COVID-19-Associated Kidney Injury: A Case Series of Kidney Biopsy Findings.
AKI
ATN
COVID-19
SARS-CoV-2
acute kidney injury
kidney biopsy
kidney pathology
Journal
Journal of the American Society of Nephrology : JASN
ISSN: 1533-3450
Titre abrégé: J Am Soc Nephrol
Pays: United States
ID NLM: 9013836
Informations de publication
Date de publication:
Sep 2020
Sep 2020
Historique:
received:
20
05
2020
accepted:
15
06
2020
pubmed:
15
7
2020
medline:
8
9
2020
entrez:
15
7
2020
Statut:
ppublish
Résumé
Reports show that AKI is a common complication of severe coronavirus disease 2019 (COVID-19) in hospitalized patients. Studies have also observed proteinuria and microscopic hematuria in such patients. Although a recent autopsy series of patients who died with severe COVID-19 in China found acute tubular necrosis in the kidney, a few patient reports have also described collapsing glomerulopathy in COVID-19. We evaluated biopsied kidney samples from ten patients at our institution who had COVID-19 and clinical features of AKI, including proteinuria with or without hematuria. We documented clinical features, pathologic findings, and outcomes. Our analysis included ten patients who underwent kidney biopsy (mean age: 65 years); five patients were black, three were Hispanic, and two were white. All patients had proteinuria. Eight patients had severe AKI, necessitating RRT. All biopsy samples showed varying degrees of acute tubular necrosis, and one patient had associated widespread myoglobin casts. In addition, two patients had findings of thrombotic microangiopathy, one had pauci-immune crescentic GN, and another had global as well as segmental glomerulosclerosis with features of healed collapsing glomerulopathy. Interestingly, although the patients had confirmed severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection by RT-PCR, immunohistochemical staining of kidney biopsy samples for SARS-CoV-2 was negative in all ten patients. Also, ultrastructural examination by electron microscopy showed no evidence of viral particles in the biopsy samples. The most common finding in our kidney biopsy samples from ten hospitalized patients with AKI and COVID-19 was acute tubular necrosis. There was no evidence of SARS-CoV-2 in the biopsied kidney tissue.
Sections du résumé
BACKGROUND
BACKGROUND
Reports show that AKI is a common complication of severe coronavirus disease 2019 (COVID-19) in hospitalized patients. Studies have also observed proteinuria and microscopic hematuria in such patients. Although a recent autopsy series of patients who died with severe COVID-19 in China found acute tubular necrosis in the kidney, a few patient reports have also described collapsing glomerulopathy in COVID-19.
METHODS
METHODS
We evaluated biopsied kidney samples from ten patients at our institution who had COVID-19 and clinical features of AKI, including proteinuria with or without hematuria. We documented clinical features, pathologic findings, and outcomes.
RESULTS
RESULTS
Our analysis included ten patients who underwent kidney biopsy (mean age: 65 years); five patients were black, three were Hispanic, and two were white. All patients had proteinuria. Eight patients had severe AKI, necessitating RRT. All biopsy samples showed varying degrees of acute tubular necrosis, and one patient had associated widespread myoglobin casts. In addition, two patients had findings of thrombotic microangiopathy, one had pauci-immune crescentic GN, and another had global as well as segmental glomerulosclerosis with features of healed collapsing glomerulopathy. Interestingly, although the patients had confirmed severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection by RT-PCR, immunohistochemical staining of kidney biopsy samples for SARS-CoV-2 was negative in all ten patients. Also, ultrastructural examination by electron microscopy showed no evidence of viral particles in the biopsy samples.
CONCLUSIONS
CONCLUSIONS
The most common finding in our kidney biopsy samples from ten hospitalized patients with AKI and COVID-19 was acute tubular necrosis. There was no evidence of SARS-CoV-2 in the biopsied kidney tissue.
Identifiants
pubmed: 32660970
pii: ASN.2020050699
doi: 10.1681/ASN.2020050699
pmc: PMC7461689
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
1948-1958Subventions
Organisme : NIDDK NIH HHS
ID : R01 DK118017
Pays : United States
Investigateurs
Mersema Abate
(M)
Hugo Paz Andrade
(H)
Richard L Barnett
(RL)
Alessandro Bellucci
(A)
Madhu C Bhaskaran
(MC)
Antonio G Corona
(AG)
Bessy Suyin Flores Chang
(BS)
Mark Finger
(M)
Steven Fishbane
(S)
Michael Gitman
(M)
Candice Halinski
(C)
Shamir Hasan
(S)
Azzour D Hazzan
(AD)
Jamie S Hirsch
(JS)
Susana Hong
(S)
Kenar D Jhaveri
(KD)
Yuriy Khanin
(Y)
Aireen Kuan
(A)
Varun Madireddy
(V)
Deepa Malieckal
(D)
Abdulrahman Muzib
(A)
Gayatri Nair
(G)
Vinay V Nair
(VV)
Jia H Ng
(JH)
Rushang Parikh
(R)
Daniel W Ross
(DW)
Vipulbhai Sakhiya
(V)
Mala Sachdeva
(M)
Richard Schwarz
(R)
Hitesh H Shah
(HH)
Purva Sharma
(P)
Pravin C Singhal
(PC)
Nupur N Uppal
(NN)
Rimda Wanchoo
(R)
Informations de copyright
Copyright © 2020 by the American Society of Nephrology.
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