Division of Nephrology, Albert Einstein College of Medicine, Montefiore Health System, Bronx, NY.
Division of Nephrology, Albert Einstein College of Medicine, Montefiore Health System, Bronx, NY; Department of Developmental and Molecular Biology, Albert Einstein College of Medicine, Bronx, NY.
Adv Kidney Dis Health. 2024 Jul;31(4):317-325. doi: 10.1053/j.akdh.2023.12.007.
The COVID-19 era has been a reminder to clinicians around the world of the important role that viral infections play in promoting glomerular disease. Several viral infections including human immunodeficiency virus (HIV), severe acute respiratory syndrome coronavirus 2, Epstein-Barr virus, cytomegalovirus, and parvovirus B19 can cause podocyte injury and present with a collapsing glomerulopathy (CG) variant of focal segmental glomerulosclerosis or minimal change disease. CG associated with COVID-19 has been termed COVID-19-associated nephropathy due to its striking resemblance to HIV-associated nephropathy. Host susceptibility is a major determinant of viral infection-associated CG, and the presence of two APOL1 risk variants explains most of the racial predilection to viral-associated CG observed in individuals of African ancestry. Interactions between APOL1 risk variants, viral genes, and the systemic inflammatory response to viral infection all contribute to kidney injury. This review will summarize our current knowledge of viral infection-associated CG, focusing primarily on the clinical presentation, histological features, mechanisms, and disease course of HIV-associated nephropathy and COVID-19-associated nephropathy.
在 COVID-19 时代，全世界的临床医生都意识到病毒感染在促进肾小球疾病方面的重要作用。几种病毒感染，包括人类免疫缺陷病毒 (HIV)、严重急性呼吸综合征冠状病毒 2、爱泼斯坦-巴尔病毒、巨细胞病毒和细小病毒 B19，都可导致足细胞损伤，并表现为局灶节段性肾小球硬化或微小病变病的塌陷性肾小球病变 (CG) 变异型。由于其与 HIV 相关性肾病惊人相似，与 COVID-19 相关的 CG 被称为 COVID-19 相关性肾病。宿主易感性是病毒感染相关性 CG 的主要决定因素，APOL1 风险变异体的存在解释了在非洲裔个体中观察到的大多数与病毒相关的 CG 的种族倾向。APOL1 风险变异体、病毒基因以及对病毒感染的全身炎症反应之间的相互作用都可导致肾脏损伤。本综述将总结我们目前对病毒感染相关性 CG 的认识，主要侧重于 HIV 相关性肾病和 COVID-19 相关性肾病的临床表现、组织学特征、发病机制和病程。
