SARS-CoV-2 causes a specific dysfunction of the kidney proximal tubule

Alexis Werion, Leila Belkhir, Marie Perrot, Gregory Schmit, Selda Aydin, Zhiyong Chen, Andrea Penaloza, Julien De Greef, Halil Yildiz, Lucie Pothen, Jean Cyr Yombi, Joseph Dewulf, Anais Scohy, Ludovic Gérard, Xavier Wittebole, Pierre François Laterre, Sara E. Miller, Olivier Devuyst, Michel Jadoul, Johann MorelleFrank Aboubakar, Souad Acid, Nadia Amini, Sarah Bailly, Christophe Beauloye, Diego Castanares-Zapatero, Emmanuel Coche, Christine Collienne, Pascale Cornette, Isabelle De Brauwer, Mélanie Dechamps, Florence Dupriez, Antoine Froidure, Quentin Garnir, Bernhard Gerber, Benoît Ghaye, Isabelle Gilard, Sophie Gohy, Charles Grégoire, Philippe Hantson, Luc Marie Jacquet, Benoit Kabamba, Shakeel Kautbally, Nicolas Lanthier, Fatima Larbaoui, Giuseppe Liistro, Frédéric Maes, Virginie Montiel, Benny Mwenge, Sophie Pierard, Charles Pilette, Anne Catherine Pouleur, Amaury Sogorb, Peter Starkel, Hector Rodriguez-Villalobos, Maximilien Thoma, Olivier Van Caeneghem, David Vancraeynest

Research output: Contribution to journalArticlepeer-review


Coronavirus disease 2019 (COVID-19) is commonly associated with kidney damage, and the angiotensin converting enzyme 2 (ACE2) receptor for SARS-CoV-2 is highly expressed in the proximal tubule cells. Whether patients with COVID-19 present specific manifestations of proximal tubule dysfunction remains unknown. To test this, we examined a cohort of 49 patients requiring hospitalization in a large academic hospital in Brussels, Belgium. There was evidence of proximal tubule dysfunction in a subset of patients with COVID-19, as attested by low-molecular-weight proteinuria (70-80%), neutral aminoaciduria (46%), and defective handling of uric acid (46%) or phosphate (19%). None of the patients had normoglycemic glucosuria. Proximal tubule dysfunction was independent of pre-existing comorbidities, glomerular proteinuria, nephrotoxic medications or viral load. At the structural level, kidneys from patients with COVID-19 showed prominent tubular injury, including in the initial part of the proximal tubule, with brush border loss, acute tubular necrosis, intraluminal debris, and a marked decrease in the expression of megalin in the brush border. Transmission electron microscopy identified particles resembling coronaviruses in vacuoles or cisternae of the endoplasmic reticulum in proximal tubule cells. Among features of proximal tubule dysfunction, hypouricemia with inappropriate uricosuria was independently associated with disease severity and with a significant increase in the risk of respiratory failure requiring invasive mechanical ventilation using Cox (adjusted hazard ratio 6.2, 95% CI 1.9-20.1) or competing risks (adjusted sub-distribution hazard ratio 12.1, 95% CI 2.7-55.4) survival models. Thus, our data establish that SARS-CoV-2 causes specific manifestations of proximal tubule dysfunction and provide novel insights into COVID-19 severity and outcome.

Original languageEnglish
Pages (from-to)1296-1307
Number of pages12
JournalKidney international
Issue number5
Publication statusPublished - Nov 2020
Externally publishedYes


  • COVID-19
  • kidney
  • renal Fanconi syndrome
  • severe acute respiratory syndrome


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