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Review
. 2020 Oct;16(10):565-567.
doi: 10.1038/s41581-020-0332-3.

COVAN is the new HIVAN: the re-emergence of collapsing glomerulopathy with COVID-19

Juan Carlos Q Velez  1   2 , Tiffany Caza  3 , Christopher P Larsen  3
Affiliations
Review

COVAN is the new HIVAN: the re-emergence of collapsing glomerulopathy with COVID-19

Juan Carlos Q Velez et al. Nat Rev Nephrol. 2020 Oct.

Erratum in

Abstract

Reports of collapsing glomerulopathy in patients of African ancestry and high-risk APOL1 genotype infected with SARS-CoV-2 have emerged during the COVID-19 pandemic. This new entity, which we term COVID-19-associated nephropathy (COVAN), may particularly impact individuals in some regions of the world. Awareness of this potentially ominous complication of COVID-19 must be raised.

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Conflict of interest statement

J.C.Q.V. has participated in Advisory Board meetings for Mallinckrodt Pharmaceuticals and Retrophin and is a member of the Speaker Bureau for Otsuka Pharmaceuticals. None of the products related to those engagements are discussed in this manuscript. T.C. and C.P.L are employees of Arkana Laboratories, which is a vendor of APOL1 genotype clinical testing.

Figures

Fig. 1
Fig. 1. Proposed pathogenesis of COVAN.
We propose that collapsing glomerulopathy associated with COVID-19 (an entity we term COVID-19-associated nephropathy; COVAN) is an entity that specifically affects individuals who carry two APOL1 risk variants. In these individuals, infection with SARS-CoV-2 through the respiratory tract triggers an inflammatory cascade that involves activation of the interferon–chemokine pathway, which in turn interacts with the APOL1 variant gene, leading to impairment in glomerular epithelial cell autophagy, mitochondrial function and cell injury. A similar collapsing glomerulopathy phenotype is observed in the context of other viral infections and conditions that increase levels of interferon. CMV, cytomegalovirus; EBV, Epstein–Barr virus; HLH, haemophagocytic lymphohistiocytosis; IFN, interferon; PLA2R-MN, PLA2R-associated membranous nephropathy; PVB19, parvovirus B19; SLE, systemic lupus erythematosus.
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