Despite evidence of multiorgan tropism of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in patients with coronavirus disease 2019 (COVID-19), direct viral kidney invasion has been difficult to demonstrate. The question of whether SARS-CoV2 can directly infect the kidney is relevant to the understanding of pathogenesis of AKI and collapsing glomerulopathy in patients with COVID-19. Methodologies to document SARS-CoV-2 infection that have been used include immunohistochemistry, immunofluorescence, RT-PCR, in situ hybridization, and electron microscopy. In our review of studies to date, we found that SARS-CoV-2 in the kidneys of patients with COVID-19 was detected in 18 of 94 (19%) by immunohistochemistry, 71 of 144 (49%) by RT-PCR, and 11 of 84 (13%) by in situ hybridization. In a smaller number of patients with COVID-19 examined by immunofluorescence, SARS-CoV-2 was detected in 10 of 13 (77%). In total, in kidneys from 102 of 235 patients (43%), the presence of SARS-CoV-2 was suggested by at least one of the methods used. Despite these positive findings, caution is needed because many other studies have been negative for SARS-CoV-2 and it should be noted that when detected, it was only in kidneys obtained at autopsy. There is a clear need for studies from kidney biopsies, including those performed at early stages of the COVID-19–associated kidney disease. Development of tests to detect kidney viral infection in urine samples would be more practical as a noninvasive way to evaluate SARS-CoV-2 infection during the evolution of COVID-19–associated kidney disease.

尽管有证据表明 2019 年冠状病毒病 (COVID-19) 患者具有严重急性呼吸综合征冠状病毒 2 (SARS-CoV-2) 的多器官趋向性，但很难证明病毒直接侵入肾脏。 SARS-CoV2是否可以直接感染肾脏的问题与了解COVID-19患者AKI和塌陷性肾小球病的发病机制有关。已使用的记录 SARS-CoV-2 感染的方法包括免疫组织化学、免疫荧光、RT-PCR、原位杂交和电子显微镜。在我们迄今为止的研究回顾中，我们发现，94 例患者中的 18 例（19%）通过免疫组织化学检测到了 COVID-19 患者肾脏中的 SARS-CoV-2，通过 RT-PCR 检测到了 144 例中的 71 例（49%）， 84 个中的 11 个 (13%) 通过原位杂交。在少数通过免疫荧光检查的 COVID-19 患者中，13 名患者中的 10 名（77%）检测到了 SARS-CoV-2。总的来说，在 235 名患者中的 102 名患者 (43%) 的肾脏中，至少使用一种方法表明存在 SARS-CoV-2。尽管有这些积极的发现，但仍需谨慎，因为许多其他研究对 SARS-CoV-2 呈阴性，而且应该指出的是，检测时仅在尸检时获得的肾脏中进行检测。显然需要进行肾活检研究，包括在 COVID-19 相关肾病早期阶段进行的研究。开发检测尿液样本中肾脏病毒感染的测试作为评估 COVID-19 相关肾脏疾病演变过程中 SARS-CoV-2 感染的非侵入性方法将更加实用。