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Letter to the Editor
Open Access

Authors’ Reply

Jordan L. Rosenstock and Vanesa Bijol
JASN January 2021, 32 (1) 255-256; DOI: https://doi.org/10.1681/ASN.2020101479
Jordan L. Rosenstock
1Divison of Nephrology, Lenox Hill Hospital, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hofstra University, New York, New York
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Vanesa Bijol
2Department of Pathology, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hofstra University, Hempstead, New York
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  • COVID AKI
  • COVID-19

Zijlstra et al.1 question whether delay to postmortem biopsy and ensuing tissue autolysis could have interfered with our molecular diagnostics. They ask how long after death were biopsies done in our study, and suggest that studies using more rapid postmortem biopsy might be more productive. Supplemental Table 1, included in our paper,2 provided the times between death and biopsy. Out of 12 cases, 11 were biopsied within 24 hours postmortem; three were performed within 2.5 hours. The fastest time to biopsy was 1.5 hours. A number of the cases had mild or no autolysis, as seen in Table 1. Similarly, Santoriello et al.3 did not find any clear evidence of viral infection of kidney in a postmortem series of 42 patients, many of whom had mild or absent autolysis. We acknowledge there remains the possibility that postmortem autolysis could interfere with the detection of the virus, although it must be emphasized that, in both of these aforementioned studies, lung specimens from autopsies used as controls were clearly positive for the virus. Corroborating our findings are two series of renal biopsy specimens in living patients with coronavirus disease 2019 included in the same issue of JASN.4,5 In these series (the majority in patients who had severe AKI), they also found no clear evidence of viral infection of the kidney, by ultrastructural examination in addition to immunohistochemical staining for viral spike and nucleocapsid proteins, and in situ hybridization for severe acute respiratory syndrome coronavirus 2 viral RNA. The conclusions of these four reports, two in living and two in postmortem kidneys, are consistent: it does not appear likely that direct viral infection is a primary contributor to renal dysfunction in patients with coronavirus disease 2019.

Disclosures

J. Rosenstock is an editorial board member of International Urology and Nephrology. V. Bijol reports honoraria from International Society of Nephrology.

Funding

None.

Footnotes

  • Published online ahead of print. Publication date available at www.jasn.org.

  • See related letter to the editor, “Post-Mortem Diagnostics in COVID-19 AKI, More Often but Timely,” on page 255, and original article “Histopathologic and Ultrastructural Findings in Postmortem Kidney Biopsy Material in 12 Patients with AKI and COVID-19,” in Vol. 31, Iss. 9, 1944–1947.

  • Copyright © 2021 by the American Society of Nephrology

References

  1. ↵
    1. Zijlstra J,
    2. van Meurs M,
    3. Moser J
    : Post-mortem diagnostics in COVID-19, more often but timely. J Am Soc Nephrol 32: 255, 2021
    OpenUrlFREE Full Text
  2. ↵
    1. Golmai P,
    2. Larsen CP,
    3. DeVita MV,
    4. Wahl SJ,
    5. Weins A,
    6. Rennke HG, et al
    .: Histopathologic and ultrastructural findings in postmortem kidney biopsy material in 12 patients with AKI and COVID-19. J Am Soc Nephrol 31: 1944–1947, 2020pmid:32675304
    OpenUrlFREE Full Text
  3. ↵
    1. Santoriello D,
    2. Khairallah P,
    3. Bomback AS,
    4. Xu K,
    5. Kudose S,
    6. Batal I, et al
    .: Postmortem kidney pathology findings in patients with COVID-19. J Am Soc Nephrol 31: 2158–2167, 2020pmid:32727719
    OpenUrlAbstract/FREE Full Text
  4. ↵
    1. Sharma P,
    2. Uppal NN,
    3. Wanchoo R,
    4. Shah HH,
    5. Yang Y,
    6. Parikh R, et al
    .; Northwell Nephrology COVID-19 Research Consortium: COVID-19 associated kidney injury: A case series of kidney biopsy findings. J Am Soc Nephrol 31: 1948–1958, 2020pmid:32660970
    OpenUrlAbstract/FREE Full Text
  5. ↵
    1. Kudose S,
    2. Batal I,
    3. Santoriello D,
    4. Xu K,
    5. Barasch J,
    6. Peleg Y, et al
    .: Kidney biopsy findings in patients with COVID-19. J Am Soc Nephrol 31: 1959–1968, 2020pmid:32680910
    OpenUrlAbstract/FREE Full Text
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Journal of the American Society of Nephrology: 32 (1)
Journal of the American Society of Nephrology
Vol. 32, Issue 1
January 2021
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Jordan L. Rosenstock, Vanesa Bijol
JASN Jan 2021, 32 (1) 255-256; DOI: 10.1681/ASN.2020101479
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