학술논문
A multi-center retrospective cohort study defines the spectrum of kidney pathology in Coronavirus 2019 Disease (COVID-19)
Document Type
article
Author
May, Rebecca M; Cassol, Clarissa; Hannoudi, Andrew; Larsen, Christopher P; Lerma, Edgar V; Haun, Randy S; Braga, Juarez R; Hassen, Samar I; Wilson, Jon; VanBeek, Christine; Vankalakunti, Mahesha; Barnum, Lilli; Walker, Patrick D; Bourne, T David; Messias, Nidia C; Ambruzs, Josephine M; Boils, Christie L; Sharma, Shree S; Cossey, L Nicholas; Baxi, Pravir V; Palmer, Matthew; Zuckerman, Jonathan E; Walavalkar, Vighnesh; Urisman, Anatoly; Gallan, Alexander J; Al-Rabadi, Laith F; Rodby, Roger; Luyckx, Valerie; Espino, Gustavo; Santhana-Krishnan, Srivilliputtur; Alper, Brent; Lam, Son G; Hannoudi, Ghadeer N; Matthew, Dwight; Belz, Mark; Singer, Gary; Kunaparaju, Srikanth; Price, Deborah; Chawla, Saurabh; Rondla, Chetana; Abdalla, Mazen A; Britton, Marcus L; Paul, Subir; Ranjit, Uday; Bichu, Prasad; Williamson, Sean R; Sharma, Yuvraj; Gaspert, Ariana; Grosse, Philipp; Meyer, Ian; Vasudev, Brahm; El Kassem, Mohamad; Velez, Juan Carlos Q; Caza, Tiffany N
Source
Kidney International. 100(6)
Subject
Language
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.