Kidney Biopsy Findings in a Critically Ill COVID-19 Patient With Dialysis-Dependent Acute Kidney Injury: A Case Against “SARS-CoV-2 Nephropathy”

Rossi, Giovanni Maria; Delsante, Marco; Pilato, Francesco Paolo; Gnetti, Letizia; Gabrielli, Liliana; Rossini, Giada; Re, Maria Carla; Cenacchi, G.; Affanni, Paola; Colucci, Maria Eugenia; Picetti, Edoardo; Rossi, Sandra; Parenti, Elisabetta; Maccari, Clara; Greco, Paolo; Mario, Francesca Di; Maggiore, Umberto; Regolisti, Giuseppe; Fiaccadori, Enrico

doi:10.1016/j.ekir.2020.05.005

Cited by 68 publications

(73 citation statements)

References 9 publications

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“…Previous meta-analyses have also reported findings consistent with our results 78 , 79 . Moreover, anatomical studies have reported significant renal inflammation in patients with severe COVID-19 75 , 80 , 81 . There might be two mechanisms by which SARS-CoV-2 induces renal inflammation.…”

Section: Discussionmentioning

confidence: 99%

Predictors of COVID-19 severity: a systematic review and meta-analysis

et al. 2020

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Background: The unpredictability of the progression of coronavirus disease 2019 (COVID-19) may be attributed to the low precision of the tools used to predict the prognosis of this disease. Objective: To identify the predictors associated with poor clinical outcomes in patients with COVID-19. Methods: Relevant articles from PubMed, Embase, Cochrane, and Web of Science were searched and extracted as of April 5, 2020. Data of interest were collected and evaluated for their compatibility for the meta-analysis. Cumulative calculations to determine the correlation and effect estimates were performed using the Z test. Results: In total, 19 papers recording 1,934 mild and 1,644 severe cases of COVID-19 were included. Based on the initial evaluation, 62 potential risk factors were identified for the meta-analysis. Several comorbidities, including chronic respiratory disease, cardiovascular disease, diabetes mellitus, and hypertension were observed more frequent among patients with severe COVID-19 than with the mild ones. Compared to the mild form, severe COVID-19 was associated with symptoms such as dyspnea, anorexia, fatigue, increased respiratory rate, and high systolic blood pressure. Lower levels of lymphocytes and hemoglobin; elevated levels of leukocytes, aspartate aminotransferase, alanine aminotransferase, blood creatinine, blood urea nitrogen, high-sensitivity troponin, creatine kinase, high-sensitivity C-reactive protein, interleukin 6, D-dimer, ferritin, lactate dehydrogenase, and procalcitonin; and a high erythrocyte sedimentation rate were also associated with severe COVID-19. Conclusion: More than 30 risk factors are associated with a higher risk of severe COVID-19. These may serve as useful baseline parameters in the development of prediction tools for COVID-19 prognosis.

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Section: Discussionmentioning

confidence: 99%

Predictors of COVID-19 severity: a systematic review and meta-analysis

et al. 2020

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“…8 9 Rossi et al also evaluated viral genetic material in renal tissue, urine and serum by real-time PCR and did not find SARS-COV-2 RNA. 47 In addition to the tubular lesion, erythrocyte aggregates obstructing peritubular capillary lumens and endothelium activation were described in optic microscopy revealing the prothrombotic status that is often observed in severe cases of COVID-19. 6 The COVID-19-related immunothrombosis is due to the macrophage activation and cytokine storm leading to elevated C reactive protein, ferritin and D-dimer levels, which are correlated to worse outcomes.…”

Section: Original Researchmentioning

confidence: 99%

High burden of acute kidney injury in COVID-19 pandemic: systematic review and meta-analysis

et al. 2020

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AimsHospitalised patients with COVID-19 have a variable incidence of acute kidney injury (AKI) according to studies from different nationalities. The present systematic review and meta-analysis describes the incidence of AKI, need for renal replacement therapy (RRT) and mortality among patients with COVID-19-associated AKI.MethodsWe systematically searched electronic database PubMed, SCOPUS and Web of Science to identify English articles published until 25 May 2020. In case of significant heterogeneity, the meta-analyses were conducted assuming a random-effects model.ResultsFrom 746 screened publications, we selected 21 observational studies with 15 536 patients with COVID-19 for random-effects model meta-analyses. The overall incidence of AKI was 12.3% (95% CI 7.3% to 20.0%) and 77% of patients with AKI were critically ill (95% CI 58.9% to 89.0%). The mortality among patients with AKI was 67% (95% CI 39.8% to 86.2%) and the risk of death was 13 times higher compared with patients without AKI (OR=13.3; 95% CI 6.1 to 29.2). Patients with COVID-19-associated AKI needed for RRT in 23.4% of cases (95% CI 12.6% to 39.4%) and those cases had high mortality (89%–100%).ConclusionThe present study evidenced an incidence of COVID-19-associated AKI higher than previous meta-analysis. The majority of patients affected by AKI were critically ill and mortality rate among AKI cases was high. Thus, it is extremely important for health systems to be aware about the impact of AKI on patients’ outcomes in order to establish proper screening, prevention of additional damage to the kidneys and adequate renal support when needed.

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“…ACE2 provides the entry point for SARS-CoV-2 to attach to and infect human cells; ACE2 is expressed on podocytes, vascular endothelial cells and proximal tubule cells. The ability of these different kidney cells to be infected may explain injuries develop in various parts of the kidneys (2)(3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14).…”

Section: Discussionmentioning

confidence: 99%

“…It appears likely that in Afrodescended individuals with high-risk APOL1 variants, SARS-CoV-2 infection acts as a "trigger" that leads to podocyte dysregulation and injury, which leads to CG. For some authors, however, this association may be just a coincidence (13) and the presence of the virus in podocytes may be an incidental finding. Moreover, a recent report of postmortem kidney tissue analysis from 6 patients who died of COVID-19 showed acute tubular injury without glomerular abnormalities (14).…”

Section: Discussionmentioning

confidence: 99%

“…Numerous morphological patterns have been described in the kidneys of patients with COVID-19, including renal infarction (3)(4)(5), collapsing glomerulopathy (CG) (6-10), tubulointerstitial nephritis (11), acute tubular injury, (2,12,13) acute pyelonephritis, rhabdomyolysis, lymphocytic infiltrates, and focal segmental glomerulosclerosis (14), isometric vacuoles in the proximal tubular epithelium (12,14) and thrombotic microangiopathy (TMA) (15).…”

Section: Introductionmentioning

confidence: 99%

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Brazilian Consortium for the Study on Renal Diseases Associated With COVID-19: A Multicentric Effort to Understand SARS-CoV-2-Related Nephropathy

et al. 2020

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Kidney involvement appears to be frequent in coronavirus disease 2019 (COVID-19). Despite this, information concerning renal involvement in COVID-19 is still scarce. Several mechanisms appear to be involved in the complex relationship between the virus and the kidney. Also, different morphological patterns have been described in the kidneys of patients with COVID-19. For some authors, however, this association

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Kidney Biopsy Findings in a Critically Ill COVID-19 Patient With Dialysis-Dependent Acute Kidney Injury: A Case Against “SARS-CoV-2 Nephropathy”

Cited by 68 publications

References 9 publications

Predictors of COVID-19 severity: a systematic review and meta-analysis

Predictors of COVID-19 severity: a systematic review and meta-analysis

High burden of acute kidney injury in COVID-19 pandemic: systematic review and meta-analysis

Brazilian Consortium for the Study on Renal Diseases Associated With COVID-19: A Multicentric Effort to Understand SARS-CoV-2-Related Nephropathy

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