Kidney Biopsy Findings in Patients with COVID-19

Satoru Kudose, Ibrahim Batal, Dominick Santoriello, Katherine Xu, Jonathan Barasch, Yonatan Peleg, Pietro Canetta, Lloyd E. Ratner, Maddalena Marasa, Ali G. Gharavi, M. Barry Stokes, Glen S. Markowitz, Vivette D. D’Agati*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

246 Scopus citations


Background Coronavirus disease 2019 (COVID-19) is thought to cause kidney injury by a variety of mechanisms. To date, pathologic analyses have been limited to patient reports and autopsy series. Methods We evaluated biopsy samples of native and allograft kidneys from patients with COVID-19 at a single center in New York City between March and June of 2020. We also used immunohistochemistry, in situ hybridization, and electron microscopy to examine this tissue for presence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Results The study group included 17 patients with COVID-19 (12 men, 12 black; median age of 54 years). Sixteen patients had comorbidities, including hypertension, obesity, diabetes, malignancy, or a kidney or heart allograft. Nine patients developed COVID-19 pneumonia. Fifteen patients (88%) presented with AKI; nine had nephrotic-range proteinuria. Among 14 patients with a native kidney biopsy, 5 were diagnosed with collapsing glomerulopathy, 1 was diagnosed with minimal change disease, 2 were diagnosed with membranous glomerulopathy, 1 was diagnosed with crescentic transformation of lupus nephritis, 1 was diagnosed with anti-GBM nephritis, and 4 were diagnosed with isolated acute tubular injury. The three allograft specimens showed grade 2A acute T cell–mediated rejection, cortical infarction, or acute tubular injury. Genotyping of three patients with collapsing glomerulopathy and the patient with minimal change disease revealed that all four patients had APOL1 high-risk gene variants. We found no definitive evidence of SARS-CoV-2 in kidney cells. Biopsy diagnosis informed treatment and prognosis in all patients. Conclusions Patients with COVID-19 develop a wide spectrum of glomerular and tubular diseases. Our findings provide evidence against direct viral infection of the kidneys as the major pathomechanism for COVID-19–related kidney injury and implicate cytokine-mediated effects and heightened adaptive immune responses.

Original languageEnglish (US)
Pages (from-to)1959-1968
Number of pages10
JournalJournal of the American Society of Nephrology
Issue number9
StatePublished - Sep 2020
Externally publishedYes

ASJC Scopus subject areas

  • Nephrology


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