ACHADOS HISTOPATOLÓGICOS RENAIS DE INDIVÍDUOS TRANSPLANTADOS RENAIS COM HIPERTENSÃO ARTERIAL SISTÊMICA QUE CONTRAÍRAM SARS-COV-2: UMA REVISÃO SISTEMÁTICA
Palabras clave:
SARS-CoV-2, Biópsia, Aloenxerto renal, Hipertensão arterial sistêmicaResumen
A prevalência de doença renal crônica no cenário mundial segue aumentando, com o transplante renal sendo o tratamento mais eficaz para os pacientes com doença renal crônica em estágio terminal. Com a pandemia de covid-19, a preocupação com o efeito deletério do SARS-CoV-2 sobre o rim dos transplantados renais tornou-se foco de diversas pesquisas. Assim, este estudo teve como objetivo construir uma revisão sistemática sobre os achados histopatológicos em pacientes com histórico de hipertensão arterial sistêmica e aloenxerto renal que foram submetidos a biópsia renal devido ao SARS-CoV-2. Para isso, foi feito um levantamento bibliográfico de janeiro de 2020 a dezembro de 2023, baseado no protocolo PRISMA, nas bases de dados PubMed e Science Direct para a coleta de dados clínicos e epidemiológicos. Foram identificados 572 pacientes, onde destes, 68% apresentavam histórico de hipertensão, com a mortalidade por covid-19 ficando em 26%. Em 94% dos casos, o exame histopatológico foi realizado devido a suspeita clínica de disfunção do aloenxerto renal. Após a biópsia renal, em 87% dos casos o diagnóstico histopatológico foi de lesão renal aguda. Os principais achados histopatológicos foram microangiopatia trombótica, inflamação intersticial e glomerulopatia colapsante. A fisiopatologia renal da hipertensão é condizente com tais achados histopatológicos, embora a lesão renal aguda esteja relacionada, principalmente, com a infecção por SARS-CoV-2. Sendo assim, levando-se em conta a alta prevalência de hipertensão entre pacientes transplantados renais, compreende-se o quão grave é que tais pacientes adquiram covid-19, visto que o vírus pode levar a disfunção do aloenxerto renal.
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