Longitudinal Outcomes of COVID-19-Associated Collapsing Glomerulopathy and Other Podocytopathies.

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 7 patients with non-collapsing 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 males, 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 6 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 days), 11 (50%) received treatment for COVID-19 and 8 (36%) received glucocorticoid therapy for podocytopathy. At follow-up, 19 (86%) patients were alive and 15 (68%) were dialysis-free, including 7 of 14 who initially required dialysis. The dialysis-free patients included 64% (7/11) of those treated for COVID-19 and 75% (6/8) 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.