Postmortem Kidney Pathology Findings in Patients with COVID-19
Postmortem Kidney Pathology Findings in Patients with COVID-19
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DOI：
10.1681/asn.2020050744
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发表时间：
2020-09-01
影响因子：
13.6
通讯作者：
Markowitz, Glen
中科院分区：
文献类型：
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作者：
Santoriello, Dominick;Khairallah, Pascale;Markowitz, Glen
背景AKI在2019冠状病毒病（COVID-19）住院患者中很常见，是死亡的独立危险因素。尽管与COVID-19相关的AKI有许多潜在机制，但我们目前对COVID-19肾脏病理发现的了解有限。方法对42例COVID-19死亡患者的死后肾脏进行检测。我们回顾了所有尸检的光镜检查结果，并对一部分样本进行了SARS-CoV-2的免疫荧光、电子显微镜和原位杂交研究。结果该队列的中位年龄为71.5岁（范围38-97岁）；69%为男性，57%为西班牙裔，73%有高血压病史。在有可用数据的患者中，33例患者中有31例（94%）发生AKI，其中6例为AKI一期，9例为AKI二期，16例为AKI三期。与AKI相关的主要表现是急性肾小管损伤。然而，急性肾小管损伤的程度通常比AKI程度的预测要轻，这表明血流动力学因素的作用，如积极的液体管理。背景高血压动脉肾硬化和糖尿病肾小球硬化的改变是常见的，但通常是轻微的。42例尸检中有6例（14%）发现局灶性肾纤维蛋白血栓。一名黑人患者出现FSGS塌陷。免疫荧光和电子显微镜基本未显示，SARS-CoV-2的原位杂交未显示明确的阳性。结论在42例死于COVID-19的患者中，尸检组织学评估显示急性肾小管损伤，相对于肌酐升高程度，急性肾小管损伤通常较轻。这些发现表明，SARS-CoV-2感染消退后可能出现可逆性。
Background AKI is common among hospitalized patients with coronavirus disease 2019 (COVID-19) and is an independent risk factor for mortality. Although there are numerous potential mechanisms underlying COVID-19-associated AKI, our current knowledge of kidney pathologic findings in COVID-19 is limited.Methods We examined the postmortem kidneys from 42 patients who died of COVID-19. We reviewed light microscopy findings in all autopsies and performed immunofluorescence, electron microscopy, and in situ hybridization studies for SARS-CoV-2 on a subset of samples.Results The cohort had a median age of 71.5 years (range, 38-97 years); 69% were men, 57% were Hispanic, and 73% had a history of hypertension. Among patients with available data, AKI developed in 31 of 33 patients (94%), including 6 with AKI stage 1, 9 with stage 2, and 16 with stage 3. The predominant finding correlating with AKI was acute tubular injury. However, the degree of acute tubular injury was often less severe than predicted for the degree of AKI, suggesting a role for hemodynamic factors, such as aggressive fluid management. Background changes of hypertensive arterionephrosclerosis and diabetic glomerulosclerosis were frequent but typically mild. We identified focal kidney fibrin thrombi in 6 of 42 (14%) autopsies. A single Black patient had collapsing FSGS. Immunofluorescence and electron microscopy were largely unrevealing, and in situ hybridization for SARS-CoV-2 showed no definitive positivity.Conclusions Among a cohort of 42 patients dying with COVID-19, autopsy histologic evaluation revealed acute tubular injury, which was typically mild relative to the degree of creatinine elevation. These findings suggest potential for reversibility upon resolution of SARS-CoV-2 infection.