title: A Case Report of a Middle East Respiratory Syndrome Survivor with Kidney Biopsy Results.
abstract: A 68-year old man diagnosed with Middle East Respiratory Syndrome-Coronavirus (MERS-CoV) presented with multiple pneumonic infiltrations on his chest X-ray, and the patient was placed on a mechanical ventilator because of progressive respiratory failure. Urinary protein excretion steadily increased for a microalbumin to creatinine ratio of 538.4 mg/g Cr and a protein to creatinine ratio of 3,025.8 mg/g Cr. The isotope dilution mass spectrometry traceable serum creatinine level increased to 3.0 mg/dL. We performed a kidney biopsy 8 weeks after the onset of symptoms. Acute tubular necrosis was the main finding, and proteinaceous cast formation and acute tubulointerstitial nephritis were found. There were no electron dense deposits observed with electron microscopy. We could not verify the virus itself by in situ hybridization and confocal microscopy (MERS-CoV co-stained with dipeptidyl peptidase 4). The viremic status, urinary virus excretion, and timely kidney biopsy results should be investigated with thorough precautions to reveal the direct effects of MERS-CoV with respect to renal complications.
authors.affiliation: Department of Internal Medicine, National Medical Center, Seoul, Korea .
authors.forename: Ran-Hui
authors.identifier: 0000-0003-2783-2600
authors.initials: RH
authors.lastname: Cha
authors.affiliation: Kidney Research Institute, Medical Research Center, Seoul National University College of Medicine, Seoul, Korea .
authors.forename: Seung Hee
authors.identifier: 0000-0002-8575-6610
authors.initials: SH
authors.lastname: Yang
authors.affiliation: Kidney Research Institute, Medical Research Center, Seoul National University College of Medicine, Seoul, Korea.; Department of Pathology, Seoul National University College of Medicine, Seoul, Korea.
authors.forename: Kyung Chul
authors.identifier: 0000-0002-1969-8360
authors.initials: KC
authors.lastname: Moon
authors.affiliation: Department of Internal Medicine, National Medical Center, Seoul, Korea .
authors.forename: Joon-Sung
authors.identifier: 0000-0002-5044-2742
authors.initials: JS
authors.lastname: Joh
authors.affiliation: Department of Internal Medicine, National Medical Center, Seoul, Korea .
authors.forename: Ji Yeon
authors.identifier: 0000-0002-7026-8235
authors.initials: JY
authors.lastname: Lee
authors.affiliation: Department of Internal Medicine, National Medical Center, Seoul, Korea .
authors.forename: Hyoung-Shik
authors.identifier: 0000-0001-6504-3413
authors.initials: HS
authors.lastname: Shin
authors.affiliation: Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea .
authors.forename: Dong Ki
authors.identifier: 0000-0002-5195-7852
authors.initials: DK
authors.lastname: Kim
authors.affiliation: Kidney Research Institute, Medical Research Center, Seoul National University College of Medicine, Seoul, Korea.; Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea.
authors.forename: Yon Su
authors.identifier: 0000-0003-3091-2388
authors.initials: YS
authors.lastname: Kim
mesh_terms: D000368:Aged; D001706:Biopsy; D018352:Coronavirus Infections / Q000175:diagnosis* / Q000821:virology; D003404:Creatinine / Q000097:blood / Q000652:urine; D018819:Dipeptidyl Peptidase 4 / Q000378:metabolism; D006801:Humans; D017404:In Situ Hybridization, Fluorescence; D007668:Kidney / Q000378:metabolism / Q000473:pathology*; D008297:Male; D018613:Microscopy, Confocal; D008854:Microscopy, Electron; D065207:Middle East Respiratory Syndrome Coronavirus / Q000235:genetics* / Q000302:isolation & purification; D012367:RNA, Viral / Q000235:genetics / Q000378:metabolism; D020133:Reverse Transcriptase Polymerase Chain Reaction; D012709:Serum Albumin / Q000032:analysis
chemical_list: D012367:RNA, Viral; D012709:Serum Albumin; D003404:Creatinine; C042807:DPP4 protein, human; D018819:Dipeptidyl Peptidase 4
keywords: Acute Tubulointerstitial Nephritis; Kidney Tubular Necrosis, Acute; Middle East Respiratory Syndrome-Coronavirus; Renal Pathology