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COVID-19-Associated Kidney Injury: A Case Series of Kidney Biopsy Findings.
J Am Soc Nephrol. 2020 Sep; 31(9):1948-1958.JA

Abstract

BACKGROUND

Reports show that AKI is a common complication of severe coronavirus disease 2019 (COVID-19) in hospitalized patients. Studies have also observed proteinuria and microscopic hematuria in such patients. Although a recent autopsy series of patients who died with severe COVID-19 in China found acute tubular necrosis in the kidney, a few patient reports have also described collapsing glomerulopathy in COVID-19.

METHODS

We evaluated biopsied kidney samples from ten patients at our institution who had COVID-19 and clinical features of AKI, including proteinuria with or without hematuria. We documented clinical features, pathologic findings, and outcomes.

RESULTS

Our analysis included ten patients who underwent kidney biopsy (mean age: 65 years); five patients were black, three were Hispanic, and two were white. All patients had proteinuria. Eight patients had severe AKI, necessitating RRT. All biopsy samples showed varying degrees of acute tubular necrosis, and one patient had associated widespread myoglobin casts. In addition, two patients had findings of thrombotic microangiopathy, one had pauci-immune crescentic GN, and another had global as well as segmental glomerulosclerosis with features of healed collapsing glomerulopathy. Interestingly, although the patients had confirmed severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection by RT-PCR, immunohistochemical staining of kidney biopsy samples for SARS-CoV-2 was negative in all ten patients. Also, ultrastructural examination by electron microscopy showed no evidence of viral particles in the biopsy samples.

CONCLUSIONS

The most common finding in our kidney biopsy samples from ten hospitalized patients with AKI and COVID-19 was acute tubular necrosis. There was no evidence of SARS-CoV-2 in the biopsied kidney tissue.

Authors+Show Affiliations

Division of Kidney Diseases and Hypertension, Department of Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Great Neck, New York psharma7@northwell.edu.Division of Kidney Diseases and Hypertension, Department of Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Great Neck, New York.Division of Kidney Diseases and Hypertension, Department of Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Great Neck, New York.Division of Kidney Diseases and Hypertension, Department of Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Great Neck, New York.Department of Pathology, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Manhasset, New York.Division of Kidney Diseases and Hypertension, Department of Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Great Neck, New York.Division of Kidney Diseases and Hypertension, Department of Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Great Neck, New York.Division of Kidney Diseases and Hypertension, Department of Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Great Neck, New York.Arkana Laboratories, Little Rock, Arkansas.Division of Kidney Diseases and Hypertension, Department of Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Great Neck, New York.Department of Pathology, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Manhasset, New York.No affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

32660970

Citation

Sharma, Purva, et al. "COVID-19-Associated Kidney Injury: a Case Series of Kidney Biopsy Findings." Journal of the American Society of Nephrology : JASN, vol. 31, no. 9, 2020, pp. 1948-1958.
Sharma P, Uppal NN, Wanchoo R, et al. COVID-19-Associated Kidney Injury: A Case Series of Kidney Biopsy Findings. J Am Soc Nephrol. 2020;31(9):1948-1958.
Sharma, P., Uppal, N. N., Wanchoo, R., Shah, H. H., Yang, Y., Parikh, R., Khanin, Y., Madireddy, V., Larsen, C. P., Jhaveri, K. D., & Bijol, V. (2020). COVID-19-Associated Kidney Injury: A Case Series of Kidney Biopsy Findings. Journal of the American Society of Nephrology : JASN, 31(9), 1948-1958. https://doi.org/10.1681/ASN.2020050699
Sharma P, et al. COVID-19-Associated Kidney Injury: a Case Series of Kidney Biopsy Findings. J Am Soc Nephrol. 2020;31(9):1948-1958. PubMed PMID: 32660970.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - COVID-19-Associated Kidney Injury: A Case Series of Kidney Biopsy Findings. AU - Sharma,Purva, AU - Uppal,Nupur N, AU - Wanchoo,Rimda, AU - Shah,Hitesh H, AU - Yang,Yihe, AU - Parikh,Rushang, AU - Khanin,Yuriy, AU - Madireddy,Varun, AU - Larsen,Christopher P, AU - Jhaveri,Kenar D, AU - Bijol,Vanesa, AU - ,, Y1 - 2020/07/13/ PY - 2020/05/20/received PY - 2020/06/15/accepted PY - 2021/09/01/pmc-release PY - 2020/7/15/pubmed PY - 2020/9/8/medline PY - 2020/7/15/entrez KW - AKI KW - ATN KW - COVID-19 KW - SARS-CoV-2 KW - acute kidney injury KW - kidney biopsy KW - kidney pathology SP - 1948 EP - 1958 JF - Journal of the American Society of Nephrology : JASN JO - J. Am. Soc. Nephrol. VL - 31 IS - 9 N2 - BACKGROUND: Reports show that AKI is a common complication of severe coronavirus disease 2019 (COVID-19) in hospitalized patients. Studies have also observed proteinuria and microscopic hematuria in such patients. Although a recent autopsy series of patients who died with severe COVID-19 in China found acute tubular necrosis in the kidney, a few patient reports have also described collapsing glomerulopathy in COVID-19. METHODS: We evaluated biopsied kidney samples from ten patients at our institution who had COVID-19 and clinical features of AKI, including proteinuria with or without hematuria. We documented clinical features, pathologic findings, and outcomes. RESULTS: Our analysis included ten patients who underwent kidney biopsy (mean age: 65 years); five patients were black, three were Hispanic, and two were white. All patients had proteinuria. Eight patients had severe AKI, necessitating RRT. All biopsy samples showed varying degrees of acute tubular necrosis, and one patient had associated widespread myoglobin casts. In addition, two patients had findings of thrombotic microangiopathy, one had pauci-immune crescentic GN, and another had global as well as segmental glomerulosclerosis with features of healed collapsing glomerulopathy. Interestingly, although the patients had confirmed severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection by RT-PCR, immunohistochemical staining of kidney biopsy samples for SARS-CoV-2 was negative in all ten patients. Also, ultrastructural examination by electron microscopy showed no evidence of viral particles in the biopsy samples. CONCLUSIONS: The most common finding in our kidney biopsy samples from ten hospitalized patients with AKI and COVID-19 was acute tubular necrosis. There was no evidence of SARS-CoV-2 in the biopsied kidney tissue. SN - 1533-3450 UR - https://www.unboundmedicine.com/medline/citation/32660970/COVID_19_Associated_Kidney_Injury:_A_Case_Series_of_Kidney_Biopsy_Findings_ L2 - https://jasn.asnjournals.org/cgi/pmidlookup?view=long&pmid=32660970 DB - PRIME DP - Unbound Medicine ER -