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    Pathology for COVID-19 Nephropathies

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    PATHOLOGY from Kidney Team

    COVID-19 Nephropathies by Lynn D. Cornell, MD and Robert B. Colvin, MD

    Glomerular Thrombi and Acute Tubular Injury

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    Kidney from patient with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) who died in Wuhan is shown. Glomerular thrombi are indications of the thrombotic microangiopathy that occurs in COVID-19. Tubules show marked loss of brush borders. (Courtesy C. Zhang, MD and H. Su, MD.)

    Platelet Thrombi in Glomeruli

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    Thrombotic microangiopathy is a common and serious consequence in COVID-19 disease. Platelets can be demonstrated in glomeruli with anti-CD61, as in this autopsy case. (Courtesy J. Stone, MD, PhD.)

    Collapsing Glomerulopathy

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    A biopsy from a patient with COVID-19 infection shows a lesion of collapsing focal segmental glomerulosclerosis with podocyte proliferation and tubular microcysts.

    Glomerular Ischemic Collapse and Peritubular Capillary Congestion

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    Kidney from a patient who died in Wuhan is shown. Glomerular ischemic collapse is evident as well as widespread acute tubular injury with vacuoles and congestion in peritubular capillaries. (Courtesy C. Zhang, MD and H. Su MD.)

    Tubular Injury and Interstitial Inflammation

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    A biopsy from a patient with COVID-19 infection and collapsing glomerulopathy also showed acute tubular injury and an interstitial nephritis with increased plasma cells, which may be related to the glomerulopathy.

    Clathrin Coated Vesicle

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    A probable clathrin coated vesicle is seen within the tubular epithelial cell cytoplasm in a patient with COVID-19 and acute tubular necrosis.

    Membranous Glomerulonephritis

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    A patient with COVID-19 had acute kidney injury and nephrotic range proteinuria. A kidney biopsy showed membranous glomerulonephritis. Subepithelial deposits are seen.
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    A patient with COVID-19 had acute kidney injury and nephrotic range proteinuria. A kidney biopsy showed membranous glomerulonephritis. Subepithelial deposits are seen, as is a tubuloreticular inclusion in an endothelial cell.

    SARS-CoV Nucleoprotein in Proximal Tubules

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    Anti-SARS-CoV nucleoprotein shows antigen in proximal tubules in an autopsy sample from Wuhan. Viral particles were also detected in proximal tubules. Antibody 40143-T62, Sino Biological, Beijing. (Courtesy C. Zhang, MD and H. Su, MD.)

    ACE2 Expression in COVID-19

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    ACE2 is increased in the proximal tubules and parietal epithelial cells in this patient who died of COVID-19 in Wuhan. The peritubular capillaries are negative. Normal kidney shows ACE2 only in proximal tubules. (Courtesy C. Zhang, MD and H. Su, MD.)

    Viral-Like Particle in Podocyte

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    Suspicious structure in podocyte in autopsy kidney from a patient with SARS-CoV-2 is shown. However, the viral nature of these structures has been challenged, since similar multivesicular bodies can be seen in podocytes of non-infected patients,. Note glomerular basement membrane. (Courtesy S. Rotman, MD.)

    Multivesicular Body in Podocyte

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    These structures can be confused with viruses since the exosomes inside are about the same size and shape. This image is from a podocyte in a renal biopsy before the SARS-CoV-2 era. (Courtesy T. Nadasdy, MD.)

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