Legend to Figure:Main laboratory results of a 63-year old black male patient admitted for acute respiratorydistress associated to novel coronavirus disease (COVID-19) are shown in the upper panel(A). He rapidly developed acute kidney injury without hemodynamic compromise. Hisrespiratory status improved but inflammatory syndrome persisted and renal function furtherdeteriorated. Illustrative images of his kidney biopsy are shown in the lower panel B, C andD). Light microscopy study (FAOG stain, original magnification x 200 (B and D) and x 400(C)) showed: 1) a severe collapsing glomerulopathy (focal segmental glomerulosclerosis)characterized by the global collapse of shrinking capillary loops (B and C) and thedetachment from the basement membrane of hypertrophic, proliferating podocytes(“cobblestone pattern”, *, B) which contained numerous proteins reabsorption vacuoles (*,C). 2) acute tubular lesions (D) with focal tubular necrosis, dilatation and the presence ofintratubular reabsorption vacuoles (*, D) reflecting the heavy proteinuria.Immunofluorescence study did not show any significant immune deposits.Electron microscopy study (E, x 15000 and F, x 73000) disclosed within the podocytescytoplasm vacuoles containing numerous spherical particles (*, E) measuring between 50 to110 nm and surrounded by spikes measuring 9-10nm (*, F). These particles have the typicalappearance (“solar corona”) of viral inclusion bodies reported with the emerging severe acuterespiratory syndrome coronavirus 2 (SARS-CoV-2)3.Abbreviations: SCr, serum creatinine. UP/Cr. Urinary protein over creatinine ratio. UAlb/Cr, urinaryalbumin over creatinine ratio. CRP, C-reactive protein. SARS-CoV-2, severe acute respiratorysyndrome coronavirus 2. WBC, white blood cell count. PN, polynuclear neutrophils. Lym,lymphocytes. Hb, haemoglobin. Plt, platelet count. IL, interleukin. IFN, interferon. CCL, CXCL, TNF,tumor necrosis factor. CH50, haemolytic complement activity 50%. AP50, alternative pathwayactivity 50%. sC5b-9, soluble C5b-9. HIV, human immunodeficiency virus. CMV, cytomegalovirus.
Legend to Figure:<br>Main laboratory results of a 63-year old black male patient admitted for acute respiratory<br>distress associated to novel coronavirus disease (COVID-19) are shown in the upper panel<br>(A). He rapidly developed acute kidney injury without hemodynamic compromise. His<br>respiratory status improved but inflammatory syndrome persisted and renal function further<br>deteriorated. Illustrative images of his kidney biopsy are shown in the lower panel B, C and<br>D). Light microscopy study (FAOG stain, original magnification x 200 (B and D) and x 400<br>(C)) showed: 1) a severe collapsing glomerulopathy (focal segmental glomerulosclerosis)<br>characterized by the global collapse of shrinking capillary loops (B and C) and the<br>detachment from the basement membrane of hypertrophic, proliferating podocytes<br>(“cobblestone pattern”, *, B) which contained numerous proteins reabsorption vacuoles (*,<br>C). 2) acute tubular lesions (D) with focal tubular necrosis, dilatation and the presence of<br>intratubular reabsorption vacuoles (*, D) reflecting the heavy proteinuria.<br>Immunofluorescence study did not show any significant immune deposits.<br>Electron microscopy study (E, x 15000 and F, x 73000) disclosed within the podocytes<br>cytoplasm vacuoles containing numerous spherical particles (*, E) measuring between 50 to<br>110 nm and surrounded by spikes measuring 9-10nm (*, F). These particles have the typical<br>appearance (“solar corona”) of viral inclusion bodies reported with the emerging severe acute<br>respiratory syndrome coronavirus 2 (SARS-CoV-2)3.<br>Abbreviations: SCr, serum creatinine. UP/Cr. Urinary protein over creatinine ratio. UAlb/Cr, urinary<br>albumin over creatinine ratio. CRP, C-reactive protein. SARS-CoV-2, severe acute respiratory<br>syndrome coronavirus 2. WBC, white blood cell count. PN, polynuclear neutrophils. Lym,<br>lymphocytes. Hb, haemoglobin. Plt, platelet count. IL, interleukin. IFN, interferon. CCL, CXCL, TNF,<br>tumor necrosis factor. CH50, haemolytic complement activity 50%. AP50, alternative pathway<br>activity 50%. sC5b-9, soluble C5b-9. HIV, human immunodeficiency virus. CMV, cytomegalovirus.
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