新型冠状病毒感染相关性肾损伤

doi:10.6040/j.issn.1671-7554.0.2020.206

摘要/Abstract

摘要： 新型冠状病毒是已知的继SARS、MERS之后第3种高致病性冠状病毒,给我国乃至全球带来巨大的公共卫生问题。自武汉疫情爆发至今,人类对新型冠状病毒的认知不断完善,但是对于肾脏损伤的关注和认知仍有诸多不足。肾脏是新型冠状病毒感染的主要靶点之一,病毒入侵诱发的细胞因子风暴、炎症细胞浸润和病毒直接攻击肾脏均可以引起肾脏损伤,并且临床证据也表明肾脏损伤比例较高,血肌酐或尿素氮升高、急性肾损伤、蛋白尿、血尿均是住院患者死亡的独立危险因素,持续性肾脏替代治疗(CRRT)的及早介入能够改善重症患者预后。肾脏损伤对于疫情的筛查、防疫、患者病情判断及预后评估意义重大。

关键词: 新型冠状病毒, 肾脏, 肾损伤, 炎症因子风暴, 持续性肾脏替代治疗, 防疫

Abstract: Coronavirus disease 2019(COVID-19)is the third knowing high pathogenic coronavirus after SARS and MERS. It challenged the public health in China and even all over the world. Since the breakout of COVID-19 in Wuhan, the recognition of human to this coronavirus has been improving, however, the recognition and attention of kidney injury due to COVID-19 are remain insufficient. Kidney is one of the main target infected by COVID-19. The infection of COVID-19 induced cytokine storm, inflammatory cell infiltration, and direct attack on kidney would cause kidney injury. High kidney injury ratio has been showed in clinical evidence. The makers of renal injury including AKI(elevated serum creatinine and urea nitrogen), proteinuria and hematuria are independent risk factors for in-hospital death. The early intervention of continuous renal replacement therapy(CRRT)would improve the outcome of severe patients. Kidney injury has great roles in screening of the infected patients, epidemic prevention, the evaluation of disease condition and prognosis.

Key words: Coronavirus disease 2019, Kidney, Kidney injury, Cytokine storm, Continuous renal replacement therapy, Epidemic prevention

中图分类号:

R563.1

胡昭,王强. 新型冠状病毒感染相关性肾损伤[J]. 山东大学学报 (医学版), 2020, 58(3): 26-31.

HU Zhao, WANG Qiang. Coronavirus disease 2019 infection associated kidney injury[J]. Journal of Shandong University (Health Sciences), 2020, 58(3): 26-31.

参考文献 29

[1]	Giwa A, Desai A. Novel coronavirus COVID-19: an overview for emergency clinicians[J]. Emerg Med Pract, 2020, 22(2 Suppl 2): 1-21.
[2]	Liu YL, Sun WW, Li J, et al. Clinical features and progression of acute respiratory distress syndrome in coronavirus disease 2019[J]. MedRxiv Preprint, 2020. doi: https://doi.org/10.1101/2020.02.17.20024166.
[3]	Xu HY, Hou KK, Xu H, et al. Acute myocardial injury of patients with coronavirus disease 2019[J]. MedRxiv Preprint, 2020. doi:https://doi.org/10.1101/2020.03.05.20031591.
[4]	Diao B, Feng ZQ, Wang CH, et al. Human kidney is a target for novel severe acute respiratory syndrome coronavirus 2(SARS-CoV-2)infection[J]. MedRxiv Preprint, 2020. doi: https://doi.org/10.1101/2020.03.04.2003-1120.
[5]	Fan ZY, Chen LP, Li J, et al. Clinical features of COVID-19 related liver damage[J]. MedRxiv Preprint, 2020. doi: https://doi.org/10.1101/2020.02.26.20026971.
[6]	Liang WC, Feng ZJ, Rao ST, et al. Diarrhea may be underestimated: a missing link in 2019 novel coronavirus[J]. MedRxiv Preprint, 2020. doi: https://doi.org/10.1101/2020.02.03.20020289.
[7]	Liu FR, Long X, Zou WB, et al. Highly ACE2 expression in pancreas may cause pancreas damage after SARS-CoV-2 infection[J]. MedRxiv Preprint, 2020. doi: https://doi.org/10.1101/2020.02.28.20029181.
[8]	Mao L, Wang MD, Chen SH, et al. Neurological manifestations of hospitalized patients with COVID-19 in Wuhan, China: a retrospective case series study[J]. MedRxiv Preprint, 2020. doi: https://doi.org/10.1101/2020.02.22.20026500.
[9]	Fan CB, Li K, Ding YH, et al. ACE2 expression in kidney and testis may cause kidney and testis damage after 2019-nCoV infection[J]. MedRxiv Preprint, 2020. doi: https://doi.org/10.1101/2020.02.12.20022418.
[10]	Yan RH, Zhang YY, Li YN, et al. Structure of dimeric full-length human ACE2 in complex with B0AT1[J].BioRxiv.doi: https://doi.org/10.1101/2020.02.17.951848.
[11]	Wrapp D, Wang N, Corbett KS, et al.Cryo-EM structure of the 2019-nCoV spike in the prefusion conformation[J]. Science, 2020. doi: 10.1126/science.abb2507.
[12]	Channappanavar R, Perlman S. Pathogenic human coronavirus infections: causes and consequences of cytokine storm and immunopathology[J]. Seminin Immunopathol, 2017, 39(5): 529-539.
[13]	Huang C, Wang Y, Li X, et al. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China[J].Lancet, 2020, 395(10223):497-506.
[14]	Wan SX, Yi QJ, Fan SB, et al. Characteristics of lymphocyte subsets and cytokines inperipheral blood of 123 hospitalized patients with 2019 novel coronavirus pneumonia(NCP)[J]. MedRxivPreprint, 2020.doi: https://doi.org/10.1101/2020.02.10.20021832.
[15]	Xu Z, Shi L, Wang Y, et al. Pathological findings of COVID-19 associated with acute respiratory distress syndrome[J]. Lancet Respir Med, 2020. doi: 10.1016/S2213-2600(20)30076-X.
[16]	Tian SF, Hu WD, Niu L, et al. Pulmonary pathology of early phase SARS-COV-2 pneumonia[J]. Preprints, 2020. doi:10.20944/preprints202002.0220.v1.
[17]	Guery B, Poissy J, el Mansouf L, et al. Clinical features and viral diagnosis of two cases of infection with Middle East Respiratory Syndrome coronavirus: a report of nosocomial transmission[J]. Lancet, 2013, 381(9885): 2265-2272.
[18]	Zhao X, Chu H, Wong BH, et al. Activation of C-type lectin receptor and(RIG)-I-like receptors contributes to proinflammatory response in Middle East respiratory syndrome coronavirus-infected macrophages[J]. J Infect Dis, 2020, 221(4): 647-659.
[19]	Ding Y, Wang H, Shen H, et al. The clinical pathology of severe acute respiratory syndrome(SARS): a report from China[J]. J Pathol, 2003, 200(3): 282-289.
[20]	Li Z, Wu M, Guo J, et al. Caution on kidney dysfunctions of 2019-nCoV patients[J]. MedRxiv Preprint, 2020. doi: https://doi.org/10.1101/2020.02.08.20021212.
[21]	Cheng YC, Luo R, Wang K, et al. Kidney impairment is associated with in-hospital death of COVID-19 patients [J]. MedRxiv Preprint, 2020. doi: https://doi.org/10.1101/2020.02.18.20023242.
[22]	Guan WJ, Ni ZY, Hu Y, et al. Clinical characteristics of 2019 novel coronavirus infection in China[J]. N Engl J Med, 2020. doi: 10.1056/NEJMoa2002032.
[23]	Wang LW, Li X, Chen H, et al. SARS-CoV-2 infection does not significantly cause acute renal injury: an analysis of 116 hospitalized patients with COVID-19 in a single hospital, Wuhan, China[J]. MedRxiv Preprint, 2020. doi: https://doi.org/10.1101/2020.02.19.20025288.
[24]	Yeo C, Kaushal S, Yeo D. Enteric involvement of coronaviruses: is faecal-oral transmission of SARS-CoV-2 possible? [J]. Lancet Gastroenterol Hepatol, 2020, pii: S2468-1253(20)30048-0. doi: 10.1016/S2468-1253(20)30048-0.
[25]	Peng L, Liu J, Xu WX, et al. 2019 novel coronavirus can be detected in urine, blood, anal swabs and oropharyngeal swabs samples[J]. MedRxiv, 2020. doi: https: //doi.org/10.1101/2020.02.21.20026179
[26]	Russell CD, Millar JE, Baillie JK. Clinical evidence does not support corticosteroid treatment for 2019-nCoV lung injury[J]. Lancet, 2020, 395(10223): 473-475.
[27]	Gao J, Tian Z, Yang X. Breakthrough: chloroquine phosphate has shown apparent efficacy in treatment of COVID-19 associated pneumonia in clinical studies [J]. Biosci Trends, 2020. doi: 10.5582/bst.2020.01047.
[28]	Yang YZ, Liu LJ, Shi SF, et al. Effects of hydroxychloroquine on proteinuria in immunoglobulin A nephropathy[J]. Am J Nephrol, 2018, 47(3): 145-152.
[29]	Gao R, Wu W, Wen Y, et al. Hydroxychloroquine alleviates persistent proteinuria in IgA nephropathy[J]. Int Urol Nephrol, 2017, 49(7): 1233-1241.

相关文章 15

[1]	吴逸南葛志明李方贺红姜虹张运. 自发性高血压大鼠肾脏血管紧张素转换酶2的表达[J]. 山东大学学报(医学版), 2209, 47(6): 5-.
[2]	刘敏,张玉超,马小莉,刘昕宇,孙露,左丹,刘元涛. 孤核受体NR4A1在H₂O₂诱导小鼠肾脏足细胞损伤中的作用[J]. 山东大学学报 (医学版), 2022, 60(5): 16-21.
[3]	王洲洋,江蓓,李宪花,甄军晖,杨向东,胡昭,刘广义,裴斐. 感染性心内膜炎、急性肾损伤伴PR3-ANCA阳性患者1例报道[J]. 山东大学学报 (医学版), 2022, 60(2): 60-64.
[4]	曹义海. 血管生成在疾病治疗中的应用与展望[J]. 山东大学学报 (医学版), 2021, 59(9): 9-14.
[5]	易凡,李亮. 组织定居性记忆T细胞在肾脏中的维持与作用[J]. 山东大学学报 (医学版), 2021, 59(9): 15-21,36.
[6]	杨璇,李岩志,马伟,贾崇奇. 基于两样本孟德尔随机化的肺功能与新型冠状病毒肺炎病死风险的因果关系[J]. 山东大学学报 (医学版), 2021, 59(7): 104-111.
[7]	周溪,黄霂晗,任玉洁,邱洋. 新型冠状病毒感染与天然免疫及炎症反应[J]. 山东大学学报 (医学版), 2021, 59(5): 15-21.
[8]	董宏杰,张俊梅,王帅,王宏伟,张坤迪,胡玮,谢晓鸿,谢时灵,谷立川. 新型冠状病毒混合样品检测研究[J]. 山东大学学报 (医学版), 2021, 59(4): 1-5.
[9]	于莹,张功,刘晶,颜世童,韩涛,黄海量. 基于网络药理学和分子对接方法探析黄芪预防新型冠状病毒肺炎的潜在作用机制[J]. 山东大学学报 (医学版), 2021, 59(4): 6-16.
[10]	任敏敏,王广梅,张丽,杨瑶瑶,封丹珺. 335名抗疫一线护理人员心理弹性对共情疲劳的影响[J]. 山东大学学报 (医学版), 2021, 59(2): 88-94.
[11]	索东阳,申飞,郭皓,刘力畅,杨惠敏,杨向东. Tim-3在药物性急性肾损伤动物模型中的表达及作用机制[J]. 山东大学学报 (医学版), 2020, 1(7): 1-6.
[12]	山东大学齐鲁医院新型冠状病毒肺炎诊治专家组. 新型冠状病毒肺炎疑似病例诊断及管理专家共识·齐鲁医院标准[J]. 山东大学学报 (医学版), 2020, 58(3): 1-7.
[13]	山东大学齐鲁医院新型冠状病毒肺炎防控工作组. 山东大学齐鲁医院新型冠状病毒肺炎防控策略与实践[J]. 山东大学学报 (医学版), 2020, 58(3): 8-18.
[14]	李士雪,单莹. 新型冠状病毒肺炎研究进展述评[J]. 山东大学学报 (医学版), 2020, 58(3): 19-25.
[15]	鞠秀丽. 间充质干细胞治疗新型冠状病毒肺炎的潜在机制和研究进展[J]. 山东大学学报 (医学版), 2020, 58(3): 32-37.

多维度评价

Viewed

Full text

Abstract

Cited

Shared

Discussed