Popov Hristo, Stoyanov George S, Petkova Lilyana
General and Clinical Pathology, Forensic Medicine and Deontology, Medical University of Varna, Varna, BGR.
Pathology, Complex Oncology Center, Shumen, BGR.
Cureus. 2023 Apr 7;15(4):e37260. doi: 10.7759/cureus.37260. eCollection 2023 Apr.
Introduction SARS-CoV-2 is an epitheliotropic viral agent with epithelial tropism. Although the clinical significance and severity of affection is the most pronounced in the respiratory system, other organs and systems are also infected and, hence affected, such as the central nervous system, gastrointestinal tract, cardiovascular, and urinary systems. Herein, we set out to evaluate the presence and degree of morphological changes within the renal parenchyma and its relation to disease outcome. Materials and methods A retrospective non-clinical approach was utilized for the means of the study. All patients with real-time reverse transcriptase-polymerase chain reaction proven infection, subject to an autopsy performed in a period of two calendar years, were included in the study. Kidney tissue histopathology samples were analyzed using a modified Banff criteria system for acute onset and chronic changes. The results were compared for statistical significance with overall patient survival from symptom onset to death. Furthermore, SARS-CoV-2 viral presence was evaluated in renal structures by means of immunohistochemistry. Results A total of 40 patients were included in the study. Immunohistochemistry showed viral presence within a myriad of renal structured - endothelial cells, tubular cells, and podocytes. Modified Banff criteria showed significant acute changes within the parenchyma, including endotheliitis, glomerulitis, mesangial matrix expansion, tubulitis, capillaritis, arteritis, thrombosis (including thrombotic microangiopathy in four patients), and hemorrhages. Individual cases also presented with signs of rhabdomyolysis - myoglobulin casts. Signs of chronic injury were also present in most patients. However, when calculated as scores, neither acute nor chronic changes showed a correlation with time from symptom onset to death. Conclusion The results of the present study show both viral presence and a myriad of induced changes in the contents of SARS-CoV-2 infection within the renal parenchyma. The lack of correlation with the degree of changes, when compared to survival, is an encouraging fact that the changes are unlikely to play a role in direct tanatogenesis while having the potential to manifest as chronic kidney disease in the future.
引言 严重急性呼吸综合征冠状病毒2（SARS-CoV-2）是一种具有上皮嗜性的病毒病原体。尽管其感染的临床意义和严重程度在呼吸系统最为显著，但其他器官和系统也会被感染并因此受到影响，如中枢神经系统、胃肠道、心血管系统和泌尿系统。在此，我们着手评估肾实质内形态学变化的存在情况和程度及其与疾病转归的关系。
材料与方法 本研究采用回顾性非临床研究方法。纳入所有经实时逆转录聚合酶链反应证实感染、在两个日历年期间接受尸检的患者。使用改良的班夫标准系统分析肾组织病理样本的急性发作和慢性变化。将结果与患者从症状出现到死亡的总体生存率进行统计学显著性比较。此外，通过免疫组织化学评估肾结构中SARS-CoV-2病毒的存在情况。
结果 本研究共纳入40例患者。免疫组织化学显示在多种肾结构——内皮细胞、肾小管细胞和足细胞中存在病毒。改良的班夫标准显示实质内有显著的急性变化，包括内皮炎、肾小球炎、系膜基质扩张、肾小管炎、毛细血管炎、动脉炎、血栓形成（包括4例血栓性微血管病）和出血。个别病例还出现横纹肌溶解——肌红蛋白管型的迹象。大多数患者也有慢性损伤的迹象。然而，以评分计算时，急性和慢性变化均与从症状出现到死亡的时间无相关性。
结论 本研究结果显示肾实质内存在SARS-CoV-2感染且病毒感染引发了多种变化。与生存率相比，变化程度缺乏相关性是一个令人鼓舞的事实，即这些变化不太可能在直接死因中起作用，同时未来有可能表现为慢性肾脏病。
