Table 1.

Key teaching points

1.Real-time reverse transcriptase polymerase chain reaction for SARS-CoV-2 on frozen kidney tissue, serum, and urinary samples collected the same day the kidney biopsy was performed were negative despite repeatedly positive nasal and oropharyngeal swabs, thus ruling out direct infection of the kidney.

2.Glomerular and vascular lesions were absent. No morphologic correlate of cytopathy was observed (e.g., syncytia, inclusion bodies, nuclear atypia). Viral particles were absent on ultrastructural examination. The predominant histologic picture was that of acute tubular injury, most likely related to acute heart failure, and therefore renal hypoperfusion.

3.This case does not support viral tropism of the kidney by SARS-CoV-2 inducing acute kidney injury as previously suggested by autopsy series, highlighting the necessity for experimental proof of productive infection of renal cells to support a SARS-CoV-2 nephropathy and not merely morphologic data.

SARS-CoV-2, severe acute respiratory syndrome coronavirus 2.