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.
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: Matt Arentz; Eric Yim; Lindy Klaff; Sharukh Lokhandwala; Francis X Riedo; Maria Chong; Melissa Lee Journal: JAMA Date: 2020-04-28 Impact factor: 56.272
Authors: Victor G Puelles; Marc Lütgehetmann; Maja T Lindenmeyer; Jan P Sperhake; Milagros N Wong; Lena Allweiss; Silvia Chilla; Axel Heinemann; Nicola Wanner; Shuya Liu; Fabian Braun; Shun Lu; Susanne Pfefferle; Ann S Schröder; Carolin Edler; Oliver Gross; Markus Glatzel; Dominic Wichmann; Thorsten Wiech; Stefan Kluge; Klaus Pueschel; Martin Aepfelbacher; Tobias B Huber Journal: N Engl J Med Date: 2020-05-13 Impact factor: 91.245
Authors: Yonatan Peleg; Satoru Kudose; Vivette D'Agati; Eric Siddall; Syeda Ahmad; Thomas Nickolas; Sergey Kisselev; Ali Gharavi; Pietro Canetta Journal: Kidney Int Rep Date: 2020-04-28
Authors: Jamie S Hirsch; Jia H Ng; Daniel W Ross; Purva Sharma; Hitesh H Shah; Richard L Barnett; Azzour D Hazzan; Steven Fishbane; Kenar D Jhaveri Journal: Kidney Int Date: 2020-05-16 Impact factor: 10.612
Authors: Ani Nalbandian; Kartik Sehgal; Aakriti Gupta; Mahesh V Madhavan; Claire McGroder; Jacob S Stevens; Joshua R Cook; Anna S Nordvig; Daniel Shalev; Tejasav S Sehrawat; Neha Ahluwalia; Behnood Bikdeli; Donald Dietz; Caroline Der-Nigoghossian; Nadia Liyanage-Don; Gregg F Rosner; Elana J Bernstein; Sumit Mohan; Akinpelumi A Beckley; David S Seres; Toni K Choueiri; Nir Uriel; John C Ausiello; Domenico Accili; Daniel E Freedberg; Matthew Baldwin; Allan Schwartz; Daniel Brodie; Christine Kim Garcia; Mitchell S V Elkind; Jean M Connors; John P Bilezikian; Donald W Landry; Elaine Y Wan Journal: Nat Med Date: 2021-03-22 Impact factor: 53.440
Authors: Omar H Fahmy; Farah M Daas; Vidyulata Salunkhe; Jessica L Petrey; Ediz F Cosar; Julio Ramirez; Ozan Akca Journal: Crit Care Explor Date: 2021-05-20
Authors: Luise Hassler; Fabiola Reyes; Matthew A Sparks; Paul Welling; Daniel Batlle Journal: Clin J Am Soc Nephrol Date: 2021-06-14 Impact factor: 8.237
Authors: Meint Volbeda; Daniela Jou-Valencia; Marius C van den Heuvel; Marjolein Knoester; Peter J Zwiers; Janesh Pillay; Stefan P Berger; Peter H J van der Voort; Jan G Zijlstra; Matijs van Meurs; Jill Moser Journal: Crit Care Date: 2021-06-10 Impact factor: 9.097