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Results from the IRoc-GN international registry of patients with COVID-19 and glomerular disease suggest close monitoring.

Kidney Disease Branch, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Maryland, USA. Electronic address: waldmanm@niddk.nih.gov. Servei Nefrologia, Hospital Universitari Vall d'Hebron, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain; Grup de Recerca de Nefrología, Vall d'Hebron Institut de Recerca (VHIR), Vall d'Hebron Hospital Universitari, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain. Centre for Inflammatory Disease, Department of Immunology and Inflammation, Faculty of Medicine, Imperial College London, London, UK; Imperial College Healthcare NHS Trust Renal and Transplant Centre, Hammersmith Hospital, London, UK. Imperial College Healthcare NHS Trust Renal and Transplant Centre, Hammersmith Hospital, London, UK. Nephrology Department, Bellvitge University Hospital, Clinical Science Department, Barcelona University, IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain. Glasgow Renal and Transplant Unit, Queen Elizabeth University Hospital Glasgow, UK. Department of Nephrology, Royal Berkshire Hospital, Reading, Berkshire, UK. Department of Medicine, Renal Division, Icahn School of Medicine at Mount Sinai, New York, New York, USA. Unità Operativa Complessa di Nefrologia, Azienda Ospedaliera-Universitaria Parma, Dipartimento di Medicina e Chirurgia, Università di Parma, Parma, Italy. Departamento de Nefrología, Hospital Universitario 12 de Octubre/Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), Madrid, Spain. Departamento de Nefrología y Metabolismo Mineral Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico. Department of Experimental Diagnostic and Specialty Medicine (DIMES), Nephrology, Dialysis and Renal Transplant Unit, St. Orsola Hospital, University of Bologna, Bologna, Italy. Complejo Hospitalario de Navarra, Pamplona, Spain. Biostatistics and Clinical Epidemiology Service National Institutes of Health Clinical Center, Bethesda, Maryland, USA. Department of Medicine, Renal Division, Icahn School of Medicine at Mount Sinai, New York, New York, USA. Electronic address: paolo.cravedi@mssm.edu.

Kidney international. 2021;(1):227-237
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Abstract

The effects of SARS-CoV-2 infection on individuals with immune-mediated glomerulonephritis, who are often undergoing immunosuppressive treatments, are unknown. Therefore, we created the International Registry of COVID infection in glomerulonephritis (IRoc-GN) and identified 40 patients with glomerulonephritis and COVID-19 followed in centers in North America and Europe. Detailed information on glomerulonephritis diagnosis, kidney parameters, and baseline immunosuppression prior to infection were recorded, as well as clinical presentation, laboratory values, treatment, complications, and outcomes of COVID-19. This cohort was compared to 80 COVID-positive control cases from the general population without glomerulonephritis matched for the time of infection. The majority (70%) of the patients with glomerulonephritis and all the controls were hospitalized. Patients with glomerulonephritis had significantly higher mortality (15% vs. 5%, respectively) and acute kidney injury (39% vs. 14%) than controls, while the need for kidney replacement therapy was not statistically different between the two groups. Receiving immunosuppression or renin-angiotensin-aldosterone system inhibitors at presentation did not increase the risk of death or acute kidney injury in the glomerulonephritis cohort. In the cohort with glomerulonephritis, lower serum albumin at presentation and shorter duration of glomerular disease were associated with greater risk of acute kidney injury and need for kidney replacement therapy. No differences in outcomes occurred between patients with primary glomerulonephritis versus glomerulonephritis associated with a systemic autoimmune disease (lupus or vasculitis). Thus, due to the higher mortality and risk of acute kidney injury than in the general population without glomerulonephritis, patients with glomerulonephritis and COVID-19 should be carefully monitored, especially when they present with low serum albumin levels.