tetano
Editor, Senior Moderator
Clin J Am Soc Nephrol
. 2021 Mar 29;CJN.16281020.
doi: 10.2215/CJN.16281020. Online ahead of print.
Association between Postmortem Kidney Biopsy Findings and Acute Kidney Injury from Patients with SARS-CoV-2 (COVID-19)
Jes?s Rivero[SUP] 1 [/SUP], Maribel Merino-L?pez[SUP] 2 [/SUP], Rossana Olmedo[SUP] 1 [/SUP], Rub?n Garrido-Roldan[SUP] 2 [/SUP], Bernardo Moguel[SUP] 3 [/SUP], Gustavo Rojas[SUP] 4 [/SUP], Alfonso Chavez-Morales[SUP] 5 [/SUP], Pablo Alvarez-Maldonado[SUP] 5 [/SUP], Pablo Duarte-Molina[SUP] 5 [/SUP], Rodolfo Casta?o-Guerra[SUP] 5 [/SUP], Ivon Karina Ruiz-Lopez[SUP] 2 [/SUP], Elizabeth Soria-Castro[SUP] 6 [/SUP], Cesar Luna[SUP] 7 [/SUP], Alejandro Bonilla-M?ndez[SUP] 8 [/SUP], Francisco Baranda[SUP] 4 [/SUP], Carlos Zabal[SUP] 4 [/SUP], Magdalena Madero-Rovalo[SUP] 3 [/SUP], Rafael Valdez-Ortiz[SUP] 2 [/SUP], Ma Virgilia Soto-Abraham[SUP] 9 10 [/SUP], Armando Vazquez-Rangel[SUP] 11 [/SUP]
Affiliations
Abstract
Background and objectives: AKI in coronavirus disease 2019 (COVID-19) is associated with higher morbidity and mortality. The objective of this study was to identify the kidney histopathologic characteristics of deceased patients with diagnosis of COVID-19 and evaluate the association between biopsy findings and clinical variables, including AKI severity.
Design, setting, participants, & measurements: Our multicenter, observational study of deceased patients with COVID-19 in three third-level centers in Mexico City evaluated postmortem kidney biopsy by light and electron microscopy analysis in all cases. Descriptive and association statistics were performed between the clinical and histologic variables.
Results: A total of 85 patients were included. Median age was 57 (49-66) years, 69% were men, body mass index was 29 (26-35) kg/m[SUP]2[/SUP], 51% had history of diabetes, 46% had history of hypertension, 98% received anticoagulation, 66% were on steroids, and 35% received at least one potential nephrotoxic medication. Severe AKI was present in 54% of patients. Biopsy findings included FSGS in 29%, diabetic nephropathy in 27%, and arteriosclerosis in 81%. Acute tubular injury grades 2-3 were observed in 49%. Histopathologic characteristics were not associated with severe AKI; however, pigment casts on the biopsy were associated with significantly lower probability of kidney function recovery (odds ratio, 0.07; 95% confidence interval, 0.01 to 0.77). The use of aminoglycosides/colistin, levels of C-reactive protein and serum albumin, previous use of angiotensin-converting enzyme inhibitors or angiotensin II receptor blockers, antivirals, nonsteroid anti-inflammatory drugs, and anticoagulants were associated with specific histopathologic findings.
Conclusions: A high prevalence of chronic comorbidities was found on kidney biopsies. Nonrecovery from severe AKI was associated with the presence of pigmented casts. Inflammatory markers and medications were associated with specific histopathologic findings in patients dying from COVID-19.
Keywords: COVID-19; SARS-CoV-2; acute kidney injury; kidney biopsy; postmortem.
. 2021 Mar 29;CJN.16281020.
doi: 10.2215/CJN.16281020. Online ahead of print.
Association between Postmortem Kidney Biopsy Findings and Acute Kidney Injury from Patients with SARS-CoV-2 (COVID-19)
Jes?s Rivero[SUP] 1 [/SUP], Maribel Merino-L?pez[SUP] 2 [/SUP], Rossana Olmedo[SUP] 1 [/SUP], Rub?n Garrido-Roldan[SUP] 2 [/SUP], Bernardo Moguel[SUP] 3 [/SUP], Gustavo Rojas[SUP] 4 [/SUP], Alfonso Chavez-Morales[SUP] 5 [/SUP], Pablo Alvarez-Maldonado[SUP] 5 [/SUP], Pablo Duarte-Molina[SUP] 5 [/SUP], Rodolfo Casta?o-Guerra[SUP] 5 [/SUP], Ivon Karina Ruiz-Lopez[SUP] 2 [/SUP], Elizabeth Soria-Castro[SUP] 6 [/SUP], Cesar Luna[SUP] 7 [/SUP], Alejandro Bonilla-M?ndez[SUP] 8 [/SUP], Francisco Baranda[SUP] 4 [/SUP], Carlos Zabal[SUP] 4 [/SUP], Magdalena Madero-Rovalo[SUP] 3 [/SUP], Rafael Valdez-Ortiz[SUP] 2 [/SUP], Ma Virgilia Soto-Abraham[SUP] 9 10 [/SUP], Armando Vazquez-Rangel[SUP] 11 [/SUP]
Affiliations
- PMID: 33782033
- DOI: 10.2215/CJN.16281020
Abstract
Background and objectives: AKI in coronavirus disease 2019 (COVID-19) is associated with higher morbidity and mortality. The objective of this study was to identify the kidney histopathologic characteristics of deceased patients with diagnosis of COVID-19 and evaluate the association between biopsy findings and clinical variables, including AKI severity.
Design, setting, participants, & measurements: Our multicenter, observational study of deceased patients with COVID-19 in three third-level centers in Mexico City evaluated postmortem kidney biopsy by light and electron microscopy analysis in all cases. Descriptive and association statistics were performed between the clinical and histologic variables.
Results: A total of 85 patients were included. Median age was 57 (49-66) years, 69% were men, body mass index was 29 (26-35) kg/m[SUP]2[/SUP], 51% had history of diabetes, 46% had history of hypertension, 98% received anticoagulation, 66% were on steroids, and 35% received at least one potential nephrotoxic medication. Severe AKI was present in 54% of patients. Biopsy findings included FSGS in 29%, diabetic nephropathy in 27%, and arteriosclerosis in 81%. Acute tubular injury grades 2-3 were observed in 49%. Histopathologic characteristics were not associated with severe AKI; however, pigment casts on the biopsy were associated with significantly lower probability of kidney function recovery (odds ratio, 0.07; 95% confidence interval, 0.01 to 0.77). The use of aminoglycosides/colistin, levels of C-reactive protein and serum albumin, previous use of angiotensin-converting enzyme inhibitors or angiotensin II receptor blockers, antivirals, nonsteroid anti-inflammatory drugs, and anticoagulants were associated with specific histopathologic findings.
Conclusions: A high prevalence of chronic comorbidities was found on kidney biopsies. Nonrecovery from severe AKI was associated with the presence of pigmented casts. Inflammatory markers and medications were associated with specific histopathologic findings in patients dying from COVID-19.
Keywords: COVID-19; SARS-CoV-2; acute kidney injury; kidney biopsy; postmortem.