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Kidney Week

Abstract: PO0830

AKI in the Setting of COVID-19: Histopathologic and Ultrastructural Findings in Postmortem Kidney Biopsy

Session Information

Category: Coronavirus (COVID-19)

  • 000 Coronavirus (COVID-19)

Authors

  • Golmai, Pouneh, Lenox Hill Hospital, New York, New York, United States
  • Larsen, Christopher Patrick, Arkana Laboratories, Little Rock, Arkansas, USA., Little Rock, Arkansas, United States
  • DeVita, Maria V., Lenox Hill Hospital, New York, New York, United States
  • Wahl, Samuel J., Lenox Hill Hospital, New York, New York, United States
  • Weins, Astrid, Brigham and Women's Hospital, Boston, Massachusetts, United States
  • Rennke, Helmut G., Brigham and Women's Hospital, Boston, Massachusetts, United States
  • Bijol, Vanesa, Hofstra Northwell School of Medicine at Hofstra University, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York, United States
  • Rosenstock, Jordan L., Lenox Hill Hospital, New York, New York, United States
Background

COVID-19 has been associated with a very high risk of AKI. The pathophysiology of the AKI is unclear with conflicting reports regarding the presence of direct infection of the kidney with SARS-CoV2.

Methods


Postmortem kidney biopsy was performed in adult patients with confirmed COVID-19 and stage 2 /3 AKI. Biopsies were examined using light and electron microscopy. Immunohistochemistry and RNA in situ hybridization were performed for SARS-CoV2.

Results

12 patients (83% male) with mean age of 70±13 years underwent biopsy. Mean baseline and peak creatinine were 1.0 and 5.3 mg/dL, respectively. Renal replacement therapy was required in 8 (67%) patients (Table 1). All 12 patients had a pathologic diagnosis of acute tubular injury with focal acute tubular necrosis (Table 2). There was no glomerulitis, vasculitis, or thrombotic microangiopathy. There were no characteristic viral particles on electron microscopy and there was no evidence of SARS-CoV-2 on Immunohistochemistry or in situ RNA hybridization.

Conclusion

AKI in patients with COVID-19 infection was associated with acute tubular injury and focal epithelial necrosis in all patients. There was no evidence of direct viral infection. It appears unlikely that SARS-CoV-2 causes renal injury by direct infection.

Table 1. Clinical characteristics of the study population

Table 2. Summary of histopathologic findings