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. 2021 Feb 12:gfab042.
doi: 10.1093/ndt/gfab042. Online ahead of print.

The spectrum of kidney biopsies in hospitalized patients with COVID-19, acute kidney injury, and/or proteinuria

Sophie Ferlicot  1   2   3 , Matthieu Jamme  4   5 , François Gaillard  6 , Julie Oniszczuk  7 , Aymeric Couturier  5   8 , Olivia May  9 , Anne Grünenwald  10   11   12 , Aurélie Sannier  3   13 , Anissa Moktefi  3   14 , Ophélie Le Monnier  15 , Camille Petit-Hoang  16 , Nadine Maroun  17 , Albane Brodin-Sartorius  18 , Arthur Michon  11 , Hélène Dobosziewicz  11 , Fabrizio Andreelli  19 , Matthieu Guillet  11 , Hassane Izzedine  20 , Christian Richard  10 , Manon Dekeyser  11 , Romain Arrestier  21 , Thomas Sthelé  7 , Edouard Lefèvre  11 , Alexis Mathian  15 , Christophe Legendre  11 , Charlotte Mussini  1   3 , Marie-Christine Verpont  22 , Nicolas Pallet  23 , Zahir Amoura  15 , Marie Essig  5   8 , Renaud Snanoudj  18 , Isabelle Brocheriou-Spelle  3   24 , Hélène François  16 , Xavier Belenfant  9 , Guillaume Geri  5   25 , Eric Daugas  6 , Vincent Audard  7 , David Buob  3   26 , Ziad A Massy  5   8 , Mohamad Zaidan  2   11   27 ; AP-HP/Universities/Inserm COVID-19 research collaboration
Affiliations

The spectrum of kidney biopsies in hospitalized patients with COVID-19, acute kidney injury, and/or proteinuria

Sophie Ferlicot et al. Nephrol Dial Transplant. .

Abstract

We report a multicentric retrospective case series of patients with COVID-19 who developed acute kidney injury and/or proteinuria and underwent a kidney biopsy in the Paris and its metropolitan area. Forty-seven patients (80.9% men) with COVID-19 who underwent a kidney biopsy between March 08 and May 19, 2020 were included. Median age was 63 years IQR [52-69]. Comorbidities included hypertension (66.0%), diabetes mellitus (27.7%), obesity (27.7%), history of chronic kidney (25.5%), cardiac (38.6%) and respiratory (27.3%) diseases. Initial symptoms were fever (85.1%), cough (63.8%), shortness of breath (55.3%), and diarrhea (23.4%). Almost all patients developed acute kidney injury (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 and focal segmental glomerulosclerosis in 17 (36.2%) patients. Two (4.3%) patients had acute vascular nephropathy, while eight (17%) had 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 collapsing glomerulopathy was only observed in patients harboring a combination of APOL1 risk variants. At last follow-up, 16 of the 30 patients who initially required dialysis were still on dialysis, and 9 died. The present 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.

Keywords: COVID-19; acute tubular injury; collapsing glomerulopathy; focal segmental glomerulosclerosis; kidney.

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