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COVID-19-Associated Collapsing Focal Segmental Glomerulosclerosis: A Report of 2 Cases
Yuvraj Sharma1, Samih H Nasr2, Christopher P Larsen3
1Division of Nephrology and Hypertension, Department of Internal Medicine, Henry Ford Health System, Detroit, MI.
Insights
Collapsing glomerulopathy, a severe kidney disease, may be a new COVID-19 complication. This risk is higher in African Americans with the apolipoprotein L1 (APOL1) high-risk genotype.
Area of Science:
- Nephrology
- Infectious Diseases
- Genetics
Background:
- Collapsing glomerulopathy is an aggressive form of focal segmental glomerulosclerosis.
- The apolipoprotein L1 (APOL1) high-risk genotype is a significant risk factor for collapsing glomerulopathy in African Americans.
- Coronavirus disease 2019 (COVID-19) is a pandemic with frequent kidney involvement and higher mortality.
Observation:
- Two African American patients developed acute kidney injury and proteinuria following COVID-19 infection.
- Kidney biopsies revealed collapsing glomerulopathy, endothelial tubuloreticular inclusions, and acute tubular injury.
- No direct evidence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) viral infection in kidney cells was found via electron microscopy or in situ hybridization.
Findings:
- Both patients possessed the APOL1 high-risk genotype.
- The clinical presentation and kidney pathology suggest a link between COVID-19 and collapsing glomerulopathy.
Implications:
- Collapsing glomerulopathy may represent a novel kidney manifestation of COVID-19.
- This association appears particularly relevant in individuals of African descent carrying the APOL1 high-risk genotype.
- Further research is needed to elucidate the mechanisms linking COVID-19, APOL1, and collapsing glomerulopathy.
Abstract:
Collapsing glomerulopathy is an aggressive form of focal segmental glomerulosclerosis with diverse causes. The presence of the apolipoprotein L1 (APOL1) high-risk genotype is a major risk factor for collapsing glomerulopathy in African Americans. Coronavirus disease 2019 (COVID-19) is an emerging pandemic with predominant respiratory manifestations. However, kidney involvement is being frequently noted and is associated with higher mortality. Currently, kidney pathology data for COVID-19 are scant and mostly come from postmortem findings. We report 2 African American patients who developed acute kidney injury and proteinuria in temporal association with COVID-19 infection. Kidney biopsy specimens showed collapsing glomerulopathy, endothelial tubuloreticular inclusions, and acute tubular injury, without evidence by electron microscopy or severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in situ hybridization of viral infection of kidney cells. Both patients had the APOL1 high-risk genotype. We propose that collapsing glomerulopathy represents a novel manifestation of COVID-19 infection, especially in people of African descent with APOL1 risk alleles.
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