COVID-19-Associated Kidney Injury: A Case Series of Kidney Biopsy Findings
COVID-19-Associated Kidney Injury: A Case Series of Kidney Biopsy Findings
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DOI：
10.1681/asn.2020050699
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发表时间：
2020-09-01
影响因子：
13.6
通讯作者：
Bijol, Vanesa
中科院分区：
文献类型：
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作者：
Sharma, Purva;Uppal, Nupur N.;Bijol, Vanesa
背景报告显示，阿基是2019年严重冠状病毒病（COVID-19）住院患者的常见并发症。研究还观察到蛋白尿和显微镜下血尿在这样的患者。尽管最近在中国死于严重COVID-19的患者的尸检系列中发现了肾脏中的急性肾小管坏死，但少数患者报告也描述了COVID-19中的塌陷性肾小球病。方法我们评估了来自我们机构的10名患有COVID-19和阿基临床特征（包括蛋白尿伴或不伴血尿）的患者的活检肾脏样本。我们记录的临床特征，病理结果，outcomes.Results我们的分析包括10例患者进行肾活检（平均年龄：65岁），5例患者是黑色的，3个是西班牙裔，和2个是白色。所有患者均有蛋白尿。8例患者患有重度阿基，需要RRT。所有活检样本均显示不同程度的急性肾小管坏死，1例患者伴有广泛的肌红蛋白管型。此外，2例患者发现血栓性微血管病，1例为免疫缺陷新月体肾炎，另1例为整体和节段性肾小球硬化，具有愈合的塌陷性肾小球病特征。有趣的是，尽管患者通过RT-PCR证实了严重急性呼吸综合征冠状病毒2（SARS-CoV-2）感染，但所有10名患者的肾活检样本SARS-CoV-2免疫组化染色均为阴性。此外，电镜超微结构检查显示活检样本中没有病毒颗粒的证据。结论在我们的10例阿基和COVID-19住院患者的肾活检样本中，最常见的发现是急性肾小管坏死。肾活检组织中没有SARS-CoV-2的证据。
Background Reports show that AKI is a common complication of severe coronavirus disease 2019 (COVID-19) in hospitalized patients. Studies have also observed proteinuria and microscopic hematuria in such patients. Although a recent autopsy series of patients who died with severe COVID-19 in China found acute tubular necrosis in the kidney, a few patient reports have also described collapsing glomerulopathy in COVID-19.Methods We evaluated biopsied kidney samples from ten patients at our institution who had COVID-19 and clinical features of AKI, including proteinuria with or without hematuria. We documented clinical features, pathologic findings, and outcomes.Results Our analysis included ten patients who underwent kidney biopsy (mean age: 65 years); five patients were black, three were Hispanic, and two were white. All patients had proteinuria. Eight patients had severe AKI, necessitating RRT. All biopsy samples showed varying degrees of acute tubular necrosis, and one patient had associated widespread myoglobin casts. In addition, two patients had findings of thrombotic microangiopathy, one had pauci-immune crescentic GN, and another had global as well as segmental glomerulosclerosis with features of healed collapsing glomerulopathy. Interestingly, although the patients had confirmed severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection by RT-PCR, immunohistochemical staining of kidney biopsy samples for SARS-CoV-2 was negative in all ten patients. Also, ultrastructural examination by electron microscopy showed no evidence of viral particles in the biopsy samples.Conclusions The most common finding in our kidney biopsy samples from ten hospitalized patients with AKI and COVID-19 was acute tubular necrosis. There was no evidence of SARS-CoV-2 in the biopsied kidney tissue.