The spectrum of kidney biopsies in hospitalized patients with COVID-19, acute kidney injury and/or proteinuria. Issue 7 (12th February 2021)

• Record Type: Journal Article
• Authors: Ferlicot, Sophie; Jamme, Matthieu; Gaillard, François; Oniszczuk, Julie; Couturier, Aymeric; May, Olivia; Grünenwald, Anne; Sannier, Aurélie; Moktefi, Anissa; Le Monnier, Ophélie; Petit-Hoang, Camille; Maroun, Nadine; Brodin-Sartorius, Albane; Michon, Arthur; Dobosziewicz, Hélène; Andreelli, Fabrizio; Guillet, Matthieu; Izzedine, Hassane; Richard, Christian; Dekeyser, Manon; Arrestier, Romain; Stehlé, Thomas; Lefèvre, Edouard; Mathian, Alexis; Legendre, Christophe; Mussini, Charlotte; Verpont, Marie-Christine; Pallet, Nicolas; Amoura, Zahir; Essig, Marie; Snanoudj, Renaud; Brocheriou-Spelle, Isabelle; François, Hélène; Belenfant, Xavier; Geri, Guillaume; Daugas, Eric; Audard, Vincent; Buob, David; Massy, Ziad A; Zaidan, Mohamad;
• Is Part Of: Nephrology dialysis transplantation. Volume 36:Issue 7(2021)
• Page Start: 1253
• Page End: 1262
• Publication Date: 2021-02-12
• Subjects: acute tubular injury -- collapsing glomerulopathy -- COVID-19 -- focal segmental glomerulosclerosis -- kidney; Nephrology -- Periodicals; Hemodialysis -- Periodicals; Kidneys -- Transplantation -- Periodicals; Hemodialysis; Kidneys -- Transplantation; Nephrology; Periodicals; 616.61
• DOI: 10.1093/ndt/gfab042
• Languages: English
• ISSNs: 0931-0509

Abstract

Abstract: Background: The coronavirus disease 2019 (COVID-19) may be associated with kidney injury, which may impact patient's prognosis. Methods: We report a multicentric retrospective case series of patients with COVID-19 who developed acute kidney injury (AKI) and/or proteinuria and underwent a kidney biopsy in Paris and its metropolitan area. Results: Forty-seven patients (80.9% men) with COVID-19 who underwent a kidney biopsy between 8 March and 19 May 2020 were included. The median age was 63 years (interquartile range 52–69). Comorbidities included hypertension (66.0%), diabetes mellitus (27.7%), obesity (27.7%), history of chronic kidney disease (25.5%), cardiac diseases (38.6%) and respiratory diseases (27.3%). Initial symptoms were fever (85.1%), cough (63.8%), shortness of breath (55.3%) and diarrhoea (23.4%). Almost all patients developed AKI (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 (CG) and focal segmental glomerulosclerosis in 17 (36.2%) patients. Two (4.3%) patients had acute vascular nephropathy, while 8 (17%) had an 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 CG was only observed in patients harbouring a combination of APOL1 risk variants. At the last follow-up, 16 of the 30 patients who initially required dialysis were still on dialysis, and 9 had died. Conclusions: This 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.