tetano
Editor, Senior Moderator
J Am Soc Nephrol. 2020 May 5. pii: ASN.2020040432. doi: 10.1681/ASN.2020040432. [Epub ahead of print]
Ultrastructural Evidence for Direct Renal Infection with SARS-CoV-2.
Farkash EA[SUP]1[/SUP], Wilson AM[SUP]2,[/SUP][SUP]3[/SUP], Jentzen JM[SUP]2,[/SUP][SUP]3[/SUP].
Author information
Abstract
BACKGROUND:
A significant fraction of patients with coronavirus disease 2019 (COVID-19) display abnormalities in renal function. Retrospective studies of patients hospitalized with COVID-19 in Wuhan, China, report an incidence of 3%-7% progressing to ARF, a marker of poor prognosis. The cause of the renal failure in COVID-19 is unknown, but one hypothesized mechanism is direct renal infection by the causative virus, SARS-CoV-2.
METHODS:
We performed an autopsy on a single patient who died of COVID-19 after open repair of an aortic dissection, complicated by hypoxic respiratory failure and oliguric renal failure. We used light and electron microscopy to examine renal tissue for evidence of SARS-CoV-2 within renal cells.
RESULTS:
Light microscopy of proximal tubules showed geographic isometric vacuolization, corresponding to a focus of tubules with abundant intracellular viral arrays. Individual viruses averaged 76 ?m in diameter and had an envelope studded with crown-like, electron-dense spikes. Vacuoles contained double-membrane vesicles suggestive of partially assembled virus.
CONCLUSIONS:
The presence of viral particles in the renal tubular epithelium that were morphologically identical to SARS-CoV-2, and with viral arrays and other features of virus assembly, provide evidence of a productive direct infection of the kidney by SARS-CoV-2. This finding offers confirmatory evidence that direct renal infection occurs in the setting of AKI in COVID-19. However, the frequency and clinical significance of direct infection in COVID-19 is unclear. Tubular isometric vacuolization observed with light microscopy, which correlates with double-membrane vesicles containing vacuoles observed with electronic microscopy, may be a useful histologic marker for active SARS-CoV-2 infection in kidney biopsy or autopsy specimens.
Copyright ? 2020 by the American Society of Nephrology.
KEYWORDS:
COVID-19; SARS-CoV-2; acute kidney failure; autopsy; electron microscopy; renal pathology
PMID:32371536DOI:10.1681/ASN.2020040432
Ultrastructural Evidence for Direct Renal Infection with SARS-CoV-2.
Farkash EA[SUP]1[/SUP], Wilson AM[SUP]2,[/SUP][SUP]3[/SUP], Jentzen JM[SUP]2,[/SUP][SUP]3[/SUP].
Author information
Abstract
BACKGROUND:
A significant fraction of patients with coronavirus disease 2019 (COVID-19) display abnormalities in renal function. Retrospective studies of patients hospitalized with COVID-19 in Wuhan, China, report an incidence of 3%-7% progressing to ARF, a marker of poor prognosis. The cause of the renal failure in COVID-19 is unknown, but one hypothesized mechanism is direct renal infection by the causative virus, SARS-CoV-2.
METHODS:
We performed an autopsy on a single patient who died of COVID-19 after open repair of an aortic dissection, complicated by hypoxic respiratory failure and oliguric renal failure. We used light and electron microscopy to examine renal tissue for evidence of SARS-CoV-2 within renal cells.
RESULTS:
Light microscopy of proximal tubules showed geographic isometric vacuolization, corresponding to a focus of tubules with abundant intracellular viral arrays. Individual viruses averaged 76 ?m in diameter and had an envelope studded with crown-like, electron-dense spikes. Vacuoles contained double-membrane vesicles suggestive of partially assembled virus.
CONCLUSIONS:
The presence of viral particles in the renal tubular epithelium that were morphologically identical to SARS-CoV-2, and with viral arrays and other features of virus assembly, provide evidence of a productive direct infection of the kidney by SARS-CoV-2. This finding offers confirmatory evidence that direct renal infection occurs in the setting of AKI in COVID-19. However, the frequency and clinical significance of direct infection in COVID-19 is unclear. Tubular isometric vacuolization observed with light microscopy, which correlates with double-membrane vesicles containing vacuoles observed with electronic microscopy, may be a useful histologic marker for active SARS-CoV-2 infection in kidney biopsy or autopsy specimens.
Copyright ? 2020 by the American Society of Nephrology.
KEYWORDS:
COVID-19; SARS-CoV-2; acute kidney failure; autopsy; electron microscopy; renal pathology
PMID:32371536DOI:10.1681/ASN.2020040432