tetano
Editor, Senior Moderator
J Am Soc Nephrol
. 2020 Jul 29;ASN.2020050744.
doi: 10.1681/ASN.2020050744. Online ahead of print.
Postmortem Kidney Pathology Findings in Patients with COVID-19
Dominick Santoriello[SUP] 1 [/SUP], Pascale Khairallah[SUP] 2 [/SUP], Andrew S Bomback[SUP] 2 [/SUP], Katherine Xu[SUP] 2 [/SUP], Satoru Kudose[SUP] 1 [/SUP], Ibrahim Batal[SUP] 1 [/SUP], Jonathan Barasch[SUP] 2 [/SUP], Jai Radhakrishnan[SUP] 2 [/SUP], Vivette D'Agati[SUP] 1 [/SUP], Glen Markowitz[SUP] 3 [/SUP]
Affiliations
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.
Keywords: COVID-19; SARS-CoV-2; acute kidney injury; acute renal failure; acute tubular injury; pathology.
. 2020 Jul 29;ASN.2020050744.
doi: 10.1681/ASN.2020050744. Online ahead of print.
Postmortem Kidney Pathology Findings in Patients with COVID-19
Dominick Santoriello[SUP] 1 [/SUP], Pascale Khairallah[SUP] 2 [/SUP], Andrew S Bomback[SUP] 2 [/SUP], Katherine Xu[SUP] 2 [/SUP], Satoru Kudose[SUP] 1 [/SUP], Ibrahim Batal[SUP] 1 [/SUP], Jonathan Barasch[SUP] 2 [/SUP], Jai Radhakrishnan[SUP] 2 [/SUP], Vivette D'Agati[SUP] 1 [/SUP], Glen Markowitz[SUP] 3 [/SUP]
Affiliations
- PMID: 32727719
- DOI: 10.1681/ASN.2020050744
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.
Keywords: COVID-19; SARS-CoV-2; acute kidney injury; acute renal failure; acute tubular injury; pathology.