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.
Keywords: COVID-19; SARS-CoV-2; clinical nephrology; histology; immunostaining; in situ hybridization; kidney.
【저자키워드】 COVID-19, SARS-CoV-2, kidney, histology, In situ hybridization, clinical nephrology, immunostaining, 【초록키워드】 Necrosis, severity, Sepsis, RT-PCR, kidney, electron microscopy, AKI, Proteinuria, Microscopy, male, Patient, virus detection, age, histology, patients, In situ hybridization, Evidence, proximal tubules, congestion, immunostaining, biopsy, evidence of, no evidence of, peritubular capillaries, interstitial inflammation, acute tubular necrosis, Tubular Necrosis, viral inclusions, no difference, one patient, Pathologists, total RNA, renal, kidney damage, N-protein, thrombi, COVID-19 cohort, POLE, Genes, FIVE, controls, Cell, highlight, nephropathy, peritubular capillary, nephron, performed, Sample, occurred, died, reported, the patient, evaluated, nine, was performed, were used, RNA RT-PCR, proximal, basolateral, diagnosed with COVID-19, distal, glomerular, patients with COVID-19, the SARS-CoV-2, with COVID-19, 【제목키워드】 capillary, tubular,