Sevignani Gabriela, Soares Maria Fernanda, Marques Gustavo Lenci, Freitas Ana Karyn Ehrenfried de, Gentili Arthur, Chula Domingos Candiota, Nascimento Marcelo Mazza do
J Bras Nefrol. 2013 Jul-Sep;35(3):185-90. doi: 10.5935/0101-2800.20130030.
Influenza A (H1N1) virus was first reported on April 2009 and, since then, several studies have reported the characteristics concerning the clinical presentation and pulmonary involvement. However, accurate information about the acute kidney injury (AKI) and kidney histopathological findings in these patients remain scarce.
To describe the kidney histopathological findings of 6 patients with H1N1 who developed AKI and underwent kidney biopsy, correlating them with clinical features.
We studied six patients admitted to Hospital de Clínicas UFPR with a PCR-confirmed diagnosis of H1N1who developed ARF and underwent kidney biopsy. We reviewed their medical file and the microscopy findings of the biopsy.
Clinical and/or laboratory evidence of AKI was present in all cases, and only one did not present oliguria. Kidney tissues revealed glomerular lesions in two patients: one patient, with systemic lupus erythematosus, showed changes consistent with lupus nephritis class III A-C according to the ISN/RPS 2003 and focal thrombotic microangiopathy; the other one had intercapillary nodular glomerulosclerosis, but without clinical or laboratory evidence of diabetes. Vacuolar degenerative tubular changes were present in all cases, with focus of oxalosis in two cases. Mild to moderate atherosclerosis was found in two patients.
In this study, varying degrees of vacuolar degenerative tubular changes were present in all patients, but there were no signs of acute tubular necrosis. It seems that in the present study a prerenal cause of acute renal failure was the main involved mechanim to explain the cause of renal failure in these patients.
甲型H1N1流感病毒于2009年4月首次被报道，自那时起，多项研究报告了其临床表现和肺部受累情况。然而，关于这些患者急性肾损伤（AKI）及肾脏组织病理学表现的准确信息仍然匮乏。
描述6例发生AKI并接受肾活检的H1N1患者的肾脏组织病理学表现，并将其与临床特征相关联。
我们研究了6例入住巴拉那联邦大学临床医院且经PCR确诊为H1N1、发生急性肾衰竭并接受肾活检的患者。我们查阅了他们的病历及活检的显微镜检查结果。
所有病例均有AKI的临床和/或实验室证据，仅1例无少尿。肾脏组织在2例患者中显示出肾小球病变：1例患有系统性红斑狼疮的患者，根据2003年国际肾脏病学会/肾脏病理学会（ISN/RPS）标准，显示出符合ⅢA-C级狼疮性肾炎及局灶性血栓性微血管病的改变；另1例有毛细血管间结节性肾小球硬化，但无糖尿病的临床或实验室证据。所有病例均存在空泡变性肾小管改变，2例有草酸沉着灶。2例患者发现轻度至中度动脉粥样硬化。
在本研究中，所有患者均存在不同程度的空泡变性肾小管改变，但无急性肾小管坏死迹象。在本研究中，急性肾衰竭的肾前性病因似乎是解释这些患者肾衰竭原因的主要机制。
