Abstract
Kidney involvement appears to be frequent in coronavirus disease 2019 (COVID-19). Despite this, information concerning renal involvement in COVID-19 is still scarce. Several mechanisms appear to be involved in the complex relationship between the virus and the kidney. Also, different morphological patterns have been described in the kidneys of patients with COVID-19. For some authors, however, this association may be just a coincidence. To investigate this issue, we propose assessing renal morphology associated with COVID-19 at the renal pathology reference center of federal university hospitals in Brazil. Data will come from a consortium involving 17 federal university hospitals belonging to Empresa Brasileira de Serviços Hospitalares (EBSERH) network, as well as some state hospitals and an autopsy center. All biopsies will be sent to the referral center for renal pathology of the EBSERH network. The data will include patients who had coronavirus disease, both alive and deceased, with or without pre-existing kidney disease. Kidney biopsies will be analyzed by light, fluorescence, and electron microscopy. Furthermore, immunohistochemical (IHC) staining for various inflammatory cells (i.e., cells expressing CD3, CD20, CD4, CD8, CD138, CD68, and CD57) as well as angiotensin-converting enzyme 2 (ACE2) will be performed on paraffinized tissue sections. In addition to ultrastructural assays, in situ hybridization (ISH), IHC and reverse transcription-polymerase chain reaction (RT-PCR) will be used to detect Severe Acute Respiratory Syndrome Coronavirus (SARS-CoV-2) in renal tissue. For the patients diagnosed with Collapsing Glomerulopathy, peripheral blood will be collected for apolipoprotein L-1 (APOL1) genotyping. For patients with thrombotic microangiopathy, thrombospondin type 1 motif, member 13 (ADAMTS13), antiphospholipid, and complement panel will be performed. The setting of this study is Brazil, which is second behind the United States in highest confirmed cases and deaths. With this complete approach, we hope to help define the spectrum and impact, whether immediate or long-term, of kidney injury caused by SARS-CoV-2.
Highlights
The coronavirus disease 2019 (COVID-19) caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has rapidly spread globally
For the patients diagnosed with collapsing glomerulopathy (CG), peripheral blood will be collected for apolipoprotein L-1 (APOL1) genotyping
Renal involvement is common in cases of COVID-19
Summary
The coronavirus disease 2019 (COVID-19) caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has rapidly spread globally. Kidney involvement is relatively common with this infection: 59% of patients present with proteinuria, 44% with hematuria, and 10–14% with azotemia. This is associated with increased morbidity and mortality, as this acute renal injury can be fatal, especially when associated with other underlying diseases [2]. Numerous morphological patterns have been described in the kidneys of patients with COVID-19, including renal infarction [3,4,5], collapsing glomerulopathy (CG) [6,7,8,9,10], tubulointerstitial nephritis [11], acute tubular injury, [2, 12, 13] acute pyelonephritis, rhabdomyolysis, lymphocytic infiltrates, and focal segmental glomerulosclerosis [14], isometric vacuoles in the proximal tubular epithelium [12, 14] and thrombotic microangiopathy (TMA) [15]
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