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

• DOI: 10.1053/j.ajkd.2020.06.009
• Publication Date: 2020-07-12T14:00:17Z
• Authors: Hélène Lazareth; Hélène Péré; Yannick Binois; Melchior Chabannes; Juliet Schurder; Thomas Bruneau; Alexandre Karras; Eric Thervet; Marion Rabant; David Veyer; Nicolas Pallet
• Keywords: Kidney transplantation; [SDV] Life Sciences [q-bio]; 03 medical and health sciences; 0302 clinical medicine; collapsing glomerulopathy; Nephrology; case report; Case Report; acute kidney injury (AKI); severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2); allograft biopsy; coronavirus 2019 (COVID-19); 3. Good health

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 polymerase chain reaction did not detect the presence of SARS-CoV-2 RNA in the biopsy fragment, and the virus was barely detectable in 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 2 risk alleles of the apolipoprotein L1 (APOL1) gene revealed that the donor carried the low-risk G0/G2 genotype. This case illustrates that coronavirus disease 2019 infection may promote a collapsing glomerulopathy in kidney allografts with a low-risk APOL1 genotype in the absence of detectable SARS-CoV-2 RNA in the kidney and that podocyte injury may precede SARS-CoV-2 RNAemia.