Smith Kelly D, Akilesh Shreeram
Department of Laboratory Medicine and Pathology, University of Washington, Seattle, Washington, USA.
Curr Opin Nephrol Hypertens. 2021 May 1;30(3):324-331. doi: 10.1097/MNH.0000000000000708.
The current review summarizes the pathologic findings in kidneys from severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)-infected patients who have had autopsies or undergone biopsy, and the pathogenic mechanisms implicated in coronavirus disease 2019 (COVID-19)-associated kidney diseases.
Direct infection of the kidney by SARS-CoV-2 is not common, and convincing morphologic evidence of substantive kidney infection by SARS-CoV-2 is lacking. Severe COVID-19-associated acute kidney injury is likely multifactorial and results from the physiologic disturbances and therapies used to treat this illness. COVID-19-associated collapsing glomerulopathy (COVAN) is seen almost exclusively in patients with apolipoprotein L1 high-risk genotypes with no evidence of direct infection of the kidney by SARS-CoV-2.
The prevailing evidence does not support substantive or persistent infection of kidneys in COVID-19 and indirect means of tissue injury are favored, although a 'hit and run' model cannot be excluded. COVAN frequently occurs in patients with mild respiratory systems, suggesting that innate and adaptive immune responses to SARS-CoV-2 infection may provide the second hit needed for the development of collapsing glomerulopathy in susceptible individuals.
本综述总结了对严重急性呼吸综合征冠状病毒2（SARS-CoV-2）感染患者进行尸检或活检后肾脏的病理发现，以及与2019冠状病毒病（COVID-19）相关的肾脏疾病的致病机制。
SARS-CoV-2直接感染肾脏并不常见，且缺乏SARS-CoV-2实质性感染肾脏的确凿形态学证据。严重的COVID-19相关急性肾损伤可能是多因素的，是由治疗该疾病的生理紊乱和治疗方法导致的。COVID-19相关的塌陷性肾小球病（COVAN）几乎仅见于载脂蛋白L1高风险基因型患者，且无SARS-CoV-2直接感染肾脏的证据。
现有证据不支持COVID-19中肾脏的实质性或持续性感染，尽管不能排除“打一枪换一个地方”的模式，但组织损伤的间接方式更受青睐。COVAN常见于呼吸系统症状较轻的患者，这表明对SARS-CoV-2感染的固有免疫和适应性免疫反应可能为易感个体发生塌陷性肾小球病提供所需的第二次打击。
