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The spectrum of kidney biopsies in hospitalized patients with COVID-19, acute kidney injury, and/or proteinuria #MMPMID33576823
Ferlicot S; Jamme M; Gaillard F; Oniszczuk J; Couturier A; May O; Grunenwald A; Sannier A; Moktefi A; Le Monnier O; Petit-Hoang C; Maroun N; Brodin-Sartorius A; Michon A; Dobosziewicz H; Andreelli F; Guillet M; Izzedine H; Richard C; Dekeyser M; Arrestier R; Sthele T; Lefevre E; Mathian A; Legendre C; Mussini C; Verpont MC; Pallet N; Amoura Z; Essig M; Snanoudj R; Brocheriou-Spelle I; Francois H; Belenfant X; Geri G; Daugas E; Audard V; Buob D; Massy ZA; Zaidan M
Nephrol Dial Transplant 2021[Feb]; ? (?): ? PMID33576823show ga
We report a multicentric retrospective case series of patients with COVID-19 who developed acute kidney injury and/or proteinuria and underwent a kidney biopsy in the Paris and its metropolitan area. Forty-seven patients (80.9% men) with COVID-19 who underwent a kidney biopsy between March 08 and May 19, 2020 were included. Median age was 63 years IQR [52-69]. Comorbidities included hypertension (66.0%), diabetes mellitus (27.7%), obesity (27.7%), history of chronic kidney (25.5%), cardiac (38.6%) and respiratory (27.3%) diseases. Initial symptoms were fever (85.1%), cough (63.8%), shortness of breath (55.3%), and diarrhea (23.4%). Almost all patients developed acute kidney injury (97.9%) and 63.8% required renal replacement therapy. Kidney biopsy showed two main histopathological patterns, including acute tubular injury in 20 (42.6%) patients, and glomerular injury consisting of collapsing glomerulopathy and focal segmental glomerulosclerosis in 17 (36.2%) patients. Two (4.3%) patients had acute vascular nephropathy, while eight (17%) had alternative diagnosis most likely unrelated to COVID-19. Acute tubular injury occurred almost invariably in the setting of severe forms of COVID-19, whereas patients with glomerular injury had various profiles of COVID-19 severity and collapsing glomerulopathy was only observed in patients harboring a combination of APOL1 risk variants. At last follow-up, 16 of the 30 patients who initially required dialysis were still on dialysis, and 9 died. The present study describes the spectrum of kidney lesions in patients with COVID-19. While acute tubular injury is correlated with COVID-19 severity, the pattern of glomerular injury is intimately associated with the expression of APOL1 risk variants.