Human Kidney is a Target for Novel Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) Infection

  1. Bo Diao
  2. Chenhui Wang
  3. Rongshuai Wang
  4. Zeqing Feng
  5. Yingjun Tan
  6. Huiming Wang
  7. Changsong Wang
  8. Liang Liu
  9. Ying Liu
  10. Yueping Liu
  11. Gang Wang
  12. Zilin Yuan
  13. Liang Ren
  14. Yuzhang Wu
  15. Yongwen Chen
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Abstract

BACKGROUND

The outbreak of a novel coronavirus (SARS-CoV-2, previously provisionally named 2019 novel coronavirus or 2019-nCoV) since December 2019 in Wuhan, China, has become an emergency of major international concern. Apart from the respiratory system, it is unclear whether SARS-CoV-2 can also directly infect other tissues such as the kidney or induce acute renal failure.

METHODS

We conducted a retrospective analysis of estimated glomerular filtration rate (eGFR) along with other clinical parameters from 85 patients with laboratory-confirmed COVID-19 admitted to a hospital in Wuhan from January 17, 2020 to March 3, 2020. Kidney tissues from six patients with postmortem examinations were analyzed by Hematoxylin and Eosin (H&E) and in situ expression of viral nucleocaspid protein (NP) antigen, immune cell markers (CD8, CD68 and CD56) and the complement C5b-9 was detected by immunohistochemistry. Moreover, the viral particles in kidneys were also investigated by transmission electronic microscope (EM).

RESULTS

27.06% (23/85) patients exhibited acute renal failure (ARF). The eldery patients and cases with comorbidities such as hypertension and heart failure more easily developed ARF (65.22% vs 24.19%, p < 0.001; 69.57% vs 11.29%, p < 0.001, respectively). H&E staining demonstrated kidney tissues from postmortems have severe acute tubular necrosis and lymphocyte infiltration. Immunohistochemistry showed that SARS-CoV-2 NP antigen was accumulated in kidney tubules. EM observation also demonstrated that viruses-like particles are visible in the kidneys. Viral infection not only induces CD68 + macrophages infiltrated into tubulointerstitium, but also enhances complement C5b-9 deposition on tubules.

CONCLUSIONS

SARS-CoV-2 induces ARF in COVID-19 patients. Viruses directly infect human kidney tubules to induce acute tubular damage. The viruses not only have direct cytotoxicity, but also initiate CD68 + macrophage together with complement C5b-9 deposition to mediate tubular pathogenesis.

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