Renal histopathological analysis of 26 postmortem findings of patients with COVID-19 in China
By H. Su, Ming-Wei Yang, Cheng Wan, Li-Xia Yi, Fang Tang, Hong Zhu, F. Yi, Hai-chun Yang, A. Fogo, X. Nie and 1 more. Kidney International, 2020
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Although the respiratory and immune systems are the major targets of Coronavirus Disease 2019 (COVID-19), acute kidney injury and proteinuria have also been observed. Currently, detailed pathologic examination of kidney damage in critically ill patients with COVID-19 has been lacking. To help define this we analyzed kidney abnormalities in 26 autopsies of patients with COVID-19 by light microscopy, ultrastructural observation and immunostaining. Patients were on average 69 years (19 male and 7 female) with respiratory failure associated with multiple organ dysfunction syndrome as the cause of death. Nine of the 26 showed clinical signs of kidney injury that included increased serum creatinine and/or new-onset proteinuria. By light microscopy, diffuse proximal tubule injury with the loss of brush border, non-isometric vacuolar degeneration, and even frank necrosis was observed. Occasional hemosiderin granules and pigmented casts were identified. There were prominent erythrocyte aggregates obstructing the lumen of capillaries without platelet or fibrinoid material. Evidence of vasculitis, interstitial inflammation or hemorrhage was absent. Electron microscopic examination showed clusters of coronavirus-like particles with distinctive spikes in the tubular epithelium and podocytes. Furthermore, the receptor of SARS-CoV-2, ACE2 was found to be upregulated in patients with COVID-19, and immunostaining with SARS-CoV nucleoprotein antibody was positive in tubules. In addition to the direct virulence of SARS-CoV-2, factors contributing to acute kidney injury included systemic hypoxia, abnormal coagulation, and possible drug or hyperventilation-relevant rhabdomyolysis. Thus, our studies provide direct evidence of the invasion of SARSCoV-2 into kidney tissue. These findings will greatly add to the current understanding of SARS-CoV-2 infection.
Subfields: Infectious Diseases, Oncology, Surgery
View Paper: https://www.semanticscholar.org/paper/fa0bb38e235f8d7a159023086b9462051a387f32
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Citations in the corpus
- COVID-19: angiotensin-converting enzyme 2 (ACE2) expression and tissue susceptibility to SARS-CoV-2 infection (2021, methodology): “[33] that detected ACE2 expression through immunohistochemistry, all used single-cell RNA-seq and protein databases, such as UniProt and Protein Atlas, to detect the receptor expression among different tissues.”
- AKI in Hospitalized Patients with COVID-19. (2020, background): “Recovery of kidney function was stratified into recover and AKD defined as (1) recovery: difference in creatinine is #0.”
- Postmortem examination of COVID‐19 patients reveals diffuse alveolar damage with severe capillary congestion and variegated findings in lungs and other organs suggesting vascular dysfunction (2020, background): “The upper respiratory tract and lungs serve as the predominant sites of entry and replication,(31) but other replication sites, such as endothelial cells(32) and the kidney, have been suggested.(33,34) As expected, major morphological findings pertaining to the cause of death of our cohort were loca”