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Case Reports
. 2020 Jul;98(1):228-231.
doi: 10.1016/j.kint.2020.04.006. Epub 2020 Apr 15.

Collapsing glomerulopathy in a COVID-19 patient

Sébastien Kissling  1 , Samuel Rotman  2 , Christel Gerber  3 , Matthieu Halfon  1 , Frédéric Lamoth  4 , Denis Comte  5 , Loïc Lhopitallier  6 , Salima Sadallah  5 , Fadi Fakhouri  7
Affiliations
Case Reports

Collapsing glomerulopathy in a COVID-19 patient

Sébastien Kissling et al. Kidney Int. 2020 Jul.
No abstract available

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Figures

Figure 1
Figure 1
A 63-year-old black male patient was admitted for acute respiratory distress associated with novel coronavirus disease 2019. (a) The main laboratory results for this patient are shown. He rapidly developed acute kidney injury without hemodynamic compromise. His respiratory status improved but inflammatory syndrome persisted and renal function further deteriorated. (b–d) Illustrative images of his kidney biopsy are shown. Light microscopy study (Masson's trichrome stain, original magnification [b,d] ×200 and [c] ×400) showed the following: first, a severe collapsing glomerulopathy (focal segmental glomerulosclerosis) characterized by (b,c) the global collapse of shrinking capillary loops and the detachment from the basement membrane of (b) hypertrophic, proliferating podocytes (or “cobblestone pattern,” [asterisk]), which contained numerous (c) protein reabsorption vacuoles (asterisk). (d) Second, acute tubular lesions with focal tubular necrosis, dilatation, and the presence of intratubular reabsorption vacuoles (asterisks), reflecting the heavy proteinuria. Immunofluorescence study did not show any significant immune deposits. (e,f) Electron microscopy study (original magnification [e] ×15,000 and [f] ×73,000) disclosed within the podocytes cytoplasm vacuoles containing numerous (e) spherical particles (asterisk) measuring between 50 to 110 nm and surrounded by (f) spikes measuring 9 to 10 nm (“solar corona” [asterisk]). These particles may correspond to viral inclusion bodies reported with the emerging severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). AP50, alternative pathway activity 50%; Bb, Bb fragment; CCL, CC chemokine ligand; CH50, hemolytic complement activity 50%; CMV, cytomegalovirus; CXCL, CXC chemokine ligand; CRP, C-reactive protein; G, × 109; Hb, hemoglobin; IFN, interferon; IL, interleukin; Lym, lymphocytes; PCR, polymerase chain reaction; Plt, platelet count; PN, polynuclear neutrophils; SAlb, serum albumin; sC5b-9, soluble C5b-9; SCr, serum creatinine; TNF-β, tumor necrosis factor-β; UAlb/Cr, urinary albumin over creatinine ratio; UP/Cr, urinary protein over creatinine ratio; WBC, white blood cell count. To optimize viewing of this image, please see the online version of this article at www.kidney-international.org.
Figure 1
Figure 1
A 63-year-old black male patient was admitted for acute respiratory distress associated with novel coronavirus disease 2019. (a) The main laboratory results for this patient are shown. He rapidly developed acute kidney injury without hemodynamic compromise. His respiratory status improved but inflammatory syndrome persisted and renal function further deteriorated. (b–d) Illustrative images of his kidney biopsy are shown. Light microscopy study (Masson's trichrome stain, original magnification [b,d] ×200 and [c] ×400) showed the following: first, a severe collapsing glomerulopathy (focal segmental glomerulosclerosis) characterized by (b,c) the global collapse of shrinking capillary loops and the detachment from the basement membrane of (b) hypertrophic, proliferating podocytes (or “cobblestone pattern,” [asterisk]), which contained numerous (c) protein reabsorption vacuoles (asterisk). (d) Second, acute tubular lesions with focal tubular necrosis, dilatation, and the presence of intratubular reabsorption vacuoles (asterisks), reflecting the heavy proteinuria. Immunofluorescence study did not show any significant immune deposits. (e,f) Electron microscopy study (original magnification [e] ×15,000 and [f] ×73,000) disclosed within the podocytes cytoplasm vacuoles containing numerous (e) spherical particles (asterisk) measuring between 50 to 110 nm and surrounded by (f) spikes measuring 9 to 10 nm (“solar corona” [asterisk]). These particles may correspond to viral inclusion bodies reported with the emerging severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). AP50, alternative pathway activity 50%; Bb, Bb fragment; CCL, CC chemokine ligand; CH50, hemolytic complement activity 50%; CMV, cytomegalovirus; CXCL, CXC chemokine ligand; CRP, C-reactive protein; G, × 109; Hb, hemoglobin; IFN, interferon; IL, interleukin; Lym, lymphocytes; PCR, polymerase chain reaction; Plt, platelet count; PN, polynuclear neutrophils; SAlb, serum albumin; sC5b-9, soluble C5b-9; SCr, serum creatinine; TNF-β, tumor necrosis factor-β; UAlb/Cr, urinary albumin over creatinine ratio; UP/Cr, urinary protein over creatinine ratio; WBC, white blood cell count. To optimize viewing of this image, please see the online version of this article at www.kidney-international.org.
See this image and copyright information in PMC

Comment in

  • Visualization of putative coronavirus in kidney.
    Miller SE, Brealey JK. Miller SE, et al. Kidney Int. 2020 Jul;98(1):231-232. doi: 10.1016/j.kint.2020.05.004. Epub 2020 May 8. Kidney Int. 2020. PMID: 32437764 Free PMC article. No abstract available.

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