CLINICAL AND MORPHOLOGICAL FEATURES OF KIDNEY DAMAGE IN PATIENTS WITH ARTERIAL HYPERTENSION DIED OF SARS-COV-2 INFECTION

Abstract

Objective: To assess clinical and pathomorphological features of kidney damage in patients with arterial hypertension (AH) who died of the new coronavirus infection COVID-19. Design and method: A complex analysis of 268 kidney autopsies was carried out, including the study of macro- and microscopic changes reflected in the protocols of pathological and anatomical autopsies and identified during the histological examination. In 224 patients (83.6%) with AH, the diagnosis was confirmed by isolating the SARS-CoV-2 RNA using the polymerase chain reaction; in 44 (16.4%) – through computed tomography of the lungs. The causes of deaths were the following: in 31 patients (11.6%) acute myocardial infarction; in 40 (14.9%) cerebrovascular accident; in 11 (4.1%) pulmonary embolism; 222 patients (83%) had acute respiratory distress syndrome. The analysis included 130 men aged 36 to 92 (72.6 years old on average) and 138 women aged 40 to 106 (77.1 years old on average). Results: In the kidneys we detected ischemic changes caused by disturbances in the microvasculature. These are stases, sludges, erythrocyte and fibrin thrombi predominantly in the medulla. In the glomeruli diapedesis hemorrhages, mesangial cells proliferation, basement membrane thickening and fibrinoid necrosis of the capillary wall were observed. In the epithelium of the convoluted tubules, a granular, hyaline-drop dystrophy and a necrosis as the extreme degree of the damage were noted. In the kidneys, a pronounced lymphoid and leukocyte infiltration was detected. These changes were accompanied by inflammation and renal failure symptoms. In particular, the level of C-reactive protein was 140.6 ± 7.42 mg/l; blood ferritin 1258.0 ± 110.1 mcg/l; blood leukocytes 15.0 ± 0.67 10^9/l; blood lymphocytes 1.54 ± 0.29 10^9/l; procalcitonin 1.350 ± 0.51 ng/ml. The development of hemorrhagic syndrome was observed in 93 (35%) cases. The level of D-dimer was 4326.4 ± 696.1 ng/ml; fibrinogen 18.2 ± 13.04 g/l; platelets 179.0 ± 8.7 10^9/l. Blood creatinine in patients aged 36 to 59 (27 people) was 120.6 ± 12.2 mmol/l; aged 60 to 80 (136 people) 136.6 ± 10.12 mmol/l; aged over 80 (105 people) 139.0 ± 11.7 mmol/l. Conclusions: The study of the kidneys in patients who died from the new coronavirus infection revealed microvasculature vessels damage and development of coagulation disorders amid the renal failure.