Tags

Type your tag names separated by a space and hit enter

Ultrastructural Evidence for Direct Renal Infection with SARS-CoV-2.
J Am Soc Nephrol. 2020 Aug; 31(8):1683-1687.JA

Abstract

BACKGROUND

A significant fraction of patients with coronavirus disease 2019 (COVID-19) display abnormalities in renal function. Retrospective studies of patients hospitalized with COVID-19 in Wuhan, China, report an incidence of 3%-7% progressing to ARF, a marker of poor prognosis. The cause of the renal failure in COVID-19 is unknown, but one hypothesized mechanism is direct renal infection by the causative virus, SARS-CoV-2.

METHODS

We performed an autopsy on a single patient who died of COVID-19 after open repair of an aortic dissection, complicated by hypoxic respiratory failure and oliguric renal failure. We used light and electron microscopy to examine renal tissue for evidence of SARS-CoV-2 within renal cells.

RESULTS

Light microscopy of proximal tubules showed geographic isometric vacuolization, corresponding to a focus of tubules with abundant intracellular viral arrays. Individual viruses averaged 76 µm in diameter and had an envelope studded with crown-like, electron-dense spikes. Vacuoles contained double-membrane vesicles suggestive of partially assembled virus.

CONCLUSIONS

The presence of viral particles in the renal tubular epithelium that were morphologically identical to SARS-CoV-2, and with viral arrays and other features of virus assembly, provide evidence of a productive direct infection of the kidney by SARS-CoV-2. This finding offers confirmatory evidence that direct renal infection occurs in the setting of AKI in COVID-19. However, the frequency and clinical significance of direct infection in COVID-19 is unclear. Tubular isometric vacuolization observed with light microscopy, which correlates with double-membrane vesicles containing vacuoles observed with electronic microscopy, may be a useful histologic marker for active SARS-CoV-2 infection in kidney biopsy or autopsy specimens.

Authors+Show Affiliations

Department of Pathology, University of Michigan Medical School, Ann Arbor, Michigan efarkash@med.umich.edu.Department of Pathology, University of Michigan Medical School, Ann Arbor, Michigan. Washtenaw County Medical Examiner's Office, Ann Arbor, Michigan.Department of Pathology, University of Michigan Medical School, Ann Arbor, Michigan. Washtenaw County Medical Examiner's Office, Ann Arbor, Michigan.

Pub Type(s)

Case Reports
Journal Article

Language

eng

PubMed ID

32371536

Citation

Farkash, Evan A., et al. "Ultrastructural Evidence for Direct Renal Infection With SARS-CoV-2." Journal of the American Society of Nephrology : JASN, vol. 31, no. 8, 2020, pp. 1683-1687.
Farkash EA, Wilson AM, Jentzen JM. Ultrastructural Evidence for Direct Renal Infection with SARS-CoV-2. J Am Soc Nephrol. 2020;31(8):1683-1687.
Farkash, E. A., Wilson, A. M., & Jentzen, J. M. (2020). Ultrastructural Evidence for Direct Renal Infection with SARS-CoV-2. Journal of the American Society of Nephrology : JASN, 31(8), 1683-1687. https://doi.org/10.1681/ASN.2020040432
Farkash EA, Wilson AM, Jentzen JM. Ultrastructural Evidence for Direct Renal Infection With SARS-CoV-2. J Am Soc Nephrol. 2020;31(8):1683-1687. PubMed PMID: 32371536.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Ultrastructural Evidence for Direct Renal Infection with SARS-CoV-2. AU - Farkash,Evan A, AU - Wilson,Allecia M, AU - Jentzen,Jeffrey M, Y1 - 2020/05/05/ PY - 2020/04/10/received PY - 2020/04/20/accepted PY - 2021/08/01/pmc-release PY - 2020/5/7/pubmed PY - 2020/8/15/medline PY - 2020/5/7/entrez KW - COVID-19 KW - SARS-CoV-2 KW - acute kidney failure KW - autopsy KW - electron microscopy KW - renal pathology SP - 1683 EP - 1687 JF - Journal of the American Society of Nephrology : JASN JO - J. Am. Soc. Nephrol. VL - 31 IS - 8 N2 - BACKGROUND: A significant fraction of patients with coronavirus disease 2019 (COVID-19) display abnormalities in renal function. Retrospective studies of patients hospitalized with COVID-19 in Wuhan, China, report an incidence of 3%-7% progressing to ARF, a marker of poor prognosis. The cause of the renal failure in COVID-19 is unknown, but one hypothesized mechanism is direct renal infection by the causative virus, SARS-CoV-2. METHODS: We performed an autopsy on a single patient who died of COVID-19 after open repair of an aortic dissection, complicated by hypoxic respiratory failure and oliguric renal failure. We used light and electron microscopy to examine renal tissue for evidence of SARS-CoV-2 within renal cells. RESULTS: Light microscopy of proximal tubules showed geographic isometric vacuolization, corresponding to a focus of tubules with abundant intracellular viral arrays. Individual viruses averaged 76 µm in diameter and had an envelope studded with crown-like, electron-dense spikes. Vacuoles contained double-membrane vesicles suggestive of partially assembled virus. CONCLUSIONS: The presence of viral particles in the renal tubular epithelium that were morphologically identical to SARS-CoV-2, and with viral arrays and other features of virus assembly, provide evidence of a productive direct infection of the kidney by SARS-CoV-2. This finding offers confirmatory evidence that direct renal infection occurs in the setting of AKI in COVID-19. However, the frequency and clinical significance of direct infection in COVID-19 is unclear. Tubular isometric vacuolization observed with light microscopy, which correlates with double-membrane vesicles containing vacuoles observed with electronic microscopy, may be a useful histologic marker for active SARS-CoV-2 infection in kidney biopsy or autopsy specimens. SN - 1533-3450 UR - https://www.unboundmedicine.com/medline/citation/32371536/Ultrastructural_Evidence_for_Direct_Renal_Infection_with_SARS_CoV_2_ L2 - https://jasn.asnjournals.org/cgi/pmidlookup?view=long&pmid=32371536 DB - PRIME DP - Unbound Medicine ER -