Kidney allograft biopsy findings after COVID-19 |
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Authors: | Emily Daniel Miroslav Sekulic Satoru Kudose Christine Kubin Xiaoyi Ye Katayoon Shayan Ankita Patel David J. Cohen Lloyd E. Ratner Dominick Santoriello M. Barry Stokes Glen S. Markowitz Marcus R. Pereira Vivette D. D’Agati Ibrahim Batal |
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Affiliation: | 1. Department of Medicine, Division of Nephrology, Columbia University Irving Medical Center, New York, New York, USA;2. Department of Pathology and Cell Biology, Columbia University Irving Medical Center, New York, New York, USA;3. Department of Pharmacy, New York Presbyterian Hospital, New York, New York, USA;4. Department of Medicine, Nephrology, Hartford Hospital, Hartford, Connecticut, USA;5. Department of Pathology, Rady Children’s Specialists of San Diego, California, USA;6. Department of Medicine, Nephrology, Hackensack University Medical Center, Hackensack, New Jersey, USA;7. Department of Surgery, Renal and Pancreatic Transplantation, Columbia University Irving Medical Center, New York, New York, USA;8. Department of Medicine, Division of Infectious Disease, Columbia University Irving Medical Center, New York, New York, USA |
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Abstract: | COVID-19 has been associated with acute kidney injury and published reports of native kidney biopsies have reported diverse pathologies. Case series directed specifically to kidney allograft biopsy findings in the setting of COVID-19 are lacking. We evaluated 18 kidney transplant recipients who were infected with SARS-CoV-2 and underwent allograft biopsy. Patients had a median age of 55 years, six were female, and five were Black. Fifteen patients developed COVID-19 pneumonia, of which five required mechanical ventilation. Notably, five of 11 (45%) biopsies obtained within 1 month of positive SARS-CoV-2 PCR showed acute rejection (four with arteritis, three of which were not associated with reduced immunosuppression). The remaining six biopsies revealed podocytopathy (n = 2, collapsing glomerulopathy and lupus podocytopathy), acute tubular injury (n = 2), infarction (n = 1), and transplant glomerulopathy (n = 1). Biopsies performed >1 month after positive SARS-CoV-2 PCR revealed collapsing glomerulopathy (n = 1), acute tubular injury (n = 1), and nonspecific histologic findings (n = 5). No direct viral infection of the kidney allograft was detected by immunohistochemistry, in situ hybridization, or electron microscopy. On follow-up, two patients died and most patients showed persistent allograft dysfunction. In conclusion, we demonstrate diverse causes of kidney allograft dysfunction after COVID-19, the most common being acute rejection with arteritis. |
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Keywords: | biopsy clinical research / practice complication: infectious infection and infectious agents - viral kidney (allograft) function / dysfunction kidney transplantation / nephrology |
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