da Mata Gustavo Ferreira, Fernandes Danilo Euclides, Luciano Eduardo de Paiva, Sales Gabriel Teixeira Montezuma, Riguetti Michelle Tiveron Passos, Kirsztajn Gianna Mastroianni
Department of Medicine (Nephrology), Federal University of São Paulo (Unifesp), São Paulo, SP, Brazil.
J Venom Anim Toxins Incl Trop Dis. 2021 Jul 28;27:e20200154. doi: 10.1590/1678-9199-JVATITD-2020-0154. eCollection 2021.
Inflammation is closely related to renal diseases. This is particularly true for renal diseases caused by infections as in viral diseases. In this review, we highlight the inflammatory mechanisms that underlie kidney dysfunction in SARS-CoV-2, human immunodeficiency (HIV), hepatitis C (HCV), and hepatitis B (HBV) infections. The pathophysiology of renal involvement in COVID-19 is complex, but kidney damage is frequent, and the prognosis is worse when it happens. Virus-like particles were demonstrated mostly in renal tubular epithelial cells and podocytes, which suggest that SARS-CoV-2 directly affects the kidneys. SARS-CoV-2 uses the angiotensin-converting enzyme 2 receptor, which is found in endothelial cells, to infect the human host cells. Critical patients with SARS-CoV-2-associated acute kidney injury (AKI) show an increase in inflammatory cytokines (IL-1β, IL-8, IFN-γ, TNF-α), known as cytokine storm that favors renal dysfunction by causing intrarenal inflammation, increased vascular permeability, volume depletion, thromboembolic events in microvasculature and persistent local inflammation. Besides AKI, SARS-CoV-2 can also cause glomerular disease, as other viral infections such as in HIV, HBV and HCV. HIV-infected patients present chronic inflammation that can lead to a number of renal diseases. Proinflammatory cytokines and TNF-induced apoptosis are some of the underlying mechanisms that may explain the virus-induced renal diseases that are here reviewed.
炎症与肾脏疾病密切相关。对于由感染引起的肾脏疾病,如病毒性疾病,情况尤其如此。在本综述中,我们重点介绍了严重急性呼吸综合征冠状病毒2(SARS-CoV-2)、人类免疫缺陷病毒(HIV)、丙型肝炎病毒(HCV)和乙型肝炎病毒(HBV)感染导致肾功能障碍的炎症机制。新型冠状病毒肺炎(COVID-19)中肾脏受累的病理生理学很复杂,但肾脏损伤很常见,一旦发生,预后更差。病毒样颗粒主要在肾小管上皮细胞和足细胞中被发现,这表明SARS-CoV-2直接影响肾脏。SARS-CoV-2利用在内皮细胞中发现的血管紧张素转换酶2受体感染人类宿主细胞。患有SARS-CoV-2相关急性肾损伤(AKI)的重症患者炎症细胞因子(白细胞介素-1β、白细胞介素-8、干扰素-γ、肿瘤坏死因子-α)增加,即所谓的细胞因子风暴,通过引起肾内炎症、增加血管通透性、血容量减少、微血管血栓栓塞事件和持续的局部炎症,促进肾功能障碍。除了急性肾损伤,SARS-CoV-2还可导致肾小球疾病,就像HIV、HBV和HCV等其他病毒感染一样。感染HIV的患者存在慢性炎症,可导致多种肾脏疾病。促炎细胞因子和肿瘤坏死因子诱导的细胞凋亡是一些潜在机制,可能解释了本文所综述的病毒诱导的肾脏疾病。