German researchers find viral RNA in kidneys of patients who died from COVID-19.
Higher rates of acute kidney injury (AKI) have been documented among patients with coronavirus disease 2019 (COVID-19), but correspondence appearing in The Lancet this week sheds new light on this troubling connection: the virus causing the pandemic can specifically attack the kidneys, causing severe illness and early death.
Authors from 2 German institutions, the University Medical Center Hamburg-Eppendorf and the University of Gottigen, led by Tobias Huber, MD, examined kidney samples from 63 patients who died after developing SARS-CoV-2 respiratory infection. They found SARS-CoV-2 RNA in 60% of the patients, and this RNA presence in the kidneys “was associated with older age and an increased number of coexisting conditions.”
The research team found that patients with SARS-CoV2 RNA had a shorter span between diagnosis and death, supporting a correlation between the virus attacking organs beyond the respiratory system and death in the first 3 weeks after diagnosis.
Among the 63 patients, 39 (62%) already showed kidney problems before death; among this group, 23 of 32 patients with AKI had SARS-CoV-2 RNA present in their kidneys after death. For those without AKI, viral RNA was found in 3 of 7 patients.
When the researchers isolated SARS-CoV-2 from an autopsied kidney, and examined samples in vitro, they were able to produce “a 1000-times increase in viral RNA,” in 48 hours, thus showing that the virus remained active even after the patient died.
“This suggests that SARS-CoV-2 is able to target the kidney, pointing towards the importance of early urinary testing and eventual therapeutic prevention of kidney infection,” they wrote.
Braun F, Lütgehetmann M, Pfefferle S, et al. SARS-CoV-2 renal tropism associates with acute kidney injury. Lancet. Published online August 17, 2020. DOI: https://doi.org/10.1016/S0140-6736(20)31759-1.