FIGURE 4.

A 67-year-old female presents with a cough and fevers. SARS-CoV-2 pneumonia is confirmed. In the next few days, her laboratory data showed worsening anemia and thrombocytopenia. Her clinical course deteriorates where she requires intubation and pressor support. Her kidney function worsens requiring kidney replacement therapy. After platelet transfusion, a kidney biopsy is performed. The biopsy confirms cortical necrosis with acute TMA. Renal cortical necrosis is the most severe expression of TMA and is characterized by coagulative necrosis with degenerative changes of all cell types and involved structures, including tubules, glomeruli and the vasculature. Adjacent parenchyma may exhibit reactive changes (hematoxylin and eosin stain, ×100).