COVID-19–Associated Glomerular Disease
Top Cited Papers
- 19 November 2020
- journal article
- research article
- Published by Ovid Technologies (Wolters Kluwer Health) in Journal of the American Society of Nephrology
- Vol. 32 (1), 33-40
- https://doi.org/10.1681/asn.2020060804
Abstract
Background Studies have documented AKI with high-grade proteinuria in patients with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. In some patients, biopsies have revealed collapsing glomerulopathy, a distinct form of glomerular injury that has been associated with other viruses, including HIV. Previous patient reports have described patients of African ancestry who developed nephrotic-range proteinuria and AKI early in the course of disease. Methods In this patient series, we identified six patients with coronavirus disease 2019 (COVID-19), AKI, and nephrotic-range proteinuria. COVID-19 was diagnosed by a positive nasopharyngeal swab RT-PCR for SARS-CoV-2 infection. We examined biopsy specimens from one transplanted kidney and five native kidneys. Three of the six patients underwent genetic analysis of APOL1, the gene encoding the APOL1 protein, from DNA extracted from peripheral blood. In addition, we purified genomic DNA from paraffin-embedded tissue and performed APOL1 genotype analysis of one of the native biopsies and the donor kidney graft. Results All six patients were of recent African ancestry. They developed COVID-19–associated AKI with podocytopathy, collapsing glomerulopathy, or both. Patients exhibited generally mild respiratory symptoms, and no patient required ventilator support. Genetic testing performed in three patients confirmed high-risk APOL1 genotypes. One APOL1 high-risk patient developed collapsing glomerulopathy in the engrafted kidney, which was transplanted from a donor who carried a low-risk APOL1 genotype; this contradicts current models of APOL1-mediated kidney injury, and suggests that intrinsic renal expression of APOL1 may not be the driver of nephrotoxicity and specifically, of podocyte injury. Conclusions Glomerular disease presenting as proteinuria with or without AKI is an important presentation of COVID-19 infection and may be associated with a high-risk APOL1 genotype.Keywords
Funding Information
- National Institute of Diabetes and Digestive and Kidney Diseases (NIH P30DK114857)
- Feinberg School of Medicine ((NUCATS) COVID fund)
- National Institute of Diabetes and Digestive and Kidney Diseases (NIH DK60635)
This publication has 41 references indexed in Scilit:
- The Innate Immune Factor Apolipoprotein L1 Restricts HIV-1 InfectionJournal of Virology, 2014
- APOL1 variants and kidney disease in people of recent African ancestryNature Reviews Nephrology, 2013
- APOL1 and kidney diseaseCurrent Opinion in Nephrology and Hypertension, 2012
- APOL1 Variants Increase Risk for FSGS and HIVAN but Not IgA NephropathyJournal of the American Society of Nephrology, 2011
- APOL1 Genetic Variants in Focal Segmental Glomerulosclerosis and HIV-Associated NephropathyJournal of the American Society of Nephrology, 2011
- A risk allele for focal segmental glomerulosclerosis in African Americans is located within a region containing APOL1 and MYH9Kidney International, 2010
- Association of Trypanolytic ApoL1 Variants with Kidney Disease in African AmericansScience, 2010
- HIV-Associated NephropathyContributions to nephrology, 2008
- Glomerular Localization and Expression of Angiotensin-Converting Enzyme 2 and Angiotensin-Converting EnzymeJournal of the American Society of Nephrology, 2006
- Expression and localization of MT1-MMP and furin in the glomerular wall of short- and long-term diabetic ratsKidney International, 2006