Evidence For and Against Direct Kidney Infection by SARS-CoV-2 in Patients with COVID-19

Link to article at PubMed

Clin J Am Soc Nephrol. 2021 Jun 14:CJN.04560421. doi: 10.2215/CJN.04560421. Online ahead of print.


Despite evidence of multi-organ tropism of SARS-CoV-2 in patients with COVID-19, direct viral kidney invasion has been difficult to demonstrate. The question of whether SARS-CoV-2 can directly infect the kidney is relevant to the understanding of pathogenesis of acute kidney injury and collapsing glomerulopathy in COVID-19. Methodologies to document SARS-CoV-2 infection that have been used include immunohistochemistry, immunofluorescence, reverse transcriptase polymerase chain reaction (RT-PCR), in situ hybridization and electron microscopy. In our review of studies to date we found that SARS-CoV-2 in the kidney of patients with COVID-19 was detected in 18 of 94 (19%) by immuno-histochemistry, 71 of 144 (49%) by RT-PCR and 11 of 84 (13%) by in situ hybridization. In a smaller number of patients with COVID-19 examined by immunofluorescence, SARS-CoV-2 was detected in 10 of 13 (77%). In total, in kidneys from 102 of 235 patients (43.4%), the presence of SARS-CoV-2 was suggested by at least one of the methods used. Despite these positive findings, caution is needed as many other studies have been negative for SARS-CoV-2 presence and it should be noted that when detected it was only in kidneys obtained at autopsy. There is a clear need for studies from kidney biopsies, including those performed at early stages of the COVID-19 associated kidney disease. Development of tests to detect kidney viral infection in urine samples would be more practical as a non-invasive way to evaluate SARS CoV-2 infection during the evolution of COVID-19-associated kidney disease.

PMID:34127485 | DOI:10.2215/CJN.04560421

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