Kidney failure is common in patients with Coronavirus Disease-19 (COVID-19) resulting in increased morbidity and mortality. In an international collaboration, 284 kidney biopsies were evaluated to improve understanding of kidney disease in COVID-19. Diagnoses were compared to five years of 63,575 native biopsies prior to the pandemic and 13,955 allograft biopsies to identify diseases increased in patients with COVID-19. Genotyping for APOL1 G1 and G2 alleles was performed in 107 African American and Hispanic patients. Immunohistochemistry for SARS-CoV-2 was utilized to assess direct viral infection in 273 cases along with clinical information at the time of biopsy. The leading indication for native biopsy was acute kidney injury (45.4%), followed by proteinuria with or without concurrent acute kidney injury (42.6%). There were more African American patients (44.6%) than patients of other ethnicities. The most common diagnosis in native biopsies was collapsing glomerulopathy (25.8%) which associated with high-risk APOL1 genotypes in 91.7% of cases. Compared to the five-year biopsy database, the frequency of myoglobin cast nephropathy and proliferative glomerulonephritis with monoclonal IgG deposits was also increased in patients with COVID-19 (3.3% and 1.7%, respectively), while there was a reduced frequency of chronic conditions (including diabetes mellitus, IgA nephropathy, and arterionephrosclerosis) as the primary diagnosis. In transplants, the leading indication was acute kidney injury (86.4%), for which rejection was the predominant diagnosis (61.4%). Direct SARS-CoV-2 viral infection was not identified. Thus, our multi-center large case series identified kidney diseases that disproportionately affect patients with COVID-19, demonstrated a high frequency of APOL1 high-risk genotypes within this group, with no evidence of direct viral infection within the kidney.
The lungs of 107 birds of 19 different species from seven orders were fixed in situ. The mean volumes of both fixed lungs together ranged from 0.15 to 95.31 cm3. Histological sections of one lung from each bird were analyzed by point counting with a Zeiss integrating eyepiece to determine the volume densities and thence the absolute volumes of the main functional components of the lung. The mean volume density of the exchange tissue was highest in the 11 passeriform species (53.5%) and lowest in the 2 charadriiform species (34.6%); that for all of the 8 non-passeriform species was 42.6%. The possible significance of these variations in relation to the differing oxygen requirements of these groups of birds is discussed. The parabronchi showed minor variations in the degree of development of the interparabronchial septa, atria, interatrial septa, and atrial muscles. The diameter of the parabronchi (including the mantle of exchange tissue) ranged from about 0.34 mm in the passeriform species to about 0.63 mm in Anser anser; the lumen of the parabronchus accounted for about half of this diameter. Body weight and lung volume were strongly correlated (0.995); the allometric function relating lung volume to body weight was 29.5 w⁰·988.
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