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

International audienceWe 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

Acute Kidney Injury Associated With Lopinavir/Ritonavir Combined Therapy in Patients With COVID-19

International audienceLopinavir and low-dose ritonavir (LPV/RTV) are associated in a fixed-dose combination protease inhibitor therapy used in patients with HIV and AIDS. The recent outbreak of severe acute respiratory syndrome coronavirus 2 infections causing coronavirus disease 2019 (COVID-19) has rekindled the interest in LPV/RTV after preclinical studies.1 Although no benefit was observed with LPV/RTV treatment beyond standard care,2 other randomized controlled trials, such as DisCoVeRy (NCT04315948), are currently enrolling. Like other antiretroviral therapies, LPV/RTV has been previously associated with acute kidney injuries (AKIs), even though no systematic pharmacovigilance analysis was ever performed.We first describe a small case series of AKI associated with LPV/RTV in the course of COVID-19 treatment. We then performed a query in the World Health Organization pharmacovigilance database, VigiBase, and extracted all AKIs associated with LPV/RTV. We then presented clinical characteristics of these events and performed a comparison between HIV and COVID-19 indication in VigiBase

Differential association between inflammatory cytokines and multiorgan dysfunction in COVID-19 patients with obesity

International audienceTo investigate the mechanisms underlying the SARS-CoV-2 infection severity observed in patients with obesity, we performed a prospective study of 51 patients evaluating the impact of multiple immune parameters during 2 weeks after admission, on vital organs' functions according to body mass index (BMI) categories. High-dimensional flow cytometric characterization of immune cell subsets was performed at admission, 30 systemic cytokines/chemokines levels were sequentially measured, thirteen endothelial markers were determined at admission and at the zenith of the cytokines. Computed tomography scans on admission were quantified for lung damage and hepatic steatosis (n = 23). Abnormal BMI (> 25) observed in 72.6% of patients, was associated with a higher rate of intensive care unit hospitalization (p = 0.044). SARS-CoV-2 RNAaemia, peripheral immune cell subsets and cytokines/chemokines were similar among BMI groups. A significant association between inflammatory cytokines and liver, renal, and endothelial dysfunctions was observed only in patients with obesity (BMI > 30). In contrast, early signs of lung damage (ground-glass opacity) correlated with Th1/M1/inflammatory cytokines only in normal weight patients. Later lesions of pulmonary consolidation correlated with BMI but were independent of cytokine levels. Our study reveals distinct physiopathological mechanisms associated with SARS-CoV-2 infection in patients with obesity that may have important clinical implications