Viral-associated nephropathy is when kidney disease results from active viral replication. Because of the high global burden of viral infections, clinicians should be aware of their incidence, kidney manifestations, mechanism of injury, and management. Some viruses, such as hepatitis B, hepatitis C, human immunodeficiency virus (HIV), and severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), can lead to nephropathy more commonly than other endemic viruses, such as Epstein-Barr virus, cytomegalovirus, and polyoma virus which are more important causes of nephropathy in the immunosuppressed patient. Other viruses, such as hantavirus and dengue virus, have a high global infectivity rate with rare but severe kidney manifestations. Advances over the past decades have offered us a better understanding of the pathogenesis of viral-associated nephropathies and antiviral therapy options. The patterns of kidney injury include glomerular and tubulointerstitial lesions in the setting of acute and chronic infection. Direct viral infection of kidney parenchymal cells may drive pathologic findings, but kidney pathology may also result from indirect mechanisms due to activation of the innate and adaptive immune system. Some viruses can cause kidney injury due to altered hemodynamics from liver dysfunction or shock. More information about the role of genetics, specifically APOL1 polymorphisms, has come to light in regard to HIV-associated nephropathy and SARS-CoV-2–associated nephropathy. Advances in antiviral therapy help reduce nephrotoxicity and improve morbidity and mortality. In this Core Curriculum, we review common viruses responsible for kidney disease worldwide, discuss mechanisms of pathogenesis, and highlight specific management principles of viral nephropathies. We also discuss other viruses with high endemicity despite low incidence of kidney disease in the immunocompetent and immunosuppressed host.

中文翻译：

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病毒性肾病：2024 年核心课程


病毒相关肾病是指由活跃的病毒复制引起的肾脏疾病。由于病毒感染的全球负担很高，临床医生应了解其发病率、肾脏表现、损伤机制和管理。一些病毒，如乙型肝炎、丙型肝炎、人类免疫缺陷病毒 （HIV） 和严重急性呼吸系统综合症冠状病毒 2 （SARS-CoV-2），比其他流行病毒更常导致肾病，例如 EB 病毒、巨细胞病毒和多瘤病毒，它们是免疫抑制患者肾病的更重要原因。其他病毒，如汉坦病毒和登革热病毒，具有较高的全球传染率，具有罕见但严重的肾脏表现。过去几十年的进步使我们更好地了解病毒相关肾病的发病机制和抗病毒治疗选择。肾损伤的模式包括急性和慢性感染情况下的肾小球和肾小管间质病变。肾实质细胞的直接病毒感染可能驱动病理结果，但肾脏病理也可能由先天性和适应性免疫系统激活引起的间接机制引起。由于肝功能障碍或休克引起的血流动力学改变，一些病毒可导致肾损伤。关于 HIV 相关肾病和 SARS-CoV-2 相关肾病的更多信息，特别是 APOL1 多态性，已经浮出水面。抗病毒治疗的进步有助于降低肾毒性并改善发病率和死亡率。在本核心课程中，我们回顾了全球导致肾脏疾病的常见病毒，讨论了发病机制，并强调了病毒性肾病的具体管理原则。 我们还讨论了其他高流行性病毒，尽管免疫功能正常和免疫抑制宿主的肾脏疾病发生率较低。