nidНефрология и диализNephrology and Dialysis1680-44222618-9801Российское диализное общество10.28996/2618-9801-2020-Special_Issue-46-55nid-249Research ArticleCOVID-19COVID-19Поражение почек при Covid-19: клинические и морфологические проявления почечной патологии у 220 пациентов, умерших от Covid-19Kidney damage in Covid-19: clinical and morphological manifestations of renal pathology in 220 patients died from Covid-19СтоляревичЕ. С.StolyarevichE. S.stolyarevich@yandex.ruФроловаН. Ф.FrolovaN. F.noemail@neicon.ruАртюхинаЛ. Ю.ArtyukhinaL. Y.noemail@neicon.ruВарясинВ. В.VaryasinV. V.noemail@neicon.ruГБУЗ «Городская клиническая больница № 52 Департамента здравоохранения г. Москвы»; ФГБОУ ВО «Московский государственный медико-стоматологический университет им. А.И. Евдокимова» Минздрава России; ФГБУ "Национальный медицинский исследовательский центр трансплантологии и искусственных органов имени академика В.И. Шумакова" МЗ РФРоссияMoscow City Hospital 52; A.I. Evdokimov Moscow State University of Medicine and Dentistry; Shumakov National Medical Research Centre of Transplantology and Artificial OrgansRussian FederationГБУЗ «Городская клиническая больница № 52 Департамента здравоохранения г. Москвы»РоссияMoscow City Hospital 52Russian Federation202030072024220Спецвыпуск4655Copyright © Столяревич Е.С., Фролова Н.Ф., Артюхина Л.Ю., Варясин В.В., 20242024Столяревич Е.С., Фролова Н.Ф., Артюхина Л.Ю., Варясин В.В.Stolyarevich E.S., Frolova N.F., Artyukhina L.Y., Varyasin V.V.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://journal.nephro.ru/jour/article/view/249

Поражение почек при COVID-19 нередко встречается при тяжелых формах заболевания и ассоциировано с плохим прогнозом. Причины возникновения и характер поражения почек при COVID-19 до конца не определены. Целью настоящего исследования было изучить частоту встречаемости, причины возникновения и характер поражения почек у пациентов с COVID-19. Материалы и методы: в исследование были включены 220 пациентов, умерших в период с 20 апреля по 20 мая 2020 г. в ГКБ № 52 от COVID-19, подтвержденного методом ПЦР. Результаты: cредний возраст пациентов составил 71,4±14 лет, соотношение мужчин и женщин - 1:1. Признаки хронической болезни почек (ХБП) на момент госпитализации имели 35 (15%) пациентов. Острое повреждение почек (ОПП) развилось у 135 пациентов (61%), в том числе у 33 больных с предсуществующей почечной патологией. Частота ОПП значимо не различалась в зависимости от исходной функции почек, составляя 66% и 61% при ХБП и исходно нормальной функции. Единственным значимым предиктором развития ОПП оказалась длительность ИВЛ (6,1 vs 1,7 дней). Число пациентов, получавших ИВЛ либо ЭКМО в течение 5 и более дней, составляло 43% vs 10% при ОПП и нормальной функции почек, соответственно. При морфологическом исследовании, выполненном у 178 пациентов, предсуществующая почечная патология выявлялась у 76 (43%), включая 34 из 55 (62%) пациентов, имевших на момент госпитализации снижение скорости клубочковой фильтрации (СКФ), и у 40 из 165 (24%) пациентов, имевших при поступлении нормальную функцию почек (Р<0,01). Морфологическим субстратом ОПП у пациентов, умерших от COVID-19, в подавляющем большинстве случаев оказалось острое повреждение канальцевого эпителия. Почти у половины пациентов отмечалось выраженное венозное полнокровие со стазами крови в перитубулярных капиллярах и венулах, в ряде случаев в сочетании с выраженным полнокровием клубочков и эритроцитарными сладжами. Более редким вариантом повреждения оказалась дистрофия канальцевого эпителия по типу изометрической вакуолизации. У 6 пациентов с ОПП (5%) имелись морфологические признаки тромботической микроангиопатии, сопровождавшиеся клиническими проявлениями (анемия тромбоцитопения, повышение ЛДГ). Заключение: острое повреждение почек является частым осложнением тяжелых форм коронавирусной инфекции, значимым предиктором которого является длительность ИВЛ. Тромботическая микроангиопатия может быть одной из редких причин поражения почек при COVID-19.

Kidney damage is common in patients with severe forms of COVID-19 and associated with poor prognosis. The causes and nature of kidney damage at COVID-19 have not yet been determined. The study aimed to investigate the incidence, causes and nature of kidney damage in patients with COVID-19. The data obtained from 220 patients, died from COVID-19 between April 20 and May 20, 2020. At the time of hospitalization, 55 (25%) patients had features of chronic kidney disease (CKD). Acute kidney injury (AKI) developed in 135 patients (61%), its frequency did not differ significantly depending on the baseline renal function (67% vs 61% in patients with CKD and with initially normal function, respectively). The only significant predictor of AKI development was the duration of mechanical ventilation (6.1 vs 1.7 days). The number of patients receiving mechanical ventilation or ECMO for 5 or more days was 43% vs 10% for AKI and normal renal function, respectively. Pathologic examination revealed preexisting renal pathology in 76 patients (43%), including 34 out of 55 (62%) patients who had a decrease in glomerular filtration rate (GFR) at the time of hospitalization, and in 40 out of 165 (24%) patients who had normal kidney function at admission (P<0.01). The most common pathological feature responsible for kidney injury in the vast majority of cases was acute tubular necrosis. In some cases, tubular damage was associated with isometric vacuolization of the tubular epithelium. Most patients had also prominent capillaries and venular congestion with erythrocyte aggregates obstructing the lumen of peritubular and glomerular capillaries. Six patients with AKI (5.2%) had morphological features of thrombotic microangiopathy, accompanied by clinical manifestations (anemia, thrombocytopenia, increased LDH). Conclusion: acute kidney injury is a common complication of severe forms of coronavirus infection. The duration of mechanical ventilation is a significant predictor of its development. Thrombotic microangiopathy may be one of the rare causes of kidney damage in COVID-19.

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The authors declare that there are no conflicts of interest present.