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SARS-CoV-2 诱导的 AKI 进展为 CKD 的潜在机制:前瞻性观点。

Potential Mechanisms of the SARS-CoV-2-induced AKI Progression to CKD: A Forward-Looking Perspective.

机构信息

Shiraz Nephro-Urology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran.

出版信息

Iran J Kidney Dis. 2021 Jul;15(4):243-255.

Abstract

Coronavirus disease 2019 (COVID‑19) was identified in December 2019 and is still expanding in most parts of the world. The wide variety of affected organs is likely based upon the shared expression of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) important entry-receptor angiotensin-converting enzyme 2 (ACE2). For this reason, the broad distribution of ACE2 receptors in different tissues plays a crucial role in the multi-organ dysfunction and fatality due to COVID-19. Because of the high prevalence of acute kidney injury (AKI) in patients with COVID-19, we review the molecular understanding into viral infection mechanisms and implications for AKI. Furthermore, mechanisms of the AKI to chronic kidney disease (CKD) progression, such as the relative contribution of immune cell reaction, fibroblasts activation, endothelial dysfunction, and subsequent hypoxia may contribute to the association of AKI with worse outcomes during this virus pandemic. We highlight the state of the knowledge on SARS-CoV-2-dependent mechanisms for AKI and list the potential management choices for the prevention of AKI aggravation and the impending possibility of CKD. Finally, we intend to provide a much better understanding of why Coronavirus induces AKI and its subsequent progression to CKD in the coming years and further discuss the acute and long-term renal consequences.

摘要

2019 年冠状病毒病(COVID-19)于 2019 年 12 月被发现,目前在世界大部分地区仍在蔓延。受影响的器官种类繁多,可能基于严重急性呼吸系统综合征冠状病毒 2(SARS-CoV-2)的重要进入受体血管紧张素转换酶 2(ACE2)的共同表达。出于这个原因,ACE2 受体在不同组织中的广泛分布在 COVID-19 导致的多器官功能障碍和死亡中起着至关重要的作用。由于 COVID-19 患者中急性肾损伤(AKI)的高患病率,我们回顾了对病毒感染机制和对 AKI 影响的分子理解。此外,AKI 向慢性肾脏病(CKD)进展的机制,例如免疫细胞反应、成纤维细胞激活、内皮功能障碍和随后的缺氧的相对贡献,可能导致 AKI 与该病毒大流行期间更差的结局相关。我们强调了 SARS-CoV-2 依赖性 AKI 机制的现有知识状态,并列出了预防 AKI 恶化和即将出现 CKD 的潜在管理选择。最后,我们旨在更好地了解为什么冠状病毒会引起 AKI 及其随后向 CKD 的进展,并进一步讨论急性和长期的肾脏后果。

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