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Postmortem Kidney Pathology Findings in Patients with COVID-19.
J Am Soc Nephrol. 2020 Sep; 31(9):2158-2167.JA

Abstract

BACKGROUND

AKI is common among hospitalized patients with coronavirus disease 2019 (COVID-19) and is an independent risk factor for mortality. Although there are numerous potential mechanisms underlying COVID-19-associated AKI, our current knowledge of kidney pathologic findings in COVID-19 is limited.

METHODS

We examined the postmortem kidneys from 42 patients who died of COVID-19. We reviewed light microscopy findings in all autopsies and performed immunofluorescence, electron microscopy, and in situ hybridization studies for SARS-CoV-2 on a subset of samples.

RESULTS

The cohort had a median age of 71.5 years (range, 38-97 years); 69% were men, 57% were Hispanic, and 73% had a history of hypertension. Among patients with available data, AKI developed in 31 of 33 patients (94%), including 6 with AKI stage 1, 9 with stage 2, and 16 with stage 3. The predominant finding correlating with AKI was acute tubular injury. However, the degree of acute tubular injury was often less severe than predicted for the degree of AKI, suggesting a role for hemodynamic factors, such as aggressive fluid management. Background changes of hypertensive arterionephrosclerosis and diabetic glomerulosclerosis were frequent but typically mild. We identified focal kidney fibrin thrombi in 6 of 42 (14%) autopsies. A single Black patient had collapsing FSGS. Immunofluorescence and electron microscopy were largely unrevealing, and in situ hybridization for SARS-CoV-2 showed no definitive positivity.

CONCLUSIONS

Among a cohort of 42 patients dying with COVID-19, autopsy histologic evaluation revealed acute tubular injury, which was typically mild relative to the degree of creatinine elevation. These findings suggest potential for reversibility upon resolution of SARS-CoV-2 infection.

Authors+Show Affiliations

Department of Pathology and Cell Biology, Columbia University Irving Medical Center, New York, New York.Division of Nephrology, Department of Medicine, Columbia University Irving Medical Center, New York, New York.Division of Nephrology, Department of Medicine, Columbia University Irving Medical Center, New York, New York.Division of Nephrology, Department of Medicine, Columbia University Irving Medical Center, New York, New York.Department of Pathology and Cell Biology, Columbia University Irving Medical Center, New York, New York.Department of Pathology and Cell Biology, Columbia University Irving Medical Center, New York, New York.Division of Nephrology, Department of Medicine, Columbia University Irving Medical Center, New York, New York.Division of Nephrology, Department of Medicine, Columbia University Irving Medical Center, New York, New York.Department of Pathology and Cell Biology, Columbia University Irving Medical Center, New York, New York.Department of Pathology and Cell Biology, Columbia University Irving Medical Center, New York, New York gsm17@cumc.columbia.edu.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

32727719

Citation

Santoriello, Dominick, et al. "Postmortem Kidney Pathology Findings in Patients With COVID-19." Journal of the American Society of Nephrology : JASN, vol. 31, no. 9, 2020, pp. 2158-2167.
Santoriello D, Khairallah P, Bomback AS, et al. Postmortem Kidney Pathology Findings in Patients with COVID-19. J Am Soc Nephrol. 2020;31(9):2158-2167.
Santoriello, D., Khairallah, P., Bomback, A. S., Xu, K., Kudose, S., Batal, I., Barasch, J., Radhakrishnan, J., D'Agati, V., & Markowitz, G. (2020). Postmortem Kidney Pathology Findings in Patients with COVID-19. Journal of the American Society of Nephrology : JASN, 31(9), 2158-2167. https://doi.org/10.1681/ASN.2020050744
Santoriello D, et al. Postmortem Kidney Pathology Findings in Patients With COVID-19. J Am Soc Nephrol. 2020;31(9):2158-2167. PubMed PMID: 32727719.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Postmortem Kidney Pathology Findings in Patients with COVID-19. AU - Santoriello,Dominick, AU - Khairallah,Pascale, AU - Bomback,Andrew S, AU - Xu,Katherine, AU - Kudose,Satoru, AU - Batal,Ibrahim, AU - Barasch,Jonathan, AU - Radhakrishnan,Jai, AU - D'Agati,Vivette, AU - Markowitz,Glen, Y1 - 2020/07/29/ PY - 2020/05/27/received PY - 2020/07/06/accepted PY - 2021/09/01/pmc-release PY - 2020/7/31/pubmed PY - 2020/9/8/medline PY - 2020/7/31/entrez KW - COVID-19 KW - SARS-CoV-2 KW - acute kidney injury KW - acute renal failure KW - acute tubular injury KW - pathology SP - 2158 EP - 2167 JF - Journal of the American Society of Nephrology : JASN JO - J. Am. Soc. Nephrol. VL - 31 IS - 9 N2 - BACKGROUND: AKI is common among hospitalized patients with coronavirus disease 2019 (COVID-19) and is an independent risk factor for mortality. Although there are numerous potential mechanisms underlying COVID-19-associated AKI, our current knowledge of kidney pathologic findings in COVID-19 is limited. METHODS: We examined the postmortem kidneys from 42 patients who died of COVID-19. We reviewed light microscopy findings in all autopsies and performed immunofluorescence, electron microscopy, and in situ hybridization studies for SARS-CoV-2 on a subset of samples. RESULTS: The cohort had a median age of 71.5 years (range, 38-97 years); 69% were men, 57% were Hispanic, and 73% had a history of hypertension. Among patients with available data, AKI developed in 31 of 33 patients (94%), including 6 with AKI stage 1, 9 with stage 2, and 16 with stage 3. The predominant finding correlating with AKI was acute tubular injury. However, the degree of acute tubular injury was often less severe than predicted for the degree of AKI, suggesting a role for hemodynamic factors, such as aggressive fluid management. Background changes of hypertensive arterionephrosclerosis and diabetic glomerulosclerosis were frequent but typically mild. We identified focal kidney fibrin thrombi in 6 of 42 (14%) autopsies. A single Black patient had collapsing FSGS. Immunofluorescence and electron microscopy were largely unrevealing, and in situ hybridization for SARS-CoV-2 showed no definitive positivity. CONCLUSIONS: Among a cohort of 42 patients dying with COVID-19, autopsy histologic evaluation revealed acute tubular injury, which was typically mild relative to the degree of creatinine elevation. These findings suggest potential for reversibility upon resolution of SARS-CoV-2 infection. SN - 1533-3450 UR - https://www.unboundmedicine.com/medline/citation/32727719/Postmortem_Kidney_Pathology_Findings_in_Patients_with_COVID_19_ L2 - https://jasn.asnjournals.org/cgi/pmidlookup?view=long&pmid=32727719 DB - PRIME DP - Unbound Medicine ER -