney Infarction in Patients With COVID-19
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DOI：
10.1053/j.ajkd.2020.05.004
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发表时间：
2020-09-01
影响因子：
13.2
通讯作者：
Berger, Stefan P.
中科院分区：
文献类型：
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作者：
Post, Adrian;den Deurwaarder, Edwin S. G.;Berger, Stefan P.
2019冠状病毒病（COVID-19）是由严重急性呼吸道综合征冠状病毒2（SARS-CoV-2）引起的一种危及生命的传染性感染。最近的研究结果表明，COVID-19感染期间急性肾损伤的风险增加。导致COVID-19感染中急性肾损伤的病理生理机制尚不清楚，但可能包括病毒对肾小管和内皮细胞的直接细胞病变作用、病毒诱导的细胞因子释放引起的间接损伤以及限制性液体策略引起的肾灌注不足。在这2例报告中，我们提出了一个额外的病理生理机制。我们描述了2例COVID-19感染患者因肾梗死导致肾功能下降的病例。这些患者没有房颤。其中1例患者接受治疗剂量的低分子量肝素治疗，之后未观察到肾功能进一步恶化。我们的研究结果表明，COVID-19感染患者急性肾损伤的鉴别诊断应包括肾梗死，这可能具有重要的预防和治疗意义。
Coronavirus disease 2019 (COVID-19) is a contagious life-threatening infection caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Recent findings indicate an increased risk for acute kidney injury during COVID-19 infection. The pathophysiologic mechanisms leading to acute kidney injury in COVID-19 infection are unclear but may include direct cytopathic effects of the virus on kidney tubular and endothelial cells, indirect damage caused by virus- induced cytokine release, and kidney hypoperfusion due to a restrictive fluid strategy. In this report of 2 cases, we propose an additional pathophysiologic mechanism. We describe 2 cases in which patients with COVID-19 infection developed a decrease in kidney function due to kidney infarction. These patients did not have atrial fibrillation. One of these patients was treated with therapeutic doses of low-molecular-weight heparin, after which no further deterioration in kidney function was observed. Our findings implicate that the differential diagnosis of acute kidney injury in COVID-19-infected patients should include kidney infarction, which may have important preventive and therapeutic implications.