Division of Kidney Diseases and Hypertension, Department of Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Great Neck, New York
Division of Kidney Diseases and Hypertension, Department of Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Great Neck, New York.
J Am Soc Nephrol. 2020 Sep;31(9):1948-1958. doi: 10.1681/ASN.2020050699. Epub 2020 Jul 13.
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.
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.
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.
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.
有报道称，急性肾损伤（AKI）是住院 COVID-19 患者的常见并发症。研究还观察到此类患者存在蛋白尿和镜下血尿。尽管中国最近的一项对死于严重 COVID-19 的患者的尸检系列研究发现了肾脏的急性肾小管坏死，但少数患者报告也描述了 COVID-19 中的塌陷性肾小球病。
我们评估了我院十名 COVID-19 合并 AKI 临床特征（包括有或无血尿的蛋白尿）患者的活检肾样本。我们记录了临床特征、病理发现和结果。
我们的分析包括十名接受肾活检的患者（平均年龄：65 岁）；五名患者为黑人，三名患者为西班牙裔，两名患者为白人。所有患者均有蛋白尿。八名患者发生严重 AKI，需要肾脏替代治疗。所有活检样本均显示不同程度的急性肾小管坏死，一名患者伴有广泛的肌红蛋白管型。此外，两名患者存在血栓性微血管病的发现，一名患者存在少免疫性新月体性肾小球肾炎，另一名患者存在广泛的肾小球硬化症和节段性肾小球硬化症，伴有愈合性塌陷性肾小球病的特征。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，但所有十名患者的肾活检样本免疫组织化学染色均为 SARS-CoV-2 阴性。此外，电子显微镜的超微结构检查未在活检样本中发现病毒颗粒。
在我院十名 AKI 合并 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。活检肾组织中没有 SARS-CoV-2 的证据。
