COVID-19 and Acute Kidney Injury: Fascinating Kidney Biopsy findings in a short Case Series

Abstract

AKI has been observed as a common problem of coronavirus disease 2019 (COVID-19) on frequent occasions in patients with moderate to severe disease. These patients showed presence of proteinuria and microscopic hematuria. Outcomes of such patients are bad with higher mortality and many of those surviving have become dialysis dependent. Kidney biopsy features show variety of tubular and glomerular involvement with acute tubular injury being a common finding.

Methods: We evaluated clinical features of four patients at our institution who had COVID-19 and AKI, with proteinuria with or without hematuria and their kidney biopsy findings. We describe clinical presentation, histopathologic findings and further course of our patients.

Results: This study includes four patients with COVID 19 who had proteinuria and renalimpairment with two requiring dialysis. We performed kidney biopsy in all four patients. Allkidney biopsies showed acute tubular necrosis. Further, additional features were seen in 3patients including minimal change disease, pauci-immunecrescentic GN, and focal as well as Segmental glomerulosclerosis in each patient. In one patient electron microscopy was done to assess ultrastructural evidence of viral particles and it was negative.

Conclusions: Acute tubular necrosis was found in all our patients who suffered from COVID-19 with acute kidney injury. SARS-CoV-2 particles were not seen when one kidneybiopsy sample was subjected to electron microscopy.