COVID-19-Related Collapsing Glomerulopathy in a Kidney Transplant Recipient

American Journal of Kidney Diseases : the Official Journal of the National Kidney Foundation
Hélène LazarethNicolas Pallet

Abstract

We report a case of a kidney transplant recipient who presented with acute kidney injury and nephrotic-range proteinuria in a context of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. Kidney biopsy revealed collapsing glomerulopathy. Droplet-based digital PCR did not detect the presence of SARS-CoV-2 RNA in the biopsy fragment, and the virus was barely detectable in the plasma at the time of the biopsy. SARS-CoV-2 RNAemia peaked several days later, followed by a seroconversion despite the absence of circulating CD19-positive lymphocytes at admission due to rituximab-based treatment of antibody-mediated rejection 3 months earlier. Genotyping for the two risk alleles of the apolipoprotein L1 (APOL1) gene revealed that the donor carried the low-risk G0/G2 genotype. This case illustrates that COVID-19 may promote a collapsing glomerulopathy in kidney allografts with a low-risk APOL1 genotype, in the absence of detectable SARS-CoV2 RNA in the kidney, and that podocyte injury may precede SARS-CoV2 RNAemia.

References

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Jul 29, 2018·American Journal of Kidney Diseases : the Official Journal of the National Kidney Foundation·Jae-Hyung ChangSumit Mohan
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May 31, 2020·Kidney International·Sébastien KisslingFadi Fakhouri
May 31, 2020·Kidney International·François GaillardEric Daugas

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Citations

Feb 22, 2021·Nefrología : publicación oficial de la Sociedad Española Nefrologia·Amir ShabakaGema Fernández-Juárez
Apr 3, 2021·Clinical Kidney Journal·Purva SharmaRimda Wanchoo
Apr 6, 2021·Clinical Kidney Journal·Néstor ToapantaFrancesc Moreso
Aug 18, 2021·American Journal of Transplantation : Official Journal of the American Society of Transplantation and the American Society of Transplant Surgeons·Emily DanielIbrahim Batal
Jul 1, 2021·ASAIO Journal : a Peer-reviewed Journal of the American Society for Artificial Internal Organs·Meghan E KappMarvin J Slepian
Sep 18, 2021·Clinical Transplantation·Nikolina Basic-JukicBojan Jelakovic
Jun 16, 2021·Clinical Journal of the American Society of Nephrology : CJASN·Luise HasslerDaniel Batlle

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Methods Mentioned

BETA
biopsy
biopsies
PCR

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