FSGS and COVID-19 in Non-African American Patients

Abstract

Collapsing Focal Segmental Glomerulosclerosis (FSGS) has been reported relatively frequently in African American (AA) patients with coronavirus disease 2019 (COVID-19), and it is associated almost always with Apolipoprotein L gen 1 (APOL1) high-risk variants. We reviewed the published literature from April 2020 to November 2022 searching for non-African American (non-AA) patients with FSGS associated with COVID-19 (eight White patients, six Hispanic patients, three Asian patients, one Indian patient, and one Asian Indian patient). The following histologic patterns were found: collapsing (n=11), not otherwise specified (n=5), tip (n=2), and perihilar (n=1). Fifteen of the 19 patients had AKI. The APOL1 genotype was reported in only six of the 19 non-AA patients. Three of them (two Hispanic patients and one White patient) with collapsing FSGS had high-risk APOL1 variants. The other three patients (two White patients and one Hispanic patient with the collapsing variant, tip variant, and not otherwise specified) had low-risk APOL1 variants. Among 53 African American patients with collapsing FSGS associated with COVID-19, 48 had high-risk APOL1 variants and five had low-risk APOL1 variants. We conclude that in non-AA patients, FSGS is a rare complication of COVID-19. FSGS associated with COVID-19 can occur rarely with low-risk APOL1 variants in non-AA and AA patients. Non-AA patients reported to be associated with high-risk APOL1 variants possibly reflect inaccuracy of self-reported race with AA admixture because of unknown ancestry. Given the importance of APOL1 in the pathogenesis of FSGS associated with viral infection and to avoid racial bias, it seems appropriate that APOL1 testing be considered in patients with FSGS associated with COVID-19, regardless of self-reported race.

Figure 1

FSGS variants and coronavirus disease 2019 in non–African American and African American patients. (A) There were 19 non–African American patients: 11 with collapsing FSGS, five with NOS, one with the tip variant, and one with perihilar. (B) There were 94 African American patients: 89 were collapsing FSGS, four NOS, and one tip variant. *The term “non–African American” included patients reported from Asia, India, and Europe on the basis of the description in the articles, and “African American” included patients described as Black, including patients outside of the United States (see Methods). NOS, not otherwise specified.

Figure 2

APOL1 Genotype. (A) In non-African Americans patients 6 were genotyped for APOL1; 3 had collapsing and APOL1-high risk, 1 had collapsing and APOL1-low risk; 1 had the tip variant and APOL1-low risk and the last patient had NOS and APOL1-low risk. (B) In African Americans patients 55 were genotyped for APOL1: 48 had collapsing and APOL1-high risk, 5 had collapsing and APOL1-low risk, and 2 had NOS and APOL1- high risk genotype. *The term “non–African American” included patients reported from Asia, India, and Europe, and “African American” included patients described as Black, including patients outside of the United States (see Methods). APOL1, Apolipoprotein L gen 1; NOS, not otherwise specified.