Механизмы острого повреждения почек при Covid-19. Обзор

Важнейшая особенность острого повреждения почек (ОПП) при новой коронавирусной инфекции (COVID-19) - отсутствие единого ведущего звена патогенеза. Глубокое понимание механизмов и основных звеньев патогенеза заболевания позволит определить ранние маркёры ОПП, что будет способствовать ранней диагностике, прогнозированию, персонифицированной терапии и профилактике повреждения почек у пациентов с COVID-19. Цель обзора: обобщить данные клинических и научных исследований по известным механизмам ОПП при COVID-19. Определить маркёры раннего повреждения почек при COVID-19. Материалы и методы: в базах данных Web of Science, Scopus и РИНЦ отобрали 81 релевантный источник, содержавший актуальные данные клинических и научных исследований по теме данного обзора. Результаты: отмечены основные механизмы повреждения почек при COVID-19: внутриклеточная активность вируса, приводящая к клеточной гибели, избыточное высвобождение провоспалительных цитокинов и цитокиновый шторм, патология ренин-ангиотензин-альдостероновой системы (РААС), гиперергическое воспаление и иммунотромбоз. Определены основные эффекты ангиотензина II при нарушении регуляции РААС, а также спектр провоспалительных цитокинов и их функций в развитии цитокинового шторма. Рассмотрена возможность прямого цитопатического действия SARS-CoV-2 на почечный эпителий как самостоятельной причины ОПП при COVID-19. Представлена взаимосвязь между гиперергической воспалительной реакцией и процессом иммунотромбоза, которая опосредована действием множества защитных систем организма, в том числе нейтрофилами, тромбоцитами и белками системы комплемента. Оценен риск тромботических осложнений в почечных сосудах у пациентов с COVID-19. Также представлен анализ потенциальных ранних биомаркёров повреждения почек при COVID-19 и сравнили их с клиническими биомаркёрами ОПП. Заключение: ОПП - одно из наиболее частых осложнений у тяжелобольных пациентов с COVID-19, которое значительно ухудшает прогноз течения болезни. Изучение механизмов повреждения почек способствует открытию новых маркёров, необходимых для ранней диагностики, прогнозирования течения болезни и дальнейшего выбора оптимальной персонифицированной терапии.

острое повреждение почек, COVID-19, иммунотромбоз, биомаркеры, цитокиновый шторм, acute kidney injury, COVID-19, immunothrombosis, biomarkers, cytokine storm

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