COVID-19-associated nephropathy includes tubular necrosis and capillarycongestion, with evidence of SARS-CoV-2 in the nephron

BOUQUEGNEAU, Antoine; ERPICUM, Pauline; GROSCH, Stéphanie; HABRAN, Lionel; HOUGRAND, Olivier; HUART, Justine; KRZESINSKI, Jean-Marie; Misset, Benoît; Hayette, Marie-Pierre; DELVENNE, Philippe; BOVY, Christophe; Kylies, dominique; huber, Tobias B.; Puelles, Victor G.; DELANAYE, Pierre; Jouret, François

doi:10.34067/KID.0006992020

Article (Scientific journals)

COVID-19-associated nephropathy includes tubular necrosis and capillarycongestion, with evidence of SARS-CoV-2 in the nephron

BOUQUEGNEAU, Antoine; ERPICUM, Pauline; GROSCH, Stéphanie et al.

2021 • In Kidney International

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https://hdl.handle.net/2268/259448

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10.34067/KID.0006992020

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Keywords :

SARS-CoV-2; acute kidney injury; tubular necrosis; capillary congestion; renal parenchyma

Abstract :

[en] Background: Kidney damage has been reported in patients with COVID-19. Despite numerous reports about COVID-19-associated nephropathy, the factual presence of the SARS-CoV-2 in the renal parenchyma remains controversial. Methods: We consecutively performed 16 immediate (≤3h) post-mortem renal biopsies in patients diagnosed with COVID-19. Kidney samples from 5 patients who died from sepsis not related to COVID-19 were used as controls. Samples were methodically evaluated by 3 pathologists. Virus detection in the renal parenchyma was performed in all samples by bulk RNA RT-PCR (E and N1/N2 genes), immunostaining (nCoV2019 N-Protein), fluorescent in situ hybridization (nCoV2019-S) and electron microscopy. Results: The mean age of our COVID-19 cohort was 68.2±12.8 years, most of whom were males (68.7%). Proteinuria was observed in 53.3% of cases, while acute kidney injury occurred in 60% of cases. Acute tubular necrosis of variable severity was found in all cases, with no tubular or interstitial inflammation. There was no difference in acute tubular necrosis severity between the patients with COVID-19 versus controls. Congestion in glomerular and peri tubular capillaries was respectively observed in 56.3 and 87.5% of patients with COVID-19 compared to 20% of controls, with no evidence of thrombi. The nCoV2019 N-Protein was detected in proximal tubules and also at the basolateral pole of scattered cells of the distal tubules in 9/16 cases. In situ hybridization confirmed these findings in 6/16 cases. RT-PCR of kidney total RNA detected SARS-CoV-2 E and N1/N2 genes in one case. Electron microscopy did not show typical viral inclusions. Conclusions: Our immediate post-mortem kidney samples from patients with COVID-19 highlight a congestive pattern of acute kidney injury, with no significant glomerular or interstitial inflammation. Immunostaining and in situ hybridization suggest that SARS-CoV-2 is present in various segments of the nephron.

Disciplines :

Laboratory medicine & medical technology
Urology & nephrology
General & internal medicine

Author, co-author :

BOUQUEGNEAU, Antoine ; Centre Hospitalier Universitaire de Liège - CHU > Département de médecine interne > Service de néphrologie

ERPICUM, Pauline ; Centre Hospitalier Universitaire de Liège - CHU > Département de médecine interne > Service de néphrologie

GROSCH, Stéphanie ; Centre Hospitalier Universitaire de Liège - CHU > Département de médecine interne > Service de néphrologie

HABRAN, Lionel ; Centre Hospitalier Universitaire de Liège - CHU > Unilab > Laboratoire biologie moléculaire

HOUGRAND, Olivier ; Centre Hospitalier Universitaire de Liège - CHU > Unilab > Laboratoire microscopie électronique

HUART, Justine ; Centre Hospitalier Universitaire de Liège - CHU > Département de médecine interne > Service de néphrologie

KRZESINSKI, Jean-Marie ; Centre Hospitalier Universitaire de Liège - CHU > Département de médecine interne > Service de néphrologie

Misset, Benoît ; Université de Liège - ULiège > Département des sciences cliniques > Soins intensifs

Hayette, Marie-Pierre ; Université de Liège - ULiège > Département des sciences biomédicales et précliniques > Bact., mycologie, parasitologie, virologie, microbio.

DELVENNE, Philippe ; Centre Hospitalier Universitaire de Liège - CHU > Unilab > Service d'anatomie et cytologie pathologiques

More authors (6 more)

Language :

English

Title :

COVID-19-associated nephropathy includes tubular necrosis and capillarycongestion, with evidence of SARS-CoV-2 in the nephron

Publication date :

12 February 2021

Journal title :

Kidney International

ISSN :

0085-2538

eISSN :

1523-1755

Publisher :

Elsevier, United States - New York

Special issue title :

Kidney 360

Peer reviewed :

Peer Reviewed verified by ORBi

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since 30 April 2021

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