Histopathologic and Ultrastructural Findings in Postmortem Kidney Biopsy Material in 12 Patients with AKI and COVID-19

Golmai, Pouneh; Larsen, Christopher P.; Devita, Maria; Wahl, Samuel; Weins, Astrid; Rennke, Helmut G.; Bijol, Vanesa; Rosenstock, Jordan L.

doi:10.1681/asn.2020050683

Cited by 138 publications

(143 citation statements)

References 18 publications

Supporting

Mentioning

122

Contrasting

Unclassified

Order By: Relevance

“… 45 , 52 If direct viral infection of the kidney occurs, the lower viral load compared to lung tissue would make ultrastructural identification of exceedingly rare SARS-CoV-2 particles in the kidney improbable amongst the ubiquitous viral mimics. 45 In contrast to the patients in two autopsy series or those in a recent biopsy series, 11 , 20 , 48 , 53 the majority of patients in our cohort had only mild COVID-19 symptoms while presenting with acute kidney injury, heavy proteinuria, and/or severe hypertension. Some diseases detected in our patient cohort may represent diagnoses coincident with COVID-19 disease.…”

Section: Discussioncontrasting

confidence: 59%

“…49,50 Therefore, these delays meant that most patients in our cohort may have cleared virus from their kidney and were therefore RT-PCR negative by nasopharyngeal J o u r n a l P r e -p r o o f swab at the time of biopsy. Even with this caveat, most recent biopsy and autopsy case series have concluded that there is no significant SARS-CoV-2 infection of the kidney, 16,20,24,48,[51][52][53] which is in contrast to the possibility of direct infection that was reported in two earlier studies. 11,45 Therefore, our study adds to the accumulating evidence that direct and persistent infection of the kidney by SARS-CoV-2 does not appear to play a significant role in kidney disease in most COVID-19 patients.…”

Section: Discussionmentioning

confidence: 82%

Section: Discussionmentioning

confidence: 99%

See 2 more Smart Citations

Multicenter Clinicopathologic Correlation of Kidney Biopsies Performed in COVID-19 Patients Presenting With Acute Kidney Injury or Proteinuria

Akilesh

Nast

Yamashita

et al. 2021

American Journal of Kidney Diseases

163

246

View full text Add to dashboard Cite

This is a PDF file of an article that has undergone enhancements after acceptance, such as the addition of a cover page and metadata, and formatting for readability, but it is not yet the definitive version of record. This version will undergo additional copyediting, typesetting and review before it is published in its final form, but we are providing this version to give early visibility of the article. Please note that, during the production process, errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.

show abstract

Section: Discussioncontrasting

confidence: 59%

Section: Discussionmentioning

confidence: 82%

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Multicenter Clinicopathologic Correlation of Kidney Biopsies Performed in COVID-19 Patients Presenting With Acute Kidney Injury or Proteinuria

Akilesh

Nast

Yamashita

et al. 2021

American Journal of Kidney Diseases

163

246

View full text Add to dashboard Cite

show abstract

“…SARS-CoV-2 utilizes angiotensin-converting enzyme 2 (ACE2) as a port of entry into cells [27], which is found mainly in the proximal tubules and to a lesser extent in podocytes [28]. Recent pathology data from autopsy and kidney biopsy studies are against direct viral toxicity being a primary mechanism of kidney injury in COVID-19 [29][30][31]. These studies suggest acute tubular injury [29,31] and cytokine-mediated hyperimmune response [30] as potential mechanisms of kidney injury.…”

Section: Discussion/conclusionmentioning

confidence: 99%

Association of Proteinuria and Hematuria with Acute Kidney Injury and Mortality in Hospitalized Patients with COVID-19

Chaudhri

Moffitt

Taub

et al. 2020

Kidney Blood Press Res

View full text Add to dashboard Cite

Introduction: Acute kidney injury (AKI) is strongly associated with poor outcomes in hospitalized patients with coronavirus disease 2019 (COVID-19), but data on the association of proteinuria and hematuria are limited to non-US populations. In addition, admission and in-hospital measures for kidney abnormalities have not been studied separately. Methods: This retrospective cohort study aimed to analyze these associations in 321 patients sequentially admitted between March 7, 2020 and April 1, 2020 at Stony Brook University Medical Center, New York. We investigated the association of proteinuria, hematuria, and AKI with outcomes of inflammation, intensive care unit (ICU) admission, invasive mechanical ventilation (IMV), and in-hospital death. We used ANOVA, t test, χ2 test, and Fisher’s exact test for bivariate analyses and logistic regression for multivariable analysis. Results: Three hundred patients met the inclusion criteria for the study cohort. Multivariable analysis demonstrated that admission proteinuria was significantly associated with risk of in-hospital AKI (OR 4.71, 95% CI 1.28–17.38), while admission hematuria was associated with ICU admission (OR 4.56, 95% CI 1.12–18.64), IMV (OR 8.79, 95% CI 2.08–37.00), and death (OR 18.03, 95% CI 2.84–114.57). During hospitalization, de novo proteinuria was significantly associated with increased risk of death (OR 8.94, 95% CI 1.19–114.4, p = 0.04). In-hospital AKI increased (OR 27.14, 95% CI 4.44–240.17) while recovery from in-hospital AKI decreased the risk of death (OR 0.001, 95% CI 0.001–0.06). Conclusion: Proteinuria and hematuria both at the time of admission and during hospitalization are associated with adverse clinical outcomes in hospitalized patients with COVID-19.

show abstract

“…Beside respiratory manifestations, up to 30% of the patients with COVID-19 may develop acute kidney injury. Postmortem findings mainly revealed morphological hallmarks of extensive acute tubular damage and necrosis, with marked degenerative changes and glomerulopathy appearing to be in line with other viral infections of the kidney [ 6 , 13 , 14 ]. Other autopsy findings included arterionephrosclerosis, extensive degenerative changes, focal segmental glomerulosclerosis and hypertensive changes in most patients (80%) [ 4 ].…”

mentioning

confidence: 87%

COVID-19: what the clinician should know about post-mortem findings

2020

View full text Add to dashboard Cite

the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic has led to over 33 million infections and 1.000.000 deaths worldwide [1]. Compared to other coronavirus outbreaks (SARS-CoV-1, MERS-CoV), SARS-CoV-2 is characterized by a higher basic reproductive rate and an overall lower mortality [2]. However, while coronavirus disease 2019 (COVID-19) typically begins as an infection of the upper aerodigestive tract, it may progress to severe forms, with an acute respiratory distress syndrome (ARDS) and a multisystemic disease.COVID-19 ARDS shares the common histological hallmarks with other infectious/non-infectious ARDS. Unspecific diffuse alveolar damage (DAD), as its histologic correlate, is characterized by edema, hemorrhage and intra-alveolar fibrin deposition, but in case of COVID-19 ARDS, also by a distinct angiocentric lymphocytic inflammation [3][4][5]. DAD is the leading pattern of lung injury and has been shown to be independent of mechanical ventilation. There is some evidence for alternative injury patterns in COVID-19 ARDS, such as acute fibrinous organizing pneumonia (AFOP). Nonetheless, COVID-19-induced DAD is by far the most frequently reported one and is also characterized by more distinct morphologic features, including vascular changes [5].In that, the detection of SARS-CoV-2 in multiple organs (respiratory tract, heart, endothelium, digestive tract, kidneys, brain) and multisystemic clinical features, suggest that COVID-19 might be a systemic "vascular disease" (Fig.

show abstract

Histopathologic and Ultrastructural Findings in Postmortem Kidney Biopsy Material in 12 Patients with AKI and COVID-19

Cited by 138 publications

References 18 publications

Multicenter Clinicopathologic Correlation of Kidney Biopsies Performed in COVID-19 Patients Presenting With Acute Kidney Injury or Proteinuria

Multicenter Clinicopathologic Correlation of Kidney Biopsies Performed in COVID-19 Patients Presenting With Acute Kidney Injury or Proteinuria

Association of Proteinuria and Hematuria with Acute Kidney Injury and Mortality in Hospitalized Patients with COVID-19

COVID-19: what the clinician should know about post-mortem findings

Contact Info

Product

Resources

About