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Renal histopathological analysis of 26 postmortem findings of patients with COVID-19 in China.
Kidney Int. 2020 07; 98(1):219-227.KI

Abstract

Although the respiratory and immune systems are the major targets of Coronavirus Disease 2019 (COVID-19), acute kidney injury and proteinuria have also been observed. Currently, detailed pathologic examination of kidney damage in critically ill patients with COVID-19 has been lacking. To help define this we analyzed kidney abnormalities in 26 autopsies of patients with COVID-19 by light microscopy, ultrastructural observation and immunostaining. Patients were on average 69 years (19 male and 7 female) with respiratory failure associated with multiple organ dysfunction syndrome as the cause of death. Nine of the 26 showed clinical signs of kidney injury that included increased serum creatinine and/or new-onset proteinuria. By light microscopy, diffuse proximal tubule injury with the loss of brush border, non-isometric vacuolar degeneration, and even frank necrosis was observed. Occasional hemosiderin granules and pigmented casts were identified. There were prominent erythrocyte aggregates obstructing the lumen of capillaries without platelet or fibrinoid material. Evidence of vasculitis, interstitial inflammation or hemorrhage was absent. Electron microscopic examination showed clusters of coronavirus-like particles with distinctive spikes in the tubular epithelium and podocytes. Furthermore, the receptor of SARS-CoV-2, ACE2 was found to be upregulated in patients with COVID-19, and immunostaining with SARS-CoV nucleoprotein antibody was positive in tubules. In addition to the direct virulence of SARS-CoV-2, factors contributing to acute kidney injury included systemic hypoxia, abnormal coagulation, and possible drug or hyperventilation-relevant rhabdomyolysis. Thus, our studies provide direct evidence of the invasion of SARSCoV-2 into kidney tissue. These findings will greatly add to the current understanding of SARS-CoV-2 infection.

Authors+Show Affiliations

Department of Nephrology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.Department of Pathology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.Department of Nephrology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.Department of Nephrology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.Department of Nephrology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.Department of Nephrology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.The Key Laboratory of Infection and Immunity of Shandong Province, Department of Pharmacology, School of Basic Medical Sciences, Shandong University, Jinan, China.Department of Pathology, Microbiology and Immunology, Vanderbilt University Medical Center, Nashville, Tennessee, USA.Department of Pathology, Microbiology and Immunology, Vanderbilt University Medical Center, Nashville, Tennessee, USA.Department of Pathology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China. Electronic address: niexiuyishi@126.com.Department of Nephrology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China. Electronic address: drzhangchun@hust.edu.cn.

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

32327202

Citation

Su, Hua, et al. "Renal Histopathological Analysis of 26 Postmortem Findings of Patients With COVID-19 in China." Kidney International, vol. 98, no. 1, 2020, pp. 219-227.
Su H, Yang M, Wan C, et al. Renal histopathological analysis of 26 postmortem findings of patients with COVID-19 in China. Kidney Int. 2020;98(1):219-227.
Su, H., Yang, M., Wan, C., Yi, L. X., Tang, F., Zhu, H. Y., Yi, F., Yang, H. C., Fogo, A. B., Nie, X., & Zhang, C. (2020). Renal histopathological analysis of 26 postmortem findings of patients with COVID-19 in China. Kidney International, 98(1), 219-227. https://doi.org/10.1016/j.kint.2020.04.003
Su H, et al. Renal Histopathological Analysis of 26 Postmortem Findings of Patients With COVID-19 in China. Kidney Int. 2020;98(1):219-227. PubMed PMID: 32327202.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Renal histopathological analysis of 26 postmortem findings of patients with COVID-19 in China. AU - Su,Hua, AU - Yang,Ming, AU - Wan,Cheng, AU - Yi,Li-Xia, AU - Tang,Fang, AU - Zhu,Hong-Yan, AU - Yi,Fan, AU - Yang,Hai-Chun, AU - Fogo,Agnes B, AU - Nie,Xiu, AU - Zhang,Chun, Y1 - 2020/04/09/ PY - 2020/04/01/received PY - 2020/04/05/revised PY - 2020/04/06/accepted PY - 2020/4/25/pubmed PY - 2020/7/4/medline PY - 2020/4/25/entrez KW - COVID-19 KW - SARS-CoV-2 KW - acute kidney injury KW - proteinuria KW - renal pathology SP - 219 EP - 227 JF - Kidney international JO - Kidney Int. VL - 98 IS - 1 N2 - Although the respiratory and immune systems are the major targets of Coronavirus Disease 2019 (COVID-19), acute kidney injury and proteinuria have also been observed. Currently, detailed pathologic examination of kidney damage in critically ill patients with COVID-19 has been lacking. To help define this we analyzed kidney abnormalities in 26 autopsies of patients with COVID-19 by light microscopy, ultrastructural observation and immunostaining. Patients were on average 69 years (19 male and 7 female) with respiratory failure associated with multiple organ dysfunction syndrome as the cause of death. Nine of the 26 showed clinical signs of kidney injury that included increased serum creatinine and/or new-onset proteinuria. By light microscopy, diffuse proximal tubule injury with the loss of brush border, non-isometric vacuolar degeneration, and even frank necrosis was observed. Occasional hemosiderin granules and pigmented casts were identified. There were prominent erythrocyte aggregates obstructing the lumen of capillaries without platelet or fibrinoid material. Evidence of vasculitis, interstitial inflammation or hemorrhage was absent. Electron microscopic examination showed clusters of coronavirus-like particles with distinctive spikes in the tubular epithelium and podocytes. Furthermore, the receptor of SARS-CoV-2, ACE2 was found to be upregulated in patients with COVID-19, and immunostaining with SARS-CoV nucleoprotein antibody was positive in tubules. In addition to the direct virulence of SARS-CoV-2, factors contributing to acute kidney injury included systemic hypoxia, abnormal coagulation, and possible drug or hyperventilation-relevant rhabdomyolysis. Thus, our studies provide direct evidence of the invasion of SARSCoV-2 into kidney tissue. These findings will greatly add to the current understanding of SARS-CoV-2 infection. SN - 1523-1755 UR - https://www.unboundmedicine.com/medline/citation/32327202/Renal_histopathological_analysis_of_26_postmortem_findings_of_patients_with_COVID-19_in_China L2 - https://linkinghub.elsevier.com/retrieve/pii/S0085-2538(20)30369-0 DB - PRIME DP - Unbound Medicine ER -