COVID‐19‐associated collapsing glomerulopathy: a report of two cases and literature review

Abstract

Nephrotic range proteinuria has been reported during the course of severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) and coronavirus disease (COVID‐19). However, the pathological mechanisms underlying this manifestation are unknown. In this article, we present two cases of collapsing glomerulopathy (CG) associated with acute tubular necrosis during the course of COVID‐19, and review the literature for similar reports. In our two cases, as in the 14 cases reported so far, the patients were of African ancestry. The 14 patients assessed had an APOL1 high‐risk genotype. At the end of the reported period, two patients had died and five patients were still requiring dialysis. The 16 cases detailed in the present report strongly argue in favour of a causal link between SARS‐CoV‐2 infection and the occurrence of CG in patients homozygous for APOL1 high‐risk genotype for which the term COVID‐associated nephropathy (COVIDAN) can be put forward.

Hematuria as an Early Sign of Multisystem Inflammatory Syndrome in Children: A Case Report of a Boy With Multiple Comorbidities and Review of Literature

“…Angiotensin-converting enzyme 2 (ACE 2) has been identified as the cell entry receptor for SARS-CoV-2, making the tubular cells that harbor ACE2 especially vulnerable and resulting in tubular damage ( 43 ). On the contrary, new cases of collapsing glomerulopathy emerged in patients of African ancestry who are homozygous for APOL risk alleles, potentially suggesting other specific molecular mechanisms ( 44 ).…”

COVID-19 Survival and its impact on chronic kidney disease

“…94 Collapsing glomerulopathy is characterized by segmental or global glomerular tuft collapse with hypertrophy and hyperplasia of the overlying podocytes. [95][96][97][98] Collapsing glomerulopathy is associated with high-risk APOL1 genetic variants (G1/G1, G2/G2, or G1/G2). The vast majority of cases of documented COVID-19 associated collapsing glomerulopathy have been reported in patients of West African or African-American descent.…”

“…However, even without direct invasion, viral-induced changes in the microenvironment surrounding the podocytes (increased cytokine production) can trigger collapsing glomerulopathy. 98 APOL1 risk alleles may also play a mechanistic role-viral infections stimulate host interferon production which stimulates APOL1 gene expression, potentially exacerbating the deleterious effects of APOL1 polymorphism on kidney function and leading to collapsing glomerulopathy. 109 May et al sought to determine if COVID-19 associated collapsing glomerulopathy was enriched in patients with COVID-19 by conducting a multi-center study that compared 240 native kidney biopsies obtained in COVID-19 infected patients to a 5-year U.S. kidney pathology database as a control.…”

A multi-center retrospective cohort study defines the spectrum of kidney pathology in Coronavirus 2019 Disease (COVID-19)

“…Case reports, small case series, and autopsy studies have shown a wide spectrum of kidney manifestations in COVID-19 patients and have improved our understanding of kidney disease in this population. Reported manifestations in native biopsies include acute tubular injury (ATI) 7 , 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , myoglobin cast nephropathy 7 , thrombotic microangiopathy (TMA) 9 , 16 , 20 , 25 , 26 , 27 ; acute interstitial nephritis 14 , 28 , non-collapsing focal and segmental glomerulosclerosis (FSGS) 9 , 19 , 20 , 29 , collapsing glomerulopathy (also known as COVID-19 associated nephropathy, COVAN) 7 , 8 , 9 , 15 , 20 , 21 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , membranous nephropathy 8 , 20 , 42 , minimal change disease 48 , 49 , 50 , 48 , 49 , 50 , 48 , …”