RESUMEN
Renal biopsy is useful to better understand the histological pattern of a lesion (glomerular, tubulointerstitial, and vascular) and the pathogenesis that leads to kidney failure. The potential impact of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) on the kidneys is still undetermined, and a variety of lesions are seen in the kidney tissue of coronavirus disease patients. This review is based on the morphological findings of patients described in case reports and a series of published cases. A search was conducted on MEDLINE and PubMed of case reports and case series of lesions in the presence of non-critical infection by SARS-CoV-2 published until 15/09/2020. We highlight the potential of the virus directly influencing the damage or the innate and adaptive immune response activating cytokine and procoagulant cascades, in addition to the genetic component triggering glomerular diseases, mainly collapsing focal segmental glomerulosclerosis, tubulointerstitial, and even vascular diseases. Kidney lesions caused by SARS-CoV-2 are frequent and have an impact on morbidity and mortality; thus, studies are needed to assess the morphological kidney changes and their mechanisms and may help define their spectrum and immediate or long-term impact.
Asunto(s)
Lesión Renal Aguda/patología , COVID-19/patología , Glomerulonefritis/patología , Riñón/patología , Microangiopatías Trombóticas/patología , Lesión Renal Aguda/sangre , Lesión Renal Aguda/inmunología , Inmunidad Adaptativa/inmunología , Arteriosclerosis/inmunología , Arteriosclerosis/patología , COVID-19/sangre , COVID-19/inmunología , Citocinas/inmunología , Glomerulonefritis/inmunología , Glomerulonefritis por IGA/inmunología , Glomerulonefritis por IGA/patología , Glomeruloesclerosis Focal y Segmentaria/inmunología , Glomeruloesclerosis Focal y Segmentaria/patología , Humanos , Inmunidad Innata/inmunología , Infarto/inmunología , Infarto/patología , Riñón/irrigación sanguínea , Riñón/inmunología , Necrosis de la Corteza Renal/inmunología , Necrosis de la Corteza Renal/patología , Nefritis Intersticial/inmunología , Nefritis Intersticial/patología , Nefrosis Lipoidea/inmunología , Nefrosis Lipoidea/patología , Rabdomiólisis , SARS-CoV-2 , Trombofilia/sangre , Microangiopatías Trombóticas/inmunologíaAsunto(s)
Enfermedades Autoinmunes/diagnóstico por imagen , Glomerulonefritis/diagnóstico por imagen , Necrosis de la Corteza Renal/diagnóstico por imagen , Nefritis Intersticial/diagnóstico por imagen , Anciano , Anticuerpos Anticitoplasma de Neutrófilos/inmunología , Enfermedades Autoinmunes/inmunología , Enfermedades Autoinmunes/patología , Glomerulonefritis/inmunología , Glomerulonefritis/patología , Humanos , Inmunoglobulina G/inmunología , Riñón/diagnóstico por imagen , Riñón/patología , Necrosis de la Corteza Renal/inmunología , Necrosis de la Corteza Renal/patología , Masculino , Nefritis Intersticial/inmunología , Nefritis Intersticial/patología , Peroxidasa/inmunología , Tomografía Computarizada por Rayos XRESUMEN
BACKGROUND: Acute rejection is still one of the main complications which enhances the cost and the risk to renal graft failure. Chemokines, interacting with respective receptors, can recruit leukocytes into grafts and mediate allograft rejection. In this study, we aimed to analyze gene expression of chemokines including CCL5/RANTES, CXCL10/IP-10, CXCL13/BCA-1, and receptors of CCR5, CXCR3, CXCR5 in peripheral blood mononuclear cells (PBMCs) during acute renal allograft rejection METHODS: Gene expression of all these chemokines and receptors in PBMCs were analyzed by real-time PCR from 14 stable recipients, 32 biopsy-proven acute rejection (AR), and 5 acute tubular necrosis (ATN). RESULTS: Gene expression of CCL5, CXCL10, CXCL13, and CCR5 were up-regulated both in AR and ATN group compared to stable recipients (fold change>2, P<0.05). Serum creatinine recovered to baseline level after anti-rejection therapy was defined as AR-sensitive and creatinine maintained above 200 µmol/L as AR-resistant. Expression of CXCL10 and CXCL13 were 5.98-, 2.94-, and 20.5, 10.8-fold change in AR-resistant and AR-sensitive compared to stable recipients, respectively. The expression of CXCL10 and CXCL13 was a twofold change in AR-resistant compared to AR-sensitive recipients (P<0.05). Five out of ten AR-resistant recipients lost graft function in the follow-up. CONCLUSION: CXCL10 and CXCL13 expression were highly up-regulated in PBMCs in acute renal allograft rejection, especially in poor response to anti-rejection therapy and detrimental prognosis.
Asunto(s)
Expresión Génica , Rechazo de Injerto/sangre , Necrosis de la Corteza Renal/sangre , Trasplante de Riñón/inmunología , Riñón/inmunología , Adolescente , Adulto , Biopsia , Quimiocina CCL5/sangre , Quimiocina CCL5/genética , Quimiocina CCL5/inmunología , Quimiocina CXCL10/sangre , Quimiocina CXCL10/genética , Quimiocina CXCL10/inmunología , Quimiocina CXCL13/sangre , Quimiocina CXCL13/genética , Quimiocina CXCL13/inmunología , Rechazo de Injerto/genética , Rechazo de Injerto/inmunología , Humanos , Terapia de Inmunosupresión/métodos , Inmunosupresores/farmacología , Riñón/metabolismo , Riñón/patología , Riñón/fisiopatología , Necrosis de la Corteza Renal/genética , Necrosis de la Corteza Renal/inmunología , Leucocitos Mononucleares , Persona de Mediana Edad , Reacción en Cadena de la Polimerasa , ARN Mensajero , Receptores CCR5/sangre , Receptores CCR5/genética , Receptores CCR5/inmunología , Receptores CXCR3/sangre , Receptores CXCR3/genética , Receptores CXCR3/inmunología , Receptores CXCR5/sangre , Receptores CXCR5/genética , Receptores CXCR5/inmunología , Estudios Retrospectivos , Regulación hacia ArribaRESUMEN
Biopsy of the transplanted kidney plays an important role in the care and treatment of patients after kidney transplantation. Today the renal biopsy is a standard procedure which is performed early after renal transplantation in the case of a primary non-functioning graft or a significant rise in serum creatinine. On the other hand, a kidney biopsy is performed if an acute or creeping rise in serum creatinine or acute onset of proteinuria or erythrocyturia is observed during follow-up. Furthermore, zero biopsies or intraoperative biopsies of the graft are important in order to obtain information about the initial quality of the graft. This is particularly important in view of the shortage of donor organs and the resulting necessity to accept increasingly marginal organs, such as for example in the ESP program. In addition, an increasing number of transplant centres perform protocol biopsies, i.e. biopsies that are not based on clinical indication, but are performed at a certain time point after transplantation to detect subclinical rejections as well as histological alterations pointing to chronic allograft damage. Additionally, there is much scientific interest in protocol biopsies.
Asunto(s)
Rechazo de Injerto/patología , Trasplante de Riñón/patología , Biopsia , Diagnóstico Diferencial , Estudios de Seguimiento , Secciones por Congelación , Rechazo de Injerto/clasificación , Rechazo de Injerto/inmunología , Humanos , Inmunidad Celular/inmunología , Riñón/inmunología , Riñón/patología , Necrosis de la Corteza Renal/inmunología , Necrosis de la Corteza Renal/patología , Pruebas de Función Renal , Trasplante de Riñón/inmunología , Microscopía Fluorescente , Factores de Riesgo , Inmunología del Trasplante/inmunologíaRESUMEN
RATIONALE: Anti-angiotensin II type 1 receptor antibodies (AT1R-Abs) have been demonstrated to increase the risk of antibody-mediated rejection. We report a case of AT1R-Ab mediated rejection which caused early critical cortical infarction. PATIENT CONCERNS: A 52-year-old man with end-stage kidney disease underwent preemptive kidney transplantation (KT) from his wife. He had no immunologic risk except ABO incompatibility. Proper desensitization treatment were applied prior to KT. On postoperative day 1, he showed stable clinical course with adequate urine output, but there was no decrease in serum creatinine level and imaging studies showed hypoperfusion in the transplanted kidney. DIAGNOSES: Allograft biopsy revealed total cortical infarction with severe necrotizing vasculitis, but the medullary area was preserved. Serum AT1R-Ab concentration was elevated from 10.9âU/mL before KT to 19.1âU/mL on 7âdays after KT. INTERVENTIONS: He was treated with plasmapheresis, intravenous immunoglobulin, rituximab, high-dose methylprednisolone, and bortezomib. OUTCOMES: The treatment showed a partial response, and he was discharged with 7.3âmg/dL creatinine level. At 4âmonths, his creatinine plateaued at 5.5âmg/dL and AT1R-Ab decreased to 3.6âU/mL. LESSONS: This case highlights the risk of early active antibody-mediated rejection by preformed AT1R-Ab, suggesting its ability to exhibit atypical histopathologic findings, such as total cortical infarction.
Asunto(s)
Rechazo de Injerto/inmunología , Infarto/inmunología , Isoanticuerpos/sangre , Necrosis de la Corteza Renal/inmunología , Trasplante de Riñón/efectos adversos , Receptor de Angiotensina Tipo 1/inmunología , Aloinjertos/irrigación sanguínea , Aloinjertos/inmunología , Aloinjertos/patología , Femenino , Rechazo de Injerto/sangre , Rechazo de Injerto/diagnóstico , Rechazo de Injerto/terapia , Prueba de Histocompatibilidad , Humanos , Factores Inmunológicos/administración & dosificación , Infarto/sangre , Infarto/diagnóstico , Infarto/terapia , Isoanticuerpos/inmunología , Corteza Renal/irrigación sanguínea , Corteza Renal/inmunología , Corteza Renal/patología , Necrosis de la Corteza Renal/sangre , Necrosis de la Corteza Renal/diagnóstico , Necrosis de la Corteza Renal/terapia , Fallo Renal Crónico/cirugía , Donadores Vivos , Masculino , Persona de Mediana Edad , Plasmaféresis , Esposos , Factores de TiempoRESUMEN
Acute kidney injury is an unusual complication during dengue infection. The objective of this study was to better identify the characteristics of glomerular changes focusing on in situ immune cells and cytokines. An immunohistochemical assay was performed on 20 kidney specimens from fatal human cases of dengue hemorrhagic fever (DHF). It was observed a lymphomononuclear infiltrate, neutrophils and nuclear fragmentation in the glomeruli, hydropic degeneration, nuclear retraction, eosinophilic tubules and intense acute congestion. Sickle erythrocytes were frequent in glomeruli and inflammatory infiltrate. The glomeruli presented endothelial swelling and mesangial proliferation. Lymphocytes CD4+ predominated over CD8+ T cells, B cells and natural killer cells. There were also an expressive number of macrophagic CD68+ cells. S100, Foxp3 and CD123 cells were not identified. Cells expressing IL17 and IL18+ cytokines predominated in the renal tissues, while IL4, IL6, IL10, IL13, TNF-alpha and IFN-gamma were rarely visualized. The high number of cells expressing IL17 and IL18+ could reflect the acute inflammatory response and possibly contribute to the local lesion. CD8+ T cells could play a role in the cytotoxic response. DHF is a multifactorial disease of capillary leakage associated with a "Tsunami of cytokines expression". The large numbers of cells expressing IL17 seems to play a role favoring the increased permeability.
Asunto(s)
Lesión Renal Aguda/etiología , Interleucina-17/inmunología , Necrosis de la Corteza Renal/etiología , Dengue Grave/complicaciones , Lesión Renal Aguda/inmunología , Lesión Renal Aguda/fisiopatología , Linfocitos B/inmunología , Linfocitos T CD4-Positivos/inmunología , Linfocitos T CD8-positivos/inmunología , Citocinas/inmunología , Humanos , Inmunohistoquímica , Necrosis de la Corteza Renal/inmunología , Necrosis de la Corteza Renal/fisiopatología , Células Asesinas Naturales/inmunología , Dengue Grave/inmunología , Dengue Grave/fisiopatologíaRESUMEN
Anaphylactoid shock, disseminated intravascular coagulation, and anuric renal failure requiring dialysis occurred in a patient receiving zomepirac sodium for toothache. Although renal function showed gradual improvement after seven days of anuria, the recovery was slow and incomplete. Renal biopsy three weeks after the onset of renal failure revealed evidence of focal renal cortical necrosis. Association of zomepirac administration with renal cortical necrosis is not known to have been previously demonstrated. This observation adds another dimension to the previously reported renal complications of nonsteroidal anti-inflammatory agents, especially zomepirac. The proportions of lymphocyte subsets, as defined with monoclonal antibodies, and the proliferative response to mitogens were normal. The patient's lymphocytes showed no proliferative response to zomepirac. Serum complement components and immunoglobulin levels were within normal limits, and radioallergosorbent testing gave negative results. The mechanism of anaphylactoid reaction to zomepirac in this case, therefore, remains unclear.
Asunto(s)
Analgésicos/efectos adversos , Anafilaxia/inducido químicamente , Necrosis de la Corteza Renal/inducido químicamente , Pirroles/efectos adversos , Tolmetina/efectos adversos , Femenino , Humanos , Inmunoglobulina E/análisis , Corteza Renal/patología , Necrosis de la Corteza Renal/inmunología , Necrosis de la Corteza Renal/patología , Activación de Linfocitos , Persona de Mediana Edad , Tolmetina/análogos & derivados , Tolmetina/inmunología , Odontalgia/tratamiento farmacológicoRESUMEN
In the presence of systemic lupus erythematosus or related autoimmune disorders, antiphospholipid syndrome (APS) is termed secondary APS. Pregnancy-related renal failure due to SAPS is rarely reported in the literature. We present the case of a young primgravida woman with bilateral renal cortical necrosis due to secondary APS in late pregnancy.
Asunto(s)
Lesión Renal Aguda/etiología , Síndrome Antifosfolípido/etiología , Muerte Fetal/etiología , Necrosis de la Corteza Renal/etiología , Lupus Eritematoso Sistémico/etiología , Preeclampsia/etiología , Lesión Renal Aguda/diagnóstico , Lesión Renal Aguda/inmunología , Lesión Renal Aguda/terapia , Adulto , Síndrome Antifosfolípido/diagnóstico , Síndrome Antifosfolípido/inmunología , Femenino , Muerte Fetal/diagnóstico , Muerte Fetal/inmunología , Humanos , Necrosis de la Corteza Renal/diagnóstico , Necrosis de la Corteza Renal/inmunología , Necrosis de la Corteza Renal/terapia , Lupus Eritematoso Sistémico/diagnóstico , Lupus Eritematoso Sistémico/inmunología , Periodo Posparto , Preeclampsia/diagnóstico , Preeclampsia/inmunología , Embarazo , Tercer Trimestre del Embarazo , Diálisis Renal , Tomografía Computarizada por Rayos X , Resultado del TratamientoRESUMEN
Dengue virus infection can clinically manifest as dengue fever, dengue shock syndrome and dengue hemorrhagic fever. Acute kidney injury as a result of dengue virus infection can occur due to various reasons including hypotension, rhabdomyolysis, sepsis and rarely immune complex mediated glomerular injury. However, glomerulonephritis associated with IgA Nephropathy in dengue virus infection has not been reported previously. We report a case of 15-year-old boy who was admitted with dengue fever and dialysis dependant acute kidney injury. Urine examination showed microscopic glomerular hematuria and proteinuria. Kidney biopsy showed mesangial proliferation with mesangial IgA dominant immune complex deposits and acute tubular necrosis. A repeated kidney biopsy 6 weeks after clinical recovery showed reversal of glomerular changes as well as resolution of mesangial IgA deposits.
Asunto(s)
Dengue/complicaciones , Glomerulonefritis por IGA/virología , Glomerulonefritis Membranoproliferativa/virología , Necrosis de la Corteza Renal/virología , Enfermedad Aguda , Adolescente , Antiinfecciosos/uso terapéutico , Biopsia , Dengue/diagnóstico , Dengue/inmunología , Dengue/terapia , Técnica del Anticuerpo Fluorescente , Glomerulonefritis por IGA/diagnóstico , Glomerulonefritis por IGA/inmunología , Glomerulonefritis por IGA/terapia , Glomerulonefritis Membranoproliferativa/diagnóstico , Glomerulonefritis Membranoproliferativa/inmunología , Glomerulonefritis Membranoproliferativa/terapia , Hematuria/virología , Humanos , Necrosis de la Corteza Renal/diagnóstico , Necrosis de la Corteza Renal/inmunología , Necrosis de la Corteza Renal/terapia , Glomérulos Renales/patología , Masculino , Proteinuria/virología , Diálisis Renal , Resultado del Tratamiento , Orina/química , Orina/citologíaAsunto(s)
Anticuerpos , Membrana Basal/inmunología , Inmunidad Celular , Enfermedades Renales/inmunología , Aminoácidos/análisis , Antígenos , Membrana Basal/análisis , Carbohidratos/análisis , Inhibición de Migración Celular , Glomerulonefritis/inmunología , Pruebas de Hemaglutinación , Humanos , Necrosis de la Corteza Renal/inmunología , Enfermedades Renales/congénito , Glomérulos Renales/análisis , Leucocitos , Poliarteritis Nudosa/inmunología , Pielonefritis/inmunologíaAsunto(s)
Necrosis de la Corteza Renal/patología , Trasplante de Riñón , Riñón/patología , Fenómeno de Shwartzman/patología , Inmunología del Trasplante , Pruebas de Aglutinación , Animales , Anticuerpos/análisis , Técnicas de Cultivo , Endotoxinas , Escherichia coli , Fibrina/análisis , Técnica del Anticuerpo Fluorescente , Pruebas de Inhibición de Hemaglutinación , Histocompatibilidad , Histocitoquímica , Inmunodifusión , Riñón/análisis , Necrosis de la Corteza Renal/inmunología , Lípidos/análisis , Conejos , Trasplante de Piel , Trombosis/patología , Trasplante HomólogoAsunto(s)
Trasplante de Riñón , Linfocitos/inmunología , Inmunología del Trasplante , Trasplante Homólogo , Isótopos de Cromo , Proteínas del Sistema Complemento , Técnicas de Cultivo , Pruebas Inmunológicas de Citotoxicidad , Rechazo de Injerto , Humanos , Riñón/citología , Necrosis de la Corteza Renal/inmunología , Microscopía de Contraste de FaseAsunto(s)
Enfermedades del Recién Nacido , Necrosis de la Corteza Renal/patología , Sistema del Grupo Sanguíneo ABO , Autopsia , Incompatibilidad de Grupos Sanguíneos , Femenino , Humanos , Recién Nacido , Riñón/patología , Necrosis de la Corteza Renal/inmunología , Sistema del Grupo Sanguíneo Rh-HrRESUMEN
Although varicella is a common disease of childhood, renal complications are quite rare. We report here the interesting case of a-22 month-old boy exhibiting renal cortical necrosis related to an acquired protein S deficiency following varicella. Ten days after the vesicle eruption appearance, he presented with ecchymosed heels, oligoanuric kidney failure, anemia [hemoglobin (Hb) 78 g/L], schizocytosis (2.5%), but normal platelet count. Kidney sonography and magnetic resonance imaging evoked renal cortical necrosis. All together, these features suggested acquired protein S deficiency secondary to varicella. Strikingly, it was confirmed by a dramatic decrease in protein S plasma activity and a huge increase in immunoglobulin (Ig)G antibodies against protein S in the plasma. Anticoagulation therapy in addition with plasmapheresis and steroid pulses allowed a dramatic decrease in the antibodies against protein S and recovery of normal protein S activity. Undelayed diagnosis and treatment did not avoid kidney insufficiency but prevented life-threatening complications. In the light of this case report, protein S deficiency due to antibody inhibition should be carefully monitored anytime in the context of varicella when kidney insufficiency or necrosis occurs.
Asunto(s)
Autoanticuerpos/inmunología , Varicela/complicaciones , Necrosis de la Corteza Renal/diagnóstico , Deficiencia de Proteína S/diagnóstico , Proteína S/inmunología , Anticoagulantes/uso terapéutico , Varicela/patología , Enoxaparina/uso terapéutico , Glucocorticoides/administración & dosificación , Glucocorticoides/uso terapéutico , Humanos , Lactante , Riñón/diagnóstico por imagen , Riñón/patología , Necrosis de la Corteza Renal/inmunología , Necrosis de la Corteza Renal/terapia , Imagen por Resonancia Magnética , Masculino , Plasmaféresis , Deficiencia de Proteína S/inmunología , Deficiencia de Proteína S/terapia , Quimioterapia por Pulso , Resultado del Tratamiento , UltrasonografíaRESUMEN
Pretreatment with multiple doses of polymyxin B and colistimethate was evaluated as to its ability to sequester sufficient antibiotic in tissues to neutralize the effects of endotoxin in three animal models. Animals were challenged with endotoxin 24, 48, or 72 h after the last dose of antibiotic when there was minimal or not detectable drug in serum. Pretreatment with polymyxin B was successful in preventing the generalized Shwartzman reaction in rabbits and reducing endotoxin lethality in mice; however, large doses (20 mg per kg per day for 2 or 4 days) were required. Prolongation by more than 24 h of the interval between the last dose of polymyxin B and endotoxin challenge resulted in reduction or loss of protection. Dogs were unable to tolerate the high polymyxin B dosage which was protective in the mouse and rabbit. Lower, nontoxic doses of polymyxin B in dogs did not prevent endotoxin shock and lethality, even when challenged as soon as 1 h after the last dose. Pretreatment with colistimethate was ineffective in all three animal models.