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Kidney Week

Abstract: PO0841

COVID-19-Associated Nephropathy (COVAN): An Emerging Entity of Severe Viral Podocyte Injury and Collapsing Glomerulopathy in Kidney Biopsies

Session Information

Category: Coronavirus (COVID-19)

  • No subcategory defined

Authors

  • Seshan, Surya V., Weill Cornell Medicine, New York, New York, United States
  • Salvatore, Steven, Weill Cornell Medicine, New York, New York, United States
  • Fyfe-Kirschner, Billie S., Rutgers The State University of New Jersey, New Brunswick, New Jersey, United States
  • Miick, Ronald, Albert Einstein Healthcare Network, Philadelphia, Pennsylvania, United States
  • Siddiqui, Aqeel A., Lankenau Medical Center, Wynnewood, Pennsylvania, United States
  • Kahila, Mohamed, SUNY Downstate Health Sciences University, Brooklyn, New York, United States
  • Ramakrishnan, Ramya, NewYork-Presbyterian Brooklyn Methodist Hospital, Brooklyn, New York, United States
  • Freundlich, Richard E., Newark Beth Israel Medical Center, Newark, New Jersey, United States
  • Nicastri, Anthony D., SUNY Downstate Health Sciences University, Brooklyn, New York, United States
Background

COVID19 caused by novel Coronavirus SARS-COV-2 initially presenting primarily as a respiratory illness, is now known to affect several organ systems as part of multiorgan failure including acute kidny injury (AKI), some cases also manifesting nephrotic range proteinuria or syndrome.

Methods

10 renal biopsies from 6 institutions (1 transplant) performed in April-May 2020 were processed for light microscopy, immunostaining (IS) and electron microscopy (EM) for clinco-pathologic analysis.

Results

The 10 patients ranged from 25-73 years (Mean 43), male:female 5:5, 8 African American, 1 Hispanic, 1 Asian Indian, having pre-existing co-morbidities of hypertension (7), Diabetes mellitus (5), obesity (9), presenting with AKI (10), nephrotic syndrome (9), proteinuria ranging from 1.5-25g/24hrs, lung symptoms or pneumonia (7), fever (5). SARS-COV-2 RT-PCR positive (7), IgG antibody positive (2), both negative (1). All kidney biopsies showed widespread acute tubular injury with focal necrosis, 9 with typical features of segmental/global collapsing glomerulopathy in 10-53% of glomeruli, global glomerulosclerosis (0-35%), focal tubular microcystic changes (8), patchy (7) or diffuse (2) active tubulointerstitial inflammation and scarring (10-40%), focal & diffuse peritubular capillary inflammation, moderate vascular sclerosis and diabetic kidney disease in 2. No immune deposits were localized by IS. By EM, varied glomerular capillary wall wrinkling and collapse with segmental or global loss of patency (7), total foot process effacement (7), with hyperplastic and vacuolated epithelial cells having protein droplets are noted.The endothelial cells are variably swollen, with tubulo-reticular inclusions in 2. Viral particles are identified within cells of glomeruli and tubulo-interstitium, scattered or in clustesr in the cytoplasm and endoplasmic reticulum vesicles, confirmed by IS.

Conclusion

The constellation of typical glomerular collapsing features with tubulo-interstitial findings and localization of virus by EM, suggests a distinct viral associated nephropathy, reminicent of HIV associated nephropathy. A role for viral cytopathic effect, cytokines and underlying APOL1 gene variants could be considered.