Abstrait

Autoimmune Mechanisms of Late Renal Complications of COVID - 19 Infection and Methods of their prevention and treatment

Voinov V.A., Voinova Ya.V.

The COVID-19 pandemic affected more than 40 million people on Earth, of which more than 1 million died. However, even among the survivors, many have long-term consequences, fraught with serious health disorders.

The kidneys are one of the target organs for COVID-19 infection. Signs of proteinuria and hematuria can be found in 75% of patients. Moreover, 52% of patients requiring artificial ventilation of the lungs develop acute kidney damage within 24 hours after intubation. The mortality rate in this case reaches 30-70%, despite the conduct of renal replacement therapy. The predisposing factors are diabetes and arterial hypertension, as well as previous chronic liver and kidney disease, which is accompanied by a higher mortality rate - up to 53%. The main pathogenetic factor in this case is endotoxemia with an increase in the levels of C-reactive protein, interleukin-6, impaired T- and B-cell immunity. Both the glomerular apparatus and the tubular epithelium with significant disorders of their functions, requiring renal replacement therapy, are subject to toxic damage. These disorders are associated not so much with their direct viral damage, but with the body's inflammatory immune response with the release of a number of cytokines and complement, which contributes to the development of vasculitis, like those that cause kidney diseases such as ANCA vasculitis (microscopic polyangiitis, granulomatous vasculitis - diseases of Wegener and Goodpasture). A kidney biopsy is sometimes the first time a true crescentic proliferative glomerulonephritis is diagnosed.