Nephrology Division, National Institute of Respiratory Diseases, Ismael Cosío Villegas, Mexico City, Mexico.
Nephrology Division, General Hospital of Mexico, Eduardo Liceaga, Mexico City, Mexico.
Clin J Am Soc Nephrol. 2021 May 8;16(5):685-693. doi: 10.2215/CJN.16281020. Epub 2021 Mar 29.
AKI in coronavirus disease 2019 (COVID-19) is associated with higher morbidity and mortality. The objective of this study was to identify the kidney histopathologic characteristics of deceased patients with diagnosis of COVID-19 and evaluate the association between biopsy findings and clinical variables, including AKI severity.
DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: Our multicenter, observational study of deceased patients with COVID-19 in three third-level centers in Mexico City evaluated postmortem kidney biopsy by light and electron microscopy analysis in all cases. Descriptive and association statistics were performed between the clinical and histologic variables.
A total of 85 patients were included. Median age was 57 (49-66) years, 69% were men, body mass index was 29 (26-35) kg/m, 51% had history of diabetes, 46% had history of hypertension, 98% received anticoagulation, 66% were on steroids, and 35% received at least one potential nephrotoxic medication. Severe AKI was present in 54% of patients. Biopsy findings included FSGS in 29%, diabetic nephropathy in 27%, and arteriosclerosis in 81%. Acute tubular injury grades 2-3 were observed in 49%. Histopathologic characteristics were not associated with severe AKI; however, pigment casts on the biopsy were associated with significantly lower probability of kidney function recovery (odds ratio, 0.07; 95% confidence interval, 0.01 to 0.77). The use of aminoglycosides/colistin, levels of C-reactive protein and serum albumin, previous use of angiotensin-converting enzyme inhibitors or angiotensin II receptor blockers, antivirals, nonsteroid anti-inflammatory drugs, and anticoagulants were associated with specific histopathologic findings.
A high prevalence of chronic comorbidities was found on kidney biopsies. Nonrecovery from severe AKI was associated with the presence of pigmented casts. Inflammatory markers and medications were associated with specific histopathologic findings in patients dying from COVID-19.
COVID-19 相关急性肾损伤（AKI）与更高的发病率和死亡率相关。本研究的目的是确定诊断为 COVID-19 的死亡患者的肾脏组织病理学特征，并评估活检结果与临床变量之间的关系，包括 AKI 的严重程度。
设计、地点、参与者和测量方法：我们的多中心、观察性研究纳入了墨西哥城 3 个三级中心的 COVID-19 死亡患者，对所有患者均进行了光镜和电子显微镜分析的死后肾脏活检。对临床和组织学变量之间进行了描述性和关联统计分析。
共纳入 85 例患者。中位年龄为 57（49-66）岁，69%为男性，体重指数为 29（26-35）kg/m，51%有糖尿病史，46%有高血压史，98%接受抗凝治疗，66%使用类固醇，35%至少使用一种潜在肾毒性药物。54%的患者存在严重 AKI。活检发现包括局灶节段性肾小球硬化症 29%，糖尿病肾病 27%，动脉硬化 81%。观察到急性肾小管损伤 2-3 级 49%。组织病理学特征与严重 AKI 无关；然而，活检中色素沉着的铸型与肾功能恢复的可能性显著降低相关（比值比，0.07；95%置信区间，0.01 至 0.77）。使用氨基糖苷类/多粘菌素、C 反应蛋白和血清白蛋白水平、以前使用血管紧张素转换酶抑制剂或血管紧张素 II 受体阻滞剂、抗病毒药物、非甾体抗炎药和抗凝剂与特定的组织病理学发现相关。
在肾脏活检中发现了大量慢性合并症。严重 AKI 无恢复与色素沉着铸型的存在相关。炎症标志物和药物与 COVID-19 死亡患者的特定组织病理学发现相关。
