目的:肾动脉梗塞(RI)是主要肾动脉或其分支中存在血凝块,导致血液供应完全或部分阻塞。其病因与肾血管系统疾病或心血管疾病有关。最近,SARSCoV-2病毒是血栓栓塞事件的一个新的原因,预计大流行后RI的发病率会增加.
方法:进行了基于COVID-19相关RI的系统评价。
方法:根据系统评价和荟萃分析的首选报告项目(PRISMA声明),对Medline/Pubmed和Scopus数据库进行系统评价。搜索策略和信息来源:使用术语“SARS-Cov-2”或“COVID-19”和“肾血栓形成”或“肾梗塞”或“肾血栓栓塞”进行手工搜索。
方法:所有类型的出版物(病例报告,案例系列,给编辑的信,短讯)进行相关性评估。纳入标准为:确诊SARS-Cov-2感染,不分年龄,在病毒感染发作期间或之后诊断RI,并排除除SARS-Cov-2外的其他潜在血栓栓塞事件原因。还考虑了肾移植患者。研究标准选择:在根据标题和摘要检查相关性后,检索所选论文的全文并进行进一步评估。排除重复和无关的病例。任何分歧都是在第三审稿人的参与下通过协商一致解决的。研究质量:对高质量病例报告的评估基于四个不同的领域:选择,确定,伤亡和报告。每篇论文都被归类为“好”,对于四个域中的任何一个,“中等”和“差”。数据提取:提取了进行研究的关键数据,包括:年龄,性别,从SARS-Cov-2感染到RI发展的时间,病史,以前或目前的抗血栓保护或治疗,侧向性和阻塞程度,其他血栓栓塞部位,治疗血栓栓塞和SARS-Cov-2和最终结果。
方法:采用描述性统计方法进行数据分析和呈现。
结果:系统评价检索了33份报告中的35例病例。在大多数情况下,尽管35名患者中有17名正在接受或最近接受了血栓预防,但RI在SARSCov-2感染后的一个月内被诊断出。对,左,分别在7、15、8和5例患者中诊断为双侧和同种异体移植物梗阻。17例患者主要在主动脉出现额外的肾外血栓栓塞,脾,脾大脑和下肢。低分子量肝素(LMWH)(通常60-80mg依诺肝素bid)是主要治疗方法,其次是普通肝素和水杨酸的组合,阿哌沙班和里瓦沙班,华法林,acenocoumarol或氯吡格雷。为五名患者提供了肾脏替代疗法,而对两名患者进行了血栓抽吸或导管溶栓的侵入性治疗。关于结果,五名患者死亡。17例保留了总肾功能,5例记录了有或没有血液透析的肾功能损害。其中两人失去了同种异体肾移植。
结论:大多数纳入的研究质量中等。结果和结论仅基于病例报告,关键数据通过相关出版物不同地呈现或缺失。
结论:血栓预防可能无法对SARS-Cov-2诱导的血栓形成提供足够的保护。大多数患者可以通过保守措施得到有效治疗,而在更严重的情况下,可以建议积极治疗。
结论:在SARS-Cov-2病例中,可以考虑使用治疗剂量的LMWH来预防RI。在谨慎平衡风险和收益之后,可以在少数更严重的病例中提供介入治疗。
OBJECTIVE: Renal artery infarction (RI) is the presence of blood clot in the main renal artery or its branches causing complete or partial obstruction of the blood supply. Its etiology is either related with disorders of the renal vasculature or with cardiovascular diseases. Recently, the SARSCoV- 2 virus is an emerging cause of thromboembolic events and the incidence of RI is anticipated to increase after the pandemic.
METHODS: A systematic review based on COVID-19 associated RI was conducted.
METHODS: A systematic review of the Medline/Pubmed and Scopus databases was conducted in accordance to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (the PRISMA statement). Search strategy and information sources: A hand-search was performed using the terms \"SARS-Cov-2\" OR \"COVID-19\" AND \"renal thrombosis\" OR \"renal infarction\" OR \"renal \"thromboembolism\".
METHODS: all types of publications (
case reports,
case series, letters to the editor, short communications) were evaluated for relevance. Inclusion criteria were: confirmed SARS-Cov-2 infection irrespectively of the age, diagnosis of RI during or after the onset of viral infection, and exclusion of other potential causes of thromboembolic event except of SARS-Cov-2. Patients with renal transplantation were also considered. Study criteria selection: after checking for relevance based on the title and the abstract, the full texts of the selected papers were retrieved and were further evaluated. Duplicated and irrelevant cases were excluded. Any disagreement was resolved by consensus with the involvement of a third reviewer. Quality of studies: The assessment of the quality
case reports was based on four different domains: selection, ascertainment, casualty and reporting. Each paper was classified as \"Good\", \"Moderate\" and \"Poor\" for any of the four domains. Data extractions: Crucial data for the conduct of the study were extracted including: age, sex, time from SARS-Cov-2 infection till RI development, medical history, previous or current antithrombotic protection or treatment, laterality and degree of obstruction, other sites of thromboembolism, treatment for thromboembolism and SARS-Cov-2 and final outcome.
METHODS: methods of descriptive statistics were implicated for analysis and presentation of the data.
RESULTS: The systematic review retrieved 35 cases in 33
reports. In most cases, RI was diagnosed within a month from the SARSCov- 2 infection albeit 17 out of 35 patients were receiving or had recently received thromboprophylaxis. Right, left, bilateral and allograft obstruction was diagnosed in 7, 15, 8 and 5 patients respectively. 17 cases experienced additional extrarenal thromboembolism primarily in aorta, spleen, brain and lower limbs. Low molecular weight heparins (LMWH) (usually 60-80 mg enoxaparine bid) was the primary treatment, followed by combinations of unfractionated heparin and salicylic acid, apixaban and rivaraxaban, warfarin, acenocoumarol or clopidogrel. Kidney replacement therapy was offered to five patients while invasive therapies with thrombus aspiration or catheter directed thrombolysis were performed in two. Regarding the outcomes, five of the patients died. The total renal function was preserved in 17 cases and renal impairment with or without hemodialysis was recorded in 5 patients, two of them having lost their kidney allografts.
CONCLUSIONS: The majority of included studies are of moderate quality. The results and the conclusions are based on
case-
reports only and crucial data are dissimilarly presented or missing through the relevant publications.
CONCLUSIONS: Thromboprophylaxis may not offer adequate protection against SARS-Cov-2 induced thrombosis. Most patients could be effectively treated with conservative measures, while in more severe cases aggressive treatment could be recommended.
CONCLUSIONS: Therapeutic doses of LMWH could be considered for protection against RI in SARS-Cov-2 cases. Interventional treatment could be offered in a minority of more severe cases after carful balancing the risks and benefits.