微小病变性肾病和局灶节段性肾小球硬化与新冠病毒相关肾病患者的良好肾脏预后相关，而血栓性微血管病与不良肾脏生存相关。
Minimal Change Disease and Focal Segmental Glomerulosclerosis Are Associated with Good Kidney Prognosis and Thrombotic Microangiopathy with Poor Kidney Survival in Patients with COVID-19-Associated Nephropathies.
作者信息
Neves Precil Diego Miranda de Menezes, Araújo Stanley Almeida, Wanderley David Campos, Sodré Andressa Monteiro, Campos Marcos Adriano Garcia, Watanabe Elieser Hitoshi, Malheiros Denise Maria Avancini Costa, Cavalcante Lívia Barreira, Ledesma Felipe Lourenço, Israel Karla Cristina Petruccelli, Barcelos Flávia Lara, Pinho Laila Lopes de Farias, Barbosa Fabrício Augusto Marques, Miranda Silvana Maria Carvalho, Dantas Márcio, Britto Welluma Lomarques de Mendonça, Paixão Jenaine Oliveira, Madeira Rafael Lage, Guedes Felipe Leite, Luchi Weverton Machado, Cuvello-Neto Américo Lourenço, Marques Igor Denizarde Bacelar, Almeida Jose Bruno, Vasco Rafael Fernandes Vanderlei, Monteiro Antonio, Ladchumananandasivam Francisco Rasiah, Júnior Antônio Augusto Lima Teixeira, Gomes Orlando Vieira, Hagemann Rodrigo, Ferra-Neto Oreste Angelo, Santos Ricardo Ferreira, Costa Denise Maria do Nascimento, Luz-Neto Epitácio Rafael, Soares Leandro de Castro Bahia Alvarenga, Mubarac Rebecca Souza, Costa Kellen Micheline Alves Henrique, Weissheimer Rafael, Almeida Christiany Moreira, da Silva Barbara Antunes Bruno, Miranda Leandro Santos, Iannuzzi Leandro Rodrigues, Murata Gilson Masahiro, Noronha Irene de Lourdes, Salgado-Filho Natalino, Onuchic Luiz Fernando, Silva Gyl Eanes de Barros
机构信息
Nephrology Division, University of São Paulo, São Paulo, Brazil.
Molecular Medicine Division, University of São Paulo, São Paulo, Brazil.
出版信息
Am J Nephrol. 2025;56(3):279-295. doi: 10.1159/000542836. Epub 2024 Dec 11.
INTRODUCTION
The kidney is a frequent target of SARS-CoV-2, potentially developing lesions in glomeruli, vessels, and tubulointerstitium in response to this infection. Herein, we present the analysis of the first large Latin American cohort of adult patients undergoing kidney biopsy due to COVID-19-associated kidney disorders.
METHODS
This retrospective, multicenter, national study was based on the collection of information on demographics, comorbidities, laboratory data, kidney histology, therapy, and therapeutic response. Patients diagnosed with collapsing glomerulopathy (CG) were genotyped for APOL1.
RESULTS
Our cohort included 94 patients, most male (62.8%). The median age was 44 (33-52) years, and 50% of them were previously hypertensive. The time between COVID-19 diagnosis and kidney biopsy was 30 (15-60) days. Most patients had decreased kidney function at diagnosis, 43.5% required dialysis upon diagnosis, 77.6% received immunosuppression, and 2/3 achieved a clinical remission. CG was the most common kidney involvement (18 cases), reproducing previous findings. Focal segmental glomerulosclerosis (FSGS), thrombotic microangiopathy (TMA), and IgA nephropathy were also frequent, with 10 cases each. FSGS and minimal change disease (MCD) were associated with the best cumulative kidney survival; none started dialysis. In contrast, patients with TMA/C3 glomerulopathy presented a poor kidney prognosis, with more than half progressing to kidney replacement therapy.
CONCLUSION
A novel and striking finding of our study, therefore, was the association of FSGS and MCD with the best kidney outcome among all COVID-19-related histological patterns. Moreover, the overall distribution of histological profiles showed significant particularities in the analyzed patient cohort, the most important being the higher frequency of TMA cases.
引言
肾脏是严重急性呼吸综合征冠状病毒2（SARS-CoV-2）的常见靶器官，感染后可能在肾小球、血管和肾小管间质中出现病变。在此，我们对拉丁美洲首个因新冠病毒相关肾脏疾病接受肾活检的成年患者大型队列进行了分析。
方法
这项回顾性、多中心、全国性研究基于对人口统计学、合并症、实验室数据、肾脏组织学、治疗方法及治疗反应等信息的收集。对诊断为塌陷性肾小球病（CG）的患者进行载脂蛋白L1（APOL1）基因分型。
结果
我们的队列包括94例患者，大多数为男性（62.8%）。中位年龄为44（33 - 52）岁，其中50%既往患有高血压。从新冠病毒诊断到肾活检的时间为30（15 - 60）天。大多数患者在诊断时肾功能下降，43.5%在诊断时需要透析，77.6%接受了免疫抑制治疗，三分之二实现了临床缓解。CG是最常见的肾脏受累类型（18例），与既往研究结果一致。局灶节段性肾小球硬化（FSGS）、血栓性微血管病（TMA）和IgA肾病也较为常见，各有10例。FSGS和微小病变肾病（MCD）的累积肾脏生存率最佳；均未开始透析。相比之下，TMA/C3肾小球病患者的肾脏预后较差，超过一半进展为肾脏替代治疗。
结论
因此，我们研究的一个新的显著发现是，在所有与新冠病毒相关的组织学类型中，FSGS和MCD的肾脏预后最佳。此外，组织学特征的总体分布在分析的患者队列中显示出显著特点，最重要的是TMA病例的频率较高。
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