It is unclear whether severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) can directly infect human kidney, thus leading to acute kidney injury (AKI). Here, we perform a retrospective analysis of clinical parameters from 85 patients with laboratory-confirmed coronavirus disease 2019 (COVID-19); moreover, kidney histopathology from six additional COVID-19 patients with post-mortem examinations was performed. We find that 27% (23/85) of patients exhibited AKI. The elderly patients and cases with comorbidities (hypertension and heart failure) are more prone to develop AKI. Haematoxylin & eosin staining shows that the kidneys from COVID-19 autopsies have moderate to severe tubular damage. In situ hybridization assays illustrate that viral RNA accumulates in tubules. Immunohistochemistry shows nucleocapsid and spike protein deposits in the tubules, and immunofluorescence double staining shows that both antigens are restricted to the angiotensin converting enzyme-II-positive tubules. SARS-CoV-2 infection triggers the expression of hypoxic damage-associated molecules, including DP2 and prostaglandin D synthase in infected tubules. Moreover, it enhances CD68+ macrophages infiltration into the tubulointerstitium, and complement C5b-9 deposition on tubules is also observed. These results suggest that SARS-CoV-2 directly infects human kidney to mediate tubular pathogenesis and AKI. Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) can lead to acute kidney injury. The authors describe that SARS-COV-2 can directly infect human kidney, possibly mediating tubular pathogenesis.
【저자키워드】 SARS-CoV-2, Acute kidney injury, Kidney diseases, 【초록키워드】 COVID-19, coronavirus disease, severe acute respiratory syndrome coronavirus 2, immunohistochemistry, Coronavirus disease 2019, coronavirus, Pathogenesis, macrophages, SARS-COV-2 infection, Comorbidities, Comorbidity, complement, Acute kidney injury, severe acute respiratory syndrome Coronavirus, elderly patients, hypertension, angiotensin converting enzyme, Autopsy, Spike protein, Histopathology, Antigen, kidney, heart failure, AKI, Viral, nucleocapsid, Patient, Retrospective analysis, antigens, Post-mortem, Viral RNA, immunofluorescence, respiratory, expression, moderate, In situ hybridization, Clinical parameters, infiltration, angiotensin, COVID-19 patient, Trigger, Elderly patient, triggers, lead, moderate to severe, double staining, Haematoxylin, prostaglandin, acute respiratory syndrome, acute respiratory syndrome coronavirus, acute respiratory syndrome coronavirus 2, eosin, kidneys, staining, CD68, C5b-9, laboratory-confirmed, clinical parameter, human kidney, hypoxic damage, infect, hypoxic, ENhance, develop, was performed, exhibited, accumulate, CD68+ macrophage, damage-associated molecules, 【제목키워드】 coronavirus, Human, Infection, kidney, respiratory, acute respiratory syndrome,