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Abstract: PO0840

Renal Histopathological Post-Mortem Findings of 17 Patients with COVID-19 in New York City

Session Information

Category: Coronavirus (COVID-19)

  • No subcategory defined

Authors

  • Munoz Casablanca, Nitzy N., Icahn School of Medicine at Mount Sinai, New York, New York, United States
  • Haroon Al Rasheed, Mohamed Rizwan, Icahn School of Medicine at Mount Sinai, New York, New York, United States
  • Hindi, Judy, Icahn School of Medicine at Mount Sinai, New York, New York, United States
  • Chan, Lili, Icahn School of Medicine at Mount Sinai, New York, New York, United States
  • Coca, Steven G., Icahn School of Medicine at Mount Sinai, New York, New York, United States
  • Salem, Fadi, Icahn School of Medicine at Mount Sinai, New York, New York, United States
  • He, John Cijiang, Icahn School of Medicine at Mount Sinai, New York, New York, United States
Background

While acute kidney injury (AKI) is a common and serious complication of patients with COVID-19, the mechanisms are unclear. Histopathologic reports of kidney tissue in COVID-19 are limited.

Methods

This was a retrospective case series of autopsy cases with confirmed SAR-CoV-2 infection performed at the Mount Sinai Hospital in patients who died between 3/21/2020 to 4/23/2020. Patients who had a kidney transplant, were on dialysis, if severe autolysis was present, or had no clinical data were excluded. To identify SARS-CoV-2, sections were examined by Transmission Electron Microscopy (TEM) and stained by In Situ Hybridization (RNAscope) in kidney sections.

Results

32 patients had autopsies done, of which 17 patients fulfilled our inclusion criteria. The median age was 64 (interquartile range (IQR) 50, 79), 70% were male, 18% were black, 42% had diabetes and 59% had hypertension. Of the 17 patients, clinical evidence of AKI was present in 12 (71%) patients; 4/12 (33%) had Stage 1 AKI, 6/12 (50%) had Stage 2 AKI, and 2/12 (17%) had stage 3 AKI. Median peak creatinine was 0.96 mg/dL IQR 0.92-1.23 in those without AKI and 2.98 mg/dL IQR 2.11 – 5.99 in those with AKI. 3 patients had urine studies performed, only one of them had AKI and had hematuria, proteinuria, and leukocyturia. On histopathology, 9/17(53%) had acute tubular injury (ATI) only (Fig 1A & B) and 1/17 (5%) had TMA and ATI (Fig 1C). ATI was present in 4/5 (80%) of patients without AKI. There was no TMA found in patients without AKI. Glomerular pathology included nodular sclerosis in diabetic nephropathy (Fig 1D) and glomerulosclerosis secondary to ischemic hypertension. Virus was found in 4 samples (Fig 1E & F).

Conclusion

There is direct involvement of kidney by SARS-CoV-2 supported by identification of viral particles by TEM, and by ISH RNAscope. The most common histopathologic finding in patients that died with COVID-19 was ATI, which was also present in patients who did not have AKI by serum creatinine criteria.