COVID-19肾移植受者肾动脉狭窄相关的同种异体肾梗死

Clinical Nephrology. Case Studies Pub Date : 2021-07-26 eCollection Date: 2021-01-01 DOI:10.5414/CNCS110462
Ekamol Tantisattamo, Donald C Dafoe, Antoney J Ferrey, Hirohito Ichii, Richard A Lee, Jonathan E Zuckerman, Anthony E Jr Sisk, Ted Farzaneh, Jack Guccione, Nii-Kabu Kabutey, Kamyar Kalantar-Zadeh, Uttam G Reddy
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引用次数: 3

摘要

同种异体肾脏梗死是罕见的,但这是一种紧急情况,需要及时干预以避免同种异体移植丢失。肾动脉血栓形成是梗死的主要原因。除了血栓形成的传统风险因素外,新出现的严重急性呼吸系统综合征冠状病毒2型使患者易患动脉和静脉血管中的血栓疾病。我们报告了一例肾移植受者血管成形术后已知移植肾动脉狭窄(TRAS)状态,伴有严重新冠肺炎,并发少尿性急性肾损伤,需要持续肾替代治疗(CRRT)。她没有血栓栓塞病史。住院过程因新发心房颤动和心室颤动以及需要多轮心肺复苏的心脏骤停而变得复杂。她没有肾脏恢复的迹象,腹部CT扫描显示有移植梗死的迹象。她接受了同种异体肾切除术。病理学显示,弥漫性血栓性微血管病涉及肾小球、小动脉和与弥漫性皮质梗死相关的动脉,严重急性呼吸系统综合征冠状病毒2型免疫染色和原位杂交阴性。这是新冠肺炎患者中第一例有TRAS病史的肾移植梗死。该患者潜在的TRAS和COVID-19相关血栓形成是独特的,可能在动脉血栓形成的同种异体移植梗死中发挥关键作用。识别同种异体移植梗死的危险因素并进行早期治疗可以改善移植结果。
本文章由计算机程序翻译,如有差异,请以英文原文为准。

Kidney allograft infarction associated with transplant renal artery stenosis in a COVID-19 kidney transplant recipient.

Kidney allograft infarction associated with transplant renal artery stenosis in a COVID-19 kidney transplant recipient.

Kidney allograft infarction associated with transplant renal artery stenosis in a COVID-19 kidney transplant recipient.

Kidney allograft infarction associated with transplant renal artery stenosis in a COVID-19 kidney transplant recipient.

Kidney allograft infarction is rare, but an urgent condition that requires prompt intervention to avoid allograft loss. Renal artery thrombosis is the leading cause of infarction. Apart from traditional risk factors for thrombosis, emerging SARS-CoV-2 predisposes patients to thrombotic diseases both in arterial and venous vasculatures. We report a case of kidney transplant recipient with known transplant renal artery stenosis (TRAS) status post angioplasty with severe COVID-19, complicated by oliguric acute kidney injury requiring continuous renal replacement therapy (CRRT). She did not have a history of thromboembolic disease. The hospital course was complicated by new-onset atrial and ventricular fibrillation and cardiac arrest requiring multiple rounds of cardiopulmonary resuscitation. She had no signs of renal recovery, and an abdominal CT scan showed evidence of allograft infarcts. She underwent an allograft nephrectomy. Pathology revealed diffuse thrombotic microangiopathy involving glomeruli, arterioles, and arteries associated with diffuse cortical infarction with negative SARS-CoV-2 immunostain and in situ hybridization. This is the first case of kidney allograft infarct with a history of TRAS in a COVID-19 patient. Underlying TRAS and COVID-19-associated thrombosis in this patient are unique and likely play a key role in allograft infarction from arterial thrombosis. Recognizing risk factors and early therapy for allograft infarction may improve transplant outcomes.

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