Longitudinal outcomes of COVID-19–associated collapsing glomerulopathy and other podocytopathies

Satoru Kudose, Dominick Santoriello, Andrew S. Bomback, Miroslav Sekulic, Ibrahim Batal, M. Barry Stokes, Iman A. Ghavami, Jung S. Kim, Maddalena Marasa, Katherine Xu, Yonatan Peleg, Jonathan Barasch, Pietro Canetta, Hila Milo Rasouly, Ali G. Gharavi, Glen S. Markowitz, Vivette D. D’Agati*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

30 Scopus citations

Abstract

Background The long-term outcome of COVID-19–associated collapsing glomerulopathy is unknown. Methods We retrospectively identified 76 native kidney biopsies from patients with history of COVID-19 between March 2020 and April 2021. Presenting and outcome data were obtained for all 23 patients with collapsing glomerulopathy and for seven patients with noncollapsing podocytopathies. We performed APOL1 genotyping by Sanger sequencing, immunostaining for spike and nucleocapsid proteins, and in situ hybridization for SARS-CoV-2. Results The 23 patients with COVID-19–associated collapsing glomerulopathy were median age 57 years (range, 35–72), included 16 men, and were predominantly (91%) Black. Severity of COVID-19 was mild or moderate in most (77%) patients. All but one patient presented with AKI, 17 had nephrotic-range proteinuria, and six had nephrotic syndrome. Fourteen (61%) patients required dialysis at presentation. Among 17 patients genotyped, 16 (94%) were high-risk APOL1. Among 22 (96%) patients with median follow-up at 155 days (range, 30–412), 11 (50%) received treatment for COVID-19, and eight (36%) received glucocorticoid therapy for podocytopathy. At follow-up, 19 (86%) patients were alive, and 15 (68%) were dialysis free, including seven of 14 who initially required dialysis. The dialysis-free patients included 64% (seven of 11) of those treated for COVID-19 and 75% (six of eight) of those treated with glucocorticoids for podocytopathy. Overall, 36% achieved partial remission of proteinuria, 32% had no remission, and 32% reached combined end points of ESKD or death. Viral infection of the kidney was not detected. Conclusions Half of 14 patients with COVID-19–associated collapsing glomerulopathy requiring dialysis achieved dialysis independence, but the long-term prognosis of residual proteinuric CKD remains guarded, indicating a need for more effective therapy.

Original languageEnglish (US)
Pages (from-to)2958-2969
Number of pages12
JournalJournal of the American Society of Nephrology
Volume32
Issue number11
DOIs
StatePublished - Nov 2021

ASJC Scopus subject areas

  • General Medicine

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