The spectrum of kidney biopsies in hospitalized patients with COVID-19, acute kidney injury and/or proteinuria
Sophie Ferlicot, Matthieu Jamme, F. Gaillard, Julie Oniszczuk, A. Couturier, Olivia May, Anne Grünenwald, Aurélie Sannier, Anissa Moktefi, Ophélie Le Monnier, Camille Petit-Hoang, N. Maroun, Albane Brodin-Sartorius, Arthur Michon, Hélène Dobosziewicz, Fabrizio Andréelli, Matthieu Guillet, Hassane Izzedine, Christian Richard, Manon Dekeyser, Romain Arrestier, Thomas Stehlé, Édouard Lefèvre, Alexis Mathian, Christophe Legendre, Charlotte Mussini, Marie‐Christine Verpont, Nicolas Pallet, Zahir Amoura, Marie Essig, Renaud Snanoudj, Isabelle Brochériou-Spelle, Hélène François, Xavier Belenfant, Guillaume Géri, Éric Daugas, Vincent Audard, David Buob, Ziad Massy, Mohamad Zaidan
Abstract
We report a multicentric retrospective case series of patients with COVID-19 who developed acute kidney injury and/or proteinuria and underwent a kidney biopsy in the Paris and its metropolitan area. Forty-seven patients (80.9% men) with COVID-19 who underwent a kidney biopsy between March 08 and May 19, 2020 were included. Median age was 63 years IQR [52-69]. Comorbidities included hypertension (66.0%), diabetes mellitus (27.7%), obesity (27.7%), history of chronic kidney (25.5%), cardiac (38.6%) and respiratory (27.3%) diseases. Initial symptoms were fever (85.1%), cough (63.8%), shortness of breath (55.3%), and diarrhea (23.4%). Almost all patients developed acute kidney injury (97.9%) and 63.8% required renal replacement therapy. Kidney biopsy showed two main histopathological patterns, including acute tubular injury in 20 (42.6%) patients, and glomerular injury consisting of collapsing glomerulopathy and focal segmental glomerulosclerosis in 17 (36.2%) patients. Two (4.3%) patients had acute vascular nephropathy, while eight (17%) had alternative diagnosis most likely unrelated to COVID-19. Acute tubular injury occurred almost invariably in the setting of severe forms of COVID-19, whereas patients with glomerular injury had various profiles of COVID-19 severity and collapsing glomerulopathy was only observed in patients harboring a combination of APOL1 risk variants. At last follow-up, 16 of the 30 patients who initially required dialysis were still on dialysis, and 9 died. The present study describes the spectrum of kidney lesions in patients with COVID-19. While acute tubular injury is correlated with COVID-19 severity, the pattern of glomerular injury is intimately associated with the expression of APOL1 risk variants.