Native and transplant kidney histopathological manifestations in association with COVID-19 infection: A systematic review

Table 3 Transplant kidney biopsy findings in coronavirus disease 2019 cases

Ref.	Age		Sex	Ethnicity	Comorbidities	Renal Presentation	Baseline creatinine (mg/dL)	Presentation creatinine (mg/dL)	Presentation proteinuria (g/day)	Presentation albumin (g/L)	Treatment received	Outcome (renal and survival)	RRT needed	Time to biopsy	Haematuria
T-cell mediated rejection
Kudose et al[13]	54		F	Caucasian	IgA Nephropathy, Donor Specific Ab +ve, HTN, obesity	AKI	1.7	2.6	0.2	-	Steroids, Tocilizumab, thymoglobulin, IVIG	DI	No	-	Yes
ABMR
Akilesh et al[17]	47		F	Black	HIV-associated Nephropathy, Deceased Donor Tx 2015, Vascular Rejection Post-Tx, HTN	AKI	-	1.63	2	-	Renal transplantation, 5-MTP, PLEX IVIG	-	-	6 wk	No
Akilesh et al[17]	54		M	Asian	Chronic Transplant Glomerulopathy, C4d –ve, HTN, T2DM	AKI with Proteinuria	1.9	5.2	3	-	Regular MMF withheld, regular tacrolimus dose reduced, steroids	DI	No	6 wk	No
Abuzeineh et al[44]	54		M	Black	Diabetic nephropathy, Tx, HTN	AKI	1.4	2.6	-	-	IVF, MMF discontinued, NHF oxygen, antibiotics, antifungals, tocilizumab	DI	No	73 d	-
Acute tubular injury
Akilesh et al[17]	42		M	Hispanic	Live Donor Tx 2019, HTN	AKI	1.27	1.53	0.15	-	-	DI	No	7 wk	No
Kudose et al[13]	54		F	Hispanic	ADPKD, Deceased Donor Tx 2020, HTN	AKI	2.5	2.9	0.2	-	None	DI	No	-	-
Westhoff et al[50]	69		M	-	Diabetic nephropathy	AKI	1.1	2.2	-	-	IV hydrocortisone, tacrolimus and MMF held, HCQ, levetiracetam	DI	No	14 d	-
FSGS
Doevelaar et al[45]		35	M	Black	Deceased donor Tx 2019	AKI, Normothermic Regional Perfusion	-	1.7	3.29	-	Steroids (Hydrocortisone 200 mg/d)	DI	No	34 d	-
Oniszczuk et al[48]		49	M	Black	Renovascular disease, deceased donor Tx 2020	AKI, Nephrotic Syndrome	1.47	2.17	3.27	2.7	Steroids, ACE Inhibitor	DI	No	2 wk	-
Yamada et al[51]		49	F	Black	Pre-eclampsia, Live donor Tx 1995 (from sibling)	AKI, Normothermic Regional Perfusion	1.6	3.4	6.3	3.8 at diagnosis with COVID-19	ACE Inhibitor, Steroids (Prednisolone 60 mg with quick wean due to side effects)	DI	No	5 d	-
Collapsing FSGS
Noble et al[43]	45		M	Black	Malignant HTN, Obesity (BMI 42.6), Live Donor Tx 2016	AKI, Nephrotic syndrome	3.22	4.69	1.09	-	MMR withheld on admission, restarted after 14 d. Steroid (Prednisolone dose doubled from 10 mg OD to 20mg OD)	DD	Yes	12 d	Yes
Lazareth et al[47]	29		M	Black	Urinary Schistosomiasis, Deceased Donor Tx 2015, Previous ABMR in Jan 2020	AKI, Nephrotic Syndrome	3.18	6.06	0.49	2.8	MMF withheld temporarily	DI	No	2 d	-
Transplant infarction
Kudose et al[13]	22		M	Black	Membranous Nephropathy PLA2R +ve, Deceased Donor Tx 2018, HTN	AKI	-	9.4	-	-	Tocilizumab, HCQ, Azithromycin	DD	Yes	-	-
Webb et al[49]	49		M	-	Chronic glomerulonephritis, HTN, DCD renal transplant 2001 with subsequent ABMR, CMV	AKI	0	2.03	-	-	Nasal high flow oxygen, prednisolone, enoxaparin, ertapenem	DD	Yes	27 d	-
TMA
Jespersen et al[46]	49		F	-	FSGS	AKI	-	2.81	-	-	Supportive	DI	No	> 22 d	-

5-MTP: 5-methoxytryptophan; Ab: Antibody; ABMR: Antibody mediated rejection; ADPKD: Autosomal dominant polycystic kidney disease; AKI: Acute kidney injury; CMV: Cytomegalovirus; DCD: Donor after circulatory death; DD: Dialysis dependent at hospital discharge; DI: Dialysis independent at hospital discharge; FSGS: Focal and segmental glomerulosclerosis; HCQ: Hydroxychloroquine; HIV: Human immunodeficiency virus; HTN: Hypertension; IVF: Intravenous fluids; IVIG: Intravenous immunoglobulin; MMF: Mycophenolate mofetil; NHF: Nasal high flow; PLA2R: Phospholipase 2 receptor antibody; PLEX: Plasma exchange; T2DM: Type 2 diabetes mellitus; Tx: Transplant.