{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,30]],"date-time":"2026-09-30T03:39:21Z","timestamp":1790739561416,"version":"4.1.0"},"reference-count":15,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"8","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JASN"],"published-print":{"date-parts":[[2020,8]]},"abstract":"\n Significance Statement<\/jats:title>\n The cause of kidney injury in COVID-19 is unclear. In an autopsy study of a single patient with COVID-19 and acute oliguric renal failure, the authors identified intracellular viral arrays within proximal tubular epithelial cells by electron microscopy, consistent with direct infection of the kidney by SARS-CoV-2. They also found ultrastructural features similar to those described in reports of kidney cell lines infected with the related SARS-CoV-1 virus. Virally infected tubular cells showed isometric vacuolization on light microscopy. These findings provide confirmatory evidence of direct kidney infection by SARS-CoV-2 in a patient. However, this work does not exclude other causes of kidney injury, and additional study is needed to determine the frequency and clinical significance of direct kidney infection on renal failure in COVID-19.<\/jats:p>\n <\/jats:sec>\n \n Background<\/jats:title>\n A significant fraction of patients with coronavirus disease 2019 (COVID-19) display abnormalities in renal function. Retrospective studies of patients hospitalized with COVID-19 in Wuhan, China, report an incidence of 3%\u20137% progressing to ARF, a marker of poor prognosis. The cause of the renal failure in COVID-19 is unknown, but one hypothesized mechanism is direct renal infection by the causative virus, SARS-CoV-2.<\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n We performed an autopsy on a single patient who died of COVID-19 after open repair of an aortic dissection, complicated by hypoxic respiratory failure and oliguric renal failure. We used light and electron microscopy to examine renal tissue for evidence of SARS-CoV-2 within renal cells.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n Light microscopy of proximal tubules showed geographic isometric vacuolization, corresponding to a focus of tubules with abundant intracellular viral arrays. Individual viruses averaged 76\n \u00b5<\/jats:italic>\n m in diameter and had an envelope studded with crown-like, electron-dense spikes. Vacuoles contained double-membrane vesicles suggestive of partially assembled virus.\n <\/jats:p>\n <\/jats:sec>\n \n Conclusions<\/jats:title>\n The presence of viral particles in the renal tubular epithelium that were morphologically identical to SARS-CoV-2, and with viral arrays and other features of virus assembly, provide evidence of a productive direct infection of the kidney by SARS-CoV-2. This finding offers confirmatory evidence that direct renal infection occurs in the setting of AKI in COVID-19. However, the frequency and clinical significance of direct infection in COVID-19 is unclear. Tubular isometric vacuolization observed with light microscopy, which correlates with double-membrane vesicles containing vacuoles observed with electronic microscopy, may be a useful histologic marker for active SARS-CoV-2 infection in kidney biopsy or autopsy specimens.<\/jats:p>\n <\/jats:sec>","DOI":"10.1681\/asn.2020040432","type":"journal-article","created":{"date-parts":[[2020,5,5]],"date-time":"2020-05-05T14:05:00Z","timestamp":1588687500000},"page":"1683-1687","source":"Crossref","is-referenced-by-count":298,"title":["Ultrastructural Evidence for Direct Renal Infection with SARS-CoV-2"],"prefix":"10.1681","volume":"31","author":[{"given":"Evan A.","family":"Farkash","sequence":"first","affiliation":[{"name":"Department of Pathology, University of Michigan Medical School, Ann Arbor, Michigan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Allecia M.","family":"Wilson","sequence":"additional","affiliation":[{"name":"Department of Pathology, University of Michigan Medical School, Ann Arbor, Michigan"},{"name":"Washtenaw County Medical Examiner\u2019s Office, Ann Arbor, Michigan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jeffrey M.","family":"Jentzen","sequence":"additional","affiliation":[{"name":"Department of Pathology, University of Michigan Medical School, Ann Arbor, Michigan"},{"name":"Washtenaw County Medical Examiner\u2019s Office, Ann Arbor, Michigan"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2020,5,6]]},"reference":[{"key":"B1-20230829","doi-asserted-by":"crossref","first-page":"829","DOI":"10.1016\/j.kint.2020.03.005","article-title":"Kidney disease is associated with in-hospital death of patients with COVID-19","volume":"97","author":"Cheng","year":"2020","journal-title":"Kidney Int"},{"key":"B2-20230829","doi-asserted-by":"crossref","first-page":"824","DOI":"10.1016\/j.kint.2020.03.001","article-title":"The Novel Coronavirus 2019 epidemic 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