Kidney Biopsy Findings in a Critically Ill COVID-19 Patient With Dialysis-Dependent Acute Kidney Injury: A Case Against “SARS-CoV-2 Nephropathy”

摘要

It is unclear whether in patients with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, acute kidney injury (AKI) results from direct infection of the kidneys or from complications arising in the course of coronavirus disease 2019 (COVID-19). Re- ports of urinary abnormalities in COVID-19 patients, S1 positive staining of tubules with viral antigens and com- plement components in one autoptic series, 1 visualization of viral particles in tubular epithelial cells and podocytes on ultrastructural examination in another, 2 and isolation of SARS-CoV-2 in urine S2,S3 raised the possibility of a SARS-CoV-2 nephropathy. We describe the clinical course, renal histopathology, and molecular testing of renal tissue, serum, and urinary samples of a critically ill patient with COVID-19 who developed oligoanuric AKI. The absence of viral genetic material in tested spec- imens and lack of histologic evidence for cytopathic ef- fects do not support the hypothesis of the kidneys as target organs of SARS-CoV-2 infection.