Diagnose This (January 17, 2022)

This is the albumin immunofluorescence stain from a biopsy from a patient with recent COVID pneumonia and nephrotic syndrome. What is your diagnosis?

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This is a case of collapsing glomerulopathy, which is most commonly seen in African Americans in association with APOL1 high-risk alleles. It can be seen in a variety of clinical settings including viral infections, autoimmune disease, and certain drugs, among others.  Recently, collapsing glomerulopathy cases have been reported in patients with COVID-19.

References:
Velez, J.C.Q., Caza, T. & Larsen, C.P. COVAN is the new HIVAN: the re-emergence of collapsing glomerulopathy with COVID-19. Nat Rev Nephrol 2020;16(10):565-567.

Wu H, Larsen CP et al. AKI and Collapsing Glomerulopathy Associated with COVID-19 and APOL1 High-Risk Genotype. JASN 2020 Jun;31:1688-1695.

May, Rebecca M. et al. A multi-center retrospective cohort study defines the spectrum of kidney pathology in Coronavirus 2019 Disease (COVID-19). Kid Int 2021 (In Press Journal Pre-Proof Published Online: Aug 2, 2021).