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COVID-19-associated Nephropathy Includes Tubular Necrosis and Capillary Congestion, with Evidence of SARS-CoV-2 in the Nephron.
Bouquegneau, Antoine; Erpicum, Pauline; Grosch, Stéphanie; Habran, Lionel; Hougrand, Olivier; Huart, Justine; Krzesinski, Jean-Marie; Misset, Benoît; Hayette, Marie-Pierre; Delvenne, Philippe; Bovy, Christophe; Kylies, Dominik; Huber, Tobias B; Puelles, Victor G; Delanaye, Pierre; Jouret, Francois.
  • Bouquegneau A; Department of Nephrology, Dialysis and Transplantation, ULiège Academic Hospital, Liège, Belgium.
  • Erpicum P; Department of Nephrology, Dialysis and Transplantation, ULiège Academic Hospital, Liège, Belgium.
  • Grosch S; Department Groupe Interdisciplinaire de Géno-protéomique Appliquée, Cardiovascular Sciences, ULiège, Liège, Belgium.
  • Habran L; Department of Nephrology, Dialysis and Transplantation, ULiège Academic Hospital, Liège, Belgium.
  • Hougrand O; Department of Pathology, ULiège Academic Hospital, Liège, Belgium.
  • Huart J; Department of Pathology, ULiège Academic Hospital, Liège, Belgium.
  • Krzesinski JM; Department of Pathology, ULiège Academic Hospital, Liège, Belgium.
  • Misset B; Department of Nephrology, Dialysis and Transplantation, ULiège Academic Hospital, Liège, Belgium.
  • Hayette MP; Department Groupe Interdisciplinaire de Géno-protéomique Appliquée, Cardiovascular Sciences, ULiège, Liège, Belgium.
  • Delvenne P; Department of Nephrology, Dialysis and Transplantation, ULiège Academic Hospital, Liège, Belgium.
  • Bovy C; Department Groupe Interdisciplinaire de Géno-protéomique Appliquée, Cardiovascular Sciences, ULiège, Liège, Belgium.
  • Kylies D; Department of Intensive Care, ULiège Academic Hospital, Liège, Belgium.
  • Huber TB; Department of Clinical Microbiology, ULiège Academic Hospital, Liège, Belgium.
  • Puelles VG; Department of Pathology, ULiège Academic Hospital, Liège, Belgium.
  • Delanaye P; Department of Nephrology, Dialysis and Transplantation, ULiège Academic Hospital, Liège, Belgium.
  • Jouret F; Department of Pathology, ULiège Academic Hospital, Liège, Belgium.
Kidney360 ; 2(4): 639-652, 2021 04 29.
Article in English | MEDLINE | ID: covidwho-1776889
ABSTRACT

Background:

Kidney damage has been reported in patients with COVID-19. Despite numerous reports about COVID-19-associated nephropathy, the factual presence of the SARS-CoV-2 in the renal parenchyma remains controversial.

Methods:

We consecutively performed 16 immediate (≤3 hours) postmortem renal biopsies in patients diagnosed with COVID-19. Kidney samples from five patients who died from sepsis not related to COVID-19 were used as controls. Samples were methodically evaluated by three pathologists. Virus detection in the renal parenchyma was performed in all samples by bulk RNA RT-PCR (E and N1/N2 genes), immunostaining (2019-nCOV N-Protein), fluorescence in situ hybridization (nCoV2019-S), and electron microscopy.

Results:

The mean age of our COVID-19 cohort was 68.2±12.8 years, most of whom were male (69%). Proteinuria was observed in 53% of patients, whereas AKI occurred in 60% of patients. Acute tubular necrosis of variable severity was found in all patients, with no tubular or interstitial inflammation. There was no difference in acute tubular necrosis severity between the patients with COVID-19 versus controls. Congestion in glomerular and peritubular capillaries was respectively observed in 56% and 88% of patients with COVID-19, compared with 20% of controls, with no evidence of thrombi. The 2019-nCOV N-Protein was detected in proximal tubules and at the basolateral pole of scattered cells of the distal tubules in nine out of 16 patients. In situ hybridization confirmed these findings in six out of 16 patients. RT-PCR of kidney total RNA detected SARS-CoV-2 E and N1/N2 genes in one patient. Electron microscopy did not show typical viral inclusions.

Conclusions:

Our immediate postmortem kidney samples from patients with COVID-19 highlight a congestive pattern of AKI, with no significant glomerular or interstitial inflammation. Immunostaining and in situ hybridization suggest SARS-CoV-2 is present in various segments of the nephron.
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Full text: Available Collection: International databases Database: MEDLINE Main subject: Acute Kidney Injury / COVID-19 Type of study: Cohort study / Diagnostic study / Experimental Studies / Observational study / Prognostic study Topics: Long Covid Limits: Aged / Humans / Male / Middle aged Language: English Journal: Kidney360 Year: 2021 Document Type: Article Affiliation country: KID.0006992020

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Full text: Available Collection: International databases Database: MEDLINE Main subject: Acute Kidney Injury / COVID-19 Type of study: Cohort study / Diagnostic study / Experimental Studies / Observational study / Prognostic study Topics: Long Covid Limits: Aged / Humans / Male / Middle aged Language: English Journal: Kidney360 Year: 2021 Document Type: Article Affiliation country: KID.0006992020