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

Rebecca M. May, Clarissa Cassol, Andrew Hannoudi, Christopher P. Larsen, Edgar V. Lerma, Randy S. Haun, Juarez R. Braga, Samar I. Hassen, Jon Wilson, Christine VanBeek, Mahesha Vankalakunti, Lilli Barnum, Patrick D. Walker, T. David Bourne, Nidia C. Messias, Josephine M. Ambruzs, Christie L. Boils, Shree S. Sharma, L. Nicholas Cossey, Pravir V. BaxiMatthew Palmer, Jonathan E. Zuckerman, Vighnesh Walavalkar, Anatoly Urisman, Alexander J. Gallan, Laith F. Al-Rabadi, Roger Rodby, Valerie Luyckx, Gustavo Espino, Srivilliputtur Santhana-Krishnan, Brent Alper, Son G. Lam, Ghadeer N. Hannoudi, Dwight Matthew, Mark Belz, Gary Singer, Srikanth Kunaparaju, Deborah Price, Saurabh Chawla, Chetana Rondla, Mazen A. Abdalla, Marcus L. Britton, Subir Paul, Uday Ranjit, Prasad Bichu, Sean R. Williamson, Yuvraj Sharma, Ariana Gaspert, Philipp Grosse, Ian Meyer, Brahm Vasudev, Mohamad El Kassem, Juan Carlos Q. Velez, Tiffany N. Caza

Research output: Contribution to journalArticlepeer-review

21 Scopus citations

Abstract

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 that have 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 was 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 and demonstrated a high frequency of APOL1 high-risk genotypes within this group, with no evidence of direct viral infection within the kidney.

Original languageEnglish
Pages (from-to)1303-1315
Number of pages13
JournalKidney International
Volume100
Issue number6
DOIs
StatePublished - Dec 2021

Keywords

  • COVID-19
  • SARS-CoV-2
  • acute kidney injury
  • coronavirus
  • kidney biopsy
  • renal pathology

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