Multicenter Clinicopathologic Correlation of Kidney Biopsies Performed in COVID-19 Patients Presenting With Acute Kidney Injury or Proteinuria.
Coronavirus disease 2019 (COVID-19)
acute kidney injury (AKI)
allograft biopsy
antibody-mediated rejection (AMR)
case series
collapsing glomerulopathy
kidney biopsy
renal complications of COVID-19
renal pathology
severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)
thrombotic microangiopathy
Journal
American journal of kidney diseases : the official journal of the National Kidney Foundation
ISSN: 1523-6838
Titre abrégé: Am J Kidney Dis
Pays: United States
ID NLM: 8110075
Informations de publication
Date de publication:
01 2021
01 2021
Historique:
received:
21
07
2020
accepted:
04
10
2020
pubmed:
13
10
2020
medline:
29
12
2020
entrez:
12
10
2020
Statut:
ppublish
Résumé
Kidney biopsy data inform us about pathologic processes associated with infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). We conducted a multicenter evaluation of kidney biopsy findings in living patients to identify various kidney disease pathology findings in patients with coronavirus disease 2019 (COVID-19) and their association with SARS-CoV-2 infection. Case series. We identified 14 native and 3 transplant kidney biopsies performed for cause in patients with documented recent or concurrent SARS-CoV-2 infection treated at 7 large hospital systems in the United States. Men and women were equally represented in this case series, with a higher proportion of Black (n=8) and Hispanic (n=5) patients. All 17 patients had SARS-CoV-2 infection confirmed by reverse transcriptase-polymerase chain reaction, but only 3 presented with severe COVID-19 symptoms. Acute kidney injury (n=15) and proteinuria (n=11) were the most common indications for biopsy and these symptoms developed concurrently or within 1 week of COVID-19 symptoms in all patients. Acute tubular injury (n=14), collapsing glomerulopathy (n=7), and endothelial injury/thrombotic microangiopathy (n=6) were the most common histologic findings. 2 of the 3 transplant recipients developed active antibody-mediated rejection weeks after COVID-19. 8 patients required dialysis, but others improved with conservative management. Small study size and short clinical follow-up. Cases of even symptomatically mild COVID-19 were accompanied by acute kidney injury and/or heavy proteinuria that prompted a diagnostic kidney biopsy. Although acute tubular injury was seen among most of them, uncommon pathology such as collapsing glomerulopathy and acute endothelial injury were detected, and most of these patients progressed to irreversible kidney injury and dialysis.
Identifiants
pubmed: 33045255
pii: S0272-6386(20)31014-3
doi: 10.1053/j.ajkd.2020.10.001
pmc: PMC7546949
pii:
doi:
Types de publication
Journal Article
Multicenter Study
Langues
eng
Sous-ensembles de citation
IM
Pagination
82-93.e1Subventions
Organisme : NCATS NIH HHS
ID : KL2 TR001882
Pays : United States
Organisme : NIDDK NIH HHS
ID : P30 DK017047
Pays : United States
Informations de copyright
Copyright © 2020 National Kidney Foundation, Inc. Published by Elsevier Inc. All rights reserved.
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