Collapsing Glomerulopathy Affecting Native and Transplant Kidneys in Individuals with COVID-19

Noble, Rebecca; Tan, Mei Ying; McCulloch, Tom; Shantier, Mohamed; Byrne, Catherine; Hall, Matthew; Jesky, Mark

doi:10.1159/000509938

Cited by 31 publications

(36 citation statements)

References 16 publications

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“…Eleven samples were from autopsied kidneys (9, 81, 82) and only 5 from kidney biopsies performed in live patients, the latter, were all in patients who were subsequently diagnosed with collapsing glomerulopathy (35)(36)(37)(38).…”

Section: Evidence For and Against Sars-cov-2 In The Kidney From Patients With Covid-19mentioning

confidence: 99%

Evidence For and Against Direct Kidney Infection by SARS-CoV-2 in Patients with COVID-19

Hassler

Reyes

Sparks

et al. 2021

CJASN

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Despite evidence of multi-organ tropism of SARS-CoV-2 in patients with COVID-19, direct viral kidney invasion has been difficult to demonstrate. The question of whether SARS-CoV-2 can directly infect the kidney is relevant to the understanding of pathogenesis of acute kidney injury and collapsing glomerulopathy in COVID-19. Methodologies to document SARS-CoV-2 infection that have been used include immunohistochemistry, immunofluorescence, reverse transcriptase polymerase chain reaction (RT-PCR), in situ hybridization and electron microscopy. In our review of studies to date we found that SARS-CoV-2 in the kidney of patients with COVID-19 was detected in 18 of 94 (19%) by immuno-histochemistry, 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 (43.4%), the presence of SARS-CoV-2 was suggested by at least one of the methods used. Despite these positive findings, caution is needed as many other studies have been negative for SARS-CoV-2 presence 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 non-invasive way to evaluate SARS CoV-2 infection during the evolution of COVID-19-associated kidney disease.

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Section: Evidence For and Against Sars-cov-2 In The Kidney From Patients With Covid-19mentioning

confidence: 99%

Evidence For and Against Direct Kidney Infection by SARS-CoV-2 in Patients with COVID-19

Hassler

Reyes

Sparks

et al. 2021

CJASN

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“…Case reports, small case series, and autopsy studies have shown a wide spectrum of kidney manifestations in COVID-19 patients and have improved our understanding of kidney disease in this population. Reported manifestations in native biopsies include acute tubular injury (ATI) 7 , 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , myoglobin cast nephropathy 7 , thrombotic microangiopathy (TMA) 9 , 16 , 20 , 25 , 26 , 27 ; acute interstitial nephritis 14 , 28 , non-collapsing focal and segmental glomerulosclerosis (FSGS) 9 , 19 , 20 , 29 , collapsing glomerulopathy (also known as COVID-19 associated nephropathy, COVAN) 7 , 8 , 9 , 15 , 20 , 21 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , membranous nephropathy 8 , 20 , 42 , minimal change disease 48 , 49 , 50 , 48 , 49 , 50 , 48 , …”

Section: Introductionmentioning

confidence: 99%

A multi-center retrospective cohort study defines the spectrum of kidney pathology in Coronavirus 2019 Disease (COVID-19)

May

Cassol

Hannoudi

et al. 2021

Kidney International

106

139

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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.

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“…To our knowledge, only 15 kidney allograft biopsy findings from COVID‐19‐infected transplant recipients have been published as case reports ( n = 9) or as part of series containing predominantly native kidney biopsies ( n = 6). 1 , 6 , 7 , 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 These reports (summarized in Table S1 ) demonstrate a variety of etiologies of allograft dysfunction in the transplanted kidney, including podocytopathies, 6 , 9 , 10 , 11 , 12 , 13 acute rejection, 1 , 15 allograft infarction, 14 thrombotic microangiopathy (TMA), 7 and acute tubular injury (ATI). 1 , 8 , 15 Direct viral invasion of kidney parenchyma was suggested in two reported cases.…”

Section: Introductionmentioning

confidence: 99%

Kidney allograft biopsy findings after COVID-19

Daniel

Sekulic

Kudose

et al. 2021

American Journal of Transplantation

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COVID‐19 has been associated with acute kidney injury and published reports of native kidney biopsies have reported diverse pathologies. Case series directed specifically to kidney allograft biopsy findings in the setting of COVID‐19 are lacking. We evaluated 18 kidney transplant recipients who were infected with SARS‐CoV‐2 and underwent allograft biopsy. Patients had a median age of 55 years, six were female, and five were Black. Fifteen patients developed COVID‐19 pneumonia, of which five required mechanical ventilation. Notably, five of 11 (45%) biopsies obtained within 1 month of positive SARS‐CoV‐2 PCR showed acute rejection (four with arteritis, three of which were not associated with reduced immunosuppression). The remaining six biopsies revealed podocytopathy ( n = 2, collapsing glomerulopathy and lupus podocytopathy), acute tubular injury ( n = 2), infarction ( n = 1), and transplant glomerulopathy ( n = 1). Biopsies performed >1 month after positive SARS‐CoV‐2 PCR revealed collapsing glomerulopathy ( n = 1), acute tubular injury ( n = 1), and nonspecific histologic findings ( n = 5). No direct viral infection of the kidney allograft was detected by immunohistochemistry, in situ hybridization, or electron microscopy. On follow‐up, two patients died and most patients showed persistent allograft dysfunction. In conclusion, we demonstrate diverse causes of kidney allograft dysfunction after COVID‐19, the most common being acute rejection with arteritis.

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Collapsing Glomerulopathy Affecting Native and Transplant Kidneys in Individuals with COVID-19

Cited by 31 publications

References 16 publications

Evidence For and Against Direct Kidney Infection by SARS-CoV-2 in Patients with COVID-19

Evidence For and Against Direct Kidney Infection by SARS-CoV-2 in Patients with COVID-19

A multi-center retrospective cohort study defines the spectrum of kidney pathology in Coronavirus 2019 Disease (COVID-19)

Kidney allograft biopsy findings after COVID-19

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