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Medicina & Laboratorio

2022, Number 3

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Medicina & Laboratorio 2022; 26 (3)

Histopathological findings in renal biopsy of patients with COVID-19 and renal involvement

Caviedes-Cleves MA, Arias LF, Ospina-Ospina S

Language: Spanish
References: 28
Page: 261-271
PDF size: 86.59 Kb.


ABSTRACT

Introduction. Acute kidney injury (AKI) in patients with COVID-19 occurs more frequently in the presence of chronic diseases such as diabetes, obesity, hypertension, and previous chronic kidney disease, and is considered a strong predictor of unfavorable outcomes and mortality. The purpose of this study was to describe the histopathological characteristics in kidney biopsies from patients hospitalized for COVID-19, who experienced some degree of kidney damage during their hospitalization. Methodology. We included 30 patients over 18 years of age, hospitalized in different care centers in Medellín, Colombia, with a confirmed diagnosis of COVID-19, without a history of renal replacement therapy, who developed some degree of kidney disease during the infection, and had histopathological study of renal biopsy. Demographic characteristics, clinical manifestations and histopathological findings were analyzed. Results. Most of the patients were male (70%). The most frequent previous pathological findings were chronic kidney disease (16.7%), diabetes mellitus (16.7%), kidney transplant (13.3%) and HIV (10%). 35.7% of the patients did not have any underlying comorbidity. The most frequent initial clinical manifestation was AKI (56.7%). Some patients had more than one initial clinical manifestation. 100% of the patients had renal histopathological findings, with acute tubulointerstitial nephritis (40%) being the most frequent. Conclusion. Our study does not rule out a possible association of the male gender with worse outcomes in COVID-19 disease. AKI was the most common initial clinical finding. It is possible that the histopathological findings of this study may be a consequence of direct damage at the renal tubulointerstitial level and poor renal perfusion due to the inflammatory storm, worsening of pre-existing diseases, or clinical overlap with other entities. However, more studies are needed to elucidate the mechanisms by which these lesions are generated.


REFERENCES

  1. Wang C, Horby PW, Hayden FG, Gao GF. Anovel coronavirus outbreak of global healthconcern. Lancet 2020;395:470-473. https://doi.org/10.1016/s0140-6736(20)30185-9.

  2. Chronic Obstructive Pulmonary Disease Groupof Chinese Thoracic Society, Chronic ObstructivePulmonary Disease Committee of ChineseAssociation of Chest Physician. [Medical managementand prevention instruction of chronicobstructive pulmonary disease during the coronavirusdisease 2019 epidemic]. Zhonghua JieHe He Hu Xi Za Zhi 2020;43:421-426. https://doi.org/10.3760/cma.j.cn112147-20200227-00201.

  3. Gutiérrez-Abejón E, Martín-García D, TamayoE, Álvarez FJ, Herrera-Gómez F. Clinicalprofile, pharmacological treatment, and predictorsof death among hospitalized COVID-19patients with acute kidney injury: A populationbasedregistry analysis. Front Med (Lausanne)2021;8:657977. https://doi.org/10.3389/fmed.2021.657977.

  4. Cheng Y, Luo R, Wang K, Zhang M, WangZ, Dong L, et al. Kidney disease is associatedwith in-hospital death of patients with COVID-19. Kidney Int 2020;97:829-838. https://doi.org/10.1016/j.kint.2020.03.005.

  5. Nlandu YM, Sakaji TM, Engole YM, MboliasaPMI, Bena DM, Abatha JM, et al. Frequencyand factors associated with proteinuria in COVID-19 patients: a cross-sectional study. Pan AfrMed J 2021;40:37. https://doi.org/10.11604/pamj.2021.40.37.29796.

  6. Qian JY, Wang B, Liu BC. Acute kidney injuryin the 2019 novel coronavirus disease.Kidney Dis (Basel) 2020;323:1-6. https://doi.org/10.1159/000509086.

  7. Hirsch JS, Ng JH, Ross DW, Sharma P, ShahHH, Barnett RL, et al. Acute kidney injury inpatients hospitalized with COVID-19. KidneyInt 2020;98:209-218. https://doi.org/10.1016/j.kint.2020.05.006.

  8. Pei G, Zhang Z, Peng J, Liu L, Zhang C, Yu C,et al. Renal involvement and early prognosisin patients with COVID-19 pneumonia. J AmSoc Nephrol 2020;31:1157-1165. https://doi.org/10.1681/asn.2020030276.

  9. Hoffmann M, Kleine-Weber H, Krüger N,Müller M, Drosten C, Pöhlmann S. The novelcoronavirus 2019 (2019-nCoV) uses the SARScoronavirusreceptor ACE2 and the cellularprotease TMPRSS2 for entry into target cells.bioRxiv 2020:2020.2001.2031.929042. https://doi.org/10.1101/2020.01.31.929042.

  10. Gagliardi I, Patella G, Michael A, Serra R,Provenzano M, Andreucci M. COVID-19 andthe kidney: From epidemiology to clinicalpractice. J Clin Med 2020;9:2506. https://doi.org/10.3390/jcm9082506.

  11. Chueh TI, Zheng CM, Hou YC, Lu KC. Novelevidence of acute kidney injury in COVID-19. J Clin Med 2020;9:3547. https://doi.org/10.3390/jcm9113547.

  12. Zhao Y, Zhao Z, Wang Y, Zhou Y, Ma Y, ZuoW. Single-cell RNA expression profiling ofACE2, the receptor of SARS-CoV-2. Am J RespirCrit Care Med 2020;202:756-759. https://doi.org/10.1164/rccm.202001-0179LE.

  13. Chen J, Subbarao K. The Immunobiologyof SARS. The immunobiology of SARS.Annu Rev Immunol 2007;25:443-472.https://doi.org/10.1146/annurev.immunol.25.022106.141706.

  14. Su H, Yang M, Wan C, Yi LX, Tang F, Zhu HY, etal. Renal histopathological analysis of 26 postmortemfindings of patients with COVID-19 inChina. Kidney Int 2020;98:219-227. https://doi.org/10.1016/j.kint.2020.04.003.

  15. Vásquez-Jiménez E, Moguel-González B,Soto-Abraham V, Flores-Gama C. Risk ofacute rejection in kidney transplant recipientsafter COVID-19. J Nephrol 2022;35:367-369.https://doi.org/10.1007/s40620-021-01192-x.

  16. Elhadi M, Momen AA, Abdulhadi O,Msherghi A. Multi-organ failure after acutekidney injury in patient with HIV and COVID-19.New Microbes New Infect 2020;37:100742.https://doi.org/10.1016/j.nmni.2020.100742.

  17. Shabaka A, Rovirosa-Bigot S, Guerrero-MárquezC, Alonso-Riaño M, Fernández-JuárezG. Fracaso renal agudo y síndrome nefróticosecundario a glomerulosclerosis segmentariay focal asociada a COVID-19. Nefrología2021;2021:e3. https://doi.org/10.1016/j.nefro.2020.10.006.

  18. Chaudhri I, Moffitt R, Taub E, Annadi RR,Hoai M, Bolotova O, et al. Association of proteinuriaand hematuria with acute kidney injuryand mortality in hospitalized patients with COVID-

  19. Kidney Blood Press Res 2020;45:1018-1032. https://doi.org/10.1159/000511946.19. Futterman I, Toaff M, Navi L, Clare CA. COVID-19 and HELLP: Overlapping clinical picturesin two gravid patients. AJP Rep 2020;10:e179-e182. https://doi.org/10.1055/s-0040-1712978.

  20. Dheir H, Sipahi S, Yaylaci S, Genc AC, GencFT, Genc AB, et al. Is the COVID-19 disease associatedwith de novo nephritic syndrome? RevAssoc Med Bras (1992) 2020;66:1258-1263.https://doi.org/10.1590/1806-9282.66.9.1258.

  21. Ng JH, Zaidan M, Jhaveri KD, Izzedine H.Acute tubulointerstitial nephritis and COVID-19.Clin Kidney J 2021;14:2151-2157. https://doi.org/10.1093/ckj/sfab107.

  22. Nangaku M, Fujita T. Activation of the reninangiotensinsystem and chronic hypoxia ofthe kidney. Hypertens Res 2008;31:175-184.https://doi.org/10.1291/hypres.31.175.

  23. Srivastava SP, Srivastava R, Chand S, GoodwinJE. Coronavirus disease (COVID)-19 anddiabetic kidney disease. Pharmaceuticals (Basel)2021;14:751. https://doi.org/10.3390/ph14080751.

  24. Huang Y, Li XJ, Li YQ, Dai W, Shao T, LiuWY, et al. Clinical and pathological findingsof SARS-CoV-2 infection and concurrent IgAnephropathy: a case report. BMC Nephrol2020;21:504. https://doi.org/10.1186/s12882-020-02163-3.

  25. Farooq H, Aemaz Ur Rehman M, Asmar A,Asif S, Mushtaq A, Qureshi MA. The pathogenesisof COVID-19-induced IgA nephropathyand IgA vasculitis: A systematic review. JTaibah Univ Med Sci 2022;17:1-13. https://doi.org/10.1016/j.jtumed.2021.08.012.

  26. Perico L, Benigni A, Casiraghi F, Ng LFP, ReniaL, Remuzzi G. Immunity, endothelial injuryand complement-induced coagulopathy inCOVID-19. Nat Rev Nephrol 2021;17:46-64.https://doi.org/10.1038/s41581-020-00357-4.

  27. Fernandez-Ruiz R, Paredes JL, NiewoldTB. COVID-19 in patients with systemic lupuserythematosus: lessons learned from the inflammatorydisease. Transl Res 2021;232:13-36. https://doi.org/10.1016/j.trsl.2020.12.007.

  28. Sethi S, D'Costa MR, Hermann SM, Nasr SH,Fervenza FC. Immune-complex glomerulonephritisafter COVID-19 infection. Kidney Int Rep2021;6:1170-1173. https://doi.org/10.1016/j.ekir.2021.02.002.




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