De Novo Focal and Segmental Glomerulosclerosis After COVID-19 in a Patient With a Transplanted Kidney From a Donor With a High-risk APOL1 Variant.

Oniszczuk, Julie; Moktefi, Anissa; Mausoleo, Aude; Pallet, Nicolas; Malard-Castagnet, Stephanie; Fourati, Slim; El Karoui, Khalil; Sahali, Dil; Stehlé, Thomas; Boueilh, Anna; Verpont, Marie-Christine; Matignon, Marie; Buob, David; Grimbert, Philippe; Audard, Vincent

BACKGROUND There is compelling evidence that renal complications in a native kidney are a major concern in patients infected with SARS-CoV-2, the causal agent of COVID-19. The spectrum of renal lesions observed on renal grafts in this context remains to be determined. METHODS We report the case of a renal transplant recipient with nonsevere COVID-19, who subsequently developed nephrotic syndrome associated with acute renal injury. RESULTS Renal biopsy demonstrated focal and segmental glomerulosclerosis lesions classified as not otherwise specified histological variant. Genotyping for 2 risk alleles of the apolipoprotein L1 (APOL1) gene demonstrated that the donor was homozygous for the G2/G2 genotype. CONCLUSIONS In renal transplant patients receiving kidneys from donors with high-risk APOL1 variants, COVID-19 may promote acute glomerular injury in the form of focal and segmental glomerulosclerosis.