Muthya Ankita, Ekinci Elif I, Lecamwasam Ashani
Department of Medicine, University of Melbourne, Melbourne, Victoria, Australia.
Department of Endocrinology, Austin Health, Melbourne, Victoria, Australia.
Intern Med J. 2024 Dec;54(12):1935-1943. doi: 10.1111/imj.16540. Epub 2024 Nov 1.
Kidney involvement occurs in almost one third of patients hospitalised with coronavirus disease 2019 (COVID-19) and is associated with increased disease severity. This review aims to outline the spectrum of kidney pathology involved in COVID-19. Literature was reviewed systematically on the databases Medline OVID and Scopus in search of case reports, case series, cohort studies and autopsy studies of patients with COVID-19 who underwent kidney biopsies. Studies were published between August 2020 and November 2021. Fourteen studies consisting of 159 patients were included in this review. Acute tubular necrosis is the most common pathology followed by collapsing glomerulopathy, occurring in 40.1% and 28.9% of patients respectively. Of the 46 patients with collapsing glomerulopathy, 44 were of African descent with high-risk apolipoprotein L1 genotypes. Less common glomerular diseases include membranous nephropathy, secondary focal segmental glomerulosclerosis, minimal change disease and primary focal segmental glomerulosclerosis occurring in 5%, 4.4%, 3.1% and 2.5% of patients respectively. Glomerulonephritis occurred in a minority of patients. Direct viral infection has not been found as a definitive aetiology. Acute kidney injury occurs frequently in hospitalised COVID-19 patients and is associated with increased morbidity and mortality. The mechanisms underpinning acute kidney injury are multifactorial. Acute tubular necrosis is the most common. Collapsing glomerulopathy is the most common glomerular injury and is strongly linked to apolipoprotein L1 genotypes. Improved understanding of COVID-19-related kidney pathologies can guide treatment to improve patient outcomes and reduce progression of chronic kidney disease. The longitudinal impact of COVID-19-related kidney disease requires further research.
在因2019冠状病毒病（COVID-19）住院的患者中，近三分之一会出现肾脏受累情况，且这与疾病严重程度增加相关。本综述旨在概述COVID-19所涉及的肾脏病理学范围。我们系统检索了Medline OVID和Scopus数据库中的文献，以查找接受肾脏活检的COVID-19患者的病例报告、病例系列、队列研究和尸检研究。研究发表时间为2020年8月至2021年11月。本综述纳入了14项研究，共159例患者。急性肾小管坏死是最常见的病理类型，其次是塌陷性肾小球病，分别发生在40.1%和28.9%的患者中。在46例塌陷性肾小球病患者中，44例为非洲裔，具有高危载脂蛋白L1基因型。较不常见的肾小球疾病包括膜性肾病、继发性局灶节段性肾小球硬化、微小病变病和原发性局灶节段性肾小球硬化，分别发生在5%、4.4%、3.1%和2.5%的患者中。少数患者出现肾小球肾炎。尚未发现直接病毒感染是明确的病因。急性肾损伤在住院的COVID-19患者中频繁发生，且与发病率和死亡率增加相关。急性肾损伤的潜在机制是多因素的。急性肾小管坏死最为常见。塌陷性肾小球病是最常见的肾小球损伤，且与载脂蛋白L1基因型密切相关。更好地了解与COVID-19相关的肾脏病理学可指导治疗，以改善患者预后并减少慢性肾脏病的进展。与COVID-19相关的肾脏疾病的长期影响需要进一步研究。
