Severe Acute Respiratory Syndrome Coronavirus 2 Induced Focal Segmental Glomerulosclerosis

Malik, Ishaq; Ladiwala, Nida; Chinta, Siddharth; Khan, Mozammel H. A.; Patel, Komal

doi:10.7759/cureus.10898

Cited by 6 publications

(3 citation statements)

References 13 publications

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“…CG was reported in 19 out of 30 native kidney biopsy studies which encompassed a total of 40 patients[ 13 - 30 ]. The median age of this cohort was 55 years with a predominance of males (80%) and black ethnicity (92.5%).…”

Section: Resultsmentioning

confidence: 99%

Native and transplant kidney histopathological manifestations in association with COVID-19 infection: A systematic review

Jeyalan¹,

Storrar²,

Wu³

et al. 2021

WJT

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BACKGROUND Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) can result in clinically significant multi-system disease including involvement in the kidney. The underlying histopathological processes were unknown at the start of the pandemic. As case reports and series have been published describing the underlying renal histopathology from kidney biopsies, we have started to gain an insight into the renal manifestations of this novel disease. AIM To provide an overview of the current literature on the renal histopathological features and mechanistic insights described in association with coronavirus disease 2019 (COVID-19) infection. METHODS A systematic review was performed by conducting a literature search in the following websites-‘PubMed’, ‘Web of Science’, ‘Embase’ and ‘Medline-ProQuest’ with the following search terms-“COVID-19 AND kidney biopsy”, “COVID-19 AND renal biopsy”, “SARS-CoV-2 AND kidney biopsy” and “SARS-CoV-2 AND renal biopsy”. We have included published data up until February 15, 2021, which includes kidney biopsies (native, transplant and postmortem) from patients with COVID-19. Data on clinical presentation, histopathological features, management and outcome was extracted from the reported studies. RESULTS The total number of biopsies reported on here is 288, of which 189 are postmortem, 84 native and 15 transplants. The results are varied and show underlying pathologies ranging from collapsing glomerulopathy and acute tubular injury (ATI) to anti-nuclear cytoplasmic antibody associated vasculitis and pigment nephropathy. There was variation in the specific treatment used for the various renal conditions, which included steroids, hydroxychloroquine, eculizumab, convalescent plasma, rituximab, anakinra, cyclophosphamide and renal replacement therapy, amongst others. The pathological process which occurs in the kidney following COVID-19 infection and leads to the described biopsy findings has been hypothesized in some conditions but not others (for example, sepsis related hypoperfusion for ATI). It is important to note that this represents a very small minority of the total number of cases of COVID-19 related kidney disease, and as such there may be inherent selection bias in the results described. Further work will be required to determine the pathogenetic link, if any, between COVID-19 and the other renal pathologies. CONCLUSION This report has clinical relevance as certain renal pathologies have specific management, with the implication that kidney biopsy in the setting of renal disease and COVID-19 should be an early consideration, dependent upon the clinical presentation.

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Section: Resultsmentioning

confidence: 99%

Native and transplant kidney histopathological manifestations in association with COVID-19 infection: A systematic review

Jeyalan¹,

Storrar²,

Wu³

et al. 2021

WJT

View full text Add to dashboard Cite

show abstract

“…FSGS accounts for 40% of nephrotic syndromes in adults and 20% of nephrotic syndromes in children, and is considered the most common primary glomerular disease resulting in end-stage renal disease in the United States [ 1 ]. The collapsing variant is one of five histological variants of FSGS and appears to be more often linked with viral causes than the other subtypes, specifically HIV [ 4 ]. Although the association of collapsing FSGS with HIV and CMV is relatively established, the COVID-19 pandemic has provided new cases of collapsing FSGS in patients without either of the aforementioned viruses and only infection with the novel SARS-CoV-2 virus.…”

Section: Discussionmentioning

confidence: 99%

“…Another study by Shetty et al (2021) analyzed the relationship between COVID-19-associated glomerular disease, in which they found that the glomerular disease caused by COVID-19 was either FSGS, podocytopathy, or both [ 6 ]. Multiple case reports including a report by Malik et al (2020) also suggest a causal relationship between COVID-19 infection and FSGS [ 4 ]. Considering all the previous studies, and a negative viral panel in our patient, including HIV, Hepatitis B and C, and CMV, suspicion was strengthened for her glomerulopathy being a result of her COVID-19 infection.…”

Section: Discussionmentioning

confidence: 99%

A Case of COVID-19-Associated Focal Segmental Glomerulosclerosis

Thomas¹,

Trainor²,

Sheingold³

et al. 2023

Cureus

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This case report details a 43-year-old female diagnosed with the collapsing variant of focal segmental glomerulosclerosis (FSGS) post-infection with coronavirus disease 2019 . The patient contracted COVID-19 after returning from a trip to Florida and initially presented to the emergency department with gastrointestinal symptoms. Thereafter, the patient was diagnosed with COVID-19 and was admitted for acute kidney injury and worsening COVID-19 infection. FSGS is a glomerulopathy that consists of glomerular scarring that leads to nephrotic syndrome, secondary to podocyte effacement. FSGS has many causes, as well as distinct variants, but is noted to have an association with some viruses, most notably HIV and cytomegalovirus (CMV). Although the association between FSGS and HIV or CMV is well established, the evidence is minimal in regard to other viruses. This case report serves to highlight the potential association of COVID-19 with FSGS.

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Acute and chronic histopathological findings in renal biopsies in COVID-19

et al. 2022

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The dominant ICU admission diagnosis of COVID-19 patients is respiratory insufficiency, but 32–57% of hospitalized COVID-19 patients develop acute kidney injury (COVID-AKI). The renal histopathological changes accompanying COVID-AKI are not yet fully described. To obtain a detailed insight into renal histopathological features of COVID-19, we conducted a review including all studies reporting histopathological findings of diagnostic and postmortem kidney biopsies from patients with COVID-19 published between January 1, 2020, and January 31, 2021. A total of 89 diagnostic and 194 postmortem renal biopsies from individual patients in 39 published studies were investigated and were included in the analysis. In the diagnostic biopsy group, mean age was 56 years and AKI incidence was 96%. In the postmortem biopsy group, mean age was 69 years and AKI incidence was 80%. In the diagnostic biopsy group, the prevalence of acute glomerular diseases was 74%. The most common glomerular lesions were collapsing focal segmental glomerulosclerosis (c-FSGS) in 54% and thrombotic microangiopathy (TMA) in 9% of patients. TMA was also found in 10% of patients in the postmortem biopsy group. The most common acute tubular lesions was acute tubular necrosis (ATN) which was present in 87% of patients in the diagnostic and in 77% of patients in the postmortem biopsy group. Additionally, we observed a high prevalence of preexisting chronic lesions in both groups such as atherosclerosis and glomerulosclerosis. Histopathological changes in renal biopsies of COVID-19 patients show a heterogeneous picture with acute glomerular lesions, predominantly c-FSGS and TMA, and acute tubular lesions, predominantly ATN. In many patients, these lesions were present on a background of chronic renal injury. Graphical abstract

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Severe Acute Respiratory Syndrome Coronavirus 2 Induced Focal Segmental Glomerulosclerosis

Cited by 6 publications

References 13 publications

Native and transplant kidney histopathological manifestations in association with COVID-19 infection: A systematic review

Native and transplant kidney histopathological manifestations in association with COVID-19 infection: A systematic review

A Case of COVID-19-Associated Focal Segmental Glomerulosclerosis

Acute and chronic histopathological findings in renal biopsies in COVID-19

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