tetano
Editor, Senior Moderator
Kidney Int
. 2021 Aug 2;S0085-2538(21)00734-1.
doi: 10.1016/j.kint.2021.07.015. Online ahead of print.
A multi-center retrospective cohort study defines the spectrum of kidney pathology in Coronavirus 2019 Disease (COVID-19)
Rebecca M May[SUP] 1 [/SUP], Clarissa Cassol[SUP] 1 [/SUP], Andrew Hannoudi[SUP] 2 [/SUP], Christopher P Larsen[SUP] 1 [/SUP], Edgar Lerma[SUP] 3 [/SUP], Randy S Haun[SUP] 1 [/SUP], Juarez R Braga[SUP] 4 [/SUP], Samar I Hassen[SUP] 1 [/SUP], Jon Wilson[SUP] 1 [/SUP], Christine VanBeek[SUP] 5 [/SUP], Mahesha Vankalakunti[SUP] 6 [/SUP], Lilli Barnum[SUP] 1 [/SUP], Patrick D Walker[SUP] 1 [/SUP], T David Bourne[SUP] 1 [/SUP], Nidia C Messias[SUP] 1 [/SUP], Josephine M Ambruzs[SUP] 1 [/SUP], Christie L Boils[SUP] 1 [/SUP], Shree S Sharma[SUP] 1 [/SUP], L Nicholas Cossey[SUP] 1 [/SUP], Pravir V Baxi[SUP] 7 [/SUP], Matthew Palmer[SUP] 8 [/SUP], Jonathan Zuckerman[SUP] 9 [/SUP], Vighnesh Walavalkar[SUP] 10 [/SUP], Anatoly Urisman[SUP] 10 [/SUP], Alexander Gallan[SUP] 11 [/SUP], Laith F Al-Rabadi[SUP] 12 [/SUP], Roger Rodby[SUP] 7 [/SUP], Valerie Luyckx[SUP] 13 [/SUP], Gusavo Espino[SUP] 14 [/SUP], Srivilliputtur Santhana-Krishnan[SUP] 15 [/SUP], Brent Alper[SUP] 16 [/SUP], Son G Lam[SUP] 17 [/SUP], Ghadeer N Hannoudi[SUP] 18 [/SUP], Dwight Matthew[SUP] 19 [/SUP], Mark Belz[SUP] 20 [/SUP], Gary Singer[SUP] 21 [/SUP], Srikanth Kunaparaju[SUP] 22 [/SUP], Deborah Price[SUP] 23 [/SUP], Chawla Sauabh[SUP] 24 [/SUP], Chetana Rondla[SUP] 25 [/SUP], Mazen A Abdalla[SUP] 26 [/SUP], Marcus L Britton[SUP] 27 [/SUP], Subir Paul[SUP] 19 [/SUP], Uday Ranjit[SUP] 28 [/SUP], Prasad Bichu[SUP] 29 [/SUP], Sean R Williamson[SUP] 30 [/SUP], Yuvraj Sharma[SUP] 31 [/SUP], Ariana Gaspert[SUP] 32 [/SUP], Phillipp Grosse[SUP] 33 [/SUP], Ian Meyer[SUP] 34 [/SUP], Brahm Vasudev[SUP] 11 [/SUP], Mohamad El Kassem[SUP] 35 [/SUP], Juan Carlos Q Velez[SUP] 36 [/SUP], Tiffany N Caza[SUP] 37 [/SUP]
Affiliations
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 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.
Keywords: COVID-19; SARS-CoV-2; acute kidney injury; coronavirus; kidney biopsy; renal pathology.
. 2021 Aug 2;S0085-2538(21)00734-1.
doi: 10.1016/j.kint.2021.07.015. Online ahead of print.
A multi-center retrospective cohort study defines the spectrum of kidney pathology in Coronavirus 2019 Disease (COVID-19)
Rebecca M May[SUP] 1 [/SUP], Clarissa Cassol[SUP] 1 [/SUP], Andrew Hannoudi[SUP] 2 [/SUP], Christopher P Larsen[SUP] 1 [/SUP], Edgar Lerma[SUP] 3 [/SUP], Randy S Haun[SUP] 1 [/SUP], Juarez R Braga[SUP] 4 [/SUP], Samar I Hassen[SUP] 1 [/SUP], Jon Wilson[SUP] 1 [/SUP], Christine VanBeek[SUP] 5 [/SUP], Mahesha Vankalakunti[SUP] 6 [/SUP], Lilli Barnum[SUP] 1 [/SUP], Patrick D Walker[SUP] 1 [/SUP], T David Bourne[SUP] 1 [/SUP], Nidia C Messias[SUP] 1 [/SUP], Josephine M Ambruzs[SUP] 1 [/SUP], Christie L Boils[SUP] 1 [/SUP], Shree S Sharma[SUP] 1 [/SUP], L Nicholas Cossey[SUP] 1 [/SUP], Pravir V Baxi[SUP] 7 [/SUP], Matthew Palmer[SUP] 8 [/SUP], Jonathan Zuckerman[SUP] 9 [/SUP], Vighnesh Walavalkar[SUP] 10 [/SUP], Anatoly Urisman[SUP] 10 [/SUP], Alexander Gallan[SUP] 11 [/SUP], Laith F Al-Rabadi[SUP] 12 [/SUP], Roger Rodby[SUP] 7 [/SUP], Valerie Luyckx[SUP] 13 [/SUP], Gusavo Espino[SUP] 14 [/SUP], Srivilliputtur Santhana-Krishnan[SUP] 15 [/SUP], Brent Alper[SUP] 16 [/SUP], Son G Lam[SUP] 17 [/SUP], Ghadeer N Hannoudi[SUP] 18 [/SUP], Dwight Matthew[SUP] 19 [/SUP], Mark Belz[SUP] 20 [/SUP], Gary Singer[SUP] 21 [/SUP], Srikanth Kunaparaju[SUP] 22 [/SUP], Deborah Price[SUP] 23 [/SUP], Chawla Sauabh[SUP] 24 [/SUP], Chetana Rondla[SUP] 25 [/SUP], Mazen A Abdalla[SUP] 26 [/SUP], Marcus L Britton[SUP] 27 [/SUP], Subir Paul[SUP] 19 [/SUP], Uday Ranjit[SUP] 28 [/SUP], Prasad Bichu[SUP] 29 [/SUP], Sean R Williamson[SUP] 30 [/SUP], Yuvraj Sharma[SUP] 31 [/SUP], Ariana Gaspert[SUP] 32 [/SUP], Phillipp Grosse[SUP] 33 [/SUP], Ian Meyer[SUP] 34 [/SUP], Brahm Vasudev[SUP] 11 [/SUP], Mohamad El Kassem[SUP] 35 [/SUP], Juan Carlos Q Velez[SUP] 36 [/SUP], Tiffany N Caza[SUP] 37 [/SUP]
Affiliations
- PMID: 34352311
- DOI: 10.1016/j.kint.2021.07.015
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 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.
Keywords: COVID-19; SARS-CoV-2; acute kidney injury; coronavirus; kidney biopsy; renal pathology.