Palabras clave
post-mortem
biopsia
insuficiencia renal aguda
necropsia
microscopía electrónica
percutánea
COVID-19
Cómo citar
Resumen
Contexto: la afectación renal en pacientes con COVID-19 ha sido reconocida como un marcador de mal pronóstico, pero sus mecanismos aún no se comprenden completamente.
Objetivo: evaluar los hallazgos histopatológicos en muestras renales obtenidas mediante biopsia percutánea con Tru-Cut® en pacientes fallecidos por COVID-19, para caracterizar la afectación renal en esta enfermedad.
Metodología: estudio observacional descriptivo de muestras renales post mortem obtenidas por punción percutánea ecoguiada en pacientes fallecidos por COVID-19 en unidad de cuidados intensivos (UCI) y sala de hospitalización (SH) (n?=?19). Las muestras se analizaron mediante microscopía óptica, inmunohistoquímica (IHQ) y microscopía electrónica de transmisión (TEM).
Resultados: en el compartimento glomerular, el 50,0?% presentó esclerosis glomerular y el 50,0?% de los pacientes con diabetes mostró nefropatía diabética (clase III de Tervaert); un paciente presentó glomeruloesclerosis focal y segmentaria. En el compartimento tubulointersticial, el 53,0?% mostró necrosis tubular aguda (NTA) y el 20,0?% daño tubular crónico con fibrosis intersticial. En el 63,0?% de los casos con NTA se observaron eritrocitos en los túbulos. A nivel vascular, se evidenció hiperplasia miointimal (60,0?%) e hialinosis arteriolar (44,0?%), sin vasculitis ni trombosis. La TEM identificó viriones compatibles con SARS-CoV-2 en células endoteliales en 4/6 casos (66,7?%) y, en todos ellos, lisis tubular, pérdida de pedicelos y microtrombos glomerulares y peritubulares con lisis endotelial.
Conclusiones: las biopsias renales post mortem en COVID-19 mostraron daño tubular agudo, microangiopatía y viriones endoteliales, lo que sugiere una combinación de lesión viral directa y disfunción endotelial. Esta técnica demostró utilidad para estudiar enfermedades emergentes.
Citas
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