Jeyalan Vishnu, Storrar Joshua, Wu Henry H L, Ponnusamy Arvind, Sinha Smeeta, Kalra Philip A, Chinnadurai Rajkumar
Department of Renal Medicine, Royal Preston Hospital, Preston PR2 9HT, United Kingdom.
Department of Renal Medicine, Salford Care Organisation, Northern Care Alliance NHS Foundation Trust, Salford M6 8HD, United Kingdom.
World J Transplant. 2021 Nov 18;11(11):480-502. doi: 10.5500/wjt.v11.i11.480.
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) can result in clinically significant multi-system disease including involvement in the kidney. The underlying histopathological processes were unknown at the start of the pandemic. As case reports and series have been published describing the underlying renal histopathology from kidney biopsies, we have started to gain an insight into the renal manifestations of this novel disease.
To provide an overview of the current literature on the renal histopathological features and mechanistic insights described in association with coronavirus disease 2019 (COVID-19) infection.
A systematic review was performed by conducting a literature search in the following websites-'PubMed', 'Web of Science', 'Embase' and 'Medline-ProQuest' with the following search terms-"COVID-19 AND kidney biopsy", "COVID-19 AND renal biopsy", "SARS-CoV-2 AND kidney biopsy" and "SARS-CoV-2 AND renal biopsy". We have included published data up until February 15, 2021, which includes kidney biopsies (native, transplant and postmortem) from patients with COVID-19. Data on clinical presentation, histopathological features, management and outcome was extracted from the reported studies.
The total number of biopsies reported on here is 288, of which 189 are postmortem, 84 native and 15 transplants. The results are varied and show underlying pathologies ranging from collapsing glomerulopathy and acute tubular injury (ATI) to anti-nuclear cytoplasmic antibody associated vasculitis and pigment nephropathy. There was variation in the specific treatment used for the various renal conditions, which included steroids, hydroxychloroquine, eculizumab, convalescent plasma, rituximab, anakinra, cyclophosphamide and renal replacement therapy, amongst others. The pathological process which occurs in the kidney following COVID-19 infection and leads to the described biopsy findings has been hypothesized in some conditions but not others (for example, sepsis related hypoperfusion for ATI). It is important to note that this represents a very small minority of the total number of cases of COVID-19 related kidney disease, and as such there may be inherent selection bias in the results described. Further work will be required to determine the pathogenetic link, if any, between COVID-19 and the other renal pathologies.
This report has clinical relevance as certain renal pathologies have specific management, with the implication that kidney biopsy in the setting of renal disease and COVID-19 should be an early consideration, dependent upon the clinical presentation.
严重急性呼吸综合征冠状病毒2（SARS-CoV-2）可导致具有临床意义的多系统疾病，包括累及肾脏。在疫情开始时，其潜在的组织病理学过程尚不清楚。随着描述肾脏活检潜在肾脏组织病理学的病例报告和系列研究的发表，我们开始深入了解这种新型疾病的肾脏表现。
概述当前关于与2019冠状病毒病（COVID-19）感染相关的肾脏组织病理学特征及机制见解的文献。
通过在以下网站进行文献检索进行系统综述——“PubMed”、“科学网”、“Embase”和“Medline - ProQuest”，检索词如下——“COVID-19与肾脏活检”、“COVID-19与肾活检”、“SARS-CoV-2与肾脏活检”以及“SARS-CoV-2与肾活检”。我们纳入了截至2021年2月15日的已发表数据，其中包括COVID-19患者的肾脏活检（原位肾、移植肾和尸检肾）。从报告的研究中提取了关于临床表现、组织病理学特征、治疗和结局的数据。
本文报告的活检总数为288例，其中189例为尸检肾，84例为原位肾，15例为移植肾。结果各不相同，显示出从塌陷性肾小球病和急性肾小管损伤（ATI）到抗核细胞质抗体相关血管炎和色素性肾病等潜在病理变化。针对各种肾脏疾病所采用的具体治疗方法存在差异，包括使用类固醇、羟氯喹、依库珠单抗、康复期血浆、利妥昔单抗、阿那白滞素、环磷酰胺以及肾脏替代治疗等。在某些情况下，对COVID-19感染后肾脏中发生的导致所述活检结果的病理过程进行了推测，但在其他情况下则未作推测（例如，ATI的脓毒症相关低灌注）。需要注意的是，这仅占COVID-19相关肾脏疾病病例总数的极少数，因此所述结果可能存在内在的选择偏倚。若要确定COVID-19与其他肾脏病理之间是否存在致病联系，还需要进一步开展工作。
本报告具有临床相关性，因为某些肾脏病理具有特定的治疗方法，这意味着在肾脏疾病合并COVID-19的情况下，应根据临床表现尽早考虑进行肾脏活检。
