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COVID-19 Collapsing Glomerulopathy — ESENeph MCQ

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ModerateGlomerulonephritisCOVID-19 Collapsing GlomerulopathyESENeph

A 45-year-old man presents with AKI and nephrotic syndrome. Biopsy shows diffuse podocyte foot process effacement and no immune deposits. Light microscopy shows collapsing glomerular tuft with podocyte hypertrophy. He recently recovered from COVID-19. What is the most likely diagnosis?

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Correct answer: D — COVID-19-associated collapsing glomerulopathy (collapsing FSGS variant)

COVID-19-associated collapsing glomerulopathy has been increasingly recognised, particularly in patients of African descent with APOL1 high-risk genotypes. The mechanism appears to involve direct viral injury or cytokine-mediated podocyte injury. Collapsing FSGS on biopsy with the clinical context of recent COVID-19 infection supports this diagnosis. Treatment is supportive (RASi, management of nephrotic syndrome). Some patients require immunosuppression if the collapsing FSGS is severe and progressive.

Reference: Kudose et al 2020 – COVID-19 Collapsing Glomerulopathy; KDIGO 2021 – GN