Kidney allograft biopsy findings after COVID-19

Daniel, Emily; Sekulic, Miroslav; Kudose, Satoru; Kubin, Christine J.; Ye, Xiaoyi; Shayan, Katayoon; Patel, Ankita; Cohen, David J.; Ratner, Lloyd E.; Santoriello, Dominick; Stokes, Michael B.; Markowitz, Glen S.; Pereira, Marcus R.; D’Agati, Vivette D.; Batal, Ibrahim

doi:10.1111/ajt.16804

Cited by 26 publications

(42 citation statements)

References 24 publications

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“…Allograft rejection was most commonly antibody‐mediated (38.6%, while 13.6% had T‐cell mediated and 9.1% antibody+T‐cell mediated acute rejection). The series of three cases reported grade 2A acute T cell–mediated rejection, cortical infarction, and acute tubular injury 8 . Noble et al.…”

Section: Discussionmentioning

confidence: 99%

Histopathologic findings on indication renal allograft biopsies after recovery from acute COVID‐19

Jukić

Čorić

Bulimbašić

et al. 2021

Clinical Transplantation

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Current knowledge on histopathological changes occurring after COVID‐19 in transplanted kidneys is limited. Herein, we present renal allograft pathology findings in patients recovered from COVID‐19. Six patients underwent indication biopsy, and one required allograft nephrectomy after acute COVID‐19. Demographic data, clinical characteristics, and laboratory findings were recorded. The histopathological analysis included light microscopy, immunostaining, and electron microscopy. Five patients were hospitalized for acute COVID‐19, and all were diagnosed with imaging‐confirmed pneumonia, one requiring mechanical ventilation, and two requiring dialysis. Two patients had mild form. Histopathologic examination of renal allograft specimens revealed collapsing, perihilar, tip‐lesion and secondary FSGS in one patient each. One patient had borderline acute cellular rejection, and two had chronic antibody‐mediated rejection. Histopathologic changes of glomerular tufts were accompanied by acute tubular injury in four patients. None of our patients had signs of viral inclusions in kidney cells. One patient died and one remained dialysis‐dependent after the good initial response to treatment. Patients with collapsing and perihilar FSGS had further progression of their chronic allograft nephropathy still without need for dialysis. In conclusion, diverse kidney pathology may be found in SARS‐CoV‐2–infected renal transplant patients. It seems that viral infection may affect the immune system with triggering of glomerular diseases, while the acute tubular injury is of multifactorial etiology. Direct viral effect is less likely.

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Section: Discussionmentioning

confidence: 99%

Histopathologic findings on indication renal allograft biopsies after recovery from acute COVID‐19

Jukić

Čorić

Bulimbašić

et al. 2021

Clinical Transplantation

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“…A large single-centre study from São Paulo, Brazil, found that 19% of transplant recipients who were alive 28 days after the onset of COVID-19 symptoms had persistent graft impairment; of the 30% who underwent biopsy, acute rejection was seen in 35% and tubular injury was present in all 30 . A single-centre study from New York City of 18 kidney transplant recipients with SARS-CoV-2 infection who underwent graft biopsy before May 2021 found vascular rejection in 33% in the first month after SARS-CoV-2 positivity 69 . Single-centre reports also exist of cytomegalovirus and BK polyomavirus activation after COVID-19 (refs 70 , 71 ), and of patients developing new donor-specific antibodies 72 .…”

Section: Covid-19 and Kidney Transplantationmentioning

confidence: 99%

COVID-19 and kidney disease: insights from epidemiology to inform clinical practice

Mahalingasivam

Iwagami

et al. 2022

Nat Rev Nephrol

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Over the course of the COVID-19 pandemic, numerous studies have aimed to address the challenges faced by patients with kidney disease and their caregivers. These studies addressed areas of concern such as the high infection and mortality risk of patients on in-centre haemodialysis and transplant recipients. However, the ability to draw meaningful conclusions from these studies has in some instances been challenging, owing to barriers in aspects of usual care, data limitations and problematic methodological practices. In many settings, access to SARS-CoV-2 testing differed substantially between patient groups, whereas the incidence of SARS-CoV-2 infection varied over time and place because of differences in viral prevalence, targeted public health policies and vaccination rates. The absence of baseline kidney function data posed problems in the classification of chronic kidney disease and acute kidney injury in some studies, potentially compromising the generalizability of findings. Study findings also require attentive appraisal in terms of the effects of confounding, collider bias and chance. As this pandemic continues and in the future, the implementation of sustainable and integrated research infrastructure is needed in settings across the world to minimize infection transmission and both prevent and plan for the short-term and long-term complications of infectious diseases. Registries can support the real-world evaluation of vaccines and therapies in patients with advanced kidney disease while enabling monitoring of rare complications.

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“…Regarding children and adolescents with transplanted kidneys ( Table 3 ), a case of collapsing glomerulopathy (CG) with concurrent chronic antibody-mediated rejection, and another case of T-cell-mediated rejection, were reported in association with acute COVID-19 infection for two adolescents aged 15 and 16 years, respectively [ 22 , 23 ]. In both of these cases, the patients required meticulous optimization of their immunosuppression medications, alongside supportive medical management to reduce the risk of further COVID-19-associated complications.…”

Section: Resultsmentioning

confidence: 99%

Intrinsic Kidney Pathology Following COVID-19 Infection in Children and Adolescents: A Systematic Review

Shenoy

Kalra

et al. 2021

Children

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Introduction: COVID-19 infections resulting in pathological kidney manifestations have frequently been reported in adults since the onset of the global COVID-19 pandemic in December 2019. Gradually, there have been an increased number of COVID-19-associated intrinsic kidney pathologies in children and adolescents reported as well. The pathophysiological mechanisms between COVID-19 and the onset of kidney pathology are not fully known in children; it remains a challenge to distinguish between intrinsic kidney pathologies that were caused directly by COVID-19 viral invasion, and cases which occurred as a result of multisystem inflammatory syndrome due to the infection. This challenge is made more difficult in children, due to the ethical limitations of performing kidney biopsies to reach a biopsy-proven diagnosis. Although previous systematic reviews have summarized the various pathological kidney manifestations that have occurred in adults following acute COVID-19 infection, such reviews have not yet been published for children and adolescents. We describe the results of a systematic review for intrinsic kidney pathology following COVID-19 infection in children and adolescents. Methods: A systematic literature search of published data up until 31 October was completed through the Preferred Reporting Items for Systematic Reviews and Meta Analyses (PRISMA) guidelines. Research articles reporting new-onset or relapsed intrinsic kidney pathology in children or adolescents (≤18 years) following acute COVID-19 infection were included for qualitative review. COVID-19 infection status was defined by a positive result from a RT-PCR, or nuclear antibody testing. Only full-text articles published in the English language were selected for review. Results: Twenty-nine cases from fifteen articles were included in the qualitative synthesis of this systematic review. Nephrotic syndrome, as an umbrella condition, appeared as the most frequently observed presentation (20 cases) with disease remission noted in all cases with steroid treatment. Other cases included numerous glomerulonephritides, such as acute necrotizing glomerulonephritis, MPO vasculitis and collapsing glomerulopathy, and thrombotic microangiopathies, such as aHUS. For patients with transplanted kidneys, T-cell-mediated rejection and mild tubular interstitial infiltration were noted following testing positive for COVID-19. There were no mortalities reported in any of the included cases, although two patients remained dialysis dependent at hospital discharge. Conclusion: This systematic review highlights the various intrinsic pathological kidney manifestations in children and adolescents as a result of acute COVID-19 infection. The clinical timeline and presentation of these cases support the mechanistic hypothesis between COVID-19 infection and the onset of intrinsic kidney pathologies within this context. The progressive introduction of vaccination programs for children and adolescents may hopefully reduce the severity of COVID-19-associated illnesses, and pathological kidney manifestations in this population.

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Kidney allograft biopsy findings after COVID-19

Cited by 26 publications

References 24 publications

Histopathologic findings on indication renal allograft biopsies after recovery from acute COVID‐19

Histopathologic findings on indication renal allograft biopsies after recovery from acute COVID‐19

COVID-19 and kidney disease: insights from epidemiology to inform clinical practice

Intrinsic Kidney Pathology Following COVID-19 Infection in Children and Adolescents: A Systematic Review

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