肾活检在 SARS-CoV-2 感染或 COVID-19 疫苗接种后的患者中的发现。
Kidney Biopsy Findings in Patients with SARS-CoV-2 Infection or After COVID-19 Vaccination.
机构信息
Nephropathology Section, Institute of Pathology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
Department of Internal Medicine II, University Hospital Giessen and Marburg, Justus-Liebig-University Giessen, Giessen, Germany.
出版信息
Clin J Am Soc Nephrol. 2023 May 1;18(5):613-625. doi: 10.2215/CJN.0000000000000106. Epub 2023 Feb 1.
BACKGROUND
Emerging case series described a temporal association between severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) vaccination and de novo or relapsing kidney diseases. We aimed to further understand vaccination- and coronavirus disease 2019 (COVID-19)-associated kidney diseases.
METHODS
We present findings from native kidney biopsies of patients recently vaccinated against SARS-CoV-2 ( n =27) and those with COVID-19 ( n =15), reviewed at a single German center. Diagnoses were compared among all native kidney biopsies ( n =10,206) obtained between the prepandemic (2019), pandemic (2020), and vaccination periods (2021) to determine whether there was an increase in kidney diseases in the observed periods.
RESULTS
Biopsy indication was increased serum creatinine and/or new-onset proteinuria. Glomerulopathies (20/27, 74%) were more common than tubulointerstitial diseases in postvaccination patients, with necrotizing GN (8/27, 30%) and primary podocytopathies and other GN types (6/27, 22% each) the most common forms. Acute tubular injury was the most common kidney disease in patients with COVID-19, followed by thrombotic microangiopathy (TMA) and necrotizing GN. The postvaccination and COVID-19 infection groups had similar kidney function recovery rates (69% and 73%, respectively). Furthermore, the frequencies of necrotizing GN, pauci-immune GN, TMA, or primary podocytopathies at our center did not increase between 2019 and 2021.
CONCLUSIONS
We observed differences in entity frequencies between the SARS-CoV-2 vaccination or COVID-19 groups, with glomerulopathies being more common in patients after vaccination and tubulointerstitial diseases in patients with COVID-19. Cases of TMA were observed only in the COVID-19 group. We detected no increase in the frequency of necrotizing GN, TMA, or podocytopathies between 2019 and 2021.
CLINICAL TRIAL REGISTRY NAME AND REGISTRATION NUMBER
Kidney Histopathology After COVID-19 and SARS-CoV-2 Vaccination, NCT05043168.
PODCAST
This article contains a podcast at https://dts.podtrac.com/redirect.mp3/www.asn-online.org/media/podcast/CJASN/2023_05_08_CJN0000000000000106.mp3.
背景
新出现的病例系列描述了严重急性呼吸综合征冠状病毒 2（SARS-CoV-2）疫苗接种与新发或复发性肾脏疾病之间的时间关联。我们旨在进一步了解与 SARS-CoV-2 疫苗接种和 2019 年冠状病毒病（COVID-19）相关的肾脏疾病。
方法
我们展示了在德国的一个中心进行的最近接种 SARS-CoV-2（n=27）和 COVID-19（n=15）疫苗患者的原发性肾脏活检的结果。将所有原发性肾脏活检（n=10206）的诊断进行比较，这些活检是在大流行前（2019 年）、大流行期间（2020 年）和疫苗接种期间（2021 年）获得的，以确定在观察期间是否有肾脏疾病的增加。
结果
活检指征为血清肌酐升高和/或新出现的蛋白尿。接种疫苗后患者的肾小球疾病（20/27，74%）比肾小管间质性疾病更常见，其中坏死性肾小球肾炎（8/27，30%）和原发性足细胞病和其他肾小球疾病（6/27，各 22%）是最常见的类型。COVID-19 患者中最常见的肾脏疾病是急性肾小管损伤，其次是血栓性微血管病（TMA）和坏死性肾小球肾炎。接种疫苗和 COVID-19 感染组的肾脏功能恢复率相似（分别为 69%和 73%）。此外，我们中心的坏死性肾小球肾炎、少免疫性肾小球肾炎、TMA 或原发性足细胞病的频率在 2019 年至 2021 年之间没有增加。
结论
我们观察到 SARS-CoV-2 疫苗接种或 COVID-19 组之间实体频率的差异，接种疫苗后患者的肾小球疾病更常见，而 COVID-19 患者的肾小管间质性疾病更常见。仅在 COVID-19 组中观察到 TMA 病例。我们在 2019 年至 2021 年期间未发现坏死性肾小球肾炎、TMA 或足细胞病的频率增加。
临床试验注册号和名称
COVID-19 和 SARS-CoV-2 疫苗接种后的肾脏组织病理学，NCT05043168。
播客
本文包含一个播客，网址为 https://dts.podtrac.com/redirect.mp3/www.asn-online.org/media/podcast/CJASN/2023_05_08_CJN0000000000000106.mp3。
Zotero 插件